ACTIVITY DESCRIPTION:

Prevention of mother to child transmission (PMTCT) services will continue to be integrated into antenatal

care (ANC) as an entry point to HIV/AIDS prevention, care and support services for mothers, their infants,

family members and the community. The landmark change in program strategies for COP08 will be the

establishment of integrated PMTCT services at primary health care (PHC) level in line with the minimum

package stipulated by the Government of Nigeria (GON). GHAIN has repositioned its strategies to train an

additional 400 health care workers (HCWs) in collaboration with other stakeholders (especially UNICEF)

using GHAIN integrated PMTCT/RH training curriculum to provide PMTCT services to 100,000 clients in

COP08, with 4,000 receiving ARV prophylaxis. This will be achieved through the continued support to the

existing 64 PMTCT sites, expansion to 15 new HIV comprehensive care sites and 9 new LGA sites. GHAIN

will continue to provide services in all its current focus states including several high prevalence states (FCT,

Anambra, Benue, Bauchi, Kano, Cross River, Edo, Lagos, Niger, Enugu, Kogi, Taraba, Adamawa, Akwa

Ibom) and expand services to additional states in Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

In line with the USG strategy to provide PMTCT service coverage at the LGA level, GHAIN will also expand

services to an additional four PMTCT sites in four LGAs in Lagos (Amuwo-odofin, Kosofe, Ajeromi-Ifelodun,

and Apapa), 2 LGAs in Cross River (Odukpani and Akpabuyo), and three LGAs in Anambra (Orumba

South, Aguata and Nnewi South).

GHAIN will lay emphasis on strategic prevention activities to promote options such as partner notification

and testing, treatment support and community outreach activities to cluster ANCs and delivery facilities

including training of TBAs (traditional birth attendants) using an adapted curriculum. Emphasis will also be

laid on infant feeding options (exclusive breast-feeding for 6 months or breast milk substitute if acceptable,

feasible, affordable, safe and sustainable), as well as continued integration of RH/FP into PMTCT. GHAIN

will offer HIV early infant diagnosis testing from 6 weeks of age using DBS in line with the National Early

Infant Diagnosis (EID) scale-up plan. Using a family centered approach, PMTCT service providers will

promote partner testing as well as testing for any other children in the family. In addition, the family will be

encouraged to enroll all their children into community and facility based OVC care and support programs.

Project activities will be tailored towards improving quality and use of MCH facilities, sensitizing and

mobilizing communities to create demand for PMTCT services; ensuring that point of service, opt out CT is

offered to all women presenting in ANC and in labor & delivery wards. Support groups will also be used to

track and support mother-infant pairs and other family members in the communities and link to care. Where

available, lay counselors will be used to reduce workload and avoid burnout of counselors. Other activities

include encouraging male involvement; and ensuring that ARV drugs are offered to HIV+ pregnant women

for PMTCT prophylaxis and/or for their own health, utilizing the national and international guidelines as

basis for treatment decisions. These include: AZT, 3TC and NVP. The woman will subsequently be followed

up at an HIV comprehensive care centre to ensure continuity of care. ARV (AZT, NVP) and CTX

prophylaxis will be provided to the exposed infant. CD4 testing will be prioritized for pregnant women to

identify those who require ART for their own health. CTX prophylactic therapy will be provided for HIV+

pregnant women as indicated. Those who test negative to HIV will receive post-test counseling on how to

remain negative. All clients who are tested will receive results on the same day. HIV testing of all partners of

pregnant women will be actively encouraged and women counseled and linked to FP services as needed.

The funding will address capacity building of health care workers on EID, couples counseling and support to

families on infant feeding options in accordance with the mother's choice and the national guideline on

infant feeding. Howard will train and re-train pharmacists in all PMTCT sites while also collaborating with the

community pharmacists to expand the reach and quality of services. PMTCT Services will also be geared

towards ensuring that in labor & delivery rooms, safe obstetrical practices are implemented. Infants of a

positive parent will be given CTX prophylaxis from six weeks after birth, until their status is determined.

GHAIN will also continue to emphasize that as a strategy to provide PMTCT plus, appropriate linkages with

the family planning services will be strengthened.

GHAIN will also strengthen the national pediatric program through a mentorship program in collaboration

with the Clinton Foundation. GHAIN will continue to support the GON in expanding PCR lab services for

EID and establish linkages with other sites using the dry blood spot (DBS) strategy. This is to enable the

expansion of infant diagnosis to all its PMTCT supported sites. HIV+ infants will be linked to comprehensive

care centers through a well-established network of care. GHAIN will support a GON zonal training on Infant

Feeding Counseling tools. All the women reached by the trainees will count as indirect targets.

Joint GON/USG/GHAIN supportive supervision will be carried out to all the sites on a quarterly basis.

Appropriate tools for program monitoring including PMTCT registers will be provided to all the sites while

monthly evaluation of the data will be carried out. The quality of services will be assured through facilitative

supervision and QA checks using standardized tools developed for this purpose.

For support of EID and VL monitoring, GHAIN will continue to receive support from those PEPFAR IPs with

PCR capacity. GHAIN will also work towards developing the PCR capacity at one of its supported sites,

contingent upon meeting the requirements set out by the PEPFAR-Nigeria LTWG (employing the services

of a molecular biology specialist to support this program, collaboration with IPs and/or other organizations

with experience in PCR development and dialog with PEPFAR on the placement of the new PCR lab).

CONTRIBUTION TO OVERALL PROGRAM AREA:

The planned scale up of PMTCT services in the PHC facilities will increase access to the under-served

population residing in the rural communities where HIV/AIDS care services including treatment, care and

support are minimal and almost non-available. Women who test positive will be linked and referred to

support groups in their communities. To increase gender equity in HIV/AIDS programs, male involvement in

PMTCT will be encouraged. The PMTCT activity will be appropriately linked to relevant services to promote

prevention & treatment of OIs, ARV treatment, palliative care, OVC support, nutritional support, reproductive

health care, PSS and community support. GHAIN will establish effective synergy with Global Fund for

HIV/AIDS, TB and Malaria Round 5 Grant (GFATM R5).

The activity will contribute significantly to Nigeria's 5-year national strategic plan in response to HIV/AIDS

which encourages pregnant women to know their HIV status, reduction in the rate of HIV transmission from

women to their unborn children and emphasizes referrals and necessary linkages.

Activity Narrative: LINKS TO OTHER ACTIVITIES:

The pregnant women attending PMTCT services will be appropriately linked to various services according

to their needs. Clients who demonstrate signs of TB will be linked accordingly to a TB program. Those who

are eligible for ART will be linked to ART centers while others who test positive to HIV will continue to

access Palliative Care (PC) services accordingly. All positive women will be linked to support groups and

other community based organizations such as those offering income generating activities (IGAs) in their

respective communities and tracked through the existing referral system. Families will be encouraged to

enroll all their children in the care and support program in the facility and be referred to community based

care and support programs for follow up.

POPULATIONS BEING TARGETED:

The program will target pregnant women, ensuring that CT (opt-out) is offered to all women presenting in

ANCs and in labor & delivery wards; TB patients that are pregnant and People living with HIV/AIDS. The

activity will ensure that ARV drugs are offered to HIV+ pregnant women for PMTCT prophylaxis and/or for

their own health, utilizing WHO and national guidelines as basis for treatment decisions. Other clients will

be reached indirectly through ripple effects from capacity building and system strengthening activities that

will be carried out with GON.

EMPHASIS AREAS:

The activity includes an emphasis on local organization capacity building. GHAIN will also continue to

strengthen its exit/sustainability plan both at the country program level showing how it will work with the

health facilities implementing PMTCT programs to build their capacity and to customize a specific plan and

schedule for each facility.

This activity will strive to increase gender equity in HIV/AIDS programs, male involvement in PMTCT will be

encouraged through sensitization, encouraging the male partners to know their HIV status and/or provide

support to their spouse. Opportunities will be sought to identify and work with other USG projects to

increase women's rights and increase women's access to income and productive resources, including

private and public sectors that provide micro-finance facilities and link up women that may require such

support to sustain their families, particularly addressing their health needs.

ACTIVITY DESCRIPTION:

GHAIN's abstinence/be faithful (A/B) program will focus on community mobilization and outreach activities

that promote abstinence, fidelity, delay of sexual activity, partner-reduction messages and related social and

community norms in the HAST LGAs in Kano and Cross River (Nassarawa and Yakur LGAs respectively)

with the aim of reaching 8,000 individuals with A/B messages.

In line with USG prevention team guidance, reinforcement of messaging through several intervention

strategies will be the focus of GHAIN programming in COP08.

Every individual will be reached with a minimum of three interventions. GHAIN will ensure that each

beneficiary is reached through community awareness campaign, peer education model and interventions

addressing vulnerability issues were appropriate within the year. These will be reinforced by mass media

campaigns.

Through community mobilization and dialogue this activity will particularly address norms affecting the

behavior of women/girls and men/boys and inequalities between males and females that increase

vulnerability to and the impact of HIV/AIDS. GHAIN will also mobilize communities to address

norms/behaviors on cross generational and transactional sex. Community mobilization will equally promote

increased male involvement in prevention activities, timely health seeking behaviors and address issues of

stigma and discrimination.

An important partner in supporting the community at large, and youth in particular, to adopt and sustain

abstinence/ be faithful behaviors is undoubtedly the faith community, leaders and organizations. Targeted

and on-going advocacy will be conducted to ensure the religious leaders reinforce correct and consistent

messages regarding HIV/AIDS prevention, stigma and discrimination as well as to promote health seeking

behaviors and address social norms and inequalities that increase vulnerability to HIV/AIDS. Religious

leaders will be mobilized and trained to include messages regarding HIV/AIDS in their weekly sermons in

churches and mosques.

In addition, community based organizations (CBOs) and non-governmental organizations (NGOs) as well as

influential individuals in the community will be strengthened to provide age and context appropriate

information in an aim to create an enabling environment for sustained behavior change. This will be

implemented through training, on-going mentoring and provision of technical assistance to build local

capacity to design and manage innovative adolescent reproductive health (ARH) projects.

Rolling out this intervention will involve conducting formative assessment, advocacy, capacity building,

trainings, community rallies and campaigns, peer education, SBC materials development and distribution,

referrals, monitoring and evaluation. Support through mentoring and training will also be given to selected

health facilities in the HAST LGAs to encourage youth friendly services for prevention and care.

Balanced AB messages will be provided during all community mobilization activities, with appropriate

linkages and referrals made to HVOP programs for people in need of correct and accurate information

about condom use. Referrals and linkages will be strengthened with other services, including palliative care,

PMTCT, VCT, TB and ART to benefit from the demand creation activities of the community mobilization in

pursuance of the PEPFAR 2-7-10 goals.

The activities will be implemented with technical support particularly from GHAIN's national and state-level

strategic behavior communication/community mobilization units to intensify and expand community

mobilization and capacity building activities. GHAIN will equip 15 individuals through training and other skills

building activities to deliver correct and effective A/B messages.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

GHAIN will work with local FBOs and NGOs to carry out AB prevention activities with the general population

through the intensification and expansion of community mobilization activities on AB and risk reduction.

The AB activities will culminate in generating numbers for CT and PMTCT which serves as entry points for

other services such as ART and palliative care. GHAIN will provide support for the integration of appropriate

reproductive health messages into the "AB" programs. Most importantly, GHAIN will focus on building the

capacity of these implementing agencies to effectively carry out sustainable HIV prevention activities,

including development and dissemination of IEC materials, community mobilization, peer education

activities, counseling services, referrals and linkages among others.

LINKS TO OTHER ACTIVITIES:

The AB activities will continue to be linked to HCT (3230.08), PMTCT (16296.08), ART (3233.08, 3231.08),

TB (3228.08) programs, HBHC (3237.08) and other relevant services available in the community. GHAIN

will ensure high quality HVAB data, through a sound information system that precludes double counting and

ensures accountability. GHAIN will develop an exit/sustainability plan both at the country program level

showing how it will work with the implementing agencies (IAs) as a group to build capacity and at the

individual implementing agency level to customize a specific plan and schedule for each organization. The

plans will include an assessment phase, customized plan for building capacity, a set of clear objectives and

indicators for measuring capacity as well as a time line based on key benchmarks.

POPULATIONS BEING TARGETED:

This activity will target youth (in and out of school) and religious leaders.

EMPHASIS AREAS:

This activity includes an emphasis on local organization capacity building, human capacity development and

gender

This activity will take consideration for increasing gender equity in HIV/AIDS programs through providing

equal quality prevention services without discrimination in regards to sex, nationality, religion, creed, etc.

Strategic efforts will be made to tailor prevention messages to match the environmental requirement of

target audiences. The activity will also help deal with stigma reduction, male norms and behaviors as well

as reducing violence and coercion through vigorous campaigns to educate people on the benefits of CT.

ACTIVITY DESCRIPTION:

It has been estimated that 5% -10% of HIV infections worldwide are transmitted through the transfusion of

contaminated blood and blood products. In order to reduce global pandemic due to unsafe blood

transfusion, this activity will support capacity development for blood safety, universal precautions, good

laboratory practice and waste management.

During COP08 this activity will provide support for 30 ART sites where GHAIN will be working to provide

comprehensive ART treatment, care and support. In the first component of this activity, four sites will be

receiving intensive support from GHAIN to become model blood banks, linked to the NBTS centers. In the

second component of this activity, the remaining 26 sites will participate in trainings and receive technical

assistance, mentoring and monitoring from GHAIN staff. All blood for emergency transfusion will be

screened with rapid test kits following standard operating procedures developed in accordance with

National guidelines.

The first component of this activity is capacity development for blood safety (training and equipment) which

will be done with technical assistance from Safe Blood for Africa Foundation. This will entail personnel and

institutional capacity development aimed at improving quality of blood safety services at site levels. The

personnel capacity development component will involve trainings in universal precaution, good laboratory

practice, laboratory safety, use of rapid test kits for emergency transfusion screening, logistics and cold

chain management training, donor recruiting and management, and appropriate use of blood. The

institutional capacity development component will mainly cover the provision of basic needs for the

collection of blood and serologic testing for the TTIs to ensure that all blood meant for emergency

transfusion are free of TTIs. In line with the GoN National training guideline and curriculum for TTIs testing

for blood transfusion safety, GHAIN with technical assistance from SBFAF will conduct a central TOT for an

average of 2 senior laboratorians per site, making a total of 60 to be trained by SBFA. To avoid double

counting, these 60 are captured in SBFA narrative and targets. These senior laboratorians will in turn train

all the laboratory officers in their sites, including all laboratory staff that handle blood for transfusion. A total

of 72 health personnel will be trained through the step down trainings. The site trainings will be conducted

under the supervision of the GHAIN laboratory staff and are captured in GHAIN's targets.

GHAIN will also link 4 sites to the NBTS centers for the NBTS- Hospital linkage. The sites to be linked will

likely be General Hospital, Wuse; Murtala Mohammed Hospital, Kano; General Hospital, Awka; and Central

Hospital, Benin. These sites will be empowered as model blood banks to collect blood from donors using

the national donor questionnaire. The collected blood will be sent to the nearest NBTS center for screening

by Elisa. It is hoped that 12,680 units of blood will be collected and about 80% of this, 10,100 will be

screened through this linkage with the NBTS. These sites will also conduct blood drives in collaboration with

the NBTS. Blood collected from such donor drives will be screened by the NBTS and the screened blood

returned to these sites. Samples of blood screened with rapid test kits for emergency transfusion will be

sent to the NBTS centers for re-testing by ELISA.

This activity will encourage blood donor drives in collaboration with NBTS centers; promote the principles of

centralized blood transfusion services; voluntary non-remunerated blood donation as opposed to paid

donors/family replacement; universal safety precautions; the reduction of unnecessary transfusions;

exposure to blood; accidental injury/ contamination as well as the provision of essential consumables and

services that protect the health worker from contacting infections especially HIV and hepatitis. These

universal precaution materials include personal protective equipment such a gloves and laboratory coats

and other consumables (Methylated-spirit, hypochlorite solutions and antibacterial soaps), which will be

provided for the sites. Equipment to be provided will include refrigerators, centrifuge, thermometer,

pipettes, and other equipment required to upgrade the facility to a blood bank activity level. In addition, each

site will make provisions for referral of staff for access to Post Exposure Prophylaxis (PEP) in case the need

arises.

All screening services will be linked to pre and post test counseling services at each site. National blood

donor questionnaires will be used to screen all donors and the data submitted to the nearest NBTS center

as part of the national database.

Proper waste management will be encouraged through the use of Bio-Hazard Bags, suitable sharps

containers and the use of incinerators. In order to maintain high quality laboratory results, GHAIN will

institute an aggressive QA/QC program that involves on-site quarterly monitoring and retraining; and

proficiency in testing for the TTIs.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This program will contribute to the prevention of HIV/AIDS through blood transfusion. This activity will also

contribute towards strengthening quality control systems on the use of HIV test kits in the PEPFAR

program.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in HVCT - 3.3.09, MTCT - 3.3.03 and HTXS - 3.3.11. All blood donors

will be offered full HCT services after screening with the blood donor questionnaire and the data captured.

Positive clients from emergency screening will be referred for ART services using GHAIN referral network

system. GHAIN will collaborate with other partners to work with the National Blood Transfusion Service to

develop a sustainable logistic plan for continuous availability of voluntary non-remunerated donors (VNRD)

and fully screened blood so that emergency screening will be minimal.

POPULATIONS BEING TARGETED:

This activity targets youth, adult men and women who are potential blood donors. It will also target health

care workers for appropriate use of blood.

EMPHASIS AREAS:

Emphasis areas include human capacity development and local organization capacity building. An

emphasis will be placed on linkage with the NBTS and training on blood safety issues. This program shall

work to reduce stigma associated with the HIV status of a blood donor and discrimination faced by

individuals with HIV/AIDS and their family members.

ACTIVITY DESCRIPTION:

By the end of COP07, GHAIN will be conducting injection safety activities along with other PEPFAR

program areas at 40 sites in FCT, Anambra, Benue, Bauchi, Kano, Cross River, Edo, Lagos, Niger, Enugu,

Kogi, Taraba, Adamawa, and Akwa Ibom. In COP08, GHAIN will expand to an additional 20 comprehensive

sites in additional states in Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

With technical assistance from The John Snow Inc./ Making Medical Injection Safer (JSI/MMIS) project,

GHAIN will apply all the four major technical approaches of making injection safer to create an enabling

environment for health workers to provide quality services to clients without fear of medical accidents and

infections. The approaches will include training and capacity building, behavioral change communication

(BCC)/advocacy, procurement and supply of safe injection equipment, and health care waste management.

GHAIN will further sponsor participants to the national training of trainers (TOT) workshop that will be

organized by JSI/MMIS on making medical injection safer and another that will be co-organized between

JSI/MMIS and the Federal Ministry of Environment on health care waste management. Trainees from these

TOTs will cascade the trainings to all the selected sites implementing HIV/AIDS services. The step down

trainings will be conducted both at the state and facility levels to ensure adequate coverage of sites and at

least 480 participants will be trained. GHAIN will support JSI/MMIS and the ENHANSE project in their

efforts towards ensuring behavior change of the communities through dissemination of the injection safety

policy at the state level of government, while focusing on ensuring behavior change of the health workers

and clients towards making medical injection safer in its supported health facilities. Behavior change

communication (BCC) materials produced by JSI/MMIS on injection safety will be obtained and distributed

to all GHAIN supported sites.

While depending on JSI/MMIS to make procurement and supplies of safe injection equipments to GHAIN

supported sites, GHAIN will make further arrangements to cope with shortfalls in supply of the equipment

and for other day-to-day consumables within the limits of the funding level. GHAIN will advocate to the

facilities to utilize the universal safety precautions in the disposal of medical wastes including use of sharps

boxes and support incineration of such medical waste through repairs and fueling. Health workers will be

encouraged to utilize the knowledge and skills gained from the universal safety precaution and post

exposure prophylaxis that will be provided through the ART unit. In each selected facility for injection safety

activities, GHAIN will focus on facility saturation so that the entire health facility is injection safety compliant.

Infection control committees will also be supported at secondary and tertiary health facilities.

CONTRIBUTION TO OVERALL PROGRAM AREA:

Injection safety will contribute to the overall program by preventing nosocomial transmission of HIV and

other blood borne pathogens. Such activities will also improve the safety of the healthcare provider thus

leading to reduction of stigma to clients and making the clients feel safe and access the health system for

care and treatment of AIDS. This will result in an increase in the uptake of Counseling and Testing (CT),

Palliative Care (PC), Antiretroviral Therapy (ART), Prevention of Mother to Child Transmission (PMTCT)

and laboratory services, leading towards target achievement in all areas.

LINKS TO OTHER ACTIVITIES:

The GHAIN Injection safety program will relate to activities in Medical transmission/Blood Safety - 3.3.03,

Condom and other preventive activities - 3.3.05, PMTCT - 3.3.01, Counseling and Testing - 3.3.09, and

HIV/AIDS Treatment services - 3.3.11. The linkages of all the above components will ensure compliance

with Principles of Universal Precautions and impact not only the quality of care given to clients but also care

and occupational safety of the health care worker.

POPULATIONS BEING TARGETED:

GHAIN will provide injection safety training and service aids to health care workers such as public health

workers, doctors, nurses, pharmacists, laboratory workers and waste handlers at the various points of

service where such sharps are used and these will include counseling and testing units, laboratory,

phlebotomy rooms, wards, labour rooms, delivery rooms and immunization clinics among others. Education

on proper handling and use of sharps, including disposal methods will be extended to health workers

outside the HIV/AIDS care arena and clients to enable them carry on such practices both in the health

facility and even in their homes. This will add value to the home based care of patients.

EMPHASIS AREAS:

This activity includes an emphasis on human capacity development through the training of key health care

employees.

Strengthening of injection safety procedures across the GHAIN supported facilities in the GHAIN focus

states will go a long way in reducing HIV/AIDS related stigma and discrimination amongst healthcare

workers. This attitude change will in turn create an enabling environment for clients to access HIV care and

Treatment services.

ACTIVITY DESCRIPTION:

In COP08, the Global HIV/AIDS Initiative Nigeria (GHAIN) will provide other prevention (OP) services to

53,400 most-at-risk persons (MARPs) including transport workers and commercial sex workers by

supporting existing and new implementing agencies (IAs) to provide services to MARPs in all project states

and expand to additional states inter alia Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

To achieve the above target, and also contribute to overall goal of reduction of the incidence and impact of

HIV&AIDS in Nigeria, GHAIN will disseminate information about the correct and consistent use of condoms,

as well as information about abstinence; and the importance of HIV counseling and testing, partner

reduction, and mutual faithfulness as methods of risk reduction. Also, information will be disseminated on

the importance of correctly and consistently using condoms during every sexual encounter with partners

known to be HIV-positive (discordant couples) or partners whose status is unknown; the critical role of HIV

counseling and testing as a risk-reduction strategy; the development of skills for vulnerable persons; the

relationship between alcohol and risky behaviours and the knowledge that condoms do not protect against

all STIs.

GHAIN's primary OP strategies will be peer education and community dialogue. This combination of

approaches will promote the acceptance of project messages, engender change and facilitate community

ownership of the project. GHAIN will train a minimum of 165 persons drawn from all project locations with

interpersonal communications and counseling (IPCC) as well as community dialogue skills to enable them

to conduct IPCC outreach activities and community dialogue sessions. Peer education will equip selected

volunteers within MARPS to provide their peers with correct and complete information on HIV/AIDS

prevention, treatment, care and support through one-on-one and group counseling activities.

Through the community dialogue sessions, members of target communities will exchange information face-

to-face, share personal stories and experiences, honestly express perspectives, clarify viewpoints, and

develop solutions to such HIV/AIDS issues as stigma and discrimination, sexual transmission, medical

transmission, and prevention of HIV within positive populations. The major output of the community

dialogue will be a critical mass of advocates within each community who are well versed in HIV&AIDS and

are working towards the reduction and elimination of new HIV cases as well as stigma that fuels the

epidemic.

GHAIN's secondary OP strategy in COP08 will be a branded multi-media campaign that will unify all OP

messages and provide over-arching communication support to the peer education and community dialogue

programs, with a focus on demand creation for HIV/AIDS services. The "Heart to Heart" logo which has

gained wide recognition and acceptance as a symbol of quality HIV/AIDS service will remain the logo for the

OP multi-media campaign.

In addition, infection control measures will be established in GHAIN comprehensive ART and CT sites to

equip health care providers with universal precautions and provide post exposure prophylaxis to them when

necessary. STI syndromic management services including training on STI syndromic management, STI

counseling for affected individuals and STI treatment services (diagnosis and drugs) will also be provided.

GHAIN will ensure that condoms are available at over 88 sites during COP08, including counseling and

testing sites and brothels. GHAIN further hopes to leverage through collaboration with the GFATM program

resources to provide condoms at additional CT centers and potential expansion into additional states. This

is entirely dependent on GFATM grant being signed to continue during this period, and if the program is

implemented according to plan. GHAIN and its IAs will continue to partner with the Society for Family

Health (SFH) and United Nations Fund for Population Activities (UNFPA) to obtain and distribute condoms

to those most at risk of transmitting or becoming infected with HIV. GHAIN will also explore the possibilities

of getting condoms directly from DFID in addition to the USG collaboration with DFID.

Referrals and networks will be strengthened to ensure effective expanded access to clinical services for

MARPS, including referral for diagnosis and treatment of sexually transmitted infections (STI); TB (DOTS

Center), RH/FP/PMTCT and linking PLHA prevention services to HIV treatment and care services, including

counseling and testing. GHAIN OP activities in COP08 will be guided by the national behavior change

communication strategy and in line with the decisions of the new Prevention Technical Working Group.

The major beneficiaries of COP08 activities will be road transport workers, commercial sex workers,

uniformed personnel and their dependants, other identified high risk groups, People Living with HIV/AIDS

(PLHA) and medical personnel.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

GHAIN will contribute to the overall United States Government (USG) strategic plan of building the capacity

of local organization by working with local non-governmental organizations (NGOs) to carry out C&OP

activities with MARPs and related segments of the general population. GHAIN will focus on building the

capacity of these implementing agencies to effectively carry out sustainable HIV prevention activities among

MARPs, including development and dissemination of strategic behavior communication (SBC) materials,

community mobilization, condom use programs, peer education activities, counseling services, referrals and

linkages among others. The C&OP activities will in turn contribute to generating demands for counseling

and testing (CT) and prevention of mother to child transmission (PMTCT) services which serve as entry

points for other services such as ART and palliative care. GHAIN will provide support for the integration of

appropriate reproductive health messages into the C&OP programs for the uniformed services and their

dependants by creating wraparounds to enhance activities initiated using Child Survival/Population Funds.

LINKS TO OTHER ACTIVITIES:

As in all OP programs, activities will continue to be linked to 3.3.09, 3.3.11, 3.3.01, 3.3.06, 3.3.07 and other

relevant services available in the community. GHAIN IAs will work with the mobile counseling and testing

team of GHAIN to locate and strategically mount services at areas identified to have concentrations of

MARPS. People who test positive will be referred for continued care along the continuum of care model.

The referral coordinators of GHAIN will take down contact details of such positive clients for the purposes of

continued counseling, palliative care and contact tracking for tuberculosis (TB) screening and ART services

(if eligible). GHAIN will ensure high quality C&OP data through a sound information system that precludes

double counting and ensures accountability.

Activity Narrative:

POPULATIONS BEING TARGETED:

The beneficiaries for the OP activities will include road transport workers, commercial sex workers (CSW),

discordant couples, PLHA, mobile populations, truck drivers, uniform services personnel and their

dependants, medical personnel (public and private health care workers), clients/partners of CSW, and out of

school youths.

EMPHASIS AREAS:

An emphasis will be on human capacity development and local organization capacity building. GHAIN will

continue to strengthen the developed exit/sustainability plan for the implementing agencies, both at the

country program level, showing how it will work with the implementing agencies (IAs) as a group to build

capacity, and at the individual implementing agency level to customize a specific plan and schedule for

each organization. The plans will include an assessment phase, a customized plan for building capacity, a

set of clear objectives and indicators for measuring capacity, and a timeline based on key benchmarks.

OP activities will take into consideration gender issues related to HIV/AIDS programs through providing

equal quality prevention services without discrimination in regards to sex, nationality, religion, creed, etc. as

well as a concerted effort to increase male involvement in HIV/AIDS activities. Strategic efforts will be made

to tailor prevention messages to match the environmental requirement of target audiences. The activity will

help address male norms and behaviors while reducing violence and coercion toward females through

vigorous campaigns to educate people on the benefits of couple counseling and testing (CT) and mutual

disclosure of HIV status. The much increased availability of mobile CT will also help reduce stigma and

discrimination against people who test positive to HIV.

ACTIVITY DESCRIPTION:

Global HIV/AIDS Initiative Nigeria (GHAIN) will provide palliative care (PC) services to 93,600 living with

(PLWHAs), or affected by HIV/AIDS (PABAs) by supporting 45 existing comprehensive antiretroviral

therapy (ART) sites, establishing 15 new sites and increasing coverage by going to additional states inter

alia Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

In Country Operational Plan 08 (COP08), GHAIN will support practical strategies that ensure people living

with HIV (PLHIV) can access comprehensive and qualitative, non-ART, basic HIV/AIDS care and support.

Based on lessons learnt, funding priorities and the present partner guidance, GHAIN will focus on facility

based approaches to PC service delivery and collaborate, through linkages and referrals, with other

implementing partners responsible for the community-based components of care as appropriate.

GHAIN will strategically engage all the comprehensive ART sites and the selected Primary Health Care

(PHC) centers to provide comprehensive basic care and support services in line with the National Palliative

Care Guidance and the USG PC Policy. Services to be provided include: HIV counseling and testing (CT)

that will be supported under the CT program; basic nursing care, assessment and management of signs

and symptoms (including pain), prevention of malaria and opportunistic infections (OIs), PC medications,

nutritional support; psychological care including adherence counseling, pain control; non-ART laboratory

services; referral support for clinical care and ART, and non medical support.

GHAIN will collaborate primarily with the Positive Living project implemented by the Center for Education

and Population Activities (CEDPA) to provide home based care (HBC) and other support services for all its

clients. GHAIN will refer all clients requiring HBC to the positive living project implemented by CEDPA to

ensure the holistic continuum of care without duplication of services. Special attention will be given to

strengthening the communication between the health facilities/ health workers and CEDPA's home based

care givers to ensure uninterrupted service along the continuum of care. GHAIN will strengthen support

groups, integrated into the health facilities providing services. Where CEDPA is unable to support the

community based care component, GHAIN will liaise with other organizations as appropriate and available,

or if funding permits, implement this component through direct support to community partners.

The activities of the support groups to be funded by GHAIN will be mainly for contact tracking and peer

support, while CEDPA provides continued community home based care services, thus, ensuring a working

continuum of care without duplication of services. GHAIN will organize monthly talks during the support

group meetings. Topics may include inter alia: nutrition, adherence, prevention for positives. A total of 200

people will be trained to provide facility based PC.

Burn out, or compassion fatigue, among care givers at all levels in health facilities and in the community is

not unusual because of the high amount of stress involved. GHAIN will institute facility based support

networks where they do not already exist for on-going support and peer counseling. Health care workers at

each facility will meet at minimum on a monthly basis in order to share experiences, motivate each other

and discuss ways of managing stress, difficult situations, and addressing other issues.

In the rural Local Government Areas (LGA) of Cross River State and urban LGAs in Kano State where

GHAIN has established comprehensive HIV/AIDS services, GHAIN will also be responsible for the provision

of holistic palliative care (addressing the emotional, spiritual, physical and social needs). In addition to the

activities listed above, GHAIN will train 45 support group members to provide home based care services.

Home based care kits will be distributed to support group members.

GHAIN will conduct advocacy for and referral to inter alia, educational and legal support, economic

strengthening and shelter. In addition, GHAIN will carry out stigma and discrimination reduction activities.

Spiritual support will be provided through linkages to religious leaders. In line with GHAIN's continued

support of the UNGASS MIPA principle we will ensure that PLWHA participate actively in the planning of

meetings and other care and support activities as appropriate.

Howard University will continue to work with the Pharmaceutical Society of Nigeria (PSN), and other

pharmacy professional bodies to help licensed patent medicine vendors to build the capacity of their

members in seven pilot communities to further improve the dispensing of prescribed PC related medications

through PHC facilities and patent medicine stores as applicable, as well as to complement the existing

referral services for clients. Additionally, Howard will be a part of the close collaboration with CEDPA and

will offer training-of-trainers workshops to their community health extension workers on aspects of

medication-related PC.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This project will contribute towards reaching 93,600 HIV+ individuals with clical basic care and support out

of the USG overall strategic five year plan for Nigeria. It will also contribute to strengthening the national,

state and local/facility level systems for implementing quality PC programs. The diagnostic laboratory

services will be used for monitoring PLHIV thus ensuring timely entry into the ART program. GHAIN will

establish effective synergy with GFATM Round 5 grant to improve HIV/AIDS Programming.

This program will also contribute to institutional and staff capacity building. Thus, GHAIN will continue to

strengthen its exit/sustainability plan both at the country program level showing how it will work with the

health facilities implementing comprehensive ART programs and the facility based support groups, to build

their capacity and to customize a specific plan and schedule for each facility. The plans will include an

assessment phase, customized plan for building capacity, and a set of clear objectives and indicators for

measuring capacity as well as a time line based on key benchmarks.

LINKS TO OTHER ACTIVITIES:

The GHAIN PC in the focal states relates to activities in 3.3.10, 3.3.07, 3.3.08 and 3.3.01.

GHAIN will concentrate its PC activities in the health facility while CEDPA takes the community home based

care services. The facilities will identify one staff person that will serve as a PC coordinator and will be

provided with necessary training to double as the supervisor for all PC activities, including the facility based

support groups. The facility referral coordinator and the PC coordinator will work hand in hand to coordinate

the linkages between CEDPA and GHAIN supported activities. These will act as linkages for those persons

Activity Narrative: who test positive to HIV (including pregnant women) to care and support services as well as providing

management for OIs and for contact tracking clients on ARV drugs who are lost to follow-up. These linkages

will assist in maximizing the support opportunities provided by PEPFAR funding.

TARGET POPULATIONS:

GHAIN will provide PC services (specifically clinical care and support services) to adults (including pregnant

women) living with HIV/AIDS through facility-based support groups. These clients will be generated from

PMTCT, Care and Treatment, counseling and testing, and TB-HIV programs. GHAIN will empower

secondary and primary health care facilities to serve as referral points for clients and their families being

provided with HBC services by CEDPA.

EMPHASIS AREAS:

This activity includes a major emphasis on capacity building through the training of key health care

providers which is critical in delivery of quality laboratory and clinical palliative care services to clients.

GHAIN will strengthen gender equity in HIV/AIDS care and support programs while emphasizing male

involvement in care initiatives to ensure sustainability. GHAIN will collaborate with the Partners for

Development to source micro-credit facilities for the indigent clients, and with other USG implementing

partners to wrap around services that protect the rights of the child, enhance food supply, improve

sanitation in communities, provide clean water, Insecticide Treated Nets (ITN) and strengthen non-HIV

health services, including family planning, child health and nutrition.

ACTIVITY DESCRIPTION:

The goal of the TB/HIV component is to support the national effort in reducing TB/HIV associated morbidity

and mortality through effective collaboration between TB and HIV programs by expanding joint TB/HIV

activities, human and institutional capacity strengthening, and increasing community participation in TB/HIV

activities.

Global HIV/AIDS Initiative Nigeria (GHAIN) will implement these activities in close collaboration with the

National Tuberculosis and Leprosy Control Program (NTBLCP) and other partners based on the following

guiding principles: services will be strengthened to ensure that all TB patients have access to HIV diagnosis

and care services, and all HIV patients have access to TB care and services; implementation of joint TB/HIV

activities (including supervision) will be in-line with national policies and guidelines; people living with

HIV/AIDS (PLWHA), tuberculosis (TB) patients, and communities will be involved in TB/HIV program

planning and implementation; proper mechanisms for preventing cross infection or re-infection of TB in the

health facilities will be put in place.

Strengthening of the TB/HIV services will involve the expansion of service delivery points to include Primary

Health Care (PHC) levels and the intensification of case finding, case holding and referrals. Services will be

expanded from the current focus states (FCT, Anambra, Benue, Bauchi, Kano, Cross River, Edo, Lagos,

Niger, Enugu, Kogi, Taraba, Adamawa, Akwa Ibom) to 4 additional states - Katsina, Nasarrawa, Kebbi,

Sokoto and Zamfara States. In line with the USG strategy to saturate LGAs with TB/HIV se+A109rvices,

GHAIN will establish expand services to an additional four LGAs in Anambra (Nkikoka, Orumba North,

Orumba South, and Nnewi South), four in Cross River (Odukpani, Akpabuyo, Etung and Calabar

Municipal)) and five in Lagos (Amuwo-odofin, Agege, Kosofe, Apapa and Epe).

The introduction TB/HIV collaborative activities at all sites will include introduction of TB control activities

into HIV service points through screening for TB at HIV counseling and testing sites, education on TB

prevention, treatment adherence and stigma reduction where HIV services are provided. Other activities will

include introduction and strengthening of sputum smear microscopy and TB treatment (DOTS); training of

health care workers in TB/HIV collaborative activities, infection control and management of drug side

effects. Training of HIV/AIDS support groups and community-based organizations (CBOs) on TB control

activities; and enhancing community involvement TB/HIV care and support, program communication and

social mobilization will also be carried out in the focal states. At TB clinics, TB/HIV services will be

strengthened by establishment or integration of HIV services. Activities to be carried out at the TB clinics

will include: provision of HIV education at TB service points; promotion & provision of HIV counseling &

testing (CT) to TB patients and provision of cotrimoxazole preventive therapy to dually infected patients.

Other activities will include active case finding of TB cases among household of HIV-infected patients;

establishment of an effective referral mechanism for management of HIV-related illnesses; and

strengthening of defaulter tracing and supervision. DOT clinic and TB microscopy laboratories will be

strengthened to provide quality services. The TB/HIV sites will be provided with all necessary facilities that

will ensure a holistic patient care according to IMAI guidelines. Renovation of dilapidated infrastructure and

procurement of commodities/equipment will be done as necessary. National guidelines for external quality

assurance will be implemented at all sites.

GHAIN Clinical Officers and facility medical officers will be trained in diagnosis of sputum smear negative

TB including the use of x-ray diagnosis and sputum culture. Health workers will also be trained in the

management of drug side effects and immune-reconstitution syndrome in addition to the training on all

aspects of TB/HIV collaborative activities in accordance with the National TB/HIV training curriculum.

GHAIN will concentrate its services within the health facilities while the Center for Development and

Population Activities (CEDPA) will support GHAIN's initiatives by providing community and home based

care for HIV positive clients who are also sputum smear positive. The exception to this will be in Yakur

Local Government Area of Cross River State and Nassarawa LGA in Kano State where GHAIN has

established comprehensive HIV/AIDS services.

GHAIN is a member of the National TB/HIV working group and is actively involved in the development of the

National TB/HIV strategic framework and guidelines. All National TB/HIV accomplishments can be claimed

as indirect targets, while GHAIN will also put systems in place to track the United State Government

(USG)/Nigeria custom indicators for TB/HIV services.

GHAIN will support the formation of TB/HIV working groups at the state levels and the development of state

specific TB/HIV strategic framework. Similarly infection control policies and guidelines will be supported at

the state levels. GHAIN will equally support the national EQA for TB laboratories.

50,000 clients presenting at DOTS centers (TB suspects and patients) will receive HIV counseling and

testing, of these 14,400 registered TB patients will receive counseling and testing for HIV while 8,860 HIV-

infected clients attending HIV care/treatment services will receive treatment for TB disease. GHAIN will

train 497 health workers in TB/HIV screening and diagnosis (emphasizing TB in HIV infected clients). Of all

PLWHA receiving ART during the reporting period, 75% will receive routine screening for TB disease at

least once using the standard IMAI TB/HIV co-management guidelines.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This project will contribute towards the overall goal of ensuring that all persons evaluated for TB disease will

receive HIV counseling and testing as part of "routine care." Those identified as HIV-infected will receive

HIV care and treatment, including cotrimoxazole and, if eligible, antiretroviral therapy (ART). All HIV-infected

patients receiving HIV services will be routinely screened for TB disease, while ensuring that patients with

initially positive TB screen access TB diagnostic services and receive uninterrupted treatment for TB

disease using DOTS-based on the national TB control strategy.

The strong monitoring and evaluation (M&E) system established by GHAIN for tracking HIV/TB activities will

contribute to strengthening the national M&E system, with clear reporting linkage to the NTBLCP, while

building towards the actualization of the above goal. The TB/HIV working group constituted by the

Government of Nigeria (GON) will be supported to strengthen linkages and coordination of TB and AIDS

control programme in Nigeria. GHAIN will hire staff that will be dedicated to coordinating and supervising its

TB/HIV activities, while each focus facility will be asked to designate a particular staff to serve as focal

Activity Narrative: person for TB/HIV activities for the facility.

LINKS TO OTHER ACTIVITIES:

This program relates to activities in 3237.08, 3230.08, 3231.08 and 5420.08. GHAIN will assist the

NTBLCP, states and local government areas (LGAs) with implementation of TB/HIV collaborative activities

at the national, state, LGA and facility levels. TB services will be co-located in ART comprehensive care and

PHC sites where these are non-existent, while HIV services will be co-located in TB sites where GHAIN is

working, and the same principle advocated for the other GON sites. Routine C&T will be advocated in all the

TB clinics, with adequate linkages strengthened for referral to other services such as ART, prevention of

mother to child transmission (PMTCT) and home-based care (HBC). Referral networks will be strengthened

to further achieve TB/HIV integration at treatment sites and directly observed therapy (DOT) centers. In

addition, GHAIN will strengthen TB screening tools/approaches and M&E systems, including record-

keeping, reporting, drug storage and management systems (including security measures).

EMPHASIS AREAS:

The activity focuses on capacity building, which is critical in quality assurance/improvement, infection

control and delivery of quality treatment services to clients. Focused efforts will also be placed on

strengthening referral networks within the service delivery points to ensure effective integration of TB/HIV.

GHAIN will also continue to strengthen its sustainability plan by building the capacity of health facilities

implementing TB/HIV programs and customize a specific plan and schedule for each facility.

GHAIN will explore wrap around opportunities to engage key TB initiatives and partners in Nigeria such as

Global Fund (GFATM), International Federation of Anti-Leprosy Associations (ILEP), United States Agency

for International Development (USAID)/TB-direct funds (non-Emergency Plan) and Canadian International

Development Association (CIDA), in order to better leverage funds, reduce redundancy, and expand

geographic coverage of TB/HIV implementation. The issues to be addressed include ensuring equity in

access to TB/HIV services and stigma and discrimination.

ACTIVITY DESCRIPTION:

Global HIV/AIDS Initiative Nigeria (GHAIN) will provide OVC services to 14,922 children living with and

affected by HIV by supporting 60 sites (new and old) and increasing coverage by going to additional states

inter alia Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

During COP08, GHAIN will support practical strategies that ensure that children living with and affected by

HIV can access comprehensive and qualitative, non-ART, basic HIV/AIDS care and support. Based on

lessons learnt, funding priorities and the present partner guidance, GHAIN will focus on facility based

approach to pediatric care and support while the Centre for Development and Population Activities

(CEDPA) - a USG partner implementing community home based care (CHBC) will continue to be

responsible for the community-based components for care. GHAIN will ensure effective linkages and

referrals to community based programs, including but not limited to those supported by CEDPA, for HBC

and other core services. In sites where CEDPA may not be active, GHAIN will rely on the referral focal

person to ensure that linkages are made as appropriate. If funding permits, GHAIN will also provide

community services for identified OVC. However, in a rural Local Government Area (LGA) of Cross River

State and an urban LGA in Kano State where GHAIN has established comprehensive HIV/AIDS services,

GHAIN will also be responsible for provision of community based care services.

GHAIN will enroll all OVC that are linked to their facilities including all children less than 18 of HIV+ adults

who are either on ART or in palliative care, other children of PMTCT clients apart from the index pregnancy,

children of patients presenting with TB/HIV and other siblings of HIV + children who are less than 18 years.

GHAIN will provide at least three of the following to all OVC: (1) Basic health care including OI treatment;

(2) Nutritional support for all OVC involving at least three of the following: assessment, counseling,

supplementation, therapeutic nutrition, etc.; (3) Psychosocial support including at least three of the

following: disclosure issues, grief and loss, kids support groups and recreation, group counseling, home

visits, etc.; (4) Child protection activities including birth registration, abuse monitoring, and meaningful child

participation.

GHAIN will strategically engage all the comprehensive ART sites and the selected primary health care

(PHC) centers to provide the above services in line with the National OVC Guidance and standards of

practice. Inter alia, GHAIN will provide basic nursing care, assessment of signs and symptoms (including

pain), prevention and treatment of opportunistic infections (OIs), nutritional support; psychological care

including adherence counseling for children and their care givers, non-ART laboratory services; referral

support for ART for infected children and other medications. HIV counseling and testing (CT) for children

will be supported under the CT program. GHAIN will also monitor children in care using the PMM for the

HIV+ children, and using GON tools (FMWA) and the OGAC OVC Child Status Index for the rest. GHAIN

will train 550 people to provide care for children living and affected by HIV/AIDS. GHAIN recognizes that all

services must be age appropriate and that OVC services and needs will change as a child grows.

GHAIN will work closely with CEDPA and other organizations to aid support groups. Activities to be funded

by GHAIN will be mainly for contact tracking of children and support to their care givers, while CEDPA

provides continued community home based care services, thus ensuring a working continuum of care

without duplication of services. GHAIN will organize resource persons to provide monthly talks during the

support group meeting. Topics may include inter alia: nutrition, adherence, prevention for positives. GHAIN

will train support group members to provide home based care services in the two LGAs in Kano and Cross

River respectively where it is providing comprehensive HIV/AIDS services.

In addition to forums established for service providers, care for the carer forums will also be established.

The difficult issues and complications that arise with facing a non-curable and life limiting illness stretch the

capacity of untrained family carers who also may not have sufficient material resources. HBCs are

particularly well placed to provide much of this care as they have generally already developed a relationship

with the family. Special attention will be given to the particular needs of child caregivers. It is assumed that

caring for carers will have an immediate spillover effect to the well-being of all children in the affected

household.

GHAIN will also conduct advocacy for and referral to other services such as educational and legal support

and shelter. In addition, GHAIN will carry out stigma and discrimination activities targeting the general

public, health care workers, and other caregivers of children. Spiritual support will be provided through

linkages to religious leaders.

Howard University will continue to work with the Pharmaceutical Society of Nigeria (PSN), other pharmacy

professional bodies and where possible, help licensed patent medicine vendors to build the capacity of their

members in seven pilot communities to further improve the dispensing of prescribed PC related medications

through PHC facilities and patent medicine stores as applicable, as well as complement the existing referral

services for clients.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This project will contribute to reaching 14,922 OVCs out of the USG overall strategic five year plan for

Nigeria. It will also contribute to strengthening the national, state and local/facility level systems for

implementing quality OVC programs. The diagnostic laboratory services will be used for monitoring CLHIV

thus ensuring timely entry into the pediatric ART program.

This program will also contribute to institutional and staff capacity building. Thus, GHAIN will continue to

strengthen its exit/sustainability plan both at the country program level showing how it will work with the

health facilities implementing comprehensive ART programs and the facility based support groups, to build

their capacity and to customize a specific plan and schedule for each facility. The plans will include an

assessment phase, customized plan for building capacity, and a set of clear objectives and indicators for

measuring capacity as well as a time line based on key benchmarks.

LINKS TO OTHER ACTIVITIES:

The GHAIN OVC in the focal states relates to activities in 3.3.10, 3.3.07, 3.3.06 and 3.3.01.

GHAIN will concentrate its OVC activities in the health facility, providing medical services, nutritional support

and psychosocial support while CEDPA takes the community home based care services, to provide

Activity Narrative: protection, spiritual care, psychosocial care, and procurement of kits. The facilities will identify one staff that

will serve as a PC/OVC coordinator and will be provided with necessary training to double as the supervisor

for all OVC/ PC activities, including the facility based support groups to ensure that the needs of children

and their care givers are catered for. The facility referral coordinator and the PC /OVC coordinator will work

hand in hand to coordinate the linkages between CEDPA and GHAIN supported activities. These will

ensure that infected and affected children receive the 6 + 1 services according to their needs. These

linkages will assist in maximizing the support opportunities provided by the Emergency Plan's funding.

TARGET POPULATIONS:

GHAIN will provide OVC services (specifically clinical care and support services) to children living and

affected by HIV/AIDS through facility-based support groups. The children will be generated from care and

treatment services provided at supported facilities, counseling and testing, and TB-HIV programs. GHAIN

will empower selected tertiary, secondary and primary health care facilities to serve as referral points for

children and their families being provided with HBC services by CEDPA.

KEY LEGISLATIVE ISSUES ADDRESSED:

GHAIN will strengthen gender equity in HIV/AIDS care and support programs using a comprehensive

approach; addressing the specific needs of children in this regard and emphasizing male involvement in

care initiatives to ensure sustainability. GHAIN will collaborate with the Partners for Development to source

micro-credit facilities for the indigent care givers to be able to support the children, and with other USG

implementing partners to wrap around good governance by securing services that protect the rights of the

child, enhance food supply, improve sanitation in communities, provide clean water and insecticide treated

nets (ITN), and strengthen non-HIV health services, including child health and nutrition.

EMPHASIS AREAS:

This activity includes a major emphasis on capacity building through the training of key health care

providers which is critical in delivery of quality laboratory and clinical OVC services to children. Minor

emphasis will lie in the development and strengthening of referrals/linkages and on commodity

procurement.

ACTIVITY DESCRIPTION:

The Global HIV/AIDS Initiative Nigeria (GHAIN) will provide counseling and testing (CT) services to 229,900

individuals by supporting 79 existing CT sites branded as Heart-2-Heart (H2H) centers and will increase

coverage of the mobile voluntary counseling and testing (VCT) services in under-served rural communities

in all its current focus states (FCT, Anambra, Benue, Bauchi, Kano, Cross River, Edo, Lagos, Niger, Enugu,

Kogi, Taraba, Adamawa, Akwa Ibom) and expand services to additional states inter alia Katsina,

Nassarawa, Kebbi, Sokoto and Zamfara States. GHAIN will complement the USG strategy to provide

PMTCT service coverage at the LGA level, by expanding CT services into an additional four PMTCT sites in

four LGAs in Lagos (Amuwo-odofin, Kosofe, Ajeromi-Ifelodun, and Apapa), two LGAs in Cross River

(Odukpani and Akpabuyo), and three LGAs in Anambra (Orumba South, Aguata and Nnewi South) to give a

total of 88 HCT service outlets.

Mobile CT in all the zonal offices will be strategically located to provide adequate coverage of their

catchment areas and to ensure targeted access to most at risk clients that will feed into the GHAIN

supported comprehensive antiretroviral therapy (ART) services. In facilities, integrated CT services

including provider-initiated CT in the wards and the out-patient departments (OPD); routine (opt-out) CT in

antenatal, tuberculosis, family planning, and sexually transmitted infection clinics, in order to increase

uptake of services and provide an opportunity for those who require care, treatment and support services to

access them. Provider-initiated counseling and testing will be offered in all secondary health facilities

through capacity building of care providers (doctors, nurses and other care providers) working in various

points of service within the facility. GHAIN will provide support to all health facilities providing blood

transfusions to ensure counseling and testing is routinely offered to all blood donors.

VCT services will be located within health facilities for self-referrals, as well as in community outreach

services. GHAIN will use the interim national approved testing algorithm and will adopt the serial testing

algorithm as soon as it is approved by the Government. This will assist in the expansion of CT services to

rural areas and the use of lay counselors to conduct HIV testing. To ensure quality of CT services, a

representative number of samples will be sent to an identified laboratory for external quality assurance. In

addition, proficiency testing, training and retraining and regular on-site monitoring, including proper waste

disposal will be done in each site to ensure quality. GHAIN will support the training of 100 individuals in CT,

including couples counseling and will subsequently step down the training to other counselors using the

curriculum at the CT sites to ensure couples have the opportunity of learning their status together.

GHAIN will provide targeted mobile CT services to address the health needs of most-at-risk-populations

(MARPS) such as long distance drivers, commercial sex workers and their clients, and armed forces

personnel. Mobile VCT services will also be extended to the youth in churches, mosques, market places,

and women/men's groups. Emphasis will be laid on couples counseling, partner notification and disclosure

of test results as well as pre- and post-test counseling opportunities for both positive and negative clients.

GHAIN will utilize the mobile CT teams to support and provide counseling and testing to private

organizations and will link up with other partners working with unions, associations, and workplace

HIV/AIDS initiatives to provide counseling and testing.

In order to support the national government in the fight against HIV/AIDS, GHAIN will build the capacity of

500 care providers in counseling and testing for the government of Nigeria and the Global Fund supported

programs. The staff will come from public and private facilities across the country. GHAIN Nigeria will also

explore models for public/private partnerships to provide counseling and testing and will build the capacities

of private practitioners to implement provider-initiated testing and counseling and will assist in supporting

clients who patronize them.

In order to emphasize HIV prevention for both those who test positive as well as those testing negative, FHI

will liaise with Society for Family Health to receive condoms which will be distributed to all CT sites. GHAIN

will ensure that every client is offered condoms after post- test counseling. These condoms will include both

male and female condoms and will be restocked when exhausted.

This funding will go specifically towards assessments, refurbishment/renovation, procurement of reagents

and materials, capacity building of counselors/testers, and training of supervisors to ensure adequate

quality of services and commodity management for all the new sites and support to the old sites. Rapid test

kits will be centrally procured by SCMS (through the USG) and stored in a central warehouse that will be

hired by Axios/GHAIN. Axios/GHAIN will also be responsible for distribution of test kits to sites, ensuring

good storage at the site levels and train at least one site staff on Logistic Management Information System

(LMIS) and Inventory Control Systems (ICS). GHAIN will continue to support and participate in the

harmonization process led by the Government of Nigeria (GON) with regard to LMIS and ICS for test kits.

GHAIN will establish one model site in each state to serve as examples for replication. GHAIN will ensure

high quality CT data collection and collation using the National HCT-monitoring and evaluation (M&E)

system GHAIN has designed for the government of Nigeria (GoN).

In COP07, GHAIN supported CT services in over 79 points of service in addition to mobile CT services

across the 6 focus states. Significant changes from COP 07 will include the intensification of mobile CT

services across the new states. Discussions have already commenced with various State governments

regarding the modalities for handover of selected sites for management by the GFATM program. A total of

79 implementing agencies will continue to be supported to provide CT services in the focus States.

For support of EID and VL monitoring, GHAIN will continue to receive support from those PEPFAR IPs with

PCR capacity. GHAIN will also work towards developing the PCR capacity at one of its supported sites,

contingent upon meeting the requirements set out by the PEPFAR-Nigeria LTWG (employing the services

of a molecular biology specialist to support this program, collaboration with IPs and/or other organizations

with experience in PCR development and dialog with PEPFAR on the placement of the new PCR lab).

CONTRIBUTION TO OVERALL PROGRAM AREA

GHAIN will continue to provide CT services in all its current focus states (FCT, Anambra, Benue, Bauchi,

Kano, Cross River, Edo, Lagos, Niger, Enugu, Kogi, Taraba, Adamawa, Akwa Ibom) and expand services

to additional to additional states inter alia Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States, thus

contributing 229,900 individuals counseled and tested to the overall emergency plan's CT targets for

Nigeria. The introduction of the non-cold chain dependent algorithm has expedited the release of results

Activity Narrative: and reduced the time between when patients are tested and when they become aware of their status.

Planned Mobile CT services will improve equity in access to HIV prevention and care services in the

currently underserved rural communities.

LINKS TO OTHER ACTIVITIES

This activity also relates to activities in HTXS, PMTCT, HVOP, HBHC, and HVTB. Linkages will be

strengthened between the various components listed above to provide total care to individuals who test

positive to HIV and make appropriate referrals. GHAIN has developed a referral directory of all care and

support services in the focus states and identified referral focal persons to ensure an active referral system.

GHAIN will also take the lead in the setting-up the CT network in the focal states, in collaboration with

United States Government (USG) and the GON. Linkages will also be strengthened with care and support

and orphans and vulnerable children activities in the focus communities.

GHAIN will continue to strengthen its exit/sustainability plan both at the country program level showing how

it will work with the health facilities implementing comprehensive CT programs to build their capacity and to

customize a specific plan and schedule for each facility.

POPULATIONS BEING TARGETED

CT services will target the general population as well as MARPs, people in workplaces/business/private

sector, and family members of index clients, especially discordant couples. Other target audiences will

include adult males and females, out-of-school youth (males and females), street youth, pregnant women,

TB patients, and people living with HIV/AIDS (PLWHA). The Heart-to-Heart centers and the mobile teams

will provide services in high traffic settings (i.e., motor parks, market places, churches, mosques), and army

and police barracks in the focus states, in collaboration with the Armed Forces Program on AIDS Control

(AFPAC) and the Police HIV/AIDS Control Committee (PACC).

EMPHASIS AREAS

This activity includes an emphasis on local organization capacity building and human capacity development.

This activity will address gender equity in HIV/AIDS programming through counseling messages targeted to

vulnerable young girls and women. This activity will also deal with male norms and behaviors through

vigorous campaigns to educate people of the focus states on the benefits of couple CT and mutual

disclosure of HIV status. The much increased availability of CT services in clinical and hospital ward

settings will also help to reduce stigma and discrimination.

ACTIVITY DESCRIPTION:

This activity has several components namely: forecasting and procurement, inventory management,

warehousing and quality delivery of antiretroviral (ARV) drugs to people living with HIV/AIDS (PLWHA) for

antiretroviral therapy (ART). Global HIV/AIDS Initiative Nigeria (GHAIN), through its sub-recipient, the Axios

Foundation emphasizes the following core project areas: capacity building and systems strengthening,

forecasting for ARVs and opportunistic infections (OIs), procurement, port clearance, warehousing, and

distribution of ARVs and related commodities to facilities under the project. Axios has developed a

functional logistics system to ensure consistent availability of secure and high quality ARVs and related

commodities plus accountability for delivery/usage. The process is guided by USG regulations, National

Treatment Guidelines, National Agency for Food and Drug Control (NAFDAC) registration or waivers with a

view towards utilizing generic ARV's once they are United States Food and Drug Administration (FDA)

approved.

Axios has implemented an Inventory Management System to track logistics data needed for the proper

management of ARV drugs. The system also has the Patient Management and Monitoring (PMM) System.

In COP08, all facilities will manage their ARVs and related commodities using the system; including

generation of management reports required for decision making at facility and Axios/GHAIN levels. Guided

by the memorandum of understanding with the Federal Ministry of health (FMOH) and States Central

Medical Stores (SCMS), Axios will continue to build capacity for warehousing and distribution by developing

standard operating procedures (SOPs) for warehousing and distribution at the central medical stores. It will

build capacity of the government of Nigeria (GON) and Axios staff at the SCMS through training and on the

job mentoring on the core project areas mentioned above. Health workers will be trained on in inventory

management of ARVs, OI medicines, rapid tests kits, and laboratory reagents/consumables. All

commodities procured are stored at the central medical stores from where they are distributed to facilities

via the state program depots. Axios will work with the GON and the medical stores to ensure adequate

security of drugs supplied.

In COP08, the strategy will focus more on the expansion of the project network of warehouses in new states

within the States Ministry of Health (SMOH), Central Medical Stores complexes and utilize their linkages to

the ART facilities to serve the needs of the focus states. Quality assurance and monitoring of the logistics

system will continue to be maintained at all levels. The SOPs and forms currently used will be revised

based on GON led harmonization process, in which Axios is actively involved. The long term plan is to

integrate the Warehousing and Distribution of ARV/related commodities into the national ARV logistics

system.

Axios/GHAIN will continue to strengthen sustainability plans by harmonizing drug logistic systems with the

GON and providing technical assistance and training in forecasting, inventory management and reporting

for pharmacists through on-site training and mentoring.

In COP08 GHAIN will build upon its achievements and experiences of COP07 to support the GON's

initiative of putting 250,000 PLWHAs on ART by training 365 persons to provide ARV drugs to 45,480

(including 21,178 new) PLWHAs during the reporting period. The cumulative number of PLWHA that GHAIN

will have supported with ARV drugs by the end of COP08 will be 55,472. This will be achieved by

supporting 45 existing ART sites, establishing 15 new sites and increasing geographical coverage with a

focus on rural areas in all its current focus states (FCT, Anambra, Benue, Bauchi, Kano, Cross River, Edo,

Lagos, Niger, Enugu, Kogi, Taraba, Adamawa, Akwa Ibom) and expand services to additional states inter

alia Nassarawa, Katsina, Kebbi, Sokoto and Zamfara States.

Effective synergies will be established with the Global Fund to fight AIDS, Tuberculosis and Malaria

(GFATM) Round Five grants to Nigeria. The new sites will be assessed using the site assessment tool and

implementation will be based on the minimum start up requirements of the site. Specific attention will be

paid to ensuring security of drugs as a component of new sites assessment and its implementation or

strengthening.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Commodity availability at facility level is the cornerstone of the strategy to increase access to the drugs and

diagnostics for PLWHA and significantly contributes to the achievement of the Emergency Plan's goals of

access to treatment. The provision of ART services through this program will contribute to strengthening

and expanding the capacity of the Government of Nigeria's response to the HIV/AIDS epidemic and

increasing the prospects of meeting the Emergency Plan's goal of providing life-saving antiretroviral

treatment to more than 350,000 individuals. This program will also contribute to strengthening the national

drug/commodity logistics and management systems, especially as it relates to ARVs and test kits among

others.

LINKS TO OTHER ACTIVITIES:

This program element relates to activities in HCT (3230.08), PMTCT (3234.08) HTXS (3231.08) and HBHC

(3237.08). Links to these programs include covering areas such as logistics and management of test kits,

laboratory reagents and consumables, , ARV drugs (HTXD) for adults and children, drugs for opportunistic

infections (OIs), prophylactic ARV drugs for pregnant women and infants. The provision of supplies for

laboratory diagnostics links directly into the ART program by providing for monitoring patient progress,

toxicity levels and clinical chemistry.

POPULATIONS BEING TARGETED:

This activity targets all health care workers directly involved in the management of ARV's and diagnostics

for ART services including pharmacists, doctor, nurses and others.

EMPHASIS AREAS:

Emphasis areas include human capacity development and local organization capacity building.

The established drugs storage facilities in each of the GHAIN focus states will increase access of such

drugs and services to the resource poor communities and increase gender equity in HIV/AIDS programs. By

this endeavor, beneficiaries have closer access to drugs and are able to live healthier lives. Increasing

access to drugs also provides a supportive environment for women's access to income and productive

resources given an improved health status.

Activity Narrative: ACTIVITY DESCRIPTION:

ACTIVITY DESCRIPTION:

This activity relates to HIV treatment services. Since 2005, with support from the Emergency Plan through

USAID, The Global HIV/AIDS Initiative Nigeria (GHAIN) has provided antiretroviral therapy (ART) services

to over 30,000 PLWHAs in 12 states of Nigeria, working with the Government of Nigeria (GON) and Faith

Based Organizations (FBOs).

During COP08, GHAIN will provide HIV comprehensive care and treatment (ART services) within secondary

facilities and expand services to tertiary and primary healthcare facilities to an additional 22,128 clients

while strengthening linkages to tertiary facilities to provide a complete network of care and treatment

services. This activity will concentrate on the development and implementation of a quality package of

services and standards of care that are consistent with the national guidelines on ART, integrate prevention

into care and treatment programs, promote adherence and comprehensive care including clinical monitoring

and manage opportunistic infections with related laboratory services, as described under palliative care.

GHAIN will build upon the lessons learned from implementing ART services in pilot primary health care

centers (PHCs) under COP07 PlusUp funding and will continue to train community health officers (CHOs),

community health extension workers (CHEWs) and nurses to provide care and treatment for HIV/AIDS in

the PHCs in rural areas using the Integrated Management of Adult and Adolescent illnesses tools. These

trainings will be carried out in collaboration with NASCP, FMOH and the World Health Organization (WHO).

GHAIN will strengthen existing supported PHCs to be able to provide community based ART services. Each

comprehensive center will be linked to at least two satellite facilities for strengthened and seamless

continuum of treatment, care and prevention. GHAIN will also strengthen the capacity of the care and

treatment teams in its focus health facilities including the GoN supported Federal Medical Centers in these

states, to implement harmonized quality services with strong focus on adherence and ensuring durability of

first line drugs. Pregnant females will be prioritized for CD4 count as they may require ART for their own

health. Prevention for positives services focusing on primary and disease transmission prevention will be

provided to all PLWHA as described in the palliative care narrative.

Particular emphasis during the COP08 period will be put on strengthening the pediatric ARV component of

the program. This strengthening will be multi-faceted. Intensive capacity building for facility staff in pediatric

HIV/AIDS clinical management will include formal and informal trainings, one-on-one mentoring and

monitoring, exchange/site visits to pediatric learning sites such as Massey Street Children's Hospital. Point

of service testing of children will be emphasized so that children seen at places such as the Nutrition clinic,

out patient clinic, MCH services and the wards will be tested for HIV at the point of service.

GHAIN will offer HIV early infant diagnosis testing, in collaboration with other IPs, from six weeks of age

using DBS in line with the National Early Infant Diagnosis scale-up plan. HIV positive infants will be linked to

comprehensive care centers through a well-established network of care.

Through an on-going collaboration with the Clinton Foundation, GHAIN will introduce fixed-dose

combinations (FDCs) for all new pediatric clients in order to facilitate storage, transportation, dispensing and

administration. In addition, GHAIN will strengthen nutritional support to children through the distribution of

the Clinton Foundations' donated ready to use therapeutic foods (RUTFs) to severely malnourished children

at all sites. In particular this will be introduced and monitored during follow up visits in the PHC facilities.

GHAIN has already incorporated both the FDCs and RUTFs in their ART training curriculum.

The patient management and monitoring (PMM) system established by GHAIN will be strengthened and

standard operating procedures (SOPs) for care and treatment services revised and implemented to ensure

continuous quality assurance/quality improvement (QA/QI). Patient monitoring will be strengthened by

providing non-routine viral load, in collaboration with other IP's through laboratory networking, in six sites to

allow for early detection of patients who are failing therapy. GHAIN will participate in the joint supervisory

visits that will be carried out by the government of Nigeria/United States Government (GON/USG) to ensure

high quality of services in all its project sites. Pediatric ART which makes up 10% of the adult antiretroviral

(ARV) services provided will be implemented with the same quality as the adult ART. HUCE-PACE will

continue to provide technical leadership in strengthening pharmacy systems and pharmacists' capacity to

contribute to the delivery of quality HIV/AIDS-related services at all levels of healthcare delivery in Nigeria

(secondary and primary health care facilities). Howard will train and re-train pharmacists in all

comprehensive ART sites in pharmaceutical care in HIV/AIDS and best pharmaceutical practices, while also

collaborating with the Community Pharmacists to expand the reach and quality of patient medication

adherence counseling, drug monitoring/support and other services in support of ARV services.

GHAIN supports the GON in the design of the ART-PMM system and the development of National curricula

and SOP for adult and pediatric ART, ensuring accurate reporting without double counting at the National

level.

GHAIN will build upon its achievements of COP07 to support the GON's goal of putting 250,000 PLWHAs

on ART by training 365 persons to provide ART services to a cumulative number of 56,421 including 22,128

new PLWHAs. This will include 60 existing ART sites, establishing 15 new sites and increasing

geographical coverage with a focus on rural areas in all its current focus states (FCT, Anambra, Benue,

Bauchi, Kano, Cross River, Edo, Lagos, Niger, Enugu, Kogi, Taraba, Adamawa, Akwa Ibom) and expand

services to additional states inter alia Katsina, Nassarawa, Kebbi, Sokoto and Zamfara States.

GHAIN's expansion into new states to start services from scratch will initially require intensive resources

which result in higher cost per targets, a figure which will be reduced over time as the program becomes

entrenched. The sites identified are in rudimentary states and will require significant infrastructural upgrades

such as the sinking of boreholes and procurement of generators. In addition, movement in these difficult

terrains is challenging and increases the costs associated with proper management and monitoring. To

partially mitigate these extra expenses for expansion, effective synergies will be established with the Global

Fund to fight AIDS, Tuberculosis and Malaria (GFATM) Round 5 Grant to Nigeria. If current collaboration

plans are fully successful, GHAIN hopes to reach an additional 11,000 new clients with expansion into

additional states. This is dependent on GFATM grant being signed to continue during this period, and if the

program is implemented according to plan.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activity Narrative: The provision of ART services through this program will contribute to strengthening and expanding the

capacity of the GON's response to the HIV/AIDS epidemic and increasing the prospects of meeting the

Emergency Plan's goal of providing life-saving antiretroviral treatment to 350,000 individuals. Planned

decentralization of services to Primary Health Care centers (PHCs) in focus States will improve equity in

access to HIV treatment and care services. GHAIN supports the GON in the design/implementation/update

of the ART-PMM system and contributes to the Three Ones. Collaboration and integration with the Global

Fund activities greatly contributes to the long-term sustainability of the ART program.

LINKS TO OTHER ACTIVITIES:

This activity relates to activities in 3.3.09, 3.3.07, 3.3.01, 3.3.08 and 3.3.06 and USAID SO 13/FHI RH-HIV

integration program. Treatment services will continue to be linked to community services to support persons

on ARV treatment as described in the palliative care narrative. ARV and tuberculosis clinic linkages will be

strengthened and fostered in all focus sites.

POPULATIONS BEING TARGETED:

This activity targets orphans and vulnerable children who are HIV positive; PLWHAs (male and female); TB

patients who are HIV positive, pregnant women who are HIV positive and all high risk groups that are

positive to HIV. Indirect targets will include patients who will be reached through ripple effects from the staff

of GON and other organizations that will utilize the trainings, treatment documents, curricula and standard

operating procedures that will be obtained with technical support from GHAIN.

EMPHASIS AREAS:

This activity includes an emphasis on human capacity development. GHAIN will also continue to strengthen

its exit/sustainability plan both at the country program level showing how it will work with the health facilities

implementing comprehensive ART programs to build their capacity and to customize a specific plan and

schedule for each facility. The plans will include indicators for measuring capacity as well as a time line

based on key benchmarks with a view to ensuring ownership and sustainability. GHAIN will also support the

national scale-up of the HIVQUAL facility quality improvement system.

GHAIN will put in place mechanisms for reduction of stigma and discrimination both among health workers

and the general population, and provide opportunities for increasing gender equity in access to the ART

programs, by mobilizing both males and females to avail themselves of treatment opportunities.

ACTIVITY DESCRIPTION:

The Global HIV/AIDS Initiative Nigeria (GHAIN) laboratory component provides high quality lab services in

support of ART programs in Nigeria. GHAIN has put in place strategies to strengthen and expand laboratory

services and upgrade infrastructure in all supported HIV treatment sites.

GHAIN is currently active in 33 secondary health facilities for comprehensive ART services. By the end of

COP 07, GHAIN will have activated a total of 45 secondary level facilities in FCT, Anambra, Kano, Lagos,

Benue, Bauchi, Cross River, Edo, Niger, Enugu, Kogi, Taraba, Adamawa, and Akwa Ibom. In COP 08,

GHAIN will provide comprehensive ART services at 15 additional secondary level facilities in 5 additional

states; Katsina, Nassarawa, Kebbi, Sokoto and Zamfara. GHAIN will also train 327 laboratory

managers/staff at all supported sites and will provide ongoing on-site capacity building and monitoring.

GHAIN will embark on an integrated expansion of laboratory training, covering HIV diagnosis, treatment and

care. All specific assays trainings will be linked to training on good laboratory practices, laboratory

management and quality assurance/quality control (QA/QC). Central level training is currently provided at

GHAIN country HQ, with hands-on training at supported lab facilities. GHAIN also utilizes other USG-IP

(e.g. IHVN-ACTION) dedicated training laboratories. On-site trainings are also offered. Standard training

tools adapted for use in Nigeria e.g. CDC/WHO HIV rapid testing and CDC/WHO smear microscopy training

packages, are utilized. GHAIN will participate in the Laboratory Management Training to be provided by the

USG through APHL.

To ensure adequate lab support for its program, GHAIN currently has 17 laboratory personnel; (2 in each of

six zonal offices, 1 in Lagos state, 3 in the country office and 1 equipment maintenance officer. An

Additional 9 lab staff will be employed in COP08 to provide support for Lab programs in Bauchi, Sokoto, and

Lagos zonal offices, and to support the PCR lab and the TB Culture lab proposed for COP08. The

responsibilities of the lab team include overall capacity building/technical assistance, supervision,

coordination of inventory management, QA; and collaboration with other IPs under the leadership of GON.

The team will be coordinated by the Director for Laboratory Services.

GHAIN will continue to support CD4+ counts/lymphocytes counts, chemistry panels, hematology assays,

using automated lab equipment in all of its secondary sites. VDRL, HBsAg, HCV, pregnancy, malaria,

microbiology tests for STIs and OI tests, including TB smear microscopy, are also routinely provided at all

facilities. In COP08, GHAIN will establish a TB culture and drug sensitivity testing laboratory in Dr.

Lawrence Henshaw Memorial Hospital, Calabar (automated TB culture system, Bactec MGIT, BD). In line

with the USG state coverage strategy, GHAIN will offer PMTCT and TB/HIV services in all identified LGAs

without these services in Lagos, Anambra and Cross River states. These activities are detailed in the

PMTCT and TB/HIV program areas.

GHAIN currently offers non-routine viral load assays in collaboration with other USG-IPs to a limited number

of patients based on clinical need. GHAIN will continue to collaborate with other IPs for early infant

diagnosis (EID) and viral load. Samples collected from GHAIN sites using dried blood spots (DBS)

technique are transported to IP facilities with DNA PCR capacity. Clinton Foundation currently provides

support for DBS collection materials and the sample shipment.

For support of EID and VL monitoring, GHAIN will continue to receive support from those PEPFAR IPs with

PCR capacity. GHAIN will also work towards developing the PCR capacity at one of its supported sites,

contingent upon meeting the requirements set out by the PEPFAR-Nigeria LTWG (employing the services

of a molecular biology specialist to support this program, collaboration with IPs and/or other organizations

with experience in PCR development and dialog with PEPFAR on the placement of the new PCR lab).

GHAIN will support 20 of its secondary facilities to obtain accreditation from the Medical Laboratory Science

Council of Nigeria (MLSCN) and will continue to work with the PEPFAR Lab TWG for the development of a

common Lab equipment platform appropriate for each level of care.

GHAIN currently has a quarterly equipment maintenance contracts with local firms. These contracts

renewable annually, will continue to be maintained in COP08. Equipment maintenance is also provided by a

dedicated equipment maintenance officer.

GHAIN will continue to use a centralized procurement and distribution strategy to ensure that needed

reagents and consumables are available at all focus sites. Laboratories at the new sites will be rolled out

and linked to existing sites through an integrated tiered national laboratory network. Axios Foundation is to

provide logistics support to GHAIN for the procurement of lab equipment and supplies. To prevent stock-

out, each facility is expected to have a minimum stock level of one month supply.

GHAIN is currently collaborating with MMIS to provide trainings on injection safety, and safe disposal of bio-

medical wastes. GHAIN is also collaborating with Safe Blood for Africa Foundation (SBFAF) and National

Blood Transfusion (NBTS) on blood safety related programs and trainings. These collaborations will be

sustained and strengthened in COP08. A post exposure prophylaxis policy is in place at all sites,

The essential components of a quality system will be put into place at each site and QA will be ensured

through monthly site visits using a standardized checklist. Reports generated will be fed back to sites. All

non-conformities will be addressed and remedial action taken. GHAIN will be an active partner in the

PEPFAR Lab TWG and will ensure a tiered system of laboratories in line with the GON guidelines. Site

monitoring visits using a standardized assessment tool developed in Nigeria by the Lab TWG will be

incorporated into the GHAIN lab QA strategy

As part of its EQA program, GHAIN is currently collaborating with the National Health Laboratory Services,

Sandringham South Africa, for HIV serology Proficiency Testing (PT). This EQA program will be expanded

in COP08 to include PT for CD4+ counts, Chemistry panels and hematology assays. Results from quarterly

site visits and PT programs will be sent into a centralized system within Nigeria (supported by PEPFAR).

An estimated 477,289 laboratory tests will be conducted in COP 08. GHAIN counts HIV serology, CD4

count, hematology, clinical chemistry panels, VDRL, pregnancy test, HBsAg and malaria parasite as one

test each.

Activity Narrative:

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The provision of Laboratory services will contribute to the strengthening of the GoN's capacity to respond to

the HIV/AIDS epidemic. GHAIN will work with GoN using established national rules and guidelines on

laboratory services to build the capacity of laboratory staff at the project sites. This program will also

contribute to infrastructural upgrade of the health facilities and provision of necessary equipment.. The

laboratory component will establish a well coordinated and efficient QA, supervision and monitoring system

at all the GHAIN sites.

LINKS TO OTHER ACTIVITIES:

This program element relates to activities in HVCT (#3230.08), PMTCT (#3234.08), HTXS (#3231.08),

HBHC (#3237.08), HVTB (#3228.08), HKID (#3229.08), HMIN (#9776.08) and HMBL (#6491.08). A referral

linkage system will be strengthened to ensure that clients are referred from sites with limited or no

laboratory infrastructure to automated laboratory sites using the integrated tiered national laboratory

network. GHAIN will implement GoN approved testing algorithm and work with the GoN and other

stakeholders on the use of non-cold chain Rapid Test Kits (RTK) for HIV testing. With the new scale up

strategy for counseling and testing (CT), GHAIN will build the capacity of counselors both at the CT and

PMTCT sites on the use of non cold chain dependent algorithm for HIV testing. GHAIN will also introduce

sputum smear microscopy and tuberculosis (TB) treatment in all CT sites.

POPULATIONS BEING TARGETED:

This activity will provide laboratory services to PLWHAs, (including pregnant women), HIV positive children,

tuberculosis (TB) patients including those that are HIV positive and are eligible for ART, HIV positive infants

and other most at risk populations (MARPS). These clients will be generated from PMTCT, Care and

Treatment, mobile and facility based counseling and testing and TB-HIV programs. The Family Centered

Care Model approach will be adopted to reach the HIV/AIDS affected families.

EMPHASIS AREAS

Emphasis will be placed on QA, quality improvement, and supportive supervision. In addition, emphasis will

be placed on Laboratory infrastructure upgrade, commodity procurement and local organizational capacity

development through trainings and on-site technical assistance and mentoring. GHAIN will also continue to

strengthen its exit/sustainability plan by building the capacity of laboratories implementing HIV/AIDS

programs, and customize a specific plan and schedule for each facility.

ACTIVITY DESCRIPTION:

The Global HIV/AIDS Initiative Nigeria (GHAIN) project focuses on rigorous and sustainable strategic

information in alignment with the Government of Nigeria (GoN) National Monitoring and Evaluation (M&E)

framework and tailored to respond to the information needs of the United States Government (USG).

GHAIN will implement strategic information (SI) activities by supporting 194 local organizations at the

national level, and in the following states among others: Anambra, Edo, FCT, Kano, Cross River, Lagos,

Niger, Akwa Ibom, Bauchi, Taraba and Sokoto. The following strategies form the basis of GHAIN's M&E

activities: (1) facilitating the implementation of the "three-ones" principle on M&E; (2) ensuring timeliness

and quality of routine data; (3) ensuring adequate utilization of the results from M&E activities for program

improvement; (4) ensuring the sustainability of the M&E efforts; and (5) facilitating national efforts to obtain

up-to-date information through public health evaluation, research and surveillance activities.

GHAIN liaises closely with other USG implementing partners (IPs) in collaborating with national and state

level partners to ensure adequate conceptualization and implementation of harmonized M&E plans and

strategic frameworks to support one national M&E system. Considerable effort will also be devoted to

building and strengthening both Federal Ministry of Health (FMOH) and NACA HIV/AIDS management

information systems toward improved harmonization of efforts through national M&E and USG technical

working groups, and upgrading and adapting routine data collection and data quality assessment tools for

different program areas and types of facilities, including primary health centers (PHCs).

Systems strengthening aimed at ensuring the timeliness and quality of data will include efforts to network

with IPs on a common approach to improving the flow and quality of data through the existing government

structure at LGA, state and national levels. Capacity building in data collection, quality and management will

also be coordinated and conducted at each level and supported by appropriate use of information

technology and databases linked to the NNRIMS and FMOH HMIS. In COP08, GHAIN will contribute to the

integration of data management systems by building local and state capacity in linking HIV/AIDS data with

the FMOH national HMIS through the use of common platforms for health data collection (i.e., District

Health Information System [DHIS] software) and reporting (i.e., the Voxiva HMIS platform).

A strong focus on data quality will be ongoing to ensure that accurate data is used to inform programmatic

decision-making at all levels. GHAIN's strategy will align with the USG SI data quality

assessment/improvement (DQA/I) and capacity building plan. In COP06 and COP07, GHAIN provided

technical assistance to the GoN on the development and implementation of a data quality assurance (DQA)

system for the National ART, PMTCT and HCT programs by developing DQA standard operating

procedures (SOPs) and checklists for on-site records review and planning for quality improvement. In

COP08, this support will be expanded to other program areas and GHAIN will continue refining data quality

assurance (DQA) tools and processes in collaboration with the USG SI team, and participate in joint DQA

assessments with national and state officials and using systematic site monitoring on a monthly basis to

identify needs for technical assistance and promote best practices. Systems will be in place to partner with

local and state health authorities in conducting supportive supervision and providing regular technical

assistance in the use of tools, storage of results and the flow of data. At the national level, GHAIN will

participate in the national M&E TWG to build an appreciation of data quality, the capacity to conduct DQA

assessments, and promote consistent practices across facilities, partners and states.

A critical success factor for any M&E system is ensuring that results inform decision-making at all levels by

creating an evidence base tailored to the needs of managers and policy-makers. GHAIN will provide

technical assistance in selecting appropriate analysis variables, in interpreting performance, and

determining gaps and priorities to enhance the analysis and use of data include systematizing quantity and

quality-related analysis at facility, LGA, state and national levels. Data dissemination will be managed

primarily through the creation and maintenance of forums and information products for providing feedback

of appropriately packaged and analyzed data to the GON, the USG, points of service (POS), program

managers and other stakeholders. Monthly M&E meetings chaired by the SACA/SAPC will continue to

serve as useful forums for local and state authorities to collect, compile and analyze data. The utilization of

results will be enhanced by the roll-out of GHAIN's patient management software, the Lafiya Management

Information Systems (LAMIS). This software combines logistics and patient management information

together at the facility level to improve routine reporting and sophisticated patient tracking and

management. In COP08 it will be installed for all comprehensive care sites in conjunction with relevant

technical assistance for its maintenance and analysis.

COP08 will be a critical year for informing the shape of GON-led M&E efforts in the future. At the national

level GHAIN will continue providing technical assistance in integrating the HIV/AIDS M&E system with the

national HMIS, and other health data collection, quality and supervision mechanisms. Increased efforts will

be devoted to building the capacity of local and state partners to manage the M&E portfolio within their

catchment areas. Initially, these efforts will involve building linkages and communication systems within and

between local and state agencies for the collection and exchange of HIV/AIDS-related data and its

integration into the national HIV/AIDS programmatic response databases. These linkages and related

capacity building will enable authorities at the LGA level to manage and oversee HIV/AIDS-related activities,

collect, interpret and feed high quality data into the state level management information system. GHAIN

does not provide remuneration to any government SI staff. To support the sustainability of the system,

staffing levels are likely to remain stable from COP07 to COP08 with five M&E officers and one data

management assistant in each zone. Leveraging of global fund resources has provided an additional 12

M&E officers who will be contributing to USG activities throughout the country.

CONTRIBUTION TO OVERALL PROGRAM AREA:

This activity will enhance client/patient management and implementation of all program elements by making

quality data available at all levels for monitoring, guiding program management and tracking program

achievements. Functional feedback mechanisms will be developed to ensure that results of M&E activities

inform program design and management, build capacity in SI at all levels, and inform development of tools,

protocols and reports. Strategic use of information contributes to improved quality of service delivery and

lessons learned, which will be shared through such channels as scientific publications (abstracts, posters,

presentations at conferences) and input into research and surveillance protocols. This funding will

specifically contribute to facility monitoring and quality management assessments and Health Management

Information Systems. Funding emphasis will also go to information technology (IT) and communication

infrastructure, monitoring, evaluation and reporting, as well as capacity building for 404 people in SI. Funds

Activity Narrative: will be used to support studies that address evaluation questions in relation to PEPFAR-provided services,

USG reporting systems and other SI activities in 194 organizations.

LINKS TO OTHER ACTIVITIES:

High quality data are required for effective and efficient client/patient and program management. HVSI will

continue producing and facilitating the use of these information at POS, state and National level (especially

for MTCT-3.3.01, HBHC-3.3.06; HVTB-3.3.07; HCT-3.3.09; HTXS-3.3.11; HMBL-3.3.03; HMIS-3.3.04;

HVOP-3.3.05; HTXD-3.3.10; and HLAB-3.3.12.)

POPULATIONS BEING TARGETED:

HVSI will principally target SI professionals working with government at the LGA, state and national level.

Others involved will include community- and faith-based organizations, non-governmental organizations and

international counterpart organizations. More generally, collaborative initiatives in this regard will inform

programming decisions by health workers, donors and the GON as well as guarantee quality of service

delivery to primary beneficiaries of these services.

EMPHASIS AREA:

HVSI will emphasize local organizational capacity building, PHEs and targeted evaluations.

This activity provides information to increase gender equity in HIV/AIDS program through activities such as

collecting data to show breakdown of women and men receiving prevention activities, treatment, care

services and developing strategies to ensure that the gender specific issues are catered for. The program

area will also utilize existing partnerships to strengthen the capacity of organizations implementing various

projects/programs as well as developing the government officials' capacity at the States and LGA level..