PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY UNCHANGED FROM FY2008
ACTIVITY NARRATIVE
This activity is linked to ART drugs, OVC and pediatric care and treatment, TB/HIV, lab, HCT, adult care
and treatment, and SI. In COP08 Vanderbilt counseled, tested, and provided results to 5,800 pregnant
women in 5 sites (2 comprehensive and 3 satellites). In COP09, Vanderbilt will build on the successes
achieved in COP08 by supporting the government of Nigeria in providing PMTCT services to a total of 6,000
pregnant women in a total of 7 sites (2 comprehensive and 5 satellite sites) and will provide antiretroviral
prophylaxis to 300 HIV-infected pregnant women. To achieve this goal Vanderbilt anticipates training and
re-training 20 health care workers (HCWs) to provide PMTCT using the National PMTCT Training
Curriculum.
PMTCT services will be offered at the two comprehensive and five satellite sites in line with the National
PMTCT Guidelines. Group health information will be provided to ANC clients during the morning health talk
and opt-out HIV testing will be offered to all attendees according to the current Nigerian HIV-testing
algorithm. Same day HIV test results will be provided to clients during individual posttest counseling.
Women who test positive for HIV will be sent for onsite CD4 testing (if available) or referred to one of the
comprehensive centers for CD4 testing. Those eligible for treatment will be offered HAART and those
eligible for prophylaxis will be provided with ARV prophylaxis consistent with the recommendations of the
National PMTCT Guidelines. Currently, the standard ARV prophylactic regimen for PMTCT consists of:
antenatal zidovudine (ZDV) beginning at 28 weeks gestation or ZDV/lamivudine (3TC) beginning at 34 - 36
weeks; intrapartum ZDV/3TC/NVP and; postpartum ZDV/3TC to mother for seven days. All HIV-exposed
infants will receive single dose NVP within 72 hours of birth and ZDV for the first six weeks of life.
Replacement doses of NVP will be available in the labor wards of project-supported facilities for women
who forget to take their NVP prior to admission.
Considering that an anticipated 20% - 40% of pregnant women will present to the labor ward "unbooked",
Vanderbilt will train the labor ward midwives to provide point-of-care, opt-out, intrapartum HIV testing and to
provide NVP prophylaxis to HIV-infected women. These mothers will also receive the postpartum regimen
(ZDV/3TC for seven days) and their infants will be given single dose NVP and ZDV for six weeks. Women
who present postpartum, or do not receive their test result until after delivery, will be offered HIV testing in
the postpartum ward. If the woman tests positive, her infant will receive the standard postpartum infant
regimen of single dose NVP and six weeks of ZDV. The mother will be referred to a treatment program for
evaluation.
Vanderbilt will support the training of 20 health care workers on PMTCT using current National guidelines.
All of the Vanderbilt-supported sites will be enrolled into the National Early Infant Diagnosis (EID) Program
by the end of COP09. HIV-exposed infants will initially be tested for HIV infection from 6 weeks of life using
DNA PCR. Repeat testing will be performed according to the national EID testing algorithm taking into
consideration the child's breast-feeding status. Vanderbilt will provide EID training using the current national
EID training curriculum. Vanderbilt-supported sites will make use of the existing PCR labs as well as the
National EID collection supplies and transport support to carry out EID at supported sites. The sites are
aware that getting infants back for follow-up and HIV testing is often challenging and will consult with the in-
country PEPFAR team regarding effective strategies. One approach may be to use lay counselors for follow
-up. Healthcare workers will also be trained using the National Infant Feeding Training curriculum and will
provide unbiased information on infant feeding following the AFASS criteria.
Community outreach activities will raise awareness of the program, encourage pregnant women to receive
HCT, and encourage women and their family members to be tested for HIV. Vanderbilt will partner with
other groups participating in the national network of care and treatment, government institutions and
community-based NGOs in the project area in order to ensure that mechanisms are in place to effectively
respond to the treatment needs of HIV positive pregnant women attending our ANCs. Vanderbilt will
continue to support and expand community outreach programs aimed at increasing community and patient
education about PMTCT, encouraging clients to adhere to medication through understanding of treatment,
follow-up visits, etc. In collaboration with community-based organizations (CBOs) appropriate follow-up of
clients and continuum of care will be ensured. Contracts with local CBOs in the vicinity of project sites will
be put into place to provide home-based care including medication administration, as needed. The project
will also strengthen the capacity of community institutions to provide quality health-related wrap-around
services including family planning, safe motherhood, nutritional support and other services as appropriate.
CONTRIBUTION TO PROGRAM
The Vanderbilt PMTCT program activities are consistent with the PEPFAR goal of providing high-quality
PMTCT services aimed at preventing mother-to-child HIV transmission including counseling and testing for
pregnant women, ARV prophylaxis for HIV-infected pregnant women and newborns, counseling and
support for maternal nutrition and safe infant feeding practices. The program will also contribute to
strengthening human capacity through training of health workers, community workers and PLWHAs and
their families.
LINKS TO OTHER ACTIVITIES
This activity is linked to ART drugs, OVC and pediatric care and treatment, TB/HIV to provide ART to
clients with TB, lab to provide ART diagnostics, HCT as an entry point to ART, adult care and support for
HIV infected adults and their children, and SI. The activities will provide the GON with crucial information for
use in the evaluation of the National ARV program and recommended drug regimens.
POPULATIONS BEING TARGETED
The counseling, testing and clinical care component of these activities will target pregnant women seeking
ANC and their babies. The operational elements of these activities (M&E, personnel training, infrastructural
supports, technical assistance and quality assurance) target program managers, doctors, nurses,
pharmacists and lab workers at PEPFAR-supported sites. The expansion of PMTCT services to satellite
rural health facilities will increase access to necessary services in poor communities.
Activity Narrative: KEY LEGISLATIVE AREAS:
Vanderbilt-supported activities will promote gender equity in PMTCT programs and increase access to
services by the vulnerable groups of women and children. It will help increase service uptake and promote
positive male norms and behaviors. This program will also help reduce stigma and discrimination through its
community-based programming.
EMPHASIS AREAS
This program seeks to increase gender equity in programming through counseling and educational
messages targeted at vulnerable pregnant women and girls. Furthermore, through gender sensitive
programming and improved quality services the program will contribute to reduction in stigma and
discrimination and address male norms and behaviors by encouraging men to contribute to care and
support in the families. Vanderbilt will strengthen the capacity of community institutions to provide quality
health-related wraparound interventions including family planning, safe motherhood, nutritional support,
malaria, and other wraparound services as appropriate.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21671
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21671 21671.08 HHS/Centers for Vanderbilt 9399 9399.08 $450,000
Disease Control & University
Prevention
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $5,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,000
Economic Strengthening
Education
Water
Table 3.3.01:
Several new CDC partners have recently been identified through a competetive funding opportunity
announcement as approved under COP08. Many of these partners are new to the PEPFAR and/or CDC
planning and implementation processes. The amounts awarded differ significantly from the original
proposal amounts submitted by these new partners. The difference now requires the new partners, working
in conjunction with the in-country CDC office and interagency technical working groups, to revise the action
plans for FY08 and FY09. CDC is currently working closely with the new partners to assure their effective
understanding of the PEPFAR planning process and that action plans for FY08 and FY09 COP submissions
are in accordance with funding awards as well as PEPFAR goals and objectives. Detailed narrative
changes will be submitted in the January 2009 reprogramming submission.
ACTIVITY DESCRIPTION
In COP08 Vanderbilt provided comprehensive adult care and treatment (ACT) services to 1200 adults at 2
comprehensive sites (site selection pending). In COP09, Vanderbilt will continue to provide adult care and
treatment to eligible adult patients at these 2 sites and upgrade 3 satellite sites established in COP08, to the
comprehensive care level. In COP09, Vanderbilt will provide care and support services to 2500 adult
clients, 1800 of whom will be on ART (including 600 new ART clients in 2009).
Patients are identified through HCT, PMTCT and PITC in in-patient and out-patient departments. Basic care
and support for HIV infection will be provided at comprehensive care sites to all adults that test positive for
HIV according to National Care and Support guidelines. All HIV-infected individuals are clinically assessed
for antiretroviral therapy (ART) eligibility. All clients are provided with basic care and support services with
continuous clinical monitoring. Eligibility for antiretroviral treatment (ART) will be determined at an initial
visit according to National Guidelines. We will provide ART to those meeting current National ART
guidelines. Patients are encouraged to participate in couples counseling and to refer family members for
HCT. Activities will also focus on PwP services. All enrolled into care will receive risk assessment and
behavioral counseling to achieve risk reduction.
All enrolled clients will have periodic follow-up to identify changes in eligibility status and to monitor disease
progression. Routine follow-up schedules are based on their ART eligibility status. Clinical exams,
hematology, chemistry and CD4 enumeration are routinely performed according to the national guidelines.
In COP08, comprehensive HIV care and treatment took place at the 2 comprehensive care sites. In
COP09, satellite sites will be upgraded to perform clinical HIV monitoring and CD4 cell counts. HIV care
and support services include: routine clinical monitoring; services to prevent and treat OIs, and malaria;
nutritional assessment (including weight, height and BMI) counseling, and intervention including
micronutrient supplementation; safe-water systems; promotion of good hygiene practices; psychosocial and
spiritual support; HIV prevention counseling (including condom promotion); and prevention and
management of STIs. All HIV+ patients will be also symptomatically screened for TB and confirmed with
laboratory and radiological diagnostics as indicated. TB diagnosis and treatment is provided to all patients
via facility co-location of DOTS centers and/or referral of HIV+ patients into ART from DOTS sites. ART-
eligible patients identified through HCT conducted for all TB patients at DOTS sites will be provided with
ART. All PLWHA will be provided with a basic care kit containing water vessel, Water guard, ORS, latex
gloves, ITN, soap and IEC materials on positive living.
Routine monitoring of disease progression will involve diagnosis and management of treatment failure.
Viral load testing will be preformed on selected patient following the national guidelines for HIV and AIDS
treatment and care. Those failing on first line regimens will be placed on second line regimens containing a
protease inhibitor and referred to tertiary level facilities as needed. ARV drug adherence is essential to
minimize drug resistance. ART patients will be provided with education on adherence and counseling prior
to and during ART provision, which follows the National Curriculum for Adherence Counseling. ART
patients are encouraged to have a treatment support partner to whom he/she had disclosed status to
improve adherence and to optimize care.
Vanderbilt facilitates the formation and sustenance of support groups and CBOs, affiliated with our sites, to
mobilize communities to provide HBC services. Site HBC activities are supervised by a hospital team.
Facility-based and community-based HBC teams follow-up on missed clinic appointments and encourage
patients to return to the clinic for medical care (defaulter tracing) and provide adherence counseling.
Clinical staff are provided with regular updates and training. Training is also provided to lab scientists
working at our supported sites. A total of 14 health care and non-health care workers will be trained in care
and support in line with the National Palliative Care Guidance and the USG Palliative Care policy. Training
will include plans for task shifting at the primary care level where appropriate.
The medical records of clients receiving HIV care and treatment are entered into an electronic medical
record system (EMRS) which improves clinical monitoring and allows for centrally coordinated program
monitoring. Quality of care will be assured through periodic chart reviews as well as reviews of data in the
EMRS using the HIV Qual approach. We will help site managers, clinical staff, and CBO partners
implement QI activities, including analyzing performance, prioritizing areas for improvement, planning and
piloting improved approaches, and rolling out improvements.
ARVs and commodities for C&S will be purchased through a central procurement mechanism. SCMS will
manage ARV procurement to the port of entry and Axios will manage storage and distribution of ARVs to
the sites and provide instruction regarding drug management at the sites. Non-ARV commodity
procurement and distribution will be managed through Axios.
Our program activities are consistent with the PEPFAR goal of providing ARV drugs, care and treatment
services to serve more HIV+ people. The program will also contribute to strengthening human capacity
through training of health workers, community workers and PLWHAs and their families.
Activity Narrative: LINKS TO OTHER ACTIVITIES
This activity is linked to ART drugs (HTXD), OVC (HKID) and Pediatric Care and Treatment (PDTX and
PDCS), PMTCT (MTCT), TB/HIV (HVTB) to provide ART to patients with TB, Lab (HLAB) to provide ART
diagnostics, HCT (HVCT) as an entry point to ART, and SI (HVSI).
The care and treatment components of these activities target HIV-infected adults for clinical monitoring ,
care and treatment. The operational elements of these activities (M&E, health personnel training,
infrastructural supports, technical assistance and quality assurance) target program managers, doctors,
nurses, pharmacists and lab workers at PEPFAR/GoN sites. The expansion of ART services to satellite
rural health facilities will increase access to care and treatment services in underserved communities.
This program emphasizes human capacity development through training of health care personnel and
volunteers. It also seeks to increase gender equity in programming through counseling and educational
messages targeted at vulnerable women and girls. Furthermore, through gender sensitive programming and
improved quality services the program will contribute to reduction in stigma and discrimination and address
male norms and behaviors by encouraging men to contribute to care and support in the families.
Continuing Activity: 21673
21673 21673.08 HHS/Centers for Vanderbilt 9399 9399.08 $115,000
* TB
Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,500
Estimated amount of funding that is planned for Water $2,500
Table 3.3.08:
Continuing Activity: 21678
21678 21678.08 HHS/Centers for Vanderbilt 9399 9399.08 $520,000
Table 3.3.09:
In COP09 Vanderbilt will provide comprehensive pediatric care and treatment (PDCT) services in two
comprehensive sites and three satellite sites that will be upgraded. Vanderbilt will support the necessary
renovations in these three satellite sites. Vanderbilt will provide basic care and support to a total of 250
children at these sites (age 0-14 years), 200 of whom will receive ART.
HIV exposed and infected children will be identified through HCT, PMTCT, early infant diagnosis (EID), and
provider-initiated testing and counseling (PITC) at well baby/immunization clinics and inpatient departments.
Vanderbilt will support expansion of EID at its five supported sites in accordance with the national EID scale
up plan and will provide standardized training on sample collection of dried blood spots (DBS). Vanderbilt
will also link with the national EID scale-up plan to make use of existing PCR labs as well as the Clinton
Foundation DBS collection supplies and transport support to carry out EID using DNA PCR.
Basic care, support, and treatment for HIV infection will be provided at two comprehensive centers and in
three upgraded satellite sites. Services will be child and adolescent friendly and will include provision of
clinical, psychological, spiritual, social, and prevention services for all HIV-exposed and infected children.
Basic care and support for HIV infection will be provided according to National Care and Support guidelines.
All HIV-infected children are clinically assessed for antiretroviral therapy (ART) eligibility according to
national guidelines and eligible clients will be provided with ART. Infants less that one year of age with
confirmed HIV infection will be started on ART according to WHO and Nigerian National recommendations.
All clients will be provided with basic care and support services with continuous clinical monitoring.
All enrolled children will have periodic follow-up to identify changes in eligibility status and to monitor
disease progression. Routine follow-up schedules are based on their ART eligibility status. Clinical exams,
Pediatric HIV care and support services include: routine clinical monitoring; services to prevent and treat
OIs, and malaria, cotrimoxazole prophylaxis according to national guidelines, insecticide treated bed nets
for malaria prevention, nutritional assessment (including weight, height and BMI-for-age or weight-for-
height) and counseling including micronutrient supplementation; safe-water systems; promotion of good
hygiene practices; psychosocial and spiritual support; and adherence counseling. Diagnostics for common
OIs will be provided. All HIV-infected children will be symptomatically screened for TB and confirmed with
laboratory and radiological diagnostics as indicated. TB diagnosis and referral for treatment is provided via
facility co-location of DOTS centers and HIV centers. ART-eligible patients identified through HCT
conducted for all TB patients at DOTS sites will be provided with ART. For older children, Vanderbilt will
support integration of syndromic management of STIs and promote risk reduction and PwP activities. All
enrolled into care will receive risk assessment and behavioral counseling to achieve risk reduction.
Children will receive a basic care kit including water vessel, water guard, ORS, latex gloves, ITN, soap, IEC
material, etc. Vanderbilt will develop collaboration with the Clinton Foundation for provision of PlumpyNut
for pediatric patients and will seek out other collaborative partnerships with programs providing food support
to children.
HIV-infected children meeting eligibility criteria will begin on the recommended first line regimen. Routine
monitoring of disease progression will involve diagnosis and management of treatment failure. Viral load
testing will be preformed on select patients following the national ART guideline. Those failing on first line
regimens will be placed on second line regimens containing a protease inhibitor, boosted whenever
possible with ritonavir. ARV drug adherence is essential to minimize drug resistance. ART patients and
their caregivers will be provided with education and adherence counseling prior to and during ART
provision, which follows the National Curriculum for Adherence Counseling.
Vanderbilt will facilitate the formation and sustenance of child-friendly services as well as support groups
and CBOs to mobilize communities to provide HBC services. HBC teams are comprised of clinicians,
nurses, community health workers, volunteers including PLWHA. The HBC teams will follow-up on missed
clinic appointments and encourage patients to return to the clinic for medical care (defaulter tracing) and
provide adherence counseling. The team will also provide basic nursing care, psychosocial support and
referrals to other services.
Clinical staff are provided with regular updates and training on pediatric care and treatment. Training is also
provided to lab scientists working at the supported sites. A total of 10 health care and non-health care
workers will be trained in pediatric care and treatment in line with the National Palliative Care and ART
Guidelines and curricula. Training will include plans for task shifting at the primary care level where
appropriate.
Quality of care will be assured through periodic chart reviews as well as reviews of data using the HIVQual
approach. Vanderbilt will help site managers, clinical staff, and CBO partners implement QI activities,
including analyzing performance, prioritizing areas for improvement, planning and piloting improved
approaches, and rolling out improvement strategies.
ARVs and commodities will be purchased through a central procurement mechanism. SCMS will manage
ARV procurement to the port of entry and Axios will manage storage and distribution of ARVs to the sites
and provide instruction regarding drug management at the sites. Non-ARV commodity procurement and
distribution will be managed through Axios.
CONTRIBUTION TO OVERALL PROGRAM AREA
Vanderbilt program activities are consistent with the PEPFAR goal of providing ARV drugs, care and
treatment services and lab support to serve more HIV+ people. The program will also contribute to
This activity is linked to ART drugs, OVC, PMTCT, TB/HIV to provide ART to patients with TB/HIV, lab to
Activity Narrative: provide ART diagnostics, and HCT as an entry point to ART. The program will provide the GON with crucial
information for use in the evaluation of the national ARV program and recommended drug regimens. This
program is linked to PMTCT services and EID.
The care and treatment components of these activities target HIV exposed & infected children (age 0-14
years) for clinical monitoring and ART treatment. The operational elements of these activities (monitoring
and evaluation, health personnel training, infrastructural supports, technical assistance and quality
assurance) target program managers, doctors, nurses, pharmacists and lab workers at PEPFAR sites. The
expansion of ART services to satellite rural health facilities will increase access to necessary and vital
services in poor communities.
This program emphasizes care and treatment of HIV-infected children and improves human capacity
through training of health care personnel, lab staff and HBC workers. It also seeks to increase gender
equity in programming through counseling and educational messages targeted at vulnerable girls.
Furthermore, through gender sensitive programming and improved quality services the program will
contribute to reduction in stigma and discrimination and address male norms and behaviors by encouraging
men to contribute to care and support in the families.
Continuing Activity: 21675
21675 21675.08 HHS/Centers for Vanderbilt 9399 9399.08 $100,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $1,250
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,250
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $1,250
Table 3.3.10:
In COP08 Vanderbilt provided comprehensive pediatric care and treatment (PDCT) services in 2
comprehensive and 3 satellite sites. In COP09, Vanderbilt will build on the successes achieved in 08 by
providing high quality basic care and support services to all HIV positive pediatric patients at a total of 2
comprehensive sites and 3 satellite sites located in two states of Kwara and Oyo. We will provide ART
services to a total of 300 children age 0-14 years age (200 new) at the end of the reporting period. Non-
ART pediatric care and support services will be rendered to a total of 100 HIV positive children (50 new) by
the end of FY 2009 making a grand total of 400 HIV positive pediatric clients.
Basic care, support, and treatment for HIV infection will be provided at our centers to all HIV exposed
children. We will ensure the provision of clinical, psychological, spiritual, social, and prevention services in
our health facilities for all HIV-exposed children that will extend and assure optimal quality of life for them.
Children will receive a "package of care" adapted to their needs that may include nutrition support for
vulnerable children. We will consult with the in-country USG team to ensure all essential elements specific
to infected children's needs are included in the package. Clinical care provided will include early infant
diagnosis, prevention and treatment of OIs and other HIV/AIDS-related complications and pain and
symptom relief. Children seeking care, support and treatment at our centers will also receive onsite
treatment of symptomatic malarial and other infections, insecticide treated bed nets for malaria prevention,
and nutritional assessment and counseling including micronutrient supplementation.
Early infant diagnosis is an important component of pediatric care and we plan to test HIV-exposed infants
at 4 to 8 weeks of life using DNA PCR, with dried blood spot (DBS) specimens. Repeat testing will be
performed at 3-4 months of life in non-breastfed infants and 4-6 weeks following cessation of breast-feeding
in breastfed infants. Infants that are at least 12 months of age will be screened with a rapid HIV test. Those
that test negative can forego PCR testing. We will treat every newborn with confirmed HIV infection. Given
the intricacies of treating pediatric HIV infection, a pediatrician will help develop and direct this aspect of the
program. First-line regimens for children will include ZDV syrup+3TC+NVP, d4T syrup+3TC+NVP, or d4T
capsules+3TC+NVP. Second line regimens in children will include protease inhibitors (either LPV/r or
nelfinavir). For all patients, at each visit, clinical exams, hematology, chemistry and CD4 enumeration are
performed. Satellite sites with limited lab capability send samples to an affiliated site lab for analysis.
Electronic clinic and lab records provide data for high quality patient care and centrally coordinated program
monitoring. As additional medical needs of patients are identified through clinic visits, they will be provided
with clinical services by clinicians or referred for specialty care as necessary.
Clinical staff will be provided regular updates and training. The sites will have a team comprised of a
medical director at each comprehensive center, and 2 PMTCT advisors (nurse/midwife), 2 HCT Advisors
(nurse/midwife), IT specialist, 3 nurse/midwife trainers/AQ/QI personnel and 3.5 outreach counselors to be
shared 100% time for each of the comprehensive centers and 50% time for each satellite center. A
consultant pediatrician will provide oversight and will be closely involved in the development and
implementation of all aspects of the program.
Quality of care will be assured through periodic external site assessments and chart reviews as well as
quarterly internal reviews, based on electronic databases as well as with HIVQual. Our M&E specialist will
train site staff to track HIV positive pediatric patients between centers and minimize loss to follow-up,
working in conjunction with the CBOs. Staff at each site will receive strategic information training and be
involved at each level of the reporting process from documenting patient encounters in reporting registers,
to compiling the information in the registers and EMR to generate monthly reports, to using the information
to improve pediatric patient care. Data will be compiled monthly and quarterly at the sites with support from
the project's M&E officer and reviewed for quality before submission. We will provide site staff with tools and
training, provide external quality monitoring, and mentor staff in QI efforts. We will help site staff implement
QC measures so that work is done correctly, including using tools like standard encounter forms that detail
the required activities for a given patient visit and programming validity checks into the EMRS. We will spot-
check the quality of data and documentation periodically, compare reported/entered data with logs and
source documentation, and train site managers to perform this QA function. We will assess the quality of
performance, tracking site performance with regard to PEPFAR and other indicators using the HRSA's
HIVQual approach. We will help site managers, clinical staff, and CBO partners implement QI activities,
approaches, and rolling out improvements.
Training will be provided for HCWs and lab scientists working at our supported sites. A total of at least 10
health care and non-health care workers will be trained in pediatric palliative care, in line with the National
Palliative Care Guidance and the USG Palliative Care policy. This funding will support the personnel, clinic
and lab services for training of at least 5 health care workers in ART, monitoring of 300 HIV positive children
at the end of COP09, which includes 200 new pediatric patients.
This program will ensure the provision of clinical, psychological, spiritual, social, and prevention services in
Children will receive a "package of care" adapted to their needs that will include onsite treatment of
symptomatic malarial and other infections, insecticide treated bed nets for malaria prevention, and
nutritional assessment and counseling including micronutrient supplementation for vulnerable children. This
program also seeks to increase gender equity in programming through counseling and educational
The care and treatment components of these activities target HIV-infected children (age 0-14 years) for
Activity Narrative: clinical monitoring and ART treatment. The operational elements of these activities (M&E, health personnel
training, infrastructural supports, technical assistance and quality assurance) target public and private
program managers, doctors, nurses, pharmacists and lab workers at PEPFAR sites. The expansion of ART
services to satellite rural health facilities will increase access to necessary and vital services in poor
communities.
services and lab support to serve more HIV+ people. The program will also contribute to strengthening
human capacity through training of health workers, community workers and PLWHAs and their families.
This activity is linked to ART drugs (HTXD), OVC (HKID), PMTCT (MTCT), TB/HIV (HVTB) to provide ART
to patients with TB, Lab (HLAB) to provide ART diagnostics, and HCT (HVCT) as an entry point to ART.
The program will provide the GON with crucial information for use in the evaluation of the National ARV
program and recommended drug regimens. This program is linked to PMTCT services to optimize the
PMTCT by providing ART to eligible pediatric patients.
Table 3.3.11:
In COP08, Vanderbilt provided HCT services to 5,000 individuals in TB-DOTS centers and is improving TB
diagnosis in TB laboratories and in radiological services. Vanderbilt also supported procurement and
distribution of anti-TB drug and laboratory commodity/reagents. In COP09, Vanderbilt will build on the
successes achieved in COP08 by providing HCT to an additional 675 new clients and continuing to provide
high quality TB-HIV care to eligible clients. Vanderbilt will implement the world strategy of three I's which
involves: isoniazid preventive therapy (IPT); intensified case finding for active TB; and TB infection control,
especially in ART settings according to national guidelines. Vanderbilt will also be involved in MDR TB
management and prevention, TB laboratory and chest x-ray strengthening, and basic infrastructure
renovations at DOTS and TB laboratory sites. In COP 09, Vanderbilt will continue to provide a
comprehensive range of TB-HIV services including: 1) supporting TB-DOTS centers located within our
comprehensive care sites with TB related trainings, renovations and TB laboratory set-up costs; 2) providing
clinical monitoring, related laboratory services, treatment and prevention of tuberculosis in HIV basic health
care settings (including pharmaceuticals); and 3) providing HCT in TB-DOTS centers in our catchment area
including provision of co-trimoxazole prophylaxis (CPT) to HIV-TB co-infected clients at these centers.
All HIV positive patients receiving care and support at Vanderbilt comprehensive sites will be
symptomatically screened for TB and confirmed with laboratory and radiological diagnostics as indicated.
By the end of COP09, 2500 HIV-infected clients will be receiving care and treatment at Vanderbilt sites. An
estimated 750 (30% of 2500) of these patients will require treatment for TB. Health care staff at the
comprehensive care centers will be trained to screen patients for TB according to national guidelines and
start patients on isoniazid prophylaxis (IPT) once active TB infection has been excluded. Laboratory
services will be upgraded (if needed) to perform smear microscopy for acid fast bacilli (AFB) using
fluorescent microscopes or fluorescent adaptors.
TB diagnosis and treatment will be provided to all patients via facility co-location of DOTS centers (where
feasible) and/or referral of HIV+ patients into ART from DOTS sites. Vanderbilt will support the
development of TB-DOTS centers at our comprehensive care sites, in terms of TB related trainings,
renovations and TB laboratory set-up costs, if such centers do not exist (site selection pending). Vanderbilt
will ensure that on-site TB treatment providers are well versed in TB-HIV drug interactions, toxicities and
side effects. By upgrading the onsite laboratory and DOTS services, provider capabilities to diagnose, treat,
and monitor TB among HIV-infected individuals will be improved and Vanderbilt will avoid referring most
patients to tertiary level facilities. This approach to coordinating TB-HIV care is critical to optimizing
treatment success and avoiding multi-drug resistant cases of TB. Vanderbilt will utilize zonal TB culture
diagnostic facilities as needed. This will involve assisting MDR TB suspects to access culture facilities and
treatment facilities within the zone as needed.
Vanderbilt will implement HCT in TB-DOTS centers in the catchment areas of our sites (to be identified) and
provide CPT to all eligible patients in these TB-DOTS centers. HIV-infected patients identified in the TB-
DOTS centers will be referred to a comprehensive care center for HIV care and treatment. All HIV-infected
clients identified at the TB-DOTS centers will receive Prevention with Positive (PWP) services including risk
assessment and behavioral counseling to achieve risk reduction.
HCT will be provided to 675 new clients with unknown HIV in TB venues. Vanderbilt will train 14 staff
members to perform HCT in TB venues. Clinical staff will be provided regular updates and training in line
with contemporary developments in the field of TB-HIV care. Vanderbilt will train 10 healthcare workers and
lab scientists working at Vanderbilt supported sites in the diagnosis and management of TB.
Vanderbilt will continue to partner with PEPFAR IPs specializing in lab programming to facilitate a QA
program that ensures quality services. The TB supported laboratory site staff will be trained on TB
microscopy using the national AFB microscopy training manual. The national QA guidelines will be
incorporated. The external quality assessment will focus on on-site assessment, slide re-reading with
blinded rechecking of examined smears, and proficiency testing through reading of blinded panel slides (5
stained and 5 unstained slides). Laboratory capacity will be strengthened by providing additional reagents
for TB microscopy and microscopes for new sites. The supported facility will be upgraded to permit easy
workloads and safe conditions. Emphasis will be placed on disposal of laboratory waste and other TB lab
effluents.
Nosocomial TB infection of HIV-infected patients will be prevented by implementation of TB infection control
in all facilities which will involve: work place policy; administrative control; environmental control; and
personal protective equipment (PPE) as may be required. Vanderbilt will ensure the setting-up of a TB
infection control work plan in all facilities.
Our program activities are consistent with the PEPFAR goal of providing clinical prophylaxis and/or
treatment for tuberculosis to HIV-infected individuals (diagnosed or presumed) in a care and treatment
setting. The program will also contribute to strengthening human capacity through training of health
workers, community workers and PLWHAs and their families.
This activity is linked to ART drugs, OVC and Pediatric ART Care and Treatment for pediatric care, Lab to
provide ART diagnostics, HCT as an entry point to ART, and SI will provide the GON with crucial
information for use in the evaluation of the National ARV program and recommended drug regimens.
The care and treatment components of these activities target HIV-infected adults in TB settings for clinical
monitoring and ART treatment. The operational elements of these activities (M&E, health personnel training,
infrastructural supports, technical assistance and quality assurance) target public and private program
Activity Narrative: managers, doctors, nurses, pharmacists and lab workers at PEPFAR sites. The expansion of DOTS
services to satellite rural health facilities will increase access to necessary services in underserved
This program emphasizes TB diagnosis and treatment among TB-HIV co-infected patients. It emphasizes
human capacity development through training in TB diagnostic and clinical care of TB-HIV co-infection.
Continuing Activity: 21674
21674 21674.08 HHS/Centers for Vanderbilt 9399 9399.08 $525,000
Table 3.3.12:
ACTIVITY UNCHANGED FROM FY2008.
In COP08 Vanderbilt University provided OVC services in Nigeria. In COP09, Vanderbilt will establish
family centered, facility and community based OVC services targeting 350 children (175 boys and 175 girls).
These children will be linked to 5 of the Vanderbilt-affiliated sites (2 comprehensive and 3 satellites). In
COP09, Vanderbilt's OVC program will focus on providing support in the following OVC programmatic
areas: 1) healthcare; 2) nutrition; 3) psychosocial; and 4) education. All children will receive at least 3 of
these core OVC services. In addition, Vanderbilt will provide OVC related training to 20 workers from
partner CBOs and our clinic facilities to enhance OVC program understanding and implementation skills
and to monitor and evaluate program activities. It will also provide 200 OVC with food and nutritional
supplements.
Children will be identified for enrollment at both the clinic and community levels. At the clinic level, children
will be identified through HCT, well baby visits, immunization visits and attendance at the ART clinic
whether or not they are on ART. In addition, we will target children of PMTCT clients (both the index
pregnancy and other siblings); children of patients presenting with HIV and TB/HIV, and siblings of children
with HIV. Children may also be identified through partnerships at the community level and linked to the
healthcare facility. Eligibility will be confirmed using the OGAC Child Status Index (CSI).
Vanderbilt will partner with local community based organizations (CBOs) to fully implement OVC services to
eligible children. We will pursue this goal largely through support of community-based interventions in
Kwara state. We will identify and partner with CBOs which are skilled in working with orphans and other
children made vulnerable by HIV and AIDS to ensure that mechanisms are in place to effectively respond to
the needs of OVCs in our project area. We are exploring a partnership with The Wellbeing Foundation in
Ilorin, founded by the Kwara State First Lady, which works in conjunction with hospitals to provide social
support, health care, nutritional assistance and scholarships to HIV orphans. We will target HIV- related
gender concerns such as early marriage, sexual exploitation and violence against women, cross
generational sex and sexual coercion through education and support of community-based interventions.
Vanderbilt will strengthen the capacity of selected community institutions to provide quality interventions
targeting the healthcare, nutrition, psychosocial and educational needs of OVCs. This program will promote
access to preventive and curative health care. We will collaborate with NPI to ensure that OVC <5 are
immunized according to national guidelines. We will provide deworming and treatment for common
childhood illnesses such as malaria, diarrhea and acute respiratory infections. All OVC households will
receive a preventive care package containing ITN, water guard, water vessel, soap, ORS, and IEC
materials on self care and prevention of common infections according to GoN guidelines. Children will
receive nutritional assessments and micronutrient supplementation, and they, along with their caregivers,
will receive nutrition counseling. We will solicit support from the Clinton Foundation for provision of food
supplementation and will seek out other collaborative partnerships with programs providing food support to
children. Psychosocial support for OVCs and their caregivers will address emotional issues faced by OVCs
and their parents/guardians including: disclosure issues, grief and loss, and living with HIV. Educational
support of OVCs will be provided in the form of block granting for identified children.
In COP 09, the national OVC training curriculum will be used to train 20 OVC care providers at the clinic
and CBO levels. Use of this curriculum ensures standard and quality trainings for all providers. Vanderbilt
will use the Child Status Index (CSI) to assess vulnerability among children receiving care, as well as the
children of HIV-infected adults receiving care, at our sites. Trainings will include proper implementation of
the CSI and monitoring of program activities using the CSI along with GoN tools. Clinical care of HIV-
infected children will also be monitored using the national PMM forms. The project will develop a cadre of
specialists (implementing team staff as well as clinical site staff who become trainers/mentors) who can
continue roll out comprehensive OVC programs in new sites. Vanderbilt will work with our CBO partners to
establish an OVC monitoring and evaluation system. Vanderbilt will orchestrate routine quality control visits
to evaluate OVC program performance, proper record keeping, referral linkages, and compliance with
standard operating procedures.
Our program activities are consistent with the PEPFAR goal of supporting community-based actions for
orphans and other children made vulnerable by HIV and AIDS (OVCs). The program will also contribute to
strengthening human capacity through training of health workers, community workers, institutions and
organizations in programs targeted to OVCs.
This activity is linked to Pediatric ART Care and Treatment for pediatric care, PMTCT, HCT as an entry
point to ART, Adult Care & Support for HIV infected adults and their children and TB/HIV.
The service components of these activities target orphans and other children made vulnerable by HIV and
AIDS. The operational elements of these activities target CBOs, public and private program managers,
doctors, and nurses in our activity area.
This program will work with CBOs to enhance community mobilization and sensitization of OVC related
issues such as educational opportunities; health care services including malaria treatment and child survival
activities; psychosocial support; and nutritional support. It emphasizes human capacity development (HCD)
through training and program implementation and monitoring. This program also seeks to increase gender
equity in programming for OVCs.
Estimated amount of funding that is planned for Human Capacity Development $10,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Estimated amount of funding that is planned for Education $5,000
Table 3.3.13:
In COP08, Vanderbilt counseled, tested, and provided results to 1160 individuals (excluding TB) in 5 sites
including 2 comprehensive and 3 satellite sites. The project used client initiated and provider initiated,
routinely offered, opt-out models to maximize uptake of HCT services at the healthcare facilities. Facility
based testing was fully integrated with other health services. Point of service testing was made available in
the General Outpatient Departments (GOPD), Inpatient Wards, ANC and Immunization clinics as well as
TB/DOTS clinics. Vanderbilt actively linked all HIV positive clients to basic care and support services.
In COP09, Vanderbilt will build on the successes achieved in COP08 by continuing to provide high quality
HIV counseling and testing services (HCT) to adult and pediatric patients at a total of 7 sites (2
comprehensive sites and 5 satellite sites). HCT services will be provided to a total of 2,500 new clients
(excluding TB and 3,175 including TB), using the serial national testing algorithm. To meet this goal,
Vanderbilt will train or retrain 8 individuals to provide HCT using the national HIV training curriculum. The
Vanderbilt HCT activities will also 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.
Testing and counseling for HIV is a critical first step in decreasing the spread of this disease. HCT services
will be based at the comprehensive and the satellite sites. These centers will provide: 1) on site, walk-up
HCT services to self- and physician-referred clients; 2) opt-out HCT for patients receiving treatment for TB
at the comprehensive sites; 3) point-of-service testing in the GOPD, ANC, Immunization clinics and
inpatient wards; and 4) point-of-service testing in the TB/DOTS clinics located within the catchment area.
Vanderbilt will ensure that trained counselors are available at HCT sites, especially PMTCT sites to provide
couples counseling and testing following standard protocols and procedures, as a means of reducing HIV
transmission in sero-discordant couples/partners. An ongoing quality assurance/quality control (QA/QC)
program, which consists of proficiency testing and blinded rechecking, will be linked to a reference
laboratory. Vanderbilt will work with the USG/GON laboratory technical working group and other partners
(IHVN) to ensure an effective QA/QC program. All patients who test positive will be referred to the care,
support, and treatment program for further evaluation and determination of ART eligibility.
Community outreach activities will raise awareness of the program. Community based groups and local
media will be utilized to disseminate HCT knowledge and address stigma. Stigma and shame are major
barriers to using HCT services; lower stigma means more users of HCT services. The kind, sympathetic,
and respectful staff will provide a welcoming, supportive atmosphere to all persons seeking HCT services.
Clients can choose from among the 2 comprehensive and 5 satellite centers which are conveniently
located. Vanderbilt will ensure that trained counselors are available at HCT sites to provide counseling and
testing following standard protocols and procedures, as a means of reducing HIV transmission. Rapid HIV
testing will assure that clients receive same day test results. As part of HCT promotion, HCT sites will be
branded with the National "Heart to Heart" logo.
Vanderbilt's program activities are consistent with the PEPFAR goal of HCT to help stop the spread of HIV,
and increase referrals to care and treatment. The program will also contribute to strengthening human
capacity through training of health workers, community workers and PLWHAs and their families.
This activity is linked to ART drugs, OVC, and Pediatric Care and Treatment for pediatric care, PMTCT,
TB/HIV to provide ART to patients with TB, Lab to provide ART diagnostics, HCT as an entry point to ART,
Adult Care and Treatment for HIV infected adults, and SI. The activities will provide the GON with crucial
information for use in the evaluation of the National ARV program and recommended drug regimens. This
program is linked to PMTCT services by providing HCT to eligible pregnant women.
The counseling and testing component of the activities will target adults, pregnant women, couples, and
children. The operational elements of these activities (monitoring and evaluation (M&E), personnel training,
managers, doctors, nurses, pharmacists and lab workers at PEPFAR sites. The expansion of HCT services
to satellite rural health facilities will increase access to necessary services in poor communities.
Continuing Activity: 21676
21676 21676.08 HHS/Centers for Vanderbilt 9399 9399.08 $225,000
Estimated amount of funding that is planned for Human Capacity Development $2,000
Table 3.3.14:
In COP08 Vanderbilt provided antiretroviral therapy (ART) to 1200 adults at 2 comprehensive care centers
in Kwara state. In COP09, Vanderbilt will provide ARV drugs to additional 600 individuals bringing the total
to 1800 adults. 200 children will also be provided with ARV drugs in the same 2 comprehensive care
centers in Kwara state.
Vanderbilt's ARV Drugs needs for COP09 have been forecasted based on the Nigerian ART Guidelines.
Drug needs were established during a PEPFAR-wide ARV forecast conducted with the help of SCMS and
USG Logistics Technical Working Group. In COP09, Vanderbilt estimates that 90% (1800 out of 2000) of
patients receiving ART in this program will be adults and 10% (200 out of 2000) will be children. An
estimated 40% (800 /2000) of clients receiving ART in COP09 will be new; the remaining will be clients who
initiated ART in 2008 (or earlier through another provider). Clients are routinely begun on NVP-based first
line regimens consistent with the National ART Guidelines. Most will be started on a regimen which
contains zidovudine (ZDV) although we anticipate that 30% will begin on a tenofovir (TDF) containing
regimen due to co-existing anemia. Efavirenz-based regimens will be available for individuals with NVP-
related hepatotoxicity or skin toxicity, and for use in patients on rifampicin-containing TB regimens.
We anticipate that approximately 96 patients (8% of the 1200) who began ART in 2008 (or earlier) will
switch to second line regimens in 2009. These regimens will contain a boosted protease inhibitor. The
most frequently prescribed second-line regimen is TDF+FTC+lopinavir 200mg and ritonavir 50 mg (LPV/r).
The remaining 1704 adults (1104 from 2008 and 600 new in 2009) will be receiving first line regimens.
Vanderbilt will solicit support from the Clinton Foundation in the receipt of pediatric formulations and second
line adults ARVs. PEPFAR and FDA-approved generic formulations will be utilized whenever available.
Delivery of optimal care depends on reliable access to the necessary drugs and supplies. Drug
procurement will follow USG regulations, National Treatment Guidelines, and comply with requirements for
NAFDAC registration or waiver. All purchases of Truvada (TDF/FTC) and ZDV-3TC-NVP Fixed Dose will
be purchased via pooled procurement mechanism by SCMS, in line with OGAC's recommendation. The
rest of the drugs will also be procured via SCMS. Prior to shipping, SCMS will inspect drugs for authenticity.
During shipping, SCMS certifies packaging and storage conditions and insures the shipment to the point of
delivery in country.
Vanderbilt has subcontracted Axios Foundation to manage drug storage and distribution in country, and
provide commodity management and staff instruction at the site level. Axios documents proper storage
conditions at the central warehouse, regional warehouse, and site levels. The system strengthening
initiatives provided by Axios will become increasingly important as ARV access expands to our primary level
facilities. Vanderbilt staff will conduct routine quality control visits to review SOP compliance and compare
reported usage based on monitoring and evaluation data with local manifests and pharmacy logs. We will
collaborate with SCMS and Axios on issues such as pricing trends, national ARV demand forecasts,
strengthening local supply chains and in-country quantification and forecasting. Such collaborations will
include harmonized procurements with other agencies involved in ARV drug logistics and continued
discussions with GoN and other donors for commodities. We will keep close track of all ARV supplies to
prevent stock-out or overstocking and subsequent wastage.
During COP09, four pharmacists and/or pharmacy technicians at the comprehensive care sites will be
trained or re-trained in drug commodity management. Vanderbilt plan to upgrade some of the satellite
clinics (launched in 2008) to comprehensive care centers, which may conduct ART follow-up visits and may
prescribe ART. This transition will involve additional training of pharmacy staff in drug forecasting,
procurement, distribution and management. This transition will also include pharmacy renovations to
ensure proper security and storage conditions. Pharmacists will receive training in inventory control system
management at the site level and proper drug storage.
human capacity through training of health workers and strengthen the ART drug procurement system.
This activity is linked to ART drugs (HTXD), OVC (HKID) and Pediatric ART Care and Treatment (PDTX
and PDCS) for pediatric care, PMTCT (MTCT), TB/HIV (HVTB) to provide ART to patients with TB, Lab
(HLAB) to provide ART diagnostics, HCT (HVCT) as an entry point to ART, and SI (HVSI) and will provide
the GON with crucial information for use in the evaluation of the National ARV program and recommended
drug regimens. This program is linked to PMTCT services to optimize the PMTCT by providing ART to
eligible pregnant women and to basic care and support by providing an access point to HIV positive
individuals.
The populations being targeted with these activities include clinical staff, predominantly pharmacists and
other pharmacy workers involved in drug procurement and distribution.
This program area involves system strengthening through training and building local human resource
capacity to manage drug forecasting, procurement, and distribution.
Continuing Activity: 21677
21677 21677.08 HHS/Centers for Vanderbilt 9399 9399.08 $520,000
Table 3.3.15:
In COP08, Vanderbilt upgraded HIV-related laboratory services in 2 comprehensive care sites to provide
rapid tests, CD4 counts, chemistry and hematology. In COP09, Vanderbilt will build on the successes
achieved in 08 by continuing to support development and strengthening of laboratory facilities to support
HIV/AIDS-related activities. This will include the purchasing of equipment and commodities, provision of
quality improvement (QI) and quality assurance (QA) measures, staff training and other technical assistance
at a total of 2 comprehensive sites and 3 satellite sites (site selection pending). Vanderbilt will provide lab-
related ART services to a total of 1800 adults (600 new in COP09) and 200 new pediatric patients at the
end of the reporting period. Our lab infrastructure specific outputs for COP 09 include: 1) continuing to
upgrade laboratories at five centers (2 comprehensive and 3 satellite sites) to perform rapid tests, CD4+
counts, chemistry and hematology; and 2) Perform 10,000 lab tests for HIV, TB, syphilis and HIV monitoring
during the year. During COP08, laboratory training and laboratory QA/QI measures were subcontracted to
the Institute of Human Virology Nigeria (IHVN). IHVN will continue to provide these services during the first
quarter of COP09 as we transition to independence. In COP09, Vanderbilt will train 10 laboratory staff to
perform routine diagnostic and monitoring tests for HIV.
Providing comprehensive HIV/AIDS care and treatment requires a strong laboratory infrastructure. In
collaboration with IHVN, Vanderbilt will continue to develop the capacity of the laboratories in the two
comprehensive care sites so that they can perform HIV tests, CD4+ cell counts, chemistry and hematology
and smear microscopy for TB and malaria. Vanderbilt will also will support development of 3 additional
satellite site laboratories to perform HIV tests, CD4 cell counts (as appropriate) and other basic lab
diagnostic tests such as smear microscopy for AFBs (so that we can diagnose TB on site) and blood films
for malaria parasites to make a total number of 5 laboratories. In COP 09, Vanderbilt will provide fluorescent
microscopes or fluorescent adaptors and reagents for enhanced TB and malaria diagnosis to its high
volume TB sites.
During the first quarter of COP09, IHVN will continue to assist Vanderbilt in the improvement of these
laboratories and laboratory staff training. Vanderbilt will support the necessary renovations and purchase
equipment (including generators, CD4+ cell count machines, chemistry and hematology analyzer,
fluorescent microscopes or adaptors) and reagents necessary to support the management of individuals
with HIV infection. Vanderbilt will support expansion of early infant diagnosis (EID) at its 7 sites (2
comprehensive and 5 satellites, including 2 new satellites to be opened in COP09) in accordance with the
national EID scale up plan and provide standardized training on sample collection of dried blood spots
(DBS). Vanderbilt will also link with the national EID scale-up plan to make use of existing PCR labs as well
as the Clinton Foundation DBS collection supplies and transport support to carry out Early Infant Diagnosis
using DNA PCR.
Vanderbilt will provide on-site capacity for HIV diagnosis, laboratory monitoring of disease progression and
response to treatment, diagnosis of opportunistic infections (OIs), and monitoring of antiretroviral drug
(ARVs) toxicity. Vanderbilt will support the improved diagnosis of TB, syphilis, hepatitis B (HBV) in COP 08,
including provision of fluorescent microscopes to enhance TB and malaria diagnostic capacity at high
volume sites. In COP 09 Vanderbilt will provide fluorescent microscopes or fluorescent adaptors for
enhanced TB and malaria diagnosis, and support necessary training and reagent procurement for this
equipment at satellites sites as they are upgraded to comprehensive labs. Vanderbilt will support waste
management activities at the sites which will include assisting sites to maintain or develop incinerators.
Vanderbilt will continue to participate in the USG-Nigeria coordinated Laboratory Technical Working Group
(LTWG) to ensure harmonization of other IPs and GoN supported laboratory program and will continue to
work with the PEPFAR LTWG for the development of a common Lab equipment platform appropriate for
each laboratory level.
Quality Assurance systems in HIV laboratories have been shown to be capable of bringing significant cost
savings to health systems. QA and QI will be integral to the development and strengthening of our lab
infrastructure. IHVN will provide quality assurance and proficiency testing during COP08 and the first
quarter of COP09, after which these responsibilities will be transferred over to Vanderbilt site staff. In COP
09, Vanderbilt will continue to conduct QA activities consisting of quarterly site monitoring visits using a
standardized monitoring tool developed by the USG-PEPFAR LTWG, quarterly proficiency testing (PT) for
all tests and providing these reports to USG-PEPFAR Nigeria LTWG.
Our program activities are consistent with the PEPFAR goal of development and strengthening of laboratory
facilities to support HIV/AIDS-related activities including purchase of equipment and commodities, provision
of quality assurance, staff training and other technical assistance to serve more HIV+ people. The program
will also contribute to strengthening human capacity through training of lab staff, counselors and other
health workers.
This activity is linked to ART drugs, OVC and Pediatric ART Care and Treatment for pediatric care,
PMTCT, TB/HIV to provide ART to patients with TB, HCT as an entry point to ART, Adult Care & Support
for HIV infected adults and their children, and SI. This activity will provide the GON with crucial information
for use in the evaluation of laboratory infrastructure for HIV diagnosis, monitoring of course of infection,
effects of treatment, opportunistic infections, and quality of care.
The diagnostic components of these activities target HIV-infected adults and children for diagnosis of HIV
infection and monitoring of the course of HIV infection including response to, and adverse effects of
treatment. The operational elements of our HIV related laboratory infrastructure development, provision of
quality assurance, staff training and other technical assistance target lab workers at PEPFAR sites,
Activity Narrative: counselors, doctors, nurses, and pharmacists. The expansion of lab technical assistance to satellite sites
will increase access to HIV related lab services at the grassroots.
This program seeks to improve human capacity development and diagnostic capabilities through laboratory
training and improved infrastructure.
Continuing Activity: 21679
21679 21679.08 HHS/Centers for Vanderbilt 9399 9399.08 $500,000
Estimated amount of funding that is planned for Human Capacity Development $25,000
Table 3.3.16:
In COP08 Vanderbilt provided HIV/AIDS Strategic Information services to a total of 5 sites (2
comprehensive centers and 3 satellite locations). Five persons were trained in program monitoring and
evaluation, and health management information systems. In COP09, Vanderbilt will build on the successes
achieved inCOP08 by continuing to develop improved tools and models for collecting, analyzing and
disseminating HIV/AIDS behavioral and biological monitoring information and other monitoring and health
management information systems through regular reporting and providing feedback to facilities for program
planning. By the end of the COP09 reporting period, we will provide technical assistance for strategic
information at 5 centers and train 5 new individuals in strategic information including monitoring and
evaluation, surveillance and/or health management information systems. Vanderbilt will support the
establishment of the "Three Ones" principles in the states in which we work and assign an M&E focal
person to participate in the "Three Ones" activities occurring at the state level.
Strategic information (SI) is a key priority area in our project. We will continue to assist our sites to establish
and/or strengthen SI systems and improve program efficiency and effectiveness, in collaboration with state
M&E officers. Quality assurance (QA) and quality improvement (QI) will be integral to our work. Staff at
each site will receive strategic information training and be involved at each level of the reporting process
from documenting patient encounters in reporting registers, to compiling the information in registers and the
electronic medical record system (EMRS), to generating routine reports and using the information to
improve patient care. Data will be routinely compiled at the sites with support from the project's M&E officer.
Vanderbilt will ensure that the national Patient Monitoring Management (PMM) forms are available at our
clinical sites and will provide site staff with training in completing the PMM forms, entering the PMM forms
into the EMRS, and performing routine quality control checks on the data. We will spot-check the quality of
data and documentation periodically, compare reported/entered data with logs and source documentation,
and train site managers to perform this QA function. Program effectiveness will be measured through a
targeted assessment of the quality of performance by tracking site performance with regard to PEPFAR and
other indicators using the HRSA's HIVQual approach. We will help site managers, clinical staff, and
community based organization (CBO) partners implement QI activities, including analyzing performance,
prioritizing areas for improvement, planning and piloting improved approaches, and rolling out
improvements. Vanderbilt will involve the state M&E officer in supervisory SI visits to the sites. This activity
will support capacity building of the state M&E officers. In addition, we may provide support for a state M&E
officer to attend SI training provided by MEASURE Evaluation. Whenever possible, Vanderbilt will use the
Logistic Health Program Management Platform (LHPMP), which is currently undergoing pilot testing, to
report and facilitate the use of aggregate level data.
Vanderbilt will develop or implement tools to monitor community based OVC and Home Based Care (HBC)
activities affiliated with our project. We will provide SI training to staff working at our partner CBOs to
ensure that the tools are implemented properly and that project activities are monitored accordingly. The
site selection process is still underway so these organizations have not yet been identified. Vanderbilt will
also facilitate data collection from non-PEPFAR sites in our catchment area as needed.
This program emphasizes human capacity development at the clinical sites and at community based
institutions through training in SI. The program also focus on quality assurance and quality improvement to
ensure high quality data and reporting.
The operational elements of our treatment for HIV/AIDS Strategic Information services (SI institutional and
human capacity development, collection and improvement of data necessary for program decision making,
monitoring and evaluation, and health-management information systems) target public and private , doctors,
nurses, pharmacists and lab workers at PEPFAR sites. The expansion of SI technical assistance to
community-based organizations will increase access to strategic information services at the grassroots.
Our program activities are consistent with the PEPFAR goal of addressing treatment for HIV/AIDS strategic-
information activities by providing technical assistance for strategic-information activities to local
organizations and strengthening human capacity development through training local health workers in
strategic information (monitoring and evaluation and/or health-management information systems).
provide ART diagnostics, HCT as an entry point to ART, and SI and will provide the GON with crucial
Continuing Activity: 21680
21680 21680.08 HHS/Centers for Vanderbilt 9399 9399.08 $35,000
Table 3.3.17:
