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
Track 1 and 2 are combined for this activity.
ACTIVITY DESCRIPTION:
In COP07 Harvard/APIN+ provided comprehensive ART services in 17 sites In COP08 will provide high
quality ART services to eligible patients at a total of 36 sites; 28 comprehensive ART sites (11 tertiary and
17 secondary facilities) and eight PMTCT sites that also provide ART for HIV+ children identified through
PMTCT services. The 28 sites are located in the nine states of Benue, Borno, Ebonyi, Enugu, Kaduna,
Lagos, Oyo, Plateau, and Yobe. This will provide ART services to a total of 48,500 individuals, including
44,000 adults (14,000 new) and 4,500 children (1,500 new) at the end of the reporting period. At the
additional eight PMTCT sites there will also be ART services provided for eligible pregnant women and
eligible infected infants. Implementation of the PEPFAR-Nigeria LGA coverage strategy in the program
areas of PMTCT and TB/HIV, designed to ensure the provision of PMTCT and TB/HIV services in at least
one health facility in every local government area (LGA) of 6 identified states, will increase the reach of
adult and pediatric ART services as well.
For patients at the Federal ART sites, the program anticipates GON provision of first line ARV drugs and
PEPFAR support for ART care and services. As patients require alternative or second line drugs, they will
receive PEPFAR provided drugs. GON provision of first line drugs, when actualized, will allow for additional
adult and pediatric targets. APIN+ estimates that 2,500 additional adults will be placed on therapy through
the leveraging of GON drugs. APIN+ will also partner with Clinton Foundation and Global Fund (GF) as
appropriate to leverage resources for providing antiretroviral drugs to patients. The site investigators and
project managers will actively participate in the GON National ART program. Harmonization of data
collection for M&E will be coordinated with USG and GON efforts. APIN+ has provided technical assistance
and training expertise to the National ART program's training program for adults and pediatric patients,
which will continue in 2008. APIN will continue to participate in the USG coordinated Clinical Working Group
to address emerging topics in ARV service provision and to ensure harmonization with other IPs and the
GON.
ART provision and monitoring follows the 2005 revised National ART guidelines for adult and pediatric care.
All sites focus on the integration of ART services for all patients regardless of the source of funding for
different components of treatment (e.g. external funding sources for services or lab commodities). A
standardized protocol for adult and pediatric ART services is followed at all APIN PEPFAR sites. At each
site support is provided for the management of electronic data and patient medical records for use in the
provision of clinical care. Continued support to ART sites in the area of pediatrics, including the training of
pediatric clinicians, will build capacity at sites to provide pediatric ART. TB diagnosis and treatment is
provided to all patients via facility co-location of DOTS centers and/or referral of patients into ART from
DOTS sites. ART eligible patients identified through HCT conducted at a DOTS site will be provided with
ART. By the end of COP07 all APIN+ ART sites will be co-located with DOT centers to facilitate TB/HIV
service linkages. All HIV infected clients will be symptomatically screened and confirmed with laboratory
and radiological diagnostics as indicated while all TB patients will be offered HIV testing.
Patients are identified through HCT services including facility based, mobile, and family centered strategies.
Those initiating ART are provided ART EAC prior to and during ART provision. ART EAC will follow the
National Curriculum for Adherence Counseling and includes partner notification, drug adherence strategies
and other prevention measures. Care services including prevention for positives will be provided for all ART
patients as outlined in the BC&S narrative.
Non-ART eligible individual that are enrolled in care will have periodic follow-up to identify changes in
eligibility status. Patients are also encouraged to refer family members for HCT. ART EAC is reinforced with
PLWHA support groups at each site, which serve both PEPFAR and Federal ART patients. PLWHA on
treatment are encouraged to have a treatment support partner to whom he/she had disclosed status to
improve adherence and to optimize care.
Scheduled physician visits are at three, six, and 12 months and every six months thereafter; patients pick
up ART drugs monthly. At each visit, clinical exams, hematology, chemistry, and CD4 enumeration are
performed. All tertiary site labs perform the necessary lab assays. Secondary and primary sites with limited
lab capability send samples to an affiliated tertiary site lab for analysis. Electronic clinic and lab records
provide data for high quality patient care and centrally coordinated program monitoring.
Clinical staff meets monthly for updates and training. Each site has a clinic coordinator and a central
committee determines and approves drug regimen switching. As clinical training needs are identified for
new sites or new staff at existing sites, APIN+ provides training on regimen switching and other relevant
topics. APIN+ will continue to implement internal and external QA/QC programs through SI activities and will
allow sites to further monitor the level of patient care. In COP07, APIN+ developed standardized indicators
and piloted QA assessments at ART sites; results were utilized to strengthen services at sites. In COP08,
APIN+ will continue to implement these assessments at additional sites. At each site, indicators specific to
site needs and activities will be developed.
In addition to providing training to improve care at supported sites, APIN+ will also fully support the training
of 100 lab scientists working at GON and GF supported sites. APIN+ will utilize its training lab to train them
in ARV lab monitoring including good laboratory practices, HIV rapid testing, automated CD4, hemogram
and chemistries. This will serve to increase the quality and sustainability of ARV services outside of
PEPFAR-supported sites.
This funding will support the personnel, clinic and lab services for training of 900 people, monitoring of
44,000 adults and 4,500 pediatric patients at the end of COP08, which includes 14,000 new adult and 1,500
new pediatric patients. Funding is also used to support renovations of physical infrastructure at expansion
sites to build physical capacity for the provision of ART services. A total of 48,500 patients will be provided
with ART services. Treatment is provided as a part of the National ART Program in 11 tertiary care teaching
hospitals and federal medical centers, located in Plateau, Lagos, Oyo, Borno, Kaduna, Enugu and Benue
states. Services will also be provided in 17 secondary level hospitals/clinics in Oyo, Yobe, Borno and
Activity Narrative: Plateau States. Mobile services are also provided to patients served by a CBO in Ebonyi State.
CONTRIBUTION TO PROGRAM:
ART activities are consistent with the PEPFAR goal of scaling up capacity to provide ARV drugs, services
and lab support to serve more HIV+ people. The 28 comprehensive ART sites represent a significant
increase in the number of ART sites. Additionally, APIN+ will expand to two new states, with the majority of
new expansion sites being secondary level sites. APIN+ will seek to support the expansion of ARV services
into more local areas by developing a network of secondary or primary health care clinics providing ART
services that are linked to tertiary health care facilities. Plateau State will be targeted for additional
expansion through PMTCT services as a component of the PEPFAR Nigeria LGA coverage plan. As
expansion of ARV drug services is prioritized to rural areas, existing referral channels and support network
coordinating mechanisms will be strengthened. These networks will ensure that facilities are able to develop
linkages, which permit patient referral and the provision of specialty care support. A tiered structure for ARV
provision and monitoring established in COP07 provides a model for additional expansion efforts in COP08
in order to meet PEPFAR treatment goals.
LINKS TO OTHER ACTIVITIES:
This activity is linked to ART drugs (9888.08), OVC (5415.08) for pediatric palliative care, adult BC&S
(5369.08), PMTCT (3227.08) as the program will support 36 PMTCT sites, TB/HIV (3222.08) to provide
ART to patients with TB, Lab (6716.08) to provide ART diagnostics, HCT (5424.08) as an entry point to
ART, and SI (3226.08) will provide the GON with crucial information for use in the evaluation of the National
ARV program and recommended drug regimens. This program is linked to PMTCT services to optimize the
PMTCT by providing ART to eligible pregnant women.
POPULATIONS BEING TARGETED:
The care and treatment components of these activities target HIV-infected adults and children for clinical
monitoring and ART treatment. The operational elements of these activities (M&E, health personnel training,
infrastructural supports, technical assistance and quality assurance) target public and private program
managers, doctors, nurses, pharmacists and lab workers at PEPFAR sites. The expansion of ART services
to secondary health facilities will increase access to necessary services in poor communities.
EMPHASIS AREAS:
Emphasis areas include in-service training. This increases gender equity by providing equitable access to
ART services for both sexes. Counseling services will seek to identify and provide appropriate referrals for
women who are or are at risk of becoming victims of violence. ART EAC will seek to provide referrals to
wraparound services, such as food & nutrition programs and educational services. ART EAC will also seek
to address stigma and discrimination.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13049
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13049 9910.08 HHS/Health Harvard University 6377 5330.08 HHS/HRSA $2,820,586
Resources School of Public Track 1.0
Services Health Harvard SPH
Administration
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
* TB
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $250,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $172,530
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $664,486
Table 3.3.09:
Track 1 and 2 funds are combined for this activity.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
As we have now split the APIN+/Harvard activities between Harvard University and APIN, Ltd., our activity
narratives will be amended to reflect activities that will be performed specifically by the efforts of Harvard
through the APIN+ Program (Harvard) as opposed to APIN, Ltd (which will be submitting a separate
narrative under the name APIN). Narrative has also been updated to reflect COP09 goals and targets. In
addition, APIN will be taking over all activities for Nigerian Institute of Medical Research (NIMR), Lagos
University Teaching Hospital (LUTH), Onikan Women's Hospital (OWH), and Mushin General Hospital
(MGH), Harvard will support the management of the Central Medical Stores (CMS) for both Harvard and
APIN supported sites. In accordance, those sites and their respective patients will drop out of the Harvard
numbers and be reflected in the APIN narrative.
This funding will specifically support the procurement of antiretroviral (ARV) drugs. Through these activities,
Harvard will provide ARV drugs for 51,850 patients (46,300 adult and 5,550 pediatric) at 24 Harvard sites in
nine states (Benue, Borno, Ebonyi, Enugu, Kaduna, Lagos, Oyo, Plateau, Yobe). These sites include ten
tertiary level comprehensive antiretroviral treatment (ART) sites serving pregnant women, adults and
children, 13 secondary level sites and one primary health care center that provide only pediatric ART. Nine
of ten tertiary level ART sites are also supported by the government of Nigeria (GON) with 14% of patients
receiving GON provided drugs. We also provide prevention of mother to child transmission (PMTCT)
services at 33 additional primary health care level PMTCT sites and eight secondary level PMTCT sites. At
all sites Harvard will provide the ART prophylaxis options and triple drug regimens for eligible pregnant
women consistent with the national guidelines. Thus, a total of 65 Harvard sites will be providing ARV drugs
through ART or PMTCT services. As part of the transition of Harvard PEPFAR activities to APIN Ltd, four
Harvard COP08 Sites (LUTH, NIMR, OWH, and MGH), will be supported by APIN in COP09. Harvard and
APIN will collaborate in order to ensure a smooth transition of clinical services. ARV drugs for such sites
will be provided by APIN and supply chain management mechanisms will be coordinated by both APIN and
Harvard to ensure proper tracking and stocking of needed pharmaceutical stocks. Harvard will continue to
directly purchase drugs for Harvard sites, and supply chain activities will continue through the existing
system, which is managed by APIN, with strategic technical support from Harvard.
All drug orders are based on projections of patient numbers as determined by annual forecast conducted in
August 2008 in conjunction with the Harvard / APIN Ltd country team, SCMS and USG Logistics Technical
Working group. The determining factors were rate of patient enrollment, weight class of patients affecting
drug dosage, gender, rates of toxicity, and rates of failure. Our rates of drug ordering and estimation of
buffer stock needs have been informed by our experience with lengthy and variable order to delivery times,
global shortages (e.g. BMS and Merck), splitting of most orders, delays in NAFDAC registration and lengthy
clearance of drugs in country. As a result, our drug forecasts and orders had been adjusted to
accommodate with an increase in buffer stocks. This year, we have buffer stocks for approximately 3-5
months for all of the requisite PMTCT, first and second line ARV drugs. Based on patient baseline data,
fixed dose combinations (FDC) of CBV+EFV/NVP will be used for first line regimen; patients with anemia or
Hepatitis B/C will be placed on TDF+FTC+NVP/EFV. Other first line alternative regimens and second line
regimens will be dictated based on individual patient data or history. FDC and generic drugs will be used
preferentially. Currently 7% of patients on ART are on second-line and 93% on first line regimens. Drug
usage updates are provided to all Harvard investigators by email on a monthly basis.
APIN Ltd. will purchase the drugs in accordance with USG, FDA and National Agency for Food and Drug
Administration and Control (NAFDAC) regulations as well as with the 2007 National Standard Treatment
Guidelines. In COP09, APIN Ltd. will continue to collaborate with the Clinton Foundation for the receipt of
second line adult and all the pediatric drugs. Harvard will also work closely with the Government of Nigeria
to leverage resources for the sites supported by both PEPFAR and GON. All purchases of Truvada
(TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be procured via pooled procurement mechanism by SCMS
in line with OGAC's recommendation. The rest of the drugs will be purchased via IDA and other
procurement mechanisms. Drugs will be shipped to Harvard Central Medical Stores (CMS) in Lagos, from
where they will be distributed to sites in accordance with the internal supply chain management system,
which is collaboratively managed by APIN Ltd. and Harvard. Harvard maintains a subcontract with Fed-Ex
to provide monthly distribution to all site pharmacies. An electronic bin card system is utilized to track and
monitor drug stores and the distribution.
APIN Ltd. has developed SOPs for supply chain management, drug usage, drug regimen tracking, drug
distribution, warehouse storage, waste management and individual pharmacy site management. These
SOPs are also used for procurement and distribution of OI drugs and certain lab supplies and test kits.
Capacity building and training for the CMS at NIMR and individual site pharmacies is ongoing
collaboratively with APIN and Harvard. to support pharmacy management and implementation of the
National ART Program. Harvard is participating in the ART harmonization process with the GON. The goal
of these harmonization activities is to facilitate the pharmacies' ability to scale up capacity as patient
utilization of ART increases. Assessments of all facilities to determine infrastructure needs have been
conducted in COP07 and COP08 and will continue to be conducted in COP09 for new sites. These site
capacity assessments have been the basis for efforts to strengthen the supply chain management system
for new sites. Ongoing assessments ensure sustainability of pharmacies and supply chain management at
the sites. All site pharmacists have participated in regular training sessions and work with site data
managers in providing regular supply chain information electronically to the APIN central pharmacy. The
computerized supply chain information system linked through APIN to patient clinical records also provides
reporting data for monitoring and evaluation (M&E) at each site. In COP08, additional logistician and supply
chain management staff were hired to provide additional support in the implementation of the supply chain
management system.
Our long-term goal is to support a sustainable supply chain management system for ART that incorporates
Activity Narrative: and bolsters existing Nigerian institutional structures and is harmonized with the GON activities. Continued
collaboration with GON procurement efforts contribute to this goal. Implementation of the PEPFAR-Nigeria
LGA coverage strategy in the program areas of PMTCT and TB/HIV, designed to ensure the provision of
PMTCT and TB/HIV services in at least one health facility in every local government area (LGA) of 6
identified states, will help guiding the ongoing site expansion for ART and PMTCT. As part of that plan,
secondary health care facilities covering all 17 LGAs in Plateau state will be targeted for pharmacy support
and drug distribution. As expansion of ARV drug services is prioritized to rural areas, Harvard will
strengthen existing referral channels and support network coordinating mechanisms. Each new site will be
visited by a team of technical staff from APIN and Harvard as well as other sub-partners. Pharmacy and
logistics management procedures will be assessed and be part of the site development plan.
Recommendations for drug storage, equipping of pharmacies and minor renovations are considered. All
Harvard pharmacists have completed the IDA ARV training program. Pharmacists hold meetings on a
quarterly basis and training updates are provided. Pharmacists and their data entry staff also participate in
the electronic data tracking system; regular training in computer entry and database management are also
provided by in-country and US-based program management staff.
EMPHASIS AREAS
Emphasis areas include military populations, through support and training for pharmacy staff and
counselors at 68 Military Hospital and Military Hospital Ikoyi, Lagos.
POPULATIONS BEING TARGETED
The primary target of these activities are health care workers, including program managers doctors, nurses,
and pharmacists who are involved in the drug procurement and distribution process. Furthermore, by
building mechanisms for drug procurement, these activities seek to target PLWHA, both adults and children,
who are in need of or already receiving ART care.
CONTRIBUTION TO OVERALL PROGRAM AREA
Through these activities we will have provided ARV drugs to 51,850 patients at 24 ART service outlets at
the end of the reporting period. In addition, we have scaled up our PMTCT activities with 64 points of
service providing access to PMTCT services for 3275 HIV-infected pregnant women. Through these
activities, we will continue to strengthen the structure of our ARV drug procurement system, as described
above, in accordance with PEPFAR goals in order to ensure cost effective and accountable mechanisms for
drug procurement and distribution. Furthermore, efforts to build local capacity through infrastructure building
and training mechanisms are consistent with PEPFAR 5-year goals to enhance the capacity of supply chain
management systems to respond to rapid treatment scale-up. Additionally, through procurement via SCMS,
we seek to provide support to efforts to build harmonized national capacity related to drug procurement and
distribution.
Additionally, as part of our sustainability building efforts, Harvard will provide technical assistance and
support for APIN to assume program management responsibility for our ARV Drugs activities. This will
include the implementation of a plan to transition site oversight, management and training over to APIN. The
goal of such efforts is to provide for greater assumption of responsibility for management and
implementation of PEPFAR programming by Nigerian nationals through an indigenous organization.
LINKS TO OTHER ACTIVITIES
This activity also relates to activities in TB/HIV, Adult Care and Treatment, Pediatric Care and Treatment,
Strategic Information, and Human Capacity Development. Through this activity, we will maintain significant
linkages with PMTCT and Adult and Pediatric Care and Treatment through the procurement of ART drugs
for individuals served by these programs. Additionally, we will develop and maintain linkages to TB/HIV
activities, with expansion focusing on co-locating ARV sites with existing DOTS sites. The supply chain
management system will serve to provide drugs to ART sites that are providing TB services in conjunction
with ART services. SI activities will provide crucial information for M&E as well as efficacy of the drug
regimens, which may impact drug procurement decision-making.
Continuing Activity: 13048
13048 6714.08 HHS/Health Harvard University 6377 5330.08 HHS/HRSA $9,401,952
Table 3.3.15:
Track 1 and Track 2 funds will be combined for this activity.
narrative under the name APIN). The narrative has also been updated to reflect COP09 goals and targets.
In addition, APIN will be taking over all activities for Nigerian Institute of Medical Research (NIMR), Lagos
(MGH), in accordance, those sites and their respective patients will drop out of the Harvard numbers and be
reflected in the APIN narrative.
This activity provides maintenance of activities at the National Central Public Health Reference Lab
(NCPHRL) and HIV labs at tertiary (11) and secondary (22) health facilities in Plateau, Oyo, Borno, Yobe,
Lagos, Enugu, Kaduna, and Benue States. These 34 labs represent an overachievement of our COP07
target (30 labs in the same 8 states). In COP08, APIN+ proposes adding additional expansion sites by
building the infrastructure and capacities of 3 labs in secondary health facilities in Plateau state to for a total
of 37 labs. In addition, we will expand the capacity of labs at primary health facilities throughout Plateau and
Oyo states (HIV testing). By the end of COP07, our 11 major tertiary level labs and the NCPHRL will have
capabilities for hematology, automated chemistry analyzers, and laser-based lymphocyte subset
enumeration. Ten of these facilities will also have PCR technology.
APIN will work with GON in developing the NCPHRL into a national reference lab, a project identified by the
MOH as a priority. This lab will serve national HIV QC/QA needs and with 2-3 additional APIN+ supported
labs, will serve as a national laboratory training center. This lab's capacity will include standard HIV assays,
clinical chemistries, hematology, and TB culture. In addition, we will continue to strengthen existing labs by
providing backup equipments to major tertiary sites in geographically isolated areas to avoid interruption in
service. Equipment maintenance is coordinated through assistance from a consultant trained in the
maintenance of freezers and through the manufacturers for other items.
All 37 labs will provide HIV diagnosis through rapid test technologies. All 36 ART sites will have western blot
capacity to confirm HIV status prior to initiation of ART. HIV serology, hematology, chemistries, and CD4
enumeration will be supported at all secondary hospitals with referral to the tertiary labs for PCR diagnostics
and viral loads. Primary health care facilities are closely partnered with secondary and tertiary care facilities,
allowing for baseline and periodic evaluation with full lab monitoring. The primary facilities provide limited
lab monitoring with basic clinical, hematologic and CD4 assays. We are currently screening for TB by
sputum and/or pulmonary X-ray at all ART sites. We will be evaluating the use of PCR diagnosis of TB at
selected tertiary sites in COP07; this will help to guide programmatic decisions regarding its use in COP08.
Our labs with infant PCR diagnostic capabilities will continue to assist other PEPFAR IPs, using dried blood
spots (DBS) to transport specimens from distant satellite sites. APIN+ will support the PEPFAR-Nigeria LGA
coverage strategy (PMTCT and TB/HIV). Secondary sites will have lab capacity for HIV serology,
hematology, chemistries, and CD4 enumeration. Primary feeder sites will be limited to HIV serology with
referral to the secondary sites for additional lab monitoring.
Standardized lab protocols have been developed to accompany the PEPFAR clinical protocol and
computerized lab results link with patient records. These protocols include provisions for the disposal of
biomedical waste in accordance with good laboratory practices. Quality control / quality assurance (QA/QC)
policies have been developed and detailed annual assessments of all lab activities are conducted. Quarterly
QA/QC lab site visits are conducted by the HSPH project management team and will use a standardized
assessment tool developed in Nigeria by the Lab Technical Working Group (LTWG). Results from the
proficiency testing and site visits will be sent into a centralized system within Nigeria, developed and
supported by the PEPFAR LTWG. EQA for lab tests was established in COP07 and is operational for CD4,
HIV, HCV and HBV serology, chemistries, VL and HIV PCR diagnostics; through individual lab registration
with UK-NEQAS and CAP. All PCR labs will participate in the CDC's DBS DNA PCR proficiency program
(EID QA). We provide support for 264 lab staff persons (based at sites), responsible for implementation of
lab protocols, data entry and performance of lab tests. In addition, we provide support for 7 APIN+ staff who
provide technical assistance to sites. Regular lab training allows the development of high quality lab
standards in our PEPFAR labs and this has been networked to our secondary and primary labs with specific
tailoring to the needs and skills at each level. Biannual trainings are provided on specific techniques/topics
integrating QA/QC, good lab practices and biosafety. Competency monitoring/evaluations and refresher
trainings will be provided within individual labs. PEP protocols have been implemented at each of our labs,
supported under our ART drugs activities. APIN has supported international laboratory accreditation for
NIMR and in COP08 will seek international accreditation for 2 additional labs and local accreditation for 10
other labs.
A laboratory information system (LIS) will be implemented at sites, with appropriate capabilities, to
streamline the capture of lab data, minimize transcription errors and facilitate data entry and results output.
We will continue to participate in LTWG monthly meetings to ensure harmonization with other IPs and the
GON, including the development of a common lab equipment platform (appropriate for each lab level).
Procurement of lab reagents is structured in two ways. Reagents available in Nigeria are procured directly
by the sites from specific distributors. Labs are advised to maintain a 3 month reagent buffer. Most reagents
needing importation are ordered at HSPH and shipped to our central warehouse in Lagos. PEPFAR funding
supports procurement of lab equipment, generators and water purifiers necessary for lab work. Equipment
costs for tertiary labs can be high in the first year, but represents significant infrastructure development.
Secondary and primary labs, including VCT facilities, have lower start up costs. Maintenance costs include
minimal renovation costs for some labs, replacement of small lab equipment and training costs for additional
personnel. As further regional networks are developed around these centers of excellence, training, lab and
Activity Narrative: clinical support will be provided to secondary and primary points of service.
CONTRIBUTION TO OVERALL PROGRAM AREA:
These activities contribute to the goal of maintaining high quality services as the PEPFAR program
expands. APIN will perform 1,137,248 tests in COP08, including HIV diagnosis and tests for disease
monitoring including CD4 enumeration, PCR diagnosis of infants and VL. In addition, we seek to train 720
lab staff members in FY08. APIN will provide training at their supported training facilities to a large number
of non-APIN and non-PEPFAR supported laboratorians. Training lab staff will assist in building the human
resource capacity of our sites to provide sustainable lab support to sites providing high quality HCT and
ART treatment. Nine labs at tertiary care hospitals will have the capacity to perform early infant diagnosis
(EID) by HIV DNA PCR. These labs are also linked to PMTCT sites, to provide a mechanism for EID as a
part of the PEPFAR supported national scale-up plan (consistent with 2008 PEPFAR objectives for Nigeria).
APIN will partner with the GON and Clinton Foundation for procurement of EID test kits and specimen
collection supplies. The NIMR PCR lab will provide QA support for the EID program in the Southern half of
Nigeria (through retesting). Through a tiered system of labs at tertiary, secondary and primary sites we are
able to ensure that patients at community based primary facilities are provided with a full complement of lab
monitoring as a part of ART treatment and care. Our training activities include management and
competency training, which seeks to build sustainability. We have provided training to lab workers through
the MOH ART training program at the NIMR. Lab workers from all 36 states and the FCT are invited to
participate on a biannual basis at the NIMR and JUTH sites. Three of our sub-partner sites are actively
involved in lab training for the MOH training program resulting in 14,000 indirect targets without budget
allocation.
These activities relate to activities in PMTCT (3227.08), Counseling & Testing (5424.08), Palliative Care
TB/HIV (3222.08), ART Services (6715.08) and OVC (5415.08). Our labs are crucial in providing adequate
HIV diagnostics in PMTCT, C&T, OVC, Palliative care and ART services. Furthermore the lab provides
other diagnostics such as OIs. As a part of this activity, we seek to build linkages between labs and our
patient care sites in order to ensure that lab information is fed back into patient records for use in clinical
care. Our SI (3226.08) activities provide support in M&E, including data management of testing results.
This program targets public and private health care workers with training to maintain high quality lab
standards.
This activity focuses on infrastructure building, creating a network of quality labs supported by strong tertiary
labs, as well as commodity procurement and logistics. This activity also focuses on QA, training and the
development of networks / linkages. QA and training are reinforced by the collaborative nature of the tiered
network of labs. This program seeks to address gender equity by building the capacity of labs at affiliated
sites to conduct testing related to PMTCT. Increased lab capacity will permit the sites to provide equitable
treatment for both women and men.
Continuing Activity: 13050
13050 9912.08 HHS/Health Harvard University 6377 5330.08 HHS/HRSA $188,039
Estimated amount of funding that is planned for Human Capacity Development $350,000
Table 3.3.16:
