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 DESCRIPTION
In COP08, Partners for Development (PFD) and their faith-based organization (FBO) sub-partner the
Daughters of Charity (DC) implemented the PMTCT component of their CDC funded project entitled
""Counseling, Care and Antiretroviral Mentoring Program" or CAMP, the name of PFD's CDC-funded
project. PFD and DC worked in two sites located in Delta and Akwa Ibom states providing PMTCT services
through a combination of community based organizations (CBOs) and facilities with a target of reaching
1,800 pregnant women. In COP09, PFD will continue to provide PMTCT services to the same target
population and plans to reach 2,000 pregnant women. Utilizing a network model with primary health care
outposts linked to secondary "hub sites" that provide more complex PMTCT care and lab testing, in COP09
2,000 women will receive PMTCT counseling and testing and receive their results. A total of 2 PMTCT hub
sites will be supported linked to at least 10 LGA level primary health care sites. Sites are located in the two
states of Akwa Ibom and Delta. PMTCT standalone points of service in the network are linked to adult and
pediatric ARV care through utilization of a PMTCT network. Using the referral SOP, HIV-positive pregnant
women who require HAART are linked to an ARV point of service. Particular emphasis is placed on the
involvement of community health workers who are the primary source of care for women in the pre and post
-partum period and are integral to a program that seeks to engage women where they seek care. This
program will work closely with the care and support team to maximally engage community based PMTCT
and ARV linkages. In addition to receiving PMTCT services, each HIV-positive pregnant woman will be
referred to OVC services in order to facilitate care for all of her affected children.
Opt-out HCT with same day test results will be provided to all women presenting for ANC and untested
women presenting for labor and delivery. All women are provided pre-test counseling services on
prevention of HIV infection including the risks of MTCT. Partner testing is offered as part of counseling
through referral to on-site HCT centers. A step down training of couple counseling and a prevention with
positives package will be utilized in all sites. This will provide an opportunity to interrupt heterosexual
transmission, especially in discordant couples. Master trainers for HCT will train labor and delivery staff in
the use of HIV rapid tests for women who present at delivery without antenatal care.
As a result of these PMTCT HCT activities, PFD anticipates that 2,000 HIV-positive pregnant women will be
tested with an estimated 200 identified as HIV-positive and provided with a complete course of ARV
prophylaxis. HIV-positive women will have access to supported lab services including CD4 counts without
charge. This will be available on-site or within the network through specimen transport. Women requiring
HAART for their own health care are linked to a network ARV service provision point. For the anticipated 2/3
of women not requiring HAART, the current national PMTCT guidelines recommended short course ARV
option will be provided which includes ZDV from 28 weeks, ZDV/3TC from 34/36weeks and intra-partum
NVP, and a 7-day ZDV/3TC post-partum tail. All HIV-positive women will be linked post-partum to an
HIV/ARV point of service, which will utilize a family centered care delivery model whenever feasible, co-
locating adult and pediatric care and providing a linkage to family planning services. Women frequently face
barriers to facility-based treatment access as a result of demands on them for childcare and to contribute to
the family economic capacity. To address this, outreach services will be integrated at the community level to
bring services to women who otherwise will opt-out of care and treatment. HIV-positive women will be
counseled pre- and postnatally regarding exclusive breast feeding with early cessation or exclusive breast
milk substitute (BMS) if AFASS using the National infant feeding curriculum. Couples counseling or family
member disclosure will be utilized to facilitate support for infant feeding choices. As part of OVC
programming, PFD will provide safe nutritional supplements as well as water guard, bed nets, and other
home based care items. HIV-positive women will be linked to support groups in their communities, which
will provide both education and ongoing support around infant feeding choices and prevention for positives.
This will ensure that HIV-positive women remain in care throughout pregnancy, receive ARV prophylaxis,
are supported in their infant feeding choice, access EID, and are linked to HIV care postpartum, thereby
reducing loss to follow-up throughout the PMTCT cascade.
Infant prophylaxis will consist of single dose NVP with ZDV for 6 weeks in accordance with Nigerian
National PMTCT Guidelines. Cotrimoxazole suspension is provided to all exposed infants pending a
negative virologic diagnosis. Testing of infants will be carried out using dried blood spot (DBS) specimen
collection. PFD will actively participate in the national early infant diagnosis initiative by providing infant for
DBS testing from 6 weeks of age. A systematic coordinated approach to program linkage will be
operationalized at the site level and program level including linkages to adult and pediatric ART services,
OVC services and basic care and support. Quality monitoring will be undertaken through site visits using an
existing assessment tool and routine monitoring and evaluation indicators.
PFD will train 5 healthcare workers from each of the 2 sites including community-based healthcare workers
in the provision of PMTCT services and infant feeding counseling. The national PMTCT training curriculum,
national infant feeding curriculum and new national training tools will be utilized.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will provide counseling & testing services to 2,000 pregnant women, and provide ARV
prophylaxis to 200 mother and infants pairs. This will contribute to the PEPFAR country specific goals of
preventing 1,145,545 new HIV infections in Nigeria by 2009.
LINKS TO OTHER ACTIVITIES
This activity is linked to care and support, OVC, ARV services, laboratory infrastructure, sexual prevention,
and SI. Prevention for positives counseling will be integrated within PMTCT care for HIV-positive women.
The basic package of care provided to all HIV-positive patients will be available to HIV-positive pregnant
women. Women requiring HAART for their own health care will be linked to ARV services. Lab staff will
ensure that HIV testing provided within the PMTCT context is of high quality by incorporating PMTCT sites
into the laboratory QA program.
POPULATIONS BEING TARGETED
This activity targets pregnant women who will be offered HCT, HIV-positive pregnant women for ARV
Activity Narrative: prophylaxis and infant feeding counseling, and exposed infants for prophylaxis and EID.
KEY LEGISLATIVE ISSUES ADDRESSED
This activity is related to issues of gender equity since treatment will be provided to women and will promote
male involvement in PMTCT programming.
EMPHASIS AREAS
The major emphasis area is training, as most supported personnel are technical experts. A secondary
emphasis area is commodity procurement as ARVs for prophylaxis and laboratory reagents for infant
diagnosis will be procured. Another secondary emphasis area is network/referral systems as networks of
care will be supported which are critical to ensuring quality of care at the primary health center level,
identifying women in need of HAART, and ensuring access to HAART within the network. In addition,
partners and PABAs will be identified for linkage to care and support services.
MONITORING AND EVALUATION
CAMP clinics will track the number and proportion of women attending antenatal care each year who
receive PMTCT services and the number of HIV-positive women receiving antiretroviral prophylaxis. The
quality of PMTCT sites will be monitored through indicators such as reduction in waiting time experienced
by participants, the percentage of participants who complete their treatment, and the number of HIV-positive
women who undertake peer education activities in their communities about the benefits of VCT.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21682
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21682 21682.08 HHS/Centers for Partners for 9401 9401.08 $135,000
Disease Control & Development
Prevention
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $8,020
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This activity is linked to counseling and testing, basic care and support, TB/HIV, OVC, strategic information,
and PMTCT.
In COP 08, Partners for Development (PFD) worked collaboratively with their sub-partner, the faith-based
organization (FBO) Daughters of Charity (DC) to provide services aimed at preventing transmission of
HIV/AIDS through two project sites: 1) the Assumption Clinic in Warri, Delta State; and 2) Catholic VCT
Center, Ikot Ekpene, Akwa Ibom state. Targets for COP08 abstinence, be faithful, and condoms and other
prevention (ABC) programming included reaching 4,091 individuals (2,000 males and 2,091 females) with
AB prevention messages and 2,727 (1,527 males and 1,250 females) with other behavior change
prevention messages from 2 outlets, and 2,000 individuals reached through abstinence only. These
activities were implemented under the "Counseling, Care and Anti-retro Viral Mentoring Program" or CAMP,
the name of PFD's CDC-funded project.
In COP 09, CAMP will support the government of Nigeria in providing timely, accessible, factual and
balanced ABC programming in line with the overall PEPFAR Nigeria goal to deliver a comprehensive
package of prevention services to targeted individuals to ensure effective communication and motivation to
practice preventive behavior, build self-efficacy, and create an enabling environment for sustaining HIV
prevention behavior change. Messages and materials will focus on: increasing risk perception of HIV and
AIDS; increasing demand for HIV testing and appropriate application of AB prevention strategy; delaying
sexual debut; and reducing the number of sexual partners. This is of particular importance, as it has been
reported that risk perception among Nigerians remains low, with 67% perceiving themselves not to be at
risk of contracting HIV, and 29% assuming they are at low risk of contracting the virus (2005 National
HIV/AIDS and Reproductive Health Survey).
CAMP prevention will focus on creating an enabling environment for sustaining HIV prevention behavior
change through providing timely, accessible, factual and relevant HIV prevention information, and ensuring
effective communication and motivation among stakeholders and targeted populations to practice
preventive behavior and build their self-efficacy. Messages and materials will focus on increasing risk
perception of HIV and AIDS; increasing demand for HIV testing; increasing self efficacy for the appropriate
application of AB prevention strategy; and delaying sexual debut and reducing the number of sexual
partners.
AB behavioral change communication programming will be implemented primarily through the following
strategies: community awareness campaigns; peer education model; "peer education plus" model; and a
school-based approach. In line with the National Prevention Plan's guidance on a minimum prevention
package, an individual will only be counted as reached after receiving AB messaging through at least three
of the above listed strategies. For the condoms and other prevention (C&OP) programming, PFD's
minimum prevention intervention package will include: 1) community outreach; 2) specific population
awareness campaigns; 3) peer education model; and 4) provision of STI management. Individuals will be
counted as having been reached when they have received C&OP messaging through at least 3 of these
strategies. The CAMP prevention team will be coordinated by a Prevention Officer who will mobilize 60
prevention volunteers from the membership of various community-based organizations (CBOs) active in
and around the two project sites. These volunteers will be trained to educate their peers in ABC messaging,
although in practice 30 volunteers will specialize in AB message delivery and 30 others will specialize in
condoms and prevention messages. The AB prevention volunteers will be drawn primarily from CBOs
active with church and primary school groups and the condoms and other prevention volunteers will be
drawn primarily from with unemployed youth and transport workers groups. The CAMP project will use
almost exclusively a community outreach approach for transmitting prevention message that will be
supplemented by complementary clinical based and counseling and testing service providers that will
reinforce and expand upon prevention messages.
HIV prevention team members will be self-nominated from local support groups of people infected and
affected by HIV/AIDS, as well as any interested members of communities groups linked to the CAMP
catchment areas. These individuals will be trained by CAMP Program Officers to promote AB messages as
well as C&OP messages, as appropriate to the population they are targeting. Training will emphasize
routine counseling and testing for couples and individuals, and AB prevention as normative in their
communities. These teams will adapt the Society for Family Health (SFH) behavior change communication
(BCC) materials and work with local support groups to translate material into their community's language.
Prevention teams will pay advocacy visits to the traditional community gatekeepers for access to the
women, men and youth in each targeted locality, and organize community mobilization events with relevant
HIV prevention messages for each group. These volunteers working with high risk groups will be coached
to link the target population to condom outlets and appropriate testing/counseling and follow-up services
(i.e., PMTCT, counseling for discordant couples, etc.) as well as sexually-transmitted infection (STI)
treatment and care.
The AB prevention team will target 4,091 individuals with a subset reached with A only message activities
(i.e., messages delivered to school groups up to the age of 13). A only messaging starts with an awareness
talk in small group discussions facilitated by the Prevention Officer, followed up by peer education outreach
by volunteer students trained as peer educators, and by a dance/drama presentations with an A message
theme. AB messages will be delivered in secondary schools following the same first two steps and
including a sporting or cultural event accompanied by an AB theme.
Condom and other prevention messages will target 2,727 individuals among those considered to be high
risk groups — unemployed youth, transport workers, STI patients, persons living with HIV/AIDS (PLWHAs),
and pregnant women. Messages will be reinforced at multiple fora such as small group discussions
(including ante-natal care talks given at health facilities), interpersonal communication and social events,
followed by mobile counseling and testing, condom distribution and follow up prevention information for
positives. Educational messages will cover the importance of partner reduction and STI prevention and
treatment.
Activity Narrative: CAMP will utilize the recently adapted national prevention with positives (PwP) training package across all
supported sites. In HIV counseling and testing (HCT), prevention of mother-to-child transmission (PMTCT),
and adult care and treatment settings, clinical staff and community workers will encourage patients to
promote testing and counseling for their sex partners. During each encounter with a positive person during
the CAMP program, CAMP staff will support the integration of prevention into care and treatment settings,
including family planning counseling and services, identification and treatment of STIs, and prevention
counseling, provided by lay counselors. The C&OP portion of this activity will include provider- and lay
counselor-delivered prevention messages promoting correct and consistent condom use during every
sexual encounter. Also, condom use will be encouraged during family planning counseling as a method of
dual protection and as part of STI management for reducing STI transmission and acquisition. These
prevention messages and interventions will be delivered during risk-reduction counseling, family planning
counseling, and STI management and counseling. CAMP staff will work with patients to encourage them to
reduce alcohol and limit all other risky behavior and activities that affect their ability to adhere well to their
ART regime, and adherence to the full course of any other medication the client is taking
Program Officers will meet with prevention teams monthly to plan community outreach projects, address
concerns, and provide any relevant or needed training in communication skills. Prevention team members
will be trained to report on delivery of behavior change communication (BCC) methodology. Delivery of the
MARCH methodology will be tracked and reported on by CAMP Prevention Project Officers. Focus will be
placed on verifying the basic prevention package of at least 3 interventions per target reached in both AB
and C&OP prevention components.
Contribution to overall program area:
PFD/DC's activities are consistent with the PEPFAR 5-year strategy, which seeks to scale-up prevention
services, build capacity for long-term prevention programs, and encourage testing and targeted outreach to
high-risk populations. The establishment of networks and referral systems from prevention efforts at the
community level to PMTCT and HIV care and treatment will help facilitate the scale-up of the overall
program.
Links to other activities
and PMTCT. PFD will procure condoms from Society for Family Health (SFH) and seek to partner with them
and other specialized community groups to socially market condoms in the program area. PFD will
promote condom usage, and other relevant prevention messages among migrant workers and other mobile
populations in the Delta region. PFD's home-based care team will also promote management of STIs and
encourage community members to know their status as a first step in preventing the spread of HIV.
Target population
The focus population for this activity will be youth (in/out of school youth), HCT clients, and TB DOTS
patients. Both Akwa Ibom and Delta states have many characteristics that contribute to accelerating the
HIV/AIDS epidemic, including high numbers of unemployed youth who may engage in transactional sex.
PFD/DC will focus prevention efforts on reaching young people both before they begin risky behaviors and
after. In addition, prevention messages will be targeted to pregnant women since they also risk
transmission to their unborn child.
Key legislative issues
Coordination meetings held at the LGA level with representation from local government assists in keeping
local governments updated on the scope of the epidemic in their area and make them better advocates for
strengthening barriers to prevention at the state level. CAMP staff will supplement these meetings with
quarterly state level task force meetings to explore ways to achieve greater economies of scale and
harmonization of approaches.
Program Emphasis
This activity includes major emphasis on information, education, and communication with minor emphasis
on community mobilization and training. These activities will also address gender equity issues by providing
equitable access to prevention services for men and women.
Continuing Activity: 21686
21686 21686.08 HHS/Centers for Partners for 9401 9401.08 $250,000
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $2,280
Table 3.3.02:
Table 3.3.03:
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.
In COP 08, Partners for Development (PFD) worked collaboratively with its sub-partner, the faith-based
organization (FBO) Daughters of Charity (DC), to implement activities at two project sites: 1) Assumption
Clinic in Warri, Delta State and 2) Catholic VCT Center and primary health care center, Ikot Ekpene, Akwa
Ibom State to implement activities under the "Counseling, Care and Antiretroviral Mentoring Program" or
CAMP, the name of PFD's CDC-funded project. This component targeted 400 adults in COP08 needing
care through a combination of community-based service provision by peers and community members linked
to treatment through health service providers. The model is based on the realization that clinics cannot
provide cost-effective, sustained follow-up and care for all infected-individuals, and in order to provide a
continuum of care, community resources and volunteers will be required. Using peers and other community
members also promotes HIV awareness and helps to reduce the stigma associated with HIV/AIDS.
Outreach services are provided through Community-based Organizations (CBO) networks to 10 LGAs. In
all activities, CAMP draws upon a network of community based groups coordinated at LGA level for service
provision on a voluntary basis. The LGA coordination meetings include Parish Action Committees which
are themselves coalitions of women's, men's and youth groups as well as health care service provider
representatives. They also include representatives from support groups of People Living with HIV/AIDS
(PLWHA) or affected by AIDS. Through these LGA coordination mechanisms, volunteers willing to provide
home based care to PLWHA are organized, trained and equipped.
In COP 09, PFD will continue to provide care and treatment services to the same target population and
plans to reach 850 newly enrolled adults (making a cumulative total of 1250) with care and support services
and 900 through ART. PFD and DC will assist adults who need palliative care through a combination of
home visits from community volunteers who have been trained in basic nursing skills plus treatment
provided by health service staff employed through the two project sites. An enrolled client will be counted to
have received care if they have received clinical care, a basic care kit plus two other supportive services
which include prevention counseling, psychosocial counseling, volunteer home visitors and logistic support.
CAMP Program Officers will train, mentor, and technically support community caregivers as they provide
services to persons living with HIV/AIDS. 36 home visitor volunteers will be recruited from PLWHA and
their caregivers support groups that have been formed through Parish Action Committees and other CBOs.
Support group leaders will coordinate their work at the community level which will in turn be coordinated by
an LGA level community nurse. They will be given a basic home nursing training course according to the
national curriculum in the beginning, plus quarterly refresher classes that serve to keep their interest high
and result in higher retention. Assistance with transportation costs will be provided as needed to
volunteers. Home volunteers will be coordinated and linked to clinical services through community
nurses/health officers supported by a social worker who will also receive training under this component
according to the national curriculum for PLWHA caregivers. There will be two levels of training for home
volunteers to correspond to different groups of clients: 1) Pre-ART clients who will require PWP services,
health education, CD4 default tracking, as well as family counseling/testing and referrals and 2) clients who
are on ART or needing significant clinical assistance/treatment (stage 3 and 4) will first be given more
advanced home nursing training and work under a clinical staff person's supervision.
Each enrolled client that receives care and support services from CAMP will be given a basic care kit
containing an analgesic (aspirin or paracetemol) and other items including ORS, ITN, water treatment
solution and vessel, cotton wool, gloves, soap & IEC materials. The gloves, soap and water treatment
solution will be replenished monthly. Home visitors will receive a basic home nursing kit that will contain a
thermometer, latex gloves and first aid items. Home visits will be arranged through a referral system
organized by an LGA-level volunteer coordinator.
Clients qualifying for care and support will be drawn from a span of intake points such as primary health
care outposts, safe motherhood and child survival programs and HCT points. All testing positive will be
referred for further medical examinations and lab analysis. ART eligible clients will be placed in ART
programs according to National ART Guidelines. Home care capacity of those with chronic and debilitating
symptoms will be assessed and those needing assistance from outside their household will be assigned to
one of the network of home visitor volunteers. Interface between the home care and clinical care activities
will be provided by community nurses who track retention of enrolled clients. Logistical support is organized
both by support group leaders who receive training in this area by CAMP personnel and by CBO and health
service representatives who have received counseling training (including bereavement counseling).
Logistic support includes organizing transportation to ensure that patients can access the clinic-based part
of their treatment
Clients will access clinical care as needed (nursing care, pain management, nutritional assessments and
interventions, OI diagnosis prophylaxis and treatment, STI diagnosis & management, lab service-baseline
hematology, chemistry, CD4 count and follow up, MP, and pregnancy tests when indicated. Clinical staff
provides counseling on the importance of adherence to prescribed drug regimes and sets up monitoring and
reinforcement chains via a community nurse. For treatments and tests, CAMP clinics have access to
supply chains organized at the national level by the Daughters of Charity referral center in Kubwa outside
Abuja.
Clinical staff will be trained on pain assessment techniques and management according to the National
Palliative Care Guideline. They will also receive a nutritional assessment based on guidelines from the
DREAM model adopted by Daughters of Charity. This stands for Drug Resource Enhancement Against
Activity Narrative: Aids and Malnutrition. The DREAM model includes an evaluation covering nutritional anthropometric,
clinical and laboratory data. Health care providers investigate the clients' nutritional history and decide on
the quality and quantity of any supplement to be prescribed. Signs and symptoms such as anorexia,
nausea, vomiting and diarrhea are recorded. Anthropometric measurements of weight, height and body
mass index (BMI) are also checked.
Three types of counseling services will also be provided. These include prevention counseling and testing
with positives and other prevention counseling for family members including discordant couples. PFD and
DC will work towards greater access of home based testing for families where one or more member is
positive. Couples where one or more partner are HIV+ will receive HIV/STI prevention counseling from this
team, according to the national standards for PWP prevention.
A second type of counseling provided will be psychosocial including bereavement and depression
counseling. Home visitor volunteers will receive training in how to provide moral support and
encouragement as well as bereavement counseling to families where one or more members are PLWHA,
and to learn signs of when their clients need referral to appropriate psychological services. Spiritual
counseling will be facilitated through participation of FBOs in the volunteer network and their affiliation to
various churches who undertake spiritual and more support activities as part of their mandate.
The third type of counseling is linked to clinical care related to adherence to prescribed treatments,
particularly ART. This counseling will be given by the attending health service team initially, but home
visitor volunteers will be requested to help with follow up and monitoring of adherence.
Home visitor volunteers are also trained in basic home nursing skills and oriented on how/when to refer
clients to CAMP clinics for follow up, counseling and testing. Couples where one or more partner are HIV+
will receive HIV/STI prevention counseling from this team. The Adult Care and Treatment team will cover
all aspects of home-based, clinic linked care except that of ARV therapy which is covered in a separate
component, however the home-based caregiver team.
PFD will through its care and treatment activities/services will contribute to PEPFAR/Nigeria goals of
providing treatment to 350,000 and care to 1.75 million people. In addition, PFD is contributing to improved
access to care and treatment, particularly to underserved areas.
This component is strongly linked to prevention, HCT, PMTCT, ARV drugs, SI, OVC, Lab infrastructure and
services. There is a strong link to the PMTCT component as mothers may need continuing follow up
assistance through this adult basic care and treatment component. Adults being cared for through this
component will be able to draw upon primary health care programs offered either through CAMP sub-
grantee Daughters of Charity, or who are participating in LGA level coordination mechanisms such as
Ministry of Health primary care units for prevention of malaria, TB and communicable diseases
Target populations for this component are HIV/AIDS infected adults their caregivers, and health care
workers. PLWHA will be provided with care and treatments through a combination of assistance from home
visit volunteers and health service staff employed at the two project sites. The home visit volunteers are
recruited and organized by a network of CBOs (particularly support groups) coordinated at the LGA level
and overseen by a community nurse who provides interface between home care and facility based care.
Key legislative issues: PLWHA continue to suffer from stigma and discrimination in many areas of society.
Those affected should be monitored and reported with data disaggregated by gender. They should be
analyzed from a gender perspective since men and women experience these problems disproportionately.
local governments updated on the scope of problems related to gender-based violence, stigmatization and
discrimination suffered by clients of this care and treatment component. This information will make them
better advocates for improved policy at the state level and national level.
Emphasis areas
The main emphasis of this activity is capacity building for improved treatment and care for PLWHA and
PABA. This will include integration of care activities with wider malaria prevention and safe motherhood
initiatives - both through mainstreaming basic best practices in those areas into training of caregivers for
PLWHA as well as using these other programs to enroll PLWHA into the Care and Treatment program as
appropriate. Focus will be placed on task shifting through increased delegation of clinical tasks to a wider
net or caregivers that have been trained according to national guidelines. This will free up physician's time
an enable the clinical/caregiver teams to serve more clients. It will also contribute to the professional
development and advancement of various levels of health care providers. PFD will participate in
subsequent yearly care and treatment evaluations if requested.
Monitoring and Evaluation
PFD program officers and DC nurse counselors and adherence counselors will work with community
volunteers (including adherence guarantees for each HIV patient on Anti-Retro Viral (ARV) drugs) to train
them in proper delivery of home-based care. Caregivers will be tasked with monitoring patients in their
homes twice weekly, and providing support as necessary. Community-health workers from CAMP sites will
do monthly rounds to see People Living With HIV/AIDS (PLWHA) and offer support to their caregivers. Key
support categories such as provision of home based care, preventive prophylaxis, palliative care, and
nutritional support will be tracked and reported on with patients disaggregated by gender.
Continuing Activity: 21688
21688 21688.08 HHS/Centers for Partners for 9401 9401.08 $40,000
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $5,665
Table 3.3.08:
Continuing Activity: 21698
21698 21698.08 HHS/Centers for Partners for 9401 9401.08 $210,000
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $4,360,927
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
At the end of COP07, the total number of children provided with clinical care services including those on antiretroviral therapy
(ART) was 15,453. In COP08, USG/Nigeria plans to have enrolled children as a 10% proportion of clients on treatment.
USG/Nigeria has successfully brought on an additional seven partners who will implement care and treatment services in COP09,
making a total of 21 implementing partners (IPs) in care and treatment. Of these, three are indigenous partners that in line with
USG sustainability goals.
USG's strategies for increasing the number of children in care (to 40,187 across 543 sites) in COP09 include: (1) Early Infant
Diagnosis (EID) scale-up to identify children early and link them to treatment; (2) active case detection through Provider Initiated
Testing and Counseling (PITC) at multiple points of service (POS), including Prevention of Mother to Child Transmission (PMTCT)
POS; (3) integration into Maternal Child Health (MCH) and scaling up PMTCT; (4) training, retraining and mentoring of staff; (5)
improved supply chain management and procurement of drugs and supplies with the implementation of pooled ARV
procurements; and (6) improved linkages between treatment, PMTCT, tuberculosis (TB) and Orphans and Vulnerable Children
(OVC) services.
Despite the slow start by the Government of Nigeria (GON) and stakeholders to provide pediatric services nationally, political will
has been building since the establishment of a National Technical Work Group in 2006. The USG also facilitated a South-South
technical assistance visit in 2007 that helped build momentum nationally towards pediatric care. A National Pediatric Treatment
Guideline and standard operating procedure (SOP) exist with draft national training materials and a draft scale-up plan. There is
also an HIV/AIDS Pediatric Care and Treatment desk officer in the Federal Ministry of Health. In COP09, USG/Nigeria will
collaborate with GON to develop a National Pediatric Care and Support guideline, training manual, and SOP.
In COP09, acceleration of a pediatric HIV program roll-out will be emphasized. Several approaches will be used, including
expansion of HIV testing of children, active case finding within USG-supported programs, provision of HIV testing and counseling
services for families of all pediatric patients enrolled in care and treatment programs, and support of the parallel development of
pediatric HIV care and treatment services with adult ART and PMTCT services (service co-location). This supports a family
focused health approach. Since most HIV treatment services for children are localized in larger clinical facilities, USG/Nigeria and
IPs are also making strides to support the development of clinical services for children at secondary and primary levels of care, to
make services more accessible to families and decrease the probability of loss to follow-up.
In COP07, the USG-supported the GON in a pilot phase of Early Infant Diagnosis (EID) in Nigeria using Dried Blood Spots (DBS).
Results from this pilot phase have demonstrated the feasibility of EID in Nigeria using DBS. With the support of PEPFAR
laboratories and a well developed national manual, the GON is following a national plan in scaling-up EID across the country. This
will ensure that HIV exposed infants are linked early enough into pediatric care and treatment in keeping with the new World
Health Organization (WHO) recommendation. IPs have committed to early treatment initiation of HIV infected infants under 12
months of age regardless of their CD4% or count and clinical status. Older children will also be initiated into treatment using
clinical and immunological parameters according to WHO 2008. The program was strengthened in COP08 and will continue in
COP09 with all partner laboratories with the capacity to do polymerase chain reaction (PCR) being enrolled to include the DBS
technique to enable more sites to participate in EID. Poor counseling on infant feeding, one of Nigeria's key challenges, tends to
reverse the gains of early diagnosis efforts. As such, Infant Feeding Counseling (IFC) training now precedes all EID training to
ensure competency in giving consistent and accurate IFC messages at facilities. Women and their families will be counseled to
exclusively breastfeed except when they can achieve Acceptable, Feasible, Affordable, Sustainable and Safe alternative (AFASS)
to breast milk. If they can, they will be encouraged to exclusively use a breast milk substitute (BMS). PEPFAR funds will not be
used to procure BMS unless medically indicated; for example, for infants who lose their mother at birth.
Despite the challenges posed to identifying positive children, (i.e., limited access to counseling and testing facilities, obtaining
parental consent) partners will continue active case finding by implementing PITC at multiple points of service, including
outpatient, inpatient, TB, and adult ART clinics and support groups. A best practice that is being adopted by more partners is the
use of genealogy mapping to identify HIV status of the family, such that untested family members can be identified and reached.
Also, the population-targeted state and local government area (LGA) coverage strategy for PMTCT will be strengthened in COP09
to improve PMTCT coverage, which will be linked to pediatric care and treatment services to capture more exposed infants and
their siblings.
The critical manpower shortage and low skill set of staff, especially in rural areas, to care for HIV positive children is a known
challenge of pediatric care and treatment; as such partners are emphasizing training, retraining and mentoring of health care
workers (HCWs) to ensure competency in the necessary skill sets. Efforts to train existing health care providers at all levels of the
health care system are key to significantly increase the numbers of children receiving quality health care services. Experienced
staff at centers of excellence for pediatric HIV will mentor new cadres of health care providers. Training and mentoring of health
care providers will emphasize HIV testing and counseling for infants, children and adolescents, cotrimoxazole (CTX) prophylaxis
and ART in children. Also, the USG is providing fellowship trainings to health care providers as described under health system
strengthening to deliver comprehensive health care services to HIV/AIDS clients including children. The USG and partners will
have a good representation of certified pediatricians among its staff in COP09. In addition, the USG/Nigeria team will continue
joint supportive supervisory site visits with relevant GON officials. The PEPFAR team will continue to engage the GON in the
development and implementation of a policy in task-shifting.
.
Available National first line regimens presently include two Nucleoside Reverse Transcriptase Inhibitors and one Non-Nucleoside
Reverse Transcriptase Inhibitor, specifically zidovudine/lamivudine/nevirapine as one recommended first line option. Most sites
will utilize Fixed Drug Combinations in COP09 leveraged from Clinton Foundation HIV/AIDS Initiative (CHAI); training is ongoing
for ease of use. In COP09 the IPs will not be using a PI based regimen when nevirapine exposure has occurred because it has
not yet been adopted nationally. Due its cost implications, challenges are significant but IPs will explore ways to address pricing
issues and implement this in the future. The National Care and Treatment ART cards and Patient Management and Monitoring
forms are used at sites by most partners to ensure continued harmony in reporting and integration.
USG/Nigeria will further strengthen (1) support groups for children, adolescents, caregivers and families, (2) support for disclosure
and informing about HIV, (3) adherence support and services, and (4) support to address caregivers' concerns and needs. TB
screening will be provided to all exposed and infected children. Cost of TB diagnosis in children will continue to be addressed
including issues around the national availability of drugs. Facilities providing pediatric care and treatment will be encouraged to
have pediatric working groups, patient care team meetings, and continuing medical education, as appropriate.
Adolescent friendly services and clinics will be operational in COP09 with age appropriate referral to Prevention with Positives
(PwP) as needed; including CTX prophylaxis, nutritional assessment and support, safe water interventions, malaria prevention
interventions, and linkages to child survival interventions, including immunizations and growth and development monitoring.
Children on ART and exposed children receive CTX prophylaxis (from 6 weeks of age until HIV status is confirmed for exposed
infants) according to National guidelines. Basic care kits containing oral rehydration salts (ORS), water vessel, insecticide treated
nets and water guard, latex gloves, and information, education and communication (IEC) materials will be provided. Care and
support services will be specifically, 20% lab monitoring for OIs including CD4 % and counts; 30% OI prophylaxis and treatment,
pain management, and malaria and 50% Home Based Care (HBC) and training.
USG and IPs will link services to immunizations (Expanded Programme on Immunizations) using a holistic approach to care. IPs
will provide well-child care programs, micronutrient supplementation and control of intestinal parasites (e.g., deworming). Children
receive clinical examination for evidence of HIV infection at each visit. Nutritional services will include assessment, counseling,
and support involving (1), growth monitoring/anthropometric status (e.g., weight for age, height for age, mid-upper arm
circumference, Body Mass Index); (2) nutrition-related symptoms (e.g., appetite, nausea, thrush, diarrhea) and diet; (3) the
provision of a daily multi-micronutrient supplement for children whose diets are unlikely to meet vitamin and mineral requirements,
(4) the provision of therapeutic or supplementary feeding support for clinically malnourished patients (i.e., plumpy nut from CHAI);
and (5) the provision of infant feeding support linked to PMTCT programs and pediatric care programs.
The challenges that exist in infant and child follow-up will be addressed by default tracking teams that provide Home-Based Care
(HBC). The HBC package is provided mainly at community and home levels by outreach teams from clinical facilities, community
volunteers, PLWHA support groups and family care-givers with linkages and supervision from trained HCWs. HBC includes:
medical and psycho-social support available to PLWHA and PABA and includes comprehensive, on-going counseling and referral,
as well as facilitation of access to support groups, transportation, micro-credit, stigma and discrimination reduction, material
support, legal aid, and housing (usually leveraged). HBC training is provided for service providers and caregivers. Trained HBC
providers are equipped with HBC kits.
USG Pediatric Care and Treatment program will continue to increase gender equity in programming through disaggregation of
pediatric indicators into sexes. 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 child care and treatment in the families.
The expansion of pediatric HIV services will require the parallel development of capacity for program monitoring and evaluation
(M&E). Program M&E will be supported by the USG, GON, and IPs to ensure that National registers, forms and tools for data
capture are available and that all staff are trained to use these tools appropriately. USG PEPFAR Nigeria teams and partners will
assist the national program to develop, collect, report and monitor pediatric HIV indicators by age categories (i.e., <2 years, 2-5
years, and 6-14 years). USG/Nigeria will collaborate with GON to support a unified and integrated national system for pediatric
HIV monitoring in order to standardize data collection and monitoring procedures and provide information to evaluate program
performance. USG/Nigeria PEPFAR programs will support and actively participate in the regular review of country data along with
the Federal Ministry of Health (FMOH) and National Pediatric technical working group. USG/Nigeria provides technical assistance
to FMOH and IPs for pediatric HIV monitoring and conducts joint site visits with FMOH.
COP09 will emphasize the quality of care and treatment services, as pediatric care and treatment programs expand. USG/Nigeria
goals will include performance measurement through the use of HIVQUAL and other QA/QI mechanisms. Best practices will be
evaluated and disseminated across PEPFAR/GON partners.
USG will utilize Supply Chain Management System (SCMS) for PEPFAR-wide forecasting and pooled procurements in a phased
approach, beginning with 2 adult ARV formulations. It is expected that this will continued to be rolled out in a step-wise fashion
annually. USG/Nigeria will continue leveraging procurements and supply chain strengthening across USG/Nigeria partners and
other stakeholders (e.g., CHAI). SCMS will procure medical supplies and equipments used in ARV services, ARV drugs, OI drugs
and other care and treatment commodities.
At the site level, PEPFAR activities already co-exist and collaborate with GON in service delivery. There are close partnerships
and leveraging of resources between the USG, GFATM, UNICEF and CHAI. These partnerships will continue in COP09 for
improved access to care and treatment services.
Table 3.3.10:
This component is new in COP09. Partners for Development (PFD) will work collaboratively with their sub-
partner, the faith-based organization (FBO) Daughters of Charity (DC), to implement activities at two project
sites: 1) Assumption Clinic in Warri, Delta State and 2) Catholic VCT Center and primary health care center,
Ikot Ekpene, Akwa Ibom State to implement activities under the "Counseling, Care and Antiretroviral
Mentoring Program" or CAMP, the name of PFD's CDC-funded project. This component targets 125
children needing care through a combination of community-based service provision by peers and
community members linked to treatment through health service providers. The model is based on the
realization that clinics cannot provide cost-effective, sustained follow-up and care for all infected-individuals,
and in order to provide a continuum of care, community resources and volunteers will be required. Using
community members also promotes HIV awareness and helps to reduce the stigma associated with
HIV/AIDS. Outreach services are provided through community-based organizations (CBO) networks to 10
LGAs. In all activities, CAMP draws upon a network of community based groups coordinated at LGA level
for service provision on a voluntary basis. The LGA coordination meetings include Parish Action
Committees which are coalitions of women's, men's and youth groups as well as health care service
provider representatives. They also include representatives from support groups of People Living with
HIV/AIDS (PLWHA) or affected by AIDS. Through these LGA coordination mechanisms, volunteers willing
to provide home based care to PLWHA are organized, trained and equipped.
In COP09, PFD will provide a continuum of care for children and adolescents exposed to and infected by
HIV/AIDS. Clients for care and treatment will be drawn from a number of entry points including PMTCT
referrals or other safe motherhood and well baby clinic programs, general pediatric care programs, and
community support groups. Babies born to mothers enrolled in PMTCT programs will be tested using Early
Infant Diagnosis (EIC) test kits that will be obtained from the Clinton Foundation, and those needing
treatment will be enrolled in the Pediatric Care and Support program. Other referrals may come through
adult care and treatment services and HCT outreach. This activity is closely linked to the OVC services,
and those children who are HIV+ will have access to programs offered under the OVC component, including
kid's clubs, however they will not be counted as primary OVC targets since they will be counted instead
under this pediatric care and support component. Pediatric home-based care providers will have access to
the same training given to OVC mentors related to monitoring the overall status of each child enrolled and
will be closely linked with OVC mentors working in the community.
A continuum of care for HIV+ children will be established through linking facility services to CHBC. The
CHBC team will comprise clinicians, nurses, community health workers and volunteers including PLWHA
who are recruited from CBOs. The CHBC team working with children and adolescents will receive
additional training to ensure a child and adolescent friendly approach. To the extent possible, those home
visitors assisting children (including adolescents) will specialize in that target group to enhance
development of child and adolescent appropriate counseling and care skills.
In COP09, PFD and DC will provide 125 children with care through a combination of home visits from
community volunteers who have been trained in basic nursing skills plus treatment. An enrolled child will be
counted to have received care if they have received clinical care, a basic care kit plus two other supportive
services which include, psychosocial, spiritual, CHBC, and age appropriate PwP and other prevention
services and logistic support. All enrolled clients will receive a basic care kit containing ORS, ITN, water
treatment solution and vessel, cotton wool, gloves, IEC material and soap. The gloves, soap and water
treatment solution will be replenished monthly. CHBC providers will receive a HBC Providers Kit that will
contain a thermometer, latex gloves and first aid items. Home visits will be arranged through a referral
system organized by an LGA-level volunteer coordinator.
interventions, OI diagnosis, treatment and prophylaxis), lab service-baseline hematology, chemistry, CD4
count and follow up, OI and STI diagnosis, and malaria prevention measures. Clinical staff provides
counseling on the importance of adherence to prescribed drug regimes and sets up monitoring and
reinforcement chains via a community nurse. ART-ineligible children that are enrolled in care will have
periodic follow-up to identify changes in eligibility status. Scheduled physician visits for all are at three, six,
and 12 months and every six months thereafter. ART pediatric patients follow the same clinical visit
schedule with more intensified monitoring and pick up drugs monthly. For all patients, at each visit, clinical
exams, hematology, chemistry and CD4 enumeration are performed when indicated. 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. Individuals will be provided with cotrimoxazole prophylaxis
according to national guidelines. Diagnostics for common OIs will be performed. All patients will be also
symptomatically screened for TB and confirmed with laboratory and radiological diagnostics as indicated.
A key component for successful ART is adherence to therapy at the household and community levels. PDF
will ensure intensive treatment preparation directed at an identified caregiver to ensure strict adherence.
PDF will continue to build and strengthen the community component by using nurses and counselors to link
health institutions to communities. Each site will appoint a specific staff member to coordinate the linkages
of patients to all services. This will also build the capacity of the facility for better patient tracking, referral
coordination, and linkages to appropriate services. These activities will be monitored by the PDF technical
and program management regional teams. All children on ARV will have at least monthly home visits to
ensure adherence and assess need for intervention. Specific efforts and training will be made to develop
adolescent friendly services for infected and affected children.
Home care capacity of those with chronic and debilitating symptoms will be assessed and those needing
assistance from outside their household will be assigned to one of the network of home visitor volunteers.
Interface between the home care and clinical care activities will be provided by community nurses who track
retention of enrolled clients. The caregivers will be further encouraged to return for "well child visits" with
their babies, at which time they will be weighed, receive immunizations and nutritional counseling and
education on safe infant feeding. At the age of six weeks, according to the Nigerian national algorithm,
these babies will all have dried blood spot collection for DNA PCR diagnosis. Based on their results, they
will be referred for treatment if positive or will continue to receive follow up care at the facility if negative.
Activity Narrative: Follow-up testing will be preformed at 18 months or twelve weeks after the cessation of breastfeeding
whichever comes later to ascertain the child's final HIV status. HIV positive children, when identified by
DBS testing at designated centers, will be referred for ART services and will continue to receive supportive
care.
CAMP program officers will train, mentor, and technically support community caregivers as they provide
services to children living with HIV/AIDS. Twenty home visitor volunteers will be recruited from PLWHA and
according to the national curriculum for PLWHA caregivers.
Home volunteers will be trained in HBC and referrals working under a clinical staff person's supervision.
Home visitor volunteers will receive training in how to provide moral support and encouragement. They will
also receive training in bereavement counseling to families where one or more members are PLWHA, and
to learn signs of when their clients need referral to appropriate psychological services. Clinical staff will be
trained on pain assessment techniques following the WHO tree ladder approach and in conformance with
national guidelines. They will also receive a nutritional assessment based on guidelines from the Drug
Resource Enhancement Against Aids and Malnutrition (DREAM) model adopted by Daughters of Charity.
The DREAM model includes an evaluation covering nutritional anthropometric, clinical and laboratory data.
Health care providers investigate the clients' nutritional history and decide on the quality and quantity of any
supplement to be prescribed. Anthropometric measurements of weight, height and body mass index (BMI)
are also checked. The Clinton Foundation has agreed to provide PlumpyNut for nutrition therapy under this
component.
PDF will provide prevention counseling and testing with positives, AB prevention counseling for the clients
and other prevention for adult family members including discordant couples. PFD and DC will work towards
greater access of home based testing for families where one or more member is positive. Couples where
one or more partner are HIV+ will receive HIV/STI prevention counseling from this team, according to the
national standards for PWP prevention. PDF will also provide psychosocial counseling including
bereavement and depression counseling. Spiritual counseling will be facilitated through participation of
FBOs in the volunteer network and their affiliation to various churches who undertake spiritual and more
support activities as part of their mandate. Counseling related to clinical care will include adherence to
prescribed treatments, particularly ART. This counseling will be given by the attending health service team
initially, but home visitor volunteers will be requested to help with follow up and monitoring of adherence.
Focus will be placed on task shifting through increased delegation of clinical tasks to a wider net or
caregivers that have been trained according to national guidelines. This will free up physician's time an
enable the clinical/caregiver teams to serve more clients. It will also contribute to the professional
PDF will collaborate with Daughters of Charity and SCMS for the procurement and distribution of specified
care and treatment drugs and commodities. PFD program officers and DC nurse counselors and
adherence counselors will work with community volunteers (including adherence guarantees for each HIV
patient on Anti-Retro Viral (ARV) drugs) to train them in proper delivery of home-based care. Caregivers
will be tasked with monitoring patients in their homes twice weekly, and providing support as necessary.
Community-health workers from CAMP sites will do monthly rounds to see children with HIV/AIDS and offer
support to their caregivers. Key support categories such as provision of home based care, preventive
prophylaxis, palliative care, and nutritional support will be tracked and reported on with patients
disaggregated by gender.
This component is strongly linked to prevention, HCT, PMTCT, ARV drugs, SI, OVC, lab, infrastructure and
assistance through pediatric care and treatment program.
Target populations for this component are HIV/AIDS exposed and infected children, their caregivers/family,
and health care workers.
The main emphasis of this activity is capacity building for improved treatment and care for children living
with HIV/AIDS integrating their care into wider malaria prevention and safe motherhood initiatives - both
through mainstreaming basic best practices in those areas into training of caregivers for PLWHA as well as
using these other programs to enroll children with HIV/AIDS into the care and Treatment program as
appropriate. Training emphasis will be in proper diagnosis, treatment and care of pediatric AIDS cases.
Within this program area, CAMP project personnel will begin with linkages with PMTCT interventions
targeted at lowering a pregnant woman's viral load to reduce the number of babies born HIV+. Early Infant
Diagnosis (EID) tests will be given to infants of HIV+ mothers in order to diagnose infants needing treatment
at the earliest possible moment. EID testing will be accessed through the Clinton Foundation programs that
Activity Narrative: provide courier services and bundled collection kits for dried blood samples for infants. Once diagnosed,
infants will be provided with ART regardless of their viral load.
Early Funding Narrative
Continuing Activity: 21691
21691 21691.08 HHS/Centers for Partners for 9401 9401.08 $50,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $2,024
Contributions to overall program area
The aim of the Pediatric Care and Treatment component is to improve the survival rate of HIV infected
children. Partners for Development (PFD) will work collaboratively with their sub-grantee, the faith-based
organization (FBO) Daughters of Charity (DC), to provide pediatric health care to HIV+ children at two
project sites: 1) Assumption Clinic in Warri, Delta State and 2) Catholic VCT Center, Ikot Ekpene, Akwa
CAMP, the name of PFD's CDC-funded project. The two project sites link clinical treatment to community
care through outreach services coordinated through networks of Civil Society Organizations (CSOs) groups
in 10 LGAs.
Program Emphasis: The emphasis area for this activity will be in proper diagnosis, and training for proper
treatment and care of pediatric AIDS cases. Within this program area, CAMP project personnel will begin
with linkages with PMTCT interventions targeted at lowering a pregnant woman's viral load to reduce the
number of babies born HIV +. Early Infant Diagnosis (EID) tests will be given to infants of HIV+ mothers in
order to diagnose infants needing treatment at the earliest possible moment. EID testing will be accessed
through Clinton Foundation programs that provide courier services and bundled collection kits for dried
blood samples for infants. Once diagnosed, infants will be provided with ART regardless of their viral load.
HIV+ children up to age 14 will be monitored through this component. Health care will be managed through
a partnership with PLWHA support groups, OVC care providers and other community initiatives that are
coordinated by CAMP Project Officers at the LGA level. Support groups and caregivers are trained under
other components to assist children living with HIV/AIDS with logistic and morale support, preventive health
information including nutritional advice and supplements, as well as basic preventive tools such as bed
nets, water guards and hygiene materials. Support networks and caregivers will also assist in ensuring
children's adherence to drug regimes prescribed in the clinical component. The two clinic sites in Delta and
Akwa Ibom will monitor HIV+ children and provide ARV treatment and other treatment for opportunistic
infections, pain and symptom relief as well as nutritional assessment/support. Clinical staff will also counsel
at-risk adolescent children they are treating.
Partners for Development (PFD) program officers will be responsible to find relevant training sessions and
Technical Assistance (TA) for CAMP staff to attend on best practices in pediatric HIV/AIDS care and
support—this will include testing, management of symptoms, pain management, management of
opportunistic infections, and care and support for the entire family system. The CAMP site in Delta State
already had a fully-functioning antenatal and post natal care unit at the beginning of COP 08, and the Akwa
Ibom site will be developed for expanded antenatal/postnatal care during COP 08/09.
This component targets children born to positive women who require post-natal and pediatric care and their
mothers during pre-natal phases through the PMTCT component. In the event that a woman in transferred
to a CAMP program late during her pregnancy, or for whatever reason delivers a baby when her viral load is
high, CAMP will conduct early infant diagnosis according to international standards.
This component is strongly linked to the PTMTC component and to wider primary health care provision for
children. CAMP clinics also provide full pediatric primary health care, so medical staff members are trained
to do syndromic management of OIs related to HIV/AIDS and to conduct HIV testing as part of diagnosis
process. Once diagnosed, children will be transferred into the Pediatric Care and Treatment program, and
linked to community based support groups.
Key legislative issues: Coordination meetings held at the LGA level with representation from local
government assists in keeping local governments updated on the scope of the epidemic in their area and
make them better advocates for strengthening gaps at pediatric health care for children with HIV/AIDS at
the state and ministry level. CAMP staff will supplement these meetings with quarterly state level task force
meetings to explore ways to achieve greater economies of scale and harmonization of approaches.
Key support categories such as provision of home based care, preventive prophylaxis, palliative care, and
nutritional support will be tracked and reported on with patients disaggregated by gender. CAMP Monitoring
Officers will collect information on a monthly basis related to number of children (<2 years and 2-14 years)
1) tested for HIV, 2) receiving HIV care, and 3) receiving antiretroviral therapy, at the beginning of the
reporting period and projected for the end of the reporting period.
Table 3.3.11:
In COP 08, Partners for Development (PFD) reached 200 OVCs through a network of CBO/FBO organized
volunteers that provided assistance to OVCs and their families/caregivers. PFD's OVC program focuses on
strengthening community-based capacity for supporting orphans and other children made vulnerable by
HIV/AIDS. PFD works collaboratively with sub-partner faith-based organization (FBO) Daughters of Charity
(DC) to provide outreach services for orphans and vulnerable children (OVC) from two project sites: 1)
Assumption Clinic in Warri, Delta State and 2) Catholic VCT Center and primary health care facility in Ikot
Ekpene, Akwa Ibom state to implement activities under the "Counseling, Care and Antiretroviral Mentoring
Program" or CAMP, the name of PFD's CDC-funded project. There are no current plans to expand the
number of sites. PFD and DC organize networks of volunteers within each LGA in the two sites' catchment
areas who are dedicated to addressing OVC's basic needs for protection, adequate health care/nutrition
and education. Assistance is offered to OVC by volunteers from CBOs (Including support groups) who are
interested in serving as mentors or "big brothers/sisters" to the children. These mentors agree to meet
regularly with their assigned OVC, organize supplemental educational activities for them (health/nutrition
education, tutoring with home work and basic "life skills"), and to ensure they access preventive health and
immunization services. In locations where there is sufficient concentration of OVC to warrant it, educational
activities are organized on school or church premises in the form of "kids" clubs.
In COP 09, PFD/DC will assist 363 OVC (146 males and 217 females) through outreach programs
organized from the two project sites. Primary OVC recipients assisted in this program component will for
the most part be HIV negative since those who are HIV+ will be assisted under the pediatric care and
support component (including home care) although they may also access some supplemental OVC services
as well. All children of less than 18 years of age whose parents or caregivers are either on ART or
receiving palliative care will automatically be enrolled as will older children of PMTCT clients and children of
patients presenting with TB/HIV. We will train 100 providers/caregivers and will provide 100 OVC with food
and nutritional supplement in COP09.
CAMP staff will work to scale up OVC support through CBO networks to provide support to vulnerable
children up to the age of 17. After receiving referrals, the LGA level social worker will complete an initial
enrollment and baseline data collection on the child's well being using the OGAC child status index tool.
Those children needing ART or palliative care/OI treatment will be counted and cared for under the
Pediatric Care and Treatment component. Preventive and other routine health care such as immunizations
will for other OVC be handled by community mentors. These volunteers (often PLWHA support group
members) have expressed interest and commitment to mentor and counsel OVC, and are trained with
appropriate counseling skills which will include counseling about prevention (A and AB messages) for the
appropriate age groups.
In addition to counseling, community volunteer mentors will be supported to organize regular OVC activities
that will contribute to their educational and developmental progress. In locations where there is sufficient
concentration of OVC, these activities will be offered after hours on school and church premises and will be
targeted to the appropriate age group. They will be organized to make learning fun - in the format of a club.
The activity programs will have components devoted to life skills (literacy, numeracy, help with homework,
understanding of basic child's rights as contained in the UN convention on the rights of the child), nutrition
and health education (including demonstration school gardens and cooking lessons), and facilitation of
group discussions in a support group format. Activities for very young children will be related to early
childhood development and will be attended by the young child and their caregiver - often an older sibling.
Three ranges of mentorship programs will be supported for 1) under five years of age, 2) ages 5-12 and 3)
ages 13-17. Mentors will receive basic training on child development for the full range of training, then more
advanced training on the age group they are handling. Training will include basic tutoring, counseling and
preventive health/hygiene and nutrition. Those mentors who have the aptitude and opportunity to facilitate
kids club activities will receive further training on facilitating workshops for arts and crafts, facilitation of
support group discussions about problems OVC may be facing, as well as other fun group educational
activities using Action Aid's REFLECT methodology for basic numeracy and literacy to help OVC in the 13-
17 year age group to catch up to their grade level if they have missed large amounts of school.
All volunteer mentors (whether or not they also facilitate kids clubs) will have committed to follow-up in
acting as a "big sister" or "big brother" to specific individual OVC. That responsibility will entail following up
on any problems raised during the group discussion, having one-to-one talks with their assigned OVC at
least once per month, escorting their assigned OVC to preventive and routine health care appointments.
The mentors will also report cases of abuse to appropriate authorities, obtaining referrals to more skilled
psychological support if needed, and organizing emergency shelter (often on school or church premises) in
cases where OVC have no caregiver or place to live. PFD/DC will explore leveraging National Youth Corps
Volunteer placements to replicate training in the OVC program, particularly for "corpers" who have studied
social work, psychology or education. Initial training curriculum, however will be commissioned from master
trainers who will be hired on a temporary basis for this purpose.
If during the period of mentorship, an OVC is found to be suffering from malnutrition, mentors will assist with
follow up of regimens prescribed in the DC clinical facilities. DC follows the "Drug Resource Enhancement
against AIDS and Malnutrition" (DREAM) approach which includes measurements of BMI, weight for height
and weight for age.
The entire program will be administered and coordinated at the LGA level by an OVC coordinator who has
had training in social work or community health. The OVC coordinator will contact support group leaders to
inform them about the volunteer mentoring program and to recruit interested volunteers. S/he will organize
OVC enrollment and status tracking and monitor performance and training of the volunteers. Training
curriculum will be provided by specialists in early childhood education and psychology, probably using
UNICEF manuals for children living in difficult circumstances. Many of the activities offered to children will
be created by the volunteers themselves as part of their training and will use low cost, simple learning
materials.
Contribution to overall program
Activity Narrative: PFD/OC activities supporting OVC will contribute to the PEPFAR Nigeria goals of reaching 400,000 OVC by
the end of 2009.
This program will focus on increasing capacity of CBO volunteers to effectively assist vulnerable children
through a basic package that addresses supplemental education needs, preventive/routine health care
(including hygiene and nutrition education), and psychosocial support (both through group settings and
individual mentoring). Training a cadre of volunteers will ultimately help raise coping skill levels of OVC and
improve their well-being.
According to the national action plan for OVC, children become more vulnerable for a variety of reasons
related to debilitation or absence of caregivers. OVC include neglected/abandoned and orphaned (by one
or both parents), children whose caregivers are chronically ill or frail, children in child-headed households,
and children of migrant workers. Such children are at high risk of abuse and exploitation including
trafficking. Children in families that include an HIV+ member are at risk and that is why they are
automatically enrolled after a family member enters the adult care and support or PMTCT program.
Because of the irregularity of their care, they often miss large blocks of their educational program and suffer
from poor nutrition. For this reason, PFD/DC has tailored their OVC program to address these vulnerability
issues.
This activity is linked to adult and pediatric care/support as well as PMTCT. OVC activities will be linked
into wider educational and family support programs undertaken by Parish Action Committees organized in
each Diocese. PFD will try to leverage educational materials and technical assistance from UNICEF
programs, particularly those for children living in difficult circumstances. Because caregivers themselves
often find their resources overstretched by their care-giving responsibilities, PFD will attempt to link them to
available micro-finance and job skills training programs. The same will be true for OVC who have inherited
income generating responsibility for other family members.
local governments updated on the plight of OVCs in their area and make them better advocates for
sufficient resources to ensure protection of children's rights at the state level. CAMP staff will supplement
these meetings with quarterly state level task force meetings to explore ways to achieve greater economies
of scale and harmonization of approaches.
OVC well-being will be monitored through periodic (bi-annual) updates of the ranking in the child status
index. Each OVC will have a unique ID number so their information can be entered into a project database.
Skill levels of volunteer mentors and activity organizers at the LGA level will be tracked by the OVC
volunteer coordinator who is ideally also a social worker.
Estimated amount of funding that is planned for Human Capacity Development $9,083
Estimated amount of funding that is planned for Food and Nutrition: Commodities $1,500
Estimated amount of funding that is planned for Education $1,000
Table 3.3.13:
THIS ACTIVITY IS UNCHANGED.
In COP08, Partners for Development (PFD) will worked collaboratively with their sub-grantee, the faith-
based organization (FBO) Daughters of Charity (DC), to provide HIV Counseling and Testing (HCT)
services organized from two project sites: 1) Assumption Clinic in Warri, Delta State and 2) Catholic
HTC/primary health care facility in Ikot Ekpene, Akwa Ibom State to implement activities under the
"Counseling, Care and Antiretroviral Mentoring Program" or CAMP, the name of PFD's CDC-funded project.
The counseling/testing target for COP08 was 7,500 persons. In COP09 the PFD 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 the HCT target will be 2,500, and will be of the facility-based, opt-out model with mobile testing
targeted to family members of HIV-positive persons and most at risk persons (MARPs) as a prevention
component (unemployed youth). Persons seeking medical assistance for STIs and TB at either of the two
sites will be offered opt-out HCT as well as women coming for antenatal care. To the extent possible, tests
will be client witnessed; results will be delivered the same day. All clients will receive both pre and posttest
counseling and receive their results. PFD will train 25 people to provide testing/counseling. 50% of those
will be nurses or other health care staff employed at DC facilities. Community based organization (CBO)
volunteers or community health extension workers (CHEWS) trained out of these number will do community
outreach testing.
HCT services will be provided by trained counselors using the national testing algorithm and opt-out
approach in accordance with the national HCT guideline. Counseling and information, education and
communication (IEC) materials will focus on abstinence, be faithful, and consistent and correct condom use
(ABC). In addition, IEC materials will include information promoting couple counseling and counselors will
be trained on couple HIV counseling and testing (CHCT). Discordant couples will receive a package of
services including safer sex behavior messages, condoms and information targeting both positive and
negative partners. This activity will be linked to PwP (prevention with positives) as detailed in the prevention
narrative. Client witnessed testing will be carried out to encourage client confidence in the result.
Before getting tested, each person will participate in a counseling session conducted by one of the CAMP
counselors. This local-language counseling session is comprised of general HIV/AIDS awareness,
information about the procedure and potential treatment options should the person test positive. Post-test
counseling for negative clients will focus on prevention using a balanced ABC approach, and partner testing
will be encouraged. Based on risk assessment, a follow-up testing interval will be recommended. Post-test
counseling for positive clients will include PwP counseling which also includes balanced ABC messaging as
appropriate. Counselors are trained in CHCT to support disclosure to spouses and sexual partners while
addressing potential negative consequences of such disclosure. PLWHA treatment support specialists are
employed at ART treatment sites to ease the referral and linkages for newly diagnosed clients. Newly
identified HIV-positive clients at free standing or community-based HCT centers will be linked to HIV care
centers in the network.
CAMP clinical activities are supplemented by a network of community groups that are coordinated at the
LGA level through meetings that include Parish Action Committees (PACS), as well as other CBOs devoted
to care/support for People Living with HIV/AIDS (PLWHA). Counseling and referral services that
accompany the testing will link participants to appropriate support. In the CAMP project, clinics in Warri and
Uyo will offer counseling and HIV rapid testing for clinic clients and individuals in the catchment area. These
will be supplemented with HCT done through mobile facilities where counselors may range from CBO
volunteers to staff of primary health posts that receive training under this program. All counselors will be
trained by CAMP rrogram officers in effective interpersonal counseling and communication, as well as
confidentiality. The clinic will allow couples to make joint testing appointments and will promote this option
through community activities and the Preventing Mother-To-Child Transmission (PMTCT) center. As
individuals may come long distances to get tested at a CAMP site far from their home community out of
concerns about maintaining anonymity, CAMP sites will have a list of referral centers in their state that can
provide services and antiretroviral (ARV) treatment closer to their home, if so desired. CAMP staff will also
aid patients in effectively making use of the services at the health center within the same day so that newly
diagnosed PLWHA will have a sense of empowerment in taking the first steps to managing their treatment
and care.
Contribution to overall program area
PFD/DC's HCT activities will contribute toward the overall goals of preventing and the wider goal of
providing care as new HIV-positive persons are identified and enrolled into services.
Patients presenting with conditions that indicate higher HIV risk will be primarily the target under this
component (pregnant women, TB/STI patients) who will be offered opt-out testing as a matter of course in
the facility. Mobile testing will be offered to family members of HIV-positive patients and to the MARP group
targeted under the prevention component - that of unemployed youth. Mobile HCT units will accompany
awareness events for that target group on a regular basis.
The PFD HCT program will be linked to sexual prevention strategies (abstinence and be faithful (AB)), as
outreach will focus on prevention education with targeted HCT activities for MARPS. In addition, positive
clients are referred into basic care & support, and OVC services. Strategic Information programs will
support data capture and facilitate feedback for further programming. The HCT program will strengthen the
HIV prevention and palliative care programs in two states and improve utilization of care and treatment
services. All clients will receive age appropriate sexual prevention messages. Newly diagnosed clients with
HIV will be referred into basic care and treatment and or PMTCT as well as support groups as appropriate,
Activity Narrative: and referral networks would be set up to ensure these linkages are activated and maintained.
Coordination meetings held at the LGA level with representation from the local government assists in
keeping local governments updated on the scope of the epidemic in their area and make them better
advocates for strengthening gaps at the state level and identifying ethical/legal issues related to testing that
are hindering access. CAMP staff will supplement these meetings with quarterly state level task force
Major emphasis will be on increasing capacity of counseling and testing staff to deliver high quality and
consistent services. 14 counselors will be trained to do pre/post test counseling - 7 for mobile testing
drawn from CBO volunteers and 7 facility-based staff who will receive more extensive training on CHCT,
particularly those staff involved in prenatal health education. Training of testing personnel will be according
to WHO/CDC HIV Testing training package and will be given to counselors, nurses, and CHEWS.
Numbers tested under this activity, including numbers who tested positive, will be collected by CAMP
project management as will the tracking of follow-up referrals provided for those who identified as HIV-
positive. On a quarterly basis, a representative number of randomly selected blood samples (5 negative and
10 positive) will be sent to an identified reference laboratory for external quality assurance. Testing sites will
be monitored to ensure proper waste disposal and proficiency of counselors and testing personnel. The
quality assurance (QA) strategy for counseling will include, among others: client exit interview forms to
assess client satisfaction, counselor reflection forms, supportive supervision of counselors by trained
counselor supervisor, mystery client visits, and regular monthly meetings by counselors/testers.
Continuing Activity: 21692
21692 21692.08 HHS/Centers for Partners for 9401 9401.08 $150,000
Estimated amount of funding that is planned for Human Capacity Development $8,555
Table 3.3.14:
In COP 09, PFD/DC (Partners for Development) will continue with the same two project sites as for COP 08
and will have antiretroviral (ARV) targets of 900 adults (cumulative including 750 new), 200 PMTCT
treatments and 180 pediatric treatments. The project name for the activities we will provide will be known
as Counseling, Care, and Antiretroviral Mentoring Program, otherwise known as CAMP. CAMP will
maintain 1080 individuals on ARV treatment between the two project sites. Patients on ARVs include those
started on ARVs in prior years, patients in care who roll over into treatment, and newly diagnosed patients
needing ART.
CAMP will prioritize maintaining uninterrupted quality ARV supply for all clients that are enrolled in the ARV
drugs program.
PFD/DC will follow the Nigerian National Treatment Guidelines in the provision of ARV regimens for adults
and children. PEPFAR and FDA-approved generic formulations will be utilized whenever available. CAMP
staff develop ARV projections, and plan procurements accordingly. All drug orders are based on projections
of patient numbers as determined by annual forecast conducted in August 2008 in conjunction with the USG
Logistics Technical Working group. Overall, it is assumed that 2% of both adults and children begun on
ARVs during prior year will ultimately require second line treatment under COP09. PFD/DC will use
Tenofovir and Zidovudine based regimens as a first line treatment. 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. The rest of the drugs will be procured through IDA. SCMS and IDA will inspect
drugs for authenticity and test selected batches prior to accepting for shipping. SCMS and IDA will certify
packaging and storage conditions during shipping and provide insurance to the point of delivery at the
frontier. Drug procurement will follow USG regulations, and will comply with requirements for NAFDAC
registration or waiver. For all regimens, a three-month buffer stock is maintained to minimize the likelihood
of problems with drug supplies.
PFD/DC will collaborate with the Clinton Foundation for the receipt of pediatric and second line ARVs.
COP '09 budget projections include costs for refresher training on ARV administration and logistics, as well
as technical assistance, as needed. CAMP program officers and pharmacists will meet once a month to
review SI data on drug storage, usage and wastage and adjust forecasts for necessary procurement. CAMP
program officers will then work with other support staff to make logistical arrangements for the ordering,
transportation and distribution of the drugs to the pharmacy. Each CAMP pharmacy will be equipped with a
refrigerator and all necessary equipment to ensure steady electricity supply for maintaining the cold chain.
Drugs will be kept in locked cabinets which will be maintained by pharmacists and assistant pharmacists. A
pharmacy store will also keep any currently unneeded drugs, from which cabinet stocks can be replenished.
PFD will arrange training for pharmacists and their staff on logistics management, drug forecasting, and
record-keeping.
Contribution to overall Program:
This activity also supports the ARV program for adults and children as well as the PMTCT program for
provision of ARVs to pregnant women and infants, and contributes to the national goal of treating 1,750,000
people living with HIV/AIDS.
Links to other Activities:
This activity relates to activities in TB/HIV, ART services, and strategic information. This activity will
maintain significant linkages with PMTCT and ART services through the procurement of ARV drugs for
individuals served by these programs. Additionally, linkages to TB/HIV activities will be developed and
maintained. The supply chain management system will serve to provide drugs to ART sites that are
providing TB services in conjunction with ART services. SI activities will provide crucial information for M&E
as well as efficacy of the drug regimens, which may impact drug procurement decision-making.
Emphasis Area:
Human capacity development is an emphasis area. PFD will work with staff at each project site to help them
make plans to ensure seamless procurement of the drugs, and to build local capacity in logistics
management, warehousing, inventory management and forecasting of drug needs.
Target population:
The direct targets of the ARV drugs activities will be the HIV+ adult men and women who will receive the
drugs. CAMP clinical and support staff will also be targets for ARV drug activities as they will be involved in
administering the drugs, ensuring procurement and proper handling of the drugs.
Links to other activities:
As ensuring drug availability is critical to the well-being of HIV+ CAMP clients, this program component
underpins other CAMP program components including adult and pediatric care and treatment, and strategic
information (SI) activities. SI data will help to provide feedback on the effectiveness of the procurement
plans that are implemented, as well as provide feedback on the cost effectiveness of these drug
procurement activities. SI data will also help alert program support staff of when new procurement of drugs
is necessary, and ensure accurate drug projections in order to prevent stock-outs.
Key legislative issues:
While it is generally understood that local programs should receive ARV drugs from the national
government, there is must advocacy and capacity building on logistics management and procurement that
needs to be done to ensure that this happens. It is critically important that HIV+ patients can readily access
the drugs that keep them alive, and therefore, in COP 09 PFD will work with the Daughters of Charity CAMP
sites in Delta and Akwa Ibom to advocate with the state and local governments for procurement and
purchase of drugs. PFD and Daughters of Charity will adhere to national Nigerian policy, PEPFAR
guidance, and its own internal policy on ARV drug provision. PFD will ensure that the program respects
relevant guidelines on FDA-approved versus generic drugs, and if appropriate, will engage with local
government authorities on planning ARV purchases and local procurement cycles.
Activity Narrative: Monitoring and Evaluation:
CAMP pharmacists and their assistants will register and catalogue all drugs, and maintain a register which
will feed into the overall CAMP database and be used to monitor drug use patterns and to make forecasts
for stock replenishment. CAMP program officers will use SI data to make corrections to the procurement
and distribution processes. Quality control involves routine monitoring visits by CAMP staff every six
months to review the implementation of SOPs and to compare reported usage based on monitoring and
evaluation data with local pharmacy record and logs.
Continuing Activity: 21696
21696 21696.08 HHS/Centers for Partners for 9401 9401.08 $210,000
Table 3.3.15:
ACTIVITY DESCRIPTION:
In COP08, Partners for Development, under the Counseling, Care and Antiretroviral Mentoring Program
(CAMP), supported ARV Services, BC&S, OVC, PMTCT, and HCT programs by building lab infrastructure
and training staff to accurately diagnose, stage and monitor patients. The COP08 target was 600 clients for
the lab services/infrastructure. In COP09, PFD will continue these services and aim for 1,000 tests. It will
also monitor laboratories through its QA/QC activities to ensure high quality results while upgrading the
infrastructure. PFD will support the national Early Infant Diagnosis (EID) scale up plan of the GON. PFD will
also support lab services to provide appropriate lab capacity and patient support at different points of
service, and including comprehensive sites as well as HCT sites. This will include the use of appropriate
technology at all service levels, using the USG-PEPFAR Lab Technical Working Group equipment platform
as a guide.
The purpose of the lab component is to assure accurate and efficient testing facilities for HIV/AIDS and
related Opportunistic Infections (OIs). Partners for Development (PFD) and their sub-partner, the faith-
based organization (FBO) Daughters of Charity (DC), is represented in two (2) primary care project sites: 1)
Assumption Clinic in Warri, Delta State and 2) Catholic VCT Center, Ikot Ekpene, Akwa Ibom State. These
two sites are primary health facilities. There are no plans to expand the number of laboratory sites in
COP09; however some of the basic lab services will be provided through referrals to other PEPFAR
implementing partners and the Daughters of Charity's main facility in Abuja. Lab activities are just one of
the components under the Counseling, Care and Antiretroviral Mentoring Program.
PFD will also support expansion of early infant diagnosis (EID) at PMTCT supported facilities in accordance
with the national EID scale up plan. PFD will provide standardized training for collection and packaging of
dried blood spots (DBS) and clinical samples.
PFD will continue to participate in the USG-Nigeria coordinated Laboratory Technical Working Group
(LTWG) to ensure harmonization with other IP and GON supported laboratory programs. PFD will continue
to work with the PEPFAR LTWG in the development of a common Lab equipment platform appropriate for
each lab level.
Each CAMP laboratory is staffed with a lab scientist and a technician. PFD has 4 Laboratory program staff
that will be trained to provide HIV diagnostics, HIV monitoring tests, and OIs diagnostics to support the
program. PFD will provide in-service training for the lab staff through IHVN, which has training facilities in
Benin, or through other IPs that have dedicated training Laboratories. Lab personnel will be trained on
Good Laboratory Practice (GLP), Laboratory safety, Quality Assurance (QA), waste disposal, post exposure
prophylaxis, records and documentation. PFD will institute a robust Quality Assurance program in all its
supported sites which include: quarterly site monitoring visits, use of proficiency testing panels, HIV rapid
test kits lot monitoring and sample retesting. Results of the quarterly QA activities will be sent to a
centralized system supported by PEPFAR. PFD will support training for sample collection using dried blood
spots (DBS) for specialized diagnostics such as early infant diagnosis (EID) and to work with the Clinton
Foundation which provides bundled collection kits, transportation to testing laboratories and taking results
back to clinics for patient care and treatment. In COP09, training and equipping for TB testing will be
completed in the CAMP laboratories, as well as in facilities for mobile HIV testing/counseling. In COP09,
PFD will provide fluorescent microscopes, or fluorescent conversion adaptors, to enhance TB and malaria
diagnostic capacity at high volume sites. It will also support necessary training and reagent equipment
procurement in order to increase the rate of TB case detection. These sites will be enrolled into the National
TB microscopy EQA program to ensure the quality of fluorescence microscopy.
In COP09, CAMP staff will work with the Supply Chain Management System (SCMS) to procure most lab
equipment and commodity needs, particularly those that need to be imported, but will also procure some
locally. Daughters of Charity have a well-established stock tally card system that helps them predict when
re-stocking will be necessary. In COP09, PFD will continue to work closely with SCMS in country to procure
equipment and supplies for its supported laboratory sites.
CAMP facilities currently dispose of hazardous waste in a clearly marked and secure biohazardous waste
container which is then transported to a hospital incineration site. PFD will continue to ensure that all bio-
medical waste generated from all of its supported sites is properly disposed of by supporting renovation of
hospital incinerators, provision of autoclaves to sites without existing incinerators, procuring and regularly
supplying sharp containers and bio-hazard bags.
The PFD lab team will continue to work closely with the Laboratory Technical Working Group (LTWG) and
the state MOH to ensure that supported labs gain local laboratory accreditation by Medical Laboratory
Science Council of Nigeria (MLSCN), which is the national laboratory regulatory body.
Program Emphasis:
In COP09, program emphasis will be on enhancing capacity of lab personnel working at the two project
sites through on-going training in testing and maintenance of laboratory infrastructure (LI). By the end of
COP08, the two CAMP sites in Delta and Akwa Ibom will have run fully-functioning HIV laboratories with
staff trained to perform pregnancy tests, CD4 counts, biochemistry tests, hematology and HIV rapid testing.
Because the two sites will not initially have capacity for CD4 testing, Partners for Development (PFD) will
help Daughters of Charity CAMP sites to develop a transportation and cold-chain maintenance plan that will
allow blood samples from patients on Anti-Retro Viral drugs (ARVs) to be transported to other testing sites,
including the DC site in Kubwa, where they are implementing the "the Drug Resource Enhancement against
AIDS and Malnutrition" (DREAM) model. This was designed by the Community of Sant'Egidio in Rome,
which provides comprehensive HIV/AIDS care, support and treatment to PLWHA. Their main DREAM site
in Kubwa near Abuja is linked to the two project sites for purposes of testing and providing
resources/technical assistance.
General populace with special emphasis on high risk groups (TB co-infections). HIV monitoring of HIV
Activity Narrative: positives and diagnosis of HIV exposed, especially vulnerable groups of women, infants and children.
Pregnancy and syphilis tests will be provided to women. Lab monitoring for HIV positives and HIV positive
mothers includes the total projected estimate of tests, including, LFTs, CBCs, CD4 counts, sputum exams,
PCRs for EID and HIV testing, as well as tests for PMTCT and TB patients. Health workers will be trained in
providing quality laboratory and testing services including collection, transport and tracking of samples and
results, especially to and from other partner networks. CBOs/FBOs will be trained to use rapid test kits
based on national algorithms.
Contribution to the overall program area:
EID availability will strengthen PMTCT, OVC and ARV Services. Testing for OIs will strengthen BC&S. PFD
will train lab personnel and healthcare providers in health facilities and DOT centers in TB diagnosis, thus
strengthening both HCT and TB. These activities will provide essential lab services to people living with
HIV/AIDS, including pregnant women, infants, and children. The QA/QC program of PFD will strengthen the
overall quality initiatives of the GON.
This activity also relates to activities in ART, Palliative Care, OVC, VCT, TB/HIV and PMTCT. These
services will directly support these activities by enabling people access to HIV/AIDS testing. It will also
enable HIV positive adults, including mothers, infants and children, to access HIV/AIDS care and treatment.
These activities will provide essential lab services to people living with HIV/AIDS, including pregnant
women, infants and children, as well as to people with TB (co-infected or not). Lab workers will benefit from
the Lab Training centers and developed SOPs and training curriculum.
Emphasis area:
An emphasis for this activity is human capacity development for sustainability through in-service training,
supportive supervision and quality assurance/improvement for laboratorians. Infrastructure development is
also emphasized through lab renovations for new sites, local organizational capacity building, and strategic
information.
Continuing Activity: 21700
21700 21700.08 HHS/Centers for Partners for 9401 9401.08 $300,000
Estimated amount of funding that is planned for Human Capacity Development $22,375
Table 3.3.16:
In COP08, PFD provided Strategic information (SI) to 2 organizations (Assumption Clinic in Warri and
Catholic VCT and Primary Health Care Centers, Ikot Ekpene). In COP09 PFD will continue SI activities in
the 2 existing project sites. This SI activity incorporates program level reporting and implementation of
paper based or computerized Health Management Information Systems (HMIS) for Faith Based
Organizations (FBO) and Daughters of Charity (DC). These SI activities will support design and
implementation of high quality, sustainable, evidence-based interventions and programs in the 2 existing
project sites: (ART Services, ARV Drugs, Laboratory infrastructure, TB/HIV, HCT, and PMTCT). These SI
activities will be in line with Government of Nigeria (GON) strategic information harmonization polices and
guidance to support the "three ones" goal of integrated national level coordination, monitoring and planning.
In COP09, it is anticipated that (30) sub-partner personnel (record officers, clinicians, nurses, pharmacists,
and administrator) will be trained in data management and data quality assurance to ensure proper record
keeping and continuity of care at all sub-partner sites. PFD will continue to provide technical assistance
(TA) to sub-partner personnel to adapt and harmonize existing paper based records and processes to meet
standards of the GON. Training for PFD specific needs will be conducted by the PFD program and available
training from implementing partners (IPs) and GON will support harmonization of data activities. PFD will
organize regular site visits to ensure proper data handling procedures are adhered to at all times.
Information sharing and feedback on monthly/quarterly reporting will continue in COP09 involve sub-
partners, State Monitoring and Evaluation (M&E) officers, State Action Committee on AIDS (SACAs) and
LGAs (Local Government Authorities). PFD will have the closest relationship with LGAs since most of their
activities will be organized on the LGA level. Quarterly state level (SACA) debriefing meetings will also be
held to review progress to date and to address challenges and constraints faced.
In COP09, in addition to providing tailored training for the "Counseling, Care and Antiretroviral Mentoring
Program" (CAMP) M&E team members, the project will work closely with other Implementing Partners
(IPs); National Agency for the Control of AIDS (NACA) and State Action Committee on AIDS (SACA) on
training M&E staff, harmonizing data collection tools and core indicators. CAMP will explore collaboration
with established IPs like Enabling HIV & AIDS, TB and USG policy partners; Monitoring and Evaluation
Management and Services (MEMS); and DC, especially in reporting the Drug Resource Enhancement
against AIDS and Malnutrition (DREAM) Model. Such collaborations will include trainings, attending
workshops and mentoring activities that will strengthen CAMP M&E systems and ensure adequate
dissemination of program information
SI in the CAMP Project will be collated and analyzed by the M&E team comprising the Director of M&E and
M&E program officers located in the two project locations of the CAMP Project (Ikot Ekpene in Akwa Ibom
State and Warri in Delta State). The CAMP M&E Team in partnership with PFD; DC; and other CAMP staff
(clinic and program) will design and implement the project's M&E system. PFD SI staff will continue to be
active participants on the SI working group constituted and coordinated by PEPFAR Nigeria USG as well as
the GON's National M&E technical working group (TWG) and its sub-committees
CONTRIBUTION TO OVERALL PROGRAM AREA:
Improvement in SI management capacity of existing sub-partners will instill a data use culture that leads to
improved quality of care. Personnel training across the PFD sites in 2 states will contribute to overall
program capacity building and sustainability. This activity will contribute to the GoN and USG strategy for
the provision of quality, relevant and timely information for decision-making. This information will then serve
as a resource in developing plans that will enhance the cost-effectiveness of the operations and
management of PFD.
The CAMP Director of M&E will train project M&E program officers and other staff to respond to the
standardized data collection and reporting requirements of the CAMP Project, which will be conformed to
that of PEPFAR. This activity will target national level policy makers, GON and national organizations such
as NACA as well as community-based organizations, FBOs, and health workers, specifically all staff
undertaking routine program monitoring at the national and local levels.
SI activities relate to all PFD HIV/AIDS activities: ARV Services, Laboratory, Basic Care and Support,
PMTCT, OVC, and Sexual Prevention. Information generated through M&E activities provide a basis for
decision making for all components, and is therefore linked closely to each one (PMTCT, OVC, Prevention,
Pediatric and Adult Care, ART and Lab).
Key legislative issues: Information generated through monitoring and evaluation activities will inform and
assist local level responses to deal with the HIV/AIDS epidemic and will be shared as appropriate in LGA
level coordination meetings with representatives from local government as well as community groups.
Summarized version will be shared with a State level Advisory Committee. This will enable State level
government representatives to be stronger advocates for support in dealing with the epidemic at the
national and ministry levels.
Building capacity of implementing staff to analyze and interpret project related information will be the key
focus of this component. The M&E tools will be developed to conform to the national and President's
Emergency Plan for HIV/AIDS Relief (PEPFAR) reporting formats. The CAMP Project will ensure utilization
of consensus indicators for patient monitoring and management (PMM). The key tools to achieve
management-for-results include the CAMP database and data reporting forms for all program activity areas.
Data will be collected monthly, compiled from reports from both CAMP clinic and non-clinic sites. To ensure
consistency of data and reports from the clinic and field locations, the Director of M&E will conduct monthly
site visits to each CAMP clinic, thereby ensuring data quality assurance. The Director of M&E will develop
an M&E improvement plan for training, supervision and mentoring of program staff.
Continuing Activity: 21702
21702 21702.08 HHS/Centers for Partners for 9401 9401.08 $25,000
Estimated amount of funding that is planned for Human Capacity Development $5,510
Table 3.3.17:
