Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7144
Country/Region: Nigeria
Year: 2008
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $11,115,812

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $328,562

ACTIVITY DESCRIPTION:

In COP08, LMS will continue the activities initiated in seven project-supported sites in Kogi and Niger states

during COP07, and will initiate services in an additional ten sites. Using the revised National PMTCT

Guidelines, 9300 women will be tested, 8, 800 will receive their results and up to 410 HIV positive pregnant

women will receive ARV prophylaxis. To achieve this, LMS, in collaboration with UNICEF, will train 220

health care workers (in addition to the 90 trained in COP07) to work in ANC clinics and delivery wards in

PICT and PMTCT.

In Nigeria, PMTCT services were originally available only at tertiary level, but are now being expanded to

secondary level. However, PMTCT services need to be made available at primary care and community

level, to ensure that pregnant women can take advantage of PMTCT services after being diagnosed as HIV

positive. LMS will emphasize and support the provision of PMTCT services at primary care level facilities.

During COP08, LMS will institute and train health care workers in provider initiated counseling and testing

(PICT) to be offered during ANC, and labor and delivery. Point of service, group, and outpatient counseling

and testing with same day results will be offered to clients. All women tested will receive post test

counseling including HIV negative women, to encourage them to remain negative. Peer support

coordinators will provide continuing support after testing and encourage pregnant women to adhere to their

ART prophylaxis and safe infant feeding choices. Peer support groups will be facilitated and trained to offer

these services. Partner and family testing will be encouraged so that PMTCT becomes the entry point for

family centered HIV care, support and treatment (PMTCT plus). CD4 testing will determine those needing

ART for their own health and they will be referred for ART. When feasible, women not needing HAART for

their own health will receive Zidovudine (AZT) from 28 weeks or Combivir from 34 weeks and single dose

Nevirapine (sdNVP) during labor with a seven days combivir tail. If these are not available then sdNVP will

be administered during labor. Women who receive no antenatal care during their pregnancy or who have

had only limited antenatal care but presented to the facility with no record of PMTCT services will receive

C&T during labor and if positive, will receive sdNVP. Infants of positive women will receive NVP syrup at

birth and AZT for six weeks. All HIV-exposed infants will be followed up postnatally and will be provided

cotrimoxazole prophylaxis from age 4 - 6 weeks until their HIV status is confirmed and they are no longer

exposed to HIV if they are not HIV infected.

LMS will participate in the GON scale up of sites for EID and establish linkages with other sites using the

dry blood spot (DBS) strategy in conjunction with other IPs who have PCR lab capability. This will ensure

earlier diagnosis of positive infants and earlier link to care and treatment.

All mothers in project supported areas will be encouraged to exclusively breast feed their infants for six

months as this strategy will reduce mother to child transmission of HIV while not stigmatizing HIV positive

mothers. HIV positive mothers will receive guidance on safer infant feeding although few mothers in project

areas will be able to make an AFASS choice to exclusively replacement feed their infants. Health workers

will be taught that recent research has demonstrated far better outcomes for exclusively breastfed infants of

HIV positive mothers even in more affluent situations (such as Botswana and South Africa) than project

communities in Nigeria. Further, recent evidence again from South Africa has shown that health workers are

not able to guide mothers to make decisions to replacement feed that are AFASS resulting in mothers who

do not have AFASS conditions replacement feeding and increasing mortality from respiratory and diarrheal

diseases amongst their infants. 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.

The project will also seek to employ women living with HIV as peer support coordinators in antenatal care

(ANC) settings providing PMTCT services. The peer support coordinators will facilitate mothers' groups that

provide peer support to pregnant women who are diagnosed as HIV positive to encourage them to accept

PMTCT services, return to the ANC for their ARVs, take the ARVs as prescribed, and adhere to their safer

infant feeding choice in the face of family pressure for mixed feeding of their infants. The peer support

coordinators will also provide positive role models to reduce stigma and act as champions for HIV positive

pregnant women to ensure that they are not discriminated against during their antenatal and maternity care.

These peer support groups will reduce the drop outs from PMTCT and increase the use of both ARVs and

safer infant feeding choices, thus greatly increasing the accessibility of these services to pregnant women.

Because many pregnant women will attend ANC but deliver at a different facility or, more likely, deliver at

home in the community, introducing mechanisms for use of ARVs—particularly Nevirapine—in the

community, if this is possible, will also greatly increase the accessibility of PMTCT. LMS will support a

national zonal training in Infant Feeding Counseling and train some of its facility staff in Infant Feeding

Counseling.

LMS, working with the peer support coordinators and local TBAs, will explore the possibilities for extending

PMTCT services into the community to reduce the numbers of HIV positive women who are lost to follow up

after testing positive in ANC. This might include training and supporting of TBAs and others using a

curriculum adapted to the Nigerian situation, so they practice universal precautions in delivery services;

refer women for HCT and, where appropriate, administer single dose NVP during labor and to the newborns

(assuming availability of single dose packaging and agreement of NASCP and State MoHs).

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activities in this area will strengthen the capacity of facility and community based resources to provide ARV

prophylaxis, counseling and support for improved maternal nutrition and safe infant feeding, and additional

HCT and support as included in PMTCT plus activities. They will also contribute to the more general

interest of improving the lives of children and families directly affected by AIDS-related morbidity and/or

mortality.

LINKS TO OTHER ACTIVITIES:

This activity relates to the HVCT (15645.08), Basic Care and Support (15642.08), ARV drugs (12414.08)

and Prevention Program Areas (9758.08, 10197.08).

POPULATIONS BEING TARGETED

This activity focuses on pregnant women and their families from the communities served by project

supported sites (17 by end of COP08).

Activity Narrative:

EMPHASIS AREAS

This activity addresses gender concerns related to the specific HIV/AIDS-related care and treatment needs

of pregnant women. The activity emphasizes developing the capacity of a wide range of persons (health

personnel, mothers' peer support groups, PLWHA and TBAs) to increase testing, counseling and treatment

and prophylaxis for pregnant women and their infants, to provide them and their families the appropriate

protection and care to reduce the risk of HIV infection or mitigate transmission and negative health effects.

This activity will address the need to counsel and test pregnant women in order to prevent future HIV

infections, to the mother, child or spouse/partner. Male involvement will be encouraged through various

strategies including partners testing together and sensitizing men through fora appropriate to them.

Funding for Care: Adult Care and Support (HBHC): $1,400,000

ACTIVITY DESCRIPTION:

This activity relates to OVC (15644.08) and TB/HIV (15643.08) ARV treatment (15647.08), and Prevention

(15641.08) Program Areas. In COP 08 the LMS project will continue the activities initiated in project-

supported comprehensive care and treatment secondary health care facilities and their feeder primary

health care facilities in Kogi and Niger states during COP07. An additional 10 comprehensive care and

treatment sites [secondary health care facilities] will be selected in COP08. The target for the number of

individuals provided with HIV-related palliative care, including persons affected by AIDS, as well as HIV-

infected individuals is 22,200. The number of HIV+ persons in this group is estimated at 7400. (See ART

Services narrative).

Basic Care and Support will focus on four priority aspects of palliative care: (1) medicines (30%):

cotrimoxazole prophylaxis for all HIV positive adults with CD4 counts of less than 350 and others in line with

the national clinical guidelines;, treatment for OIs, malaria, STIS (using syndromic management protocols)

and other AIDS related conditions. (The national guidelines advocate for cotrimoxazole prophylaxis for

primary and secondary prevention,) (2) Laboratory services 20% - including general blood tests (FBC,

ESR, renal and hepatic function tests), CD4 counts and OI diagnosis with tests for STIs, malaria, gastro-

intestinal and urinary infections for HIV positive patients. (3) Community /home-based care (15%) and

training (35%) - which will be implemented through local NGOs, FBOs, CBOs and associations of people

living with HIV, with additional potential for some health facility outreach through the mobile VCT clinics.

The project palliative care advisor and project state staff including the care managers will work with local

organizations to identify their staff and volunteers who will be trained to provide community/home-based

care. Community /home-based care providers and support groups will provide basic nursing care; mental

health and psychosocial care; spiritual care; nutrition and locally raised financial support for families in dire

need; health, hygiene and sanitation education; prevention for positives; and support for treatment

adherence in the home. (4) Human capacity development for palliative care through training, equipping and

supporting a wide range of non-traditional service providers including family members, faith based

congregations and people living with HIV to provide basic care and support services in the community and

home.

Forty (40) clinicians in medical outpatient and inpatient wards will receive training and supportive

supervision in prevention, diagnosis and management of OIs and management of distressing symptoms

including pain, and in recognition of and referral for signs & symptoms of TB. Wider basic care and support

including end of life care, the importance of mental health care, psycho-social and spiritual support, and the

holistic needs of patients and families for economic strengthening, as well as legal protection for property

and inheritance rights will be emphasized in all the trainings for health facility clinical staff as well as for

community/home-based care volunteers. All clinical trainings will conform to the national clinical guidelines

and OGAC guidelines for palliative care and draw on existing materials and training resources in use in

Nigeria. Care coordinators and managers will be trained in holistic patient care and support, and care

managers will work to identify local NGOS, FBOs and CBOs providing care and support services for people

living with HIV and their families, to facilitate referrals of patients and families in need to the relevant

resources in the community, e.g., for legal and financial support.

The project will ensure supplies of medicines for treatment of STIs and prophylaxis and treatment of OIs.

Laboratories at comprehensive care and treatment sites will be strengthened to ensure capacity to diagnose

STIs and other OIs.

In COP08, project staff (including the palliative care advisors, palliative care specialists, care managers and

care coordinators) will identify local NGOs, including CBOs, FBOs and associations of persons living with

HIV that have assets and provide services in the community, and will form a community network of

providers of basic care and support in the community, including home-based end of life care. Project care

managers and care coordinators, with the consent of persons who are diagnosed as HIV positive, will

ensure their clients are referred to the appropriate providers in their local network of community and home-

based providers. Training will be based on the national palliative guidelines—which are currently under

revision—and other existing curricula that government , IP's and others use in Nigeria, and will conform to

NASCP approved harmonized curricula as they are published.

Monitoring and evaluation of basic care and support activities will be accomplished several ways. Data for

monitoring the PEPFAR specific indicators will come from: (1) the LMS internal quarterly reporting system

which collects data on the achievement of outputs and outcomes as defined in the work plan and (2) data

collected at the facility level using the federal MOH standard tools and aggregated by project staff at the

state level on the number of clients served. Special attention will be given to data quality through training of

health facility staff and inclusion of data quality monitoring in all supervisory visits.

LMS partner, Axios Foundation, will ensure that their patient management monitoring software (PMM) is in

place with the necessary resources to support the system.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activities will contribute 22,200 persons towards the PEPFAR target of 1,350,000 receiving basic care and

support in COP08. LMS will strengthen the capacity of facility and community based resources to provide

on-going basic care and support from diagnosis, management and treatment STIs, OIs and other HIV-

related conditions for HIV positive clients and wider basic care and support for adults living with HIV and

their families and others in the community affected by AIDS. LMS will achieve this through expanded

training of service providers, introduction of training for local NGOS, CBOs, FBOs and associations of

PLHA, and community and family members in holistic care and support, improved diagnostic capabilities,

strengthened, prophylaxis and treatment of opportunistic infections (for PLHA) and implementation of

community/home based care.

LINKS TO OTHER ACTIVITIES:

This activity links to prevention, TB/HIV, OVC, ARV treatment, and prevention activities. Activities will

improve the care and treatment of people living with and affected by HIV by linking medical, psychosocial,

legal, financial, and spiritual resources at the facility, community and community and home levels.

POPULATIONS BEING TARGETED:

This activity focuses on meeting the needs of HIV positive adults and their families, and communities served

Activity Narrative: by the LMS project; and building the capacities of a wider constituency of providers of community and home

-based care, and support services.

EMPHASIS AREAS:

Great emphasis (35%) is placed on training to build the capacities of a wide range of non-traditional health

care service providers including family, friends, faith-based congregations and people living with HIV to

provide community and home-based care (15%). An emphasis will also be placed on local organization

capacity building.

These activities and this program area address the larger issue of not just "quantity" of life (increasing life

expectancy) but "quality" of life for patients and their friends and families. LMS will advocate for more

community involvement of care of PLHA and for the administration of opiate pain relief by nurses as well as

doctors to inform policy for enhanced practice. LMS will also advocate for harmonization of training

curricula for HBC in Nigeria.

Funding for Care: TB/HIV (HVTB): $207,250

ACTIVITY DESCRIPTION:

This activity relates to the TB/HIV (12369.08), Basic Care and Support (15642.08) and Prevention Program

Areas (15641.08, 5271.08, 10197.08). In COP08, the LMS project will continue the activities initiated in

COP07 project-supported sites in Kogi and Niger states in COP07 and in up to an additional 10 sites

selected in COP08.

In COP08 LMS will build on established TB diagnostic and treatment services and ensure integration of TB

control in HIV service points and integration of HIV services into TB clinics. At service points, LMS will

continue to focus on improved clinical management of TB/HIV, integration of TB/HIV diagnosis and

treatment, TB-HIV co-infection diagnosis and treatment, basic palliative care, diagnosis and management of

OIs as well as end of life care. LMS will ensure that established referral mechanisms are in place to

facilitate TB/HIV collaborative activities.

There will be continuous training and retraining of health staff and supervision of TB/HIV activities at the

medical, pediatric outpatients and inpatient wards and TB and DOTS clinics. This on the job training (OJT)

will include provider initiated counseling and testing (PICT), clinical examination, appropriate laboratory

testing and use of drugs as per the national clinical guidelines for TB/HIV co-infection. Training will be

based on the national clinical guidelines and the Federal MOH TB/HIV training modules. These activities will

provide quality of service that meets national and international standards. LMS will continue to work with the

National TB and Leprosy Control Program (NTBLCP) in the Federal Ministry of Health to strengthen

management information systems at all sites.

In COP08, LMS will forge links with local NGOs, FBOs associations of people living with HIV, and CBOs.

These links will provide opportunities for case finding and screening and adherence to treatment. These

linkages will build and strengthen referral networks.

In COP08, LMS will activate 10 new sites. Activities for the activation of sites include, renovations, staff

trainings, establishment of efficient systems and processes for forecasting, inventory management and

control, establishment of management information systems and monitoring and evaluation to ensure

collection of quality data.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activities will strengthen the capacity of health facilities to deliver TB palliative care to HIV-infected

individuals. The number of detection and service entry points will be increased by emphasizing the need to

check for co-infection in patients presenting at TB and/or HIV/AIDS service delivery points.

LINKS TO OTHER ACTIVITIES:

This activity links to other Palliative Care services (Basic Health Care), Counseling, Testing, and provision

of ART. In addition, MSH/LMS through its Capacity Building project will strengthen the leadership and

management skills of health facility managers to assist them in the integration of health facility TB and HIV

services.

POPULATIONS BEING TARGETED:

This activity targets persons presenting at TB clinics or health facilities who are at increased risk for HIV and

TB co-infection. Conversely, HIV infected persons (diagnosed or presumed) are targeted for determination

of possible TB co-infection

EMPHASIS AREAS:

This activity emphasizes renovation and human capacity development. In addition, NGO and volunteer

community training and education will increase community awareness and demand for TB/HIV services.

This activity will support improved prevention and clinical/medical care services to address the issue of

under treatment of individuals with TB/HIV co-infection.

Funding for Care: Orphans and Vulnerable Children (HKID): $0

ACTIVITY NARRATIVE:

This activity relates to LMS's activities under the ART (15646.08) ART services (15647.08), Basic Care and

Support (15642.08) and PMTCT (15641.08) program areas. In COP 08, the Leadership, Management and

Sustainability (LMS) will continue those activities initiated in COP 07 project-supported sites in Kogi and

Niger states and in up to an additional 10 sites selected in COP ‘08.

During COP 08, the LMS Comprehensive AIDS Services (COMPARE) project strategies for OVC will be to

strengthen family coping capacity, mobilize and support community responses and provide essential

services to OVC and their families. Key activities will be identification, enrollment and provision of essential

services to OVC, training for care providers including clinicians and emphasizing the importance of referring

the families of their HIV positive patients both for screening for HIV infection and for community services for

their children. The Health Facility Care Coordinators will play a key role in ensuring all HIV positive patients

and their families are offered available comprehensive care and treatment support services. Support will be

provided in the OVC core areas of health care, psychosocial support, birth registration for under-fives and

education. Food and nutritional support services will include nutritional assessment, counseling and micro-

nutrient supplementation when indicated. Linkages for food supplementation will be fostered with the USG

supported wrap-around initiatives in States where they co-locate with the COMPARE project. Networking

with Clinton Foundation will be explored for provision of ready to use therapeutic food for malnourished HIV

infected children

Project care managers and care coordinators, with the consent of persons who are diagnosed as HIV

positive via, PMTCT, ART and HCT activities, will ensure their children are referred to the appropriate

providers of OVC services in their local network. Clients will be offered HIV testing for their children to

ensure any infected children are identified and offered co-trimoxazole prophylaxis, screening and treatment

for OIs and AIDS. Basic care kits for prevention of common opportunistic infections obtained from SFH will

be provided to vulnerable children and their families. Materials used to support programming will include

adaptations of the International HIV/AIDS Alliance OVC Toolkit. Target is to reach 6,400 orphans and

vulnerable children with OVC programs. Monitoring of the well being of these children and data collection

will be conducted utilizing the Child Status Index and the existing GoN tools.

In COP 08, LMS will seek increased community support for OVC by forging links with local NGOs, FBOs,

associations of people living with HIV, and community based organizations. These links will ensure referrals

for psychosocial, support, education for OVC and their families etc. Project staff will identify the local NGOs

that have assets and are providing services in their communities. They will form a community network of

providers of basic care and support in the communities. The project aims to identify at least one

organization for each site, with a total of 17 NGOs, CBOs and FBO in providing OVC activities in COP 08,

and community health workers and volunteers.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

In providing services to 6,400 OVC and building the capacity of 200 care providers the COMPARE Project

will contribute to PEFAR Nigeria meeting it's five-year emergency plan targets of providing care and support

to 400,000 OVC. It will add to the implementation of Nigeria's National Plan on OVC. Activities will

strengthen the capacity of facility and community based resources to provide support aimed at improving

the lives of children and families directly affected by AIDS-related morbidity and/or mortality.

LINKS TO OTHER ACTIVITIES:

This activity links to Prevention, HCT and HTXD, HTXS activities. Activities will improve the health and

education of individuals made vulnerable by HIV/AIDS and create a supportive social environment that will

support prevention activities in this group and in their peers. Linkages with other USG PEPFAR activities

and GFATM activities existing in the same states will be initiated and strengthened. In addition, the LMS

comprehensive AIDS Services project is linked to the LMS capacity project that will continue to develop

leadership and management skills of the National OVC Coordinating unit in the Federal Ministry of

Women's Affairs as well its counterparts in the State Ministries of Women Affairs. This support will also

include strengthening organizational and programs management capacity to efficiently and effectively

address the National OVC response.

POPULATIONS BEING TARGETED:

These activity targets children 0-17 years old in the catchment areas of the secondary and primary facilities

supported by the project as well as OVC as a result of HIV AIDS to receive appropriate health care,

HIV/AIDS information and psychosocial counseling/referral services.

EMPHASIS AREAS:

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

development. LMS, working with Local NGOs and CBO in the communities, will strengthen the care and

coping capacities of families and communities. The primary strategy will be the identification of children

most in need, and filling the gap in the safety net traditionally provided by the extended family. This will be

an efficient, cost effective and sustainable way of caring for orphans and vulnerable children.

This activity will support health staff and local community organizations (NGOs, FBOs) in helping to care for

and re-integrate orphans and vulnerable children, contributing to social stability and improving future

economic well-being. COMPARE will work with state government, local government, NGO, and CSOs in

ensuring that appropriate policies are put in place to protect orphans and other vulnerable children and their

families. These policies must contain clauses to prohibit discrimination in access to medical services,

education, employment, and housing, and protect the inheritance rights of widows and orphans.

Funding for Prevention: HIV Testing and Counseling (HVCT): $1,320,000

ACTIVITY DESCRIPTION:

This activity links to activities in PMTCT (15641.08), Basic Care and Support (15642.08), TB HIV

(15643.08), OVC (15644.08), and prevention activities of other IPs and the GON.

LMS is presently supporting HCT services (integrated) in 7 secondary health care facilities in 2 states, Kogi

and Niger states, and 2 PHC feeder sites in Kogi state.

In COP 08, the LMS Comprehensive AIDS project will continue to build upon the counseling and testing

activities initiated during COP 07. Counseling and testing services will be further strengthened and

expanded to 10 additional secondary facilities in 3 additional states. These states will be identified in

conjunction with the GON based on assessed needs and the GON'S HCT expansion strategy. HCT

services will also be expanded to 15 PHCs that will serve as feeder sites. These feeder sites will provide

HCT services and provide referral to the secondary sites for treatment, care and support services as

appropriate.

Counseling skills will be strengthened in the existing secondary facilities and feeder sites through

appropriate retraining and short term training focused on enhancing skills. LMS will further provide training

on HCT to 124 new counselors in the 10 new hospitals and 15 feeder sites in the focus states. Training

shall be provided in collaboration with other USG-IPs such as FHI/GHAIN and IHVN-ACTION, who have

many years of experience and proficiency in HCT training. This will also build the capacity and proficiency of

LMS training staff. Trainings focusing on supplies management, HCT QC/EQA, Biomedical safety, and HCT

ethics shall be provided to appropriately selected LMS and point of service staff.

LMS shall support 3 Mobile HCT Team in each state which will be deployed to extend counseling and

testing to remote areas by way of Community Outreach programs, and HCT for most at risk populations,

MARPS, such as commercial sex workers, long distance truck drivers and uniformed services. HCT

services will also be extended to incarcerated populations (prisoners) in the focus states. Clients accessing

the mobile HCT services shall be linked to treatment, care and support programs of LMS and other IPs in

the focus areas based on clients' convenience and ease of access. A referral system that ensures feedback

from the referred facility to the referral site shall be adopted for this purpose, and LMS will provide training in

management systems including referral systems and patient tracking.

LMS will begin to identify and partner with local NGOs and CBOs in the communities surrounding the

seventeen secondary facilities and their feeder sites to enlist them to mobilize and support the general

population to be tested. These NGOs will also play a crucial role in dealing with the stigma of HIV/AIDS,

encouraging HIV positive parents to seek testing and treatment for their children, and supporting persons

living with HIV/AIDS. LMS will also collaborate with private health care providers in the locality to provide

HCT services with LMS support after appropriate training, following national guidelines. HIV testing at all

sites will be conducted using the current national algorithm and a switch will be made to the serial algorithm

once approved. LMS project will provide counseling and testing with result to 46,667 individuals in COP08.

LMS will adopt the Provider Initiated Testing and Counseling (PITC) strategy in all supported health

facilities. This shall be done by providing HCT points of services wherever possible, in the Out Patient

Departments, Emergency units, TB and STI clinics, and other hospital wards. In facilities where this

approach is not feasible, HCT services shall be linked to the various hospital wards and clinics, and patients

shall be routinely offered HIV counseling and testing using the opt-out model. LMS shall provide appropriate

training and orientation to the facility health care workers, and collaborate closely with the hospital

administration to ensure compliance and uptake of services. HCT services shall also be provided routinely

to blood donors as a component of the blood transfusion services in supported sites. This will enable blood

donors to get to know their HIV status and to be linked to treatment, care and support as appropriate, and to

benefit from HIV prevention messaging based on Abstinence, Be faithful and Correct and consistent

condom use (ABC), as appropriate.

In order to increase HCT uptake and help deal with issues of discordance amongst couples, LMS shall offer

couples counseling and testing (CHCT), following standard protocols and guidelines. In order to strengthen

these services, LMS will support its staff to receive CHCT training to be provided by USG as part of its

couples counseling roll - out plan for Nigeria. Appropriate post test counseling will be provided to discordant

couples, with emphasis on prevention for positives. Household HCT services will also be offered to families

to enable family members know their status and depending on the results linked to appropriate of treatment

care and support services. Prevention messaging based on ABC will be provided to families. Pediatric HIV

testing also will be offered following standard guidelines and protocols.

Prevention for positives is a key area of emphasis for the project. The prevention for positives strategy will

include provision of condoms and information on correct and consistent use, especially to MARPs,

discordant couples and prevention of super infection in couples that are concordantly positive.

LMS supported HCT sites will be branded with the national "Heart to Heart" logo for easy recognition as a

center for high quality HCT services. IEC materials focusing on abstinence be faithful, and correct and

consistent use of male and female condoms (ABC), shall be made available in all of these sites. To ensure

appropriate condom messaging, models shall be provided in all HCT sites for the demonstration of correct

condom use and condoms provided through the Society for Family Health shall be made available at all

HCT sites including mobile HCT units.

To ensure uniform and consistent data collection and M&E processing, LMS shall use the national HCT

registers and other M&E tools for data collection at the secondary and primary sites alike. Aggregate site

data shall be summarized and reported to the national M&E program officer and the HCT TWG as required.

LMS will through its dedicated quality control lab staffs provide routine HCT sites monitoring and

appropriate mentoring to site staff. Personnel involved in HIV testing shall undergo a quarterly proficiency

testing, while testing accuracy will be routine re-checked using limited retesting of patient samples. EQA for

HIV serology will be linked to other USG IPs EQA programs until LMS can develop its own program. As part

of quality control measures instituted at all HCT sites, the quality control staff will also ensure that standard

procedures are strictly followed in the safe handling and disposal of medical waste and other lab waste

materials. Training for PEP will also be provided to all staff involved in HCT services.

Activity Narrative:

HIV test kits shall be procured through the USG-SCMS partnership mechanism, while the LMS logistic

partner, AXIOS, shall be responsible for the appropriate warehousing and distribution of the kits to the sites.

T o ensure consistent availability of test kits and supplies at the sites, LMS shall adopt the use of Supplies

Consumption Data Feedback Form from all the sites. This will be used to determine the actual test kits and

reagent consumption and based on this, provide appropriate replenishment.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Counseling and testing is a vital entry point for HIV positive individuals into treatment and support for

positive living. Widespread HCT activities support and contribute to the success of ARV treatment, TB-HIV,

PMTCT, OVC, and prevention, and strengthen the capacity of facility and community based resources to

provide comprehensive HIV/AIDS services, serving the wider interest of improving the lives of adults,

children and families directly affected by HIV.

LINKS TO OTHER ACTIVITIES:

This activity links to activities in PMTCT (15641.08), Basic Care and Support (15642.08), TB HIV

(15643.08), OVC (15644.08), and prevention activities of other IPs and the GON.

POPULATIONS BEING TARGETED:

This activity focuses on the needs of adults and children from the catchment areas of the project supported

sites (17 by end of COP '08).

EMPHASIS AREAS:

This activity focuses on increasing the availability and accessibility of HCT (a crucial entry point to

comprehensives AIDS care and treatment, and prevention) through provider initiated counseling and

testing, increasing static VCT centers, and provision of mobile VCT services. It also addresses gender

concerns related to HIV/AIDS care and treatment by promoting access to diagnosis, care and treatment for

women, particularly pregnant women through PICT in antenatal clinics and delivery wards. This activity

addresses the need to counsel and test to find and treat persons with HIV/AIDS and the need to prevent

future HIV infections.

Funding for Treatment: ARV Drugs (HTXD): $3,500,000

ACTIVITY DESCRIPTION:

In COP08 LMS will build upon its achievements and experiences of COP07 to meet its COP08 target on

ART by training 124 persons to provide ARV drugs to 8,200 including 7,150 new PLWHAs during the

reporting period. The cumulative number of PLWHAs that LMS will have supported with ARV drugs by the

end of COP08 will be 10,000. This will be achieved by supporting seven existing ART sites in Kogi and

Niger States and establishing 10 new sites in three other yet to be identified states.

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). It 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. LMS partner

Axios Foundation has developed a functional logistics system to ensure consistent availability of secure and

high quality ARVs and related commodities plus accountability for the deliveries/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 the United States Food

and Drug Administration (FDA) approved.

LMS will ensure uninterrupted availability of ARV to all ART facilities through close relationship with

Government of Nigeria (GON), USAID and other PEPFAR implementing Partners (IPs). This concerted

effort will efficiently promote a sustainable supply of ARVs and other HIV related products to all health

facilities covered by these programs.

To effectively manage ARVs and related commodities, LMS supported facilities will use a paper based

Logistics Management Information System (LMIS). A computerized Inventory Management System with

ability to interface with the Patient Management and Monitoring System (PMM) has also been developed

and will be introduced into supported sites. These systems ensure generation of management reports

required for decision making at facility level and program management level.

Our strategic priorities for COP08 will include: (1) strengthening health facility commodity management

systems to build sustainable logistics management capability for ARV drugs, Drugs for OIs, Rapid Test Kits

(RTKs) and Lab reagents; (2) continued effort to improve the efficiency and effectiveness of mechanisms for

procurement, warehousing, distribution and Logistics MIS; (3) continued rollout of our computerized

Inventory Management System and ensuring a feedback mechanism that will promote analysis and

utilization of collected data for making appropriate policy decisions; (4) integrating the warehousing function

into the MOH system at Federal, State and Local Government wherever applicable; (5) consolidation of

capacity building through, tools development, training, on-site training, supportive supervision and

mentoring; and (6) design and implementation of Supply Chain Management Quality Assurance

The project will be guided by the memorandum of understanding with the FMOH and the States Central

Medical Stores in continuing to build capacity for warehousing and distribution by implementing already-

developed standard operating procedures (SOPs) for warehousing and distribution at the central medical

stores. It will build capacity of the GON, State Central Medical store's counterpart logistics officers and

project staff at the State Central Medical Stores through training and on-the-job mentoring on forecasting

and procurement planning, warehousing and distribution of ARVs and related commodities at the central

and state levels. All commodities procured are stored at the central medical stores from where they are

distributed to facilities via the state program office.

In COP08, the strategy will focus more on the state FMOH owned Central Medical Stores and utilize their

linkages to the ART facilities (State Government owned) to serve the needs of the focus states and build

partnerships with private/not for profit sector by sub-contracting warehousing and distribution services at

state government level. Quality assurance and monitoring of the logistics system is through development of

SOPs at all levels regarding forecasting, procurement, warehousing and distribution, stock management

and reporting. At state level, the state logistics officer will enforce the standards and provide on site support

supervision. The long term plan is to coordinate the distribution and utilization of the drugs from all sources

through a harmonized system.

The project will continue to work to strengthen its exit/sustainability plan for drug logistics management both

at the State and National 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 an assessment phase, customized plan for building capacity, and a set

of clear objectives and indicators for measuring capacity as well as a timeline based on key benchmarks.

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

(GFATM) round 5 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 to significantly contribute to the achievement of PEPFAR goals of access to

care. 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 10,000 individuals.

This program will also contribute to strengthening the national drug/commodity logistics management

systems, especially as it relates to ARVs, OIs, Test Kits, lab reagents and consumables among others.

LINKS TO OTHER ACTIVITIES:

This program element relates to activities in HVCT (3.3.09), MTCT (3.3.01) HTXS (3.3.11) and HBHC

(3.3.06). Links to these programs include covering areas such as logistics/ supply chain management and

management of test kits (CT), ARV drugs (HTXS) for adults and children, drugs for opportunist infections -

OIs (HBHC), prophylactic ARV drugs for pregnant women and infants (PMTCT).

Activity Narrative: 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, doctors, nurses, lab scientists, counselors and others.

EMPHASIS AREAS:

Emphasis areas for the COP08 ART Drugs component will include strengthening of health facility logistic

systems to sustainably manage ARV drugs, Drugs for OIs, RTKs and lab reagents and quality assurance,

quality improvement and supportive supervision. This will be achieved through the integration of the

project‘s distribution system into the national network and also building capacity at state and site level to

ensure sustainability of the developed supply chain management system. Building upon the Integrated

Inventory Management Systems implemented at the facility levels, the project will continue to provide

regular on site support to sustain usage. Finally LMS will continue to work with GON and implementing

partners to ensure the harmonization and standardization of the LMIS tools & standard operating

procedures in pharmacy.

The establishment of drugs storage facilities in or close to the LMS focus states will ensure that the drugs

are proximal to health facilities and thus 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.

Funding for Treatment: Adult Treatment (HTXS): $2,160,000

ACTIVITY DESCRIPTION:

In COP08, the LMS Comprehensive AIDS Services project will continue the activities initiated in project-

supported comprehensive AIDS care and treatment sites in Kogi and Niger states during COP07, and 10

comprehensive AIDS care and treatment sites selected in COP08. LMS will provide antiretroviral (ARV)

services including laboratory monitoring to 7150 individuals including 715 children at a total of 17

comprehensive aids care and treatment sites in COP08. It is expected that at the end of COP08, 9,000

individuals will be on treatment and the total ever received ART will be 10,000. To achieve this, an

additional 124 health care workers will be trained in ART service delivery.

MSH will provide training for clinicians including staging of HIV infection, diagnosis of AIDS and monitoring

of ART using modern technology as detailed in the lab section. The trainings will be in accordance with

national ARV clinical guidelines and will emphasize quality of care and client satisfaction as well as how to

support adherence to treatment.

Clients identified as HIV positive at PHC and DOTS feeder sites (in the hub and spoke model) will be

referred for care, diagnosis, staging and treatment as appropriate. The care coordinator in each feeder site

will be responsible for ensuring clients understand the importance of early diagnosis, treatment and care,

and for following up to ensure all patients have received quality diagnosis, care and treatment. The care

coordinators will also ensure referrals, with the client's consent, to local NGOS providing relevant

community services and associations of people living with HIV for peer support. Mobile VCT clinics with a

physician or nurse led outreach team and HCT will increase the accessibility of entry points to ARV

treatment. In COP08, where possible and supported by the state MoH and NASCP, provision of follow up

treatment including refills of ARV prescriptions will be decentralized to PHC sites - and potentially through

the mobile VCT clinics - for patients that are stable on ARV treatment and wanting to receive their

treatment closer to their home.

Pediatric ARV care will be included at all secondary sites. LMS will be part of the national Early Infant

Diagnosis testing scale up, which will increase children identified for care and treatment. An active case

finding for children will be in place with entry points including under-5 clinic and inpatient wards amongst

others and children will make up 10 - 15% of persons on treatment in COP08. LMS will collaborate with the

FMOH/PHCDA to adapt and expand the IMCI curriculum to facilitate high quality pediatric AIDS diagnosis

and care at the PHC level. Primary feeder sites offering PMTCT will be linked to adult and pediatric ARV

care, and referrals facilitated through the facility peer support coordinator and her links to the care

coordinator at the secondary referral facility (the "hub" in the spoke and hub model). The LMS project will

enhance the referral SOP, and champion team approaches and family centered care in all health provider

trainings, and monitor referrals and linkages at sites through regular site visits with the relevant state

MOH/SASCP staff and LGA staff for primary health care facilities.

In PHC facilities with DOTS clinics, TB-HIV services will be strengthened to ensure that all clients receipt

PICT. With state MOH and NASCP agreement, in COP08, PHC staff at selected facilities will receive

additional training to enable them to provide follow up care and refills of ARVs for stable patients referred

back from the secondary health with the goal of improving adherence and retention on ART.

LMS will capitalize upon in-country ARV treatment expertise to ensure high quality of care using an

approach which combines both instructional training and on-the-job training and coaching during

supervisory visits by project state team staff and State MoH personnel. Clinical health workers (physicians,

nurses, community health officers and community health extension workers) and pharmacists at all points of

service will have been trained in adult and pediatric ARV care utilizing existing Federal Ministry of Health

curricula and training manuals. Using NASCP and State MoH staff and others as resource persons, staff

from new COP08 points of service will participate in project facilitated state level trainings on

comprehensive AIDS care and treatment including adult and pediatric ARV care, and adherence support.

All trainings will include approaches to prevention for positives to be integrated into the clinic and

community setting. The project will use WHO IMAI and IMCI modules adapted for use in Nigeria for PHC

and DOTS clinic staff. The project will provide training for health facility pharmacy staff in the management

and dispensing of ARVs including patient guidance, adherence to treatment support and appropriate actions

to take if experiencing side effects.

National ARV Guidelines were updated in 2007 for consistency with WHO 2006 Guidelines and a national

ARV SOP exists. These guidelines and SOP will represent the standards for ARV care at LMS supported

sites. Basic renovations will be supported at the sites to ensure clinic facilities are adequate and particularly

that pharmacy stores and dispensing areas are able to securely store ARVs consistent with manufacturer

guidelines. Training materials will be harmonized and upgraded to ensure that all providers are in touch

with the latest standards. Job aides like dosing guides, pocket cards and SOPs will also be provided for

staff use. Strong PLWHA support groups are a valuable adherence support strategy and LMS will identify

associations of people living with HIV and work with them to provide peer support for ARV treatment.

These associations will be offered IEC materials focusing, inter alia, on adherence and ART education. All

sites will employ treatment coordinators: PLWHAs who will participate in patient education, client advocacy,

and home visits to track defaulters as well as support referrals for facility and community services.

ARVs are procured utilizing Emergency Plan funds with pharmacy commodity management subcontracted

to Axios Foundation. Limited pediatric formulations will be donated by the Clinton Foundation. Some sites

may have limited access to high quality first line adult ARVs provided by the government of Nigeria (GON)

financed by the Global Fund and other sources. When this is the case, LMS provides pharmaceutical

commodity management, ensures access to alternative first line and second line ARVs, pediatric

formulations, and wrap around services including lab monitoring and high quality on going clinical training to

ensure a common high standard across all programs in the network of care. Coordination with the FMOH to

plan site targets will ensure a single comprehensive HIV care program although there may be multiple ARV

sources. Collaboratively with the USG and GON, LMS carries out site program review visits.

LMS will support and use GON/WHO standardized HMIS forms and oversee site data management and

M&E. LMS will be actively involved in the USG Clinical Working Group Meetings and the USG ART

technical working group meetings. LMS will participate with other stakeholders in ART in the GON national

task team meetings and quarterly joint USG/GON supportive supervisory site visits.

Activity Narrative: CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Harmonization of the ARV program around drug sourcing and QI, including decentralization of follow-up

ARV treatment to selected primary health facilities as ARV points of service, and expanding the role of

nurses and health care workers will support the scale up of ARV care which is a high priority for both the

PEPFAR and the GON. As expansion of ARV drug services is decentralized to rural facilities and DOTS

clinics, LMS will strengthen existing referral channels and support network coordinating mechanisms. This

will address a key FMOH and OGAC priority to improve access to care.

LINKS TO OTHER ACTIVITIES:

This activity is linked to activities in Antiretroviral services (15647.08), Counseling and Testing (15645.08),

Condoms and Other Prevention (10197.08), Orphans and Vulnerable Children (3.3.08), Care & Support

(15642.08), TB/HIV (15643.08), PMTCT (15641.08), and Lab (15648.08).

A major challenge to successful implementation of ARV services is to ensure that all persons identified in

need of ARV treatment are routinely linked to comprehensive care and treatment services. Persons who

are identified as HIV positive through HCT are the entry point for their family members to access

comprehensive HIV diagnosis care and treatment services. Thus, all ART patients are offered a care

package as described in the BC&S program area. The enhanced network model, linking to ARV services for

HIV+ women identified through PMTCT, and for HIV-exposed infants are in place, and the project care

coordinators and peer support coordinators will support clients to attend for referral care and ARV

treatment. High quality laboratory services supported by an LMS facilitated laboratory QI program are

available at comprehensive care and treatment facilities with appropriate laboratory investigations or

specimen transport systems to be established for primary health facility laboratories.

POPULATIONS BEING TARGETED:

ARV services are offered, when clinically indicated, to HIV positive infants, children, adolescents and adults

living with HIV. Clinical health workers and pharmacists are targeted for training in both the public and

private sectors.

EMPHASIS AREAS:

Emphasis areas include human capacity development and SI. This activity's emphasis is in increasing the

entry points to diagnosis, care and treatment for HIV+ , increasing the demand for the services, supporting

adherence to treatment and putting in place systems (people, equipment, drugs and supplies) to make this

happen.

Funding for Laboratory Infrastructure (HLAB): $2,200,000

ACTIVITY DESCRIPTION:

The LMS program currently provides high quality laboratory services in support of HCT, ART, PMTCT,

TB/HIV, OVC and Blood Safety, as part of its comprehensive HIV/AIDS services. LMS is presently in 7

secondary facilities in 2 states: Kogi and Niger. In COP08, LMS will further activate 10 additional

secondary sites in 3 states, bringing the total of LMS supported lab sites to 17 in 5 states. The 3 new states

will be identified in conjunction with the Government of Nigeria (GON), based on needs assessment and

ART scale-up strategy. Each of the secondary sites will be further linked to at least 2 primary feeder sites in

a "hub and spoke" model. The primary sites will serve as HCT centers and referral points (not counted as

lab sites).

To ensure that high quality and reproducible laboratory services are provided using appropriate modern

technology, while guaranteeing safety of staff, patients, communities and the environment, LMS is currently

providing structural renovations, upgrading of infrastructures and provision of essential amenities including

portable water and electricity supply in all of the selected sites. This will also be undertaken in all the 10 new

sites and primary feeder sites in COP08.

In all supported labs HIV diagnosis, CD4 counts, hematology assays, chemistry assays will be routinely

offered using appropriate automated laboratory equipment, and following internationally accepted standards

and national guidelines. LMS will also provide support for VDRL, HBsAg, malaria parasite, pregnancy and

routine microbiology tests for STIs. Opportunistic Infections (OIs), diagnosis will also be offered. This shall

on a minimum include TB microscopy, Cryptococcus serology test and diarrhea and respiratory tract

infections. It is estimated that LMS will provide a minimum of 127,270 tests.

In COP 08, LMS will embark on an integrated expansion of laboratory training, covering HIV diagnosis,

Good Laboratory Practice, Quality Control and Quality Assurance procedures, biomedical safety, laboratory

equipment care and maintenance, specific lab assays, lab ART monitoring, and others based on identified

training needs. These trainings will be provided through collaboration with other USG-IPs such as

FHI/GHAIN and IHVN-ACTION, who currently have training labs and experienced and proficient laboratory

trainers. This collaboration will also build the training capacity of LMS training staff that will be identified.

LMS will also participate in the lab management training to be provided by the USG through APHL.

LMS will provide training at all supported sites for the collection of dried blood spots (DBS) for DNA PCR

testing at tertiary level sites supported by other USG- Implementing Partners (IPs) in support of the national

EID scale up plan. Clinton Foundation will provide supplies for DBS collection and support for

specimen/results transport.

LMS in conformity with LTWG will have 1 Medical Lab Scientist staff person for every 3 labs supported.

LMS employs a full-time laboratory specialist in Abuja and lab coordinators for each state. The

responsibilities of the lab team will include overall capacity building/technical assistance and supervision of

all supported sites, coordination of inventory management system for commodities, QA/QC support and

oversight; promote collaborations and networking opportunities with other IPs under the leadership of GON,

and participating actively in the LTWG programs.

LMS would like to move towards gaining local accreditation through the Medical Laboratory Science Council

of Nigeria (MLSCN), for all its PEPFAR supported laboratories. To this end, 5 of the supported labs will be

accredited in COP08. The project will also continue to work with the PEPFAR Lab Technical Working Group

for the development of a common Lab equipment platform appropriate for laboratory services at different

levels of care.

Quality assurance/quality control of laboratory services will be ensured to support HIV diagnosis, treatment

and care. The essential components of a quality system will be put into place at each site and quality

assurance (QA) will be ensured through quarterly on-site monitoring visits using standardized checklists.

Reports will be generated and fed back to the sites. All non-conformities will be addressed and remedial

action taken to rectify problems in the testing process. LMS will work in collaboration with FHI/GHAIN, IHVN

-ACTION and HAVARD-APIN for External Quality Assurance (EQA), for specific laboratory assays.

Outcome of these QC and EQA programs will also be fed into the LTWG system on a quarterly basis.

The Axios Foundation has set up an efficient supply chain management system that will provide continuous

and uninterrupted supply of rapid test kits, laboratory reagents and consumables. They will be responsible

for forecasting, procurement, warehousing and distribution of the lab materials to all LMS supported sites.

HIV rapid test kits will be procured through SCMS and LMS will be responsible for warehousing and

distribution of these kits.

LMS will work with JSI/MMIS to provide training on injection safety, provision of AD needles and training on

safe handling and disposal of bio-medical wastes in all supported facilities. In this vein, LMS will provide

standard sharp containers at all supported sites. The quality control staff will ensure strict compliance with

national standards of biomedical waste handling and disposal. Clinicians will be trained in offering post

exposure prophylaxis (PEP) in all sites. Laboratory staff will also be trained on steps to follow in case of

accidents that could lead to exposure to HIV infections.

Information management and inventory management systems will be strengthened to support these lab

activities. LMS project will train 90 laboratory managers/staff at all supported sites and will also provide

ongoing on-site capacity building and monitoring. TB microscopy will be carried out at all lab sites at the

secondary health facilities. TB microscopy training will be provided using the CDC/WHO TB microscopy tool

that has been adapted for use in the country.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

The provision of Laboratory services through this program will contribute to strengthening and expanding

the capacity of the GON response to the HIV/AIDS epidemic, build the capacity of laboratory staff at the

project sites and contribute to infrastructural upgrade of the health facilities and provision of necessary

equipment. Considering the complexity of antiretroviral therapy (ART) and the strict requirements for

standards and procedures, the laboratory component will aim to establish a well coordinated and efficient

quality assurance, supervision and monitoring system at all supported sites.

Activity Narrative: LINKS TO OTHER ACTIVITIES:

This program element relates to activities in 15645.08, 15641.08, 15647.08, 15642.08, 15643.08 and

15644.08. A referral linkage system will be strengthened to ensure that clients are referred from sites with

limited or no laboratory infrastructure to properly equipped laboratory sites using an integrated tiered

national laboratory network. LMS will work with the GON to implement approved testing algorithms and will

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), LMS 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. The project 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.

EMPHASIS AREAS

Emphasis will be placed on quality assurance, quality improvement, and supportive supervision, as well as,

laboratory infrastructure upgrade, including commodity procurement (laboratory equipment and reagents)

and local organizational capacity development through trainings and on-site technical assistance and

mentoring.

Funding for Strategic Information (HVSI): $0

ACTIVITY DESCRIPTION:

This is a new activity that is linked to Program Service Delivery Areas through the strategic information

provided for improved oversight, management, and learning from these activities.

During COP 08, the LMS Comprehensive AIDS Services Rapid Expansion (COMPARE) project will

continue to monitor and report on output and achievements of program level results initiated in COP '07

project sites in Kogi and Niger states, as well as new sites in COP08. Program monitoring will allow for

tracking of results; analysis of scale up; improved program management; and feedback to service providers

which will enhance quality of not only data collection, but service provision as well.

Technical assistance provided to sites will be coordinated with other SI programs and aligned with the USG

data quality assessment/improvement (DQA/I) and capacity building plan. Capacity building in this area

will be achieved through a combination of approaches, including workshop training (training content will

include M&E skills building, surveillance topics, and HMIS concepts), on the job training, and facilitative

supervision. Technical Assistance will focus on: self-guided assessment of information systems; use of

existing methods and tools for collecting, analyzing and disseminating data; use of data for service

planning, monitoring and evaluation; and measuring and improving data quality.

The implementing partner (IP) will provide technical assistance to 17 service delivery locations (fixed and

mobile) and M&E training to at least 80 individuals.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

Activities will strengthen the capacity of individuals and units (facilities) from project-supported sites to

identify, properly collect, analyze and use HIV/AIDS related data, for reporting as well as program

management and planning.

LINKS TO OTHER ACTIVITIES:

Strategic information links to the other PEPFAR Program Areas LMS is engaged in, primarily by ensuring

accurate data collection, reporting, and utilization. The current program areas funded in this LMS project

are: PMTCT; Basic Care and Support; HIV/TB; OVC; Voluntary Counseling and Testing; ARV Drugs; ARV

Services; and Lab. Strategic Information activities will serve as a vital link between these areas, ensuring

not only data collection and sharing, but enabling program managers to adapt programs to strengthen

linkages, build support networks, and provide comprehensive and holistic care for clients and their families.

POPULATIONS BEING TARGETED:

This activity targets health providers, facility managers and other individuals in the community or in

organizations in LMS supported states that are involved in the collection, analysis, reporting and use of

HIV/AIDS related data.

EMPHASIS AREAS:

This activity includes an emphasis on capacity development in M&E. It will promote understanding among

service providers and health managers regarding the nature of data they are asked to collect and report on,

as well as the importance and utilization of the information obtained. In addition, this activity contributes to

gender equity in HIV/AIDS programming through data collection. Data on services received, by gender, can

inform program planning and intervention design changes. In line with the USG DQA/I plan, this project will

develop capacity of GoN staff at State, LGA, and facility level.