ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The project will be scaled-up in Zamfara state with replication of activities in other local government areas

(LGAs).

Activity Description

The Zamfara Akwa Ibom HIV/AIDS project (ZAIHAP) will use evidence-based technical and programmatic

approaches to improve access to quality PMTCT services in the target states. In the first two years of the

project (COP08, COP09), the focus will be on Zamfara state where three sites will be supported to provide

PMTCT services in COP08 and another three sites in COP09, making a total of 6 sites.

The overall goal of the proposed project is to establish sustainable approaches for the reduction of morbidity

and mortality due to HIV/AIDS among vulnerable populations. By using platforms of integrated health

services and community outreach to scale-up PMTCT and HIV counseling and testing (HCT) programs,

ZAIHAP will strengthen the capacity and expansion of primary prevention of HIV infection.

Jhpiego is currently working in Zamfara state to implement the ACCESS program, which focuses on

strengthening primary and secondary health facilities to provide emergency obstetric and newborn care

(EmONC) services as well as increasing demand for these services through community mobilization

activities.

In COP09, ZAIHAP will continue to work with the State Ministry of Health (SMOH) and State Agency for

Control of AIDS (SACA) to increase access to and use of high quality PMTCT services at facility and

community levels in Zamfara state. Using a network approach with basic PMTCT secondary health care

centers linked to primary health care centers, ZAIHAP will provide a hub and spoke model of PMTCT

services across all supported sites.

Group health information will be provided to all antenatal clients. Individual pre-test and post-test

counseling will be offered and HIV testing and counseling using the opt-out approach will be provided to all

pregnant women at the time of antenatal booking. All points of service will provide same-day results. An

estimated 7,500 pregnant women will be counseled, tested and receive their test results. Partner testing

will be offered as part of counseling using onsite facility or referral to an HCT site. Women who are HIV-

negative will be counseled on how to remain negative, safer sexual practices, and safe motherhood.

Healthcare providers from these sites will participate in the national couple counseling training.

An estimated 300 HIV-positive pregnant women will be provided with a complete course of ARV

prophylaxis. Pregnant women who are infected with HIV will also receive other services at PMTCT sites

including medical evaluation, laboratory analysis including CD4 count (onsite or within network through

specimen transportation), and treatment of opportunistic infections (OIs). Pregnant women requiring

HAART for their own health will be placed on therapy (based on the national guidelines) at the secondary

health centers or through referral from the primary health centers. For women not requiring HAART, the

national PMTCT guideline that prescribes ZDV from 28 weeks or ZDV/3TC from 34/36 weeks will be

followed. They will also be placed on intrapartum NVP and a 7-day ZDV/3TC postpartum tail. Infant

prophylaxis will consist of single dose NVP at birth and ZDV for 6 weeks. Cotrimoxazole will be provided to

all HIV-exposed infants from 6 weeks of age until a definite diagnosis is made.

The project will ensure that after delivery, all HIV-positive women are properly referred to the nearest ART

center for care and treatment and directed to wraparound services such as health and psychosocial

support, gender-based violence prevention and response, support for formal and informal education, skills

and vocational training and income generation. All HIV-positive women will be counseled on appropriate

infant feeding options. This counseling will be done using the national PMTCT guidelines where unbiased

counseling will be offered and informed choice made between exclusive breastfeeding (EBF) and formula

feeding if AFASS. HIV-positive women will also be linked to support groups within the network, which will

provide both education and ongoing support around infant feeding choices.

Jhpiego will participate in the national early infant diagnosis program where all six sites will be linked.

These services will be provided using dried blood spots (DBS) technology. All HIV-exposed infants will be

linked postpartum to the nearest OVC services.

Jhpiego will train 20 health workers in three sites on the provision of PMTCT services using the national

PMTCT training curriculum. ZAIHAP will apply the Community Action Cycle (CAC) and Partnership Defined

Quality (PDQ) methodologies, which will bring service providers and community members together to define

quality of care, identify and prioritize problems and create solutions. This will empower and mobilize local

communities to support and increase demand for uptake of PMTCT services. Support groups for mothers

will be established/ strengthened to promote uptake of PMTCT and other maternity services and adherence

to treatment protocols, using the Mothers-2-Mothers model.

Jhpiego will use national PMTCT registers across all sites and train three M&E officers using the national

PMTCT MIS system. These M&E officers will play a critical role in building the capacity of the LGAs and will

also send monthly reports to the SASCP.

Contribution to Overall Program Area

Jhpiego's work at these six sites will contribute to achieving the PEPFAR 2-7-10 goals of preventing more

than 1.1 million new HIV infections, providing care to 1.75 million people and providing ART to 350,000

people. To measure and report on progress toward achieving program objectives, Jhpiego will implement a

detailed monitoring and evaluation (M&E) plan that acknowledges the critical importance of collecting and

reporting on the PEPFAR program-level indicators. Program-level indicators will be collected quarterly

during site visits through available project records, client registers, and the Nigerian National Response

Information Monitoring System (NNRIMS), as appropriate. Jhpiego's Training Information Monitoring

System (TIMS) will also be used to track persons trained and facilitate follow-up.

Activity Narrative: While recognizing that data from the Jhpiego-supported sites will be reported to the Ministry of Health to

calculate the outcome indicators on a national level, Jhpiego will also calculate these indicators on a project

level to ensure proper project implementation and management.

Links to Other Activities

The ZAIHAP project will build onto and link closely with Jhpiego's ongoing ACCESS program in Zamfara

state which has strong community mobilization and demand generation interventions. ZAIHAP will take

advantage of this existing network and add messages on the benefits of PMTCT, the existence of PMTCT

services to reduce the likelihood of HIV transmission to infants, and appropriate infant feeding choices. The

PMTCT activities can serve as a platform through which other family members are targeted for HCT

services. ZAIHAP activities will be linked to other important services such as HIV care and treatment, OVC

services, and other services including psychosocial support and economic empowerment schemes, through

referral to nearby services. Understanding the importance of the ‘Three Ones', Jhpiego will work with the

Ministry of Health, UNAIDS, and other donors to implement the National M&E Plan and support the National

HIV/AIDS Strategy.

Target Population

The target population is pregnant women and their infants. These women will be reached through both

facility based (antenatal clinic) and community-based activities. Women reached through community

activities will be encouraged to utilize antenatal care services in the health facilities.

Key Legislative Issues

This activity addresses the key legislative issue of gender, as pregnant women will be provided with ARV

prophylaxis and treatment. Data will be collected from our female clients to demonstrate this.

Emphasis Areas

The activity includes a major emphasis on local organization capacity building and minor emphases on

quality assurance, quality improvement and supportive supervision, commodity procurement and

infrastructure.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21683

Continued Associated Activity Information

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

System ID System ID

21683 21683.08 HHS/Centers for Johns Hopkins 9403 9403.08 $1,138,250

Disease Control & University

Prevention

Emphasis Areas

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $30,851

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

FY08 CollaborativeNigeriaNG.08.0203Multi-countryPMTCTHow to Optimize PMTCT Effectiveness (HOPE)

Project

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Estimated amount of funding that is planned for Public Health Evaluation $220,500

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

The project will be modestly scaled-up in Zamfara state with replication of activities in other Local

Government Areas (LGAs).

Activity Description

In COP08, the ZAIHAP Project will have established three HCT sites in three LGAs of Zamfara State.

Twenty health care workers were trained to provide quality HCT services.

In COP09, the Zamfara Akwa Ibom HIV/AIDS Project (ZAIHAP) will use evidence-based technical and

programmatic approaches to improve access to quality HCT services by training 20 healthcare workers

using the National HCT training curriculum. The project will be implemented in Zamfara state in by

establishing two additional HCT sites using a health facility based model supported by community

mobilization, for a total of five sites under COP09. It is projected that a total of 2,500 clients (1,500 women

and 1,000 men) will undergo counseling and testing and receive their results. The project will be scaled-up

to Akwa Ibom state in subsequent years subject to funding. ZAIHAP will also work 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.

The overall goal of the proposed project is to establish sustainable approaches for the reduction of morbidity

and mortality due to HIV/AIDS among vulnerable populations. By using platforms of integrated health

services and community outreach to scale-up HCT programs, ZAIHAP will strengthen the capacity and

expansion of primary prevention of HIV infection.

ZAIHAP will continue to work with the State Ministry of Health (SMOH) and State Agency for Control of

AIDS (SACA) to increase access to and use of high quality HCT services at facility and community levels in

Zamfara. This will be carried out by focusing on provider-initiated HCT services. Site strengthening for

provision of high quality HCT services will also be carried out by the project. This will be preceded by site

assessments and identification of low-cost solutions to improve client flow. HIV rapid test kits will be

procured by USG using Supply Chain Management System (SCMS). Test kits and other consumables will

be stored centrally by ZAIHAP and distributed to HCT sites based on projected needs with proper inventory

management by designated staff. The project will work with SCMS to strengthen the re-supply system at

supported sites. Provider-initiated testing and counseling (PITC) for TB and STI patients will also be

established and providers working with such patients will be trained. Additional on-the-job training will be

provided during supportive supervisory visits.

The project takes a holistic approach to interventions and will ensure that all individuals who test positive

are referred to ART sites and are linked to care and support services. To this end, an LGA based referral

network will be established that will map out public service delivery outlets, private providers, CBOs, FBOs

and others involved in providing integrated HIV/AIDS services. Post-test clubs with both HIV-positive and

HIV-negative participants will also be established and strengthened to improve links between PLWHAs and

support services.

To establish an enabling environment and community support for HIV related services to create increased

demand for uptake of HCT services, ZAIHAP will develop and support implementation of community level

behavior change communication (BCC) interventions to provide accurate information about HIV/AIDS, help

bring about attitudinal and social norm change, and encourage individuals to seek HCT services. The

National HCT logo will be conspicuously displayed at all HCT sites.

To measure and report on progress toward achieving program objectives, Jhpiego will implement a detailed

monitoring and evaluation (M&E) plan that acknowledges the critical importance of collecting and reporting

on the PEPFAR program-level indicators for CDC/Nigeria. This information will be used for both project

reporting and ensuring that the project is meeting its targets and achieving its goals. Program-level

indicators will be collected quarterly during site visits through available project records, client registers, and

the Nigerian National Response Information Monitoring System (NNRIMS), as appropriate. Jhpiego's

Training Information Monitoring System (TIMS) will also be used to track persons trained and facilitate

follow-up.

While recognizing that data from the Jhpiego-supported sites will be reported to the Ministry of Health to

calculate the outcome indicators on a national level, Jhpiego will also calculate these indicators on a project

level to ensure proper project implementation and management.

Contribution to Overall Program Area

HCT is a key component of comprehensive HIV/AIDS programs, serving as the link between prevention

efforts, and care and treatment programs. ZAIHAP will contribute to the Federal Ministry of Health's

(FMOH) National Policy's goals on HIV/AIDS to increase access to HCT.

Links to Other Activities

To reach target populations, ZAIHAP will use a two-pronged approach: (1) strengthening/establishing facility

based HCT comprehensive care, and (2) creating an enabling environment for social and community

support for HIV/AIDS related services. This will increase demand for and uptake of HCT services. Program

implementation will be guided by a continuum of care model that ensures referral to prevention, support,

care and treatment services for families and communities. The ZAIHAP project will build onto and link

closely with Jhpiego's ongoing ACCESS program in Zamfara which has strong community mobilization and

demand generation interventions to encourage women to utilize ANC and Emergency Obstetric and

Newborn Care services. ZAIHAP will take advantage of this existing network and add messages on the

benefits of HCT. The HCT activities will serve as a platform through which other family members are

targeted for HCT services. HCT will be offered to families of PLWHAs through strategies such as couples

counseling and testing. ZAIHAP activities will be linked to other important services such as HIV care and

treatment, and other wraparound services such as ANC and delivery services, psychosocial support,

economic empowerment schemes, and others.

Activity Narrative: Target Population

ZAIHAP will reach most-at-risk populations (MARPS) for the HCT component of the project. These include

STI and TB patients/suspects, clients admitted to hospitals who perceive themselves at risk for HIV

infection, commercial sex workers, transport workers, and youth.

Key Legislative Issues

ZAIHAP will work closely with the state and local government authorities to ensure compliance with HCT

national guidelines. In addition to using M&E data to monitor project achievements, the data will also be

used to ensure that the project is on target with financial goals such as the average cost of training each

participant. Illustrative outcome indicators are based on PEPFAR recommended outcome indicators and the

Nigeria HIV/AIDS Strategic Framework for Action (2005-2009).

Emphasis Areas

The project will apply several cross-cutting and capacity building interventions at two new HCT sites with

input from state and local government authorities and HHS. ZAIHAP will ensure that quality HCT services

are established by: site strengthening in each of the selected facilities, training of providers and supervisors,

and implementation of Jhpiego's hallmark Standards-Based Management and Recognition (SBM-R)

approach.

Site strengthening: ZAIHAP will work with the State Ministry of Health to open two new HCT sites in year

two. The project will create linkages between HCT and PMTCT services integrating these services in many

facilities and coordinating and promoting follow-up for both PMTCT and HCT. Because nursing staff are in

short supply, ZAIHAP will encourage facility administrations to staff the VCT services with trained

community counselors. Provider-initiated counseling and testing services will be established for TB and STI

patients. This will ensure that patients with TB/HIV co-infection will receive antiretroviral therapy (ART) if

they are HIV-positive.

The project will provide the HIV test kits and ensure that facilities have an effective re-supply system in

collaboration with SCMS.

Training of health care providers: To establish/strengthen both client-initiated (HCT) and provider-initiated

testing and counseling (PITC) services, ZAIHAP will train twenty providers using the national curriculum to

conduct HCT services using appropriate training approaches. Training will include specific modules on

interpersonal communication and counseling and friendly client oriented services, and address key barriers

to uptake of services such as poor provider attitude and lack of confidentiality. In addition to the above, a

training of trainers activity will ensure that if providers are transferred from their site, enough trainers are

available to train new providers and do on-the-job refresher training. All of the training activities are highly

participatory based on the latest evidence in adult learning.

Follow-up and supervision: To ensure that quality HCT services are established, ZAIHAP team will use the

SBM-R approach for ongoing quality assessment and improvement. SBM-R involves the systematic use of

performance standards and the rewarding of compliance with these standards. This process helps ensure

that the implementation of skills and knowledge results in higher quality, more standardized services for

beneficiaries. SBMR will improve the quality of services provided under this project and will promote

sustainability by giving users tools they can use to assess their own performance. Providers and

supervisors will be trained on HCT performance standards for SBM-R, record keeping procedures and the

use of data for decision making. Since the MIP project is already applying the SBM-R approach, the

ZAIHAP team can use local technical assistance for implementation. ZAIHAP will use existing National

HCT standards for its SBM-R approach. Post-training follow-up will be conducted six weeks after to assess

whether knowledge and skills are retained and provide on-the-job refresher training. ZAIHAP will work with

the State Ministry of Health to conduct supportive supervisory visits to each of the selected facilities on a

quarterly basis.

Establishing Referral Networks: To link ZAIHAP activities to other important services including care and

treatment and wraparound services, LGA level referral networks will be created. The network will utilize

existing procedures and tools for referral. Orientation of service providers will be organized to promote

understanding of and buy into the network's objectives and procedures.

Behavior Change Communication and Community Mobilization: Drawing from evidence-based behavior

change communication (BCC) methodologies, the project will dispel myths and misconceptions by providing

correct and comprehensive information about HIV/AIDS to youth, PLWHAs, health care providers, men and

women of reproductive age, as well as most-at-risk populations (MARPS) such as transport workers, and

commercial sex workers. ZAIHAP will review and adopt existing BCC messages and train its community

directed distributors to disseminate these messages.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21704

Continued Associated Activity Information

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

System ID System ID

21704 21704.08 HHS/Centers for Johns Hopkins 9403 9403.08 $225,000

Disease Control & University

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $3,428

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: