ACTIVITY DESCRIPTION:

In COP 08, Positive Living (PL) Abstinence and Be Faithful (AB) component will be implemented in 20

states (FCT, Bauchi, Edo, Enugu, Kano, Anambra, Cross River, Lagos, Kogi, Imo, Niger, Benue, Taraba,

Adamawa, Sokoto, Zamfara, Kebbi, Nassarawa, Katsina, and Akwa Ibom). The program will reach 80,000

people with AB interventions, reach 20,657 with abstinence (A) only, and will train 2,400 as peer educators

and facilitators to disseminate information for AB through a systematic community-based program. This

activity will embrace counseling, mentoring, peer support, information sharing, and provision of technical

guidance and support to Anglican Communion AIDS program (ACAP) and the AIDS Program for Muslim

Ummah (APMU) a project of the Nigerian Supreme Council for Islamic Affairs as multiplier organizations.

CEDPA's AB prevention strategic approach involves a series of interrelated interventions (community

mobilization, social marketing, advocacy, targeted inter-personal communication, capacity enhancement of

individual and community groups) directed at different levels of society to enhance individual behavior

change in a supportive environment.

A total of 2,400 Peer Educators will be trained of whom 350 are teachers, 450 are parents, 2000 are youth

in and out of school, 350 are religious leaders and 150 are PHA. Special attention will be given to children

who act as family heads to strengthen their coping mechanisms. PL will expand by increasing access to

community-level, gender-sensitive and targeted prevention services. PL will also forge networks and

linkages between outreach activities and Government of Nigeria (GoN) and other USG partners that provide

AIDS care, support and treatment.

Intensive community mobilization and sensitization will reach underserved rural and hard to reach

communities. Each individual will be reached with a minimum of three interventions i.e. community

awareness, peer education and family level services. CEDPA will ensure that each beneficiary is reached

through community awareness, peer education and one other targeted strategy within the year. The other

interventions will include focus group discussions to identify community HIV needs and possible solutions;

formation of anti-AIDS clubs for youth in school; public debates on HIV/AIDS and other social interactive

events for out-of-school youth for information sharing and channeling their energies towards less risky

behaviors; and skills building sessions for PHA and OVC to promote supportive relationships with peers and

sexual partners. Religious leaders will be supported to integrate HIV/AIDS activities within all religious

events and services.

PL AB program activities are implemented at 4 levels: 1) Individual level where activities promote

development of life skills that support practicing abstinence by young people and adults in low risk settings;

encourage delay of sexual debut, denounce intergenerational sex, rape, incest; and promote counseling

and other means of interpersonal communication techniques; 2) Family level where services will be

provided by Peer Educators during home visits. Services will focus on couple counseling to promote mutual

fidelity/partner reduction/elimination of casual sex relationships, VCT, dovetailing with prevention in

discordant relationships. Family members will be guided to recognize symptoms of common STIs and TB.

3) Community-wide prevention programs which are provided by pastors, Imams, peer educators, teachers,

parents including Church/Mosque sermons/pulpit preaching and club activities, in-school peer-education

and out- of- school youth prevention programs that address sexual development, reproductive health and

promotion of secondary abstinence particularly for at-risk out-of school youth through alternative livelihood

opportunities. 4) National prevention programs where a collaborative effort with ENHANSE project will

implement a 3 pronged program with the Nigeria Teacher's Union that addresses HIV awareness and

prevention by teachers; teachers ethics- coercive sexual relationships with students; teachers as role

models to guide in-school youth peer AB prevention programs.

Using standardized forms, IA/MO/PL M+E Officers collect data monthly, detailing numbers/demographics of

clients reached and messages provided. This provides timely information for effective decision making,

particularly the breadth and depth of AB coverage. AB M+E activities develop sustainable capacity at IAs

and MOs to collect relevant data. Direct M+E expenditures by PL, MOs and IAs will total $196,000.

POPULATIONS TARGETED:

PL targets children (10-14 years), young people (15-24 years) in and out-of school, PHA, religious leaders

and the general population. Teachers are targeted to act as change agents.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

HVAB emphasizes human capacity development through training, task-shifting and volunteer retention and

therefore enhances sustainability. Scaling up prevention, involving PHAs and youth, and encouraging peer

educators to work together with community health care providers contributes directly to the US Global

HIV/AIDS Strategy by reaching 173,598 people indirectly through cascaded training by Peer Educators. The

activities stimulate demand for other HIV/AIDS services offered by GoN and USG partners throughout the

20 states. This contributes to increasing sustainability of institutions by vesting program responsibility in 56

indigenous Nigerian organizations.

LINKS TO OTHER ACTIVITIES:

AB activities relate to HVCT (#3230.08, #5424.08), by increasing awareness of HIV, to HBHC (# 9839.08,

3237.08, 5369.08), HVOP (# 9779.08, 3236.08), as a complementary prevention strategy and on HKID

(#12378.08, 12373.08, 3229.08) and other services that will be provided at GHAIN, ACTION project,

Harvard ART, and PMTCT sites through cross referrals. Public-private partnerships and collaboration with

local business groups will also be explored. High risk individuals will be referred PL and SFH service outlets

for condoms; as well as Nigerian Network of Religious Leaders Living with AIDS (NINERELA) and the

Association of Women Living with HIV/AIDS in Nigeria provide support for prevention among positives.

EMPHASIS AREAS:

PL promotes a rights-based approach to prevention among positives and other vulnerable members of

society and equal access to information and services; enlightens men on special needs of women and

youth; and challenges traditional gender norms of male dominance, female subservience and gender

inequality in sexual relationships. Reduction of stigma and discrimination is also key.

WRAP AROUND ACTIVITIES: PL will scale up the prevention initiative with the Nigerian Union of Teachers

that addresses HIV awareness and prevention by teachers for teachers; teachers ethics- coercive sexual

Activity Narrative: relationships with students; teachers as role models to guide in-school youth peer AB prevention programs.

Youth curricular will focus on building life skills such as negotiation and self esteem issues for youth

especially girls. Primary target populations are in-school youth 10-19 and school teachers.

ACTIVITY DESCRIPTION:

Positive Living (PL) activities of HVOP will be implemented in 19 states of FCT, Bauchi, Edo, Kano,

Anambra, Adamawa, Cross River, Lagos, Kogi, Benue, Imo, Niger, Taraba, Sokoto, Zamfara, Kebbi,

Nassarawa, Katsina and Akwa Ibom. This activity is a key component of PL's strategy and encompasses

provision of information and access to correct and consistent condom use, prevention of HIV among

discordant couples, promotion of counseling and HIV testing, partner reduction, and mutual faithfulness as

methods of risk reduction. PL will reach 15,275 persons, train 2,400 peer educators, distribute 6,000,000

condoms and open 65 service outlets.

HVOP will augment the HBHC component of PL and enhance the capacity of Primary Health Care and

other referral facilities in communities to diagnose and treat STIs by providing laboratory equipment such as

specimen bottles, reagents, consumables, etc. These facilities will serve as referral centers for diagnosis

and treatment of STIs and will be considered as some of the service outlets for HVOP. All HVOP activities

will be coupled with information about abstinence as well as the importance of HIV counseling and testing,

partner reduction, and mutual faithfulness as methods of risk reduction. PL will build on past achievements

by continuing to target long distance truck drivers, migrant workers, out of school youth, Orphans and

Vulnerable Children, people living with HIV/AIDS (PHA) and clients of commercial sex workers.

Peer educators (PE) including religious leaders, teachers, persons living with HIV/AIDS and parents (trained

in HVAB and HKID) will be trained to act as condom distributors, provide prevention options for people at

risk who cannot practice A&B. Such options include support for PLWHA to disclose their sero-status to

sexual partners and significant others, proper nutrition and boosting body immunity, prevention of

pregnancy among PLWHA, PMTCT and early diagnosis and treatment of STI. PEs will hold discussions in

homes, communities and workplaces with their peers focusing on prevention for positives during one-on-

one and group discussions in support group meetings using CEDPA's Prevention manual.

Each individual will be reached with a minimum package of three interventions. The package will consist of

community-wide AIDS awareness campaigns, targeted AIDS education programs at community level and

various institutions, participation in focus groups and peer support groups for people identified as being at

high risk of HIV infection, psychosocial support, and ‘prevention with positives' programs. Community-wide

prevention activities will disseminate messages on prevention and stigma reduction during wedding

receptions, naming ceremonies, age grade meetings, rallies, and youth club activities such as celebration of

solidarity days. Existing media materials on prevention will be adapted and reproduced for distribution

during these events.

Condoms will be made available to all sexually-active individuals and PLWHAs through PL's comprehensive

service delivery points at primary health care facilities, workplace programs and community condom

distribution points run by PE and other commercial vendors who will be trained. The PE will provide one-on-

one counseling; distribute condoms, facilitate support group discussions and act as peer buddies to ensure

and maintain behavior change. Mobile populations will be reached through comprehensive activities

reinforced by necessary follow-up. Activities will be integrated with an emphasis on MARPs, strengthened

linkages, training and on-going support.

Using standardized forms, staff of implementing agencies (IA) multiplier organizations (MO) and Monitoring

and Evaluation officer of PL will collect data on a monthly basis, detailing numbers/demographics of clients

reached and messages provided. This will provide timely information for effective decision making,

particularly the regarding the breadth and depth of HVOP coverage.

POPULATIONS TARGETED:

HVOP will be focused on most at risk populations (MARPs), e.g. long distance truck drivers, migrant

workers, out of school youth, PHAs including OVC and clients of commercial sex workers, sexually active

men, women, adolescent girls and boys in the general population. Prevention for Positives will target mainly

discordant couples. Pregnant positive women will be mobilized and referred for PMTCT services.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Condom and Other Prevention activities of PL will contribute to PEPFAR's 5 year strategic plan for Nigeria

by reaching selected individuals considered to be at high risk of HIV infection with information and services

that enhance their abilities to adopt risk reduction measures. Combined, these activities will contribute to

averting new HIV infections. With the number of discordant couples on the increase, PL will promote active

participation of PHA in prevention activity to encourage disclosure of sero status and protecting their sexual

partners.

LINKS TO OTHER ACTIVITIES:

HVOP activities relate to HVAB (9759.08) as a complementary prevention strategy, to HBHC (9839.08) by

potentially decreasing demand for HBC services, to HKID (12378.08) by targeting young people in and out

of school, parents and guardians and by increasing awareness of the virus. PL will liaise with DFID and

SFH to ensure the provision of condoms. Activities will be linked to other reproductive health activities

provided by CEDPA in Bauchi, Kano, and Lagos states. HIV+ pregnant women will be referred to MTCT

centers.

EMPHASIS AREAS: Commodities procurement and distribution, particularly of condoms, will be an area of

emphasis. Other areas include community mobilization and demand creation for HIV related services and

training. The program will address will include increasing gender equity in HIV programs and promoting

male norms and behaviors that encourage HIV prevention. Violence and coercion reduction will be

addressed through couple counseling for disclosure and collaboration with legal aid clinics.

ACTIVITY DESCRIPTION:

This activity also relates to HVAB (3.3.02), HVOP (3.3.05), HVTB (3.3.07), HKID (3.3.08), HVCT (3.3.09)

HTXS (3.3.11) and HLAB (3.3.12). The community/home-based services of Positive Living (PL) compliment

facility-based palliative care provided at secondary and tertiary level hospitals. In COP 08, HBHC activities

will focus on consolidating structures for palliative care delivery and community level referral networks

developed in COP 06-07. PL HBC coverage will be offered to all GHAIN clients in "GHAIN states", including

six new states (Sokoto, Zamfara, Kebbi, Katsina, Nasarawa, Akwa Ibom) as well as to GHAIN, other USG

and GoN clients in 14 COP07 states: Federal Capital Territory (FCT), Lagos, Bauchi, Kano, Edo, Cross

River, Anambra, Kogi, Niger, Benue, Imo, Enugu, Taraba and Adamawa. PLHAs (112,060) will be reached

(93,600 referred from GHAIN sites and 18,460 from PL's comprehensive sites and self referrals) and

224,120 PABAs (187,200 are from GHAIN sites and 36,920 from PL's comprehensive sites). A total of

336,180 individuals will be reached with community base HBC services by CEDPA but only 242,580 will be

attributed to CEDPA since GHAIN is providing clinical basic care to 93,600 to avoid double counting. At

least 3,800 home-based care (HBC) volunteers, 240 professional health care providers and 25,271 family

members will be trained. PL will maintain partnerships with 58 IAs to provide HBHC services.

PL services will reach clients referred from GHAIN and other USG implementing partners, and directly

generated from communities as identified by HBC volunteers and self-referrals. All clients will be assigned

to one of three categories and provided appropriate services: 1) those who have just been tested but

without major need for medical care will be assisted to access services that promote prevention of

opportunistic infections and emphasize the need to protect others; 2) those with opportunistic infections will

be provided with home-based care and supported to access medical care and routine medical tests

including CD4 count; 3) those on ART will receive intensive adherence counseling, regular home visits for

monitoring and referral. All clients will be offered psychological and spiritual counseling. Twenty percent of

the total 112,060 clients to be served are estimated to require home-based nursing care and will be served

by home-based care (HBC) volunteers trained at the community level. Following the National Palliative Care

Guidance and USG PC Policy, PL will provide a Basic Care Package including clinical care, prophylaxis and

management of opportunistic infections, laboratory support, counseling and adherence support, home-

based care, and active linkages between hospitals, PHCs and communities; and training of healthcare

providers and community volunteers.

Clinical care services will be provided at primary health care facilities (PHC) to compliment care and support

services offered at ART centers and general health care facilities and utilize an outreach HBC volunteer

program. Staff at various PHC facilities will be introduced to standardized clinical management of AIDS

related infections and the cross referral procedures to USG service sites. PL will enhance the capacity of

PHC and other referral facilities in communities to diagnose and treat STIs by providing laboratory

equipment such as specimen bottles, reagents, and drugs, while health workers will be trained on

syndromic management of STIs where laboratories are not available. These facilities will serve as referral

centers to which HBC volunteers and peer educators under PL's HVAB and HVOP programs will send

clients for diagnosis and treatment of STIs.

PL will support 24 community-based clinical facilities to handle OI management, basic laboratory and

prophylaxis services for PHAs. Of these 4 will be additional to the 20 PHCs supported in COP07. Based on

outcomes of needs assessments, PL will facilitate renovation and/or refurbishment of basic laboratories at

PHC; provide reagents, STI drugs and essential drugs for treatment and prevention of opportunistic

infections and other HIV/AIDS-related complications e.g. malaria and diarrhea. Each new client will receive

a self-care kit consisting of ORS, ITN, water guard, bleach, cotton wool, gloves, soap, calamine lotion,

Vaseline, and gentian violet (GV). A total of 10,258 kits will be distributed to newly registered clients in

COP08. Water guard and other consumable supplies will be purchased and distributed to all clients

including those carried over from COP07. HBC volunteers and health care providers will be given home

based care kits containing drugs for pain relief; the kits will be replenished to ensure constant supplies

needed for first aid. Care coordinators will head the homecare teams in providing home-based nursing care.

The HBC volunteers will link PHAs, their families, and community members to HIV/AIDS related services

and social welfare services for orphans and vulnerable children (OVC).

To strengthen the HBC volunteer program and improve quality of care, PL will train 3,800 HBC volunteers,

240 professional health care providers mainly nurses and community health extension workers (CHEWS)

and family members. If funds allow, refresher trainings will be provided to all care providers trained in

COP07. PHAs will be trained to enhance skills in advocacy and public speaking, and supported to disclose

sero-status to partners and immediate family members. Trained volunteers will offer psychological and

spiritual support to PHA and their families through group and individual counseling. Culturally appropriate

methods will be adopted for end-of-life care and bereavement services. PHA will further be supported to

promote the philosophy of "prevention for positives" to peers, especially for family members and those in

discordant relationships.

Social-economic support enhanced by seed grants and vocational training, income-generating activities,

linkages to social and legal protection, and training and support of caregivers will be maintained in Kano

and Benue and extended to Bauchi and Imo states. Priority will be given to households headed by children,

the elderly, and PHAs who lack regular sources of income. Seed grants will be provided to small groups of

PHAs and their families to invest in small-scale businesses and revolving funds for health care. PL will

support PHA in their communities and improve the economic capacities of additional 40 groups of PHA and

800 families.

Using standardized forms, M+E Officers collect data monthly, detailing numbers/demographics of clients

reached and services provided. This provides timely information for effective decision making, particularly

regarding the breadth and depth of HBHC coverage. HBHC M+E activities develop sustainable capacity at

IAs and MOs to collect relevant data. Direct M+E expenditures by PL, MOs and IAs will total $ 328,071.

POPULATIONS TARGETED:

The primary beneficiaries for PL palliative care services are PHA and their families. Community members,

professional health care workers, CHEWs and caregivers of PHA will be trained. Since women form most of

PL's beneficiaries, extra effort will be taken to reach out to men as community leaders and partners of PHA

to increase male involvement in palliative care.

Activity Narrative: CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The planned community/home-based palliative care interventions will contribute to the overall PEPFAR care

and support goal by reaching 112,060 PHA and 224,120 PABAs with basic care and support services. PL

will work with stakeholders at all levels, to strengthen community systems for the provision of quality care to

PHA and their families; build community capacity to deliver palliative care by training a total of 4,040

community resource persons and improve the economic capacities of 1,500 PHA.

LINKS TO OTHER ACTIVITIES:

PL will consolidate linkages, with GHAIN and other USG partners providing palliative care at healthcare

facilities, to ensure that all PHA receive community/home-based care services. Care coordinators will be

placed in facilities providing ART, VCT, PMTCT and pediatric palliative care services to register all those

patients who may require HBC services and offer information on follow-up support for PHA. Planning and

review meetings will be held regularly with partners to maintain effective referral. PL will collaborate with

Howard University to train community pharmacists and health care providers including community health

extension workers and patent medicine vendors. Activities will be linked to HVAB (3.3.02), HVOP (3.3.05),

HVTB (3.3.07), HKID (3.3.08), HVCT (3.3.09) through training PHAs on various aspects of HIV prevention

and control Of OIs.

EMPHASIS AREAS:

PL will advocate for reduced stigma and discrimination at all levels, increasing acceptance of PHA within

communities. Interventions will increase gender sensitivity in programming by targeting vulnerable young

girls and women, and promote male involvement in care and support. PL will contribute to development of

legal frameworks that uphold the rights of PHA.

ACTIVITY DESCRIPTION:

This activity also relates to HBHC (9839), HVOP (9779), HVAB (9759), HKID (12378). The TB component

of Positive Living (PL) will address the increasing TB case load among HIV positive persons by increasing

access to treatment and improving treatment outcomes. This activity will link TB and HIV prevention, care

and treatment activities at community and primary health care level.

In collaboration with state TB control programmes, PL will build the capacity of 36 CBOs/FBOs and six

NGO/FBO owned primary health facilities to expand community based TBHIV services to an additional two

states making a total of 14 states (Bauchi, FCT, Lagos, Kano, Anambra, Edo, Enugu, Taraba, Adamawa,

Niger, Cross River, Imo, Kogi and Benue) in COP 08. All sites will be provided with necessary facilities that

will ensure holistic patient care according to IMAI guidelines. These services will provide a network, linking

facility-based TB/HIV services provided by GHAIN in secondary facilities with primary and community based

services. A total of 6,554 HIV infected clients receiving TB treatment in GHAIN supported sites will have

access to community based TB/HIV activities.

The 36 CBOs will contribute to TB/HIV care in the following ways: 1) provide treatment support services

through out-patient treatment until cure; 2) provide patient, family and community education on TB/HIV co-

infection; 3) complement case finding efforts of traditional facility-based TB treatment programs; 4) increase

accountability of local health services to the community; and 5) lobby the state and local authorities for

increased commitment to TB/HIV control, including through work practice, administrative and environmental

control measures.A total of 30 individuals will be trained to provide treatment for TB to HIV-infected

individuals while 1,800 community health workers, home based care volunteers and peer educators will be

trained in TB/HIV education, care and support including adherence to TB treatment regimens. Family

members (two per PHA) will be given basic skills to provide continuous care and support.

PL will support a total of six community-based clinical facilities to handle TB management and to provide

basic laboratory and community services for HIV positive persons. Following assessments, PL will assist

health facilities to do basic renovations, to purchase equipment and laboratory reagents, to develop storage

space for drugs and commodities and to write up and publish infection control plans. In addition, clinics will

be assisted to augment extant quality assurance standards, particularly by implementing Nigerian national

guidelines for external quality assessments (double-blinded slide rechecking).

Medical officers from community-based clinical facilities will be trained in X-ray diagnosis of TB while

laboratory technicians/scientists will undergo training in sputum smear microscopy. This activity will ensure

that 800 HIV positive persons and their family members are referred and supported to access routine

screening for TB. It is anticipated that 300 HIV positive persons will require treatment for TB. Co-infected

TB/HIV patients will be linked to medical services at GHAIN, other USG-funded health care facilities and

DOTS centers. Communities will have increased knowledge on prevention and control of TBHIV and

increased capacity to provide care and support for dually infected patients.

PL IAs will counsel partners and family members of HIV/TB patients and refer them for TB screening. In the

process partners/family members will be linked to appropriate care and support services. TB/HIV activities

will be integrated into ongoing palliative care (HBHC #9839) and prevention programs (HVAB and HV0P).

HBC volunteers will be trained to recognize TB symptoms and danger signs; to conduct proper referral of

PHAs for TB screening and treatment; to provide home-based nursing care, infection control, follow-up and

adherence counseling; and to trace clinic defaulters. Care coordinators at CBOs will undergo mandatory

clinical TBHIV training and in supportive supervision. Care coordinators will supervise HBC volunteers, and

provide continuing education during volunteer meetings. This activity will incorporate standard operating

procedures; training manuals and IEC materials will be adapted and updated. The ELICO maps model will

be adopted to help HBC volunteers keep track of individuals and families they visit, and organize follow-up.

Project activities will be properly documented at every stage of implementation.

Using standardized forms, M+E officers collect data monthly, detailing numbers/demographics of clients

reached and messages provided. This provides timely information for effective decision making, particularly

regarding the breadth and depth of TB/HIV coverage. TB/HIV M+E activities will develop sustainable

capacity at IAs and MOs to collect relevant data. . Direct M+E expenditures by PL, MOs and IAs will total $

55,686.

POPULATIONS TARGETED:

Referral for TB/HIV screening will be done for all PHAs who will be enrolled into the care and support

program in the four PL states. Their family members will be recommended for screening as well. PHAs

infected with TB will be linked to DOTS centers and supported for drug adherence. Healthcare providers at

DOTS centers and other PHCs will be facilitated for training and re-training in TB prevention and

management. Family and other community members will be provided with information on TB and infection

control.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will contribute to prevention and control of TB among HIV positive persons. HIV positive

persons will be screened for TB by members of their communities and referred for treatment. In a

pioneering effort, treatment support will be provided to HIV positive patients on TB treatment to ensure

completion of treatment and prevent the onset of drug resistance. Community linkages will strengthen

facility based TB/HIV service providers' collaboration.

LINKS TO OTHER ACTIVITIES:

TBHIV activities will be linked to activities in HVAB (3.3.02) and HVOP (6735, 6707) through community and

faith-based organizations and to CEDPA's palliative care program for follow up and psychological and

spiritual support. These linkages will ensure that all TB/HIV patients are provided with co-trimaxozole

preventive therapy (CPT) and other prophylaxis for opportunistic infections. TB/HIV activities will be linked

to HVSI (3.3.13) with improved tools and models for collecting, analyzing and disseminating TB/HIV data,

and also to the newly approved NTBLCP tool for reporting. TB/HIV efforts will also support HVCT (3.3.09)

activities to ensure that counseling and testing is done for all TB cases; and to MTCT (3.3.01) to ensure that

HIV positive pregnant women are screened for TB.

EMPHASIS AREAS:

Activity Narrative: This activity has an emphasis on human capacity development and local organization capacity building. All

support activities are undertaken in collaboration with the STBLCP.

This activity will address infection control and gender and age equity by providing TB/HIV information and

services at community levels. This will ensure access to TB/HIV services for PHAs who are on ART and

other community members - especially women - who may otherwise not know their risk of TB infection.

Educative and preventive messages targeted at children (10-14), young people (15-24) and adults will

address the importance of TB prevention and care. The thrust will be to ensure that all population cohorts

seek TB/HIV services in a timely manner. A secondary activity will be to train community outreach workers

to deliver such messages effectively.

ACTIVITY DESCRIPTION:

This activity also relates to activities in HVAB (3.3.02), HBHC (3.3.06), HVTB (3.3.07), HVCT (3.3.09),

HTXS (3.3.11) and HLAB (3.3.12). Positive Living (PL) is presently in four sites in four states. Positive Living

(PL) is presently in four sites in four states: Kano, Cross River, Bauchi and Edo. By the end of COP07, PL

will have opened 4 additional sites in these same states. In COP08 PL will expand to 10 new sites in 10

states: FCT, Anambra, Adamawa, Lagos, Kogi, Benue, Imo, Niger, Kogi and Taraba. OVC is an on-going

activity and in COP08, PL will focus on scale up, tripling COP07 figures, ensuring increased coverage of

present sites and going on to new sites.

PL activities in COP08 will respond to the OVC situation in project states, consolidating structures initiated

in COP07 and strengthening community linkages and referral networks, while initiating services in the new

states. PL will limit expansion of the OVC services to the geographical scope of the Implementation

Agencies (IAs) and Multiplier Organizations (MOs) within the 14 PL states. Three thousand OVC will be

reached via family centered approaches. Through partnerships with 16 IAs and MOs, 600 caregivers among

family members and 300 home based care (HBC) volunteers will be trained in OVC care.

Volunteers and community health extension workers (CHEWs) will reach OVC in homes and communities,

maintaining stability, care, and protection. PL will work at extant structures within PL HBHC and collaborate

with OVC stakeholders at all levels - the Federal Ministry of Women Affairs and Social Development, their

State counterparts, GHAIN, and other USG IPs - and contribute to sustainability by expanding community

resources to improve quality care for OVCs.

PL's OVC services will be provided to children referred from GHAIN/other USG IPs and clients referred by

community members. 0 - 4 yr. olds (and/or guardians) will receive safe water kits, growth monitoring,

counseling on routine immunization protocols, CT for HIV, birth registration, nutritional counseling,

prevention and treatment of OIs and malaria services. 5 - 17 yr. olds will receive CT for HIV, nutritional

assessments and counseling, enrolment into formal education settings (back to school)/vocational skills

acquisition), AIDS education and on-going counseling. In addition HIV+ OVC will be assisted to access

ART, OI diagnosis and treatment (including STIs) and malaria prevention and treatment services at GHAIN

or other USG/GoN supported sites. They will also receive preventive kits. PL will provide nutrition support to

families as needed. To accomplish this in COP08 PL will make appropriate linkages with and leverage

resources from the new USG supported food and nutrition wrap around activities being implemented by the

MARKETS is states where they are co-located. An OVC will be considered served when he/she receives

the three services as recorded during an assessment and that follows the nationally approved plan of action

and guidelines, including the harmonized National OVC Vulnerability and child status indices.

PL has agreements with the GoN and FBOs (Anglican Communion AIDS Programme and the National

Supreme Council for Islamic Affairs) to place OVC, especially girls, in selected 10 and 20 schools. These

are the schools targeted by PL's AB program (avoiding duplication of efforts). In selected schools PL will

continue to contribute overhead in exchange for free tuition and education materials (uniforms, books, etc.)

for OVC. PTA members will be trained to recognize and respond to academic needs of OVC, to support

PTA levy waivers, and to provide three different, OGAC-recognized forms of psychological support. Where

indicated, PL will leverage further educational support for needy OVC from the ABE-Link wrap-around

activity. Out of school OVC, particularly those heading households or caring for sick parents/siblings, will be

supported to attend evening classes in the community. Others will be enrolled in contracted institutions that

provide specific training in vocations and business entrepreneurship. OVC who have completed vocational

training will be given seed grants to purchase equipment for microenterprises. OVC needing additional

funds for economic activities will be linked to banks and microfinance institutions to source soft loans.

The adapted curriculum equips OVC with life skills and age appropriate HIV/AIDS and sexuality/RH

information; it will be used for refresher training. PHA from support groups will be models for PL and

demystify stigma and discrimination. Peer facilitators from PL prevention (AB, OP) will mentor and guide

OVCs by counseling and engaging OVC in physical and social activities. Youth volunteers already trained

by PL will continue to provide HIV/AIDS prevention information to colleagues and siblings, focused on AB.

Age appropriate prevention messages and education to prevent abuse will be shared. Sexually active youth

will be provided with appropriate information on prevention and treatment of STIs.

Health care services will be provided at PL supported PHC facilities to supplement C&S support services

offered at ART centers and general health facilities. These services will follow the basic care and support

model. PL will continue to negotiate for subsidized/free medical care for OVC at GoN-owned and privately-

owned health facilities. Staff at PHCs will be trained on OVC health needs. Each HIV positive OVC will be

screened for TB, provided with a self care kit containing an insecticide treated net, water-guard (refilled

regularly) and receive OI prophylaxis. She/he will be linked to GHAIN, GoN and other USG sites for

pediatric ART and treatment for advanced OIs.

To expand the core of the program, caregivers will be recruited from members of extended families to care

for more OVC. COP08 and COP07 caregivers will be provided training and refresher training respectively

on psychological and spiritual support to OVC, pediatric treatment adherence, nutrition issues, diet and food

preparation techniques, communicating with children, and healthy life decision-making. Caregivers will be

linked to USG support sites to access other services for OVC. Seed grants will be given to care givers to set

up IGAs that augment household income, for transportation of OVCs to access services, for support of OVC

staying in schools and vocational facilities. PL will monitor these grants through structured guidelines.

HBC volunteers will also serve as OVC volunteers. Refresher training on OVC services will be provided to

support best performance. Topics will include promoting birth registration, carrying out nutritional

assessments, counseling, monitoring immunization status of infants, and monitoring growth. They will

support supervision of care givers; monitor OVC, assist youth headed households to maintain their homes

and refer OVC for treatment of ailments, immunization, child welfare and wrap around services.

Using standardized forms, IA/MO/PL M+E Officers collect data monthly, detailing numbers/demographics of

clients reached and messages provided. This provides timely information for effective decision making,

particularly regarding the breadth and depth of OVC coverage. OVC M+E activities will develop sustainable

capacity at IAs and MOs to collect relevant data.

Activity Narrative: POPULATIONS TARGETED:

The primary beneficiaries for the OVC program are children aged 0-17 yrs. who have lost one or both

parents to HIV/AIDS and/or are vulnerable because they are HIV positive; live without adequate adult

support; live outside of family care or are stigmatized, marginalized or discriminated against. Stigma

reduction activities and training will target caregivers, PTA members and HBC service providers.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The planned OVC interventions will contribute to the overall PEPFAR C&S goal of mitigating consequences

of the epidemic by reaching 3000 OVC with care and support services. PL, working with all stakeholders at

all levels will contribute to the sustainability of interventions by strengthening community systems to improve

quality care for OVC, build community-capacity of 600 caregivers to support OVC by training and providing

seed grants.

LINKS TO OTHER ACTIVITIES:

PL will strengthen and consolidate linkages with stakeholders, particularly GHAIN, SFH, and GoN, to

provide care and support packages for OVC and establish linkages between HVCT (3.3.09) centers and

care outlets. This will improve utilization of MTCT (3.3.01), HBHC (3.3.06), HVTB (3.3.07), HTXS (3.3.11)

and HLAB (3.3.12) services and enhance community participation in care for OVC and ensure service

quality. PL will refer for wrap around activities - social services, food and livelihood opportunities. Girl-

headed households will be linked with supportive women's groups to provide them with psychosocial

support and protection. Follow-up supportive supervision will be provided. At each site, PL activities will

strengthen linkages to AB and OP prevention activities as integral parts of home-based care for OVC

offered by care givers. Those linkages already established will be strengthened with TB/HIV intervention

programs, PMTCT services, USG-funded immunization projects (COMPASS) and child welfare services.

EMPHASIS AREAS:

Successes recorded on gender issues will be consolidated, particularly sensitivity in programming that

targets vulnerable young girls, and address women's rights to income and productive resources. PL will

work with legal aid initiatives to develop legal frameworks that uphold the rights of OVC, particularly

inheritance. Wraparound activities related to food will be another emphasis area.