PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In COP09 LMS will continue the activities initiated in 17 project-supported sites in Kogi, Niger, Adamawa,
Taraba, Kebbi and Kwara States during COP07 and COP08. In addition, PMTCT services will be initiated at
2 secondary and 10 PHC health facilities in existing states. This makes a total of 29 PMTCT sites in
COP09. Using the revised National PMTCT Guidelines, 12,000 pregnant women will be counseled, tested
and receive their results and 560 HIV-positive pregnant women will receive ARV prophylaxis. In addition,
LMS will provide food and nutritional supplementation to 50 HIV-positive pregnant women/lactating women
and will train 175 health care workers to work in ANC clinics and delivery wards.
In Nigeria, PMTCT services were originally available only at the tertiary level, but are now being expanded
to the secondary level. In COP09, PMTCT services will further be decentralized to the primary care and
community levels to ensure increased access of PMTCT services to remote populations. All women tested
including HIV-negative women will receive posttest counseling to encourage them to remain negative. Peer
support coordinators will provide continuing support after testing and encourage pregnant women to adhere
to their ART prophylaxis and safe infant feeding choices. Members of peer support groups will be trained
and supported to provide ongoing counseling to newly recruited PMTCT mothers. LMS will emphasize and
support the provision of PMTCT services at selected primary care level facilities that have capacity for
providing minimum PMTCT services that include group health information, post test counseling, lab
investigation, dispensing of NVP and client follow-up using PLWHA and PMTCT support groups.
During COP09, LMS will train health care workers in provider-initiated testing and counseling (PITC) to be
offered during ANC, labor and the immediate post-delivery period. In order to reduce the workload on
healthcare providers, lay counselors will be trained to carry out PMTCT counseling and support newly
recruited PMTCT parents to adhere to prophylaxis and infant feeding practices. The project will offer same-
day HIV counseling, testing and results to clients. Spouse/partner and family testing will be encouraged so
that PMTCT becomes the entry point to family-centered HIV care, support and treatment (PMTCT plus).
CD4 testing will be conducted on every positive pregnant woman. Those with CD4 count <350 will be
referred for HAART for their own health while those with CD4 count of 350 and above will receive
Zidovudine (AZT) from 28 weeks or (AZT/3TC) Combivir from 34 weeks. In labor, all positive pregnant
women will receive sdNVP + Combivir with a 7-day Combivir tail. All HIV-positive pregnant women will be
given sdNVP tablet to take home on their first antenatal visit, with instructions to swallow the tablet when
labor begins and before they report to hospital for delivery. Women who receive no antenatal care during
their pregnancy or who have had only limited antenatal care but presented to the facility with unknown HIV
status will receive HCT during labor and if positive, will receive sdNVP and 7-day Combivir tail. LMS will
ensure the mother's CD4 count results are available the same day to guide commencement of HAART if
<350 or PMTCT prophylaxis if 350 and above. The mother will be counseled on infant feeding options and
supported to adhere to her chosen option. Mothers will be encouraged to disclose their HIV sero status and
the PMTCT services they are receiving to their spouses and to request the spouses to come with them to
the clinic at the next visit for family counseling and testing.
Food and nutritional supplements will be leveraged from non-PEPFAR implementing partners to provide to
malnourished pregnant and lactating positive women. Infants of HIV-positive women will receive NVP syrup
at birth and AZT for six weeks. All HIV-exposed infants will be followed-up in the postnatal period and
provided with cotrimoxazole prophylaxis from 6 weeks of age until their HIV status is confirmed negative
and are no longer exposed to risk of HIV infection through breast milk. Cotrimoxazole prophylaxis will be
continued if the children are confirmed HIV-positive. All HIV-exposed infants will be referred for early infant
diagnosis (EID) at 6 weeks and followed-up with care and treatment depending on their HIV result.
All HIV-positive mothers receiving project-supported PMTCT services will be encouraged to exclusively
breast feed their infants for six months as this strategy will reduce mother to child transmission of HIV while
not stigmatizing HIV-positive mothers. HIV-positive mothers who meet the AFASS criteria will be supported
and guided on safe infant feeding with breast milk substitute. Healthcare workers will be taught that recent
research has demonstrated far better outcomes for exclusively breastfed infants of HIV-positive mothers
even in more affluent situations. In addition to receiving PMTCT services, each mother-baby pair will be
registered with the health facility referral coordinator for linkage and access to community HIV/AIDS
services like follow-up and support of mother-baby pairs, OVC services, ongoing adherence counseling,
home-based care (HBC) and others. This will enable the HBC volunteers to give psychosocial support and
nutrition education, and leverage nutritious foods and conduct child growth monitoring.
LMS will train and support some of the women living with HIV to function as peer support coordinators in
antenatal care (ANC) settings, helping newly recruited PMTCT families to understand and appreciate the
benefits of PMTCT services and to adhere to the counseling and prophylaxis information given to them. The
peer support coordinators will be positive role models to reduce stigma and act as champions for HIV-
positive pregnant women to ensure that they are not discriminated against during their antenatal and
maternity care. The peer support coordinators will share their own experience with newly diagnosed
pregnant HIV-positive mothers and assess how they are coping. This will support the pregnant HIV-positive
mothers to come to terms with their own HIV status and reduce "self-stigma". Through the work of peer
support groups, traditional birth attendants (TBAs) and engagement of spiritual leaders, the project will
reduce dropout rates from PMTCT services and increase adherence to ARV prophylaxis and safer infant
feeding choices. The Nigerian-adapted curriculum for training TBAs will be used to equip TBAs with
knowledge and skills to support PMTCT services in the community. Every pregnant HIV-positive mother at
first antenatal visit will be given a tablet of nevirapine to take home for use at the onset of labor.
In COP09, LMS will support zonal training programs on infant feeding counseling in collaboration with the
GON and will support cascade training for selected facility-based healthcare workers. Also, LMS will
continue to support the Niger State PMTCT committee to develop a scale-up and implementation strategy
to ensure that all local government areas (LGAs) in Niger state have at least one site with PMTCT services,
hence reaching more underserved communities. LMS will further strengthen the partnership with Clinton
Foundation for supply of antiretroviral drugs and dried blood spot (DBS) kits. The advocacy strategy with
Activity Narrative: National, State and LGA governments implemented in COP08 will be enhanced in COP09 to promote
government ownership and increase their contributions to HIV/AIDS services in general and PMTCT
services in particular.
Joint GON/USG/LMS supportive supervision will be carried out in all sites on a quarterly basis, in addition to
regular onsite mentoring and support of the sites by the LMS technical team. Appropriate tools for program
monitoring including National PMTCT registers will be provided to all the sites, while monthly data quality
assurance (DQA) will be carried out in collaboration with the relevant state and national bodies. Feedback
will be provided to the facilities and stakeholders through LMS's participation in monthly M&E meetings
hosted at SACA offices. Quality of services will be assured through supervision, M&E, QA/QI analysis and
QA checks using standardized national tools. LMS will disseminate information through regular reporting to
the USG and the GON via NACA and NASCP.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Activities in this area will strengthen the capacity of facility and community-based resources to provide ARV
prophylaxis, counseling and support for improved maternal nutrition and safe infant feeding and additional
HCT and support as included in PMTCT plus activities. This will also contribute to the more general interest
of improving the lives of children and families directly affected by HIV/AIDS.
LINKS TO OTHER ACTIVITIES:
This activity relates to the HCT where every effort will be made to counsel and test every pregnant woman
that visits the project-supported health facilities through the PITC approach, and if positive enrolled into care
to utilize the PMTCT services provided. Adult care and support will be provided in terms of basic
investigation like CD4 count for women that are positive, diagnosis and treatment of OIs, malaria, urinary
tract infection and provision of ITN and water guard, and ARV drugs for prophylaxis.
POPULATIONS BEING TARGETED
This activity focuses on pregnant women and their families from the communities served by project-
supported sites.
EMPHASIS AREAS
This activity addresses gender concerns related to the specific HIV/AIDS-related care and treatment needs
of pregnant women. Many gender issues have been reported in relation to PMTCT services ranging from
rejection by spouses and families to gender-based violence. The project will train healthcare workers to
appreciate gender issues and learn ways they can be mitigated. The activity emphasizes developing the
capacity of a wide range of persons (healthcare personnel, mothers' peer support groups, PLWHA and
TBAs) to increase testing, counseling and treatment and prophylaxis for pregnant women and their infants,
to provide them and their families the appropriate protection and care to reduce the risk of HIV infection or
mitigate transmission and negative health effects.
Male involvement will be encouraged through various strategies including partner testing together and
sensitizing men through the fora that are appropriate to them. Pregnant women accessing PMTCT services
will be counseled and referred to family planning (FP) services to enable them to make informed decisions
on future pregnancies. HIV-exposed infants will be followed-up in young children clinics where they will
receive routine immunizations, nutritional counselling and growth monitoring. Malnourished mothers and
their children will receive nutritional supplementation leveraged from the Clinton Foundation and the
community-food basket to be established through the peer support coordinators.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15641
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15641 15641.08 U.S. Agency for Management 7144 7144.08 USAID Track $328,562
International Sciences for 2.0 LMS
Development Health Associate
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $130,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $40,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY DESCRIPTION:
This is a new activity for LMS Associate, comprised of abstinence/be faithful (AB) and other sexual
prevention (HVOP) programs. It links to activities in Adult Care and Support, TB/HIV, Counseling & Testing,
OVC, and PMTCT.
In COP 08, LMS is supporting the provision of comprehensive AIDS care and treatment services at 17
secondary and 22 primary healthcare (PHC) feeder health care facilities in 6 states; Kogi, Niger, Adamawa,
Taraba, Kebbi, and Kwara. In COP 09, the LMS AIDS Care and Treatment project will build on activities
initiated in COP 08 and expand to 2 additional secondary facilities in states where LMS is currently working.
HIV/AIDS services will be further decentralized and strengthened at an additional 10 PHC sites within the
local government areas (LGAs) for a total of 51 sites (19 comprehensive care and treatment [CCT], 32
PHC) providing AIDS care and prevention services in COP09.
In COP09, the presence of LMS at 19 CCT secondary facilities offers the opportunity to serve at least 19
LGA catchment populations with AB programs. AB programs will be further decentralized to remote
communities through a network of 32 PHC health facilities. In COP09, LMS will have established strong
community HIV services in all project LGAs through its partnerships with faith-based, community-based,
and non-governmental organizations (FBOs, CBOs, NGOs) and school teachers, which will provide an
effective vehicle for the delivery of comprehensive AB services.
In COP 09, LMS AB programs will promote low-risk behaviors among in-school and out-of-school youth
aged 15 to 24 years. The project will target most-at-risk populations (MARPS), such as transport workers,
uniformed service men and women, men who have sex with men (MSM), and persons living with HIV/AIDS
(PLWHA), from LMS-supported facility based support groups. AB messages will be packaged using themes
on primary abstinence and delay of sexual debut for younger youth, secondary abstinence among
unmarried youth. and unmarried and mobile adults, HIV counselling and testing (HCT) for everyone, and
mutual fidelity for spouses/partners. The most effective channels for targeting the various groups will be
explored. LMS will also develop promotional materials, such as T-shirts, caps, exercise books, and pens to
reinforce the messages of information, education, and communication (IEC) materials. The project will
develop and/or adapt community training manuals that use the AB strategy and train peer educators for
each of the above target groups. Peer education manuals used by Family Health International (FHI) and
Society for Family Health (SFH) will be incorporated into the LMS AB training manuals. The LMS AB
manual will include the following topics: basic knowledge on transmission and prevention of STIs and HIV;
benefits and process of knowing one's HIV status through counseling and testing; setting personal goals
and values for life; life building skills; gender inequalities that promote HIV/STI transmission and how to
minimize them; sexual violence; trans-generational sex; secondary abstinence; and alcohol and substance
abuse. Peer education materials will inform community outreach activities and seminars to educate the
targeted population. Other IEC materials, including audio visual materials leveraged from other
implementing partners (IPs) will be distributed and discussed during community seminars. LMS will build
skills of CBOs, FBOs, community leaders and other gate keepers in supported LGAs to address social or
cultural practices, such as polygamy, widow inheritance etc., which affect AB choices and increase the
likelihood of risky behaviors. The interpersonal communication systems proven effective in the past will be
strengthened through FBOs and CBOs already in the targeted communities. LMS will ensure that all targets
are reached with a minimum of three prevention intervention strategies as required by the national
prevention plan minimum package recommendation.
LMS will collaborate with other IPs, such as SFH and CEDPA, to build upon existing AB messaging and
mass media campaigns. LMS will also work with HIV/AIDS clubs in 19 secondary schools and 6 tertiary
institutions in 6 states, to promote such ABC messages as abstinence, mutual fidelity, delay of sexual
debut, partner reduction, and gender and social issues that increase vulnerability to HIV transmission.
Youth-friendly sexually-transmitted infection (STI) and HIV prevention services will be established at
convenient locations within the LMS project LGAs to be managed by the trained youth peer educators. In
COP 09, 250 persons will be trained to reach 49,091 persons (28,000 males and 21,091 females) directly
with AB messaging in 6 states.
In COP 09, the LMS condoms and other prevention activities will be implemented at 51 facility-based sites
(19 CCT facilities and 32 PHC) and through community mobilization of targeted MARPs in project-
supported LGAs in 6 States. Local CBOs, FBO and NGOs will be supported to train peer educators among
brothel-based female commercial sex workers and their clients, MSM, long distance truck drivers, out- of-
school youth, incarcerated persons, uniformed service men, and PLWHA. Peer educators will be supported
to conduct weekly sessions for their target/peer groups to discuss accurate information about correct and
consistent condom use as a means of reducing but not eliminating the risk of transmitting HIV and other
sexually transmitted infections (STIs), HIV prevention among known HIV positive partners, prompt and
complete treatment of STIs, the importance of HCT, partner reduction, partner testing and mutual
faithfulness as methods of risk reduction. The project will leverage male condoms and lubricants from SFH
and female condoms from UNFPA and other sources for distribution to the peer educators, who will act as
distribution points for their groups. In addition, LMS will collaborate with condom social marketing
companies to ensure a steady flow of condoms to the project supported communities.
LMS will ensure that condoms are available at all supported health facilities for distribution to PLWHA as
part of the "prevention with positives" (PwP) strategy. This will prevent re-infection among PLWHA and limit
transmission to others. Condoms will also be given to discordant couples to limit transmission to the
uninfected partner while promoting family relationships that are necessary for parents' survival. The
prevention with positives strategy will include provision of condoms and information on correct and
consistent use, discordant couples, and prevention of super infection in couples that are both positive.
LMS will adopt a phased peer education program in 19 project facility communities in 6 States. The first
phase will include: advocacy visits, community mobilization, village square meetings, and group
discussions. The second phase will include: distribution of condoms and IEC materials; identification of peer
groups; training of peer educators among targeted groups in HIV counseling, HIV education, life building
Activity Narrative: skills; organizing prevention education/awareness events; and facilitating group discussions in communities
using the developed peer education manual. The third phase will be focused towards sustainability of the
program by collaborating with CBOs, FBOs and local NGOs and trained peer educators from the targeted
groups, to strengthen their capacity to continue to build upon initiated prevention activities. LMS will support
6 mobile community outreach teams, one in each project state, to engage in community-wide prevention
activities, such as: facilitating group discussions; disseminating culturally appropriate messages on
prevention, partner reduction, inter-generational sex, mutual fidelity, and stigma reduction; promoting
access to HCT for targeted MARPS;and distributing condoms and culturally specific IEC materials
leveraged from other IPs. To ensure appropriate condom messaging, mobile teams will be provided with
penile models for demonstration of correct condom use. Clients accessing the mobile IEC or HCT services
will be linked to treatment, care and support programs at supported health facilities. An already established
referral system that ensures a linkage between mobile outreach teams and the facility will be strengthened
for this purpose. LMS will train mobile teams in systems management, referral systems, and patient
tracking.
In COP 09, 320 persons from 190 outlets will be trained to reach 32,727 (18,654 males and 14,073
females) directly with other prevention information and messages for correct and consistent condom use,
and prompt and complete treatment of STIs. Ten million condoms will be distributed from 51 outlets and 5
mobile units, targeting MARPs groups.
To ensure uniform and consistent data collection and effective monitoring and evaluation (M&E), LMS will
use nationally harmonized registers and HIMIS tools to capture, manage, and report relevant data. The
program will utilize participatory M&E for its internal evaluation. Focus-group discussions and semi-
structured interviews will be used for the baseline study and program monitoring. Data quality will be
ensured through the adaptation of the Winrock Means of Verification (MOV) tool.
AB activities will contribute to the USG PEPFAR plan by reaching 49,091 persons with AB messages and
32,727 with condoms and other prevention programs. This program will help to strengthen the capacity of
community based resources to serve the wider interest of improving the lives of families and contribute to
reducing new infections in Nigeria.
Sexual prevention links to activities in Adult Care and Support, TB/HIV, Counseling & Testing, OVC, and
PMTCT.
POPULATIONS BEING TARGETED:
This activity focuses on the needs of adults and youth from LGA catchment areas in the 19 project
supported sites, with a focus on in- and out-of-school youth, teachers, young women and men reporting
multiple partners, OVC, PLWHA, and MARPS (incarcerated persons, transport workers, sex workers).
Prevention with positives will form an integral part of this activity with special focus on discordant couples
and positive pregnant women.
EMPHASIS AREAS:
Emphasis will be placed on community mobilization, participation and the training of peer educators to
increase access to ABC messages. Emphasis will also be placed on messages that address social or
cultural practices which can hinder wise ABC choices and increase the likelihood of risky behaviors.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.02:
Table 3.3.03:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Care and treatment narratives have been
merged.
ACTIVITY DESCRIPTION
This activity relates to OVC (15644.08) and TB/HIV (15643.08), and HCT. In COP09, LMS will build upon its
achievements and experiences of COP08 to meet its COP09 ART targets by training 70 persons to provide
ART services to both the 6,120 clients carried over from COP08 and the 968 adults newly initiating ART in
COP09. By the end of COP 09, LMS will have supported 7,088 adult PLWHAs with ART services. This will
be achieved by supporting 17 existing Comprehensive Care and Treatment (CCT) sites in Kogi, Niger,
Kebbi, Kwara, Adamawa and Taraba States, as well as upgrading 2 secondary health facilities to CCT sites;
and further decentralizing access to ARV drugs at selected linked PHC units in existing states. The project
will therefore operate a total of 19 CCT sites in COP09. Prior to initiating CC&T services, baseline
assessments will be conducted and key hospital units will be refurbished based on need. To promote
ownership and for sustainability of the program, LMS will advocate to State and Local Government Councils
to support the refurbishment of these units and take responsibility for the procurement of a certain
percentage of commodities such as Rapid Tests Kits and laboratory reagents.
Many opportunities to diagnose HIV in clinical settings in Nigeria are being missed because the provider-
initiated approach to HIV counselling and testing is not widely practiced. In COP09, LMS will build on the
successes of the Provider-Initiated Testing and Counselling (PITC) approach to initiate points of service
testing in all hospital clinics and units including in-patient wards as a strategy to capture more HIV positive
individuals. LMS will support the establishment of two types of clinics at every CCT site: a) a care clinic to
which all identified HIV positive clients will be referred for initial baseline CD4 and clinical staging of the
HIV/AIDS disease according to National Guidelines. HIV positive clients not eligible for ART according to
national treatment guidelines will be enrolled in this clinic for on-going psycho-social, medical and
psychological care, prophylaxis and Prevention-with-Positives (PwP) package. The care clinic clients will
have their CD4 levels and clinical picture assessed every 3-6 months or as appropriate to determine
progress and eligibility for ART. LMS will initiate the diagnosis and management of STIs using WHO
syndromic management protocols. To further strengthen clinical laboratory support services, LMS will
advocate to the facility management to procure reagents for diagnosis of OIs so that other patients can
benefit from the wide range of tests available. b) The second clinic will be the Antiretroviral Therapy (ART)
or simply the treatment clinic to which clients eligible for ART according to the national guideline shall be
further assessed both clinically and in the laboratory to obtain their baseline chemistry and hematological
profiles. These patients will be commenced on first line highly active antiretroviral therapy (HAART) regimen
and monitored every month for adherence and detection of any adverse drug reactions. Prior to initiation of
HAART, all eligible patients will undergo three adherence counselling sessions and will be encouraged to
disclose to a few family members who will serve as treatment buddies. Adherence counselling services will
be provided at the health facility by trained pharmacists and persons living with HIV/AIDS (PLWHAs) who
will work as ART aides. Patients enrolled in care or treatment will be offered on-going counseling, diagnosis
of opportunistic infections (OIs), prophylaxis and treatment as indicated. LMS will provide cotrimoxazole
prophylaxis for all HIV positive adults with CD4 counts of less than 350 in line with national clinical
guidelines. TB screening will be done using a structured symptom checklist. These patients will also be
enrolled into the facility and community-based family support groups for continuous psychosocial support
and education.
All enrolled patients will be provided with a basic home care kit consisting of insecticide treated bed nets
(ITNs), Water Guard, cotton wool, latex gloves, soap, calamine lotion, Vaseline, and Gentian Violet and
condoms as part of the prevention package. LMS will source drug-fact sheets from the USG ART TWG,
while other patient education materials and resources will be leveraged from PEPFAR IPs. In order to
increase access and retain patients on care and treatment, LMS will decentralize services gradually building
the capacity of select primary health care centers (PHC) to provide ART refill services in its focus states. In
addition, clinicians from MSH-supported sites will be encouraged to apply and participate in the PEPFAR
Health Professional Fellowship Program. The Fellowship program is aimed at building the capacity of health
professionals like nurses, community health officers, and PHC coordinators to improve their clinical skills
and effectively respond to the challenges of managing HIV/AIDS services. LMS supports the policy of task-
shifting and will build the capacity of nurses, laboratory technicians and pharmacy assistants to take-on
more responsibilities and allow time for doctors, pharmacists and laboratory scientists to manage the more
advanced tasks.
Once task-shifting is initiated, all clients newly initiating ART will be evaluated by a doctor and as soon as
they are stabilized on treatment, they will be followed up by a nurse whose capacity has been built to
provide this service. The clients may be seen at each monthly visit by any other trained clinician. In COP08,
LMS initiated a default tracking system that ensured that defaulting patients are tracked back to care by
referral and tracking coordinators based in the facility. In COP09, LMS will build on the successes of this
innovative approach through the involvement of community-based organizations (CBOs) and persons living
with HIV/AIDS (PLWHA) groups. As a strategy to mainstream quality in COP08, MSH supported the
initiation of multidisciplinary care coordination teams to maintain and improve ART services, as well as
provide patient-centered care. LMS also conducted periodic clinical audits using structured Clinical Quality
Assessment tools. This activity evaluated standards of care relating to CD4 monitoring, adherence to
treatment, OI prophylaxis, TB screening, and prevention education. In COP09, health workers in outpatient
and inpatient units will be trained and supported to offer HIV/AIDS care & treatment with emphasis on
diagnosis; treatment of OIs and pain management; nutritional assessment/therapeutic feeding; wider basic
care and support issues like end-of-life care, mental health, and legal protection for property and inheritance
rights using standard national training curricula. In addition, LMS will conduct trainings on Good Clinical
Care for 85 health workers from the 19 CC&T sites to further ensure that they adhere to the ethics and
principles of good clinical practice. The training curriculum will be adapted from WHO's training package on
good clinical practice.
In COP09 LMS will participate in the HIVQUAL project and the yearly National ART evaluation. LMS will
also participate with other stakeholders in GoN National ART task team meetings as well as USG Clinical
Activity Narrative: and ART technical working group meetings.
The target for the number of HIV-positive individuals provided with HIV-related adult care and support
services is 4,153. An additional 8,305 persons affected by HIV/AIDS will also be reached with care and
support services. It is anticipated that food and nutritional supplementation will be provided to 250
individuals receiving ART who are moderately or severely malnourished.
In COP08, LMS initiated a unique community network model - facility, community institutions, PHCs,
PLWHA groups; that linked patients to community based resources through a two way referral system. In
COP09, community / home-based care will be implemented through identified local FBOs and CBOs such
as Centre for Health and development in Africa (CHEDA), Health Development Agency (HAD), Centre for
Communication and Reproductive Health (CCRH) and associations of people living with HIV/AIDS. These
CBOs will be supported to engage community health workers / volunteers who will conduct home visits and
provide nursing and psychosocial care services to clients in addition to providing hands-on training for
family care givers. These volunteers will include PLWHAs and persons affected by AIDS (PABAs). Health
facility mobile outreach services will also be provided for selected home-based clients. LMS will work with
local organizations to identify HCW and volunteers who will be trained to provide community/home-based
care. The community / home-based care providers will in addition provide mental health, psychosocial and
spiritual care; and leverage community financial support / income generation activities for PLWHA and
families. LMS through identified CBOs and NGOs will also train family members on proper hygiene and
sanitation, PwP, and support for treatment adherence in the home. LMS will train and support a wide range
of non-traditional service providers including family members, faith based organizations (FBOs) and
PLWHA in provision of basic palliative care using national guidelines that are currently being harmonized
with the NASCP approved curricular. Care managers and coordinators, with the consent of persons who are
diagnosed as HIV positive, will ensure referral to appropriate providers in their local network of community
and home-based providers. HBC volunteers and community escort and follow up volunteers identified from
partner CBOs and FBOs will keep track of the individuals and families they visit and follow-up defaulters.
Community volunteers and PLWHAs will work as conduits to their families, support groups and communities
for improved service delivery and reach out to vulnerable people like orphans and widows. PLWHAs and
their care givers will be linked to community based organizations that provide support in terms of income
generation activities (IGA) and vocational training.
Monitoring and evaluation of basic care and support activities will be accomplished in several ways. Data for
monitoring PEPFAR specific indicators will come from: (1) LMS-ACT internal monthly reporting system
which collects data on the achievement of outputs and outcomes as defined in the work plan and (2) data
collected at the facility level using FMOH standard tools and aggregated by project staff at the state level on
the number of clients served. Special attention will be given to data quality through training of health facility
staff and inclusion of data quality monitoring in all supervisory visits.
Activities will contribute 12,458 persons towards the PEPFAR target of 1,350,000 receiving basic care and
support in COP 09. LMS will continue to strengthen the capacity of facility and community based resource
persons to provide on-going basic care and support to HIV positive clients and their families. Improved care
of adults will reduce mortality and improve the quality of life for PLWHA hence reducing the incidence of
OVCs. PwP services will significantly reduce the spread of HIV by controlling the primary source of
infection. This strategy will immensely benefit the prevention of sexual transmission program.
This activity links to prevention, TB/HIV, OVC, and HCT. Activities will improve the care and treatment of
PLWHA by linking medical, psychosocial, legal, financial, and spiritual resources at the facility, community
and community and home levels.
This activity focuses on meeting the needs of HIV positive adults, their families and PABAs. However to
reach them, the project will target clients seeking health care at health facilities. Communities served by the
LMS-ACT project will also be targeted to identify sick persons and refer to care.
Great emphasis is placed on training to build the capacities of health workers and non-traditional health
care service providers including family care givers, FBOs and PLWHA to provide care and treatment.
Emphasis will also be placed on local organization capacity building. These activities and this program area
address the larger issue of not just "quantity" of life (increasing life expectancy) but "quality" of life for
patients and their families. LMS-ACT will therefore advocate for more government and community
involvement and ownership of the program. Specific advocacy and linkages will be made with hospice
organizations in the country to leverage their narcotic-pain relief services to project operational areas.
Essential wrap around services particularly nutrition and income generating activities (IGA) will be leveraged
through networking and collaboration with other IPs and organizations that provide these services. Care
coordinators and managers will be trained in holistic patient care and support, and care managers will work
to identify local NGOS, FBOs and CBOs providing care and support services for people living with HIV and
their families to facilitate referral of patients and families in need to the relevant resources in the community,
e.g., for legal and financial support. LMS will work with other IPs through the TWG to initiate a gender
analysis of the ART and adult care and support program and develop an action plan to mitigate gender
disparities.
Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including
spaces)
Drugs for OI are required early in the year to avoid interruption in prophylaxis and quality of adult care and
support. Already LMS has indicated need for early money for the ARVs
Activity Narrative:
Continuing Activity: 15642
15642 15642.08 U.S. Agency for Management 7144 7144.08 USAID Track $1,400,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000
Estimated amount of funding that is planned for Water $15,000
Table 3.3.08:
Continuing Activity: 15647
15647 15647.08 U.S. Agency for Management 7144 7144.08 USAID Track $2,160,000
Table 3.3.09:
This narrative covers two activities pediatric treatment and pediatric care and support. It relates to OVC,
adult care and treatment, ART drugs, and PMTCT.
In COPO8 LMS provided pediatric care, support and treatment in 17 comprehensive care and treatment
centers (CCT) located in the six states of Kogi, Niger, Adamawa, Kebbi, Taraba and Kwara. In COP09 the
LMS project will continue these activities initiated in project-supported comprehensive care and treatment
centers at secondary and primary health care (PHC) facilities and their feeder primary health care facilities
in Kogi, Niger, Adamawa, Kebbi, Taraba and Kwara states. Seventeen existing ART sites will be supported
to provide pediatric ART and care. In addition, the project will upgrade two secondary and 10 PHC health
facilities to provide pediatric care and treatment services. The project will therefore in COP09 operate a total
of 29 pediatric care and support centers of which 19 will offer pediatric ART treatment as well. The centers
will be zoned into four with zonal offices located in Niger, Kogi, Adamawa and Kebbi. The target for children
newly enrolled into pediatric ART in COP09 is 277, with an estimated 800 in treatment at the end of the
reporting period. The target for pediatric care and support (number of HIV-positive children 0-17 years
provided with HIV-related clinical care services including those on ART and excluding TB/HIV) is 1,200.
LMS-ACT will train and support 70 healthcare providers in the supported states and sites to adhere to the
Ten-Point Package for Comprehensive Pediatric AIDS Care. This package includes confirmation of HIV
status as early as six weeks of birth with antibody testing or dried blood spot (DBS) samples for PCR assay
under the early infant diagnosis (EID) program. LMS will offer HIV EID in line with the National Early Infant
Diagnosis scale-up plan from six weeks of age using DBS. Implementation of the EID scale-up will be done
under the guidance of the GON and in conjunction with other IPs (IHVN, Harvard and APIN) who will be
conducting the laboratory testing. LMS will collaborate with the Clinton Foundation as appropriate for
commodities and logistics support for the EID program. Exposed infants will be actively linked to pediatric
care and treatment. In COPO8 LMS activated seven CCT centers and one PHC for EID with DBS. In
COP09, LMS will extend EID activities/DBS collection to two CCT sites and six PHCs.
PMTCT focal persons at all sites will keep records of all exposed infants at enrollment soon after birth;
informing HIV-positive mothers of the six weeks exact date for DBS collection. LMS will encourage CCT
sites to step down DBS collection to affiliate PMTCT sites and thus decentralize EID activities at these sites.
CCT sites will ensure supplies of DBS collecting kits from their own stock to these PMTCT sites and the
samples collected returned to the parent sites for dispatch to the testing labs. All diagnosed children will be
enrolled.
LMS will engage PMTCT support groups and the larger support group(s) in tracking un-booked pregnant
women and infants in the community, linking them to sites where they can access PITC. LMS will establish
linkages with other health care providers (public and private) proximal to LMS-supported sites with full
fledged ANC activities. This will encourage two-way referrals of HIV-positive mothers and their infants from
these providers to LMS-supported sites and thus benefit from EID/ART activities. All diagnosed infants will
also be enrolled in care and followed-up.
Proper history and physical examination of all systems shall be done on exposed or infected children.
Staging of HIV disease will be done according to GON guidelines and when practicable the new WHO
guidelines will be applied. Counseling of mother or caregiver on the need to conduct basic CD4 count
biannually or as the clinical condition may warrant will be done. Laboratory investigations to diagnose the
disease and guide support care will include hemoglobin estimation, CD4%/count, and HIV rapid antibody
test or DBS depending on the age of the child. Clinical monitoring will be based on follow-up clinical
examination findings at which time the level of immunological status will be assessed by repeat CD4%.
Growth monitoring will also be undertaken in the child follow-up care clinic to identify children that are
vulnerable as well as to monitor the effect of interventions. Growth monitoring will employ the standard
Road to Health Card and other milestones especially for the low birth weight infant, children with underlying
chronic diseases such as TB, macro/micro nutrient deficiencies, or a combination of all.
HIV-exposed or infected children are vulnerable to other deadly childhood diseases like every other child.
All exposed infants will be immunized according to the recommended national schedule. However live
vaccines such as Yellow Fever and BCG will not be given to symptomatic infants. The measles vaccine will,
however, be given because the morbidity and mortality from the wild virus far outweighs the mild symptoms
that occur from the vaccine. An estimated 420 malnourished children will be provided with Ready to Use
Therapeutic Food (RUTF) through our collaboration with the Clinton Foundation. Also therapeutic food
regimens will be provided to eligible children.
Pneumocystis jeroveci pneumonia is a very important cause of morbidity and mortality among infants in
Africa. Cotrimoxazole significantly reduces the incidence and severity of PJP. A Zambian study recently
demonstrated a 45% reduction in mortality among HIV-infected children who receive cotrimoxazole
prophylaxis. All exposed and infected infants in LMS-supported sites will be placed on cotrimoxazole
prophylaxis from 4-6 weeks of age until a definitive negative diagnosis is made either by HIV PCR or
antibody. Any HIV-positive child known to have suffered from PJP will continue with cotrimoxazole for life.
Children less than five years exposed to smear positive TB in their household will be given INH prophylaxis
at 5mg/kg for six months after ruling out active disease using the pediatric TB score chart. Those with
indications for active TB will be referred to other facilities with capacity to rule out active TB for further
assessment.
HIV-exposed and infected children are susceptible to acute infections and other HIV-related conditions like
malaria, otitis media, diarrhea, pneumonias, recurrent oropharyngeal candidiasis, herpes virus encephalitis
and meningitis. These conditions need to be aggressively treated to avert fatality. Anti-malarials, ITN, water
guard and water vessel will be provided to children enrolled into care. Third generation cephalosporins are
included in the pharmaceuticals for systemic infections.
Monitoring of children's growth and development, and immunization will be done in line with the national
recommended schedule. In addition, the following activities will be undertaken: provision of prophylaxis for
opportunistic infection (PJP and TB), actively seek and treat inter-current infections, counsel mother and
family on optimal infant feeding and support, conduct disease staging for infected child, offer and or refer
infected child for ARV treatment, provide psychosocial support to child and mother, refer to higher levels of
specialized care if need be or to social or community based programs.
Regular follow-up care is very essential for the exposed child. LMS will use the WHO recommended
schedule. This will be adapted to take care of the clinical and environmental condition of the child. However,
children will be seen more frequently in infancy and at longer intervals as the child grows older especially for
those that keep to appointments. An appropriate referral system will continue to be a very important link to
Activity Narrative: care for the exposed child, particularly when in need of higher level of specialized care for further
investigation and treatment or social support services and HCT for parents and siblings.
LMS will establish 19 dedicated pediatric ART clinics in some of the supported health facilities to raise the
prominence of this neglected area. Healthcare providers in all the supported sites will be trained to offer
pediatric treatment, care and support services in line with pediatric care and treatment national guidelines.
Disease staging will be done in line with the national pediatric HIV treatment guidelines. Prior to the
commencement of treatment, facilities will counsel parents or care givers on the importance of adherence to
therapy and ART for those that are eligible for ART. In the absence of facility for laboratory confirmation of
HIV diagnosis, ARVs will be provided to infants less than 18 months with a positive antibody test if there is
immunodeficiency (CD4% of 20% or WHO pediatric stage 3 or 4).
All exposed babies above 18 months will be referred for testing following the national guidelines' serial
algorithm and enrolled appropriately. Community pediatric care services will be provided through the
identified CBOs, FBOs and NGOs (e.g., Global Initiative for Community Development in Lokoja and Center
for Communication and Reproductive Health Services in Niger). Their activities will consist of follow-up of
children, and care givers' prevention of malaria, promotion of hygiene and good sanitation. Community-
based family support group meetings will be encouraged with specific activities for children during such
meetings. Identified adolescents will be counseled separately on disclosure, adolescent reproductive health
and any other challenges. Support group activities will be designed for them and they will be supported to
ensure disclosure. All identified pediatric patients will be enrolled in the OVC program. It is expected that
about 10% of the enrolled OVCs will benefit from pediatrics ART care and treatment.
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
By adhering to the Nigerian National ART service delivery guidelines and building strong community
components into the program, this activity will contribute to achieving PEPFAR Nigeria goals and the
Nigerian government's universal access to ART by 2010 initiative. By putting in place structures to
strengthen site health systems, LMS will contribute to the long term sustainability of the ART programs.
This activity is linked to PMTCT, OVC, adult care and treatment and TB/HIV. Networks will be created to
ensure cross-referrals and effective synergies within these program areas.
These activities target children infected with HIV, particularly those who qualify for the provision of ART,
from rural and underserved communities.
LEGISLATIVE ISSUES.
All treatment protocols are designed to follow the national guidelines and LMS will work in close
collaboration with the state and local government structures.
This activity will include emphasis on human capacity development specifically for active enrolment of all
expose babies and initiation of treatment. There will be active on-the-job mentoring and supportive
supervision. The extension of ARV services into rural and previously underserved communities will
contribute to the equitable availability of ART services in Nigeria and towards the goal of universal access to
ARV services in the country. The provision of ART services will improve the quality of life of infected
children and thus reduce the stigma and discrimination against them.
Continuing Activity: 15644
15644 15644.08 U.S. Agency for Management 7144 7144.08 USAID Track $0
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.10:
This narrative covers 2 activities Pediatric Treatment and Pediatric Care and Support. It relates to OVC
(15644.08), Adult Care and Treatment, ART drugs, and PMTCT.
In COPO8 LMS Pediatrics Care, support and treatment in 17 comprehensive Care and treatment centers
located in 6 states of Kogi, Niger Adamawa, Kebbi Taraba and Kwara state. In COP 09 the LMS project will
continue these activities initiated in project-supported comprehensive care and treatment centers at
secondary and Primary health care facilities and their feeder primary health care facilities in Kogi, Niger,
Adamawa, Kebbi, Taraba and Kwara states. These. Seventeen existing ART sites will be supported to
provide pediatric ART and care. In addition, the project will upgrade 2 secondary and 10 PHC health
will be Zoned into four with zonal offices in Niger Kogi Adamawa and Kebbi. The target for the number of
children to be enrolled into pediatric ART in COP 09 is 800, while the target for pediatric care and support (#
of HIV positive children 0-17 years provided with HIV-related clinical care services including those on ART
and excluding TB/HIV is 1200. LMS-ACT will train and support 70 health care providers in the supported
states and sites to adhere to the Ten-Point Package for Comprehensive Pediatric AIDS care. This package
includes: confirmation of HIV status as early as six weeks of birth with antibody testing or Dry Blood Spot
(DBS) samples for PCR assay, LMS will offer HIV early infant diagnosis (EID) in line with the National Early
Infant Diagnosis scale-up plan from 6 weeks of age using DBS. Implementation of the EID scale-up will be
done under the guidance of the GON and in conjunction with other IPs(IHVN and APIN)who will be
conducting the laboratory testing. LMS will collaborate with Clinton Foundation as appropriate for
care and treatment. In COPO8 LMS has activated 7 CCT centers and 1 PHC for EID/ DBS. In COP09, LMS
will extend EID activities/DBS collection to 2 CCT Sites, and 6 PHCs.
informing HIV+ mothers of the 6 weeks exact dates for DBS collection. LMS will encourage CCT sites to
step down DBS collection at affiliate PMTCT sites and thus decentralize EID activities at these sites. CCT
sites will ensure supplies of DBS collecting kits from their own stock to these PMTCT sites and the samples
collected returned to the parent sites for dispatch to the testing labs. All diagnosed children will be enrolled.
women and infants in the community, linking them to sites where they can access PITC.LMS will establish
linkages with other health care providers; public and private, proximal to LMS Sites, with full fledged ANC
activities. This will encourage two-way referrals of HIV+ mothers and their infants from these providers to
LMS sites and thus benefit from EID/ART activities at LMS sites. All diagnosed infants will also be enrolled
in care and followed up.
Proper history and physical examination of all systems shall be done on exposed or infected child, staging
of disease will be done according to GON guidelines and when practicable the new WHO guidelines will be
applied. Counseling of mother or caregiver on need to conduct basic CD4 count biannually or as the clinical
condition may warrant will be done. Laboratory investigations to diagnose the disease and support care will
include HB estimation, CD4% count, rapid antibody test or DBS to be conducted depending on the age of
the child,. Clinical monitoring will be based on follow up clinical examination findings at which time level of
immunological status will be assessed by repeat CD4%. Growth monitoring will also be undertaken in the
Child follow up Care clinic to identify children that are vulnerable as well as monitor the effect of
interventions. Growth monitoring will employ the standard Road to Health Card and other milestones
especially for the low birth weight infant, the HIV-infected, children with underlying chronic disease such as
TB, macro/micro nutrient deficiencies, or a combination of all.
HIV-exposed or infected children are vulnerable to the childhood killer diseases like every other child. All
exposed infants will be immunized according to the recommended national schedule. However live vaccines
like Yellow fever and BCG will not be given to symptomatic infants. Measles vaccine will however be given
because the morbidity and mortality from the wild virus far outweighs the mild symptoms that occur from the
vaccine. Malnourished children will be provided with Ready to Use Food (RUF) through our collaboration
with Clinton Foundation. Also therapeutic food regimens will be provided to eligible children.
Africa. Co-trimoxazole significantly reduces the incidence and severity of PJP.A Zambian study recently
demonstrated a 45% reduction in mortality among HIV infected children who receive co-trimoxazole
prophylaxis. All exposed and infected infants in MSH supported sites will be placed on Co-trimoxazole
prophylaxis from 4-6 weeks of age till a definitive diagnosis is made either by PCR negative or antibody
negative. Any child known to have suffered from PJP will continue with Co-trimoxazole for life. Children less
than 5 years exposed to smear positive TB in their household will be given INH prophylaxis at 5mg/kg for 6
months after ruling out active disease using the Pediatric TB score chart. Those with indications for active
TB will be referred to other facilities with capacity to rule out active TB for further assessment.
Monitoring of child's growth and development, and immunization will be done in line with national
recommended schedule, provision of prophylaxis for opportunistic infection (PJP and TB), actively look for
and treat inter-current infections, counsel mother and family on optimal infant feeding and support, conduct
disease staging for infected child, offer and or refer infected child, for ARV treatment, provide psychosocial
support to child and mother, refer to higher levels of specialized care if need be or to social or community
based programs..
Regular follow-up Care and referrals is very essential for the exposed child. We will use the WHO
recommended schedule. This will be adapted to take care of the clinical and environmental condition of the
child. However children will be seen more frequently in infancy and at longer intervals as child grows older
especially for those that keep to appointments. Appropriate referral system will continue to be a very
important link to care for the exposed child particularly when in need of higher level of specialized care for
further investigation and treatment or social support services and HCT for parents and siblings
LMS will establish 19 dedicated pediatric ART clinics in some of their supported health facilities to raise the
Activity Narrative: prominence of this neglected area. Health care providers in all the supported sites will be trained to offer
pediatric Treatment, Care and Support services in line with Pediatric Care and Treatment National
guidelines. Disease Staging will be done in line with the National Pediatric HIV Treatment guidelines.
Facilities will before commencement of treatment Counsel Parents or care givers on the importance of
adherence to therapy and given ART for those that are eligible for ART.
In the absence of facility for laboratory confirmation of HIV diagnosis, ARVs will be provided to infants less
than 18 months with a positive antibody test if there is immunodeficiency (CD4% of 20% or WHO pediatric
stage 3 or 4. The first line HAART regimen for children will comprise of ZDV (AZT) + Lamivudine (3TC) +
NVP or ZDV + Stavudine (d4t) + NVP.
All exposed babies above 18 months will be referred for testing following the national guideline serial
identified CBOs, FBOs and NGOs (e.g Global initiative for community development in Lokoja and Center for
communication and reproductive health services in Niger). Their activities will consist of follow up of
children, and their care givers prevention of malaria, promotion of hygiene and good sanitation. Community
based Family support group meeting will be encouraged with specific activities for children during such
and any other challenges. Support group activities will design for them and they will be supported to ensure
disclosure. All identified Pediatric patients will be enrolled in the OVC program. It is expected that about
10% of the enrolled OVCs will benefit from Pediatrics ART care and treatment.
components into the program, this activity will contribute to achieving the overall PEPFAR Nigeria target of
placing 35,000 children on ART by 2009 and will also support the Nigerian government's universal access
to ART by 2010 initiative. By putting in place structures to strengthen site health systems, LMS will
contribute to the long term sustainability of the ART programs.
This activity is linked to PMTCT (1561.08), OVC (15644.08), Adult care and Treatments (15642.08) TB/HIV
(15643.08). Networks will be created to ensure cross-referrals and effective synergies within this program
areas
collaboration with the state and Local government structures.
expose babies pediatrics and initiation of treatment. There will be active on the Job mentoring and
supportive supervision. The extension of ARV services into rural and previously underserved communities
will contribute to the equitable availability of ART services in Nigeria and towards the goal of universal
access to ARV services in the country. The provision of ART services will improve the quality of life of
infected children and thus reduce the stigma and discrimination against them.
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
This activity relates to the TB/HIV, Adult Care and Support, Pediatric Care and Support and Counselling
and Testing. In COP09, the LMS project will continue the activities initiated in COP08 supporting 17
existing TB/HIV sites in Kogi, Niger, Adamawa, Taraba, Kebbi and Kwara States, adding 2 new TB/HIV
treatment sites and further decentralizing TB/HIV services at selected linked primary healthcare centers
(PHC) in existing states. The project will therefore operate a total of 19 TB/HIV sites in COP09.
In COP09 LMS will build on established TB diagnostic and treatment services and ensure integration of TB
control in HIV service points and integration of HIV services into TB clinics. At service points, LMS will
continue to focus on intensified case detection of TB/HIV co-infected cases through the use of a symptom
checklist to screen HIV Positive clients for possible TB infection. Provider initiated counseling and testing
(PICT) will be introduced in all TB DOTS clinics in the facilities in which LMS is currently working as well as
within the local government DOTS centers. The project will strengthen laboratory capacity for TB smear
microscopy. Given the difficulties of diagnosing pediatric TB, special training will be conducted for TB
diagnosis in children to raise the index of suspicion among health workers. Treatment for TB will be
integrated with other adult and pediatric care and support, pain relief as well as end of life care. LMS will
ensure that referral mechanisms are in place to facilitate TB/HIV collaborative activities within the facilities
and the communities.
The project will establish good infection control measures and provide infection control SOPs for all
comprehensive sites and PHCs with TB DOTS centers. Infection control measures will be established
especially in the laboratory and clinic waiting areas as well as in-patient wards. This will be part of the
TB/HIV training for health workers and will also be included in the routine site supervisory visits to ensure
compliance. LMS will establish prevention with positives in all facilities. To this effect, the project will provide
posters and distribute condoms to patients and educate them on its proper usage.
There will be continuous training and retraining of health staff and supervision of TB/HIV activities at the
medical, pediatric outpatients and inpatient wards and TB and DOTS clinics. This on the job training (OJT)
will include PICT, clinical examination, appropriate laboratory testing and use of drugs as per the national
clinical guidelines for TB/HIV co-infection. Training will be based on the national clinical guidelines and the
Federal Ministry of Health (FMOH) TB/HIV training modules. These activities will provide quality of service
that meets national and international standards. LMS will continue to work with the National TB and Leprosy
Control Program (NTBLCP) in the FMOH to strengthen management information systems at all sites.
In COP09, LMS will forge links with local NGOs, FBOs associations of people living with HIV, and CBOs.
These links will provide opportunities for case finding and screening and adherence to treatment. These
linkages will also build and strengthen referral networks in the community. The CBOs will facilitate in
identification and selection of community volunteers for community TB care. This will increase TB case
detection and treatment in the communities. The volunteers who must be residents of the community will be
responsible for community TB education and control, and will assist in identification of treatment supporters
as well as tracking treatment defaulters. These volunteers as well as health workers will be trained in DOTS
using national guidelines.
In COP09, LMS will activate 2 new TB/HIV treatment sites. Activities for the activation of sites include minor
renovations, staff trainings, establishment of efficient systems and processes for forecasting, inventory
management and control, establishment of management information systems and monitoring and
evaluation to ensure collection of quality data.
Given that over 50% of patients with TB also have HIV infection, activities in this program area are critical
for successful management of AIDS. As TB is known to significantly increase mortality among HIV infected
individuals, so addressing both conditions will improve survival of HIV positive clients. Activities will
strengthen the capacity of health facilities to deliver TB palliative care to HIV-infected individuals. The
number of diagnostic and clinical service entry points will be increased by emphasizing the need to check
for co-infection in patients presenting at TB and/or HIV/AIDS service delivery points.
This activity links to Adult Care and Support, Pediatric Care and Support, Laboratory, Counseling & Testing,
and Adult and Pediatric ART Treatment. In addition, MSH/LMS, through its Capacity Building project, will
strengthen the leadership and management skills of health facility managers to assist them in the
integration of health facility TB and HIV services.
This activity targets adults and children presenting at TB clinics or health facilities who are at increased risk
for HIV and TB co-infection. Conversely, HIV infected persons (diagnosed or presumed) are targeted for
determination of possible TB co-infection. Contacts of index TB clients are also targeted. Number of HIV-
infected clients: 800; Number of individuals trained: 35; Number of registered TB patients: 850.
This activity emphasizes human capacity development. The capacity of health workers to manage TB/AIDS
co-morbidity will be strengthened. In addition, the capacity of community health workers, CBOs and NGO
will be strengthened for joint TB/ART drug monitoring and adherence counselling in communities. Health
wrap around activities will include child survival activities for children with TB/HIV, nutritional assessment
and therapeutic food support for malnourished children, and prevention of malaria through use of ITNs. The
project will undertake a gender analysis of the TB/HIV services and institute activities that promote equitable
access and quality of care services offered.
Continuing Activity: 15643
15643 15643.08 U.S. Agency for Management 7144 7144.08 USAID Track $207,250
Estimated amount of funding that is planned for Human Capacity Development $20,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000
Table 3.3.12:
ACTIVITY NARRATIVE:
This activity relates to ART (15646.08) program, Adult and Pediatric Care and Support (15642.08) and
PMTCT (15641.08) program areas. In COP 08, LMS Assoc is providing orphans and vulnerable children
(OVC) services to 6,400 clients in Kogi, Niger, Adamawa, Taraba, Kwara and Kebbi States. An additional
1,800 OVCs will be served in COP09 making a cumulative total of 7,200 OVCs by the end of COP09.
During COP09, LMS Assoc will train 70 OVC providers in the communities who will reach out to the OVCs.
The project will continue with the activities initiated in COP08 and build a network of linked health facility
and community-based HIV/AIDS services in which the health facility staffs, reputable CBOs and FBOs,
teachers, LGA leaders and traditional leaders meet monthly to discuss HIV/AIDS control efforts in the
catchment area of a Comprehensive AIDS Care and Treatment site. This network forum will be used to map
OVC and eliminate selection bias. The forum will also be used to identify which resources are available in
the LGA and what needs to be leveraged from without. LMS Assoc OVC activities aimed at improving the
lives of orphans and other vulnerable children (OVC) 0-17 years affected by HIV/AIDS will be implemented
in communities in the catchment of 19 comprehensive care and treatment (CCT) sites in 6 states. Services
offered will be based on the actual needs of the children as determined by OVC-care givers and guardians
closely related with the communities to avoid serving children of influential community leaders who are not
orphans themselves. The project will implement household-centered approaches that strengthen the
capacity of the family unit to cope and mobilize collective community responsibility for care of OVCs. OVC
services will be linked with HIV-affected families through the PMTCT, palliative care, and ART services.
Various community OVC care structures like adoption of OVC in the extended family system or guardians,
foster parents and child-headed families supervised by caring neighboring families will be supported
depending on the circumstances. Although these community OVC structures promote healthy child
development, additional project support will be provided to minimize stretching this traditional coping
mechanism.
The LMS Assoc will support provision of key OVC services including ensuring access to basic education,
broader health care services, targeted food and nutrition support, including support for safe infant feeding
and weaning practices, child protection and legal aid, economic strengthening and training of caregivers in
HIV prevention and home-based care. The project will enroll all HIV+ children into Pediatric Care and
Support, support treatment of opportunistic infections, offer nutritional education and support, psychosocial
support, child education and child protection. To allow children and parents to learn from one another and
improve the quality of their lives, kids support groups and recreation centers will be established to provide
experiential learning activities. The project will support OVC education by assisting OVC care-givers, foster
parents, guardians, PLWHA, CBOS, FBOS, teachers and schools to understand the holistic needs of
growing children with emphasis on OVC and define what individuals, communities and leaders must do to
support OVC remain in school. The project will support community dialogue on OVC to identify community
resources (care and love, shelter, food and clothing) and what needs to be leveraged from outside. The
project may support selected homes and schools caring for OVCs with small grants. In addition, the LMS
Assoc will identify potential partners and link them with communities to support OVCs. Trained OVC care-
givers and community service providers will carry out community group counseling, home visits, and
distribution of water guard and ITNs to selected OVC families. Older OVCs will join adolescent-friendly
health clubs and other community health promotion activities at which life-skills education will be provided.
Orphans and vulnerable children care-givers, community service providers and teachers will be trained in
psychosocial skills to enable them counsel OVCs and their guardians on prevention of HIV/STIs, living
positively with HIV/AIDS and reduction of stigma and discrimination. Child counselling and guidance will
build OVC to develop self-esteem and appreciate that being an OVC is not a limitation to their achievement
of full potential in life. Care givers will also identify and refer families of sick people to the Health Facility
Care Coordinators (HFCC) for HCT and comprehensive care and treatment. Potential vulnerable children
will be identified early in this process and supported even when their parents are still alive. The HFCC with
consent of persons who are diagnosed as HIV positive at the facility will refer their children to the
appropriate providers of OVC services in their local network for follow-up and support.
The LMS Assoc OVC activities will also include prevention of malaria through use of ITNs, provision of safe
water by use of water guard, education on food security, proper sanitation and nutrition counseling.
Community welfare clinics will be conducted through outreach programs to promote early health-seeking
behavior. Food and nutritional support services will include nutritional assessment, counseling and
micronutrient supplementation when indicated. Linkages for food supplementation will be fostered with the
USG supported wrap-around initiatives in States where they are co-located with the ACT project. The
project will partner with the Clinton Foundation and other local private companies like MTN to leverage food
support for OVCs and ready-to-use therapeutic foods for the malnourished HIV infected children. An
anticipated 540 OVC will receive food and nutritional supplementation through the program. LMS Assoc will
train and provide small grants to NGOS, FBOs, CBOs and associations of people living with HIV/AIDS for
delivery of OVC services in the community. Based on their comparative advantages, the CSOs will provide
varied OVC services and will refer OVCs among themselves and to the health facility through their network.
The linked facility-community network will provide a forum for monthly sharing of issues arising from
provision of OVC services and for ensuring the quality of services offered. Health workers will be trained in
provision of quality clinical care based on SOPs while CSOs and teachers will be trained to always
undertake a comprehensive assessment of OVC needs and ensure holistic provision of education, shelter,
medical, psychosocial and nutritional support services. They will also be trained to detect OVC abuse using
a standard checklist and initiate remedial action.
LMS Assoc working with the OVC TWG will train and roll out use of OVC monitoring tools to all supported
CSOs and health facilities to capture OVC service utilization. OVC data will be reported monthly by the
health facility and the CSOs. The project will as much as possible avoid hybrid sites and services to
minimize double counting of OVCs. Facility-based clinical services provided to OVCs, EID and Pediatric
ART will not be counted under OVC services. Monitoring of the wellbeing of these children and data
collection will be conducted utilizing the Child Status Index and the existing GoN tools.
Activity Narrative: CONTRIBUTIONS TO OVERALL PROGRAM AREA:
In providing services to 1,800 OVC and building the capacity of 70 care providers, the ACT Project will
contribute to PEFAR Nigeria meeting it's five-year emergency plan targets of providing care and support to
400,000 OVC. It will add to the implementation of Nigeria's National Plan on OVC. Activities will strengthen
the capacity of facility and community based resources to provide support aimed at improving the lives of
children and families directly affected by AIDS-related morbidity and/or mortality.
This activity links to Prevention, HCT and HTXD, HTXS activities. Activities will improve the health and
education of individuals made vulnerable by HIV/AIDS and create a supportive social environment that will
support prevention activities in this group and in their peers. Linkages with other USG PEPFAR activities
and Global Fund activities existing in the same states will be initiated and strengthened. In addition, the
LMS comprehensive AIDS Services project is linked to the LMS capacity project that will continue to
develop leadership and management skills of the National OVC Coordinating unit in the Federal Ministry of
Women's Affairs as well its counterparts in the State Ministries of Women Affairs. This support will also
include strengthening organizational and programs management capacity to efficiently and effectively
address the National OVC response.
This activity targets OVC 0-17 years old in the catchment areas of the secondary and primary facilities
supported by the project. OVC of index clients attending HIV/AIDS services at the health facilities and other
OVC living in the community have been targeted regardless of cause and HIV sero-status.
This activity includes an emphasis on local organization capacity development and human capacity
development. LMS, working with Local NGOs and CBO in the communities, will strengthen the care and
coping capacities of families and communities. The primary strategy will be the identification of children
most in need, and filling the gap in the safety net traditionally provided by the extended family. This will be
an efficient, cost effective and sustainable way of caring for orphans and vulnerable children.
This activity will support health staff and local community organizations (NGOs, FBOs) in helping to care for
and re-integrate orphans and vulnerable children, contributing to social stability and improving future
economic well-being. ACT will work with state government, local government, NGO, and CSOs in ensuring
that appropriate policies are put in place to protect orphans and other vulnerable children and their families.
These policies will contain clauses to prohibit discrimination in access to medical services, education,
employment, and housing, and protect the inheritance rights of widows and orphans.
Estimated amount of funding that is planned for Human Capacity Development $54,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $45,000
Estimated amount of funding that is planned for Economic Strengthening $20,000
Estimated amount of funding that is planned for Education $60,000
Table 3.3.13:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: LMS will train health workers to provide
counseling and testing in TB clinics both within LMS-supported facilities and stand-alone TB DOTS clinics.
This activity links to activities in PMTCT, adult and pediatric care and support, TB/HIV, OVC, and prevention
activities of other implementing partners (IPs) and the Government of Nigeria (GON). LMS in COP08 is
supporting provision of HCT services at 17 secondary and 22 feeder Primary Health Care (PHC) facilities in
6 states of Kogi, Niger, Taraba, Adamawa, Kebbi and Kwara. In COP09, the LMS AIDS Care and
Treatment project will continue to build upon the counseling and testing activities initiated in COP08 and
expand to 2 additional secondary facilities in the existing states. HCT services will be further decentralized
and strengthened at satellite PHC sites within each Local Government Area (LGA) to identify HIV positive
clients and refer them to the comprehensive care and treatment (CCT) sites for treatment, care and support
services as appropriate. Therefore a total of 41 sites (19 Comprehensive Care and Treatment and 22 PHC)
will provide HCT in COP09. LMS will continue to leverage resources from state governments through high
level advocacy, to support service delivery in the 41 supported sites. The LMS HCT site and community
level activities will stress: (1) providing technical assistance, particularly in identifying most at risk persons in
need of HCT, and (2) working with sites to identify potential additional resources (from the GON, other
donors, Global Fund, etc.) to provide commodities and increase uptake of HCT services in all points of
service in the facilities. In COP09 8,500 clients will be reached with HIV counseling and testing and receive
their results.
Through this approach, the project proposes to saturate each LMS supported facility LGA with an integrated
HIV/AIDS and TB service that is more accessible to remote communities and stimulates community
ownership and personal behavioral modification for prevention and health-care seeking. Some PHC
facilities will be supported to become refilling centers for ARVs once clients have been stabilized at the
secondary CCT sites. Counseling skills will be strengthened in the existing secondary facilities and feeder
sites through appropriate training and retraining of 70 counselors. The counselor training program will be
revised to include emerging issues such as provider initiated testing and counseling (PITC), family centered
counseling, pediatrics counseling, home based counseling and testing, laboratory quality control/external
quality assurance (QC/EQA), biomedical safety, rapid test kit (RTK) supply management, the continuum of
care, linkages between HCT and other HIV/AIDS, TB and sexually transmitted infection (STI) services,
professional HCT ethics, and how to work with local communities. Within the 70 counselors to be trained,
LMS will provide PITC training to some counselors in TB clinics both within LMS-supported facilities and
stand alone TB DOTS clinics. Counselor training in couples counseling will be leveraged from other IPs for
counselors drawn from all LMS supported sites. Training shall be line with the GON national and
international standards. LMS shall support facility-based HCT counselors to provide Mobile HCT services in
remote areas targeting most at risk populations (MARPS), such as commercial sex workers, long distance
truck drivers and uniformed service men. HCT services will also be extended to incarcerated populations
(prisoners) in two prisons in Kogi and Adamawa States and remote PHC in the focus states. LMS will also
support home based care providers within the basic care and support team who have competence in HCT
to provide home based HCT services to families of index clients as part of its family centered approach and
a contribution to prevention with positives. Clients accessing the mobile HCT services shall be linked to
treatment, care and support programs of LMS and other IPs in the focus areas based on clients'
convenience and ease of access. A referral system that promotes facility-to-community linkages and
ensures feedback from the referred facility to the referral site shall be adopted for this purpose. LMS has
identified a referral coordinator in each supported comprehensive care and treatment facility to drive this
process. LMS will provide training in management systems including referral systems and patient tracking.
LMS will begin to identify and partner with local NGOs and CBOs in the communities surrounding the 19
secondary facilities and their feeder sites to enlist them to mobilize and support the general population to be
tested. These NGOs will also play a crucial role in supporting LMS family approach to service delivery,
dealing with the stigma of HIV/AIDS, encouraging HIV positive parents to seek testing and treatment for
their children, and supporting persons living with HIV/AIDS. LMS will also collaborate with private health
care providers in the locality to provide HCT services with LMS support after appropriate training, following
national guidelines. HIV testing at all sites will be conducted using the current national serial algorithm. LMS
project will provide counseling and testing and give results to 9,350 individuals including those with TB in
COP09. In order to promote sustainability of the program and the buy-in of the host state governments,
LMS will conduct advocacy visits to state governments to leverage resources. LMS will also facilitate
quarterly HCT program update meetings with relevant state officials. LMS will also train counselling
supervisors to maintain quality of service delivery and promote the sustainability of HCT services in the
facility. LMS will buy into the USG HCT TWG intention to leverage rapid test kits from GON. This will afford
LMS the opportunity to increase access to HCT by providing counseling and testing to the general
population.
LMS will strengthen the Provider Initiated Testing and Counseling (PITC) strategy in all supported health
facilities. This shall be done by continuous mentoring and supportive supervision of trained staff that provide
HCT at all points of service - the Outpatient Departments, Emergency units, TB and STI clinics, Laboratory,
Dental department and other inpatient hospital wards. All patients visiting the hospital shall be routinely
offered HIV counseling and testing using the opt-out model. LMS shall collaborate closely with the hospital
administration to ensure compliance and uptake of services. HCT services shall also be provided routinely
to blood donors as a component of the blood transfusion services in supported sites. This will enable blood
donors to get to know their HIV status and to be linked to treatment, care and support as appropriate, and to
benefit from HIV prevention messaging based on abstinence, be faithful and correct and consistent condom
use as appropriate. In order to increase HCT uptake and help deal with issues of discordance amongst
couples, LMS shall offer couples counseling and testing (CHCT), following international standard protocols
and guidelines. In order to strengthen these services, LMS will support its staff to step down the CHCT
training provided by USG as part of its couples counseling roll - out plan for Nigeria. Appropriate post-test
counseling will be provided to discordant couples, with emphasis on prevention for positives. In pursuit of a
family-centered HIV/AIDS, TB and STI services, index clients will be counseled to bring their family
members for HCT and subsequent care. Prevention messages based on ABC will be provided to families.
Activity Narrative: Pediatric HIV testing also will be offered at pediatric clinics and wards following standard guidelines and
protocols.
LMS will implement the Prevention with Positives strategy including provision of condoms and information
on correct and consistent use, especially to MARPs, counseling discordant couples and prevention of re-
infection in couples that are concordantly positive. Condoms will be sourced from the Society for Family
Health. LMS will establish two HCT stand alone sites within LMS supported facilities in centers in Niger and
Taraba States. These supported HCT sites will be branded with the national "Heart to Heart" logo for easy
recognition as a center for high quality HCT services. Information, education, and communication (IEC)
materials focusing on abstinence and be faithful, and correct and consistent use of male and female
condoms (ABC), shall be made available in all of these sites. To ensure appropriate condom messaging,
models shall be provided in all HCT sites for the demonstration of correct condom use and condoms
provided through the Society for Family Health shall be made available at all HCT sites including mobile
HCT units. To ensure uniform and consistent data collection and monitoring and evaluation (M&E)
processing, LMS shall use the national HCT registers and other national M&E tools for data collection at the
secondary and primary sites alike. Aggregate site data shall be summarized and reported to the State M&E
program officer and the HCT TWG as required. LMS will through its dedicated quality control lab staff
provide routine HCT sites monitoring and appropriate mentoring to site staff. Personnel involved in HIV
testing shall undergo quarterly proficiency testing, while testing accuracy will be routinely re-checked using
limited retesting of patient samples. EQA for HIV serology will be linked to other USG IPs EQA programs
until LMS can develop its own program as detailed in the laboratory narrative. As part of quality control
measures instituted at all HCT sites, the quality control staff will also ensure that standard procedures are
strictly followed in the safe handling and disposal of medical waste and other lab waste materials. Training
for PEP will also be provided to all staff involved in HCT services. HIV test kits shall be procured through the
USG-SCMS partnership mechanism, while the LMS logistic partner, AXIOS, shall be responsible for the
appropriate warehousing and distribution of the kits to the sites. To ensure consistent availability of test kits
and supplies at the sites, LMS shall adopt the use of the Supplies Consumption Data Feedback Form from
all the sites. This will be used to determine the actual test kits and reagent consumption and based on this,
provide appropriate replenishment.
Counseling and testing serves as an entry point for HIV positive individuals into treatment and support for
positive living. HCT activities support and contribute to the success of ARV treatment, TB-HIV, PMTCT,
OVC, and prevention, and strengthen the capacity of facility and community based resources to provide
comprehensive HIV/AIDS services, serving the wider interest of improving the lives of adults, children and
families directly affected by HIV. LMS shall promote TB/HIV collaboration by providing HCT training to
service providers in DOTS clinics and including community TB screening in mobile HCT activities
This activity links to activities in Laboratory, PMTCT, Adult Care and Support, TB/HIV, OVC, and prevention
activities of other IPs and the GON.
This activity focuses on clients attending the various clinics at the 19 CCT and 45 PHC health facilities.
Clinics targeted include TB, outpatient, ANC, inpatient wards, STI and Pediatric clinics. Adults and children
from the catchment areas of the project supported sites are also targeted for HCT. The project will
specifically target MARPs who have a relatively higher HIV prevalence and will require enrollment into care
and treatment.
This activity focuses on increasing the availability and accessibility of HCT (a crucial entry point to
comprehensives AIDS care and treatment, and prevention) through provider initiated counseling and
testing, establishing stand alone HCT centers, and provision of mobile HCT services which target MARPS.
It also addresses gender concerns related to HIV/AIDS care and treatment by promoting access to
diagnosis, care and treatment for women, particularly pregnant women through PITC in antenatal clinics
and delivery wards. This activity addresses the need to counsel and test in order to link infected persons to
care and treatment and prevent future infections in persons who test negative.
Continuing Activity: 15645
15645 15645.08 U.S. Agency for Management 7144 7144.08 USAID Track $1,320,000
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.14:
In COP09 LMS will build upon its achievements and experiences of COP08 to meet its COP09 target of
providing antiretroviral (ARV) drugs to 6120 existing clients and 1768 new people living with HIV/AIDS
(PLWHA) - adults and children - during the reporting period. The cumulative number of PLWHA that LMS
will have supported with ARV drugs by the end of COP09 will be 7,888. This will be achieved by supporting
seventeen (17) existing antiretroviral therapy (ART) sites in Kogi, Niger, Adamawa, Taraba, Kebbi and
Kwara States, and upgrading 2 sites to full Comprehensive Care and Treatment (CCT) and further
decentralizing access to drugs at selected linked primary health care (PHC) units in existing states. The
project will therefore operate a total of 19 CCT sites in COP09.
This activity has several components namely: product selection, forecasting, procurement, inventory
management, warehousing and quality delivery of antiretroviral (ARV) drugs to people living with HIV/AIDS
(PLWHA). This narrative also describes the system strengthening efforts done by LMS and its subcontractor
Axios.
First step of the process is product selection. LMS follows USG and FDA regulations, National Treatment
Guidelines, National Agency for Food and Drug Control (NAFDAC) regulations.
LMS participated in the August 2008 forecasting exercise organized by the USG and SCMS project. The
following assumptions were used in the forecasting for ARVs: Children will constitute 10% of all ARVs to be
procured. 80% of patients will be on AZT-based containing regimens and 20% on D4T-containing regimen.
Second line drugs will account for 3% of all treated clients. For PMTCT, 40% will receive single dose AZT
300 mg orally twice daily starting at 28 weeks through labor and delivery to one week post partum; and 60%
will receive dual therapy of AZT/3TC 300/150 mg orally twice daily starting at 34 weeks through labor and
delivery to one week post partum. One-hundred percent of mothers will receive NVP 200mg at onset of
labor. One-hundred percent of the babies will receive 0.6 ml NVP within 72 hours of birth followed by
4mg/kg AZT orally twice a day for the next six weeks.
LMS will during COPO9 use the following drug regimens: First Line ART for adults will comprise of
AZT+3TC+NVP (65%) or D4T+3TC+NVP (15%) or AZT+3TC+EFV (15%) or D4T+3TC+EFV (5%). Second
line regimen will comprise of TDF/FTC+LVP/r. First line pediatric regimen will comprise of AZTs +3TCs
+NVPs (15%) or AZTs +3TCs +EFV 50 (10%) or D4T6/3TC30/NVP50 (20%) or D4T12/3TC60/NVP100
(40%) or D4T20+ 3TCs +EFV (10%) or D4T12/3TC60 +EFV (5%). Second line pediatric regimen will
comprise of ABC+DDI+LPV/r (100%). PMTCT regimen will comprise of Nevirapine 200mg Tablet and
Zidovudine/Lamivudine 300/150mg.
For the procurement portion of the process, LMS partner Axios Foundation has developed a functional
logistics system to ensure consistent availability of secure and high quality ARVs and related commodities
plus accountability for the deliveries/usage. COP09 drug orders are determined by the result of the forecast.
All purchases of Truvada (TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be purchased via SCMS pooled
procurement mechanism in line with OGAC's recommendation. Generic formulations will be used
preferentially. Axios will use its distribution and warehousing network to deliver goods to patients.
LMS will ensure uninterrupted availability of ARV to all ART facilities through close relationship and
leveraging resources with Government of Nigeria (GON), USAID and other stakeholders as well as
PEPFAR implementing Partners (IPs). This concerted effort will efficiently promote a sustainable supply of
ARVs and other HIV related products to all health facilities covered by the project. The project will leverage
second line pediatric ARVs from the Clinton Foundation.
To effectively manage ARV inventory system, LMS supported facilities will continue to use a paper based
Logistics Management Information System (LMIS). A computerized Inventory Management System with
ability to interface with the Patient Management and Monitoring System (PMM) has also been developed
and will be introduced at 2 selected supported sites in COP09. This system will ensure generation of
management reports required for decision-making at facility and program management level. LMS will
closely monitor the expiry dates on all the ARVs, so a timely re-allocation of drugs to high volume sites can
help manage the system better. Should any drugs expire within the pipeline, LMS will destroy them in line
with national waste management guidelines.
AXIOS, the LMS SCM agency is guided by the memorandum of understanding with the FMOH and the
States Central Medical Stores in continuing to build capacity for warehousing and distribution by
implementing already-developed standard operating procedures (SOPs) for warehousing and distribution at
the central medical stores. In pursuance of increased government capacity to manage the SCM system and
lead HIV/AIDS control efforts, LMS and AXIOS will in COP09 implement the following strategic priorities:
(1) strengthening health facility commodity management systems to build sustainable logistics management
capability for ARV drugs, Drugs for OIs, Rapid Test Kits (RTKs) and Lab reagents; (2) continued effort to
improve the efficiency and effectiveness of mechanisms for procurement, warehousing, distribution and
Logistics MIS; (3) continued rollout of our computerized Inventory Management System and ensuring a
feedback mechanism that will promote analysis and utilization of collected data for making appropriate
policy decisions; (4) integrating the warehousing function into the MOH system at Federal, State and Local
Government wherever applicable; (5) consolidation of capacity building through, tools development,
training, on-site training, supportive supervision and mentoring; (6) Continued implementation of the
established Supply Chain Management Quality Assurance, (7) Collaborating with the SCMS project on joint
forecasting and harmonization of procurement efforts to harness the economies of scale, and (8)
establishing effective collaboration mechanisms with the GoN, Global Fund to fight AIDS, Tuberculosis and
Malaria (GFATM) and other development partners for sustainability of program activities.
The Project State Logistics Officers will provide technical support to the State Governments to improve
management of supplies and link SCM with the state M&E system and decision-making.
The LMS phase-out and sustainability plan includes building capacity of health unit stores officers, program
Activity Narrative: staff and state stores managers in the using the LMIS data to implement a "pull system" for commodities. IN
COP09, LMS will strengthen its capacity building efforts in 2 states of Niger and Adamawa. The plans will
include an assessment phase, customized plan for building capacity, and a set of clear objectives and
indicators for measuring capacity as well as a timeline based on key benchmarks. The sites will be
assessed using the site assessment tool and implementation will be based on the minimum start up
requirements of the site. Specific attention will be paid to ensuring security of drugs.
Commodity availability at facility level is the cornerstone of the strategy to increase access to the drugs and
diagnostics for PLWHA, and to significantly contribute to the achievement of PEPFAR goals of access to
care. The provision of ART services through this program will contribute to strengthening and expanding the
capacity of the Government of Nigeria's response to the HIV/AIDS epidemic, and increasing the prospects
of meeting the Emergency Plan's goal of providing life-saving antiretroviral treatment to infected individuals.
This program will also contribute to strengthening the national drug/commodity logistics management
systems, especially as it relates to ARVs, OIs, Test Kits, lab reagents and consumables among others.
This program element relates to activities in HVCT, MTCT, HTXS, and HBHC. Links to these programs
include covering areas such as logistics/ supply chain management and management of test kits (CT), ARV
drugs for adults and children, drugs for opportunist infections - OIs, prophylactic ARV drugs for pregnant
women and infants.
The provision of supplies for laboratory diagnostics links directly into the ART program by providing for
monitoring patient progress, toxicity levels and clinical chemistry.
The drugs are for HIV positive clients enrolled on care and requiring HAART. Both adult and pediatric HIV
infected clients are targeted. Also drugs for PMTCT prophylaxis
Emphasis areas for the COP09 ART Drugs component will include strengthening of health facility logistic
systems to sustainably manage ARV drugs, Drugs for OIs, RTKs and lab reagents and quality assurance,
quality improvement and supportive supervision. This will be achieved through the integration of the
project‘s distribution system into the national network and also building capacity at state and site level to
ensure sustainability of the developed supply chain management system. Building upon the Integrated
Inventory Management Systems implemented at the facility levels, the project will continue to provide
regular on site support to sustain usage. Finally LMS will continue to work with GON and implementing
partners to ensure the harmonization and standardization of the LMIS tools & standard operating
procedures in pharmacy.
The establishment of drugs storage facilities in or close to the LMS focus states will ensure that the drugs
are proximal to health facilities and thus will increase access of such drugs and services to the resource-
poor communities. By this endeavor, beneficiaries have closer access to drugs and are able to live healthier
lives.
Continuing Activity: 15646
15646 15646.08 U.S. Agency for Management 7144 7144.08 USAID Track $3,500,000
Estimated amount of funding that is planned for Human Capacity Development $100,250
Table 3.3.15:
In COP08, LMS activated seven additional sites, including one in a tertiary health facility supported by the
State Ministry of Health in Taraba state and six in secondary health facilities. In COP09, LMS will activate
an additional laboratory in a secondary health facility to support the provision of ART and cryptococcal
serology, which will bring the total labs supported with PEPFAR funds to 18. LMS will provide step down
training on laboratory management to laboratory managers. Other tests for opportunistic infections will be
included based on the recommendations of the PEPFAR-Nigeria Laboratory Technical Working Group
(LTWG). Training on opportunistic infection diagnosis will be provided by American Society of Microbiology
(ASM).
The LMS program currently provides high quality laboratory services through a tiered laboratory system in
support of HCT, ART, PMTCT, TB/HIV, OVC and Blood Safety, as part of its comprehensive HIV/AIDS
services. By the end of COP08, LMS will be supporting a total of 17 laboratories in 1 tertiary and 16
secondary health facilities in Kogi, Niger, Taraba, Adamawa, Kebbi and Kwara states. The states were
identified in conjunction with the Government of Nigeria (GON), based on needs assessment and ART
scale-up strategy. Each of the secondary sites, as well as the tertiary sites, are linked to at least 2 primary
feeder sites in a "hub and spoke" model. The primary sites will serve as HCT/PMTCT centers and referral
points (not counted as lab sites). One additional secondary level laboratory will be established in COP09 for
a total of 18 laboratories; 1 tertiary and 17 secondary level sites in the 6 project states.
To ensure that high quality and reproducible laboratory services are provided using appropriate modern
technology, while guaranteeing safety of staff, patients, communities and the environment, LMS advocated
for structural renovations in COP07. This included upgrading infrastructure and providing essential
amenities, such as portable water, water distillers, overhead water tanks for sustainable water supply and
electricity supply in Kogi and Niger states. In COP08, the same renovations were extended to all of the 7
new labs in the new intervention states.. This approach will also be extended to the 2 new labs in COP09.
In all supported labs, HIV diagnosis, CD4 counts, hematology assays, chemistry assays will be routinely
offered using appropriate testing technology and automated laboratory equipment, and will be in line with
internationally accepted standards as well as national guidelines. LMS will also provide support for syphilis,
HBsAg, malaria parasite, pregnancy and routine microbiology tests for other STIs. Laboratory diagnosis for
opportunistic infections (OIs) will also be offered. This will, at minimum, include TB microscopy and
cryptococcal serology testing. It is estimated that LMS will provide a minimum of 150,000 tests in COP09.
LMS counts each test, including chemistry panel, as a single test.
In COP08, LMS embarked on an integrated expansion of laboratory training, covering HIV/STI serology,
Good Laboratory Practice, Quality Control and Quality Assurance procedures, biomedical safety, laboratory
equipment care and maintenance, specific lab assays, lab ART monitoring, commodities management as
well as laboratory information systems, and others. Training was based on identified training needs. These
trainings will be provided to supported site staff in-country through collaboration with other USG-IPs such as
FHI/GHAIN and IHVN-ACTION, who currently have both training labs and experienced and proficient
laboratory trainers. This collaboration will also build the training capacity of LMS training staff that will be
identified. LMS participated in the lab management training provided by the USG through APHL. LMS also
participated in the PEPFAR funded harmonization training of trainers on Haematology/CD4/Clinical
Chemistry provided by ASCP to develop a team of trainers for the program and for the PEPFAR/Nigeria. In
COP09, LMS will provide these trainings to laboratory site staff using adapted training packages. LMS
training packages are PEPFAR/GON harmonized training packages, and are appropriately adapted to meet
local needs. In COP09, LMS will further provide step down training to 48 laboratory managers, from 18
networks of supported laboratories in the 6 states, using the adapted lab management training packages
developed by APHL. In COP09, LMS will train a total of 108 laboratorians.
LMS would like to move towards gaining local accreditation through the Medical Laboratory Science Council
of Nigeria (MLSCN), for all of its PEPFAR supported laboratories. To this end, 5 of the supported labs will
be accredited by the end of COP08 and another 7 will be accredited in COP09. The project will also
continue to work with the PEPFAR Lab Technical Working Group for the development of a common lab
equipment platform appropriate for laboratory services at different levels of care, provide training at all
supported sites for the collection of dried blood spots (DBS) for DNA PCR testing at identified PCR testing
sites supported by other USG- Implementing Partners (IPs) in support of the national EID scale up plan.
The Clinton Foundation will provide supplies for DBS collection and support for specimen/results transport
while LMS will roll out the existing plan for EID services in selected LMS pilot sites.
LMS-ACT in-country lab program staffing is made up of one advisor in Abuja and 4 lab specialists
overseeing the 6 states. The Lab Specialists are core members of the Project Management team at both
the Country and State offices. The Laboratory Advisor provides programmatic and technical oversight and
support to the States and serves as the link between the Country program Management as well as the
various Technical Working Groups and the GON. The Laboratory Specialists provide on-site technical
direction, mentoring and supervision to all supported lab sites. The Laboratory Unit oversees the laboratory
inventory systems for commodities, the QA/QC program and capacity building of site staff. In COP09,
additional lab staff will be engaged in the program as part of the expansion.
Quality assurance/quality control of laboratory services will be strengthened in order to support quality HIV
diagnosis, treatment and care. The essential components of a quality system will be strengthened further at
each site. LMS will support External Quality Assessment through quarterly on-site monitoring visits using
standardized checklists. Reports will be generated and fed back to the sites. All non-conformities will be
addressed and remedial action taken to rectify problems in the testing process. LMS will work in
collaboration with FHI/GHAIN, IHVN-ACTION and HAVARD-APIN for External Quality Assessment (EQA)
for specific laboratory assays. Outcome of these QC and EQA programs will also feed into the LTWG
system on a quarterly basis.
LMS, through its strategic partnership with Axios Foundation, has set up an efficient supply chain
Activity Narrative: management system that will provide a continuous and uninterrupted supply of rapid test kits, laboratory
reagents and consumables. Axios will be responsible for forecasting, procurement, warehousing and
distribution of the laboratory commodities to all LMS supported sites. HIV rapid test kits will be procured
through SCMS and Axios will be responsible for the warehousing and distribution of these kits.
LMS will, in COP 09, collaborate with lab equipment manufacturers/vendors to provide specialized lab
equipment maintenance and repairs training to 5 facility based biotech engineers to enable them provide
appropriate equipment maintenance and repair support within the supported facilities. This arrangement is
in addition to the lab equipment maintenance contract with vendors.
LMS will work with JSI/MMIS to provide training on injection safety, provision of AD needles and training on
safe handling and disposal of bio-medical wastes in all supported facilities. In this vein, LMS will continue to
provide standard sharp containers at all supported sites. The quality control staff will ensure strict
compliance with national standards of biomedical waste handling and disposal. Efforts will be sustained at
encouraging the use of the PEPFAR identified incinerator at the National Hospital for sites proximal to Abuja
while other sites will be supported to provide technologically appropriate incinerators. 34 Laboratory staff
from LMS supported labs will be trained on post exposure prophylaxis (PEP) and on steps to follow in case
of accidents that could lead to exposure to HIV infections.
LMS will sustain and strengthen advocacy to leverage resources from stakeholders to support laboratory
infrastructural development. This will include working with the relevant State and Local Government to
support the provision of infrastructure at both secondary and primary health facilities. Information
management and inventory management systems will be strengthened to support these lab activities. LMS
will train 155 laboratory managers/staff at all supported sites in information and inventory management, and
will also provide ongoing on-site capacity building and monitoring.
TB microscopy will be carried out at tertiary, secondary and primary health facilities. Leveraging resources
from the National TB & Leprosy Control Program (NTBLCP), TB microscopy training will be conducted for
34 lab staff using the CDC/WHO TB/AFB microscopy training package that has been adapted for use in the
country. In COP 09, LMS will procure additional equipment for TB diagnosis using fluorescence microscopy
in four major health facilities (e.g. a tertiary health facility supported by the state government, and three
secondary health facilities) while others will be provided with conversion kits and reagents for staining AFB.
These will include model Primary Health Center Laboratory to support the provision of quality smear
microscopy screening in the rural communities. Training will continually be conducted using
CDC/WHO/GON TB/AFB harmonized training package.
The provision of laboratory services through this program will contribute to strengthening and expanding the
capacity of the GON to respond to the HIV/AIDS epidemic, build the capacity of laboratory staff at the
project sites and contribute to the infrastructural upgrading of health facilities as well as the provision of
necessary equipment. Considering the complexity of antiretroviral therapy (ART), and the strict
requirements for standards and procedures, the laboratory component will aim to establish a well
coordinated and efficient quality assurance, supervision and monitoring system at all supported sites.
This program element relates to activities in PMTCT, HCT, BC&S, TB/HIV, and OVC. A referral linkage
system will be strengthened to ensure that clients are referred from sites with limited or no laboratory
infrastructure to properly equipped laboratory sites using an integrated tiered national laboratory network.
LMS will work with the GON to implement approved testing algorithms and will work with the GON and other
stakeholders on the use of non-cold chain Rapid Test Kits (RTK) for HIV testing. With the new scale up
strategy for counseling and testing (CT), LMS will build the capacity of counselors, both at the CT and
PMTCT sites, on the use of non-cold chain dependent algorithm for HIV testing. The project will also
introduce sputum smear microscopy and tuberculosis (TB) treatment in all CT sites.
This activity will provide laboratory services to PLWHAs, (including pregnant women), HIV positive children,
tuberculosis (TB) patients including those that are HIV positive and are eligible for ART, HIV positive infants
and other most at risk populations (MARPS). These clients will be generated from PMTCT, Care and
Treatment, mobile and facility based counseling and testing and TB-HIV programs.
Emphasis will be placed on quality assurance, quality improvement, and supportive supervision, as well as,
laboratory infrastructure upgrade, including commodity procurement (laboratory equipment and reagents)
and local organizational capacity development through trainings and on-site technical.
Continuing Activity: 15648
15648 15648.08 U.S. Agency for Management 7144 7144.08 USAID Track $2,200,000
Table 3.3.16:
This is a continuing activity that is linked to Program Service Delivery Areas through the strategic
information provided for improved oversight, management, and learning from these activities.
During COP09, the LMS ACT project will continue to monitor and report on output and achievements of
program level results from 17 COP08 existing Comprehensive Care and Treatment (CCT) sites in Kogi,
Niger, Adamawa, Taraba, Kebbi and Kwara States and 2 additional sites that will be upgraded to full CCT in
COP09. In addition, program results will be collected on the hub and spokes model that we are building to
link CCT and satellite Primary Health Care (PHC) unit services and analyzed to further inform the
decentralization process. Program monitoring will allow for tracking of results; analysis of scale up;
improved program management; and feedback to service providers which will enhance quality of not only
data collection, but service provision as well. LMS ACT will assure that there are dedicated M&E officers at
all facilities and points of service, that data collection systems will track linkages for prevention-care-
treatment continuum and harmonized with electronic Patient Management and Monitoring (PMM) platforms.
Technical assistance provided to sites will be coordinated with other SI programs and aligned with the USG
data quality assessment/improvement (DQA/I) and capacity building plan. Capacity building in this area
will be achieved through a combination of approaches, including workshop training (training content will
include M&E skills building, surveillance topics, and Health Management Information Systems (HMIS)
concepts), on the job training, and facilitative supervision. Technical Assistance will focus on self-guided
assessment of information systems; use of existing methods and tools for collecting, analyzing and
disseminating data; use of data for service planning, monitoring and evaluation; and measuring and
improving data quality. HIVQual will be used at all pertinent programs for services quality control. The
project will strengthen the skills of health unit staff to use data for planning and to advocate for increased
local leadership and community involvement as well as leveraging resources to support sustainable service
delivery. CCTs, satellite PHC facilities, LGA leaders, CBOs, FBOs and NGOs in the LGA catchment area
will hold periodic meetings to discuss the analyzed SI and design strategies for improving program resource
management and performance. LMS Associates will work closely with state level M&E officers to enhance
local capacity, champion the uniform National M&E system (Third One) and promote their participation in
routine state-level monitoring and reporting. LMS Assoc will provide Technical Assistance to 19 local
organization for strategic information activities and train 50 individuals in strategic Information (includes
M&E, surveillance, and/or HMIS).
Activities will strengthen the capacity of individuals and units (facilities) from project-supported sites to
identify, properly collect, analyze and use HIV/AIDS related data, for reporting as well as program
management and planning.
Strategic information links to the other PEPFAR Program Areas LMS is engaged in, primarily by ensuring
accurate data collection, reporting, and utilization. The current program areas funded in this LMS project
are: PMTCT; Adult Care and Support; Pediatric Care and Support, TB/HIV; OVC; Counseling and Testing;
ARV Drugs; Adult Treatment, Pediatric Treatment, and Lab. Strategic Information activities will serve as a
vital link between these areas, ensuring not only data collection and sharing, but enabling program
managers to adapt programs to strengthen linkages, build support networks, and provide comprehensive
and holistic care for clients and their families.
This activity targets health providers, facility managers and other individuals in the community or in
organizations in LMS supported states that are involved in the collection, analysis, reporting and use of
HIV/AIDS related data.
This activity includes an emphasis on capacity development in M&E. It will promote understanding among
service providers and health managers regarding the nature of data they are asked to collect and report on,
as well as the importance and utilization of the information obtained. In addition, this activity contributes to
gender equity in HIV/AIDS programming through data collection. Data on services received, by gender, can
inform program planning and intervention design changes. In line with the USG DQA/I plan, this project will
develop capacity of GoN staff at State, LGA, and facility level. Data analysis will wherever possible highlight
the gender disparities in access to prevention and care resources lending opportunity for the design of
gender-sensitive programs. Also, the program will regularly collect and disseminate SI on gender and
HIV/AIDS for use by health workers and state and local government leadership.
Continuing Activity: 15649
15649 15649.08 U.S. Agency for Management 7144 7144.08 USAID Track $0
Table 3.3.17:
