WHO will continue activities during the COP08 reporting period using prior year funding with no new targets.

Below is the approved COP07 narrative.

ACTIVITY DESCRIPTION This activity is linked to the goal of reducing the burden of TB in HIV patients, the

second objective of the WHO Interim Policy on Collaborative TB/HIV activities, as intensified TB case

finding and TB care is offered to HIV positive patients. WHO in collaboration with the federal and state

ministries of health will use FY07 funds to continue the 3rd year of phased implementation of TBHIV

activities initiated with FY05 funds. Using FY07 funds, WHO will continue to provide technical assistance to

federal and state TB and HIV control programs to coordinate and implement TBHIV activities in 6 additional

states. TBHIV activities will be initiated and implemented in 36 DOTS facilities, 12 ART sites and 6

community based organizations providing HIV/AIDS care and support services. In each state there will be a

network of 2 ART sites with referral links to 6 DOTS facilities and 2 care and support organizations. HIV

Counseling and testing services will be established in 36 DOTS facilities. Health workers in DOTS facilities

will have the capacity to diagnose HIV in TB suspects, treat HIV positive persons with active TB, and

provide CPT and referral to ART clinics and care and support services. Six community based organizations

providing HIV/AIDS care and support services will be trained and mentored to identify and refer members

with symptoms and signs of TB to DOTS facilities for diagnosis and treatment. Thirty-six community

members will be trained as treatment supporters and will also facilitate links between community and facility

based activities. To ensure intensified case finding, screening and diagnosis of TB will be strengthened in

12 ART clinics, referral links established with DOTS services and TB infection control measures instituted.

Based on the patient load in the past year, it is anticipated that the 36 DOTS facilities will test an estimated

32,500 TB suspects for HIV. Of these about 6,000 persons will be dually infected and require treatment . A

total of 234 health workers of different cadres, including state TB and HIV control officers and community

workers, including PLWHA representatives will be trained to implement TBHIV activities. By the end of

FY07, and cumulating with, TBHIV activities in FY05 and FY06, a total of 18 states will have a network of 36

ART sites with capacity for referral / diagnosis and treatment of TB; 108 TB DOTS treatment clinics will

provide counseling and testing services with referral to HIV care and treatment services; 18 HIV/AIDS care

and support organizations will serve as community links for symptomatic screening and referral of HIV

positive TB patients. FY07 funds will also be used to strengthen coordination and reporting of TB and HIV

activities in all the states supported by USG in TBHIV activities. State TB/HIV working groups will be

established in the additional six states and at the same time the working groups already established in the

12 states during FY05 and FY06 will also be maintained. In addition, WHO and the FMOH will also use

FY07 funds to establish state TB/HIV working groups in states where other PEPFAR partners are

implementing collaborative TB/HIV activities. FY07 funds will also be used to conduct advocacy and

sensitization for TBHIV activities at state and local government levels and annual coordination meetings of

state AIDS and TB program coordinators with the National TB and HIV coordinators. Two dedicated

National Professional Officers will be hired by WHO to provide technical assistance and facilitate, national,

state and Local government mentoring, supervision and coordination of TBHIV activities. In collaboration

with the FMOH, joint monitoring and supervision will be conducted and FY07 funds will also be utilized as

required for on-going revision, printing and dissemination of national TBHIV reporting and recording forms.

CONTRIBUTIONS TO OVERALL PROGRAM AREA TB is the most common cause of morbidity and

mortality among HIV positive persons. This activity focuses on reducing the burden TB in HIV patients and

will contribute to the goals of the Government of Nigeria and the Emergency Plan targets. While the DOTS

strategy started by establishing TB clinics in primary health care facilities, the HIV/AIDS strategy started by

establishing ART facilities at tertiary institutions, the result has been an incongruity between the location of

DOTS clinics and ART facilities to the detriment of the dually infected. By linking TB and HIV services, this

activity contributes to the Federal Governments strategy to have DOTS clinics and ART sites in the same

facility or close by with a very strong referral mechanism. LINKS TO OTHER ACTIVITIES This activity is

linked to ART, counseling and testing, palliative care and community based care and support services. This

activity is linked to the goal of reducing the burden of TB in HIV patients, the second objective of the WHO

Interim Policy on Collaborative TB/HIV activities, as intensified TB case finding and TB care is offered to

HIV positive patients. It also contributes to reducing the burden of HIV in TB patients, the third objective of

the Interim Policy, as the ART sites serve as referral facilities for the DOTS sites where CT takes place.

Individuals identified as TB/HIV patients will be referred to appropriate TB and HIV health facilities in order

to receive appropriate care and treatment. This activity is also linked to the strategic direction of the National

TB and Leprosy Control Program (NTBLCP) to establish DOTS clinics in all the ART sites in the country to

reduce the incongruity in the availability of TB and HIV services and promote TB/HIV collaboration at the

facility level. POPULATIONS BEING TARGETED This activity targets HIV positive persons receiving

treatment, care and support and HIV positive persons with active TB. This activity also targets HIV patients

who had hitherto not had access to TB screening and care. In Nigeria, TB is the commonest Opportunistic

Infection (OI) in (PLWHA). This activity thus offers HIV patients a longer life free of the morbidity and

mortality caused by TB. KEY LEGISLATIVE ISSUES ADDRESSED This activity will work to increase

equitable access to quality TB and HIV services to women, children, and other marginalized populations. It

is also anticipated that the ready availability of such services will reduce stigma and discrimination that is

associated with TB and HIV patients. EMPHASIS AREAS This activity includes major emphasis on training.

Minor emphasis will be on human resources and on development of network/linkages/referral systems, and

infrastructure.