PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY DESCRIPTION:
In COP08, CRS AIDSRelief (AR) will increase the PMTCT sites it supports from 28 comprehensive Local
Partner Treatment Facilities (LPTFs) and 2 PMTCT sites in COP07 to an additional 2 LPTF sites for a total
of 32 sites providing PMTCT services in 16 states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu,
FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Taraba). AR, with other IPs, will implement the
PEPFAR-Nigeria LGA coverage strategy in Anambra, ensuring the provision of PMTCT services in at least
one health facility in every local government area (LGA). This is a critical step toward universal access to
PMTCT services. In setting and achieving COP08 targets, consideration has been given to modulating AR's
rapid COP07 scale-up plans in order to concomitantly work towards continuous quality improvement.
Through its PMTCT services AR will provide counseling, testing and received result to 28,750 pregnant
women. Antiretroviral (ARV) prophylaxis will be provided to 1,600 women and an additional 410 clients will
be placed on HAART for their own disease for a total of 2,010 women receiving antiretrovirals (7% positivity
rate based on historical data at AR supported LPTFs). In setting and achieving COP08 targets,
consideration has been given to modulating AR's rapid COP07 scale up plans in order to concomitantly
work towards continuous quality improvement.
This activity will include, as a part of the standard package of care, routine provider initiated opt-out HIV
counseling and testing (HCT) in antenatal clinics (ANC) for all presenting women and in labor and delivery
wards (L&D) and the immediate post-delivery setting for women of unknown HIV status. Same day results
will be provided to clients. AR will use group and individual pre- and posttest counseling strategies and rapid
testing based on the National testing algorithm. Partner testing and couple counseling will be offered as part
of PMTCT services to enhance disclosure. AR, through its community and faith-based linkages, will utilize
community and home based care services to promote partner testing. Clients will have access to free
laboratory services including CD4 counts and STI screening. Free medications including those for OIs as
needed and hematinics will also be provided. 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.
Strong referral systems that incorporate active follow-up will be put in place to ensure that women requiring
HAART are not lost during referral for ARV services. For the anticipated number of women not requiring
HAART for their own health, the current WHO recommended short course ARV option will be provided. This
includes ZDV from 28 weeks with intra-partum sdNVP and a 7-day ZDV/3TC post-partum tail or ZDV/3TC
from 34-36 weeks with intra-partum sdNVP and a 7-day ZDV/3TC post-partum tail. Infant prophylaxis will
consist of single dose NVP and ZDV for 6 weeks. AR will use its community linkages and mother-to-mother
support groups to encourage HIV+ pregnant women to deliver in a health facility. For those HIV+ women
who choose not to do so and deliver at home, the same community volunteers will follow-up and identify
them for needed postpartum services.
AR will explore the training and utilization of traditional birth attendants (TBAs) in addition to the mother-to-
mother support groups to reach HIV+ women who choose to deliver outside of the health facility. A focal
person at each LPTF will be responsible for tracing HIV+ mothers and their infants in the community and
linking then back to care. The HIV+ mothers and their infants will be linked postpartum to ART care and
support services which will utilize a family centered care model. AIDSRelief will offer HIV early infant
diagnosis (EID) in line with the National Early Infant Diagnosis scale-up plan from 6 weeks of age using
DBS. Implementation of the EID scale-up will be done under the guidance of the GON and in conjunction
with other IPs who will be conducting the laboratory testing. AR will collaborate with Clinton Foundation as
appropriate for commodities and logistics support of the EID program. Exposed infants will be actively linked
to pediatric care and treatment. While there families will be referred to age-appropriate OVC services
HIV+ women will be counseled in the pre and postnatal periods regarding exclusive breast feeding with
early cessation or exclusive BMS if AFASS criteria can be met using the WHO UNICEF curriculum adapted
for Nigeria. AR will support couple counseling and family disclosure that will enhance adherence to infant
feeding choices. Full and accurate information will be provided on family planning and prevention services.
Infants of positive mothers will be linked to immunization services and well child care. Cotrimoxazole
prophylaxis will be provided to infants from 6 weeks of age until definitive HIV status can be ascertained.
In COP08, AR will strengthen its program for Continuous Quality Improvement (CQI) in order to improve
and institutionalize quality interventions. Monitoring and evaluation of the AIDSRelief PMTCT program will
be consistent with the national plan for patient monitoring. Within each regional TA team AR will have a
PMTCT specialist assisted by a team of nurses and counselors to offer technical assistance to LPTFs and
take the lead on training and supervisory activities. AR PMTCT specialists will work in conjunction with
regional CQI specialists, program managers, clinical associates, and LPTFs PMTCT coordinators as well as
counterparts at other IPs. AR regional PMTCT specialists will join the CQI-led team in conducting site visits
at least quarterly during which they will evaluate PMTCT clinical services, HCT done in the PMTCT setting,
the utilization of National PMM tools and guidelines/SOPs, proper medical record keeping, referral
coordination, and use of standard operating procedures in PMTCT. On-site TA with more frequent follow-up
monitoring visits will be provided to address weaknesses when identified during routine monitoring visits.
AR will provide training on PMTCT service delivery to 200 healthcare workers according to the national
curriculum. AR will collaborate with UNICEF-supported PMTCT sites and the CRS 7D program for
community and home based PMTCT initiatives in its scale-up plans.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will provide counseling and testing services to 28,750 pregnant women, and provide ARV
prophylaxis to 1,600 and 410 clients on ART. This will contribute to the PEPFAR goal of preventing
1,145,545 new HIV infections in Nigeria by 2009. With 32 operational sites in 16 states, the PMTCT
supports the rapid scale up of PMTCT services desired by the FMOH.
LINKS TO OTHER ACTIVITIES:
The PMTCT services will be linked to HCT (5425.08), basic care and support (5368.08), ARV services
(6678.08), ARV drugs (9889.08), OVC (5416.08), TB/HIV (5399.08), laboratory services (6680.08) and SI
(5359.08). Pregnant women who present for HCT services will be provided with information about the
PMTCT program and referred accordingly. ARV treatment services for infants and mothers will be provided
through ART services. Basic pediatric care, including TB care, is provided for infants and children through
Activity Narrative: OVC activities. All HIV+ women will be registered for adult care and support services.
AR PMTCT activities will focus on strengthening community and home-based care services to pregnant
women where appropriate and in collaboration with the CRS 7-Diocese program and other family-centered
care services provided by UNICEF, GON and the Catholic Secretariat of Nigeria. The AR senior PMTCT
specialist will offer technical assistance to 7-Diocese facilities. AR will collaborate with other IPs, particularly
IHV-ACTION, working at tertiary institutions for infant diagnosis using dried blood spot (DBS) technology.
POPULATIONS BEING TARGETED:
This activity targets women of reproductive age and their partners, infants and PLWHAs. This activity also
targets training of health care providers, TBAs and mothers who will work as peer educators.
EMPHASIS AREAS
This activity has an emphasis on training, supportive supervision, quality assurance/improvement and
commodity procurement.. Emphasis is also placed on development of networks/linkages/referral systems.
In addition, integrating PMTCT with ANC and other family-centered services while ensuring linkages to
Mother-Child-Health (MCH) and reproductive health services will ensure gender equity in access to
HIV/AIDS services.
AIDSRelief (AR) is a consortium of five organizations which includes Catholic Relief Services (CRS)
working as the lead agency, the Institute of Human Virology (IHV), Constella Futures Group (CF), Catholic
Medical Mission Board (CMMB) and Interchurch Medical Assistance World Health (IMA) of which three
(CRS, IHV, CF) are operational in Nigeria. AIDSRelief provides a comprehensive care and treatment
program emphasizing strong links between PLWHA, their family, communities and health institutions. Its
goal is to ensure that people living with HIV/AIDS have access to Antiretroviral Therapy (ART) and high
quality medical care.
AR will be a new partner in Nigeria in the program area of Abstinence/Be Faithful (AB) in COP08. AR 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 through a balanced portfolio of
prevention activities. Through the involvement of AR as a new partner in this activity, PEPFAR Nigeria will
extend its reach with AB services in more states and communities.
The program will support Local partner treatment facility (LPTF) activities targeting HIV + clients, their
families and communities who access care at these points of service. Prevention priorities will include
behavior change for risk reduction and risk avoidance, counseling and testing. All sites will provide
education to patients and community health volunteers on secondary prevention.
The goal of the program is to be focused on the communities targeted and to cover those communities with
messages conveyed through multiple fora. Utilizing such a methodology, a large number of people will be
reached with messages via one method or another, but the counted group will be those individuals that
would have received AB messaging: (1) on a regular basis and (2) via the three strategies AR will employ
(community awareness campaigns, peer education models and peer education plus activities). The target
for this intensive AB messaging campaign is 8,000 individuals. In addition, age appropriate abstinence only
messaging and secondary abstinence messaging will be conveyed to 4,000 children and adolescents,
especially orphans and vulnerable children receiving both facility and home based support. In COP08 AB
services will be offered through 30 local partner treatment facilities (LPTF), 20 satellite sites and 3
community based programs in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,
Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau and Taraba.
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. 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 that these age groups will be reached with prevention interventions.
The strong community and adherence programs developed by LPTFs in the AR program will continue to
serve as the foundation for outreach to communities. In COP08, the program will continue to ensure that all
sites provide education to patients and community health volunteers on secondary prevention. Couple
centered AB prevention will also be emphasized. Prevention activities will include distribution of patient
education materials, community sensitization, increased couple testing, promotion of LPTF couple support
groups, and advocacy for risk reduction strategies for discordant relationships. High risk reduction
measures will include treatment of sexually transmitted infections (STIs). Couples will be treated at LPTFs
or other referral centers that offer specialized treatment for STIs.
Fidelity in relationships will be promoted through information, education and communication (IEC) materials
and enlisting the support of religious leaders in community-led peer education plus activities such as drama
groups. Messages will also target the reduction of high risk behaviors such as alcohol abuse, drug use, and
transactional/cross generational sex. With the family-centered approach, primary prevention messages will
be provided to families of those affected by HIV/AIDS, especially children. These messages will focus on
abstinence and avoidance of high risk behaviors. Linkages with CRS' OVC program will further promote
messages that emphasize abstinence and fidelity and the avoidance of high risk behaviors. AR will explore
with its faith-based partners opportunities for extending these messages into faith-based schools and
developing peer educators in the schools. Catholic Relief Services has experience in such programs
through its Track 1 grant in Ethiopia, Rwanda and Uganda and will draw on this experience and materials
already developed to further engage youth in culturally appropriate AB activities.
Training will be an integral part of this program and will be directed at facility staff, community level staff and
religious leaders. A total of 240 facility staff plus 320 community volunteers and religious leaders will be
trained and given adequate skills to be able to promote abstinence and being faithful messages to patients,
their families and communities. Thus a total of 560 persons will be trained.
Strategic information (SI) is crosscutting in all program areas. AIDSRelief SI activities will incorporate
program level reporting, enhancing the effectiveness and efficiency of both paper-based and computerized
patient monitoring and management (PMM) systems, assuring data quality and continuous quality
improvement, and using SI for program decision making across all LPTFs. In COP08, AR will carry out site
visits to provide technical assistance that will ensure continued quality data collection, data entry, data
validation and analysis, and dissemination of findings across a range of stakeholders. It will provide
relevant, LPTF-specific technical assistance to develop specific data quality improvement plans. It will also
capture and report on individuals reached with abstinence and be faithful prevention messages using
relevant data collection tools and the PMM system.
AR has developed a Sustainability Plan in Year 4 focusing on technical, organizational, funding, policy and
advocacy dimensions. To date, the program, through its comprehensive programming, has been able to
increase access to quality care and treatment, while simultaneously strengthening health facility systems
through human resource support, equipment, financial training and improvements in health management
information. In COP08, the program will further build on this foundation to work with catholic nursing schools
to incorporate comprehensive HIV/AIDS training modules into the existing curriculum to ensure continuity of
skills training. The program will also support linkages between LPTFs and the Nigerian Ministry of health to
Activity Narrative: tap into locally available training institutions. AR will particularly focus on its relationship with indigenous
organizations such as the Catholic Secretariat of Nigeria (CSN) to build their institutional capacity, both
programmatic and financial, to support local partners. These strategies will enable AR to fully transfer its
knowledge, skills and responsibilities to in-country service providers as part of the program's sustainability
plan.
AR AB activities emphasize the integration of prevention activities with treatment and care services. Use of
community awareness campaigns, the peer educator model, and peer education plus activities (community
drama, dance events, etc.) allows dissemination of AB messaging. This activity contributes to the USG
target of preventing 1,145,545 new infections by 2009 through the promotion of AB and A-only messaging
in a comprehensive approach.
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 and to OVC programming (5547.08) by
targeting orphans and vulnerable children.
The program will also seek to link up with other CBOs/FBOs that serve the same geographic areas, as well
as partners working in other sectors, wherever possible to collaborate on meeting the needs of the
community.
POPULATIONS TARGETED:
Key populations targeted are the healthcare community in treatment facilities, PLWHA, youths and adults
accessing HCT services, support group members and family members of PLWHA.
This activity has an emphasis on training and community mobilization.
This activity will support the linkage of AIDSRelief (AR) supported Local Partner Treatment Facilities (LPTF)
and their satellite sites to the National Blood Transfusion Service (NBTS) zonal centers across the country.
In COP08 AR will be supporting 30 LPTFs in 16 states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo,
Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba). Blood transfusions occur at
all 30 of these facilities.
In COP08, AR 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. AR 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 linkages its zonal centers will develop with AR and its
supported facilities, will provide TA for blood donation drives held by these AR-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 AR will be
instrumental in working with hospital management and staff at all LPTFs 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. AIDSRelief will draw upon its unique position in working with
mainly faith-based facilities to facilitate blood donation activities within parishioner communities. AR 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, AR will work closely with LPTF
management to establish blood transfusion committees to oversee blood use based on national algorithms
and standards in the health facilities.
The first component of this activity is the linkage of 5 AR-supported LPTF to proximal zonal NBTS centers in
Jos, Kaduna and Oweri. 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 1,125 transfusions will take place. AR 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, at least
900 units of blood will be collected and sent to the nearest NBTS centers for ELISA screening as outlined.
AR will work with the 30 LPTFs 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. At least 2,500 blood donors will be
screened using the National HCT testing algorithm, thereby utilizing the blood donor setting as another point
of service for HCT during pre-donation. 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.
This activity will support personnel capacity development through SBFA-conducted blood safety training in
line with NBTS approved standardized training curricula appropriate to various levels of trainees. Through
this mechanism AR will identify 34 laboratory staff and other health care workers involved in blood
transfusion services at supported sites who will be trained by SBFA. In order to avoid double counting,
these 34 targets are counted under the SBFA blood safety narrative. For core TOT modules developed by
SBFA, AR will conduct step down training to 75 laboratory, allied health workers and hospital management
staff involved in blood transfusion services at their sites.
In addition to institutional capacity building for blood safety activities, AR will support the implementation of
universal precautions, good laboratory practice and waste management. This activity will promote the
principles of universal safety precautions and the reduction of unnecessary transfusions, occupational
exposure to blood, and accidental injury/contamination. Essential consumables and services that protect the
health worker from contacting infections especially HIV will be provided. These universal precaution
materials include personal protective equipment such as hand gloves, laboratory coats, and other
consumables (methylated-spirit, hypochlorite solutions, antibacterial soaps, etc.), which will be provided to
sites. Other equipment to be provided will include centrifuges, thermometers, pipettes and HIV rapid test
kits. In addition, each site will establish clearly defined procedures for healthcare workers, other staff, and
patients to access post exposure prophylaxis (PEP). Proper waste management will be encouraged through
the use of biohazard bags, suitable sharps containers and the use of incinerators.
In order to maintain high quality laboratory results, AR will institute an aggressive QA/QC program that
involves on-site quarterly monitoring, retraining and proficiency in rapid HIV testing. AR will dedicate one
blood safety focal person, working with the lab team, to coordinate this activity for all LPTFs in COP08.
Monitoring and evaluation of the AIDSRelief blood safety program will be consistent with the NBTS national
plan. There will be evaluations of transfusion committee activities, infection control practices, waste
management systems, and use of standard operating procedures for donor screening and blood collection.
On-site TA with more frequent follow-up monitoring visits will be provided to address weaknesses when
identified during routine monitoring visits.
CONTRIBUTION TO OVERALL PROGRAM AREA:
This activity contributes to the USG target of preventing 1,145,545 new infections by 2009 through the
prevention of medical transmission of HIV by ensuring a supply of safe and screened blood for blood
transfusions. This activity will help establish mechanisms for linkages with NBTS centers for blood banking
services, while providing the logistics and training to AR health facilities to effectively collect and store
blood. Donor drives in the faith based communities for VNRD will be done in collaboration with the NBTS.
This also contributes to the overall goal of GON to establish an effective and nationally coordinated and
regulated blood program.
Activity Narrative: LINKS TO OTHER ACTIVITIES:
This activity is linked to HCT (5425.08), PMTCT (6485.08), ARV services (6678.08), basic care and support
(5368.08), OVC (5416.08), laboratory services (6680.08), AB (15655.08), injection safety (6820.08), and SI
(5359.08). AR activities in blood safety relate to HCT since HCT services will be made available to all
donors. Injection safety is linked thru universal precautions equipment and laboratory equipment. This
activity is most immediately linked to laboratory services to strengthen the collection, testing and storage of
blood units at LPTFs. Through transfusion committees and trainings AR will strengthen the links with other
LPTF health services to ensure that these activities benefit from a screened, safe blood supply which will
also promote program sustainability.
This activity targets health care providers, particularly laboratory staff including laboratory assistants and
phlebotomists. This activity also targets doctors and nurses. AR mainly works with faith-based rural facilities
that serve rural populations who would otherwise have limited or no access to these services. Adults
18years and above in these communities will be targeted as voluntary non-remunerated blood donors.
This activity has an emphasis on training and institutional capacity building.
ACTIVITY DESCRIPTION
AIDSRelief (AR) local partner treatment facilities (LPTFs) consist largely of primary healthcare institutions
located within communities that are poor and underserved in all areas of social infrastructure including
healthcare. A proportion of HIV infections are still transmitted within these healthcare facilities through
unsafe injection practices. In COP07, AR supported specific safe injection activities at 28 LPTFs, two
PMTCT sites and 10 satellite clinics in 14 states of Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,
Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. In COP08, AR will expand to support safe
injection activities at a total of 83 sites (30 LPTF, 2 PMTCT, 20 satellite sites, and 31 TB DOTS) in a total of
16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi,
Nasarrawa, Ondo, Plateau and Taraba. In setting and achieving COP08 targets, consideration has been
given to modulating AR's rapid COP07 scale-up plans in other programs in order to concomitantly work
towards continuous quality improvement.
AR injection safety activities encompass the training of infection control personnel from each supported
facility on universal precautions and medical waste management. Healthcare workers trained in
collaboration with JSI/Making Medical Injections Safer (MMIS) will step down the training to ensure
sustainability and behavioral change. It is expected that a total of 240 personnel will be trained. This step
down training to other LPTF staff, including nurses, doctors, laboratory staff, hospital cleaners, laundry
workers and waste managers, will include topics such as proper techniques for drawing blood, dispensing
blood into laboratory bottles for laboratory testing, and disposal of used needles, sharps and other materials
contaminated by blood and other biohazardous materials. AR will obtain and use MMIS supplied manuals to
conduct follow-up on-site training at AR-supported LPTFs. Behavioral change communication (BCC)
activities will be carried out to reduce unnecessary use of injections. AR will work with MMIS to provide
supportive supervision to all trained AR supported facilities.
AR will collaborate with JSI/MMIS to supply and distribute single-use needles, safety boxes and personal
protective equipments to all AR-supported LPTFs. This activity will involve the provision of retractable
needles and syringes, sharps containers and liquid hand washing soap in LPTF wards, clinic rooms,
laboratory work stations and strategic areas to encourage their use. This activity will also provide personal
protective equipment (PPE) for health workers and ancillary hospital staff who come into contact with
sharps and contaminated materials. AR will work with each LPTF to improve access to water at each hand
washing point. For sustainability purposes, AR will ensure that these activities are integrated within each
facility's overall infection prevention and control and workplace safety programs. AR will also support post-
HIV exposure prophylaxis (PEP) programs at all sites.
Health care waste management will be supported in this activity. Incinerators will be repaired and fueled
where they are available and appropriate safe final disposal in rural setting instituted where there are no
incinerators.
In COP08, AR will strengthen its program for Continuous Quality Improvement (CQI) to improve and
institutionalize quality interventions. CQI specialists and laboratorians will conduct team site visits at least
quarterly during which there will be evaluations of infection control practices, waste management
procedures, proper record keeping, and use of standard operating procedures for injection safety.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity contributes to the USG Nigeria target of preventing 1,145,545 new HIV infections through the
prevention of medical transmission of HIV. Planned training courses and the provision of safe injection
commodities and PPE will reduce occupational hazards and exposure of health workers and ancillary staff.
LINKS TO OTHER ACTIVITIES
AIDSRelief activities in injection safety relate to activities in ARV services (6678.08), PMTCT (6485.08),
laboratory services (6680.08), basic care and support (5368.08), TB/HIV (5399.08), OVC (5416.08), blood
safety (5392.08), and SI (5359.08) to ensure that healthcare providers and ancillary staff under all these
programs adhere to the principles of injection safety.
POPULATIONS BEING TARGETED
This activity will mainly target healthcare providers including doctors, laboratory workers, nurses,
pharmacists. Ancillary staff, who may not have direct patient contact but handle or manage biohazardous
materials, will also be targeted.
KEY LEGISLATIVE ISSUES ADDRESSED
Through the increased knowledge gained by healthcare workers and laypersons via IEC/BCC these
activities will result in a reduction in unnecessary demand for injection and better care of PLWHA.
This activity has an emphasis on training on universal safety precautions and SI.
In COP07 AIDSRelief (AR) is providing adult care and support services through 28 Local Partner Treatment
Facilities (LPTFs) and 10 satellite sites in 14 states of Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu,
FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. In COP08 AR will provide a
comprehensive package of palliative care services to 42,070 PLWHA and 84,140 People Affected By
HIV/AIDS (PABAs) for a total of 126,210 people accessing care and support services. These services will
be provided through 30 LPTFs and 20 satellite clinics in 16 states to give total of 50 service outlets in Abia,
Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarrawa, Ondo,
Plateau and Taraba. In setting COP08 targets, consideration has been given to modulating AR's rapid
COP07 scale up plans in order to concomitantly work towards continuous quality improvement.
The package of services provided to each PLWHA includes a minimum of one clinical service and two
supportive services delivered at the facility, community, and household (home based care) levels in
accordance with the PEPFAR and Government of Nigeria (GON) national palliative care policies and
guidelines. This includes: laboratory services; OI prophylaxis/diagnosis/treatment, diagnosis and treatment;
pain management; nutritional assessment/therapy; psychosocial support; spiritual support; and prevention
for positives.
AR will ensure that all LPTFs have the capacity to: provide PLWHAs with a preventive care package made
up of ITN, water guard, water vessel, soap, ORS sachet, and IEC materials on self care and common OI
prevention. All PLWHA will have CD4 counts and other necessary lab analyses performed at least every 6
months to monitor ART effectiveness/side effects for those on ART and to identify eligibility status for those
not on ART. All AR sites will integrate prevention with positives (PwP) activities including: adherence
counseling; syndromic management of STIs in line with National STI control policy and guidelines; risk
assessment and behavioral counseling to achieve risk reduction; counseling and testing of family members
and sex partners; counseling for discordant couples; IEC materials and provider delivered messages on
disclosure. All PLWHAs' nutritional status will be assessed at contact and on follow-up visits, micronutrients
will be provided as necessary, and those diagnosed as severely malnourished will be placed on a
therapeutic feeding program. This will be done through wraparound services as well as direct funding.
AR will collaborate with faith-based organizations (FBOs) and community-based organizations (CBOs) such
as 7-Diocese of Catholic Relief Services (CRS) in Benue, Kaduna and Edo states, CSADI in Kano, Spring
of Life in Plateau, New Life Support in Anambra and other CBOs attached to AR LPTFs in the 16 states.
These FBOs and CBOs may be subgrantees of AR and/or other PEPFAR IPs. Through these partnerships
care clients will receive a comprehensive package of community and home based care services.
In COP08 AR will continue to strengthen institutional and health worker capacity through the training of 110
persons to provide care services at the facility and community levels. Doctors, pharmacists, nurses,
counselors, and community health extension workers will receive training that will allow them to provide
comprehensive care. AR will also train community volunteers including PLWHA and religious leaders to
help with the psychosocial and spiritual counseling, respectively. AR will use GON/USG recommended
standardized training aides and manuals for all community volunteer trainings. Information, education and
communication materials will be provided to enhance these trainings.
institutionalize quality interventions. AR will hire an additional three CQI staff who will be supervised by the
CQI specialist. The 4 CQI specialists will be responsible for spearheading CQI activities in their respective
regions. This will include standardizing patient medical records to ensure proper record keeping and
continuity of care at all LPTFs. Monitoring and evaluation of the AIDSRelief basic care and support program
will be consistent with the national plan for patient monitoring. The CQI specialists will conduct team site
visits at least quarterly during which there will be evaluations of infection control, the utilization of National
PMM tools and guidelines, proper medical record keeping, efficiency of clinic services, referral coordination,
and use of standard operating procedures across all disciplines. On-site TA with more frequent follow-up
Some of the data will be used to generate biannual life table analyses that identify factors associated with
early discontinuation of treatment. Each of these activities will highlight opportunities for improvement of
facility, community, and home based care practices.
Sustainability lies at the heart of the AR program. AIDSRelief has developed a Sustainability Plan in Year 4
focusing on technical, organizational, funding, policy and advocacy dimensions. Through its comprehensive
approach to programming, AR has been able to increase access to quality care and treatment, while
simultaneously strengthening health facility systems. All activities will continue to be implemented in close
collaboration with the Government of Nigeria (GON) to ensure coordination and information sharing, thus
promoting long-term sustainability. AR will continue to strengthen the health systems of LPTFs.. This will
include human resource support and management, financial management, infrastructure improvement, and
strengthening of health management information systems. In collaboration with the CRS SUN project, AR
will focus on institutional capacity building for indigenous umbrella organizations such as the Catholic
Secretariat of Nigeria (CSN). These strategies will enable AR to transfer knowledge, skills and
responsibilities to in-country service providers.
AR's expansion of adult basic care and support activities, including effective linkages with HBC providers,
will contribute to increased access of such services to underserved rural communities. By providing services
to 42,070 Adult PLWHA and 84,140 PABAs, AR will contribute to the overall PEPFAR palliative care target
of providing these services to 10 million people globally by 2009. The activity contributes to the overall AR
comprehensive HIV and AIDS services by providing the supportive services for all adult PLWHA including
those on ART.
AR activities in adult basic care and support are linked to HCT (5425.08), ARV services (6678.08), PMTCT
(6485.08), ARV drugs (9889.08), laboratory (6680.08), OVC (5416.08), AB (15655.08), TB/HIV (5399.08),
and SI (5359.08) to ensure that PLWHA and their family members have access to a continuum of services.
AR will work with other CBOs and FBOs including the CRS 7-D program for the provision of HBC including
psychosocial support for our clients. AR will work with the Catholic Church and other faith-based networks
Activity Narrative: for the provision of psychosocial support to PLWHA and PABAs. The CBOs and FBOs will be funded to
provide community and home based services for AR clients. AR will work with the GON and the USG in the
harmonization of basic palliative care services and in the standardization of training manuals for community
volunteers and providers. AR will facilitate linkages between the LPTFs and other organizations providing
livelihood development program for PLWHA and caregivers/PABAs requiring such services so as to
improve the quality of life of PLWHA and their families. Identified child or adolescent headed households will
be linked to with OVC programs and other programs which will meet the needs of the household.
AR targets PLWHA, including PMTCT clients, and PABAs predominantly located in rural and previously
underserved areas. This activity also targets CBOs and FBOs for capacity building and targets care
providers (healthcare professionals, community volunteers) for training.
Emphasis areas are human capacity development including training and task shifting, local organization
capacity building for community mobilization and participation, development of networks/linkages/referral
systems, and quality assurance/ quality improvement. In addition, adult basic care and support activities AR
will ensure gender equity in access to these services for both male and female PLWHA. AR will work with
CBOs, networks of PLWHA and FBOs in educational activities and delivery of targeted messages that
promote improved general care and support of PLWHA and raise awareness on HIV and AIDS, thus
reducing the issue of stigma and discrimination.
AIDS Relief's (AR) strategy for TB/HIV is to ensure that all HIV positive clients in Local Partners Treatment
Facilities (LPTFs) are routinely screened for TB while TB patients have access to HIV counseling and
testing (HCT). Dually infected clients are offered appropriate care within and outside the LPTF. In COP07,
AR is supporting TB DOTS centers at 28 LPTFs and HCT at 28 stand alone TB DOTS centers in 14 states
(Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau,
Taraba). In COP08 AR will extend these services to a total of 30 LPTFs and 31 TB DOTS centers in 16
states (those above plus Abia and Imo). In setting and achieving COP08 targets, consideration has been
given to modulating AR's rapid COP07 scale up plans in order to concomitantly work towards continuous
quality improvement.
AR will implement HCT in existing TB DOTS centers to provide HCT to all TB patients and suspects and will
also ensure facility co-location of TB DOTS centers in all supported LPTFs. Referral mechanisms will
ensure TB/HIV co-infected clients access AIDSRelief (or other) supported HIV care and treatment services.
AR, with other IPs, will implement the PEPFAR-Nigeria LGA coverage strategy in Anambra, ensuring the
provision of TB/HIV services in at least one health facility in every local government area (LGA). This is a
critical step towards the provision of universal access for TB/HIV services. In line with this plan, HIV testing
will be done at an additional 5 functional TB DOTS sites in selected local government areas in Anambra
state.
In total, 42,070 HIV positive patients in care at all AR supported sites will be screened for signs of TB and
from these 7% (3,024) are expected to be diagnosed with active disease and will be treated for TB. The
TB/HIV program will be in collaboration with State and National Tuberculosis and Leprosy control programs
(STBLCP and NTBLCP). A total of 8,000 clients will be offered HIV counseling and testing services from the
TB DOTS centers; it is expected that 20%, or 1600, will be diagnosed with TB. Laboratory infrastructure will
be upgraded and human capacity developed to ensure adequate TB diagnosis for HIV positive patients. AR
will provide diagnostic equipment, including microscopes to supported TB DOTS sites. One high yielding
LPTF currently serves as a reference site for TB in the South Eastern region of the country. AR will also
strengthen the pharmacy services at supported TB DOTS sites to improve forecasting and avoid stock outs
and will work with sites to recognize if stock outs are due to facility level or government level TB logistic
weaknesses.
Through basic care and support services all TB/HIV patients will be put on cotrimoxazole prophylaxis
therapy (CPT). Community health care providers will trace family members of PLWHA accessing TB/HIV
services and facilitate their TB screening and appropriate care. This activity will be linked to activities in
basic care and support (through community and faith based organizations (CBOs/FBOs) and home based
care programs. TB/HIV treatment and care will be provided in a comprehensive approach consistent with
GON treatment guidelines and IMAI guidelines.
AR will ensure proper patient triage, specimen collection, waste disposal, proper ventilation and
administrative control activities such as active identification of those with TB symptoms and patient
segregation. TB infection prevention and control will be accomplished using these work practices,
administrative and environmental measures. Patient and staff education will be routinely conducted to
ensure program success. AR will develop joint adherence strategies for patients on ARVs and TB DOTS
and strengthen the facilities' capacity to meet special needs of PLWHA on both ART and anti-TB treatment.
Nosocomial transmission of TB to HIV+ patients will be prevented through measures and principles such as
basic hygiene, proper sputum disposal, and good cross ventilation at clinics. Facility co-location of TBHIV
services is preferred to clinic co-location. The national guidelines on infection control on co-located sites will
be implemented in all AR supported sites. Patients screened and treated for TB and TB/HIV will be entered
into the updated reporting tool provided by the NTBLCP with appropriate linkages of medical records
between TB and HIV points of service.
AR will train 72 healthcare workers in the TB/HIV program. Medical records staff will be trained on data
collection for suspected and diagnosed TB cases. Healthcare providers will be trained on x-ray diagnosis,
clinical management, and care of TB/HIV co-infected patients which will be complemented by onsite
preceptorships and mentoring to enhance case finding. Community health workers, treatment support
specialists (including PLWHA), and members of Society of People Affected by TB (SOPAT) will be trained
to assist with patient adherence to ART and anti-TB drugs. AR will hire 2 additional TB/HIV focal persons
and 1 TB laboratory specialist to support the current 2 TB/HIV focal persons for the management of this
program area. All AR TB staff will be trained/ retrained to enhance TB diagnostic and management skills.
senior CQI specialist. The 4 CQI specialists will be responsible for spearheading CQI activities in their
respective regions. This will include standardizing patient medical records to ensure proper record keeping
and continuity of care at all LPTFs. AR TB/HIV activities that will be addressed include program level
reporting to enhance the effectiveness and efficiency of both paper based and computer based Patient
Monitoring and Management (PMM) systems assuring data quality across all LPTFs. Using in-country
networks and available technology, AR will build a strong PMM system with added emphasis on
harmonization with the Government of Nigeria's (GoN) emerging National PMM system. AR's TB team will
work with the AR CQI specialists to conduct formalized site visits at least quarterly during which there will be
evaluations of TB/HIV clinic services, TB laboratory services, infection control practices, utilization of
National PMM tools and guidelines, proper medical record keeping, patient follow-up and referral
coordination. On-site TA/supportive supervision with more frequent follow-up monitoring visits will be
provided to address weaknesses when identified during routine monitoring visits. Each of these activities
will highlight opportunities for improvement of clinical practices.
approach to programming, AR will increase access to quality care and treatment, while simultaneously
strengthening health facility systems. All activities will continue to be implemented in close collaboration with
the Government of Nigeria (GON) to ensure coordination and information sharing, thus promoting long-term
sustainability. AR will continue to strengthen the health systems of LPTFs. This will include human resource
support and management, financial management, infrastructure improvement, and strengthening of health
Activity Narrative: management information systems. In collaboration with the CRS SUN project, AR will focus on institutional
capacity building for indigenous umbrella organizations such as the Catholic Secretariat of Nigeria (CSN).
These strategies will enable AR to transfer knowledge, skills and responsibilities to in-country service
providers.
TB/HIV care through collaborative activities with NTBLCP will contribute to the GON's goal for appropriate
TB/HIV care. The co-location of TB DOTS centers in all AR supported LPTFs will expand access to quality
TB services for HIV infected clients. This improved access will result in higher TB case detection and
improved clinical outcomes. The systematic implementation of TB/HIV collaborative activities by AIDSRelief
will contribute to Nigeria's 5-Year plan which is expected to result in synergies to decrease TB prevalence
rates.
LINK TO OTHER ACTIVITIES:
AR activities in TB/HIV are linked to HCT (5425.08), palliative care (5399.08), ARV services (6678.08),
PMTCT (6485.08), ARV drugs (9889.08), laboratory (6680.08), OVC (5416.08), AB (15655.08), and SI
(5359.08) to ensure that TB/HIV patients have a continuum of services. This will be in collaboration with the
7-Diocese program of CRS and other FBOs and CBOs. It will be linked to PMTCT to ensure that HIV
positive pregnant women are screened for TB, so that those dually infected are treated to reduce the risk of
transmission to the baby postpartum and to the community. This will also reduce the mother's morbidity and
mortality.
POPULATION BEING TARGETED:
The target population is all PLWHAs enrolled into the care and support program at LPTFs. In addition, TB
patients and suspects in supported DOTS centers are targeted. Household members of TB/HIV co-infected
patients will also be targeted as they are at increased risk of acquiring TB.
This activity has an emphasis on human capacity development through training to meet immediate
workforce requirements. Emphasis areas also include wraparound TB programs, renovations, quality
assurance, and development of linkages/referral and networks in collaboration with the STBLCP in support
of TB/HIV and TB DOTS programs. In addition, this activity will increase gender and age equity by ensuring
access to TB/HIV services for young women who account for 41% of TB cases in Nigeria and are about
60% of the PLWHAs screened for TB at LPTFs.
AIDSRelief (AR) has a family-centered approach for the care and treatment of PLWHA and those affected
by the epidemic, especially orphans and vulnerable children (OVC). In COP07, AR reached 2,239 OVC
through 28 Local Partner Treatment Facilities (LPTFs) and 10 satellite sites in 14 states (Adamawa,
Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Taraba). In
COP08, AR will work in 16 states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo,
Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Taraba) at a total of 30 LPTFs and 20 satellite sites.
During COP08, a full package of OVC services will be provided to 4,207 OVC including 2,270 HIV-positive
children receiving ART, HIV-positive children not yet eligible for ART, and HIV-negative children who are
vulnerable or orphaned due to the parent(s) being HIV-positive. In setting and achieving COP08 targets,
consideration has been given to modulating AR's rapid COP07 scale-up plans in order to concomitantly
AR 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 nutritional assessments
and support; ensuring adequate health care for OVC; and providing enhanced psychosocial support at both
the facility and community levels. AR will place significant emphasis on strengthening services to OVC
beginning with building skills in LPTF staff and community/home based care providers to identify children
who are OVC and providing them with appropriate services. Adequate health care will include strengthening
linkages and referrals to other facility services (maternal/child health, inpatient and outpatient departments).
Community based services will be strengthened to ensure referral to facilities for OVC households through
a family-centered opt-out approach to HCT services for all children <18 years of age and their caregivers.
Once OVCs have been identified, AR's OVC program focuses on providing an appropriate balance of
services in the facility, community and home settings. Through the establishment of linkages with CBOs,
FBOs and other OVC programs, in particular the Scale-Up Nigeria (SUN Project) of Catholic Relief Services
(CRS), AR will ensure that OVCs receive comprehensive care and support services and that there is
continuity of care in the home based care (HBC) setting. All OVC households will also receive a preventive
care package obtained from the USG-supported Society for Family Health containing ITN, water guard,
water vessel, soap, ORS sachets, and IEC materials on self care and common OI prevention. For HIV+
children under care and treatment AR will also provide full OVC comprehensive health services. This
includes laboratory analyses (CD4 count) and monitoring for OIs (such as TB). All HIV+ children and HIV-
exposed infants (through PMTCT) will receive cotrimoxazole according to GON guidelines. For the AR/SUN
collaboration where both collaborators are PEPFAR IPs, the SUN project will cover the costs of OI drugs
distributed in the HBC setting and will report these targets. AR, on the other hand, will provide the facility
based OI and TB management. To avoid double counting, AR carries out joint quarterly monitoring of these
activities using GON tools (FMWA) and OGAC OVC CSI.
All OVC and their households reached by the AR program will be assessed for the identification of specific
client/household needs and will be provided with psychosocial support. The psychosocial support provided
to OVC, including their caregivers, is multifaceted and comprehensive and includes counseling on stigma
and discrimination, disclosure, and grief, and recreational activities.
AR will provide nutritional services including nutritional assessment and micronutrient supplementation.
Malnourished children will be provided therapeutic nutritional supplements in collaboration with Clinton
Foundation and also via referrals to other PEPFAR-supported organizations offering food program for OVC
such as the MARKET activity and CRS 7 Dioceses (7D) in states where they are co-located. AR is exploring
the development of similar linkages with Christian Aid. Other services provided by AR include the facilitation
of birth registration for OVC within the program. In addition, AR will utilize wraparound services to ensure
that all OVC under 5 years are appropriately immunized. AR will also participate in advocating the GON at
the state levels for welfare services for OVC (e.g., free primary education).
Ninety healthcare workers will be trained in COP08 using national guidelines, OVC NPoA and OVC
standards of practice. Specific training relevant to each level of HCW will be provided at each LPTF for at
least one doctor, one nurse and one counselor. AR in partnership with the African Network for Children
affected by HIV (ANECCA) has developed a pediatric counseling course which will be rolled out to all
LPTFs and also offered to other stakeholders in Nigeria. Increasing skilled providers will help meet the
special needs of children and their parents/caregivers and will provide the support needed at the family level
by working with HBC programs under the 7D and SUN programs of CRS.
institutionalize quality interventions. This will include standardizing patient medical records to ensure proper
record keeping and continuity of care between LPTFs and communities. Monitoring and evaluation of the
AIDSRelief OVC program will be consistent with the national plan for patient monitoring. AR CQI specialists
and OVC focal persons will conduct team site visits at least quarterly during which there will be evaluations
of OVC services provided, the utilization of National PMM tools and guidelines, proper medical record
keeping, referral coordination, and use of standard operating procedures by the HBC and facility providers.
identified during routine monitoring visits. Each of these activities will highlight opportunities for
improvement of clinical practices.
Sustainability lies at the heart of the AR program. AR has developed a sustainability plan in year four of the
proposed program focusing on technical, organizational, funding, policy and advocacy dimensions. Through
its comprehensive approach to programming, AR will increase access to quality care and treatment, while
collaboration with the GON to ensure coordination and information sharing, thus promoting long-term
management information systems. In collaboration with CRS SUN project, AR will focus on institutional
Activity Narrative: CONTRIBUTION TO OVERALL PROGRAM AREA:
Scaling-up OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of
care to 400,000 children infected and affected by HIV/AIDS in Nigeria. The OVC activity will contribute to
the AR overall comprehensive package of care for PLWHAs by ensuring that children's specific needs are
met. Training activities will contribute to overall program sustainability by building the knowledge and skill
base across all supported sites.
AR activities in OVC are linked to HCT (5425.08), ARV services (6678.08), PMTCT (6485.08), ARV drugs
(9889.08), laboratory (6680.08), AB (15655.08), TB/HIV (5399.08), injection safety (6820.08), blood safety
(5392.08) and SI (5359.08) to ensure that OVC are provided a continuum of care. Linkages to CRS SUN,
7D and other CBOs will ensure the full provision of community and HBC services to OVC clients.
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. Health and allied care
providers in clinical and community settings will be trained to provide services to OVC.
EMPHASIS AREAS:
The activity has an emphasis on human capacity development through training and commodity
procurement. Other areas of emphasis include wraparound services (food, immunizations) and SI.
The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to
both male and female OVCs in AR-supported LPTFs.
AIDSRelief (AR) will increase support for counseling and testing (HCT) services from 28 Local Partner
Treatment Facilities (LPTFs), 2 PMTCT sites and 10 satellite clinics in COP07 (in 14 states Adamawa,
Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau, and Taraba)
to an additional 2 LPTFs and 10 satellite sites in COP08 in 16 states (14 above plus Abia and Imo). In
COP08 HCT activities will be expanded from 26 to 31 stand alone TB DOTS sites as well; these activities
are funded and outlined in the TB/HIV program. An emphasis will be placed on expansion into rural areas.
70,000 persons will receive HCT and receive their results. This includes 63,000 adults and 7,000 pediatric
clients. AR will build the capacity at existing and new LPTFs to enable them to integrate HCT services
within care and treatment systems and to increase uptake of HCT services in all points of service in the
facilities to ensure sustainability.
All HCT service outlets will be branded with the "Heart to Heart" logo. AR will utilize Provider Initiated
Testing and Counseling (PITC) and opt-out testing in COP08 in all supported healthcare facilities. These
approaches to HCT will be actualized by AR technical and programmatic staff through organized HCT
training, onsite mentoring /preceptorship of providers and the engagement of leadership at AR-supported
facilities. AR will also scale-up couples counseling and testing in all supported sites. AR will promote HCT
as a necessary and important arm of HIV prevention in terms of averting new infections and providing
treatment for those in need, and posttest counseling will be strengthened to lay emphasis on prevention for
positives. Posttest counseling will include full and accurate information on all prevention strategies.
Referrals to outlets that provide other prevention services not available at AR-supported facilities will be
provided and tracked.
All HCT sites will provide same day results and will use the current National testing algorithm. A switch to
the serial algorithm will occur if the national algorithm changes as expected. For infants and children less
than 18 months Early Infant Diagnosis (EID) will be available at PMTCT sites; lab testing for EID will be
done in conjunction with other IPs. The USG team will provide AR with rapid HIV test kits and AR will be
responsible for their warehousing, storage and distribution to LPTFs. Sites will be trained on forecasting and
stock control using bin cards and will maintain a three month buffer. LPTFs will report on inventory and
forecasting to the central office on a monthly basis. AR HCT sites will use the GON Heart-to-Heart logo for
ease of recognition by clients.
In COP08, AR will target the provision of HCT services PABAs as well as STI patients and TB DOT clients
at the LPTFs. AR will also provide HCT services as a routine component of blood transfusion services. All
HCT clients will be linked to prevention services, as well as treatment, care and support services where
applicable.
AR will train and retrain 320 LPTF staff on counseling and testing using the GON HCT training curriculum.
Counselor training will include couple counseling to strengthen this aspect of the program. This will ensure
the availability of a pool of trained counselors to promote continuity. In addition, providers will be sensitized
on the adoption of PITC and opt-out testing. Non-laboratorians will be used at multiple points of service for
facility based HCT where appropriate and when allowed by national policy. To this effect AR will train HCW
(counselors, nurses and outreach workers) that will be supervised by onsite laboratorians to assure quality.
To expand HCT services within the network of faith based organizations and increase rural access to HCT,
AR community based HCT will advocate for greater use of non-laboratory staff to conduct testing in the
community setting as well.
AR will carry out quarterly monitoring visits which focus on quality assurance and onsite mentoring. There
will be evaluations of counseling techniques, HCT testing algorithms, the utilization of the National CT
Register, proper medical record keeping, referral coordination, patient flow, and use of standard operating
procedures for HCT. On-site TA with more frequent follow-up monitoring visits will be provided to address
weaknesses when identified during routine monitoring visits. Semiannual partner meetings will provide an
additional forum for sharing of new information between sites and communities.
AIDSRelief will collaborate with faith based and community based organizations, in particular the 7-
Dioceses program of Catholic Relief Services, in carrying out community based and mobile HCT services.
AR will also collaborate with state and local government HCT programs by carrying out joint trainings and
monitoring visits. AR will also continue collaborations with FHI/GHAIN who will carry out HCT services
including mobile HCT services, training activities, and provision of IEC materials.
AIDSRelief will provide HCT services at 52 sites at the primary and secondary levels in rural and previously
underserved communities to provide services to 70,000 clients including 7,000 children thus contributing to
the PEPFAR and GON targets for increasing access to HIV counseling and testing. The HCT services will
enable the identification of HIV positive individuals in a timely manner and will direct them into care and
treatment services. HCT will also support AIDSRelief's target of placing 10,200 new clients on ART in
COP08. In addition, HCT services will add to the prevention strategies of averting new infections through
efficient and effective posttest counseling and patient education. HCT services will further contribute to the
National goal of universal access to HIV/AIDS services. By building LPTF capacity through training, salary
support to faith based institutions and refitting of LPTF counseling rooms, AR will contribute to the
sustainability of HCT activities at these sites and in Nigeria.
This activity also relates to activities in ARV services (6678.08), ARV drugs (9889.08), laboratory (6680.08),
care and support (5368.08), PMTCT (6485.08), OVC (5416.08), AB (15655.08), TB/HIV (5399.08), and SI
(5359.08). Linkage of HCT services to treatment, care and support services shall be strengthened within
and across programs and between other implementing partners using standard referral tools. AR will
establish referral linkages with National TB DOTs centers to ensure that TB patients are routinely screened
for HIV and those testing HIV+ are referred to AR LPTFs for HIV/AIDS care and treatment. The LPTFs will
ensure integration of the AR-supported HCT program with other departments to provide routine HCT
services to all patients and to ensure that those testing HIV+ are referred for appropriate care.
This activity targets the general population and in particular PABAs, STI patients, and TB patients.
Activity Narrative:
This activity has emphasis on training including supportive supervision and quality assurance/quality
improvement. There is an emphasis on local organization capacity building, community mobilization,
infrastructure development/renovation, and the development of linkages/referral systems.
The expansion of free HCT services will ensure gender equity in access to HCT services in rural and
previously underserved communities. It will also ensure that HIV-positive people are identified and linked to
timely life-saving ART services and HIV-negative clients are educated on the importance of avoiding risky
behaviors.
Track 1 and 2 funds are combined for this activity.
In COP07 AIDSRelief (AR) is providing ARV drugs to 18,304 PLWHAs at 28 Local Partner Treatment
Facilities (LPTFs) and 10 satellite clinics in 14 states of Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu,
FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. In COP08, AR will procure first and
second line ARV drugs to treat 28,200 patients including 27,914 adults and 2,270 children at 30 LPTFs and
20 satellite clinics in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo,
Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. An estimated 30% of PLWHA already enrolled
in care will start treatment during the year. An estimated 8% of ART clients will require 2nd line treatment in
COP08. In setting and achieving COP08 targets, consideration has been given to modulating AR's rapid
AR's supply chain management system will ensure that the necessary infrastructure, systems and skills are
in place for efficient forecasting, procurement, storage, and distribution of quality and efficacious ARVs to
AR-supported LPTFs with effective monitoring and evaluation. Assessment of new sites follows the AR
Information Gathering Tool and the Pharmacy Support and Assessment Standards Checklist. Pharmacies
will be refitted to improve commodity security. Technical support to LPTFs to institutionalize standard
operating procedures (SOPs) for drug management will continue in COP08. AR will train 30 pharmacists
and 30 other health workers including pharmacy technicians or assistants in the use of developed SOPs
which are in line with national guidelines. These SOPs include drug requests, receipts, recording,
dispensing, discrepancy reporting, temperature control and disposal of expired drugs. In-depth training of
the LPTF staff in the utilization of SOPs, forecasting and quantification for ARVs and general drug
management issues will be conducted.
All ARVs are from Good Manufacturing Practice certified sources and are FDA approved/preapproved.
Generic batches are tested by an independent laboratory (VIMTA) in India or CENQAM, North West
University, South Africa for compliance with all requirements before shipping. They are warehoused and
transported under air-conditioned environments in-country and have in transit insurance coverage. AR uses
the same supply chain management system for ARVs purchased under this program and for laboratory
reagents purchased under other program areas.
Procurement procedures follow USG and NAFDAC regulations and are consistent with National Treatment
Guidelines. NAFDAC importation waivers are secured through the USG for unregistered drugs. IDA and
Phillips Pharmaceuticals are contracted for procurement and CHAN Medi-Pharm for warehousing and
distribution. AR will substitute innovator proprietary ARVs with FDA approved generic equivalents taking
into consideration issues of safety, quality and cost. SCMS will be used for some of the drug procurement in
line with USG Nigeria's guidance on this, and potentially through an Indefinite Quantity Central Contract that
CRS-Baltimore has with SCMS. CHAN Medi-Pharm is the first source for palliative care drugs for AR
LPTFs. As a backup, AR will ensure that LPTFs can source for palliative care drugs from GON certified
distributors with evidence of regulatory clearance for quality reasons.
The Pharmaceutical Management Team manages country operations with a Therapeutic Drug Committee
(TDC) of clinicians, pharmacists, strategic information advisors and program managers. The TDC reviews
drug utilization patterns across all LPTFs, assesses scale-up progress and develops required technical
support plans. The TDC is replicated at the LPTF level to ensure that the ARV supply chain management is
clinically informed and logistically supported. Quality assurance covers the entire spectrum from
procurement to dispensing. All sites will be provided with ongoing TA by AR's Health Supply chain technical
team. Pharmacy and logistics management procedures will be assessed and will be part of site
development planning. The LMIS used includes a web-based enterprise inventory and financial
management system that allows drug tracking from procurement to dispensing and interfaces with the ART
Dispensing Software developed by MSH RPMPlus Program installed at LPTFs. The LMIS will be
harmonized with the national system.
CRS AIDSRelief has allocated $3,015,506 of its ARV Drugs budget to SCMS for procurement of
commodities. This amount is captured under the SCMS Drugs activity.
The ART drug activity will ensure that quality ARVs are supplied to all patients in a timely manner.
Appropriate product selection and forecasting will ensure the effective use of scarce resources. By scaling
out ARV drug services to 2 new LPTFs and 10 satellite clinics in COP08 (mostly rural based primary and
secondary faith based facilities), AR will contribute towards the National and PEPFAR plans of increasing
access to ARV drugs in previously underserved communities. As expansion of ARV drug services is
prioritized to rural areas, AR will strengthen existing referral channels and will support network coordinating
mechanisms. By providing ARV drug services to 28,200 clients, the activity will contribute to the PEPFAR
target of providing ARV drugs to 350,000 PLWHAs in Nigeria by 2009 as well as to the Government of
Nigeria's (GON) plan for universal access to ARV drugs by 2010.
In contributing to overall sustainability, the capacity of LPTFs to take on supply chain responsibilities will be
strengthened. AR will continue strengthening local distribution agents (CHAN Medi-Pharm) and helping
LPTFs integrate ARVs with other hospital drug management systems.
This activity is linked to ARV services (6678.08), basic care and support (5368.08), OVC (5416.08), and
PMTCT (6485.08), thus ensuring continuity of services to all AR supported clients. It is also linked to
laboratory (6680.08), by providing the supply chain for lab reagents and SI (5359.08) for LMIS services. AR
will continue collaboration with other IPs including Harvard/APIN+, GHAIN, ICAP-CU, and IHVN-ACTION
for information sharing on procurement mechanisms and for sharing of supplies when unanticipated delivery
delays occur. AR will continue collaboration with the GON in the harmonization of procurement and
forecasting for ARVs. Opportunities for leveraging on expertise in training will be actively pursued. AR will
collaborate with the Clinton Foundation in order to leverage their resources for OI drugs, pediatric lab
reagents and ARVs, and adult second line ARVs. In addition, AR will partner with Global Fund as
appropriate to leverage resources for providing antiretroviral drugs to patients. Currently 10% of ART
patients at AR-supported LPTFs are receiving GON procured ARV drugs; in COP08, AR will continue this
Activity Narrative: collaboration. The program will, as part of the global AR effort, proactively identify areas of collaboration
with USAID's SCMS project for long term harmonization and local sustainability.
TARGET POPULATIONS:
The activity targets all PLWHAs, particularly those qualifying for ART according to WHO and GON
guidelines, including women from PMTCT clinics and children in OVC programs.
This activity has an emphasis on local organization capacity building, logistics, training (including in-service
supportive supervision), renovations of pharmacy/stock rooms, quality assurance/quality improvement and
linkages with other sectors and initiatives.
In COP07 AIDSRelief (AR) is providing ART services to 28 Local Partner Treatment Facilities (LPTFs) and
10 satellite sites. In COP08 these services will be increased to cover 30 LPTFs and 20 satellites across the
Nasarawa, Ondo, Plateau, and Taraba. Through primary and secondary faith-based facilities AR will extend
ART services to underserved rural communities to reach 10,200 new patients (including 1000 children) for a
total of 28,200 active patients (including 2270 children) reached in COP08. In setting and achieving COP08
targets, consideration has been given to modulating AR's rapid COP07 scale-up plans in order to
concomitantly work towards continuous quality improvement.
All LPTFs will have the capacity to provide comprehensive quality ART services through a variety of models
of care delivery. This includes quality management of OIs and ART, a safe, reliable and secure
pharmaceutical supply chain, technologically appropriate lab diagnostics, treatment preparation for patients,
their families and supporters and community based support for adherence. This technical and programmatic
assistance utilizes on-site mentoring and preceptorship. It also supports the development of site specific
work plans and ensures that systems are in place for financial accountability. AR will adhere to the Nigerian
National ART service delivery guidelines including recommended first and second line ART regimens. In
addition, AR will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for
providing antiretroviral drugs to patients.
In COP07 AR trained 690 health service providers. In COP08 AR will train and retrain an additional 400
health service providers. Training topics include ART clinical care, treatment adherence and laboratory
monitoring consistent with the National ARV guidelines/training curriculum. AR will make special efforts to
increase LPTF capacities in the delivery of pediatric ART services, including counseling, using one of its
established partners in Jos for practical training. In COP08 AR will continue conducting 2-week intensive
didactic and practical trainings preceding site activation followed by continuous onsite mentoring. Training
will maximize use of all available human resources including a focus on community nursing and community
adherence. AR will work closely with the USG team to monitor quality improvement at all sites and across
the program.
AR will work with supported sites to identify HIV-infected patients, 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. Non ART eligible individuals will
be enrolled into care for periodic follow-up, including laboratory analysis at least every 6 months, to identify
changes in ART eligibility status. All enrolled PLWHA will have access to the preventive care package
(water sanitation/treatment education, ITN), and be linked to community social services. Other care
components, discussed under the basic care and support narrative, include TB screening, OI
prophylaxis/treatment, routine laboratory analysis, and nutritional counseling. ART sites at LPTFs are co-
located in facilities with TB DOTS centers to facilitate TB/HIV service linkages. As a part of comprehensive
service delivery, activities addressing prevention for positives shall be enhanced through counseling and
provision of full and accurate information for PLWHA including discordant couples.
A key component for successful ART is adherence to therapy at the household and community levels.
PLWHA on treatment are encouraged to have a treatment support person such as a family member to
whom he/she had disclosed HIV status to improve support in the home and increase adherence. AR will
continue to build and strengthen the community components by using nurses and counselors to link health
institutions to communities. Each LPTF will appoint a specific staff member to coordinate the linkages of
patients to all services. This will also build the capacity of LPTFs for better patient tracking, referral
coordination, and linkages to appropriate services. These activities will be monitored by the AR technical
and program management regional teams.
and institutionalize quality interventions. AR will hire an additional three CQI staff that will be supervised by
the CQI specialist. These 4 CQI specialists will be responsible for spearheading CQI activities in their
and continuity of care at all LPTFs. Monitoring and evaluation of the AIDSRelief ART program will be
consistent with the national plan for patient monitoring. The CQI specialists will conduct team site visits at
least quarterly during which there will be evaluations of infection control, the utilization of National PMM
tools and guidelines, proper medical record keeping, efficiency of clinic services, referral coordination, and
use of standard operating procedures across all disciplines. On-site TA with more frequent follow-up
early discontinuation of treatment. In addition, at each LPTF an annual evaluation of program quality shall
consist of a 10% random sample of linked medical records, adherence questionnaires and viral loads to
examine treatment compliance and viral load suppression for adult patients who have been on treatment for
at least 9 months. A similar process will be undertaken for all children who have been on ART for at least 9
months. Each of these activities will highlight opportunities for improvement of clinical practices.
Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health
systems strengthening. AIDSRelief has developed a Sustainability Plan in Year 4 focusing on technical,
organizational, funding, policy and advocacy dimensions. Through its comprehensive approach to
programming, AR will increase access to quality care and treatment while simultaneously strengthening
health facility systems. All activities will continue to be implemented in close collaboration with the
Government of Nigeria (GON) to ensure coordination and information sharing, thus promoting long term
management information systems. In collaboration with the CRS SUN project, AR will focus on institutional
AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in
the USG coordinated clinical working group to address ongoing topics in ARV service delivery.
CRS AIDSRelief has allocated $315,000 of its ARV Services budget to SCMS for procurement of
commodities. This amount is captured under the SCMS ARV Services activity.
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
By adhering to the Nigerian National ART service delivery guidelines and building strong community
components into the program, this activity will contribute to achieving the overall PEPFAR Nigeria target of
placing 350,000 clients on ART by 2009 and will also support the Nigerian government's universal access to
ART by 2010 initiative. By putting in place structures to strengthen LPTF health systems, AR will contribute
to the long term sustainability of the ART programs.
This activity is linked to HCT services (5425.08) to ensure that people tested for HIV are linked to ART
services; it also relates to activities in ARV drugs (9889.08), laboratory services (6680.08), care & support
activities including prevention for positives (5368.08), PMTCT (6485.08), OVC (5416.08), AB (15655.08),
TB/HIV (5399.08), and SI (5359.08).
AR will collaborate with the 7-D program of Catholic Relief Services to establish networks of community
volunteers. Networks will be created to ensure cross-referrals and sharing of best practices among AR and
other implementing partner sites. Effective synergies will be established with the Global Fund to Fight AIDS,
Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders.
This activity targets PLWHA, particularly those who qualify for the provision of ART, from rural and
underserved communities. Special focus will be placed on identification and treatment of HIV infected
children.
This activity will include emphasis on human capacity development specifically through in-service training.
These ART services will also ensure gender and age equity in access to ART through linkages with OVC
and PMTCT services in AR sites and neighboring sites. The extension of ARV services into rural and
previously underserved communities will contribute to the equitable availability of ART services in Nigeria
and towards the goal of universal access to ARV services in the country. The provision of ART services will
improve the quality of life of PLWHA and thus reduce the stigma and discrimination against them.
This activity ensures that appropriate Lab support is provided for lab diagnosis, clinical monitoring and HIV
testing. Linkages with HVSI will ensure tracking of lab infrastructure indicators. AIDSRelief (AR) works in
tertiary and secondary health care facilities to provide quality HIV and AIDS services to people living with
HIV and AIDS (PLWHAs). AR supports Laboratory (Lab) infrastructure to all of our local partner treatment
facilities (LPTFs).
AR provides on-site capacity to test for HIV, laboratory monitoring of disease progression and response to
treatment, opportunistic infections (OIs) diagnosis and monitoring of antiretroviral drug (ARVs) toxicity. AR
will support the improved diagnosis of TB, cryptococcal infection, syphilis, hepatitis B (HBV) and other
bacterial infections. AR does not routinely do Viral load (VL) testing since our LPTFs are mostly primary and
secondary level facilities, but ensure that VL testing is done to make difficult therapy switch decisions as
well as for program evaluation on a random 10% subset of our clients from each LPTF who have been on
therapy for longer than 9 months annually at Institute of Human Virology (IHV-ACTION) supported
laboratories and at 2 of our LPTFs with VL capacity. In addition, 2-3% of AR clients on ART would require
VL testing based on clinical indications. AR will also support expansion of early infant diagnosis (EID) at
PMTCT supported facilities in accordance with the national EID scale up plan. AR will provide standardized
training and supplies for collection and transport of dried blood spots (DBS) and clinical samples.
AR will continue to participate in the USG-Nigeria coordinated Laboratory Technical Working Group (LTWG)
to ensure harmonization with other IP and the Nigerian government. AIDSRelief will continue to work with
the PEPFAR LTWG for the development of a common Lab equipment platform appropriate for each lab
level.
In COP07 AIDSRelief is providing support to 30 sites in a total of 14 states (Adamawa, Anambra, Benue,
Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau and Taraba). Of these 30 sites,
28 are secondary level and 2 are tertiary level. Two of these facilities have PCR capacity: 1) St Vincent's
DOC (DREAM model) has bDNA VL testing supported by CRS private funding and 2) Annunciation
Specialist Hospital in Enugu has NucliSens VL machine (initiated prior to PEPFAR). AR will continue
providing automated CD4 testing equipment with capacity for processing large patient loads, cytosphere
reagents using binocular microscopes that are easy to use and appropriate for secondary care centers for
manual CD4 testing as backup in place of automated CD4, hematology analyzers and chemistry machines.
All labs will be supported to test for syphilis, TB, HBV, hematology, chemistry, cryptococcosis and CD4. In
COP 07, AR provided 5 LPTFs with fluorescent microscopes. In COP08, fluorescent microscopes will be
provided to 5 additional LPTFs. In addition to 10 primary level satellites activated in COP07, 10 new satellite
sites will have a laboratory capacity for hematology and HIV rapid testing and positive patients will be
referred to the parent site for ART. Satellite sites do not have full laboratory capacity and are therefore not
counted as lab targets. In setting COP08 targets and expansion, consideration has been given to
modulating AR's rapid COP07 scale up plans in order to concomitantly work towards continuous quality
improvement.
All equipment will be centrally procured and shipped to Nigeria. AR in-country lab specialists will be
responsible for equipment installation. All AR lab specialists have received training by CD4 manufacturers
as maintenance engineers to service CD4 machines. 10% of the cost of all equipment is kept in reserve for
maintenance purposes.
In COP08 AR will develop a comprehensive lab program with 9 locally based FTE lab specialists focused in
the following areas: 1 centrally based lab program director, 1 equipment installation/trouble shooting, 3
QA/QC, 1 blood / injection safety, 1 TB lab and 2 training. These will be supported by a Baltimore-based lab
specialist.
AR will use its reagent forecasting tools at all levels to determine consumption and predict need, to forestall
stock outs. Working with SCMS and CHANPharm, AR will centrally procure lab reagents from
manufacturers locally and abroad and distribute to LPTFs. HIV Test kits will be provided directly by the USG
through the SCMS mechanism.
AR works with UMD-ACTION for external QC, back-up CD4 testing support, training support for EID/DBS
and provision of specialized Lab tests such as VL and DNA-PCR. To support pediatric diagnostic and
treatment, Clinton Foundation will provide DBS collection material, transportation of specimens/results and
CD4 test reagents. AR will work with MMIS to provide blood safety training and AD needles to all sites.
To ensure safe lab conditions, AR will increase its provision of appropriate sharps and bio-medical waste
disposal containers at all sites. AR will ensure the availability of functional incinerators and/or collection of
biomedical waste by approved, private companies. AR will also support post HIV exposure programs (PEP)
at all sites.
In COP 08, AR will work with MLSCN to gain accreditation for 10 labs. This will include 2 tertiary and 8
secondary sites across 5 states.
In COP08 AR will contract with IHV-ACTION tertiary lab specialists to train 90 lab personnel from all LPTFs
in the following areas: HIV diagnostics, CD4, chemistry, hematology and OI diagnosis. AR emphasizes
hands-on training during laboratory start up in lab techniques and lab management. Refresher trainings are
done at six months and periodically as per identified needs at each LPTF. AR provides simplified lab
manuals to reinforce each training episode. AR use Nigerian Institute of Medical Research Training
Manuals to supplement simplified manual from IHV-University of Maryland.
AR will conduct QA activities consisting of quarterly site monitoring visits (using a standardized tool
developed by the LTWG), quarterly proficiency testing (PT) for all tests and reporting of these results into a
centralized system. AR will sub-contract to IHV ACTION for support of the AR PT program.
AR lab personnel and selected partner personnel will participate in the training of trainers (TOT) lab
management program to be provided by Association of Public Health Labs, with support from USG-Nigeria.
Activity Narrative: They will then transfer the knowledge gained to all LPTF lab personnel using the provided training
materials.
By supporting Lab infrastructure AR will help all LPTFs carry out 282,738 tests (including testing for 7,000
children). This will contribute to the Nigeria PEPFAR target of preventing 1,145,545 new infections in
Nigeria by 2010. The activity will also contribute to AIDSRelief's target of providing quality ART services to
28,200 clients including 2,270 pediatric patients in COP08. This activity will also contribute to the reduction
in Mother to child transmission of HIV and early detection of any infant HIV infection. The activity will further
contribute to the reduction and early detection of any treatment failures among our clients by providing for
VL tests for a subset of the 28,200 ART clients in COP08. This will support the possible need for ARV
regimen switch for patients failing on first line regimens. The activity will also provide infrastructure and
training for TB diagnosis for the 42,070 clients in care at the 30 LPTFs and will contribute to the overall
program sustainability by improving Lab infrastructure and by building capacity among primary and
secondary level facilities.
(6485.08), ARV drugs (9889.08), OVC (5416.08), AB (15655.08), TB/HIV (5399.08), and SI (5359.08) to
ensure that appropriate Lab support is provided for lab diagnosis, clinical monitoring and HIV testing. AR
will collaborate with IHV-ACTION, other implementing partners and state hospitals to optimize resources
and strengthen the comprehensive networks of care across the 16 states including centralized lab training,
establishment of high level laboratory services for VL testing and EID. AR will link LPTFs with local and
PEPFAR procurement and distribution agents such as CHANPharm and SCMS to ensure a sustainable
supply chain for lab reagents. AR regional program managers will act as network coordinators.
In COP07, AIDSRelief provided strategic information (SI) management services to 28 local partner
treatment facilities (LPTFs), 10 satellite clinics, 28 tuberculosis (TB) DOTS centers and 2 prevention of
mother-to-child transmission (PMTCT) sites in 14 states (Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu,
the FCT, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Taraba). In COP08, AIDSRelief will provide
support for SI management for 30 LPTFs, 20 satellite clinics, 2 PMTCT and 31 TB DOTS sites for a total of
83 facilities in the aforementioned states plus Abia and Imo. In setting and achieving COP08 targets across
all program areas, consideration has been given to modulating AIDSRelief's rapid COP07 scale up plans in
order to concomitantly work towards continuous quality improvement in SI activities.
AIDSRelief's SI activity incorporates program level reporting and implementation of both paper-based and
computerized Health Management Information Systems (HMIS) for AIDSRelief LPTFs. This activity is
coordinated by Constella Futures, one of AIDSRelief's consortium members. Using in-country networks and
available technology, AIDSRelief will build a strong Patient Management Monitoring (PMM) system with
added emphasis on harmonization with the Government of Nigeria's (GON) emerging National PMM
system. It is anticipated that the USG-supported Voxiva system will complement the National system when
the Voxiva web-portal becomes operational. AIDSRelief will support the implementation of this system at
appropriate points of service. As part of capacity building and contribution to program sustainability
AIDSRelief currently provides logistical support for automated PMM to AIDSRelief LPTFs by providing them
with computers and other logistical support systems and will continue to do so in COP08.
In COP08, AIDSRelief will strengthen its program for Continuous Quality Improvement (CQI) in order to
improve and institutionalize quality interventions. This will include standardizing patient medical records to
ensure proper record keeping and continuity of care at all LPTFs. AIDSRelief will continue to provide TA to
LPTFs and personnel to adapt and harmonize existing tools to meet the standards of the GON and ensure
proper roll-out of GON's revised PMM tools. Monitoring and evaluation of the AIDSRelief program will be
consistent with the national plan for patient monitoring. AIDSRelief's SI team will work with the AIDSRelief
CQI specialists to conduct site visits at least quarterly during which there will be evaluations of the utilization
of National PMM tools and guidelines, proper medical record keeping, efficiency of clinic services and
referral coordination. Data flow including data collection, management and reporting will be assessed and
recommendations for improvement will be given. Supportive supervision and mentoring will be provided to
all on-site staff that collect and utilize data (e.g., clinicians, pharmacists, data entry personnel,
administrators). On-site TA with more frequent follow-up monitoring visits will be provided to address
weaknesses when identified during routine monitoring visits. In order to provide comprehensive support for
all program activities the current AIDSRelief SI team of 3 will be expanded to a minimum of 8 staff who will
comprise the headquarters team in Abuja and the regional teams.
A total of 120 LPTF personnel (including but not limited to data entry personnel, clinicians, nurses,
pharmacists, and administrators) will be trained in PMM to ensure that all health workers coming into
contact with patient records use them appropriately. State M&E officers shall be informed of, and involved in
the monitoring processes and the training programs in order to instill a sense of ownership and ensure
sustainability of these efforts. This strategy is in line with the USG SI data quality assessment/ improvement
(DQA/I) and capacity building plan. Additionally, information shall be shared and feedback from periodic
(monthly and quarterly) reports shall be provided to LPTFs and respective state and local government
agencies for AIDS control (SACAs and LACAs) for their planning purposes.
AIDSRelief SI team will continue to be active participants on the SI working group established and
coordinated by USG-Nigeria as well as the GON's National M&E Technical Working Group and its sub-
committees. In this regard, AIDSRelief will also actively participate in the proposed HIVQual implementation
at all sites where applicable. Another effort being implemented at the site level is the use of Life Table
Analysis (LTA). The LTA publicly-available software will assist LPTF partners to analyze and interpret their
patient data using simple procedures and recognized statistics. These procedures compute program
continuation rates from existing medical records maintained by the ART program. AIDSRelief will train LPTF
personnel to enable them to continue to conduct these LTAs independently and thus contribute to the
sustainability of this activity. Due to the limitations of the CAREWare software that has been in use by
AIDSRelief across 9 countries, in COP07 AIDSRelief is working towards transitioning to IQCare software,
which provides for a more robust open source, freeware solution. IQCare will be introduced into new LPTFs
and will continue to be supported, developed and enhanced in the existing ones. AIDSRelief will participate
in the harmonization process of the existing IQCare with the National Public Health online real-time data
system (Voxiva).
Improvement in SI management capacity of existing and new LPTFs will instill a data use culture that leads
to improved quality of care. Staff training across the AIDSRelief sites in 16 states will contribute to overall
program capacity building and sustainability. The provision of logistics for automated PMM will contribute
towards the GON and USG strategy on provision of quality and timely data for decision making.
This activity relates to all AIDSRelief HIV/AIDS activities - basic care and support (5368.08), ARV services
(6678.08), ARV drugs (9889.08), counseling and testing (5425.08), PMTCT (6485.08), TB/HIV (5399.08),
OVC (5416.08), blood safety (5392.08), injection safety (6820.08) and laboratory infrastructure (6680.08).
All programs require a robust data management system and data quality checks to ensure effective
programming.
The AIDSRelief SI activity targets AIDSRelief LPTF personnel including those primarily engaged in SI
activities (on-site project coordinators, on-site M&E officers, data entrants, medical records technicians) and
other health care workers (physicians, nurses, counselors, pharmacy and laboratory staff). This is to ensure
that all personnel coming in contact with the patient keep appropriate records and manage them efficiently
and effectively.
This activity has a major emphasis on strategic information (HMIS development) and reporting for program
level M&E with emphasis on targeted evaluations, logistics and training.
Activity Narrative: ACTIVITY DESCRIPTION:
