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:
?Extension of local government coverage to Enugu State
?Extension of EID activities to all sites
The PMTCT services will be linked to HCT, adult and pediatric care and treatment, ARV drugs, OVC,
TB/HIV, laboratory services and SI.
ACTIVITY DESCRIPTION:
In COP08, CRS AIDSRelief (AR) supported PMTCT services in 30 Local Partner Treatment Facilities
(LPTF) and 2 PMTCT satellite sites (An additional one LPTF and 2 satellites were supported as part of the
local government coverage strategy in Anambra state). In COP 09 AR will increase the PMTCT sites it
supports to an additional 3 LPTF sites and 13 satellites providing PMTCT services in an effort to
decentralize services and increase coverage. This will make it a total of 51 sites providing PMTCT services
in 16 states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi,
Nasarawa, Ondo, Plateau and Taraba). AR, with other IPs, will complete the implementation of the
PEPFAR-Nigeria Local Government Area (LGA) coverage strategy in Anambra, ensuring the provision of
PMTCT services in at least one health facility in every LGA of the state. This is a critical step toward
universal access to PMTCT services. AR will work to extend the local government coverage strategy to
Enugu State. This will involve the support of the Enugu state SASCP to establish PMTCT committees.
Through its PMTCT services AR will provide testing, counseling and received results to 29,000 pregnant
women. Antiretroviral (ARV) prophylaxis will be provided to 740 women and an additional 246 clients will be
placed on HAART for their own disease for a total of 986 women receiving antiretrovirals (4% positivity rate
and 85% retention in care based on historical data at AR supported LPTFs). In setting and achieving
COP09 targets, consideration has been given to strengthening the quality of service delivery in order to
promote the best outcomes.
This activity will include, as a part of the standard package of care, routine provider initiated opt-out HIV
counseling and testing (HCT) in antenatal clinics (ANC) for all presenting women and in labor and delivery
wards (L&D) and the immediate post-delivery setting for women of unknown HIV status. Same day results
will be provided to clients. AR will use group health information, individual pre test and posttest strategies
and rapid testing based on the National testing algorithm. Partner testing and couple counseling will be
offered as part of PMTCT services to enhance disclosure. AR, through its community and faith-based
linkages, will utilize community and home based care services to promote partner testing. Clients will have
access to free laboratory services including CD4 counts and STI screening. Free medications including
those for OIs as needed and hematinics will also be provided. In addition to receiving PMTCT services,
children of HIV positive clients will be linked to OVC services and, for those who are HIV positive, to
pediatric care and treatment services.
Pregnant women requiring HAART will be placed on such during pregnancy and referred to HIV
comprehensive care centers after delivery. Referral coordinators will be identified in all AR-supported sites
and the communities, with their capacities built in collaboration with other IPs. Consideration may also be
given depending on LPTF acceptability to provide ART services within ANC clinics in order to increase
acceptability of initiating care and treatment.
For the anticipated number of women not requiring HAART for their own health, the current National
guidelines recommended short course two drug ARV option will be provided. This includes ZDV from 28
weeks with intrapartum single dose nevirapine (sdNVP) and a 7-day ZDV/3TC postpartum tail or ZDV/3TC
from 34-36 weeks with intrapartum sdNVP and a 7-day ZDV/3TC postpartum tail. Infant prophylaxis will
consist of single dose NVP and ZDV for 6 weeks. Single dose nevirapine will be given to all women at first
contact. AR will use its community linkages and mother-to-mother support groups to encourage HIV+
pregnant women to deliver in a health facility. For those HIV+ women who choose not to do so and deliver
at home, the same community volunteers will follow-up and identify them for needed postpartum services.
AR will explore the training and utilization of traditional birth attendants (TBAs) in addition to the mother-to-
mother support groups to reach HIV+ women who choose to deliver outside of the health facility. A focal
person at each LPTF will be responsible for tracing HIV+ mothers and their infants in the community and
linking them back to care. The HIV+ mothers and their infants will be linked postpartum to ART care and
support services which will utilize a family-centered care model.
AR, through its pediatric care and support program, will offer HIV early infant diagnosis (EID) in line with the
National Early Infant Diagnosis scale-up plan from 6 weeks of age using dried blood spots (DBS).
Implementation of the EID scale-up will be done under the guidance of the GON and in conjunction with
other IPs who will be conducting the laboratory testing. AR will collaborate with GoN as appropriate for
commodities and logistics support of the EID program. Exposed infants will be actively linked to pediatric
care and treatment, while their families will be referred to age-appropriate OVC services. In COP09, AR will
work to implement EID with a view to activating all AR LPTFs and their satellites. PMTCT focal persons at
all AR LPTFs will keep records of all exposed infants at enrollment soon after birth, informing HIV+ mothers
of the 6 weeks exact date for DBS collection. AR will encourage hub LPTFs to step down DBS collection at
affiliate PMTCT satellite sites and thus decentralize EID activities at these sites. AR will train members of
PMTCT support groups in HCT skills. AR will engage PMTCT support groups and the larger support group
(s) in tracking unbooked pregnant women and infants in the community, linking them to sites where they
can access HCT. AR will establish linkages with other non-AR providers, public and private, proximal to AR
LPTFs, with full-fledged ANC activities. This will encourage two-way referrals of HIV+ mothers and their
infants from these providers to AR LPTFs and thus benefit from EID/ART activities at AR sites. Throughout
these linkages there were be a strong focus on ensuring confidentiality at all levels.
HIV+ women will be counseled in the pre and postnatal periods regarding exclusive breastfeeding with early
cessation or exclusive breast milk substitute if AFASS criteria are met using the National Infant Feeding
Curriculum. AR will support couples counseling and family disclosure that will enhance adherence to infant
Activity Narrative: feeding choices. Full and accurate information will be provided on family planning and prevention services.
Women accessing family planning services will be offered/referred for HIV Counseling and Testing. Infants
of positive mothers will be linked to immunization services and well childcare. Cotrimoxazole prophylaxis will
be provided to infants from 6 weeks of age until definitive HIV status can be ascertained.
In COP09, AR will strengthen its program for Continuous Quality Improvement (CQI) in order to improve
and institutionalize quality interventions. Monitoring and evaluation of the AIDSRelief PMTCT program will
be consistent with the national plan for patient monitoring. Within each regional TA team AR will have a
PMTCT specialist assisted by a team of nurses and counselors to offer technical assistance to LPTFs and
take the lead on training and supervisory activities. AR PMTCT specialists will work in conjunction with
regional CQI specialists, program managers, clinical associates, and LPTF PMTCT coordinators as well as
counterparts from other IPs. AR regional PMTCT specialists will join the CQI-led team in conducting site
visits at least quarterly during which they will evaluate PMTCT clinical services, HCT done in the PMTCT
setting, the utilization of National PMM tools and guidelines/SOPs, proper medical record keeping, referral
coordination, and use of standard operating procedures in PMTCT. On-site TA with more frequent follow-up
monitoring visits will be provided to address weaknesses when identified during routine monitoring visits.
AR will provide training on PMTCT service delivery to 45 healthcare workers and retraining of an additional
45 staff according to the national curriculum. Trained staff will be required to step down trainings to other
Health Care Workers in their facilities and in nearby government health facilities as a human capacity
development activity. AR will collaborate with UNICEF-supported PMTCT sites and the CRS 7D programs
for community and home based PMTCT initiatives in its scale-up plans.
Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health
systems strengthening. AR will focus on the transition of the management of care and treatment activities to
indigenous organizations by actively using its extensive linkages with faith based groups and other key
stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will be
designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue
to be implemented in close collaboration with the Government of Nigeria to ensure coordination, information
sharing and long term sustainability. For the transition to be successful, sustainable institutional capacity
must be present within the indigenous organizations and LPTFs they support; therefore, AR will strengthen
the selected indigenous organizations according to their assessed needs, while continuing to strengthen the
health systems of the LPTFs. This capacity strengthening will include human resource support and
management, financial management, infrastructure improvement, and strengthening of health management
information systems.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will provide counseling and testing services to 29,000 pregnant women, and provide ARV
prophylaxis to 740 clients. This will contribute to the PEPFAR and GON prevention goals. With 44
operational sites in 18 states, AR PMTCT program supports the rapid scale up of PMTCT services desired
by the FMOH.
LINKS TO OTHER ACTIVITIES:
TB/HIV, laboratory services and SI. Pregnant women who present for HCT services will be provided with
information about the PMTCT program and referred accordingly. ARV treatment services for infants and
mothers will be provided through ART services. Basic pediatric care, including TB care, is provided for
infants and children through pediatric care and treatment. All HIV+ women will be registered for adult care
and treatment services.
AR PMTCT activities will focus on strengthening community and home-based care services to pregnant
women where appropriate and in collaboration with the CRS 7-Diocese program and other family-centered
care services provided by UNICEF, GON and the Catholic Secretariat of Nigeria. The AR senior PMTCT
specialist will offer technical assistance to 7-Diocese facilities. AR will collaborate with other IPs, particularly
IHV-ACTION, working at tertiary institutions for early infant diagnosis using DBS technology.
POPULATIONS BEING TARGETED:
This activity targets women of reproductive age and their partners, infants and PLWHAs. This activity also
targets training of health care providers, TBAs and mothers who will work as peer educators.
EMPHASIS AREAS:
This activity has an emphasis on training, supportive supervision, quality assurance/improvement and
commodity procurement. Emphasis is also placed on development of networks/linkages/referral systems. In
addition, integrating PMTCT with ANC and other family-centered services while ensuring linkages to
Maternal-Child-Health (MCH) and reproductive health services will ensure gender equity in access to
HIV/AIDS services.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12994
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12994 6485.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $1,425,000
Resources Services Track 2.0 CRS
Services AIDSRelief
Administration
6683 6485.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,150,000
Resources Services
Services
6485 6485.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $222,000
Emphasis Areas
Construction/Renovation
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $180,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM FY2008
In COP08 AIDSRelief (AR) is providing support to 31 Local Partner Treatment Facilities (LPTFs) and 10
satellite sites. In COP09 Sexual Prevention services will be offered through 34 local partner treatment
facilities (LPTF), 19 satellite sites, and 1 community based program in 16 states including Abuia, Adamawa,
Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nassarawa, Ondo, Plateau, and
Taraba. All HIV programs supported by AR promote abstinence until marriage, and mutual fidelity within
marriage. AR does not finance, promote or distribute condoms. In line with its HIV Policy, however, AR does
provide age-appropriate, complete and accurate information about condoms to its partners as part of its HIV
activities. AR will implement its AB programming activities in line with the overall PEPFAR Nigeria goal of
providing prevention services to individuals reached through a balanced portfolio of prevention activities.
Through the involvement of AR as a partner in this activity, PEPFAR Nigeria will extend its reach with AB
services in more states and communities. AR will provide full and accurate information on prevention
services. In COP 09, AR will dedicate a staff to focus on sexual prevention activities.
The program will support local partner treatment facility (LPTF) activities targeting HIV+ clients, their
families and communities who access care at these points of service. Prevention priorities will include
behavior change for risk reduction and risk avoidance and counseling and testing. All AR supported LPTFs
will provide education and training to patients and community health volunteers on secondary prevention.
This includes encouraging appropriate status disclosure according to OGAC and national guidelines,
counseling for sero-discordant couples, risk reduction and adherence to ART, and training for health
workers and peer outreach workers. Programs will include reducing societal stigma through appropriate
health education at facility and community levels and reducing gender based violence. There will be
structured peer education that includes systematic training curricula, refresher training, and training on
essential life skills. In addition, age appropriate abstinence only messaging and secondary abstinence
messaging will be conveyed to adolescents, especially orphans and vulnerable children receiving both
facility and home based support. AR through this program will cover the communities with AB messages
conveyed through multiple media. Through this methodology, a large number of people will be reached with
messages via one method or another; however, in line with the National Minimum Prevention Package
requirements, the counted group will be those individuals that would have received AB messaging: on a
regular basis and via the three strategies AR will employ (community awareness campaigns, peer education
models and peer education plus activities). AR anticipates reaching 6,591 people (2,636 male and 3,955
female) directly through community awareness campaigns, peer education models and peer education plus
activities; indirect beneficiaries are those who receive messages via other multiple media.
Data from the 2005 ANC Survey and the National HIV/AIDS and Reproductive Health Survey indicate a
high level of infection among 15 to 29 year olds together with a low level of risk perception (28%). AR will
incorporate messages that address behavior change, reduction of number of sexual partners, trans-
generational and transactional sex, sexually transmitted infections (STIs), and drug abuse into its services.
The strong community and adherence programs developed by LPTFs in the AR program will continue to
serve as the foundation for outreach to communities. In COP09, the program will continue to ensure that all
sites provide education to patients and community health volunteers on secondary prevention. Couple
centered prevention will also be emphasized. Prevention activities will include distribution of patient
education materials, community sensitization, increased couple testing, promotion of LPTF couple support
groups, and advocacy for risk reduction strategies for discordant relationships. High risk reduction
measures will include treatment of STIs and to a lesser extent interventions on drug abuse. Couples will be
treated at LPTFs or other referral centers that offer specialized treatment for STIs, where necessary.
AIDSRelief will provide full and accurate information on HIV prevention to all patients, as appropriate. AR
sites will integrate prevention with positives (PwP) activities including: adherence counseling; syndromic
management of STIs in line with National STI control policy and guidelines; risk assessment and behavioral
counseling to achieve risk reduction; counseling and testing of family members and sex partners;
counseling for discordant couples; IEC materials and provider delivered messages on disclosure. 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.
Fidelity in relationships will be promoted through information, education and communication (IEC) materials
and enlisting the support of religious leaders in community-led peer education plus activities, such as drama
groups. A family-centered approach will provide opportunities to maximize prevention messaging to all
family members. Linkages with CRS' OVC program will further promote messages that emphasize
abstinence and fidelity and the avoidance of high risk behaviors. AR will explore with its faith-based partners
opportunities for extending these messages into faith-based schools and developing peer educators in
schools. AR will draw on culturally appropriate prevention messaging material for these activities. AR will
enhance capacity development and partnership with the Federal government, State governments, Local
governments, CBO, and women's groups. Special messages targeting the males will be emphasized. AR
will implement its AB services while providing full and accurate information on other prevention services in
the area.
Training will be an integral part of this program and will be directed at facility staff, community level staff and
religious leaders. A total of 180 people (60 facility staff plus 120 community volunteers and religious
leaders) will be trained and given skills to be able to promote abstinence and being faithful messages to
patients, their families and communities.
Strategic information (SI) is crosscutting in all program areas. AIDSRelief SI activities will incorporate
program level reporting to enhance the effectiveness and efficiency of both paper-based and computerized
patient monitoring and management (PMM) systems, assure data quality and continuous quality
improvement, and promote data use for program decision making across all LPTFs. In COP09, AR will carry
out site visits to provide technical assistance that will ensure continued quality data collection, data entry,
data validation and analysis, and dissemination of findings across a range of stakeholders. It will provide
relevant, LPTF-specific technical assistance to develop specific data quality improvement plans. It will also
capture and report on individuals reached with abstinence and be faithful prevention messages using
Activity Narrative: relevant data collection tools and the PMM system.
AR Sexual Prevention activities emphasize the integration of prevention activities with treatment and care
services. Use of community awareness campaigns, the peer educator model, and peer education plus
activities (community drama, dance events, etc.) allows dissemination of Sexual Prevention messaging.
This activity contributes to the USG target of preventing 1,145,545 new infections by 2009 through the
promotion of AB and A-only messaging in a comprehensive approach.
LINKS TO OTHER ACTIVITIES
Sexual prevention activities will be linked to HCT, basic care and support (through dissemination of
information by home based care providers and ultimately by decreasing demand on care services through
decreased prevalence), ARV services, ARV drugs, OVC, TB/HIV, laboratory services, and SI activities.
The program will also seek to link up with other CBOs/FBOs that serve the same geographic areas, as well
as partners working in other sectors, wherever possible to collaborate on meeting the needs of the
community. It also will seek to link the various cadres of government (Federal, State and Local government)
and seek effective collaboration with relevant NGOs.
POPULATIONS TARGETED:
Key populations targeted are the healthcare community in treatment facilities, PLWHA, youths and adults
accessing HCT services, support group members and family members of PLWHA.
KEY LEGISLATIVE ISSUES ADDRESSED
AB activities promote a rights based approach to prevention with positives and other vulnerable members of
society and equal access to information and services. The activities will also address issues of stigma and
discrimination through the education of individuals and communities reached.
EMPHASIS AREAS
This activity has an emphasis on training and community mobilization.
Continuing Activity: 15655
15655 15655.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $200,000
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.02:
This activity will support the linkage of AIDSRelief (AR) supported Local Partner Treatment Facilities (LPTF)
and their satellite sites to the National Blood Transfusion Service (NBTS) zonal centers across the country.
In COP09, AR will be supporting 34 LPTFs and 19 satellite sites in 18 states (Abia, Adamawa, Anambra,
Benue, Delta, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, Rivers and
Taraba). Blood transfusions occur at all 34 LPTFs.
In COP09, AR will continue to work closely with the National Blood Transfusion Service (NBTS) and Safe
Blood for Africa Foundation (SBFA) in all aspects of its blood safety program. AR 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 linkages its zonal centers will develop with AR and its
supported facilities, will provide TA for blood donation drives held by these AR-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, AR will be
instrumental in working with hospital management and staff at all LPTFs to develop buy-in for the NBTS
blood services program, to create support for blood donor organizers, and to strengthen health facility and
community focused blood drive activities. AIDSRelief will draw upon its unique position in working with
mainly faith-based facilities to facilitate blood donation activities within parishioner communities. AR will
support the distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for
voluntary non-remunerated blood donation. In addition, AR will work closely with LPTF management to
establish blood transfusion committees to oversee blood use based on national algorithms and standards in
the health facilities.
Under this activity AR will continue the linkage of 5 AR-supported LPTF to proximal zonal NBTS centers in
Jos, Kaduna and Owerri. 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 1,125 transfusions will take place. AR 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, at least
900 units of blood will be collected and sent to the nearest NBTS centers for ELISA screening as outlined.
AR will work with the 34 LPTFs 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. Deferred donors will be offered HCT. At
least 450 blood donors will be screened using the National HCT testing algorithm, thereby utilizing the blood
donor setting as another point of service for HCT during pre-donation. 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.
This activity will support personnel capacity development through SBFA-conducted blood safety training in
line with NBTS approved standardized training curricula appropriate to various levels of trainees. Through
this mechanism AR will identify 40 laboratory staff and other health care workers involved in blood
transfusion services at supported sites that will be trained by SBFA. In order to avoid double counting, these
40 targets are counted under the SBFA blood safety narrative. For core Training of Master Trainers (TOT)
modules developed by SBFA, AR will conduct step down training to 80 laboratorians, allied health workers
and hospital management staff involved in blood transfusion services at their sites.
In addition to institutional capacity building for blood safety activities, AR will support the implementation of
universal precautions, good laboratory practice, and waste management. This activity will promote the
principles of universal safety precautions and the reduction of occupational exposure to blood, and
accidental injury/contamination. Essential consumables and services that protect the health worker from
contacting infections, especially HIV, will be provided. These universal precaution materials include
personal protective equipment, such as hand gloves, laboratory coats, and other consumables (e.g.,
methylated-spirit, hypochlorite solutions, antibacterial soaps, etc.), which will be provided to sites. Other
equipment to be provided will include centrifuges, thermometers, pipettes, and HIV rapid test kits. In
addition, each site will establish clearly defined procedures for healthcare workers, other staff, and patients
to access post-exposure prophylaxis (PEP). Proper waste management will be encouraged through the use
of biohazard bags, suitable sharps containers and the use of incinerators. AR will also support clinical
meetings and seminars to promote rational use of blood and blood products and reduce unnecessary
transfusions.
In order to maintain high quality laboratory results, AR will continue its aggressive QA/QC program that
involves on-site quarterly monitoring, retraining, and proficiency in rapid HIV testing. Monitoring and
evaluation of the AIDSRelief blood safety program will be consistent with the NBTS national plan. There will
be evaluations of transfusion committee activities, infection control practices, waste management systems,
and use of standard operating procedures for donor screening and blood collection. On-site TA with more
frequent follow-up monitoring visits will be provided to address weaknesses when identified during routine
monitoring visits.
systems strengthening. In COP09, AR will focus on the transition of the management of care and treatment
activities to indigenous organizations by actively using its extensive linkages with faith based groups and
other key stakeholders to develop a transition plan that is appropriate to the Nigerian context. The plan will
be designed to ensure the continuous linkage with the National Blood Transfusion Service for access to
Activity Narrative: safe blood, and that all activities facilitate effective coordination, information sharing and long term
sustainability. For the transition to be successful, sustainable institutional capacity must be present within
the indigenous organizations and LPTFs they support; therefore, AR will strengthen the selected
indigenous organizations according to their assessed needs, while continuing to strengthen the health
systems of the LPTFs. This capacity strengthening will include human resource support and management,
financial management, infrastructure improvement, and strengthening of health management information
systems.
CONTRIBUTION TO OVERALL PROGRAM AREA:
This activity contributes to USG and GON prevention efforts through the prevention of medical transmission
of HIV by ensuring a supply of safe and screened blood for blood transfusions. This activity will continue to
establish mechanisms for linkages with NBTS centers for blood banking services, while providing the
logistics and training to AR health facilities to effectively collect and store blood. Donor drives in the faith
based communities for VNRD will be done in collaboration with the NBTS. This also contributes to the
overall goal of GON to establish an effective and nationally coordinated and regulated blood program.
This activity is linked to HCT, PMTCT, care and treatment services, OVC, laboratory services, AB, injection
safety, and SI. AR activities in blood safety relate to HCT since HCT services will be made available to
deferred donors. Injection safety is linked thru universal precautions equipment and laboratory equipment.
This activity is most immediately linked to laboratory services to strengthen the collection, testing and
storage of blood units at LPTFs. Through transfusion committees and trainings AR will strengthen the links
with other LPTF health services to ensure that these activities benefit from a screened, safe blood supply
which will also promote program sustainability.
This activity targets health care providers, particularly laboratory staff including laboratory assistants and
phlebotomists. This activity also targets doctors and nurses. AR mainly works with faith-based rural facilities
that serve rural populations who would otherwise have limited or no access to these services. Adults 18
years and above in these communities will be targeted as voluntary non-remunerated blood donors.
This activity has an emphasis on training and institutional capacity building
Continuing Activity: 12995
12995 5392.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $115,000
6676 5392.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $0
5392 5392.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $72,000
Estimated amount of funding that is planned for Human Capacity Development $3,000
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Total Planned Funding for Program Budget Code: $2,938,502
Total Planned Funding for Program Budget Code: $0
Table 3.3.05:
ACTIVITY DESCRIPTION
AIDSRelief (AR) local partner treatment facilities (LPTFs) consist largely of primary healthcare institutions
located within communities that are poor and underserved in all areas of social infrastructure including
healthcare. A proportion of HIV infections are still transmitted within these healthcare facilities through
unsafe injection practices. In COP08, AR supported specific safe injection activities at 31 LPTFs and 10
satellite clinics in the 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo,
Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau and Taraba. In COP09, AR will expand to support safe
injection activities at a total of 53 sites (34 LPTF and 19 satellite sites) in a total of 18 states of Abia,
Adamawa, Anambra, Benue, Delta, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarrawa, Ondo,
Plateau Rivers and Taraba. In setting and achieving COP09 targets, consideration has been given to
modulating AR's rapid COP07 scale-up plans in other programs in order to concomitantly work towards
continuous quality improvement.
AR injection safety activities encompass the training of infection control personnel from each supported
facility on universal precautions and medical waste management. Healthcare workers trained in
collaboration with John Snow Inc./Making Medical Injections Safer (JSI/MMIS) will step down the training to
ensure sustainability and behavioral change. It is expected that a total of 120 personnel will be trained. This
step down training to other LPTF staff, including nurses, doctors, laboratory staff, hospital cleaners, laundry
workers and waste managers, will include topics such as proper techniques for giving injections, drawing
blood, dispensing blood into laboratory bottles for laboratory testing, and disposal of used needles, sharps
and other materials contaminated by blood and other biohazardous materials. AR will obtain and use MMIS
supplied manuals to conduct follow-up on-site training at AR-supported LPTFs. Behavioral change
communication (BCC) activities will be carried out to reduce unnecessary use of injections. In COP09, AR
will work with MMIS to provide supportive supervision to all trained AR supported facilities.
AR will collaborate with JSI/MMIS to supply and distribute single-use needles, safety boxes, and personal
protective equipments to all AR-supported LPTFs. This activity will provide retractable needles and
syringes, sharps containers, and liquid hand washing soap in LPTF wards, clinic rooms, laboratory work
stations, and strategic areas to encourage their use. This activity will also provide personal protective
equipment (PPE) for health workers and ancillary hospital staff who come into contact with sharps and
contaminated materials. AR will work with each LPTF to improve access to water at each hand washing
point. For sustainability purposes, AR will ensure that these activities are integrated within each facility's
overall infection prevention and control and workplace safety programs. AR will also support post-HIV
exposure prophylaxis (PEP) programs at all sites.
Health care waste management will also be supported in this activity. Incinerators will be repaired and
fueled where they are available and constructed where there are no incinerators.
In COP09, AR will strengthen its program for Continuous Quality Improvement (CQI) to improve and
institutionalize quality interventions. CQI specialists and laboratorians will conduct team site visits at least
quarterly during which there will be evaluations of infection control practices, waste management
procedures, proper record keeping, and use of standard operating procedures for injection safety.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity contributes to the USG Nigeria target of preventing 1,145,545 new HIV infections through the
prevention of medical transmission of HIV. Planned institutional and human capacity building and the
provision of safe injection commodities/PPE will reduce occupational hazards and unnecessary exposure of
health workers and ancillary staff to blood borne pathogens.
AIDSRelief activities in injection safety relate to activities in ARV services, PMTCT, laboratory services,
basic care and support, TB/HIV, OVC, blood safety, and SI to ensure that healthcare providers and ancillary
staff under all these programs adhere to the principles of infection prevention and control including injection
safety.
POPULATIONS BEING TARGETED
This activity will mainly target healthcare providers including doctors, laboratory workers, nurses,
pharmacists. Ancillary staff, who may not have direct patient contact but handle or manage biohazardous
materials, will also be targeted.
Through the increased knowledge gained by healthcare workers and laypersons via IEC/BCC these
activities will result in a reduction in unsafe injection practices and unnecessary demand for injection. This
activity addresses issues of stigma and discrimination as the services will reduce stigma and discrimination
associated with HIV status in the health care facility setting and better care of PLWHA.
This activity has an emphasis on training on universal safety precautions, supportive supervision and
appropriate health care waste management.
Continuing Activity: 12996
12996 6820.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $175,000
6820 6820.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $25,000
Workplace Programs
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Fusion of ART Services & Care and
support Services
In COP08 AIDSRelief (AR) is providing adult treatment, care and support services to 31 Local Partner
Treatment Facilities (LPTFs) and 10 satellite sites. In COP09 these services will be increased to cover an
additional 3 LPTFs and 9 satellites across the 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo,
Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. Through primary and
secondary faith-based facilities AR in COP09 will continue to extend ART services to underserved rural
communities to reach 4,770 new patients for a total of 30,150 adult patients by the end of the year.
Comprehensive package of care and support services will be provided to a cumulative 50,589 PLWHA and
101,178 PABAs in the same period. In setting and achieving COP09 targets, consideration has been given
to consolidating on AR's rapid COP08 scale-up efforts in order to concomitantly work towards continuous
quality improvement.
The package of care services provided to each PLWHA includes a minimum of clinical service with basic
care kit and two supportive services in the domain of psychological, spiritual, and PwP delivered at the
facility, community, and household (home based care) levels in accordance with the PEPFAR and
Government of Nigeria (GON) national care and support policies and guidelines. The basic care package
for PLWHAs in AR's partner sites include Basic Care Kit (ORS, LLITN, water guard, water vessel, gloves,
ORS, soap and IEC materials,); Home-Based Care (client and caregiver training and education in self-care
and other HBC services); Clinical Care (basic nursing care, pain management, OI and STIs prophylaxis and
treatment, Laboratory Services (which will include baseline tests - CD4 counts, hematology, chemistry,
malarial parasite, OI and STI diagnostics when indicated) nutritional assessment- weight, height, BMI,
micronutrient counseling and supplementation and referrals; Psychological Care (adherence counseling,
bereavement counseling, depression assessment and counseling with referral to appropriate services);
Spiritual Care (access to spiritual care); Social Care (support groups' facilitation, referrals, and
transportation) and Prevention Care (Prevention with Positives). All PLWHAs' nutritional status will be
assessed at contact and on follow-up visits, micronutrients will be provided as necessary, and those
diagnosed as severely malnourished will be placed on a therapeutic feeding program. This will be done
through wraparound services as well as direct funding. AR will procure basic care kits through a central
mechanism and OI drugs will be procured mechanisms that ensure only NAFDAC approved drugs are
utilized.
ART sites at LPTFs that are co-located in facilities with TB DOTS centers will have the services integrated
to facilitate TB/HIV service linkages. All PLWHA will have CD4 counts and other necessary lab analyses
performed at least every 6 months to determine the optimal time and eligibility status to initiate ART and
monitor effectiveness/side effects for those on ART. AR sites will integrate prevention with positives (PwP)
activities including: adherence counseling; syndromic management of STIs in line with National STI control
policy and guidelines; risk assessment and behavioral counseling to achieve risk reduction; counseling and
testing of family members and sex partners; counseling for discordant couples; IEC materials and provider
delivered messages on disclosure. Cotrimoxazole prophylaxis will be provided for PLWHAs according to the
National guidelines. AR will support a pilot program for cervical cancer screening in HIV positive women.
AR will collaborate with faith-based organizations (FBOs) and community-based organizations (CBOs) such
as 7-Diocese of Catholic Relief Services (CRS) in Benue, Kaduna, Nasarawa and Edo states, CSADI in
Kano, Spring of Life in Plateau, New Life Support in Anambra and other CBOs attached to AR LPTFs in the
16 states. These FBOs and CBOs may be sub grantees of AR and/or other PEPFAR IPs. Through these
partnerships clients in care will receive a comprehensive package of community and home based care
services. LPTF HBC teams comprising nurses, community health workers and trained volunteers are
supported by AR to provide HBC services as well as facilitate support group activities. LPTFs HBC
providers will use HBC kits. AR will focus on improving pre-ART retention in support groups. Strategies to
retain clients in care include intensive home visits by HBC team during the first 6 months of enrolment.
All LPTFs will consolidate on their capacity to provide comprehensive quality ART services through existing
AR supported varieties of models of care delivery. This includes quality management of OIs and ART, a
safe, reliable and secure pharmaceutical supply chain, technologically appropriate lab diagnostics,
treatment preparation for patients, their families and supporters and community based support for
adherence. This technical and programmatic assistance utilizes on-site mentoring and preceptorship. It also
supports the development of site specific work plans and ensures that systems are in place for financial
accountability. AR will adhere to the Nigerian National ART service delivery guidelines including
recommended first and second line ART regimens. In addition, AR will partner with Clinton Foundation and
Global Fund as appropriate to leverage resources for providing antiretroviral drugs to patients.
In COP09 AR will continue to strengthen institutional and health worker capacity through the training,
retraining and mentoring of health service providers to provide care and treatment services at the facility
and community levels. Doctors, pharmacists, nurses, counselors, and community health extension workers
will receive training and onsite mentoring that will allow them to provide comprehensive care. Training will
maximize use of all available human resources including a focus on community nursing and community
adherence. Care and Treatment trainings will be based on the national curricula. AR will collaborate with the
GoN and other stakeholders to develop task shifting strategies to enable nurses and community health
officers to provide ART.
In COP09 AR will continue conducting 2-week intensive didactic and practical trainings preceding site
activation followed by regular onsite mentoring. AR will also train community volunteers including PLWHA
and religious leaders to provide peer education counseling, psychosocial and spiritual counseling,
respectively. AR will use GON/USG recommended standardized training curriculums, manuals and training
aides for all trainings. Information, education and communication materials will be provided to enhance
these trainings. AR will work closely with the USG and GoN team to monitor quality improvement at all sites
and across the program. 90 Health care workers will benefit from these trainings referred to above in HIV
Care, Treatment and Support.
Activity Narrative: A key component for successful ART is adherence to therapy at the household and community levels.
PLWHA on treatment are encouraged to have a treatment support person such as a family member to
whom he/she had disclosed HIV status to improve support in the home and increase adherence. AR will
continue to build and strengthen the community components by using nurses and counselors to link health
institutions to communities. Each LPTF will appoint a staff member to coordinate the linkages of patients to
all services. This will also build the capacity of LPTFs for better patient tracking, referral coordination, and
linkages to appropriate services. These activities will be monitored by the AR technical and program
management regional teams.
In COP09, AR will continue to strengthen its expanded Quality Improvement Program (QIP) consisting of
the annual cross sectional Outcomes & Evaluation (O&E) exercise, the GON/USG supported HIVQual
monitoring and the quarterly Continuous Quality Improvement (CQI) activities in order to improve and
institutionalize quality interventions. The 4 existing QIP specialists will be responsible for spearheading QIP
activities in their respective regions. This will include standardizing patient medical records to ensure proper
record keeping and continuity of care at all LPTFs. Monitoring and evaluation of the AIDSRelief ART
program will be consistent with the national plan for patient monitoring. The QIP specialists will conduct
team site visits at least quarterly during which there will be evaluations of infection control, the utilization of
National PMM tools and guidelines, proper medical record keeping, efficiency of clinic services, referral
coordination, and use of standard operating procedures across all disciplines. On-site technical assistance
(TA) with more frequent follow-up monitoring visits will be provided to address weaknesses when identified
during routine monitoring visits. Some of the data will be used to generate biannual life table analyses that
identify factors associated with early discontinuation of treatment. In addition, at each LPTF an annual cross
sectional evaluation of program quality shall consist of a 10% random sample of linked medical records,
adherence questionnaires and viral loads to examine treatment compliance and viral load suppression for
adult patients who have been on treatment for at least 9 months. A similar process will be undertaken for all
children who have been on ART for at least 9 months. Each of these activities will highlight opportunities for
improvement of clinical practices.
AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in
the USG coordinated clinical working group to address ongoing topics in ARV service delivery.
AR's expansion of adult care and treatment activities, including effective linkages with HBC providers, will
contribute to increased access of such services to underserved rural communities. By providing services to
50, 589 Adult PLWHA, AR will contribute to the overall PEPFAR care and support target of providing these
services to 10 million people globally by 2009 and will help accomplish the PEPFAR Nigeria target of
placing 350,000 clients on ART by 2009 and will also support the Nigerian government's universal access to
ART by 2010 initiative. This activity contributes to the overall AR comprehensive HIV and AIDS services by
providing the supportive services for all adult PLWHA including those on ART.
AR activities in adult care and treatment are linked to HCT, PMTCT, ARV drugs, laboratory, OVC, Sexual
Prevention, Medical Prevention, TB/HIV and SI to ensure that PLWHA and their family members have
access to a continuum of care. AR will continue to collaborate with the 7-D program of Catholic Relief
Services to establish networks of community volunteers to support livelihood development program for
PLWHA and caregivers requiring such services and support identified child or adolescent headed
households to be linked with CRS/SUN and other OVC programs which will meet the needs of the
household. Networks will be created to ensure cross-referrals and sharing of best practices among AR and
other implementing partner sites for the provision of psychosocial support and community and home based
services to PLWHA. Effective synergies will be established with the Global Fund to Fight AIDS,
Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders for
harmonization of basic care and support services and the standardization of training manuals for community
volunteers and providers
This activity targets PLWHA, particularly those who qualify for the provision of ART, including PMTCT
clients from rural and underserved communities. This activity also targets CBOs and FBOs for capacity
building and targets care providers (healthcare professionals and community volunteers) for training.
This activity will include emphasis on human capacity development specifically through in-service training
and task-shifting, local organization capacity building for community mobilization and participation,
development of networks/linkages/referral systems, and quality assurance/ quality improvement This activity
will also ensure gender equity, ensuring access to ART through linkages with PMTCT services, addressing
male norms & behaviors, increasing women's legal rights and access to income & productive resources,
and reducing violence & coercion against women. AR will work with CBOs, networks of PLWHA and FBOs
Activity Narrative: and other USG/GON programs to promote economic strengthening activities; education and safe water
initiatives, and create access to food and nutritional services. The extension of this activity into rural and
previously underserved communities will contribute to the equitable availability of ART services in Nigeria
and towards the goal of universal access to ARV services in the country. This activity will improve the
quality of life of PLWHA and thus reduce the stigma and discrimination against them.
Continuing Activity: 12997
12997 5368.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $2,797,655
6675 5368.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,630,000
5368 5368.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $917,526
Estimated amount of funding that is planned for Human Capacity Development $90,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $25,000
Estimated amount of funding that is planned for Water $25,000
Table 3.3.08:
In COP09, CRS 7D will provide comprehensive BC&S to 20,000 People Living with HIV (PLHIV) and 60,000
People Affected by HIV/AIDS (PABAs) in 13 arch/dioceses (mega sites) in 8 states of Nigeria. CRS 7D will
continue to provide basic health care services in 5 saturated stand-alone and Primary Health Care (PHC)
facilities and client households across 251 parishes which are sub-sites from the mega sites totaling 65
PHC sites. Program growth in COP 09 will be focused in 5 saturation parishes in each of the 13 dioceses.
The total number of sites (parishes) will not increase in COP09 from COP08.
CRS 7D will continue to involve more PLHIV in the provision of palliative care services through recruitment
of HIV+ volunteers and support groups composed primarily of PLHIV.
Under social support, economic strengthening will be provided to PLHIV and PABAs through
individual/group grants and promotion of Savings and Internal Lending Community (SILC) - a CRS program
that works with groups to leverage internal savings as a mechanism for raising loan capital for group
members. The SG+ members will be expected to pay little intrest for the money they borrow which will
eventually form capital for the groups. This approach has been successfully implemented in South Sudan.
500 PAVs and SGP+ members will be trained to increase their capacity to provide care, support and
prevention in households, communities and PHC facilities.
Staff capacity enhancement will focus on PAV recruitment, motivation and retention. CRS 7D will explore
different mechanism of motivating volunteers in COP 09. These may include extension of economic
strengthening support through formation of SILC groups or through recognition of the best performing
volunteers by offering them awards.
COP 09 ACTIVITY DESCRIPTION:
In COP09, CRS 7D will provide comprehensive BC&S to 20,000 People Living with HIV (PLHIV) who were
already tested in the 135 CT service outlets according to FGoN Guidelines in 9 states (Kogi, Benue,
Plateau, Nassarawa, Niger, Kaduna, Edo, Cross River and Lagos states) including the FCT & registered by
sub-partners; and 60,000 People Affected by HIV/AIDS (PABAs) in 13 arch/dioceses. CRS 7D BC&S will
CRS 7D will continue to involve State Ministry of Women Affairs (SMoWA), SMoH, SACA & LGA staff in
M&E visit to partners & training. The total number of sites (parishes) will not increase in COP09 from
COP08. The program will piggyback on activities of other program within 7D, SUN & AIDS Relief (AR) for
delivery of BC&S services to all those that require them. Clients will be linked to nutritional services as
identified including leveraging CHAI's resources.
CRS 7D will continue to support dioceses in developing institutional relationships with at least 5 PHC
facilities to provide basic clinical services to PLHIVs including: basic laboratory monitoring for OIs; urine &
stool analyses; STI & malaria treatment; basic OI prevention (CPT) & management. Management of OIs
will include treating basic OIs including malaria & syndromic management of STIs; LFT for PLHIV,
hemoglobin estimates, CD4 count & other advanced HIV disease laboratory diagnostic tests will be referred
to AIDSRelief (AR), & other USG IP supported sites, HIV+ pregnant women will be prioritized for CD4
testing & linked to HAART if needed. Clients will also receive PwP services at facilities and in the
communities.
For HBC services, CRS 7D will continue to support non-paid PAVs & Support Groups of People Living
Positively (SGP+) in the sites to provide non-clinical BC&S Services. In both cases, CRS 7D will continue to
involve more PLHIV in the provision of palliative care services through recruitment of HIV+ volunteers &
support groups composed primarily of PLHIV. CRS 7D will provide a basic preventive self care package
including, provision of ITN, water guard, water vessels, soap, ORS & basic first aid materials. Prevention for
positives will be incorporated into home visits & support group meetings through targeted messaging on
Abstinence & Be Faithful, counseling for discordant couples, & provision of complete & accurate
information/referrals for other prevention methods.
Under psychological care, 7D will provide psychosocial & spiritual counseling for PLHIV & PABAs, facilitate
SGP+ & adherence counseling. Counseling will address prevention, mental health, disclosure, crisis,
bereavement & adherence to all medication including ART, INH & CPT.
Under social support, economic strengthening will be provided to PLHIV & PABAs through individual/group
grants & promotion of Savings & Internal Lending Community (SILC) - a CRS program that works with
groups to leverage internal savings as a mechanism for raising loan capital for group members. Nutrition &
health education emphasizing personal hygiene & proper disposal of waste will continue to be provided.
Under spiritual care, 7D will be sensitive to the culture and rituals of the individuals & communities it
interacts with. With the 7D stigma & discrimination curriculum, 7D will train more clergy, traditional &
spiritual leaders on how to provide non-stigmatizing care.
7D will collaborate with the CRS SUN & AR programs in planning & providing holistic services to PLHIV &
families with infected individuals or OVCs. Mechanisms will be developed that allow the flow of human,
material & financial resources among the programs for effective leverage of each program's comparative
advantage. Coherently planning centrally and implementation in project sites will ensure seamless
integration for service beneficiaries.
AR & 7D ART & PMTCT sites will also provide palliative care for HIV+ pregnant women, PLHIV & OVC with
back & forth linkages among the 3 programs for ART, health, educational, social support & other services.
Through integrated activities among the three programs, PAVs and SGP+ will be given information that will
increase their capacity to provide care, support and prevention services in households, communities and
PHC facilities. 500 PAVs and SGP+ members will be trained using FGoN C&S providers' manual & CRS
HBC manual to increase their capacity to provide care, support and prevention in households, communities
Activity Narrative: & PHC facilities. Volunteers will continue to use HBC kits with the following contents 2 kidney dishes, a pair
of forceps & scissors, dressings, protective wears - disposable gloves, plastic aprons mackintosh, bleach
e.g. jik, washing materials e.g. plastic bowl, soap, towel soap container, lotions - calamine , ointment -
unscented petroleum jelly & waterguard bottles. Provision will be made to replenish the HBC kit contents
after each home visit. Each PHC facility is expected to reach 300 PLHIV with BC&S services. 7D will
engage SGP+ & PAVs in capacity building that will promote linkages between SGP+, PAVs & PHC facilities
for optimal utilization of health facilities & community resources. Service directories will be placed in
strategic places such as SGP+ meeting places & HCT centers.
In COP08 CRS carried out Training of Trainers (TOT) on food security and nutrition for Diocesan staff, who
will step down the training to the volunteers to increase their service provision to PLHIV. CRS through
collaboration with Clintons Foundation will leverage the supply of fortified nutritional supplements to PLHIV
as appropriate. CRS will continue to encourage food security & advocate to the dioceses to support food
supplementation to PLWHA, as this has been the practice for the past two years.
Staff capacity enhancement will focus on Partner Staff training, PAV recruitment, motivation & retention
FGoN Providers' manual and CRS HBC C&S manual. CRS 7D will explore different mechanisms of
motivating volunteers in COP 09. These may include extension of economic strengthening support through
formation of SILC groups or through recognition of the best performing volunteers by offering them awards.
For hard to reach areas, CRS 7D will carry out advocacy with diocesan authorities to facilitate PAVs with
motorbikes & fuel on days when they carry out home visits. Site hiring practices will be encouraged to draw
from experienced PAVs & SGP+. HBC Kits & other necessary tools will continue to be given to volunteers.
One PAV or SGP+ member will be assigned to a PHC center to triage with the PHC facilities & PLHIV &
SGP+ to facilitate access to clinical services. S/he will work with Diocesan Action Committee on AIDS
(DACA) staff to develop effective patient follow-up & referral mechanisms that bridge the health facility-
community gap. 7D will leverage 7D PMTCT & AR sites in the provision of advanced clinical services.
Organizational development support including administration & financial accounting will be given to PHC,
SGP+ & partners to position them for effective participation in BC&S service delivery. Transportation &
health care costs for caregivers & clients requiring specialized care not obtainable in immediate PHC will be
incorporated.
PAVs are trained to effectively collect data using stardardized M&E tools & are monitored by DACA staff
during home visits and as they fill the forms using the information generated. PLHIV are only counted as
direct beneficiaries when they access 1 clinical & at least 2 services from the other domains (psychological,
social, spiritual) then supplemental direct if they access only 1 service. Given the diversity of the package of
services PLHIV receive from different IPs, double counting of services will be highly probable. To avoid this,
7D in collaboration with other USG IPs will develop a tracking mechanism that follows the different services
from AR and other USG supported IPs.
These BC&S services will contribute to several of the PEPFAR goals. The goal of mitigating the impact of
HIV/AIDS will be achieved by the provision of BC&S services. This activity will also contribute to the goal of
providing treatment to HIV+ individuals, as adults who are eligible for ART will be referred for these
services.
BC&S relates to other HIV/AIDS activities to ensure continuity of care for persons accessing BC&S through
the 7D. This activity links with Prevention of Mother to Child Transmission (PMTCT) (#5448.08), Voluntary
Counseling & Testing (#5422.08), Abstinence & Be Faithful (#5312.08) and OVC (5407.08) and SI activities
(#9913.08) being undertaken by CRS 7D. Given the increased integration of CRS programming, there will
also be close links to the activities across program areas being undertaken by CRS AIDSRelief especially
their ART activities (#6678.08).
The populations to be served include children & youth, PLHIV & their families, caregivers &
widows/widowers within the 13 Arch/dioceses, LGA staff, clergy and lay people & health workers. Through
linkages with other program areas (PMTCT, VCT, ART), recently diagnosed HIV positive adults (including
TB-HIV) in these communities in need of BC&S are also targeted. Pediatric C&S clients will be assisted
through a family care approach and referred to the SUN program for additional child-centered services.
The emphases of the BC&S Program activities are local organization capacity development, training,
developing networks, linkages & referral systems.
These activities will include an emphasis on reducing stigma associated with HIV status and the
discrimination faced by individuals with HIV/AIDS & their family members.
HIV prevention will include gender sensitive activities which will address behaviors, social norms & resulting
inequalities between men & women that increase the vulnerability to & impact of HIV/AIDS.
Continuing Activity: 13002
13002 6678.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $7,102,211
Estimated amount of funding that is planned for Human Capacity Development $120,000
Estimated amount of funding that is planned for Water $89,134
Table 3.3.09:
In COP08 AIDSRelief (AR) provided care and treatment services to 31 Local Partner Treatment Facilities
(LPTFs) and 10 satellite sites in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,
Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. In COP09 these services will be
maintained and expanded to an additional 3 LPTFs and 9 satellite sites, for a total of 53 sites with further
emphasis on decentralization to community and home levels. Through primary and secondary faith-based
facilities, AR will extend care and treatment services to underserved rural communities to reach 3,350
children on ART (530 new) by the end of the COP year. In setting and achieving COP09 targets,
consideration has been given to modulating AR's rapid COP07 scale-up plans in order to concomitantly
work towards continuous quality improvement.
Key to increasing pediatric enrollment into care and treatment will be to strengthen linkages at all service
levels within the LPTFs where AR is working as well as reinforced and expanded community outreach. This
will require staff training and strengthened referral linkages. In order to increase the number of children
brought into care and treatment, AR will support a multi pronged approach: organization of services to
provide family centered care and treatment, provider initiated testing and counseling for children (PITC) and
community mobilization. Organization of ART clinics to include family days will also provide opportunities to
increase testing for children and provide comprehensive care. All exposed infants delivered in the LPTFs, or
identified through the family centered approach, will be linked to the HIV Comprehensive Care clinic for
enrollment for care and support, and to community-based OVC programs.
The package of care services provided to each HIV positive child/care givers includes a minimum of clinical
service with provision of a basic care kit and two supportive services in the domain of psychological,
spiritual, and PwP delivered at the facility, community, and household (home-based care, HBC) levels in
accordance with the PEPFAR and Government of Nigeria (GON) national care and support policies and
guidelines. The basic care package for HIV positive child/care givers in AR's partner sites includes provision
of a basic care kit (ORS, LLITN, water guard, water vessel, soap, IEC materials, and gloves); home-based
care (client and caregiver training and education in self-care and other HBC services); clinical care (basic
nursing care, pain management, OI and STIs prophylaxis and treatment, nutritional assessment- weight,
height, BMI, micronutrient counseling and supplementation and referrals); laboratory services (which will
include baseline tests - CD4 counts, hematology, chemistry, malarial parasites, OI and STI diagnostics
when indicated); psychological care (adherence counseling, bereavement counseling, depression
assessment and counseling with referral to appropriate services); spiritual care (access to spiritual care);
social care (support groups' facilitation, referrals, and transportation) and prevention care (Prevention with
Positives). All HIV positive children's nutritional status will be assessed at contact and on follow-up visits,
micronutrients will be provided as necessary, and those diagnosed as severely malnourished will be placed
on a therapeutic feeding program. This will be done through wraparound services as well as direct funding.
AR will procure basic care kits through a central mechanism and OI drugs will be procured through
mechanisms that ensure only NAFDAC approved drugs are utilized.
All LPTFs will be strengthened in their capacity to provide comprehensive quality care and treatment
services through a variety of models of care delivery. This includes quality management of OIs and ART, a
accountability.
AR will provide DBS/DNA PCR technology for early infant diagnosis (EID) in addition to the logistic support
for transportation of blood samples to designated laboratories in collaboration with Clinton Foundation. EID
activities supported under pediatric care and treatment are linked to PMTCT. AR will provide access to viral
loads for children with suspected treatment failure. All infected children will be evaluated for ART using CD4
count or CD4%. All AR sites will be equipped with capacity to determine CD4% for evaluation of
immunological status of children less than six years.
Based on available evidence concerning child survival and morbidities in relation to immunological staging,
AR will provide ARVs for all infected infants (less than 1 year) in accordance with revised national pediatric
ART guidelines so as to prevent mortality and brain damage in rapid progressors. Appropriate first and
second line regimens that preserve future options with minimal toxicity profiles will be adopted for all LPTFs.
AR will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for providing
antiretroviral drugs to infected children.
ART sites at LPTFs are co-located in facilities with TB DOTS centers to facilitate TB/HIV service linkages.
AR will intensify collaboration with GON and other stakeholders to ensure prompt diagnosis of TB in
children and facilitate provision of pediatric TB formulations.
A key component for successful ART is adherence to therapy at the household and community levels. AR
will ensure intensive treatment preparation directed at an identified caregiver to ensure strict adherence. AR
will continue to build and strengthen the community components by using nurses and counselors to link
health institutions to communities. Each LPTF will appoint a specific staff member to coordinate the linkages
of patients to all services. This will also build the capacity of LPTFs for better patient tracking, referral
coordination, and linkages to appropriate services. These activities will be monitored by the AR technical
and program management regional teams. All children on ARVs will have at least monthly home visits to
ensure adherence and assess need for intervention. Specific efforts and training will be made to develop
adolescent friendly services for infected and affected children including linkages to reproductive health.
Non ART eligible children will be enrolled into care for periodic follow-up, including laboratory analysis at
least every six months, to identify changes in ART eligibility status. All enrolled children will be linked to the
AR OVC program to access an array of services including nutritional support, preventive care package
Activity Narrative: (water sanitation/treatment education, ITN) and psychosocial support. All LPTFs will be empowered with
training and tools to ensure nutritional assessment. Educational support and food supplements will be
leveraged from other partners, particularly the CRS SUN program and Catholic Secretariat of Nigeria USG
funded SUCCOUR program.
In COP08 AR trained 90 health service providers in pediatric care and treatment. In COP09 AR will train
and retrain an additional 90 health service providers according to the National Pediatric HIV Training
curriculum. Training will maximize use of all available human resources including a focus on community
nursing and community adherence to ensure care is decentralized to the home level. AR will collaborate
with the GON and other stakeholders to develop task shifting strategies to enable nurses and community
health officers to provide pediatric ART. AR will work closely with the USG team to monitor quality
improvement at all sites and across the program. AR will actively participate in and facilitate activities to
review practices in pediatric HIV care and treatment particularly GON technical working group meetings. AR
will share with the GON a new pediatric counseling curriculum developed with the African Network for
Caring for Children with HIV and, if acceptable, will roll this training out to all AR sites. AR will support the
development of a national pediatric HIV care and support guideline and training curriculum.
AIDSRelief will offer HIV EID in line with the National Early Infant Diagnosis scale-up plan from six weeks of
age using DBS. Implementation of the EID scale-up will be done under the guidance of the GON and in
conjunction with other IPs who will be conducting the laboratory testing. AR will collaborate with Clinton
Foundation as appropriate for commodities and logistics support for the EID program. Exposed infants will
be actively linked to pediatric care and treatment. In COP09, AR will extend EID activities/DBS collection to
all AR LPTFs and their satellites. PMTCT focal persons at all AR LPTFs will keep records of all exposed
infants at enrollment soon after birth; informing HIV+ mothers of the six week mark for DBS collection. AR
will encourage hub LPTFs to step down DBS collection at affiliate PMTCT satellite sites and thus
decentralize EID activities at these sites. Hub LPTFs will ensure supplies of DBS collecting kits from their
own stock to these satellites and the samples collected returned to the hub sites for dispatch to the testing
labs. AR will train members of PMTCT support groups in HCT skills. AR will engage PMTCT support groups
and the larger support group(s) in tracking unbooked pregnant women and infants in the community, linking
them to sites where they can access HCT. AR will establish linkages with other health care providers, public
and private, proximal to AR LPTFs, with full-fledged ANC activities. This will encourage two-way referrals of
HIV+ mothers and their infants from these providers to AR LPTFs and thus benefit from EID/ART activities
at AR sites. LPTF EID focal persons will ensure prompt dissemination of results to providers and mothers
as soon as they are available.
In COP08 AR built a team of four specialists to ensure Continuous Quality Improvement (CQI) to improve
and institutionalize quality interventions. The team will sustain the efforts with a modification of evaluation
tools to assess and report on both qualitative and quantitative indicators of care delivery. Monitoring and
evaluation of the AIDSRelief ART program will be consistent with the national plan for patient monitoring.
The CQI specialists will conduct team site visits at least quarterly during which there will be evaluations of
infection control, the utilization of National PMM tools and guidelines, proper medical record keeping,
efficiency of clinic services, referral coordination, and use of standard operating procedures. On-site TA with
more frequent follow-up monitoring visits will be provided to address weaknesses when identified during
routine monitoring visits. Some of the data will be used to generate biannual life table analyses that identify
factors associated with early discontinuation of treatment. In addition, at each LPTF an annual evaluation of
program quality shall consist of a 10% random sample of linked medical records, adherence questionnaires
and viral loads to examine treatment compliance and viral load suppression for children who have been on
treatment for at least nine months. Each of these activities will highlight opportunities for improvement of
clinical practices.
AR will focus on the transition of the management of care and treatment activities to indigenous
organizations by actively using its extensive linkages with faith-based groups and other key stakeholders to
develop a transition plan that is appropriate to the Nigerian context. The plan will be designed to ensure the
continuous delivery of quality HIV care and treatment, and all activities will continue to be implemented in
close collaboration with the Government of Nigeria to ensure coordination, information sharing and long
term sustainability. For the transition to be successful, sustainable institutional capacity must be present
within the indigenous organizations and LPTFs they support. As a result, AR will strengthen the selected
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
By adhering to the Nigerian National ART service delivery guidelines and building strong community
components into the program, this activity will contribute to achieving global PEPFAR treatment targets and
will also support the Nigerian government's universal access to ART by 2010 initiative. By putting in place
structures to strengthen LPTF health systems, AR will contribute to the long term sustainability of the ART
programs.
AR will collaborate with the Catholic Relief Services 7D program to establish networks of community
volunteers. Networks will be created to ensure cross-referrals and sharing of best practices among AR and
other implementing partner sites. Effective synergies will be established with the Global Fund to Fight AIDS,
Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders.
This activity targets HIV exposed and infected children and their caregivers as well as HCWs from rural and
underserved communities.
Activity Narrative: LINKS TO OTHER ACTIVITIES:
This activity is linked to HCT services to ensure that people tested for HIV are linked to ART services; it also
relates to activities in ARV drugs, laboratory services, sexual prevention, PMTCT, OVC, TB/HIV, and SI.
This activity will include emphasis on human capacity development specifically through in-service training.
These ART services will also ensure gender and age equity in access to ART through linkages with OVC
and PMTCT services in AR sites and neighboring sites. The extension of ARV services into rural and
and towards the goal of universal access to ARV services in the country. The provision of ART services will
improve the quality of life of infected children and thus reduce the stigma and discrimination against them.
Continuing Activity: 12999
12999 5416.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $945,000
6679 5416.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $288,000
5416 5416.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $150,625
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Table 3.3.10:
In COP08 AIDSRelief (AR)provided Care and Treatment services to 31 Local Partner Treatment Facilities
maintained and expanded to an additional 3 LPTFs and 9 satellite sites, with further emphasis on
decentralization to community and home levels. Through primary and secondary faith-based facilities AR
will extend care and treatment services to underserved rural communities to reach 3,350 children on ART
(530 new) by the end of the COP year. In setting and achieving COP09 targets, consideration has been
given to modulating AR's rapid COP07 scale-up plans in order to concomitantly work towards continuous
levels within the LPTFs that AR is working as well as reinforced and expanded community outreach. This
provide family centered care and treatment, PITC (provider initiated testing and counseling for all children)
and community mobilization. Organization of ART clinics to include family days will also provide
opportunities to increase testing for children and provide comprehensive care. All exposed infants delivered
in the LPTF or identified through the family centered approach will be linked to the HIV Comprehensive
Care clinic for enrollment for care and support, and to community based OVC programs.
service with basic care kit and two supportive services in the domain of psychological, spiritual, and PwP
delivered at the facility, community, and household (home based care) levels in accordance with the
PEPFAR and Government of Nigeria (GON) national care and support policies and guidelines. The basic
care package for HIV positive child/care givers in AR's partner sites include Basic Care Kit (ORS, LLITN,
water guard, water vessel, soap, IEC materials, and gloves); Home-Based Care (client and caregiver
training and education in self-care and other HBC services); Clinical Care (basic nursing care, pain
management, OI and STIs prophylaxis and treatment, nutritional assessment- weight, height, BMI,
micronutrient counseling and supplementation and referrals, Laboratory Services (which will include
baseline tests - CD4 counts, hematology, chemistry, malarial parasite, OI and STI diagnostics when
indicated); Psychological Care (adherence counseling, bereavement counseling, depression assessment
and counseling with referral to appropriate services); Spiritual Care (access to spiritual care); Social Care
(support groups' facilitation, referrals, and transportation) and Prevention Care (Prevention with Positives).
All HIV positive children's nutritional status will be assessed at contact and on follow-up visits,
AR will procure basic care kits through a central mechanism and OI drugs will be procured mechanisms that
ensure only NAFDAC approved drugs are utilized.
AR will provide DBS/DNA PCR technology for early infant diagnosis in addition to the logistic support for
transportation of blood samples to designated laboratories in collaboration with Clinton foundation. AR
Regional laboratories will be provided with capacity to do viral load and AR will provide access to viral loads
for children with suspected treatment failure. All infected children will be evaluated for ART using CD4 or
CD4%. All AR sites will be equipped with capacity to determine CD4% for evaluation of immunological
status of children less than 6 years.
Based on available evidence on child survival and morbidities in relation to immunological staging, AR will
provide ARVs for all infected infants (less than 1 year) tin accordance with revised National pediatric ART
guidelines so as to prevent mortality and brain damage in rapid progressors. Appropriate first and second
line regimens that preserve future options with minimal toxicity profiles will be adopted for all LPTF. AR will
partner with Clinton Foundation and Global Fund as appropriate to leverage resources for providing
will ensure intensive treatment preparation directed at an identified caregiver to ensure strict adherence
AR will continue to build and strengthen the community components by using nurses and counselors to link
and program management regional teams. All children on ARV will have at least monthly home visits to
least every 6 months, to identify changes in ART eligibility status. All enrolled children will be linked to the
(water sanitation/treatment education, ITN) and psychosocial support. All LPTFs will be empowered with
Activity Narrative: training and tools to ensure nutritional assessment. Educational support and food supplements will be
leveraged from other partners particularly the CRS SUN program and Catholic Secretariat of Nigeria USG
with the GoN and other stakeholders to develop task shifting strategies to enable nurses and community
health officers to provide Pediatric ART. AR will work closely with the USG team to monitor quality
review practices in Pediatric HIV care and treatment particularly GON technical working group meetings. AR
Caring for Children with HIV and roll this training out to all AR sites. AR will support the development of a
national pediatric HIV care and support guideline, and training curriculum.
AIDSRelief will offer HIV early infant diagnosis (EID) in line with the National Early Infant Diagnosis scale-up
plan from 6 weeks of age using DBS. Implementation of the EID scale-up will be done under the guidance
of the GON and in conjunction with other IPs who will be conducting the laboratory testing. AR will
collaborate with Clinton Foundation as appropriate for commodities and logistics support for the EID
program. Exposed infants will be actively linked to pediatric care and treatment. In COP09, AR will extend
EID activities/DBS collection to all AR LPTFs and their satellites. PMTCT focal persons at all AR LPTFs will
keep records of all exposed infants at enrollment soon after birth; informing HIV+ mothers of the 6 weeks
exact dates for DBS collection. AR will encourage parent LPTFs to step down DBS collection at affiliate
PMTCT satellite sites and thus decentralize EID activities at these sites. Parent LPTFs will ensure supplies
of DBS collecting kits from their own stock to these satellites and the samples collected returned to the
parent sites for dispatch to the testing labs. AR will train members of PMTCT support groups in HCT skills.
AR will engage PMTCT support groups and the larger support group(s) in tracking unbooked pregnant
women and infants in the community, linking them to sites where they can access HCT. AR will establish
linkages with other health care providers; public and private, proximal to AR LPTFs, with full fledged ANC
activities. This will encourage two-way referrals of HIV+ mothers and their infants from these providers to
AR LPTFs and thus benefit from EID/ART activities at AR sites. LPTF EID focal persons will ensure prompt
dissemination of results to providers and mothers as soon as they are available.
In COP08 AR built a team of 4 specialists to ensure Continuous Quality Improvement (CQI) to improve and
institutionalize quality interventions. The team will sustain the efforts with a modification of evaluation tools
to assess and report on both qualitative and quantitative indicators of care delivery. Monitoring and
efficiency of clinic services, referral coordination, and use of standard operating procedures across all
disciplines. On-site TA with more frequent follow-up monitoring visits will be provided to address
weaknesses when identified during routine monitoring visits. Some of the data will be used to generate
biannual life table analyses that identify factors associated with early discontinuation of treatment. In
addition, at each LPTF an annual evaluation of program quality shall consist of a 10% random sample of
linked medical records, adherence questionnaires and viral loads to examine treatment compliance and
viral load suppression for adult patients who have been on treatment for at least 9 months. A similar
process will be undertaken for all children who have been on ART for at least 9 months. Each of the se
activities will highlight opportunities for improvement of clinical practices.
organizations by actively using its extensive linkages with faith based groups and other key stakeholders to
develop a transition plan that is appropriate to the Nigerian context. For the transition to be successful,
sustainable institutional capacity must be present within the indigenous organizations and LPTFs they
support; therefore, AR will strengthen the selected indigenous organizations according to their assessed
needs, while continuing to strengthen the health systems of the LPTFs. This capacity strengthening will
include human resource support and management, financial management, infrastructure improvement, and
strengthening of health management information systems.
components into the program, this activity will contribute to achieving the overall PEPFAR Nigeria target of
placing 35,000 children on ART by 2009 and will also support the Nigerian government's universal access
to ART by 2010 initiative. By putting in place structures to strengthen LPTF health systems, AR will
contribute to the long term sustainability of the ART programs.
This activity is linked to HCT services (5425.08) to ensure that people tested for HIV are linked to ART
services; it also relates to activities in ARV drugs (9889.08), laboratory services (6680.08), and care &
support activities including Sexual Prevention (5368.08), PMTCT (6485.08), OVC (5416.08), AB (15655.08),
TB/HIV (5399.08), and SI (5359.08).
AR will collaborate with the 7-D program of Catholic Relief Services to establish networks of community
Activity Narrative: POPULATIONS BEING TARGETED:
This activity targets children infected with HIV and their caregivers/HCWs from rural and underserved
Table 3.3.11:
AIDS Relief's (AR) strategy for TB/HIV is to ensure that all HIV positive clients in Local Partners Treatment
Facilities (LPTFs) are routinely screened for TB while TB patients have access to HIV counseling and
testing (HCT). Dually infected clients are offered appropriate care within and outside the LPTF. In COP08,
AR is supporting TB DOTS centers at 31 LPTFs and HCT at 31 stand alone TB DOTS centers in 16 states
(Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Plateau,
Taraba Abia and Imo). In COP09, AR will continue these services and expand services to 3 LPTFs and 12
satellites in the same states. In setting and achieving COP09 targets, consideration has been given to
modulating AR's rapid COP08 scale up plans in order to concomitantly work towards quality improvement
program and decentralizing services.
AR will continue to implement HCT in existing TB DOTS centers to provide HCT to all TB patients and
suspects and will also ensure facility co-location of TB DOTS centers in all supported LPTFs. Ten of the
current TB DOT Centers will have expanded satellite services to care and follow up patients on treatment.
Referral mechanisms will ensure TB/HIV co-infected clients access AIDSRelief (or other) supported HIV
care and treatment services. AR, with other IPs, will continue to implement the PEPFAR-Nigeria LGA
coverage strategy in Anambra, ensuring the provision of TB/HIV services in the existing identified AR
supported health facilities at the local government area (LGA). This is a critical step towards the provision of
universal access for TB/HIV services.
AR will implement the global 3 "I"s program of TB/HIV management strategy. In total, 20,000 HIV positive
patients in care at all AR supported sites will be rescreened for signs of TB clinically with symptom driven
follow up laboratory screening. From these 5%, or 1,000, are expected to be diagnosed with active disease
and will be treated for TB while 1%, or 200, without active TB will be place on Isonizide Preventive Therapy
(IPT) as a pilot program. The TB/HIV program will be in collaboration with State and National Tuberculosis
and Leprosy control programs (STBLCP and NTBLCP). A total of 1500 clients offered HIV counseling and
testing services from the TB DOTS centers will receive their results; it is expected that 10%, or 150, will be
diagnosed with HIV. Laboratory infrastructure will be upgraded and human capacity developed to ensure
adequate TB diagnosis for HIV positive patients. AR will continue to strengthen the pharmacy services at
supported TB DOTS sites to improve forecasting and avoid stock outs. AR will work with sites and State
Government to recognize and eliminate stock outs due to facility level or government level TB logistic
weaknesses, as an aspect of health systems capacity strengthening.
Through basic care and support services all TB/HIV patients will be put on co-trimoxazole prophylaxis
therapy (CPT) according to the national guidelines. Community health care providers will trace family
members of PLWHA accessing TB/HIV services and facilitate their TB screening and appropriate care. This
activity will be linked to activities in basic care and support through community and faith based
organizations (CBOs/FBOs) and home based care programs. TB/HIV treatment and care will be provided in
a comprehensive approach consistent with GON treatment guidelines and IMAI guidelines.
AR will ensure proper patient triage, specimen collection and processing, waste disposal, proper ventilation
and administrative control activities such as active identification of those with TB symptoms and patient
segregation. TB infection prevention and control will be accomplished using these workplace practices,
administrative and environmental measures. Patient and staff education will be routinely conducted to
ensure program success. AR will continue to use the joint adherence strategies for patients on ARVs and
TB DOTS and strengthen the facilities' capacity to meet special needs of PLWHA on both ART and anti-TB
treatment. Nosocomial transmission of TB to HIV+ patients as well as facility staff will be prevented through
measures and principles such as basic hygiene, proper sputum disposal, and good cross ventilation at
clinics. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on
TB infection control on co-located sites will be implemented in all AR supported sites. Patients screened
and treated for TB and TB/HIV will be entered into the updated reporting tool provided by the NTBLCP with
appropriate linkages of medical records between TB and HIV points of service. In support of the NTBLCP
and STBLCP, AR will provide TB consumables, reporting & recording tools, ACSM materials in places
where these are not available.
AR will train 77 healthcare workers in the TB/HIV program. Medical records staff will be trained on data
collection for suspected and diagnosed TB cases. Healthcare providers will be trained on x-ray diagnosis,
clinical management, and care of TB/HIV co-infected patients which will be complemented by onsite
preceptorships and mentoring to enhance case finding. Community health workers, treatment support
specialists (including PLWHA), and members of Society of People Affected by TB (SOPAT) will be trained
to assist with patient adherence to ART and anti-TB drugs. AR will deploy 2 TB/HIV focal nurses and 1 TB
laboratory specialist to support the current 3 TB/HIV focal physicians and 1 TB laboratory specialist for the
management of this program especially in areas of community TB care (CBTC), DOTS Expansion MDR
surveillance, operational research and PPM DOTS. All AR TB staff will be trained/ retrained to enhance TB
diagnostic and management skills.
In COP09, AR will use its Quality Improvement Program (QIP) to improve and institutionalize quality
interventions. The existing 4 CQI specialists will continue to spearhead QIP activities in their respective
regions. This will include standardizing patient medical records to ensure proper record keeping and
continuity of care at all LPTFs. AR TB/HIV activities that will be addressed include program level reporting
to enhance the effectiveness and efficiency of both paper based and computer based Patient Monitoring
and Management (PMM) systems assuring data quality across all LPTFs. Using in-country networks and
available technology, AR will strengthen PMM system with added emphasis on harmonization with the
Government of Nigeria's (GoN) emerging National PMM system. AR's TB/HIV team will continue to work
with the AR QIP specialists to conduct formalized site visits at least quarterly during which there will be
evaluations of TB/HIV clinic services, TB laboratory services, infection control practices, utilization of
National PMM tools and guidelines, proper medical record keeping, patient follow-up and referral
coordination. On-site TA/supportive supervision with more frequent follow-up monitoring visits will be
provided to address weaknesses when identified during routine monitoring visits. Each of these activities
Activity Narrative: will highlight opportunities for improvement of clinical practices.
Sustainability lies at the heart of the AR program. AIDSRelief will continue the Sustainability Plan developed
in Year 4 focusing on technical, organizational, funding, policy and advocacy dimensions. Through its
comprehensive approach to programming, AR will increase access to quality care and treatment, while
simultaneously strengthening health facility systems. All activities will continue to be implemented in close
collaboration with the Government of Nigeria (GON) at both the State and Federal levels, to ensure
coordination and information sharing, thus promoting long-term sustainability. AR will continue to strengthen
the health systems of LPTFs. This will include human resource support and management, financial
management, infrastructure improvement, and strengthening of health management information systems. In
collaboration with the CRS SUN project, AR will focus on institutional capacity building for indigenous
umbrella organizations such as the Catholic Secretariat of Nigeria (CSN). These strategies will enable AR to
transfer knowledge, skills and responsibilities to in-country service providers.
TB/HIV care through collaborative activities with NTBLCP will contribute to the GON's goal for appropriate
TB/HIV care. The co-location of TB DOTS centers in all AR supported LPTFs and HCT services in all AR
supported TB DOT sites will expand access to both quality TB services for HIV infected clients and HIV
services for TB Patients. This improved access will result in higher TB case detection and improved clinical
outcomes. The setting up of two state reference laboratories in collaboration with the respective state
governments will improve TB diagnosis among PLWHAs, increase access to TB culture in the country and
support the country program in MDR TB surveillance, diagnosis and management. The systematic
implementation of TB/HIV collaborative activities by AIDSRelief will contribute to Nigeria's 5-Year plan
which is expected to result in synergies to decrease TB prevalence rates.
LINK TO OTHER ACTIVITIES:
AR activities in TB/HIV are linked to HCT ARV services, ARV drugs, laboratory, care and support, PMTCT,
OVC, AB, and SI to ensure that TB/HIV patients have a continuum of services. This will be in collaboration
with the 7-Diocese program of CRS and other FBOs and CBOs. It will be linked to PMTCT to ensure that
HIV positive pregnant women are screened for TB, so that those dually infected are treated to reduce the
risk of transmission to the baby postpartum and to the community. This will also reduce the mother's
morbidity and mortality.
POPULATION BEING TARGETED:
The target population is all PLWHAs enrolled into the care and support program at LPTFs. In addition, TB
patients and suspects in supported DOTS centers are targeted. Household members of TB/HIV co-infected
patients will also be targeted as they are at increased risk of acquiring TB.
This activity has an emphasis on human capacity development through training to meet immediate
workforce requirements. Emphasis areas also include wraparound TB programs, renovations, quality
assurance, and development of linkages/referral and networks in collaboration with the STBLCP in support
of TB/HIV and TB DOTS programs. In addition, this activity will increase gender and age equity by ensuring
access to TB/HIV services for young women who account for 41% of TB cases in Nigeria and are about
60% of the PLWHAs screened for TB at LPTFs.
Continuing Activity: 12998
12998 5399.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $870,000
6677 5399.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,033,750
5399 5399.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $331,184
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $40,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000
Table 3.3.12:
AIDSRelief (AR) has a family-centered approach for the care and treatment of people living with HIV/AIDS
(PLHA) and those affected by the epidemic, especially orphans and vulnerable children (OVC). In COP08,
AR reached 4,207 OVC through 31 Local Partner Treatment Facilities (LPTFs) and 10 satellite sites in 16
states (Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa,
Ondo, Plateau and Taraba). In COP09, AR will work in a total of 34 LPTFs and 19 satellite sites in the same
states.
During COP09, a full package of OVC services will be provided to 4,000 OVC. All 4,000 children will
receive at least 3 core services from AR. In setting and achieving COP09 targets, consideration has been
given to modulating AR's rapid COP08 scale-up plans in order to concomitantly work towards continuous
AR OVC programming has several key elements: proactively seeking children at risk through a multi
pronged approach for increasing access to HIV Counseling and Testing (HCT); providing a holistic family-
centered approach to care of OVC; providing nutritional assessment, nutritional demonstration activities and
support; ensuring adequate primary health care for OVC; and providing enhanced psychosocial support at
both the facility and community levels. AR will place significant emphasis on strengthening services to OVC
beginning with building skills in LPTF staff and community/home based care providers to identify children
who are vulnerable and providing them with appropriate services. Adequate health care will include
strengthening linkages and referrals to other facility services (maternal/child health, inpatient and outpatient
departments). Community based services will be strengthened to ensure referral to facilities for OVC
households through a family-centered opt-out approach to HCT services for all children <18 years of age
and their caregivers.
AR will adopt use of the Child Status Index to assess vulnerability and provide services. In collaboration
with Community Based Organizations (CBOs), Faith Based Organizations (FBOs) and other OVC
programs, particularly the Catholic Relief Services (CRS) SUN project, AR will ensure that OVCs receive
comprehensive care and support services with emphasis on decentralization of these services to the
community and home levels. All OVC households will also receive a preventive care package containing
ITN, water guard, water vessel, soap, ORS sachets, and Information Education and Communication
materials on self care and prevention of common infections according to Government of Nigeria (GoN)
guidelines. These services will be underpinned by providing good supportive counseling for children and
adolescents. AR will intensify collaboration with GON and other stakeholders to ensure prompt diagnosis of
tuberculosis (TB) in children and facilitate provision of pediatric TB formulations. To avoid double counting,
AR carries out joint quarterly monitoring of these activities using GON tools and OGAC OVC CSI.
All OVC and their households reached by the AR program will be assessed for the identification of specific
client/household needs and provided with psychosocial, nutritional, protection and health care supports
where necessary. The psychosocial support provided to OVC, including their caregivers, is multifaceted and
comprehensive and includes frequent home visits by facility trained community volunteer or volunteers from
the LPTFs for assessment of health status, counseling on stigma and discrimination, disclosure, and grief.
AR will strengthen existing structures to build kid support groups in all LPTFs and expand their activities to
include periodic social/recreational and educational activities with the involvement of uninfected children to
address issues of stigma and discrimination. AR will build capacity in the team and at the LPTF to establish
adolescent programs for infected and affected children.
AR will provide nutritional services including nutritional assessment and micronutrient supplementation to
approximately 1,000 OVC. AR will expand its central OVC team to include a nutritionist who will assist in
building capacity of HCW in nutritional assessment, establishing nutritional corners in all LPTFs for culturally
and regionally sensitive counseling rehabilitation. AR will strengthen collaboration with Clinton Foundation
for provision of therapeutic food supplements and also with other PEPFAR-supported organizations offering
food program for OVC such as the MARKETS activity and CRS 7 Dioceses (7D) in states where they are co
-located. In addition, AR will collaborate with NPI to ensure delivery free and appropriate immunization to all
OVC less than 5 years. AR will ensure birth registration for OVC and roll out of a child protection policy for
all our LPTFs in collaboration with appropriate GoN agencies and other CBOs. AR will also participate in
advocating the GoN at the state levels for welfare services for OVC (e.g., free primary education). Linkages
to CRS SUN, 7D and other CBOs will ensure the full provision of community and HBC services to OVC
clients.
AR will facilitate a summit for the review of and adoption of evidence based best practices in maternal and
child health for IPs and stakeholders in collaboration with the University of Maryland School of Medicine.
60 health care workers will be trained in COP09 using national guidelines and OVC standards of practice.
Specific training relevant to each level of HCW will be provided at each LPTF for at least one doctor, one
nurse and one counselor. AR will sustain training in pediatric counseling using the curriculum developed by
AR in partnership with the African Network for Children affected by HIV (ANECCA) to all LPTFs and other
stakeholders in Nigeria. Increasing the skills of providers will help meet the special needs of children and
their parents/caregivers and will provide the support needed at the family level by working with HBC
programs under the 7D and SUN programs of CRS. This curriculum will also be shared with the GON to
elicit endorsement of the materials and also the opportunity of the GoN to benefit from the materials.
institutionalize quality interventions. This will include standardizing patient medical records to ensure proper
record keeping and continuity of care between LPTFs and communities. Monitoring and evaluation of the
AIDSRelief OVC program will be consistent with the national plan for patient monitoring. AR CQI specialists
and OVC focal persons will conduct team site visits at least quarterly during which there will be evaluations
of OVC services provided, the utilization of National PMM tools and guidelines, proper medical record
keeping, referral coordination, and use of standard operating procedures by the HBC and facility providers.
On-site TA with more frequent follow-up monitoring visits will be provided to address weaknesses when
Activity Narrative: identified during routine monitoring visits. Each of these activities will highlight opportunities for
Scaling-up OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of
care to 400,000 children infected and affected by HIV/AIDS in Nigeria. The OVC activity will contribute to
the AR overall comprehensive package of care for PLWHAs by ensuring that children's specific needs are
met. Training activities will contribute to overall program sustainability by building the knowledge and skill
base across all supported sites.
AR activities in OVC are linked to HCT, ARV services, PMTCT, ARV drugs, laboratory, AB, TB/HIV,
Pediatric care and treatment, and SI to ensure that OVC are provided a continuum of care. Linkages to
CRS SUN, 7D and other CBOs will ensure the full provision of community and HBC services to OVC clients.
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. Health and allied care
providers in clinical and community settings will be trained to provide services to OVC.
The activity has an emphasis on human capacity development through training and commodity
procurement. Other areas of emphasis include wraparound services (food, immunizations) and SI.
The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to
both male and female OVCs in AR-supported LPTFs.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $60,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000
Table 3.3.13:
AIDSRelief (AR) will increase support for counseling and testing (HCT) services to a total of 84 sites. This
would comprise the current 31 Local Partner Treatment Facilities (LPTFs) and 10 satellite (in 16 states of
Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarrawa, Ondo,
Plateau, and Taraba) and to an additional 3 LPTFs, 9 satellite sites in COP09 in the 16 states. HCT
services will also continue at the 31 TB DOT sites supported by AIDSRelief. An emphasis will be placed on
satellite decentralization clinics and family members of in care clients. 9,000 persons will benefit from HCT
and receive their results. This includes 8,100 adults and 900 pediatric clients. AR will build the capacity at
existing and new LPTFs to enable them to integrate HCT services within care and treatment systems. In
COP09 the AR HCT site and community level activities will stress: (1) providing technical assistance,
particularly in identifying most at risk persons in need of HCT, and (2) working with sites to identify and
obtain 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.
All HCT service outlets will continue to be branded with the "Heart to Heart" logo. AR will continue to
encourage Provider Initiated Testing and Counseling (PITC) and point of service testing started in COP08 in
all supported healthcare facilities. This approach to HCT will be actualized by AR technical and
programmatic staff through onsite mentoring/preceptorship of providers and the engagement of leadership
at AR-supported facilities. AR will also scale-up couples counseling and testing in all supported sites
through organized training, family centered testing and on- site mentorship. AR will promote HCT as a
necessary and important arm of HIV prevention in terms of averting new infections and providing treatment
for those in need, and post-test counseling will be strengthened to lay emphasis on prevention for positives.
Post test counseling will include full and accurate information on all prevention strategies. Referrals to
outlets that provide other prevention services not available at AR-supported facilities will be provided.
All HCT sites will provide same day results and will use the current National serial testing algorithm. For
infants and children less than 18 months, Early Infant Diagnosis (EID) will be available at PMTCT sites
according to the national scale up plan; lab testing for EID will be done in conjunction with other IPs. The
USG will provide AR with rapid HIV test kits and AR will be responsible for their warehousing, storage and
distribution to LPTFs. Sites will be actively linked to the Government of Nigeria and other donor agencies to
access extra kits and supplies needed, and supported to maintain their regular usage and feedback through
the above mentioned strategies. Sites will be trained on forecasting and stock control using bin cards and
will maintain a three month buffer stock. LPTFs will report on inventory and forecasting to the AIDSRelief
central office on a monthly basis.
In COP09, AR will target the provision of HCT services mainly to People Affected by HIV/AIDS (PABAs) -
especially children, as well as to STI patients and TB DOT clients at the LPTFs and satellite clinics. At rural
satellite clinics, AR will also target women of reproductive age with combined HCT and STI screening. AR
will also provide HCT services at blood transfusion points of service, following the multiple points of service
model for facility based HCT. All HCT clients will be linked to prevention services, as well as treatment, care
and support services where applicable.
AR will train 30 LPTF staff on counseling and testing using the GON HCT training curriculum. Counselor
training will include couples counseling to strengthen this aspect of the program. This will ensure the
availability of a pool of trained counselors to promote continuity. In addition, providers will be sensitized on
the adoption of PITC and point of service testing in their facilities. Non-laboratorians will be used at multiple
points of service for facility based HCT where appropriate and when allowed by national policy. To this
effect AR will train HCW (counselors, nurses and outreach workers) that will be supervised by onsite
laboratorians to assure quality. To expand HCT services within the network of faith based organizations and
increase rural access to HCT, AR community based HCT will advocate for greater use of non-laboratory
staff to conduct testing in the community setting as well.
AR will carry out quarterly monitoring visits which focus on quality assurance and onsite mentoring. There
will be evaluations of counseling techniques, HCT testing algorithms, the utilization of the National CT
Register, proper medical record keeping, referral coordination, patient flow, and use of National HCT tools.
identified during routine monitoring visits. Semi-annual subpartner meetings will provide an additional forum
for sharing of new information between sites and communities.
AIDSRelief will collaborate with faith based and community based organizations, in particular the 7-
Dioceses program of Catholic Relief Services, in carrying out community based and mobile HCT services.
AR will also collaborate with state and local government HCT programs by carrying out joint trainings,
monitoring visits and leveraging resources to test those who may require testing outside the USG supported
numbers.
AIDSRelief will provide HCT services at 84 sites at the primary and secondary levels in rural and previously
underserved communities to provide services to 9,000 clients including 900 children thus contributing to the
PEPFAR and GON targets for increasing access to HIV counseling and testing. HCT services will enable
the identification of HIV positive individuals in a timely manner and will direct them into care and treatment
services. HCT will add to the prevention strategies of averting new infections through efficient and effective
posttest counseling and patient education. HCT will further contribute to the National goal of universal
access to HIV/AIDS services. By building LPTF capacity through training, salary support to faith based
institutions and refitting of LPTF counseling rooms, AR will contribute to the sustainability of HCT activities
at these sites and in Nigeria.
This activity relates to activities in care and treatment (adult and pediatric), laboratory, PMTCT, OVC, AB,
TB/HIV and SI. Linkage of HCT to care and treatment services shall be strengthened within and across
Activity Narrative: programs and between other implementing partners using standard referral tools. AR will establish referral
linkages with National TB DOTs centers to ensure that TB patients are routinely screened for HIV and those
testing HIV+ are referred to AR LPTFs for HIV/AIDS care and treatment. The LPTFs will ensure integration
of the AR-supported HCT program with other departments to provide routine HCT services to all patients
and to ensure that those testing HIV+ are referred for appropriate care.
This activity targets particular PABAs (especially children), STI patients, and TB suspects/patients in the
general population.
This activity has emphasis on training, including supportive supervision and quality assurance/quality
improvement. There is an additional emphasis on local organization capacity building, community
mobilization, infrastructure development/renovation, and the development of linkages/referral systems.
The expansion of free HCT services will ensure gender equity in access to HCT services in rural and
previously underserved communities. It will also ensure that HIV-positive people are identified and linked to
timely life-saving ART services and HIV-negative clients are educated on the importance of avoiding risky
behaviors.
Continuing Activity: 13000
13000 5425.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $980,000
6681 5425.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $1,025,000
5425 5425.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $240,000
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.14:
ACTIVITY MODIFIED AS FOLLOWS:
In COP09, AIDS Relief (AR) will procure anti-retroviral (ARV) drugs so that ARV treatment can be provided
to 33,450 patients including 30,150 adults and 3,300 children at 34 Local Partner Treatment Facilities
(LPTFs) and 19 satellite clinics in 16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT,
Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba. In COP09 AR will open 3 new LPTFs and
9 satellite clinics to broaden access to the ARV Drugs. In setting and achieving COP09 targets,
consideration has been given to modulating AR's rapid COP08 scale up activities in order to concomitantly
AR's supply chain management system will ensure that the necessary infrastructure, systems and skills are
in place for efficient forecasting, procurement, storage, and distribution of quality anti-retrovirals (ARVs) to
AR-supported LPTFs. Assessment of new sites will follow the AR Information Gathering Tool and the
Pharmacy Support and Assessment Standards Checklist. Pharmacies will be refitted to improve commodity
security. Technical support to LPTFs to institutionalize standard operating procedures (SOPs) for drug
management will continue in COP09. AR will train and retrain 40 pharmacists and 50 other health workers
including pharmacy technicians or assistants in the use of developed standard operating procedures
(SOPs) that are in line with national guidelines. These SOPs include drug requests, receipts, recording,
dispensing, discrepancy reporting, temperature control and disposal of expired drugs. In-depth training of
the LPTF staff in the utilization of SOPs, forecasting and quantification for ARVs and general drug
management issues will be conducted.
AR annual forecasting exercise was done in conjunction with the USG Logistics Technical Working Group
and SCMS in August 2008. Based on the projections, AR is moving towards a predominantly Tenofovir-
based first line regimen in accordance with National Treatment Guidelines. An estimated 25% of people
living with HIV/AIDS (PLWHA) already enrolled in care will qualify for and be placed on ART during the
year. According to projections, 5% of the patients are expected to be on second line ARV regimens. The
use of pediatric Fixed Dose Combinations (FDC) will be stepped up in COP 09.
Procurement procedures will follow USG, FDA and National Agency for Food and Drugs and Control
(NAFDAC) regulations. NAFDAC importation waivers are secured through the USG for unregistered drugs.
All ARVs are procured from Good Manufacturing Practice certified sources which are FDA approved/pre-
approved. Generic batches are tested by an independent laboratory (VIMTA Laboratories) in India or Center
for Quality Assurance of Medicines (CENQAM), North West University, South Africa for compliance with all
requirements before shipping. They are warehoused and transported under air-conditioned environments in
-country and have in-transit insurance coverage. IDA Foundation and Phillips Pharmaceuticals are
contracted for procurement and CHAN Medi-Pharm for warehousing and distribution. AR will substitute
innovator proprietary ARVs with FDA approved generic equivalents taking into consideration issues of
safety, quality and cost. All purchases of Truvada (TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be
purchased via SCMS pooled procurement mechanism in line with OGAC's recommendation.
The Pharmaceutical Management Team manages country operations with a Therapeutic Drug Committee
(TDC) comprising of clinicians, pharmacists, palliative care specialists, strategic information advisors and
program managers. The TDC reviews drug utilization patterns across all LPTFs, assesses scale-up
progress and develops required technical support plans. AR will support the strengthening or establishment
of Therapeutics Drug Committees (TDC) at all Local Partner Treatment Facilities. The TDC will have the
key responsibility of developing policies for managing medicines use and administration, evaluating the
clinical use of drugs and managing a formulary system. The TDC will promote rational use of medicines
(RUM) through the medication use reviews, provision of drug information to patients, monitoring medication
errors, development and implementation of pharmacovigilance plans and development and implementation
of continuing education plans. The AR technical team will provide technical assistance through training and
on site mentorship for these committees. Technical assistance will be provided to the LPTFs in
development and implementation of Pharmacovigilance plan (data gathering activities relating to detection,
assessment and understanding of adverse drug events/reactions i.e. Adverse Drug Effects or Adverse Drug
Reactions and treatment failure). The TDC is replicated at the LPTF level to ensure that the ARV supply
chain management is clinically informed and logistically supported. Quality assurance covers the entire
spectrum from procurement to dispensing. All sites will be provided with ongoing TA by AR's Health Supply
chain technical team. Pharmacy and logistics management procedures will be assessed and will be part of
site development planning. The Logistics Management Information System (LMIS) will include an inventory
tracking tool that allows drug tracking from procurement to dispensing and interfaces with the ART
Dispensing Software developed by Management Sciences for Health installed at LPTFs. AR will participate
in the ongoing harmonization of the national LMIS system.
AR will continue to work with the Government of Nigeria, Clinton Foundation (Pediatric ARVs and Second-
line Adult ARVs) and other stakeholders to leverage resources for ARVs.
The ARV drug activity will ensure that quality ARVs are supplied to all patients in a timely manner.
Appropriate product selection and forecasting will ensure the effective use of scarce resources. By scaling
out ARV drug services to 3 new LPTFs and 9 satellite clinics in COP09 (mostly rural based primary and
secondary faith based facilities), AR will contribute towards the National and PEPFAR plans of increasing
access to ARV drugs in previously underserved communities. As expansion of ARV drug services is
prioritized to rural areas, AR will strengthen existing referral channels and will support network coordinating
mechanisms. By providing ARV drug services to 33,110 clients, the activity will contribute to the PEPFAR
target of providing ARV drugs to 350,000 PLWHAs in Nigeria by 2009 as well as to the Government of
Nigeria's (GON) plan for universal access to ARV drugs by 2010.
This activity relates to activities in ARV services, laboratory, care and support, PMTCT, and SI.
Continuing Activity: 13001
13001 9889.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $8,535,519
Table 3.3.15:
This activity ensures that appropriate lab support is provided for HIV clinical monitoring and HIV testing.
Linkages with Strategic Information (HVSI) will ensure tracking of lab infrastructure indicators. AIDSRelief
(AR) works in tertiary and secondary health care facilities to provide quality HIV/AIDS services to people
living with HIV and AIDS (PLWHAs). AR supports Laboratory (Lab) infrastructure for all of our local partner
treatment facilities (LPTFs).
AR provides on-site capacity for HIV testing, laboratory monitoring of disease progression and response to
treatment, diagnosis of opportunistic infections (OIs), and monitoring of antiretroviral drug (ARVs) toxicity.
AR will support the improved diagnosis of TB, PCP, cryptococcal infection, syphilis, hepatitis B (HBV),
protozoal and bacterial infections. AR does not routinely do Viral load (VL) testing but ensures that VL
testing is performed to make difficult therapy switch decisions as well as to evaluate the program. A random
10% subset of clients from each LPTF who have been on therapy for a period of 6 -9 months is tested
annually through collaboration with other PEPFAR IPs with viral load capacity and at 2 of our LPTFs with VL
testing capacity. In addition, 2-3% of AR clients on ART will require VL testing based on clinical indications
AR will also continue to support expansion of early infant diagnosis (EID) at PMTCT-supported facilities in
accordance with the national EID scale up plan. AR, with support from the Clinton Foundation, will provide
standardized training and supplies for collection and transport of dried blood spots (DBS) to DNA PCR
testing laboratories and return of results to clinics.
AR will continue to participate in the USG-Nigeria coordinated Laboratory Technical Working Group (LTWG)
to ensure harmonization with other IPs and GoN-supported laboratory programs. AIDSRelief will continue to
work with the PEPFAR LTWG towards the development of a common Lab equipment platform appropriate
for each lab level.
In COP08, AIDSRelief is providing support to 30 sites in a total of 16 states (Abia, Adamawa, Anambra,
Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo, Plateau, and Taraba). Of
these 30 sites, 28 are secondary level and 2 are tertiary level. Two of these facilities have PCR capacity: 1)
St Vincent's DOC (DREAM model) has bDNA VL testing supported by CRS private funding and 2)
Annunciation Specialist Hospital in Enugu has NucliSens VL machine (initiated prior to PEPFAR). AR will
continue providing automated CD4 testing equipment with capacity for processing large patient loads
cytosphere reagents using binocular microscopes that are easy to use and appropriate for secondary care
centers for manual CD4 testing as backup in place of automated CD4, hematology analyzers and chemistry
machines. All labs will be supported to test for syphilis, PCP, TB, HBV, hematology, chemistry,
cryptococcosis, and CD4 count.
In COP08, AR provided 10 LPTFs with fluorescent microscopes to enhance TB and malaria diagnostic
capacity at high volume sites. In COP09, AR will provide an additional 5 LPTFs with fluorescent
microscopes and support necessary training and reagent procurement for these equipment at all 15 labs.
In addition to 10 primary level satellites activated in COP08, 9 new satellite sites will have a laboratory
capacity for hematology, CD4 and HIV rapid testing and positive patients will be referred to the parent site
for ART. In setting COP09 targets and expansion, consideration has been given to modulating AR's rapid
COP08 scale up plans in order to concomitantly work towards continuous quality improvement.
In COP09, AR will continue to improve lab equipment sourcing locally and lab equipment maintenance at
our secondary and tertiary LPTFs. To this end some of the lab equipment will be centrally procured and
shipped to Nigeria and some will be sourced locally using reputable vendors. An AR in-country lab specialist
will be dedicated to overall equipment installation and maintenance. All AR lab specialists have received
training and will continue to receive updated trainings from CD4 manufacturers and other lab equipment
manufacturers as maintenance engineers to support the servicing of CD4 and other machines. 10% of the
cost of all equipment will be kept in reserve for maintenance purposes. AR-supported lab engineers at 6
supported LPTFs will be included in these trainings and used as trainers, mentors and engineers, along with
AR Lab specialists for other AR-supported labs, where appropriate, as an approach to sustainability. AR will
build the capacity of 2 LPTF regional labs already supported (Evangel Hospital Jos and Annunciation
Hospital, Enugu), by training biotech engineers as equipment repairs/maintenance engineers and
technicians. This will be done in collaboration with the equipment manufacturers and vendors.
In COP08, AR developed a comprehensive lab program with 9 locally based FTE lab specialists focused in
the following areas: 1 centrally based lab program director, 1 equipment installation/trouble shooting, 3 site
quality monitoring, 1 blood / injection safety, 1 TB lab and 2 training. These will be supported by a Baltimore
-based lab specialist. AR will deploy 2 Lab specialists who will be dedicated to lab commodity management
and quality monitoring respectively.
AR will use its reagent forecasting tools at all levels to determine consumption and predict need, to forestall
stock outs. Working with SCMS and CHANPharm, AR will centrally procure lab reagents from
manufacturers locally and abroad and distribute to LPTFs. HIV Test kits will be provided directly by the USG
through the SCMS mechanism.
AR will work with locally certified QA experts to implement the Lab external quality assurance (EQA)
program, and work with UMD-ACTION for back-up CD4 testing support, training support for EID/DBS and
provision of specialized Lab tests such as VL and DNA-PCR. To support pediatric diagnostic and treatment,
Clinton Foundation will provide DBS collection material and transportation of specimens/results. AR will
work with JSI/MMIS to provide blood safety training and other safety materials to all sites.
To ensure safety in the lab, AR will increase its provision of appropriate sharps and bio-medical waste
disposal containers at all sites. In COP08, AR supplied biosafety containers to 10 of its LPTF labs to ensure
a safe work environment during AFB method of TB diagnosis. In COP09 AR will extend provision of the
same to all remaining LPTFs. AR will ensure the availability of functional incinerators and/or collection of
biomedical waste by approved, private companies. AR will also support and provide post HIV exposure
Activity Narrative: programs (PEP) at all sites.
In COP08, AR is working with MLSCN to gain local accreditation for 10 labs. This will include 2 tertiary and
8 secondary sites across 5 states. In COP09, AR will work with 5 additional laboratories to gain an initial
accreditation.
In COP08, AR worked with IHVN-ACTION tertiary lab specialists to train 90 lab personnel from all LPTFs in
the following areas: HIV diagnostics, CD4, chemistry, hematology and OI diagnosis. AR emphasizes hands-
on training during laboratory start up in lab techniques, lab management, simple equipment maintenance
and QA technique applicable to each level of laboratory. Refresher trainings are done at monthly intervals
and periodically as per identified needs at each of the older LPTF. AR provides simplified bench aids & lab
manuals to reinforce each training episode. AR will use the PEPFAR/Nigeria harmonized Training Manuals
to supplement the simplified manual from IHVN-UMSOM-University of Maryland. In COP09, in addition to
other activities AR will train selected LPTF personnel in equipment maintenance.
In COP09, AR will continue to conduct QA activities consisting of quarterly site monitoring visits (using a
standardized tool developed by the PEPFAR LTWG), quarterly proficiency testing (PT) for all tests and
reporting of these results into a centralized system. AR will sub-contract to locally certified QA experts to
implement the PT aspect of the EQA Program. They will offer trainings to AR Lab specialists in the act of
panel preparation, lab audits, and interpretation of EQA results and implementation of corrective actions.
In COP08, AR lab personnel participated in the training of trainers (TOT) lab management program
provided by Association of Public Health Labs (APHL), with support from PEPFAR/Nigeria. Knowledge
gained will be transferred to all LPTF lab personnel using the provided training materials. In COP09, AR will
organize 2 regional trainings on lab management for all heads of LPTF labs that AR supports.
By supporting Lab infrastructure AR will help all LPTFs carry out 182,738 tests. The activity will also
contribute to AIDSRelief's target of providing quality ART services to 33,450 clients including 3,300 pediatric
patients in COP09. This activity will also contribute to the reduction in Mother to child transmission of HIV
and early detection of any infant HIV infection. The activity will further contribute to the reduction and early
detection of any treatment failures among our clients by providing VL tests for a subset of the 33,450 ART
clients in COP09. This will support the possible need for ARV regimen switch for patients failing on first line
regimens. The activity will also provide infrastructure and training for TB diagnosis for the 50,000 clients in
care at the 34 LPTFs and will contribute to the overall program sustainability by improving Lab infrastructure
and by building capacity among primary and secondary level facilities.
AR activities in adult basic care and support are linked to HCT, Blood Safety, Injection Safety, ARV
services, PMTCT, ARV drugs, OVC, AB, TB/HIV, and SI to ensure that appropriate Lab support is provided
for lab diagnosis, clinical monitoring and HIV testing. AR will collaborate with IHVN-ACTION, other
implementing partners and state hospitals to optimize resources and strengthen the comprehensive
networks of care across the 16 states including centralized lab training, establishment of high level
laboratory services for VL testing and EID. AR will link LPTFs with local and PEPFAR procurement and
distribution agents such as CHANPharm and SCMS to ensure a sustainable supply chain for lab reagents.
AR regional program managers will act as network coordinators.
Continuing Activity: 13003
13003 6680.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $3,726,342
Table 3.3.16:
In COP08, AIDSRelief provided strategic information (SI) management services to 31 local partner
treatment facilities (LPTFs), 10 satellite clinics and 31 TB DOTS stand-alone sites in 16 states (Abia,
Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi, Nasarawa, Ondo,
Plateau, and Taraba). In COP09 AIDSReliefR will continue to support these facilities and further expand
services to an additional 3 LPTFs and 9 satellites in the aforementioned states. In setting and achieving
COP09 targets across all program areas, consideration has been given to modulating AIDSRelief's rapid
scale-out plans in order to concomitantly work towards continuous quality improvement in SI activities.
AIDSRelief's SI activity incorporates program level reporting and implementation of both paper-based and
computerized Health Management Information Systems (HMIS) for AIDSRelief LPTFs. This activity is
coordinated by Constella Futures, one of AIDSRelief's consortium members. Using in-country networks and
available technology, AIDSRelief has continued to strengthen LPTFs' Patient Management Monitoring
(PMM) systems with added emphasis on harmonization with the Government of Nigeria's (GON) emerging
National PMM system in COP08. As part of capacity building and contribution to program sustainability
AIDSRelief has continued to provide logistical support for automated PMM to local partner facilities by
providing them with computers and other logistical support systems and will continue to expansion of these
services in COP09. Support has also been provided in COP08 for the pilot process of GON's Logistics and
Health Program Management Information Platform (LHPMIP) developed by Voxiva at AIDSRelief partner
and other facilities. AIDSRelief has already initiated the process of harmonizing its existing IQCare PMM
system with the LHPMIP with a view to actualizing efficient PMM-PME integration.
Throughout COP08, AIDSRelief has continued to strengthen its program for Continuous Quality
Improvement (CQI) in order to improve and institutionalize quality interventions. This has included
standardizing patient medical records to ensure proper record keeping and continuity of care at all LPTFs.
In COP09 AIDSRelief will continue to provide TA to LPTFs and personnel to adapt and harmonize existing
tools to meet the standards of the GON having conducted proper roll-out of GON's revised M&E tools thus
ensuring that monitoring and evaluation of the AIDSRelief program is consistent with the national plan for
patient monitoring. AIDSRelief's SI team has worked with the AIDSRelief CQI specialists to conduct site
visits at least quarterly during which evaluations of the utilization of National tools and guidelines, proper
medical record keeping, efficiency of clinic services and referral coordination were conducted. Data flow
including data collection, management and reporting was assessed and recommendations for improvement
given. Supportive supervision and mentoring has been provided to all on-site staff that collect and utilize
data (e.g., clinicians, pharmacists, data entry personnel, administrators). All of these activities will continue
to be supported in COP09 with more frequent on-site TA and follow-up monitoring visits to address any
weaknesses identified during routine monitoring visits.
A total of 120 LPTF personnel (including but not limited to data entry personnel, clinicians, nurses,
pharmacists, and administrators) will be trained in PMM to ensure that all health workers coming into
contact with patient records use them appropriately. State M&E officers shall be informed of, and involved in
the monitoring processes and the training programs in order to instill a sense of ownership and ensure
sustainability of these efforts. This strategy is in line with the USG SI data quality assessment/ improvement
(DQA/I) and capacity building plan. Information sharing and feedback from periodic (monthly and quarterly)
reports instituted in COP08 shall be continued in COP09 involving all LPTFs and respective state and local
government action committeesagencies onfor AIDS control (SACAs and LACAs) for their planning
purposes. In COP08, AIDSRelief entered into an agreement with MEASURE Evaluation to assist in training
and provision of TA for Data Demand and Information Use (DDIU) at selected AIDSRelief LPTFs. In
COP09, the DDIU trainings will be expanded to cover all local partner facilities as well as respective SACAs
and LACAs. A total of 84 of local organizations will be provided with technical assistance for strategic
information activities in COP09.
AIDSRelief SI team will continue to be active participants on the SI working group established and
coordinated by USG-Nigeria as well as the GON's National M&E Technical Working Group and its sub-
committees. In COP08 AIDSRelief actively participated in the pilot process for HIVQual and its phased roll
out at selected LPTFs. Due to the limitations of the CAREWare software that has been in use by AIDSRelief
across the 9 countries, the process of transitioning to IQCare with successful migration of all CAREWare
databases to the new software which provides for a more robust open source, freeware solution was
concluded in early COP08. IQCare will continue to be supported, developed and enhanced in AIDSRelief
partner facilities. Additionally, AIDSRelief will continue pursuing the harmonization process of its IQCare
application with the National Public Health online real-time data system (LHPMIP) as well as HIVQual.
Other activities being implemented at the site level is the use of IQCare queries for custom reports and Life
Table Analysis (LTA). LPTF staff have been trained and continuous TA is being provided to enable them
utilize the information in their IQCare databases to produce these custom reports. The LTA enables
utilization of publicly-available software to assist LPTFs to analyze and interpret their patient data using
simple procedures and recognized statistics. These procedures compute program continuation rates from
existing medical records maintained by the ART program. AIDSRelief has been training LPTF personnel
and will continue to provide TA in COP09 to enable them to continue to conduct these LTAs and custom
reports independently and thus contribute to the sustainability of this activity.
Improvement in SI management capacity of existing and new LPTFs will instill a data use culture that leads
to improved quality of care. Staff training across the AIDSRelief sites in 16 states will contribute to overall
program capacity building and sustainability. The provision of logistics for automated PMM will contribute
towards the GON and USG strategy on provision of quality and timely data for decision making.
Since all programs require a robust data management system and data quality checks to ensure effective
programming, this activity relates to all AIDSRelief HIV/AIDS activities ARV services (6678.09), ARV drugs
(9889.09), laboratory (6680.09), care and support (5368.09), PMTCT (6485.09), OVC (5416.09), AB
(15655.09), TB/HIV (5399.09), Blood Safety (HMBL; HMIN; CIRC; IDUP) and Injection Safety.
The AIDSRelief SI activity targets AIDSRelief LPTF personnel including those primarily engaged in SI
activities (on-site project coordinators, on-site M&E officers, data entrants, and medical records
technicians), other health care workers (physicians, nurses, counselors, pharmacy and laboratory staff) and
decision-makers (at LPTF, program and Government levels). This is to ensure that all personnel coming in
contact with the patient keep appropriate records and manage them efficiently and effectively with the data
thus gathered playing a major part in evidenced-based decision making at all levels.
This activity has a major emphasis on strategic information (HMIS development) and reporting for program
level M&E with emphasis on targeted evaluations, logistics and training.
Continuing Activity: 13004
13004 5359.08 HHS/Health Catholic Relief 6365 3688.08 HHS/HRSA $1,100,000
6674 5359.07 HHS/Health Catholic Relief 4162 3688.07 Track 2.0 $400,000
5359 5359.06 HHS/Health Catholic Relief 3688 3688.06 Track 1.0 $365,917
Table 3.3.17:
