Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7144
Country/Region: Nigeria
Year: 2009
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $10,375,711

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $384,000

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:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $1,080,000

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $1,080,000

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $872,000

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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:

New/Continuing Activity: Continuing Activity

Continuing Activity: 15642

Continued Associated Activity Information

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

System ID System ID

15642 15642.08 U.S. Agency for Management 7144 7144.08 USAID Track $1,400,000

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $15,000

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $2,073,600

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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:

New/Continuing Activity: Continuing Activity

Continuing Activity: 15647

Continued Associated Activity Information

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

System ID System ID

15647 15647.08 U.S. Agency for Management 7144 7144.08 USAID Track $2,160,000

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000

Economic Strengthening

Education

Water

Estimated amount of funding that is planned for Water $15,000

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $120,000

ACTIVITY DESCRIPTION

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15644

Continued Associated Activity Information

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

System ID System ID

15644 15644.08 U.S. Agency for Management 7144 7144.08 USAID Track $0

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $240,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY DESCRIPTION

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

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 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

commodities and logistics support for the EID program. Exposed infants will be actively linked to pediatric

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.

PMTCT focal persons at all sites will keep records of all exposed infants at enrollment soon after birth;

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.

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 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.

Pneumocystis jeroveci pneumonia is a very important cause of morbidity and mortality among infants in

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.

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 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

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 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

meetings. Identified adolescents will be counseled separately on disclosure, adolescent reproductive health

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.

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 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.

LINKS TO OTHER ACTIVITIES:

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

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

This activity will include emphasis on human capacity development specifically for active enrolment of all

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15647

Continued Associated Activity Information

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

System ID System ID

15647 15647.08 U.S. Agency for Management 7144 7144.08 USAID Track $2,160,000

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $160,000

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15643

Continued Associated Activity Information

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

System ID System ID

15643 15643.08 U.S. Agency for Management 7144 7144.08 USAID Track $207,250

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $20,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $432,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15644

Continued Associated Activity Information

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

System ID System ID

15644 15644.08 U.S. Agency for Management 7144 7144.08 USAID Track $0

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $54,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $45,000

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $20,000

Education

Estimated amount of funding that is planned for Education $60,000

Water

Table 3.3.13:

Funding for Prevention: HIV Testing and Counseling (HVCT): $85,000

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.

ACTIVITY DESCRIPTION:

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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

LINKS TO OTHER 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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15645

Continued Associated Activity Information

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

System ID System ID

15645 15645.08 U.S. Agency for Management 7144 7144.08 USAID Track $1,320,000

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $30,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Treatment: ARV Drugs (HTXD): $1,876,580

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15646

Continued Associated Activity Information

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

System ID System ID

15646 15646.08 U.S. Agency for Management 7144 7144.08 USAID Track $3,500,000

International Sciences for 2.0 LMS

Development Health Associate

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,250

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.15:

Funding for Laboratory Infrastructure (HLAB): $1,912,531

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).

ACTIVITY DESCRIPTION:

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.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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 AREAS

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15648

Continued Associated Activity Information

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

System ID System ID

15648 15648.08 U.S. Agency for Management 7144 7144.08 USAID Track $2,200,000

International Sciences for 2.0 LMS

Development Health Associate

Table 3.3.16:

Funding for Strategic Information (HVSI): $60,000

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY DESCRIPTION:

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).

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

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.

LINKS TO OTHER ACTIVITIES:

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.

POPULATIONS BEING TARGETED:

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.

EMPHASIS AREAS:

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15649

Continued Associated Activity Information

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

System ID System ID

15649 15649.08 U.S. Agency for Management 7144 7144.08 USAID Track $0

International Sciences for 2.0 LMS

Development Health Associate

Table 3.3.17:

Cross Cutting Budget Categories and Known Amounts Total: $1,629,250
Human Resources for Health $130,000
Food and Nutrition: Policy, Tools, and Service Delivery $40,000
Human Resources for Health $150,000
Human Resources for Health $150,000
Human Resources for Health $200,000
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Food and Nutrition: Commodities $60,000
Water $15,000
Human Resources for Health $200,000
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Food and Nutrition: Commodities $60,000
Water $15,000
Human Resources for Health $40,000
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Human Resources for Health $40,000
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Human Resources for Health $20,000
Food and Nutrition: Policy, Tools, and Service Delivery $30,000
Food and Nutrition: Commodities $20,000
Human Resources for Health $54,000
Food and Nutrition: Policy, Tools, and Service Delivery $50,000
Food and Nutrition: Commodities $45,000
Economic Strengthening $20,000
Education $60,000
Human Resources for Health $30,000
Human Resources for Health $100,250