PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
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.
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.
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.
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.
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.
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.
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
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
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.
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
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.
SURVEY TITLE: National Tuberculosis Drug Resistance and HIV Survey in Nigeria
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.
This HKID activity relates directly to all HHS Nigeria OVC COP08 activities (see ID references in the
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
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.
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.
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.
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
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.
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
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.
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)
(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.
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.
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).
The major emphasis area for this activity is human capacity development.
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.
