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.
Years of mechanism: 2008 2009
ACTIVITY DESCRIPTION:
This MTCT activity relates directly to all Nigeria PMTCT COP09 activities as part of the USG technical
oversight role.
The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria, has two full time staff
positions (one Senior Program Specialist and one Program Specialist) for PMTCT, both of which were first
approved in COP05. The budget includes funding for 2.25 FSN salaries, funding for (limited) international
and required domestic travel, training funds and allocated minor support costs. Funds are not requested in
COP09 for international TA as this is understood to be funded by the HQ operational plan (HOP). These
staff members will be supervised by a Senior Prevention Unit Manager partially funded under HHS/CDC
PMTCT as noted above.
These HHS/CDC PMTCT staff members will work in close coordination with the USAID and DOD PMTCT
staff and directly provide quality assurance and program monitoring to all HHS supported implementing
partners including: University of Maryland-ACTION, Harvard, Columbia University SPH-ICAP, International
Foundation for Education and Self-Help (IFESH), Catholic Relief Services-AIDSRelief, Africare, Vanderbilt
University, Partners for Development, Johns Hopkins-Jhpeigo, APIN LLC, University Research Co., and
Pathfinder International. HHS/CDC PMTCT staff will also assist USAID staff in joint monitoring visits of
Family Health International-GHAIN, Catholic Relief Services-7 Dioceses, LMS Associate and USAID APS
awards for COP09. USAID and CDC PMTCT staff will provide assistance as needed to the U.S.
Department of Defense program with the Nigerian Ministry of Defence.
HHS/CDC and USAID PMTCT staff will also provide technical support and capacity development to new
partners undertaking PMTCT activities through the New Partner Initiative as well as provide support to the
Government of Nigeria at the national and state levels to promote Nigerian national PMTCT guidelines.
Support to Global Fund activities will be also be provided as requested. It is estimated that the PMTCT staff
under this activity will provide monitoring and support to approximately 700 PMTCT sites in COP09.
ICASS and CSCS charges related to these positions are funded under M&S in compliance with COP09
guidance.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13132
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13132 5350.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $248,800
Disease Control & Disease Control 2.0 Agency
Prevention and Prevention Funding
6784 5350.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $395,000
Disease Control & Disease Control Agency Funding
Prevention and Prevention
5350 5350.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $111,000
Table 3.3.01:
FY08 CollaborativeNigeriaNG.08.0203Multi-countryPMTCTHow to Optimize PMTCT Effectiveness (HOPE)
Project
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Estimated amount of funding that is planned for Public Health Evaluation $24,500
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $18,773,234
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
PEPFAR programming in the area of sexual transmission prevention utilizes current data on the drivers of the epidemic and the
most-at-risk populations (MARPs) for program strategy and targeting. Preliminary results from the 2007 National HIV/AIDS and
Reproductive Health Survey (NARHS-Plus) highlight significant aspects of the Nigerian epidemic. National coverage of HIV
testing is only about 14.5%. Overall HIV prevalence was found to be 3.6%. HIV prevalence was higher among females (4.0%)
than males (3.2%) and slightly higher in urban areas (3.8%) compared with rural areas (3.5%). It was highest in the North Central
zone (5.7%) and lowest in the South East zone (2.6%). It was highest among respondents with primary education (4.6%) and
lowest among respondents that had no education (2.7%). HIV prevalence was highest among the 30-39 years age group (5.4%)
and lowest among the 15-19 years age group (1.7%). HIV prevalence was much higher than the national average among females
who were separated (10.8%), divorced (10.9%) or widowed (10.4%). Sixty percent of respondents believed that they were at no
risk of HIV. The prevalence of HIV was higher among those who rated themselves as high risk for infection than among those who
felt they were at a low risk. HIV prevalence was higher among respondents who have exchanged sex for gifts than among those
who did not. The rate of condom use with a non-marital partner was generally low (49%) across the nation, with the least use in
the North-East, North-Central and North-West zones.
The 2007 Integrated Bio-Behavioral Surveillance Survey (IBBSS) identified female sex workers (FSWs) as the sub-population
most affected by HIV/AIDS in Nigeria (30% Prevalence). HIV prevalence was also high among men who have sex with men
(MSM; 13.5%). The IBBSS also revealed a generally low risk perception among MARPs (FSWs, MSM, injecting drug users (IDU),
transport workers, police, and armed forces), at less than 20%. Evidence from these recent studies show that the drivers of the
epidemic in Nigeria include transactional sex, low risk perception, high risk behavior and sexual networks among MARPS, multiple
and concurrent partnerships (MCP), poor sexually-transmitted infection (STI) management, and vulnerability arising from
economic challenges.
In COP08, the Sexual Prevention program was redesigned based on suggestions from a prevention technical assistance visit,
results of recent surveys, and the introduction of the National HIV Prevention Plan. USG/Nigeria's strategy for COP09 Sexual
Prevention programming will build on the COP08 strategy and be refined based on the currently available evidence. Focus areas
will include: (1) development of a comprehensive package of services to promote abstinence, fidelity and related community and
social norms; (2) development of a comprehensive prevention package of services for persons engaged in high-risk behaviors
(PEHRBs), promoting correct and consistent use of condoms as well as STI management; (3) implementation of the minimum
prevention package of services targeting the general population and targeted programming for MARPS guided by evidence from
recent studies, taking into account the drivers of the Nigerian epidemic; (4) continued growth in the capacity of faith-based and
community based organizations (FBOs and CBOs) to implement high-quality prevention programming; (5) integration of
comprehensive prevention programming in care and treatment services including Prevention with Positives; and (6) evidenced-
based programming within the national and USG prevention portfolios.
USG/Nigeria, through its implementing partners (IPs), will continue to provide a minimum package of services with particular
attention to intensity and dosage of messages. Best practices in abstinence and be-faithful (AB) include: peer education model;
post-exposure prophylaxis (PEP) plus model; curriculum and non-curriculum based school programmes; community awareness
campaigns; interventions that address income generation activities, and build essential life skills; and workplace programmes
providing interventions targeting adult males and females that encourage greater involvement of people living with HIV/AIDS
(GIPA). Best practices in condom and other prevention (C&OP) program area, include: appropriate condom messaging;
structured peer education using systematic training curricula; STI management; interventions addressing vulnerability issues like
income generation activities, and essential life skills for young women engaging in informal transactional sex; and condom
services, including education of sex workers on the use of water based lubricants, condom negotiation skills and condom use.
Messages related to alcohol use and its attendant disinhibition effects will feature as a cross cutting message for target
populations. IPs will utilize a minimum of three of these interventions to count a target as reached, and these will be reinforced
with mass media activities. It is envisioned that, following the data triangulation exercise, population-specific packages will be
recommended based on evidence from successful practices in the field.
In COP09, USG/Nigeria will focus on expanding services to reach specific high risk populations located within the 36 states and
the Federal Capital Territory (FCT) of the Federation, as guided by available epidemiological evidence. This expansion effort will
be guided by the distribution of the target populations as well as HIV prevalence rates. At the community level, the Condoms and
Other Prevention program will target "hot spots" where high risk behaviors are more likely to occur. The Priorities for Local AIDS
Control Efforts (PLACE) method, a new assessment and monitoring tool to identify potentially high transmission areas, will guide
deployment of services.
Key achievements to date include: a successful mass media campaign (Zip-up) targeting youth and males in the general
population; successful dissemination of the national prevention plan with roll out of its recommended minimum package of
services; and successful conduct of surveys such as the IBBSS and NARHS. The diversification of the AB portfolio has been
another significant achievement and has resulted in the deployment of varied combinations of partners and strategies addressing
specific high risk populations. The Winrock vulnerability intervention strategy resulted in 6.7% of their target population (i.e.,
FSWs) taking up alternative means of livelihood, in addition to increased correct and consistent condom use in the target
population.
In COP09, USG/Nigeria will continue to encourage mutual fidelity and avoidance of multiple and concurrent partners, through
targeted mass media approaches and specific community-based interventions that address social norms and attitudes. A
reinforcement of the successful Zip-up campaign and peer education plus models will target youth. These will be complemented
with the "parents as counselors" model that encourages "A" messaging from an early age. The expanded scope of curriculum-
based school HIV/AIDS program achieved in COP07 and COP08 will be reinforced in COP 09.
Programmatic gaps identified in COP07 and addressed through new procurement mechanisms in COP08 will continue to be
addressed in COP 09. IPs will build sustainability through programming at the grass-root level and, when capacity reaches a level
of sustained implementation, the IP will move to a new community, while Community Reach/PACT will provide continued support
to these local CBOs and FBOs for their behavior maintenance interventions. This will expand the national prevention program to
rural communities.
A data triangulation exercise will be conducted with COP08 funding to provide input to COP09 prevention programming through
analysis of available qualitative and quantitative data. In COP09, a second wave of IBBSS will be conducted and will include a
wider range of MARP groups and a larger sampling frame covering all geo-political zones of the country.
COP09 will also target efforts at special populations to address the ‘bridge' phenomenon. Efforts towards reaching transport
workers and adult males will be replicated in more states and sites across the country. Current services to the military will be
expanded to reach other uniformed services. The C&OP program will be strengthened to provide priority population groups
(e.g.female sex workers, male and female out-of-school youths, members of the uniformed services, incarcerated populations,
long distance truck drivers, and taxi drivers) with direct access to quality counseling and testing services, STI treatment, and
condom services, including messages on consistent and correct use guided by the findings of the 2007 IBBSS.
Current work with FSW will be expanded to non-brothel settings and will include STI management, counseling and testing
services, provision of condoms and training on condom negotiation skills, with appropriate information on use of water-based
lubricants. Training of FSWs in vocational skills (as income generating alternatives) will reduce dependence on commercial sex
activity. Information will be provided and awareness created on the need for alcohol use reduction as well as condom use with
boyfriends, spouses and non-paying clients to ensure risk reduction.
Interventions with transport workers will be continued through successful peer education models and condom services in motor
parks, selected transport corridors and recreational spots of transport workers. Major transport corridors will be targeted with
mobile and "moonlight" voluntary counseling and testing (VCT) services provided at truck stops and parks to encourage transport
workers to know their status, and receive behavioral counseling on multiple partner reduction, as well as correct condom use with
every sexual encounter. STI treatment services will be provided along these major corridors.
Work with high risk-youth will be refined to develop gender sensitive programming to meet the prevention needs of young,
unmarried out-of-school females and males. The peer education model will be used as a channel to offer appropriate condom
messages, essential life skills training and address the risks of multiple partnerships, intergenerational and transactional sex.
Messages promoting abstinence (primary or secondary) as the most effective form of prevention will also be given.
In COP07, a formal labor force program with AB and appropriate C&OP messaging and services was developed to reach men
and women in the workplace. This mechanism was sustained in COP08 and will be continued in COP09.
In COP09, to ensure comprehensiveness of HIV/AIDS services, steps will be taken to integrate ABC with care and treatment
services. In this effort, treatment partners will continue to integrate prevention services into care and treatment settings. Also,
implementing partners providing care and treatment services will continue to provide a minimum package of prevention services
for people living with HIV through the adoption of a comprehensive Prevention with Positives (PwP) package. This PwP package
will have a community component in line with the National Response, which will be implemented through support groups and
CBOs. Several partners will provide appropriate information on correct and consistent use of condoms as well as provide
condoms to PLWHA. The majority of costs associated with PwP will be offset under care and treatment. In addition, prevention
services will be integrated into other clinical services, including family planning and reproductive health. STI treatment, rather
than referrals, will be provided in clinical settings for HIV positives and MARPS. This intervention will be implemented using the
recently adapted HIV Prevention in Care and Treatment Settings Prevention Package, which includes several training modules
and job aids.
In COP09, the USG/Nigeria Prevention technical working group (TWG) will continue to implement the peer and participatory rapid
appraisal for action (PPRAA) approach to help foster coordination and harmonization of partner activities. The combined USG
Nigeria/IP/GoN prevention TWG (including state and local government levels) will visit various partner implementation sites
together to assess their programs and interact with recipient communities and target populations. This allows for constructive
criticism of strategies and a sharing and adoption of successful strategies without inhibition since they participate as peers with
similar goals and objectives. This also helps partners and local authorities to leverage resources from one another and foster
referral linkages.
The USG continues to collaborate with the UN and other organizations for condom commodities. Collaboration with DFID to
leverage condoms from their social marketing programs will continue. UNFPA provides female and male condoms through
federal and state government machinery. Quantification for condom supplies nationwide will be hinged on the 5-year national
condom strategy. These mechanisms will be further exploited in COP09 with partners assisted to provide quantifications
disaggregated according to male and female condoms. In COP09, the principle of the "three-ones" will remain the overarching
principle guiding USG collaborations with GON through compacts, grants and cooperative agreements, which will aim at
motivating the GON to provide enabling policy environment for, and efficient coordination of, an effective national response to the
epidemic.
The GON's 2003 National Policy and 2005-2009 Strategic Framework for Action provides a comprehensive framework for
HIV/AIDS control efforts. Results from the recent IBBSS and NARHS-Plus studies provide evidence for policy support for
targeted programming for vulnerable populations (MSM, IDUs). However, victims of trafficking as a vulnerable group presents a
gap that will require programmatic intervention. The National Prevention Technical Working Group (NPTWG) inclusive of the
USG Prevention TWG is providing technical leadership and direction for HIV prevention activities in Nigeria. The two-year
National Prevention Plan developed by the NPTWG continues to provide programmatic guidelines for the National Prevention
response. In COP09, the USG team will further support the NPTWG to develop National Sexual Prevention curriculum and
guidelines in an effort to ensure harmonization of prevention efforts in Nigeria.
Table 3.3.02:
This Sexual Transmission activity relates directly to all Nigeria AB and Condoms/Other Prevention COP09
activities as part of the USG technical oversight role. The USG team, through the HHS/CDC Global AIDS
Program (GAP) office in Nigeria, has one full time staff position for HIV Sexual Transmission, which was
previously approved in COP07. The budget includes funding for 1.25 FSN salary, funding for required
domestic travel, training funds and allocated minor support costs. This staff member will be supervised by a
Senior Prevention Manager funded across the CDC agency prevention programs as noted above. Funds
are not requested in COP09 for international TA as this is understood to be funded by the HQ operational
plan (HOP).
This HHS/CDC HIV Sexual Transmission program specialist will work in close coordination with the USAID
and DoD prevention staff and directly provide quality assurance and program monitoring to all HHS-
supported implementing partners with prevention activities in the area of sexual transmission programming
including: University of Maryland-ACTION, Harvard SPH-APIN, Columbia University SPH-ICAP, Catholic
Relief Services-AIDSRelief, Population Council, Partners for Development, IFESH, ECEWS, Africare, APIN,
LLC and CDC RFA awards in COP09. HHS/CDC prevention staff will also assist USAID staff in joint
monitoring visits of Family Health International-GHAIN, CEDPA, Society for Family Health, Population
Council, Christian AID, Catholic Relief Services-7 Dioceses, Winrock International, Hope Worldwide South
Africa, Hope Worldwide Nigeria, Food for Hungry, LMS Associates, LMS Leader, Pro Health, YWCA, C-
Change, NELA, GECHAAN, CSN, Community Reach, AIDSTAR, AED Workplace and USAID APS awards
for COP09. USAID and CDC prevention staff will provide assistance as needed to the U.S. Department of
Defense program with the Nigerian Ministry of Defence. The strategic shift undertaken by the National
Prevention TWG to mandate a minimum package of prevention services requires a significant level of
programmatic guidance and oversight for the partners, and the robust integrated prevention team provides
the technical leadership required for an appropriate response. The sexual prevention team's responsibilities
include: 1) representing the USG in technical discussions with the GON, 2) overseeing technical aspects of
the program, including program management and oversight of partners to ensure high-quality and
accountable programs, 3) interfacing with OGAC technical working groups, and 4) participating in the USG
prevention working group.
HHS/CDC, DoD and USAID prevention staff will also provide technical support and capacity development to
new partners undertaking prevention of sexual transmission activities through the New Partner Initiative as
well as provide support to the Government of Nigeria at the national and state levels to promote Nigeria's
national prevention guidelines.
ICASS and CSCS charges related to this position are funded under M&S in compliance with COP09
Continuing Activity: 13133
13133 9833.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $15,000
9833 9833.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $27,500
Continuing Activity: 13136
13136 5370.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $50,000
6787 5370.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $27,500
5370 5370.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $10,000
Table 3.3.03:
This is a continuing activity. This activity relates directly to all Nigeria HHS Medical Transmission Blood
Safety COP09 activities (see activity references in the narrative below).
The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has one full time staff
position to support Medical Transmission prevention activities with 75% of time allocated to Blood Safety
and 25% of time allocated to Safe Injection (6817.09 for a more detailed description of safe injection
responsibilities). The budget includes FSN salary, funding for required domestic and international travel,
training funds and allocated support costs. Funds are not requested in COP09 for international TA as this is
understood to be funded by the HQ operational plan (HOP). This staff member will be supervised by a
Senior Prevention Manager funded across the CDC agency prevention programs.
The HIV Medical Transmission Prevention local staff member works in close coordination with the USAID
HIV Medical Transmission Prevention staff and directly provides quality assurance and program monitoring
or coordination to HHS-supported implementing partners with Blood Safety activities including: University of
Maryland-ACTION, Harvard SPH, Columbia University SPH-ICAP, Catholic Relief Services-AIDSRelief, the
Nigeria Ministry of Health National Blood Transfusion Service, and the Safe Blood for Africa Foundation.
This position will also work with USAID staff on joint monitoring visits of non-HHS PEPFAR partners such as
FHI-GHAIN and give technical assistance to the DoD Safe Blood program as requested. HIV medical
transmission staff will also monitor procurements made through SCMS for Safe Blood activities.
The HHS/CDC staff member provides technical support and capacity development to new partners selected
through Requests for Applications (RFAs), the New Partner Initiative and to the Government of Nigeria at
the national and state levels to promote Nigeria national guidelines related to blood safety. Technical
assistance through the HIV Medical Transmission TWG will be provided as need to the Department of
Defense and USAID partners with Blood Safety activities. Under this activity the staff member will provide
direct or indirect monitoring and support to over 230 Emergency Plan supported sites in COP09.
Continuing Activity: 13134
13134 5395.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $40,000
6789 5395.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $60,000
5395 5395.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $10,000
Table 3.3.04:
This activity represents the fully-loaded costs of a full-time Nigerian program officer for biomedical
transmission. This is a continuing position.
This activity relates directly to all Nigeria HHS Medical Transmission Injection Safety COP09 activities.
The USG team through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria hired one full time staff
position in FY07 to support Medical Transmission prevention activities with 75% of time allocated to Blood
Safety and 25% of time allocated to Safe Injection. The budget includes 25% of one FSN salary, funding for
required domestic or international travel, training funds and allocated minor support costs. Funds are not
requested in COP09 for international TA as this is understood to be funded by the HQ operational plan
(HOP). This staff member will be supervised by a Senior Prevention Manager funded across the CDC
agency prevention programs.
The HIV Medical Transmission Prevention staff member will work in close coordination with their USAID
HIV Medical Transmission Prevention counterpart and directly provide quality assurance and program
monitoring to HHS supported implementing partners with Injection Safety activities: University of Maryland-
ACTION, Harvard SPH-APIN, Columbia University, SPH-ICAP, and Catholic Relief Services-AIDSRelief,
and Safe Blood for Africa Foundation as well as to USAID-supported partners and the DoD program. The
program officer for biomedical transmission provides technical and programmatic support to the USG
partners in the areas of safe injection, blood safety, and generalized health care waste management. The
program officer's responsibilities include: 1) representing the USG in technical discussions with the GON
with guidance from the Senior Prevention Manager, 2) overseeing technical aspects of the program,
including program management and oversight of partners to ensure high-quality and accountable programs,
3) interfacing with OGAC technical working groups, and 4) interfacing with the USG/Nigeria prevention
team.
These HHS/CDC and USAID HIV Medical Transmission staff members provide technical support and
capacity development to new partners selected through RFAs, the New Partner Initiative and to the
Government of Nigeria at the national and state levels to promote Nigeria national guidelines related to
injection safety. Technical assistance through the HIV Medical Transmission TWG will be provided as
needed to all USG partners with Safe Injection activities. Under this activity the staff member will provide
direct or indirect monitoring and support to over 700 Emergency Plan supported sites with injection safety
activities in COP09.
Continuing Activity: 13135
13135 6817.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $15,000
6817 6817.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $20,000
Table 3.3.05:
This care and treatment activity relates directly to all HHS Nigeria Adult Care and Treatment COP09
activities.
To support and enhance the USG Nigeria Care and Treatment activities, the USG team through the
HHS/CDC Global AIDS Program (GAP) Office in Nigeria, has 2 full time staff positions planned that will
focus on adult/adolescent palliative care/basic care and support issues. The care and support sub-budget
also includes partial funding for two FSN salaries (shared with OVC or pediatric care), for (limited)
international and required domestic travel, for training and also for minor support costs. Additionally, to
support the USG Nigeria ARV services program, the USG team through the HHS/CDC Global AIDS
Program (GAP) Office in Nigeria, has one full time staff position planned for adult ART services that will
focus on supporting implementing partner ART issues. The adult treatment sub-budget also includes partial
funding for two FSN salaries shared with care and support or pediatric ARV services, funding for (limited)
international and required domestic travel, funding for training and also for minor support costs. Funds are
not requested in COP08 for international TA as this is understood to be funded by the HQ operational plan
(HOP). These staff members will be supervised by a Senior Clinical Services Manager across all Care and
Treatment program areas funded under HHS/CDC M&S.
These HHS/CDC adult care and treatment staff positions will coordinate with the USAID and DoD care and
treatment staff and will provide direct quality assurance and program monitoring to HHS supported
implementing partners. HHS supported treatment partners include: University of Maryland-ACTION,
Harvard University SPH, APIN Ltd, Columbia University-ICAP, Catholic Relief Services-AIDS Relief,
Vanderbilt University, University Research Corporation and Partners for Development. The HHS/CDC staff
will also assist USAID staff in joint monitoring visits of USAID-supported treatment partners - Family Health
International-GHAIN, LMS Associates, CHAN, AIDSTAR and NEPWHAN. USAID and CDC care and
treatment staff will provide assistance as needed to the U.S. Department of Defense program with the
Nigerian Ministry of Defense. Other partners providing care (but not treatment services) will also receive
close monitoring by the CDC care and support staff. These include HHS-supported Africare, ECEWS and
IFESH as well as USAID-supported Catholic Relief Services-7 Dioceses, CEDPA, Winrock and NELA.
The USG care and treatment teams will provide technical support and capacity development to new
partners undertaking care and treatment activities through the CDC RFA, USAID APS, and New Partner
Initiative activities, as well as provide support to the Government of Nigeria at the National and State levels
to promote Nigeria National policies, guidelines, and training activities. It is estimated that the care and
treatment staff under this activity will provide monitoring and support to over 370 clinical sites in COP09.
Continuing Activity: 13137
13137 5365.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $75,000
6786 5365.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $210,000
5365 5365.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $34,474
Table 3.3.08:
CDC RFA
BCS ($275,000)
These funds are to be used by the award recipients of the FY09 HHS/CDC RFA, with emphasis on local
implementing partners, to implement HIV care and support programs in new underserved areas of Nigeria.
Basic Health Care package services that may be included by the award recipient include: basic medical,
laboratory and nursing care, adherence counseling, prevention for positives, linkage to psychosocial
support through participation in PLWHA support groups and individual counseling operational at points of
service with transportation, communication and referrals, pain and symptom management, and provision of
community home based care (HBC).
The award recipients should reach approximately 2,750 PLWHA with care services and will be expected to
provide the following types of basic care and support: laboratory monitoring which include CD4 counts,
hemogram, clinical chemistry, and malaria smears which are supported and funded under this program area
for those not requiring ARV treatment. This activity will include the provision of cotrimoxazole prophylaxis
(CPT) to eligible HIV positive patients, including TB/HIV co-infected clients that will be identified and
referred from program sites. Special effort will be made to expand upon the growing collaboration between
the TB and HIV/AIDS control program to link such care to TB/HIV patients. This activity is also identified as
a key intervention in the Government of Nigeria's plan to address TB and HIV.
The recipients will be expected to provide palliative and home based care both at the facility level and in
communities with an appropriate combination of models which will be utilized depending upon the site
preference. The RFA will supplement site staffing with trained PLWHAs and volunteers from communities
to provide this service. An identified trained Basic Care and Support Program Officer with a counseling
background at each facility will work with support groups to improve educational and support programs, and
coordinate linkage of the facility points of service to the communities.
Training essential for program success and sustainability will target doctors, nurses, health aids,
counselors, PLWHAs and community volunteers. This training will be conducted by RFA program staff at
the site level to maximize coverage. Training will be done using the training manual which is being
developed with the GON by current large treatment partners through PEPFAR support. All HBC providers
will receive a provider's manual describing methods of assessment, diagnosis, treatment, management and
referral for HIV related symptoms. This will ensure all PLWHAs, including HIV positive pregnant women as
well as all TB/HIV patients, get the correct care and the same quality of care across the sites. There will
also be Standard Operating Procedures for Basic Care and Support at all service outlets.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity provides services which are a high priority for the President's Emergency Plan by providing a
basic package of care for all PLWHA including HIV positive pregnant women and TB/HIV patients. The
services are consistent with the Guidelines for Palliative Care in Nigeria as well as the Nigerian Guidelines
for ART which emphasize HBC, symptom management, and OI prophylaxis. Capacity development at the
site level and consistency with national guidelines will ensure sustainability. RFA identified staff will
contribute to development of a national palliative care training curriculum, identified as a priority by the
Government of Nigeria (GON).
LINKS TO OTHER ACTIVITIES:
This activity is linked to HVCT, HVOP, PMTCT, HVTB, HKID and HTXS. HCT will target at risk populations
including all pregnant women and all TB patients. All patients are monitored and linked to ARV therapy
when indicated. Care and Support services such as psychosocial support and symptom management
promotes ARV adherence. Prevention for Positives which includes counseling and condom availability will
be integrated into this activity. Services are co-located with TB Directly Observed Treatment Services
(DOTS) centers with referrals from other DOTS centers. RFA identified staff will work with sites to ensure
effective referral/linkage and coordination systems are in place. High quality laboratory services supported
by CDC/RFA facilitated laboratory QA program will be available at sites.
POPULATIONS BEING TARGETED:
Services are offered to all PLWHAs including HIV positive TB patients and pregnant women identified
through TB DOT Centers and PMTCT programs, respectively. Doctors, nurses, other health workers,
PLWHAs and volunteer caregivers of PLWHA are targeted for training. The volunteers participate in
providing HBC services as well as adherence counseling.
EMPHASIS AREAS: The emphasis area for this activity is training as capacity development for
sustainability is a key focus.
COVERAGE AREAS: underserved expansion states TBD when awarded.
***The USG Nigeria team is proposing estimated targets in the narratives and not in the target tables in the
COPRS for open solicitations for USAID APS and CDC RFAs. These solicitations have not been awarded
at this time and targets and other specifics will only be finalized and reflected in the activities in COPRS
after negotiations have been concluded and the award has been made.
This HTXS activity relates directly to all HHS Nigeria ART COP07 activities (see ID references in the
narrative).
Activity Narrative: To support and enhance the USG Nigeria ARV services program, the USG team through the HHS/CDC
Global AIDS Program (GAP) Office in Nigeria has two full time staff positions planned for ART Services that
will focus on supporting implementing partner ART issues. The budget includes two FSN salaries, funding
for (limited) international and required domestic travel, training funds and allocated minor support costs.
Funds are not requested in COP08 for international TA as this is understood to be funded by the HQ
operational plan (HOP). These staff members will be supervised by a Senior Clinical Services Manager
across all Care and Treatment program areas funded under HHS/CDC M&S.
These HHS/CDC ART staff positions will work in coordination with the USAID ART staff (#5398.08.08) and
directly provide quality assurance and program monitoring to HHS supported implementing partners
including: University of Maryland-ACTION (#3255.08), Harvard SPH-APIN (#6715.08), Columbia University
-ICAP (#5408.08), Catholic Relief Services-AIDSRelief (#6678.08), and a partner to be determined by an
RFA in the first quarter of FY2008. The HHS/CDC staff will also assist USAID staff in joint monitoring visits
of Family Health International-GHAIN (#6703) and LMS Associates (#15647.08). USAID and CDC ART
staff will provide assistance as needed to the U.S. Department of Defense (#3243.08) program with the
Nigerian Ministry of Defense.
HHS/CDC and USAID ART staff will provide technical support and capacity development to new partners
undertaking ART activities through the New Partner Initiative as well as provide support to the Government
of Nigeria at the National and State levels to promote Nigeria National ART guidelines. It is estimated that
the ART staff under this activity will provide monitoring and support to over 200 clinical sites in COP08, with
over 250,000 patients on therapy by the end of the program period, 225,000 of these as direct PEPFAR
targets.
ICASS and CSCS charges related to this position are funded under M&S in compliance with COP08
Continuing Activity: 13142
13142 5406.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $906,361
6791 5406.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $145,000
5406 5406.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $107,000
Table 3.3.09:
FY08 CollaborativeNigeriaNG.08.0201Multi-countryCARTEvaluation of Interventions to Reduce Early
Mortality among Persons Initiating ART in Emergency Plan Countries
Estimated amount of funding that is planned for Public Health Evaluation $20,000
This care and treatment activity relates directly to all HHS Nigeria Pediatric Care and Treatment COP09
To support and enhance USG Nigeria Care and Treatment activities, the USG team, through the HHS/CDC
Global AIDS Program (GAP) office in Nigeria, has 2 partial FSN staff positions. These positions will be
shared with OVC and focus on pediatric palliative care/basic care and support issues. The care and
support sub-budget also includes funding for (limited) international and required domestic travel, for training
and for minor support costs. Additionally, to support the USG Nigeria pediatric ARV services program, the
USG team, through the HHS/CDC Global AIDS Program (GAP) office in Nigeria, has one full time staff
position for pediatric ART services that will focus on supporting implementing partner ART issues. The
pediatric treatment sub-budget also includes one partial FSN salary shared with adult ARV services, funding
for (limited) international and required domestic travel, for training and for minor support costs. Funds are
These HHS/CDC pediatric care and treatment staff positions will work in coordination with the USAID and
DoD care and treatment staff and will directly provide quality assurance and program monitoring to HHS
supported implementing partners. HHS-supported treatment partners include: University of Maryland-
ACTION, Harvard University SPH, APIN Ltd, Columbia University-ICAP, Catholic Relief Services-AIDS
Relief, Vanderbilt University, University Research Corporation and Partners for Development. The
HHS/CDC staff will also assist USAID staff in joint monitoring visits of USAID-supported treatment partners
- Family Health International-GHAIN, LMS Associates, CHAN, AIDSTAR and NEPWHAN. USAID and CDC
care and treatment staff will provide assistance as needed to the U.S. Department of Defense program with
the Nigerian Ministry of Defense. Other partners providing pediatric care but not treatment services will also
receive close monitoring by the CDC care and support staff include HHS-supported Africare, ECEWS and
partners undertaking pediatric care and treatment activities through the CDC RFA, USAID APS, and New
Partner Initiative activities, as well as provide support to the Government of Nigeria at the National and
State levels to promote Nigeria National policies, guidelines, and training activities. It is estimated that the
care and treatment staff under this activity will provide monitoring and support to over 370 clinical sites in
COP09.
Table 3.3.10:
Table 3.3.11:
ACTIVITY DESCRIPTION: This activity is a continuation from COP08. Under COP09 there is a new
emphasis on the provision of the "Three Is" and an increasing focus on MDR TB response, particularly in
the co-infected population.
The TB/HIV team, working with the wider PEPFAR TB/HIV team and with Government of Nigeria and
Implementing Partner counterparts, provides oversight, supervision, capacity-building and technical
assistance and leadership for the TB/HIV interventions and services.
This HVTB activity relates directly to all HHS Nigeria TB/HIV COP09 activities (see ID references in the
narrative below).
The USG team in Nigeria through HHS/CDC will utilize TB/HIV funds to support two full time TB/HIV
program officers and one half Lab program officer for the HHS/CDC Global AIDS Program (GAP) Office
Clinical Care Unit in Nigeria. Each of these qualified FSN officers (one Senior Program Specialist, one
Program Specialist and one TB/HIV Laboratory Technician) will take a leadership role in identifying
additional local partners suitable for PEPFAR support in order to expand integrated and sustainable TB/HIV
activities. The budget includes funding for two and a half FSN salaries, limited international and required
domestic travel, training and minor support costs. Funds are not requested in COP09 for international TA
as this is understood to be funded by the HQ operational plan (HOP). These staff members will be
supervised by a Senior Clinical Services Manager across all Care and Treatment program areas funded
under HHS/CDC M&S.
They will be responsible for providing strategic leadership and technical support to the Government of
Nigeria as well as to USG (CDC, USAID and DoD) partners including: University of Maryland-ACTION,
Harvard School of Public Health, AIDSRelief , Columbia University School of Public Health-ICAP, Dept of
Defense, Africare, IFESH, ECEWS, Vanderbilt University , APIN LLC, URC, Society for Family Health,
GHAIN, TBCAP, CEDPA, CHAN, LMS Leader, and LMS Associates. The objective of this support is to
develop and efficiently implement the USG's PEPFAR TB/HIV strategy and the TB/HIV 5-year strategic plan
recently developed by the Government of Nigeria. These strategies call for integrating TB and HIV services
to allow TB patients to be counseled and tested for HIV and referred to HIV care as appropriate, and for
patients infected with HIV to be adequately screened for TB and linked with care and treatment. Specific
activities are the establishment of quality TB DOTS services at all HIV care points of service and the
availability of confidential HIV counseling and testing at TB points of service supported by PEPFAR.
The team will also continue their leadership and participation in an MDR TB surveillance activity started
under COP08 and a PHE. The team's responsibilities include: 1) representing the USG in technical
discussions with the GON, particularly with the National TB program 2) overseeing technical aspects of the
program, including program management and oversight of partners to ensure high-quality and accountable
programs, 3) interfacing with OGAC technical working groups, and 4) interfacing with the USG TB/HIV
Technical Working Group headed by CDC. They will also coordinate USG TB/HIV activities with other key
TB and HIV initiatives such as the Global Fund Against HIV/AIDS, TB, and Malaria, The World Health
Organization (WHO) and The International Association of Anti-Leprosy Association (ILEP) in Nigeria.
The TB/HIV program officers will represent HHS/CDC as part of the USG team on the National TB/HIV
Working Group. This group has the mandate to provide national leadership for TB/HIV strategy, program
development, and implementation. They will also work in coordination with the USAID TB/HIV staff and
their partners (noted above). This coordination will be in the form of joint work plans, regular meetings and
communication between agencies, and joint internal and external TA to partners.
Continuing Activity: 18832
18832 18832.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $1,300,000
Table 3.3.12:
This HKID activity relates directly to all HHS Nigeria OVC COP09 activities.
The USG Nigeria team's OVC program, through the HHS/CDC Global AIDS Program (GAP) Office,
includes full support for an OVC specialist and partial support for specialists working on OVC and pediatric
linkages, totaling 3.25 FTE FSN salaries, funding for (limited) international and required domestic travel,
training funds and allocated minor support costs. Funds are not requested in COP09 for international TA as
this is understood to be funded by the HQ operational plan (HOP). These staff members are part of the
Clinical and Care Unit, which in turn is supervised by the Medical Epidemiologist and Associate Director for
Programs.
This HHS/CDC OVC staff members will work in close coordination with the USAID Senior OVC program
specialist and directly provide quality assurance and program monitoring to HHS supported implementing
partners including: University of Maryland-ACTION, Harvard SPH, Columbia University-ICAP, Catholic
Relief Services-AIDSRelief, Africare, IFESH, ECEWS, AIHA, Vanderbilt, APIN LTD, URC, Partners For
Development and partners to be determined by RFA in COP09. The HHS/CDC staff will also assist USAID
staff in joint monitoring visits of Family Health International-GHAIN, CEDPA, Hope Worldwide Nigeria, Hope
Worldwide South Africa, Christian AID, Society for Family Health, Catholic Relief Services - OVC project,
ABELINK, AIDSTAR, CHAN, Community Reach, Compass, CSN, ENHANSE, GECHAAN, Markets,
Measure, LMS Leader, LMS Associates, NELA, NEPWHAN, SCMS, Sesame Workshop, Winrock and
USAID APS partners in COP09. USAID and CDC OVC staff will provide assistance as needed to the U.S.
Department of Defense program with the Nigerian Ministry of Defense.
HHS/CDC and USAID OVC staff will provide technical support and capacity development to new partners
undertaking OVC activities through the New Partner Initiative as well as provide support to the Government
of Nigeria at the national and state levels to promote Nigeria national OVC guidelines and the "OVC
National Plan of Action." It is estimated that the OVC staff under this activity will provide monitoring and
support to over 250 OVC program sites in COP09.
Continuing Activity: 13139
13139 5419.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $130,000
6792 5419.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $100,000
5419 5419.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $25,000
Table 3.3.13:
This activity is a continuation from COP08. This HCT activity relates directly to all Nigeria HCT COP09
activities (see references in narrative below).
The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has one full time
Program Specialist staff position for HCT, approved and hired under COP07 authority and funding. The
budget includes funding for one FTE FSN salary, funding for (limited) international and required domestic
travel, for training and for minor support costs. Funds are not requested in COP09 for international TA as
this is understood to be funded by the HQ operational plan (HOP). This staff member is supervised by a
Senior Clinical Services Manager across all Care and Treatment program areas.
The HHS/CDC HCT staff member will work in close coordination with the USAID HCT staff. They will be
responsible for providing strategic leadership and technical support to the Government of Nigeria as well as
to USG (CDC, USAID and DoD) partners, including: University of Maryland-ACTION, Harvard School of
Public Health, AIDSRelief, Columbia University School of Public Health-ICAP, Africare, IFESH, ECEWS,
Vanderbilt University, APIN LTD, URC, Pro Health, Partners for Development, Pathfinder, Population
Council, Johns Hopkins University/Jhpiego, Dept of Defense, and USAID implementing partners funded to
conduct HCT activities.
The HCT team, working with the wider PEPFAR HCT team, with Government of Nigeria and with
Implementing Partner counterparts, provides oversight, supervision, capacity-building, technical assistance
and leadership for the TB/HIV interventions and services. HHS/CDC and USAID HCT staff will provide
technical support and capacity development to new partners undertaking HCT activities, including HCT in
TB/HIV DOTS sites and through the New Partner Initiative as well as provide support to the Government of
Nigeria at the National and State levels to promote Nigerian National HCT guidelines and training manuals.
It is estimated that the HCT staff under this activity will provide monitoring and support to at least 24
implementing partners in nearly 700 HCT sites in COP09.
The team's responsibilities include: 1) representing the USG in technical discussions with the GON,
particularly with the National HCT Technical Working Group, 2) overseeing technical aspects of the
programs, 3) interfacing with OGAC technical working groups, and 4) interfacing with the USG HCT
Technical Working Group including USG-supported IPs. The USG HCT team will work with partners and
GON to strategically focus PEPFAR resources in HCT to Most At Risk Populations (MARPs) using evidence
-based data from partners and from most recent surveillance activities. They will work with GON to identify
ways to continue to increase harmonization of PEPFAR resources with GON resources, such as the
utilization of HIV test kits procured by GON by PEPFAR IPs and within PEPFAR-supported sites. They will
also coordinate USG HCT activities with other key HCT initiatives such as the Global Fund Against
HIV/AIDS, TB, and Malaria and the National HIV Counseling and Testing Week.
CDC will also facilitate the clearance process of USG test kits and supplies entering Nigeria through
diplomatic shipments for PEPFAR implementing partners.
Continuing Activity: 13140
13140 6816.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $120,000
6816 6816.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $100,000
Table 3.3.14:
These funds will be used by CDC for the preclearance fees of perishable ARV drugs for HHS treatment
partners in Nigeria including University of Maryland, Harvard University SPH, APIN LTD, Columbia
University SPH, Catholic Relief Services, Partners for Development, Vanderbilt University, and University
Research Co. In COP09 a larger portion of the ARVs will be procured through SCMS for all PEPFAR
Nigeria treatment partners, and embassy clearance charges for these ARV drugs charged directly to CDC.
The total value of ARV drugs to be cleared by CDC is estimated at $80,000,000.
Continuing Activity: 13141
13141 12436.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $350,000
12436 12436.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $50,000
Table 3.3.15:
This activity is a continuation from COP08. In COP09 there is an increased emphasis on Quality
Assurance/Quality Improvement protocols within the PEPFAR program and the national program. Work
with the GON will include sensitization towards the development of national level laboratory QA programs.
This HLAB activity relates directly to all Nigeria LAB COP09 activities (see references in narrative below).
To support the USG Nigeria laboratory program, the HHS/CDC Global AIDS Program (GAP) Office in
Nigeria has seven full time staff positions (one US Direct Hire, one FSN senior laboratory specialist, and five
FSN laboratory systems specialists focused on laboratory quality assurance/ site monitoring, HIV molecular
studies (viral load and infant diagnosis), surveillance, blood and injection safety, and procurement/inventory
management to support the Laboratory Infrastructure program area. A partial FSN laboratory systems
specialist was hired in 2007 to focus on TB/HIV lab activities and is funded under TB/HIV. The budget
includes one USDH and seven FSN salaries, funding for (limited) international and required domestic travel,
this is understood to be funded by the HQ operational plan (HOP).
These HHS/CDC staff members will work in coordination with the USAID/DOD ART and Lab staff. The
HHS/CDC Nigeria Lab Scientist (USDH) holds a USG Lab TWG co-chair position for laboratory issues and
programmatic monitoring. The HHS/CDC Nigeria Lab Scientist (USDH) also provides leadership to the
PEPFAR-Laboratory Technical Working Group which meets every month. This monthly meeting serves as
a forum for receiving updates from the IPs, identification/sharing of best practices, presentations by visiting
lab experts and reviewing expansion plans. Membership includes lab focal persons from all the USG
agencies (HHS/CDC, USAID and DOD), and lab implementing partners (IPs) which include: University of
Maryland-ACTION, Family Health International-GHAIN, Harvard SPH, Catholic Relief Services-AIDSRelief,
Columbia University SPH-ICAP, LMS Associates, Vanderbilt University, Partners for Development,
University Research Company (URC), APIN LTD, Axios, Federal Ministry of Health, NEPWHAN, CHAN,
and new partners identified through HHS/CDC RFA and USAID APS mechanisms. Laboratory
Management staff will also coordinate the technical services of contracted laboratory consultants: Clinical
and Laboratory Standards Institute (CLSI), American Society for Clinical Pathology (ASCP), Association of
Public Health Laboratories (APHL) and American Society for Microbiology (ASM).
As part of the USG Nigeria team, HHS/CDC Nigeria laboratory staff will provide support to the Government
of Nigeria at the national and state levels to promote Nigerian national ART laboratory quality assurance
guidelines, support the development of a National Laboratory Strategic Plan, support implementation of a
standard tiered lab equipment platform for HIV clinical monitoring, continue the support for the
implementation of a national network for Early Infant Diagnosis (EID), support improved TB and malaria
capability, support the Field Epidemiology and Laboratory Training Program (FELTP), provide Quality
Control (QC) of all HIV Rapid Test Kits procured for the PEPFAR program, and conduct the Rapid Test Kit
Evaluation phases II and III. The HHS/CDC Nigeria laboratory staff will also be significantly involved across
the areas of PMTCT, Surveillance, Counseling and Testing, TB/HIV, Safe Blood and Safe Injection where
laboratory issues arise.
particularly with the national HIV lab program, 2) overseeing technical aspects of the program, including
program management and oversight of partners to ensure high-quality and accountable programs, 3)
interfacing with OGAC technical working groups, and 4) interfacing with the USG Laboratory Technical
Working Group. They will also work in coordination with the DoD and USAID laboratory staff and their
partners (noted above). This coordination will be in the form of joint work plans, regular meetings and
CDC will also facilitate the preclearance process of perishable lab supplies entering Nigeria through
Continuing Activity: 13143
13143 5390.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $610,000
6788 5390.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $905,740
5390 5390.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $670,000
Table 3.3.16:
This activity is a continuation from COP08. New in COP09 are the 2010 HIV sero-prevalence survey in
antenatal clinics, an integrated bio-behavioral survey (IBBS) among high risk groups and two additional
public health evaluations which have been submitted for funding in COP09.
The USG team, through the HHS/CDC Global AIDS Program (GAP) office in Nigeria has ten full time staff
positions planned for the Strategic Information (SI) program area. This includes one USDH, a senior SI
manager, three HIV surveillance specialists, two HMIS program specialists, two monitoring and evaluation
officers, and a junior support officer. The budget includes salary and expenses for one USDH and nine FSN
salaries, funding for (limited) international and required domestic travel, training funds and allocated minor
support costs. Funds are not requested in COP09 for international TA as this is understood to be funded by
the HQ operational plan (HOP).
These ten staff members will work in coordination with the USAID Strategic Information staff members and
directly provide joint quality assurance/quality improvement (QA/QI) strategies and programmatic monitoring
to HHS and USAID supported implementing partners. The SI team, while developing and updating the USG
database will provide oversight and technical support to PEPFAR partners and the GON and will also
strengthen their M&E systems through feedback and capacity building. The HHS/CDC Nigeria SI staff will
also be significantly involved across the other PEPFAR programmatic areas where data collection and
interpretation issues arise.
The HHS/CDC SI team's responsibilities include: 1) representing the USG in technical discussions with the
GON, particularly in relation to National surveys and the National Monitoring and Evaluation framework, 2)
overseeing technical aspects of the program, including program management and oversight of partners to
ensure high-quality and accountable programs, 3) interfacing with OGAC technical working groups, and 4)
interfacing with the USG SI Technical Working Group. They will work in coordination with DoD and USAID
SI staff in conducting these activities. This coordination will be in the form of joint work plans, regular
meetings and communication between agencies, and joint internal and external TA to partners.
The USG SI team has set up a national HIVQual team and by end of COP08 will have rolled out the
HIVQual program in 40 treatment sites. In COP09, HIVQual will be implemented in all treatment sites in the
country. The HIVQUAL activity involves building capacity in performance measurement, quality
improvement, and infrastructure development at the facility level. HHS/CDC will continue to develop
measurement tools for compliance and performance according to national standards and will provide quality
assessment in other program areas to ensure that implementing partners and service delivery points are
complying with these standards. HIVQual is budgeted at $750,000 under SI and has linkages to Adult and
Pediatric Care and Treatment Services, PMTCT, OVC and HIV counseling and testing.
In 2008 the HHS/CDC GAP Nigeria SI and laboratory staff have provided technical assistance to the
Nigerian Federal Ministry of Health (FMOH) to develop local capacity for SI and to plan and conduct the bi-
annual HIV sero-prevalence sentinel survey (ANC). In this national survey the team assisted in the
development of survey instruments including survey protocols and questionnaire, training of field staff, field
supervision, coordination meetings, quality assurance and data management. In COP09 the USG SI team
will continue its support of the FMOH through technical assistance including survey activities. Under
COP09 the USG will initiate planning (including commodity procurements) and development of survey
instruments for the next ANC survey; this activity is budgeted at $1,700,000. The USG is also funding
FHI/GHAIN to conduct a second round of the integrated biological and behavioral surveillance survey
among high-risk groups to monitor the trend of HIV prevalence and key behavioral indicators in these
populations.
In COP09 the USG SI team also expects to have results from other COP08 SI activities that can be utilized
to better direct program activities. These include the HHS/CDC evaluation to assess the utility of PMTCT
program data for HIV surveillance, an incidence survey focused on a specific population - pregnant women
attending antenatal care (ANC) clinics, a drug resistance threshold survey to examine whether standard first
-line ARVs will continue to be effective due to viral mutagenecity by assessing the level of transmitted
resistance in drug-naïve populations. An ongoing HHS/CDC GAP activity started in COP06 is Nigeria's
participation in a multi-country HIV drug resistance monitoring project which was implemented in 2 ART
sites in COP08. In COP09 this study will be expanded to 10 additional sites. This study will continue to
monitor the emergence of HIV drug resistance (HIVDR) during a client's first year of ART and evaluate
potentially associated program factors on which action could be taken to optimize ART program functioning
for HIVDR prevention. This HIV drug resistance monitoring activity is budgeted at $500,000.
The USG SI team will also be involved in TB/HIV evaluation activities. CDC SI staff will collaborate with the
TB/HIV working group and other stakeholders in Nigeria to conduct a National TB Drug Resistance and HIV
Survey to estimate rates of TB/HIV co-infection and to assess the prevalence of drug resistant tuberculosis
(MDR and XDR) in patients attending TB/HIV clinics in Nigeria (approved and funded under COP08).
Public Health Evaluations (PHE) started in COP08 will continue to be monitored. These include a)
Evaluation of intensified TB case finding (ICF) to reduce early mortality in ART eligible patients, b) How to
Optimize PMTCT Effectiveness (HOPE) Project: a Multi-Country PEPFAR Public Health Evaluation
Proposal and c) Evaluating the impact of Task Shifting for ART Delivery on Patient and Process Outcomes.
Two new PHEs have been proposed for COP09. These include: a) Determining the impact of PEPFAR HIV
-related services on other health services in health facilities and on the broader health system and b)
Evaluation of Patients in Pre-ART Care and Interventions to Improve their Retention. The USG SI team will
work with other technical staff, USG PEPFAR implementing partners and GON to implement these
evaluations activities.
These projects, through different approaches, seek to improve the quality of USG-sponsored HIV
prevention, care and treatment programs, while ensuring adequate use of resources, reducing harm, and
reducing the emergence of resistant strains of HIV that may accompany non-adherence. Further details
Activity Narrative: about proposed surveillance activities can be found in Table 5.5.
In order to successfully develop and interpret SI and implement evidence-based HIV/AIDS programs and
policies, Nigerian HIV/AIDS program managers and policymakers must be able to generate, analyze, and
interpret quantitative information. They must critically evaluate and use data generated by epidemiologic
studies, surveillance, program monitoring, public health evaluations (PHEs) and similar efforts. USG
PEPFAR Nigeria will, in collaboration with the Federal Ministry of Health and two Nigerian universities,
provide training for public health HIV/AIDS managers in field epidemiology. This includes training of state
and national level program managers in relevant short course topics and enrollment of a selected cohort
into the two-year long course for the award of a master's degree in field epidemiology through this Field
Epidemiology and Laboratory Training Program (FELTP). The FELTP program operates under a Steering
Committee chaired by the Director of Public Health and including key stakeholders from the Ministry of
Agriculture, Ministry of Health, academic institutions, HHS/CDC, and recognized national experts. FELTP is
funded under System Strengthening and has linkages to SI and service delivery program areas.
Continuing Activity: 13144
13144 5358.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $2,775,000
6785 5358.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $1,350,000
5358 5358.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $731,333
Table 3.3.17:
FY08 CollaborativeNigeriaNG.08.0205Multi-countryHRHImpact of Task Shifting Type II for ART Delivery on
Patient and Process Outcomes in Emergency Plan Countries
Estimated amount of funding that is planned for Public Health Evaluation $52,215
Table 3.3.18:
To support the USG Nigeria health system strengthening program, the HHS/CDC Global AIDS Program
(GAP) Office in Nigeria has nine full time staff positions planned in COP09. These nine staff comprise the
Capacity Development Coordinating Unit and cover cross-cutting issues. The capacity development
coordinating unit utilizes the paired leadership model (1 US Direct Hire paired with 1 senior Nigerian) to
manage the unit, thereby building capacity of the Nigerian staff in the management and leadership of the
PEPFAR program. This model is also used to manage the CDC Program Services Branch and the CDC SI
Unit. The capacity development coordinating unit includes 3 US Direct Hire (USDH) positions (previously
approved as PSC positions, restructuring based on DHHS approvals), and 6 FSN (network coordinators,
training coordinator, quality improvement specialist, health system strengthening specialist). The budget
includes three USDH and six FSN salaries, funding for (limited) international and required domestic travel,
These HHS/CDC staff members will coordinate with USAID/DOD staff, in clinical service provision,
prevention, and SI program areas. Additionally, the staff work closely with the GON (Federal Ministry of
Health, Federal Ministry of Education, State Ministries of Health, the National Agency for the Control of
AIDS) and the PEPFAR implementing partners in the advancement of initiatives such as referral networks,
implementation of the hub and spoke model of service provision, standardization of training packages,
implementation of continuous quality improvement systems, and human capacity development. In addition,
two significant USG initiatives in health system strengthening are supported in this program, the West
African Infectious Disease Institute and the Nigerian Field Epidemiology, Veterinary and Laboratory Training
Program.
In COP09, USG will continue to build on the gains of the development of the West African Infectious
Disease Institute (WAIDI) activities started in COP08 in a proposed collaboration with Exxon Mobil. COP08
activities include the planned training of 20 master trainers who will be identified from the PEPFAR
implementing partners, Abuja College of Medicine, GON and USG to attend a 4-week customized workshop
and training course at the Infectious Disease Institute (IDI) in Kampala, Uganda using a standardized ART
training curriculum that was prepared in COP08. The overall goals of the course are to develop a group of
highly skilled, advance trainers, in the ART program area and to establish a broad support base for WAIDI.
There has been direct involvement of the Government of Nigeria (GON) in the ART curriculum development
process and in the broader discussions about the creation of a WAIDI.
Under COP09, the master training conducted under COP08 as described above will be followed by step
down training courses (conducted by the initial cohort of 20 master trainers) in the six geopolitical zones of
Nigeria. The trainees in these step-down trainings have been identified, and will be comprised of 130
Nigerians who had previously been trained at the IDI in an ART program. The graduates will be enlisted to
participate in a 2-week master training program, thereby developing a much larger pool of master trainers
nationwide.
ACCORDIA Foundation, USA (an organization that was instrumental in the development of the Ugandan
IDI) has conducted an advocacy visit and fact finding mission to Nigeria in COP08. During this visit, the
proposed WAIDI plans were discussed and advocacy visits to the GON were conducted. In COP09, the
USG WAIDI team will further develop its collaborations with ACCORDIA Foundation in the planning and
development of WAIDI, including the exploration of private sector interests such as Exxon Mobil and
associated resources to sponsor other phases of the WAIDI project. Another initial activity in this
partnership and the long term management of WAIDI will be the formation of a Nigerian chapter of the
Academic Alliance. This will begin with the identification and assembly of a team of 6 to 8 university
professors in the specialty areas of HIV/AIDS and other infectious diseases (such as malaria and
tuberculosis) through advocacy to their various institutions. The WAIDI team will also collaborate with the
ACCORDIA Foundation, the GON and the Abuja College of Medicine in the identification of a site within the
Abuja metropolis to serve as a temporary site to key start activities of WAIDI in the clinical training area.
Under COP09, $700,000 will be devoted to the scale-up of this project.
Another key USG activity, in the area of Health System Strengthening, is the Nigerian Field Epidemiology,
Veterinary and Laboratory Training Program (N-FELTP) modeled after CDC's Epidemic Intelligence Service
program. N-FELTP commenced in Nigeria in 2007 and since then has trained 164 public health
practitioners from 30 states in five short courses and currently has 13 persons enrolled in the first 2-year
MPH degree awarding long course. The N-FELTP program is a collaborative activity with funding from not
only CDC PEPFAR but also from USAID's avian influenza program and from the WHO, as well as in-kind
contributions from the Government of Nigeria including a training/office facility and a part time program
administrative assistant. It also involves critical collaborations with 2 Nigerian universities that have
approved the curriculum and are providing MPH degrees to graduates. The initial short courses have led to
significant improvement in surveillance activities and outbreak response across the federation leading to
evidence-based decision making. The collaborative nature of the N-FELTP program is exemplified in the
MPH program which has training for field epidemiologists, veterinary epidemiologists and laboratory
scientists in HIV/TB and other issues of public health importance, addressing the "one health" concept.
While the short courses seeks to provide immediate personnel to strengthen the state public health
systems, the long course is designed to train and produce public health administrators to re-engineer the
national public health systems. The training is conducted in collaboration with the National Universities
Commission, Federal Ministry of Health and two focal Nigerian universities, with linkages with African Field
Epidemiology Network (AFENET) and Training in Epidemiology and Public Health Interventions Network
(TEPHINET). The broad base of support that the program enjoys in country contributes to its sustainability.
The goal of N-FELTP is to build capacity and epidemiological service provision at the local, state, and
federal level. COP09 funding for the activity implementation is $700,000.
The USG, through these activities, will ensure leadership in system improvements and capacity
development at the national, state, and local levels. The capacity development coordinating unit will
Activity Narrative: facilitate transition and address issues as the PEPFAR Nigeria program transitions from an emergency plan
under PEPFAR I to a sustainability plan under PEPFAR II. The WAIDI program is the beginning of a long
term sustainability plan for improved, consolidated, national level clinical training. The FELTP will ensure
sustainability through the involvement of graduates in the program, as well as by placing graduates back
into their positions within the state and national Ministries of Health.
The GON and implementing partners are targeted for continued improvements in linkages and
advancement of networks of care. Additionally, physicians, laboratory scientists, nurses, and other
healthcare workers with a basis in ART are targeted for training as master trainers under the WAIDI
program. The FELTP trainees that are targeted for training are physicians, epidemiologists and
laboratorians who work within the state and Federal Ministries of Health.
COVERAGE AREAS:
This program is national in its scope as the trainees will come from any of the 36 states or the Federal
Capital Territory.
These HHS/CDC PSC staff positions will work in coordination with the Federal Ministry of Health, Federal
Ministry of Education, Federal Ministry of Agriculture and the Federal Ministry of Defense to provide
mentoring and technical assistance related to epidemiology, strategic information, clinical and laboratory
services.
EMPHASIS AREAS:
The emphasis areas for this activity are human capacity development and system strengthening.
Continuing Activity: 13145
13145 12447.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $675,000
12447 12447.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $750,000
Estimated amount of funding that is planned for Human Capacity Development $700,000
ACTIVITY DESCRIPTION: This narrative describes the CDC Nigeria M&S needs for both GHCS and GAP
funds. The CDC Nigeria M&S budget, including GCS and GAP funding, has been vetted through the
interagency decision making process and agreed to as presented in the COP09 submission.
The USG Nigeria team's M&S goal, through the HHS/CDC office in Nigeria, is to have sufficient staff for
COP09 to provide more technical and programmatic oversight and assistance to all implementing partners
in Nigeria. The CDC M&S budget in COP09 supports the USG interagency team process of providing
technical assistance and monitoring of PEPFAR activities across a significant array of implementing
partners in Nigeria, which is the second largest PEPFAR country based on the established 2009 end
targets. Geographic size of the country, 25% larger than Texas, also influences the USG staffing needs to
provide monitoring of activities. Dramatic expansion of the Nigeria PEPFAR program in COP08 has more
than doubled the number of ARV treatment partners from seven to sixteen by end of COP08. Direct country
project officer oversight at CDC is in place for eight of the sixteen treatment partners working in nearly 300
clinical sites (Harvard University SPH-APIN, University of Maryland-ACTION, Columbia University-ICAP,
Catholic Relief Services-AIDSRelief, Vanderbilt University, Partners for Development, APIN LTD and URC).
Additionally, HHS has fifteen other cooperative agreements supporting a broad range of implementing
partner activities in Nigeria such as laboratory, safe blood, TB/HIV, OVC and PMTCT. RFA awards in
COP08 have added ten new HHS/CDC funded partners with an eleventh additional new award, to the
FMOH HIV/AIDS Division, in process. COP09 RFA awards will likely add 1-2 new partners. These new
partners will need rapid integration and agency management to influence achievement and progress
towards Nigerian national and PEPFAR goals.
To achieve the goals of effective technical assistance to the Government of Nigeria and joint USG oversight
of implementing partners, the CDC Global AIDS Program (GAP) Office in Nigeria has planned for full
staffing at 81 positions in FY09, which is a level total number of staffing as approved in COP08. Some of
the previously approved positions, however, have been adjusted to reflect changes in program
management; for example, the decision reached with the US Mission to indefinitely delay the opening of a
CDC-supported PEPFAR office in Lagos due to Mission support constraints. Those positions have been
incorporated into respective support in the Abuja office. Presently 57 of the 81 approved COP08 positions
have been filled and five positions are under recruitment, including three US Direct Hire (USDH) positions
which are in the selection process.
The COP09 HHS/CDC staffing plan includes 10 USDH that are comprised of the Chief of Party, Deputy
Director, Associate Director for Epidemiology & Clinical Programs, Associate Director for Laboratory
Science, Associate Director for Management and Operations, Associate Director for Program Monitoring
and Evaluation, Associate Director for Program Administration, Associate Director for Health Systems
Strengthening, and Resident Advisor and Laboratory Advisor for the CDC Field Epidemiology and
Laboratory Training Program. Due to safety and security issues, the PEPFAR team and US Mission have
decided in 2008 to delay plans to open a CDC-supported PEPFAR field office in Lagos. The positions
planned for the Lagos PEPFAR Field Office in COP07 and COP08 have been transitioned to the Abuja-
based office and will support activities in the Lagos area. Two PSC positions approved in COP08 are
planned to transition to USDH positions and have been approved by HHS; they are included in the total
above. It is not expected that these USDH positions will be filled immediately in COP09 due to the timeline
for incorporation into US Mission management support plans and Mission approval, followed by recruitment,
selection and relocation. A further breakdown of total staff requested includes 35 FSN technical staff
(funded under specific program areas and M&S), 1 PSA technical staff, 1 PSA administrative staff and 35
M&S FSN support staff including 23 administrative, finance and IT staff plus 12 drivers. The attached
supporting documents include a full USG PEPFAR Nigeria organizational chart. The specific disciplines of
technical staff were determined through an interagency staffing for results process that allows for
complementary staffing across agencies. While some technical positions in program areas are duplicative
for agencies, that duplicity is based on the total size of COP09 programming and the minimum time required
to adequately monitor field work of partners and provide technical assistance to the Government of Nigeria.
Additionally, an independent review of USG staffing management and plans is scheduled for Q1 FY09.
This analysis will assist the team in identifying any gaps and will provide guidance on management and
staffing needs. As the program moves into PEPFAR II, the team will need to ensure appropriate focus on
programmatic oversight, technical assistance to support the GON, and development and implementation of
the PEPFAR Compact.
M&S costs are inclusive of rent for offices and warehouse space, utilities, office operational costs, M&S
specific equipment, M&S specific staff inclusive of all associated costs, travel for M&S staff, training for M&S
staff, general ICASS charges, ICASS and CSCS for M&S staff, relocation costs of USDH M&S positions
expected in FY09, residential leases and post allowance for 10 USDH M&S positions, security services for
offices/warehouse, and communications costs. This COP09 submission does not include HQ TA support in
keeping with COP09 guidance that this will be funded through the Headquarters Operational Plan process.
ICASS charges of $1,169,376 and CSCS charges of $623,803 are budgeted separately in their own
activities as required by COP09 guidance.
Reprogramming: during the April 2009 reprogramming, $150,000 was programmed into this activity to
support the development of Nigeria's PEPFAR Partnership Framework.
Continuing Activity: 13146
13146 6566.08 HHS/Centers for US Centers for 6397 1561.08 HHS/CDC Track $1,984,840
6794 6566.07 HHS/Centers for US Centers for 4187 1561.07 HHS/CDC $1,050,000
6566 6566.06 HHS/Centers for US Centers for 2783 1561.06 HHS/CDC $925,626
Table 3.3.19:
