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 HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In COP09, ICAP will continue to work in the six states of Kaduna, Cross River, Benue, Kogi, Akwa Ibom and
Gombe.
A total of 100 existing Government of Nigeria (GON), mission and private health facilities will continue to
receive support to provide PMTCT services and community outreach activities through existing hospital
networks. These networks, which will include 30 secondary health facilities and 70 primary health centers
(PHCs), will provide HIV counseling testing and results to 57,100 pregnant women and be linked into
appropriate care and treatment programs.
ICAP will train 650 healthcare workers (HCWs), support infrastructure, purchase equipment and supplies,
monitor, evaluate and provide supportive supervision to the sites. ICAP, with other implementing partners,
will continue to support the implementation of the PEPFAR-Nigeria local government area (LGA) coverage
strategy in Kaduna and Kogi, ensuring the provision of PMTCT services in at least one health facility in
every local government area for designated states. In these states ICAP will actively engage the state level
ministry of health to improve leadership and management of PMTCT programming in each state. Active
efforts will be made to facilitate the public health approach in taking PMTCT services to the PHCs and
community levels.
In COP09, ICAP will support comprehensive PMTCT services for communities, including HIV testing for
pregnant women. ICAP will work to increase uptake of these services, including routine antenatal care and
facility-based deliveries. ICAP will support PMTCT activities through these approaches: HIV counseling and
testing (HCT) for all pregnant women (ANC, labor and postpartum period); ARV interventions dispensed in
ANC and maternity for HIV-positive women; integrated routine group counseling into other health services
attended by pregnant women and women of childbearing age; provision of services for well or sick children
(immunization clinic); linkages to family planning and sexually transmitted infections (STI) clinics; and
integration of HAART into maternal child health (MCH) services at comprehensive ART sites. Pregnant
women, especially HIV-positive mothers, will be supported to deliver in health facilities through the provision
of the national safe motherhood program delivery kits ("mama kits"). Mothers-to-Mothers support groups will
be established and/or strengthened to increase facility-based delivery and reduce the number of women lost
to follow-up. ICAP will support and train mentor mothers who will spearhead mother-to-mother support
groups at PMTCT sites. Mentor mothers will conduct peer counseling to newly diagnosed HIV-positive
pregnant women, adherence counseling to women on ARV prophylaxis or HAART, and default tracking for
positive mother-baby pairs. The use of ART for PMTCT will follow the National PMTCT guidelines. HIV-
infected women ineligible for ART will be offered a combination of zidovudine (AZT) from 28 weeks or
Combivir from 34/36 weeks and single dose nevirapine (SD-NVP) at onset of labor. All positive women
ineligible for HAART will receive a Combivir tail as part of their regimen. Women presenting in labor will be
offered rapid testing and, if HIV-infected, provided with SD-NVP. All infants born to HIV-infected women will
be provided with SD-NVP at birth and AZT for 6 weeks. 3,300 mother-baby pairs will receive ARV
prophylaxis. Through appropriate infant feeding counseling and follow-up, ICAP will provide support for a
mother's infant feeding choice as well as provide ongoing psychosocial and adherence support. HAART
eligible women (20% of positive women) will be enrolled at the nearest comprehensive site through referral
and linkages. Health facilities will be supported to provide basic laboratory services and, if not available on
site, will be linked to a laboratory in which CD4 testing can be performed by logging samples through
specimen transport systems. ICAP will provide support for CD4 capability to high volume PHCs. Exposed
infants will be actively linked to pediatric care and treatment through under-5 cards issued in labor and
delivery. Women who test HIV-negative will receive prevention counseling and appropriate support to
remain negative.
ICAP programming will emphasize group counseling and opt-out testing with same day results at ANC,
labor and postpartum service delivery points. Partners, households and children will be linked into HCT.
ICAP will actively promote community-based PMTCT services through CBOs to provide "doorstep"
counseling services to pregnant women, their partners and other household members during home-based
care activities. Clients will be counseled on the beneficial effect of couple/partner HCT and disclosure on
adherence to infant feeding choice. Eligible HIV-infected women will be assessed and linked into care and
treatment services including ART and cotrimoxazole prophylaxis (CTX). Other activities are enhanced
pediatric care including CTX from 6 weeks of age and promotion of best practices for infant feeding,
nutritional support and linkages to family planning services. ICAP will ensure that 330 HIV positive pregnant
and lactating women are provided with food and nutritional supplementation. In addition to receiving PMTCT
services, each woman will be referred to OVC services upon her HIV diagnosis in order to facilitate care to
all of her affected children. ICAP will actively encourage male circumcision as a preventive measure
especially in Kaduna and Gombe states.
Identification and follow-up of HIV-infected and exposed children living within the community will be a
priority with CBOs/FBOs assisting with adherence issues and defaulter tracking. ICAP will continue to
implement a basic minimum package of care services to exposed infants at PMTCT/HCT-only sites. This
would ensure that exposed infants are linked into care and prevent loss to follow-up. The minimum package
includes: simplified Exposed Infant Registers for data capturing, prophylactic ARV syrups (NVP and AZT)
within exposed infant/immunization clinic, HCT services at immunization clinics and for women with
unknown HIV status. To implement these services at the PHC level, ICAP will train PHC staff to encourage
task shifting in the care of HIV exposed infants. ICAP will also support training of non-lab personnel in HCT
and utilize lay counselors as well as peer health educators to improve care and support services.
ICAP and its sub-partners will train 650 HCWs using GON curricula to provide quality services to HIV-
infected pregnant women. The training will focus on prevention messaging (including balanced ABC
messaging as appropriate), STI screening and treatment, safer sex, nutrition, malaria prophylaxis, use of
ITNs and safe water. It is estimated that about 15% of babies born to HIV-positive women will become HIV-
infected through mixed feeding. To reduce this risk, ICAP will provide unbiased infant feeding counseling to
mothers based on WHO/GON recommendations (exclusive breastfeeding or use of breast milk substitute
based on AFASS criteria). ICAP will facilitate the government's efforts in improving infant feeding
counseling by supporting a zonal training of trainers on HIV and infant feeding. ICAP will also support infant
Activity Narrative: feeding meetings and reprinting of National guidelines. 100 additional health care providers will also be
trained to educate and assist mothers make appropriate infant feeding options and discourage mixed
feeding practices.
Home deliveries remain a very strong preference among many communities in Nigeria as two-thirds of
pregnant women either deliver with birth attendants or in their homes (DHS, 2005; Piper CJ, 1997). In order
to reduce the number of HIV-positive mothers and their exposed infants lost to follow-up after home
deliveries, ICAP will support community sensitization and organization and capacity building of 200
traditional birth attendants (TBAs) across communities surrounding PMTCT sites in the six ICAP- supported
states. TBAs will be trained on basic HIV prevention and infection control, the need for HIV counseling and
testing especially among pregnant women, and their role in referrals of newly delivered mothers and their
babies for follow-up care. Retired midwives and healthcare providers will be identified to monitor effective
case finding and referrals of pregnant women, newly delivered mothers and their exposed infants to nearby
PMTCT sites for enrolment into care.
ICAP will address the critical challenge of limited/lack of male partner involvement in PMTCT services and
will strengthen male involvement through gender transformative activities. Through ‘Men taking Action'
ICAP will strive to increase service uptake, promote positive male norms and behaviors (especially as it
relates to discordant couples) and help reduce stigma and discrimination through community-based
activities. These activities include community education/behavioral change communication (EBCC),
outreach HCT at male-friendly HIV/AIDS events, use of trained community leaders/gate keepers to conduct
EBCC, deliver accurate messages related to PMTCT and offer HCT to male partners of pregnant women
attending ANC.
ICAP will work in close partnership with GON on HIV early infant diagnosis, offering HIV infant diagnosis
testing in line with the National Early Infant Diagnosis Initiative from 6 weeks of age using dried blood spots
(DBS). HIV-positive infants will be enrolled and linked to appropriate care and treatment. A joint
USG/GON/ICAP team will provide ongoing monitoring and evaluation (M&E), provide supportive
supervision, and contribute to the national PMTCT program's M&E efforts. ICAP is also earmarking
USD125,000 for procurement of goods and supplies through the SCMS mechanism.
CONTRIBUTIONS TO OVERALL PROGRAM GOAL:
ICAP and its sub-partners target states with some of the highest seroprevalence rates in Nigeria. Providing
services at the primary and secondary levels assists the GON in achieving its goal of decentralizing PMTCT
services beyond the tertiary care level. ICAP will significantly contribute to an increase in PMTCT services
by supporting 100 existing primary and secondary healthcare facilities, (government, mission and private
facilities) and also indirectly supporting GON ministries/programs in their rapid scale-up plans for PMTCT.
ICAP will partner with local institutions with appropriate expertise and capacity to reach out to primary
facilities in line with national PMTCT scale-up plans.
The targets of 62,817 pregnant women counseled and tested and 3,300 mother-infant pairs for ARV
prophylaxis will be reached by the end of COP09. This will significantly contribute to the emergency plan
targets of increased national coverage and reduction in PMTCT transmission. ICAP will strengthen national
and state PMTCT programs by: support of capacity building of master trainers for PMTCT services;
production of GON-approved infant feeding support tools; printing of national PMTCT registers; and support
of regular coordination meetings in collaboration with other partners at national and state levels. ICAP will
also strengthen the programmatic skills of partner community and faith-based organizations (CBOs, FBOs)
in line with GON sustainability plans.
LINKS TO OTHER ACTIVITIES:
This activity is related to activities in adult and pediatric care and treatment, OVC, counseling and testing,
SI, lab, and sexual prevention. Provider-initiated opt-out HCT will be offered to all pregnant women at ANC
and to their partners. Women presenting in labor will have rapid HIV tests and receive single dose NVP if
positive. Infants born to HIV-infected women will access ART (single dose NVP and ZDV) and CTX
prophylaxis. Infant PCR HIV testing via DBS will be conducted, with HIV-positive infants linked to
appropriate OVC care and treatment services. Linkages will enable HIV-positive women and family
members access to support groups. All pregnant women will be linked into family planning services. Partner
counseling/communication will be promoted through sexual prevention activities. M&E activities at PMTCT
sites will contribute to the national PMTCT program's M&E efforts using national PMTCT management
information systems.
POPULATIONS BEING ADDRESSED:
Pregnant women, postpartum mothers, their partners and household members, including HIV exposed
infants and HIV infected children, will be targeted and supported so that they have full access to HCT at
multiple entry points of care. HIV infected women will be provided with PMTCT/PMTCT-plus services, while
HIV infected infants/children and infected partners will access care and treatment services, including OVC
services. Uninfected women will be supported to remain HIV-negative. CBOs, FBOs, support groups and
men will also be targeted so that they participate fully in community based PMTCT services. Healthcare
providers will be trained on providing services while the management skills of GON policy makers and
implementers at all levels will be improved to enable them to manage programs effectively.
EMPHASIS AREAS:
Emphasis in this activity will be on training, increasing gender equity in HIV/AIDS programs, human capacity
development and SI.
Gender plays an important role in determining a woman's vulnerability to HIV infection and violence, her
ability to access care and treatment, and her ability to cope when infected or affected. This activity will
promote gender equity in HIV/AIDS programs and increase access to services by the vulnerable groups of
women and children. Emphasis will also be on primary prevention of HIV infection and prevention of
unintended pregnancies among women living with HIV. HCT services will be integrated in reproductive
health and family planning (RH/FP) services, while all PMTCT clients will be referred to access RH/FP
Activity Narrative: services post-delivery. The health status of HIV-positive women will be further enhanced by actively
screening them for TB. Recognizing the impact of male involvement on a woman's access to PMTCT and
HCT services, ICAP will use strategies to enhance partner testing, engagement in care and overall
awareness of HIV/AIDS.
In the public health approach, tasks can be shifted from more specialized to less specialized healthcare
workers. At comprehensive/high volume PMTCT/HCT-only sites "Mentor Mothers" will be trained to
spearhead support groups. They will also be trained to participate in peer/adherence counseling and
tracking of defaulting mother-infant pairs, thus further leveraging task-shifting. At the state government level,
training of trainers will build the capacity of state PMTCT task force members, provide an opportunity for
task shifting, and promote sustainability by engaging these state personnel in clinical system
mentoring/supervisory activities at sites.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13021
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13021 6622.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $2,000,000
Disease Control & University 2.0 Columbia
Prevention Mailman School of Univ SPH
Public Health
6699 6622.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $700,000
Disease Control & University Agreement
Prevention Mailman School of
6622 6622.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $600,000
Disease Control & University
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $216,666
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $35,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $25,345
Education
Water
Estimated amount of funding that is planned for Water $23,100
Table 3.3.01:
ACTIVITY NARRATIVE:
ICAP-CU will be a new partner in the program area of Abstinence/Be Faithful (AB) in COP08. ICAP-CU will
implement its AB programming activities in line with the overall PEPFAR Nigeria goal of providing a
comprehensive package of prevention services to individuals reached (thereby improving the effectiveness
of this messaging) through a balanced portfolio of prevention activities including condoms and other
prevention. Through the involvement of ICAP-CU as a new partner in this activity, PEPFAR Nigeria will
extend its reach with AB services as ICAP-CU will be active in six states (Akwa Ibom, Benue, Cross River,
Gombe, Kaduna, and Kogi) by the end of COP08.
ICAP-CU is currently providing prevention messages for positives (funded under care) to its large
population of adults, adolescents and children, and will add on AB messaging to these prevention activities
for increased balanced messaging.
In addition, ICAP-CU will target activities to HIV-negative persons in its catchment areas in order to
minimize their risk behaviors and contribute to an overall reduction in HIV prevalence. A key age group for
AB activities is youth/young adults aged 15-24 years as this encompasses the highest prevalence age
group. The 2005 ANC survey in Nigeria indicates that among age cohorts in Nigeria, the 20-29 year old age
group has the highest HIV prevalence (4.9% compared to a national prevalence of 4.4%). In addition, the
2005 National HIV/AIDS and Reproductive Health Survey (NARHS) demonstrated a low risk perception
(28%) among the general population and significant reports of transactional sex (11%) among young
women aged 15-29 years. This age cohort for both men and women represents the working age group in
Nigeria; it is expected that a combination of prevention messaging approaches will ensure they are reached
with prevention interventions.
In COP08 ICAP-CU will implement this activity at both the facility and community levels utilizing a
combination of multiple strategies in this implementation, including community awareness campaigns, peer
education models, peer education plus activities, and workplace activities (specifically Greater Involvement
of People with HIV/AIDS, or GIPA). Activities conducted at the local level by ICAP-CU will be reinforced
through national level mass media campaigns by other USG partners such as the successful Zip-Up
campaign. AB messages will be balanced with concurrent condoms and other prevention messaging where
appropriate and will be integrated with other PEPFAR services being provided at 25 hospital networks and
their surrounding communities which will serve as the platform for ICAP-CU prevention activities in the
coming year in six states. The goal of the program is to be focused on the communities targeted and to
cover those communities with messages conveyed in multiple fora. Utilizing such a methodology, a large
number of people will be reached with messages received via one method or another, but the target group
will be those individuals that will have received AB messaging: (1) on a regular basis and (2) via at least
three of the four strategies ICAP-CU will employ (community awareness campaigns, peer education
models, per education plus activities, and workplace programs). The target for this intensive AB messaging
campaign is 4,800 individuals. In addition, age appropriate abstinence only messaging and secondary
abstinence messaging will be conveyed to 2,400 children and adolescents, particularly focused on those
orphans and vulnerable children receiving both facility and home based support. A total of 375 health care
providers, counselors, and peer educators will be trained to conduct effective prevention interventions
inclusive of AB messaging.
ICAP-CU collaborates with several community based organizations (CBOs), faith based organizations
(FBOs), and PLWHA support groups at its facilities and surrounding communities in other PEPFAR
programming activities. These CBOs, FBOs and support groups will also serve as appropriate partners in
the dissemination of ABC messaging to other PLWHA utilizing the peer education model, and to wider
audiences through the peer education plus model and community awareness campaigns. The community
and peer education plus activities will be organized through CBOs and FBOs under the supervision of ICAP
-CU and will include activities such as drama presentations, musical events, and road shows/rallies. To
address stigma issues and in compliance with the GIPA principle, approximately 10 PLWHA from the pool
of those receiving treatment at facilities who are living openly and positively will be trained using the peer
education model on dissemination of ABC messaging. They will serve as peer educators to extended family
members and members of their support groups. These trained PLWHA will in turn reach individual cohorts
of at least 10 other persons from among their social peers. With 50 facilities (including PMTCT sites), this
will serve as an effective tool for reaching individuals in at least as many communities with balanced ABC
messages.
A community awareness strategy will also be employed to serve the catchment areas of the hospital
facilities which will be linked with community mobilization efforts promoting HCT. During static and mobile
HCT services, counselors will be disseminating balanced ABC messages to recipient communities and
clients through focused group discussions and interpersonal communication. With an HCT target of 112,500
clients getting counseled, tested and receiving their results, a minimum of this many clients will receive
balanced ABC messaging through this approach. The key messages that will be conveyed are delay in
sexual debut, secondary abstinence, mutual fidelity, prompt and complete treatment of all STIs and
promotion of need to ascertain HIV serostatus through HCT.
ICAP-CU will also implement the peer education model targeting job peers who are healthcare workers.
Healthcare workers at each site will be trained (the exact number will vary based on facility size) using
established national peer education curricula and each will be requested to form peer groups of
approximately 10 members from the healthcare worker community for dissemination of balanced ABC
messaging. It is anticipated that these healthcare workers will continually serve as conduits for age
appropriate prevention messaging not only for their work peers but also for their social peers and for all
clients with whom they come in contact.
A focus of the program in COP08 will be improvement of the integration of prevention activities into the HIV
care and treatment settings; specifically, healthcare providers and lay counselors in care and treatment
settings will be trained to appropriately deliver integrated ABC prevention messages and incorporate the
messages into routine clinic visits using IEC materials and job aids. An appropriate balance of abstinence
Activity Narrative: and be faithful, and correct/consistent condom use education will be tailored to the needs and social
situation of each individual client in its presentation. In addition to the integration of such services into the
HIV-specific treatment setting, prevention activities will be assimilated into other points of service in each
health facility (general outpatient clinics, emergency services, etc.), particularly into reproductive health
services including, family planning counseling, sexually transmitted infection management and counseling,
and risk-reduction counseling.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
ICAP-CU AB activities emphasize integration of prevention activities with treatment and care services. Use
of the community awareness campaigns, the peer educator model, and peer education plus activities
(community drama, dance events, etc.) allows dissemination of AB messaging, including integration with
condom messaging, from society-attributed sources of credible information - healthcare workers and
PLWHA. This program will contribute to the Global HIV/AIDS Strategy by reaching 4,800 people with AB
messaging and 2,400 people with abstinence only messaging in a comprehensive approach. The activities
will also address issues of stigma and discrimination through the education of individuals and communities
reached.
AB activities relate to HCT (5550.08), by increasing awareness of HIV. It also relates to care and support
activities (5552.08) through dissemination of information by home based care providers and ultimately by
decreasing demand on care services through decreased prevalence. Linkages also exist to condoms and
other prevention (9208.08) as a complementary prevention strategy and to OVC programming (5547.08) by
targeting orphans and vulnerable children.
POPULATIONS TARGETED:
Key populations targeted are youth, OVC, PLWHA, adults accessing HCT services at either static or mobile
within catchment areas of the treatment sites, support group members and immediate families of PLWHA.
Emphasis areas include human capacity development, workplace programs and gender.
AB activities promote a rights based approach to prevention among positives and other vulnerable
members of society and equal access to information and services. Reduction of stigma and discrimination
are also key to the program.
Continuing Activity: 15654
15654 15654.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $120,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $70,094
Table 3.3.02:
This activity also relates to activities in AB, Care and Support, ARV services, HCT, OVC and PMTCT.
In COP08, ICAP programming has expanded support from 10 to an additional 18 hospitals for a total of 28
hospital networks, located in 6 states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna, Kogi). In COP08,
ICAP implemented a balanced portfolio of prevention activities in abstinence, be faithful and condom and
other prevention (COP) programming in line with the overall PEPFAR Nigeria goal of providing a
comprehensive package of prevention services to individuals. ICAP implemented these activities at both the
facility and community levels utilizing a combination of strategies, including community outreach campaigns,
peer education models, a school-based approach (non-curricula based), infection control activities, sexual
transition infection (STI) management and treatment, and workplace activities (specifically, Greater
Involvement of People with HIV/AIDS, or GIPA).
In COP09, ICAP will provide support to a total of 30 hospital networks (28 existing and 2 new); these
facilities will serve as the platform for ICAP prevention activities in the coming year. ICAP will continue to
support abstinence (primary & secondary), risk reduction, and safe sex promotion activities among 30,152
individuals (10,251 males and 19,901 females). Targeted populations include: people living with HIV/AIDS
(PLWHA), out-of-school youth, transport workers. and people affected by AIDS. They will receive
abstinence, be faithful, and condom/other prevention messaging on a regular basis via activities such as
community outreach campaigns, peer education models, non-curricula based school approach, infection
control, STI management/treatment, workplace and skills acquisition, and essential life skills training.
Individuals who are counted as reached will have received at least 3 of these interventions in line with the
minimum prevention package requirement of the National Prevention Plan.
ICAP will reach out of school youth in targeted communities with messages of delaying sexual debut or
adopting secondary abstinence through focused small-group discussions, and inter-personal
communication strategies, non-curricula school based approaches, and essential life skills training. ICAP
will encourage PLWHAs and care givers to engage in productive income generating activities by providing
training on essential life skills and referring PLWHAs to other partners who provide services not available
through ICAP. ICAP will continue to support PLWHA peer health educators to help other PLWHAs acquire
skills for positive living.
ICAP will implement a peer education model that targets job peers who are healthcare workers. Healthcare
workers at each site will be trained (the exact number will vary based on facility size) using established
national peer education curricula and each will be requested to form peer groups of approximately 10
members from the healthcare worker community for dissemination of prevention messaging, with a
particular focus on infection control practices in the workplace. Health and allied care providers will be
encouraged to adopt positive attitudes and behaviors, including safe practices to reduce their risk of
exposure. Facilities will be assisted to implement standard operating procedures (SOPs) for post-exposure
prophylaxis, should exposure occur.
In COP 09, ICAP will continue to support the provision of correct, timely and appropriate information and
skills that will assist people in different audience groups to adopt safe sex and risk reducing behaviors for
primary and secondary prevention.
ICAP will use available communication tools and aids to provide a comprehensive package of "prevention
with positives" (PwP) activities in all supported networks and linked communities. BCC materials review
workshops in partnership with community based organizations will be conducted in all the ICAP supported
regions. This will provide an opportunity to assess the impact of existing BCC materials, receive inputs of
community members and train an estimated 410 facility and community based health care providers and
counselors on prevention counseling. Contents will include partner counseling and testing, disclosure, dual
protection, linkage to existing family planning and child spacing services, personal hygiene, safe water use,
and healthy lifestyle. Culturally acceptable materials developed from these meetings will be pre-tested and
produced for use by ICAP-supported facilities and partners.
ICAP will also facilitate the distribution of at least 800,000 condoms through its 19 CBOs/NGOs (Tulsi
Chanrai Foundation, GHAC, GAWON, Rekindle Hope) to enable HIV positive and high risk negative
individuals to adopt dual protection choices. These condoms will be obtained from Society for Family
Health.
ICAP will build capacities of health care workers in patient education and supportive counseling to reduce
the burden of STIs, improve health seeking behaviors and linkages to diagnosis and treatment services for
both STIs and HIV/AIDS, and educate HIV positive patients on risk reduction, skills development for
practicing sexual abstinence and/or correct and consistent use of male or female condoms, and healthy life
planning. Referral linkages for STI management will also be strengthened as a component of preventive
services. Support groups, peer educators, local non-governmental and community-based organizations
(NGOs and CBOs) in each hospital network will be equipped to conduct prevention activities for HIV-
positive persons, their partners and households.
COP09 capacity building activities will also target both health care providers in ICAP supported sites as
well as staff of CBOs/NGOS / FBOs with special focus on those who have access to most at risk
populations (MARPs; i.e. youth, commercial sex workers, and persons involved in trans-generational
transactional sex). Patient education and supportive behavioral change counseling activities will target all
individuals accessing ICAP supported facilities, especially discordant couples and communities at large with
a special focus on MARPs. As part of targeting MARPs, ICAP will develop youth focused programs
highlighting youth friendly behavioral intervention approaches intending to empower young people.
ICAP will train a total of 620 health care workers (including 154 on AB messages and 466 on other
prevention) at facility and community levels to deliver appropriate BCC messages during routine clinic visits
using tools and job aids, and provide referrals to HIV infected individual to enter care and treatment
services. Care providers will be equipped with the requisite skill to discuss prevention, disclosure to
partners and negotiation of safer sex. Training geared towards counseling HIV positive individuals will be
Activity Narrative: based on a standardized Nigeria-specific prevention for positives curriculum. This will be augmented by
building the capacity of at least 19 local CBOs, NGOs and support groups, to conduct activities to promote
identified BCC strategies across their communities.
In COP09, all ICAP supported treatment sites will integrate prevention counseling and services for people
living with HIV (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 into HIV care and treatment clinics. In
addition family planning counseling and services, identification and treatment of STIs, and prevention
counseling will be offered. Other services such as prevention messages, promoting correct and consistent
condom use will be promoted. These interventions will be implemented using the recently adapted HIV
Prevention in Care and Treatment Settings Prevention Package, which includes several training packages
and job aids. Support groups will be assisted with patient education materials to build and support their
skills on addressing prevention topics. ICAP will provide effective support for communication and behavioral
change in partner notification practices, through training and modifications to care delivery. ICAP will assist
facilities to institute a new model of partner notification that offers rapid HIV testing to partners and utilizes
peer health educators and community based mechanisms to provide prevention counseling and referral to
partners.
ICAP will continue to harness its partnerships with CBOs and link to communities through peer health
educators, mother-to-mother support groups and other community liaisons. Identified community, faith-
based and non-governmental partners will be provided assistance to conduct community outreach activities
including community dialogues, community rallies and other community mobilization approaches through
innovative approaches to disseminate information and promote discussions around safe sex behaviors, risk
reduction approaches, promote abstinence and partner reduction in selected audiences/target groups.
Prevention programs for MARPs will remain a priority in COP09. This will include youth targeted through the
youth friendly program. Trained staff of CBOs will also address behavior change in the areas of stigma,
gender empowerment, male involvement in HIV care and treatment and other related issues during
community dialogues. Targeted and culturally acceptable sexual prevention messages will be delivered by
CBOs during outreach activities at market places, work places, churches, mosques, and schools, and
reinforce balanced ABC messages in support groups.
These activities contribute to the COP09 targets by focusing on reaching at least 30,152 HIV positive
persons especially women and their household members by promoting the adoption of positive attitudes
and behaviors consistent with PEPFAR's 5-Year Strategy for averting new infections in Nigeria. ICAP will
also reach a total of 4091 individuals (1,677males and 2,414 females) with abstinence/be faithful messages
POPULATIONS BEING TARGETED:
HIV positive persons, especially women, their partners, adolescent children and other household members
will be supported to adopt positive attitudes and behaviors to reduce the transmission of HIV, and promote
positive living among infected and affected persons. Health care providers will also be targeted. Facility
based care providers and community based care organizations, including program managers and care
providers will be trained to provide quality focused BCC activities that will promote the adoption and practice
of positive behaviors. Most-at-risk populations (including HIV-negative individuals), such as out of school
youth, commercial sex workers, and persons involved in transactional/transgenerational sex will also be
targeted for sexual prevention activities.
EMPHASIS AREAS
Areas of emphasis include human capacity development and local organization capacity building. Advocacy
will be intensified to target men in communities where ICAP supported sites exist, to encourage men's
support to vulnerable partners and involvement in HIV treatment and care, and HIV counseling and testing.
In addition, women will be empowered with knowledge and communication skills so as to make informed
decisions. Support groups will occasionally be segregated by sex to enable participants to speak freely on
sensitive issues and find solutions that are most appropriate for them. This activity will promote gender
equity, especially among vulnerable groups of women and youth, by facilitating the availability of client
education programs. The program will also contribute to the reduction of stigma and discrimination among
care providers towards HIV-positive clients.
Continuing Activity: 13024
13024 9208.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $1,068,500
9208 9208.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $200,000
Estimated amount of funding that is planned for Human Capacity Development $140,189
Table 3.3.03:
ACTIVITY DESCRIPTION:
ICAP-CU has supported 12 hospital networks in Kaduna and Cross River States to improve safe blood
practices and reduce medical transmission of HIV and other infections. In COP08 ICAP-CU plans to expand
into 13 additional hospital networks in six states (Kaduna, Gombe, Cross River, Benue, Akwa Ibom and
Kogi), resulting in a total of 25 facilities receiving support through ICAP-CU. Blood transfusions occur at all
25 of these facilities.
In COP08, ICAP-CU will work closely with the National Blood Transfusion Service (NBTS) and Safe Blood
for Africa Foundation (SBFA) in all aspects of its blood safety program. ICAP-CU will support the NBTS in
implementing its primary objective of migrating fragmented hospital-based blood services to centralized
NBTS-based blood services nationwide. A key feature of this program is the development of a nationwide
voluntary donor recruitment system. NBTS, through the linkages its zonal centers will develop with ICAP-
CU and its supported facilities, will provide TA for blood donation drives held by these ICAP-CU supported
hospital facilities. In addition, SBFA will train nurses and medical laboratory scientists in these facilities to
recruit repeat voluntary blood donors from the ranks of current family replacement donors. In this plan ICAP
-CU will be instrumental in working with hospital management and staff at all comprehensive sites to
develop buy-in for the NBTS blood services program, to create support of blood donor organizers, and to
strengthen health facility and community focused blood drive activities. Health facilities will be supported by
ICAP-CU to work with the local Red Cross on community sensitization and blood drives.
ICAP-CU will also work through local community based organizations and support groups to increase
demand and awareness on safe blood practices. These local organizations will be supported to promote
safe blood donor drives and activities in their communities. They will also be supported to sensitize the
hospitals and communities on the need for voluntary blood donation. ICAP-CU will support the production
and distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for voluntary non
-remunerated blood donation. In addition, ICAP-CU will work closely with facility management to establish
blood transfusion committees to oversee blood use based on national algorithms and standards in the
health facilities.
ICAP-CU will facilitate the development of an NBTS/hospital blood exchange program at 5 health facilities
that will be selected based on proximity to a zonal NBTS office, availability of blood banking facilities,
support infrastructure and other resources. This linkage will include regular delivery of donated units of
blood to NBTS for screening in conjunction with a regular delivery of screened units of blood to the facility.
NBTS will pick up unscreened blood units that these 5 hospitals have appropriately collected and stored
and will transport these units back to NBTS centers where they will be screened for the 4 transfusion
transmissible infections (TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA techniques.
In addition to collecting unscreened units, NBTS will deliver to these 5 hospitals their requested order of
screened units for blood banking and use at the facilities. NBTS will also provide monthly feedback on rates
of the 4 TTIs found by ELISA screening of blood units collected by each facility. It is expected that at these
5 blood banking facilities a total of 4170 transfusions will take place. ICAP-CU will work to ensure that 80%
of blood transfusions that occur at these hospitals will be with NBTS-screened blood units, while only 20%
will be emergency transfusions whereby the hospital will screen the donors on site using rapid test kits only.
Therefore, approximately 3,340 units of blood will be collected and sent to the nearest NBTS centers for
ELISA screening as outlined.
ICAP-CU will work with all 25 of its hospitals that do blood transfusions to ensure appropriate facility-level
collection of blood. Directed and voluntary donors will be prescreened with the NBTS donor screening
questionnaire and donors will be deferred as necessary based on their responses. 10,400 blood donors will
be screened using the HCT testing algorithm, thereby utilizing the blood donor setting as another point of
service for HCT during predonation. A PEPFAR-supported evaluation of the current emergency-based
transfusion system will provide insight into rates of TTIs, including HIV, that go undetected in emergency
screened blood.
ICAP-CU will identify appropriate staff for training by SBFA who, in turn, will utilize standardized training
modules that are appropriate to the various levels of trainees and approved by NBTS. Through this
relationship 26 laboratory staff and other health care workers involved in blood transfusion services at ICAP
-CU supported sites will be trained by SBFA. In order to avoid double counting, these 26 targets are
counted under the SBFA blood safety narrative. For core TOT modules developed by SBFA, ICAP-CU will
conduct step down training to 225 laboratory, allied health workers and hospital management staff involved
in blood transfusion services at their sites.
Other activities for COP08 include infection prevention services to reduce occupational hazards, provision
of contaminated waste and sharps collection and disposal units, and infection prevention equipment such
as disposable and surgical gloves, disposable syringes, respiratory masks, and gowns. Quality assurance
(QA)/Quality Improvement (QI) management systems will be put in place to ensure the quality of the rapid
HIV testing at all sites. All sites will be provided with copies of the National Blood Policy, operational
guidelines for blood transfusion, SOPs and job aids to support blood safety activities. This activity also
includes partnerships and support to the following sub recipients for program activities: local red cross/red
crescent organizations and HARHL Trust Nigeria.
As part of a comprehensive package of services and its contribution to the national strategic plan, ICAP-CU
considers it essential to prevent HIV transmission in health care settings and to increase blood transfusion
safety.
In COP08, ICAP-CU will support the training of health care workers to provide quality safe blood services,
and will increase the availability of support personal protective equipment like hand gloves, lab coats, face
shield and protective goggles to ensure that the lab staff are adequately protected. 10,400 donors will be
prescreened according to National guidelines and 3,340 units of blood will be sent to NBTS to screen for 4
TTIs to ensure safe blood transfusion at ICAP-CU's supported sites in line with the National Blood
Activity Narrative: Transfusion policy on blood and blood product safety.
This activity is linked to Counseling and Testing (5550.08) as directed donors and voluntary donors will be
provided with full HCT services prior to blood donation. This activity is closely linked to Injection Safety
(6819.08) where ICAP-CU also plans to train laboratory and allied health workers at all its supported sites.
With linkage to Lab (5544.08), lab-based activities will support safe blood activities at all ICAP-CU-
supported sites through training, supervision, equipment maintenance and supplies.
This activity targets health care workers at both public and private health sectors responsible for safe blood
activities in all ICAP-CU-supported health facilities. Targeted also are all persons 18 years of age and
above and family replacement donors.
This activity includes emphasis on institutional capacity development for blood safety which includes
training of lab staff and provision of equipment. This activity will also increase awareness and build skills
around safe blood issues at facility and community levels, reducing stigma and discrimination among health
care workers. It is expected to also promote awareness about safe blood practices in the communities and
indirectly increase the number of volunteers available for blood donations.
Continuing Activity: 13022
13022 6490.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $115,000
6698 6490.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $0
6490 6490.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $50,000
Table 3.3.04:
In COP09, ICAP will promote biomedical prevention through the promotion of safe injections, directly
targeting health care workers at ICAP supported facilities. Specifically, ICAP will emphasize training to build
human capacity in safe injections and promote commensurate behavior change through IEC; institute safe
injection, provision of commodities, increase community awareness, and strategic linkages with other
partners and initiatives like the Making Medical Injections Safer (MMIS) project. ICAP will also collaborate
with MMIS to support the government in the development and implementation of health care waste
management policy.
While injection is a necessary mode of providing treatment, contraception and immunization, contaminated
injections add to the burden of illness. Reused syringes and needles, lack of sterilization, suboptimal
collection and disposal of used needles as well as lack of training or standards of procedures lead to the
exposure to HIV and other blood borne pathogens.
As a response and in consultation with the Federal Ministry of Health (FMOH) and MMIS, ICAP has
implemented the Safe Injection Global Network (SIGN) strategy, an infection prevention strategy to reduce
HIV transmission through unsafe injections. In COP08, ICAP supported injection safety in the context of
infection prevention and control services at 28 hospital networks in the 6 states of Kaduna, Cross River,
Benue, Gombe, Kogi and Akwa Ibom. Infection prevention practices were enhanced and universal
precautions were introduced. By the end of COP08, 900 health care providers will be trained on injection
safety, including general aspects of universal safety procedures and health care waste management, while
advocacy and BCC activities on safe injection are conducted amongst health care workers to enable
adoption of safer workplace behaviors.
ICAP in COP09 will continue to focus on these strategies to effect change in injection practices. These
include: training to build the capacity of health care providers to provide safe injections advocacy and
behavior change communication (BCC) to promote safe injections; improving health care waste
management; implementing universal safety precautions, and providing commodities necessary for safe
injection and waste disposal.
Training to build human capacity and effect behavior change: Training will be based on the National
Training manual adapted from WHO Do-No-Harm curriculum. Trainers trained in COP08 by MMIS have
conducted step down trainings. The training focused on safety standards of safe injections procedures,
behavior change to prevent unsafe and overuse of injections, consistent practice of universal precautions,
and appropriate health care waste management.
In COP09, 100 health care providers from two new health facilities will be trained on infection control in the
context of injection safety to enable them adopt safer workplace behaviors. Refresher/ update trainings will
be conducted for 280 staff across the 28 existing sites.
ICAP will also continue to promote and facilitate behavioral change among health workers through
supportive supervision, distribution of communication materials (leaflets, posters, reference guides) on safer
injection practices, and support to the FMOH to adopt a national health care waste management plan in
collaboration with JSI/MMIS. This will also address stigma and discrimination issues that are often
generated by fear among health care providers. Behavior change communication activities will facilitate the
adoption of safe injection practices among health care providers.
Improve health care waste management: In COP09, ICAP will focus on promoting effective waste
management in 30 (28 existing and 2 new) comprehensive secondary health facilities across the 6 states
namely, Kaduna, Cross River, Benue, Gombe, Kogi and Akwa Ibom. ICAP will implement these activities
by partnering with a local non-governmental organization, HIV/AIDS Restoring Hope and Life (HARHL)
Trust. This local NGO has extensive experience in responding to health sector program needs including
issues of safe injection, universal safety precautions, and safe blood. In addition, this organization will
assist the sites to develop and implement appropriate work plans and policies using the SIGN strategy for
ensuring injection safety.
Provide commodities: ICAP will procure color-coded bin liners for segregation of infectious waste and
personal protective equipment (i.e. disposable surgical gloves, disposable syringes, respiratory masks and
gowns) for these sites. ICAP will also support proper waste management by repairing incinerators in
selected sites based on need.
These activities will contribute to the overall Emergency Plan for prevention of new infections by promoting
injection safety. It will also reduce exposure of health care workers to occupational hazards in the supported
health services. ICAP will also support effective waste disposal through the repair/purchase of incinerators
in need based selected health facilities.
This activity is closely linked to activities in ART, Palliative Care, OVC, HCT, Lab, and PMTCT to ensure
that health workers under all these areas adhere to principles of safe injection and universal precautions.
With the linkage to Lab, lab-based activities will support injection safety activities at all ICAP supported sites
through training, supervision, equipment maintenance and supplies.
Continuing Activity: 13023
13023 6819.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $172,000
6819 6819.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $100,000
Estimated amount of funding that is planned for Human Capacity Development
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $40,000
Table 3.3.07:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: : Combination of ART, & Care and support
Services and narrative.
ACTIVITY DESCRIPTION: ADULT CARE, SUPPORT AND TREATMENT
In COP08, ICAP supported 28 hospital networks and their communities, partnering with community-based
organizations (CBOs), faith-based organizations (FBOs), and PLWHA groups to enable people with
HIV/AIDS to access clinical care and support as well as laboratory and pharmacy services across the 6
states of Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi.
In COP09, ICAP will continue to provide support to 30 comprehensive facilities which will include 28 existing
health facility networks and expand support to 2 additional new comprehensive health facilities in Akwa
Ibom and Gombe States to provide care and support services to 52,310 HIV+ clients and 104,620 PABAs.
A total of 28,351 (3,238 new) patients will be enrolled on ART among the HIV positive patients in COP09.
In COP09, ICAP will enable health facilities to provide clinical care, support and treatment to HIV positive
persons by supporting: strategic approaches including training; clinical, laboratory and pharmacy services;
systems management; procurement of drugs and supplies; and the expansion of support groups and peer
health educator programs.
Following National Palliative Care Guidance and USG PC policy, ICAP-supported sites will provide a basic
package of care services, including basic care kits, prevention with positives, clinical care (nursing care,
pain management, OI and STI treatment and prophylaxis, nutritional assessment and support, lab- baseline
hematology, chemistry and CD4 and follow up, OI and STI diagnosis, psychosocial support, home based
care and active linkages between hospitals, health centers, and communities. ICAP will provide clinical care
with basic care kits plus at least two other supportive services in the domains of psychosocial, spiritual and
preventive services to all PLWHA. The activities will be approximately 20% laboratory monitoring and OI
diagnostics, 30% OI management and prevention (cotrimoxazole), and 50% Home Based Care and
training. Patient education to promote positive living, self-care, and support adherence will be provided.
ICAP will support integration of syndromic management of STIs and risk reduction interventions into care.
ICAP will continue to strengthen the HBC teams (doctors, nurses, CHEW, PHEs, members of CBOs). ICAP
will expand HBC services to include the provision of domestic support, nursing care, pain management,
counseling and referral services. CBOs and FBOs will be supported to package and distribute standardized
HBC kits (consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline, gentian violet,
etc.) to each trained HBC provider for use when visiting clients. Basic care kits containing ITN, water guard,
water vessel, soap, gloves, ORS, condoms and IEC materials will be distributed to all PLWHAs through
facility and community based support groups. Retired health care providers within the communities will be
encouraged to volunteer to lead HBC teams through existing CBOs.
At the facility level, ICAP will conduct quality improvement activities using processes like Clinical System
Mentorship and HIVQUAL. Checklist, SOPs, Standard of Care and Model of care assessment will be used
to enhance quality of services in all comprehensive sites and PHCs.
ICAP will train, retrain and mentor health care providers on HIV/AIDS care and management. ICAP will
enhance adult care and treatment by providing ongoing site-level mentoring and supportive supervision of
facility-based staff. Job aids and SOPs will be provided to support and enhance provider skills. ICAP will
participate in the USG/GoN joint supervisory sites visits.
ICAP will further strengthen patient appointment and defaulter tracking systems, as well as routine reporting
systems for monitoring basic care and support activities. Outreach teams linking hospital programs to
primary health centers and communities will be expanded and supported by ICAP network coordinators. In
order to improve access to services and retain in care, HIV positive clients will be supported to access
health care facilities via community-based transportation support. Adherence trainings and support services
will facilitate adherence, support patient education, enhance appointment system, and strengthen referral
linkages/defaulter tracing programs. ICAP will also expand its successful Peer Health Educator program,
enhancing family counseling and testing, defaulter tracking, and inter/intra-facility linkages. ICAP also
support the development of patient education materials that encourages retention in care.
In COP09, ICAP will maintain provision of quality focused ART services at 28 existing health networks and
scale up services in 2 additional health facilities to provide comprehensive ART services to a total number
of 28,351 clients by the end of COP09, out of which 25,516 clients will remain on treatment at the end of the
reporting period. ICAP will participate in the yearly National Care and treatment evaluation.
Based on FY08 experience, ICAP will provide support for infrastructural development, program
management and systems strengthening, including within-facility linkages, retention of health care workers,
Management Information System, and inter-disciplinary partnerships.ICAP will facilitate onsite assistance to
strengthen systems, including ART clinic management, medical records, referral linkages, patient follow-up,
integration of prevention into care and treatment, and involvement of PLWHA; laboratory services. We
anticipate increasing need for second-line ART, and will place special emphasis on training and mentoring
health care providers to identify treatment failure and initiate second-line regimens when needed. Building
on the ICAP-model which emphasizes comprehensive support, capacity-building and local ownership as
mechanisms to provide sustainable high-quality HIV/AIDS care and treatment to families and communities,
facilities will be supported through enhancement of site-level project management teams (PMTs).
ICAP will prioritize the expansion and decentralization of palliative care services to selected primary health
centers (PHC) to reduce the client load on the existing secondary health facility networks. Building on the
network of care model, ICAP will scale up care, support and ART drugs refills to PHCs by identifying at least
one PHC around each secondary hospital that can provide care and ART drug refills to stable patients.
ICAP will also enable the decentralization of existing facility-based support groups, facilitating their
expansion into surrounding communities to promote acceptance and ownership, reduce stigma, and
increase sustainability. To do this, ICAP will work closely with the state and local governments of the six
Activity Narrative: ICAP supported states to further explore and put in place mechanisms to strengthen the role of PHCs in
providing quality ART care and ART drugs refills. ICAP will work closely with established State primary
health care development agencies to develop/adapt mechanisms to strengthen the health care systems by
leveraging available HIV/AIDS resources. This decentralization will include the development/adaptation of
referral protocols (for both "down" and "up" referrals), referral forms/tools, and site supervision tools.
Networking and referral linkages between hospital based providers and PHCs will be strengthened. Health
Teams in PHCs will be trained on Care and Treatment to encourage task shifting.
This will be a critical element in ICAP's support to health care cadres through the COP09 program activities.
Clinicians at all 30 sites will be assisted to identify ‘most at risk' HIV-infected patients, enroll them in care
and treatment, to perform appropriate clinical and laboratory staging of adults and children, and to provide
comprehensive care and support, including the prompt initiation of ART for eligible patients. ICAP will
provide follow-on ART/Palliative Care trainings, including ongoing CME and QA activities, for 500 health
care workers (including physicians, nurses, counselors, pharmacy, and laboratory personnel) and 100
members of CBOs on palliative care. Onsite clinical mentoring will enhance quality of care and build site-
level clinical and management skills for program sustainability. ART reference tools will include pocket
guides, dosing cards, posters, and detailed SOPs.
ICAP will continue to work closely with other PEPFAR IPs and GON to ensure compliance with National
policies, curricula and guidelines. ICAP will continue to participate in the USG Technical Working Groups to
address emerging treatment and care -related topics and further promote harmonization with other IPs and
the GON. ICAP will also continue its partnership with SCMS by allocating USD 675,000 of its resources for
care, support and treatment related procurements.
ICAP will facilitate linkages through existing and new CBO/NGO or FBOs within the communities to
economic empowerment and other programs such as safe motherhood and child survival activities.
Therapeutic feeding using approved selection and exit criteria will be provided via referrals where possible
and directly when no alternatives exist. Facilities and communities will be supported to identify innovative
approaches to sustainable food support such as establishment of innovative food banks, linkages with
wraparound programs and existing microfinance opportunities. At the community level, HBC, OVC, HCT
outreaches, AB messages, patient retention mechanisms and other support services will be subcontracted
to non-governmental, community and FBOs. Trained HBC providers, including PLWHA, will be supported to
deliver care and support services to stable patients and family members at home.
By training and retraining at least 600 care providers including PLWHA, ICAP will enhance the delivery of
comprehensive basic care and support within national guidelines and protocols via a multidisciplinary family
-focused approach. This activity contributes to the USG cumulative targets by reaching at least 52,310
PLWHAs (104,620 persons affected by HIV/AIDS) on care, including 28,351 HIV positive adults on
treatment.
This activity relates to OVC, HCT, PMTCT, LAB, sexual prevention, TB/HIV, Gender, Human capacity
development and SI. As expansion of ART services is prioritized to rural areas, ICAP will strengthen referral
channels and network mechanisms. TB/HIV linkages will be strengthened where ART and TB DOTS sites
are co-located, and co-location of new ARV sites will be actively promoted in TB DOTS stand-alone sites.
All HIV infected patients will be screened for TB using the National algorithm while all TB patients will be
offered HIV testing. ICAP will also provide onsite assistance with data management and M&E to guide
quality improvement. Relationships between secondary hospitals and community-based referral facilities will
be strengthened via the use of network coordinators, CBOs and NGOs. Patients not yet eligible for ART will
be carefully monitored (via clinical and laboratory monitoring), and will receive OI prophylaxis and other
preventive services where indicated. Women who become pregnant will be referred to PMTCT; after
delivery mother-baby pairs will be referred for care and treatment/OVC services. All care and treatment
clients will receive PwP messaging as appropriate. Partnerships with other IPs will provide opportunities for
leveraging resources. Patients and their families will be linked to community-based income-generating
activities where available.
All HIV positive persons including women and their households will be assisted to access care and support.
HIV positive persons in the general population will be reached through CBOs and support groups. Persons
Affected By HIV/AIDS (PABAs) will also be targeted and enrolled into care under the ICAP family-centered
approach as will pregnant women, OVC and TB patients. Facility based care providers and CBOs/FBOs will
be trained to provide quality services and facilitate the establishment/strengthening of referral networks.
Health care providers in secondary and primary health facilities will be trained to deliver quality ART
services.
Areas of emphasis will include quality improvement and system strengthening human capacity
development, Gender and other health related wrap around.
This activity will facilitate equitable access to care and support especially to vulnerable groups of women
and children. ICAP will advocate for men's involvement in care and treatment in the community (rallies,
community sensitization) for improved inheritance rights for women and children. ICAP will also advocate
for stigma and discrimination reduction at the community level. ICAP will emphasize quality
assurance/improvement and clinical systems mentorship as part of its capacity building. ICAP personnel
including national and international experts will provide skill and competency-based trainings, CME, and
ongoing clinical mentoring to enable onsite staff to provide quality ARV services to patients. Services will
also focus on addressing the needs of women to reduce gender inequalities and increase access to ART
services. ARV services will facilitate linkages into community and support groups for nutritional support and
Activity Narrative: micro-credit/finance activities.
Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including
spaces)
Early funding is requested for USD 4,009,000 to procure drugs (other than ART), commodities and supplies
for currently enrolled in care and treatment patients from the existing 28 facility networks. This is to ensure
that orders are placed early to forestall any gaps in supplies and further enhance quality of services
provided. In addition, as services for many facilities and CBOs are by subcontract, ICAP is unable to
execute subcontracts (which represent an obligation of funding) in a timely manner without such funds.
Continuing Activity: 13025
13025 5552.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $3,050,000
6697 5552.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $1,270,000
5552 5552.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $626,500
Estimated amount of funding that is planned for Human Capacity Development $193,816
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $8,750
Estimated amount of funding that is planned for Food and Nutrition: Commodities $14,250
Estimated amount of funding that is planned for Water $129,600
Table 3.3.08:
Continuing Activity: 13030
13030 5404.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $8,628,014
6690 5404.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $4,300,560
5404 5404.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $1,765,000
Table 3.3.09:
If continuing, paste your COP08 narrative here and put one of the following at the beginning of your
narrative:
In COP08, ICAP has expanded support to a total of 28 health facility networks in the six high-prevalence
states of Gombe, Akwa Ibom, Cross river, Kaduna, Benue and Kogi. By the end of COP08, ART will have
been provided to a cumulative of 2664 children (including1744 new).
In COP09, ICAP will provide support to 30 hospital networks in 6 states and to 3,200 HIV-infected (including
536 new) infants and children enrolled on ART. During COP09, pediatric care and support services will be
provided to 4000 children and adolescents HIV-positive.
ICAP programming for care and treatment services for HIV-positive children has several key elements
which include: supporting pediatric HIV diagnosis; enhancing pediatric case finding and referral to care and
treatment; ensuring comprehensive care and treatment services, including ART, for HIV-exposed infants
and HIV-infected infants and children; and providing enhanced psychosocial support at both facility and
community levels. Following National Palliative Care Guidance and USG PC policy, ICAP-supported sites
will provide a basic package of care services, including basic care kits, prevention with positives, clinical
care (nursing care, pain management, OI and STI treatment and prophylaxis, nutritional assessment and
support, lab- baseline hematology, chemistry and CD4 percentage and follow, OI and STI diagnosis-
psychosocial support, , home based care, and active linkages between hospitals, health centers, and
communities.
ICAP family-focused model of care is an optimal platform for pediatric case-finding and referrals. ICAP uses
adult care and treatment venues as additional entry points for pediatric services, utilizing a genealogy form
that ensures that HIV-positive adults are asked about the HIV status of their children at each visit.
In COP09, ICAP support for pediatric diagnosis will continue to include: enhancing linkages between
PMTCT programs and those supporting OVC and ART services; supporting early infant diagnosis via dried
blood spot (DBS) testing; initiating and expanding routine opt-out pediatric testing at inpatient and outpatient
wards (including OPDs, casualty wards, well baby immunization clinics, child welfare venues, and
adolescent/youth-friendly clinics) following national norms regarding counseling and consent of minors; and
providing training, supplies, and laboratory support for HIV testing. DBS is collected from ICAP supported
Nationally approved EID sites; ICAP will continue to partner with Clinton Foundation ensure regular supply
of DBS materials to all sites and shipment of samples /collection of results to and from National PCR labs.
Enrolment into care and treatment
In COP09, 4000 HIV-infected infants and children will be enrolled in care, and carefully staged, both at
baseline and at subsequent follow up visits. Following clinical and immunologic staging, those not yet
eligible for ART will receive clinical services including ongoing monitoring, charting and plotting of growth
and development, screening and prophylaxis (IPT) for TB when indicated, cotrimoxazole prophylaxis (CPT)
following national guidelines, and diagnosis and management of opportunistic infections as needed. Ready-
to-Use-Therapeutic Feeding" (RUTF) using criteria agreed upon by the USG in-country and GON team will
be provided at facility and community level via referrals where possible. Parents / caregivers of HIV-infected
children (regardless of their HIV status) will receive a standardized "preventive care package" including
basic care kits, ITN water guard, water vessel, ORS, soap and gloves. Infants and children who are eligible
for ART will receive appropriate first and/or second-line therapy accompanied by careful monitoring for
toxicity and efficacy and by intensive adherence support
Decentralization of pediatric care and treatment services
In COP09 ICAP will continue to build capacities of pilot comprehensive PHCs to link to referring hospitals to
support HIV/AIDS programs and provide onsite ART refills and follow up for stable patients, at the PHC
level. Experienced nurses and community health officers identified in high volume pilot PHCs will be
further trained to deliver quality focused care and treatment services including conduct nutritional
assessments and monitor growth and development,, provide drug refills based on a symptom checklists,
provide CTX and micronutrients, and referral to the comprehensive treatment sites as needed. ICAP will
work with local State primary health care agencies to develop/adapt job aids and SOPs for providing HIV
care and treatment at the PHC. Pediatric ART services in COP 09 will include having a minimum package
of care for infected children at all ICAP sites. This minimum package of care for infected children will
include: growth and development monitoring, CD4, CTX prophylaxis, Multivitamins, antihelminthics,
antibiotics (Ampiclox, Co-trimoxazole, and erythromycin), antimalarials for treatment, basic care kits,
basseline investigations and nutritional supplement.
This minimum package of care for infected children in the PMTCT-only sites is in line with the
decentralization of pediatric ART services to smaller sites (PMTCT only) and will bring ARV treatment, care
and support services closer to families and communities. This will require building the capacity of the health
care workers at the primary and secondary sites to scale up pediatric ART services of which ICAP will be
supporting in COP09.
In the PMTCT only sites where there is no CD4 machine, ICAP will continue to support CD4 sample logging
using the same channel of sample logging with the PMTCT, TB and Adult ART services.
Implementation of HIV-exposed infant registers at hospitals and PHCs, initiation of exposed-infant clinics,
and training and mentoring of PMTCT care providers on the use of registers, referrals, and tracking systems
will also further strengthen access to pediatric care and treatment to HIV infected children.
Training and supportive supervision of health care cadres will be a vital element in ICAP's COP09 program.
Clinicians at all 30 hospitals will be assisted to identify HIV-infected children, to enroll them in care and
treatment, to perform appropriate clinical and laboratory staging of these children, and to provide
comprehensive care and support, including the prompt initiation of ART for eligible children. ICAP will also
train PHCs staff to encourage task shifting in the care of HIV positive children. ICAP will conduct pediatric
ART trainings, ongoing CME and QA activities for 306 clinicians and allied health care providers who will
support pediatric care and treatment. ICAP trainings will reinforce the need for opt-out testing for pediatric
inpatients, pediatric TB patients, adolescent patients and children suffering from malnutrition and common
Activity Narrative: illnesses which are also warning signs of HIV infection.
Trainings will also focus on second line and switch regimens for children who are already on ARVs.
Additional training and support will enhance the specialized counseling, patient education, and linkages
required in early infant diagnosis programs. Facility-level staff will be trained and supported to collect,
prepare, and transport DBS samples for testing to be performed at laboratories supported by other
implementing partners.
Adherence trainings and support services will be provided at each site. These will facilitate adherence
assessment and support including group counseling, disclosure counseling, patient/family/caregivers
education, appointment diary system, referral linkages, patient follow-up, provision of support tools (dosage
guides, reminders etc.), linkages to community-based adherence support and retention in care programs.
Clinical Systems Mentoring and Quality of Care
Onsite clinical mentoring will enhance quality of care and build site-level clinical and management skills for
program sustainability. ART reference tools will include pocket guides, dosing cards, posters, and detailed
SOPs. ICAP will continue to implement innovative training and clinical mentoring activities, including
ongoing support for the successful South-to-South pediatric training initiative in South Africa; ICAP, in
collaboration with GoN and other implementing partners, will support the adaption of the HIV/AIDS
pediatric care training manual. ICAP will support quality improvement/quality assurance mechanisms to
facilitate the delivery of optimal care and treatment services. ICAP will also facilitate and actively support
onsite standardized HMIS using GON forms and provide onsite assistance with data management and M&E
to guide quality improvement measures.
Harmonization of Activities
In COP09, ICAP will continue to work closely with other PEPFAR IPs and GON to ensure compliance with
National policies, curricula and guidelines, and continue to participate in the USG Clinical Working Group to
address emerging treatment-related topics and further promote harmonization with other IPs and the GON.
ICAP will continue to also partner with Clinton Foundation as appropriate to leverage resources for
providing antiretroviral drugs to pediatric doses to HIV+ children and Plumpy nuts and EID commodities..
Community Linkages
In COP09, ICAP will continue to work closely with its 19 NGO/CB/FBO partners to promote community
involvement, provide HIV prevention activities and linkages to wraparound activities, and facilitate
adherence among HIV positive community members. ICAP will continue to strengthen/establish children
support groups as part of the psycho-social support.
ICAP will also continue to provide in COP09 nutritional support through partners CBOs to all 3,200 HIV +
children on ART. Support will include provision of RUTF as needed and other nutritional support. ICAP will
also expand its successful Peer Health Educator program, enhancing targeted family counseling and
testing, defaulter tracking, and inter/intra-facility linkages. Efforts will be made to ensure that HIV-exposed
infants and HIV-infected infants and children are linked into OVC services. Prevention for positives
messaging will include a balanced ABC approach messaging for adolescents infected with HIV. All HIV
positive infected children/adolescents will be linked to home based care and support, community and social
services for referrals for food and education assistance, economic empowerment , and other wraparound
One of the pioneers of family-focused multidisciplinary HIV/AIDS treatment in resource-limited settings,
ICAP will be providing in COP09, ART services to 3,200 HIV infected children, contributing to the
GON/PEPFAR targets for Nigeria. ICAP will build the skills of at least306 care providers thus contributing to
national sustainability plans.
This activity relates to HBHC (XXX), OVC (XXX), HCT (XXX), PMTCT (XXX), HVOP (XXX), TB/HIV (XXX),
AB (XXX), and SI (XXX). As expansion of ART services is prioritized to rural areas, ICAP will strengthen
referral channels and network mechanisms. Children on ART will be linked to home based care and support
and community and social services. TB/HIV linkages will be strengthened where ART and TB DOTS sites
All HIV infected children will be screened for TB using the National algorithm while all children infected with
TB will be offered HIV testing. ICAP will also provide onsite assistance with data management and M&E to
guide quality improvement.
TARGET POPULATIONS:
HIV positive children, will be provided access to pediatric ART services. Health care providers in secondary
and primary health facilities will be trained to deliver quality ART services.
Emphasis areas are quality assurance/improvement and supportive supervision. ICAP personnel including
national and international experts will provide skill and competency-based trainings, CME, and ongoing
clinical mentoring to enable onsite staff to provide quality ARV services to children infected with HIV.
Emphasis areas also include training, human resources issues, referral networks, infrastructure support,
linkages to other sectors and initiatives. Services will also focus on addressing the needs of women, infants
and children to reduce gender inequalities and increase access to ART services among these vulnerable
groups. ARV services will facilitate linkages into community and support groups for nutritional support and
other wrap around services.
Continuing Activity: 13027
13027 5547.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $2,023,000
6694 5547.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $334,400
5547 5547.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $155,000
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.10:
Activity Narrative:
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $10,569,102
Program Area Narrative:
Nigeria is ranked 5th among the 22 high TB Burden Countries in the world. HIV prevalence among TB patients in Nigeria is
estimated at 25%. Currently about 800,000 people are co-infected with HIV and TB and an additional burden of 50,000 TB cases
is added annually from the pool of People Living with HIV/AIDS (PLWHA). The World Health Organization (WHO) estimates the
incidence of all types of TB in Nigeria to be 311/100,000 population and the incidence of smear positive cases 137/100,000
population. It is estimated that 1.9% of new TB cases are multi-drug-resistant (WHO global report 2008).
USG Nigeria's strategy for COP09 TB/HIV services will build on COP08 activities and increase collaboration with Government of
Nigeria (GON) through the National Tuberculosis and Leprosy Control Program (NTBLCP), the National HIV/AIDS Division (HAD),
the Global Fund to fight AIDS, TB and Malaria (GFATM) and WHO. The areas of strategic focus during COP09 are:
1) To strategically expand TB/HIV collaborative activities nationally and integrate prevention with positives activities and
community linkages at DOTS sites.
2) To continue provider initiated HIV counseling and testing (PICT) to all TB patients and suspects at the point of first clinical
contact and to ensure adequate TB screening, diagnosis, and treatment for all HIV infected individuals at PEPFAR supported
facilities;
3) To improve diagnosis of MDR TB, through AFB sputum microscopy, TB culture, Hains PCR assay, chest x-ray services, and
quality assurance in testing laboratories nationwide.
4) To strengthen and scale up implementation of the 3 ‘I's strategy: intensified TB case finding among HIV positive persons;
infection control to prevent TB transmission; and scale up of isoniazide preventive therapy (IPT) in PLWHA nationally.
5) To increase access to TB treatment by supporting anti-TB drug and lab commodity procurement/ logistics of the national TB
control program
6) To strengthen pediatric TB/HIV management and MDR TB program surveillance & management in the national TB control
program.
USG support has pioneered, strengthened and scaled up TB/HIV collaboration and services in Nigeria. The USG supported
TB/HIV program has scaled up from 68 sites at inception in COP 05 to 256 sites in 35 states to date. By the end of COP 08, it is
anticipated that USG support will have increased to 535 sites in 36 states and 644 sites by the end of COP 09. It is anticipated
that 6,018 health workers will be trained by the end of COP 09. Currently, 40,177 HIV-positive patients have received TB
treatment; this is expected to increase by approximately 40,000 by the end of COP 09. In COP 08 the USG supported the
development of guidelines and strategic framework for MDR TB, Infection control and Public Private Mix DOTS. USG has
supported the establishment of TB culture facilities and Hains PCR assay facilities in one national reference laboratory. In COP09,
the USG will support two advanced TB culture facilities in order to provide quality assured aerosol-free, safe laboratory for
tuberculosis testing and drug sensitivity testing in Nigeria.
In spite of the rapid scale up of TB/HIV services, less than 20% of DOTS sites provide HCT services. TB/HIV service coverage as
well as training remain limited nationwide. Case detection rate for TB remains low at 33% due to poor infrastructure for TB
services, often dilapidated laboratories, weak X-ray diagnostic services, and minimal community awareness of TB/HIV co-
infection. Despite the influx of new funds from the Global Fund, substantial gaps remain in TB and TB/HIV programming. Access
to CPT and ART for HIV-positive patients detected in DOTS centers remains limited particularly in rural areas. Nigeria receives
anti-TB drugs through the WHO Global Drug Fund; however weak drug and commodity logistics systems resulted in episodes of
stock-out in health facilities in COP 08. The USG is providing on-going support to develop and strengthen a functional drug and
commodity logistics system. However, human resource challenges such as mal-distribution, inadequate skill mix, high mobility,
frequent rotation, poor retention of staff, lack of motivation, and poor work environment continue to limit performance and
sustainability of TB/HIV programs
USG Nigeria will continue with its priority objective of integrating HCT into DOTS services. In COP09, the focus is to improve
diagnosis and management of TB among HIV positive patients using the global 3 "I"s strategy, and to increase access to basic
microscopy, TB culture, and Hains PCR assay. The objective of this strategy is to intensify TB case finding among HIV positive
patients and to prevent TB infection and transmission of TB among HIV positive patients. The USG will support TB laboratory
upgrades through renovation of infrastructure and purchase of equipment, as is elaborated in the laboratory program area
submissions. X-ray services will be strengthened to improve diagnosis of smear negative TB while fluorescent microscopy will be
used in high workload facilities. The USG will continue to support the provision of services for the detection, surveillance and
management of MDR TB.
The USG will continue to collaborate with the GON, WHO, GFATM, Canadian International Development Agency (CIDA), Clinton
Foundation, International Leprosy Eradication Partners (ILEP) and other donors to address on-going challenges in TBHIV
implementation. Anti-TB drugs are provided through the WHO Global Drug Fund, and support for continued expansion of DOTS
services from the USAID TB funds, CIDA and the Global funds. USG is represented in the Technical Advisory Committee (TAC)
of Global fund, national TB planning group, and TB/HIV working group, MDR-TB working group, and TB Laboratory working
group. The USG piloted the TB infection control and IPT programs in Nigeria. There is joint monitoring of TB/HIV activities by
USG and other donors and stakeholders. The USG TB/HIV technical working group carries out site monitoring in collaboration
with state program officers using a standard monitoring tool. All USG partners report data on TB treatment through the national
and state control program. The USG has supported the revision of national TB/HIV working tools. The joint USG, GON, WHO,
ILEP and GFATM supervisory and monitoring visits help improve the quality of TBHIV data collection and reporting.
The USG team has indicated its interest in an FY08 multi-country Public Health Evaluation (PHE) that will evaluate whether an
enhanced approach to TB diagnosis and the prevention of cryptococcal disease can reduce mortality among persons initiating
ART for advanced HIV infection in resource limited settings. If approved, this PHE will continue into COP09 and data collected
from the study will be used to inform strategies to reduce early mortality in TB patients and provide the justification for further
evaluation and implementation of point-of-care laboratory diagnostic tests for TB diagnosis.
USG will contribute to the host country leadership of the TB response by supporting the TB control strategic framework (2008-
2010) through strengthened human resource development in management and leadership of TB/HIV service delivery, including
commodity logistics and laboratory diagnosis. The USG will continue to advocate for increased budgetary commitment by the
GON for TB/HIV program to ensure sustainability.
The USG, having pioneered the TB/HIV collaborative program in Nigeria in 2005, is stepping up collaboration with the GON and
other stakeholders to improve implementation of the three Is. Through infrastructure building, provision of quality equipment and
commodities, training of health workers, upgrading of laboratory and treatment facilities, evaluation of interventions to reduce
mortality, and conduct of MDR-TB and TB prevalence surveys the USG TB/HIV program will enhance sustainability of TB/HIV
control in Nigeria.
Table 3.3.12:
In COP08, ICAP provided TB/HIV services at 28 hospital networks and initiated linkages with 63 DOTS
sites in Cross River, Benue, Kaduna, Gombe, Akwa Ibom and Kogi States.
In COP09, TB/HIV integration activities will be strengthened at existing hospitals and DOTS clinics to
provide enhanced TB services at 30 (28 existing and 2 additional) HIV comprehensive care and treatment
sites in 6 states (Kaduna, Cross River, Benue, Gombe, Akwa Ibom and Kogi), and HIV services at 70 (63
existing and 7 additional sites) DOTS sites. Working closely with the national and state level TB/HIV
technical working groups, National TB Leprosy Control Program (NTBLCP) and state/LGA TB control
programs, ICAP will provide services to TB/HIV co-infected patients through point of service laboratory
support, development of SOPs/guidelines, and strengthening of TB screening, referrals and linkages both
within DOTS sites and between community-level health care facilities and DOTS sites. ICAP, with other
implementing partners, will implement the PEPFAR-Nigeria Local Government Area (LGA) coverage
strategy in Kaduna, ensuring the provision of TB/HIV services in at least one health facility in every
LGA.This will enable the states to approach universal access to TB/HIV services in states designated ‘LGA
Coverage States'.
ICAP approach to TB/HIV collaborative activities will focus on the three "I"s' including: Intensified TB case
finding among people living with HIV/AIDS (PLWHA), Isoniazid Preventive Therapy (IPT) and TB infection
control.
Intensify TB case finding
ICAP will intensify TB case detection amongst HIV infected patients by screening for TB at various points of
service (such as voluntary counseling and testing centers, PMTCT, Out Patient Departments and wards);
conduct TB screening of contacts of smear positive index cases; use of fluorescent microscopy and support
for the radiological diagnosis of TB. ICAP will strengthen TB/HIV referrals by utilizing LGA
Tuberculosis/Leprosy supervisors and Peer Health Educators for escort services. Non-HIV positive
members of CBOs will be encouraged to act as TB treatment supporters.
Isoniazid Preventive Therapy (IPT)
All TB/HIV co-infected patients will be provided with cotrimoxazole (CTX) prophylaxis and linked to other
palliative care services and prevention messaging (including balanced ABC messaging as appropriate).
ICAP will support standardized TB screening and case finding in 17,437 HIV infected patients using
structured symptom checklists and the national algorithm. ICAP will facilitate access to TB DOTS services
for co-infected patients identified through ART clinics and will facilitate access to HIV treatment and care for
co-infected patients identified through TB DOTS clinics. It is expected that this will result in the treatment of
TB in at least 3,700 HIV positive patients. DOTS facilities will be supported to provide HCT to at least 2,166
clients, of whom it is expected that 650 will be diagnosed with HIV. TB patients will be encouraged to bring
contacts for early TB case-finding, and HCT preventive therapy (IPT). One hundred and fifty HIV positive
patients will be provided with IPT services in line with the GoN guidelines.
Five ICAP TB/HIV advisors will be provided with formal TB/HIV training to enhance their productivity. A total
of 60 ICAP staff and facility-based medical officers will undergo training on x-ray diagnostic skills. A total of
50 ICAP staff and facility-based laboratory officers will be retrained on good sputum specimen collection
and laboratory AFB sputum smear diagnosis to enhance their diagnostic capabilities. Refresher HCT
trainings will be provided for TB care providers to ensure quality of counseling and testing. Service provision
will also be improved through capacity building of health care providers with the GoN and other USG
implementing partners and International Federation of Anti-Leprosy Associations (ILEP) partners through
training programs conducted at TB training laboratories. Across the various TB/HIV training activities, it is
expected that a minimum of 166 individual trainees will be directly reached in collaboration with NTBLCP. In
addition to current practices, ICAP will implement the national guidelines for External Quality Assessment.
Infection control
Nosocomial transmission of TB will be mitigated through attention to principles of TB infection control,
including administrative and environmental control measures such as clinic design, good ventilation,
appropriate patient triage, staff training, and enforcement of basic hygiene and proper sputum disposal.
Patient and staff education on infection control measures will be routinely carried out to ensure program
success. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on
infection control will be implemented in all ICAP supported sites. There will be also be onsite trainings of
triage nurses on fast tracking to enable identified co-infected patients receive care as soon as possible and
reduce risk of nosocomial transmission of infections. Peer Health Educators (PHE) will be trained and
retrained to include and reinforce positive prevention messages including cough etiquette in health talks.
IEC materials and job aids will be developed /adapted and distributed to reinforce behavior change
messages. ICAP will support NTBLCP in the development of clinical support tools/job aids, national
registers and referral forms for recording/reporting systems, and in the production of IEC materials. ICAP
will also support the utilization of the updated NTBLCP recording and reporting formats that captures HIV
information by the TB program.
Support will be provided to at least 70 DOTS (30 hospital and 40 non-hospital) sites to initiate and/or
enhance provider-initiated HIV counseling and opt-out testing for TB patients and suspects and strengthen
referral linkages from the DOTS sites to care and anti-retroviral treatment (ART) centers through partnering
with CBOs/NGOs/FBOs and PLWHA groups. The TB DOTS sites will be supported to provide holistic
patient care according to National and Integrated Management of Adolescent and Adult Illness guidelines.
Sites will be assisted to put in place and/or improve defaulter tracking mechanisms. ICAP will also support
the state TB programs to put in place functional mechanisms to identify and manage drug resistant TB.
ICAP will support referrals of TB treatment failure cases to zonal culture laboratories. Collaboration will
continue with GON, other PEPFAR implementing partners, International Federation of Anti-leprosy
Association partners and relevant organizations (eg. TBCAP), to rapidly scale-up TB/HIV integration
activities at ICAP supported sites. TB/HIV coordinators will facilitate sites' activities in collaboration with
state/LGA TB focal persons.
Activity Narrative: ICAP will also work closely with the SCMS mechanisms in country to procure equipment and supplies for its
supported TB/HIV integration sites, and $45,000 has been placed in the SCMS mechanism for this purpose.
ICAP will upgrade facilities through infrastructure support such as basic renovations, upgrading equipment
and procuring supplies and consumables (e.g. TB microscopy reagents, sputum containers). To ensure
continuous availability of drugs and commodities in supported sites, ICAP will strengthen the logistics
management of the states and LGAs in areas of operation.
ICAP will contribute to the overall program goal of enhancing integration of TB/HIV activities by enabling at
least 3,700 HIV-infected patients to receive TB treatment. As part of the sustainability plans of the GoN and
in line with the 5-Year Strategy, at least 166 health care workers will receive TB orientation training. ICAP
will also ensure that GoN structures are strengthened and integrated through joint capacity building of
StateAction Committee against AIDS, Local government Action Commttee against AIDS and NTBLCP,
states, and LGA TB supervisors for effective program management including joint supportive supervision.
ICAP will help provide basic tools and equipment to reactivate non-functional DOTS sites in focus states.
ICAP will ensure that activities are implemented with the full participation of other government partners
especially German Leprosy Relief Association and Netherlands Leprosy Relief to promote sustainability
and facilitate equity and synergy in line with GoN plans.
This activity also relates to ART, Palliative Care, Orphans and Vulnerable Children, Voluntary Counseling
and Testing and PMTCT , AB and sexual prevention. The focus is on ensuring adequate and prompt
linkage of TB patients and their household contacts to HIV counseling, testing, care and treatment services,
to ensure that all HIV patients are screened for TB, and to enable all HIV-infected patients with TB to
access services at DOTS clinics. Similar services will be made available to OVCs and PMTCT clients. In
collaboration with other relevant partners/organizations, ICAP in COP09 will facilitate linkage of clients to
other support services such as micro credit and nutritional support.
ICAP will support activities to encourage all patients in related communities living with TB to bring family
members and household contacts to the clinic, particularly children (five years and younger), to enhance
screening, early diagnosis and prompt treatment for positive cases. In collaboration with NTBLCP and other
TB supporting partners, ICAP will establish TB/HIV services for clients in prisons located within the ICAP
supported LGAs, and facilitate linkages to care and treatment clinics. Health care workers in both public and
private sectors will be trained to provide high quality TB/HIV integrated services. Other targeted populations
will include OVC, pregnant women and PLWHAs.
A major area of emphasis is on human capacity development through the training of health care providers
on TB/HIV integration services. Health care providers will be trained to provide counseling and testing
services, care and treatment, screening for TB, and referrals between care and treatment centers and
DOTS sites. Other emphasis areas include local organization capacity building, SI and gender.
ICAP will work with the relevant agencies and organizations to enhance policies that will ensure that clients
located within ICAP supported sites have access to adequate and integrated TB/HIV services, thereby
promoting equitable access to care and treatment programs, especially for women, children, underserved
and incarcerated populations in all the served states.
Continuing Activity: 13026
13026 5551.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $1,121,750
6696 5551.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $859,075
5551 5551.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $502,500
Estimated amount of funding that is planned for Human Capacity Development $279,190
Formation of Community Care Coalition for OVC (CCC for OVC)
ICAP will support CBO partners to constitute "Community Care Coalition for OVC; these CCC for OVC will
comprise of CBO members, key community leaders, Representatives of local Parents-Teachers-
Associations, clergy/Imam, local representatives of Ministry of Women Affairs, LACAs, youth leaders and
key OVC Caregivers and will serve as an active interface between ICAP supported facilities and the
community. CCC for OVC will assist in identifying/tracking OVC within the community and refer them for
relevant services available. CCC will also follow up with communal initiatives, decisions, and ethical/legal
issues for OVC and will also provide input into developing key indices (criteria) for educational support and
various other services where available resources are limited. ICAP will support training/orientation for CC
for OVC on OVC support services.
In COP08, ICAP assisted 28 secondary hospitals and 19 CBOs in Kaduna, Benue, Akwa Ibom, Kogi,
Gombe and Cross River States to support 8,000 HIV-infected and affected children (OVC) to access health
care, and other related services at the hospitals, their referral networks, and surrounding communities. In
COP09, ICAP will continue to support the 19 CBOs/FBOs/NGOs to provide community OVC services in the
6 states (Kaduna, Cross River, Benue, Akwa Ibom, Kogi and Gombe), During COP09, OVC services will be
provided to 6,559 OVC (3,345 males and 3214 females), including adolescents. These OVC include HIV
positive and HIV-negative children of PLWHA or HIV affected orphans. Primary direct services will be
provided to 536 OVCs while 6,023 will receive supplemental services. Nutritional supplements will be
provided to 1,640 OVCs.
ICAP family-focused approach is applied not only at the facility level but also at the community and home
levels through care services. Community based programming leads to identification of OVC through
awareness campaigns, support groups, and community-based HCT. OVC are also identified through
provider initiated counseling and testing of children accessing care in ICAP supported facilities following
national norms regarding counseling and consent of minors. Once OVC have been identified, ICAP's OVC
program focuses on providing an appropriate balance of services in the facility, community and home
settings.
ICAP OVC programming has several key elements: appropriately identifying OVC who are not receiving
services; providing a holistic family centered approach to care of OVC and adolescents (Creating exit
strategy at 18 years and appropriate prevention message with existing reproductive health services);
providing educational support; providing nutritional assessments and support; providing health care services
for HIV infected and affected children; and providing enhanced psychosocial support at both facility and
community levels. Health care services for OVC will include ongoing monitoring of growth and development,
immunization, malaria treatment, screening and prophylaxis (IPT) for TB when indicated, cotrimoxazole
prophylaxis (CPT) following national guidelines, and diagnosis and management of opportunistic infections
as needed. Also, as a component of ICAP HBC program, basic preventive care packages comprised of
ITNs, ORS sachets, soap for effective hygiene, water guard and water cans procured from SFH (another
USG supported IP) will be given to all clients.
Through its support and capacity building of local NGOs, CBOs and FBOs, ICAP enables the
implementation of advocacy and social mobilization, psychosocial support, home based care (HBC), and
educational support for OVCs and their households. The psychosocial support provided to OVC and their
care givers is multifaceted and comprehensive; it includes counseling on stigma and discrimination,
disclosure and grief, and recreational activities. OVC services are also integrated into community HBC
programs. Networking with community organizations and other implementing partners enables leveraging of
resources and enhances service delivery and sustainability. ICAP provides capacity building to community
and faith based organizations such as Fantsuam Foundation, Tulsi Chanrai Foundation (TCF), GAWON
Foundation, Catholic Archdiocese of Ogoja (CACA), Grassroots HIV/AIDS Counselors, ARFH and other
CBOs and PLWHA groups to provide family-focused OVC services. These CBOs/FBOs provide home
based primary care, psychosocial support and links for OVCs to health facilities for basic health care needs
by providing transport and other support. Through ICAP support some of these partners will also provide
peer education programming at primary and secondary schools. In COP09 ICAP will work through local
partners to provide educational support (e.g., school levies, school supplies) to most at-need children
following clearly identified selection criteria.
In COP08 ICAP provided nutritional support to OVC and worked with the GON in partnership with Clinton
Foundation, MARKETS and ACTION to leverage resources for providing therapeutic food for OVC
diagnosed with malnutrition; ICAP also facilitated the establishment of community driven "food bank"
initiative by 12 CBOs to provide nutritional support to OVC. In COP09 ICAP will continue to facilitate this
process with 7 additional CBOs. ICAP will also strengthen the reporting mechanism for OVC beneficiaries of
the food banks. Furthermore, OVC and their caregivers will be linked to the economic empowerment
programs provided by other partners (Winrock, Save the Children) in states like Cross River, Kaduna and
Benue. For sustainability and household food security, linkages to other community-based/faith-based food
and microfinance programs through the CBOs/FBOs listed above will be explored.
ICAP will provide training for 160 care providers including, counselors, and community/HBC providers using
GON National guidelines, OVC National Plan of Action and SOPs. In addition ICAP and local partners will
set up a monitoring system using the nationally approved tools that allows the monitoring of services
provided directly by ICAP and/or by referral from ICAP to other organizations.
ICAP, in partnership with other organizations, will provide training and scale up of OVC services that will
enhance the delivery of quality services to 6,559 OVC enrolled in core programs such as health,
educational support, psychosocial support, and food and nutrition. All these activities will improve the lives
of OVC reached in line with the national plan of Action on OVC and the National Strategic Framework, and
will contribute to meeting PEPFAR goals.
Activity Narrative: LINKS TO OTHER ACTIVITIES:
This activity relates to activities in ART (5404.08), Lab (5544.08), Palliative Care (5552.08), TB/HIV
(5551.08), AB (15654.08), and SI (5541.08). HIV-exposed and infected children will be placed on
prophylactic cotrimoxazole (CTX) following National guidelines. Household members of OVC will be
referred for HCT (5550.08) and children of women enrolled in PMTCT (6622.08) will be offered HCT as well
as referred for OVC services. Policy makers and key decision makers in the health and education sectors
will be reached by advocacy efforts.
This activity targets infants, young children, adolescents and other at-risk children in HIV infected and
affected families. It also targets the households, including caregivers, of OVC. The entry point for OVC in
the general population will be ICAP-supported sites and partner organizations. Health and allied care
providers in clinical and community settings will be trained to provide services to OVC. Community and
facility based volunteers, traditional birth attendants and support group programs, will be used to increase
access to care and support especially to the underserved.
ICAP's area of emphasis will be the development of networks, linkages and referral systems as well as
capacity development and food/nutrition support. In addition, ICAP will advocate equal access to education
and improved legal and social services such as the protection of inheritance rights for women and children,
especially for female children, and increased gender equity in HIV/AIDS programming. ICAP will advocate
for increased access to income and productive resources for HIV infected and affected women and care
givers. This activity will foster necessary policy changes and ensure a favorable environment for OVC
programming.
In COP09, ICAP support will continue to enhance equity and gendered approaches that lessen vulnerability
of female OVC by increasing their access to education, care and other support services. Increasing
involvement of men in caring for OVC will also be emphasized.
Estimated amount of funding that is planned for Human Capacity Development $60,400
Estimated amount of funding that is planned for Food and Nutrition: Commodities $13,500
Estimated amount of funding that is planned for Education $46,460
Estimated amount of funding that is planned for Water $6,050
Table 3.3.13:
In COP08, ICAP supported HIV counseling and testing (HCT) at 52 sites including 27 secondary hospitals,
20 primary health centers and 5 non-hospital facilities (five stand-alone voluntary counseling and testing
(VCT) centers) in six states of Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi. In COP09, this
support will be streamlined to focus on most at risk populations in selected sites within the six states. In
COP09, ICAP will provide HIV counseling and testing services in a total of 55 HCT sites (30 secondary
hospitals, 20 primary health centers and 5 non-hospital facilities (i.e., five stand-alone VCT centers) in six
states Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi. Included within the non-hospital facilities
are linkages to health facilities. At least 12,000 most at risk individuals will receive counseling and testing (in
a non-TB/non-PMTCT setting) and receive their results. ICAP's HCT support has 5 themes: supporting
provider-initiated opt-out HIV testing (PITC) in all health care facilities, including TB DOTS sites; providing
HCT services throughout health care facilities by strengthening point of service (POS) testing in both
inpatient and outpatient settings; expanding access to HCT centers; strengthening opt-out HCT in the ANC
setting; and promoting case-finding via the family-focused approach to HIV/AIDS diagnosis, care, and
treatment. Additionally, ICAP will work with sites to identify potential additional resources (from the GON,
other donors, Global Fund, etc.) to provide commodities and increase uptake of HCT services in all points of
service in the facilities.
ICAP will ensure quality HCT services through the implementation of training courses for staff and
volunteers. In FY08, 350 individuals, including health care providers and laboratory staff at the facility and
community levels, were trained to provide services in over 50 HCT outlets in the six states. In COP09, ICAP
will support HCT training using the National HCT training curriculum, and will provide ongoing mentoring to
enhance the skills of at least 125 providers. Counselors will have access to couples HIV counseling and
testing (CHCT) training to improve their skills to provide adequate couples counseling and testing following
the best practices protocol in all supported sites. HCT refresher trainings will be provided to site health care
providers as needed. In addition to the HCT specific training, ICAP will also provide trainings to improve
monitoring and evaluation.
Innovative approaches will be instituted to effectively reach and focus on the most at risk populations. A risk
assessment checklist will be developed and introduced as part of counseling tools to identify most at risk
persons presenting in facilities. ICAP will support selected local nongovernmental organizations to partner
with NYSC-trained peer educators in selected sites to reach the student population (especially at tertiary
institutions around each region). Existing youth-friendly centers in supported states will be strengthened to
provide information (written, audio-visuals) on HCT to young people in and out of school, following the
standardized consent procedures where necessary. ICAP will work to provide training of Youth Corp
Volunteers as lay counselors for HCT services through community outreach programs which could easily
serve as their required community development activity and provide a much needed service. ICAP will
maintain access to HCT outreach to high risk communities in already established sites - long distance truck
drivers' parks in Benue State and Ogoja prison. ICAP-CU will collaborate with outreach teams from
nongovernmental and faith based organizations to ensure regular outreach to communities, churches and
mosques to promote HCT. ICAP will continue to support the use of multidisciplinary teams including lay
counselors where appropriate.
The national ‘Heart to Heart' logo will be used at HCT sites for integration with national branding of HIV
testing services. ICAP will support community-level HCT services through identified community and faith
based organization (CBO/FBO) outreach initiatives, targeting mainly most-at-risk-populations and further
strengthening the network of HCT available to the community. ICAP will ensure that secondary and primary
healthcare facilities are key partners in these networks. Referral linkages will be strengthened between HCT
services at smaller primary health care (PHC) facilities and care and treatment services at bigger PHC or
comprehensive sites. ICAP will encourage the single sitting approach at all supported facilities and develop
standard operating procedures (SOP) for mobile HCT and make them available to mobile service providers.
Independent HCT centers will be established at sites closest to MARPs to provide client-initiated HCT.
At all health facilities, an "open access" approach will be promoted to ensure that HCT is available to all
patients utilizing a facility. ICAP will foster linkages of HCT services to treatment, care and support services
within and across programs and between other implementing partners using standard referral tools,
ensuring quality implementation of HCT data management and reporting systems. HCT services will
promote couples counseling and testing at the service outlets with a special emphasis on HCT for
discordant couples. In addition, post-test counseling resources, such as support groups and peer
educators, will support disclosure when appropriate and address the special issues facing discordant
couples. Post-test counseling for HIV-negative patients will emphasize primary prevention; that for HIV-
infected patients will focus on appropriate prevention with positives (PwP) messages to reduce risk of HIV
transmission from HIV-positive individuals. Post-test counseling for clients shall include appropriately
balanced messaging, including abstinence, be faithful, and information on correct and consistent condom
use. Male and female condom distribution will be supported by ICAP and implemented by CBO partners.
Condoms will be supplied by the Society for Family Health (SFH) and distributed to CBOs for use in
condom education activities. IEC materials on HCT and prevention messaging will be available to all clients.
Laboratory QA will be provided by ICAP laboratory advisors to ensure quality HIV testing. HIV testing will be
conducted using the new National serial testing algorithm. ICAP will continue to store test kits centrally in a
secure warehouse in Abuja and distribute to sites as needed. Technical assistance will be given to sites to
ensure appropriate storage, record keeping and forecasting. ICAP will work closely with the SCMS
mechanisms in country to procure equipment and supplies for its supported HCT sites and to participate in
the GON-led harmonization process of logistics management information systems in Nigeria. ICAP will work
closely with the federal and state governments through the federal and state ministries of health, NACA and
SACAs in the six states to enable them provide HCT support across health facilities. ICAP will partner with
states with free maternal child health (MCH) policies to provide technical assistance for HCT services for
pregnant women. ICAP will also explore partnership with the Global Fund supported health facilities to
ensure service linkage and promote quality of counseling and testing services.
Activity Narrative: CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will contribute to the overall COP09 maintenance plans by enabling 30 secondary hospitals and
25 non-hospital facilities in six states (a total of 55 service outlets) to provide access to HCT services to at
least 12,000 most at risk persons who will also receive their results. HIV-positive clients will be provided
with access to care and treatment, including ART when needed. 125 individuals, including health care
providers and laboratory staff at facility and community levels, will be trained and retrained to provide
services. ICAP will continue to support and participate in the harmonization process led by the GON with
regard to Global Fund, logistics management information systems and Inventory Control System (ICS) for
test kits and other related service delivery issues.
This activity also relates to activities in care and treatment, TB/HIV, OVC, HCT, and PMTCT. The HCT
activities in the sites supported by ICAP will encourage the enrollment of patients and family members into
care through multiple entry points. ICAP will also support community HCT linked to the hospital networks,
enabling referral of HIV positive clients to the hospitals to access care and treatment as appropriate.
This activity targets the most at risk populations such as women in the reproductive age group, young
people, truck drivers, who are mostly male and sex workers; ICAP will promote pediatric and family testing
to family and household members of HIV-positive clients using a family focused approach at multiple entry
points. Community based and faith based organizations/facilities will be targeted for training to provide HCT
to increase access in non-clinical settings to most at risk groups.
Emphasis areas include human capacity development, increasing gender equity in HIV/AIDS programs,
local organization capacity building and SI. As part of its human capacity development and sustainability
efforts, HCT refresher trainings will be conducted for facility-based service providers. Site HCT focal
persons will receive HCT supervision training to help oversee activities. ICAP will also support consistent
and regular monitoring and onsite mentoring at all sites to ensure sustainability and maintenance of quality
services. ICAP will support HCT activities targeted at increasing male enrollment. Lay persons will be
trained in rapid HIV testing and counseling to increase access to more clients. Activities will also focus on
using gender transformative approaches through counseling, behavior change communication and other
program interventions to address and deliberately include women and men in activities that query gender
norms and masculinity, especially as it relates to reproductive health and HIV/AIDS. Health and other
related care provider trainings will include gender transformative skills training to enable them identify and
implement gender relational activities that will focus on integrating and engaging men and boys with efforts
to empower women and girls. For sustainability and maintenance of quality data collection, reporting, and
reviewing, ICAP will continue to build the capacity of state and site staff in quality data collection, program
monitoring and evaluation. ICAP will also support the capacity building and use of community volunteers for
different aspects of data collection. The quality of counseling at points of service, especially post-test
counseling, will be monitored. Close supervision and monitoring will check for adherence to protocols and
strengthen referral linkages from HCT. The training and quality of HCT provided by TB health providers at
TB sites will be monitored and strengthened.
ICAP will also support improving the capacities of Local Government Areas (LGA) and state monitoring and
evaluation (M&E) focal persons to effectively revitalize the information management systems across the
different service delivery levels.
Continuing Activity: 13028
13028 5550.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $1,710,000
6695 5550.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $756,667
5550 5550.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $410,000
* Reducing violence and coercion
Military Populations
Table 3.3.14:
In COP08, ICAP supported procurement and distribution of antiretroviral (ARV) drugs; and has expanded
antiretroviral therapy (ART) services support to 13 additional hospital networks, resulting in coverage in 6
states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna and Kogi states). A total of 27,777 patients are
targeted to be enrolled in ART programs by the end of the program year.
Expansion of the supply chain and logistics system: In COP08, ICAP supported a supply chain
management system to ensure a continuous supply of ARV drugs with FDA approval or tentative approval,
and which are National Agency for Food and Drug Administration and Control (NAFDAC) registered or have
received a waiver. ICAP will continue utilizing generic drug formulations where possible. Product selection is
based on existing national adult and pediatric treatment guidelines. In COP09, ICAP will continue to
forecast, quantify, procure and deliver ARVs and other clinical supplies for all supported sites; share
monitoring tools and skills with the site pharmacists and logisticians to ensure proper assessing of usage
and needs, and timely and proper stocking. ICAP will continue to work mainly with the UNICEF Supply
Division, which presently procures ARV drugs for ICAP, handles customs clearance and delivers to a
secure warehouse at the ICAP office in Abuja. ICAP will also leverage the economies of scale provided
through the utilization of the Partnership for Supply Chain Management (SCMS) for ARV drug procurement
as SCMS increases its services in Nigeria. Columbia has allocated $800,000 of its ARV Drugs budget to
SCMS for procurement of commodities. All of ZDV-3TC-NVP Fixed Dose Combination will be bought via
SCMS pooled procurement mechanism. Quantities procured are based on projections of patient numbers
as determined by annual forecast conducted in August 2008 in conjunction with the ICAP country team,
SCMS and USG Logistics Technical Working group. ICAP will enlist a logistics company such as FEDEX in
order to facilitate prompt and efficient delivery of drugs and other commodities to regional offices and sites.
As expansion of ARV drug services is prioritized to rural areas, ICAP will continue to strengthen existing
referral channels and support network coordinating mechanisms.
Systems Strengthening:
ICAP will assess the pharmacy and logistics management procedures available at new sites in the six
supported states as part of the site development plan for each new site. ICAP will support the renovations
and expansion of storage facilities in all supported sites. In COP09, ICAP will assess pharmacy capacity in
all new sites, working towards secure storage and stock management. Standard Operating Procedures
(SOPs) in line with national SOPs will be provided to guide quality ARV drug management. ICAP will also
support the maintenance of all existing stores at its older sites. For sustainability and maintenance of
logistics and timely supply, ICAP will use state stores as regional stores for commodities to enable faster
distribution and build the capacity of state facilities in supply chain management.
ICAP will work closely with the state counterparts to renovate and revitalize identified state medical stores
and state logistic systems where available. Staff of these state medical stores will be retrained in current
approaches to logistics and supply chain management using national curricula where available. ICAP will
also strengthen the state logistics system through continued partnership with the states and private
organizations to provide logistics support to sites. Additionally, ICAP will decentralize commodities
distribution as a means of facilitating smoother and quicker distribution to the sites. ICAP will also continue
to support training of site pharmacy staff and provide onsite mentoring and technical support as needed.
ICAP will also strengthen site logistics system by introducing monitoring tools and strengthening Logistics
Management Information System (LMIS) and inventory control systems with the gradual progression
towards electronic supply databases.
Quality Assurance and Systems monitoring: ICAP has integrated quality assurance, monitoring and
evaluation systems into its existing logistics system.. ICAP's procurement and store managers provide
technical assistance including: training pharmacists in forecasting, stock management, record keeping,
quality assurance, and distribution; and providing infrastructure support for pharmacies and storerooms,
including renovation, refurbishment, and provision of equipment, supplies and job aids. In addition to the
hands-on training above, ICAP uses a state-endorsed pharmacy technician in-service training course, and
trains key staff on record keeping for ARV drug storage and distribution at points of service. Pharmacists at
every site participate in multidisciplinary team ART training activities.
Harmonization of Procurement Mechanisms and Leveraging resources: ICAP will work closely in
conjunction with other implementing partners, the GON and the Global Fund to harmonize and institute a
nationwide supply chain and logistics management system that will not only cater for ARV drugs but will
increase efficiency and effectiveness of distribution of other commodities and supplies especially procured
by governments at all levels. Key areas in need of further integration with the GON program such as
medical records systems, personnel, monitoring and evaluation, and supply chain management systems will
be strengthened during the COP09 year. ICAP will continue to participate in and support the harmonization
process led by the GON in line with one national program at all levels for sustainability. In addition, ICAP will
work towards sustainability by strengthening existing structures and building capacity of health care
providers in all health facilities that it supports. As expansion of ARV drug services is prioritized to rural
areas, ICAP will strengthen existing referral channels and support network coordinating mechanisms.
ICAP will also continue to partner with the Clinton Foundation for second line adult and first and second line
pediatric drugs.
In COP09, ICAP activities under ARV drugs will support the PEPFAR goals of ensuring a continuous supply
of ARV drugs to HIV infected adults and children who require treatment. In COP09, 3,774 individuals (3238
adults and 536 children) will newly initiate ART. By the end of COP09,28,076 people will be receiving ART
at ICAP-supported sites, thus contributing to the national goal of treating 350,000 patients by Sept 30, 2010.
This activity also relates to activities in ART, Palliative Care, OVC, HCT, PMTCT and TB/HIV for the
Activity Narrative: provision of HIV/AIDS related commodities needed in those services.
Health care workers especially pharmacists doctor and nurses, will acquire skills to manage ARV drugs
appropriately along the supply chain.
Emphasis areas include human capacity development and gender equity.
Due to the staffing challenges at the sites, ICAP will encourage the use of volunteer pharmacists from
private pharmacies especially on clinic days at supported sites; encourage the use of Post NYSC and
consultant pharmacists in the more rural areas where the volunteers are not available. ICAP will support the
use of pharmacists in already established sites as consultants to mentor decentralized and outreach sites.
These pharmacists will be trained using existing national training curricula.
Continuing Activity: 13029
13029 5493.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $9,393,931
6691 5493.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $4,845,000
5493 5493.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $1,270,000
Estimated amount of funding that is planned for Human Capacity Development $183,600
Table 3.3.15:
In COP08, the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University
continued to expand its laboratory network model across the six states of Kaduna, Benue, Cross River
States, Gombe, Akwa Ibom and Kogi, enabling 28 (25 plus 3 plus-up funded) hospital networks to support
HIV/AIDS care and treatment programs. ICAP achieved its lab target of 25 sites for COP08 and opened an
additional 3 sites using plus-up funding. Due to limited funding resources and need to decelerate expansion
activities, targets for COP09 will be set at 27 lab sites, reflecting a 7% growth from COP08 targets. ICAP
has already achieved its COP09 target and will continue to maintain the additional 28th lab site with
leveraged funding.
ICAP's experience in COP08 will inform maintenance and minimum lab expansion plans in COP09. In
COP08, baseline laboratory assessments for additional sites revealed infrastructural deficiencies, including
lack of electricity and potable water, obsolete equipment and testing methods, severe staffing shortages
and under-skilled staff.
ICAP's response to challenges enumerated above has been multi-pronged and includes development of the
Laboratory network model, a detailed Laboratory Support plan, and support for renovation and training. The
Laboratory Support plan established a logical step-wise approach to phasing in the services needed by
HIV/AIDS care and treatment programs.
Phase I provides the "minimum package" elements of a functioning lab: electricity, running water, adequate
interim space, training and supervision, reorganization of labs as needed, ability to perform HIV testing,
complete blood counts, simple chemistries and CD4 capability. Almost all the labs in the 28 secondary
health facilities have been provided with the phase 1 minimum package to enable them to function
effectively. In COP09, no additional lab sites at health facilities will be developed.
Phase II includes the introduction of analyzers, the initiation of standard QA/QC systems, the expansion of
capacity to include additional chemistry tests, urinalysis, malaria parasite, STI screening tests, pregnancy
tests, stool microscopy, urinalysis and blood cultures, Hepatitis B and C screening, and liver function tests
where feasible, and the completion of renovation and refurbishment activities as well as the introduction of
protocols to collect and prepare dried blood spot (DBS) samples for use in early infant diagnosis (EID).
ICAP will continue to support and expand services for the diagnosis of the following opportunistic infections:
Malaria, TB, Hepatitis B and Hepatitis C among others. ICAP will continue to work closely with the clinical
TWG team on OI diagnosis. ICAP will also continue to participate in the National EID scale up plan, sending
DBS specimens to appropriate laboratories supported by other PEPFAR implementing partners with DNA
PCR capabilities. ICAP will also continue collaboration with the Clinton Foundation for sample collection
materials and transport of specimens/results.
Lab staff will be trained and retrained in the use of already designed specimen shipment forms and other
identified mechanisms to track samples and results among ICAP lab network and other partner networks. In
COP09, ICAP will continue to fully fund training on diagnostic testing and monitoring, good laboratory
practices (GLP) and biosafety. It will continue to coordinate and fully fund formal didactic training sessions
and share training resources to avoid duplication. On-the-job training will continue to be enhanced by job
aids, standard operating procedures (SOPs) and diagnostic algorithms. In COP09, ICAP will provide 245
laboratory staff with training in GLP, HIV serology, and CD4 enumeration among others. Additional training
on microscopy for AFB using the new nationally adapted WHO/CDC AFB smear microscopy training
packages will be conducted at 17 DOTS sites to identify TB/HIV co-infections. Training of Trainers on lab
management was provided by APHL in collaboration with PEPFAR -Nigeria LTWG to one ICAP lab advisor
as a training of trainers (TOT) who will with others step down the training to 30 site level lab supervisors to
enhance lab management skills. ICAP will also support the training of "back-up" Lab Scientists to provide
services when regular ones are on annual leave or posted to different facilities. All available trainable lab
personnel will be trained on all analyzers, regardless of specialty, to address the challenges of lab
personnel shortages at some of these facilities. ICAP will continue to support task shifting by training of non
lab personnel in rapid HIV testing with appropriate mentoring, monitoring and supervision.
ICAP will work closely with the PEPFAR lab technical working group for the development of a common lab
equipment list and will procure appropriate equipment for the different lab levels that it supports.
ICAP will support the renovations and expansion of lab facilities especially at the PHC level in all supported
sites. In COP09, ICAP will assess lab capacity in all new sites, to provide the right environment for lab
activities. Renovations and refurbishments will include the addition of partitions, workbenches and stools,
water and adequate lighting, installation of air conditioners, refrigerators, freezers, back up energy sources,
shelving and other storage, and security elements such as bars and locks.
ICAP will also support selected Primary Health Care (PHC) centers to provide basic monitoring
investigations using manual method or simple auto-analyzers via the development of mini labs (FBC,
chemistry, and CD4). ICAP will strengthen existing sample transportation (shipment) flows from rural PHCs
to the comprehensive site/urban PHC mini labs closest to them. ICAP will also support the continued
development of mobile lab teams which started in COP 08, to extend lab services to very remote/hard to
reach communities and rural PHCs in Akwa Ibom, Kogi, Gombe and Kaduna. These mobile labs will be
equipped with semi-automated machines (which can be operated by low skilled personnel) like the reflotron
for chemistry, hand held hemocue machines for HB estimation. The mobile team will operate from the
regional offices across the six states using ICAP field vehicles in the short term. More appropriate and
customized transportation will be identified in conjunction with other implementing partners (e.g. IHVN) in
the long term. ICAP will work with the state governments to identify National Youth Service Corps
(NYSC)/post NYSC volunteer scientists to operate these mobile labs in hard to reach areas. The mobile
team will provide opportunities for on the spot services to process samples and produce same day results
for patients.
ICAP will support the National TB program to improve on the quality of TB diagnosis by equipping four high
volume TB smear microscopy sites with fluorescence microscopes. This will increase the rate of TB case
Activity Narrative: detection following the sensitivity of this technique. ICAP will train 10 lab technicians/Scientists on TB
diagnosis using the fluorescence microscopy technique and provides reagents. These sites will be enrolled
for the National TB microscopy EQA program to ensure the quality of TB Smear Microscopy.
ICAP will ensure that all bio-medical waste generated from all its supported sites will be properly disposed
of by supporting renovation of hospital incinerators, provision of autoclaves to sites without existing
incinerators, procuring and regularly supplying sharp containers, bio-hazard bags. ICAP will continue to
work closely with the SCMS mechanisms in country to procure equipment and supplies for its supported
laboratory sites.
ICAP will continue to participate in the QA/QC national networks discussions and will support the active
integration of recommendations/guidelines at its sites and state levels. ICAP will implement already
developed QA/QC plans at all supported labs using national guidelines/tools where available. ICAP will
institute a robust 4 - pronged Quality Assurance management program in all its supported sites. These
components will include quarterly site monitoring visits, use of proficiency testing panels, survey of rapid
tests and equipment/results performance in the field and sample retesting. Results of the quarterly QA
activities will be made available to a national centralized system (supported by PEPFAR). Positive and
negative HIV serology panel will be prepared in collaboration with the PEPFAR-Nigeria Quality Assurance
team and transported to sites to support and increase the quality of HIV diagnosis. This will be used for
daily quality control for rapid HIV testing by personnel in the facilities as well as lot/batch monitoring of the
integrity of all HIV test kits supplied to sites. Laboratory heads of secondary health facilities will be trained
to serve as quality assurance (QA) focal persons and will be responsible for distributing serology panels to
testing personnel at the PHCs level during their monthly supervisory visits to the PHCs zoned to their
facilities. All testing lab with storage facilities will be required to store 5% of all samples tested in the
facilities, while those without storage facilities will be expected to store 5% of all sample tested on filter
paper DBS. These samples are to be collected quarterly for retesting in an approved laboratory.
Four ICAP supported labs that have been accredited by the German National CD4 EQA program will be
used as reference lab for all other CD4 processing labs .These sites will be used to prepare CD4 low and
High panel using sample bottle that can preserve CD4 cells for 2-3 days.
ICAP will also regularly assess the quality of rapid HIV testing done in remote PHCs and stand alone VCT
using standard QA tools which will include regular supervisory visits to provide mentoring, regular use of
controls, competency assessments after training, biweekly proficiency testing and regular refresher
trainings. ICAP will continue to support PEP programs in all its sites by emphasizing the availability of this
service in all its lab training.
ICAP laboratory program is currently supported by a regional lab advisor from the HQ who provides regular
TA to in country lab team. The in country team is comprised of one Associate Director for laboratory
services, one central lab advisor (supervises all lab activities from the central office), one central biomedical
engineer, one lab QA advisor and five regional lab advisors. This lab team will continue to work closely with
the Lab TWG and the state MOH to ensure that at least 10 ICAP supported labs gain local lab accreditation
through the national lab regulatory body (MLSCN). Also, a total of USD200,000 is set aside for
procurements through the SCMS mechanism.
In FY09, ICAP will use EP funds to support 28 hospital labs using the phased approach described above.
To facilitate GoN scale up plans, 245 laboratory staff will be trained on the provision of high-quality lab.
Trainings will be stepped down to laboratory technicians and assistants from the primary health centers.
Sixty lab technicians will be trained on ZN-staining /AFB identification to enhance TB diagnosis at the DOT
sites. ICAP will also strengthen the laboratories at new sites by renovating space and facilities (within the
existing hospital building space), and enhancing their diagnostic abilities. By ensuring appropriate training,
supervision, equipment, maintenance and supplies, all 30 hospital labs will be strengthened to support
these institution's rapidly-growing adult and pediatric HIV/AIDS care and treatment programs.
LINKAGES TO OTHER ACTIVITIES:
This activity also relates to activities in ART, Palliative Care, OVC, VCT, TB/HIV and PMTCT. These
services will directly support these activities by enabling 12,000 people access to HIV/AIDS testing and
28,800 HIV positive adults, and 3,200 infants and children on treatment, and an additional 3,300 HIV
positive mothers to access HIV/AIDS care and treatment.
General populace with special emphasis on high risk groups (TB co-infections). HIV monitoring of HIV
positives and diagnosis of HIV exposed especially vulnerable groups of women, infants and children.
Pregnancy and syphilis tests will be provided to women. Lab monitoring for 52,310 HIV positives and 3,300
HIV positive mothers includes a projected total estimate of 510,320 tests consisting of 139,200 LFTs,
139,200 CBCs, 143,220 CD4 counts, 7,200 sputum exams, 4,100 PCRs for EID and 77,400 HIV testing
including tests in PMTCT and TB patients. Health workers will be trained in providing quality laboratory and
testing services including collection, transport and tracking of samples and results especially to and from
primary healthcare centers and other partner networks. CBOs/FBOs will be trained in using rapid test kits
based on national algorithms.
Emphasis areas include renovations including upgrading of infrastructure, commodity procurement, training,
quality improvement/assurance, supportive supervision, and development of referrals, network/linkages.
Continuing Activity: 13031
13031 5544.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $2,876,055
6693 5544.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $1,410,000
5544 5544.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $500,000
Estimated amount of funding that is planned for Human Capacity Development $112,878
Table 3.3.16:
As government and international partners/donors move towards increasing access to HIV prevention and
care and treatment, monitoring and evaluation (M&E) will continue to play a critical role in providing
information for adequate program planning through the development of processes and strategies that will be
used to assess project/program progress, performance, and quality. To be adequately positioned for these
challenges, ICAP Nigeria M&E will continue to adopt new approaches to M&E in HIV care (FAME) and this
will aide in the improvement of skills at facility and other service delivery points. ICAP Nigeria M&E will
adopt the use of Government of Nigeria (GoN) harmonized tools and develop an M&E guide that will put
together best practices and strategies in M&E, and promote program monitoring and evaluation (PME).
These efforts, in collaboration with the GoN (including State M&E officers),will help ICAP move forward in
the implementation of the National strategic M&E framework.
In COP08, ICAP provided strategic information (SI) management services to 144 sites in six states
(Kaduna, Benue, Cross River, Akwa Ibom, Kogi and Gombe). These included (107) primary health centers
(PHCs) providing a combination of PMTCT, TB/HIV and/or HCT, 9 Community Based Organizations
(CBOs) and 28 secondary hospitals providing comprehensive HIV/AIDS programs.
In COP09, ICAP will build upon the successes and the lessons learned from COP08 to date to sustain and
improve on the SI support to a total of 30 comprehensive health facility networks and 19 CBOs in six states
(Cross River, Kaduna, Benue, Gombe, Akwa Ibom and Kogi states).
ICAP's M&E team with COP08 funding consists of 20 technical staff and a cadre of facility based data
clerks and medical records officers that support the system to implement M&E activities for patient
monitoring and management (PMM), Quality Management (QM) and Program Monitoring and Evaluation
(PME). The ICAP M&E team has supported the implementation of basic site patient tracking (using national
paper-based systems) for care and treatment, including the identification and harmonization of indicators
and definitions, and the adaptation and printing of data collection forms. M&E activities also included the
initiation of a paper-based records system, strengthening facility M&E systems through mentoring and
monthly facility data updates and system support. Also ICAP has conducted regular data collection and
verification and data quality requirements, tracking referrals and linkages to ICAP-supported hospitals for
HIV care and treatment services and introduction /support of new advances in HIV care monitoring and
evaluation.
ICAP also uses an electronic database to aid comprehensive patient tracking, facilitate site monitoring
activities, assist reporting, monitor quality of services provided, and enhance programmatic evaluation.
Using in-country networks and available technologies, ICAP has built a strong PMM system harmonized
with the Government of Nigeria's (GON) emerging national PMM system. ICAP has continued to participate
and key into the GON Three Ones strategy of one National M&E strategic framework, one coordinating
body and one reporting system. This has led to ICAP active participation in LHIPMIP (Voxiva platform),
HIVQUAL and membership of both State and National M&E Technical working groups.
In COP09, ICAP M&E staff will carry out regularly scheduled mentoring, monitoring and supervisory visits to
all sites during which they will strengthen M&E systems by providing National PMM tools and encouraging
their constant and correct use. This will ensure proper medical record keeping, efficiency of data flow,
referral coordination, and the use of standard operating procedures, in line with the USG SI data quality
assessment/improvement (DQA/I) and capacity building plan. On-site TA with more frequent follow-up
monitoring visits will be provided to reinforce and ensure that standards and best practices are adhered to.
In addition, we will vigorously pursue and implement activities that will increase data quality (data quality
assurance, chart reviews), and data use for programming at the Point of Service (POS?) communities,
Local Government Council and states where supported facilities are located by providing regular feedback
from the data generated. Focus will also be on improving real time data entry, data collection, data
validation and analysis at the POS to ensure sustainability and dissemination of findings across a range of
stakeholders.
In COP09, 13 additional M&E staff and 30 site data entry persons will be hired in order to sufficiently
address the greater level of M&E activities across all programs. Out of the 13 additional ICAP core staff to
be hired, one will be based in Abuja and 12 at the region. Of the 13 new hires 4 (Kogi, Cross Rivers, Akwa
Ibom and Kaduna) will be hired as State M&E officers to provide support in the strengthening of state and
facility M&E systems and to assist the Regional Advisors in the planning and implementation of M&E
activities in the State and Region. Seven regional and one Central M&E assistants will assist the State M&E
Officer, Regional M&E advisors and Central M&E team in the development and refinement of M&E
materials and provide support in the development and establishment of a systematic procedure for patient
monitoring and evaluation including collecting, collating and reporting all data tracked by the ICAP Nigeria
. In COP09, ICAP will train and provide ongoing technical assistance to at least 250 individuals at ICAP-
supported facilities (facility health personnel at secondary hospitals, primary health care facilities, DOTS
sites, CBOs, NGOs, and PLWHA groups) to enter and manage the information required to monitor program
performance, evaluate quality, and identify areas in which program services can be strengthened. Funds
will be used to train in basic computer skills, data management and general M&E as well as monitoring
quality of service using appropriate quality management (QM) tools. Service providers will also be
supported to complete medical records and registers in an accurate and timely manner. In addition, ICAP
will provide technical assistance to 150 local organizations and facilities, enabling them to strengthen their
own monitoring and evaluation activities.
ICAP will continue to support additional M&E activities, including monthly feedback meetings with facilities
and GON at all levels and regular quality checks on data and other services via adapted QM tools. Support
will be provided to the GON as necessary on program evaluation. In line with USG SI focus for FY09, ICAP
will support the establishment of the "Three Ones" at the state level, support capacity building of State M&E
officers, facilitate collection of data from non PEPFAR sites within the states of their operations, and involve
Activity Narrative: the state M&E officers in their routine program monitoring activities in order to instill a sense of ownership
and ensure sustainability of these efforts. Additionally, ICAPs SI team will continue to be active participants
in the SI working group established and coordinated by USG-Nigeria.
Correct and consistent data collection will contribute to the measurement of the achievement of the
GON/PEPFAR care and treatment goals. It will be utilized to strengthen systems for increased and rapid
expansion, planning and sustainability purposes. In addition, it will provide appropriate information to assess
quality of care provided to PLWHA's and PABA's.
M&E is concerned with the collection of data on all services provided to improve program activities and
enhance reporting. Thus, this activity will relate to activities in PMTCT, adult basic care and support,
TB/HIV, OVC, HCT, sexual prevention, ARV services, ARV drugs, lab, blood safety and injection safety.
ICAP will also conduct public health evaluations of selected interventions during the COP09 year as well as
routine evaluation of the PMTCT service delivery and decentralization of ART services to Primary Health
Clinics (PHCs).
The population being targeted includes the M&E officers in partner implementing organizations and various
CBO/FBO/NGO/PVO and medical records officers in health facilities. The various cadres of service
providers will also be provided with technical assistance to enhance accurate record keeping.
Emphasis areas include human capacity development, system strengthening and SI.
By collecting data about relative numbers of men and women accessing prevention, care, and treatment
services, strategic information will be available to inform the development of strategies to mitigate gender
inequity. Strategic information also enables programs to assess the effectiveness of referrals and linkages
to wraparound programs providing food support, microfinance initiatives, and reproductive health services
(and other required services). Data will routinely be used to assess and enhance program quality and
program effectiveness.
Continuing Activity: 13032
13032 5541.08 HHS/Centers for Columbia 6372 2768.08 HHS/CDC Track $1,500,000
6692 5541.07 HHS/Centers for Columbia 4166 2768.07 Cooperative $300,000
5541 5541.06 HHS/Centers for Columbia 2768 2768.06 Track 1.0 $188,500
Estimated amount of funding that is planned for Human Capacity Development $141,630
Table 3.3.17:
