ACTIVITY DESCRIPTION:

In COP08, ICAP-CU will continue to work in the three states of Kaduna, Cross River and Benue. ICAP-CU

will also support PMTCT services in 3 additional states (Gombe, Kogi and Akwa Ibom), assisting a total of

70 (33 new, 37 existing) government (GON), mission and private health facilities to provide PMTCT services

and community outreach activities throughout 25 hospital networks. These networks, which will include

hospitals, PHC centers, and community-based service outlets, will provide HIV counseling and testing to

55,000 pregnant women, of whom at least 50,000 will receive their results and be linked into appropriate

care and treatment programs.

ICAP-CU will train health care workers (HCWs), support infrastructure, purchase equipment and supplies,

monitor, evaluate and provide supportive supervision to the sites. ICAP-CU, with other implementing

partners, will implement the PEPFAR-Nigeria LGA coverage strategy in Kaduna, ensuring the provision of

PMTCT services in at least one health facility in every local government area (LGA) for states designated

‘LGA Coverage States'. This is an essential step toward universal access to PMTCT services and moves

the program closer to the shared goal of eliminating perinatal HIV transmission. Active efforts will be made

to facilitate the public health approach in taking PMTCT services to the primary (PHCs) and community

levels.

In COP08, ICAP-CU will support comprehensive PMTCT services for communities, including marked

expansion of HIV testing for pregnant women. ICAP-CU will work to increase uptake of these services,

including routine antenatal care and facility-based deliveries. Pregnant women, especially HIV-positive

mothers, will be supported to deliver in health facilities through the provision of the national safe

motherhood program delivery kits ("mama kits"). Mother support groups will be established and/or

strengthened to increase facility-based delivery and reduce the number of women lost to follow up. Post-

delivery care and treatment for women and infants will be augmented. The use of ART for PMTCT will

follow the National PMTCT guidelines. HIV-infected women ineligible for ART will be offered a combination

of zidovudine (AZT) from 28 weeks (when feasible) or combivir from 34/36 weeks and single dose

nevirapine (SD-NVP) at onset of labor. Women presenting at labor will be offered rapid testing and if HIV-

infected provided with SD-NVP. All infants born to HIV-infected women will be provided with SD-NVP at

birth and AZT for 6 weeks. 2,500 mother-baby pairs will receive ARV prophylaxis. Through appropriate

infant feeding counseling and follow-up, ICAP-CU will provide support for a mother's infant feeding choice

as well as provide ongoing psychosocial and adherence support. Health facilities will be supported to

provide basic laboratory services and, if not available on site, will be linked to a laboratory network model in

which CD4 testing can be performed via specimen transport systems. Exposed infants will be actively linked

to pediatric care and treatment through under-5 cards issued in labor and delivery.

The COP08 programming will emphasize provider-initiated opt-out testing with same day results at ANC,

labor and postpartum service delivery points. Partners, households and children will be linked into HCT.

ICAP-CU will actively promote community-based PMTCT services to provide doorstep HCT to pregnant

women, their partners and other household members. Clients will be counseled on the beneficial effect of

couple/partner HCT/disclosure on adherence to infant feeding choice. Eligible HIV-infected women will be

assessed and linked into care and treatment services including ART and cotrimoxazole prophylaxis (pCTX).

Other activities are enhanced pediatric care including pCTX from 6 weeks of age and promotion of best

practices for infant feeding, nutritional support and linkages to family planning services. In addition to

receiving PMTCT services, each woman will be referred to OVC services upon her HIV diagnosis in order to

facilitate care to all of her affected children.

Identification and follow-up of HIV-infected children living within the community will be a priority with

CBOs/FBOs assisting with adherence issues and defaulter tracking. ICAP-CU and its sub-partners will train

450 HCWs, using GON curricula, to provide quality services to HIV-infected pregnant women. The training

will focus on prevention messaging (including balanced ABC messaging as appropriate), STI screening and

treatment, safer sex, nutrition, malaria prophylaxis, use of ITNs and safe water. 200 additional health care

providers will be trained to educate and assist mothers make appropriate infant feeding options and

discourage "mixed feeding" practices. ICAP-CU will facilitate the government's efforts in improving infant

feeding counseling by supporting a zonal train-the-trainer on HIV and infant feeding. HIV-negative mothers

will be counseled and supported to remain HIV negative. By the end of COP08, a total of 650 HCWs will be

trained. ICAP-CU will partner with CBOs and FBOs such as TCF, CACA, GHAC, Gawon Foundation and

PLWHAs as key players to provide innovative community and home-based PMTCT services to pregnant

women. ICAP-CU will actively support innovative community-based approaches and activities to reach and

link male partners into existing services.

ICAP-CU will work in close partnership with IHVN and the Clinton Foundation on HIV infant diagnosis,

offering HIV infant diagnosis testing in line with the National Early Infant Diagnosis Initiative from 6 weeks of

age using DBS. HIV positive infants will be linked to appropriate care and treatment. A joint

USG/GON/ICAP-CU team will provide ongoing M&E and supportive supervision activities and contribute to

the national PMTCT program's M&E efforts.

CONTRIBUTIONS TO OVERALL PROGRAM GOAL:

ICAP-CU and its sub-partners target states with some of the highest seroprevalence rates in Nigeria.

Providing services at the primary and secondary levels assists the GON in achieving its goal of

decentralizing PMTCT services beyond the tertiary care level. ICAP-CU will significantly contribute to an

increase in PMTCT services by supporting 37 existing and 33 additional government, mission and private

health facilities and also indirectly supporting GON ministries/programs in their rapid scale-up plans for

PMTCT. ICAP-CU will partner with local institutions with appropriate expertise and capacity to reach out

into primary facilities in line with national PMTCT scale-up plans.

The targets of 50,000 pregnant women counseled and tested and 2,500 mother-infant pairs for ARV

prophylaxis will be reached by the end of COP08. This will significantly contribute to the emergency plan

targets of 80% coverage and 40% reduction in PMTCT transmission by 2008. ICAP-CU will strengthen

national and state PMTCT programs by: support of capacity building of master trainers for PMTCT services;

production of GON approved infant feeding support tools; printing of national PMTCT registers; and support

of regular coordination meetings in collaboration with other partners at national and state levels. ICAP-CU

will also strengthen the programmatic skills of partner CBOs/FBOs in line with GON sustainability plans.

Activity Narrative: LINKS TO OTHER ACTIVITIES:

This activity is related to activities in ARV services (5404.08), Basic Care and Support (5552.08), OVC

(5547.08), counseling and testing (5550.08), SI (5541.08), Lab (5544.08), AB (15654.08) and Other

Prevention (9208.08). Provider-initiated opt-out HCT will be offered to all pregnant women at ANC, and to

their partners. Women presenting in labor will have rapid HIV tests and receive single dose NVP if positive.

Infants born to HIV-infected women will access ART (single dose NVP and ZDV) and CTX prophylaxis.

Infant PCR HIV testing via DBS will be conducted with HIV positive infants linked to appropriate OVC care

and treatment services. PC linkages will enable HIV+ women and family members access to support

groups. All pregnant women will be linked into FP services. Partner counseling/communication will be

promoted through other prevention for positive activities. M&E activities at PMTCT sites will contribute to the

national PMTCT program's M&E efforts using national PMTCT MIS.

POPULATIONS BEING ADDRESSED:

Pregnant women, postpartum mothers, their partners and household members including HIV exposed

infants and HIV infected children will be targeted and supported so that they have full access to HCT at

multiple entry points of care. HIV infected women will be provided with PMTCT/PMTCT plus services, while

HIV infected infants and children, and infected partners, will access care and treatment services, including

OVC services. Uninfected women will be supported to remain HIV negative. CBOs, FBOs, support groups,

and men will also be targeted so that they participate fully in community based PMTCT services. Healthcare

providers will be trained on providing services while the management skills of GON policy makers and

implementers at all levels will be improved to enable them to manage programs effectively.

EMPHASIS AREAS:

Emphasis, in this activity, will be on training, increasing gender equity in HIV/AIDS programs, local

organization capacity building and SI.

This activity will promote gender equity in HIV/AIDS programs and increase access to services by the

vulnerable groups of women and children. It will help increase service uptake, promote positive male norms

and behaviors, especially as it relates to discordant couples, and help reduce stigma and discrimination

through its community based activities.

Columbia University (CU), through this new award, proposes to extend its innovative and successful

PMTCT-Plus programming to the Kachia local government area (LGA) of Kaduna State. Kaduna State is

the 12th largest of Nigeria's 36 states, with a population of 4,652,989 and an estimated overall HIV

seroprevalence of 5.6% (as high as 10% in some communities). This intervention is focused on the Kachia

LGA with a total population of 600,000 people and an estimated HIV prevalence of 7.0% in 2005. ICAP will

provide support to at least four primary health centers (PHCs) and one referral General Hospital (GH),

Doka. The referral facility will also be targeted to provide comprehensive ART services, including TB/HIV

integration, palliative and preventive care, and early infant diagnosis via dried blood spots (DBS) for adults

and children. Key interventions at the will include: provider-initiated opt-out HIV testing with same day

results at the ANC, L&D units including postnatal wards; development of linkages between PMTCT and

reproductive and maternal/child health care continuum; strengthen linkages between PMTCT and HIV

care/treatment services at GH Doka to ensure prompt immunologic staging via CD4; follow-up of HIV

infected women with advanced disease who have initiated ART at GH Doka following the National

guidelines; partner testing; pediatric care and treatment; cotrimoxazole prophylaxis for HIV-exposed

infants/children; promotion of best practices for infant feeding among HIV-infected women via counseling for

informed decision making and linkages to programs that supply free breast milk substitute if desired;

involvement of people living with HIV/AIDS (PLWHA) in program activities; and development of linkages

between communities and health facilities. These will be carried out in collaboration with the GON and other

implementing partners and stakeholders as appropriate. (PHCs will be involved mainly in HIV counseling

and testing services, provision of ARV prophylaxis (AZT and Combivir) for those not eligible for HAART,

infant feeding counseling, referrals and linkages of mother/baby pairs to secondary health facilities and

community support groups.)

Using its model of family-centered care delivered by multidisciplinary teams, CU will support the

establishment of PMTCT-Plus programs at the 5 designated sites. CU will ensure the availability of on-site

HCT services in order to provide HIV counseling and testing (HCT) to pregnant women, their partners, and

other family members (including children). At the PHC level CU supports both PMTCT services and HCT for

the general population. ICAP will develop side labs at ANC and labor and delivery (L&D), enabling point-of-

service opt-out HIV testing with same-day results. Couples counseling and outreach to partners and older

children of HIV-infected pregnant women will be supported.

Following the National Guidelines, CU will ensure that quality ANC services will be provided to all HIV-

infected pregnant women, with a special focus on STI screening and syndromic management, promotion of

safer sex during pregnancy and post-delivery (periods of greater risk for HIV transmission), provision of

maternal and infant feeding counseling and micronutrient supplementation, malaria prophylaxis and the

provision of long-lasting insecticide-treated bed nets, immunizations, delivery preparedness and provision of

"mama packs" to encourage facility-based delivery. Linkages to family planning will be created and

strengthened. HIV support groups, peer educators, and community-based support services will also be

strengthened.

CU will ensure prompt clinical and immunologic staging of HIV-infected pregnant women. Training and

supportive supervision will enable ANC staff to conduct standardized clinical assessments and WHO

staging of HIV-infected women, using validated algorithms, checklists, and job aids. Immunologic staging

will be provided immediately upon HIV diagnosis via on-site CD4 testing (at the GH) or specimen referral (at

the PHCs). This staging will enable site staff to identify pregnant HIV-infected women who are eligible for

ART for treatment (as opposed to ARV prophylaxis for PMTCT), facilitating rapid and effective referrals for

treatment. PHCs will offer ARV prophylaxis only and will refer treatment eligible mothers to the GH.

CU will provide safer L&D and post-partum services. CU-supported PMTCT sites will provide quality L&D

services, HCT for women of unknown HIV status, safe obstetric practices, universal precautions, and

appropriate post-partum follow-up. Any unbooked pregnant woman that presents in labor will be offered

HCT and if positive will receive ARV prophylaxis as well as her infant. She will also benefit from infant

feeding counseling for her to make an informed decision. Staff will be provided with basic materials that

ensure universal precautions.

The use of ART for PMTCT will follow the National PMTCT guidelines. HIV-infected women who do not

meet the national eligibility criteria for ART will be offered a combination of zidovudine (AZT) from 28 weeks

or Combivir from 34/36 weeks and single dose nevirapine (SD-NVP) at onset of labor. Women presenting at

labor will be offered rapid testing and if HIV-infected provided with SD-NVP. All infants born to HIV-infected

women will receive SD-NVP at birth and AZT for 6 weeks.

Women found via PMTCT services to have advanced HIV disease by clinical or immunologic staging will be

linked to GH Doka for the initiation of ART. While laboratory specimens will routinely be sent to the GH

Doka, patient transportation will be minimized by the use of a mobile "treatment team" which will visit the

PHC sites on a regular basis. All eligible clients will be referred to GH for ART initiation; after initiation, to

improve compliance and minimize loss to follow-up, the outreach team will visit each PHC regularly to

provide supportive supervision to trained nurses in following up patients and provide refills for ART. Blood

samples for CD4 and other routine laboratory tests will be transferred to the GH.

In addition to the support for safe infant feeding described above, HIV-exposed infants diagnosed through

the National EID system will be enrolled in care at the PMTCT site, receiving prophylactic cotrimoxazole,

growth and development monitoring, immunizations, and clinical and immunologic staging (via specimen

transfer). Infant follow-up services will be enhanced by job aids and ongoing supportive supervision by CU

pediatric clinical advisors. National EID registers will be use to follow-up exposed infants until results are

obtained through DBS. Linkages to GH Doka will enable the diagnosis and treatment of opportunistic

infections as well as access to CD4 testing and pediatric ART services. EID services using DBS will also be

introduced at the sites in conjunction with the GON and USG team.

Linkages to care and treatment services will be developed, including site-level linkages between HCT,

PMTCT, ANC, and laboratory services. Women not eligible for ART will receive ARV prophylaxis for

PMTCT, and then continue follow-up at the ANC or Maternal Child Health clinics at PHCs and at the HIV

clinics in the referral General Hospitals.

Psychosocial and adherence support services will also be implemented. HIV counseling, support groups

Activity Narrative: and peer health educator programs will be initiated at each site. Inventories of community-based resources

will be conducted, and linkages to these appropriate pre-existing local services will be developed and

strengthened. This will enhance the development of outreach and defaulter tracking services as well as

accompaniment to appointments, systems navigation, activities to promote male involvement, community

mobilization activities, and access to economic, nutritional and other support services.

Organizations/resources identified and assessed may be local non-governmental, community-based and/or

faith-based organizations, creating a network of partners. CU will initiate both facility-based and community-

based support groups, conduct community sensitization activities, provide "love letters" for partners inviting

them for HCT, and pilot home-based family HCT services. Local partner staff will attend referral network

trainings and quarterly meetings with CU-supported sites. Other PHCs within the community will also be

identified and assessed for additional support services.

CU will focus on strengthening of the health care system within the Kachia LGA. It will partner with site staff

and leadership to conduct baseline site assessments, and to develop and implement collaborative site

workplans. Physical infrastructure will be enhanced as needed to provide PMTCT-Plus services at GH Doka

including installation of generators and refrigerators and renovations (consistent with acceptable use of

CDC funding), repairs and refurbishment of clinical, laboratory, pharmacy, and medical records areas.

Furnishings, supplies, and a standard package of medical and laboratory equipment will be provided to

each site. Staff will strengthen on-site laboratory capacity as needed, ensuring site-level access to HIV

testing and hemoglobin monitoring at the PHC level, and installing chemistry and hematology analyzers and

CD4 machines at the General Hospital. Stock management, forecasting, and pharmacy operations will be

enhanced, and appropriate medical records systems (appointment books, logs, patient files/forms) and data

management will be introduced. Ongoing mentoring and supportive supervision of clinical, laboratory,

records and pharmacy/dispensary staff will be provided. In collaboration with the PHC coordinator and the

Local Government council, CU will continue to support state PMTCT coordination meetings as needed.

ACTIVITY NARRATIVE:

ICAP-CU will be a new partner in the program area of Abstinence/Be Faithful (AB) in COP08. ICAP-CU will

implement its AB programming activities in line with the overall PEPFAR Nigeria goal of providing a

comprehensive package of prevention services to individuals reached (thereby improving the effectiveness

of this messaging) through a balanced portfolio of prevention activities including condoms and other

prevention. Through the involvement of ICAP-CU as a new partner in this activity, PEPFAR Nigeria will

extend its reach with AB services as ICAP-CU will be active in six states (Akwa Ibom, Benue, Cross River,

Gombe, Kaduna, and Kogi) by the end of COP08.

ICAP-CU is currently providing prevention messages for positives (funded under care) to its large

population of adults, adolescents and children, and will add on AB messaging to these prevention activities

for increased balanced messaging.

In addition, ICAP-CU will target activities to HIV-negative persons in its catchment areas in order to

minimize their risk behaviors and contribute to an overall reduction in HIV prevalence. A key age group for

AB activities is youth/young adults aged 15-24 years as this encompasses the highest prevalence age

group. The 2005 ANC survey in Nigeria indicates that among age cohorts in Nigeria, the 20-29 year old age

group has the highest HIV prevalence (4.9% compared to a national prevalence of 4.4%). In addition, the

2005 National HIV/AIDS and Reproductive Health Survey (NARHS) demonstrated a low risk perception

(28%) among the general population and significant reports of transactional sex (11%) among young

women aged 15-29 years. This age cohort for both men and women represents the working age group in

Nigeria; it is expected that a combination of prevention messaging approaches will ensure they are reached

with prevention interventions.

In COP08 ICAP-CU will implement this activity at both the facility and community levels utilizing a

combination of multiple strategies in this implementation, including community awareness campaigns, peer

education models, peer education plus activities, and workplace activities (specifically Greater Involvement

of People with HIV/AIDS, or GIPA). Activities conducted at the local level by ICAP-CU will be reinforced

through national level mass media campaigns by other USG partners such as the successful Zip-Up

campaign. AB messages will be balanced with concurrent condoms and other prevention messaging where

appropriate and will be integrated with other PEPFAR services being provided at 25 hospital networks and

their surrounding communities which will serve as the platform for ICAP-CU prevention activities in the

coming year in six states. The goal of the program is to be focused on the communities targeted and to

cover those communities with messages conveyed in multiple fora. Utilizing such a methodology, a large

number of people will be reached with messages received via one method or another, but the target group

will be those individuals that will have received AB messaging: (1) on a regular basis and (2) via at least

three of the four strategies ICAP-CU will employ (community awareness campaigns, peer education

models, per education plus activities, and workplace programs). The target for this intensive AB messaging

campaign is 4,800 individuals. In addition, age appropriate abstinence only messaging and secondary

abstinence messaging will be conveyed to 2,400 children and adolescents, particularly focused on those

orphans and vulnerable children receiving both facility and home based support. A total of 375 health care

providers, counselors, and peer educators will be trained to conduct effective prevention interventions

inclusive of AB messaging.

ICAP-CU collaborates with several community based organizations (CBOs), faith based organizations

(FBOs), and PLWHA support groups at its facilities and surrounding communities in other PEPFAR

programming activities. These CBOs, FBOs and support groups will also serve as appropriate partners in

the dissemination of ABC messaging to other PLWHA utilizing the peer education model, and to wider

audiences through the peer education plus model and community awareness campaigns. The community

and peer education plus activities will be organized through CBOs and FBOs under the supervision of ICAP

-CU and will include activities such as drama presentations, musical events, and road shows/rallies. To

address stigma issues and in compliance with the GIPA principle, approximately 10 PLWHA from the pool

of those receiving treatment at facilities who are living openly and positively will be trained using the peer

education model on dissemination of ABC messaging. They will serve as peer educators to extended family

members and members of their support groups. These trained PLWHA will in turn reach individual cohorts

of at least 10 other persons from among their social peers. With 50 facilities (including PMTCT sites), this

will serve as an effective tool for reaching individuals in at least as many communities with balanced ABC

messages.

A community awareness strategy will also be employed to serve the catchment areas of the hospital

facilities which will be linked with community mobilization efforts promoting HCT. During static and mobile

HCT services, counselors will be disseminating balanced ABC messages to recipient communities and

clients through focused group discussions and interpersonal communication. With an HCT target of 112,500

clients getting counseled, tested and receiving their results, a minimum of this many clients will receive

balanced ABC messaging through this approach. The key messages that will be conveyed are delay in

sexual debut, secondary abstinence, mutual fidelity, prompt and complete treatment of all STIs and

promotion of need to ascertain HIV serostatus through HCT.

ICAP-CU will also implement the peer education model targeting job peers who are healthcare workers.

Healthcare workers at each site will be trained (the exact number will vary based on facility size) using

established national peer education curricula and each will be requested to form peer groups of

approximately 10 members from the healthcare worker community for dissemination of balanced ABC

messaging. It is anticipated that these healthcare workers will continually serve as conduits for age

appropriate prevention messaging not only for their work peers but also for their social peers and for all

clients with whom they come in contact.

A focus of the program in COP08 will be improvement of the integration of prevention activities into the HIV

care and treatment settings; specifically, healthcare providers and lay counselors in care and treatment

settings will be trained to appropriately deliver integrated ABC prevention messages and incorporate the

messages into routine clinic visits using IEC materials and job aids. An appropriate balance of abstinence

and be faithful, and correct/consistent condom use education will be tailored to the needs and social

situation of each individual client in its presentation. In addition to the integration of such services into the

HIV-specific treatment setting, prevention activities will be assimilated into other points of service in each

health facility (general outpatient clinics, emergency services, etc.), particularly into reproductive health

Activity Narrative: services including, family planning counseling, sexually transmitted infection management and counseling,

and risk-reduction counseling.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

ICAP-CU AB activities emphasize integration of prevention activities with treatment and care services. Use

of the community awareness campaigns, the peer educator model, and peer education plus activities

(community drama, dance events, etc.) allows dissemination of AB messaging, including integration with

condom messaging, from society-attributed sources of credible information - healthcare workers and

PLWHA. This program will contribute to the Global HIV/AIDS Strategy by reaching 4,800 people with AB

messaging and 2,400 people with abstinence only messaging in a comprehensive approach. The activities

will also address issues of stigma and discrimination through the education of individuals and communities

reached.

LINKS TO OTHER ACTIVITIES:

AB activities relate to HCT (5550.08), by increasing awareness of HIV. It also relates to care and support

activities (5552.08) through dissemination of information by home based care providers and ultimately by

decreasing demand on care services through decreased prevalence. Linkages also exist to condoms and

other prevention (9208.08) as a complementary prevention strategy and to OVC programming (5547.08) by

targeting orphans and vulnerable children.

POPULATIONS TARGETED:

Key populations targeted are youth, OVC, PLWHA, adults accessing HCT services at either static or mobile

within catchment areas of the treatment sites, support group members and immediate families of PLWHA.

EMPHASIS AREAS:

Emphasis areas include human capacity development, workplace programs and gender.

AB activities promote a rights based approach to prevention among positives and other vulnerable

members of society and equal access to information and services. Reduction of stigma and discrimination

are also key to the program.

ACTIVITY DESCRIPTION:

ICAP-CU has supported 12 hospital networks in Kaduna and Cross River States to improve safe blood

practices and reduce medical transmission of HIV and other infections. In COP08 ICAP-CU plans to expand

into 13 additional hospital networks in six states (Kaduna, Gombe, Cross River, Benue, Akwa Ibom and

Kogi), resulting in a total of 25 facilities receiving support through ICAP-CU. Blood transfusions occur at all

25 of these facilities.

In COP08, ICAP-CU will work closely with the National Blood Transfusion Service (NBTS) and Safe Blood

for Africa Foundation (SBFA) in all aspects of its blood safety program. ICAP-CU will support the NBTS in

implementing its primary objective of migrating fragmented hospital-based blood services to centralized

NBTS-based blood services nationwide. A key feature of this program is the development of a nationwide

voluntary donor recruitment system. NBTS, through the linkages its zonal centers will develop with ICAP-

CU and its supported facilities, will provide TA for blood donation drives held by these ICAP-CU supported

hospital facilities. In addition, SBFA will train nurses and medical laboratory scientists in these facilities to

recruit repeat voluntary blood donors from the ranks of current family replacement donors. In this plan ICAP

-CU will be instrumental in working with hospital management and staff at all comprehensive sites to

develop buy-in for the NBTS blood services program, to create support of blood donor organizers, and to

strengthen health facility and community focused blood drive activities. Health facilities will be supported by

ICAP-CU to work with the local Red Cross on community sensitization and blood drives.

ICAP-CU will also work through local community based organizations and support groups to increase

demand and awareness on safe blood practices. These local organizations will be supported to promote

safe blood donor drives and activities in their communities. They will also be supported to sensitize the

hospitals and communities on the need for voluntary blood donation. ICAP-CU will support the production

and distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for voluntary non

-remunerated blood donation. In addition, ICAP-CU will work closely with facility management to establish

blood transfusion committees to oversee blood use based on national algorithms and standards in the

health facilities.

ICAP-CU will facilitate the development of an NBTS/hospital blood exchange program at 5 health facilities

that will be selected based on proximity to a zonal NBTS office, availability of blood banking facilities,

support infrastructure and other resources. This linkage will include regular delivery of donated units of

blood to NBTS for screening in conjunction with a regular delivery of screened units of blood to the facility.

NBTS will pick up unscreened blood units that these 5 hospitals have appropriately collected and stored

and will transport these units back to NBTS centers where they will be screened for the 4 transfusion

transmissible infections (TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA techniques.

In addition to collecting unscreened units, NBTS will deliver to these 5 hospitals their requested order of

screened units for blood banking and use at the facilities. NBTS will also provide monthly feedback on rates

of the 4 TTIs found by ELISA screening of blood units collected by each facility. It is expected that at these

5 blood banking facilities a total of 4170 transfusions will take place. ICAP-CU will work to ensure that 80%

of blood transfusions that occur at these hospitals will be with NBTS-screened blood units, while only 20%

will be emergency transfusions whereby the hospital will screen the donors on site using rapid test kits only.

Therefore, approximately 3,340 units of blood will be collected and sent to the nearest NBTS centers for

ELISA screening as outlined.

ICAP-CU will work with all 25 of its hospitals that do blood transfusions to ensure appropriate facility-level

collection of blood. Directed and voluntary donors will be prescreened with the NBTS donor screening

questionnaire and donors will be deferred as necessary based on their responses. 10,400 blood donors will

be screened using the HCT testing algorithm, thereby utilizing the blood donor setting as another point of

service for HCT during predonation. A PEPFAR-supported evaluation of the current emergency-based

transfusion system will provide insight into rates of TTIs, including HIV, that go undetected in emergency

screened blood.

ICAP-CU will identify appropriate staff for training by SBFA who, in turn, will utilize standardized training

modules that are appropriate to the various levels of trainees and approved by NBTS. Through this

relationship 26 laboratory staff and other health care workers involved in blood transfusion services at ICAP

-CU supported sites will be trained by SBFA. In order to avoid double counting, these 26 targets are

counted under the SBFA blood safety narrative. For core TOT modules developed by SBFA, ICAP-CU will

conduct step down training to 225 laboratory, allied health workers and hospital management staff involved

in blood transfusion services at their sites.

Other activities for COP08 include infection prevention services to reduce occupational hazards, provision

of contaminated waste and sharps collection and disposal units, and infection prevention equipment such

as disposable and surgical gloves, disposable syringes, respiratory masks, and gowns. Quality assurance

(QA)/Quality Improvement (QI) management systems will be put in place to ensure the quality of the rapid

HIV testing at all sites. All sites will be provided with copies of the National Blood Policy, operational

guidelines for blood transfusion, SOPs and job aids to support blood safety activities. This activity also

includes partnerships and support to the following sub recipients for program activities: local red cross/red

crescent organizations and HARHL Trust Nigeria.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

As part of a comprehensive package of services and its contribution to the national strategic plan, ICAP-CU

considers it essential to prevent HIV transmission in health care settings and to increase blood transfusion

safety.

In COP08, ICAP-CU will support the training of health care workers to provide quality safe blood services,

and will increase the availability of support personal protective equipment like hand gloves, lab coats, face

shield and protective goggles to ensure that the lab staff are adequately protected. 10,400 donors will be

prescreened according to National guidelines and 3,340 units of blood will be sent to NBTS to screen for 4

TTIs to ensure safe blood transfusion at ICAP-CU's supported sites in line with the National Blood

Transfusion policy on blood and blood product safety.

LINKS TO OTHER ACTIVITIES:

This activity is linked to Counseling and Testing (5550.08) as directed donors and voluntary donors will be

Activity Narrative: provided with full HCT services prior to blood donation. This activity is closely linked to Injection Safety

(6819.08) where ICAP-CU also plans to train laboratory and allied health workers at all its supported sites.

With linkage to Lab (5544.08), lab-based activities will support safe blood activities at all ICAP-CU-

supported sites through training, supervision, equipment maintenance and supplies.

POPULATIONS BEING TARGETED:

This activity targets health care workers at both public and private health sectors responsible for safe blood

activities in all ICAP-CU-supported health facilities. Targeted also are all persons 18 years of age and

above and family replacement donors.

EMPHASIS AREAS

This activity includes emphasis on institutional capacity development for blood safety which includes

training of lab staff and provision of equipment. This activity will also increase awareness and build skills

around safe blood issues at facility and community levels, reducing stigma and discrimination among health

care workers. It is expected to also promote awareness about safe blood practices in the communities and

indirectly increase the number of volunteers available for blood donations.

ACTIVITY DESCRIPTION:

In consultation with the Federal Ministry of Health (FMOH) and John Snow Incorporated (JSI)/Making

Medical Injection Safer (MMIS), ICAP-CU has implemented the Safe Injection Global Network (SIGN), an

infection prevention strategy to reduce HIV transmission through unsafe injections. The strategy includes:

effective health care waste management; capacity building of health care providers to avoid unsafe

injections; implementation of universal safety precautions; ensuring availability of safe injection equipment;

and advocacy and behavior change communication (BCC) to promote safe injections.

In COP07, ICAP-CU supported injection safety in the context of infection prevention and control services at

12 hospital networks in 3 states of Kaduna, Cross River and Benue. Infection prevention practices were

enhanced and universal precautions were introduced. In COP07, 450 health care providers were trained on

general aspects of universal safety procedures, while advocacy and BCC activities on safe injection were

conducted amongst health care workers to enable adoption of safer workplace behaviors. In COP08, ICAP-

CU support will expand to 13 additional hospital networks and 3 additional states (Gombe, Kogi and Akwa

Ibom). This will result in a total of 25 sites in 6 states (25 comprehensives secondary facilities).

Site assessments will be performed to identify gaps in knowledge, skills, and behavior among health care

workers, to ascertain the need for required equipment and supplies, and to plan for safe waste disposal

where needed. In COP08, ICAP-CU will collaborate with FMOH and JSI/MMIS to conduct a Training of

Trainers (TOT) for facility staff who will in turn conduct step down training to other healthcare workers (i.e.,

injection prescribers, injection providers, waste handlers and laundry workers, pharmacists, nursing staff,

nursing support staff and nursing/medical students) in all the sites using the revised WHO/AFRO/JSI

training curriculum on injection safety, sharps waste management and handling of injection devices. A total

of 900 individuals will be trained.

In addition, ICAP-CU will procure color coded bin liners for segregation of infectious waste and personal

protective equipment (i.e. disposable surgical gloves, disposable syringes, respiratory masks and gowns)

for these sites. ICAP-CU will also promote and facilitate behavioral change among health workers, distribute

communication materials (leaflets, posters, reference guides) on safer injection practices, and support

government to adopt a national health care waste management plan in collaboration with JSI/MMIS. ICAP-

CU will also support proper waste management by repairing incinerators in these sites.

ICAP-CU will implement these activities by partnering with local non-governmental organizations, including

HIV/AIDS Restoring Hope and Life (HARHL) Trust and DRPC. These local NGOs have extensive

experience in responding to health sector program needs including issues of safe injection, universal safety

precautions and safe blood. In addition, these organizations will assist the sites to develop and implement

appropriate work plans and policies using the SIGN strategy for ensuring injection safety.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

These activities will contribute to the overall Emergency Plan for prevention of new infections by promoting

injection safety. It will also reduce exposure of health care workers to occupational hazards in the supported

health services.

LINKS TO OTHER ACTIVITIES:

This activity is closely linked to activities in Blood Safety (6490.08), ART (5404.08), Palliative Care

(5552.08), OVC (5547.08), HCT (5550.08), Lab (5544.08) and PMTCT (6622.08) to ensure that health

workers under all these areas adhere to principles of safe injection and universal precautions.

POPULATIONS BEING TARGETED:

This activity targets all health care workers directly (doctors, nurses, pharmacists, phlebotomists, laundry

workers and waste handlers) and indirectly at both public and private health sectors responsible for safe

injection activities in all ICAP-CU supported health facilities.

EMPHASIS AREAS

The emphasis area is quality assurance and improvement and training in addition to workplace programs,

promoting behavior change through IEC and strategic linkages with other partners and initiatives like the

‘Making Injections Safer' project. ICAP-CU will also collaborate with JSI/MMIS to support government in the

development of health care waste management policy. The proposed package of injection safety activities

will help address stigma and discrimination issues that are often generated by fear among health care

providers. Behavior change communication activities will facilitate the adoption of safe injection practices

among health care providers.

ACTIVITY DESCRIPTION:

In COP07, the International Center for AIDS Care and Treatment Programs at Columbia University (ICAP-

CU) supported 10 hospital networks in Kaduna and Cross River states, providing HIV/AIDS care and

treatment via a multidisciplinary, family-focused approach at the hospital and community level. In COP08,

ICAP-CU programming will expand support to 13 additional hospital facilities; these 25 hospital networks

located in 6 states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna, Kogi) will serve as the platform for

ICAP-CU prevention activities in the coming year.

ICAP-CU will implement its condom and other prevention (COP) programming activities in line with the

overall PEPFAR Nigeria goal of providing a comprehensive package of prevention services to individuals

reached (thereby improving the effectiveness of this messaging) through a balanced portfolio of prevention

activities which will also include abstinence and be faithful activities. In COP08 ICAP-CU will implement this

activity at both the facility and community levels utilizing a combination of multiple strategies in this

implementation, including community outreach campaigns, peer education models, infection control

activities, STI management/treatment and workplace activities (specifically Greater Involvement of People

with HIV/AIDS, or GIPA). In COP08, ICAP-CU will support risk reduction and safer sex promotion activities

among HIV positive clients, partners and their households. The goal of the program is to be focused on the

communities targeted and to cover those communities with messages conveyed in multiple fora. Utilizing

such a methodology, a large number of people will be reached with messages received via one method or

another, but the target group will be those individuals that will have received condom/other prevention

messaging: (1) on a regular basis and (2) via at least three of the five strategies ICAP-CU will employ

(community outreach campaigns, peer education models, infection control activities, STI

management/treatment and workplace activities). The target for this intensive COP activity campaign is

23,750 individuals. ICAP-CU will identify a dedicated staff person to oversee their prevention activities.

ICAP-CU will implement the peer education model targeting job peers who are healthcare workers.

Healthcare workers at each site will be trained (the exact number will vary based on facility size) using

established national peer education curricula and each will be requested to form peer groups of

approximately 10 members from the healthcare worker community for dissemination of prevention

messaging, especially focusing on infection control practices in the workplace. Health and allied care

providers will be supported to adopt positive attitudes and behaviors including safe practices to reduce their

risks of exposure. Facilities will be assisted to implement SOPs for post-exposure prophylaxis should

exposure occur.

ICAP-CU will build capacities of health care providers in patient education and supportive counseling to

reduce the burden of sexually transmitted infections (STI), improve health seeking behaviors and linkages

to diagnosis and treatment services for both STIs and HIV/AIDS, and educate HIV positive patients on risk

reduction, skills development for practicing sexual abstinence and/or correct and consistent use of male or

female condoms, and healthy life planning. Support groups, peer educators, local NGOs and CBOs in each

hospital network will be equipped to conduct activities for prevention for HIV positives, partners and

households.

In COP08, all ICAP-CU supported treatment sites will integrate prevention counseling and services for

people living with HIV into HIV care and treatment clinics (funded under care). Specifically, healthcare

providers and lay counselors in care and treatment settings will be trained to deliver prevention messages

during routine clinic visits using tools and job aids. In addition family planning counseling and services,

identification and treatment of STIs, and prevention counseling will be offered. Other services such as

prevention messages, promoting correct and consistent condom use will be promoted. ICAP-CU will use

available communication tools and aids to provide this comprehensive package of prevention for positives

activities.

To achieve these condom and other prevention objectives, ICAP-CU will also build the capacity of at least

20 local CBOs and support groups to conduct community outreach activities including development

workshops on HIV prevention. Through this relationship with the CBOs and support groups ICAP-CU will

provide outreach to most at risk populations such as the youth, commercial sex workers, and persons

involved in transgenerational transactional sex. Peer educators will be trained to provide one-on-one

outreach to these populations. Community outreach through activities such as HCT and condom distribution

will also be incorporated. ICAP-CU will distribute at least 400,000 condoms for its CBOs/NGOs (Tulsi

Chanrai Foundation, GHAC, GAWON, Rekindle Hope) to support HIV positive and high risk negative clients

adopt dual protection choices. These condoms will be provided by Society for Family Health and will be

distributed via health care facility outlets as well as via community based programming.

Two-hundred and fifty facility and community based health care providers and counselors will be trained on

prevention counseling. Training of health care and allied workers at facility and community levels will be

conducted to ensure correct counseling and appropriate BCC messages; skills training on disclosure to

partners and negotiation of safer sex will be included. Training will be based on a standardized Nigeria-

specific prevention for positives curriculum.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity contributes to the COP08 targets by focusing on reaching at least 23,750 HIV positive and at

risk individuals by promoting the adoption of positive attitudes and behaviors consistent with the PEPFAR 5-

Year Strategy for averting new infections in Nigeria.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in AB (15654.08), Care and Support (5552.08), ARV services

(5404.08), HCT (5550.08), OVC (5547.08) and PMTCT (6622.08).

POPULATIONS BEING TARGETED:

HIV positive persons, especially women and children and including their partners, children and other

household members will be supported to adopt positive attitudes and behaviors to reduce the transmission

of HIV, and promote positive living among infected and affected persons. Health and allied care providers

will also be targeted. Facility based care providers and community based care organizations including their

program managers and care providers will be trained to provide quality focused BCC activities that will

promote the adoption and practice of positive behaviors. Most at risk negative populations including out of

Activity Narrative: school youth, commercial sex workers, and persons involved in transactional/transgenerational sex will also

be targeted for prevention messaging.

EMPHASIS AREAS

Areas of emphasis include human capacity development and local organization capacity building.

This activity will promote gender equity especially among vulnerable groups of women and young girls

through the delivery of BCC messages. By facilitating the availability of client education programs, it will

contribute to the reduction of stigma and discrimination among care providers towards HIV positives.

ACTIVITY DESCRIPTION:

In COP07, ICAP-CU supported 12 hospital networks and their communities, partnering with community-

based organizations (CBOs), faith-based organizations (FBOs), and PLWHA groups to enable people with

HIV/AIDS to access clinical care and support as well as laboratory and pharmacy services. In COP08, ICAP

-CU will expand support to 13 new comprehensive health facilities in Akwa Ibom, Benue, Cross River,

Gombe, Kaduna, and Kogi states, and to 25 non-facility based outlets for a total of 50 outlets in 6 states

(Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi). Palliative care services will be provided to an

estimated 136,500 clients including 45,500 HIV+ patients.

In COP08, ICAP-CU will enable health facilities to provide clinical palliative care (PC) by supporting:

training; clinical, laboratory and pharmacy services; systems management; procurement of drugs and

supplies; and the expansion of support groups and peer health educator programs. ICAP-CU will also

prioritize the expansion and decentralization of palliative care services to the primary health center (PHC)

and community levels and will rapidly expand HCT services to family members via home-based care (HBC)

programs. Building on the network of care model, ICAP-CU will scale up palliative care to PHCs by

identifying at least 4 PHCs around each secondary hospital that can provide PC to stable patients. ICAP-CU

will also enable the decentralization of existing facility-based support groups, facilitating their expansion into

surrounding communities to promote acceptance and ownership, reduce stigma, and increase

sustainability.

Following National Palliative Care Guidance and USG PC policy, ICAP-CU-supported sites will provide a

basic package of care services, including prevention for positives (balanced ABC messaging as

appropriate), clinical care, prophylaxis and management of opportunistic infections, laboratory support,

counseling and adherence support, home based care, and active linkages between hospitals, health

centers, and communities. ICAP-CU will provide at least one clinical service (laboratory, OI prophylaxis &

management, HBC, nutritional assessment/therapy) plus at least two other services in the domains of

psychosocial, spiritual or preventive services to all PLWHA. The activities will be approximately 20%

laboratory monitoring and OI diagnostics, 30% OI management and prevention (cotrimoxozole), and 50%

Home Based Care (including 10% pain management, psychosocial support, and end of life care). Patient

education to promote positive living, self-care, and support adherence will be provided. Other activities will

focus on prevention with HIV positives including referral for HCT of family members and sex partners,

counseling for discordant couples, provider delivered prevention messages and IEC materials on

disclosure. ICAP-CU will support integration of syndromic management of STIs and risk reduction

interventions into care. All enrolled into care will receive risk assessment and behavioral counseling to

achieve risk reduction.

Linkages to wraparound services including income generation and other programs such as safe

motherhood and child survival activities will be facilitated. Therapeutic feeding using approved selection and

exit criteria will be provided via referrals where possible and directly when no alternatives exist. Facilities

and communities will be supported to establish innovative food banks, and linkages with wraparound

programs and existing microfinance opportunities will be prioritized. At the community level, services will be

subcontracted to non governmental, community and faith based organizations. Trained HBC providers,

including PLWHA, will be supported to deliver PC services to stable patients and family members at home.

Home Based Care (HBC) programs will be expanded, including the provision of services such as domestic

support, management of minor ailments (e.g., the preparation and use of oral dehydration solution, ORS, for

diarrhea), pain management, referral services, and counseling services. Partnerships with other IPs will be

established and strengthened. CBOs and FBOs will be supported to package and distribute standardized

HBC kits (consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, vaseline, gentian violet,

etc.) to each trained HBC provider for use when visiting clients. Basic care packages containing ITN, water

guard, water vessel, soap, ORS, condoms and IEC materials will be distributed to PLWHAs and PABAs

through facility and community based support groups. At the facility level, ICAP-CU will support: laboratory

diagnostics for OIs; procurement of drugs and supplies for care and treatment of opportunistic infections;

pain and symptom management; and pharmacy services. As expansion of ARV drug services is prioritized

to rural areas, ICAP-CU will strengthen existing referral channels and support network coordinating

mechanisms. Pharmacy and logistics management procedures will be assessed and be part of the site

development plan. PC commodities will be procured using existing supply mechanisms including the SCMS

and the Society for Family Health (SFH).

ICAP-CU will also train and retrain health care providers, including continuing medical education activities

and clinical mentoring for adult and pediatric care including opportunistic infection (OI) prevention and

treatment, pain management, and management of other clinical conditions. ICAP-CU, in collaboration with

GON, IHV/ACTION-University of Maryland and other implementing partners, will develop a HIV/AIDS

pediatric care training manual. ICAP-CU clinical advisors will enhance adult and pediatric care and

treatment by providing ongoing site-level mentoring and supportive supervision of facility-based staff. Job

aids and patient education materials will be provided to support and enhance provider skills. Peer Health

Educator programs will reduce stigma, enhance adherence, facilitate linkages and educate communities

about available services. ICAP-CU will also establish quality patient appointment and defaulter tracking

systems, as well as routine reporting systems for monitoring basic care and support activities. Outreach

teams linking hospital programs to primary health centers and communities will be established and

supported by ICAP-CU network coordinators. In order to improve access to services, HIV positive clients

will be supported to access health care facilities via community-based transportation support.

ICAP-CU will work with sub-grantees including: Fantsuam Foundation, Tulsi Chanrai Foundation, GAWON

Foundation, Catholic Action Committee Against AIDS, Rekindle Hope, Grassroots HIV/AIDS Counselors,

Association for Reproductive and Family Health, and HARTL Trust.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

By training at least 450 care providers including PLWHA, ICAP-CU will enhance the delivery of

comprehensive basic care and support within national guidelines and protocols via a multidisciplinary family

-focused approach. This activity contributes to the COP08 targets by reaching at least 136,500 persons

affected by HIV/AIDS including 45,500 HIV positive persons including women and children and their

households. By actively involving PLWHA and CBOs in program development and implementation ICAP-

CU will facilitate strong linkages and referral networks.

Activity Narrative:

LINKS TO OTHER ACTIVITIES:

This activity links to activities in ART services (5404.08), enhancing adherence and facilitating defaulter

tracking and patient retention. Relationships between secondary hospitals and community-based referral

facilities will be strengthened via the use of network coordinators, CBOs and NGOs. Patients not yet eligible

for ART will be carefully monitored (via clinical and laboratory monitoring), and will receive OI prophylaxis

and other preventive services where indicated. OVC (5547.08) will be integrated into HBC activities and all

clients will be encouraged to bring their household members to access HCT services. Women who become

pregnant will be referred to PMTCT (6622.08). All care clients will receive AB (15654.08) and COP

(9208.08) messaging as appropriate. Partnerships with other IPs will provide opportunities for leveraging

resources. Patients and their families will be linked to community-based income-generating activities where

available.

POPULATIONS BEING TARGETED:

All HIV positive persons including women and children and their households will be assisted to access care

and support. HIV positive persons in the general population will be reached through CBOs and support

groups. Persons Affected By HIV/AIDS (PABAs) will also be targeted and enrolled into care under the ICAP

-CU family-centered approach as will pregnant women, OVC and TB patients. Facility based care providers

and CBOs/FBOs will be trained to provide quality services and facilitate the establishment/strengthening of

referral networks.

EMPHASIS AREAS:

Areas of emphasis will include human capacity development, local organization capacity building and SI.

This activity will facilitate equitable access to care and support especially to vulnerable groups of women

and children. ICAP-CU will advocate for men's involvement in care in the community and for improved

inheritance rights for women and children. This activity will foster necessary policy changes and a favorable

environment for orphans and vulnerable children programming. ICAP-CU will also advocate for stigma and

discrimination reduction at the community level.

ACTIVITY DESCRIPTION:

In COP07, ICAP-CU provided TB/HIV services at 12 hospital networks and initiated linkages with 35 DOTS

sites in Cross River, Benue and Kaduna States. In COP08, TB/HIV integration activities will be expanded at

hospitals and DOTS clinics to provide enhanced TB services at 25 HIV comprehensive care and treatment

sites in 6 states (Kaduna, Cross River, Benue, Gombe, Akwa Ibom and Kogi), and HIV services at 35

DOTS sites. Working closely with the national and state level technical TB/HIV working groups, NTBLCP

and state/LGA TB control programs, ICAP-CU will provide services to TB/HIV co-infected patients through

point of service laboratory support, development of SOPs/guidelines, and strengthening of screening,

referrals and linkages both within DOTS sites and between community-level health care facilities and DOTS

sites. ICAP-CU, with other implementing partners, will implement the PEPFAR-Nigeria LGA coverage

strategy in Kaduna, ensuring the provision of TB/HIV services in at least one health facility in every local

government area (LGA). This will enable the states to approach universal access to TB/HIV services in

states designated ‘LGA Coverage States'.

All TB/HIV co-infected patients will be provided with cotrimoxazole (CTX) prophylaxis and linked to other

palliative care services and prevention messaging (including balanced ABC messaging as appropriate).

ICAP-CU will support standardized TB screening and case finding in 13,150 HIV infected patients using

structured symptom checklists and the National algorithm. ICAP-CU will facilitate access to TB DOTS

services for co-infected patients identified through ART clinics and will facilitate access to HIV treatment and

care for co-infected patients identified through TB DOTS clinics. It is expected that this will result in the

treatment of TB in at least 3,700 HIV positive patients. DOTS facilities will be supported to provide HCT to

at least 14,000 clients, of which it is expected that 4,000 will be diagnosed with TB. TB patients will be

encouraged to bring contacts for early TB case-finding, preventive therapy (IPT) and HCT. 150 HIV+

patients will be provided with IPT services.

Five ICAP-CU TB/HIV advisors will be provided with formal TB/HIV training to enhance their productivity. A

total of 115 ICAP-CU staff and facility-based medical officers will undergo retraining on x-ray diagnostic

skills. A total of 95 ICAP-CU staff and facility-based laboratory officers will be retrained on good sputum

specimen collection and laboratory AFB sputum smear diagnosis to enhance their diagnostic capabilities.

Service provision will also be improved through capacity building of health care providers with the GON and

other USG implementing partners and ILEP partners through training programs conducted at TB training

laboratories. Across the various TB/HIV training activities it is expected that a minimum of 185 individual

trainees will be directly reached in collaboration with NTBLCP. In addition to current practices, ICAP-CU will

implement the national guidelines for External Quality Assessment.

Nosocomial transmission of TB will be mitigated through attention to principles of TB infection control,

including administrative and environmental control measures such as clinic design, good ventilation,

appropriate patient triage, staff training, and enforcement of basic hygiene and proper sputum disposal.

Patient and staff education on infection control measures will be routinely carried out to ensure program

success. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on

infection control will be implemented in all ICAP-CU supported sites. ICAP-CU will support NTBLCP in the

development of clinical support tools/job aids, national registers and referral forms for recording/reporting

systems, and in the production of IEC materials. ICAP-CU will also support the utilization of the updated

NTBLCP recording and reporting formats that captures HIV information by the TB program.

Support will be provided to at least 60 DOTS (25 hospital and 35 non-hospital) sites to initiate and/or

enhance provider-initiated HIV counseling and opt-out testing and strengthen referral linkages from the

DOTS sites to care and treatment (ART) centers through partnering with CBOs/NGOs/FBOs and PLWHA

groups. The TB DOTS sites will be supported to provide holistic patient care according to National and IMAI

guidelines. Sites will be assisted to put in place and/or improve defaulter tracking mechanisms. ICAP-CU

will also support the state TB programs to put in place functional mechanisms to identify and manage drug

resistant TB. Collaboration will continue with GON, other PEPFAR implementing partners, ILEP partners

and relevant organizations to rapidly scale-up TB/HIV integration activities at ICAP-CU supported sites.

TB/HIV coordinators will facilitate sites' activities in collaboration with state/LGA TB focal persons.

ICAP-CU will also work closely with the SCMS mechanisms in country to procure equipment and supplies

for its supported TB/HIV integration sites. ICAP-CU will upgrade facilities through infrastructure support

such as basic renovations, upgrading equipment and procuring supplies and consumables (e.g. sputum

containers). To ensure continuous availability of drugs and commodities in supported sites, ICAP-CU will

strengthen the logistics management of the states and LGAs in areas of operation.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

ICAP-CU will contribute to the overall program goal of enhancing integration of TB/HIV activities by enabling

at least 3,700 HIV-infected patients to receive TB treatment. As part of the sustainability plans of the GON

and in line with the 5-Year Strategy, at least 185 health care workers will be trained. ICAP-CU will also

ensure that GON structures are strengthened and integrated through joint capacity building of SACA, LACA

and NTBLCP, states, and LGA TB supervisors for effective program management including joint supportive

supervision. ICAP-CU will help provide basic tools and equipment to reactivate non-functional DOTS sites in

focus states. ICAP-CU will ensure that activities are implemented with the full participation of other

government partners especially GLRA and NLR to promote sustainability and facilitate equity and synergy

in line with GON plans.

LINKS TO OTHER ACTIVITIES:

This activity also relates to ART (5404.08), Palliative Care (5552.08), Orphans and Vulnerable Children

(5547.08), Voluntary Counseling and Testing (5550.08) and PMTCT (6622.08), AB (15654.08) and COP

(9208.08). The focus is on ensuring adequate and prompt linkage of TB patients and their household

contacts to HIV counseling, testing, care and treatment services, to ensure that all HIV patients are

screened for TB, and to enable all HIV-infected patients with TB to access services at DOTS clinics. Similar

services will be made available to OVCs and PMTCT clients. In collaboration with other relevant

partners/organizations, ICAP-CU in COP08 will facilitate linkage of clients to other support services such as

micro credit and nutritional support.

POPULATIONS BEING TARGETED:

ICAP-CU will support activities to encourage all patients in related communities living with TB to bring family

Activity Narrative: members and household contacts to the clinic, particularly children (five years and younger), to enhance

screening, early diagnosis and prompt treatment for positive cases. In collaboration with NTBLCP and other

TB supporting partners, ICAP-CU will establish TB/HIV services for clients in prisons located within the

ICAP-CU supported LGAs, and facilitate linkages to care and treatment clinics. Health care workers in both

public and private sectors will be trained to provide high quality TB/HIV integrated services. Other targeted

populations will include OVC, pregnant women and PLWHAs.

EMPHASIS AREAS:

A major area of emphasis is on human capacity development through the training of health care providers

on TB/HIV integration services. Health care providers will be trained to provide counseling and testing

services, care and treatment, screening for TB, and referrals between care and treatment centers and

DOTS sites. Other emphasis areas include local organization capacity building, SI and gender.

ICAP-CU will work with the relevant agencies and organizations to enhance policies that will ensure that

clients located within ICAP-CU supported sites have access to adequate and integrated TB/HIV services

thereby promoting equitable access to care and treatment programs, especially for women, children,

underserved and incarcerated populations in all the served states.

ACTIVITY DESCRIPTION:

In COP07, ICAP-CU assisted 12 secondary hospitals in Kaduna, Benue and Cross River States to support

2,786 HIV-infected and affected children (OVC) to access health care, and other related services at the

hospitals, their referral networks, and surrounding communities. In COP08, ICAP-CU will expand support to

13 new hospital networks in 6 states (Kaduna, Cross River, Benue, Akwa Ibom, Kogi and Gombe), for a

total of 25 sites providing OVC services. During COP08, OVC services will be provided to 8,000 OVC

including adolescents and caregivers. These OVC include HIV-positive children either on ART or not yet

eligible for ART, and HIV-negative children of PLWHA or HIV affected orphans.

The ICAP-CU family-focused model of care utilizes a genealogy form that captures all children within the

family of HIV-positive adults accessing TB/HIV, ART, PMTCT and BC&S services. This family-focused

approach is applied not only at the facility level but also at the community and home levels through care

services. Community based programming leads to identification of OVC through awareness campaigns,

support groups, and community-based HCT. OVC are also identified through provider initiated counseling

and testing of children accessing care in ICAP-CU supported facilities following national norms regarding

counseling and consent of minors. Once OVC have been identified, ICAP-CU's OVC program focuses on

providing an appropriate balance of services in the facility, community and home settings.

ICAP-CU OVC programming has several key elements: appropriately identifying OVC who are not receiving

services; providing a holistic family centered approach to care of OVC; providing educational support;

providing nutritional assessments and support; providing health care services for HIV infected and affected

children; and providing enhanced psychosocial support at both facility and community levels. Health care

services for OVC will include ongoing monitoring of growth and development, screening and prophylaxis

(IPT) for TB when indicated, cotrimoxazole prophylaxis (CPT) following national guidelines, and diagnosis

and management of opportunistic infections as needed. Also, as a component of ICAP-CU's HBC program,

basic preventive care packages comprised of ITNs, ORS sachets, soap for effective hygiene, water guard

and water cans procured from SFH (another USG supported IP) will be given to all clients.

Through its support and capacity building of local NGOs, CBOs and FBOs, ICAP-CU enables the

implementation of advocacy and social mobilization, psychosocial support, home based care (HBC), and

educational support for OVCs and their households. The psychosocial support provided to OVC, including

their care givers, is multifaceted and comprehensive, including counseling on stigma and discrimination,

disclosure, and grief, and recreational activities. OVC services are also integrated into community HBC

programs. Networking with community organizations and other implementing partners enables leveraging of

resources and enhances service delivery and sustainability. ICAP-CU provides capacity building to

community and faith based organizations such as Fantsuam Foundation, Tulsi Chanrai Foundation (TCF),

GAWON Foundation, Catholic Archdiocese of Ogoja (CACA), Grassroots HIV/AIDS Counselors, ARFH and

other CBOs and PLWHA groups to provide family-focused OVC services. These CBOs/FBOs provide home

based primary care, psychosocial support and links for OVCs to health facilities for basic health care needs

by providing transport and other support. Through ICAP-CU support some of these partners will also

provide peer education programming at primary and secondary schools.

In COP08 ICAP-CU will work through local partners to provide educational support (e.g., school levies,

school supplies) to most at-need children following clearly identified selection criteria. ICAP-CU will also

provide nutritional support to OVC and will work with the GON in partnering with Clinton Foundation, as

appropriate, to leverage resources for providing therapeutic food for OVC diagnosed with malnutrition.

Furthermore, OVC and their caregivers will be linked to the USG-supported education and nutrition

wraparound activities in states like Cross River where they will be co-located with CU-ICAP. For

sustainability and household food security, linkages to other community-based/faith-based food and

microfinance programs through the CBOs/FBOs listed above will be explored. Training provided to care

providers through PMTCT programming, such as infant feeding counseling and follow-up, will enhance the

counseling, patient education, and linkages that are required for appropriate care of OVC. Such

strengthening of the coordination of pediatric services (PMTCT, ART) with OVC allows for seamless

movement of clients across these various services.

To achieve these objectives ICAP-CU will provide infrastructure support and training for 200 care providers

including clinical staff, counselors, and community/HBC providers using GON National guidelines, OVC

NPoA and SOPs. In addition ICAP-CU and local partners will set up a monitoring system using the

nationally approved tools that allows the monitoring of services provided directly by ICAP-CU and/or by

referral from ICAP-CU to other organizations.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

ICAP-CU, in partnership with other organizations, will provide training and scale up of OVC services that will

enhance the delivery of quality services to 8,000 OVC enrolled in core programs such as health,

educational support, psychosocial support, and food and nutrition. All these activities will improve the lives

of OVC reached in line with the national plan of Action on OVC and the National Strategic Framework, and

will contribute to meeting PEPFAR goals.

LINKS TO OTHER ACTIVITIES:

This activity relates to activities in ART (5404.08), Lab (5544.08), Palliative Care (5552.08), TB/HIV

(5551.08), AB (15654.08), and SI (5541.08). HIV-exposed and infected children will be placed on

prophylactic cotrimoxazole (CTX) following National guidelines. Household members of OVC will be

referred for HCT (5550.08) and children of women enrolled in PMTCT (6622.08) will be offered HCT as well

as referred for OVC services. Policy makers and key decision makers in the health and education sectors

will be reached by advocacy efforts.

POPULATIONS BEING TARGETED:

This activity targets infants, young children, adolescents and other at-risk children in HIV infected and

affected families. It also targets the households, including caregivers, of OVC. The entry point for OVC in

the general population will be ICAP-CU supported sites and partner organizations. Health and allied care

providers in clinical and community settings will be trained to provide services to OVC. Community and

facility based volunteers, traditional birth attendants and support group programs, will be used to increase

access to care and support especially to the underserved.

Activity Narrative: EMPHASIS AREAS

ICAP-CU's area of emphasis will be the development of networks, linkages and referral systems as well as

capacity development and food/nutrition support. In addition, ICAP-CU will advocate equal access to

education and improved legal and social services such as the protection of inheritance rights for women and

children, especially for female children, and increased gender equity in HIV/AIDS programming. ICAP-CU

will advocate for increased access to income and productive resources for HIV infected and affected women

and care givers. This activity will foster necessary policy changes and ensure a favorable environment for

OVC programming.

ACTIVITY DESCRIPTION:

In COP07, ICAP-CU supported HIV counseling and testing (HCT) at 45 sites including 10 secondary

hospitals, 20 primary health centers and 15 non-hospital facilities (two VCT sites, six DOTS sites, seven

stand-alone VCT centers) in Kaduna, Benue and Cross River States. In COP08, this support will increase to

a total of 50 HCT sites (25 secondary hospitals, 25 non-hospital facilities which are CBO/FBO based with

their associated mobile testing) in six states including Benue, Kaduna, Cross River, Akwa Ibom, Gombe and

Kogi. Included within the non-hospital facilities are linkages to private health facilities. At least 112,500

individuals will receive counseling & testing (in a non-TB/non-PMTCT setting) and receive their results. This

will include HCT for a minimum of 2500 non-remunerated blood donors. ICAP-CU's HCT support has 5

themes: supporting provider-initiated opt-out HIV testing (PIHCT) in all health care facilities, including TB

DOTS sites; providing HCT services throughout health care facilities by strengthening point of service

(POS) testing in both inpatient and outpatient settings; expanding access to HCT centers; strengthening opt

-out HCT in the ANC setting; and promoting case-finding via the family-focused approach to HIV/AIDS

diagnosis, care, and treatment.

ICAP-CU will ensure quality HCT services through the implementation of training courses for staff and

volunteers. In FY08, 350 individuals, including health care providers and laboratory staff at the facility and

community levels, will be trained to provide services in these 50 HCT outlets in the six states. ICAP-CU will

support HCT training using the National curriculum, and will provide ongoing mentoring to enhance

providers' skills. Counselors will have access to training to improve their skills to provide adequate couple

counseling and testing following the best practice protocol in all supported sites. Refresher trainings will be

provided to site staff as needed. In addition to the HCT specific training, ICAP-CU will also provide trainings

to improve monitoring and evaluation.

Innovative approaches will be instituted to reach as many people as possible, especially the most at risk

populations. ICAP-CU will support local nongovernmental organizations to partner with NYSC-trained peer

educators in each region to reach the student population (especially at tertiary institutions around each

region). Existing youth-friendly centers in supported states will be strengthened to provide information

(written, audio-visuals) on HCT to young people in and out of school, following the standardized consent

procedures where necessary. ICAP-CU will work to provide training of Youth Corp Volunteers as lay

counselors for HCT services through community outreach programs which could easily serve as their

required community development activity and provide a much needed service. ICAP-CU will also expand

access to HCT outreach to high risk communities such as long distance truck drivers' parks, regular motor

parks, prisons, artisans (e.g., auto mechanics), and out of school youth including the female population.

ICAP-CU will support outreach teams from nongovernmental and faith based organizations to ensure

regular outreach to communities, churches and mosques to promote HCT. ICAP-CU will support the use of

multidisciplinary teams including lay counselors where appropriate, and will pilot the use of nursing and

health technology students as counselors in selected training institutions. ICAP-CU will also facilitate the

training of lay counselors in rapid testing especially in churches and mosques. The national ‘Heart to Heart'

logo will be used at HCT sites for integration with national branding of HIV testing services. ICAP-CU will

support community-level HCT services through identified CBO/FBO outreach initiatives, further

strengthening the network of HCT available to the community. ICAP-CU will ensure that secondary and

primary healthcare facilities are key partners in these networks.

At all health facilities, an "open access" approach will be promoted to ensure that HCT is available to all

patients utilizing a facility. ICAP-CU will foster linkages of HCT services to treatment, care and support

services within and across programs and between other implementing partners using standard referral

tools, ensuring quality implementation of HCT data management and reporting systems. HCT services will

promote couples counseling and testing at the service outlets with a special emphasis on HCT for

discordant couples. In addition, posttest counseling resources, such as support groups and peer educators,

will support disclosure when appropriate and address the special issues facing discordant couples. Posttest

counseling for HIV-negative patients will emphasize primary prevention; that for HIV-infected patients will

focus on appropriate prevention for positive messages to reduce risk of HIV transmission from HIV+

individuals. Posttest counseling for clients shall include appropriately balanced messaging, including

abstinence, be faithful, and information on correct and consistent condom use. Male and female condom

distribution will be supported by ICAP-CU and implemented by CBO partners. Condoms will be supplied by

the Society for Family Health (SFH) and distributed to CBOs for use in condom education activities. IEC

materials on HCT and prevention messaging will be available to all clients.

Laboratory QA will be provided by ICAP-CU laboratory advisors to ensure quality HIV testing. HIV testing

will be conducted using the current interim National testing algorithm and will change to the new testing

algorithm once it is approved. ICAP-CU will continue to store test kits centrally in a secure warehouse in

Abuja and distribute to sites as needed. Technical assistance will be given to sites to ensure appropriate

storage, record keeping and forecasting. ICAP-CU will work closely with the SCMS mechanisms in country

to procure equipment and supplies for its supported HCT sites and to participate in the GON-led

harmonization process of the LMIS system in Nigeria.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will contribute to the overall 2008 emergency funding plans by enabling 25 secondary hospitals

and 25 non-hospital facilities in six states (a total of 50 service outlets) to provide access to HCT services

to at least 112,500 people who will also receive their results. HIV positive clients will be provided with

access to care and treatment, including ART when needed. Three hundred and fify individuals, including

health care providers and laboratory staff at facility and community levels, will be trained to provide

services. ICAP-CU will continue to support and participate in the harmonization process led by the GON

with regard to LMIS and ICS for test kits.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), TB/HIV (5551.08), OVC

(5547.08), HCT (5550.08) and PMTCT (6622.08). The HCT activities in the sites supported by ICAP-CU will

encourage the enrollment of patients and family members into care through multiple entry points. ICAP-CU

will also support community HCT linked to the hospital networks, enabling referral of HIV positive clients to

the hospitals to access care and treatment as appropriate.

POPULATIONS BEING TARGETED:

Activity Narrative: This activity targets the general population especially young women and other most at risk populations such

as truck drivers and sex workers. ICAP-CU will target the provision of HCT services to family and household

members of HIV+ clients using a family focused approach at multiple entry points. Community based and

faith based organizations/facilities will be targeted for training to provide HCT to increase access in non-

clinical settings. The availability of trained volunteers will further increase uptake.

EMPHASIS AREAS:

Emphasis areas include human capacity development, increasing gender equity in HIV/AIDS programs,

local organization capacity building and SI.

ACTIVITY DESCRIPTION:

In COP07, The International Center for AIDS Care and Treatment Programs at Columbia University (ICAP-

CU) supported procurement and distribution of antiretroviral (ARV) drugs for 10 hospital networks and two

primary health centers in three states. In COP08, ICAP-CU will expand antiretroviral therapy (ART) services

support to 13 additional hospital networks, resulting in coverage in 6 states (Akwa Ibom, Benue, Cross

River, Gombe, Kaduna and Kogi states). A total of 25,000 patients will be on ART by the end of the program

year.

ICAP-CU supports a supply chain management system to ensure a continuous supply of ARV drugs with

FDA approval or tentative approval, and which are National Agency for Food and Drug Administration and

Control (NAFDAC) registered or have received a waiver. Product selection is based on existing national

adult and pediatric treatment guidelines. ICAP-CU will continue to work closely with the UNICEF Supply

Division, which presently procures ARV drugs for ICAP Nigeria, handles customs clearance and delivers to

a secure warehouse at the ICAP-CU office in Abuja. Quantities procured are based on effective and

efficient forecasting mechanisms in place at the central and regional offices. ICAP-CU will procure

additional delivery trucks or arrange delivery via bonded transport agencies to facilitate prompt and efficient

delivery of drugs and other commodities to regional offices and sites. As expansion of ARV drug services is

prioritized to rural areas, ICAP-CU will strengthen existing referral channels and support network

coordinating mechanisms. Pharmacy and logistics management procedures will be assessed and will be

part of the site development plan for each new site. ICAP-CU will also leverage the economies of scale

provided through the utilization of the Partnership for Supply Chain Management (SCMS) for ARV drug

procurement as SCMS increases its services in Nigeria.

ICAP-CU has integrated quality assurance, monitoring and evaluation systems into its existing logistics

system. ICAP's procurement and store managers provide technical assistance including: training

pharmacists in forecasting, stock management, record keeping, quality assurance, and distribution; and

providing infrastructure support for pharmacies and storerooms, including renovation, refurbishment, and

provision of equipment, supplies and job aids. In addition to the hands-on training above, ICAP-CU uses a

state-endorsed pharmacy technician in-service training course, and trains key staff on record keeping for

ARV drug storage and distribution at points of service. Pharmacists at every site participate in

multidisciplinary team ART training activities. In COP08, ICAP-CU will assess pharmacy capacity in all new

sites, working towards secure storage and stock management. Renovations and refurbishments will include

the addition of partitions to create private adherence counseling space, repairs to walls, doors, and ceilings,

installation of air conditioners, refrigerators, shelving and other storage, and security elements such as bars

and locks. Standard Operating Procedures (SOPs) in line with national SOPs will be provided to guide

quality ARV drug management. The cost per patient may increase in COP08 as some patients fail first-line

regimens and as treatment-experienced patients from distant ART facilities transfer to local ICAP-CU

supported hospitals. To minimize such cost increases and support the GON desire to utilize generic drugs,

as generic ARV drugs obtain FDA approval or tentative approval as well as NAFDAC registration or waiver,

they will replace more expensive versions. ICAP-CU will also continue to partner with the Clinton

Foundation and the Global Fund to utilize opportunities to reduce the cost of approved drugs. ICAP-CU will

continue to participate in and support the harmonization process led by the GON in line with one national

program at all levels for sustainability. In addition, ICAP-CU will work towards sustainability by strengthening

existing structures and building capacity of health care providers in all health facilities that it supports. As

expansion of ARV drug services is prioritized to rural areas, ICAP-CU will strengthen existing referral

channels and support network coordinating mechanisms.

Columbia has allocated $800,000 of its ARV Drugs budget to SCMS for procurement of commodities. This

amount is captured under the SCMS Drugs activity.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

In COP08, ICAP-CU activities under ARV drugs will support the PEPFAR goals of ensuring a continuous

supply of ARV drugs to HIV infected adults and children who require treatment. In COP08 16,537

individuals (14,883 adults and 1,654 children) will newly initiate ART. By the end of COP08, 25,000 people

will be receiving ART at ICAP-supported sites, thus contributing to the national goal of treating 350,000

patients by Sept 30, 2009.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), OVC (5547.08), HCT

(5550.08), PMTCT (6622.08) and TB/HIV (5551.08) for the provision of HIV/AIDS related commodities

needed in those services.

POPULATIONS BEING TARGETED:

Health care workers especially pharmacists doctor and nurses, will acquire skills to manage ARV drugs

appropriately along the supply chain.

EMPHASIS AREAS:

Emphasis areas include human capacity development.

ACTIVITY DESCRIPTION:

In FY07, ICAP-CU continued to support multidisciplinary family-focused HIV/AIDS care and treatment,

including antiretroviral therapy (ART), at 12 sites, including 10 Government of Nigeria (GON) secondary

hospitals and 2 PHCs in rural and semi-urban areas of Kaduna, Benue and Cross River States. In COP08,

ICAP-CU will expand support to 13 new hospitals in high-prevalence states Gombe, Akwa Ibom, and Kogi,

totaling 25 sites in 6 states. By the end of COP08 ART will have been provided to a cumulative 25,000

patients, including 22,500 adults (14,883 new) and 2,500 children (1,654 new). Implementation of the

PEPFAR-Nigeria LGA coverage strategy in the program areas of PMTCT and TB/HIV, designed to ensure

the provision of PMTCT and TB/HIV services in at least one health facility in every local government area

(LGA) of 6 identified states, will increase the reach of adult and pediatric ART services in these states as

well through referral networks.

The ICAP-CU model emphasizes comprehensive support, capacity-building and local ownership as

mechanisms to provide sustainable high-quality HIV/AIDS care and treatment to families and communities.

Facility support begins with systematic site assessments and the initiation of site-level project management

teams (PMTs). Community outreach and education begins early in the process, and links between

hospitals, community leaders, and community-based organizations are facilitated to share information about

new services, ensure transparency, and elicit community support for HIV/AIDS care and treatment.

Based on FY07 experience and initial site assessments, ICAP-CU anticipates the need to support

necessary infrastructure activities (generators, bore holes, renovations) at all facilities in line with the USG

PEPFAR guidelines. Staffing shortages suggest that support for facility staff, following USG and GON

guidelines, will also be important. Support for program management and systems strengthening, including

within-facility linkages, documentation/record-keeping, and inter-disciplinary partnerships, will be key to the

initiation and sustainability of chronic care systems.

Training and supportive supervision of all health care cadres will be a vital element in ICAP's COP08

program. Clinicians at all 25 hospitals will be assisted to identify HIV-infected patients (see HCT narrative),

to enroll them in care and treatment, to perform appropriate clinical and laboratory staging of adults and

children, and to provide comprehensive care and support, including the prompt initiation of ART for eligible

patients. ICAP-CU will provide ART training, including ongoing CME and QA activities, for 500 physicians,

nurses, counselors, pharmacy, and laboratory personnel, 125 of whom will also be trained to support

pediatric care and treatment. Onsite clinical mentoring will enhance quality of care and build site-level

clinical and management skills for program sustainability. ART reference tools will include pocket guides,

dosing cards, posters, and detailed SOPs. ICAP-CU will continue to implement innovative training and

clinical mentoring activities, including ongoing support for the successful South-to-South pediatric training

initiative in South Africa, intensive clinical mentoring workshops at the Stephen Lewis Foundation program

in Uganda, clinical mentoring seminars, and the adaptation of ICAP's Clinical Mentoring toolbox for use in

Nigeria. ICAP-CU works closely with other PEPFAR IPs and GON to ensure compliance with National

policies, curricula and guidelines. ICAP-CU will continue to participate in the USG Clinical Working Group to

address emerging treatment-related topics and further promote harmonization with other IPs and the GON.

Adherence training and support services will be provided at each site. These will facilitate adherence

assessment and support including individual and group counseling, patient education, enhanced

appointment system, referral linkages, patient follow-up, provision of support tools (dosage guides,

reminders etc.), linkages to community-based adherence support and defaulter tracing programs. ICAP-CU

will also expand its successful Peer Health Educator program, enhancing family counseling and testing,

defaulter tracking, and inter/intra-facility linkages.

ICAP-CU will facilitate onsite assistance to strengthen systems, including ART clinic management, medical

records, referral linkages, patient follow-up, integration of prevention into care and treatment, involvement of

PLWHA, and access to laboratory services. ART for adults and children will be provided using National

protocols and guidelines. ICAP-CU will support both first and second-line ART. As the program and cohorts

mature, we anticipate increasing need for second-line ART, and will place special emphasis on training and

mentoring health care providers to identify treatment failure and initiate second-line regimens when needed.

ICAP-CU will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for

providing antiretroviral drugs to patients. Non-ART eligible individuals will be enrolled into care and will

receive regular clinical monitoring.

To enhance uptake and quality of services, ICAP-CU will provide routine opt-out testing and provider

initiated testing and will strengthen linkages with entry points including: HCT, ANC, PMTCT, TB clinic, under

-5 clinic, GOPD, inpatient ward, family planning, STI clinic and palliative care services. Efforts will be made

to ensure that HIV-exposed infants and HIV-infected infants and children are identified through multiple

points of entry and linked into OVC and treatment services. Other activities will include strengthening the

family-centered approach to care via the use of genealogy forms, co-located services, family counseling,

provider-initiated counseling and testing for partners and family members, and the use of Peer Health

Educators.

Using the HIV health network model, ICAP-CU will work to establish and strengthen links between primary

(PHC) and secondary health facilities, PLWHA groups, NGO/FBOs, and communities. ICAP-CU will also

identify and build capacities of pilot comprehensive PHCs to link to referring hospitals to support HIV/AIDS

programs and provide onsite ART at the PHC level. This decentralization will include the

development/adaptation of referral protocols (for both "down" and "up" referrals), referral forms/tools, and

site supervision tools. Communication between hospital based providers and PHCs will be facilitated.

Health Teams in PHCs will be trained. This will ensure patients' access to, and utilization of, comprehensive

continuity care and support.

ICAP-CU will work closely with NGOs/FBOs to promote community involvement, provide HIV prevention

activities and linkages to wraparound activities, and facilitate adherence among HIV positive community

members. Prevention for positives messaging will include a balanced ABC approach messaging. All

PLWHA will be linked to home based care and support, community and social services for referrals for food

and education assistance, livelihood opportunities, and other wraparound services. ICAP-CU will support

quality improvement/quality assurance mechanisms to facilitate the delivery of optimal care and treatment

services. ICAP-CU will also facilitate and actively support onsite standardized HMIS using GON forms and

Activity Narrative: provide onsite assistance with data management and M&E to guide quality improvement measures.

Columbia has allocated $500,000 of its ARV Services budget to SCMS for procurement of commodities.

This amount is captured under the SCMS ARV Services activity.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

One of the pioneers of family-focused multidisciplinary HIV/AIDS treatment in resource-limited settings, at

end of COP08 ICAP-CU will be providing ART services to 25,000 people, contributing to the GON/PEPFAR

targets for Nigeria. ICAP-CU will build the skills of at least 500 care providers thus contributing to national

sustainability plans.

LINKS TO OTHER ACTIVITIES:

This activity relates to HBHC (5552.08), OVC (5547.08), HCT (5550.08), PMTCT (6622.08), HVOP

(9208.08), TB/HIV (5551.08), AB (15654.08), and SI (5541.08). As expansion of ART services is prioritized

to rural areas, ICAP-CU will strengthen referral channels and network mechanisms. Patients on ART will be

linked to home based care and support and community and social services. TB/HIV linkages will be

strengthened where ART and TB DOTS sites are co-located, and co-location of new ARV sites will be

actively promoted in TB DOTS stand-alone sites. All HIV infected patients will be screened for TB using the

National algorithm while all TB patients will be offered HIV testing. ICAP-CU will also provide onsite

assistance with data management and M&E to guide quality improvement.

TARGET POPULATIONS:

PLWHA, especially the vulnerable groups of women and children, will be provided access to ART services.

Health care providers in secondary and primary health facilities will be trained to deliver quality ART

services.

EMPHASIS AREAS:

Emphasis areas are quality assurance/improvement and supportive supervision. ICAP-CU personnel

including national and international experts will provide skill and competency-based trainings, CME, and

ongoing clinical mentoring to enable onsite staff to provide quality ARV services to patients. Emphasis

areas also include training, human resources issues, referral networks, infrastructure support, linkages to

other sectors and initiatives. Services will also focus on addressing the needs of women, infants and

children to reduce gender inequalities and increase access to ART services among these vulnerable

groups. ARV services will facilitate linkages into community and support groups for nutritional support and

micro-credit /finance activities.

ACTIVITY DESCRIPTION:

In COP07, the International Center for AIDS Care & Treatment Programs at Columbia University (ICAP-CU)

continued to expand its laboratory network model in Kaduna, Benue and Cross River States, enabling 10

hospital networks to support HIV/AIDS care and treatment programs. In COP08, ICAP-CU will support an

additional 15 secondary hospital labs for a total of 25 labs (all secondary level facilities) in 3 additional

states (Kogi, Akwa Ibom and Gombe). This will enable 118,125 people to access HIV/AIDS testing. It will

also support 25,000 HIV-positive adults, infants and children on treatment, 20,500 HIV positive adults,

infants and children not on treatment and 2,500 HIV positive mothers to benefit from HIV/AIDS care and

treatment services. At total of 548,750 lab tests will be conducted during COP08.

ICAP's experience in COP07 will inform expansion plans in COP08. In COP07, baseline laboratory

assessments revealed infrastructural deficiencies including lack of electricity and potable water, obsolete

equipment and testing methods, severe staffing shortages and under-skilled staff. This will continue to be a

challenge in COP08. ICAP-CU's response to these challenges has been multi-pronged and includes

development of the Laboratory Network Model, a detailed Laboratory Support plan, and support for

renovation and training. The Laboratory Support plan established a logical step-wise approach to phasing in

the services needed by HIV/AIDS care and treatment programs. Phase I provides the "minimum package"

elements of a functioning lab: electricity, running water, adequate interim space, training and supervision,

reorganization of labs as needed, ability to perform HIV testing, complete blood counts, simple chemistries

and manual CD4 enumeration. Phase II includes the introduction of analyzers, the initiation of standard

QA/QC systems, the expansion of capacity to include additional chemistry tests, urinalysis, malaria parasite,

STI screening tests, pregnancy tests, stool, urine and blood cultures, Hepatitis B and C screening and liver

function tests where feasible, and the completion of renovation and refurbishment activities as well as the

introduction of protocols to collect and prepare dried blood spot (DBS) samples for use in early infant

diagnosis (EID). ICAP-CU will participate in the National EID scale up plan, sending DBS specimens to

appropriate laboratories supported by other PEPFAR implementing partners. ICAP-CU will collaborate with

Clinton Foundation for sample collection materials and transport of specimens/results.

Lab staff will be trained in the use of already designed specimen shipment forms and other identified

mechanisms to track samples and results among ICAP-CU lab network and other partner networks. In

COP08, ICAP-CU will continue to fully fund training on diagnostic testing and immunologic monitoring, good

laboratory practices (GLP) and biosafety. ICAP-CU will also support urban Primary Health centers,

especially in the saturation plan states of Gombe and Kaduna States, to provide basic monitoring

investigations using manual method/simple auto-analyzers via the development of mini labs (FBC,

chemistry, and CD4). ICAP-CU will strengthen existing shipment flows from rural PHCs to the

comprehensive site/urban PHC mini labs closest to them. ICAP-CU will also support the development of

mobile lab teams to extend lab services to very remote/hard to reach communities and rural PHCs (Gombe

and Kaduna). ICAP-CU will ensure that all bio-medical waste generated from all its supported sites will be

properly disposed of by supporting renovation of hospital incinerators, provision of autoclaves to sites

without existing incinerators, procuring and regularly supplying sharp containers, bio-hazard bags. ICAP-CU

will continue to work closely with the SCMS mechanisms in country to procure equipment and supplies for

its supported laboratory sites.

ICAP-CU will work closely with the PEPFAR lab technical working group for the development of a common

lab equipment list and will procure appropriate equipment for the different lab levels that it supports. It will

continue to coordinate and fully fund formal didactic training sessions and share training resources to avoid

duplication. On-the-job training will continue to be enhanced by job aids, standard operating procedures

(SOPs) and diagnostic algorithms. 220 laboratory staff will be trained in GLP, HIV serology, and CD4

enumeration among others. Additional training on microscopy for AFB using the new nationally adapted

WHO/CDC AFB smear microscopy training packages will be conducted at 50 DOTS sites to identify TB/HIV

co-infections. TOT lab management training which will be offered by CDC/APHL will be provided for 2 ICAP

lab advisors who will in turn step down the training to 25 site level lab supervisors to enhance lab

management skills. ICAP-CU will also support the training of back-up Lab Scientists to provide services

when regular ones are on annual leave or posted to different facilities. All available trainable lab personnel

will be trained on all analyzers, regardless of specialty, to address the challenges of lab personnel

shortages at some of these facilities. ICAP-CU will continue to advocate for and support the training of non

lab personnel in rapid HIV testing at all sites.

ICAP-CU will continue to participate in the QA/QC national networks discussions and will support the active

integration of recommendations/guidelines at its sites and state levels. ICAP-CU will also develop and

implement QA/QC plans at all supported labs using national guidelines/tools where available. ICAP-CU will

institute a robust 4 - pronged Quality Assurance management program in all its supported sites. These

components will include quarterly site monitoring visits, use of proficiency testing panels, survey of rapid

tests and equipment/results performance in the field and sample retesting. Results of the quarterly QA

activities will be made available to a national centralized system (supported by PEPFAR). ICAP-CU will

regularly assess the quality of rapid HIV testing done in remote PHCs and stand alone VCT using various

QA tools which will include regular supervisory visits to provide mentoring, regular use of controls,

competency assessments after training, biweekly proficiency testing and regular refresher trainings. ICAP-

CU will continue to support PEP programs in all its sites by emphasizing the availability of this service in all

its lab training.

ICAP- CU laboratory program is currently supported by a regional lab advisor from the HQ who provides

regular TA to in country lab team. The in country team is comprised of one senior lab advisor, one central

lab advisor (supervises all lab activities from the central office), one central biomedical engineer, and two

regional lab advisors. An additional five lab advisors are expected to join the team before the end of

COP07. This lab team will work closely with the LTWG and the state MOH to ensure that at least 8 ICAP-

CU supported labs gain local lab accreditation through the national lab regulatory body (MLSCN).

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

In FY08, ICAP-CU will use EP funds to support 25 hospital labs using the phased approach described

above. To facilitate the GoN scale up plans, 245 laboratory staff will be trained on the provision of high-

quality lab. Trainings will be stepped down to laboratory technicians and assistants from the primary health

centers. Sixty lab technicians will be trained on ZN-staining /AFB identification to enhance TB diagnosis at

the DOT sites. ICAP-CU will also strengthen the laboratories at new sites by renovating space and facilities

Activity Narrative: (within the existing hospital building space), and enhancing their diagnostic abilities. By ensuring

appropriate training, supervision, equipment, maintenance and supplies, all 25 hospital labs will be

strengthened to support these institution's rapidly-growing adult and pediatric HIV/AIDS care and treatment

programs.

LINKAGES TO OTHER ACTIVITIES:

This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), OVC (5547.08), VCT

(5550.08), TB/HIV (5551.08) and PMTCT (6622.08). These services will directly support these activities by

enabling 118,125 people access to HIV/AIDS testing and 25,000 HIV positive adults, infants and children on

treatment, 20,500 HIV positive adults, infants and children not on treatment and an additional 2500 HIV

positive mothers to access HIV/AIDS care and treatment.

TARGET POPULATIONS:

General populace with special emphasis on high risk groups (TB co-infections). HIV monitoring of HIV

positives and diagnosis of HIV exposed especially vulnerable groups of women, infants and children.

Pregnancy and syphilis tests will be provided to women. Lab monitoring for 45,500 HIV positives and 2,500

HIV positive mothers includes a projected total estimate of 548,750 tests consisting of 116,000 LFTs,

116,000 CBCs, 119,250 CD4 counts, 5000 sputum exams, 2500 PCRs for EID and 190,000 HIV testing

including tests in PMTCT and TB patients. Health workers will be trained in providing quality laboratory and

testing services including collection, transport and tracking of samples and results especially to and from

primary healthcare centers and other partner networks. CBOs/FBOs will be trained in using rapid test kits

based on national algorithms.

EMPHASIS AREAS:

Emphasis areas include commodity procurement, training, quality improvement/assurance, supportive

supervision, upgrading of infrastructure and development of referrals, network/linkages.

ACTIVITY DESCRIPTION:

The Monitoring and Evaluation (M&E) component of ICAP-CU programs enables the assessment of

progress towards program goals/objectives and supports quality improvement activities. It strengthens

medical records and patient information systems, improves data management and data quality, and

enhances clinical services at ICAP-CU-supported sites.

In COP07, ICAP-CU provided strategic information (SI) management services to 42 sites in three states

(Kaduna, Benue and Cross River). These included primary health centers (PHCs) providing a combination

of PMTCT, TB/HIV and/or HCT, and 10 secondary hospitals providing comprehensive HIV/AIDS programs.

In COP08, ICAP-CU will provide support for SI management to a total of 89 entities (70 sites and 19 CBOs)

in six states (Cross River, Kaduna, Benue, Gombe, Akwa Ibom and Kogi states). The 70 sites include 25

secondary hospitals providing comprehensive services (increased from 10 in COP07) plus satellite PMTCT,

TB DOTS and HCT sites.

Currently ICAP-CU's M&E team, with COP07 funding, consists of 16 ICAP technical staff and 24 data clerks

(facility based) that support systems to monitor program activities and report on indicators required for

national and USG reporting. The ICAP M&E team has supported the implementation of basic site patient

tracking (using national paper-based systems) for care and treatment, including the identification and

harmonization of indicators and definitions, and the adaptation and printing of data collection forms. M&E

activities include the initiation of a paper-based records system, regular data collection and verification to

meet reporting and data quality requirements, and tracking referrals and linkages to ICAP-CU-supported

hospitals for HIV care and treatment services.

ICAP-CU also uses an electronic database to aid comprehensive patient tracking, facilitate site monitoring

activities, assist reporting, monitor quality of services provided, and enhance programmatic evaluation.

Using in-country networks and available technologies, ICAP-CU is building a strong Patient Management

Monitoring (PMM) system harmonized with the Government of Nigeria's (GON) emerging national PMM

system. ICAP-CU will fully participate in the GON to roll out the new national on-line real time data system

(Voxiva platform) and implementation of HIVQual at all sites where applicable. Logistic support will include

the printing and distribution of required forms and purchase of computers with relevant software packages

(for data management at the sites) for these activities.

The monitoring and evaluation component of the ICAP-CU PEPFAR program enables the assessment of

progress towards program goals/objectives and supports quality improvement for all activities. It

strengthens medical records and patient information systems, improves data management and data quality,

and enhances clinical services at ICAP-CU supported sites. In COP08, ICAP-CU staff will carry out

regularly scheduled monitoring visits to all sites during which they will evaluate M&E activities including the

utilization of National PMM tools and guidelines, proper medical record keeping, efficiency of data flow,

referral coordination, and use of standard operating procedures, in line with the USG SI data quality

assessment/improvement (DQA/I) and capacity building plan. On-site TA with more frequent follow-up

monitoring visits will be provided to address weaknesses when identified during routine visits. This will

ensure continued quality data collection, data entry, data validation and analysis, and dissemination of

findings across a range of stakeholders. It will: ensure compilation of complete and valid HIV patient

treatment/ARV data; enhance analysis of required indicators for quality HIV patient treatment program

monitoring and reporting; and provide relevant site-specific TA to develop targeted data QI plans. Emphasis

will be placed on creating a system to ensure that data collected at the site is used by site service delivery

staff for strategic planning to improve program quality and inform programmatic decisions, thus ensuring

ownership of the data and sustainability of M&E activities. Furthermore, robust systems for tracking patients

and monitoring adherence will be developed.

In COP08, additional M&E staff (including site data entry persons) will be hired in order to sufficiently

address the greater level of M&E activities across all programs. Ideally, ICAP will hire eight additional full

time staff (for a total of 24) and 26 facility-level data clerks (for a total of 50). Out of the eight additional ICAP

core staff to be hired, three staff will be based in Abuja, including a database programmer/developer, a data

analyst, and a quality management advisor. The database programmer's primary responsibility will be to

develop a database application for HMIS collection and storage of aggregate and patient-level data for

monitoring and evaluation of HIV clinical programs. The data analyst will merge and clean large datasets in

Access, Excel or SAS format across ICAP-supported HIV prevention, care and treatment sites for use in

routine monitoring and evaluation, and will also conduct descriptive and multivariate analysis of collected

aggregate and patient-level data. The quality management advisor will lead the planning and

implementation of service quality and data quality protocols across ICAP-CU supported sites in Nigeria and

will ensure compliance with the protocols. Two regional M&E advisors will be hired to lead the M&E team in

ICAP-CU's regional office in the planning, implementation and review of M&E activities at ICAP supported

health facilities. Three regional M&E assistants will assist the regional M&E advisors in the development

and refinement of M&E materials and provide support in the development and establishment of a systematic

procedure for patient monitoring and evaluation including collecting, collating and reporting all data tracked

by the ICAP Nigeria program.

ICAP-CU M&E staff train service providers in appropriate record-keeping and provide ongoing technical

assistance to facility personnel to enhance site capacity to keep and review completed service delivery

forms/registers, and to implement data quality assurance systems. In COP08 ICAP-CU will train and

provide ongoing technical assistance to at least 250 individuals at ICAP-supported facilities (strategic

information staff of secondary hospitals, primary health care facilities, DOTS sites, CBOs, NGOs, and

PLWHA groups) to enter and manage the information required to monitor program performance, evaluate

quality, and identify areas in which program services can be strengthened. Funds will be used to train

facility medical records officers and data clerks in basic computer skills, data management and general

M&E. Service delivery staff will be trained on monitoring quality of service using appropriate quality

management (QM) tools. Service providers will also be supported to complete medical records and

registers in an accurate and timely manner. In addition, ICAP-CU will provide technical assistance to 89

local organizations and facilities, enabling them to strengthen their own monitoring and evaluation activities.

ICAP-CU will continue to support additional M&E activities, including monthly feedback meetings with

facilities and GON at all levels and regular quality checks on data and other services via adapted QM tools.

Support will be provided to GON as necessary, and evaluation protocols will be developed and

Activity Narrative: implemented. State M&E officers will participate in the monitoring processes and the training programs in

order to instill a sense of ownership and ensure sustainability of these efforts. Additionally, the SI team will

continue to be active participants in the SI working group established and coordinated by USG-Nigeria.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Correct and consistent data collection will contribute to the measurement of the achievement of the

GON/PEPFAR care and treatment goals. It will be utilized to strengthen systems for increased and rapid

expansion, planning and sustainability purposes.

LINKS TO OTHER ACTIVITIES:

M&E is concerned with the collection of data on all services provided to improve program activities and

enhance reporting. Thus, this activity will relate to activities in PMTCT (6622.08), adult basic care and

support (5552.08), TB/HIV (5551.08), OVC (5547.08), HCT (5550.08), AB (15654.08), condoms and other

prevention (9208.08), ARV services (5404.08), ARV drugs (5493.08), lab (5544.08), blood safety (6490.08)

and injection safety (6819.08). ICAP-CU will conduct evaluations of PMTCT service delivery and

decentralization of ART services to PHCs.

POPULATIONS BEING TARGETED:

The population being targeted includes the M&E officers in partner implementing organizations and various

CBO/FBO/NGO/PVO and medical records officers in health facilities. The various cadres of service

providers will also be provided with technical assistance to enhance accurate record keeping.

EMPHASIS AREAS:

Emphasis areas include human capacity development and SI.

By collecting data about relative numbers of men and women accessing prevention, care, and treatment

services, strategic information will be available to inform the development of strategies to mitigate gender

inequity. Strategic information also enables programs to assess the effectiveness of referrals and linkages

to wraparound programs providing food support, microfinance initiatives, and reproductive health services

(and other required services). Data will routinely be used to assess and enhance program quality.