ACTIVITY DESCRIPTION:

IFESH will increase the PMTCT sites it supports from 12 in COP07 to 15 in COP08 and provide counseling

and testing to 8,000 pregnant women who will also receive their results. It is expected that this will result in

the provision of Antiretroviral (ARV) prophylaxis to 352 clients.

Group counseling and testing (HCT) using the opt-out approach will be offered to all pregnant women at

antenatal clinic and in labor. Same day results will be provided at all points of services. Post test counseling

will be provided to all women. Couple counseling and partner testing will be offered on-site to increase

disclosure and address issues around discordance. The ‘Testing & Counseling for PMTCT' support tools

produced by CDC, USAID and WHO will be adopted for use in IFESH sites. HIV positive pregnant women

will have access to laboratory services including CD4 measurements. Women requiring HAART for their

own health will be referred to sites providing ART services with follow up to ensure access to such services.

PMTCT services will be provided based on the recently revised (2007) Nigerian National Guidelines. HIV-

infected women ineligible for HAART will receive zidovudine (AZT) from 28 weeks or combivir from 34

weeks and single dose nevirapine (sdNVP) at the onset of labor as well as the combivir tail for 7 days.

Women presenting in labor will be offered rapid testing and if HIV-infected provided with sdNVP as well as

the combivir tail for 7 days. All infants born to HIV infected women will be provided with sdNVP at birth and

AZT for 6 weeks.

In COP08, emphasis will be placed on the follow-up of all mother/infant pairs to ensure uptake of ARV

prophylaxis and provide support for infant feeding choices. Infant feeding counseling will start from ANC and

continue through the postpartum period. Community based workers will also ensure that infant feeding

options are in accordance with the WHO and the newly adopted Nigerian infant feeding guidelines. IFESH

will strengthen its collaboration with TBAs in order to improve uptake of PMTCT services. Cotrimoxazole

prophylaxis will be provided to all exposed infants from 6 weeks and continued pending HIV definitive

diagnosis. IFESH will work in close partnership with other PEPFAR IPs, the Clinton Foundation, and the

GON to offer early infant diagnosis (EID) to HIV exposed infants from 6 weeks age in line with the National

EID Initiative. DBS samples will be sent to a PEPFAR supported DNA PCR laboratory. In addition to

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

facilitate care to all of her affected children.

IFESH will use supervisory teams to conduct quarterly visits to all sites to ensure optimal quality of care. All

HIV+ clients who are ART eligible will continue to be referred to the state ARV clinics and state pediatric

HIV clinics for treatment. In COP 08, 80 PMTCT service providers will be trained using the recently revised

National PMTCT Training Manual. Quality Assurance (QA) for both counseling and testing will be carried

out at timely intervals in COP08 through submitting blood samples to a designated reference laboratory for

testing and sending certified counselors for site assessments. All 15 sites will use the National PMTCT

Registers and data collection for Monitoring and Evaluation of all activities in line with the National PMTCT

MIS. IFESH is presently supporting PMTCT services at 12 sites and will support an additional 3 in COP08

for a total of 15 sites. All sites will be in Rivers State and Imo States.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Supporting 15 sites in rural areas of Rivers and Imo States is in line with the desire of the Government of

Nigeria to have 1,200 PMTCT sites operational by the year 2008 and the USG`s target of having 80%

coverage for PMTCT across the country.

LINKS TO OTHER ACTIVITIES:

This activity is linked to activities in care & support (#5665.08), AB (#15679.08), Other Prevention

(#15664.08), OVC (#15678.08), HCT (5668.08), TB/HIV (#15665.08) and Strategic Information

(#15669.08). Prevention for positives counseling will be integrated within PMTCT care for HIV+ women. The

basic package of care provided to all HIV+ patients will be available to HIV+ pregnant women. Women

requiring HAART for their own health will be linked to within network ARV services. Laboratory staff will

ensure that HIV testing provided within the PMTCT context is of high quality by incorporating PMTCT sites

into the laboratory QA program.

POPULATIONS BEING TARGETED:

This activity targets men and women of reproductive age, family planning clinics, pregnant women, their

spouses or partners and the children of the index pregnancy and health care workers. CBOs, FBOs,

support groups, and men will also be targeted so that they participate fully in community based PMTCT

services.

EMPHASIS AREAS:

The PMTCT service has an emphasis on training, local organization capacity development and

development of linkages/ referral networks. This activity addresses the issue of "Gender" since services are

primarily targeted at women. The activity also addresses the key legislative area of "Stigma and

Discrimination" as issues of disclosure and discordance are addressed.

COVERAGE AREAS:

Sites are located in states chosen based on high prevalence and proximity of both states, Rivers and Imo.

ACTIVITY DESCRIPTION:

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

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

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

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

prevention (funded under C&OP). IFESH's goal for its new activities in the AB program is to contribute to a

reduction in HIV prevalence among youths, particularly in the most at risk age group of 15-24 year olds, and

to promote mutual fidelity among married adults. The 2005 ANC survey in Nigeria indicates that among age

cohorts in Nigeria, the 20-29 year old age group has the highest HIV prevalence (4.9% compared to a

national prevalence of 4.4%). In addition, the 2005 National HIV/AIDS and Reproductive Health Survey

(NARHS) demonstrated a low risk perception (28%) among the general population and significant reports of

transactional sex (11%) among young women aged 15-29 years. This age cohort for both men and women

represents the working age group in Nigeria; it is expected that a combination of prevention messaging

approaches will ensure they are effectively reached with prevention interventions.

In COP08, IFESH will implement AB programming in underserved areas in Nigeria and will couple these

activities with condoms and other prevention program services and with counseling and testing program

services where appropriate. This activity will be implemented at the community level and will be reinforced

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

campaign. Priority populations to be targeted by IFESH will be pregnant women, TB DOTS patients,

transport workers, in-school and out-of-school youths and orphans and vulnerable children receiving home

based support. These target groups will be reached with a minimum of three strategies derived from the

recommended minimum package (community awareness campaigns, peer education models, peer

education plus activities, and school based activities).

This first year of funding will include an evaluation of current AB activities in its communities that will be

used to guide specific activities to be conducted under each strategy in the target communities. Gaps in the

AB programming will be identified so that IFESH can effectively work within and contribute to a

comprehensive and harmonized national program. AB messages will be balanced with concurrent condoms

and other prevention messaging where appropriate and will be integrated with services provided by IFESH

in a total of 34 sites (20 HCT sites including facility-based, 10 DOTS sites, and four schools) plus outreach

in the surrounding communities in two states (Imo and Rivers).The program will be targeted towards

achieving coverage for these communities with balanced ABC messaging and each target counted will be

individuals reached on a regular basis and with the four strategies IFESH will employ.

The target for this intensive AB messaging campaign is 2,000 individuals. In addition, age appropriate

abstinence only messaging and secondary abstinence messaging will be conveyed to 1,000 children and

adolescents, particularly focused on in-school youths and orphans and vulnerable children receiving home

based support. A total of 160 people will be trained, including but not limited to teachers, religious leaders,

students, and peer educators.

As a component of the community based programming and the school based programming activities such

as game shows/quiz contests on AB messaging will be conducted. A complete prevention package of

materials utilizing both AB and COP programming will be distributed at all HCT sites and at all points of

service in health care facilities where IFESH is working. This will include AB IEC materials and condoms.

IFESH will target communities where these registered clients live for community and school based AB

messaging in order to continue to reinforce messages provided in the facility setting.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The funding in this activity area will contribute to the overall PEPFAR goals of preventing further infections

and reducing HIV rates in Nigeria. It will also help to lay the foundation for more sustainable programs.

LINKS TO OTHER ACTIVITIES:

This activity will be integrated with Counseling and Testing (5668.08), PMTCT (3248.08) Basic Care and

Support (5665.08), Other Prevention (15664.08), TB/HIV (15665.08), OVC (15678.08) and Strategic

Information (15669.08).

POPULATIONS BEING TARGETED:

The focus population for this activity will be youth (young adults and particularly, young women and girls,

and in/out of school youths), pregnant women, TB DOTS patients, the police, incarcerated persons, and

transport workers. It will also target community/religious leaders, teachers and parents.

EMPHASIS AREAS: This activity includes an emphasis on gender, human capacity development and local

organization capacity building.

COVERAGE AREAS:

Rivers and Imo states

ACTIVITY NARRATIVE:

IFESH will provide community outreach to individuals identified at high risk for HIV and direct them to

counseling and testing while promoting prevention through activities other than abstinence and be faithful

messages. This activity will focus on condom use promotion in most at risk populations and referral to

IFESH supported and/or other local PEPFAR-supported HCT sites. Condoms and other prevention

activities will be provided in 35 sites (20 HCT sites including facility-based, 10 DOTS sites, and five

brothels) targeting 4,286 most at risk persons (MARPs) which include GOPD and STI patients, TB patients,

PMTCT patients, PLWHA, incarcerated populations, youth, police, transport workers, and commercial sex

workers in Rivers and Imo states.

IFESH will implement its condom and other prevention (C&OP) programming activities in line with the

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

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

activities which will also include abstinence and be faithful activities.

In COP08 IFESH will implement this activity at both the facility and community levels utilizing multiple

strategies which include community outreach campaigns, peer education models, condom services and STI

management/treatment with messages conveyed in multiple fora. Each person will be reached with

messages in appropriate dose and intensity to stimulate behavior change delivered on a regular basis and

with at least three of the strategies IFESH will employ. The target for this intensive C&OP activity campaign

is 4,286 individuals.

C&OP and AB programming will be prioritized to communities that will be identified through a COP08

supported community assessment to map out areas of high sexual networking (barracks, parks, markets,

drinking joints, and the presence of brothels). IFESH will initiate community based advocacy activities with

owners and managers of relevant establishments to enable access to the sex workers and to introduce a

peer education program which encourages 100% condom use. Free condoms will be given to brothels, and

sex workers will be advised to insist on condom use with each client. Using the peer education approach,

IFESH will select peer facilitators from each brothel and train them to provide HIV prevention messages to

their peers on a daily basis. The key messages will include correct and consistent condom use in all sex

acts, prompt and complete treatment of STIs and testing for HIV. Advocacy with brothel owners will be

primarily to support the girls in enforcing a "no rubber no show" policy in their establishments. 10 peer

facilitators will be trained to reach 100 commercial sex workers. Peer facilitators will also be taught

participatory monitoring and evaluation to enable them to monitor their progress against joint objectives. In

addition, a yearly survey will be conducted on the outcome of the activities. In addition to reaching 100

commercial sex workers, IFESH will reach 2,686 clients in clinics, 500 uniformed personnel, and 1000 out of

school youth with C&OP messages and services, thereby reaching a total of 4,286 MARPs.

As a component of the community based programming, messages shall be communicated through local

dramas and singers that are found in the brothel clubs, parks, drinking joints and barracks. They will be

taught the basics of HIV prevention, especially COP and encouraged to weave prevention themes into their

songs promoting partner reduction and consistent condom use. In total, 100 of health care workers, peer

educators and community volunteers will be trained in COP messaging. Community outreach will target

most at risk individuals with the purpose of preventing geographic spread. Doctors and counselors in STI,

ANC and postnatal clinics will distribute condoms and conduct prevention with positives advocacy (HCT for

family members and sex partners, counseling for discordant couples, counseling on healthy lifestyles and

positive living, prevention messages and IEC materials on disclosure). For HIV negative individuals, trained

counselors will provide education on HIV/AIDS transmission, risks behaviors, and risk reduction strategies

including condom use.

Condoms will be procured by Society for Family Health (SFH) for all IFESH sites. The provision of condoms

will be accompanied by individual and/or group counseling and demonstrations from experienced

counselors on their proper use. Information Education Communication materials tailored to address the

unique risks that individuals from high risk groups face and the correct and consistent use of condoms will

also be provided in all sites at all POS within those sites.

CONTRIBUTION TO OVERALL PROGRAM AREA:

IFESH activities are is in line with the PEPFAR vision of enhancing indigenous capacity to provide

integrated HIV/AIDS services from the community to the national level, and in the process to strengthen the

health care system and the capacity of local development partners. These prevention activities are

consistent with PEPFAR's five year goals for Nigeria, which plan to prevent 1,145,545 new infections

through a number of prevention strategies including (but not limited to) condoms and other prevention to

specific high risk groups.

In order to be maximally effective, the prevention messages developed at different sites will be tightly

targeted to the various high risk groups that they serve. Furthermore, these activities are in line with the

PEPFAR 5 year strategy which seeks to scale up prevention services, build capacity for long term

prevention programs and target outreach to promote correct and consistent use of condoms with MARPs to

reduce the risk of HIV infection for these populations with the purpose of preventing geographical spread.

The continuation of IFESH-supported services in HCT and PMTCT as well as STI management will help

facilitate the scale up of the overall program, and increase utilization of these services, expected to result

from other prevention and outreach initiatives.

LINKS TO OTHER ACTIVITIES:

This activity relates to Counseling and Testing (#5668.08), PMTCT (#3248.08) Basic Care and Support

(#5665.08), AB (# 15679.08), TB/HIV (#15665.08), and Strategic Information (#15669.08). Prevention for

positives counseling to include condom use will be an important component of posttest counseling in the

STI clinics. Prevention for positives counseling will be incorporated in counseling for persons receiving ARV

treatment. This service will also complement HCT services for those who ultimately test HIV negative.

Through this program as well as basic care and support, IFESH will ensure access to STI treatment.

POPULATIONS BEING TARGETED:

This activity focuses on discordant couples, GOPD and STI patients, TB patients, PMTCT patients,

Activity Narrative: PLWHA, incarcerated populations, youth, police, and commercial sex workers. Training will also be focused

on healthcare workers and counselors.

EMPHASIS AREA:

An emphasis area for this activity is human capacity development in order to build the organizational

capacity of HCT service outlets to provide a full range of prevention strategies including correct and

consistent use of condoms to persons attending these centers. Other emphasis areas include gender and

local organization capacity building.

ACTIVITY DESCRIPTION:

Under COP08 funding, IFESH will provide basic care and support services to individuals identified as HIV+

from HCT, TB/HIV and PMTCT programs. Care and support services will also be provided to family

members/household members of PLWHA. Services will be provided through 30 sites (where HCT, TB/HIV

and PMTCT services are provided) located in Rivers and Imo states. Sites are located in states chosen

based upon high prevalence in the most recent 2005 antenatal HIV sero-survey and geo-political

distribution. This activity provides a critical component of the complete HIV related care package by offering

initial care and support to HIV-infected individuals. Under COP08 activities IFESH will provide basic care

and support services to 3,500 PLWHA. In addition, IFESH estimates that 7,000 People Affected by

HIV/AIDS (PABAs) will be reached, giving a total of 10,500 adults reached with care and support services.

Following National Palliative Care Guidance and USG PC policy, HIV positive persons identified through

mobile/community HCT, PMTCT and DOTS activities will be provided with basic care services including:

patient training and education in self care, medical services (assessment of signs and symptoms and

referrals), psychological care (adherence, crisis, bereavement), nutritional counseling, prevention for

positives, fellowship to share coping mechanisms through enlisting in a support group, provision of

cotrimoxazole prophylaxis, pain and symptom management, and access to community home based care

services. The activities will be approximately 20% laboratory monitoring and OI diagnostics, 30% OI

management and prevention (i.e., cotrimoxozole), and 50% Home Based Care. Other activities will focus on

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

discordant couples, provider delivered prevention messages and IEC materials on disclosure. All enrolled

into care will receive risk assessment and behavioral counseling to achieve risk reduction.

IFESH will facilitate support group activities to combat denial, stigma and discrimination. Funds will support

the recruitment of a Care & Support program specialist to monitor program activities in the field. Community

home based care will be provided in the catchment areas that IFESH supports. This will be implemented by

trained community health extension workers and community volunteers, among whom would be retired

nurses and midwives within the community and volunteer PLWHA from support groups. Standardized HBC

kits (consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, vaseline, gentian violet, etc.) will

be provided to each trained HBC provider for use when visiting clients. PLWHAs will be provided with

prevention care package containing water treatment solution, water vessel, Insecticide Treated Nets (ITNs),

soap, condoms, and prevention for positives IEC materials. All identified HIV positive persons will be linked

to treatment facilities with comprehensive HIV/AIDS related services for baseline laboratory investigations

and for referral for ART where indicated. Laboratory monitoring (CD4 counts, hemotology, blood chemistry,

and malaria smears) will be supported from this funding. This activity will be linked to the primary

prevention, PMTCT and HCT programs emphasizing the "home-based" prevention linkage to ensure that

family members at risk are tested and counseled, a strategy that supports family engagement in home-

based care and support. Home based care providers will be organized into a team that is linked to a facility

within their catchment area.

IFESH will collaborate with other IPs to use standard training curricula and standard provider manuals will

be used during training activities. There will be training of new healthcare workers including community

volunteers and re-training sessions for the previously trained HCWs. The training will equip the trainees with

the capacity to provide basic care and support services (OI prophylaxis, psychosocial support, home based

care). A total of 60 care providers will be trained. The capacity of already existing healthcare facilities in the

targeted areas will be strengthened to provide quality care and support to the PLWHAs. Healthcare workers

in the general hospitals and the surrounding health centers will be mobilized, sensitized, trained and

equipped to provide these services. IFESH will provide outreach services at each site to HIV-infected and

uninfected individuals through HCT advocacy, antiretroviral therapy education, stigma reduction, and risk

reduction through other prevention activities.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity provides services which are a high priority for the 2-7-10 Emergency Plan strategy by providing

a basic care services for HIV+ adults and PABAs. The services are consistent with the draft Guidelines for

Palliative Care in Nigeria and the USG Palliative Care Policy as well as the Nigerian Guidelines for

Antiretroviral Therapy which stress home based care, symptom management, and OI prophylaxis. Capacity

development and consistency with national guidelines will ensure sustainability.

LINKS TO OTHER ACTIVITIES:

This activity is linked to VCT (5668.08), PMTCT (3248.08), condoms and other prevention (15664.08), AB

(15679.08), and TB/HIV (15665.08). All patients are monitored and linked to ARV therapy when indicated.

Care and support services such as psychosocial support and symptom management promote ARV

adherence. Services will be integrated with prevention for positives activities including counseling and

condom availability. Home based care programs will be implemented by a number of indigenous NGOs,

CBOs, and FBOs. Sub-agreements will be coordinated with other Emergency Plan IPs to ensure non-

overlap of funding and services. Women will be linked to Income Generating Activities (IGAs) where

available.

POPULATIONS BEING TARGETED:

Targeted populations include MARPs, TB patients and People Living with HIV/AIDS. Services are offered to

adults living with HIV/AIDS and their affected family members, men and women of reproductive age,

pregnant women, their spouses or partners, and health care workers. Sites have been chosen to maximize

linkage with USG supported facilities providing comprehensive HIV treatment services and to provide

services for HIV+ pregnant women identified through PMTCT. Nurses, other health workers as well as

volunteer PLWHA and caregivers of PLWHAs are targeted for training.

EMPHASIS AREAS:

Emphasis areas include human capacity development, local organization capacity building, SI and TB

wraparound programs.

ACTIVITY DESCRIPTION:

In COP08 IFESH will expand HCT services to DOTS sites in line with the National TB and Leprosy Control

Program (NTBLCP) to focus on strengthening the integration of high quality TB and HIV care delivery.

Under COP07 HCT programming, IFESH reached five TB DOTS sites. In COP08, IFESH will expand to five

additional TB DOTS points of service for 10 total sites in two states (Rivers and Imo).

A total of 3,500 newly presenting TB suspect patients developing symptoms will be screened for HIV and

provided appropriate counseling based on results. Of these, it is expected that 350 will have TB and of

those, 105 (30%) will have TB/HIV co-infection. DOTS site personnel will also be trained in HIV diagnosis

using HIV rapid test kits and educated in referring HIV+ individuals to comprehensive care for assessment

including for antiretroviral treatment eligibility. The focus of the IFESH TB/HIV program is on ensuring

adequate and prompt linkage of TB patients and their household contacts to HIV counseling, testing, care

and treatment services, to ensure that all HIV patients are screened for TB, and to enable all HIV-infected

patients with TB to access services at DOTS clinics.

IFESH will partner with PEPFAR implementing partners specializing in lab programs to facilitate QA

programs to ensure quality of services. IFESH master trainers will train and work with TB DOTS staff to

ensure that HIV testing provided within the TB DOTS context is of high quality by incorporating TB DOTS

sites into the laboratory QA program. A TB diagnostics QA program will be conducted including: joint site

visits with the FMOH or relevant State MOH for observation/retraining, selective review of completed smear

examinations, and proficiency testing with "unknown" slides provided by the QA team. Regarding quality of

TB treatment being provided, IFESH will work in close collaboration with the German Leprosy and TB Relief

Association (GLRA) to ensure that TB DOTS staff are following the National TB treatment algorithm. IFESH

will support training, including refresher on x-ray diagnostics and sputum microscopy training, for a total of

20 staff in TB treatment.

IFESH will upgrade facilities through infrastructure support such as basic renovations, upgrading equipment

and procuring supplies and consumables (e.g. sputum containers). Microscopes and supplies will be

provided to sites where deficiencies are noted. Nosocomial transmission of TB will be prevented through

such measures and principles as basic hygiene, proper sputum disposal, and good cross ventilation at

clinics. The national guidelines on infection control on co-located sites will be implemented in all IFESH-

supported sites.

The IFESH M&E staff will work with sites to ensure that incident TB cases are properly reported to the

FMOH. IFESH will network with Global Fund in implementing these plans to avoid duplication of services to

be developed under Global Fund. IFESH will provide palliative care to TB/HIV coinfected patients including

other opportunistic infections and will refer appropriately for ART. Cotrimoxazole Preventive Therapy (CPT)

will be provided to eligible TB/HIV patients as a component of basic care and support. HCT in DOTS sites

will be established at the secondary and primary health center levels with linkages to tertiary centers to

provide accessibility of services to patients. The TB DOTS sites will be supported to provide holistic patient

care according to National and IMAI guidelines. Sites will be assisted to put in place and/or improve

defaulter tracking mechanisms.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Training and support to improve the quality and integration of TB/HIV services are consistent with FMOH

and EP priorities. The aims are co-location of HCT services in the TB DOTS setting, an increased number

of TB suspect patients screened for HIV, appropriate provision of care and support for HIV+ clients, and

improvement of overall TB services (i.e., diagnostics and treatment) at supported sites. An overarching

focus on technical capacity development will ensure sustainability. Smear microscopy QA will be carried out

collaboratively with the FMOH or the relevant state MOH to promote sustainability through capacity

development and integration into the health sector system.

LINKS TO OTHER ACTIVITIES:

This activity is also linked to Counseling and Testing (5668.08), Basic Care and Support (#5665.08), OVC

(#15678.08), Abstinence and Be Faithful (#15679.08), PMTCT (#3248.08), Strategic Information

(#15669.08) and Condoms & Other Prevention (#15664.08). Linkage to TB diagnosis and treatment is an

important component of adult Care and Support and OVC services.

POPULATIONS BEING TARGETED:

TB suspect patients, PLWHA, OVC, pregnant women and their family members are targeted in this activity.

EMPHASIS AREAS:

The emphasis areas are human capacity development, local organizational strengthening and SI.

ACTIVITY DESCRIPTION:

In COP08 IFESH will commence the provision of OVC activities and provide preventive care packages to

HIV infected children, to families with an HIV infected parent/caregiver, and/or to orphans of HIV/AIDS.

IFESH will provide primary direct OVC services to 2,000 OVC clients, including HIV+ children, at 30 sites

(where HCT, TB/HIV and PMTCT services are provided) located in Rivers and Imo states. Sites are located

in states chosen based upon high prevalence in the most recent 2005 antenatal HIV sero-survey and geo-

political distribution. In its OVC programming, IFESH will focus on providing health services, nutrition,

psychosocial support, and education to OVCs that it serves. IFESH will guide OVCs and caregivers to

providers of other services such as protection, shelter and care, vocational training, and/or Income

Generating Activities (IGA).

IFESH will provide OVC services in a family centered approach, identifying HIV infected women during

pregnancy through its PMTCT program, and following the mother and the infant after birth with care

services. The package of health services which will be available to all HIV+ children, orphans due to HIV, or

eligible caregivers receiving services includes: access to appropriate TB diagnostics and linkage with GON

sponsored DOTS programs described under TB/HIV; instruction for parents/caregivers in appropriate water

purification and provision of water guard; provision of ITNs; provision of trimethoprim/sulfamethoxazole

prophylaxis; and symptom management including provision of pediatric formulations of

antidiarrheals/analgesics/antipyretics. In addition, a standard formulary will be provided to sites to treat

common opportunistic infections. Preventive care packages will be received from SFH for distribution to

identified OVCs.

Access to food and nutrition support is a significant need for HIV-exposed and HIV+ children. IFESH will

provide comprehensive nutritional support for OVCs, especially those that are clearly malnourished,

including assessment, counseling, supplementation and multivitamins/minerals, with referral for therapeutic

nutritional services. IFESH will explore linkages to community resources with therapeutic feeding programs.

Linkages with community NGOs and faith based organizations (FBOs) as well as traditional community

OVC providers will also be established for ongoing food and nutrition resource support. In addition, as a

new partner in this area IFESH will network with other PEPFAR IPs and through the USG with Clinton

Foundation to leverage funds for appropriate nutritional supplements for OVCs.

In COP08, IFESH will provide direct educational support for OVCs including: school uniforms, books, shoes,

and/or incidental fees. IFESH will provide supportive supervision for school performance and any behavioral

issues through relationships that will be formed with the school administration and teachers. This will allow

early recognition of problems that need to be addressed.

Psychosocial support including disclosure management, grief and loss, stigma and discrimination issues

etc. will be provided to all identified OVC. Support groups for OVCs will be facilitated by CBOs/FBOs for

peer support and recreational activities. In COP08, IFESH will develop capacity to strengthen psychosocial

support for children by improving the quality of counseling available for children at points of service through

conducting a training focused on counseling of children to include child development, disclosure of the

diagnosis, grief and loss, and adherence to medications. IFESH will work in COP08 with the GON, other

IPs, FBOs and community resources to promote preventive care training. One hundred (100)

community/home based care providers will be trained through this activity. The trained providers will

conduct step down training to the caregivers in the households they serve.

The Child Survival Index tracking form will be utilized to ensure that each child has access to OVC services

needed. Quality of services will be ensured through supportive supervision, feedback from families of

OVCs, and through regular monitoring of OVCs.

COVERAGE AREA:

IFESH is working in Rivers and Imo states.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity provides services which are a high priority for the 2-7-10 EP strategy by providing a basic

package of services for all identified HIV+ children, families with an HIV infected parent/caregiver or children

orphaned by HIV/AIDS. The services are consistent with the National Plan of Action for OVC in Nigeria and

the Standard Operational Guideline for OVC services. Capacity development at the site level and

consistency with national guidelines will ensure sustainability. IFESH staff will contribute to the development

of a National OVC training curriculum, identified as a priority by the FMOH.

LINKS TO OTHER ACTIVITIES:

This activity is linked to PMTCT (3248.08), Counseling and Testing (5668.08), TB/HIV (15665.08), AB

(15679.08), COP (15664.08), and Strategic Information (15669.08). HCT services will be available to OVCs

in HIV affected families. OVCs will be identified at birth through the PMTCT program. All HIV positive OVCs

are monitored and linked to ARV therapy when indicated. OVC services such as psychosocial support for

families and symptom management promotes ARV adherence. Services are co-located in facilities with TB

DOTS centers and IFESH staff work with sites to ensure coordination systems are in place for referral and

diagnosis of TB in OVCs. Data reporting services supported by IFESH will be available at sites. Home

based care programs will be implemented under the guidance of IFESH.

POPULATIONS BEING TARGETED:

OVC services are offered to HIV exposed infants, HIV positive children, children orphaned by HIV,

caregivers of OVC/PLWHAs, pregnant women and HIV/AIDS affected families. Health workers in the public

and private sector are targeted for training. Community groups including CBOs, NGOs and FBOs will be

targeted for training, linkages and identifying OVCs.

EMPHASIS AREAS:

An emphasis area for this activity is human capacity development, local organization capacity building and

SI.

ACTIVITY DESCRIPTION:

Under COP08 funding, IFESH will provide access to quality HIV counseling and testing (CT) services to

13,000 individuals who will also receive their results. HCT services under COP07 were provided at 10 sites;

in COP08 IFESH will expand to 20 sites in Rivers and Imo States (10 per state). From these 20 sites, staff

and volunteers will also conduct community outreach HCT activities. In order to accomplish this, CT

services will be targeted to populations that have been shown to be at increased risk for being infected with

HIV through high-risk behavior. Targeting this population will identify HIV infected individuals and provide

them with appropriate counseling, care and treatment. A total of 13,000 people will be counseled, tested

and receive results. All individuals requiring treatment will be referred to ART treatment sites in the states.

Under COP07, IFESH provided HCT at all points of service within all IFESH-supported health care facilities

using provider initiated and opt-out approaches. In COP08, IFESH will continue to provide these services

and will employ the same model in newly supported health care facilities.

Counseling and IEC materials will focus on abstinence, be faithful, and consistent and correct condom use

(ABC), providing this messaging in a balanced approach appropriate for each individual client. For clients

testing HIV positive, prevention with positives services will be provided, including HCT for family members

and sex partners, counseling for discordant couples, counseling on healthy lifestyles and positive living,

prevention messages and IEC materials on disclosure. Post-test counseling for those testing negative will

focus on prevention using the ABC approach as well, and partner testing will be encouraged when

necessary. Based on risk assessment, a follow-up testing interval will be recommended.

Funding will be used to support the training of staff utilizing HIV counseling and testing SOPs and the

standardized National training curriculum. Fifty people will be trained on counseling and rapid testing at the

20 service outlets. Some of those trained will be community health workers who will do mobile HCT in order

to carry out family HCT and house-to-house testing campaigns during home care visits for PMTCT, OVC,

and basic care and support clients. Training will be appropriately tailored to the targeted population to which

it will be delivered, and counseling will be provided in local languages whenever possible. In view of the

remoteness of most communities in these states and the trend towards home-based testing, IFESH will

establish mobile HCT teams specifically to target hard-to-reach high risk groups such as commercial sex

workers and truck/long distance drivers at community and ward levels. Due to the risk of HIV infection

among these populations, a key component of the HCT delivery will include enhancing the linkage of the

HIV infected individuals to HIV care and treatment services as necessary. IFESH will educate communities

in local languages in order to increase awareness of such services. Counselors fluent in these local

languages will be available to ensure that appropriate counseling messages are conveyed to the clients.

All testing will be conducted using the nationally approved algorithm for HIV testing that utilizes rapid test

kits and same day results. IFESH laboratory program officers will provide training and supportive

supervision. A quality assurance program will be put in place to ensure the accuracy of testing particularly

for testing conducted outside of health facilities. Quality Assurance (QA) for both counseling and testing will

be carried out at timely intervals in COP08 through submitting blood samples to a designated reference

laboratory for testing and sending certified counselors for site assessments. IFESH will communicate with

the USG laboratory team and other IPs to ensure that its laboratory QA system is of high quality.

CONTRIBUTION TO THE OVERALL PROGRAM:

The activities supported with these funds are in-line with both the Government of Nigeria and the

Emergency Plan 5-year strategy for addressing HIV/AIDS. Increasing access to HCT, particularly to high

risk populations, is an efficient strategy to identifying individuals that will benefit from prevention, care, and

treatment activities. Clients found to be infected with HIV will be linked with prevention for positives, care

and treatment support. Those individuals found to be HIV negative will be provided with prevention services

to remain negative.

LINKS TO OTHER ACTIVITIES:

This activity is linked to Basic Care and Support (#5665.08), PMTCT (#3248.08), Condoms and other

prevention (#15664.08), TB/HIV (#15665.08), OVC (#15678.08), AB (#15679.08), Strategic Information

(#15669.08).

POPULATIONS BEING TARGETED:

This activity targets those individuals known to be at increased risk of HIV infection in Nigeria. These

include most at risk populations (MARPS), hospital patients, commercial sex workers, uniformed

populations, mobile populations, truck drivers, and out of school youth. To accomplish this, HCT services

will be located where such populations are known to congregate.

EMPHASIS AREAS:

This activity includes an emphasis on training.

COVERAGE AREAS:

Sites are located in states chosen upon high prevalence in the most recent 2005 ANC survey and include

Rivers and Imo states.

ACTIVITY DESCRIPTION:

In COP08 IFESH will begin activities under the Strategic Information (SI) program area. IFESH will be

supporting the SI activities that will occur across seven program areas for a total of 35 sites (20 hospitals,

10 TB DOTS sites, five community sites for OVC/adult care/ABC activities) in two states (Rivers and Imo).

IFESH will strengthen Strategic Information (SI) under the "One M&E Framework" by supporting

standardized HIV indicator reporting systems at program sites and registering sites in the national M&E

system. For facilities where there is other donor support, data collection and indicator reporting will be

harmonized and one reporting system will be used in accordance with the national guidelines and

indicators. IFESH will work with USG and GON to include IFESH-supported facilities in the National Public

Health data system launched in 2007 (Voxiva platform) where applicable. IFESH will be an active

participant on the USG SI working group supporting PEPFAR in Nigeria.

Funding will be used to provide information technology (IT) infrastructure for data aggregation and reporting.

Effective use of paper-based and electronic data systems will be promoted in clinical settings to enhance

the enrollment, follow-up, assessment, and referral/linkages to other IFESH-supported services (e.g., TB,

PMTCT, STI, home-based care, HCT, etc.) and to services outside of IFESH's programs (e.g., ART

services) for all clients.

IFESH's data quality assurance program will involve several components. IFESH will have a dedicated M&E

SI staff person who will work with IFESH staff in other programs and with site-level staff. The M&E staff

person as well as the programmatic staff will also work with sites to ensure that they are reporting

appropriately to state level data collection authorities as part of the national system. They will liaise with

state level M&E authorities regarding site level reporting and monitoring; state M&E officers will be invited to

participate in monitoring activities in order to build relationships and capacity within the states. National

registers and data collection tools will be used at all service delivery points. IFESH will ensure that copies of

registers are available and in use at sites and will provide supportive supervision to site staff to ensure they

are being used correctly. IFESH programmatic and M&E staff will conduct regular monitoring and

supervisory visits to all sites. During routine monitoring visits data collection tools will be reviewed for

completeness and accuracy and on-site technical assistance will be provided. Randomly selected individual

patient records will be reviewed across tools as one method of assessing accuracy. For sites identified as

having problems with data reporting requirements, the M&E staff person will involve the site in developing a

corrective plan that may include follow-up through additional visits, mentoring and more regular

communication/reporting via other routes (phone, email). IFESH staff will liaise with the USG SI staff as they

develop and implement their DQA activities to ensure completeness and harmonization with PEPFAR and

GON reporting requirements.

Evaluations using data collected through facility-based services and community-based services will be

performed to provide evidence-based decisions for program quality, impact, and effectiveness. IFESH will

also work with on-site administrators and staff to improve their knowledge and understanding of the data

from their sites so that they will be involved in decision-making, thus promoting sustainability of the

program.

Building site staff capacity to monitor key metrics in an ongoing way is an important strategy for promoting

sustainability. Emergency Plan (EP) funding will be used to train 36 individuals including one IFESH staff

and 35 site level health care providers and medical data personnel on data collection, data use and

reporting. Site level M&E staff are hired/identified through the hospital or health center personnel system.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Strengthening SI will enable timely, transparent, and quality data reporting of 2008 EP targets for Nigeria.

Through concurrent collaboration with the Government of Nigeria and the PEPFAR team IFESH will support

the establishment of one standardized system to monitor National HIV programs.

LINKS TO OTHER ACTIVITIES:

SI activities are cross-cutting and relate to PMTCT (3248.08), condoms and other prevention (15664.08),

abstinence and be faithful messaging (15679.08), adult basic care and support (5665.08), TB/HIV

(15665.08), OVC (15678.08), and counseling and testing (5668.08). Linkages between these program

activities will be strengthened to improve efficiency and effectiveness of services in order to catalyze the

formation of networks of care.

POPULATIONS BEING TARGETED:

This activity targets health care providers in best practices on information use and reporting. Provision of TA

targets host country government workers. HMIS and program evaluations target general population and

people affected by HIV/AIDS receiving services supported by the IFESH.

EMPHASIS AREAS:

This activity includes major on human capacity development and SI.