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 UNCHANGED FROM FY2008
ACTIVITY DESCRIPTION:
In COP08 IFESH supported PMTCT activities in 15 sites. In COP09 IFESH will continue to conduct
activities at these 15 sites. IFESH will support the equipping of two of the health facilities that are in rural
communities and will promote their utilization. All sites will be in Rivers and Imo states. IFESH will serve as
lead PEPFAR IP in Rivers state and will support and provide technical assistance to the Rivers state
government to improve the quality and coverage of PMTCT services in the state. A total of 8,000 pregnant
women will be counseled, tested and receive their results in COP09. Of this number, 352 pregnant positive
women will receive Antiretroviral (ARV) prophylaxis for PMTCT.
As in COP08, group health information and opt-out HIV testing and counseling (HCT) will be offered to all
pregnant women at antenatal clinic. IFESH will promote task shifting and the use of lay counselors,
particularly in facilities within hard-to-reach or underserved communities. Unbooked women presenting in
labor will be offered HCT. Same day results will be provided at all points of service. Posttest counseling will
be provided to all women. Couple counseling and partner testing will be offered on-site to increase
disclosure, address issues around discordance and increase support for mother's infant feeding choices.
HIV-positive pregnant women have access to laboratory services including CD4 counts. Samples for CD4
are collected and transported to the sites where CD4 machines are located. IFESH will strengthen this
network of sample transportation. Women requiring HAART for their own health (CD4 count less than 350)
will be referred to sites providing ART services with follow-up to ensure access to these services. PMTCT
services will be provided based on the recently revised (2007) Nigerian National PMTCT Guidelines. HIV-
infected women ineligible for HAART will receive zidovudine (AZT) from 28 weeks or AZT/3TC from 34
weeks and single dose nevirapine (sdNVP) at the onset of labor as well as the combivir tail for 7 days.
IFESH will initiate the provision of ‘take home' sdNVP at first contact. All HIV-positive women will be offered
pCTX (cotrimoxizole) within the 2nd or 3rd trimester depending on booking date. Women presenting in labor
will be offered HCT and if HIV-infected provided with sdNVP as well as the combivir tail for 7 days. All
infants born to HIV-infected women will receive sdNVP at birth and AZT for 6 weeks.
In COP09, IFESH will conduct support groups to promote utilization of PMTCT services, follow-up
mother/infant pairs to ensure uptake of ARV prophylaxis and provide support for infant feeding choices.
IFESH will support the provision of unbiased infant feeding counseling starting from ANC and continuing
through the postpartum period. Community-based workers will also ensure that infant feeding options are in
accordance with the WHO and the newly adopted Nigerian infant feeding guidelines: exclusive
breastfeeding for the first 6 months of life or exclusive breast milk substitute (BMS) if the AFASS criteria are
met. IFESH will strengthen its collaboration with traditional birth attendants (TBAs) in order to improve
uptake of PMTCT services. Cotrimoxazole prophylaxis will be provided to all exposed infants from 6 weeks
of age and continued pending definitive diagnosis of HIV status. IFESH will strengthen referrals of HIV-
exposed infants to appropriate pediatric care and treatment services as well as OVC services. IFESH will
support the provision of early infant diagnosis (EID) to HIV-exposed infants in line with the National EID
Initiative. Dried blood spot (DBS) samples will be sent to a PEPFAR-supported DNA PCR laboratory. In
addition to receiving PMTCT services, each HIV-positive woman will be referred to OVC services upon her
HIV diagnosis in order to facilitate care to all of her affected children.
For pregnant women who test negative, IFESH will support the provision of prevention counseling and
related support. In COP09, IFESH will initiate the provision of rapid testing in the existing family planning
(FP) clinics and also create linkages between the FP clinics and care and support services.
IFESH will use supervisory teams to conduct quarterly visits to all sites to ensure optimal quality of care. All
HIV-positive clients who are ART eligible will continue to be referred to the state ARV clinics and state
pediatric HIV clinics for treatment. In COP09, 60 PMTCT service providers will be trained using the recently
revised National PMTCT Training Manual. Step down trainings will also be carried out regularly to address
problems of staff transfer and attrition and also to maintain human capacity.
Quality Assurance (QA) for both counseling and testing will be carried out at timely intervals in COP09
through submitting blood samples to a designated reference laboratory for testing and sending certified
counselors for site assessments. All 15 sites will use the National PMTCT registers and data collection for
monitoring and evaluation of all activities in line with the National PMTCT MIS.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Supporting 15 sites in rural areas of Rivers and Imo states is in line with the desire of the Government of
Nigeria to have 1,200 PMTCT sites operational and with the USG`s target of having 80% coverage for
PMTCT across the country.
LINKS TO OTHER ACTIVITIES:
This activity is linked to activities in care and support, AB, other prevention, OVC, HCT, TB/HIV, and
strategic information . Prevention with positives counseling will be integrated within PMTCT care for HIV-
positive women. The basic package of care provided to all HIV-positive patients will be available to HIV-
positive pregnant women. Women requiring HAART for their own health will be linked to within network ARV
services. Laboratory staff will ensure that HIV testing provided within the PMTCT context is of high quality
by incorporating PMTCT sites into the laboratory QA program.
POPULATIONS BEING TARGETED:
This activity targets men and women of reproductive age, family planning clinics, pregnant women, their
spouses or partners, and the children of the index pregnancy and health care workers. Community and faith
-based organizations (CBOs, FBOs), support groups, and men will also be targeted so that they participate
fully in community-based PMTCT services.
EMPHASIS AREAS:
The PMTCT service has an emphasis on training, local organization capacity development and
development of linkages/ referral networks. This activity addresses the issue of "Gender" since services are
Activity Narrative: primarily targeted at women. The activity also addresses the key legislative area of "Stigma and
Discrimination" as issues of disclosure and discordance are addressed.
COVERAGE AREAS:
Sites are located in Rivers and Imo states, which were chosen based on high HIV prevalence and proximity
to each other.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13065
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13065 3248.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $400,000
Disease Control & Foundation for 2.0 IFESH
Prevention Education and Self
-Help
6725 3248.07 HHS/Centers for International 4172 555.07 Cooperative $345,000
Disease Control & Foundation for Agreement
3248 3248.06 HHS/Centers for International 2774 555.06 Cooperative $300,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $10,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,500
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $3,000
Water
Table 3.3.01:
This activity relates to HCT, PMTCT, Basic Care and Support, TB/HIV, and Strategic Information.
IFESH will continue its COP08 Abstinence/Be Faithful (AB) and other sexual prevention programs in
COP09. These will be implemented in line with PEPFAR Nigeria guidance for providing a comprehensive
package of prevention services to individuals through a balanced portfolio of activities. IFESH's goal is to
contribute to a reduction in HIV prevalence among youth, particularly in the most-at-risk age group of 15-24
year olds, promote mutual fidelity among married adults, and encourage safe sexual practices. The 2005
ANC survey in Nigeria indicates that among age cohorts in Nigeria, the 20-29 year old age group has the
highest HIV prevalence. In addition, the 2005 National HIV/AIDS and Reproductive Health Survey (NARHS)
demonstrated a low risk perception (28%) among the general population and significant reports of
transactional sex (11%) among young women aged 15-29 years.
In COP09, IFESH will continue its implementation of AB programming in underserved areas in Nigeria and
will couple these activities with condoms and other prevention programs, as well as linkages to counseling
and testing services, where appropriate. This activity will be implemented at the community level and will be
reinforced through national level mass media campaigns by other USG partners, such as the successful Zip
-Up campaign.
In-school youth will be targeted with AB messaging using the non curricula school-based activities, peer
education, and peer education plus strategies. These are derived from the recommended national minimum
package for sexual prevention activities. Abstinence clubs will be formed in schools and activities such as
film and game shows/quiz contests on AB messaging will be conducted. A total of 30 peer educators
selected from four schools will be trained in AB messaging and will work closely with IFESH to improve
program quality. For an individual to be counted as having been reached, (s)he must have received all three
listed interventions.
Priority populations to be targeted by AB and other prevention messaging, will be out-of school youth,
persons living with HIV/AIDS (PLWHAs), transport workers, orphans and vulnerable children (OVC)
receiving home based support, and clients accessing HIV counseling and testing (HCT) services. These
target groups will be reached with a minimum of three strategies selected from the following: community
awareness campaigns, HCT outreach, STI counseling or management, condom messaging/distribution, and
peer education models. Out-of school youth will be reached through community outreach and community
youth groups. PLWHAs and OVCs will be reached through support groups, and transport workers will be
reached at their motor parks through their unions. IFESH will implement this activity at both the facility and
community levels with messages conveyed in multiple fora. Each person will be reached with messages in
appropriate dose and intensity, delivered on a regular basis to stimulate behavior change
As a component of community based programming, messages will be communicated through local drama
presentations and singers drawn from the community. Information imparted will include the basics of HIV
prevention, especially condoms and other prevention (COP) and performers will be encouraged to build
prevention themes into their songs to promote sexual partner reduction and consistent condom use. A total
of 70 persons, including but not limited to health care workers, peer educators, teachers, religious leaders
and community volunteers will be trained in C&OP messaging. Community outreach will target most-at-risk
individuals with the purpose of limiting further infections. Doctors and counselors in STI, ante-natal care
(ANC) and postnatal clinics will distribute condoms and conduct prevention-with-positives advocacy
messages (i.e., HCT for family members and sex partners, counseling for discordant couples, counseling on
healthy lifestyles and positive living, prevention messages, and IEC materials on disclosure). For HIV
negative individuals, trained counselors will provide education on HIV/AIDS transmission, risk behaviors,
and risk reduction strategies, including condom use.
Condoms will be procured from Society for Family Health (SFH) for all IFESH sites. The provision of
condoms will be accompanied by individual and/or group counseling and demonstrations from experienced
counselors on their proper use. Information, education and communication (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 in all sites and all points of service within those sites.
A complete prevention package of materials utilizing both AB and COP programming will be distributed at
all HCT sites and at all points of service in health care facilities where IFESH is working. This will include AB
IEC materials and condoms. IFESH will target communities where registered clients live for the purpose of
community and school based AB messaging in order to continue to reinforce messages provided in the
facility setting.
There will be continued evaluation of current sexual prevention activities within communities that will be
used to guide specific activities to be conducted under each strategy in the target communities. Gaps in
programming identified in COP08 will be addressed so that IFESH can effectively work within and contribute
to a comprehensive and harmonized national program. AB messages will be balanced with concurrent
condoms and other prevention messaging where appropriate, and will be integrated with services provided
by IFESH in a total of 34 sites (20 HCT sites including facility-based, 10 DOTS sites, and four schools) and
surrounding communities in two states (Imo and Rivers).The program will be designed to achieve maximum
coverage for these communities with balanced ABC messaging. Individuals will be reached on a regular
basis with a minimum of three of the listed prevention strategies IFESH will employ.
The target for this intensive prevention campaign is 2,273 persons (1,200 males and 1,073 females) for AB
messaging and 4,242 (2,400 males and 1,842 females) persons for COP messaging. All in all, age
appropriate abstinence only messaging and secondary abstinence messaging will be conveyed to 1,000
children and adolescents (600 males and 400 females), particularly focused on in-school youth and OVC
receiving home based support. A total of 100 people will be trained in the two program areas.
CONTRIBUTION TO OVERALL PROGRAM AREA:
Activity Narrative: IFESH activities are in line with the PEPFAR vision of enhancing indigenous capacity to provide integrated
HIV/AIDS services from the community to the national level, and in the process strengthen the health care
system and the capacity of local development partners. These prevention activities are consistent with
PEPFAR's five year goals for Nigeria, which plan to prevent 1,145,545 new infections through a number of
prevention strategies including (but not limited to) condoms and other prevention to specific high risk
groups.
In order to be maximally effective, the prevention messages developed at different sites will be targeted to
the various high risk groups that they serve. These activities are in line with the PEPFAR 5 year strategy,
which seeks to scale up prevention services, build capacity for long term prevention programs and target
outreach to promote correct and consistent use of condoms with MARPs to reduce the risk of HIV infection.
The continuation of IFESH-supported services in HCT and PMTCT as well as STI management will help
facilitate the scale up of the overall program, and increase utilization of these services, expected to result
from other prevention and outreach initiatives.
This activity relates to HCT, PMTCT, basic care and support, TB/HIV, and strategic information. Prevention
for positives counseling, including promotion of condom use will be an important component of post-test
counseling in STI clinics. Prevention for positives counseling will be incorporated into counseling for
persons receiving antiretroviral (ARV) treatment. This service will also complement HCT services for those
who ultimately test HIV-negative. Through this program as well as basic care and support, IFESH will
ensure access to STI treatment.
This activity focuses on discordant couples, STI patients, TB patients, PMTCT patients, PLWHA, and youth.
Training will also be focused on healthcare workers, counselors, and volunteers.
EMPHASIS AREA:
An emphasis area for this activity is human capacity development in order to build the organizational
capacity of HCT service outlets to provide a full range of prevention strategies, including correct and
consistent use of condoms to persons attending these centers. Other emphasis areas include gender and
local organization capacity building
Rivers and Imo states
Continuing Activity: 15679
15679 15679.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $50,000
Estimated amount of funding that is planned for Human Capacity Development $11,150
Estimated amount of funding that is planned for Education $12,500
Table 3.3.02:
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.03:
By the end of COP08 IFESH will reach a total of 30 sites. These 30 sites will be maintained in COP09.
IFESH will continue to provide basic care and support services to individuals identified as HIV+ from HCT,
TB/HIV and PMTCT programs. Care and support services will also be provided to family
members/household members of PLWHA. Services will be provided through the 30 sites (where HCT,
TB/HIV and PMTCT services are provided) located in Rivers and Imo states. Sites are located in states
chosen based upon high prevalence in the most recent 2005 antenatal HIV sero-survey and geo-political
distribution. This activity provides a critical component of the complete HIV related care package by offering
initial care and support to HIV-infected individuals. As in COP08 activities IFESH will provide basic care and
support services to 3,500 PLWHA and an estimated 7,000 People Affected by HIV/AIDS (PABAs).
Following National Palliative Care Guidelines and USG PC guidance, HIV positive persons identified
through mobile/community HCT, PMTCT and DOTS activities will be provided with basic care package. All
PLWHAs will receive clinical services (lab, OI management, pain management, nutritional assessment) with
basic care kits (water treatment solution, water vessel, Insecticide Treated Nets (ITNs), soap, condoms, and
prevention for positives IEC materials) plus two other services in the domain of psychosocial, HBC, spiritual,
Prevention with Positives (PwP) and other prevention services. Clients will be provided with training and
education in self care. The activities will be approximately 20% laboratory monitoring and OI diagnostics,
30% OI management and prevention (i.e., cotrimoxozole), and 50% Home Based Care. PwP activities will
include referral for HCT of family members and sex partners, counseling for discordant couples, provider
delivered prevention messages and IEC materials on disclosure. All enrolled into care will receive risk
assessment and behavioral counseling to achieve risk reduction.
IFESH will facilitate support group activities to combat denial, stigma and discrimination. Funds will support
the recruitment of a Care & Support program specialist to facilitate program activities in the field.
Community home based care will be provided in the catchment areas that IFESH supports. This will be
implemented by a team of trained community health extension workers and community volunteers, among
whom would be retired nurses and midwives within the community and volunteer PLWHA from support
groups. Standardized provider HBC kits (consisting of ORS, bleach, cotton wool, latex gloves, soap,
calamine lotion, vaseline, gentian violet, etc.) will be provided to each trained HBC provider for use when
visiting clients. PLWHAs will be provided with basic care kits. All identified HIV positive persons will be
linked to treatment facilities with comprehensive HIV/AIDS related services for baseline laboratory
investigations and for referral for ART when and where indicated. Laboratory monitoring (CD4 counts,
hematology, blood chemistry, and malaria smears) will be supported from this funding. All enrolled are
encouraged to register in a support group whose activities are facilitated by the IFESH C&S team. All clients
are referred to a support group where they receive a two way referral form which is used to track the
success of referrals. This activity will be integrated with primary prevention, PMTCT and HCT programs
emphasizing the "home-based" prevention component to ensure that family members at risk are tested and
counseled, a strategy that supports family engagement in home-based care and support. The team of
Home based care providers will be linked to a facility within their catchment area.
The capacity of the 30 healthcare facilities in the targeted areas will be strengthened to provide quality care
and support to the PLWHAs. Master trainers from IFESH will facilitate trainings using the National training
curricula. Health Care Workers (HCW) and community volunteers (including PLWHAs) will be trained and re
-trained to provide care and support services. A total of 60 care providers will be trained. Home base care
teams will provide counseling services, nutritional education and demonstrations, psychosocial support,
basic nursing care, PwP and pain management. IFESH plans to provide HBC services for full coverage of
all 30 sites by the end of COP09.
This activity provides services which are a high priority for the 2-7-10 Emergency Plan strategy by providing
basic care services for 3500 HIV+ adults and 7000 PABAs. The services are consistent with the Guidelines
for Palliative Care in Nigeria and the USG Palliative Care Policy. Capacity development and consistency
with national guidelines will ensure sustainability.
This activity is linked to HCT, PMTCT, OVC, other prevention, and TB/HIV. All patients are monitored and
linked to ARV therapy when indicated. Care and support services such as psychosocial support and
symptom management promote ARV adherence. Services will be integrated with prevention for positives
activities including counseling and condom availability. Home based care programs will be implemented by
a number of indigenous NGOs, CBOs, and FBOs. Sub-agreements will be coordinated with other
Emergency Plan IPs to ensure non-overlap of funding and services. Women will be linked to Income
Generating Activities (IGAs) where available.
Targeted populations include MARPs, TB patients and People Living with HIV/AIDS. Services are offered to
adults living with HIV/AIDS and their affected family members, men and women of reproductive age,
pregnant women, their spouses or partners, and health care workers. Sites have been chosen to maximize
linkage with USG supported facilities providing comprehensive HIV treatment services and to provide
services for HIV+ pregnant women identified through PMTCT. Nurses, other health workers as well as
volunteer PLWHA and caregivers of PLWHAs are targeted for training.
Emphasis areas include human capacity development, local organization capacity building, SI and TB
wraparound programs.
Activity Narrative: ACTIVITY UNCHANGED FROM FY2008
Activity Narrative:
Continuing Activity: 13066
13066 5665.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $150,000
6747 5665.07 HHS/Centers for International 4172 555.07 Cooperative $200,000
5665 5665.06 HHS/Centers for International 2774 555.06 Cooperative $75,000
* Increasing women's access to income and productive resources
* Family Planning
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $5,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Estimated amount of funding that is planned for Economic Strengthening $37,000
Estimated amount of funding that is planned for Water $7,650
Table 3.3.08:
In COP09, IFESH will provide care and support services and preventive care packages to HIV-exposed and
infected children. IFESH will provide services to 1,250 HIV infected children at 30 sites located in Rivers
and Imo states in which HCT, TB/HIV and PMTCT services are also provided. The pediatric care program
will provide clinical services (basic nursing, lab, OI management, pain management, and nutritional
assessment) with basic care kits (water treatment solution, water vessel, ORS, Insecticide Treated Nets
(ITNs), soap with IEC materials) plus two other services in the domain of psychosocial, spiritual, and other
prevention services. Home-based care (HBC) services will also be provided. IFESH will work in close
partnership with other PEPFAR IPs, the Clinton Foundation, and the government of Nigeria (GON) to offer
early infant diagnosis (EID) to HIV-exposed infants in line with the National EID Initiative. Clients will be
referred to designated IFESH dried blood spot (DBS) collection sites where samples will be sent to a
PEPFAR-supported DNA PCR laboratory.
IFESH will provide care services in a family centered approach, identifying HIV-infected women during
pregnancy through its PMTCT program, and following the mother and the infant after birth with care
services. The package of health services which will be available to all HIV-positive children includes access
to ARVs, appropriate TB diagnostics, and linkages with GON sponsored DOTS programs. Enrolled children
will also be provided with anti-malaria prophylaxis and symptom management, including provision of
pediatric OI formulations. In COP09 IFESH will continue to follow SOPs for the treatment of common
opportunistic infections.
Access to food and nutrition support is a significant need for HIV-exposed and HIV-positive children. IFESH
will provide comprehensive nutritional support for such children (especially those that are clinically
malnourished) including assessment, counseling, supplementation and multivitamins/minerals, with referral
for therapeutic nutritional services. Linkages with community nongovernmental organizations (NGOs) and
faith based organizations (FBOs) as well as traditional community OVC providers will also be established
for ongoing food and nutrition resource support. IFESH will network with other PEPFAR IPs and with the
Clinton Foundation and other global donors to leverage funds for appropriate nutritional supplements for
HIV-positive children.
Psychosocial support including disclosure management, grief and loss, and stigma and discrimination
issues will be provided to all identified HIV-positive children. HIV-positive children will access OVC support
groups which will be facilitated by CBOs/FBOs for peer support and recreational activities.
HBC will be implemented by an HBC team comprised of a supervising community home-based care nurse,
health extension workers and volunteers including PLWHAs. This activity will be linked to primary
prevention and HCT programs to ensure that family members at risk are tested and counseled - a strategy
that supports family engagement in home-based care and support. All HBC providers will be trained on HIV
counseling and testing to enable them carry out HCT services in the homes of enrolled children. Basic care
kits containing ITN, water guard, water vessel, soap, ORS, latex gloves and age appropriate prevention with
positives (PwP) IEC materials will be distributed to enrolled children. A standardized provider HBC kit
(consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline, gentian violet, analgesics,
etc.) will be carried by each trained HBC provider for use on home visits. HBC will be linked to the facility
through the supervising community home-based care nurse. Care and support drugs and commodities will
be procured through a central purchase mechanism. IFESH will develop effective two way referral
mechanisms to secondary and tertiary health care facilities for enrolment into ART when needed. As part of
retention strategies, enrolled children and care givers will be linked to the IFESH OVC program for
supplemental services and participation in the OVC Kids Club. HBC trace defaulters will also facilitate client
retention. IFESH will leverage resources to make the facilities kids friendly.
IFESH will provide trainings for facility providers to strengthen their capacity to provide psychosocial support
for children and improve the quality of counseling that they provide to children and their care givers at points
of service. The trainings will be provided to 60 care providers using the national training curriculum. IFESH
will work in COP09 with the GON, other IPs, FBOs and community resources to promote better access to
pediatric care and support services.
Monitoring and Evaluation (M&E) of the program will be supported by IFESH's M&E program officers who
will provide national registers, forms and tools for data collection. All staff will be trained to recognize and
use these tools appropriately, and provide supportive supervision around data capture after service
provision so that pediatric clinical care services are appropriately documented. IFESH will provide training to
state M&E officers and involve them in supervisory functions to ensure sustainability.
This activity provides services which are a high priority for the EP strategy by providing a basic package of
services for all identified HIV-positive children and their families. Pediatric care and support activities are
consistent with the PEPFAR goal of scaling up capacity to provide services to more HIV-positive children.
IFESH will continue to support the expansion of services into more underserved areas by developing a
network model. These networks will ensure that facilities are able to develop linkages, which permit patient
referral from primary health centers to specialized care centers. The program will also contribute to
strengthening human capacity through training of health workers, community workers and HIV-positive
children and their families.
This activity is linked to PMTCT, counseling and testing, TB/HIV, AB and other prevention, and strategic
information. HCT services will be available to OVCs in HIV-affected families. Exposed children will be
identified at birth through the PMTCT program. All HIV-positive children are monitored and linked to ARV
therapy when indicated. Pediatric care and support services will promote ARV adherence. Services are co-
located in facilities with TB DOTS centers and IFESH staff work with sites to ensure coordination systems
are in place for referral and diagnosis of TB. Data reporting services supported by IFESH will be available at
sites. Home-based care programs will be implemented under the guidance of IFESH.
Activity Narrative: POPULATIONS BEING TARGETED:
This program targets HIV-exposed and infected children and their families. Healthcare workers in the public
and private sector are targeted for training.
Emphasis areas for this activity are human capacity development, local organization capacity building and
SI. This program seeks to increase gender equity in programming through counseling and educational
messages targeted at girls and boys. Furthermore, through gender sensitive programming and improved
quality services, the program will contribute to reduction in stigma and discrimination and address male
norms and behaviors by encouraging men to contribute to care and treatment in families.
Continuing Activity: 15678
15678 15678.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $500,000
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $3,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $750
Estimated amount of funding that is planned for Food and Nutrition: Commodities $7,500
Estimated amount of funding that is planned for Education $1,500
Estimated amount of funding that is planned for Water $2,750
Table 3.3.10:
Under COP08 HCT programming, IFESH reached 10 TB DOTS sites. In COP09, IFESH will maintain TB
DOTS points of service in its current 10 sites in two states (Rivers and Imo). In COP09 IFESH will
strengthen HCT services in DOTS centers and collaborate with the National TB and Leprosy Control
Program (NTBLCP) to provide TB screening for HIV positive clients. 352 HIV positive clients from the HCT
program will be screened for TB in collaboration with the NTLCP.
A total of 5,000 newly presenting TB suspect patients developing symptoms will be screened for HIV and
provided appropriate counseling based on results. Of these, it is expected that 500 will have TB and, of
those, 150 (30%) will have TB/HIV co-infection. DOTS site personnel will also be trained in HIV diagnosis
using HIV rapid test kits and educated in referring HIV+ individuals to comprehensive care for assessment
including for antiretroviral treatment eligibility. The focus of the IFESH TB/HIV program is on ensuring
adequate and prompt linkage of TB patients and their household contacts to HIV counseling, testing, care
and treatment services, to ensure that all HIV patients are screened for TB, and to enable all HIV-infected
patients with TB to access services at DOTS clinics.
IFESH will partner with PEPFAR implementing partners specializing in lab programs to facilitate QA
programs to ensure quality of services. IFESH master trainers will train and work with TB DOTS staff to
ensure that HIV testing provided within the TB DOTS context is of high quality by incorporating TB DOTS
sites into the laboratory QA program. A TB diagnostics QA program will be conducted including: joint site
visits with the FMOH or relevant State MOH for observation/retraining, selective review of completed smear
examinations, and proficiency testing with "unknown" slides provided by the QA team. Regarding quality of
TB treatment being provided, IFESH will work in close collaboration with the German Leprosy and TB Relief
Association (GLRA) to ensure that TB DOTS staffs are following the National TB treatment algorithm.
IFESH will support training, including refresher on x-ray diagnostics and sputum microscopy training, for a
total of 15 staff in TB treatment.
IFESH will support facilities in procuring supplies, laboratory reagents and consumables. Microscopes will
be provided to sites where deficiencies are noted. IFESH will collaborate with other IPs and the NTLCP to
ensure that the principle of the 3 "I"s of intensive case finding amongst HIVpositive clients, INH preventive
therapy (IPT) and TB infection control at health facilities are implemented in all our sites. Nosocomial
transmission of TB will be prevented through such measures and principles as basic hygiene, proper
sputum disposal, and good cross ventilation at clinics. The national guidelines on infection control on co-
located sites will be implemented in all IFESH-supported sites.
The IFESH M&E staff will work with sites to ensure that incident TB cases are properly reported to the
FMOH. IFESH will network with Global Fund in implementing these plans to avoid duplication of services to
be developed under Global Fund. IFESH will provide palliative care to TB/HIV co-infected patients including
other opportunistic infections and will refer appropriately for ART. Cotrimoxazole Preventive Therapy (CPT)
will be provided to eligible TB/HIV patients as a component of basic care and support. HCT in DOTS sites
will be established at the secondary and primary health center levels with linkages to tertiary centers to
provide accessibility of services to patients. The TB DOTS sites will be supported to provide holistic patient
care according to National and IMAI guidelines. Sites will be assisted to put in place and/or improve
defaulter tracking mechanisms.
Training and support to improve the quality and integration of TB/HIV services are consistent with FMOH
and PEPFAR priorities. The aims are co-location of HCT services in the TB DOTS setting, an increased
number of TB suspect patients screened for HIV, appropriate provision of care and support for HIV+ clients,
and improvement of overall TB services (i.e., diagnostics and treatment) at supported sites. An overarching
focus on technical capacity development will ensure sustainability. Smear microscopy QA will be carried out
collaboratively with the FMOH or the relevant state MOH to promote sustainability through capacity
development and integration into the health sector system.
This activity is also linked to Counseling and Testing, Basic Care and Support, OVC, Abstinence and Be
Faithful, PMTCT, Strategic Information, and Condoms & Other Prevention. Linkage to TB diagnosis and
treatment is an important component of adult Care and Support and OVC services.
TB suspect patients, PLWHA, OVC, pregnant women and their family members are targeted in this activity.
The emphasis areas are human capacity development, local organizational strengthening and SI.
Continuing Activity: 15665
15665 15665.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $100,000
* TB
Estimated amount of funding that is planned for Education $2,000
Table 3.3.12:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In COP09 IFESH will serve 30 sites in Rivers and Imo States and will continue to provide preventive care
and support packages to all categories of orphans and vulnerable children (OVC) and their caregivers. In
addition, IFESH will provide economic empowerment activities to child headed households and to OVC
caregivers based on a needs assessment using the Child Status Index. IFESH will continue to provide
primary direct OVC services to 2000 OVC clients at all 30 of our sites which also offer HIV Counseling and
Testing (HCT), TB/HIV, and prevention of mother to child transmission (PMTCT) services. Sites are located
in states chosen based upon high prevalence in the most recent 2005 antenatal HIV sero-survey and geo-
political distribution. In its OVC programming, IFESH will focus on providing health services, nutrition,
psychosocial support, and educational support to OVC. IFESH will refer OVC and their caregivers to
providers of other services such as protection, shelter and ART eligible OVC for treatment, and vocational
training.
IFESH will provide OVC services in a family centered approach, identifying HIV infected women during
pregnancy through its PMTCT program, and following the mother and the infant after birth with care and
OVC services. The package of health services which will be available to all OVC and their eligible
caregivers receiving services includes: referral to appropriate TB diagnostics and linkage with Government
of Nigeria (GON)-sponsored DOTS programs described under TB/HIV; training for parents/caregivers in
appropriate water purification and basic pediatric health, caregiver education of diarrhea management and
oral rehydration salts preparation, provision of water guard, provision of insecticide-treated mosquito nets;
insuring that OVC obtain childhood immunizations, growth monitoring and assistance with birth registration.
Access to food and nutrition support is a significant need for OVC. IFESH will provide comprehensive
nutritional support for 1200 OVC, especially those that are clearly malnourished, including assessment,
counseling, supplementation and multivitamins/minerals, with referral for therapeutic nutritional services.
More linkages with community non-governmental organizations (NGOs) and faith-based organizations
(FBOs) will be established for food and nutrition resource support. IFESH will network with other PEPFAR
Implementing Partners (IPs), the Clinton Foundation, and other global donors to leverage funds for
appropriate nutritional supplements for OVC.
In COP09, IFESH will provide Supplemental Direct services to 800 OVC out of which 100 OVC will receive
educational support which will include school uniforms, books, shoes, and school fees. IFESH staff and
trained volunteers will continue to provide supportive supervision for academic and psychosocial issues
through existing relationships with the school administration and teachers. This will allow early recognition
of problems that need to be addressed.
Psychosocial support including disclosure management, grief and loss, stigma and discrimination issues,
etc. will be provided to all identified OVC. Support groups for OVC will be facilitated by CBOs/FBOs for peer
support and recreational activities. In COP09, IFESH will provide trainings for community based home care
providers to strengthen their capacity to provide psychosocial support for children, improve the quality of
counseling available for children in the community. The trainings will include counseling of children, child
development, disclosure of the diagnosis, grief and loss, legal and protection issues and adherence to
medications. One hundred (100) community/home based care providers will be trained through this activity.
The trained community based providers will conduct step down training to the caregivers in the households
they serve. IFESH will work in COP09 with the GON, other IPs, FBOs and community resources to
promote and advocate for OVC issues. In COP09 IFESH will continue to work with the Rivers State
Sustainable Development Agency to address OVC issues.
The Child Status Index tracking form will be utilized to ensure that each child's needs have been assessed
and children referred to appropriate services. Quality of services will be ensured through supportive
supervision, feedback from families of OVC, and through regular monitoring of OVC.
COVERAGE AREA:
IFESH is working in Rivers and Imo States.
This activity provides services which are a high priority for the 2-7-10 PEPFAR strategy by providing
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
the Standard Operational Guideline for OVC services. Capacity development at the site level and
consistency with national guidelines will ensure sustainability. IFESH staff will contribute to the development
of a National OVC training curriculum, identified as a priority by the Federal Ministry of Health.
This activity is linked to PMTCT, Counseling and Testing, TB/HIV, sexual prevention and Strategic
Information. HCT services will be available to OVC in HIV-affected families. OVC will be identified at birth
through the PMTCT program. All HIV-positive OVC are monitored and referred to anti-retroviral (ARV)
therapy when indicated. OVC services such as psychosocial support for families and symptom
management promote ARV adherence. Services are co-located in facilities with TB DOTS centers, and
IFESH staff work with sites to ensure coordination systems are in place for referral and diagnosis of TB in
OVC. Data reporting services supported by IFESH will be available at sites. Home based care programs will
be implemented under the guidance of IFESH.
OVC services are offered to HIV-exposed infants, HIV-positive children, children orphaned by HIV,
caregivers of OVC/PLWHAs, pregnant women and HIV/AIDS affected families. Health workers in the public
and private sector are targeted for training. Community groups including CBOs, NGOs and FBOs will be
targeted for training, linkages and identifying OVC.
Activity Narrative: EMPHASIS AREAS:
Emphasis areas for this activity are human capacity development, local organization capacity building, child
survival strategies, and strategic information.
Estimated amount of funding that is planned for Human Capacity Development $15,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $65,000
Estimated amount of funding that is planned for Economic Strengthening $40,000
Estimated amount of funding that is planned for Education $45,000
Estimated amount of funding that is planned for Water $11,000
Table 3.3.13:
HCT services under COP08 were provided at 20 sites; in COP09 IFESH will continue to maintain services
in these 20 sites in Rivers and Imo states (10 per state). Under COP09, IFESH will provide access to quality
HIV counseling and testing (HCT) services to 8,000 individuals who will also receive their results. Staff and
volunteers will also conduct focused community outreach HCT activities from the 20 sites. In order to
accomplish this, HCT services will be targeted to populations that have been shown to be at increased risk
for being infected with HIV through high-risk behaviors. Targeting this population will identify HIV-infected
individuals and provide them with appropriate counseling, care and treatment. All individuals requiring
treatment will be referred to ART treatment sites in the states. Additionally, IFESH will work 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. Under COP09, IFESH will continue to provide HCT at all
points of service within all IFESH-supported health care facilities using provider initiated and opt-out
approaches.
Counseling and information, education, and communication (IEC) materials will focus on abstinence, be
faithful, and consistent and correct condom use (ABC), providing this messaging in a balanced approach
appropriate for each individual client. For clients testing HIV-positive, prevention with positives (PwP)
services will be provided, including HCT for family members and sex partners, counseling for discordant
couples, counseling on healthy lifestyles and positive living, prevention messages, and IEC materials on
disclosure. Post-test counseling for those testing negative will focus on prevention using the ABC approach
as well, and partner testing will be strengthened. Based on risk assessment, a follow-up testing interval will
be recommended.
Funding will be used to support the training of staff utilizing HIV counseling and testing standard operating
procedures (SOPs) and the standardized National training curriculum. 30 people will be trained on
counseling and rapid testing at the 20 service outlets. Some of those trained will be community health
workers who will do mobile HCT in order to carry out family centered home-based HCT during home care
visits for PMTCT, OVC, and basic care and support clients. Training will be appropriately tailored to the
targeted population to which it will be delivered, and counseling will be provided in local languages
whenever possible. In view of the remoteness of most communities in these states and the trend towards
home-based testing, IFESH will establish mobile HCT teams specifically to target hard-to-reach high risk
groups such as commercial sex workers and truck/long distance drivers at community and ward levels. Due
to the risk of HIV infection among these populations, a key component of the HCT delivery will include
enhancing the linkage of the HIV-infected individuals to HIV care and treatment services as necessary.
IFESH will educate communities in local languages in order to increase awareness of such services.
Counselors fluent in these local languages will be available to ensure that appropriate counseling messages
are conveyed to the clients. Individuals who received counseling and testing for HIV and received their test
results (including TB) will be 13,000.
All testing will be conducted using the nationally approved algorithm for HIV testing that utilizes rapid test
kits and same day results. IFESH laboratory program officers will provide training and supportive
supervision. A quality assurance program will be put in place to ensure the accuracy of testing particularly
for testing conducted outside of health facilities. Quality Assurance (QA) for both counseling and testing will
be carried out at timely intervals in COP09 through submitting blood samples to a designated reference
laboratory for testing and sending certified counselors for site assessments. IFESH will communicate with
the USG laboratory team and other IPs to ensure that its laboratory QA system is of high quality.
CONTRIBUTION TO THE OVERALL PROGRAM:
The activities supported with these funds are in line with both the Government of Nigeria and the
Emergency Plan strategies for addressing HIV/AIDS. Increasing access to HCT, particularly to high risk
populations, will be utilized to identify individuals that will benefit from prevention, care, and treatment
activities. Clients found to be infected with HIV will be linked to prevention with positives and care and
treatment services. Those individuals found to be HIV-negative will be provided with counseling and
prevention services to remain negative.
This activity is linked to adult and pediatric care and treatment, PMTCT, condoms and other prevention,
TB/HIV, OVC, AB, and strategic information.
This activity targets those individuals known to be at increased risk of HIV infection in Nigeria. These
include most at risk populations (MARPS), hospital patients, commercial sex workers, uniformed
populations, mobile populations, truck drivers, and out of school youth. To accomplish this, HCT services
will be located where such populations are known to congregate.
This activity includes an emphasis on training.
Sites are located in states chosen upon high prevalence in the most recent 2005 ANC survey and include
Rivers and Imo states.
Continuing Activity: 13067
13067 5668.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $300,000
6748 5668.07 HHS/Centers for International 4172 555.07 Cooperative $275,000
5668 5668.06 HHS/Centers for International 2774 555.06 Cooperative $100,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $7,000
Table 3.3.14:
ACTIVITY IS MODIFIED IN THE FOLLOWING WAYS
1.State level M&E capacity building.
2.Quality management including HIVQUAL participation
In COP08, IFESH is working in 35sites (20 hospitals, 10 TB DOTS sites, five community sites for OVC/adult
care/ABC activities) in two states (Rivers and Imo). M&E activities of trainings, workshops, provision of
Technical Assistance (TAs) and Data Quality Assurance (DQA) will continue in all our sites up to the end of
COP08. We shall be working towards achieving our targets of training 36 M&E officers and provision of 35
TAs to the various facilities.
In COP09 IFESH will continue with its activities under Strategic Information (SI) across the 7 program areas
for a total of 35 sites. One of our priorities is to strengthen SI under the "One M&E Framework" by
supporting standardized HIV indicator reporting systems at program sites. For facilities where there are
other donor supports, data collection and indicator reporting will be harmonized and one reporting system
will be used in accordance with the national guidelines. IFESH will work with USG and Government of
Nigeria (GON) to include IFESH-supported facilities into the National Public Health data system
(Voxiva/LHPMIP platform). IFESH will be an active participant on the USG SI working group supporting
PEPFAR in Nigeria.
Funding will be used to provide information technology (IT) infrastructure for data aggregation and reporting.
Effective use of paper-based and electronic data systems will be promoted in clinical settings to enhance
the enrollment, follow-up, assessment, and referral/linkages to other IFESH-supported services (e.g., TB,
PMTCT, STI, home-based care, HCT, etc.) and to services outside of IFESH's programs (e.g., ART
services) for all clients.
IFESH will have a dedicated M&E staff who will work with state M&E focal person and site-level staff to
ensure proper data collection and dissemination to relevant authorities. IFESH will collaborate with state
level M&E authorities in manpower training meeting in order to build and sustain capacity for M&E within the
states. IFESH will also work with the State Ministry of Health and State Action Committee on AIDS (SACA)
to strengthen their M&E framework. National registers and data collection tools will be used at all service
delivery points. IFESH will ensure that copies of registers are available and in use at sites and will provide
technical assistance and supportive supervision to all site M&E staff to ensure these tools are being used
correctly.
Randomly selected individual patient records will be reviewed across Management Information System
(MIS) tools as one method of assessing accuracy. For sites identified as having problems with data
reporting requirements, the M&E staff will work with such sites in developing a corrective plan that may
include follow-up through additional visits, mentoring and regular communication/reporting via other means
(phone, email, etc). IFESH will organize DQA training workshops and step-down trainings for states and site
level M&E staff and will liaise with the USG SI staff to support the development and implement of DQA
activities. This will ensure harmonization with PEPFAR and GON national guidelines. Ensuring the delivery
of high quality services will be the hallmark of project implementation in COP09, and IFESH will be disposed
to participating in the USG/GON quality management activities including HIVQUAL.
Periodic review of data collected through facility and community-based services will be performed to support
evidence-based decision making to improve program quality and effectiveness. IFESH will also work with
on-site administrators and staff on analyzing and using data from their sites for decision-making, thus
promoting sustainability of the program.
.
In COP09, IFESH will train 41 more individuals in addition to those trained in COP08 and will including 1
IFESH staff, 35 site level staff 5 state level M&E officers (3 from Imo state and 2 from Rivers state) on data
collection, data use and reporting. Technical assistance will be provided to the states and 3 problematic
sites, therefore a total of 5 TAs will be provided in all.
Strengthening SI will enable timely, transparent, and quality data reporting. Through concurrent
collaboration with the Government of Nigeria and the PEPFAR team IFESH will support the establishment
of one standardized system to monitor National HIV programs.
SI activities are cross-cutting and relate to PMTCT, condoms and other prevention, abstinence and be
faithful messaging, adult basic care and support, TB/HIV, OVC, and counseling and testing. Linkages
between these program activities will be strengthened to improve efficiency and effectiveness of services in
order to enhance the formation of networks of care.
This activity targets health care providers on best practices of information demand, use and reporting.
These include program managers and M&E officers, site coordinators and administrators to provide them
with skills and tools for programmatic evaluation.
This activity includes major emphasis on human capacity development and SI.
Continuing Activity: 15669
15669 15669.08 HHS/Centers for International 6380 555.08 HHS/CDC Track $40,000
Estimated amount of funding that is planned for Human Capacity Development $8,000
Table 3.3.17:
