ACTIVITY DESCRIPTION:

In COP07 7D PMTCT had 12 sites in Benue, FCT, Kaduna, Cross River, Lagos, Kogi, Ebonyi and Niger.

These will be expanded to 16 sites in COP08 with concentration in Benue and a new site in Benin City.

This project seeks to increase access to PMTCT services for pregnant women by building community

support for PMTCT and increasing the capacity of health facilities to provide PMTCT services. 7D will use

existing diocesan AIDS structure and Parish AIDS Volunteers (PAVs) to create demand for PMTCT

services through social mobilization campaigns in two ways. Firstly, PMTCT Point of Services (POS) will

establish a network of Primary Health Care Centers that will provide basic ANC and Counseling and Testing

Services for everyone including pregnant women. Secondly, educational sessions on PMTCT followed with

C&T will be done in churches and Parishes using existing 7D structures and volunteers. CRS 7D will create

and strengthen linkages between its PMTCT program and treatment services offered by other IPs.

The uniqueness of this structure is the integration of Community based PMTCT with Health Facility based

PMTCT. This synergy will facilitate effective tracking of HIV positive pregnant through out the course of their

pregnancy and after delivery. This tracking is essential to support women with infant feeding choices they

will make.

The PMTCT services will follow the newly revised national PMTCT guidelines which include group health

information and routine Counseling and Testing (CT) using opt out strategy with same day result, partner

testing, OI treatment and prophylaxis, infant feeding counseling during first and subsequent ANC visits, and

ART prophylaxis for pregnant women. Free baseline hematinics, STD screening, CD4 Count and viral loads

where possible, will be conducted to all pregnant women accessing PMTCT in 7D supported site. Family

Planning services will be provided on site. Where these services are not available, they will be referred to

facilities including AIDS Relief (AR) ART sites and other IPs.

7D PMTCT Sites are positioned within AIDS Relief, FGON and IPs' ART networks to which women who

need ART will be referred. Since 7D and AR PMTCT Team functions as a unit and are co-located in 90% of

sites, seamless transition of patients between the two will be initiated. This will happen in two ways. The first

way is through the existing co-location in facilities. Since 7D PMTCT and AR ART are already located in the

same facilities in current 7D PMTCT sites, those women found to have a lower CD4 Count (<200) and to be

eligible for HAART will be taken up by AR. Secondly, referral within the geographic area will take place, with

7D PMTCT enrollees who qualify for HAART being referred to a nearby AR sites where they will receive

these services. This referral mechanism will function smoothly since 7D and AR PMTCT Teams currently

function as an integrated team that plans and executes tasks as one unit.

For those not requiring HAART, the nationally recommended short course will continue to be available. This

includes ZDV from 28 weeks or LAM + ZDV from 34-36wks and single does NVP at onset of labor as well

as a 7 day Combivir tail. Women presenting in labor will be offered rapid testing and if HIV-infected provided

with SD-NVP and a 7 day Combivir tail. All infants born to HIV-infected women will be provided with SD-

NVP according to the guidelines (July 2008) on PMTCT. It will ensure that all PMTCT sites have and utilize

the approved National PMTCT registers.

Exposed infants will be actively linked to pediatric care and treatment, and their families will be referred to

age-appropriate OVC services. 7D will offer HIV infant diagnosis testing in line with the nationally

recommended Early Infant Diagnosis Initiative from 6 weeks of age using Dried Blood Spots. Infants will

also be linked to immunization services to access the WHO/UNICEF and FGON recommended set of

vaccines.

7D will collaborate with TBAs through trainings using nationally recommended curriculum and will provide

PMTCT HBC kits and information packs for effective support of pregnant women who choose to give birth

outside health facilities. Through this training TBAs will provide support for and promote utilization of

PMTCT services. TBA's from each PMTCT site will be trained totaling 115 trained TBAs. 5 TBAs from 13

partner arch/dioceses will also be trained resulting into 65 trained TBAs. Altogether 180 TBAs trained will

each reach 100 women with improved information and obstetric practices on PMTCT. Altogether 18,000

pregnant women will receive counseling, testing and test results.

Counselors from 7D and PMTCT sites will be trained as Trainers on infant feeding using the WHO/UNICEF

infant feeding manual currently being adapted for use in Nigeria. 2 counselors per PMTCT site and 2 per

partner arch/diocese will be trained giving a total of 58 staff trained. Each of these trained counselors will

train 10 others giving a total of 580 trained people. Each of these trained people will reach 5 mothers,

therefore 3,410 mothers will be reached with infant feeding counseling.

To ensure quality, monthly supervisory visits will be made by diocesan staff to each site. CRS staff will visit

each site quarterly and visits with USG/GON/IP will occur bi-annually. These will continue in COP08.

Monitoring tools will be improved and disseminated to all arch/dioceses. Volunteers will continue to be been

sensitized on PMTCT, maternal nutrition and safe infant feeding practices for correct PMTCT service

provision. Volunteers will support mothers' infant feeding choices through on-going counseling in line with

the national guidelines which is exclusive breast feeding for 6 months with abrupt cessation or exclusive

replacement feeding if the AFASS criteria are met.

Support and capacity building given to Abuja, Ibadan and Kaduna provincial structures in COP07 will

continue in COP08. This support has encompassed engagement of key points of staff and included capacity

building for both PMTCT and financial management specialists.

Targets for COP 08 included CT for 18,500 pregnant women with 18,000 receiving results, 1,000 pregnant

women placed on antiretroviral prophylaxis and training of 44 health care workers using national PMTCT

curriculum in 16 sites.

The 11 centers activated in COP06 and carried through to COP07 required extensive financial and technical

investment for startup; therefore cost per beneficiary was comparatively higher. The 12 COP07 sites are

located in Lagos, Benue, Ibadan, Kaduna, Edo and Abuja. These will be carried through COP08 and 4 new

sites will be activated. Overall costs will not reduce because significant investments in PMTCT demand

creation and establishment of referral ANC and HCT networks will be undertaken more intensively in

Activity Narrative: COP08.

Collaboration with the FMOH on HIV and Infant feeding counseling and other PMTCT services will be

strengthened. Support will be given for a National zonal TOT on Infant feeding counseling. 7D will be

involved in the PMTCT TWG which provides guidance and leadership to the USG PMTCT program.

COPO7 Plus Up funds were used for hiring PMTCT Specialists to respond to immediate and long term

PMTCT needs. It also enabled 7D collaboration with AR in leveraging resources and expertise through

forming a PMTCT Team that plans and responds to 7D, AR and partner PMTCT needs coherently. Partner

PMTCT capacities have been enhanced through training of POS staff and archdiocesan PMTCT

coordinators. Site antenatal clinic refurbishment and laboratory support have also been done. These

activities will continue throughout COP08

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activities that were conducted in year 2007 that will continue in 2008 include CT, HBC, and Support Groups

for HIV positive pregnant women. Infant feeding counseling in all sites will be undertaken. These PMTCT

services will continue to contribute to several of the PEPFAR goals. The goal of preventing new infections

by offering CT services to pregnant women, as well as providing PMTCT prophylaxis to prevent infecting

the newborn child is already contributing to prevention of new infections.

LINKS TO OTHER ACTIVITIES :

PMTCT activities will be linked to CT (3.3.09), ART (3.3.10 and 3.3.11) services, care and support (3.3.06),

TB/HIV (3.3.07), and OVC (3.3.08) services. 7D has established referral linkages with TB DOTs centers

and other health care facilities to ensure that PMTCT clients are treated for TB, STIs and other opportunistic

infections. However there will be STI and opportunistic infection treatment in 7D supported health facilities.

7D will work closely with AR for ART services where project activity areas overlap. Referral coordinators

have been employed to ensure timely referrals to services offered by other implementing partners. This

area has been identified as a "best practice" that needs support both at state and national levels.

POPULATIONS BEING TARGETED:

Women (including women of reproductive age), pregnant women and HIV + pregnant women, their care

givers, partners, religious leaders and children are the populations being targeted.

EMPHASIS AREAS :

The emphasis area is local organization capacity development and development of

linkages/networks/referral systems, and training. Gender-activities have been organized with the aim of

addressing inequalities between men and women and subsequent behaviors that increase the vulnerability

to and impact of HIV/AIDS. Provisions were made for training/education on couple counseling, stigma

reduction and risk taking. Women's legal rights and access to income and productive resources will be

carried out through linking care and support programs to income generation activities within 7D SUN

programs.

ACTIVITY DESCRIPTION:

During COP08, CRS 7 Dioceses (7D) will support Catholic Secretariat of Nigeria (CSN) in its role as a

training body. CSN will conduct workshops for clergy and laity in partnership with 13 Arch/dioceses from

COP06's 10 Arch/dioceses, and provide marital counseling trainings and ongoing support to 13 partner

Arch/dioceses. CRS 7D's support will enable CSN to continue developing accurate, target-specific and

"faith sensitive" IEC/BCC materials and to sensitize clergy, catechists, and laity including Imams and other

Muslims leaders on AB prevention in six additional arch/dioceses.

7D will tailor its AB activities to conform to the national BCC strategy and ensure that each person reached

with AB activities benefit from at least three AB services: Peer education, community awareness

campaigns, and a school based approach. In COP08 7D will support three new dioceses. This is not a

geographic expansion, but rather an administrative division to enable wider and more concentrated LGA

coverage in the larger dioceses.

AB information will be delivered during Sunday mass services. A total of 570 individuals will be trained in 19

arch/dioceses. Each of these individuals will reach 500 people at mass each week over the course of the

year. These 285,000 individuals are not hearing a one-off message, but rather hearing about the issue,

from trusted advisors, continuously over time. This community mobilization strategy keeps the issue of

HIV/AIDS in the fore, educates people, motivates volunteers and raises awareness about available

services.

Each of the 13 partner arch/dioceses will be supported to train 15 couples (30 individuals) in marital

counseling totaling 195 couples (390 individuals) trained in AB prevention during a five day training program

with additional monthly follow-up over 6 months. The program is premised on building strong and intact

families using Christian principles as a shield against HIV/AIDS. The program's goal is to build happy and

lasting marriages that prevent HIV infection using the concept of building a house with the four pillars: True

love, Faithfulness, Respect and dignity for human life and communication with God and one another among

married couples. The trained couples will train a minimum of five couples each totaling 975 couples (1950

individuals). Therefore, 2,340 individuals will receive comprehensive marital counseling training. This

intensive approach includes community mobilization, peer education and IEC materials.

The marital training itself is also peer education and includes IEC materials for individuals already reached

by community mobilization at mass. Each of the 195 originally trained couples will also conduct marital

counseling for ten other couples over the course of the year, resulting in 3,900 receiving three AB services.

Each of the second group of 975 marital counselor couples will reach an average of four couples each,

thereby reaching another 7,800 individuals with this very intense AB approach.

The husbands as well will play an active role in educating their children and friends on AB. 7D will

encourage each of the 7,020 couples (1170 counseling couples and 5,850 counseled couples) enrolled in

the program to dialogue with their children on "A" specific messages. In this way, during COP 08, the project

will reach a total of 21,060 children with three strategies to promote "A" behaviors, including tips to prevent

sexual abuse.

Each of the 13 partners will initiate youth activities in two primary and two secondary schools with Anti-AIDS

youth clubs. Through these clubs 1,040 young people attending schools will receive repeated and

concentrated training in "A". Of these, 520 will be from secondary schools where they will be trained in

secondary abstinence and a similar number from primary schools that will be trained in primary abstinence.

It is expected that on average these groups will reach 15 other school attending youths per member with

community mobilization+, IEC and peer education/counseling service, totaling situations totaling 15,600

youths reached with three "A" strategies.

AB Prevention trainings will be conducted for 300 PLWHA, who are serving or have the potential to serve as

Support Group Leaders. Those trained will counsel and communicate information about AB Prevention in

support groups, households and communities. Each of these will reach 50 people giving totaling 15,000

people. Those willing to disclose their HIV positive status as part of AB prevention will be supported with

additional training and logistics. Each of these support group participants receive community mobilization,

IEC, peer education and vulnerability reduction strategies, and active recruitment and involvement of

PLWHA will be encouraged among the partner dioceses in line with the GIPA principle.

HCT Centers will form a critical forum for AB prevention. HCT centers will be supported with formation and

management of Post Test Clubs. These post test clubs will offer counseling on AB to all those tested.

Refreshment and transport subsidies will be offered to participants. Other support will include development

of Post Test Information Packs, materials and curriculum to be given to all tested. The 27,000 people

targeted under palliative care will be reached with AB information, though not by three strategies.

Home-based care and counseling conducted by Parish AIDS Volunteers (PAVs) will include AB information

sessions for 13,000 palliative care clients and their households. These sessions will include accurate

information about condoms. PAVs will reach fourpeople in households with AB information totaling 52,000

people, though only the clients can be assumed to have been reached by three or more strategies.

The 13 partner dioceses will be supported in development of Health Information Centers that will provide AB

services to youths and adults. This support will include provision of refreshments and media visual facilities

such as projector, laptop for AB education purposes. Periodic "Youth Days" and "Couples Days" will be

conducted at these centers for continuous reach of youths, adults and couples (one per quarter). At least 25

youths and a similar number of adults will access AB services monthly in each center giving a total of 3,900

youths and 3,900 adults reached. Altogether, 7,800 people will be reached. It is hoped that these couples or

youth will then enroll in one of the more intensive AB programs and become more involved.

CRS will strive for partner visibility, leadership and active involvement in AB prevention. It will provide

support to 350 parishes on BCC activities. Advocacy to government agencies will be undertaken to develop

partnerships for AB program. This will include engagement of LGA and the Catholic Youth Organization of

Nigeria (CYON). Support will be given 10 LGA leaders and 10 CYON leaders for AB prevention in the

arch/dioceses. These will each reach 100 people giving a total of 13,000 people with A and an equal

number with "B" information. Altogether 26,000 people will be reached indirectly.

Activity Narrative:

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Regular AB activities in the 13 Arch/dioceses will encourage youths to adopt behaviors that reduce risk of

HIV infection such as delaying sexual debut until marriage and promoting social/community norms which

favor AB. Adults in the Arch/dioceses will be motivated to adopt sexual partner reduction behaviors.

LINKS TO OTHER ACTIVITIES:

A/B prevention strategies in the 12 Arch/dioceses and neighboring areas relate to HCT (5422.08),

Prevention of Mother to Child Transmission (PMTCT) (5348.08), and Orphan and Vulnerable Children

(OVC) (5407.08) activities. The targeted population in the Arch/dioceses will be linked to VCT centers in

the communities in order to ascertain their HIV status. CRS will deepen its presence through developing

linkages with IPs, with particular focus on providing AIDS Relief sites with AB information packs and

curricular for utilization in HICT, PMTCT and ART and PMC Centers.

PMTCT activities and OVC activities will include A/B prevention.

POPULATIONS BEING TARGETED:

Target populations of the A/B Prevention messages include: adults, children and youth, PLHIV HIV/AIDS

affected families, and community leaders. This includes both girls and boys from primary school through

university students, as well as adults of both genders with activities specifically tailored for pregnant women.

Other target groups include the Catholic clergy and laity. Men will also be targeted.

Direct targets include delivery of AB services through outreach programs to 80,610 individuals, 21,060 of

which will benefit from A-specific services through the clergy and catechists; and 3,210 individuals receiving

training. Coverage areas of the activity are: Kaduna and Kafanchan A/dioceses (Kaduna), Minna Diocese

(Niger), Jos Archdiocese (Plateau), Lafia Diocese (Nasarawa), Makurdi, Otukpo, Dioceses (Benue), Idah

Diocese (Kogi), Benin A/diocese (Edo), Abuja A/diocese (FCT) and 3 arch/dioceses to be determined. The

location of the 6 additional arch/dioceses to benefit from AB activities will be indicated by CSN.

EMPHASIS AREAS:

An emphasis will be placed on human capacity development. This activity will increase gender equity in

programming through dissemination of messages centered on AB prevention targeted at young girls and

women. Abstinence messages will encourage boys to delay sexual activity while Be Faithful messages will

discourage men from having many sexual partners. Males will be encouraged to take more responsibility

over their sexual activities with the goal of reducing multiple partners. The involvement of PLWHA in the

sensitization workshops will also assist in reducing stigma and discrimination in the 12 Arch/dioceses.

ACTIVITY DESCRIPTION:

This activity relates to the provision of BC&S services to 13,000 People Living with HIV/AIDS (PLWHA) and

26,000 People Affected by HIV/AIDS (PABAs) in 13 arch/dioceses (service outlets or sites) in 8 states of

Nigeria. CRS 7D BC&S will provide basic health care services in 65 (5/site) stand-alone and mobile Primary

Health Care (PHC) facilities and client households. The 7D BC&S has been receiving a maintenance

budget for the past three years, and significant demands are being made on the project due to changes in

BC&S guidelines, the type of services required and expansion of service sites.

As these demands increased over time, the 7D Palliative Care budget has remained constant. In order to

maintain the current volume and quality of services, 7D will work with fewer PHC facilities and conduct less

training than originally planned and focus on providing more complete, better quality services in the sites

that it retains. The program will piggyback on activities of other program within 7D, SUN and AIDS Relief

(AR) for delivery of BC&S services to all those that require them.

In COP08, BC&S targets remain unchanged from COP07 at 13,000 PLWHA. In response to new guidance

from the USG team in COP08, 7D will start capturing the PABAs that are being provided with services and

plans to reach 26,000 PABAs. Sites will increase from 10 in CO P07 to 13 in COP08 due to the split of

Shendam diocese from Jos archdiocese. Two more dioceses are expected to be split from Makurdi

diocese.

CRS 7D will support each site in developing relationships with 5 PHC facilities to provide basic clinical

services including: Basic laboratory monitoring for OIs, urinary and stool analyses, STI and malaria. 7D will

provide basic OI preventive (CPT) and management. Management of OI will include treating basic OIs

including malaria and syndromic management of STIs. LFT, hemoglobin estimates, CD4 count and other

advanced HIV disease laboratory diagnostic tests will be done at AidsRelief (AR), and other USG supported

sites.

For HBC services, CRS 7D will support Parish AIDS Volunteers (PAVs) and Support Groups of People

Living with HIV/AIDS (SGP+) in the sites to provide non-clinical BC&S Services. Under prevention with

positives, CRS 7D will provide a basic preventive care package including, provision of ITN, water guard,

water vessels, soap, abstinence and faithfulness messages, counseling for discordant couples, referrals

and correct information about other prevention methods.

Under psychological care, 7D will provide psychosocial and spiritual counseling for PLWHA and PABAs,

facilitate SGP+ and adherence counseling. Counseling will address prevention, mental health, disclosure,

crisis, bereavement and adherence to all medication including ART, INH and CPT.

Under social support, microfinance will be provided to PLWHA and PABAs. With the CRS cost share, food

supplements will continue to be provided through SGP+s in the sites. Nutrition and health education

emphasizing personal hygiene and proper disposal of waste will continue to be provided.

Under spiritual care, 7D will be sensitive to the culture and rituals of the individuals and communities it

interacts with. With the 7D stigma and discrimination curriculum, 7D will train more clergy, traditional and

spiritual leaders on how to provide non-stigmatizing care.

7D, SUN and AR will implement the recommendations of the technical assistance mission on program

integration conducted by CRS and AR in May, 2007. 7D will work very closely with SUN and AR in planning

and providing holistic services to PLWHAs and families with infected individuals or OVCs. Mechanisms will

be developed that allow the flow of human, material and financial resources among the programs for

effective leverage of each program's comparative advantage. Coherently planning centrally and

implementation in project sites will ensure seamless integration for service beneficiaries.

AR and 7D ART and PMTCT sites will also provide palliative care for HIV+ pregnant women, PLWHA and

OVC with back and forth linkages among the 3 programs for ART, health, educational, social support and

other services.

Through integrated activities among the three programs, PAVs and SGP+ will be given information that will

increase their capacity to provide care, support and prevention services in households, communities and

PHC facilities. 400 PAVs and SGP+ members will be trained. Each PHC facility is expected to reach 200

with BC&S services. 7D will engage SGP+ and PAVs in capacity building that will promote linkages

between SGP+, PAVs and PHC facilities for optimal utilization of health facilities and community resources.

Service directories will be placed in strategic places such as SGP+ meeting places and HCT centers.

Staff capacity enhancement will focus on volunteer recruitments and motivation. Motivation such as

stipends for health care workers in short term work will be given to PAVs and SGP+. Site hiring practices

will be encouraged to draw from experienced PAVs and SGP+. Other motivation will include recognition

awards for reaching service milestones. Transport re-imbursements, bicycles for providers, HBC Kits and

other necessary tools will be given to volunteers. CRS will hire 1 HBC and 1 Community Development

specialist to support PAVs, SGP+ and PHCs.

One PAV or SGP+ member will be assigned to a PHC center to triage with the PHC facilities and PLWHA

and SGP+ to facilitate access to clinical services. S/he will work with Diocesan Action Committee on AIDS

(DACA) staff to develop effective patient follow-up and referral mechanisms that bridge the health facility-

community gap. 7D will leverage 7 D PMTCT and AR sites in the provision of advanced clinical services.

Organizational development support including administration and financial accounting will also be given to

PHC, SGP+ and dioceses to position them for effective participation in BC&S service delivery.

Transportation and health care costs for caregivers and clients requiring specialized care not obtainable in

immediate PHC will also be incorporated.

Given the diversity of the package of services PLWHA receive from different IPs, double counting of

services will be highly probable. To avoid this, 7D in collaboration with other USG providers will develop a

tracking mechanism that follows the different services from AR and other USG supported IPs.

Activity Narrative: Indirect targets will include: zonal trainings on BC&S for LGA staff and periodic site visits by arch/diocesan

staff for supportive supervision at the LGA health facility level. Ten LGA staff will be trained in BC&S. Each

of these will train 10 others. Through these trainings it is expected that each of the 10 LGA facilities will

provide BC&S to 50 people giving a total of 500 people reached indirectly. For every 1 PLWHA reached 2

PABAs will be reached. Therefore 1000 PABAs will benefit from the indirect programming. Diocesan (Site)

staff will support BC&S services in 7 states and the FCT (Kogi, Benue, Plateau, Nassarawa, Niger, Kaduna,

and Edo States) in a total of 13 sites). All this will be achieved by piggy backing on trainings and resources

from other program areas such as PMTCT, AB and HCT.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

These BC&S services will contribute to several of the PEPFAR goals. The goal of mitigating the impact of

HIV/AIDS will be achieved by the provision of BC&S services. This activity will also contribute to the goal of

providing treatment to HIV infected individuals, as adults who are eligible for ART will be referred for these

services.

LINKS TO OTHER ACTIVITIES:

BC&S relates to other HIV/AIDS activities to ensure continuity of care for all persons accessing BC&S

through the 7D. This activity links with Prevention of Mother to Child Transmission (PMTCT) (#5448.08),

Voluntary Counseling and Testing (#5422.08), Abstinence & Be Faithful (#5312.08) and OVC (5407.08)

and SI activities (#9913.08) being undertaken by CRS 7D. Given the increased integration of CRS

programming, there will also be close links to the activities across program areas being undertaken by CRS

AidsRelief, especially their ART activities (#6678.08).

POPULATIONS BEING TARGETED:

The populations to be served include children and youth, PLWHA and their families, caregivers and

widows/widowers within the 13 Arch/dioceses, LGA staff, clergy and lay people and health workers.

Through linkages with other program areas (PMTCT, VCT, ART), recently diagnosed HIV positive adults

(including TB-HIV) in these communities in need of BC&S are also targeted. Pediatric C&S clients will be

assisted through a family care approach and referred to the SUN program for additional child-centered

services. The funding covers training of 130 Health Care Staff and 400 care givers/care providers.

EMPHASIS AREAS:

The emphases of the BC&S Program activities are local organization capacity development, training,

developing networks, linkages and referral systems.

These activities will include an emphasis on reducing stigma associated with HIV status and the

discrimination faced by individuals with HIV/AIDS and their family members.

HIV prevention will include gender sensitive activities which will address behaviors, social norms and

resulting inequalities between men and women that increase the vulnerability to and impact of HIV/AIDS.

ACTIVITY DESCRIPTION:

The CRS Seven Diocese Project provides HCT in 135 sites in eight states of Nigeria including the FCT.

These states are FCT, Edo, Kaduna, Kogi, Nassarawa, Niger, Jos Plateau and Benue. Of these 65 are

integrated, 44 stand alone and 26 mobile sites. Home based HCT is also provided during the Home Based

Care activities conducted by trained Parish AIDS Volunteers (PAVs).

The requested funding in COP08 will be used to support the procurement of medical supplies (disposable

gloves, etc.), the provision of various CT services, the training of staff in the provision of CT services, quality

assurance, and strengthening of post-test counseling services offered to clients.

CRS 7 Dioceses will continue the provision of HCT services in all the 135 supported sites. No site

expansion will be undertaken in COP08. Instead the program will focus on improving the quality of services

and targeting high risk populations such as commercial sex workers and prisoners.

In all the 7D supported hospital facilities Provider Initiated Counseling and Testing (PICT) strategy will be

adopted by establishing linkages between HCT sites within the facilities and STI, TB, OPD, ANC, and other

wards and clinics. This linkage will ensure that patients in wards, clinics and departments are routinely

offered HCT services using opt out model and appropriate referrals to care and treatment services. In

health facilities that support blood transfusion services, HCT will be provided as a routine component of

blood transfusion services to enable blood donors access HIV C&T services and linkages to prevention,

treatment, care and support services. This will entail provision of rapid test kits, training of service staff and

regular quality control and oversight support.

CRS 7D will strengthen its couple counseling and testing services by ensuring that HCT services are

provided to couples following standard guidelines and protocols. Couples Counseling and testing will also

be integrated with the BC&S, AB & PMTCT programs. CRS staff have received Couples Counseling and

Testing training provided by the USG and will continue to participate in the planned Couples HCT Training

of Trainers (TOT), training. This is part of the Couples Counseling HCT roll out plan for Nigeria. Home-

based HCT will continue to be provided to households of clients being served by different programs. At least

6,000 People Affected by AIDS (PABAs) in the 13,000 households to be reached with BC&S services will

be Counseled and tested. This is detailed in the BC&S program area. This will ensure that family members

of PLWHA know their HIV status and are linked to appropriate prevention, care and support services.

Pediatric CT will be increased with access to the pediatric clients through CRS OVC program, children of

individuals with HIV, and PMTCT clients.

In COP08, mobile testing activities will be continued and strengthened to provide HCT services in

community outreach activities and will be coupled with prevention messages encouraging partner reduction

and faithfulness. Strategies will be developed to make HCT services as youths friendly as appropriate. This

will increase service uptake and enhance active case detection. Prevention information based on ABC will

be provided and referral to prevention, care and support services made.

In all 7D supported sites HIV Testing will be provided using the current national testing algorithm, and a shift

to serial algorithm will be made when finally approved by GON.

Post test counseling will include counseling on AB and accurate information on correct and consistent use

of condoms. Where condoms cannot be provided, clients will be referred to the nearest condom outlet.

Support Groups of People Living with HIV/AIDS (SGP+) will carry out continuous counseling to encourage

individuals to disclose their status to partners and family members. When necessary, individuals

encountering difficulties with disclosure will be referred for spiritual and psychosocial counseling for added

support. Formation and management of post test clubs and SGP+, development of post-test information

packages, materials and curriculum development for ongoing post-test counseling as integral part HCT, will

be done through the AB program area. 7D will get the mentioned materials approved by the USG HCT

technical working groups to ensure correct and balanced messaging.

The 7D project will take deliberate steps in maintaining internal and external quality control measures in its

HCT Program. At least one integrated C&T site will be designated to provide laboratory support for external

and internal quality control of C&T in each service area. Quarterly site monitoring assessment for quality

control will be provided by CRS laboratory staff. In COP08, 2 laboratory scientists will be employed to

provide this technical support while 2 laboratory scientists will be kept on retainer for training and oversight

needs at 7D HCT and PMTCT sites. Trained PAVs carrying out HCT services will be supported with a

modest per diem to offset transport and time costs. This practice will enable high quality C&T in the service

sites, which will be branded with the national Heart to Heart logo.

The procurement of test kits will be through the SCMS. CRS will distribute the kits to partners according to

partner-developed testing projections in collaboration with SCMS. The kits and associated commodities will

be replenished periodically. Partners will be supported by CRS Program Managers and diocesan staff to

develop and manage the inventory of test kits and associated commodities. CRS will continue to support

and participate in the harmonization process led by FGON with regard to LMIS, ICS and CT for non-

laboratory staff.

Given the pending shift to serial testing, 7D project will collaborate with AIDS Relief, IHV, GHAIN and other

IPs in capacity building and training of counselors to adopt serial testing. Training and re-training will be

conducted for 270 people (2 from each of the 135 sites), using the GON nationally approved C&T

curriculum. 7D will collaborate with AIDS Relief, IHV, GHAIN and other partners in training the HCT site

staff. The trainings will include CT services, medical waste disposal and quality assurance. Individuals

trained will receive a 1-day refresher training every 6 months at the arch/diocesan level.

M&E of CT activities will be on monthly basis by arch/diocesan staff, primarily the Referral Coordinator and

Monitoring and Evaluation Officer and CRS program managers. The National HCT registers and M&E tools

will be used for data collection at all HCT sites.

As part of its direct targets, 7D will counsel and test 22,500 individuals, 10% (2,250) of which will be

pediatric clients who will be tested following standard protocols and guidelines. At least 22,450 individuals,

2,230 of which will be pediatric clients, will receive their test results. Indirect targets will include the training

of LGA health facility staff on CT; and the provision of technical support for CT implementation and

Activity Narrative: monitoring at the LGA health facility level. Training, capacity building, and working within existing church

structures will lay the foundation for sustainable programming in the long run.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The CT services will further contribute towards the National goal and universal access to CT services. In

addition to assisting CRS and PEPFAR to meet CT goals, CT has been shown to be an important entry

point of access to prevention, care and support services. This project will strengthen testing and

psychosocial and spiritual support services. The 7D project will continue to support post-test clubs at the

parishes which will decrease stigma and discrimination experienced by PLWHA. In addition, it will feed into

care and treatment services that further refer HIV positive individuals to comprehensive care and support

services being provided by CRS and other PEPFAR Implementing Partners.

LINKS TO OTHER ACTIVITIES:

Very strong linkages exist between CT and CS (3.3.06), PMTCT (3.3.01), and AB (3.3.02). 7D aims to

strengthen linkages between CT services and PMTCT, and OVC specifically. Adults who undertake a test

will be invited to become volunteers, or post-test club members. Youth who undertake a test will be invited

to become active members of the Abstinence Diocesan Youth Groups, as well as referred to OVC (3.3.08)

services if they qualify. Adults testing positive will be referred, in addition to Post Test Clubs, to SGP+,

referred to PMTCT for pregnant women, and to ART centers. Youth testing positive will be linked to

pediatric ART (3.3.11 and 3.3.10) and OVC services.

POPULATIONS BEING TARGETED:

This activity will target adults and youths accessing health care services, in and out of places of work, in and

out of institutions of learning, HIV&AIDS affected families, Faith-Based Organizations, Private Health Care

facilities, and Health Care Workers. The 90 Parish communities with stand-alone CT centers target the

general population which includes: adults, out-of-school youth, orphans and vulnerable children, and

community workplaces. These CT centers are designed as places that would bring all members of the

community together in order to provide services to and reduce HIV&AIDS-related stigma in communities.

EMPHASIS AREAS:

Human capacity development will be an emphasis of this activity. The parish stand-alone CT centers will

primarily focus on development of network/linkages/referral systems. Stigma and discrimination against

PLWHA will be addressed through PACA and community mobilization. Post-test clubs will be designed to

decrease stigma in the local communities. Issues of stigma and discrimination will also be addressed such

as assisting in the provision of legal services to deal with inheritance issues.

ACTIVITY DESCRIPTION:

CRS Seven Dioceses (7D) will collaborate with the CRS SUN project to strengthen monitoring & evaluation

(M&E) capacity and build strategic information (SI) activities in 13 project sites across eight states, including

the FCT. These states are Benue, Edo, Kaduna, Niger, Kogi, Nassarawa and Plateau. The service area will

not expand in COP08 but the number of sites will increase from 10 to 13 sites due to the creation of three

dioceses—one in Jos and two in Makurdi diocese. Activities will focus on program level reporting, Health

Management Information System (HMIS), and quality assurance, and will be aligned with the USG strategic

information (SI) data quality assessment/improvement (DQA/I) and capacity building plan to enhance

reporting, monitoring, and management of the SUN/7D project.

The M&E system established in COP07 will be further strengthened in COP08. An M&E System Review

Workshop will be conducted to assess the data collection tools and reporting structure through a

participatory process involving the partners and representatives of Parish AIDS Volunteers (PAVs).

Necessary adjustments will correct any identified gaps or weaknesses of the system during the workshop.

7D/SUN SI resources will be used to modify and print existing M&E tools that complement the harmonized

Government of Nigeria (GoN) harmonized registers and reporting forms, to better capture program

performance.

A total of 13 Arch/dioceses, the care and support network, and PMTCT facilities will participate in SI

activities in COP08. To strengthen the HMIS, at least 13 new computer units will be acquired for dedicated

application to M&E data entry, management, and analysis using excel, EPINFO and other appropriate data

analysis software. A refresher course on data management will be conducted for the 13 diocesan M&E

officers while the health coordinators and HIV/AIDS coordinators will be trained on the use of data for

programmatic decision making by CRS in conjunction with appropriate GON M&E specialists. This training

will introduce the participants to M&E principles and the National M&E Framework.

Two staff from each of the 20 SUN/7D supported PMTCT sites will be trained as well in SI by CRS and

GON M&E specialists. This training will focus on utilization of the PMTCT M&E tools developed by the

GON. Ongoing TA will be provided by the M&E specialist and the program managers to the diocesan

management staff on how to use data generated in each diocese to improve project management as part of

the CRS technical support functions to Partners. CRS staff will work with state M&E officers program

monitoring and data quality improvement efforts and, to the extent possible, state M&E officers will be

included in training programs in order to instill a sense of ownership and ensure sustainability of these

efforts.

Due to high attrition of PAVs who are the primary implementers of activities in SUN/7D, a quarterly M&E

orientation and training will be conducted at the Parish Action Committee on AIDS (PACA) level for the new

volunteers by the diocesan M&E officers. This training will focus on the effective use of the data collection

instruments already developed by CRS. Specifically two volunteers from each of the 13 partner

arch/dioceses will be trained and given the data collection instruments to record the services delivered to

clients. The trained PAVs will each conduct step-down training for 30 individuals in the use of program

monitoring tools for a total of 780 PAVs indirectly trained in routine M&E.

SUN/7D M&E activities will function within the national framework and in the context of the "three ones"

initiative. It will harmonize its M&E system with the national M&E framework. In particular, the program will

use and adapt existing nationally developed M&E tools for data collection and collation. For example, the

7D supported PMTCT and HCT sites will use the national PMTCT and VCT registers. The 7D project will

also attend and support periodic state and LGA co-ordination meetings.

Where necessary, CRS headquarters and Regional Technical Advisers and USG/CDC experts will be

called upon for technical support purposes to CRS and partner programs. Routine supportive and

supervision of PAVs, however, will be done by the diocesan staff.

A CRS training coordinator will work closely with SUN/7D and partner staff to determine the training needs

of partner organizations. She will also ensure that trainings follow current modules, learning methods and

curriculum that increase the capacity of participants to learn, retain and apply new knowledge. She will be

supported with resources to synthesize key emerging effective employee practices for improved program

outcomes. An M&E specialist will provide technical support and training to partner staff. The M&E

Specialist will collaborate with the training coordinator to enhance both quality and technical depth of

trainings. With technical support, partners will develop the capacity to evaluate their existing data and use

this information to influence programming and improve performance.

The current quarterly PACA meeting will be expanded to include planning and feedback to LGA and State

Actors on SUN/7D program performance in coverage areas. Additionally, SI resources will be used to

support small-scale operation research. A "Do No Harm" analysis will be conducted in five selected

dioceses to assess the effects of our intervention on the rights, privacy and quality of life of the beneficiaries

and their families. An external consultant and or HIV/AIDS Technical Advisor from the CRS regional office

will join the program staff to conduct the study. Moreover, monitoring data will be utilized to assess the

motivations of volunteers and potential strategies to maximize their satisfaction and contribution. Self-

stigma of PLWHA will also be assessed in an effort to design interventions to combat it.

SUN/7D SI activities will also focus on assessing compliance to existing national protocols and guidance for

service provision. The outcome of the assessment will provide updated information on training needs for

partner staff.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The SI activities will contribute to improved quality and reliability of data being reported on PMTCT, Basic

Care and Support, HIV Counseling and Testing (HCT) and AB Prevention. Improvement in SI management

capacity of existing and new partners will ensure effective data use and management and will contribute

towards the GON and USG strategy for the provision of quality and timely information for decision making.

This information will serve as a valuable resource in developing corrective action plans that would enhance

the efficiency and effectiveness of operations and management of the SUN/7D project. By strengthening

the capacity of local partners, SI activities will further increase the sustainability of HIV/AIDS programs in

Nigeria. As a result of the combined SUN/7D SI activities, a total of 46 people from 23 organizations will be

Activity Narrative: trained in SI, and 13 organizations will receive TA in SI activities in addition to the 30 PAVs trained giving a

total of 76 persons directly trained.

LINKS TO OTHER ACTIVITIES:

SI activity relates to PMTCT (3.3.01), Abstinence and Be Faithful Prevention (3.3.02), Palliative Care: basic

health care and support (3.3.06), and counseling and testing (3.3.09). In addition, links with the GON and

other USG IPs will be strengthened.

POPULATIONS BEING TARGETED:

This activity targets religious leaders, public health care workers, community-based organizations, and faith

based organizations.

EMPHASIS AREAS

This activity includes an emphasis on human capacity development.