Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1561
Country/Region: Nigeria
Year: 2008
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $9,384,780

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $185,000

ACTIVITY DESCRIPTION:

This MTCT activity relates directly to all Nigeria PMTCT COP08 activities as part of the USG technical

oversight role.

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has two full time staff

positions (one Senior Program Specialist and one Program Specialist) for PMTCT, both of which were

approved in COP05. The budget includes funding for two FSN salaries, funding for (limited) international

and required domestic travel, training funds and allocated minor support costs. Funds are not requested in

COP08 for international TA as this is understood to be funded by the HQ operational plan (HOP). This staff

member will be supervised by a Senior Prevention Manager funded under HHS/CDC M&S.

These HHS/CDC PMTCT staff members will work in close coordination with the USAID PMTCT staff

(#6812.08) and directly provide quality assurance and program monitoring to all HHS supported

implementing partners including: University of Maryland-ACTION (#3257.08), Harvard SPH-APIN

(#3227.08), Columbia University, SPH-ICAP (#6622.08), International Foundation for Education and Self-

Help (IFESH) (#3248.08), Catholic Relief Services-AIDSRelief( #6485.08) ; and 3-4 PMTCT partners to be

determined by RFA awards in FY08 (#12968.08). HHS/CDC PMTCT staff will also assist USAID staff in

joint monitoring visits of Family Health International-GHAIN (#3234.08), Catholic Relief Services-7 Dioceses

(#5348.08), LMS Associate (#15641.08) and USAID APS awards (#9747.08) for COP08. USAID and CDC

PMTCT staff will provide assistance as needed to the U.S. Department of Defense (#3246.08) program with

the Nigerian Ministry of Defense.

HHS/CDC and USAID PMTCT staff will also provide technical support and capacity development to new

partners undertaking PMTCT activities through the New Partner Initiative as well as provide support to the

Government of Nigeria at the National and State levels to promote Nigeria National PMTCT guidelines.

Support to Global Fund activities will be also be provided as requested. It is estimated that the PMTCT staff

under this activity will provide monitoring and support to approximately 300 PMTCT sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $15,000

ACTIVITY DESCRIPTION:

This AB activity relates directly to all Nigeria AB COP08 activities as part of the USG technical oversight

role. The USG team, through the HHS/CDC Global AIDS Program (GAP) office in Nigeria has one full time

staff position for HIV Sexual Transmission, which was previously approved in COP07. The budget includes

funding for 25% of one FSN salary, funding for required domestic travel, training funds and allocated minor

support costs. This staff member will be supervised by a Senior Prevention Manager funded under

HHS/CDC M&S. Funds are not requested in COP08 for international TA as this is understood to be funded

by the HQ operational plan (HOP).

This HHS/CDC HIV Sexual Transmission program specialist will work in close coordination with the USAID

and DoD prevention staff and directly provide quality assurance and program monitoring to all HHS-

supported implementing partners with AB programs including: University of Maryland-ACTION

(#15651.08), Harvard SPH-APIN (#15652.08), Columbia University SPH-ICAP (#15654.08), Catholic Relief

Services-AIDSRelief (#15655.08); and 1-2 AB partners to be determined by RFA awards in FY08

(#14086.08). HHS/CDC PMTCT staff will also assist USAID staff in joint monitoring visits of Family Health

International-GHAIN (#15661.08), CEDPA (#9759.08), Society for Family Health (#5316.08), Population

Council (#5315.08), Christian AID (#9764.08), Catholic Relief Services-7 Dioceses (#5312.08), Winrock

International (#9766.08, Hope Worldwide (#5343.08), Food for Hungry (#5314.08), LMS Associates

(#15641.08) and USAID APS awards (#9747.08) for COP08. USAID and CDC AB staff will provide

assistance as needed to the U.S. Department of Defense (#5313.08) program with the Nigerian Ministry of

Defence.

HHS/CDC, DoD and USAID prevention staff will also provide technical support and capacity development to

new partners undertaking AB activities through the New Partner Initiative as well as provide support to the

Government of Nigeria at the national and state levels to promote Nigeria's national prevention guidelines.

The staff member under this activity will provide monitoring and support to 15-18 implementing partners in

COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Biomedical Prevention: Blood Safety (HMBL): $40,000

ACTIVITY DESCRIPTION:

This HMBL activity relates directly to all Nigeria HHS Medical Transmission Blood Safety COP08 activities

(see activity ID references in the narrative below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria will hire one full time

staff position to support Medical Transmission prevention activities with 75% of time allocated to Blood

Safety and 25% of time allocated to Safe Injection (# 6817.08 for a more detailed description of safe

injection responsibilities). The budget includes FSN salary, funding for required domestic and international

travel, training funds and allocated support costs. Funds are not requested in COP08 for international TA

as this is understood to be funded by the HQ operational plan (HOP). This staff member will be supervised

by a Senior Prevention Manager funded under HHS/CDC M&S.

The HIV Medical Transmission Prevention local staff member works in close coordination with the USAID

HIV Medical Transmission Prevention staff (#9777.08) and directly provides quality assurance and program

monitoring or coordination to HHS supported implementing partners with Blood Safety activities including:

University of Maryland-ACTION (#3258.08), Harvard SPH-APIN (#6489.08), Columbia University SPH-

ICAP (#6490.08), Catholic Relief Services-AIDSRelief (#5392.08), the Nigeria Ministry of Health National

Blood Transfusion Service (#5669.08), and the Safe Blood for Africa Foundation (#6641.08 & #9772.08).

This position will also work with USAID on joint monitoring visits of non-HHS PEPFAR partners such as FHI

-GHAIN (#6491.08) and give technical assistance to the DoD Safe Blood program (#5388.08) as requested.

HIV Medical transmission staff will also monitor procurements made through SCMS for Safe Blood activities

(#14085.08 & #9773.08).

The HHS/CDC staff member provides technical support and capacity development to new partners selected

through RFAs, the New Partner Initiative and to the Government of Nigeria at the National and State levels

to promote Nigeria National guidelines related to blood safety. Technical assistance through the HIV

Medical Transmission TWG will be provided as need to the Department of Defense and USAID partners

with Blood Safety activities. Under this activity the staff member will provide direct or indirect monitoring

and support to over 125 Emergency Plan supported clinical sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Biomedical Prevention: Injection Safety (HMIN): $15,000

ACTIVITY DESCRIPTION:

This HMIN activity relates directly to all Nigeria HHS Medical Transmission Injection Safety COP08 activities

(see related activity ID references in the narrative below).

The USG team through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria hired one full time staff

position in FY07 to support Medical Transmission prevention activities with 75% of time allocated to Blood

Safety (#5395.08) and 25% of time allocated to Safe Injection. The budget includes 25% of one FSN

salary, funding for required domestic or international travel, training funds and allocated minor support

costs. Funds are not requested in COP08 for international TA as this is understood to be funded by the HQ

operational plan (HOP). This staff member will be supervised by a Senior Prevention Manager funded

under HHS/CDC M&S.

The HIV Medical Transmission Prevention staff member will work in close coordination with their USAID

HIV Medical Transmission Prevention counterpart (#9777.08) and directly provide quality assurance and

program monitoring to HHS supported implementing partners with Injection Safety activities: University of

Maryland-ACTION (#6821.08), Harvard SPH-APIN (#6818.08), Columbia University, SPH-ICAP (#6819.08),

and Catholic Relief Services-AIDSRelief (#6820.08), and Safe Blood for Africa Foundation (#9772.08).

This HHS/CDC and USAID HIV Medical Transmission staff members provides technical support and

capacity development to new partners selected through RFAs, the New Partner Initiative and to the

Government of Nigeria at the National and State levels to promote Nigeria National guidelines related to

injection safety. Technical assistance through the HIV Medical Transmission TWG will be provided as need

to all USG partners with Safe Injection activities. Under this activity the staff member will provide direct or

indirect monitoring and support to over 125 Emergency Plan supported clinical sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $50,000

ACTIVITY DESCRIPTION:

This Condoms and Other Prevention activity relates directly to all Nigeria Condoms and Other Prevention

COP08 activities as part of the USG technical oversight role.

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has one full time staff

position for HIV Sexual Transmission, which was approved in COP07. This individual will provide TA and

program oversight to USG partners in implementing and strengthening programs to reach Most At-Risk

Populations (MARPs) who are HIV-negative with prevention counseling and other services. Additional

focus will be to integrate programming for prevention for HIV positives as an added component of Basic

Care and Support. The budget includes funding for 75% of one FSN salary, funding for required domestic

travel, training funds and allocated minor support costs. Funds are not requested in COP08 for international

TA as this is understood to be funded by the HQ operational plan (HOP). This staff member will be

supervised by a Senior Prevention Manager funded under HHS/CDC M&S.

The HHS/CDC HIV Sexual Transmission Specialist staff position will work in coordination with the USAID

and DoD prevention staff to provide program monitoring and quality assurance to HHS supported

implementing partners including: University of Maryland-ACTION (#9210.08), Harvard SPH-APIN

(#9216.08), Columbia University-ICAP (#9208.08), ECEWS (#5656.08), Africare (#15667.08), IFESH

(#15664.08) and multiple partners to be determined by RFA awards in COP08 (#12969.08). The HHS/CDC

staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#3236.08),

Population Council (#15662.08) Society for Family Health (#5372.08), and CEDPA (#9779.08) and new

APS awards (#9782.08). USAID and CDC Condoms and Other Prevention staff will provide assistance as

needed to the U.S. Department of Defense program (#5362.08) with the Nigerian Ministry of Defense.

HHS/CDC, DoD and USAID prevention staff will also provide technical support and capacity development to

new partners undertaking Condoms and Other Prevention activities through the New Partner Initiative as

well as provide support to the Government of Nigeria at the national and state levels to promote Nigeria

national prevention guidelines. The staff member under this activity will provide monitoring and support to

15-16 implementing partners working in over 200 clinical sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Care: Adult Care and Support (HBHC): $75,000

ACTIVITY DESCRIPTION:

This HBHC activity relates directly to all HHS Nigeria Basic Care and Support COP08 activities (see ID

references in the narrative).

To support and enhance the USG Nigeria Basic Care and Support activities, the USG team through the

HHS/CDC Global AIDS Program (GAP) Office in Nigeria has two full time staff positions planned that will

focus on adult/adolescent palliative care/basic care and support issues. The budget includes two partial

FSN salaries shared with OVC or ARV Services, funding for (limited) international and required domestic

travel, training funds and allocated minor support costs. Funds are not requested in COP08 for international

TA as this is understood to be funded by the HQ operational plan (HOP). These staff members will be

supervised by a Senior Clinical Services Manager across all Care and Treatment program areas funded

under HHS/CDC M&S.

These HHS/CDC BC&S staff positions will work in coordination with the USAID BC&S staff (#5364.08) and

directly provide quality assurance and program monitoring to HHS supported implementing partners

including: University of Maryland-ACTION (#3259.08), Harvard SPH-APIN (#5369.08), Columbia University

-ICAP (#5552.08), Catholic Relief Services-AIDSRelief (#5368.05), Africare (#6493.08), ECEWS

(#15657.08), IFESH (#5665.08) and a partner to be determined by an RFA (#12970.08). The HHS/CDC

staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#3237.08),

Catholic Relief Services-7 Dioceses (#5366.08), CEDPA (#9839.08), Winrock International (#9841.08) and

LMS Associate (#15642.08). USAID and CDC Basic Care and Support staff will provide assistance as

needed to the U.S. Department of Defense (#3247.08) program with the Nigerian Ministry of Defense

through the joint TWG process.

HHS/CDC and USAID Palliative Care staff will provide technical support and capacity development to new

partners undertaking BC&S activities through the New Partner Initiative as well as provide support to the

Government of Nigeria at the National and State levels to promote Nigeria National palliative care

guidelines. It is estimated that the BC&S staff under this activity will provide monitoring and support to over

150 clinical sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Care: TB/HIV (HVTB): $190,000

ACTIVITY DESCRIPTION:

This HVTB activity relates directly to all HHS Nigeria TB/HIV COP08 activities (see ID references in the

narrative below).

The USG team in Nigeria through HHS/CDC will utilize TB/HIV funds to support three full time TB/HIV

program officers and one half Lab program officer for the HHS/CDC Global AIDS Program (GAP) Office

Clinical Care Unit in Nigeria. Each of these qualified FSN officers (one Senior Program Specialist, two

Program Specialist and one TB/HIV Laboratory Technician) will take a leadership role in identifying

additional local partners suitable for PEPFAR support in order to expand integrated and sustainable TB/HIV

activities. The budget includes funding for three and half FSN salaries, limited international and required

domestic travel, training and minor support costs. Funds are not requested in COP08 for international TA

as this is understood to be funded by the HQ operational plan (HOP). These staff members will be

supervised by a Senior Clinical Services Manager across all Care and Treatment program areas funded

under HHS/CDC M&S.

They will be responsible for providing strategic leadership and technical support to the Government of

Nigeria as well as to USG partners including: University of Maryland-ACTION (#3254.08), Harvard School

of Public Health-APIN (#3220.08), AIDSRelief (#5399.08), Columbia University School of Public Health-

ICAP (#5551.08), Dept of Defense (#3240.08), Africare (#9879.08), IFESH (#15665.08), ECEWS

(#15658.08), Society for Family Health (#12364.08), TBCAP (#12423.08), CEDPA (#12373.08) and LMS

Associates (15643.08). The objective of this support is to develop and efficiently implement the USG's

PEPFAR TB/HIV strategy as outlined in PEPFAR/Nigeria's 5-year strategy and the TB/HIV 5-year strategy

recently developed by the Government of Nigeria. These strategies call for integrating TB and HIV

services to allow TB patients to be counseled and tested for HIV and referred to HIV care as appropriate,

and for patients infected with HIV to be adequately screened for TB and linked with care and treatment.

Specific activities are the establishment of quality TB DOTS services at all HIV care points of service and

the availability of confidential HIV counseling and testing at all TB points of service supported by PEPFAR.

They will also coordinate USG TB/HIV activities with other key TB and HIV initiatives such as the Global

Fund Against HIV/AIDS, TB, and Malaria, The World Health Organization (WHO) (#3220.08), and The

International Association of Anti-Leprosy Association (ILEP) in Nigeria.

The TB/HIV program officers will represent HHS/CDC as part of the USG team on the National TB/HIV

Working Group. This group has the mandate to provide national leadership for TB/HIV strategy, program

development, and implementation. They will also work in coordination with the USAID Basic Care and

Support TB/HIV staff and their partners (WHO, FHI/GHAIN). This coordination will be in the form of joint

work plans, regular meetings and communication between agencies, and joint internal and external TA to

partners.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Care: TB/HIV (HVTB): $1,300,000

SURVEY TITLE: National Tuberculosis Drug Resistance and HIV Survey in Nigeria

ACTIVITY DESCRIPTION:

The activity described here is a National Tuberculosis Drug Resistance and HIV Survey for Nigeria. At the

recommendation of the OGAC TB/HIV technical working group, this survey is submitted as a Public Health

Evaluation. The activity description, however, is written in the form of other surveys submitted to COP08.

This is a cross-sectional survey of adult tuberculosis (TB) patients attending DOTS clinics, including both

HIV-positive and HIV-negative clients in selected treatment. The objective is to asses: the prevalence,

pattern and distribution of anti-TB drug resistance in the country among new and re-treatment cases; the

frequency of multi-drug resistant TB isolates among new, re-treatment, and failed treatment cases (i.e., drug

susceptibility testing for Isoniazid and Rifampicin); and the frequency of extensive-drug resistant TB isolates

(resistance to INH, rifampicin, plus one of three injectable second line drugs) among new, re-treatment, and

failed treatment cases; and the prevalence of TB/HIV co-infection in the population. The survey will estimate

the proportion of TB patients with TB drug resistance who are HIV positive thus providing critical information

for program planning and the national response to the pending tuberculosis and HIV epidemics in the

country.

The emergence of resistance to anti-TB drugs, and particularly multi drug-resistant TB and extremely drug-

resistant TB have become a significant public health problem in a number of countries and an obstacle to

effective global TB control. In many countries, including Nigeria, the presence or extent of MDR-TB is

unknown and the management of patients with MDR-TB is inadequate. The third global report on anti-TB

drug resistance surveillance indicates that many areas of the world face endemic and epidemic MDR-TB,

and in some areas resistance is alarmingly high. There has been no previous national drug resistance

surveillance in Nigeria, but inconclusive private studies are ongoing.

TB is a major public health problem in Nigeria, which ranks fourth among the 22 countries considered the

highest TB burden countries in the world, and first among the highest TB burden countries in Africa. To

date, there has been no national survey to determine the burden of TB; however, annually there are an

estimated 105,000 deaths due to TB. In 2005 alone, the national TB program registered a total of 66,848 TB

patients (all forms of TB), 35,048 of which were new sputum smear positive. There were 2,009 relapses,

1,056 treatment failures, 1,802 return-after-default (RAD) cases, and 1,392 others cases. It is also

estimated that 1.7% of new TB cases are multi-drug-resistant.

The survey population will be comprised of representative samples drawn from new and old cases of smear

positive TB patients drawn in all 36 states and the federal capital territory (FCT). Included in this population

will be new smear-positive TB patients with no previous history of anti-TB treatment and smear positive TB

patients that have received anti-TB treatment for 5 or more months. Patients eligible for the study will meet

the following criteria: strongly sputum-smear positive TB cases of grades ++ and +++ who have not had any

previous anti-TB treatment; sputum-smear positive TB cases that have been on treatment for more than 5

months and are still smear positive; above 15-years of age (male and female); have given informed written

or verbal consent to participate in the study; and any HIV status. Patients excluded from this study are any

un-diagnosed TB patients and non-consenting diagnosed TB patients. Informed and written consent will be

obtained from all participating patients. Trained clinical personnel will administer the consent form and the

patient will be given a copy for their own use. A detailed study protocol will be developed in consultation

with relevant stakeholders in Nigeria, will be consistent with available CDC and/or WHO recommended

resistant TB survey protocols with HIV markers, and will be subjected to IRB review at country level and

within USG agencies.

This survey has been designed to ensure that all pulmonary TB patients in the six geo-political zones of the

country will have an equal opportunity to participate. A modified, weighted cluster sample method will be

used. Each state (37 total) will constitute one cluster and the number of patients selected per cluster will be

proportional to disease burden. A list of all microscopy centers (including peripheral, secondary, and tertiary

health facilities) in each zone will be compiled with the numbers of new and old sputum-smear positive TB

cases seen in the year 2006. The peripheral facilities will include chest clinics, hospitals and TB microscopic

centers where TB patients are diagnosed and treated across the country.

The sample size will be adequate to account for 95% confidence, an anticipated 5% initial non-response

(opt out) rate, a 10% drop-out or defaulter rate, a design effect of 2.0, and a maximum tolerable error of 2%

to 5% for both new and old cases.

This survey will be a collaborative effort by the USG, GON (NASCP and NTBLCP at the national, zonal,

state, local and facility levels), the National TB/HIV Working Group, the WHO NPO Zonal Representative,

and selected implementing partners (IPs; University of Maryland IHVN-ACTION and Harvard University's

APIN program).

A survey team of local investigators will be constituted at national, state, and facility level. The results of this

survey will help the USG, GoN, Global Fund for AIDS, Tuberculosis, and Malaria (GFATM), ILEP partners,

and other stakeholders strengthen TB disease prevention and control measures, facilitate the process of

establishing an MDR/XDR TB control initiative, and provide a platform for future scientific studies.

HHS/CDC GAP Nigeria received $200,000 of COP07 funds to conduct a small TB/HIV co-infection survey.

Based on the approval of this submission, the smaller survey will not go forward, and the funding allotted to

conduct that survey will be applied as early funding to commence planning and protocol development for

this activity. This $200,000 was subtracted from the total estimated cost for the survey in determining the

proposed COP08 budgetary needs. The final protocol will be an adaptation of existing CDC/WHO protocol

for national surveys of TB resistance and HIV.

Funding for Care: Orphans and Vulnerable Children (HKID): $130,000

ACTIVITY DESCRIPTION:

This HKID activity relates directly to all HHS Nigeria OVC COP08 activities (see ID references in the

narrative below).

The USG Nigeria team, through the HHS/CDC Global AIDS Program (GAP) Office has one full time staff

position, and four partial staff positions planned for OVC that will focus on pediatric basic care and support

issues. The budget includes 2.5 FTE FSN salaries, funding for (limited) international and required domestic

travel, training funds and allocated minor support costs. Funds are not requested in COP08 for international

TA as this is understood to be funded by the HQ operational plan (HOP). These staff members will be

supervised by a Senior Clinical Services Manager across all Care and Treatment program areas funded

under HHS/CDC M&S.

This HHS/CDC OVC staff member will work in close coordination with the USAID Senior OVC program

specialist and directly provide quality assurance and program monitoring to HHS supported implementing

partners including: University of Maryland-ACTION (#5417.08), Harvard SPH-APIN (#5415.08), Columbia

University-ICAP (#5547.08), Catholic Relief Services-AIDSRelief (#5416.08), Africare (#15666.08), IFESH

(#XXXXX.08), and partners to be determined by RFA in COP08 (#14087.08). The HHS/CDC staff will also

assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#3229.08), CEDPA

(#12378.08), Hope Worldwide (#5405.08), Christian AID (#9881.08), Society for Family Health (#6497.08),

Catholic Relief Services - OVC project (#5407.08), and a USAID APS partners (#12415.08) in COP08.

USAID and CDC OVC staff will provide assistance as needed to the U.S. Department of Defense

(#5409.08) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID OVC staff will provide technical support and capacity development to new partners

undertaking OVC activities through the New Partner Initiative as well as provide support to the Government

of Nigeria at the National and State levels to promote Nigeria National OVC guidelines. It is estimated that

the OVC staff under this activity will provide monitoring and support to over 150 clinical sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Prevention: HIV Testing and Counseling (HVCT): $120,000

ACTIVITY DESCRIPTION:

This HVCT activity relates directly to all Nigeria VCT COP08 activities (see ID references in narrative

below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria proposed one full time

Program Specialist staff position and two partial staff positons for VCT, approved and hired under COP07

authority and funding. The budget includes funding for 2 FTE FSN salaries, funding for (limited)

international and required domestic travel, training funds and allocated minor support costs. Funds are not

requested in COP08 for international TA as this is understood to be funded by the HQ operational plan

(HOP). These staff members will be supervised by a Senior Clinical Services Manager across all Care and

Treatment program areas funded under HHS/CDC M&S.

These HHS/CDC VCT staff members will work in close coordination with the USAID TB/HIV staff (#6781)

and directly provide quality assurance and program monitoring to all HHS supported implementing partners

including: University of Maryland-ACTION (#5462.08), Harvard SPH-APIN (#5424.08), Columbia

University, SPH-ICAP (#5550.08), Africare (#6642.08), International Foundation for Education and Self-Help

(IFESH) (#5668.08), Catholic Relief Services-AIDSRelief (#5425.08) and new partners selected by CDC

RFA (#12972.08). HHS/CDC VCT staff will also assist USAID staff in joint monitoring visits of Family Health

International-GHAIN (#3230.08), Catholic Relief Services-7 Dioceses (#5422.07), and a USAID APS partner

(#9884 & #6760) for COP06 and COP07 to be selected. USAID and CDC VCT staff will provide assistance

as needed to the U.S. Department of Defense (#3241.08) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID TB/HIV staff will provide technical support and capacity development to new partners

undertaking TB/HIV and VCT activities through the New Partner Initiative as well as provide support to the

Government of Nigeria at the National and State levels to promote Nigeria National VCT guidelines. It is

estimated that the VCT staff under this activity will provide monitoring and support to approximately 15

implementing partners in over 350 VCT sites in COP08.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Treatment: ARV Drugs (HTXD): $350,000

ACTIVITY DESCRIPTION:

These funds are to be used by CDC for the preclearance fees of perishabled ARV drugs for HHS treatment

partners in Nigeria including University of Maryland, Harvard University SPH, Columbia University SPH, and

Catholic Relief Services. In COP08 a larger portion of the ARVs will be procured through SCMS and

clearance charges for ARV drugs charged directly to CDC. The total value of ARV drugs to be cleared by

CDC is $80,000,000.

Funding for Treatment: Adult Treatment (HTXS): $885,211

ACTIVITY DESCRIPTION:

This HTXS activity relates directly to all HHS Nigeria ART COP07 activities (see ID references in the

narrative).

To support and enhance the USG Nigeria ARV services program, the USG team through the HHS/CDC

Global AIDS Program (GAP) Office in Nigeria has two full time staff positions planned for ART Services that

will focus on supporting implementing partner ART issues. The budget includes two FSN salaries, funding

for (limited) international and required domestic travel, training funds and allocated minor support costs.

Funds are not requested in COP08 for international TA as this is understood to be funded by the HQ

operational plan (HOP). These staff members will be supervised by a Senior Clinical Services Manager

across all Care and Treatment program areas funded under HHS/CDC M&S.

These HHS/CDC ART staff positions will work in coordination with the USAID ART staff (#5398.08.08) and

directly provide quality assurance and program monitoring to HHS supported implementing partners

including: University of Maryland-ACTION (#3255.08), Harvard SPH-APIN (#6715.08), Columbia University

-ICAP (#5408.08), Catholic Relief Services-AIDSRelief (#6678.08), and a partner to be determined by an

RFA in the first quarter of FY2008. The HHS/CDC staff will also assist USAID staff in joint monitoring visits

of Family Health International-GHAIN (#6703) and LMS Associates (#15647.08). USAID and CDC ART

staff will provide assistance as needed to the U.S. Department of Defense (#3243.08) program with the

Nigerian Ministry of Defense.

HHS/CDC and USAID ART staff will provide technical support and capacity development to new partners

undertaking ART activities through the New Partner Initiative as well as provide support to the Government

of Nigeria at the National and State levels to promote Nigeria National ART guidelines. It is estimated that

the ART staff under this activity will provide monitoring and support to over 200 clinical sites in COP08, with

over 250,000 patients on therapy by the end of the program period, 225,000 of these as direct PEPFAR

targets.

ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08

guidance.

Funding for Laboratory Infrastructure (HLAB): $610,000

ACTIVITY DESCRIPTION:

This HLAB activity relates directly to all Nigeria LAB COP08 activities (see ID references in narrative below).

To support the USG Nigeria team laboratory program, the HHS/CDC Global AIDS Program (GAP) Office in

Nigeria has seven full time staff positions (one US Direct Hire, one FSN senior laboratory scientist, five FSN

laboratory systems specialists focused on HIV) to support the Laboratory Infrastructure program area. A

partial FSN laboratory systems specialist was hired in 2007 to focus on TB/HIV lab activities and is funded

under TB/HIV. The budget includes one USDH and seven FSN salaries, funding for (limited) international

and required domestic travel, training funds and allocated minor support costs. Funds are not requested in

COP08 for international TA as this is understood to be funded by the HQ operational plan (HOP).

These HHS/CDC staff members will work in coordination with the USAID/DOD ART and Lab staff. The

HHS/CDC Nigeria Lab Scientist (USDH) will take the USG Lab TWG co-chair for laboratory issues and

directly provide quality assurance and programmatic monitoring to HHS/USAID supported implementing

partner lab activities including: University of Maryland-ACTION (#15673.08), Family Health International-

GHAIN (#5420.08), Harvard SPH-APIN (#6716.08), Catholic Relief Services-AIDSRelief (#6680.08),

Columbia University SPH-ICAP (#5544.08) and LMS Associates (#15648.08). Laboratory Management

staff will also coordinate the technical services of contracted laboratory consultants CLSI (#9845.08), ASCP

(#9846.08), APHL (#12440.08) and ASM (#9847.08).

As part of the USG Nigeria team, HHS/CDC Nigeria laboratory staff will also identify potential local partners

for capacity development and entry into the PEPFAR ART program in COP07 as well as provide support to

the Government of Nigeria at the national and state levels to promote Nigeria National ART laboratory

quality assurance guidelines. The HHS/CDC Nigeria laboratory staff will also be significantly involved

across the areas of PMTCT, Counseling and Testing, TB/HIV, Safe Blood and Safe Injection where

laboratory issues arise.

CDC will also facilitate the preclearance process of perishable lab supplies entering Nigeria through

diplomatic shipments for PEPFAR implementing partners. ICASS and CSCS charges related to this

position are funded under M&S in compliance with COP08 guidance.

Funding for Strategic Information (HVSI): $2,775,000

ACTIVITY DESCRIPTION:

The USG team, through the HHS/CDC Global AIDS Program (GAP) office in Nigeria has seven full time

staff positions planned for the Strategic Information (SI) program area. This includes one USDH, a senior SI

manager, two HIV surveillance specialists, one HMIS program specialist and four monitoring and evaluation

officers. The budget includes salary and expenses for one USDH and six FSN salaries, funding for (limited)

international and required domestic travel, training funds and allocated minor support costs. Funds are not

requested in COP08 for international TA as this is understood to be funded by the HQ operational plan

(HOP).

These seven staff members will work in coordination with the USAID Strategic Information staff members

and directly provide joint quality assurance/quality improvement (QA/QI) strategies and programmatic

monitoring to HHS and USAID supported implementing partners. The SI team, while developing and

updating the USG database will provide oversight and technical support to EP partners and the GON and

will also strengthen their M&E systems through feedback and capacity building.

The USGSI has set up a national HIVQual team and has begun the piloting of HIVQual in 20 treatment

sites. In COP08, HIVQual will be implemented in all treatment sites in the country. The HIVQUAL activity

involves building capacity in performance measurement, quality improvement, and infrastructure

development at the facility level. HHS/CDC will continue to develop measurement tools for compliance and

performance according to National standards and will provide quality assessment in other program areas to

ensure that implementing partners and service delivery points are complying with these standards. HIVQual

is budgeted under ARV Treatment Services (see #5406.08) and described under SI Activity #6662.08.

In COP07 the HHS/CDC GAP Nigeria laboratory and SI staff will have provided technical assistance to the

Nigerian Federal Ministry of Health (FMOH) to develop local capacity for SI and to plan and conduct the bi-

annual HIV sero-prevalence sentinel survey (ANC). In addition the team will have provided technical

assistance to the FMOH for the National HIV/AIDS and Reproductive Health survey (NARHS+), which is a

nationally representative AIDS Indicator Survey with a bio-marker. In both national surveys the team will

have assisted in the development of survey instruments including survey protocols and questionnaire,

training of field staff, field supervision, coordination meetings, quality assurance and data management. In

COP08 the USGSI team will continue its support of the FMOH through technical assistance including

survey activities.

With the planned rapid expansion of the PMTCT program in the country, a large percentage of ANC sero-

survey sentinel sites will be providing PMTCT services in FY08 and many more in subsequent years. In

COP08 HHS/CDC GAP will undertake an evaluation study to assess the utility of PMTCT program data for

HIV surveillance. This study will be conducted using the multi-country protocol developed by CDC-Atlanta

and is budgeted at $50,000.

In COP06, HHS/CDC GAP Nigeria began participation in a multi-country HIV drug resistance monitoring

demonstration project which was implemented in 2 ART sites in COP07. In COP08 this study will be

expanded to 10 additional sites. This study will continue to monitor the emergence of HIV drug resistance

(HIVDR) during a client's first year of ART and evaluate potentially associated program factors on which

action could be taken to optimize ART program functioning for HIVDR prevention. This HIV drug resistance

monitoring activity is budgeted at $850,000.

Related to this HHS/CDC also intends to examine whether standard first-line ARVs will continue to be

effective due to viral mutagenecity by assessing the level of transmitted resistance in drug naïve

populations. This study will be conducted in 5 PMTCT sites using blood samples obtained through informed

consent from HIV+ patients who have never taken ARV drugs. This drug resistance threshold survey is

budgeted at $250,000.

The USGSI team will also be involved in TB/HIV evaluation activities. CDC SI staff will collaborate with the

TB/HIV working group and other stakeholders in Nigeria to conduct a National TB Drug Resistance and HIV

Survey to estimate rates of TB/HIV co-infection and to assess the prevalence of drug resistant tuberculosis

(MDR and XDR) in patients attending TB/HIV clinics in Nigeria. This activity was submitted as a PHE in the

TB/HIV program area (see #18832.08).

SI will also undertake a survey designed to measure the incidence of recent HIV infections through a

focused study of a specific population - that of pregnant women attending antenatal care (ANC) clinics.

Specimens for this survey will come from leftover blood collected at ANC clinics, a number of which are

supported with PEPFAR PMTCT programming. Data collection will be retrospective and prospective using

specimens collected under an IRB-approved protocol. Analysis will be done on the samples from negative

HIV testing results using line listing data for surveillance, and where unavailable, aggregated data may be

used. This activity is funded at $100,000.

These projects, through different approaches, seek to improve the quality of USG-sponsored HIV care

programs, while ensuring adequate use of resources, reducing harm, and reducing the emergence of

resistant strains of HIV that may accompany non-adherence. Further details about proposed surveillance

activities can be found in Table 5.5.

In order to successfully develop and interpret strategic information (SI) and implement evidence-based

HIV/AIDS programs and policies, Nigerian HIV/AIDS program managers and policymakers must be able to

generate, analyze, and interpret quantitative information. They must critically evaluate and use data

generated by epidemiologic studies, surveillance, program monitoring, targeted evaluations, public health

evaluations (PHEs) and similar efforts. USG PEPFAR Nigeria will, in collaboration with the Federal Ministry

of Health and two Nigerian universities, provide training for public health HIV/AIDS managers in field

epidemiology. A total of 75 program managers will be trained in COP08 on relevant short courses and 15

will be enrolled into the two-year long course for the award of a master's degree in field epidemiology

through this Field Epidemiology and Laboratory Training Program (FELTP). FELTP is funded under SI

($550,000) and also under System Strengthening (see #12447.08).

CONTRIBUTION TO OVERALL PROGRAM AREA:

SI activities will directly ensure generation of quality data to measure EP program achievements,

Activity Narrative: performance towards set targets as well as accountability of resources. These SI activities will build the

capacity of at least 200 staff of EP partners and the federal and state GON staff, and provide TA to at least

50 organizations.

LINKS TO OTHER ACTIVITIES:

CDC Strategic information activities are related to all program areas across all IPs as SI activities are a

critical component for appropriate monitoring of activities under each program area. All data collected and

analyzed will be disaggregated by age/age-group, sex and other relevant qualitative variables to inform

program planning and more particularly to identify any underserved populations. This links to System

Strengthening (#12447.08); TB/HIV (#18832.08); ARV Services (#5406.08); and SI (#6662.08).

EMPHASIS AREAS:

Local organizational capacity building will occur through TA provided to IPs as well as state and federal

government staff. Human capacity will be developed through USGSI staff participation in training activities.

Funding for Health Systems Strengthening (OHSS): $675,000

ACTIVITY DESCRIPTION:

This is a new activity to develop a long term fellowship program for health care workers in Nigeria to provide

sustainability and surge capacity to the government of Nigeria at the state and national levels. This activity

is a wraparound because it utilizes both HHS/CDC and USAID central funds (non-PEPFAR) to support a

portion of its implementation. This activity is linked to HHS/CDC-SI (#5358.08) with partial funding in that

area.

The Nigeria Field Epidemiology and Laboratory Training Program (N-FELTP) which started in 2007 is an

adapted version of the CDC International Field Epidemiology and Laboratory training program. Its main

objective is to develop in-country capacity and Leadership in Strategic Information (LSI) within the health

sector including HIVAIDS. It is being implemented by the Federal Ministry of Health (FMOH) in collaboration

with CDC/USG-PEPFAR, two in-country universities, and other stakeholders. The program will train junior

level professionals (physicians, laboratorians) from the state and federal ministries of health. It consists of

three tracks that focus on epidemiology, laboratory and veterinary epidemiology, respectively. N-FELTP

includes two distinct programs that include a series of short courses (three months) which are certificate-

awarding and a long course (two year fellowship program) which is degree-awarding in each of the three

tracks. Both the short and long courses provide 25% didactic training and 75% field work experience.

While the short courses are designed to meet Nigeria's short term training demands in issues of curbing

epidemic diseases and emerging public health concerns, the long courses are designed to meet longer term

demands of developing technically strong public health leadership that can guide the process of sustainable

development of health systems. To date 25 senior public health practitioners have been trained in short

courses and two other planned trainings (25 participants each) will be conducted by the end of COP07.

The long course will begin in COP08. This fellowship program will be a two-year in-service training program

in applied epidemiology and public health laboratory practice. The applied epidemiology fellowship program

for physicians will serve to link their medical background to the public health needs at the local level specific

to HIV/AIDS. They will develop skills that can be applied in their positions at the state and national

government levels, thereby furthering the government's capacity in areas such as identifying and

interpreting prevalence rates in different populations including most at risk populations (MARPs), evaluating

prevention intervention strategies, identifying/quantifying causes of loss-to-follow up, developing and

evaluating monitoring systems, and developing referral networks. The public health laboratory fellowship

program for laboratorians will serve to link their laboratory background to the public health needs at the local

level specific to HIV/AIDS. They will develop skills that can be applied in their positions at the state and

national government levels, thereby furthering the government's capacity in areas such as appropriate scale

up of HIV diagnostics (for example training of non-laboratorians to conduct rapid HIV testing), scale up of

early infant diagnosis, appropriate scale up and application of resistance testing, and identifying/addressing

notification requirements for laboratories with regard to MDR/XDR. The fellows will develop into leaders in

public health in Nigeria, and in addition to their applied work, they will be expected to organize or facilitate

public health training courses for their colleagues in the government and/or at the local level.

While the fellows will train in applied epidemiology related to other public health priorities in Nigeria as well,

PEPFER funds will be used to develop a specific focus on HIV/AIDS activities within the fellowship program.

For non-HIV activities N-FELTP leverages resources from non-PEPFAR sources such as USAID, CDC, and

the Government of Nigeria. CDC influenza resources funded the development of the N-FELTP program and

the first short courses. USAID avian influenza resources are being used to support the veterinary laboratory

long course. Work is also being done to develop public/private partnerships for additional support for future

years. The FMOH has embraced this program as a critical system strengthening tool and is establishing a

counterpart funding line in its annual budget beginning with their 2008 fiscal year budget submission. USG

plans to continue providing direct support for N-FELTP for the next five years, at which time the program is

expected to be sustained by the Nigerian Government.

With the graduation of fellows and their return to the public sector, the program will develop a self sustaining

institutionalized capacity to train public health leaders in field epidemiology and field-oriented public health

laboratory practice. Graduates of the program will serve as mentors to new trainees and will also present

lectures to trainees during didactic portions of the program. As fellows are trained through conducting

activities in the field, the program will provide epidemiological services to the public health system at

national, zonal, state, and local levels which will serve to address gaps in the government's ability to

respond to the HIV/AIDS epidemic. South-south collaboration will be used to link fellows to applied public

health training programs in other countries, thereby utilizing lessons learned in similar settings.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The curriculum will lead to capacity development at the national, state, and local level and will ensure

sustainability through the involvement of graduates in the program. Sustainability will also be ensured by

placing graduates back into their positions within the state and national Ministries of Health.

POPULATIONS BEING TARGETED:

The fellows in this program that are targeted for training are physicians, epidemiologists and laboratorians

who work within the state and Federal Ministries of Health.

COVERAGE AREAS:

This program is national in its scope as the trainees will come from any of the 36 states or the Federal

Capital Territory and will return to their respective positions after completion of the fellowship program.

LINKS TO OTHER ACTIVITIES:

These HHS/CDC PSC staff positions will work in coordination with the Federal Ministry of Health and the

Federal Ministry of Defense to provide mentoring and technical assistance related to epidemiology and

laboratory services. HHS/CDC-SI (# 5358.08).

EMPHASIS AREAS:

The major emphasis area for this activity is human capacity development.

Funding for Management and Operations (HVMS): $1,969,569

ACTIVITY DESCRIPTION: This narrative describes the CDC Nigeria M&S needs for both GHAI and GAP

funds. The CDC Nigeria M&S budget, including GHAI and GAP funding, has been vetted through the

interagency decision making process and agreed to as presented in the COP08 submission.

The USG Nigeria team's M&S goal, through the HHS/CDC office in Nigeria, is to have sufficient staff for

COP08 to provide more technical and programmatic oversight and assistance to all implementing partners

in Nigeria. The CDC M&S budget in COP08 supports the USG interagency team process of providing

technical assistance and monitoring of PEPFAR activities across a significant array of implementing

partners in the Nigeria, which is the second largest PEPFAR country based on the established 2009 end

targets. Geographical size of the country, 25% larger than Texas, also influences the USG staffing needs to

provide monitoring of activities. Direct country project officer oversight at CDC is in place for four of the

seven existing Nigeria PEPFAR ARV treatment partners working in over 250 clinical sites (Harvard

University SPH-APIN, University of Maryland-ACTION, Columbia University-ICAP and Catholic Relief

Services-AIDSRelief). Additionally, CDC has seven other cooperative agreements supporting a broad

range of implementing partner activities such as laboratory, safe blood, TB/HIV, OVC and PMTCT.

Upcoming RFA awards will likely add 4-8 new partners by November 2007. These new partners will need

rapid integration and agency management to influence achievement of the Nigeria 2-7-10 goals.

To achieve the goals of effective technical assistance to the Government of Nigeria and joint USG oversight

of implementing partners, the CDC Global AIDS Program (GAP) Office in Nigeria has planned for full

staffing at 81 positions in FY2008, an increase of 14 technical and 8 administrative support staff (see USG

Nigeria Staff Matrix COP08). Presently 51 of the 59 approved COP07 positions have been filled and eight

positions are under recruitment. Three of these vacant CDC positions are for USDH staff for which

candidates have been found and processes for selection are nearing completion.

The COP08 HHS/CDC staffing plan includes 7 USDH that are comprised of the Chief of Party, Deputy

Director, Associate Director for Epidemiology & Clinical Programs, Associate Director for Laboratory

Science, Associate Director for Management and Operations, Associate Director for Program Monitoring,

and the Associate Director for a USG PEPFAR field office in Lagos. The Lagos PEPFAR Field Office, while

initially staffed and funded by HHS/CDC will support the extensive USG PEPFAR program in southern

Nigeria. No new USDH positions are sought in COP08, but two PSC positions to support systems

strengthening is requested to support the CDC Field Epidemiology and Laboratory Training Program. The

envisioned period of staffing for these positions is for two years with technical independence for

continuation of the program after this timeframe. It is not expected that these PSC positions will be filled

until Q3 FY08 due to the process for position approval at HHS/CDC and the timeline for recruitment,

selection and relocation. A further breakdown of total staff requested includes 38 FSN technical staff

(funded under specific program areas and M&S), 2 PSC technical positions (under Systems Strengthening,

and 34 M&S FSN support staff including 17 administrative, finance and IT staff plus 15 drivers. In the

attached supporting documents a full USG PEPFAR Nigeria organizational chart is attached. The specific

disciplines of technical staff were determined through an interagency staffing for results process that allows

for complementary staffing across agencies. While some technical positions in program areas are

duplicative for agencies, that duplicity is based on the total size of COP08 programming and the minimum

time required to adequately monitor field work of partners and providing technical assistance to the

Government of Nigeria.

M&S costs are inclusive of rent for offices and warehouse space, utilities, office operational costs, M&S

specific equipment, M&S specific staff inclusive of all associated costs, travel for M&S staff, training for M&S

staff, general ICASS charges, ICASS and CSCS for M&S staff, relocation costs of 4 USDH M&S positions

expected in FY08, residential leases and post allowance for 7 USDH M&S positions, security services for

offices/warehouse, 1 new vehicle for increased CDC Nigeria technical staff field support, and increased

communications costs related to staff growth. This COP08 submission does not include HQ TA support in

keeping with COP08 guidance that this will be funded through the Headquarters Operational Plan process.

Funding for M&S related equipment and supplies in the amount of $400,000 for HHS/CDC has been placed

under SCMS M&S for procurement purposes. ICASS charges of $1,000,000 and CSCS charges $289,531

are budgeted separately in their own activities as required by COP08 guidance.

Cross Cutting Budget Categories and Known Amounts Total: $0
Food and Nutrition: Commodities $0
Food and Nutrition: Commodities $0
Food and Nutrition: Commodities $0