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
This activity is related to activities in ARV services, Basic Care and Support, OVC, counseling and testing,
SI, and Lab.
In COP08, URC is providing PMTCT services to 2,000 women in Enugu State through work at 12 sites.
This was implemented in coordination with the government of Enugu and the state SASCP. In COP09,
URC will continue to support and strengthen PMTCT services in all 12 sites and expand services to 3
additional sites making a total of 15 PMTCT supported sites. URC will help set up and improve linkages
between comprehensive ART sites at the primary and secondary facility. Following the national PMTCT
guidelines, the hub and spoke model will be utilized. The comprehensive sites will form the hub and the
primary cares sites will be the spokes. This will allow for increased access to diagnostic and monitoring
tests for PMTCT. Stand alone PMTCT points of service at the primary care level will be liked to adult and
pediatric care as part of a comprehensive PMTCT network.
At URC supported PMTCT service points 2,500 pregnant clients will be provided opt-out provider initiated
HIV testing, counseling and results. URC will train 12 healthcare workers to provide couple counseling
using current national training manuals. The prevention with positives package will be utilized in all sites.
This will provide an opportunity to interrupt heterosexual transmission, especially in discordant couples.
HIV testing and counselling will be provided during labor and delivery by facility supported staff. HIV rapid
tests will be used for women who present at delivery without antenatal care.
URC will support facilities to provide highly active antiretroviral therapy (HAART) to pregnant women if their
CD4 is less than 350 in accordance with the National PMTCT guidelines. For the women not requiring
HAART, the current national guidelines recommended short course ARV option will be provided which
includes ZDV from 28 weeks, ZDV/3TC from 34-36 weeks and intrapartum NVP, and a 7 day ZDV/3TC
postpartum tail. This will result in the provision of ARV prophylaxis to 125 pregnant women. 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 this approach will involve providing the services at the points most appropriate and
convenient including maternal and child services.
URC will ensure that all HIV-positive pregnant women gain access to the basic care package of insecticide
treated nets, water vessels, water guard and soap. URC will support the training of 12 health workers on
infant feeding using the National Infant feeding training manual. HIV-positive women will be counselled on
infant feeding practices pre and postnatally. The options will include early cessation of breast feeding,
exclusive breastfeeding or breast milk substitute feeding if acceptable, affordable, available, safe and
feasible. Couples counselling will help support and sustain the infant feeding choices. Mothers will be linked
to peer support groups within the community.
HIV-exposed infants will be provided with single dose NVP at birth and ZDV for 6 weeks in accordance with
Nigerian National PMTCT Guidelines. Cotrimoxazole suspension for all exposed infants will also be
provided from 6 weeks until definitive HIV diagnosis. Testing of infants will be carried out using dried blood
spot (DBS) specimen collection. URC will actively participate in the national early infant diagnosis initiative
by providing infants for DBS testing from 6 weeks of age.
All capacity development undertaken by URC for its PMTCT program will adhere to the Nationally approved
training curriculum and will utilize the existing trainer of trainers (TOT) in Enugu to support the training and
retraining of 40 health workers on PMTCT across all sites.
URC notes the importance of ensuring postpartum follow up for completion of prophylaxis, early infant
diagnosis, cotrimoxazole prophylaxis and referral of mothers for ongoing care, support and treatment if
indicated. URC with its partner, Vision Africa, will work with community health workers to prevent losses
outside the health facility. Within the health facility, URC will encourage the formation of multidisciplinary
teams to adapt national referral procedures and to oversee program implementation and improvement.
URC will ensure the use of the national PMTCT registers across all supported sites and work to strengthen
data collection and transmission and encourage the use of this data at the site level to improve
implementation.
The PMTCT program will work closely with the care and support program to ensure no mothers are lost to
follow-up. Particular attention will be paid to community linkages through community health workers as
many women obtain most of their pre and postpartum care from them. These workers will be trained and
supported to improve referrals to hospitals for antenatal care and to help track and refer clients for delivery.
Vision Africa will continue its work, supported by URC, in this area.
POPULATIONS BEING TARGETED
This activity targets pregnant women who will be offered HCT, HIV-positive pregnant women for ARV
prophylaxis and infant feeding counseling, and exposed infants for prophylaxis and EID.
KEY LEGISLATIVE ISSUES ADDRESSED
This activity addresses gender since treatment will be provided to women and will focus on family centric
issues including male involvement in PMTCT programming.
EMPHASIS AREAS
Major emphasis of this activity focuses on training and network/linkages. Minor emphasis includes other
sectors and initiatives, commodity procurement, and community mobilization/participation.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21684
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21684 21684.08 HHS/Centers for University 9404 9404.08 $150,000
Disease Control & Research
Prevention Corporation, LLC
Emphasis Areas
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $4,150
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Several new CDC partners have recently been identified through a competetive funding opportunity
announcement as approved under COP08. Many of these partners are new to the PEPFAR and/or CDC
planning and implementation processes. The amounts awarded differ significantly from the original
proposal amounts submitted by these new partners. The difference now requires the new partners, working
in conjunction with the in-country CDC office and interagency technical working groups, to revise the action
plans for FY08 and FY09. CDC is currently working closely with the new partners to assure their effective
understanding of the PEPFAR planning process and that action plans for FY08 and FY09 COP submissions
are in accordance with funding awards as well as PEPFAR goals and objectives. Detailed narrative
changes will be submitted in the January 2009 reprogramming submission.
In COP 08, URC will provide care and support services to 1,900 clients and 3,800 persons affected by
HIV/AIDS (PABAs) with 1,350 receiving ART services. In COP 09, URC will continue to serve 1,900
PLWHA and 3,800 PABAs with HIV-related care and support. Among those receiving treatment will be 450
new clients. We will work in coordination with the state government of Enugu, the health commissioner and
ENSACA, the primary HIV/AIDS program implementing agency in Enugu to continue to select health facility
sites for program implementation in the highest HIV prevalence areas of Enugu state. We plan to be
working in 10 health facilities to enhance and/or establish care and treatment services. URC will assist
facilities to effect strengthening of internal and external referrals and linkages in order to promote access
and further care and treatment of all clients through regularly scheduled meetings between the primary care
coordinator for each relevant LGA in Enugu (state, private and NGO-supported facilities). Not all service
providers or facilities will be able to offer care and treatment within their facilities. In such cases, URC will
work with the State Department of Health to develop referral linkages to ensure that clients have easy
access to services. We will be training 20 individuals in ART and HIV-related care and support, including
community workers and PLWHA to scale up home-based care and support services for people living with
HIV/AIDS.
URC will address the shortcomings of supported health facilities in Enugu through training of additional
health staff and community workers and provision of needed infrastructure improvements to health facilities
and improve coordination and synergy among agencies working on HIV/AIDS in Enugu. We will provide
care services in the range of clinical care with basic care kits, psychological, spiritual, social, preventive
services, and home-based care. Clinical care will include basic nursing and end-of-life care, assessment
and management of pain, nutritional assessment and intervention, OI prophylaxis and management, STI
diagnosis and management, and laboratory services. All enrolled clients will receive a basic care kit which
includes ITN, water vessel, water guard and ORS, latex gloves, IEC materials, condom, and soap. The
minimum care package includes the basic care kit with clinical care, plus two supportive services of those
listed above. We will conduct pain assessment and management using WHO step-ladder approach and
according to national guidelines. URC will help provide prevention support for HIV positive clients. The
Prevention with Positives (PWP) programme will address on going prevention needs for all clients including
assistance with disclosure counselling for intimate partners, partner counselling and referral, ongoing risk
reduction counselling, provision of condoms, lifestyle counselling, referral linkages to patient support groups
and ongoing counselling, screening for STI, staff will be supported using the national and international best
practice to provide PWP support. Cotrimoxazole prophylaxis will be provided according to National
guidelines. URC will integrate nutrition support into the care and support programme. This support will
include nutritional assessment using Body Mass Index (BMI) assessment for all clients to achieve this all
clients will have their height and weight measured and recorded. Further all clients with BMI less than 18
will qualify for nutrition support by prescription through the provision of high energy macro and
micronutrients. URC will strengthen referral linkages to nutritional support programmes. Patient nutrition
education and counselling will also form a major part of the support provided. URC will support clinicians at
facility level to stage and manage patients according to national standards. These will be achieved though
on site mentorship support and off site but remote training. It is estimated that the 1,350 individuals
receiving ART will display moderate or severe malnutrition and thus be provided with food and nutritional
supplementation.
URC will work with its partner Vision Africa to support home based care activities. Through this collaboration
current and volunteer providers will be accessed and trained on the provision of appropriate support within
the home. This will include identification of cases for referral, psychosocial support, patient education, basic
first aid and adherence support according to the nationally accepted guidelines. We will provide increased
clinic-based and home/community-based activities to adults or adolescent HIV-positive individuals through
the training of healthcare workers, PLWHA and community workers in adherence counseling, management
of opportunistic infections, diagnosis and relief of symptoms, psychological and spiritual support, clinical
monitoring, related laboratory services and delivery of other palliative care services to the community
including culturally appropriate end-of-life care per Nigeria's National Palliative Care Standards and
Guidelines. This program area also includes the provision of ARV drugs which will be carried out by our
partner, Crown Agents, in concurrence with the Nigerian ART guidelines.
URC will ensure that the national guidelines on antiretroviral therapy are implemented. To this end, all ART
eligible clients will be taken through a pre-ART programme. This programme will focus on patient
preparation, readiness and adherence counselling and will then be placed on the triple ART regimen of
either Tenofovir( Zidovudine)/Lamivudine( Emcitrabine)/Nevirapine(Efavirenz), the nationally recommened
first line drugs. All clients will be eligible to a CD4 test on enrollment to the programme. All clients on ART
will be monitored closely with initial haemoglobin, liver function tests, creatinine and full blood counts carried
out for all clients. At a minimum all these will be repeated one month after initiation of therapy and six
monthly thereafter. Immunological and clinical monitoring will be used to identify treatment failure, all eligible
cases placed on Didanosine (Abacavir)/Lamivudine (Emcitrabine) and a ritonavir boosted protease inhibitor
as recommended in the national guidelines with appropriate permutations depending on initial regimens,
pregnancy and morbidity status. Education & Adherence Counseling will be closely linked to treatment
initiation and maintained with every patient contact. Close links will be formed with home based care
providers to maintain adherence within the home setting. Client and family centred approaches will be used.
These include disclosure and assisted counselling, the encouragement of treatment support buddies,
Activity Narrative: patient support groups. National pre-ART & ART client attendance registers will be used to track defaulters
and those lost to follow up. Facility based community meetings with community gate keepers will be held to
help improve community treatment literacy. As part of improving and increasing the effectiveness of care,
treatment and support URC will work together with other PEPFAR partners to support the proposed
development of a national policy on task shifting. This programme, under the leadership of the Government
of Nigeria, aims to shift non essential and routine follow up of clients from physicians to nurses ( for ongoing
follow up of stable ART and pre-ART clients) and from nurses to counsellors( for adherence counselling and
support.)
URC will train 20 health care workers on site, using the national curriculums for palliative care, ART and
adherence. This training will be supplemented by on site close support mentoring to ensure proper skills
transfer and usage. Local trainer of trainers will be capacitated to provide this training. In addition URC
recognizes the work and role of the current implementing partners in Enugu and will use their current
expertise to prevent the duplication and wastage of training and other implementation resources.
There will be ongoing monitoring and evaluation of the programme using application of quality
improvement initiatives including HIVQUAL, the plan, do, study act cycle, standard setting and tracking,
best practice sites with intentional spread and collaboration is the signature hallmark of URC programmes.
In addition, on site data collected will be analyzed and used for process and programme improvement. M&E
support will be provided by URC's technical team in collaboration with site staff and USG to increase
sustainability and ownership.
URC will focus part of its programming on improvement of referral systems to improve the coordination
between lower and higher level public healthcare facilities as well as between the public and private sector.
This will be accomplished through the scheduling of regular meetings with the primary care coordinator for
each relevant LGA in Enugu state, private and NGO-supported facilities to jointly develop indicators that are
followed so that weak areas among these facilities can be addressed.
URC recognizes the importance of ensuring uninterrupted supply of drugs, laboratory and allied
commodities and will work together with its partner, Crown Agents, through the available central supply
systems. This support will supplement the national commodity supply. Locally sourced and
USFDA/PEPFAR approved commodity will be procured through this mechanism.
CONTRIBUTIONS TO OVERALL PROGRAM
Training and support to improve the quality and integration of care and treatment services are consistent
with FMOH and PEPFAR priorities and will support the strengthening of the health system. URC will hold
workshops to promote sharing of knowledge and best practices in all HIV-related services which will allow
rapid and effective spread of good practices throughout Enugu State. Our care and support program will
build on our partner, Vision Africa's network in Enugu which is affiliated with dozens of FBOs, CBOs and
CSOs in Enugu State, including Enugu State's branches of The Network of People Living with HIV/AIDS in
Nigeria (NEPWHAN) to train community workers and PLWHAs in the delivery of home-based care services.
Additionally, our work in this area will also involve training and new reporting on performance indicators as
specified by PEPFAR. This activity in the region will strengthen all reporting, accountability of facilities and
data collection in all areas of the health sector in Enugu State. The networking, sharing of best practices
and training of health and community workers in ART care and treatment services promotes sustainability.
This program seeks to increase gender equity in programming through counseling and educational
messages targeted at vulnerable women and girls. Furthermore, through gender sensitive programming and
improved quality services the program will contribute to reduction in stigma and discrimination and address
male norms and behaviors by encouraging men to contribute to care and support in the families
LINKS TO OTHER ACTIVITIES
This activity is linked to Counseling and Testing, PMTCT, TB/HIV, OVC, Human Capacity Development and
Strategic Information.
People Living with HIV/AIDS (PLWHA), their family members, caregivers and health care workers are
targeted in this activity.
The emphasis areas for this program activity includes: Capacity Building of agencies, organizations and
health facilities responsible for delivery of HIV interventions, Collaboration and coordination to improve
referral systems and availability of services and Community outreach and involvement.
Continuing Activity: 21689
21689 21689.08 HHS/Centers for University 9404 9404.08 $200,000
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $2,075
Table 3.3.08:
Continuing Activity: 21699
21699 21699.08 HHS/Centers for University 9404 9404.08 $365,000
Table 3.3.09:
University Research Co., LLC (URC), in COP09, will serve 190 children with HIV-related care and support,
150 receiving treatment. Among these will be 100 newly initiating on treatment. URC will work in
coordination with the state government of Enugu, the health commissioner and ENSACA, the primary
HIV/AIDS program implementing agency in Enugu to continue to select health facility sites for program
implementation in the highest HIV prevalence areas of Enugu state. URC plans to be working in 10 health
facilities to enhance and/or establish pediatric care and treatment services. URC will assist facilities to effect
strengthening of internal and external referrals and linkages in order to promote access and further care and
treatment of all clients through regularly scheduled meetings between the primary care coordinator for each
relevant LGA in Enugu (state, private and NGO-supported facilities). URC will work with the State
Department of Health to develop referral linkages to ensure that clients have easy access to services. URC
will train 10 individuals in pediatric HIV-related care and support, including community workers and PLWHA
to scale up home-based care and support services for people living with HIV/AIDS and health workers in
dried blood spot collection.
and improve coordination and synergy among agencies working on HIV/AIDS in Enugu. URC will provide
and management of pain, nutritional assessment and intervention, and laboratory services. All enrolled
clients will receive a basic care kit which includes ITN, water vessel, water guard and ORS, latex gloves,
IEC materials and soap. The minimum care package includes the basic care kit with clinical care, plus two
supportive services of those listed above. Pain assessments will be conducted and managed using WHO
step-ladder approach and according to national guidelines. Cotrimoxazole prophylaxis will be provided to
all paediatric clients according to national guidelines.
The needs of adolescents will also be catered for in URC's support to the pediatric program in Enugu state.
URC will work with partners to ensure that facilities provided child and adolescent friendly services through
dedicated paediatric service days and modification of infrastructure to create child friendly spaces.
Psychosocial support of the older child will also be catered for by mentoring and supporting health care
workers and guardians. URC will utilize available technical support from other implementing partners and
government advisors.
URC will work toward the integration of nutritional support into the care and treatment program. This support
will include nutritional assessment using growth monitoring and assessment cards and charts. Those
children that qualify for nutritional support (an estimated 150 children) will receive high energy macro and
micronutrients. URC will strengthen referral linkages to nutritional support programs and will collaborate with
these programs by providing gap support for nutritional supplements. Caregiver nutrition education and
counselling will also form a major part of the support provided. URC will support clinicians at the facility level
to stage and manage patients according to national standards. This will be achieved though on site
mentorship support and off site but remote training. URC will emphasize early and appropriate referral of
guardians to programs that support economic empowerment as poverty is the major factor in malnutrition.
Further, all children will be supported to get the recommended childhood immunizations and treatment of
childhood illnesses by ensuring that HIV services are provided in the maternal and child settings.
URC recognizes the importance of ensuring the prompt diagnosis of all HIV exposed infants, using early
infant diagnosis (EID.) The Clinton HIV AID Initiative (CHAI) and PEPFAR support the National EID
program in Nigeria and URC will help setup and or improve linkages to this program. URC will help ensure
that health workers are trained on proper dried blood spot collection and onward transmission as part of the
National EID program.
URC will work with its partner Vision Africa to support home based care activities. Through this
collaboration, HBC providers will be accessed and trained on the provision of appropriate support within the
home. This will include identification of cases for referral, psychosocial support, patient education, basic first
aid and adherence support according to the nationally accepted guidelines. URC will provide increased
clinic-based and home/community-based activities to HIV-positive children through the training of
healthcare workers, PLWHA and community workers in adherence counseling, management of
opportunistic infections, diagnosis and relief of symptoms, psychological and spiritual support, clinical
Guidelines. This program area also includes the provision of ARV drugs which will be carried out by a URC
partner, Crown Agents, in concurrence with the National Pediatric ART Guideline.
URC will help ensure that the national guidelines on pediatric antiretroviral therapy are implemented. This
program will focus on patient preparation, readiness, education and adherence counselling and all clients
will then be placed on the triple ART regimen for children as contained in the national guidelines
(Zidovudine( Stavudine)/Lamivudine)/Nevirapine (Efavirenz)). All clients will have baseline CD4
count/percent on enrollment to the program and follow-up. All clients on ART will be monitored closely with
baseline hematology and chemistry. At a minimum all these will be repeated one month after initiation of
therapy and six monthly thereafter. Immunological and clinical monitoring along with CD4 count/percent will
be used to identify treatment failures with all eligible cases placed on ART.
Adherence counseling of guardians will be linked to treatment initiation and maintenance with initial, one
month and six monthly counselling sessions. Close links will be formed with HBC providers to maintain
adherence within the home setting. A family-centered approach will be used. For children, proper
preparation of the guardian is crucial. National client attendance registers will be used to track defaulters
and those lost to follow up. Facility-based community meetings with community gate keepers will be held to
Activity Narrative: development of a national policy on task shifting. This program, under the leadership of the Government of
Nigeria, aims to shift non essential and routine follow up of clients from clinicians to nurses (for ongoing
follow up of stable clients on ART) and from nurses to counselors (for adherence counseling and support.)
URC will train 10 health care workers on site, using the national curricula for pediatric care and treatment.
This training will be supplemented by on site mentoring to ensure proper skills transfer and usage. Local
facilitators will be used to provide this training. URC will collaborate with the current implementing partners
in Enugu and will use their current expertise to minimize the duplication of training and implementation of
activities.
The ongoing monitoring of the program as implemented will play a critical role in improvement initiatives.
The use of data, the application of quality improvement initiatives including the "plan, do, study act" cycle,
standard setting and tracking, best practice sites with intentional spread and collaboration is the signature
hallmark of URC programs. URC will strengthen the national data capture and reporting systems at site
levels. In addition, on-site data collected will be analyzed and used for process and program improvement.
This support will be provided by URC's technical team in collaboration with site staff to increase
commodities and will work together with its partners Crown Agents, through the available central supply
USFDA/PEPFAR approved commodities will be procured through this mechanism.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
Training and support to improve the quality, scale-up and integration of pediatric care and treatment
services are consistent with FMOH and PEPFAR priorities. The aims are to increase access of services to
HIV+ children through a concerted effort to improve linkages and referral systems between maternal and
child health clinics, PMTCT and nutrition services by setting up functional and documented systems for
referral of children into care programs. Additionally, URC will be using Vision Africa's radio programming
and network of community and PLWHA groups to increase community outreach in Enugu state to help bring
these children into health facilities as well as bringing services out to the home. An overall focus on
improved referral systems and community linkages with health facilities will ensure sustainability.
This program activity is also linked to Counseling and Testing, PMTCT, OVC, TBHIV, Adult CT, and
laboratory infrastructure.
HIV-exposed and infected children (under 15) and their families/caregivers.
Healthcare providers working with children.
The emphasis areas for this program are:
Capacity building of health facilities and organizations responsible for delivery of HIV interventions.
Collaboration and coordination to improve referral systems and availability of services. This program will
also increase gender equity in programming through counseling and educational messages targeted at girls
and boys. Furthermore, through gender sensitive programming and improved quality services the program
will contribute to reduction in stigma and discrimination and address male norms and behaviors by
encouraging men to contribute to care and treatment in families. Emphasis on child survival strategies and
TB identification and referral will also be included in this activity. Community outreach and involvement as
described above.
New/Continuing Activity: New Activity
Continuing Activity:
Gender
* Addressing male norms and behaviors
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $2,500
Table 3.3.10:
URC with its partners will review facility pediatric care and support and related registers and patient records
to establish baseline HIV-related pediatric care and support uptake in each new facility. We will enhance or
establish 10 centers for HIV-related pediatric care and support. In FY 2009, we expect to be serving 212
children with HIV-related care and support, including testing using Early Infant Diagnosis techniques. We
will be training 10 individuals in HIV-related pediatric care and support, including community workers and
PLWHA to scale up home-based care and support services for people living with HIV/AIDS. We will also
train community workers and counselors in dried blood spot preparation of sample for Early Infant Diagnosis
and laboratory and community workers in DNA PCR for EID testing. We will mobilize our network of
community groups to train health and community workers in ART, prevention and treatment of OIs in
children and other HIV-related complications including malaria and diarrhea, pain and symptom relief and
nutritional assessment and support. The mobilization of these community groups and workers will help to
increase access to pediatric care and support services and will serve to bring more children in for treatment
care and support through improved linkages with PMTCT and maternal and child health clinics. Our
program will include providing the necessary equipment and infrastructure upgrades needed for at least one
laboratory in Enugu State to accurately perform EID. Our M&E staff will work to ensure proper reporting on
pediatric treatment and care indicators, including those diagnosed using EID and receiving results.
Training and support to improve the quality, scale and integration of pediatric care and treatment services
are consistent with FMOH and PEPFAR priorities. The aims are to increase access of services to HIV+
children through a concerted effort to improve linkages and referral systems between maternal and child
health clinics, PMTCT and nutrition services by setting up functional and documented systems for referral of
children into care programs. Additionally, we will be using Vision Africa's radio programming and network of
community and PLWHA groups to increase community outreach in Enugu state to help bring these children
into health facilities as well as bringing services out to the home. An overall focus on improved referral
systems and community linkages with health facilities will ensure sustainability.
This program activity is also linked to Counseling and Testing, PMTCT, OVC and laboratory infrastructure.
HIV-exposed and HIV-infected children (under 15) and their families
1.Capacity building of health facilities and organizations responsible for delivery of HIV interventions
2.Collaboration and coordination to improve referral systems and availability of services
3.Community outreach and involvement
as described above.
Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including
spaces)
Table 3.3.11:
In COP 08, URC is providing HCT in TB settings to 2,500 clients and providing TB treatment to 250 clients
at 10 sites. URC is supporting enhancement of laboratory and x-ray services for HIV/TB cross-testing at
these 12 health facilities. URC is working to ensure that every ART site has a DOTS site and all DOTS
sites are being expanded to include HCT services. URC is also assisting in provision of anti-TB drugs,
laboratory commodities and reagent procurement and distribution.
In COP 09, URC will continue to support all TB/HIV activities from COP 08 and will expand HCT services in
three additional DOTS sites in line with the National TB and Leprosy Control Program (NTBLCP) to focus
on strengthening the integration of high quality TB and HIV care delivery. URC will counsel, test and
provide HIV test results to 350 clients in TB settings, treat 225 HIV+ individuals for TB disease and screen
300 HIV+ individuals for TB. Over the course of the year, URC will train 15 health workers at HIV counseling
and testing outlets to provide TB treatment. DOTS site personnel will be trained in HIV diagnosis using HIV
rapid kits and be educated in referring HIV+ individuals to comprehensive care for assessment including for
ARV treatment eligibility. URC will assist facilities to effect strengthening of internal and external referrals
and linkages in order to promote access and further screening of both HIV and TB clients. Not all service
providers or facilities will be able to offer HIV testing within their facilities. In such cases, URC will work with
the State Ministries of Health to develop referral linkages to ensure that clients have easy access to
services. Linkages between counseling and testing sites and sites offering ART treatment will also be
developed and improved.
URC will also provide the necessary training and infrastructure upgrades for laboratories to ensure that TB
diagnosis is performed correctly including training on x-ray diagnostics and sputum microscopy training.
URC will implement the three I's which involve increased TB case finding among HIV positive patients,
isoniazide preventive therapy (IPT) in ART centers, and TB infection control in all our facilities according to
the national guidelines. URC will also support MDR TB management and prevention and basic
infrastructure renovations at DOTS sites and TB laboratories.
URC will continue to partner with PEPFAR IPs specializing in laboratory programs to facilitate Quality
Assurance programs in ensuring quality services. TB-supported lab staff will be trained using the national
AFB microscopy training manual and QA guidelines will be incorporated. The external quality assessment
program will be implemented through on-site visitation of all supported sites, slide re-reading through
blinded re-checking and proficiency testing using five stained and five unstained panel slides. The capacity
of laboratory will be strengthened through additional commodity support (e.g. staining reagents and
equipment) to Government of Nigeria sites. URC placed $12,500 into the SCMS mechanism for commodity
and logistical support in this area. Facilities will be upgraded to permit easy workflow and safe working
practices. Adequate attention will be provided to the disposal of laboratory waste and other effluents.
National guidelines on infection control on co-located sites will be implemented in all 13 supported sites and
URC will also provide necessary training to ensure that the National TB treatment algorithm is followed at all
participating sites. URC will provide palliative care to TB/HIV co-infected patients including other
opportunistic infections and will refer appropriately for ART. Cotrimoxazole Preventive Therapy (CPT) will
be provided to eligible TB/HIV patients as a component of basic care and support. HCT in DOTS sites will
be established at the secondary and primary health center levels with linkages to tertiary centers to provide
accessibility of services to patients.
TB suspects, TB patients, PLWHA and their family members. Healthcare workers will be targeted on TB
infection control.
Training and support to improve the quality and integration of TB/HIV services is consistent with FMOH and
PEPFAR priorities. The focus of the URC TB/HIV program is on the provision of HCT in DOTS centers,
referral of TB/HIV patients to TB treatment and ART services. Focus on improved referral systems,
technical capacity development and improved health services in facilities will ensure sustainability and will
greatly improve all services across the health sector.
This activity is also linked to Counseling and Testing, ART care and treatment, OVC, PMTCT and Strategic
Information
Continuing Activity: 21705
21705 21705.08 HHS/Centers for University 9404 9404.08 $150,000
Construction/Renovation
Table 3.3.12:
In COP09, URC is working in a total of 12 satellite sites in Enugu state. For COP09, a full package of
Orphaned and Vulnerable Children (OVC) services will be provided to 83 OVC. All 83 children (41 males
and 42 females) will receive at least 3 core services from URC. It will also provide 83 OVC with food and
nutritional supplement. URC will train 10 providers/caregivers in COP09.
The 3 core services to be provided include food and nutrition, health care and psychosocial support. URC
will provide referral linkages to the other core services including shelter and care, protection and education
and vocational training. URC will use a multifaceted approach to increase access to HIV counseling and
testing and provide a family-focused approach to the care of OVC. We will use the clinical and community
health workers as entry points to HIV preventive services. All OVC and their households will be assessed
by URC and its sub partner Vision Africa for the specific household needs and provided with psychosocial,
nutritional, educational support and health care support where necessary.
URC will use rights-based family focused approach as outlined in the national OVC guidelines with child
and wider community participation. In addition URC will work to ensure equal service provision to boys and
girls to maintain a gender balance and ensure quality, integrated and holistic approach that will leverage on
the partnerships with PEPFAR and non-PEPFAR partners.
The psychosocial support provided to the OVC will include frequent home visits by our facility trained
community volunteers from Vision Africa and our partners Primary Health Centres (PHC) for assessment of
health status, counselling on stigma, grief, disclosure and coping mechanism to further help in reducing
their vulnerability to HIV.
URC will strengthen the existing structures to build child support groups in all support PHCs and expand
their activities to include periodic social/recreational and educational play activities with the involvement of
both infected and uninfected children as a way to address the issue and concerns surrounding stigma and
discrimination. URC will further build the capacity in the team and at the PHC to establish adolescent
programmes for infected and affected children.
URC will provide nutritional assessment, nutritional demonstration activities and associated support to and
help ensure adequate primary health care for OVC. This will be anchored on enhanced psychosocial
support at both facility and community levels. The nutritional services to be provided by URC will include
nutritional assessment using the growth monitoring strategies and micronutrient supplementation. URC will
work with the Clinton HIV AIDS Initiative (CHAI) for provision of therapeutic food supplements and also with
other PEPFAR-supported organization offering food programmes for OVC.
Adequate health care will include strengthening linkages and referrals to other facility services including
maternal and child health, inpatient and outpatient departments. Community-based HIV prevention services
will be strengthened to ensure referral to facilities for OVC households through a family-centered opt-out
approach to HCT services for all children less than 18 years of age and their caregivers.
All OVC households will receive a preventive care package containing insecticide treated nets (ITN), water
guard, water vessel, ORS sachets, and information education and communication materials on self care
and prevention of common infection as outlined in the Government of Nigeria (GON) guidelines.
URC will provide good supportive counseling for children and adolescents. URC will intensify collaboration
with GON and other stakeholders to ensure prompt diagnosis of TB in children and facilitate provision of
pediatric TB formulations. In addition, URC will collaborate with National Programme on Immunization to
ensure delivery free and appropriate immunization to all OVC under 5 years. URC will ensure birth
registration for OVC and roll out of a child protection policy for all our PHCs in collaboration with appropriate
GON agencies and other community based organizations (CBOs.) URC will also participate in advocating
the GON in Enugu State for welfare services for OVC. Linkages to Vision Africa and other URC partners will
ensure the full provision of community and HBC services to OVC clients.
URC will build the skills of CBO staff and community health workers and home based care providers to
identify children who are vulnerable and to provide them with appropriate services. URC will contribute in
this way to strengthening the regional system to ensure sustainability and effectiveness of OVC
programming.
URC will adopt use of the subjective rating scales in Child Status Index to assess vulnerability and provide
services. In collaboration with CBOs, FBOs and other OVC programs, and in particularly Vision Africa, URC
will ensure that OVCs receive comprehensive care and support services with emphasis on decentralization
of these services to the community and home levels.
Monitoring and evaluation of the URC OVC program will be consistent with the national plan for patient
monitoring. URC M&E specialists and OVC focal persons will conduct team site visits at least quarterly
during which there will be evaluations of OVC services provided, the utilization of National patient
management monitoring (PMM) tools and guidelines, proper medical record keeping, referral coordination,
and use of standard operating procedures by the HBC and facility providers. Frequent follow-up monitoring
visits will be provided to address weaknesses when identified during routine monitoring visits. Each of
these activities will highlight opportunities for improvement of the OVC programme.
URC will facilitate the training of 10 health care workers in OVC programme implementation using nationally
recognized and approved curriculum and the existing training systems including regional partner and
government trainers. Health care workers will be trained in COP09 using national guidelines and OVC
standards of practice. Specific training relevant to each level of HCW will be provided at each PHC for at
least one doctor, one nurse and one counselor.
CONTRIBUTION TO OVERALL PROGRAM AREA:
Scaling-up OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of
care to 400,000 children infected and affected by HIV/AIDS in Nigeria. The OVC activity will contribute to
the URC overall comprehensive package of care for PLWHAs by ensuring that children's specific needs are
Activity Narrative: met. Training activities will contribute to overall program sustainability by building the knowledge and skill
base across all supported sites.
LINKS TO OTHER ACTIVITIES:
URC activities in OVC are linked to HCT, ARV, services PMTCT, ARV drugs, laboratory, AB TB/HIV
Pediatric care and treatment and SI to ensure that OVC are provided a continuum of care. Linkages to
URC's subpartners and other CBOs will ensure the full provision of community and HBC services to OVC
clients.
POPULATION BEING TARGETED:
This activity targets infants, young children, adolescents and other at-risk children in HIV infected and
affected families. It also targets the households, including caregivers, of OVC. Health and allied care
providers in clinical and community settings will be trained to provide services to OVC.
EMPHASIS AREAS:
The activity has an emphasis on human capacity development through training and commodity
procurement. Other areas of emphasis include wraparound services (food, immunizations) and SI.
The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to
both male and female OVCs in any IP-supported PHCs.
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Human Capacity Development $3,000
Table 3.3.13:
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In COP08, URC is providing HCT to clients in Enugu State at 12 sites. The project uses provider initiated,
routinely offered, opt-out models to maximize uptake of HCT services at the healthcare facilities. Facility-
based testing is fully integrated with other health services. Point of service testing is made available in the
General Outpatient Departments (GOPD), Inpatient Wards, ANC and Immunization Clinics as well as
TB/DOTS clinics. URC actively links all HIV positive clients to care. From all points of service, clients are
referred to receive basic care and support services.
In COP09 URC will continue to support the HCT activities carried out in COP08. URC expects to counsel,
test and provide HIV test results to 2,500 clients through these facilities, including results for TB. The URC
HCT activities will also stress: (1) providing technical assistance, particularly in identifying most at risk
persons in need of HCT, and (2) working with sites to identify potential additional resources (from the GON,
other donors, Global Fund, etc.) to provide commodities and increase uptake of HCT services in all points of
service in the facilities. Over the course of the year, URC will train 17 health workers in HIV counseling and
testing using the national HCT training curriculum. HIV testing will be conducted using the national serial
testing algorithm. An ongoing quality assurance/quality control program which consists of quarterly
proficiency testing and blinded re-checking will be linked to a reference laboratory. URC will work with the
USG and GON laboratory technical working group and other partners to ensure an effective quality
assurance/control (QA/QC) program. URC will ensure that trained counselors are available at HCT sites,
especially PMTCT sites to provide couples counseling and testing following standard protocols and
procedures as a means of reducing HIV transmission in sero-discordant couples/partners. Client-witnessed
testing will be carried out to encourage client confidence in the test results. In this case, same day results
will be provided for the clients. URC will assist facilities to effect strengthening of internal and external
referrals and linkages in order to promote access and further care and treatment of all clients. URC will
access to services. Linkages between counseling and testing sites and sites offering ART treatment will
also be developed and improved. URC will mobilize partnerships with community based organizations
(CBOs), civil service organizations (CSOs) and faith based organizations (FBOs) and train community
workers and PLWHAs to access, inform and encourage the most vulnerable populations in Enugu such as
commercial sex workers, long-distance truck drivers and patrons of STI clinics. URC will establish detailed
guidelines for referral and cross-referral for HCT with prenatal care, TB DOTS programs, PMTCT and ART
services and will provide infrastructure upgrades to ensure adequate space and training for counseling and
testing, including any necessary infrastructure support such as basic renovations, upgrading equipment and
procuring supplies and consumables. The monitoring and evaluation (M&E) staff will work with sites to
ensure that all HIV counseling and testing is properly reported to the Federal Ministry of Health (FMOH).
The counseling and testing component of URC activities will target most-at-risk populations (MARPs) such
as commercial sex workers, truck drivers, men who have sex with men (MSM), discordant couples and
migrants.
This activity supports the national HCT scale-up plan by promoting the accessibility of HCT services using
the FMOH-approved training curriculum and procedures. HCT services are essential to identify HIV positive
people to maximize this impact. Training and support to improve the quality, scale and integration of
counseling and testing services are consistent with FMOH and PEPFAR priorities. The aims are to scale up
access and provision of counseling and testing services to those most-at-risk in Enugu state, followed by
increased numbers of HIV+ people on ARVs, referrals to TB, STI, PMTCT and other clinics, improved lab
services performing HIV screening tests and ultimately, improvement of the overall health system, including
functional referrals among clinic areas and between facilities and communities.
The emphasis areas for this program activity are building of organizations and health facilities responsible
for delivery of HIV interventions;
improvement of referral systems within health facilities, between health facilities and from the community;
community outreach and involvement; training; and access to most-at-risk populations. This project will
also increase gender equity and programming through HIV counseling and testing, targeting adults,
especially women of child-bearing age and men who do not routinely present to health care facilities. The
activities will also support mobilization and palliative care programs targeted at reducing stigma and
discrimination in project communities and encourage support and care of PLWHA.
URC HCT program will be linked ART, PMTCT, TB/HIV and Strategic Information. In addition, positive
clients will be referred into basic care and support services, TB/HIV and PMTCT services. Strategic
Information programs will support data capture and facilitate feedback for further programming. HCT
program will strengthen HIV prevention and palliative care in Enugu State and improve utilization of URC
and other USG-supported care and treatment services.
Continuing Activity: 21693
21693 21693.08 HHS/Centers for University 9404 9404.08 $125,000
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $17,000
Table 3.3.14:
In COP 09, URC expects to be serving a total of 1,500 individuals (1,350 adult clients including clients
referred from PMTCT and 150 paediatric clients) with antiretroviral (ARV) drugs in Enugu State including
900 from COP 08. URC, together with its partners, will facilitate training of care providers in the use of ARV
using the nationally approved curriculum.
URC will provide ARV drugs in concurrence with the Nigerian National Treatment Guidelines for HIV and
AIDS Treatment and Care in Adolescent, Adults and Paediatrics. All drug orders will be based on
projections of patient numbers as determined by annual forecast conducted in August 2008 in conjunction
with the SCMS and USG Logistics Technical Working group. URC will utilize the recommended first line
regimen for ART in Nigeria Tenofovir/Emcitrabine/Nevirapine (Efavirenz). The first two drugs come as a
fixed dose combination called Truvada and this improves drug adherence - the most important variable for
treatment success. The second line regimen to be used will be Abacavir (Didanosine)/ Emcitrabine and
Ritonavir boosted Lopinavir (Kaletra). URC anticipate a second line rate of approximately 2%, while 98% of
clients will be on the first line regimen. Paediatric clients will be on the nationally recommended combination
of Zidovudine/Lamivudine/Nevirapine(Efavirenz). We anticipate a second line rate of less than 1% for
children. A small proportion of single drug or double drug substitute will be maintained to counter adverse
side effects associated with the first line for adults (renal impairment for Tenofovir, and Anaemia for
Zidovudine).
URC will purchase the drugs in accordance with USG, FDA and National Agency for Food and Drug
Administration and Control (NAFDAC) regulations or waiver. All purchases of Truvada (TDF/FTC) and ZDV-
3TC-NVP Fixed Dose will be purchased via pooled procurement mechanism by SCMS, in line with OGAC's
recommendation. Our partner, Crown Agent, will procure, distribute and provide consistent oversight for the
supply chain management of the remaining drugs.
In COP09, URC will collaborate with the Clinton Foundation for the receipt of second line adult and all the
pediatric drugs. URC will also work closely with the Government of Nigeria to leverage resources for the
sites supported by both PEPFAR and GON..
URC will work to strengthen the logistics capability of public sector healthcare facilities in Enugu. We will
work with the Central Supply Mechanism (SCM) to ensure that the desired products are supplied to Nigeria
based on an agreed delivery schedule. A quarterly ordering schedule will be adhered to, based on 12 month
lead-in forecasting. The adjusted forecasting will be based on the use of data on consumption, stock use,
storage, patient numbers both new and old, default rates and will use the state of the art quantification tools
as developed by Crown agents, SCMS, implementing partners and the Government of Nigeria (GON).
URC will work at the site level to help identify ARV drug needs by using nationally approved paper based
logistics management tools. We will define the needs and develop a work plan that will clearly define the
activities needed to forecast one year ahead, do quarterly drug ordering based on forecasts, collect and
utilize data, train staff, assess the supply chains and follow up the performance of actual drug delivery
systems.
URC will undertake capacity building activities to raise the performance levels and deliver sustainable
improvements in the management and technical skills of pharmaceutical and procurement practitioners in
Nigeria. At the site level, URC will mentor pharmacy based staff to implement the nationally approved ARV
and allied drug management systems. This includes improving the reporting on consumption, drug ordering
and re-ordering and maintenance of emergency stock levels. Our team, led by the Clinical Services advisor
will work with the sites to understand treatment needs.
People Living with HIV/AIDS (PLWHA), health care providers, pharmacists.
As URC undertakes these activities, we will also be raising performance levels and deliver sustainable
improvements in the management and technical skills of procurement practitioners and managers in Nigeria
in addition to strengthening the procurement capacity and skill level at all participating health facilities. This
includes significant, sustainable improvements in procurement systems, staff competency in forecasting,
documentation and reporting, system set-up and maintenance.
The major emphasis area for this program activity is capacity building of agencies, organizations and health
facilities involved in delivery of HIV intervention.
This activity is also linked to PMTCT, TB/HIV, OVC and Strategic Information
Continuing Activity: 21697
21697 21697.08 HHS/Centers for University 9404 9404.08 $365,000
Table 3.3.15:
URC, with its partners, will conduct assessments of laboratories serving targeted facilities to establish
baseline capacity for HIV-related testing. Such items as the specific staffing of the in-country laboratory
program, the number of staff working within the program, the organization of these staff, their
responsibilities and how they support the lab sites will be determined as a part of the assessments. Given
the data collected during the assessments, and in consultation with the USG PEPFAR Nigeria Laboratory
Technical Working Group (LTWG), we will then develop a plan to equip and train 15 laboratory personnel in
5 laboratories serving the target communities in Enugu State. Using the standard training packages already
developed, or being developed by the PEPFAR Nigeria Team, URC will train appropriate laboratory
personnel in good laboratory practice, HIV testing, TB testing, specimen handling and processing,
laboratory safety, QA/QC, biomedical waste and disposal, preventive maintenance for all equipment,
documentation, data collection and reporting. We expect that our participating laboratories will conduct
6,960 tests in: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring during
the reporting period. We expect that out of 6,000 HIV tests conducted at our facilities, there will be 960 CD4
tests performed. We will also link with the national EID scale-up plan to make use of existing PCR labs as
well as the Clinton Foundation DBS collection supplies and transport support to carry out Early Infant
Diagnosis using DNA PCR for 80 children. The URC team will make improvements needed in laboratory
facilities, including ensuring adequate space, power, ventilation, plumbing, cabinets, biological safety
cabinets, safety measures, cold storage, waste disposal facilities, etc. We will supply high TB workload
sites with fluorescent microscopes or fluorescent adapters for TB and malaria diagnosis.
We will ensure effective routine operation of laboratories to support HIV and opportunistic infection
diagnoses, staging of persons with HIV and monitoring clinical response and drug resistance across Enugu
state, including overseeing regular quality assurance of laboratory services. We will work to establish a
tiered laboratory system from public healthcare centers to referral centers, including the institution of
support supervision and QA/QC. We will work with the PEPFAR-Nigeria Lab Technical Team for
development and implementation of QA/QC programs/policies. Quarterly QA/QC lab site monitoring visits
will be conducted using a standardized assessment tool developed by USG PEPFAR- Nigeria LTWG.
Reports from proficiency testing and site monitoring visits will be sent into a centralized system, that will be
developed and supported by the PEPFAR- Nigeria LTWG. Strengthening of laboratory capacity will be
conducted concurrently with routine operation of laboratories to support HIV testing and treatment programs
across Enugu state, in order to ensure achievement of program goals while delivering sustainable
improvements in the management and technical skills of laboratory staff.
URC will work with the USG, Medical Lab Science Council of Nigeria (MLSCN), hospital management and
the FMOH/SMOH towards local accreditation of some of our laboratories by the MLSCN. URC will also
support HIV post exposure programs (PEP) at all sites. We will provide guidelines for minimum as well as
ideal site requirements and will assess Laboratory Information Management System (LIMS) needs in
Enugu. We will then recommend an action plan for the purchase and implementation of LIMS if feasible
and at selected sites. Site staff will be trained - initially on a pilot basis and then gradually rolling out as the
appropriate levels and capabilities become clear.
URC will consult with the PEPFAR-Nigeria Lab Technical team on selection of equipment for supported
sites. We will develop specifications for equipment and supplies, including liaison as appropriate with the
PEPFAR-funded Partnership for Supply Chain Management (SCMS) on supply, installation and
maintenance requirements.
Laboratory personnel as well as adults and children needing HIV-related testing
Training and support to improve the quality and function of laboratories supporting HIV testing is consistent
with FMOH and PEPFAR priorities. Improvements in laboratory infrastructure, equipment, supply systems
and personnel training will significantly improve the effectiveness of all health sector areas that require
testing of any kind. Building more effective laboratories will result in more accurate and reliable diagnosis of
HIV and other diseases as well as better monitoring of ART and HIV+ patients for more effective,
appropriate and sustainable care and treatment for people living with HIV and those at risk. Additionally,
URC employs a method of collaborative sharing of best practices across facilities which will serve to better
link higher and lower level laboratories and health facilities with each other for more effective referral
processes overall and will facilitate better and more functional linkages between these facilities whether
they be public, private, NGO-supported or otherwise. These improvements in communication and referral
systems serve to promote sustainability of quality programs.
The emphasis areas for this program activity are capacity building of facilities responsible for delivery of HIV
interventions, infrastructure enhancement and quality improvement as described above.
This activity is linked to Counseling and Testing, ART care and treatment, PMTCT, TB/HIV and Strategic
Information.
Continuing Activity: 21701
21701 21701.08 HHS/Centers for University 9404 9404.08 $300,000
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.16:
In COP 09, URC will focus its Strategic Information (SI) efforts on creating and/or enhancing Health
Management Information Systems and monitoring and evaluation (M&E) systems. URC and its partners
will conduct an assessment of the types and functional levels of Health Management Information Systems
across participating health facilities. URC will work to institute or enhance these systems such that they can
be integrated across URC-participating sites and, linked into the Logistics Health Program Management
Information Platform (LHPMIP), the broader national health information system. Training will be provided to
two organizations in set-up and management of Health Management Information Systems (HMIS). URC
utilizes an intentional spread best practice model to entrench high quality service implementation and
delivery. Under this approach, key sites are identified and rapid and intense logistic and implementation
support is provided, using the site staff as leaders. Performance of these sites will be monitored and where
deemed satisfactory, supported to train other sites to launch their own initiatives to lead to an expanding
intentional spread cascade of best practice.
URC subscribes to the "three ones" principle and will champion the institutionalization of the "third one" at
the state level. This will be achieved through continuous engagement of the Enugu State Action Committee
on AIDS (ENSACA) and the corresponding Local Action Committee where our supported facilities are
located, to build their capacities. Compliance with the Government of Nigeria's (GON) national HIV strategic
plan will be placed at the centre of all our SI efforts, in order to contribute to the national M&E framework. In
addition URC will work under the federal and zonal coordinating bodies of the Federal Ministry of Health,
HIV and AIDS Division ENSACA and will abide to the responsibilities of stakeholders as enshrined in Enugu
State's Strategic Plan (2006-2010).
URC will continue to enhance our program's M&E system to collect data on all relevant indicators and
ensure data quality. Routine reporting and communication of PEPFAR results will follow PEPFAR
guidelines. We will track specific program-level indicators as well as PEPFAR indicators using harmonized
national tools for data collection. Training on general M&E will be provided to 10 individuals to support data
collection and reporting. The training will be based on a Nationally approved training curriculum. Two local
organizations will be provided with technical assistance on strategic information activities in COP09.
Generation of valid, reliable and consistent data continues to be a challenge. URC will engender a culture of
quality improvement in all SI processes. This will be achieved through regular training and retraining of data
officers at the supported sites in Enugu. Our technical team will work to optimize the workload associated
with reporting to minimize duplicate data entry. Data reconstruction exercises will be undertaken and the
opportunity afforded by this exercise will be used to provide onsite mentorship. Feedback and local use of
data will help in entrenching the quality approach to SI. URC will also organize data quality workshops for
health facility/community focal staff and ENSACA M&E focal persons on the basics of data quality and how
to conduct checks to ensure data quality is maintained. These sessions will ensure all players have a
thorough understanding of the PEPFAR Data Quality Toolkit (which includes the Monitoring and Evaluation
Systems Strengthening Tool, the Data Quality Assessment Tool and the Data Quality Assurance Tool for
Program-level Indicators) and how they can use the toolkit to evaluate their own M&E systems. Facilities will
be able to address and share their data quality issues.
The URC technical staff will team up with state officials to undertake, at a minimum, quarterly field
monitoring visits to improve data quality, mentor field staff, and promote local ownership of the program.
URC recognizes the contribution of state actors and implementing partners (PEPFAR and non-PEPFAR) at
community level, tertiary, secondary and primary facilities in developing M&E capacities. URC will contribute
to the current policy and operational discourse aimed at improving these systems. Further, URC will avoid
duplication of effort by adopting national and partner data collection and distribution tools. URC notes the
existence of Patient Management and Monitoring (PMM) systems developed by partners like Global
HIV/AIDS Initiative Nigeria (GHAIN) and will endeavour to utilize this and other similar systems. URC will
work with our oversight home office, CDC, to locate, identify, and adapt existing best practices.
URC notes the place of its regional activities in the larger national response and will work as part of the pilot
and implementation phase of the HIVQUAL ® monitoring and quality improvement system. Sites will be
supported to analyze and utilize locally generated information to improve service provision processes. URC
has developed over several decades, proven principles of quality improvement, which include the use of
standard setting, on site mentorship and training, intentional spread models, attention to logistics support
and focused incremental quality improvement approach. A critical aspect is defining quality from the
perspective of the consumers, health providers, and state actors which will serve as a basic guide for all our
Quality Improvement (QI) initiatives.
Health facility M&E, program managers/decision makers and other organization staff involved in the HIV
program.
Improvements in data collection and reporting systems strengthens the health sector's capacity overall. It
increases the effectiveness of HIV-related services by drawing on important groups of data to plan and
implement HIV programs based on more reliable, documented health needs of the population. The greater
accessibility of important health-related data will serve to influence health policy and programs in the region
of interest and in the country of Nigeria as a whole.
The major emphasis area is human capacity development and local organizational strengthening.
This activity is also linked to laboratory infrastructure, counseling and testing, PMTCT, OVC, and care and
treatment.
Continuing Activity: 21703
21703 21703.08 HHS/Centers for University 9404 9404.08 $25,000
Table 3.3.17:
