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: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
CEDPA will continue to strengthen institutional capacity of its selected implementing agencies (IAs) to
develop sustainable programs within the same states as under COP08. These activities will involve:
developing organizational management system and leadership skills of IAs to optimize their ability to
effectively address stigma and discrimination in the communities through training of faith and community
leaders; developing peer education activities for improved advocacy for foster care and support to people
living with HIV/AIDS (PLWHA); facilitating the formation and strengthening of networks of community peer
groups and linkages to treatment outlets, communication centers, HCT centers, ART sites, and vocational
training centers; supporting women by linking them to sexual and reproductive health services provided by
CEDPA in family planning programs, improved referrals for PMTCT and ANC; and increasing young girls
and women access to comprehensive sexual information and prevention services through community
outreach, focus group discussions (FGDs), peer education, and peer counseling.
ACTIVITY DESCRIPTION:
In COP 09, CEDPA's Abstinence and Be Faithful (AB) and HIV prevention through behavior change beyond
abstinence and be faithful (C&OP) components will be maintained in 20 states namely: FCT, Bauchi, Edo,
Enugu, Kano, Anambra, Cross River, Lagos, Kogi, Imo, Niger, Benue, Taraba, Adamawa, Sokoto, Zamfara,
Kebbi, Nassarawa, Katsina, and Akwa Ibom. CEDPA's AB minimum package is composed of community
awareness campaigns, peer education, and school based approach for youths. In line with the National
Prevention Plan's guidance on Minimum Prevention Package, each individual will be reached with a
minimum of the three intervention strategies. CEDPA will ensure that each beneficiary is reached through
community awareness, peer education and one other targeted strategy within the year.
Community awareness campaigns will be used as an entry point to all community-based HIV prevention
activities. Trained peer facilitators and educators will organize and conduct AIDS awareness seminars at
the community level to sensitize the public about HIV prevention and the need to participate actively in care
and support activities. Such seminars will be held during religious gatherings, traditional ceremonies, and
sports events. Focus group discussions and community dialogues will be organized for key community
stakeholders, such as civic and traditional leaders.
Peer education models will be used to reach out to PLWHA groups, age, and job peers. These will include
targeted HIV prevention activities for PLWA support group members, okada drivers (commercial bike
riders), and youth groups within church and Muslim communities.
Age appropriate messaging and non-curricular based approach will be used to target in-school youth with
abstinence and be faithful messages through the formation of anti-AIDS clubs and drama activities. Trained
peer educators will facilitate the implementation of these activities.
CEDPA will ensure that each beneficiary is reached with a minimum of three interventions (i.e., community
awareness campaigns, peer education models and school-based approaches). Messages will emphasize
partner reduction and faithfulness to one partner or mutual fidelity, and discourage inter- generational and
multiple sex partnerships. Intensive community mobilization and sensitization will reach underserved rural
and hard-to-reach communities.
The AB program will reach 42,705 people with the minimum package of AB interventions, of which 14,947
individuals will be reached with abstinence only interventions. CEDPA will train 1,500 peer educators and
facilitators to disseminate information on AB through a systematic community-based approach. CEDPA's
prevention training manual includes topics such as basic facts on HIV/AIDS and life skills (e.g., negotiation
skills and assertiveness). Training will take a minimum of five days. AB activities will include counseling,
mentoring, peer support, information sharing, and provision of technical guidance and support to all the IAs
spearheaded by the Anglican Communion AIDS program (ACAP) and the AIDS Program for Muslim
Ummah (APMU), a project of the Nigerian Supreme Council for Islamic Affairs as multiplier organizations.
CEDPA's AB prevention strategic approach involves a series of interrelated interventions (community
mobilization, advocacy, targeted inter-personal communication, capacity enhancement of individual and
community groups) directed at different levels of society to enhance individual behavior change in a
supportive environment.
AB program activities under CEDPA's Positive Living (PL) project are implemented at the individual, family,
and community levels. At the individual level, activities promote development of life skills that: support
practicing abstinence by young people and adults in low risk settings; encourage delay of sexual debut;
denounce intergenerational sex, rape, and incest; and promote counseling and other means of
interpersonal communication techniques. At the family level, services will be provided by peer educators
during home visits and will focus on couples counseling to promote mutual fidelity/partner
reduction/elimination of casual sex relationships, HCT, and prevention in discordant relationships.
Community-wide prevention programs will be provided by pastors, Imams, peer educators, teachers, and
parents. These programs will include messaging from the Church pulpit or at the Mosque, messaging
through club activities, and through in-school peer education and out-of-school youth prevention programs
that address sexual development, reproductive health and promotion of secondary abstinence particularly
for at-risk out-of-school youth through alternative livelihood opportunities. Community-based approaches
will promote collaboration with other implementing partners and credible teachers' union.
CEDPA's C&OP program activities will complement the AB programs. The C&OP minimum package is
composed of: community outreach activities, peer education, and provision of STI management. Community
outreach activities will precede other C&OP interventions that include counseling and testing, condom
messages and distribution, youth peer education, and STI counseling for affected individuals. Trained peer
facilitators and educators will organize and conduct community outreach activities while healthcare workers
will provide syndromic management and STI treatment services at CEDPA triage centers. All C&OP
activities will be coupled with information about abstinence as well as the importance of HIV counseling and
testing, partner reduction, and mutual faithfulness as methods of risk reduction. Information on correct and
Activity Narrative: consistent condom use will be provided at condom distribution outlets and healthcare facilities.
AIDS awareness seminars at the community level will be organized for most at risk populations (MARPs;
e.g., commercial sex workers, long distance truck drivers, market women, and okada drivers) and married
couples to sensitize the public about HIV prevention and the need to participate actively in care and support
activities.
The primary target group for the peer education model will be out-of-school youth, okada drivers, and
leaders of organized groups of the MARPs in the community. These will include targeted HIV prevention
activities for PLWHA support group members and youth groups within the church and Muslim communities.
C&OP will augment the basic care and support (BC&S) component of PL and enhance the capacity of
Primary Health Care and other referral facilities in project communities to diagnose and treat STIs by
providing laboratory equipment, such as specimen bottles, reagents, consumables, etc. These facilities will
serve as referral centers for diagnosis and treatment of STIs and will be considered service outlets for
C&OP. PL will build on past achievements by continuing to target long distance truck drivers, migrant
workers, out of school youth, orphans and vulnerable children (OVC), PLWHA and clients of commercial
sex workers. Healthcare providers trained under BC&S and TB/HIV program areas will deliver prevention
messages on routine clinic days during risk-reduction counseling, family planning counseling, and sexually
transmitted infection management and counseling. Condoms will be distributed at every treatment facility.
This activity is a key component of the PL strategy and encompasses provision of information and access to
correct and consistent condom use, prevention of HIV transmission among discordant couples, promotion of
HCT, partner reduction, and mutual faithfulness as methods of risk reduction. PL will reach 28,705 persons,
train 1,500 peer educators, distribute 3,000,000 condoms and open 413 condom distribution outlets.
Peer educators, including, teachers, PLWHA, and parents (trained in AB) will be trained to act as condom
distributors and provide prevention options for people at risk who cannot practice AB. Options include
support for PLWHA to disclose their sero-status to sexual partners and significant others, proper nutrition
and boosting body immunity, prevention of pregnancy among PLWHA, PMTCT and early diagnosis and
treatment of STI. Peer Educators will hold discussions in homes, communities and workplaces with their
peers focusing on prevention for positives during one-on-one and group discussions in support group
meetings, where they will distribute condoms, facilitate support group discussions, and act as peer buddies
to ensure and maintain behavior change, as appropriate.
Using standardized forms, project M&E Officers will collect data on an ongoing basis and compile data
monthly, including numbers and demographic characteristics of clients reached and messages provided.
This will provide timely information for effective decision making. ABC M&E activities will develop
sustainable capacity at CEDPA's subpartner levels to collect relevant data.
POPULATIONS TARGETED:
AB activities will target young people in school, and out-of school youth PLWHA, religious leaders and the
general population. Teachers and parents are targeted to act as change agents.
C&OP will focus on most at risk populations (MARPs; e.g., long distance truck drivers, migrant workers, out
of school youth, PLWHAs, clients of commercial sex workers), sexually active men and women, and
adolescent girls and boys in the general population. Prevention for Positives will target mainly discordant
couples. Pregnant positive women will be mobilized and referred for PMTCT services.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
AB emphasizes human capacity development through training, task-shifting and volunteer retention and
therefore enhances sustainability. This contributes to increasing sustainability through capacity
development of 41 indigenous organizations.
Condom and Other Prevention activities of PL will contribute to PEPFAR's 5 year strategic plan for Nigeria
by reaching high risk population with information and services that enhance risk reduction abilities. These
activities will contribute to averting new HIV infections. PL will promote active participation of PLWHA by
encouraging disclosure of sero-status and protection of their sexual partners.
LINKS TO OTHER ACTIVITIES:
ABC activities relate to HCT, BC&S, and HKID. Public-private partnerships and collaboration with local
business groups will also be explored. To ensure the comprehensiveness of CEDPA's prevention services,
individuals identified in the program will be linked to the micro credit finance project under BC&S, HVOP,
and other implementing partners like Maximizing Agricultural Revenue and Key Enterprises in Targeted
Sites (MARKETS), WINROCK, and healthcare facilities for medical care.
EMPHASIS AREAS:
PL promotes a rights-based approach to prevention among positives and other vulnerable members of
society and equal access to information and services. Traditional gender norms of male dominance, female
subservience and gender inequality in sexual relationships as well as stigma and discrimination reduction
are all addressed through this program. Commodities procurement and distribution, particularly of condoms,
will be an area of emphasis. The program will address increasing gender equity in HIV programs through
education and family-based dialogues and promoting male norms and behaviors that encourage HIV
prevention such as creating awareness on reduction in number of sexual partners, and equal power sharing
between males and females, and testing before marriage, particularly for those who practice polygamy.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13012
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13012 9759.08 U.S. Agency for Centre for 6368 5267.08 USAID Track $2,000,000
International Development and 2.0 CEDPA
Development Population
Activities
9759 9759.07 U.S. Agency for Centre for 5267 5267.07 APS $3,201,814
International Development and
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $189,018
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Continuing Activity: 13013
13013 9779.08 U.S. Agency for Centre for 6368 5267.08 USAID Track $534,000
9779 9779.07 U.S. Agency for Centre for 5267 5267.07 APS $1,100,000
Table 3.3.03:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS,
Significant changes from COP08 to COP09 for this activity include:
•Reduction of individuals to be served from 80,860 in COP08 to 23,000 in COP09.
•Reduction of the number of implementing agencies from 65 to 41.
As part of the exit strategy, CEDPA intends to;
•Strengthen the organizational management systems and leadership skills of the community based
organizations (CBOs) and faith based organizations (FBOs) to optimize the delivery of home based care
services at the community level.
•Facilitate formation and/or strengthening networks and linkages of community/home based care services to
health care facilities.
•Support women in their care-supporting role by linking them to micro-credit finance opportunities.
•Ensure that women's practical needs are addressed by involvement of women and young people through
greater representation of women groups, PLWHAs and people with gender expertise.
•Enlist support of males within households in the care of PLWHAs.
•Refer back to GHAIN, other implementing partners (IP) and Nigerian government departments all clients
recruited in COP 08 for continuation of care and treatment.
The community/home-based services of Positive Living (PL) compliment facility-based care and support
provided at secondary and tertiary level hospitals. In COP 09, Basic care and support (BC&S) activities will
scale down activities to focus on consolidating structures for care and support delivery and community level
referral networks developed in COP 06-08. PL Community Home based Care (CHBC) services will be
offered to clients from selected GHAIN-supported ART sites in 20 states namely: Federal Capital Territory
(FCT), Lagos, Bauchi, Kano, Edo, Cross River, Anambra, Kogi, Niger, Benue, Imo, Enugu, Taraba,
Adamawa., Sokoto, Zamfara, Kebbi, Katsina, Nasarawa and Akwa Ibom. A total of 69,000 people will be
reached and these will include 23,000 people living with HIV/AIDS (PHA) and 46,000 people affected by
AIDS (PABA). At least 41 Primary health care (PHC) facilities will be supported to provide medical care
services required for prevention and treatment of opportunistic infections. These facilities are referred to as
triage centers where patients who are very sick are stabilized before referral for advanced care and support.
CEDPA works in partnership with existing local NGO/FBO and government owned PHCs in the
communities. The facilities are supported with minor renovations, clinical equipment, and essential drugs to
act as a one-stop centre for care and support services.
A total of 644 individuals will be trained and these will include 400 home based care (HBHC) volunteers,
164 care coordinators and 80 health care workers. The HBC volunteers will be trained in HIV counseling,
care and support for PHA; the care coordinators will be given refresher training in supervisory roles; while
the healthcare workers will be supported to get in-service training in clinical management of OIs. Training of
home based care volunteers will be facilitated by CEDPA staff and IA trained staff. The HBC volunteers will
be supervised by health workers who may be doctors, nurses, pharmacists, laboratory scientists or
community health officers. HBC volunteers are selected from family members, PLWHAs, community
healthcare workers, religious leaders. The HBC volunteers will be trained for a minimum of five days on HIV
education, patient care and management of opportunistic infections using the National Guideline on Care
and Support. Following the National Care and support Guidance and USG Palliative Care (PC) Policy,
Positive Living (PL) will provide a Basic Care Package including clinical care, basic nursing care, provision
of basic care kit, prophylaxis and management of opportunistic infections, referral for laboratory services,
nutritional assessments, counseling and adherence support, home-based care (HBC), and active linkages
between hospitals, PHCs and communities; and training of healthcare providers and community volunteers.
If funds allow, refresher trainings will be provided to all care providers trained in COP08. Trained volunteers
will offer psychological and spiritual support to PHA and their families through group and individual
counseling.
PL services will reach clients directly generated from communities as identified by HBC volunteers at HIV
Counseling and Testing Centres (HCT) and provider intended testing and counseling (PITC) sites. All
clients will be assigned to one of three categories and provided appropriate services: those who have just
been tested but without major need for medical care will be offered basic care kit, psychosocial and spiritual
support, nutritional assessment, prevention with positives (PwP), income generation activities IGA, and
those with opportunistic infections will receive intensive adherence counseling, and regular home visits for
monitoring and referral. Clients will be attached to specific home-based care teams for follow up. The home
-care teams, headed by a trained nurse or Community Health Extension Worker (CHEW) (as care
coordinators) will conduct regular home visits and/or telephone contact to assess needs and ensure that
registered clients are retained in the program. The identified needs will be addressed through counseling
and referral to relevant services. The care coordinators will liaise with the referral focal persons at health
care facilities to complement client tracking.
Clinical care services will be provided at 41 primary health care facilities (PHC) (at least 2 facilities per
state) to complement care and support services offered at ART centers and general health care facilities
and utilize an outreach HBC volunteer program. Staff at various PHC facilities will be trained on clinical
management of AIDS related infections and the cross referral procedures. PL will enhance the capacity of
PHC and other referral facilities in communities to diagnose and treat STIs by providing laboratory
equipment such as specimen bottles, reagents, and drugs, while health workers will be trained on
syndromic management of STIs where laboratories are not available. These facilities will serve as referral
centers to which HBC volunteers and peer educators under PL's Sexual prevention programs will refer
clients for diagnosis and treatment of STIs. Each new client will receive a self-care kit consisting of ORS,
insecticide treated nets (ITN) and water guard, information, education and communication (IEC) materials,
soap, latex gloves, condom and jerry cans. Basic Care and Support (BC&S) commodities will be purchased
through open bidding mechanism from suppliers, after selection and recommendation is carried out by the
procurement committee to management. Commodities like ITN, water guard and condoms will be procured
from Society for Family Health (SFH). Home care kits containing latex gloves, calamine lotion, vaseline,
genetian violet, paracetamol, a pair of scissors, forceps, cotton wool, non sterile gauze, antiseptic soap,
soap case, and disinfectant liquid (JIK) provided to HBC volunteers in COP 08 will be replenished
regularly.to ensure constant supplies needed. The HBC volunteers will link PLWHAs, their families, and
Activity Narrative: community members to anti-retroviral therapy centres, TB treatment centres, HIV/AIDS related services and
social welfare services for orphans and vulnerable children (OVC). CEDPA will work with other partners
towards providing nutritional supplements for its clients.
To strengthen the HBC volunteer program and improve quality of care, 2 implementing agencies will be
selected in each state and mentored to become coordinating agencies through whom CEDPA will support
other smaller IAs and support groups to be referred to as satellite groups. The selected IAs will form a core
of hubs consisting of other IAs and support groups that CEDPA has been working with through COP 06-08.
CEDPA working closely with PHCs will provide minimum/basic package of care and support services. The
basic care package includes provision of Basic Care Kit (ORS, ITN, water guard, cotton wool, gloves, soap,
Vaseline, Gentian Violet, methylated spirit); Home-Based Care (Client and caregiver Training and education
in self-care); Clinical care ( Basic nursing care, pain management, OI and STIs prophylaxis and treatment,
Nutritional assessment and referrals, Laboratory services; baseline tests Hematology, MP, OI and STI
diagnostics when indicated); Psychological (adherence counseling, Prevention with Positives, Bereavement
counseling, Depression Assessment and counseling with referral to appropriate services); Spiritual care
(access to spiritual care); Social supports: (package of care and support services); The coordinating IAs will
be linked to the PHC facilities to manage a one-stop center where adults and children (PHA and PABA) will
access psycho-social services, HIV prevention information and linkage to medical treatment from the triage
centers. The IAs will be encouraged to establish day-care programs where PHA and PABA can share
experiences and learn skills for coping with the impact of HIV/AIDS. Referral/Care coordinator attached to
each HBC team will meet monthly with representatives of the IA and the facility to redistribute clients for
effective management as the need arises.
Local government staff will be involved in the selection of triage centers and the selection of volunteers for
sustainability and ownership. CEDPA will continue to participate in the TWG on training manuals, attend
quarterly meetings, joint supervisory visits and be available in any other capacity that its presence or
assistance may be required by the USG/GON. CEDPA uses a set of community based care and support
monitoring tools to report care and support services. These tools include benefiary household assessment
forms, caregiver services forms and client registers. The community based volunteers and M&E focal
persons will be trained in the use of these tools. The M&E Officers at the State level shall provide technical
assistance to the CBOs/FBOs on data collection and reporting. The M&E Officers conduct routine
monitoring visits to CBOs/FBOs for data quality assurance and advice on quality improvement processes.
The State reports shall be collated at the Country Office after conducting routine quality checks on reported
service statistics. CEDPA care and support monitoring tools have variables to capture separately clients
recruited from GHAIN and non GHAIN sites. Referrals and linkages to ARV treatment will also be
supported. Linkages to GHAIN and other USG partners providing care and support at healthcare facilities
will be strengthened, to ensure that all PHAs receive community/home-based care services. Care
coordinators will be placed in facilities providing ART, VCT, PMTCT and pediatric care and support services
to register all those patients who may require HBC services and offer information on follow-up support for
PHA. Planning and review meetings will be held regularly with partners to maintain effective referral.
Social-economic support will be provided to 800 individuals in 41 groups enhanced by seed grants between
$ 4310- $ 8620 per group and vocational training for income-generation will be maintained in Kano, Benue,
Bauchi and Imo states through close monitoring and supervision of on going activities. This activity will be
facilitated by partnering with microfinance banks Priority will be given to households headed by children, the
elderly, and PLWHAs who lack regular sources of income. Seed grants will be provided to small groups of
PLWHAs and their families to invest in small-scale businesses and revolving funds for health care. This
activity will benefit an additional 8 groups through re-investment of funds to be disbursed by OCEANIC
bank.
The primary beneficiaries of PL care and support services are PHA and their families. Community
volunteers, and caregivers of PHA will be trained. Since women form most of PL's beneficiaries, extra effort
will be taken to reach out to men as community leaders and partners of PHA to increase male involvement
in HIV care and support.
The planned community/home-based care and support interventions will contribute to the overall PEPFAR
care and support goal by reaching 23,000 PHA and 46,000 PABAs with community basic care and support
services. PL will work with stakeholders at all levels, to strengthen community systems for the provision of
quality care to PHA and their families; build community capacity to deliver care and support by training a
total of 644 community resource persons and improve the economic capacities of PHA.
BC&S activities will be linked to CEDPA's HVTB, HVOP, and HKID programs. Activities will be linked to
HVAB, HVOP, HVTB, HKID, HVCT through training PLWHAs on various aspects of HIV prevention and
control of OIs. PL will strengthen and consolidate linkages with stakeholders, particularly GHAIN, SFH, and
GoN, to provide care and support packages for OVC and establish linkages between HVCT centers and
care outlets. This will improve utilization of MTCT, HKID, HVTB, HTXS and HLAB services and enhance
community participation in care for PLWHAs and ensure service quality. PL will refer for wrap around
activities - social services, food and livelihood opportunities. Girl-headed households will be linked with
supportive women's groups to provide them with psychosocial support and protection. Follow-up supportive
supervision will be provided. At each site, PL activities will strengthen linkages to AB and OP prevention
activities as integral parts of home-based care for OVC offered by care givers. Those linkages already
established will be strengthened with TB/HIV intervention programs, PMTCT services, USG-funded
immunization projects and child welfare services.
PL will advocate for reduced stigma and discrimination at all levels, increasing acceptance of PHA within
communities. Interventions will increase gender sensitivity in programming by targeting vulnerable young
Activity Narrative: girls and women, and promote male involvement in care and support. Emphasis will be placed on capacity
building of care providers and implementing agencies.
Continuing Activity: 13014
13014 9839.08 U.S. Agency for Centre for 6368 5267.08 USAID Track $4,126,000
9839 9839.07 U.S. Agency for Centre for 5267 5267.07 APS $3,513,750
* Increasing women's access to income and productive resources
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development $85,893
Table 3.3.08:
In COP09 CEDPA will reach 750 children (0-14 years) with pediatric care and support sevices. The children
will be a part of the total number of individuals reached under CEDPA's basic care and support (BC&S)
program. Services will be provided in 20 states: Anambra, Adamawa, Akwa Ibom, Bauchi, Benue, Cross
Rivers, Edo, Enugu, FCT, Imo, Lagos, Niger, Kano, Kebbi, Kogi, Sokoto, Taraba, Nasarawa, Katsina and
Zamfara. The target group for pediatric care and support will include HIV-positive children below the age of
14 years and infants born to HIV-positive parents. The pediatric care and support minimum package will
consist of clinical care, home based nursing care cotrimoxazole prophylaxis, referral for advanced
management of AIDS related illnesses, laboratory services including CD4 count and provision of the
preventive care kits.
Services will reach children of support group members and other clients served under the BC&S program.
The children will be identified through healthcare facilities and community-based care and support activities
conducted by home based care volunteers and peer educators under CEDPA's BC&S, sexual prevention,
TB/HIV and OVC programs. Some children will be identified through referrals from ART, PMTCT, HCT sites
and private clinics. Children below the age of five will be provided with the following services: growth
monitoring, immunization, and nutritional assessment and support. Infants born to HIV positive mothers will
be facilitated to access early infant diagnosis services through referral for viral detection test and/or HIV
antibody testing. All HIV positive children will be provided with cotrimoxazole prophylaxis while adolescent
children will be linked to support groups for experience sharing and mentoring. Children with TB will be
referred to directly observed treatment support (DOTS) centers. Parents and guardians will be provided with
psychosocial and spiritual counseling, HIV/AIDS prevention, care and support education.
Children will access clinical care services at the 40 primary health care facilities (PHC) supported under
BC&S and will receive DOTS for TB treatment. Staff at the PHC facilities will be mentored on pediatric care
and support. Each new client will receive a self-care kit consisting of ORS, ITN and water guard, IEC
material, soap, latex gloves and water vessel.
Home based care (HBC) volunteers trained under BC&S and OVC will also serve as care providers under
the pediatric care and support program. The HBC volunteers are selected from family members, PLWHAs,
community healthcare workers and religious leaders and trained in providing home based nursing care and
support of PLWHA at the community level. HBC volunteers and community health extension workers
(CHEWs) will reach children in homes and communities to enhance quality care and protection.
Referral/care coordinators attached to each BC&S team will meet monthly with representatives of the
implementing agency and the facility to redistribute clients for effective management as the need arises.
Pediatric care and support services will be implemented in collaboration with the Ministry of Women Affairs
and Social Development at national and state levels and other USG implementing partners providing
pediatric services.
To ensure sustainability, CEDPA will enhance the capacity of existing support groups and anti-AIDS clubs
to provide age appropriate services to pediatric clients. Such services will include the provision of child
counseling, day care centers and AIDS education. Parents, guardians and care givers of HIV positive
children will be linked to micro-credit finance opportunities and others for improved livelihood.
The primary beneficiaries of CEDPA's pediatric care and support services are HIV-positive children below
the age of 15 and their caregivers. Secondary beneficiaries will include healthcare providers, HBC
volunteers and teachers.
The planned pediatric basic care and support interventions will contribute to the overall PEPFAR care and
support goal by reaching 750 children living with HIV/AIDS with pediatric care and support services. CEDPA
will work with stakeholders at all levels to strengthen community systems for the provision of quality care to
HIV positive children and their families and to build the community capacity to deliver quality care and
support services.
CEDPA will consolidate linkages, with GHAIN and other USG partners providing care and support at
healthcare facilities, to ensure that all HIV-positive children receive pediatric care and support services.
Care givers will be linked to micro-credit finance services provided by other IPs such as the Chemonics
Maximizing Agricultural Revenue and Key Enterprises in Targeted Sites (MARKETS) project and the
Winrock AIM project. Activities will be linked to HVAB, HVOP, HVTB, HVCT, through training of volunteers
on various aspects of HIV prevention and control of OIs. Key to increasing pediatric care and support will be
to strengthen linkages at all community service levels, HCT and PITC.
CEDPA will promote provision of quality age appropriate and relevant care and support services to children
infected and affected with HIV/AIDS. Nutritional support and psychosocial counseling will be emphasized in
all interventions.
New/Continuing Activity: New Activity
Continuing Activity:
* Child Survival Activities
Table 3.3.10:
ACTIVITY UNCHANGED FROM FY2008
As part of the exit strategy, CEDPA intends to strengthen institutional capacity of their selected IAs to
develop sustainable programs. These activities will involve:
•Build the organizational management systems and leadership skills of the CBOs and FBOs to optimize the
delivery of TB/HIV services at the community level.
•Facilitate formation and/or strengthening of networks and linkages in community/home based care services
to health care facilities.
This activity also relates to HBHC (9839), HVOP (9779), HVAB (9759), HKID (12378). The TB component
of Positive Living (PL) will address the increasing TB case load among HIV positive persons by increasing
access to treatment and improving treatment outcomes. This activity will link TB and HIV prevention, care
and treatment activities at community and primary health care level.
In collaboration with state TB control programmes, PL will build the capacity of 36 CBOs/FBOs and six
NGO/FBO owned primary health facilities to expand community based TBHIV services to an additional two
states making a total of 14 states (Bauchi, FCT, Lagos, Kano, Anambra, Edo, Enugu, Taraba, Adamawa,
Niger, Cross River, Imo, Kogi and Benue) in COP 08. All sites will be provided with necessary facilities that
will ensure holistic patient care according to IMAI guidelines. These services will provide a network, linking
facility-based TB/HIV services provided by GHAIN in secondary facilities with primary and community based
services. A total of 6,554 HIV infected clients receiving TB treatment in GHAIN supported sites will have
access to community based TB/HIV activities.
The 36 CBOs will contribute to TB/HIV care in the following ways: 1) provide treatment support services
through out-patient treatment until cure; 2) provide patient, family and community education on TB/HIV co-
infection; 3) complement case finding efforts of traditional facility-based TB treatment programs; 4) increase
accountability of local health services to the community; and 5) lobby the state and local authorities for
increased commitment to TB/HIV control, including through work practice, administrative and environmental
control measures.A total of 30 individuals will be trained to provide treatment for TB to HIV-infected
individuals while 1,800 community health workers, home based care volunteers and peer educators will be
trained in TB/HIV education, care and support including adherence to TB treatment regimens. Family
members (two per PHA) will be given basic skills to provide continuous care and support.
PL will support a total of six community-based clinical facilities to handle TB management and to provide
basic laboratory and community services for HIV positive persons. Following assessments, PL will assist
health facilities to do basic renovations, to purchase equipment and laboratory reagents, to develop storage
space for drugs and commodities and to write up and publish infection control plans. In addition, clinics will
be assisted to augment extant quality assurance standards, particularly by implementing Nigerian national
guidelines for external quality assessments (double-blinded slide rechecking).
Medical officers from community-based clinical facilities will be trained in X-ray diagnosis of TB while
laboratory technicians/scientists will undergo training in sputum smear microscopy. This activity will ensure
that 800 HIV positive persons and their family members are referred and supported to access routine
screening for TB. It is anticipated that 300 HIV positive persons will require treatment for TB. Co-infected
TB/HIV patients will be linked to medical services at GHAIN, other USG-funded health care facilities and
DOTS centers. Communities will have increased knowledge on prevention and control of TBHIV and
increased capacity to provide care and support for dually infected patients.
PL IAs will counsel partners and family members of HIV/TB patients and refer them for TB screening. In the
process partners/family members will be linked to appropriate care and support services. TB/HIV activities
will be integrated into ongoing palliative care (HBHC #9839) and prevention programs (HVAB and HV0P).
HBC volunteers will be trained to recognize TB symptoms and danger signs; to conduct proper referral of
PHAs for TB screening and treatment; to provide home-based nursing care, infection control, follow-up and
adherence counseling; and to trace clinic defaulters. Care coordinators at CBOs will undergo mandatory
clinical TBHIV training and in supportive supervision. Care coordinators will supervise HBC volunteers, and
provide continuing education during volunteer meetings. This activity will incorporate standard operating
procedures; training manuals and IEC materials will be adapted and updated. The ELICO maps model will
be adopted to help HBC volunteers keep track of individuals and families they visit, and organize follow-up.
Project activities will be properly documented at every stage of implementation.
Using standardized forms, M+E officers collect data monthly, detailing numbers/demographics of clients
reached and messages provided. This provides timely information for effective decision making, particularly
regarding the breadth and depth of TB/HIV coverage. TB/HIV M+E activities will develop sustainable
capacity at IAs and MOs to collect relevant data. . Direct M+E expenditures by PL, MOs and IAs will total $
55,686.
Referral for TB/HIV screening will be done for all PHAs who will be enrolled into the care and support
program in the four PL states. Their family members will be recommended for screening as well. PHAs
infected with TB will be linked to DOTS centers and supported for drug adherence. Healthcare providers at
DOTS centers and other PHCs will be facilitated for training and re-training in TB prevention and
management. Family and other community members will be provided with information on TB and infection
control.
This activity will contribute to prevention and control of TB among HIV positive persons. HIV positive
persons will be screened for TB by members of their communities and referred for treatment. In a
pioneering effort, treatment support will be provided to HIV positive patients on TB treatment to ensure
completion of treatment and prevent the onset of drug resistance. Community linkages will strengthen
facility based TB/HIV service providers' collaboration.
Activity Narrative: LINKS TO OTHER ACTIVITIES:
TBHIV activities will be linked to activities in HVAB (3.3.02) and HVOP (6735, 6707) through community and
faith-based organizations and to CEDPA's palliative care program for follow up and psychological and
spiritual support. These linkages will ensure that all TB/HIV patients are provided with co-trimaxozole
preventive therapy (CPT) and other prophylaxis for opportunistic infections. TB/HIV activities will be linked
to HVSI (3.3.13) with improved tools and models for collecting, analyzing and disseminating TB/HIV data,
and also to the newly approved NTBLCP tool for reporting. TB/HIV efforts will also support HVCT (3.3.09)
activities to ensure that counseling and testing is done for all TB cases; and to MTCT (3.3.01) to ensure that
HIV positive pregnant women are screened for TB.
This activity has an emphasis on human capacity development and local organization capacity building. All
support activities are undertaken in collaboration with the STBLCP.
This activity will address infection control and gender and age equity by providing TB/HIV information and
services at community levels. This will ensure access to TB/HIV services for PHAs who are on ART and
other community members - especially women - who may otherwise not know their risk of TB infection.
Educative and preventive messages targeted at children (10-14), young people (15-24) and adults will
address the importance of TB prevention and care. The thrust will be to ensure that all population cohorts
seek TB/HIV services in a timely manner. A secondary activity will be to train community outreach workers
to deliver such messages effectively.
Continuing Activity: 13015
13015 12373.08 U.S. Agency for Centre for 6368 5267.08 USAID Track $482,000
12373 12373.07 U.S. Agency for Centre for 5267 5267.07 APS $482,000
Estimated amount of funding that is planned for Human Capacity Development $19,850
Table 3.3.12:
As part of its sustainability strategy, CEDPA intends to strengthen institutional capacity of selected
implementing agencies (IAs) to develop sustainable programs. These activities will involve:
delivery of OVC services at the community level.
•Facilitate formation and/or strengthening of networks and linkages in OVC services to community and
health care services.
•Support women/girls in their care-supporting role by linking them to micro-credit finance opportunities.
This activity also relates to activities in HVAB (3.3.02), HBHC (3.3.06), HVTB (3.3.07), HVCT (3.3.09),
HTXS (3.3.11) and HLAB (3.3.12). Positive Living (PL) is presently in four sites in four states. Positive Living
(PL) is presently in four sites in four states: Kano, Cross River, Bauchi and Edo. By the end of COP07, PL
will have opened 4 additional sites in these same states. In COP08 PL will expand to 10 new sites in 10
states: FCT, Anambra, Adamawa, Lagos, Kogi, Benue, Imo, Niger, Kogi and Taraba. OVC is an on-going
activity and in COP08, PL will focus on scale up, tripling COP07 figures, ensuring increased coverage of
present sites and going on to new sites.
PL activities in COP08 will respond to the OVC situation in project states, consolidating structures initiated
in COP07 and strengthening community linkages and referral networks, while initiating services in the new
states. PL will limit expansion of the OVC services to the geographical scope of the Implementation
Agencies (IAs) and Multiplier Organizations (MOs) within the 14 PL states. Three thousand OVC will be
reached via family centered approaches. Through partnerships with 16 IAs and MOs, 600 caregivers among
family members and 300 home based care (HBC) volunteers will be trained in OVC care.
Volunteers and community health extension workers (CHEWs) will reach OVC in homes and communities,
maintaining stability, care, and protection. PL will work at extant structures within PL HBHC and collaborate
with OVC stakeholders at all levels - the Federal Ministry of Women Affairs and Social Development, their
State counterparts, GHAIN, and other USG IPs - and contribute to sustainability by expanding community
resources to improve quality care for OVCs.
PL's OVC services will be provided to children referred from GHAIN/other USG IPs and clients referred by
community members. 0 - 4 yr. olds (and/or guardians) will receive safe water kits, growth monitoring,
counseling on routine immunization protocols, CT for HIV, birth registration, nutritional counseling,
prevention and treatment of OIs and malaria services. 5 - 17 yr. olds will receive CT for HIV, nutritional
assessments and counseling, enrolment into formal education settings (back to school)/vocational skills
acquisition), AIDS education and on-going counseling. In addition HIV+ OVC will be assisted to access
ART, OI diagnosis and treatment (including STIs) and malaria prevention and treatment services at GHAIN
or other USG/GoN supported sites. They will also receive preventive kits. PL will provide nutrition support to
families as needed. To accomplish this in COP08 PL will make appropriate linkages with and leverage
resources from the new USG supported food and nutrition wrap around activities being implemented by the
MARKETS is states where they are co-located. An OVC will be considered served when he/she receives
the three services as recorded during an assessment and that follows the nationally approved plan of action
and guidelines, including the harmonized National OVC Vulnerability and child status indices.
PL has agreements with the GoN and FBOs (Anglican Communion AIDS Programme and the National
Supreme Council for Islamic Affairs) to place OVC, especially girls, in selected 10 and 20 schools. These
are the schools targeted by PL's AB program (avoiding duplication of efforts). In selected schools PL will
continue to contribute overhead in exchange for free tuition and education materials (uniforms, books, etc.)
for OVC. PTA members will be trained to recognize and respond to academic needs of OVC, to support
PTA levy waivers, and to provide three different, OGAC-recognized forms of psychological support. Where
indicated, PL will leverage further educational support for needy OVC from the ABE-Link wrap-around
activity. Out of school OVC, particularly those heading households or caring for sick parents/siblings, will be
supported to attend evening classes in the community. Others will be enrolled in contracted institutions that
provide specific training in vocations and business entrepreneurship. OVC who have completed vocational
training will be given seed grants to purchase equipment for microenterprises. OVC needing additional
funds for economic activities will be linked to banks and microfinance institutions to source soft loans.
The adapted curriculum equips OVC with life skills and age appropriate HIV/AIDS and sexuality/RH
information; it will be used for refresher training. PHA from support groups will be models for PL and
demystify stigma and discrimination. Peer facilitators from PL prevention (AB, OP) will mentor and guide
OVCs by counseling and engaging OVC in physical and social activities. Youth volunteers already trained
by PL will continue to provide HIV/AIDS prevention information to colleagues and siblings, focused on AB.
Age appropriate prevention messages and education to prevent abuse will be shared. Sexually active youth
will be provided with appropriate information on prevention and treatment of STIs.
Health care services will be provided at PL supported PHC facilities to supplement C&S support services
offered at ART centers and general health facilities. These services will follow the basic care and support
model. PL will continue to negotiate for subsidized/free medical care for OVC at GoN-owned and privately-
owned health facilities. Staff at PHCs will be trained on OVC health needs. Each HIV positive OVC will be
screened for TB, provided with a self care kit containing an insecticide treated net, water-guard (refilled
regularly) and receive OI prophylaxis. She/he will be linked to GHAIN, GoN and other USG sites for
pediatric ART and treatment for advanced OIs.
To expand the core of the program, caregivers will be recruited from members of extended families to care
for more OVC. COP08 and COP07 caregivers will be provided training and refresher training respectively
on psychological and spiritual support to OVC, pediatric treatment adherence, nutrition issues, diet and food
preparation techniques, communicating with children, and healthy life decision-making. Caregivers will be
linked to USG support sites to access other services for OVC. Seed grants will be given to care givers to set
Activity Narrative: up IGAs that augment household income, for transportation of OVCs to access services, for support of OVC
staying in schools and vocational facilities. PL will monitor these grants through structured guidelines.
HBC volunteers will also serve as OVC volunteers. Refresher training on OVC services will be provided to
support best performance. Topics will include promoting birth registration, carrying out nutritional
assessments, counseling, monitoring immunization status of infants, and monitoring growth. They will
support supervision of care givers; monitor OVC, assist youth headed households to maintain their homes
and refer OVC for treatment of ailments, immunization, child welfare and wrap around services.
Using standardized forms, IA/MO/PL M+E Officers collect data monthly, detailing numbers/demographics of
clients reached and messages provided. This provides timely information for effective decision making,
particularly regarding the breadth and depth of OVC coverage. OVC M+E activities will develop sustainable
capacity at IAs and MOs to collect relevant data.
The primary beneficiaries for the OVC program are children aged 0-17 yrs. who have lost one or both
parents to HIV/AIDS and/or are vulnerable because they are HIV positive; live without adequate adult
support; live outside of family care or are stigmatized, marginalized or discriminated against. Stigma
reduction activities and training will target caregivers, PTA members and HBC service providers.
The planned OVC interventions will contribute to the overall PEPFAR C&S goal of mitigating consequences
of the epidemic by reaching 3000 OVC with care and support services. PL, working with all stakeholders at
all levels will contribute to the sustainability of interventions by strengthening community systems to improve
quality care for OVC, build community-capacity of 600 caregivers to support OVC by training and providing
seed grants.
PL will strengthen and consolidate linkages with stakeholders, particularly GHAIN, SFH, and GoN, to
provide care and support packages for OVC and establish linkages between HVCT (3.3.09) centers and
care outlets. This will improve utilization of MTCT (3.3.01), HBHC (3.3.06), HVTB (3.3.07), HTXS (3.3.11)
and HLAB (3.3.12) services and enhance community participation in care for OVC and ensure service
quality. PL will refer for wrap around activities - social services, food and livelihood opportunities. Girl-
headed households will be linked with supportive women's groups to provide them with psychosocial
support and protection. Follow-up supportive supervision will be provided. At each site, PL activities will
strengthen linkages to AB and OP prevention activities as integral parts of home-based care for OVC
offered by care givers. Those linkages already established will be strengthened with TB/HIV intervention
programs, PMTCT services, USG-funded immunization projects (COMPASS) and child welfare services.
Successes recorded on gender issues will be consolidated, particularly sensitivity in programming that
targets vulnerable young girls, and address women's rights to income and productive resources. PL will
work with legal aid initiatives to develop legal frameworks that uphold the rights of OVC, particularly
inheritance. Wraparound activities related to food will be another emphasis area.
Continuing Activity: 13016
13016 12378.08 U.S. Agency for Centre for 6368 5267.08 USAID Track $700,000
12378 12378.07 U.S. Agency for Centre for 5267 5267.07 APS $705,000
Estimated amount of funding that is planned for Human Capacity Development $154,336
Table 3.3.13:
