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 HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In COP08, the Christian Health Association of Nigeria (CHAN)'s Nigeria Indigenous Capacity Building
(NICaB) project used drugs donated by the Clinton Foundation and leveraged training resources from other
US government (USG) funded Implementing Partners (IPs) to provide PMTCT services at 12 facilities in 6
states of Abia, Benue, Delta, Oyo, Sokoto and Taraba. Services provided included HIV counseling and
testing, early infant diagnosis (EID) and infant feeding counseling. Prophylaxis was given to pregnant
mothers, while those who needed HAART for their own health were referred to the ART clinic. Community
health workers promoted PMTCT and followed up mother/infant pairs within the community to provide
support for infant feeding choices and provide referrals in case of complications. In COP09 this activity will
be modified by conducting EID and infant feeding counseling components under the pediatrics care and
support program area. Additionally, NICaB will participate in the USG local government area (LGA)
coverage strategy and facilitate the formation of PMTCT committees in three of the six states where CHAN
is working and committees do not already exist. NICaB will initiate and participate in their monthly meetings
with the aim of supporting states to develop a scale-up and implementation plan.
The NICaB project will utilize a network model with PMTCT care centers linked to secondary level CHAN
member institution health facilities - "hub sites" that provide more complex PMTCT care and lab testing to
reach HIV-positive women with HIV-related services. In COP09, 6,200 women will receive PMTCT
counseling & testing and receive their results through networks that include 12 hub and 12 spoke sites,
giving a total of 24 PMTCT sites supported in 6 states of Abia, Benue, Delta, Oyo, Sokoto and Taraba. This
activity will impact both HIV-negative and HIV-positive pregnant women - HIV-negative women to stay
negative and HIV-positive women to avoid cross infection due to increased vulnerability during pregnancy.
As part of the USG LGA coverage strategy in PMTCT, CHAN NICaB will support PMTCT services at ANC
sentinel survey sites in Abia state, with future expansion to primary health center level based on resources.
PMTCT stand-alone points of service in the network will be linked to adult and pediatric ARV care through
utilization of a PMTCT consultant coordinator and a health facility coordinator in each network based at the
hub site. NICaB will utilize network referrals, SOPs, monthly PMTCT network meetings and incorporation of
team approaches to care in all training, service provision and site monitoring activities. Meetings with the
State Action Committees on AIDS (SACAs) will be facilitated and will lead to the formation of state PMTCT
committees in order to strengthen the scale-up and implementation plans in 3 NICaB-supported states of
Abia, Sokoto, and Delta. In line with the National PMTCT guideline, HIV-positive pregnant women with CD4
cell count of <350 require HAART for their own health and will be linked to an ARV point of service at CHAN
member institutions (MIs). CHAN will facilitate linkages between HIV-exposed infants by stating this in the
health card for mother/infant pairs. Particular emphasis will be placed on the involvement of community
health workers who are the primary source of care for women in the pre and postpartum period and are
integral to a program that seeks to engage women where they seek care. This program will work closely
with the care and support team to maximally engage community based PMTCT and ARV linkages. In
addition to receiving PMTCT services, each HIV-positive pregnant woman will be referred to OVC services
in order to facilitate care for all of her affected children.
Provider initiated testing and counseling services with opt-out option and with same day test results will be
provided to all women presenting for ANC and untested women presenting for labor and delivery. All
women would be provided pre-test group health information services on prevention of HIV infection
including the risks of MTCT using lay counselors who will be members of mother-to-mother support groups.
Male involvement in PMTCT will be strengthened by promoting couples counseling and partner testing will
be offered as part of counseling through referral to on-site HCT centers. A step down training of couples
counseling and prevention for positives package will be utilized in all sites. This will provide an opportunity
to prevent heterosexual transmission and reduce incidence of violence against positive partners, especially
in discordant couples. Master trainers for HCT already trained in COP08 at CHAN-supported
comprehensive sites will in turn train labor and delivery staff in the use of HIV rapid tests for women who
present in labor without antenatal care.
An anticipated 248 HIV-positive pregnant women will be identified and provided with ARV prophylaxis
(based on CHAN NICaB's current program utilizing 4% prevalence). HIV-positive women will have access
to lab services including CD4 counts without charge. This will be available on-site or within the network
through specimen transport. Women requiring HAART for their own health care will be linked to a network
ARV center. For the anticipated 2/3 of women not requiring HAART, the current WHO recommended short
course ARV option will be provided which includes ZDV from 28 weeks or ZDV/3TC from 34/36 weeks, intra
-partum NVP, and a 7 day ZDV/3TC postpartum tail. Women presenting in labor will receive single dose
nevirapine (sdNVP) and a 7-day ZDV/3TC postpartum tail. All HIV-positive women will be linked postpartum
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 linkages to family planning services. HIV-positive
pregnant women with CD4 <350 will be placed on cotrimoxazole preventive therapy in the 2nd and 3rd
trimesters.
Healthcare workers at the facility and community levels will be trained to counsel HIV-positive women pre-
and postnatally regarding exclusive breast feeding during the first six months of life or exclusive breast milk
supplements (BMS) if Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS) based on the WHO
UNICEF curriculum adapted for Nigeria. Couples counseling or family member disclosure will be utilized to
facilitate support for infant feeding choices. Consistent with national policies on importation of infant formula
and recent concerns regarding appropriate use of breast milk substitute (BMS), CHAN NICaB will not utilize
emergency program funds to purchase BMS. As part of OVC programming CHAN NICaB will provide safe
nutritional supplements as well as water guard, bed nets and other home based care items. HIV-positive
women will be linked to support groups in their communities, which will provide both education and ongoing
support around infant feeding choices and prevention with positives. PLWHA are currently engaged at
CHAN NICaB ARV points of service as treatment support specialists. The use of dedicated treatment
support specialists for PMTCT in the clinic and community will be expanded based upon the successful
"Mothers to Mothers" model. This will ensure that HIV-positive women remain in care throughout pregnancy
and receive appropriate services for herself and her infant during follow up.
Activity Narrative: Infant prophylaxis will consist of single dose NVP with ZDV for 6 weeks in accordance with Nigerian
National PMTCT guidelines. Cotrimoxazole suspension is provided to all exposed infants pending a
negative virologic diagnosis. CHAN NICaB will refer all HIV-exposed infants to USG supported laboratories
for DNA PCR. Testing of infants will be carried out using dried blood spot (DBS) specimen collection. DBS
specimens from PMTCT sites in the network will be pooled at the hub sites from where they will be taken to
nearby USG-supported labs for testing by trained lab personnel using DNA PCR.
A systematic coordinated approach to program linkages will be operationalized at the site and program level
including linkages to adult and pediatric care and treatment services as well as OVC services. Quality
monitoring will be undertaken through site visits using an existing assessment tool and routine monitoring
and evaluation indicators. Hospital coordinators will supervise activities on a daily basis while the NICaB
clinical coordinator will collaborate with the USG TWG and GON to conduct quarterly site visits. Reports of
activities will be sent to the USG and copies to NACA and the HIV and AIDS Division (HAD) of the FMOH.
The NICaB project will work with community based workers including traditional birth attendants to support
the already widespread practice of male child circumcision.
The CHAN NICaB project will train an average of 2 healthcare workers (HCWs) from each of the 24 sites,
including community-based health workers and traditional birth attendants (TBAs), in the provision of
PMTCT services and infant feeding counseling. The national PMTCT training curriculum, national infant
feeding curriculum and new national training tools currently under development will be utilized. TBAs will be
trained using a version of the PMTCT National Curriculum that has been adapted and modified for TBAs
which focuses on HCT and referral of HIV-positive women. Thus the total direct training target is 72.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will provide counseling & testing services to 6,200 pregnant women and provide ARV
prophylaxis to 248 mother and infants pairs. This will contribute to the PEPFAR goal of preventing new HIV
infections. With 24 operational sites, the PMTCT activity is in line with the desire of the GON to have 1,200
PMTCT sites operational by 2009 and the USG's target of having 80% PMTCT coverage.
LINKS TO OTHER ACTIVITIES:
This activity is linked to adult and pediatric care and treatment, OVC, laboratory infrastructure, condoms &
other prevention, AB, and SI. Prevention with positives counseling will be integrated within PMTCT care for
HIV-positive women. The basic package of care provided to all HIV-positive patients will be available to HIV
-positive pregnant women. Positive pregnant women will be linked with nutritional support programs where
they exist. CHAN NICaB lab staff will ensure that HIV testing provided within the PMTCT context is of high
quality by incorporating PMTCT sites into the laboratory QA program. CHAN NICaB will collaborate with
UNICEF in the support of PMTCT services at some sites, leveraging their training expertise and other
resources without duplication and creating a more sustainable service support structure.
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 referral to EID. Couple
counseling will be used to reach partners of pregnant women so as to reduce instances of violence
following disclosure. Family members will be counseled to provide support to pregnant and breast feeding
mothers.
EMPHASIS AREAS
The key emphasis area is training, as most supported personnel are technical experts. A secondary
emphasis area is network/referral systems as networks of care will be supported which are critical to
ensuring quality of care at the PHC level, identifying women in need of HAART and ensuring access to
HAART within the network. In addition, partners and people affected by HIV/AIDS will be identified for
linkage to care and support services. This activity addresses gender since treatment will be provided to
women and will focus on family centric issues including male involvement in PMTCT programming.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $72,000
Public Health Evaluation
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: Care and treatment narratives were fused.
The Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building (NICaB) will
provide ARV services and lab monitoring to 2286 adults (1350 new). In COP08 CHAN NICaB supported
ARV services at 12 sites and under COP09 will consolidate services at these 12 sites: all medium - small
secondary level mission hospitals will be linked to 60 primary health centers (PHC) using the hub-and-
spoke model. Sites will be located in 6 states of Abia, Benue, Delta, Oyo, Sokoto and Taraba. Services at
PHC and DOTS satellite sites are limited based on staff strength and their capacity. The model of service
delivery at the PHC and DOT sites are modeled on these sites providing HCT and PMTCT and referring
positive clients to the hub sites. Following base line investigations, clients are sent back to spoke sites to
continue with adherence monitoring. Drugs are sent to spoke sites for patient refill and every three months,
they return to hub site for CD4 cell count. Clients who are not eligible for ART are referred to community
based NGOs/CBOs/FBOs (CISNAN at national and state levels, NEPWHAN and FOMWAN at state level.)
and enrolled into care and support. They return to hub site every six months for CD4 cell count. In all
models of community outreach a portable pharmacy is employed to deliver ARVs to patients at the
community level.
The CHAN NICaB project will collaborate with GON to adapt and expand the IMAI curriculum to facilitate
quality adult ARV care at the PHC level. CHAN NICaB participated actively in the review of the National
ARV Guidelines for adults and pediatrics updated in 2007 for consistency with WHO 2006 guidelines. A
corresponding National ARV SOP has been developed that is being used at all CHAN NICaB sites to align
CHAN NICaB services with GON guidelines. Non-ART and ART eligible clients will be enrolled into care
and will receive regular clinical monitoring including CD4 count. CHAN NICaB supports PLHA support
groups to facilitate adherence and to provide IEC materials. All sites are supported to engage treatment
support specialists - PLHA who participate in patient education, client advocacy, and home visits to track
defaulters. All enrolled PLWHA will receive care services including prevention for positives activities (e.g.,
balanced ABC messaging, couples counseling), ITN, water guard, malaria diagnosis/treatment, OI
prophylaxis/diagnosis/treatment (including TMP/SMX), pain/symptom medications, and psychosocial
support including linkages to community and facility-based support groups. Home based care programs
provide linkages between the medical home and the community.
NICaB will work with civil society organizations and the affiliated CBOs to ensure effective good quality
home based care. Working with these groups, support groups will be assisted in capacity building for
counseling and adherence support, nutritional counseling, referrals and organization of community
assistance. Home based care providers will include PHC staff, infected and affected support group
members, family members of HIV positive persons and community volunteers. These providers will be
provided with in house trainings by the Civil Society network after TOT conducted for them on basic facts in
HIV, H CT, CHTC, Adherence, PMTCT, infant feeding. HBC kits will be procured by SCMS based on
National Guidelines for distribution to care givers. Insert here - Strategy for the CHBC services including
the cadre of service providers in your HBC team, the provision of training and HBC kits for the HBC service
providers.
PMTCT stand-alone points of service (POS) is linked to adult and pediatric ARV care through utilization of a
network PMTCT coordinator based at the hub site. A specific referral SOP is used to ensure that HIV+
pregnant women who require HAART for their own care are linked to an ARV POS.
CHAN NICaB uses ART expertise to ensure high quality care using a two-pronged didactic and experiential
training approach. Using expert staff from established POS as resource persons, 36 health care workers
(physicians, nurses, counselors, pharmacists) from COP08 POS will participate in central trainings on adult
and pediatric ARV care, adherence counseling, and/or pharmacy SOPs. All training will include approaches
for prevention with positives integrated into the clinic and community setting. Nationally adapted and
harmonized IMAI/Pediatrics training manuals for training various cadres will be used to step down trainings
for secondary, PHC and DOTS sites.
A clinical QA program in CHAN NICaB's training uses objective measures of health care team capacity
based on knowledge assessment of individual providers, metrics from SI analysis, and onsite observational
assessment of clinical practice and community linkages. Collaboratively with the USG and GON, CHAN
NICaB carries out site program review visits. The QA program has site level clinical QA coordinators
assigned at each POS who perform structured periodic chart reviews that are incorporated into the QA
assessment process. Site level Care service aggregate data is evaluated and feedback provided. Based on
gaps in knowledge identified the Training Department refines/updates training materials for new and
ongoing training activities. CHAN NICaB will also facilitate and actively support onsite standardized HMIS
using GON forms and National electronic platforms and will provide onsite assistance with data
management and M&E to guide quality improvement measures.
Sites are supported to carry out renovations to ensure clinic facilities are adequate and particularly that
pharmacy store and dispensing areas are able to store ARVs consistent with manufacturer guidelines.
ARVs are procured as described in the ARV drugs narrative. CHAN NICaB will partner with Clinton
Foundation and GF as appropriate to leverage resources for providing ARVs to patients. SCMS provides
pharmaceutical commodity management and ensures access to alternative first line and second line ARVs,
pediatric formulations, and wraparound services including lab monitoring and high quality clinical care.
Coordination with the FMOH to plan site targets will ensure a single comprehensive HIV care program
although there may be multiple ARV sources. Additionally, sites receive training, a standard SOP, and
emergency prophylaxis starter kits for post-exposure prophylaxis to address occupational HIV exposure of
health care workers.
CHAN NICaB services will reach adult clients referred from ART clinics and other USG implementing
partners, directly generated from communities as identified by HBC volunteers and self-referrals. All clients
will be assigned to one of three categories and provided appropriate services: 1) those who have just been
tested and are positive but without major need for medical care will be assisted to access services that
Activity Narrative: promote prevention of opportunistic infections including basic Co-trimoxazole for prevention of Opportunistic
Infections, CD4 count to monitor their status and laboratory services for OI diagnosis. Counseling will
emphasize the need to protect others; 2) those with opportunistic infections will be provided with home-
based care and supported to access medical care and routine medical tests including CD4 count; 3) those
on ART will receive intensive adherence counseling, regular home visits for monitoring and referral. All
clients will be offered adherence counseling as well as psychological and spiritual counseling. 20% of the
2836 clients to be served are estimated to require home based nursing care and will be served by home-
based care (HBC) volunteers. Following the National Palliative Care Guidance and USG PC Policy, CHAN
NICaB will provide a Basic Care Package including clinical care, prophylaxis and management of
opportunistic infections, laboratory support, counseling and adherence support, home-based care, and
active linkages between hospitals, PHCs and communities; and training of healthcare providers and
community volunteers. CHAN NICaB will continue to provide clinical services (laboratory, OI
prophylaxis/management, nutritional assessment/therapy) with Basic care kits plus at least two other
services in the domains of HBC, psychosocial, spiritual, prevention with positives (PwP) and preventive
services to all PLWHA enrolled into care.
Clinical care services will be provided at CHAN MIs ART centers and at primary health care facilities (PHC)
and will utilize both facility and outreach HBC volunteer programs involving community health extension
workers, support group members and TBAs supervised by health care providers trained under the CHAN-
NICaB project. Staff at various PHC facilities will be introduced to standardized clinical management of
AIDS related infections and the cross referral procedures to USG service sites. CHAN NICaB will enhance
the capacity of MIs, feeder PHCs and other referral facilities in communities to diagnose and treat STIs by
providing laboratory equipment such as specimen bottles, reagents, and drugs, while health workers will be
trained on syndromic management of STIs where laboratories are not available.
CHAN NICaB will support MIs and feeder PHCs and 24 NGOs/CBOs/FBOs to handle OI management,
basic laboratory and prophylaxis for PLHA. Basing on outcomes of needs assessments, CHAN NICaB will
facilitate renovation and/or refurbishment of basic laboratories at PHC; provide reagents, STI drugs and
essential drugs for treatment and prevention of opportunistic infections and other HIV/AIDS-related
complications e.g. malaria and diarrhea. Each new client will receive a self care kit consisting of ORS, ITN,
water guard, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline and gentian violet (GV). A total of
1900 kits will be distributed to newly registered clients in COP09. Water guard and other consumable
supplies will be purchased and distributed to all clients carried over from COP 08. All clients will receive
refills of water guard in the COP year.
HBC volunteers and health care providers will be given home based care kits containing outreach worker
treatment guideline manual, ORW check list, antiseptic soap, bleach, Gentian violet, unscented petroleum
jelly, Calamine lotion, disposable latex gloves, ORS sachets, mackintosh, gauze, adhesive plaster and
cotton wool. Towels. Included in the kit also are bowls. The kit also are pair of scissors, forceps, plastic
apron, crepe bandage, two exercise books , water guard for demonstration and drugs for pain relief; the
kits will be replenished to ensure constant supplies needed for first aid. To strengthen the HBC volunteer
program and improve quality of care HBC volunteers, 240 professional health care providers, mainly nurses
and community extension workers (CHEWs) and family members will be trained. PHAs will be trained to
enhance skills in advocacy and public speaking, and supported to disclose sero-status to partners and
immediate family members. Trained volunteers will offer psychological and spiritual support to PHA and
their families through group and individual counseling. Culturally appropriate methods will be adopted for
end-of-life care and bereavement services. PHA will further be supported to promote the philosophy of
"prevention for positives" to peers, especially those in discordant relationships and family members.
At the end of COP09 CHAN NICaB will be providing ART services to 2286 people, contributing to
GON/PEPFAR targets for Nigeria. The CHAN NICaB project will build the skills of at least 48 care providers
thus contributing to national sustainability plans.
The intervention will contribute to the PEPFAR care and support goal by reaching 2836 PLHA and 5672
PABA with basic care and support services. CHAN NICaB will work with stake holders at all levels to
strengthen community systems for the provision of quality care to PHA and their families and build
community capacity to deliver palliative care by training community resource persons.
This activity is linked to drugs, HCT, HVOP, OVC, HBHC, TB/HIV, PMTCT, lab, and SI. Patients on ART will
be linked to home based care and support and community and social services. TB/HIV linkages will be
strengthened; all HIV infected patients will be screened for TB using the National algorithm. CHAN NICaB
will also provide onsite assistance with data management and M&E to guide quality improvement. HCT
targeting MARPs is established proximate to ARV POS. Using a network model, linkage to ARV services for
HIV+ women identified through PMTCT and HIV-infected infants are in place. Quality lab services supported
by CHAN NICaB-facilitated lab QA program are available at comprehensive sites while manual lab methods
or specimen transport systems will be established for primary health center satellites.
Care coordinators will be placed in facilities providing ART, VCT, PMTCT and pediatric palliative care
services to register all those patients who may require HBC services and offer information on follow-up
support for PHA. Planning and review meetings will be held regularly with partners to maintain effective
referral. CHAN NICaB will collaborate with Howard University to train community pharmacists and health
care providers including CHEWs and patent medicine vendors.
ARV services are offered to HIV positive adults. Doctors, nurses, and pharmacists are targeted for training
Activity Narrative: in private-not-for profit, private-for-profit and public sectors.
EMPHASIS AREAS:
An emphasis will be placed on human capacity development through training and local organization
capacity building. It will also emphasize on community mobilization, develop sustainable community based
support system and decrease stigmatization.
Estimated amount of funding that is planned for Human Capacity Development $29,000
Table 3.3.08:
Table 3.3.09:
Pediatric care and support and early infant diagnosis have been added to this program area. There will be a
focus on intensive case finding in order to get pediatric cases to make up to 10% of total clients placed on
ART.
The Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building (NICaB) project's
strategy for pediatrics care and treatment focuses on health facility and community-based activities for HIV-
exposed and HIV-infected children (<2 years and 2-14 years) and their families (HIV-affected individuals).
The activity is aimed at extending and optimizing quality of life for HIV-infected children from the time of
diagnosis throughout the continuum of illness through provision of clinical, psychological, social, spiritual
and prevention services.
In COP09 the NICaB project, working with 12 of CHAN-supported member institutions (hospitals) and 24
community based organizations in the six states of Abia, Benue, Delta, Oyo, Sokoto and Taraba, will
provide ARV services and lab monitoring to 210 children (150 new children). In COP08 CHAN NICaB
supported ARV services at 12 sites. Under COP09 CHAN will consolidate services at these 12 sites. All
small to medium secondary level mission hospitals will be linked to 60 primary health centers (PHC) using
the hub-and-spoke model.
The CHAN NICaB COP09 activities will focus on intensive pediatric case identification by scaling up Early
Infant Diagnosis (EID) using dry blood specimens (DBS) to ensure early identification of HIV-positive
children and link them to care. Additionally, HIV testing and counseling will be incorporated into pediatric
clinic activities. Leveraging support from the Clinton Foundation for test kits and specimen transport, EID
will be available at PMTCT points of service (POS) in COP09 to improve the identification of HIV+ children
for referral to ARV services. ART will be initiated for children below one year with a CD4 of 25% and
children over two years with a CD4 of 15%. The CHAN NICaB project will collaborate with other USG
supported laboratories for DNA PCR to increase access to testing of infants using DBS specimen collection.
In addition, community-based testing of children will be carried out in the OVC program through
collaboration with identified CBOs in partnership with civil society organizations like CISNAN, NEPWHAN
and FOWAN actively involved in CHAN NICaB's care program. These organizations will identify exposed
and/or ill children and refer to the NICaB project's twelve supported sites for assessment and referral as
necessary. A systematic, coordinated approach to program linkages will be operationalized at the site and
program levels, including linkages between adult care and treatment services, pediatric care and treatment
services and OVC services. Quality monitoring will be undertaken through site visits using an existing
assessment tool and routine monitoring and evaluation indicators.
Project staff will identify children at outpatient settings (children who accompany parents to the out patient
department (OPD) and antenatal care (ANC)) who will then be counseled and tested. All children admitted
into the wards for whatever reason will be counseled and tested through provider initiated testing and
counseling. Children who are brought in for immunizations will be tested while intensifying follow-up of
exposed children by support group members and following index cases into homes to test children by
community-based partners. Such activities will contribute to initiating 150 children on ARVs and bringing an
additional 190 into care and support activities.
In line with the national guidelines, all exposed children from six weeks of life will be placed on
cotrimoxazole prophylaxis while children found eligible for ARVs will be placed on the first line pediatric
formulations according to national guidelines. Thirty-six health care workers from CHAN member
institutions (MIs) (doctors, pharmacists and nurses) will undergo a six day refresher training in pediatric ART
to sharpen their skills to identify and manage pediatric HIV clients at the health facilities, while care givers
and volunteer home-based care providers will be trained on adherence counseling to ensure that children
take their drugs on time and they are brought to the clinic when due. A pediatric focal person, identified for
each facility, will work in collaboration with the health facility coordinator to ensure that the treatment team
pays attention to pediatric issues and that all pediatric services are provided according to nationally
approved guidelines.
Currently, less than 10% of CHAN NICaB-supported ARV patients are children; this will be increased to
10% in COP09. Pediatric ARV care will be expanded to all supported CHAN member institution hospitals.
CHAN NICaB will collaborate with the GON to implement recommendations of the National Guidelines as
published in order to facilitate quality pediatric ARV care at the PHC level. CHAN NICaB staff participate
actively in National ARV Guideline Committees. National guidelines concerning pediatrics were updated in
2007 for consistency with WHO 2006 guidelines. A corresponding National ARV SOP has been developed.
These are currently being used at the sites and ensure that CHAN NICaB ARV services are in line with
GON guidelines.
Non-ART and ART eligible clients will be enrolled into care and will receive regular clinical monitoring
including CD4 counts. CHAN NICaB supports PLWHA support groups to facilitate adherence and to provide
IEC materials. All sites are supported to engage treatment support specialists (PLWHA) who participate in
patient education, client advocacy, and home visits to track defaulters. All ARV clients receive care services
including prevention with positives activities including balanced ABC messaging, couples counseling for
parents of diagnosed children, ITN, water guard, malaria diagnosis/treatment, OI
prophylaxis/diagnosis/treatment (including TMP/SMX), pain/symptom medications, and psychosocial and
spiritual support with linkages to community and facility-based support groups. Home-based care programs
provide linkages between the medical facility and the community. The basic health care package, which will
be available to all of the HIV-infected children as well as HIV-exposed infants receiving services, includes:
access to appropriate TB diagnostics and linkage with GON sponsored DOTS programs described under
TB/HIV, instruction for parents/caregivers in appropriate water purification, provision of basic care kits
(water guard, water vessels, soaps, Vaseline, latex gloves, ITNs, IEC materials, ORS) provision of
cotrimoxazole prophylaxis, diagnosis and treatment of malaria, and symptom management including
provision of pediatric formulations of antidiarrheals/antihelminthics/analgesics/antipyretics.
Activity Narrative: The NICaB project, through its partners, will support infant feeding. Nutritional counseling will be provided at
ANC, the postnatal and child welfare clinics and also in the homes by unpaid volunteer care providers and
community peer groups to support mothers. The CBOs, support group members, PHC staff and maternity
staff from NICaB's twelve supported sites will be trained in infant feeding, use of therapeutic nutritional
supplements and nutritional counseling. Mothers will be provided with all infant feeding options but
encouraged to exclusively breastfeed children for six months with safe weaning using locally available
cereals because of its proven role in improving child survival and lower rates of HIV transmission. However,
mothers that choose breast milk supplements (BMS) will be advised on using BMS that are AFASS-
Affordable, Feasible, Accessible, Available and Safe. Exposed children will be followed up with monthly
clinic visits and growth monitoring. Those found not to be thriving will be placed on ready to use therapeutic
nutritional supplements (plumpy nut) sourced from the Clinton HIV/AIDS Initiative (CHAI). NICaB will
provide infant weighing scales and growth charts to the twelve sites and the satellite PHCs. NICaB will also
collaborate with the GON and support the finalization of the National Nutrition Guidelines
Through follow-up of trained home-based care givers, all families with HIV-exposed infants and children will
be given ITNs and water guard to make drinking water safe. One-hundred and twenty religious and
community leaders, including church groups, will be trained to provide psychological, social and spiritual
services for 1,200 families. Activities in this program area for under-five children and will focus on
strengthening linkages to routine child health services such as immunization, growth monitoring and the well
child monitoring activities. Older children (aged 5 - 14 years) who require support for education, protection
and shelter will be linked up with the OVC program, while school nurses will be trained to follow up with
adolescents in schools who have been placed on ARVs. Through the NICaB CSO/CBO partnership with
communities, 190 children will receive palliative care.
training approach. Using expert staff from established points of service (POS) as resource persons, 48 staff
(physicians, nurses, counselors, pharmacists) from COP08 POS will participate in central adult and
pediatric ARV care, adherence counseling, and/or pharmacy training using the national pediatrics ARV
training curriculum in collaboration with other PEPFAR implementing partners. All training will include
approaches for prevention with positives integrated into the clinic and community setting. The nationally
harmonized treatment manuals will be used to step down trainings for secondary, PHC and DOTS sites.
Bedside teaching and clinical case discussions are also components of ongoing education.
A clinical QA program in CHAN NICaB's training uses objective measures of healthcare team capacity
assessment of clinical practice and community linkages. Apart from routine monitoring and supervisory
visits in COP09, CHAN will collaborate with the USG and the GON as CHAN NICaB carries out site
program review visits. The QA program has site level clinical QA coordinators assigned at each POS who
perform structured periodic chart reviews that are incorporated into the QA assessment process. Site level
care service aggregate data is evaluated and feedback provided. CHAN NICaB will also facilitate and
actively support onsite standardized HMIS using GON forms and national electronic platforms and will
provide onsite assistance with data management and M&E to guide quality improvement measures.
pharmacy stores and dispensing areas are able to store ARVs consistent with manufacturer guidelines.
Foundation and Global Fund when available to leverage resources for providing ARVs to patients. CHAN
NICaB provides pharmaceutical commodity management and ensures access to alternative first line and
second line ARVs, pediatric formulations, and wraparound services including lab monitoring and high quality
clinical care. Coordination with the FMOH to plan site targets will ensure a single comprehensive HIV care
program although there may be multiple ARV sources. Additionally, the twelve CHAN-NICaB- supported
sites will receive training for 60 providers, a standard SOP, and emergency prophylaxis starter kits for post-
exposure prophylaxis sources from already established programs to address occupational HIV exposure of
At the end of COP09 CHAN NICaB will be providing ART services to 150 children, contributing to
GON/PEPFAR targets for Nigeria. CHAN NICaB will build the skills of at least 70 care providers thus
contributing to national sustainability plans.
This activity is linked to drugs, HCT, other prevention, OVC, adult care and treatment, TB/HIV, PMTCT, lab,
and SI. Patients on ART will receive home-based care and support and community and social services.
TB/HIV linkages will be strengthened; all HIV infected patients will be screened for TB using the National
algorithm. CHAN NICaB will also provide onsite assistance with data management and M&E to guide
quality improvement. HCT targeting parents that are MARPs is established proximate to ARV POS. Using a
network model, linkages to ARV services for HIV-positive women identified through PMTCT and HIV-
infected infants are in place. Quality lab services supported by a CHAN NICaB-facilitated lab QA program
are available at comprehensive sites while manual lab methods or specimen transport systems will be
established for primary health center satellites.
ARV services are offered to HIV-positive infants, children and adults living with HIV/AIDS. Doctors, nurses,
and pharmacists are targeted for training in both the public and private sectors. Health workers and lab
personnel at non-PEPFAR supported sites will be targeted by offering dedicated central ARV training.
capacity building.
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $7,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,500
Table 3.3.10:
If continuing, paste your COP08 narrative here and put one of the following at the beginning of your
narrative:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Pediatric care and support and early infant
diagnosis have been added to this program area. There will be a focus on intensive case finding in order to
get pediatric cases to make up to 10% of total clients placed on ART.
This activity also relates to activities in HCT, TB/HIV, OVC and PMTCT.
strategy for pediatrics care and treatment focuses on health facility and community based activities for HIV
exposed and HIV-infected children (<2 years and 2-14 years) and their families (HIV-affected individuals)
aimed at extending and optimizing quality of life for HIV-infected children from the time of diagnosis
throughout the continuum of illness, through provision of clinical, psychological, social, spiritual and
prevention services.
In COP 09 the NICaB project, working with 12 of CHAN's member institutions (hospitals) and 24 community
based organizations in the six states of Abia, Benue, Delta, Oyo, Sokoto and Taraba, will provide ARV
services and lab monitoring to 210 children (150 new). In COP08 CHAN NICaB supported ARV services at
12 sites and under COP09 will consolidate services at these 12 sites: all medium - small secondary level
mission hospitals which will be linked to 60 primary health centers (PHC) using the hub-and-spoke model.
Infant Diagnosis (EIDs) using dry blood specimens (DBS) to ensure early identification of HIV positive
children and linking them up to care and incorporating testing and counseling into pediatric clinic activities.
Leveraging support from the Clinton Foundation for test kits and specimen transport, EID will be available at
PMTCT points of service (POS) in COP09 to improve the identification of HIV+ children for linkage into ARV
services. ART will be initiated for children below one year with CD4% of 25% and children over two years
with CD4% of 15%. The CHAN NICaB project will collaborate with other USG supported laboratories for
DNA PCR to increase access to testing of infants using dried blood spot (DBS) specimen collection. In
addition, community based testing of children will be carried out in the OVC program through collaboration
with identified CBOs in partnership with Civil Society Organizations like CISNAN, NEPWHAN and FOWAN
actively involved in CHAN NICaB's Care and Support program. These organizations will identify exposed
and/or ill children and refer to the NICaB's twelve program sites for assessment and referral as necessary.
A systematic coordinated approach to program linkage will be operationalized at the site level and program
level including linkages to adult and pediatric ART services, OVC services and basic care and support to
ensure EID. Quality monitoring will be undertaken through site visits using an existing assessment tool and
routine monitoring and evaluation indicators.
Additionally, the project will identify children at outpatient settings [children who accompany parents to the
out patient department (OPD) and antenatal care (ANC)] will be counseled and tested, all children admitted
counseling. Children who are brought for immunization will be tested while intensifying follow up of exposed
children by support group members and following index cases into homes to test children by community
based partners. All of these will contribute to starting 150 children on ARVs and bringing an additional 190
into care and support activities.
formulations, a combination of 2 NRTI and 1 NNRTI, specifically ZDV, 3TC and NVP with alternate
regimens. Thirty-six Health care workers from CHAN member institutions (MIs) (doctors, pharmacists and
nurses) will undergo a 6-day refresher training in pediatric ART to sharpen their skills to identify and
manage pediatric HIV clients at the health facilities, while care givers and volunteer home based care
providers will be trained on adherence counseling to ensure that children take their drugs on time and they
are brought to the clinic when due. A pediatric focal person, identified for each facility will work in
collaboration with the health facility coordinator to ensure that the treatment team pays attention to pediatric
issues and that all pediatric services are provided according to nationally approved guidelines.
CHAN NICaB will collaborate with GON to implement recommendations of the National Guidelines as
actively in National ARV Guideline Committees. Guidelines pediatrics were updated in 2007 for consistency
with WHO 2006 guidelines. A corresponding National ARV SOP has been developed. These are currently
being used at the sites and ensure that CHAN NICaB ARV services are in line with GON guidelines. Non-
ART and ART eligible clients will be enrolled into care and will receive regular clinical monitoring including
CD4 count. CHAN NICaB supports PLHA support groups to facilitate adherence and to provide IEC
materials. All sites are supported to engage treatment support specialists - PLHA who participate in patient
education, client advocacy, and home visits to track defaulters. All ARV clients receive care services
including prevention for positives activities including balanced ABC messaging, couples counseling for
prophylaxis/diagnosis/treatment (including TMP/SMX), pain/symptom medications, and psychosocial &
spiritual support with linkages to community and facility-based support groups. Home based care programs
provide linkages between the medical facility and the community.
The basic health care package which will be available to all of the HIV-infected children as well as HIV-
exposed infants receiving services includes: access to appropriate TB diagnostics and linkage with GON
sponsored DOTS programs described under TB/HIV, instruction for parents/caregivers in appropriate water
purification and provision of Basic care kits (water guard, water vessels, soaps, Vaseline, latex gloves,
ITNs, IEC materials, ORS) provision of cotrimoxazole prophylaxis, diagnosis and treatment of malaria, and
symptom management including provision of pediatric formulations of antidiarrheals/ antihelminthics/
analgesics/ antipyretics.
Activity Narrative: The NICaB project through its partners will support infant feeding. Nutritional counseling will be provided at
community peer groups to support mothers. The CBO's involved and support group members , PHC staff
and maternity staff from NICaB's twelve sites will be trained in infant feeding, use of therapeutic nutritional
supplements and nutritional counseling. Mother will be provided with all infant feeding options but
Affordable, Feasible, Accessible, Available and Safe. Exposed children will be followed up during monthly
clinic visits through growth monitoring, and those found not to be thriving will be placed on ready to use
therapeutic nutritional supplements (plumpy nuts) sourced from the Clinton HIV/AIDS Initiative (CHAI).
NICaB will provide infant weighing scales and growth charts to the twelve sites and the satellite PHCs.
NICaB will also collaborate with the GON and support the finalization of of the National Nutrition Guidelines
Through follow up of trained home based care givers, all families with HIV-exposed infants and children will
be given ITN and water guard to make drinking water safe. 120 religious and community leaders from
church men and women groups, will be trained to provide psychological, social and spiritual services for
1200 families. Activities in this program area for under-five children will focus on strengthening linkages to
routine child health services such as immunization, growth monitoring and the well child monitoring
activities. Older children (aged 5 - 14years) who require support for education, protection and shelter will be
linked up with the OVC program while school nurses will be trained to follow up adolescents in schools who
have been placed on ARVs. Through the NICaB CSO/CBO partnership with communities, 190 children will
receive palliative care.
training approach. Using expert staff from established POS as resource persons, 48 staff (physicians,
nurses, counselors, pharmacists) from COP08 POS will participate in central adult and pediatric ARV care,
adherence counseling, and/or pharmacy training using the National pediatrics ARV training curriculum in
collaboration with other PEPFAR Implementing Partners. All training will include approaches for prevention
for positives integrated into the clinic and community setting. The nationally harmonized treatment manuals
will be used to step down trainings for secondary, PHC and DOTS sites. Bedside teaching and clinical case
discussions are also components of ongoing education.
visits in COP 09, CHAN will collaborate with the USG and GON, CHAN NICaB carries out site program
review visits. The QA program has site level clinical QA coordinators assigned at each POS who perform
structured periodic chart reviews that are incorporated into the QA assessment process. Site level care
services aggregate data is evaluated and feedback provided. CHAN NICaB will also facilitate and actively
support onsite standardized HMIS using GON forms and National electronic platforms and will provide
onsite assistance with data management and M&E to guide quality improvement measures.
Foundation and GF as appropriate to leverage resources for providing ARVs to patients. In this scenario,
CHAN NICaB provides pharmaceutical commodity management and ensures access to alternative first line
and second line ARVs, pediatric formulations, and wraparound services including lab monitoring and high
quality clinical care. Coordination with the FMOH to plan site targets will ensure a single comprehensive HIV
care program although there may be multiple ARV sources. Additionally, the twelve CHAN-NICaB sites will
receive training for 60 providers, a standard SOP, and emergency prophylaxis starter kits for post-exposure
prophylaxis source from already established programs to address occupational HIV exposure of health care
workers.
At the end of COP 09 CHAN NICaB will be providing ART services to 150 children, contributing to
This activity is linked to drugs (HTXS), HCT (HVCT), HVOP, OVC (HOVC), HBHC (), TB/HIV (HVTB),
PMTCT, lab (HLAB), and M&E. Patients on ART will be linked to home based care and support and
community and social services. TB/HIV linkages will be strengthened; all HIV infected patients will be
screened for TB using the National algorithm. CHAN NICaB will also provide onsite assistance with data
management and M&E to guide quality improvement. HCT targeting parents that are MARPs is established
proximate to ARV POS. Using a network model, linkage to ARV services for HIV+ women identified through
PMTCT and HIV-infected infants are in place. Quality lab services supported by a CHAN NICaB-facilitated
lab QA program are available at comprehensive sites while manual lab methods or specimen transport
systems will be established for primary health center satellites.
ARV services are offered to HIV positive infants, children and adults living with HIV/AIDS. Doctors, nurses,
Table 3.3.11:
ACTIVITY UNCHANGED FROM COP08
In COP08 the Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building (NICaB)
project supports integrated TB/HIV services at 12 CHAN member institution sites and will consolidate
TB/HIV integration at these sites in COP09. Structured under a hub and spoke network model, TB DOTS
sites will be supported to provide HCT services for TB patients for a total of 12 sites in 6 states of Abia,
Benue, Delta, Oyo, Sokoto and Taraba in COP09.
The integrated management of HIV/TB co-infected patients at CHAN NICaB points of service (POS) will
remain a major focus. TB screening and diagnosis follows the national algorithm and is in line with national
guidelines. At ARV points of service (POS), patient record forms have been modified to prompt for TB
screening indicators and site level training of health workers is on utilization of symptom history including
chronic cough, fever, weight loss, or night sweats to prompt referral for TB evaluation. Eligible TB/HIV
patients will also receive Cotrimaxozole Preventive Therapy (CPT). The TB DOTS sites will be supported to
provide holistic patient care according to National and IMAI guidelines. In addition, HIVQUAL will be utilized
as a clinical quality indicator and improvement strategy at sites.
Under COP09, CHAN NICaB will support HCT for 400 clients being evaluated for TB at
12 DOTS points of service. These will be mainly DOTS centers at comprehensive care sites. Of these, it is
expected that 130 of those getting HCT will have TB. CHAN NICaB will reach a total of 130 TB/HIV co-
infected patients with TB treatment. Infection control at health centers is a priority to limit nosocomial
transmission of TB to HIV+ patients. Basic hygiene, proper sputum disposal, and good cross ventilation at
clinics will be promoted. Facility co-location of TB/HIV services is preferred to clinic co-location. National
guidelines on infection control for co-located sites will be implemented at all sites.
In COP09, DOTS staff at targeted centers will be trained on the National testing
algorithm using the National HCT training curriculum. Training will be conducted by
CHAN NICaB program staff. In line with provider initiated testing and counseling policy, all clients
presenting to DOTS centers will receive HIV pre and posttest counseling with rapid testing carried out using
an opt-out approach to provide same day results. Those testing HIV+ will be referred for further evaluation
and care to an ARV point of service within the network. CHAN NICaB hospital coordinators and other
program staff will ensure referral linkage for DOTS stand alone sites.
A minimum of 24 TB DOTS staff from CHAN NICaB will be trained in HCT in a TB setting and refresher
trained in smear microscopy. Twelve senior site physicians will be trained in a training of trainers focusing
on diagnosis and management of TB/HIV co-infection. They will each train a minimum of 5 health care
workers at their respective sites for an indirect target of 60.
CHAN NICaB will also work with SCMS in country to procure equipment and supplies.
Commodity management of HIV test kits and supplies will be provided by CHAN Medipharm in collaboration
with SCMS using the current CHAN NICaB distribution system. CHAN NICaB will upgrade facilities through
infrastructure support such as basic renovations, upgrading equipment and procuring supplies and
consumables. In collaboration with SCMS, CHAN NICaB will strengthen the pharmacy services at
supported TB DOTS sites to improve forecasting and avoid stock outs and will work with sites to determine
if stock outs are due to facility level or government level TB logistics issues.
Training and support to improve the quality and integration of TB/HIV services are consistent with Federal
Ministry of Health (FMOH) and PEPFAR priorities. Activities will be carried out collaboratively with FMOH
and state MOH to promote sustainability through capacity development and integration into the health
sector system. COP09 activities will focus on sustainability of the national training program and the national
model facility for laboratory diagnosis and clinical care with a decreasing dependence upon CHAN NICaB
technical expertise.
HCT targets in this section are not included in the testing target in the HCT narrative and
those in the HCT narrative do not overlap with these targets. This activity is linked to
HCT, Adult ART, Care and Support, Pediatric Care & Support, OVC and ARV services, lab, and SI. CHAN
NICAB will expand HIV treatment access to community venues including DOTS centers, an approach that
will also strengthen treatment adherence for both TB and HIV and articulate TB and ARV services to
promote seamless transition from TB to HIV treatment and care. Linkage to TB diagnosis and treatment is
an important component of adult BC&S and OVC services. Linkage to ARV services and proper
management of patients requiring ARV and TB medications is a focus.
TARGET POPULATIONS:
Persons at risk, including household members of known patients, people who have documented TB, OVC,
pregnant women and PLHA are targeted. Screening of close household members for
both HIV and TB will promote a public health strategy reaching populations at risk with diagnosis and
services. ARV services are offered to HIV+ infants/children and adults with TB. Doctors, nurses, laboratory
workers community outreach workers, GON staff, and DOTS staff are targeted for training in mission and
private-for-profit health facilities.
Emphasis areas include construction and renovation, human capacity development, capacity building of
local organizations, and TB related wraparound programs. This activity focuses on the issue of wraparound
as the activity relies upon non-PEPFAR TB funding and promotes linkage with HIV-specific programs to
ensure that comprehensive services are available to TB/HIV co-infected persons.
Table 3.3.12:
This activity also relates to activities in HVAB, HBHC, HVTB, HVCT, HTXS, PDCS and HLAB.
In COP09, the Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building
(NICaB) project will provide OVC services through a comprehensive package of care to 83 children at a
minimum of 2 sites, one each in Abia and Benue States. This will include 50 HIV-infected children and 33
uninfected OVC who will be directly provided with three core OVC services of health care, food/nutrition,
and psychosocial support and linked to a community OVC provider in each of the 2 networks to ensure
access to the other core OVC services of shelter & care, protection, and education. CHAN NICaB will give
priority to MARP of children such as girls in child labor, girl street hawkers, almajiris in the North and street
boys in the South East. Data will be disaggregated by sex and age.
Children (0 - 4 yr. Olds) and/or their guardians will receive safe water kits, growth monitoring, counseling on
routine immunization protocols, CT for HIV, birth registration, nutritional counseling, prevention and
treatment of OIs, and malaria services. The 5 - 17 yr. olds will receive CT for HIV, nutritional assessments
and counseling, AIDS education and ongoing counseling. In addition, HIV-positive OVC will be assisted to
access ART, OI diagnosis and treatment (including for STIs), and malaria prevention and treatment services
at our comprehensive sites. They will also receive preventive kits. CHAN NICaB will provide nutrition
support to families as needed. An OVC will be considered served when he/she receives the 3 services as
recorded during an assessment, following the nationally approved plan of action and guidelines, including
the National OVC Vulnerability and child status indices.
Community and home-based care (CHBC) for children isstill in need of extensive development in Nigeria. In
COP09, CHAN NICaB will support a community OVC provider (CBO/NGO/FBO) in each of the 2 states who
will provide core OVC services for children within the Network. These organizations will work with
volunteers and community health extension workers (CHEWs) to reach OVC in homes and communities,
maintaining stability, care, and protection. CHAN NICaB will work at extant structures within CHAN NICaB
pediatric and care and treatment and collaborate with OVC stakeholders at all levels - the Federal Ministry
of Women Affairs and Social Development, their State counterparts, and other USG IPs - and contribute to
sustainability by expanding community resources to improve quality care for OVCs. The Network Nurse
Coordinator will link all enrolled OVCs/children to receive pediatric specific CHBC and other core services.
He/She will also supervise the Community health extension workers and volunteers. This activity will be
linked to primary prevention and HCT programs emphasizing the home-based approach to ensure that
family members at risk including other children in the household are tested and counseled. This strategy
supports family engagement in HBC and identifies family members in need of HIV care. In addition to HBC
for those children requiring classic "palliative care" interventions, home-based care staff support parents
with ART adherence for children in the home setting through education and addressing adherence barriers.
Home based care staff focus on linkages to services, ensuring that clients in need of hospital care are able
to access this care and linking family members to PMTCT, community immunization, family planning, and
TB DOTS services. CHAN NICaB will continue to utilize different models depending upon the site
preference including supplementing site staffing with dedicated home based care staff or developing
agreements with local NGOs/CBOs/FBOs to provide this service. Extension workers will be preferentially
recruited from the PLHA support group membership. HBC will be linked to the child's medical care source,
as the supervising community home based care nurse/PHC extension worker will work under the medical
direction of the site physician.
Access to food and nutrition support is a major need for children. Leveraging support from the Clinton
Foundation, CHAN NICaB will provide comprehensive nutritional support for OVCs through the provision of
fortified cereals and PlumpyNut, targeting HIV-infected children as well as HIV-exposed infants weaning
after exclusive breastfeeding. This will include nutritional assessment and counseling at the facility.
Additionally CHAN NICaB will build the capacity of caregivers by providing instructions and demonstrations
on how they can prepare Kwashi-pap at home. CHAN NICaB will prioritize partnering with new USG-
supported wraparound services in states where it is co-located with these activities.
CHAN NICaB will strengthen psychosocial support for children by improving the quality of counseling
available for HIV-infected children at points of service through training focused on counseling of children. In
COP09 CHAN NICaB will expand this training curriculum by adapting a pediatric specific adherence SOP
for use at facility and community levels. This curriculum includes formal child development, socialization,
limit setting, pediatric counseling, diagnosis disclosure, grief and loss, and adherence to medications. In
addition to HIV-infected children and HIV-exposed infants, CHAN NICaB's partnership with community OVC
providers in the 2 networks will enhance provision of core OVC services including: shelter and care,
protection, education/vocational training, and economic opportunities/strengthening to OVCs in their homes
and those in orphanages/motherless babies homes. Other services to be provided include community
based HCT in order to identify HIV positive children who need to be enrolled into care, as well as the
identification and linkage of MARPS to core OVC services. Access, referral, defaulter tracking, monitoring
will be accomplished and supervised by the Health Facility Coordinator. Identification of other resources in
the communities will be a joint collaboration of the community OVC provider and the Health Facility
Coordinator.
CHAN NICaB will support one centralized training for the 2 Health Facility Coordinators on Pediatric ART
care, treatment and support, pediatric specific CHBC, OVC core services, adherence SOP etc. CHAN
NICaB will also support 2 site-based trainings for the Community OVC providers in healthcare for HIV
exposed and infected children, adherence support and linkage to care, stigma surrounding HIV-positive
children and the need to integrate healthy HIV positive children into mainstream social and school settings.
This training will target a total of 8 volunteers per network, reaching a total of 16 trained providers.
This activity provides services which are a high priority for the 2-7-10 Emergency Plan strategy by providing
core OVC services to all HIV-positive children. The services are consistent with the National OVC Standard
of Practice and OVC National Plan of Action. Capacity development at the site level and consistency with
national guidelines will ensure sustainability. Capacity development will be achieved through regional
Activity Narrative: training and skills development.
This activity is linked to HCT, ARV services, TB/HIV, AB, lab, and SI. HCT services will be available to HIV
affected family members (PABAs) in need of HIV testing including in-home HCT through HBC services. All
patients are monitored and linked to ARV therapy when indicated. OVC services such as psychosocial
support for families and symptom management promotes ARV adherence. Home based care programs will
be implemented by a number of indigenous NGOs, CBOs and FBOs. Sub-agreements will be coordinated
with other PEPFAR-supported IPs to ensure non-overlap of funding and services. Services are co-located
with TB DOTS centers and CHAN NICaB staff work with sites to ensure coordination systems are in place.
High quality laboratory services supported by a CHAN NICaB facilitated laboratory QA program are
available at sites. CHAN NICaB will refer for wrap around activities - social services, food and livelihood
opportunities. Girl-headed households will be linked with supportive women's groups to provide them with
psychosocial support and protection. Follow-up support supervision will be provided. At each site, CHAN
NICaB activities will strengthen linkages to AB and OP prevention activities as integral parts of home-based
care for OVC offered by care givers. Those linkages already established will be strengthened with TB/HIV
intervention programs, PMTCT services, USG-funded immunization projects and child welfare services.
OVC services are offered to HIV positive infants and children, children orphaned by HIV, caregivers of OVC
and HIV/AIDS affected families. Doctors, nurses, social workers, care givers, teachers, family members and
other health workers in the public and private sector are targeted for training. Community groups including
CBOs, NGOs and FBOs will be targeted for training, linkages and identifying OVCs.
Emphasis is placed on training and human resources as capacity development for sustainability is a key
focus and much of the community linkages are through partners. In addition, community mobilization and
infrastructure development of CBOs/FBOs is critical for the identification and care of OVC.
This activity addresses the area of wraparounds as activities will strengthen/develop linkages between
HIV/AIDS services and other sectors for food resources. The activity also addresses the key area of stigma
and discrimination as training of health care workers and community volunteers will reduce stigma.
Estimated amount of funding that is planned for Human Capacity Development $1,200
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $400
Estimated amount of funding that is planned for Food and Nutrition: Commodities $400
Table 3.3.13:
ACTIVITY UNCHANGED FROM FY2008
The Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building (NICaB) project
will provide Counseling & Testing (HCT) services to 2,500 in COP09. HCT services will be supported at 12
CHAN member institutions and 24 standalone HCT sites, for a total of 36 service outlets in 6 states of Abia,
Benue, Delta, Oyo, Sokoto and Taraba. The CHAN NICaB project will collaborate with non-governmental,
community and faith based organizations (NGOs/CBOs/FBOs) to offer testing to most at risk persons
(MARPs) using a mobile strategy linking HCT to Condoms and Other Prevention (C&OP) activities. The
NICaB will be working with the following categories of most at risk populations: migrant workers, young
persons in and out of school, as well as commercial sex workers. The HCT site and community level
activities will stress: (1) providing technical assistance, particularly in identifying and reaching the MARP
groups listed above, 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.
HCT services will be provided by trained counselors using the national testing algorithm, which in this case
is the serial algorithm and opt-out approach in accordance with the national HCT standard operating
procedure (SOP) and testing strategy. The national "Heart to Heart" branding logo will be utilized at all
Points of Service (POS). Counseling and information, education, and communication (IEC) materials will
focus on abstinence, be faithful, and consistent and correct condom use (ABC). In addition, IEC materials
will include information promoting couples counseling and counselors will be trained on partner-based
approaches to counseling. Discordant couples will receive a package of services including safer sex
behavior messages, condoms and information targeting both positive and negative partners. This activity
will be linked to prevention with positives (PwP) as detailed in the adult ART and Care and Support
narrative. Whenever feasible, client witnessed testing will be carried out to encourage client confidence in
the result. As a result of the ongoing intensive advocacy for implementation of HIV testing by non-lab
personnel, thus counselors will continue to carry out rapid tests in most settings. To ensure the quality of
test results, laboratory personnel will assist with training. Additionally, a QA program focused on rapid test
monitoring is in place. Prevalence will be monitored regularly to optimize targeted screening of populations
with high rates of infection.
Post-test counseling for those who test negative will focus on prevention using a balanced ABC approach,
and partner testing will be encouraged. Based on risk assessment, a follow-up testing interval will be
recommended. Post-test counseling for those who test positive will include PwP counseling which also
includes balanced ABC messaging as appropriate. Counselors are trained to encourage disclosure to
spouse and sexual partners while addressing potential negative consequences of such disclosure. PLWHA
treatment support specialists will be engaged at ART treatment sites to ease the referral and linkages for
newly diagnosed clients. Newly identified HIV positive clients at free standing or community based HCT
centers will be linked to HIV care centers in the network.
Hospital-based HCT services will be provided in all CHAN member institutions supported by CHAN NICaB
and feeder primary health facilities. The CHAN NICaB project will promote innovative and varied
approaches like Provider Initiated HIV Testing and Counseling (PITC) to enhance uptake of services. PITC
with opt-out option for individuals who specifically decline testing will be encouraged to ensure early
diagnosis of HIV infection and increase access to a high proportion of people in the health facilities who are
unaware of their status. The initiative will be encouraged under the condition of informed consent,
confidentiality, and counseling in all hospital departments (Out Patient Department, ANC, inpatients, TB
clinic and STI clinic). The HIV counseling and testing services will be provided in the TB clinics as part of
the normal standard of care to clients in those clinics being investigated for TB infection. Screening of HIV-
positive clients for TB will be encouraged and reinforced. Also as part of the PITC, patients in the
STI/Sexual Health Clinics will be counseled and diagnosed for HIV with an opt-out option. NICaB will focus
on HIV-positive adults; they will be encouraged to propose HCT to their partners or identify them for
possible follow up and partner disclosure under acceptable atmosphere. Index cases will also be followed
up with the client's permission to ensure that all members of the family are offered counseling and testing
including children. Couples counseling and testing will be emphasized to minimize conflict, issues of blame,
and violence at home. Priests and pastors in the targeted communities will be trained to mobilize the
community to access and promote voluntary counseling and testing of couples preparing for marriage and
to address stigma, fear and discrimination, which are major obstacles to accepting HIV testing. For those
health facilities providing blood transfusion services, all potential blood donors will be offered HCT at the
facility and receive standard HCT services as part of pre-donation screening. In addition, HCT staff will
support DOTS center staff in the provision of HCT services to patients presenting for evaluation as detailed
in the TB/HIV narrative.
Community based mobile HCT services will be expanded, with support to non-governmental, community,
and faith based organizations (NGOs/CBOs/FBOs) to conduct outreach activities to remote villages on
market days and solidarity days like the World AIDS Day. Home based care teams from collaborating
community based organizations will be supported to provide counseling and testing in homes. These
community based HCT teams will link HIV positive patients identified to treatment, care and support.
Monitoring and evaluation (M&E) staff will compile data on rates by target population and venue and use the
data to guide systematic screening strategies. Additionally, in order to increase access to HCT outside of
facilities, home-based care (HBC) teams will be trained and equipped to provide home-based HCT to family
members of HIV positive HBC clients. Those who test HIV positive will be linked to care within the network.
MARPs who test HIV negative will be linked to condoms and other prevention (C&OP) services offering
education, counseling, social support, and syndromic STI management. Additionally, all HCT clients will be
screened for TB and STIs using standard questionnaires and referrals made to TB and/or STI clinics linked
to the sites.
The standard National M&E and data collection tools will be used for data collection and service
implementation monitoring. The M&E system will be primarily ledger based to maximize time devoted to
service provision and facilitate services in the primary health center and community mobile settings.
Activity Narrative: Aggregate data will be reported to the CHAN zonal coordinator and the M&E specialist on a monthly basis.
A referral tracking system for HIV-positive clients has been developed and will be utilized. The quality
assurance (QA) strategy for counseling will include post-test client surveys, quarterly site monitoring visits
using an existing quality assessment tool, and routine reviewing of M&E data. A measure of the QA process
will be the percentage of positives entering care. Feedback to sites will occur quarterly with targeted
refresher courses and TA for those needing capacity building. An extensive laboratory QA program
(described under lab program area) is in place to ensure the accuracy of HIV rapid testing. Test kits and
disposables will be warehoused by CHAN Medipharm and provided to sites based on a pull system using
site level inventory control systems linked to the CHAN NICaB's logistics management information system
which has been harmonized with the national test kit logistics management information system and
inventory control system.
In COP09, a total of 24 staff from 12 COP09 sites will undergo refresher trainings. New staff who had not
been trained before then will receive the complete HCT training using the National HCT training curricula
and standard operating procedures (SOPs). Training will target staff from existing sites, ensuring that
refresher training is provided and couples counseling is integrated at all sites. A minimum of 2 staff from
each of the 12 HCT points of service (POS) will be trained for a direct target of 24. This target will include a
refresher for 12 Master Trainers from the NICaB comprehensive sites. They will conduct step-down
trainings to reach at least 2 additional counselors from each of the 24 PHC feeder sites that will be providing
HCT for a total target of 48. Training to facilitate the provision of HCT at DOTS POS is described under the
TB/HIV program area.
This activity supports the national HCT scale up plan by promoting the accessibility of HCT services using a
FMOH approved training curriculum and procedures. HCT services are essential to identifying HIV positive
people to meet national prevention goals and the national ARV/HIV care scale-up goals. HCT services will
target most at risk persons to maximize this impact. The activity will support the FMOH and emergency plan
goal of having high quality HIV testing available at all sites.
This activity is linked to care and support, OVC, ARV services, condoms & other prevention, AB, lab and SI.
Prevention with positives (PwP) counseling and a prevention care package will be integrated with post-test
counseling for HIV positive persons. Access to care services and ARV services will be provided. Other at
risk family members including vulnerable children will be identified through community based HCT
approaches and referred to services. In appropriate settings, testing will be carried out by counselors with
training and oversight by the CHAN NICaB project laboratory staff. HCT sites are incorporated into the
laboratory QA program to ensure that HIV testing is of high quality.
This activity serves children, youth and adults in the general population who will be offered HCT. However,
special focus will be given to MARPs, including discordant couples, mobile populations, commercial sex
workers and their partners/clients and those who abuse alcohol and other substances. Training targets
health care workers, counselors and community volunteers.
An emphasis for this activity is human capacity development. Other areas of emphasis include local
organization capacity building and SI. This activity addresses the issue of stigma and discrimination since
HIV counseling reduces stigma associated with HIV status through education.
New/Continuing Activity: Continuing Activity
Continuing Activity: 21708
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21708 21708.08 U.S. Agency for Christian Health 9408 9408.08 USAID Track $165,161
International Association of 2.0 CHAN
Development Nigeria
Estimated amount of funding that is planned for Human Capacity Development $5,300
Table 3.3.14:
In COP09 ARV drugs will be procured so that ARV treatment can be provided to 2263 adults (1350 new)
and 226 children (150 new) at 12 clinical sites in 6 states of Abia, Benue, Delta, Oyo, Sokoto and Taraba
chosen consistent with the National ARV Scale-Up Plan with the goal of universal access.
This activity has several components. The first component of this activity includes forecasting and
procurement of ARV drugs.
It is estimated that 90% of patients begun on emergency program (EP)-provided ARVs will be adults and
the remaining 10% will be children. Patients on ARVs include those started on ARVs in prior years, patients
in care who roll over into treatment, and newly diagnosed patients needing ART. Overall, it is assumed
that .5% of both adults and children begun on ARVs during prior years will ultimately require second line
treatment under COP09. The CHAN NICaB project will follow the Nigerian Treatment Guidelines in the
provision of ARV regimens for adults and children. The regimen mix has been forecasted based on current
utilization and balancing best clinical evidence with scalability. For adults the NICaB project will use
Zidovudine, Lamivudine and Nevirapine as first line with Tenofovir, Emtricitabine and Efavirenz as alternate
first line drugs and Didanosine, Abacavir and Lopinavir/Ritonavir as second line drugs. The children
regimen will include Zidovudine, Lamivudine and Niverapine or Efavirenz as first line drugs and Abacavir,
Didanosine and Lolinavir/Ritonavir or Nelfinavir as second line drugs. All drug orders are based on
projections of patient numbers as determined by annual forecast conducted in August 2008 in conjunction
with SCMS.
In COP09 all of NICaB's ARV procurement will be done by SCMS in order to provide support to efforts of
building a centralized capacity related to drug procurement. All purchases of Truvada (TDF/FTC) and ZDV-
3TC-NVP Fixed Dose Combination will be bought via SCMS centrally pooled procurement mechanism in
line with OGAC's guidelines. SCMS inspects drugs for authenticity and test selected batches prior to
accepting for shipping. SCMS certify packaging and storage conditions during shipping and provide
insurance to the point of delivery at the port. Drug procurement will follow USG, FDA regulations and
comply with requirements for NAFDAC registration or will be part of the USG obtained importation waiver.
FDA-approved and tentatively approved generic formulations will be utilized whenever available. For all
regimens, a four-month buffer stock is maintained to minimize the likelihood of problems with drug supplies.
The second component of this activity includes expediting commodities through the port of entry, followed
by storage, distribution, and management of the commodities. CHAN Medipharm will do the warehousing
and distribution as well as maintenance of a site level commodities management system, and instruction to
site staff regarding the system. CHAN Medipharm documents proper storage conditions at the central
warehouse and at site levels. CHAN NICaB will conduct site assessment of pharmacies and storage
facilities, will renovate pharmacies for proper security and storage conditions where necessary. Training of
site pharmacists for drug commodity management using a computer or card-based inventory control system
at the site level and training in proper drug storage will be carried out by SCMS. With an expansion of ARV
access to community venues including mobile clinics, local health centers, DOTS centers, and community
pharmacies, logistical management of ARV drugs will require increasingly sophisticated monitoring
strategies. The success of such approaches is vital to increasing adherence and avoiding patient default
which program evaluations have shown is often linked to distance traveled from home to the ARV center.
The CHAN NICaB project will continue leveraging resources from other stakeholders. Although
collaboration with the FMOH may facilitate some sites being provided with first line ARV formulations
through Global Fund support, the full cost of ARV drugs required to care for new and maintenance of ARV
patients has been budgeted in the COP09 at this time. Should FMOH be able to provide first line ARV
formulations, targets will be adjusted accordingly, and CHAN NICaB will ensure access to alternative first
line and second line ARVs, pediatric formulations, and wrap around services including lab monitoring.
Similarly, collaborations with the Clinton Foundation will result in obtaining pediatric formulations and
second line adult ARVs. Coordination with the FMOH to plan site targets will ensure a single comprehensive
HIV care program although there may be multiple ARV sources. The key principle adopted by CHAN NICaB
is that all patients receive equal high quality clinical, laboratory, and community services regardless of the
drug source.
Quality control involves routine monitoring visits by SCMS and CHAN NICaB staff from Abuja office to all
sites every six months to review the implementation of SOPs and to compare reported usage based on
monitoring and evaluation data with local manifests and pharmacy logs. SCMS and the CHAN NICaB
training coordinator and M&E specialist analyze data for patterns in order to improve training.
This activity supports the scale up of ARV treatment in Nigeria, a major priority for the FMOH. Through
these activities, CHAN NICaB will continue to strengthen the structure of its ARV drug procurement system,
in accordance with PEPFAR goals in order to ensure cost effective and accountable mechanisms for drug
procurement and distribution. Furthermore, efforts to build local capacity through infrastructure building and
training mechanisms are consistent with PEPFAR goals to enhance the capacity of supply chain
management systems to respond to rapid treatment scale-up. Additionally, through procurement via SCMS,
CHAN NICaB seeks to provide support to efforts to harmonize drug procurement and distribution. This
activity also supports the ARV program for adults and children as well as the PMTCT program for provision
of ARVs to pregnant women and infants.
This activity relates to activities in TB/HIV, ART services, and strategic information. This activity will
maintain significant linkages with PMTCT and ART services through the procurement of ARV drugs for
individuals served by these programs. Additionally, linkages to TB/HIV activities will be developed and
Activity Narrative: maintained. The supply chain management system will serve to provide drugs to ART sites that are
providing TB services in conjunction with ART services. SI activities will provide crucial information for M&E
as well as efficacy of the drug regimens, which may impact drug procurement decision-making.
The primary targets of these activities are health care workers, including program managers doctors,
nurses, and pharmacists who are involved in the drug procurement and distribution process. Furthermore,
by building mechanisms for drug procurement, these activities seek to target PLHA, both adults and
children, who are in need of or already receiving ART care.
Human capacity development is an emphasis area. Training initiatives have been incorporated into these
activities in order to build the local human resource capacity to manage a sustainable drug procurement and
distribution system.
Table 3.3.15:
The Christian Health Association of Nigeria (CHAN) Nigeria Indigenous Capacity Building Project (NICaB)
will support ARV Services, adult and pediatric care and treatment, orphans and vulnerable children (OVC),
TB/HIV, prevention of mother-to-child transmission (PMTCT), and HIV counseling and testing (HCT)
programs by building lab infrastructure and training staff to accurately diagnose, stage and monitor patients.
CHAN NICaB will monitor laboratories through its QA/QC activities to ensure high quality results while
upgrading the infrastructure at new sites. A minimum of 10,363 lab tests will be performed in COP09.
CHAN NICaB will support lab services at 12 individual points of service in 6 states of Abia, Benue, Delta,
Oyo, Sokoto and Taraba, using a network model to provide appropriate lab capacity and patient support at
comprehensive sites as well as HCT stand alone and DOTS sites. An integrated tiered referral lab network
with mentoring by trained lab personnel in existing hub sites has been established. This includes the use of
appropriate technology at all service levels, using the USG-PEPFAR lab technical working group (TWG)
equipment platform as a guide. At medium secondary CHAN member institution hospitals, 12 network
reference or hub labs provide high output hemogram, clinical chemistry, and CD4 assessment services. At
other sites where ARV services will be provided, labs are equipped to provide HIV rapid testing and
hemogram (including lymphocyte count) services, and collect/package samples for transport to a more
advanced lab in their network. Services at stand alone HCT sites and TB DOTS points of service are limited
to HIV rapid testing. This approach facilitates the rapid scale up of ART services at all tiers of health care
facilities.
CHAN NICaB has an aggressive QA/QC program with specially trained site lab staff dedicated to carrying
out on-site quarterly monitoring, retraining, and overseeing a proficiency panel testing program. In COP09,
90 individuals will receive training in the provision of laboratory-related activities. QA monitoring is carried
out jointly with the Federal Ministry of Health (FMOH) or State Ministry of Health (SMOH) responsible for the
point of service. CHAN NICaB will continue to share tools and expertise from other IPs and the GON.
CHAN will continue to collaborate actively with other USG supported IPs in carrying out tests for EID by
sending samples to nearby regional labs with capacity to carry out this test. In the same vein, CHAN NICaB
will collaborate with USG supported IPs to conduct centralized trainings that will include: Good Lab
Practices (GLP), HIV diagnosis, pediatric diagnosis, CD4 staging, hematology, blood chemistry, record
keeping and storage. This is followed up by refresher trainings carried out at sites. Ninety lab staff will be
trained. In COP09, CHAN will train a total of 90 laboratorians to support its program.
PEP will be made available at all CHAN NICaB supported labs. Waste management and disposal, including
access to a proper incinerator, is a key component of training and site activation.
EID regional availability will strengthen PMTCT, OVC and ARV Services. Testing for
OIs will strengthen adult care and treatment. Training lab personnel and healthcare providers from TB labs
and FMOH DOT centers will strengthen both HCT and TB. These activities will provide essential lab
services to people living with HIV/AIDS, HIV positive pregnant women, HIV positive infants, and HIV
positive children. The QA/QC program of CHAN NICaB will contribute to strengthening the overall quality
initiatives of the GON.
These activities will be linked to activities in PMTCT, OVC, ARV Services, Blood safety and SI. Tests for
opportunistic infections and training in these techniques will strengthen Adult Care and treatment, HCT, and
HIV/TB.
These activities will provide essential lab services to people living with HIV/AIDS with or without co-infection
with TB, HIV+ pregnant women, HIV+ infants, and HIV+ children. Lab workers will benefit from the Lab
Training centers and developed standard operating procedures (SOPs) and training curriculum.
An emphasis for this activity is human capacity development for sustainability through in-service training,
supportive supervision and quality assurance/improvement for laboratory personnel. Also emphasized is
infrastructure development through lab renovations for new sites, local organizational capacity building, and
strategic information.
Estimated amount of funding that is planned for Human Capacity Development $50,700
Table 3.3.16:
