PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
ACTIVITY DESCRIPTION
NEPWHAN will implement PMTCT activities in six states consisting of 18 sites, with 3 sites located in each
state, to provide comprehensive HIV and AIDS prevention, treatment and care. Capacity of sites will be
improved to provide PMTCT services in COP09 serving as the hub to other PHCs providing PMTCT
services. This activity will provide counseling, testing and referral services to 2,920 pregnant women who
will receive their test results. 128 HIV-positive pregnant women will be placed on antiretroviral (ARV)
prophylaxis and HAART for their own health. The national prevalence rate of 4.4% was used in setting and
achieving COP09 targets. Consideration will be given to strengthening the quality of service delivery in
order to promote the best outcomes.
This activity will include, as a part of the standard package of care, routine provider initiated opt-out HIV
counseling and testing (HCT) in antenatal clinics (ANC) for all presenting pregnant women, in labor and
delivery wards (L&D), and in the immediate post-delivery setting for women of unknown HIV status. Same
day results will be provided to clients. This activity will use group and individual pre- and posttest counseling
strategies and rapid testing based on the national testing algorithm. Partner testing and couple counseling
will be offered as part of PMTCT services to enhance disclosure. NEPWHAN will also establish community
and faith-based linkages and will utilize community and home-based care services to promote partner
testing. Clients will have access to free laboratory services including CD4 counts and STI screening. Free
medications including those for OIs as needed and hematinics will also be provided. In addition to receiving
PMTCT services, each woman will be referred to the ART clinic for further follow-up treatment and care.
Her children will be eligible to access OVC services.
Referral systems that incorporate active follow-up will be put in place to ensure that women requiring
HAART are not lost during referral for ARV services. Referral coordinators will be identified at sites and in
the communities with their capacities built to carry out needed services. This activity will explore the training
and utilization of traditional birth attendants (TBAs) in addition to the mother-to-mother support groups to
reach HIV-positive women who choose to deliver outside of the health facility. A focal person at each site
will be responsible for coordinating the tracing of HIV-positive mothers and their infants in the community
and linking them back to care. The HIV-positive mothers and their infants will be linked postpartum to ART
care and support services which will utilize a family centered care model.
For the anticipated number of women not requiring HAART for their own health, the current WHO
recommended short course two drug ARV option will be provided. This includes ZDV from 28 weeks with
intra-partum single dose nevirapine (sdNVP) and a 7-day ZDV/3TC post-partum tail or ZDV/3TC from 34-36
weeks with intra-partum sdNVP and a 7-day ZDV/3TC post-partum tail. Infant prophylaxis will consist of
sdNVP and ZDV for 6 weeks. NEPWHAN will use established community linkages and mother-to-mother
support groups to encourage HIV-positive pregnant women to deliver in health facilities. For those HIV-
positive women who choose not to do so and deliver at home, the same community volunteers will follow-up
and identify them for needed postpartum services.
HIV exposed infants will be referred for early infant diagnosis (EID) to the pediatric clinic of the sites for
testing in line with the National Early Infant Diagnosis scale-up plan from six weeks of age using DBS.
Implementation of the EID scale-up will be done under the guidance of the GON and in conjunction with
other IPs who will be conducting the laboratory testing. NEPWHAN will collaborate with Clinton Foundation
as appropriate for commodities and logistics support of the EID program. Exposed infants will be actively
linked to pediatric care and treatment, while their families will be referred to age-appropriate OVC services.
In COP09, PMTCT focal persons at the sites will keep records of all exposed infants at enrollment soon
after birth; informing HIV-positive mothers of the six weeks exact date for DBS collection.
Support groups consisting of HIV-positive individuals will be established in communities including identified
HIV-positive pregnant women and mothers and will train five members from six communities where the sites
are located in HCT skills. These 30 trained members of the PMTCT support groups will be engaged in
tracking un-booked pregnant women and infants in the community, and linking them to sites where they can
access HCT, PMTCT, EID/DBS collection for their exposed infants and pediatric care and treatment.
Linkages with other providers, public and private, who provide full-fledged ANC activities will be established.
This will encourage two-way referrals of HIV-positive mothers and their infants from these providers to
supported hospitals. Throughout these linkages, there will be a strong focus on ensuring confidentiality at all
levels.
HIV-positive women will be counseled in the pre- and postnatal periods regarding exclusive breastfeeding
with early cessation or exclusive breast milk substitute (BMS) if AFASS criteria can be met using the WHO
UNICEF curriculum adapted for Nigeria. This activity will support couples counseling and family disclosure
that will enhance adherence to infant feeding choices and also record issues of violence surrounding
disclosure especially among discordant couples. Full and accurate information will be provided on family
planning and prevention services. Women accessing family planning services will be offered or referred for
HIV counseling and testing. Infants of positive mothers will be linked to immunization services and well
childcare. Cotrimoxazole prophylaxis will be provided to infants from six weeks of age until definitive HIV
status can be ascertained.
In COP09, NEPWHAN will initiate its program for Continuous Quality Improvement (CQI) in order to
strengthen and institutionalize quality interventions. Monitoring and evaluation of the activity's PMTCT
program will be consistent with the national plan for patient monitoring. Identified and trained activity-
supported PMTCT specialists will work in conjunction with CQI specialists, program managers, clinical
associates as well as counterparts at other IPs. PMTCT specialists will join the CQI-led team in conducting
site visits at least quarterly, during which they will evaluate PMTCT clinical services, HCT done in the
PMTCT setting, the utilization of national PMM tools and guidelines/SOPs, proper medical record keeping,
referral coordination, and the use of standard operating procedures in PMTCT. On-site TA with more
frequent follow-up monitoring visits will be provided to address weaknesses when identified during routine
monitoring visits. State agency representatives and the USG will be included in quarterly monitoring and
Activity Narrative: supportive supervision visits and submit reports of visits accordingly.
The activity will collaborate with UNICEF-supported PMTCT sites to provide training on PMTCT service
delivery to 36 healthcare workers according to the national curriculum. Trained staff will be used as
facilitators to step down trainings to other health care workers in their facilities and in nearby government
health facilities as a human capacity development activity.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will provide counseling and testing services to 2,920 pregnant women, and provide ARV
prophylaxis to 128 clients. This will contribute to the PEPFAR goal of preventing 1,145,545 new HIV
infections in Nigeria by 2009.
LINKS TO OTHER ACTIVITIES:
The PMTCT services will be linked to HCT, basic care and support, ARV services, ARV drugs, OVC,
TB/HIV, laboratory services, and SI. All identified pregnant women who present at every point of service
will be provided with information about the PMTCT program and referred accordingly. ARV treatment
services for infants and mothers will be provided through ART services. Basic pediatric care, including TB
care, is provided for infants and children through OVC activities. All HIV-positive women will be registered
for adult care and support services.
POPULATIONS BEING TARGETED:
This activity targets women of reproductive age and their partners, infants and PLWHAs. This activity also
targets training of health care providers, TBAs, and mothers who will work as peer educators and referral
persons.
EMPHASIS AREAS:
This activity includes major emphasis on training, supportive supervision, quality assurance/improvement
and commodity procurement. Emphasis is also placed on development of networks/linkages/referral
systems. In addition, integrating PMTCT with ANC and other family-centered services while ensuring
linkages to Mother-Child-Health (MCH) and reproductive health services will ensure gender equity in access
to HIV/AIDS services.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In COP09, NEPWHAN will provide adult treatment, care and support services in a to-be-determined number
of secondary treatment facilities and primary health care (PHC) centers. These services will take place in 7
states. Through primary and secondary facilities in COP09, NEPWHAN will provide ART services to
underserved rural communities to reach 1,490 new patients for a total of 1,490 active adult patients by the
end of the year. Comprehensive packages of care and support services will be provided to 2,000 HIV-
positive clients (PLWHA) and an additional number of PABAs in the same period.
The package of care services provided to each PLWHA will include one clinical service with the basic care
kit and two supportive services including psychological, spiritual, and PwP delivered at the facility,
community, and household (home based care) levels in accordance with the PEPFAR and national care
and support policies and guidelines. The basic care kit for PLWHAs at sites will include Basic Care Kit (ORS
& SSS, LLITN, water treatment solution, water vessel, gloves, soap, condoms and IEC materials,); Home-
Based Care (client and caregiver training and education in self-care and other HBC services); Clinical Care
(basic nursing care, pain management, OI and STIs prophylaxis and treatment, nutritional assessment-
weight, height, BMI, micronutrient counseling and supplementation and referrals) Laboratory Services
(which will include baseline tests - CD4 counts, hematology, chemistry, malarial parasite, OI and STI
diagnostics when indicated); Psychological Care (adherence counseling, bereavement counseling,
depression assessment and counseling with referral to appropriate services); Spiritual Care (access to
spiritual care); Social Care (support groups' facilitation, referrals, and transportation) and Prevention Care
(Prevention with Positives). All PLWHAs' nutritional status will be assessed at contact and on follow-up
visits. By doing BMI and plotting on infant growth charts, micronutrients will be provided as necessary, and
those diagnosed as severely malnourished will be placed on a therapeutic feeding program through
wraparound services as well as direct funding. The activity will procure basic care kits through the SCMS
central mechanism and OI drugs will be procured through mechanisms that ensure only NAFDAC approved
drugs are utilized.
ART services at sites that are co-located in facilities with TB DOTS centers will have the services integrated
to facilitate TB/HIV service linkages. All PLWHA will have CD4 counts and other necessary lab analyses
performed at least every 6 months to determine the optimal time and eligibility status to initiate ART and
monitor effectiveness/side effects for those on ART. Sites will integrate prevention with positives (PwP)
activities including: adherence counseling; syndromic management of STIs in line with National STI control
policy and guidelines; risk assessment and behavioral counseling to achieve risk reduction; counseling and
testing of family members and sex partners; counseling for discordant couples; IEC materials and provider
delivered messages on disclosure. Cotrimoxazole prophylaxis will be provided for PLWHAs when CD4 <200
or prior TB or other AIDS defining illnesses. The activity will support a pilot program for cervical cancer
screening in HIV positive women.
The partner will collaborate with faith-based organizations (FBOs) to achieve these targets by recruiting
volunteers and community-based organizations (CBOs). Through these partnerships clients in care will
receive a comprehensive package of community and home based care services. HBC teams comprised of
nurses, community health workers and trained volunteers will provide HBC services as well as facilitate
support group activities. HBC providers will use HBC kits. Partner will focus on improving pre-ART
retention in support groups. Strategies to retain clients in care include intensive home visits by HBC team
during the first 6 months of enrolment.
All sites will consolidate on their capacity to provide comprehensive quality ART services through
management of OIs and ART, a safe, reliable and secure pharmaceutical supply chain, technologically
appropriate lab diagnostics, treatment preparation for patients, their families and supporters and community
based support for adherence. This technical and programmatic assistance utilizes on-site mentoring and
preceptorship. It also supports the development of site specific work plans and ensures that systems are in
place for financial accountability. Partner will adhere to the Nigerian National ART service delivery
guidelines including recommended first and second line ART regimens. In addition, partner will collaborate
with the Clinton Foundation and Global Fund as appropriate to leverage resources for providing
antiretroviral drugs to patients.
Monitoring and evaluation will be carried out by a team of trained volunteers working in the communities
who will work with the activity's data officers and M&E officers. In addition, data generated will be shared
with local government areas to allow them to track their clients and provide ongoing support for
sustainability. Registers, forms, and other data tools will be provided and replenished as necessary and
staff trained in their use. Partner will report on sex distribution of PLWHAs receiving care and support
services and the numbers of PLWHAs reached with community home based care. Personnel will be trained
in the use of registers for documentation and data reporting.
The activity will continue to strengthen institutional and health worker's capacity through the training,
retraining and mentoring of health service providers to provide care and treatment services at the facility
and community levels. 180 doctors, pharmacists, nurses, counselors, and community health extension
workers will receive training and onsite mentoring that will allow them to provide comprehensive care.
Training will maximize use of all available human resources including a focus on community nursing and
community adherence. Care and Treatment trainings will be based on the national curricula. Partner will
collaborate with the GoN and other stakeholders to develop task shifting strategies to enable nurses and
community health officers to provide ART.
Partner will conduct 2-week intensive didactic and practical trainings preceding site activation followed by
regular onsite mentoring. Community volunteers, including PLWHA and religious leaders will be trained to
provide peer education, counseling, psychosocial and spiritual counseling, respectively. Partner will use
GON/USG recommended standardized training curriculums, manuals and training aides for all trainings.
Information, education and communication materials will be provided to enhance these trainings.
NEPWHAN partners will work closely with the USG and GoN team to monitor quality improvement at all
sites and across the program. XX Health care workers will benefit from these trainings referred to above in
HIV Care, Treatment and Support.
Activity Narrative: A key component for successful ART is adherence to therapy at the household and community levels.
PLWHA on treatment are encouraged to have a treatment support person such as a family member to
whom he/she had disclosed HIV status to improve support in the home and increase adherence. Partner
will continue to build and strengthen the community components by using nurses and counselors to link
health institutions to communities. Each site will appoint a staff member to coordinate the linkages of
patients to all services. This will also build the capacity of sites for better patient tracking, referral
coordination, and linkages to appropriate services. These activities will be monitored by the partner's
technical and program management regional teams.
In COP09, the activity will continue to strengthen its expanded the Quality Improvement Program (QIP)
consisting of the annual cross sectional Outcomes & Evaluation (O&E) exercise, the GON/USG supported
HIVQual monitoring and the quarterly Continuous Quality Improvement (CQI) activities in order to improve
and institutionalize quality interventions. Patient medical records will be standardized to ensure proper
record keeping and continuity of care at all sites. Monitoring and evaluation of the ART program will be
consistent with the national plan for patient monitoring. Specialists will conduct team site visits at least
quarterly during which there will be evaluations of infection control, the utilization of National PMM tools and
guidelines, proper medical record keeping, efficiency of clinic services, referral coordination, and use of
standard operating procedures across all disciplines. On-site technical assistance (TA) with more frequent
follow-up monitoring visits will be provided to address weaknesses when identified during routine monitoring
visits. Some of the data will be used to generate biannual life table analyses that identify factors associated
with early discontinuation of treatment. In addition, at each site an annual cross sectional evaluation of
program quality shall consist of a 10% random sample of linked medical records, adherence questionnaires
and viral loads to examine treatment compliance and viral load suppression for adult patients who have
been on treatment for at least 9 months. A similar process will be undertaken for all children who have
been on ART for at least 9 months. Each of these activities will highlight opportunities for improvement of
clinical practices.
Sustainability lies at the heart of this program, and is based on durable therapeutic programs and health
systems strengthening. The activity will focus on the transition of the management of care and treatment
activities to indigenous organizations by actively using its extensive linkages with faith based groups and
other key stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will
be designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will
continue to be implemented in close collaboration with the GON to ensure coordination, information sharing
and long term sustainability. For the transition to be successful, sustainable institutional capacity must be
present within the indigenous organizations and sites they support; therefore, the activity will strengthen
selected indigenous organizations according to their assessed needs, while continuing to strengthen the
health systems of the sites. This capacity strengthening will include human resource support and
management, financial management, infrastructure improvement, and strengthening of health management
information systems.
The partner will continue to participate in GON harmonization activities and to participate in the USG
coordinated clinical working group to address ongoing topics in ARV service delivery.
CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity will contribute to the expansion of adult
care and treatment activities, including effective linkages with HBC providers, will contribute to increased
access of such services to underserved rural communities. By providing services to 2,000 Adult PLWHA,
the activity will contribute to the overall PEPFAR care and support target of providing these services to 10
million people globally by 2009 and will help accomplish the PEPFAR Nigeria target of placing 1,490 clients
on ART by 2009 and will also support the Nigerian government's universal access to ART by 2010 initiative.
This activity contributes to the overall comprehensive HIV and AIDS services by providing the supportive
services for all adult PLWHA including those on ART.
LINKS TO OTHER ACTIVITIES: Activities in adult care and treatment are linked to HCT ( HVCT), PMTCT
(MTCT), ARV drugs (HTXD), laboratory (HLAB), OVC (HOVC), Sexual Prevention (HVAB), Medical
Prevention (HMBL) (HMIN) TB/HIV (HVTB ) and SI (HVSI ) to ensure that PLWHA and their family
members have access to a continuum of care. Awardee will continue to collaborate with the XX program of
the award to establish networks of community volunteers to support livelihood development program for
PLWHA and caregivers requiring such services and support identified child or adolescent headed
households to be linked with XX and other OVC programs which will meet the needs of the household.
Networks will be created to ensure cross-referrals and sharing of best practices among implementing
partner sites for the provision of psychosocial support and community and home based services to PLWHA.
Effective synergies will be established with the Global Fund to Fight AIDS, Tuberculosis and Malaria
through harmonization of activities with GON and other stakeholders for harmonization of basic care and
support services and the standardization of training manuals for community volunteers and providers
POPULATIONS BEING TARGETED: This activity targets PLWHA, particularly those who qualify for the
provision of ART, including PMTCT clients from rural and underserved communities. This activity also
targets CBOs and FBOs for capacity building and targets care providers (healthcare professionals and
community volunteers) for training.
EMPHASIS AREAS: This activity will include emphasis on human capacity development specifically
through in-service training and task-shifting, local organization capacity building for community mobilization
and participation, development of networks/linkages/referral systems, and quality assurance/ quality
improvement This activity will also ensure gender equity, ensuring access to ART through linkages with
PMTCT services, addressing male norms & behaviors, increasing women's legal rights and access to
income & productive resources, and reducing violence and coercion against women. This activity will work
with CBOs, networks of PLWHA and FBOs and other USG/GON programs to promote economic
strengthening activities; education and safe water initiatives, and create access to food and nutritional
services. The extension of this activity into rural and previously underserved communities will contribute to
Activity Narrative: the equitable availability of ART services in Nigeria and towards the goal of universal access to ARV
services in the country. This activity will improve the quality of life of PLWHA and thus reduce the stigma
and discrimination against them.
Construction/Renovation
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Estimated amount of funding that is planned for Water
Table 3.3.08:
In COP09, this activity will provide adult treatment, care and support services to XX secondary Treatment
Facilities and XX PHC centers. These services will take place in 7 states. Through primary and secondary
facilities in COP09, the partner will provide ART services to underserved rural communities to reach XXX
new patients for a total of XXX active adult patients by the end of the year. Comprehensive packages of
care and support services will be provided to a cumulative XXXX PLWHA and XXXX PABAs in the same
period.
and community levels. XXX doctors, pharmacists, nurses, counselors, and community health extension
Information, education and communication materials will be provided to enhance these trainings. APS 2
partners will work closely with the USG and GoN team to monitor quality improvement at all sites and
across the program. XX Health care workers will benefit from these trainings referred to above in HIV Care,
Treatment and Support.
access of such services to underserved rural communities. By providing services to XXX Adult PLWHA, the
activity will contribute to the overall PEPFAR care and support target of providing these services to 10
million people globally by 2009 and will help accomplish the PEPFAR Nigeria target of placing XXX clients
Prevention (HMBL) (HMIN) TB/HIV (HVTB) and SI (HVSI ) to ensure that PLWHA and their family members
have access to a continuum of care. Awardee will continue to collaborate with the XX program of the award
to establish networks of community volunteers to support livelihood development program for PLWHA and
caregivers requiring such services and support identified child or adolescent headed households to be
linked with XX and other OVC programs which will meet the needs of the household. Networks will be
created to ensure cross-referrals and sharing of best practices among implementing partner sites for the
provision of psychosocial support and community and home based services to PLWHA. Effective synergies
will be established with the Global Fund to Fight AIDS, Tuberculosis and Malaria through harmonization of
activities with GON and other stakeholders for harmonization of basic care and support services and the
standardization of training manuals for community volunteers and providers
Table 3.3.09:
In COP09, this activity will provide care and treatment services in 3 treatment facilities in two geo-political
zones. Through primary and secondary facilities it will extend care and treatment services to selected
communities in targeted states to reach 210 children on ART by the end of COP09.
Entry points where children will be identified for pediatric basic care and support will include the ANC and
labor and delivery (PMTCT clinics) where mothers who are identified as HIV positive will be encouraged to
return to deliver their babies and ensure they receive PMTCT services. Other entry points include the
TB/DOTS centers from family contact tracing, mothers support groups, outpatient clinics, inpatient wards
and immunization centers. Mothers will be further encouraged to return for "well child" visits with their
babies, at which time they will be weighed, receive immunizations and nutritional counseling and education
on safe infant feeding. At the age of six weeks, according to the Nigerian national algorithm, these babies
will all have dried blood spot (DBS) collection for DNA PCR diagnosis. Based on their results, they will be
referred for treatment if positive or will continue to receive follow up care at the facility if negative. A second
test will be performed at the age of 18 months or six weeks after the cessation of breastfeeding whichever
comes later to ascertain the child's final HIV status.
other IPs who will be conducting the laboratory testing. The activity will collaborate with the Clinton
Foundation as appropriate for commodities and logistics support for the EID program. Exposed infants will
be actively linked to pediatric care and treatment. EID activities/DBS collection will extend to selected sites
and their satellites. PMTCT focal persons at all sites will keep records of all exposed infants at enrollment
soon after birth; informing HIV+ mothers of the six week mark for DBS collection. This activity will
encourage parent sites to step down DBS collection at affiliate PMTCT satellite sites and thus decentralize
EID activities at these sites. Parent sites will ensure supplies of DBS collecting kits from their own stock to
these satellites. The samples collected will be returned to the parent sites for dispatch to the testing labs.
NEPWHAN will train members of PMTCT support groups in HCT skills. NEPWHAN will engage PMTCT
support groups and the larger support group(s) in tracking unbooked pregnant women and infants in the
community, linking them to sites where they can access HCT. Linkages will be established with other
proximal public and private health care providers, with full fledged ANC activities. This will encourage two-
way referrals of HIV+ mothers and their infants from these providers to the sites. Site EID focal persons will
ensure prompt dissemination of results to providers and mothers as soon as they are available.
A key to increasing pediatric enrollment into care and treatment will be strengthening linkages at all service
levels within the sites, as well as reinforcing and expanding community outreach. This will require staff
training and strengthened referral linkages. In order to increase the number of children brought into care
and treatment, NEPWHAN will support a multi-pronged approach: organization of services to provide family
centered care and treatment, provider initiated testing and counseling (PITC) for all children, and community
mobilization. Organization of ART clinics to include family days will provide opportunities to increase testing
for children and provide comprehensive care. All exposed infants delivered in the ART sites, or identified
through the family centered approach, will be linked to the HIV comprehensive care clinic for enrollment for
care and support, and to community based OVC programs.
The package of care services provided to each HIV positive child/care givers includes a minimum of clinical
service with provision of a basic care kit and two supportive services in the domain of psychological,
spiritual, and PwP services delivered at the facility, community, and household (home based care) levels in
accordance with the PEPFAR and Government of Nigeria (GON) national care and support policies and
guidelines. The basic care package for HIV positive child/care givers includes the provision of a basic care
kit (ORS & SSS, LLITN, water treatment solution, water vessel, soap, IEC materials, and gloves); home-
based care (client and caregiver training and education in self-care and other HBC services); clinical care
weight, height, BMI, micronutrient counseling and supplementation and referrals); laboratory services
diagnostics when indicated); psychological care (adherence counseling, bereavement counseling,
depression assessment and counseling with referral to appropriate services); spiritual care (access to
spiritual care); social care (support groups' facilitation, referrals, and transportation) and prevention care
(prevention with positives). All HIV positive children's nutritional status will be assessed during initial
consultations and on follow-up visits. Micronutrients will be provided as necessary, and those diagnosed as
severely malnourished will be placed on a therapeutic feeding program. This will be done through
wraparound services as well as direct funding. NEPWHAN will procure basic care kits through a central
mechanism and OI drugs will be procured mechanisms that ensure only NAFDAC approved drugs are
utilized.
Safe infant feeding will be supported from the antenatal period through pregnancy, delivery and infancy.
Mothers will receive individual and group counseling using the Nigerian national HIV and infant feeding
protocol, and will be further supported psychosocially after they have made informed decisions about infant
feeding choices to ensure the avoidance of mixed feeding which will be emphasized continually. Mothers
will continue to receive infant feeding support through support groups, which will address the social issues
around breastfeeding or choosing not to breastfeed, as well as how to reduce stigmatization through
education of peers and family members. A nutritional assessment, through the use of growth monitoring and
recording on growth charts, will be accompanied by the provision of nutritional education around
supplementary and complementary feeding and safe early weaning. Mothers will be encouraged to
exclusively breastfeed except if AFASS. PEPFAR funds will not be used to procure BMS except clinically
indicated.
All sites will be strengthened in their capacity to provide comprehensive quality care and treatment services
through a variety of models of care delivery. This includes quality management of OIs and ART, a safe,
reliable and secure pharmaceutical supply chain, technologically appropriate lab diagnostics, treatment
preparation for patients, their families and supporters and community-based support for adherence. This
technical and programmatic assistance utilizes on-site mentoring and preceptorship. It also supports the
development of site specific work plans and ensures that systems are in place for financial accountability.
Activity Narrative: NEPWHAN will provide access to viral loads for children with suspected treatment failure by intake to other
facilities with viral load. All infected children will be evaluated for ART using CD4 count or CD4%. All sites
will be equipped with capacity to determine CD4% for evaluation of immunological status of children less
than six years.
Based on available evidence on child survival and morbidities in relation to immunological staging, ARVs
will be provided for all infected infants (less than one year old) in accordance with revised WHO
recommendations so as to prevent mortality and brain damage in rapid progressors. Appropriate first and
second line regimens that preserve future options with minimal toxicity profiles will be adopted for all sites.
NEPWHAN will partner with the Clinton Foundation and the Global Fund as appropriate to leverage
resources for providing antiretroviral drugs and nutritional supplements to infected children.
ART sites are co-located in facilities with TB DOTS centers to facilitate TB/HIV service linkages.
Collaboration with the GON and other stakeholders will be intensified to ensure prompt diagnosis of TB in
children and to facilitate provision of pediatric TB formulations. A key component for successful ART is
adherence to therapy at the household and community levels. Intensive treatment preparation, directed at
an identified caregiver, will ensure strict adherence. NEPWHAN will continue to build and strengthen the
community components by using nurses and counselors to link health institutions to communities. Each site
will appoint a specific staff member to coordinate the linkages of patients to all services. This will also build
the capacity of sites for better patient tracking, referral coordination, and linkages to appropriate services.
These activities will be monitored by technical and program management regional teams. All children on
ARV will have at least monthly home visits to ensure adherence and assess the need for intervention.
Specific efforts and training will be made to develop adolescent friendly services for infected and affected
children including linkages to reproductive health.
Non-ART eligible children will be enrolled into care for periodic follow-up, including laboratory analysis at
least every six months, to identify changes in ART eligibility status. All enrolled children will be linked to an
OVC program to access an array of services including nutritional support, preventive care package (water
sanitation/treatment education, ITN) and psychosocial support. All sites will be empowered with training and
tools to ensure nutritional assessment. Educational support and food supplements will be leveraged from
other partners.
In COP09, 10 health service providers will be trained in pediatric care and treatment according to the
National Pediatric HIV Training curriculum. Training will maximize use of all available human resources
including a focus on community nursing and community adherence to ensure care is decentralized to the
home level. Partner will collaborate with the GoN and other stakeholders to develop task shifting strategies
to enable nurses and community health officers to provide Pediatric ART. Close collaboration with the USG
team to monitor quality improvement at all sites and across the program will be required. NEPWHAN will
actively participate in, and facilitate activities to, review practices in pediatric HIV care and treatment
particularly GON technical working group meetings. Partner will share with the GON a new pediatric
counseling curriculum developed with the African Network for Caring for Children with HIV and roll this
training out to all sites. The activity will support the development of a national pediatric HIV care and support
guideline, and training curriculum.
In COP09, NEPWHAN will build a team of specialists to ensure continuous quality improvement (CQI) to
improve and institutionalize quality interventions. The team will sustain the efforts with a modification of
evaluation tools to assess and report on both qualitative and quantitative indicators of care delivery.
Monitoring and evaluation of the ART program will be consistent with the national plan for patient
monitoring. The CQI specialists will conduct team site visits at least quarterly during which there will be
evaluations of infection control, the utilization of national PMM tools and guidelines, proper medical record
keeping, efficiency of clinic services, referral coordination, and use of standard operating procedures across
all disciplines. On-site TA with more frequent follow-up monitoring visits will be provided to address
weaknesses when identified during routine monitoring visits. Some of the data will be used to generate bi-
annual life table analyses that identify factors associated with early discontinuation of treatment. Each site
will establish an annual evaluation of program quality consisting of a 10% random sample of linked medical
records, adherence questionnaires and viral loads to examine treatment compliance and viral load
suppression for adult patients who have been on treatment for at least nine months. A similar process will
be undertaken for all children who have been on ART for at least nine months. Each of these activities will
highlight opportunities for improvement of clinical practices.
systems strengthening. The focus will be on the transition of the management of care and treatment
be designed to ensure the continuous delivery of quality HIV care and treatment. All activities will continue
to be implemented in close collaboration with the GON to ensure coordination, information sharing and long
-term sustainability.
CONTRIBUTION TO THE OVERALL PROGRAM AREA: By adhering to the Nigerian National ART service
delivery guidelines and building strong community components into the program, NEPWHAN will contribute
to achieving the overall PEPFAR Nigeria target of placing 35,000 children on ART by 2009 and will also
support the GON's universal access to ART by 2010 initiative. By putting in place structures to strengthen
health systems will contribute to the long-term sustainability of the ART programs.
POPULATIONS BEING TARGETED: This activity targets children infected with HIV and their
caregivers/HCWs from rural and underserved communities.
through in-service training. These ART services will also ensure gender and age equity in access to ART
Activity Narrative: through linkages with OVC and PMTCT services in neighboring sites. The extension of ARV services into
rural and previously underserved communities will contribute to the equitable availability of ART services in
Nigeria and towards the goal of universal access to ARV services in the country. The provision of ART
services will improve the quality of life of infected children and thus reduce the stigma and discrimination
against them.
Table 3.3.10:
In COP09, this activity will provide Care and Treatment services to Treatment Facilities in 2 geo-political
communities in the target States to reach XXX children on ART by the end of the COP year.
Entry points where children would be identified for pediatric basic care and support would include the ANC,
Labor and delivery (PMTCT clinics) where mothers who are identified as HIV positive would be encouraged
to return to deliver their babies and ensure they receive PMTCT services. Other entry points include the
TB/DOTS centers from family contact tracing, mothers support groups, outpatient clinics, inpatient wards,
immunization centers and the mothers would be further encouraged to return for well child visits with their
babies, at which time they would be weighed, receive immunizations and nutritional counseling and
education on safe infant feeding. At the age of 6 weeks, according to the Nigerian National algorithm, these
babies would all have dried blood spot collection for DNA PCR diagnosis, and based on their results would
be referred for treatment if positive or will continue to receive follow up care at the facility if not. A second
test would be performed at the age of 18 months or six weeks after the cessation of breastfeeding
whichever comes later to ascertain the child's final HIV status.
other IPs who will be conducting the laboratory testing. The activity will collaborate with Clinton Foundation
as appropriate for commodities and logistics support for the EID program. Exposed infants will be actively
linked to pediatric care and treatment. EID activities/DBS collection will extend to selected sites and their
satellites. PMTCT focal persons at all sites will keep records of all exposed infants at enrollment soon after
birth; informing HIV+ mothers of the 6 weeks exact dates for DBS collection. This activity will encourage
parent sites to step down DBS collection at affiliate PMTCT satellite sites and thus decentralize EID
activities at these sites. Parent sites will ensure supplies of DBS collecting kits from their own stock to these
satellites and the samples collected returned to the parent sites for dispatch to the testing labs. It will train
members of PMTCT support groups in HCT skills. APS 1 will engage PMTCT support groups and the larger
support group(s) in tracking unbooked pregnant women and infants in the community, linking them to sites
where they can access HCT. Linkages will be established with other proximal public and private health care
providers, with full fledged ANC activities. This will encourage two-way referrals of HIV+ mothers and their
infants from these providers to the sites and thus benefit from EID/ART activities. Site EID focal persons
will ensure prompt dissemination of results to providers and mothers as soon as they are available.
service with basic care kit and two supportive services in the domain of psychological, spiritual, and PwP
delivered at the facility, community, and household (home based care) levels in accordance with the
PEPFAR and Government of Nigeria (GON) national care and support policies and guidelines. The basic
care package for HIV positive child/care givers include Basic Care Kit (ORS & SSS, LLITN, water treatment
solution, water vessel, soap, IEC materials, and gloves); Home-Based Care (client and caregiver training
and education in self-care and other HBC services); Clinical Care (basic nursing care, pain management, OI
and STIs prophylaxis and treatment, nutritional assessment- weight, height, BMI, micronutrient counseling
and supplementation and referrals, Laboratory Services (which will include baseline tests - CD4 counts,
hematology, chemistry, malarial parasite, OI and STI diagnostics when indicated); Psychological Care
(adherence counseling, bereavement counseling, depression assessment and counseling with referral to
appropriate services); Spiritual Care (access to spiritual care); Social Care (support groups' facilitation,
referrals, and transportation) and Prevention Care (Prevention with Positives). All HIV positive children's
nutritional status will be assessed at contact and on follow-up visits, micronutrients will be provided as
necessary, and those diagnosed as severely malnourished will be placed on a therapeutic feeding program.
AR will procure basic care kits through a central mechanism and OI drugs will be procured mechanisms that
ensure only NAFDAC approved drugs are utilized.
Safe infant feeding would be supported from the antenatal period through pregnancy, delivery and infancy.
Mothers will receive individual and group counseling using the Nigerian National HIV and infant feeding
education of peers and family members. Nutritional assessment through the use of growth monitoring and
recording on growth charts will be accompanied by nutritional education around supplementary and
complementary feeding and safe early weaning. Mothers will be encouraged to exclusively breastfeed
except if AFASS. PEPFAR funds will not be used to procure BMS except clinically indicated.
preparation for patients, their families and supporters and community based support for adherence. This
technical and programmatic assistance utilizes on-site mentoring and preceptorship.
The activity will provide access to viral loads for children with suspected treatment failure by intake to other
facilities with viral load. All infected children will be evaluated for ART using CD4 or CD4%. All sites will be
equipped with capacity to determine CD4% for evaluation of immunological status of children less than 6
years.
will be provided for all infected infants (less than 1 year) in accordance with revised WHO recommendations
so as to prevent mortality and brain damage in rapid progressors. Appropriate first and second line
regimens that preserve future options with minimal toxicity profiles will be adopted for all sites. Activity will
partner with Clinton Foundation and Global Fund as appropriate to leverage resources for providing
antiretroviral drugs and nutritional supplements to infected children.
Activity Narrative: Collaboration with GON and other stakeholders will be intensified to ensure prompt diagnosis of TB in
children and facilitate provision of pediatric TB formulations. Intensive treatment preparation, directed at
an identified caregiver will ensure strict adherence Activity will continue to build and strengthen the
ARV will have at least monthly home visits to ensure adherence and assess need for intervention. Specific
efforts and training will be made to develop adolescent friendly services for infected and affected children
including linkages to reproductive health.
Non ART eligible children will be enrolled into care for periodic follow-up, including laboratory analysis at
least every 6 months, to identify changes in ART eligibility status. All enrolled children will be linked to an
In COP09, XXX health service providers will be trained in pediatric care and treatment according to the
to enable nurses and community health officers to provide Pediatric ART. Partner will actively participate
in and facilitate activities to review practices in Pediatric HIV care and treatment particularly GON technical
working group meetings. Partner will share with the GON a new pediatric counseling curriculum developed
with the African Network for Caring for Children with HIV and roll this training out to all sites. The activity will
support the development of a national pediatric HIV care and support guideline, and training curriculum.
In COP09, partner will build a team of specialists to ensure Continuous Quality Improvement (CQI) to
evaluations of infection control, the utilization of National PMM tools and guidelines, proper medical record
will establish an annual evaluation of program quality consisting a 10% random sample of linked medical
suppression for adult patients who have been on treatment for at least 9 months. A similar process will be
undertaken for all children who have been on ART for at least 9 months. Each of these activities will
The plan will be designed to ensure the continuous delivery of quality HIV care and treatment, and all
activities will continue to be implemented in close collaboration with the GON to ensure coordination,
information sharing and long-term sustainability. For the transition to be successful, sustainable institutional
capacity must be present within the indigenous organizations and the sites they support, strengthening
indigenous organizations according to their assessed needs, while continuing to strengthen the health
systems of the sites. This capacity strengthening will include human resource support and management,
financial management, infrastructure improvement, and strengthening of health management information
systems.
Partner will continue to participate in GON harmonization activities and to participate in the USG
delivery guidelines and building strong community components into the program, this activity will contribute
LINKS TO OTHER ACTIVITIES: This activity is linked to HCT services (5425.08) to ensure that people
tested for HIV are linked to ART services; it also relates to activities in ARV drugs (9889.08), laboratory
services (6680.08), and care & support activities including Sexual Prevention (5368.08), PMTCT (6485.08),
OVC (5416.08), AB (15655.08), TB/HIV (5399.08), and SI (5359.08).
Networks will be created to ensure cross-referrals and sharing of best practices among other implementing
partner sites. Effective synergies will be established with the Global Fund to Fight AIDS, Tuberculosis and
Malaria through harmonization of activities with GON and other stakeholders.
through linkages with OVC and PMTCT services in neighboring sites. The extension of ARV services into
Activity Narrative: against them.
Table 3.3.11:
The activity will focus on scaling up support to orphans and vulnerable children (OVC) and caregivers in
four states (Benue, Rivers, Zamfara and one state yet to be determined) to expand access to treatment
services, and care and support for OVC infected and affected by HIV and AIDS. The activity will provide
care and support for OVC through a community based system of assessment, action planning, home visits,
referrals, and specific support in psychosocial, education and economic strengthening. It will work with
already developed and successful child protection committees that are trained and experienced in
assessing the needs of the most vulnerable children and families. Community structures to reach children
of HIV-affected families will be used and will expand outreach to improve access to pediatric treatment,
prevention of mother to child transmission services (PMTCT), economic strengthening, education
enrollment and psychosocial support.
The activity will strengthen the capacity of indigenous organizations to respond to HIV/AIDS in their
communities; provide quality comprehensive and compassionate care for OVC; and strengthen the legal
policy and institutional framework for OVC and protection at sub-national levels. The project will provide
direct support and services through scholarships, psychosocial support to families, referrals and support for
transportation costs as needed, testing and treatment services, nutrition and basic health education, and
economic strengthening.
The partner will work with community groups that are trained and experienced in identifying vulnerable
children and families, providing a strategic starting point for a project that will work with community-based
systems to effectively reach OVC. Diverse members of communities, representing a range of levels of
education and income, religious and ethnic groups, disabled, etc., will be invited to create a forum to reflect
on issues of power, privilege, access and vulnerability specific to the community.
The activity will complement the services of local agencies by reaching children and families who may not
have yet accessed treatment, or that may be reluctant to seek treatment because of concerns around
confidentiality and stigma. Issues of stigma through awareness activities, peer advocates, and support
groups will be addressed. The program will work with service providers to help provide support for transport
costs when needed to access treatment and link with other organizations and agencies providing services
to OVC and caregivers to maximize support and avoid overlapping services. Linkages will be sought for
nutritional and educational support with United States Government (USG)-supported wrap-around activities.
Education will be supported through teachers' training and through the provision of teaching materials, as
well as through operational partnerships with schools, in order to create a more conducive environment for
learning for all students, including OVC. OVC completing vocational training will be linked to economic
strengthening opportunities.
Healthcare will be provided through partnerships with USG Implementing Partners, Government of Nigeria,
faith-based organizations and healthcare centers for monitoring and treatment of opportunistic infections
and through health education at support group meetings and home visits. Other services will include
immunization, provision of preventive care packages comprising insecticide treated nets and water
guard/containers and the treatment of other minor ailments. Peer education will be initiated in schools and
communities to create demand for HIV Counseling and Testing among OVC, caregivers and the general
population. Psychosocial support will be provided through group counseling, for formation of HIV/AIDS
prevention clubs, the reinforcement of established youth-friendly centers, home visitations, and through the
integration of OVC into community recreational facilities.
CONTRIBUTION TO OVERALL PROGRAM AREA: This activity program area focus is on strengthening
the capacity of families and communities to provide care and support for OVC. These activities contribute
to the USG's PEPFAR five year strategy of providing care and support to OVC and are also consistent with
the Strategic Framework on OVC. 50 Caregivers will be trained and 96 OVCs provided with supplemental
direct support.
LINKS TO OTHER ACTIVITIES: Linkages will be established with HIV/AIDS treatment centers and
community care and support program to ensure that OVC and caregivers stay alive and in good health, to
counseling and testing centers to enable family members to receive necessary support and care for HIV-
positive children.
POPULATION BEING TARGETED: This activity will target girl and boy OVC and families affected by
HIV/AIDS. It will provide services to OVC, caregivers of OVC and other children/siblings living in OVC
households in community settings using existing established and accepted organizations as service
providers. In addition, religious and community leaders and leaders of women's organizations will be
trained to combat stigma in their work.
EMPHASIS AREAS: The activity includes an emphasis on local organization capacity development and
community mobilization, nutrition and training. The program will aim to support equal numbers of males and
female OVC and address economic factors that limit access to services of either gender.
* Increasing women's access to income and productive resources
* Increasing women's legal rights
Table 3.3.13:
These funds will be used to award grants to implementing partners to provide adult and pediatric
antiretroviral (ARV) drugs in underserved areas in Nigeria. It will provide ARV drugs to an estimated 1700
HIV-positive adults and children affected by HIV and AIDS. The recipient will support the treatment
components of the PEPFAR Nigeria program by ensuring an uninterrupted availability of high quality first
and second-line ARV drugs to clinic sites.
Choice of ARVs to be used on the program will be based on the guidance provided in the national treatment
guideline disseminated by the Government of Nigeria. Zidovudine and Tenofovir based regimen will
dominate the first line regimen for adult patients to be placed on treatment, and second line regimen will
basically be a combination of NRTI and protease inhibitors (PI). Children ARV regimen to be used include
Zidovudine and Stavudine based combination for first line, and a combination of NRTI and PI for those
requiring second line regimen. Procurement will be based on the COP year ARV morbidity based forecast
by team of supply chain experts on the program, taking into consideration the patients targets and
enrollment rates. Provision for a 6 months buffer will be made in the forecast to ensure an uninterrupted
supply of ARVs in the COP year.
High quality ARVs (predominately generic formulation) will be procured in line with FDA, PEPFAR and
NAFDAC (Nigeria Drug regulatory agency) guidance. All purchases of Truvada (TDF/FTC) and ZDV-3TC-
NVP Fixed Dose will be purchased via SCMS pooled procurement mechanism in line with OGAC's
recommendation. Other ARVs will be procured via other suitable procurement agencies on need basis.
SCMS and procurement agencies used by USG agencies certify packaging and storage conditions during
shipping and provide insurance to the point of delivery at the frontier. Potential collaboration with other
agencies will facilitate leveraging of resources (ARVs supplies and technical assistance) for this program
area, Clinton Foundation will be approached for donation of second line adult ARVs, first and second line
children ARVs .
The storage and distribution of ARVs to service delivery points will be coordinated from the program central
warehouse, the program will exploit opportunities of integrating this activity with the Nigerian government
Logistics system at the federal and state level where possible. To ensure proper management and
utilization, storage facilities at service delivery points will be assessed and supported to meet standard
requirements that will ensure optimum storage; support will include renovations of storage infrastructures,
training of Pharmacists and support staff on logistics management with emphasis on ordering, storage,
inventory management and Logistics Management Information System (LMIS). Periodic LMIS reports from
various sites will be collated and used for program management and improvement. The program will
program will work closely with the FMOH in achieving the Nigeria's long-term goal of supporting a
sustainable supply chain management system for ART that incorporates and bolsters existing Nigerian
institutional structures and is harmonized with Government of Nigeria (GON) activities.
Quality control measures involve routine monitoring visits by Program staff from the central level to sites at
least on a quarterly basis during with implementation of SOPs related to commodity management with be
reviewed and improvement measures discussed with the site staff. This program area may likely result to
generation of hazardous waste products through expiries of ARVs, affected items will be inventoried and
destroyed in line of relevant national policies at recommended sites using the appropriate mode of
destruction.
CONTRIBUTION TO OVERALL PROGRAM AREA: This activity supports the scale up of ARV treatment in
Nigeria, a major priority for the FMOH. Through these activities, NEPWHAN will continue to strengthen the
structure of its ART drug procurement system, in accordance with PEPFAR goals in order to ensure cost
effective and accountable mechanisms for drug procurement and distribution. Furthermore, efforts to build
local capacity through infrastructure building and training mechanisms are consistent with PEPFAR 5-year
goals to enhance the capacity of supply chain management systems to respond to rapid treatment scale-up.
Additionally, through procurement via SCMS, NEPWHAN seeks to provide support to efforts to build
capacity related to drug procurement and distribution. This activity also supports the ARV program for adults
and children as well as the PMTCT program for provision of ARVs to pregnant women and infants
LINKS TO OTHER ACTIVITIES: This activity relates to activities in TB/HIV, ART services, and strategic
information. This activity will maintain significant linkages with PMTCT and ART services through the
procurement of ARV drugs for individuals served by these programs. Additionally, linkages to TB/HIV
activities will be developed and maintained. The supply chain management system will serve to provide
drugs to ART sites that are providing TB services in conjunction with ART services. SI activities will provide
crucial information for M&E as well as efficacy of the drug regimens, which may impact drug procurement
decision-making.
POPULATION BEING TARGETED: ARV drugs will be offered to HIV positive infant, children and adults.
EMPHASIS AREAS: Emphasis include strengthening of health facility logistics systems to manage ARV
drugs in a sustainable manner, drugs for OI, RTKs and lab reagents and quality assurance, quality
improvement and supportive supervision. areas will
Table 3.3.15:
The aim of this activity is to provide laboratory support for the HIV/AIDS treatment and general health
services system strengthening program that is robust and of comprehensive quality. This activity will occur
in partnership with four state governments in the South East and South-South geopolitical regions of
Nigeria. The activity will identify, upgrade and equip four secondary level hospital laboratories, one in each
state, (Anambra, Ebonyi, Bayelsa and Imo). It will also provide comprehensive laboratory services for the
diagnosis, treatment and monitoring of drug toxicity for HIV/AIDS as well as for related opportunistic
infections. The laboratories will also be equipped to provide standard laboratory services for the diagnostic,
treatment, monitoring and infection control needs of the population within the catchments areas of the target
facilities.
Through this corporation between the partner and the state governments, laboratory infrastructural needs
will be identified in an initial assessment of lab service readiness. Water and electricity will be provided by
the state governments, while the partner will provide both the basic and state-of the-art lab equipment that
is needed, as well as build the capacity of laboratory scientists and other lab staff to use these equipment.
The partner will also provide lab services that follow good laboratory practice and standard best practices.
The lab equipment that will be provided in these sites will be in conformity with the guidelines from the Lab
Technical Working Group (TWG) on the use of appropriate lab technology and equipment that is most
suitable for the different levels of care in consonance with WHO recommendations. The partner and the
participating state governments will jointly recruit appropriately qualified staff to fill identified positions.
This activity will support the 4 laboratories to develop capacity for the following laboratory assays: Complete
Blood Count, Chemistry panel including electrolytes, CD4 counts, serology assays for HIV, syphilis,
Hepatitis including but not limited to HBV& HCV, malaria, pregnancy test, TB microscopy, referral for TB
cultures, general medical microbiology and blood group serology assays. Capacity for limited fungal tests
will also be developed. Referral linkages will be established with other PEPFAR supported facilities with
PCR capacities, such as IHVN, APIN and FHI/GHAIN, for RNA based viral load assays for patients when
clinically indicated. Similar referral arrangements will be used for the provision of Early Infant HIV diagnosis
(EID) for all identified HIV exposed infants within the activity's PMTCT and Pediatrics treatment programs
(this activity is also detailed in the Pediatrics program area). Support for EID specimen collection and
shipment will be provided by the Clinton Foundation through a collaborative arrangement with the USG. It is
estimated that a total of 15,000 Lab tests will be conducted in COP09 in all the supported sites. Counting of
the number of Lab tests performed will be based on the guidelines from the Lab Technical working Group
(LTWG).
In the partnership arrangement with collaborating state governments, the activity's Laboratory program will
be staffed with 5 seasoned Medical Lab specialists with cognizant experience in the following disciplines:
Medical Microbiology, Clinical Chemistry, Hematology, Flow Cytometry and Laboratory Management/Lab
Information Management System. This Lab team will be headed by a Laboratory program Director. To
ensure effective mentoring of site Lab staff, after the initial trainings and site preparations, the Lab team will
work with site Lab staff, on a daily basis for a minimum of one month, providing continuous on- the job
training and mentoring. When site Lab staff have demonstrated the required proficiency in Lab services
provision, the Lab team will then fall back to providing service quality oversight, supervision and mentoring
on a regularly scheduled basis - at first monthly following the period of initial mentorship, then quarterly.
The outcome of these quarterly Lab assessments will be shared with the sites, and fed into a central Lab
assessment data system that will be supported by the LTWG.
Partners will collaborate with USG IPs with well established training structures and programs, such as
FHI/GHAIN, IHVN and APIN to provide Laboratory trainings for all Lab staff of the supported facilities. In
COP09, NEPWHAN will train a total of 20 Lab staff in specific lab techniques (5 from each of the 4
facilities), and another 4 site equipment bioengineers will receive a specialized training. The trainings for lab
staff will include: HIV Testing based on the WHO/CDC training package, Flow-Cytometry techniques for
CD4 enumeration, Clinical Chemistry, and Hematology. The training packages developed and adapted for
use in Nigeria by USG PEPFAR-Nigeria LTWG in collaboration with ASCP will be used for this training. TB
AFB smear microscopy training will also be provided and the WHO/CDC training package that has also
been adapted for use in Nigeria will be used. In addition, trainings basic Laboratory procedures, Good
Laboratory Practice, Laboratory Reagents and Equipment Logistics Management trainings that will also be
provided.. Training on lab reagent and logistics management will be provided in collaboration with
SCMS.The Lab managers for each of the supported Labs will be trained further on Laboratory Management
using the training package developed by APHL, and Laboratory Quality Assessment and Audit using
another standard training package that will be identified. The partner will aslo collaborate with Lab
equipment manufacturers and vendors to provide specific equipment trainings that will cover equipment
principles and techniques, routine maintenance, calibration, and trouble shooting. The activity will not have
a dedicated Bioengineer in its employment; instead, Lab equipment maintenance engineers at the
supported sites will be supported to obtain the required equipment maintenance and repairs training from
the specific equipment manufacturers/vendors. In COP09, 4 site equipment bioengineers (1 from each site)
will be supported to obtain these specialized training.
The major Lab equipment procurement, warehousing and distribution will be implemented through the Axios
mechanism, while HIV test kits procurement will be through the SCMS mechanism. Other Lab consumables
will however be procured locally using the established facility procurement system. The partner will
collaborate with SCMS to train staff logistics managers on supplies forecasting and general logistics
management in order to build site staff capacity and ensure program sustainability.
In COP09 the partner will seek accreditation for all of its supported Labs from the Medical Laboratory
Science Council of Nigeria - the government Lab accrediting agency.
During the mentoring period, the activity's Lab specialists will work with the site staff to develop site specific
standard operating procedures for all Lab processes and procedures, including the Quality Control and
Quality Assurance processes. In conjunction with USAID, the partner will provide training and support the
implementation and use of quality control charts to monitor all the internal quality control processes.
Activity Narrative: Capacity will be developed at supported facilities in local brewing and characterization of heat inactivated
serum. They will use this for the HIV proficiency testing program that will be administered to all of the HCT,
TB, STI and PMTCT sites that will be supported by the Lab for HIV testing quality assurance. The Labs will
be linked to the PEPFAR supported National Lab QA for Proficiency Testing program.
As part of its Lab safety procedures, the partner will collaborate with JSI/MMIS to provide medical waste
management and injection safety training to all Lab staff. In addition, the partner will procure standard
laboratory autoclave to ensure potential infectious materials from the Lab are sterilized before being
disposed, following standard procedures. The partnering state governments will be responsible for the
procurement of appropriate hospital incinerators for efficient waste management. Post exposure prophylaxis
treatment training will also be provided and guidelines on the protocol for seeking PEP will be developed.
Appropriate clinical staff will be designated for this purpose in all the supported sites.
CONTRIBUTIONS TO OVERALL PROGRAM AREA: The provision of Laboratory services through this
program will contribute to strengthening and expanding the capacity of the GON to respond to the HIV/AIDS
epidemic. It will also build the capacity of laboratory staff at the project sites and contribute to the upgrading
of infrastructure at 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.
LINKS TO OTHER ACTIVITIES: This program element relates to activities in PMTCT, BC&S, TB/HIV, and
HCT. 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.
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, facility based counseling and testing and TB-HIV
programs.
EMPHASIS AREAS: A major emphasis area for the partner's Lab program is human capacity building.
This will be done through training and mentoring of Lab staff in all of its supported sites. A second emphasis
area is sustainable health infrastructural development, which the partner hopes to achieve through its
model partnership with state governments and the provision of basic infrastructure in all the hospitals that
will be supported. Human capacity building and all lab equipment needs will also be provided by the activity.
Table 3.3.16:
