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 AS FOLLOWS:
Early Infant diagnosis has been added in this narrative, targets have been reviewed upwards from 1500 to
2500
ACTIVITY DESCRIPTION
This activity is linked to HCT, basic care, OVC services, SI, and sexual prevention.
In COP08 Africare initiated PMTCT services with the establishment of two PMTCT sites in Lagos state with
a target of 1,500 pregnant women counseled, tested and receiving their results. In COP09, one additional
PMTCT site will be set up at a primary health center with a high volume antenatal clinic (ANC) in Lagos.
Work will involve regular outreaches to the traditional birth attendants in the three local government areas to
ensure more pregnant women receive testing and counseling services; 2,500 pregnant women will be
counseled and tested and will receive their results at the three sites. 125 mothers will receive HAART or
ARV prophylaxis onsite.
Africare will continue programming during the COP09 year to emphasize provider initiated opt out testing
with group pre test counseling, individual post test counseling with provision of results at ANC, labor and
post partum wards. Whole blood samples for women who test positive will be collected and sent for CD4+
count and Hb estimation to ensure HAART eligible mothers are identified, contacted by telephone and
actively referred into linked treatment programs at nearby treatment facilities. In accordance with National
guidelines, non-HAART eligible HIV-positive pregnant women will receive combivir or zidovudine
prophylaxis depending on gestational age. Single dose nevirapine (SD-NVP) will be dispensed on first
contact to all positive clients to take home with instructions for use at the onset of labor. Sample logging
would be done for blood samples from sites where CD4 estimations are not performed onsite. All HIV-
exposed infants at birth will receive SD-NVP and a 6-week course of AZT to take home, which will be
dispensed at the labor and delivery. All three PMTCT sites will be linked into the National Early Infant
Diagnosis (EID) scale up plan to ensure diagnosis at 6 weeks using dried blood spots, and early referral to
care and treatment.
In addition, testing of partners and children of the index client, TB screening of HIV-infected pregnant
women with referral for treatment where needed, ARV prophylaxis for HIV infected women and newborns,
maternal nutrition and infant feeding counseling and infant follow-up will be supported. HIV positive
pregnant mothers will be given unbiased counseling on infant feeding with emphasis on AFASS in
accordance with the National PMTCT guidelines. Infant follow-up will continue to be optimized through the
co-location and co-scheduling of mother support group activities with infant follow-up clinics,
immunization/post natal clinic days, and provision of maternal care and support services at all times onsite.
Mother support groups will be formed in the new facility and strengthened in the old facilities to provide
support from more experienced "Champion Mothers" to newer mothers around appropriate options for
delivery, infant feeding, maternal nutritional counseling and disclosure, to reduce the effects of
stigmatization. These champion mothers will also receive training and onsite supervision. Mothers will also
be strongly discouraged from engaging in mixed feeding.
These support activities will be actively linked into existing OVC and pediatric care and support programs
and young kids clubs to optimize sustainable infant follow-up. Cotrimoxazole prophylaxis will be provided
onsite as part of the OVC basic care and support continuum from age 6 weeks until final HIV status is
known, and for all HIV-infected children. The three PMTCT sites will also have care and support services for
families. These sites will be actively linked into a care network with a treatment facility where HAART-
eligible pregnant women will be referred.
The program will also continue to support identification of fathers for participation in PMTCT through the
support of couples counseling, increasing male involvement through the use of "love invitation letters", and
formation of male support groups integrated into existing community support groups. Women and their
partners will receive educational materials, brochures, pamphlets, and other materials during ANC visits. In
partnership with Gospel Communications, movies focusing on PMTCT will be aired during the visits. They
will also focus on promoting early identification of HIV and early initiation of antiretroviral drugs for HAART-
eligible HIV-infected pregnant women and their newborns.
Africare will build capacity at the new facility to provide and strengthen integrated PMTCT and family
planning services linked with onsite care services. 26 health care workers will be trained this year to provide
PMTCT services, including refresher trainings at the two facilities started under COP08. On-site training will
be provided at all three primary health centers for all staff. Laboratory staff will receive training on manual
CD4 estimation and a transport mechanism will be set up to ensure CD4 samples can be collected and sent
to nearby partner-supported labs with the results transported back to the PHCs to determine HAART
eligibility for mothers. All health care workers at the PHC will be trained using the National PMTCT
curriculum to provide the full complement of PMTCT services. Other trainings will include HIV and infant
feeding, making medical injections safer, MIS and early infant diagnosis training. Champion Mother
counselors will also be trained on an ongoing basis to provide mother support group leadership.
The PMTCT advisor and other project staff will provide onsite mentorship and supervision of staff at the
sites to ensure quality of PMTCT care. The project will provide training and onsite mentorship of counselors
to increase skills in couple counseling and integration of partners into PMTCT related decision-making.
Nigerian National PMTCT manuals, guidelines, SOPs, registers and job aids will be provided throughout the
facilities and will be available for referral and use in the ANC, labor wards and post natal clinics.
Particular emphasis will continue to be laid on data collection and reporting. Staff capacity to work with data
around collection, compilation and evaluation will be strengthened through training and follow-up at all
points of service delivery, with regular hands-on onsite mentoring and supportive supervision on capturing
National PMTCT indicators, completion of registers and proper data entry. Staff will be taught how to
interpret and integrate data from all the onsite HCT, OVC, care and support and PMTCT services, ensuring
Activity Narrative: smooth referrals into other onsite programs. Staff will be further trained to use data to improve quality of
care and to highlight areas for improvement.
Partnering with the NYSC, Africare will support the employment of an additional youth corps member in the
new facility, a physician who will provide support for the PMTCT clinics as well as develop and strengthen
the linkages between program components, working alongside the facility based staff. Africare will also
partner with already identified traditional birth attendants (TBAs) in the communities where HCT outreach is
already taking place and whose pregnant HIV-positive patients will be referred to the primary or secondary
health facilities for delivery.
Delivery kits will be provided at the facilities. Each kit will contain gloves, sanitary pads, cotton wool, cord
clamp, delivery mat, gentian violet, methylated spirits and clean surgical blades. Defaulter mothers who do
not return for subsequent visits will be followed up by the TBAs in the communities who will work alongside
the mother support groups and referral network coordinators.
PMTCT services will be strengthened within the framework of a decentralized and integrated HIV care
program. All protocols followed will be in line with the National PMTCT guidelines, and outcomes of the
program will be reported to the health facilities, local government areas (LGAs), State Action Committee on
AIDS (SACA) and state PMTCT programs. Attendance at all state PMTCT meetings by community and
LGA PMTCT representatives will be facilitated by Africare.
A patient management team and a project monitoring team will be established at the new facility in keeping
with the model of care. The responsibilities of these teams will be separate but have some overlap. The
project team will consist of leadership from all units of the hospital who will provide support for the entire
hospital-wide project including the administrative support and supervision of the other program areas. The
patient management team consisting of direct patient care providers will focus on clinical issues as they
arise in the PMTCT clinic, and the provision of continuing medical education. Strong referral networks will
be established, aimed at strengthening linkages between the PMTCT services and other care services
within the facility, and between separate facilities and the communities they serve. The referral network
coordinators will meet monthly and the members will include management and clinical staff responsible for
the ANC and PMTCT clinics, support group leadership, referral treatment clinics, local and international
NGOs, and other donor projects. It is envisaged that these networks will also encourage rapid testing for
syphilis and, if possible, gonorrhea, along with single dose, directly observed treatment as appropriate.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Africare will contribute to the overall PEPFAR goals of preventing further new infections and reducing HIV
incidence and prevalence rates in Nigeria. It will also contribute to the National plan of scaling up PMTCT
services across all levels of care. It will help to lay the foundation for a more sustainable HIV intervention
program in Nigeria through a focus on community-based responses.
LINKS TO OTHER ACTIVITIES
This activity relates to ongoing activities in care and support (mothers are linked into C&S services once
they are diagnosed and initially will receive these through the support groups) care of OVC, early infant
diagnosis (infants are immediately enrolled upon delivery as well as their older siblings as applicable), adult
and pediatric care and treatment, HCT, sexual prevention, and SI. Health systems strengthening with
human capacity development will be emphasized. Gender issues are addressed ensuring both males and
females are reached though this program.
POPULATIONS BEING TARGETED
Pregnant women, post partum mothers and their partners and household members including young children
- HIV-exposed, infected children and non-infected OVC - will be targeted to ensure they have access to
HCT services at entry points to care. HIV-infected women will be provided care, prophylaxis and treatment
as indicated, and other family members will receive care and treatment. The non infected women will also
receive counseling with their HIV testing to support them to stay negative. Men, support groups, and
community and faith based organizations will be targeted to ensure their participation in community PMTCT
activities. 26 Health care providers will be trained for service provision. Capacity of local government and
state leaders will be built to support prevention activities, particularly PMTCT.
KEY LEGISLATIVE ISSUES ADDRESSED
These include gender equity in HIV and AIDS programming and increasing access of vulnerable groups to
services. It also will address health related wraparound programs with safe motherhood, child survival,
family planning and malaria prevention initiatives. Gender will be addressed through this project by
optimizing the number of pregnant women who receive care, support and prophylaxis, as well as increasing
male involvement by involving partners of pregnant women in the decision making and actively engaging
them in the issues around PMTCT and infant health. Partners will be encouraged to test for HIV using
"invitation love letters", an activity that seeks to actively engage prospective fathers. Infected partners or
family members will be integrated into the HIV care and support and ARV service program areas.
EMPHASIS AREAS
Emphasis areas are strengthening of referral networks between PMTCT and other vertical programs and
increasing male involvement.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21665
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21665 21665.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $100,000
Disease Control & 2.0 Africare
Prevention
Emphasis Areas
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
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $6,990
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In COP 08, Abstinence & Be Faithful (AB) services were provided to 2,000 individuals in 25 service outlets
in Lagos Rivers and Bayesla states. Sixty (60) people were trained, including teachers, religious leaders,
students, and other peer educators. Condoms and other prevention services were provided at 23 sites,
4,286 most at risk persons (MARPs) were reached, and 100 peer educators were trained on the use of
advocacy tool kits.
In COP 09, Africare will be consolidating the implementation of its sexual transmission prevention
programming activities in line with the overall PEPFAR Nigeria goal of providing a comprehensive package
of prevention services to individuals reached, and improving the effectiveness of the prevention messages,
through a balanced portfolio of prevention activities including messages on abstinence and being faithful,
distribution of condoms and support for other forms of prevention. The program aims to: promote
abstinence, fidelity and related community and social norms; implement the minimum prevention package of
services within the targeted populations; develop a comprehensive prevention package of services for
persons engaged in high-risk behaviors; and integrate these services into care and treatment settings and
other health related settings.
AB messages will continue to promote abstinence, including delay of sexual debut or secondary abstinence,
and fidelity (including partner reduction and mutual fidelity), while addressing related social and community
norms. The target population for AB programming will be: TB DOTS patients, uniformed service personnel,
incarcerated persons, transport workers, and in-school and out-of-school youth. Four strategically chosen
sites will be added to the existing 25 service outlets, which will result in a total of 29 outlets for AB services
in COP 09. In addition, age/culturally appropriate abstinence only messages and secondary abstinence
messages will be conveyed to 500 children and young adults, particularly focused on in-school youths and
orphans/vulnerable children receiving home based support, and through peer education in schools. These
services will be integrated with the HCT and OVC programs as well as the palliative care and TB/HIV
programs, and appropriate messages will be given in support group settings as part of prevention for
positives activities. Out of school youth will be targeted to receive AB messages at vocational training
centers. The program will contribute to the reduction of new infections by reaching 2,273 individuals (1,000
male and 1,273 female) with intensive AB services. 1,137 of these will be reached with abstinence
messages alone. Where appropriate, AB programs will be implemented alongside C&OP services at
Africare-supported facilities and communities.
Twelve persons will be trained in AB messages and programming. This number includes teachers, religious
leaders, students, and peer educators. Those who were trained in the preceding year will be given refresher
training. All trained individuals will receive training materials and job aids as reference materials. The
capacity building of health teachers, religious leaders, students, and peer educators will ensure
sustainability and ongoing community activities.
A comprehensive prevention package that will include IEC materials for both AB and C&OP programs and
condoms will be distributed to all HCT sites and at all points of service in supported health facilities. Africare
will continue to target communities where registered clients live in order to reinforce messages provided in
the facility setting. As a component of the community based and school based programs, AB messages will
be integrated into games and sports activities. Activities highlighting role models, drama presentations and
film shows will be organized for in- and out-of-school youth. The peer education model will be used to
organize formal peer groups that will then actively develop AB messaging campaigns for their peers through
the formation of school Anti-AIDS clubs and HIV/AIDS Committees.
C&OP activities will be implemented at facility and community levels utilizing a combination of strategies
aimed at saturating focus communities with messages conveyed in multiple fora. Condoms and other
prevention (C&OP) programs will be provided at 30 outlets (16 health facilities, 5 stand alone HCT sites, 5
workplaces, and 4 brothels). An anticipated 4,242 individuals will be reached with C&OP programs that
promote correct and consistent condom use, referral to HIV Counseling & Testing (HCT) sites, referral into
STI management, and messages aimed at reducing other risks of persons engaged in high-risk behaviors.
C&OP programming will focus on at-risk (out of school) youth, long distance drivers and other mobile
populations, targeted alcohol users, women engaged in prostitution and transactional sex relationships
(both brothel-based and non-brothel-based), incarcerated populations, PLWHA, and members of the
uniformed services. It is expected that a combination of sexual prevention message approaches will ensure
clients are effectively reached with prevention interventions. In line with the National guidelines for a
minimum prevention package, individuals will be reached with a minimum of three interventions that will
include community awareness campaigns, peer education models and school or work based activities, as
appropriate.
Bridge populations, including students in institutions of higher learning who are involved in transactional sex
or high end commercial sex work, will be targeted for sexual prevention activities through campus based
outreach programs aimed at providing education, condoms and peer support.
Africare will follow existing methodology for measuring achievements in AB programming, through program
officers dedicated to providing oversight and guidance on prevention activities under AB and C&OP
programs. Members of the National Youth Services Corps (NYSC) will be actively recruited as peer
education trainers and supported in collaboration with the states and UNICEF to work alongside program
officers.
Trained health care workers, counselors and peer educators will provide the comprehensive Prevention with
Positives (PwP) package, including counseling on partner disclosure, family planning and STI management,
partner testing, risk reduction and adherence counseling, and correct consistent condom use to infected
individuals. Africare will participate in the development of the National prevention with positives training
manual and its implementation across the sites. Prevention for positives packages for those living positively
with HIV will be included in care services and will involve activities such as HCT for family members and sex
partners, counseling for discordant couples, counseling on healthy lifestyles and positive living, prevention
Activity Narrative: messages and IEC materials on disclosure.
For HIV negative individuals, education on HIV/AIDS transmission, risks, and risk reduction strategies
including correct and consistence condom use will be provided.
C&OP activities will include condom distribution, education on correct and consistent use of condoms, and
referral/provision of STI diagnosis and syndromic management of STIs. As a component of the community
outreach strategy, Africare will support drama presentations, film shows and conduct road shows on a
regular basis in the targeted communities. This strategy will be closely linked to the peer education model
strategy as community groups will be organized and will help guide the development of community events.
Peer educators will also work one-on-one with community members to provide education on condom use
and to distribute condoms. Africare will discuss avenues of addressing sexual activities in the prisons with
the authorities.
Africare's C&OP workplace strategy will focus on the formal work sector and brothel-based commercial sex
workers as well non-brothel settings like beer parlours and night clubs where transactional sex may occur
under the influence of alcohol. Free condoms will be given at these locations. Using a peer education
approach, Africare will select peer facilitators from these locations and train them to provide HIV prevention
messages to their peers and patrons on a routine basis. The key messages will include correct and
consistent condom use in all sex acts, prompt and complete treatment of STIs and testing for HIV.
Advocacy with brothel, beer parlour and night clubs owners will be carried out to support the female sex
workers in enforcing a 100% condom use policy in their establishments and to encourage patrons on
condoms use. Workplace strategies focused on the organized sector will also include training of peer
educators to promote condom use. In addition, Africare will work with the management of the organizations
to identify strategic centralized mechanisms to reach their employees with COP messages and condom
distribution.
Africare will train 37 new peer educators made up of community group members, health care workers,
counselors and volunteers in appropriate provision of condom and other prevention services. Peer
educators will be trained on the use of advocacy tool kits including IEC materials, condoms and job aids.
They will also be taught participatory monitoring and evaluation to enable them to monitor their progress
against project objectives. Health care workers, counselors and home based care volunteers will be trained
on condom use and syndromic STI diagnosis and treatment.
Condoms will be procured from Society for Family Health (SFH) for all Africare sites. Condom provision will
be accompanied by individual and/or group counseling and demonstrations on proper use. Culturally
appropriate IEC materials tailored to address the unique risks that individuals from high risk groups face and
the correct and consistent use of condoms will also be provided through the community groups, peer
groups, and in all Africare-supported health facilities.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity area will contribute to the overall PEPFAR goals of preventing further new infections and
reducing HIV incidence and prevalence rates in Nigeria. It will also help to lay the foundation for more
sustainable HIV intervention programs in Nigeria through a focus on community based responses.
This activity will be integrated with counseling and testing, basic care and support, TB/HIV, OVC, PMTCT,
and strategic information. Prevention for positives counseling to include condom use will be an important
component of post-test counseling in the STI clinics and in follow up care and support activities. This
service will also complement HCT services for those who ultimately test HIV negative. Through this program
as well as basic care and support, Africare will ensure access to STI treatment.
The focus population for this activity will be youth (in/out of school), HCT clients, TB DOTS patients, the
uniformed service personnel, incarcerated persons, and transport workers, commercial sex workers. It will
also target community leaders, brothel and night club owners and management of corporate organizations.
Project activities will increase gender equity in young adults. Male involvement would be specifically
addressed through the Union of transport workers and the Market men/Butchers associations who would
receive intensive advocacy and campaigning in sexual prevention through HCT-linked outreach activities.
High risk urban dwelling male youth will be reached through continuing advocacy and sensitization at
stadium and sports arena outreach activities on weekends when they gather for scheduled sports activities.
The program will reach out to religious organizations and leaders to provide culturally and religiously
appropriate sexual prevention messages and emphasize the need to reduce the instance of cross
generational sex.
This activity includes major emphasis on information, education, and communication with minor emphasis
on community mobilization and training.
COVERAGE AREAS
Sites are located in states chosen based upon high prevalence in the most recent 2005 HIV sero-survey
and geo-political distribution. These states include Rivers and Bayelsa (South-South zone) and Lagos
(South West zone).
Continuing Activity: 12986
12986 9879.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $337,500
9879 9879.07 HHS/Centers for Africare 4161 4133.07 Cooperative $100,000
Disease Control & Agreement
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $8,237
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activity Narrative: partners, counseling for discordant couples, counseling on healthy lifestyles and positive living, prevention
messages and IEC materials on disclosure.
Continuing Activity: 15667
15667 15667.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $150,000
Table 3.3.03:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: : Fusion of Care and support & ART
Services and narratives.
Of the 1,750,000 PEPFAR target for basic care and support services, Africare will provide quality care
services to a total of 4,500 (1250 new) PLWHAs and 9000 PABAs in COP 09.
Care and support services were provided through 17 service outlets in COP08. In COP09 Africare/TAP will
be consolidating its basic care and support program, strengthening community based support groups, and
linkages with PMTCT, TB/HIV, community based OVC and facility based pediatric care and support
services in addition to strengthening the care and support received by clients at the community level by
expanding provision of care at primary health centers. Services provided will include clinical, psychological,
preventive, spiritual and social services actively linked into the OVC and PMTCT programs, forming a broad
based continuum of care for PLWHAs in the host communities. All enrolled clients will receive clinical
services with basic care kits plus at least 2 support services in the domain of psychological preventive and
social in the facility and as part of community home base care. An additional 4 community based sites in the
3 project states will be identified and strengthened, one each in a local government area where services
have already commenced, aimed at further expanding support within each community. TB/HIV services
will be available onsite at 6 of the 17 other facilities. Home based care (HBC) will form a large part of the
services being supported in COP 09. This care will mostly be provided by trained HBC team of clinicians,
nurses, CHEW, medical social workers and volunteers including PLWHAs and supervised by local
government health care workers. Community interventions will further be strengthened through the Local
Government Partnership Initiative, (LGPI) and home based nursing care services will be provided by
Africare in partnership with 4 additional CBOs and FBOs that specialize in community health services (total
21 service outlets supported COP09).
Care and support services will be offered to ensure that 20% effort is laboratory, 30% is OI management
with STI diagnosis and treatment, and 50% HBC and training. Following on the strategy newly developed in
COP 08, Africare will continue with its partnerships with 8 existing organizations (FBOs/CBOs) to link
PLWHA identified through community mobilization and HCT with psychosocial services, basic clinical follow
-up and HBC, providing services both at primary health care level and at homes, linking these services to
other community based services including OVC support, PMTCT, and facility based TB/HIV integration.
Support groups will be further decentralized as they increase in size to accommodate new members with
emphasis on clients with similar needs. Clinical services will continue to include the prevention and
treatment of OIs (excluding TB), malaria, diarrhea through access to Co-Trimoxazole, LLITNs and safe
water interventions such as water guard, nursing care, pain management, nutrition assessment and support
lab services.
PMTCT will be integrated into the basic care and support component of the project with continuation of the
initiative aimed at increasing male involvement through support groups. Gender/occupation based and
community support groups will continue to be supported, as well as pregnant women's support groups with
champion mothers facilitating. These mothers encourage experience sharing and provide peer education
and psychosocial support to other newly diagnosed HIV positive pregnant women.
Psychosocial support will continue through expanded support groups which will be integrated into other care
activities, and will address depression assessment and spiritual counseling. Prevention activities will follow
on from COP 08 programming and will include prevention for positives, family planning and condom
provision with education, behavioral and adherence counseling with patient training and education in self-
care. Counseling and testing of family members and sex partners will be addressed through support groups,
provision of couples counseling, disclosure counseling and psychosocial support for discordant couples. All
clients enrolled into care will receive risk assessment and behavioral counseling early on to achieve risk
reduction. Patient education to promote positive living, self-care, and adherence will be provided. Support
group activities will also include training on proper nutrition with food demonstrations and information on
economic empowerment activities.
Africare, in collaboration with LGA supervisors and CBOs, will ensure weekly and monthly on-site
supportive supervision of service delivery activities. HIV infected individuals who are not ART-eligible will be
followed up regularly, with provision of a package of basic care and support services including TB
assessment and enrolment into the support group. Project interns and community based volunteers will
champion integrated networks of care of PLWHAs at the designated PHCs in central health facilities in
Local Government secretariats. They will work closely with the LACAs, community development
associations and support group facilitators
PLWHAs will be provided with cotrimoxazole according to National guidelines. Each new client diagnosed
with HIV will receive a basic care kit containing water guard, water vessel, LLITN, vitamin supplement,
soap, condoms, ORS and IEC materials. These will be replenished as needed. Newly diagnosed clients will
continue to be screened for risk of TB disease using a questionnaire and referred to further diagnostic
testing and treatment as necessary. Africare would actively support these referrals, providing escort service
for clients. IEC materials will be produced that cover an array of issues including PwP messages, basic
infection control and self care and TB control and treatment.
Home based care providers will work with care givers of PLWHA and will be assigned or linked to a team of
medical staff in the hospitals that report to the team's physician. The project will also work with community
groups and members, with the full involvement of PLWHAs to form or join existing support groups. PLWHAs
are visited by home based care volunteers on at least a monthly basis. Those that are identified as needing
additional medical assistance receive either immediate referral to a medical facility or follow-up visits by a
home based care medical provider. Home based care volunteers will have Home Based Care kits
containing items such as ORS, water guard, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline,
and gentian violet for use when visiting clients. HBC kits outfitted for health care workers will also contain
additional items such as aprons, bandages, analgesics, anti-diarrheas, and anti-malarias. Referral for
Activity Narrative: advanced laboratory diagnostics and clinical management is made to partner facilities. With the integration
of TB/HIV program activities into HCT activities, HIV+ clients will be screened and referred for TB diagnosis
and/or treatment.
GON palliative care and HBC curricula will be used to train 30 additional volunteers, HBC workers and
health care workers. Those who were trained in the past will receive continuing medical education on site,
with refresher courses. Mobile counselors will be trained to carry out symptoms screening for STIs, TB and
other OIs in homes and make referrals for advanced management of TB and OIs. The Traditional Birth
Attendants (TBAs) will be trained for integration with PMTCT care and support. The PMTCT component will
be integrated into the family planning, safe motherhood programs already existing in designated facilities.
The community health extension workers (CHEWs) will be trained to work in the communities through the
Community Development Association (CDAs) who will be affiliated with Africare/TAP project interns based
in the Local Government facilities. The capacity building of health care providers will ensure continuity and
spill over beyond Africare catchments areas at project close out. In our support groups and CBOs/FBOs
partnership PLWHAs are actively involved in the planning and provision of services.
Africare will use data tools to track activities and follow up clients at project sites. SOPs and providers'
manuals will be given to all service providers to ensure quality service delivery and national algorithm
compliance.
The care and support strategy will work to integrate services between communities and facilities and
development of strong community and home based interventions for support. The Community Development
Associations (CDAs) will be instrumental in the development of these support systems.
Monitoring and evaluation will be carried out by a team of trained volunteers working in the communities
who work with Africare data officers and M&E unit officers. In addition, data generated will be shared with
local government areas to allow for them to track their clients and provide ongoing support for sustainability.
Registers, forms, and other data tools will be provided and replenished as necessary and staff trained in
their use. Africare will report on sex distribution of PLWHAs receiving care and support services and the
numbers of PLWHAs reached with community home based care. Personnel will be trained in the use of
registers for documentation and data reporting
Africare will contribute to the overall PEPFAR care and support goal of supporting 1,750,000 individuals
through care for 4500 PLWHA and 9000 PABAs. This activity will also contribute to the sustainability of the
program through continuing capacity building of the 8 existing partner organizations, support of 21 health
facilities and training of 30 additional health care providers. The integrated approach in health facilities will
encourage increased use of HCT services by ensuring that clients who test HIV+ receive necessary care
and support. In addition, prompt TB diagnosis and treatment will reduce morbidity and mortality of co-
infected individuals. Outreach basic care and support services will ensure that care services reach
communities that are underserved due to geography or marginalized groups. The networks and linkages
established with CBOs/FBOs, state and local authorities will ensure the continuum of care in the
communities.
Adult Care and support activities are related to Counseling and Testing as the entry point to care and
support, as well as Sexual prevention, OVC, TB/HIV. All served HIV+ clients needing advanced care will be
referred to USG supported, GON and private ART sites. Clients will also have access to Africare's TB/HIV
program and prevention activities. Households with children will be linked to Africare's OVC program, or
receive facility based pediatric basic care and support services. Networks and linkages are established with
CBOs/FBOs, state and local government authorities through this program.
PLWHA and their families will be targeted for service provision. Volunteers, care givers in communities and
at facilities are targeted for training and capacity building. Local Government officials including members of
the community development associations, and policy makers at state level are also targeted for training and
capacity building to ensure sustainability of programs.
Project activities will increase gender equity in programming through HIV care and support targeting adults,
especially males through the PMTCT and basic care and support enrollment activities. Champion fathers
will continually be actively enrolled whose role will be to encourage other men to support their families to
access care and treatment services, putting them in charge of the decision making process and ensuring
that they remain involved through buddy male involvement and support group activities. Stigma and
discrimination of PLWHA will be addressed through mobilization and adult care programs targeted at
reducing stigma and discrimination in project communities and encourage care and support of PLWHA
through support group participation. The project will use strategies that address other social norms of
women's and men's behavior in the communities that increase their vulnerability to impact of HIV and TB.
Such strategies include the involvement of men as peer educators and counselors at support group
meetings.
Program emphasis will be on human capacity building, addressing gender balance through addressing male
norms and behaviors and focusing on health related wrap-around programs, integrating health services with
care and support activities. Home based care volunteers will be trained. The Local government staff will be
trained in central PHC facilities in Local government secretariat in conjunction with (CDAs). Nutritional
assessment skills of volunteers will be built and nutritional support systems such as food security will
developed through partnership with other partners. Key emphasis will be laid on the provision of basic care
and support services through the PMTCT program support group facilitation. It is expected that experience
sharing and pregnant women peer support will consolidate the basic care and support program strategy in
the communities, as this will be central to all the other support groups in the communities including the
Activity Narrative: OVC, male and youth groups. Limited task shifting and sharing at facility level within the confines of existing
government policy will address existing human resource constraints. Also, Africare will engage NYSC
members, project interns as well as support community based volunteers and local government/community
leaders to fill in the gaps created by personnel shortages.
Lagos, Rivers and Bayelsa states will be covered in COP 09. Sites will be established at the secondary and
primary health center levels with linkages to tertiary centers to provide accessibility of services to patients.
Sites for expansion of support will depend on existing networks and state allocation of sites and local
government areas
Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including
spaces)
Africare hereby requests $150,000 early funding to ensure the support of continuous and uninterrupted
procurement of basic care and support items and service delivery necessary for existing clients in care.
Africare's funds are disbursed from head office in Washington DC; thus, early funding is requested to
forestall the delays experienced with overseas fund transfers.
Continuing Activity: 12985
12985 6493.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $170,000
6672 6493.07 HHS/Centers for Africare 4161 4133.07 Cooperative $375,000
6493 6493.06 HHS/Centers for Africare 4133 4133.06 Cooperative $100,000
* Increasing women's access to income and productive resources
* TB
Estimated amount of funding that is planned for Human Capacity Development $29,988
Estimated amount of funding that is planned for Food and Nutrition: Commodities $3,478
Estimated amount of funding that is planned for Water $602
Table 3.3.08:
In COP09 Africare will be continuing the support of facility-based activities for 450 HIV exposed and infected
children aged 0-14 years and their families. Activities will be aimed at extending and optimizing quality of life
from diagnosis through the continuum of illness by providing clinical, psychosocial and age appropriate
prevention services.
Entry points where children will be identified for pediatric basic care and support will include antenatal and
PMTCT clinics where mothers who are identified as HIV-positive will be encouraged to return to the clinic to
deliver their babies and ensure they receive PMTCT services. Other entry points include the TB/DOTS
centers from family contact tracing, mothers support groups, immunization centers, HCT sites, community
outreaches and home based care (HBC) services. The HBC team is comprised of nurses, community health
extension workers, medical social workers and volunteers (including PLWHA) who provide services using
an HBC provider kit.
Pediatric care and support services provided will include clinical, psychological, spiritual, preventive and
social services actively linked into the OVC and PMTCT programs, forming a broad based continuum of
care for enrolled children in the host communities. All enrolled children will receive clinical services with
basic care kits plus at least two support services in the domain of psychological, spiritual, preventive and
social services, in the facility and as part of community HBC. Clinical services will include: early infant
diagnosis (EID) which will be linked to the existing PMTCT program; appropriate HCT services for at risk
children and adolescents; prevention and treatment of OIs, malaria and diarrhea; provision of access to
commodities such as LLITNs, safe water interventions, pain and symptoms relief; and nutritional
assessments and support. Age appropriate prevention with positives (PwP) packages will be provided for
children.
Psychosocial support will be provided within site facility-based pediatric support groups (kids clubs) which
will be co-located and co-scheduled with maternal support groups, immunization clinics and nutritional
demonstration activities for mothers. Children will receive age appropriate psychosocial support around
issues such as disclosure and feelings, and will participate in games and activities appropriate for their
ages. Service areas in facilities will be made child and adolescent friendly. Age appropriate prevention
activities will be provided for the younger children. Information and education will mainly be provided to
mothers and caregivers. Older children and adolescents will be counseled directly by peer educators from
the linked OVC program.
Mothers will be further encouraged to return for visits with their babies, at which time they will be weighed
and receive immunizations, while mothers receive nutritional counseling and education on safe infant
feeding. At the age of six weeks, according to the Nigerian national algorithm, these babies will have
undergone dried blood spot collection (DBS) for DNA PCR diagnosis. Based on their results, they will be
referred for treatment if positive. If HIV-negative they will continue to receive follow up care at the facility. A
second test will be performed at the age of 18 months, or twelve weeks after the cessation of breastfeeding
whichever comes later, to ascertain the child's final HIV status. When identified by DBS testing at the
designated centers HIV-positive children will be referred to a treatment center and will continue to receive
their supportive care at the referring facility.
Exposed and infected children will be provided with a basic care kit (provision of LLITNs, water treatment
solution, a water vessel, ORS, gloves, soap, IEC materials) and cotrimoxazole prophylaxis according to
National Palliative Care Guidelines. Continuing education for the family with follow-up home visits by the
home based care team will also be provided. A nutritional assessment, through the use of growth
monitoring and recording, will be accompanied by nutritional education and interventions. "Champion
Mothers" who have recently given birth will support active referrals and linkages. A buddy system will be set
up to pair mothers who live close by, or who share certain interests, to ensure they benefit from one
another. Children who need to be referred for treatment will be transported in small groups to ensure group
cohesion and support on enrollment days at treatment centers. This will also allow opportunities to explore
outreach treatment services with the Massey Street Children's Hospital to further reduce the burden on
caregivers.
Fifteen care providers, including members of the HBC team, will be trained to provide care and support for
enrolled children.
Personnel shortages in state primary and secondary health facilities will be addressed through task shifting
and task sharing in keeping with national guidelines. This will ensure that community health extension
workers and community health officers play a role in the counseling, immunization support, growth
monitoring and developmental evaluation of infants, especially as the cohort size increases.
Monitoring and evaluation (M&E) of the program will be supported by Africare's M&E program officers who
will provide national registers, forms and tools for data collection. They will ensure that all staff are trained to
recognize and use these tools appropriately, and will provide supportive supervision around data capture so
that pediatric clinical care services are appropriately documented. Supervisory support from the state M&E
program will be encouraged to ensure sustainability. Such officers will also be trained to use the national
data capture tools.
Africare will contribute to the overall PEPFAR goal of providing access to care for HIV-exposed and infected
children by providing care and support services to 450 children and capacity building of health care workers
to comfortably care for exposed and infected children in this program.
This program will be targeting HIV-exposed and infected children from 0 to 14 years of age and their
caregivers. Health care workers and community based volunteers will be trained to provide basic care and
support services.
Activity Narrative: KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses the key legislative area of wraparound services, as activities will strengthen/develop
linkages between HIV/AIDS services and other sectors for food resources and legal support.
Emphasis areas include provision of health related wraparound programs including child survival activities,
malaria prevention, safe water provision, food and nutrition as well as human capacity development.
Activities will be carried out at centrally located primary health facilities within Local Government Areas in
Rivers, Bayelsa (South-South zone) and Lagos (South West zone)
Africare hereby requests $20,000 early funding to ensure the support of continuous and uninterrupted
procurement of basic care and support commodities and service delivery necessary for children already
receiving care and support services. Africare's funds are disbursed from head office in Washington DC, thus
early funding is also necessary to forestall the delays experienced with overseas fund transfers.
Continuing Activity: 15666
15666 15666.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $500,000
Estimated amount of funding that is planned for Human Capacity Development $2,768
Estimated amount of funding that is planned for Food and Nutrition: Commodities $261
Table 3.3.10:
The incidence of all types of TB in Nigeria is estimated to be 290/100,000 population and the incidence of
smear positive cases at 125/100,000 population. An estimated 616/100,000 persons are currently living with
TB disease. DOTS coverage by the national program has been estimated at 75% (target is 100%). The
case detection of sputum smear positive TB cases within DOTS areas is estimated at 27% (target is 70%).
The treatment success of these patients is 75% (target is 85%) and about 9.3% of the total TB cases are
retreatment cases.
The TB/HIV co-infection rate in 2007 was 30-40% among HIV infected patients, thus about 1 million adults
are living with both HIV and TB infections. A national survey is being planned to determine the true rates
and pattern of MDR-TB in Nigeria (which has been estimated at 1.9% by WHO) and the 2006-2010 national
strategic framework of the NTBLCP has identified control of MDR-TB as a key priority.
In COP08 Africare supported 10 TB/DOTS sites in 3 states; Lagos, Rivers and Bayelsa. During this period,
Africare provided HIV related palliative care services to 7,170 adults and 2,000 children including PABA'S
and 850 HIV positive clients attending HIV palliative care services received treatment for TB disease.
Africare provided logistics and transportation support to ensure drugs were available to facilities and prevent
stock-outs. Staff at TB/DOTS sites were trained to provide HCT as well as basic care and support services
to co-infected clients whom they also actively referred into treatment and supported. The HCT program was
fully integrated into the TB/HIV program and all TB/HIV co-infected patients were being referred for care
and treatment at both TB and HIV treatment centers. The project provided HCT to 5,000 people in DOTS
sites, and 500 of these clients were diagnosed with TB
In COP09 Africare will expand its TB/DOTS services to include 3 more facilities all primary health care
centers designated as TB/DOTS sites, one in each state. Africare will work with the state TBLCP to
strengthen these sites for maximum efficiency. Five hundred individuals including TB suspects will receive
HCT services in the TB settings with results provided. All newly diagnosed HIV Patients at the TB/DOTS
sites will immediately be counseled and started on co-trimoxazole prophylaxis (CPT) and actively referred
into designated treatment centers to obtain CD4 counts. Clients will be followed up by community-based
organizations linked into comprehensive care network to ensure adherence to care and TB as well as ARV
treatment. Family contact tracing will be done so that all patients presenting in DOTS centers are counseled
and tested for HIV and their contacts and family members are traced and provided TB screening and HCT,
as part of the focus on most at risk populations and family centered approach to comprehensive HIV care
services.
Emphasis will remain on the implementation of the global strategies of 3 "I"s for TB/HIV management-
Intensified TB case finding among HIV positive patients, INH prophylaxis and TB Infection control as well as
provider initiated counseling. More attention will be paid to intensified case finding as Africare does not
provide ART services. In line with available services at existing Africare supported TB/DOTS sites,
counselors at the new sites will be taught to administer TB screening questionnaires to all clients who test
positive for HIV at the HCT centers. This will determine the need for further TB diagnostic testing. All
sputum positive patients will also receive HCT services on site. TB/HIV co-infected clients will be linked into
basic care and support services, which include: clinical and laboratory diagnosis, home based care and
psychosocial and spiritual support. HAART eligible clients will be referred to nearby partner treatment sites
linked by support and referral networks into the TB/DOTS sites. Africare will produce IEC materials for use
by health workers. Volunteer care givers and peer educators will educate beneficiaries on basic TB infection
control, basic hygiene, ventilation and adherence to medication. Pediatric TB/HIV will be incorporated as
part of TB/HIV palliative care. These services will be linked to maternal support groups, OVC support
groups and care centers; thus all children living with HIV will also be actively screened, and receive
diagnostic testing for TB, aimed at ensuring proper management of pediatric TB/HIV patients through
improved case finding and provision of pediatric formulations.
As in the past, HCT and TB screening will be supported on clinic days at the PHCs, and referrals made for
laboratory diagnosis. TB clients with HIV will be linked to the project's care and support services, which
include clinical and laboratory diagnosis, home based care, and psychosocial and spiritual support. Clients
who are due for HIV treatment will be referred to ART sites in the network.
Africare will also continue to support HCT outreaches to prison inmates, military and police barracks in
Rivers state, again focusing on most at risk populations for TB and providing linkages for all who test
positive or are co-infected into care at designated centers, ensuring CD4 counts are completed and clients
are further actively referred into treatment
In COP09, Africare will minimally upgrade infrastructure at the 3 new PHCs, providing basic renovations for
the TB/DOTS sites upgrading equipment and procuring supplies and consumables as needed. Africare will
provide logistics support to ensure that drugs and other essential commodities including reagents are
moved from the state central stores to sites and will work with the National TB and Leprosy Control Program
(NTBLCP) to ensure that drugs are made available at sites to avoid TB drug stock outs.
At the health facility and community levels, infection control education will be emphasized according to
National TB infection control guidelines. Nosocomial transmission of TB will be mitigated through attention
to principles of TB infection control, including administrative and environmental control measures such as
clinic design, good ventilation, appropriate patient triage, staff training, and enforcement of basic hygiene
and proper sputum disposal. Patient and staff education on infection control measures will be routinely
carried out to ensure program success, as part of continuing medical education activities for health care
workers and support group meetings for clients and families.
Africare will train health care providers within the health facilities, who will in turn train mobile counselors
and volunteers using the approved national training curriculum. A total of 17 care providers will be trained
and educated to screen for TB among HIV+ clients. Training of medical staff will also include x-ray
diagnostic skills, good sputum specimen collection and laboratory AFB sputum smear diagnosis to enhance
Activity Narrative: diagnostic capabilities. Good laboratory practices will be ensured through the implementation of the existing
National Guidelines for External Quality Assessment. Routine laboratory investigations will be conducted for
health care workers providing TB/HIV services. TB/HIV facility staff will also be trained on adherence
counseling in order to prevent MDR TB
With the use of GON tools including registers and treatment cards, Africare's M&E staff and trained
volunteers and health care providers will track activities at project sites. Africare will build the capacity of
health care providers and CBOs/FBOs to ensure sustainability. All providers will be given manuals/SOPs
adapted from existing national guidelines to assist them in service provision. Sites will also be assisted to
put in place and/or improve defaulter tracking by setting up facility based support groups which would be
linked into the other activities supported on site including OVC and pregnant women support groups to
ensure cohesion and a family and community centered approach to integration of care.
Africare's TB/HIV program will build the capacity of the health facilities on TB/HIV management. The
integration of HCT into the TB treatment services will afford HIV+ clients the opportunity to know their TB
status early. Conversely, increased availability of diagnostic counseling and testing services in medical
settings will assist to identify the number of clients with TB/HIV who are potential candidates for HIV
treatment and care services. The TB treatment program by NTBLCP will strengthen the project's palliative
care program. Training of mobile counselors and volunteers on screening for TB will assist early diagnosis
of TB. The outreach programs will also ensure that services reach the underserved in the communities. This
activity will also contribute to the national plan of early diagnosis of TB/HIV and referral/linkages to care.
Africare's TB/HIV program is also related to Basic Care and Support, Counseling and Testing, Other
Prevention, AB, OVC, and Strategic Information. TB patients who are HIV+ will be counseled on prevention
for positives while those who are HIV- will be given prevention messages as well. The project will ensure
that clients for TB diagnosis receive HCT services on site, and those who are HIV+ enroll in the project's
care and support program. The home based care program for clients will provide basic care kits,
prophylaxis for minor ailments, spiritual counseling and other support. Clients will also be referred to ART
sites for treatment. The TB/HIV program will assist in strengthening the capacity and practices in health
facilities to screen, diagnose and treat HIV infected patients for TB, which is an essential component of
quality care in HIV program. The networks and linkages established with CBOs/FBOs, state and local
authorities will close gaps in the provision of services to the communities. This will help reduce new
infections.
The TB/HIV activities specifically target HIV+ clients and those who may be at risk of infection such as their
family members and close contacts. Activities will target young people, adults, pregnant women, transport
workers, mobile populations and other most at risk populations. Project activities will include testing for TB
among caregivers and family members of TB/HIV patients and provision of information on TB case
management. Medical staff in the health facilities and volunteers from partner organizations would be
trained on TB management especially among PLWHAs. Similar training will also be made available to the
support groups, local groups and care givers of PLWHA in project communities.
Africare's TB/HIV program will help increase gender equity in programming by ensuring that equitable
number of men and women participate in program activities. Stigma and discrimination of PLWHA
contribute to the problems of disclosure by those infected, either to partners or family members. Activities
will support programs targeted at reducing stigma and discrimination in the project communities, which will
encourage care and support for PLWHAs. The project will use strategies that address other social norms of
women and men's behavior in the communities that increase their vulnerability to impact of HIV and TB.
Such strategies include the involvement of men as peer educators, counselors and support group members.
Major emphasis will be on human capacity development through training of facility based staff on TB/HIV in
view of the regular staff turnover, TB prevention for HIV positives through procurement of cotrimoxazole and
INH prophylaxis. Minor emphasis will be on pediatric TB/HIV formulations, increasing gender equity in
HIV/AIDS programs and health related wrap around programs, integrating child survival activities with TB
care and treatment at facility level.
Activities will be carried out at primary health facilities (providing community level health care services) to
ensure continuum of service provision. Sites are located in states chosen based upon high incidence rate
(South West zone). HCT outreaches will be streamlined to target populations e.g. military /police
populations (barracks), refugee/internally displaced populations for prompt case detection and urgent
diagnostic and treatment interventions.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $10,862
Table 3.3.12:
ACTIVITY DESCRIPTION:
In COP09 Africare will continue to provide relevant services to 2,500 Orphans and Vulnerable Children
(OVC).
In continuation of the Africare COP08 strategy to provide care and ensure maximal impact by saturation of
services in local government areas (LGA), Africare will in COP09 continue its OVC activities by expanding
coverage within each local government area. In COP 09, Africare will continue to provide services at 15
OVC sites actively linked into a central "medical home" (primary health center) in 6 local government areas
in 3 states - Rivers, Bayelsa (South-South zone) and Lagos (South West zone) States -
where a comprehensive package of HIV support services existed. Local Government staff, health care
workers and service corps (community based) volunteers were trained and supported in the provision of
these services.
Accomplishments from last year include the establishment of community child forums, with capacity building
at the level of LGAs working closely with community development associations to strengthen the ability of
the communities to support OVC services, and support the response to OVC. Project support was provided
through a Service Corps Volunteer to establish patterns of OVC need identification, work planning and
policy development, and the development of an OVC community servicing plan.
Direct assistance to OVC was provided, with the establishment of kids support groups (kids clubs) providing
homework assistance, skills in writing and caring for others, and psychosocial support as appropriate for the
age and culture of the OVC. The kids clubs were established with project support and designed in
conjunction with the Local government area and the Community Development Associations. 50 OVC
received full educational support (payment of school fees, uniforms, books and school supplies) with
training in life skills as appropriate. Peer educators and peer counselors were trained in the communities to
support children and youth attending kids clubs. Health care access was integrated into OVC services for
children under the age of two. Africare will continue to support two youth friendly centers that provide
appropriate HIV prevention services to adolescents.
Currently Africare provides nutritional assessment and counseling (with supplementation to approximately
50 OVC), educational and psychosocial support, and clinical services. Clinical services include referrals for
early infant diagnosis, appropriate counseling and testing for at-risk children and adolescents, prevention
and treatment of common infections including malaria, diarrhea and TB, and provision of the basic care kit
for OVC. Existing service corps volunteers in conjunction with CBOs will provide home-based care as well
as referral/escort services for OVC to ensure that growth monitoring, immunizations, management of
common illnesses, and nutritional needs are addressed. Caregiver education will also be provided during
home-based visits.
In COP 09 Africare will further incorporate specific age-appropriate life-building skills into the Kids' clubs
such as life goal planning, personal empowerment, caring for others, public speaking, writing skills and
homework support. Workshops will be held to jointly establish roles, functions, and the service complement
of Child Forums and Kids' Clubs. Under guidance from the State Ministry of Women Affairs, support will
focus on the communities through a phased-in mechanism.
In COP 09 Africare will address continuing challenges that include the provision of legal aid, provision of
support for child-headed households, and the need for food supplements to households- especially when
caregivers are still quite sick- by supporting capacity building for Africare staff and members of child care
fora.
Child headed households and older OVC will be specifically targeted for educational support, wrap-around
services, and training in vocational and livelihood skills through vocational training centers and training
organizations. Africare will provide Kids Club leaders with educational support in HIV and AIDS and care
and support of OVC. Peer Educators and Peer Counselors will be trained to support children and youth
attending Kids' Clubs in the community. Altogether 50 care providers will be trained, including direct
providers and supervisors at local and state government levels to provide the various aspects of OVC care
Capacity of OVC managers and focal persons at State and Local government will be built in conjunction
with the State Ministries of Women's Affairs. OVC managers/focal persons will be trained to provide
supportive supervision in areas of psychosocial counseling and mentoring. This training will employ
nationally approved standards for training of supervisors, in addition to on-site support and mentoring to
ensure sustainability.
Relationships will be developed with two local organizations to which clients can be referred for support for
economic empowerment, and OVC and caregivers will be assisted in securing funding for economic
empowerment activities. At the level of the primary health facility, three nurses will be trained to provide
youth friendly adolescent health services for out of school OVC.
Africare will use GoN approved curriculum to train providers of psychosocial support for children. Through
FIDA (International Federation of Female Lawyers), local legal aid services will be engaged to train child
forum members and volunteers in basic legal aid support for OVC and families, such as wills, succession
planning, and identity documents including birth registration. The project will facilitate the development of a
referral system between the community, LGA, CDAs and legal aid for common legal needs.
Linkages between the OVC activities will be strengthened with PMTCT services which would also be
starting up in the same funding year. In addition OVC services will be linked to HCT, TB/HIV, Basic care
and support, as well as to adult and pediatric treatment services. Africare will refer eligible caregivers to
Activity Narrative: Winrock International's AIDS Impact Mitigation Project to support economic empowerment activities. All
referrals will be recorded, actively followed up and reported to ensure accurate data compilation. Network
referral meetings will also be established around these partners' services to ensure completion of referrals,
and that OVC and caregivers are receiving comprehensive services as needed.
OVC households will be linked to ongoing and expanding food garden projects, soup kitchens and locally
available food parcels distributed by churches and CBOs. Schools and Kids' Clubs will be aware of children
and youth needing referrals for health care and HIV treatment, linking them through the structures above to
ensure that clinic or hospital level care is provided. Child Forums, Kids' Clubs, and community caregivers
will link OVC and child heads of households to social services for necessary support.
Monitoring and evaluation of the support services being provided will be carried out. To further support the
identification and tracking of support to OVC, community stakeholders' meetings will be convened for
community leaders, development partners and local leaders, similar to the M&E meetings that hold monthly
at the state level. The Child Status Index will be used for the monitoring and evaluation of the Africare OVC
program.
Africare will support the printing and dissemination of registers and other tools for data and information
capture. The Project will support the State's Ministry of Women's Affairs in refining and further developing
an OVC registration system and other tools for identifying vulnerable households. Volunteers, health sector
community care-givers, and Child Forum members will be trained to identify OVC and vulnerable
households, and ongoing household needs assessments will be initiated and made routine.
This activity provides services which are a high priority for the 2-7-10 strategy by providing a range of
services for all identified HIV-positive children, families with an HIV infected parent/caregiver or children
orphaned by HIV/AIDS. The services are consistent with the National Plan of Action for OVC in Nigeria and
Standard Operational Guideline for OVC services.
LINKS TO OTHER ACTIVITIES: This activity is linked to Counseling and Testing, TB/HIV, AB, OP, Pediatric
Basic Care & Support, Strategic Information, PMTCT, prevention and palliative care. HCT services will be
available to OVC in HIV affected families. All HIV-positive children will be monitored and referred for
treatment if HAART eligible. Where services are co-located with TB DOTS centers, Africare staff will work
with sites to ensure integrated systems are in place. Data reporting services supported by Africare will be
available at all sites. Home based care programs will be implemented by indigenous CBOs and FBOs under
Africare's guidance and supervision.
POPULATIONS BEING TARGETED: OVC and their caregivers will be targeted for services. Health care
workers, volunteers CBOs and FBOs will be targeted for training.
KEY LEGISLATIVE ISSUES ADDRESSED: This activity addresses the key legislative area of "Wrap
Around services" as activities will strengthen/develop linkages between HIV/AIDS services and other
sectors for food resources, legal support and educational services. The activity also addresses the key
legislative area of "Stigma and Discrimination" as training of personnel and dissemination of knowledge to
the community level will reduce stigma.
EMPHASIS AREAS: Major emphasis will be on linkages for health related wrap around programs in form of
nutrition and education services for children, encouraging referrals and strengthening linkages with other
partners including Sesame Street, MARKETS and COMPASS to ensure access to community based-
psychosocial support, agricultural, economic empowerment, nutritional support for caregivers and
educational support for children respectively. Other areas include community mobilization with identification
and birth registration of OVC, emphasizing human capacity development for sustainability by training local
government and CDA officials, gender equity (increasing women's access to income, productive resources,
and legal rights) by providing linkages to the legal and income generating activities that other partners
provide.
Estimated amount of funding that is planned for Human Capacity Development $43,831
Estimated amount of funding that is planned for Food and Nutrition: Commodities $4,696
Estimated amount of funding that is planned for Education $35,478
Table 3.3.13:
Services will expand to four (4) new HCT sites in COP09.
In COP08, Africare provided counseling and testing (HCT) services at 19 service outlets (15 integrated
facilities and 4 stand alone sites) in Lagos, Rivers and Bayelsa states. The project used provider initiated,
routinely offered, opt-out models to maximize uptake of HCT services at the healthcare facilities. Facility
based testing was fully integrated with other health services. Point of service testing was made available in
the General Outpatient Departments (GOPD), Inpatient Wards, ANC and Immunization clinics as well as
TB/DOTS clinics. Africare actively referred all HIV-positive pregnant women into PMTCT, providing
laboratory and transportation support. From all points of service, clients were referred to receive basic care
and support services and then actively referred into treatment. The 4 stand-alone sites are located at motor
parks in close proximity to red light districts and markets. Targeted testing of most at risk populations
(MARPS), including long distance drivers, commercial sex workers, students, and prisoners, was embarked
upon by Africare in COP08. To strategically meet the need for large numbers of people to receive HCT
services, community focused HCT outreaches were also embarked upon. These highly effective and
targeted programs were aimed at reaching specific local government areas and working with key
community members (community development associations, traditional birth attendants, religious leadership
and local government authorities) as well as state ministries of health, agriculture and rural development.
Additionally, Africare conducted targeted workplace programs in conjunction with prevention activities. In
addition, Africare partnered with CBOs including Rhema Care Partners and Initiative for African Youth
Development in Rivers state; these organizations also provided community outreach activities.
These activities will be continued in COP09 at 19 outlets with the provision of HCT services (counseling,
testing and receiving results) to 9,000 clients. In COP09 the Africare 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.
HCT will also be occurring in TB DOTS and PMTCT sites under the TB/HIV and PMTCT program areas,
respectively, as described in those program narratives. PITC services will be focused to integrate
reproductive health services and maternal child health at primary health centers. This will facilitate the
completion of referrals into care and treatment in these centers and will provide linkages to OVC and
PMTCT services. HCT will be further incorporated into periodic health awareness programs/health
fairs/health week activities and government ministry programs, and will also target institutions of higher
learning through the use of Youth Friendly Centers. Africare will continue to partner with community-based
organizations (CBOs) and faith based organizations (FBOs) to carry out community HCT activities to
increase access to underserved and marginalized Most at Risk Populations (MARPs) in the communities.
Africare's HCT program will ensure gender balance by providing services in collaboration with traditional
gender based organizations: associations of road transport workers, taxi cab operators, hairdressers and
barbers, and commercial sex workers (brothel and non-brothel based). Africare's HCT program is closely
linked with its prevention services, including prevention with positives (which encourages HCT for family
members and sex partners of HIV-positive clients), healthy lifestyles and positive living (whose activities
promote disclosure), and referrals for STI syndromic management and treatment to partners and family
members. Home based counseling and testing services will also be provided. Clients that test HIV positive
will be referred to the project's co-located basic care and support programs; those subsequently identified
as needing treatment will be referred to USG or GON-supported sites providing ART services. All
individuals presenting to HCT sites, even those who ultimately opt-out or decline results, will be reached
with balanced ABC messaging and offered condoms.
HIV testing will be carried out using the National HIV rapid test kit serial algorithm. An ongoing QA/QC
program, which consists of quarterly proficiency testing and blinded rechecking, will be continued during
COP09. Africare will work with the USG/GON laboratory technical working group and other partners (e.g.,
HARVARD, IHVN) to ensure an effective QA/QC program. Quality evaluation in counseling will be done
using quality assurance tools in counseling, such as client exit interview forms to assess client satisfaction,
counselor reflection forms, supportive supervision of counselors by trained counselor supervisors, and
regular monthly meetings by counselors and testers. A total of 9,500 clients (including TB clients) will be
counseled and tested and receive their results.
10 additional health care providers, laboratorians, counselors and volunteers will be trained (1) to provide
HCT services to clients at the facilities and within the community using the national HCT training curriculum
and (2) to make appropriate referrals for other services. Additional training will be provided in STI syndromic
management and treatment. There will be refresher trainings for previously trained counselors on updated
national guidelines on HCT. All trained HCT providers will receive standardized counseling and testing tools
as reference materials. The capacity building of health workers, with training of state and local government-
based providers, will ensure health systems strengthening and sustainability.
HIV rapid test kits will be procured by the USG using the Supply Chain Management System in Abuja. Test
kits and other consumables will be stored centrally by Africare's Country Office in Abuja and distributed to
the sites based on projected needs with proper LMIS and inventory management by designated staff.
Condoms will be sourced from Society for Family Health (SFH) for distribution as part of HCT activities.
Age/culturally appropriate behavior change communication/information, education, communication
(BCC/IEC) materials will be adapted and reproduced by the project. Africare's monitoring and evaluation
staff will track activities at project sites.
Africare's HCT program, through its advocacy and mobilization activities, is expected to increase the
number of most at risk persons accessing HIV testing services. Increased availability of diagnostic
counseling and testing services at health facilities and in the communities will assist in identifying the
Activity Narrative: number of clients with HIV infection who are potential candidates for treatment and palliative care services,
and will also serve at-risk groups in the community. HCT activities targeting pregnant women at outpatient
departments, primary health care centers and antenatal clinics will contribute to the PMTCT program. The
networks and linkages established with CBOs/FBOs/state and local health facilities will close existing gaps
in the provision of services to the communities. The referrals for treatment will help link clients to treatment
programs provided by PEPFAR, GON and other partners. Africare will build the capacity of partner
FBOs/CBOs on program management to ensure sustainability.
Africare's HCT program will be linked to sexual prevention strategies, as outreach will focus on prevention
education targeting MARPs. In addition, positive clients are referred into care and treatment, TB/HIV, and
OVC services. Strategic information programs will support data capture and facilitate feedback for further
programming. The HCT program will strengthen the HIV prevention and care programs in the states and
improve utilization of Africare's and other (USG-supported) care and treatment services in the states. All
clients will receive age appropriate sexual prevention messages. Newly diagnosed clients with HIV or who
have dual TB/HIV infection will also be referred into basic care, TB/DOTS, treatment and/or PMTCT, as well
as support groups as appropriate. Referral networks would be utilized to ensure these linkages are
activated and maintained. Local and state government staff and officials will play supervisory roles in
outreach activities within local government areas as well as in facility based activities to ensure
sustainability.
Africare's HCT activities target MARPS, including transport workers, mobile populations, commercial sex
workers, incarcerated persons, in and out-of-school youth, couples, and PLWHA family members. HCT
services will be provided to caregivers and family members of PLWHA, themselves MARPs. Training on
HCT programs will be made available to health care workers and volunteers.
The project activities will increase gender equity in programming through HIV counseling and testing
targeting adults, especially women of child bearing age and men who do not routinely present to health care
facilities. Activities will support mobilization and palliative care programs targeted at reducing stigma and
discrimination in project communities and will encourage care and support of PLWHA.
Emphasis will be on capacity building and increasing the number of MARPS accessing HCT. Other areas of
emphasis include, community mobilization and participation along with building networks/linkages/referral
systems especially with TB//DOTS sites to ensure completion of referrals, and supportive supervision.
Networks will be formed with government agencies, NGOs, and other groups for support in mobilization
activities to generate clients for HIV testing. Staff of health facilities and volunteers of partner organizations
will be trained to conduct quality counseling and testing. Africare staff along with partners will carry out
quality assurance in project sites and provide supervision.
Activities will be carried out mostly at health facilities, and less at stand-alone sites and in the communities
in Rivers and Bayelsa (South-South zone) and Lagos (South West zone). Branded "Heart to Heart" logos
will be used for identification at all Africare HCT sites and in facilities where HCT is supported.
Continuing Activity: 12987
12987 6642.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $410,000
6673 6642.07 HHS/Centers for Africare 4161 4133.07 Cooperative $550,000
6642 6642.06 HHS/Centers for Africare 4133 4133.06 Cooperative $350,000
Estimated amount of funding that is planned for Human Capacity Development $6,980
Table 3.3.14:
Africare in COP09 will continue to strengthen Strategic Information (SI) under the "One M&E Framework" by
supporting standardized HIV program reporting systems in 34 Service Delivery Points (13 facility-based
sites, 4 stand alone HCT sites, 10 community sites, 7 CBO/FBOs) in 3 states (Lagos, Rivers and Bayelsa).
These organizations are providing technical assistance in data collection, collation, reporting and chart
reviews for QA/QI improvement. Africare staff and the staff of the CBO and FBOs that partner with Africare
for activities at a variety of these sites were involved in these site-level SI activities. Data collection and
indicator reporting will be harmonized and one reporting system will be used in accordance with the national
guidelines and indicators. Africare will harmonize and develop linkages between information systems
between community based activities and facility based activities with a strong emphasis on well
documented referral systems reflecting the prevention-care-treatment continuum of HIV services.
Funding will be used to provide information technology (IT) infrastructure for data aggregation and reporting.
Effective use of paper-based and electronic data systems, including the use of the web-based portal for
data reporting (LHPMIP), where feasible, will be promoted in clinical settings as well as at the community
level to enhance assessment, enrollment, referrals/linkages to other supported services as well as follow-up
of clients into and around the services supported by Africare and its care and treatment partners.
Africare's data quality assurance program will involve several components. The data/record persons in each
site/facility will work with Africare's team for effective data generation. Africare will report verified data to
stakeholders at facility, state and federal levels. Africare will provide training to medical records and data
collection staff at designated facilities to ensure their understanding of the indicators they are expected to
report on. Project staff will also work with sites to ensure that they are reporting appropriately to state level
data collection authorities as part of the national system strengthening mechanism. National registers and
data collection tools will be used at all service delivery points. Africare will ensure that copies of registers
are available and in use at sites and that there are dedicated M&E officers at each facility and/or point of
service with the necessary knowledge, skills and abilities to carry out their responsibilities. The Africare
M&E team, in collaboration with State M&E officer(s) will provide regular monitoring and supportive
supervision to site staff to ensure correct use of harmonized registers. Africare staff will also support and
attend the monthly state M&E meetings. During routine monitoring visits data collection tools will be
reviewed for completeness and accuracy and on-site technical assistance will be provided. Randomly
selected individual patient records will be reviewed across tools as one method of assessing accuracy. For
sites identified as having problems with data reporting requirements, SI staff will involve the site in
developing a corrective plan that may include follow-up through additional visits, mentoring and more
regular communication/reporting via other routes (phone, email). Africare SI staff will develop and
implement DQA activities to ensure completeness and harmonization with USG and GON reporting
requirements. Africare will ensure the involvement of the State and Local authorities in data monitoring and
supervision to ensure sustainable support.
Evaluations using data collected through facility-based services and community-based services will be
performed to provide evidence-based decisions for program quality, impact, and effectiveness. Africare will
also work with on-site administrators and staff as well as supervisory staff at the Local Action Committee on
AIDS (LACA) and State Action Committee on AIDS (SACA) levels to improve their knowledge and
understanding of the data from their sites, local government areas and states to improve their decision
making ability and therefore promoting sustainability of the program. Africare's programs make referrals to
other programs for treatment, and some other forms of support such as legal and income generating
activities. Program surveillance will be enhanced through the use of structured assessment tools to
generate information for analysis on program specific areas such as the referral systems. These
assessments will seek to identify the gaps in the community based referrals/linkages for other care and
treatment services. Information generated from these assessments will inform planning for other project
funded program design.
Capacity building of health facility staff in the SI program will be on going in COP09 as an important strategy
for promoting sustainability. Funding will be utilized to provide refresher training for those trained in COP08.
In COP09, 197 individuals comprising members of CBOs, FBOs, as well as health care workers including
counselors and facility based data focal persons, will be trained in data collection, data use/reporting M&E
and on the NHMIS. Additional training will be provided to 5 supervisors (total 202).
Strengthening SI will enable timely, transparent, and quality data reporting for Nigeria. Concurrently,
through collaboration with the GON, Africare will work to establish one standardized system to monitor the
National HIV program, which is a high priority for the GON. Targeted evaluations that could guide decisions
in improving program implementation and scale-up and will be discussed, defined and coordinated with the
USG team in-country. Africare will work to promote effective use of patient data by care providers to ensure
best practices in HIV prevention and care.
SI activities are cross-cutting and related to PMTCT, Sexual Prevention, HCT, basic care and support,
TB/HIV, and OVC. Linkages between these program activities/areas will be strengthened to improve
efficiency and effectiveness of services in order to catalyze and strengthen the formation of networks of
care.
This activity targets health care providers, counselors, facility-based data focal persons, home based care
providers, peer educators, and community groups to ensure best practices around information use and
reporting. NHMIS and program evaluations target the general population and people affected by HIV/AIDS
receiving services supported by the Africare.
Activity Narrative: The project activities will increase gender equity in programming. Africare's SI program consistently collects
sex-disaggregated service delivery data in the target communities. Africare's SI program will support data
gathering programs that disaggregate service delivery based on gender.
This activity emphasizes monitoring, evaluation and reporting. Emphasis is also on local organization
capacity development.
Activities will be carried out in States of project activities, which are Rivers and Bayelsa (South-South zone)
and Lagos (South West zone).
Continuing Activity: 15668
15668 15668.08 HHS/Centers for Africare 6361 4133.08 HHS/CDC Track $40,000
Estimated amount of funding that is planned for Human Capacity Development $8,124
Table 3.3.17:
