Pathfinder (PI) in COP08 supported PMTCT activities in a total of eight facilities (two general hospitals and

six primary health centers (PHCs)) in two local government areas (LGAs) of Edo state where the HIV

prevalence is 4.6% (HSSS, 2005). In COP08 this program is providing HIV counseling, testing and results

to 6,000 pregnant women. In COP09, PI will add on two new ‘feeder' sites from among PHCs/private

hospital facilities in the same LGAs (one in each LGA) as COP08. Therefore, PI will provide PMTCT

services and community outreach activities throughout ten (10) hospital networks. These networks will

provide HIV counseling and testing to 6,000 pregnant women, who will receive their results.

PI will train 8 health care workers (HCWs) using the National PMTCT training curriculum in addition to those

trained under COP08. The program will also support infrastructure, purchase equipment and supplies,

monitor, evaluate and provide supportive supervision to the sites. Active efforts will be made to facilitate the

public health approach in taking PMTCT services to the primary (PHC) and community levels.

In COP09, PI will support comprehensive PMTCT services for communities, including marked expansion of

HIV testing for pregnant women. PI will work to increase uptake of these services, including routine

antenatal care and facility-based deliveries. Pregnant women, especially HIV-positive mothers, will be

supported to deliver in health facilities through the provision of the national safe motherhood program

delivery kits ("mama kits"). Post-delivery care and treatment for women and infants will be augmented. The

use of ART for PMTCT will follow the National PMTCT guidelines. HIV-infected women who are not eligible

for HAART for their own disease will be offered a combination of zidovudine (AZT) from 28 weeks (when

feasible) or combivir from 34-36 weeks, cotrimoxazole prophylaxis (pCTX) and single dose nevirapine (SD-

NVP) at onset of labor. Women presenting at labor will be offered rapid testing and if HIV-infected provided

with SD-NVP. All positive women ineligible for HAART will receive a combivir tail as their postpartum

regimen.

All infants born to HIV-infected women will be provided with SD-NVP at birth and AZT for 6 weeks. 276

mother-baby pairs will receive ARV prophylaxis. PI will provide support for a mother's infant feeding choice

through appropriate infant feeding counseling as well as provide ongoing psychosocial and adherence

support. Health facilities will be supported to provide basic laboratory services and will be linked to a

laboratory network model in which CD4 testing can be performed via specimen transport systems. In

addition, linking with family planning (FP) counseling and service provision and effective condom promotion

(including post-partum FP) will be done. Exposed infants will be actively linked to pediatric care and

treatment through under-5 cards issued in labor and delivery. Other activities are enhanced pediatric care

including prophylactic cotrimoxazole (pCTX) from 6 weeks of age and promotion of best practices for infant

feeding, nutritional support and linkages to family planning services.

The project will strengthen the capacity of the additional two (2) facilities to provide quality PMTCT services

through providing management and PMTCT technical training for key managers and service providers.

Training will include HCT, PMTCT, infant feeding counseling, infection prevention, pediatric follow-up,

supervision, monitoring and evaluation and training on laboratory safety skills. Training will again be

conducted by selected members of the PMTCT core trainers and supported by staff trained in COP08 of the

project using the national curricula as appropriate. An on-site training approach will be used to train

laboratory scientists and technicians.

PI will identify and provide orientation for heads of other facilities in the LGA (nurses/midwives) from

surrounding local hospitals and provide copies of the referral charts, which will include PMTCT services

available at the intervention facilities. PI will strengthen the LGA HIV/AIDS program.

All HIV-exposed infants will be provided with infant diagnosis testing using dried blood spots (DBS) in line

with the National Early Infant Diagnosis (EID) Initiative from 6 weeks of age. HIV-positive infants will be

linked to appropriate care and treatment services. NGOs (one per LGA) will be sub-granted funds to create

demand for PMTCT and implement a number of activities to achieve this objective.

Project staff will visit project facilities on a weekly basis to provide supervision and technical assistance in

record keeping and hands-on training on the use of data to improve program quality. There will be on-going

technical assistance and oversight of NGO/community-based activities to ensure that activities are carried

out as planned. TA will be provided as needed and formal discussions will be held to understand the

intervention's contributions to community needs and to elicit proposed solutions to challenges faced. Visits

will carry out quality of service checks, using checklists based on national policy to ensure constant quality

service delivery.

The M&E system established in COP08 and led by the M&E officer will be expanded to additional facilities

to ensure consistent and continuous reporting and monitoring. Data information and analysis will be shared

with facility managers, the PMTCT state team and NASCP. PI will use nationally approved registers and

forms across all existing sites.

CONTRIBUTIONS TO OVERALL PROGRAM GOAL

PI, by providing services at the primary and secondary levels, will assist the GON in achieving its goal of

decentralizing PMTCT services beyond the tertiary care level and will significantly contribute to an increase

in PMTCT services by supporting ten health facilities and also indirectly supporting GON

ministries/programs in their rapid scale-up plans for PMTCT. PI will partner with local institutions with

appropriate expertise and capacity to reach out to primary facilities in line with national PMTCT scale-up

plans.

The targets of 6,000 pregnant women counseled and tested and 276 mother-infant pairs for ARV

prophylaxis will be reached by the end of COP09. This will significantly contribute to the emergency scale

up plan targets of 2010. PI will strengthen national and state PMTCT programs by: support of capacity

building of healthcare staff for PMTCT services; printing of national PMTCT registers; and support of regular

coordination meetings in collaboration with other partners at national and state levels. PI will also strengthen

Activity Narrative: the programmatic skills of partner CBOs/FBOs in line with GON sustainability plans.

LINKS TO OTHER ACTIVITIES

This activity is related to activities in HCT. HCT will be offered to all pregnant women at ANC, and to their

partners. Women presenting in labor will have rapid HIV tests and receive single dose NVP if positive.

Infants born to HIV-infected women will access ART (single dose NVP and ZDV) and CTX prophylaxis.

Infants will be referred for DBS and linked to appropriate OVC care and treatment services. Community

linkages will enable HIV-positive women and family members access to support groups. All pregnant

women will be linked into FP services. Partner counseling/communication will be promoted through other

prevention with positive activities. M&E activities at PMTCT sites will contribute to the national PMTCT

program's M&E efforts using national PMTCT MIS.

POPULATIONS BEING ADDRESSED

Pregnant women, postpartum mothers, their partners and families, including HIV-exposed infants and HIV-

infected children, will be targeted and supported so that they have full access to HCT at multiple entry

points of care. HIV infected women will be provided with PMTCT services, while HIV infected infants and

children, and infected partners, will access care and treatment services, including OVC services. Uninfected

women will be supported to remain HIV negative. CBOs, FBOs, support groups, and men will also be

targeted so that they participate fully in community based PMTCT services. Healthcare providers will be

trained on providing services while the management skills of GON policy makers and implementers at all

levels will be improved to enable them to manage programs effectively.

KEY LEGISLATIVE AREAS

This activity will promote gender equity in HIV/AIDS programs and increase access to services by the

vulnerable groups of women and children. It will help increase service uptake, promote positive male norms

and behaviors, especially as it relates to discordant couples, and help reduce stigma and discrimination

through its community based activities.

EMPHASIS AREAS

Major emphasis of this activity focuses on training, network/linkages and community

mobilization/participation. Minor emphasis includes other sectors and initiatives, commodity procurement,

IEC, supportive supervision, quality assurance and improvement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21685

Continued Associated Activity Information

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

System ID System ID

21685 21685.08 HHS/Centers for Pathfinder 9405 9405.08 $300,000

Disease Control & International

Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $46,848

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

This Activity has been modified in the following ways:

In COP08, Pathfinder supported eight (8) HIV counseling and testing sites in two local government areas in

Edo state. Counselors were trained using the national HCT training curriculum. The project used provider

initiated counseling and testing to maximize the uptake of HCT services at the health care facilities.

Pathfinder actively referred all HIV positive clients to access treatment. In line with the provisions of the

PEPFAR/CDC COP09 funding requirements, Pathfinder in continuation of COP08 activities will provide

additional HCT activities in two (2) health facilities, one in each of the two Local Government Areas (LGAs)

of Edo State and will support planned outreach activities for HIV counseling and testing. HCT will be

provided to 3,000 men, women and youth. Pathfinder's HCT site and community level activities will stress:

(1) providing technical assistance, particularly in identifying most at risk persons in need of HCT, and (2)

working with sites to identify potential additional resources (from the GON, other donors, Global Fund, etc.)

to provide commodities and increase uptake of HCT services in all points of service in the facilities.

Pathfinder will utilize the provider initiated testing and counseling model to maximize uptake of HCT

services at the health care facility. The HCT services will be provided using facility-based HCT service

delivery points at the general outpatient departments of the general hospitals. At the primary health center

level targeted for COP09 the ‘mobile HCT unit' will provide services on specific days of the week targeting

persons at risk. In addition, this unit will be providing services at specific locations in the community

targeting in addition most-at-risk populations (MARPs).

The program shall be integrated into the national framework for HCT by using the national ‘heart to heart'

logo. All HCT services carried out shall be in accordance with the national algorithm. Individualized

abstinence, be faithful and correct and consistent use of condoms shall be the main message design for the

counseling sessions as well as the information, education, communication (IEC) provided during those

sessions. Positive clients shall be provided with appropriate prevention with positives (PwP) messages and

linked to appropriate support services. Other services that meet the needs of positive clients like HCT for

family members and sex partners, counseling for discordant couples, counseling on positive

lifestyles/disclosure and prevention messages shall be offered. Negative clients shall be counseled using

the ABC approach and where appropriate follow-up tests shall be advocated.

Pathfinder-supported facility-based HCT services shall be of the provider initiated testing and counseling

(PITC) approach. This shall be done with the full participation of the facility authorities while making

adequate provisions for respect of client/patient right to refusal. A more intense advocacy will be directed

towards high risk individuals who access clinical services at the facility, community and local authorities

(including traditional and government leaders) to build support and acceptance for HCT services. Pathfinder

will participate in the national network of care, treatment and support for HIV/AIDS and TB and work closely

with state MOH officials to collaborate with key policy makers (e.g., Commissioners for Health and Women

Affairs, Permanent Secretaries and Directors of Medical Services) for the implementation of project

activities. The project will work directly with local health facility staff for strategy development and planning

to build cooperation and enhance sustainability. Local NGO partners will implement advocacy and

sensitization activities at the community level through stakeholders' and community group meetings in

collaboration with Pathfinder.

HCT services will be provided for all TB suspects/patients and pediatric counseling shall be encouraged. All

HCT clients will be screened for TB using standard questionnaires and referrals made as appropriate for TB

diagnosis and treatment based on scores. Patients attending STI clinics will have access to HCT while HCT

clients will be screened for STIs using a standard questionnaire and referrals made as appropriate. Patients

who are positive will be linked to ART services.

Manpower for the HCT services shall be drawn as much as possible from the beneficiary community using

a participatory approach. Selection shall be based on experience and possible prior training on HCT service

provision. Technical capacity and training shall be made available from the pool of nationally-qualified HCT

consultants. The project will provide technical training on HCT to sixteen (16) persons (retired nurses,

teachers, Civil Service Organization staff , laboratory technicians and lay counselors) using the National

HCT training curriculum. They will form the ‘Mobile HCT team' to provide HCT services. Technical training

will include the following key elements: confidential HCT protocols including obtaining consent, risk

assessment, risk reduction negotiation, and referrals; collection of HCT data and use of national registers;

HIV testing using rapid test algorithms and supply management for HIV test kits. Counselors will also be

trained in couple HIV counseling and testing (CHCT) following standard protocols and procedures as a

means of reducing HIV transmission in serodiscordant couples and partners.

HIV rapid test kits (RTKs) will be procured using the USG supply chain management system. RTKs and

other consumables will be stored in the Pathfinder storeroom and distributed to the sites based on projected

needs using a proper inventory tracking system by designated staff.

In collaboration with the health facility management, Pathfinder will ensure appropriate medical waste

management and disposal.

Pathfinder will conduct External Quality Assurance (EQA) activities for HIV rapid testing in collaboration with

other PEPFAR supported laboratories which will be used as a reference laboratory for quarterly proficiency

testing. Testing and retesting of blood samples will be conducted by trained counselors with support from

facility laboratory staff. Quality control in testing will be instituted daily by trained counselors. Quality

evaluation in counseling will be conducted using quality assurance tools in counseling such as client exit

interview forms to assess client satisfaction, counselor reflection forms, supportive supervision by trained

counselor supervisors, regular monthly counselors'meetings and mystery client visits.

Referral networks will be set up to ensure linkages of HIV positive clients to treatment and care services

including referrals to support groups of PLWHAs in the community. For PEP, Pathfinder will refer affected

individuals to comprehensive health facility for further management.

Activity Narrative: Contribution to overall Program Area:

This activity supports the national HCT scale-up plan by promoting the accessibility of HCT services using

an FMOH approved curriculum and procedures. Pathfinder will provide services to 3,000 clients who will be

counseled, tested, and receive their results. HCT will further contribute to the national goal of universal

access to treatment. In addition, it will accomplish community participation. Pathfinder HCT services will

enable the identification of HIV positive individuals to be linked directly to treatment, care and support.

Link to other Activities

This activity is related to activities in PMTCT and strategic information. Linkage to treatment, care and

support services shall be strengthened within and across programs within and between other implementing

partners using standard referral mechanisms.

Population Targeted

Pathfinder will target the general population and most at risk persons.

Legislative Issues:

Owing to increased stigma and discrimination in HIV /AIDS related issues, this activity will contribute directly

to stigma reduction associated with PLWHA.

Emphasis Area

Emphasis will be on capacity building of local counselors. Other areas of emphasis will include community

mobilization and participation along with building networks, linkages and referral systems.

Monitoring and Evaluation:

Regular programmatic supervisory visits and monitoring and evaluation (M&E) for this component will be to

ensure a smooth and seamless strategy that ensures quality facility and community-based services and

activities across the entire project. It will also ensure that data collection, collation and use continue to direct

implementation and fulfill project requirements.

Mobile teams will be given data registers and the Pathfinder project focal person will monitor and supervise

data entry to ensure accuracy and discuss results. Ongoing supervision by the Pathfinder focal person and

community based organizations/non-governmental organizations (CBOs/NGOs) will ensure that trained

HCT staff are adhering to the national procedures and protocols. Pathfinder will adopt the use of the

national monitoring and evaluation tools to ensure standardized data capturing and reporting.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21694

Continued Associated Activity Information

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

System ID System ID

21694 21694.08 HHS/Centers for Pathfinder 9405 9405.08 $200,000

Disease Control & International

Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $17,316

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: