ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Nigeria, with a population of about 140million people (2006 census), ranked 5th among the 22 high TB

burden countries in the world and 2nd in Africa (2008 TB Global report). A total of 86,241 TB cases were

notified in Nigeria during 2007, representing a case notification rate of about 62/100,000 population. The TB

burden in the country is further compounded by the high HIV/AIDS prevalence. The prevalence of HIV/AIDS

among TB patients increased from 2.1 in 1991 to 19.1 in 2003 (National sentinel survey), and is now

estimated to be 27% (2007 TB Global report) which indicates that the TB situation will continue to be HIV-

driven.

The deadly interaction of TB and HIV affects millions of people in Nigeria, threatens public health, and

stretches the already weak health sector infrastructure. TB is the leading cause of morbidity and mortality

among People Living with HIV/AIDS (PLWHA), and HIV is fuelling the epidemic of TB in Nigeria. About 32%

of the notified TB cases in 2007 had access to HCT (2007 NTBLCP report), hence the need for further

expansion and strengthening of TB/HIV services towards reaching the universal access of care for co-

infected patients.

The planned activities for COP09 are linked to the goal of reducing the burden of TB and HIV in dually

affected populations and the three objectives of the WHO Interim Policy on Collaborative TB/HIV activities

which are: establishing mechanisms for coordination at all levels; reducing the burden of TB in HIV patients;

and reducing the burden of HIV among TB patients. The COP09 will place emphasis on TB infection control

measures while scaling up services to prevent transmission of TB. Another chief concern is MDR-TB, with a

current estimated prevalence of 1.9% and 9.3% among new and re-treatment TB cases respectively (2008

WHO Global report).

TB CAP will use COP09 funds to continue to provide technical assistance to federal and state TB and HIV

control programs to coordinate and scale up implementation of TB/HIV collaborative activities at the

National level and in the current 24 states. TB/HIV activities will be initiated and implemented in 80

additional DOTS centers from the existing 24 states, 12 ART sites and 12 community based organizations

providing HIV/AIDS care and support services.

The key intervention areas for COP09 will be to:

1.Strengthen capacity at National, State, LGA and facility levels to effectively coordinate and manage

TB/HIV collaborative activities

2.Scale up of TB/HIV collaborative activities

3.Involve community and faith based organizations in the implementation of the TB/HIV activities

4.Strengthen implementation of the 3Is in Nigeria

Support for MDR-TB (through WHO) and TB Drugs Logistics (through MSH) will be covered by the work

plan on TB DOTS Expansion. TBCAP has streamlined its activities under Child Survival Funds and

PEPFAR Funds among all country projects. Support for MDR-TB and TB Drug Logistics will be covered by

the work plan. Only specific TB/HIV activities as TB/HIV Capacity Building, expansion of collaborative

activities, implementation of the 3 Is (including infection control) and involvement of CBOs and FBOs

already working in the field of HIV/AIDS will thus fall under the COP09 application.

The Key activities that will be supported include:

Strengthen capacity at National, State and LGA levels to effectively coordinate and manage TB/HIV

collaborative activities:

DuringCOP08, TBCAP collaborated with Scientifico di Tradate, Italy to develop the skills of the national

facilitators from NTBLCP and NASCP in building capacity for TB/HIV management and leadership in

Nigeria. UnderCOP09, TBCAP will undertake the following activities:

Build capacity for State TBL Control Officers, State TBL supervisors and State HIV/AIDS Programme

Managers from 12 states on TB/HIV Leadership and management using the existing pool of facilitators;

Build capacity for 2 newly recruited programme staff each from NTBLCP and the HIV/AIDS Division of the

Federal Ministry of Health (FMOH) on TB/HIV leadership and management using the existing pool of

facilitators;

Support quarterly meetings of National TB/HIV working group;

Support quarterly meetings of State TB/HIV working groups in 24 states;

Support quarterly meetings of LGA TB/HIV working groups in 24 states; and

Support formation and monthly meetings of facility based TB/HIV coordinating committees in 204 Health

facilities.

Scale up of TB/HIV collaborative activities to 80 additional DOTS centers in 40 LGAs:COP09 will support

FMOH to scale up services to 80 additional DOTS centers from 20 LGAs in line with the NTBLCP & NASCP

scale up plan and in close collaboration with the International Federation of anti-Leprosy Associations

(ILEP) members in particular and other collaborative partners. The goal of this activity is to increase access

to TB/HIV services in the 24 states currently receiving support from FMOH with PEPFAR grants through

TBCAP in the implementation of TB/HIV collaborative activities while maintaining activities in the existing

centers. Provider initiated HIV testing and counseling services will be established in 80 additional DOTS

centers. One hundred and sixty general health workers from these facilities will be trained to provide DOTS

and health care provider initiated testing and counseling for TB suspects and patients. The workers will also

have the capacity to diagnose HIV in TB suspects, treat HIV positive persons with active TB, provide

Cotrimoxazole preventive therapy(CPT) and referral to ART clinics and care and support services. The

national HCT training curriculum will be used for CT training.

In addition, 80 laboratory staff from the identified 40 TB microscopy centers will be trained to conduct AFB

microscopy, carry out HIV testing in line with the national HIV testing algorithm and provide supervision

back up for other staff involved in multi point HCT service deliveries. The national strategy for HIV

Activity Narrative: counseling and testing to be implemented in these sites adopts a total and comprehensive approach to

client management. IEC materials will also be produced to raise awareness about the availability of the

TB/HIV services in the facilities and communities to increase service utilization. Technical assistance will be

provided by TBCAP staff to national, state and local government in mentoring, supervision and coordination

of TB/HIV activities at all levels. In collaboration with the FMOH, joint monitoring and supervision will be

conducted from all levels and FY09 funds will also be utilized as required for on-going revision, printing and

dissemination of national TB/HIV reporting and recording forms.

Involve community and faith based organizations in the implementation of the TB/HIV activities: The review

of the national guidelines on Community TB Care will be supported through the TBCAP mechanism in order

to increase the information on TB/HIV collaborative activities. Advocacy visits to the traditional and religious

leaders will be organized. A system will be developed within 6 selected states to involve two Community

and Faith Based Organizations (working in the field of HIV/AIDS) per state in TB case finding and case

holding activities. A TOT will be developed to enable master trainers (24) to train community volunteers

(120). HIV positive TB patients from the DOTS centers will be linked up to the community support groups

and poverty eradication of the Government, and nutritional support will be leveraged from the available

services in the communities for co-infected patients.

Strengthen implementation of the 3 Is (TB infection control, Isoniazide preventive therapy and Intensive

case findings) in Nigeria:The key major challenges in the scaling up of TB/HIV services nationwide are in

the area of effective implementation of the 3Is; these activities are vital in view of the emerging threat of

MDR-TB, the rates of morbidity and mortality among co-infected patients, and low TB case detection rate of

31% - which is still far below the set global target of 70% (NTBLCP annual report). COP09 will be used to

support effective implementation of the 3Is in Nigeria through support for the following activities:

a.Revision and dissemination of the national guidelines and SOPs on TB infection control;

b.Training of national and state staff from TB and HIV/AIDS control Programmes on TB infection control;

c.Capacity building for health workers from 80 Health facilities on TB Infection control;

d.Support the formation and monthly meetings of TB infection control committee in 80 Health facilities; this

committee will be incorporated into the existing TB/HIV coordinating committees at the facilities as a sub-

committee;

e.Support development and implementation of TB infection control plan in 80 Health facilities;

f.Support for basic renovation and upgrading activities at the microscopy centers;

g.Support expansion of DOTS and TB/HIV services in congregate settings such as Prisons and HIV Service

Delivery Centers in the 12 states (1 prison facility per state and 1 Care and Treatment Center per state);

and

h.Collaborate with FMOH and partners in implementing IPT in 12 selected ART centers.

Populations being Targeted

This activity targets HIV positive persons receiving treatment, care and support and HIV positive persons

with active TB, providing services to 2,500 HIV infected clients and 11,500 registered TB patients. In

addition, TBCAP will provide testing and counseling to 50,000 individuals and training to 304.

This activity also targets HIV patients who had hitherto not had access to TB screening and care, TB

suspects and patients from TB/DOTS centers who represent a high-risk population for HIV/AIDS. In Nigeria,

TB is the most common Opportunistic Infection (OI) in PLWHA and the one that causes most deaths among

this group. The new patient intake forms at ART sites provide space for grading TB symptoms and those

with grade of 1 or more are sent to DOTS sites for laboratory screening and, if necessary, radiological

screening. Those found with active TB are provided with TB treatment in line with the National guidelines.

This activity thus offers HIV patients a longer life free of the morbidity and mortality caused by TB.

The activity also focused on TB suspects and TB patients with unknown HIV status who will be provided

with provider initiated HIV testing and counseling and those with positive result among them provided with

CPT at DOTS centers, and linked to other necessary HIV services, thus reducing morbidity and mortality

among HIV positive TB patients.

Contributions to Overall Program Area

TB and HIV constitute a major public health problem in Nigeria. TB is the most common cause of morbidity

and mortality among HIV positive persons, in addition, HIV is the most important factor for increase in the

burden of TB in the country. This activity which focuses on reducing the burden TB and HIV among dually

infected patients will contribute to the goals of the Government of Nigeria towards reaching the Stop TB

targets, MDG targets and the Emergency Plan targets of providing HIV care to more than 1,500,000

persons while preventing 800,000 new infections by 2009.

While the DOTS strategy started by establishing TB clinics in primary health care facilities, the HIV/AIDS

strategy started by establishing ART facilities at tertiary institutions, the result has been an incongruity

between the location of DOTS clinics and ART facilities to the detriment of the dually infected. By linking TB

and HIV services, this activity contributes to the Federal Governments strategy to have DOTS clinics and

ART sites in the same facility or close by with a very strong referral mechanism.

This activity also offers both TB and HIV patients a longer life free of the morbidity and mortality caused by

TB and HIV interactions, thus allowing dually infected patients to contribute positively to the economic

development of the country thereby contributing to the poverty alleviation Programme of the Government.

Links to other USG resources and /or other donor support.

This activity is linked to ART, palliative care and community based care and support services which are

funded with PEPFAR funds through other implementers. This activity is also linked to ART services

supported with the Round 5 GFATM HIV/AIDS grants.

This activity will also leverage nutritional support in areas where organizations are providing such support.

Activity Narrative: This activity is also linked to the strategic direction of the National TB and Leprosy Control Program

(NTBLCP) to establish DOTS clinics in all the ART sites in the country to reduce the incongruity in the

availability of TB and HIV services and promote TB/HIV collaboration at the facility level. It is also linked to

that of NASCP at achieving universal access for HCT services by 2010 supported by either Government

funds, debt relief or MDG funds.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13105

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13105 12423.08 U.S. Agency for Tuberculosis 6393 6171.08 USAID Track $1,900,000

International Control Assistance 2.0 FS TB CAP

Development Program, KNCV

Foundation

12423 12423.07 U.S. Agency for Tuberculosis 6171 6171.07 KNCV $250,000

International Control Assistance Tuberculosis

Development Program, KNCV Foundation

Foundation

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $355,200

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12: