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 COP09, the Harvard University plans to move over 4 of its PEPFAR supported sites to APIN, Ltd (APIN).
The sites include Lagos University Teaching Hospital, Nigerian Institute of Medical Research, Onikan
Women's Hospital, and Mushin General Hospital. The activity narrative reflects the transfer of targets from
Harvard to APIN. The activities will build on the structure and systems put in place through Harvard. APIN
will maintain a strong collaboration with Harvard University.
NARRATIVE:
In COP08 APIN supported PMTCT in 2 sites. In COP09 funding will support 4 additional sites, providing a
comprehensive PMTCT program in line with the revised National PMTCT Guidelines (2007), for a total of 6
service outlets in 3 states (Lagos, Ogun and Oyo). This consists of 2 tertiary, 3 secondary and 1 primary
(PHC) sites. "Opt-out" testing and counseling with same-day test results will be provided to all pregnant
women presenting for antenatal care (ANC) and labor and delivery (L&D). The current level of PMTCT
counseling and testing uptake from women presenting for ANC or L&D is 90%. All women are provided post
-test counseling services on prevention of HIV infection, including the risks of MTCT. They are encouraged
to bring partners and family members for onsite HCT. The program has a target of providing HCT to
pregnant women with 14,200 receiving results. PMTCT prophylaxis will be provided to approximately 852
women in line with the national guidelines. In addition, APIN will provide basic care and ARV prophylaxis to
852 HIV-exposed infants. Infant follow-up care linked with PMTCT activities includes nutritional counseling
and support, growth monitoring, cotrimoxazole prophylaxis and other preventative care services. Early
Infant Diagnosis (EID) will be carried out using dried blood spots (DBS) in line with the national EID scale up
plan.
Through this program area, APIN will provide linkages to other prevention, care and treatment services. All
ART-ineligible women will be placed on zidovudine from 28 weeks and or zidovudine and lamivudine from
34/36 weeks until delivery and will be enrolled into basic care services at the time they access PMTCT
services. Following delivery, mothers will be monitored in the care and treatment program, where services
include onsite enrollment or referrals for family planning and other reproductive health services. In addition,
PMTCT services are integrated into a system of maternal and child services designed to promote maternal
and child health for all women. All ART-eligible pregnant women will be provided with ART through the adult
care and treatment program area in line with national guidelines. Children who become HIV-infected during
the time they are being monitored as part of the PMTCT program will be linked to the pediatric care and
treatment program. Those HIV-exposed children placed on single dose nevirapine at birth and zidovudine
for 6 weeks and who remain uninfected at 18-months following the completion of ARV prophylaxis will be
linked to the OVC program for continued services.
Counseling on infant feeding options occurs during the antenatal period, at L&D, and throughout infant
follow-up and is done according to the National PMTCT and Infant Feeding Guidelines. Infant feeding
counseling will be performed in an unbiased manner and women will be supported in their choice of
method. Clients will also be counseled on the beneficial effect of couple/partner HCT/disclosure on
adherence to infant feeding choice. A follow-up team consisting of counselors and a home-based care
(HBC) support group of PLWHAs will assist in home and community tracking of positive mothers to provide
nutritional support and ascertain infant diagnosis. This funding will support the ANC, labs, ARV prophylaxis
intervention to mothers and babies (not ART), and training of personnel involved in PMTCT.
A regular training program will be established at all sites to train and retrain 111 personnel involved in the
PMTCT program using the National PMTCT Guidelines. This includes non-laboratory personnel who will be
trained in HIV counseling and testing and traditional birth attendants (TBAs) using an adapted curriculum in
local areas near sites in PMTCT counseling. PMTCT counselors in the National PMTCT Program will also
be trained. APIN Ltd will provide technical assistance for the development of the National Infant Feeding
Counseling Manual and will subsequently conduct a zonal training of trainers with this manual.
During COP09, APIN will scale up the Harvard initiated quality assurance/quality improvement (QA/QI)
activities to the APIN-supported PMTCT sites. The program will also continue to monitor and utilize
electronic data captured through SI activities to measure the quality of services provided as well as the
associated patient outcomes.
APIN will partner with Harvard and other implementing partners (IPs) in the implementation of the PEPFAR-
Nigeria local government area (LGA) coverage strategy in the program areas of PMTCT, OVC and TB/HIV,
designed to ensure the provision of PMTCT and TB/HIV services in at least one health facility in each LGA
of Oyo state. Under the coverage strategy, these facilities are all linked with primary health facilities, which
provide HCT and referrals for PMTCT services for HIV-infected mothers.
EMPHASIS AREAS
This activity will place emphasis on the development of networks through expansion into more local areas
through a network of secondary or primary PMTCT clinics, with rural outreach to community healthcare
workers and TBAs involved in home delivery. All community workers and TBAs with whom APIN works are
linked to tertiary health care facilities. In addition, major emphasis will be placed on building organizational
capacity in order to work towards sustainability of PMTCT centers. These system strengthening activities
are led by local investigators at current PMTCT sites who participate in new site assessments, overseeing
QA/QI, capacity development and training for new PMTCT centers. Emphasis is also placed on performing
targeted evaluations of PMTCT interventions in line with National guidelines to estimate the rate of
transmission with each of the ARV prophylaxis regimens used.
POPULATIONS BEING TARGETED
In addition to providing PMTCT services to pregnant women that know their HIV infection status, this
program also targets women who may not know their HIV status and may be at greater risk for MTCT.
Furthermore, it targets infants who are most at risk of becoming infected from an HIV positive mother during
the antepartum, intrapartum and postpartum periods. Through the counseling and testing program area,
Activity Narrative: APIN seeks to target a broader group of adults by encouraging women to bring their partners and family
members in for HCT. Furthermore, training activities will train public and private health care workers on the
implementation of PMTCT protocols and HIV-related laboratory testing.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
Through the PMTCT program, APIN will provide counseling and testing with test results to 14,200 pregnant
women. Additionally, treatment and prophylaxis will be provided to 852 pregnant women. Implementation of
the National PMTCT Guidelines in 6 sites contributes to the PEPFAR goal of expanding ART and PMTCT
services. Counseling will encourage mothers to bring their partners and family members for testing to reach
discordant couples and expand the reach of HCT. This program is implemented in geographically
networked sites to optimize training efforts and provide collaborative clinic/lab services as needed. APIN will
train and retrain 111 health care personnel from the PMTCT sites, including doctors, nurses, pharmacists
and counselors. Training will build capacity at local sites to implement PMTCT programs and provide
essential treatment support to pregnant women with HIV/AIDS. Capacity building efforts are aimed at future
expansions of PMTCT programs. QA/QI will be carried out through personnel training, data collection from
sites for monitoring and evaluation and supervisory visits from key program management staff, which may
include representatives from the USG and government of Nigeria (GON).
The program will increase gender equity by specifically targeting pregnant females for HCT and PMTCT
prophylaxis and their male partners for HCT. Data collection on PMTCT regimens in line with the National
guidelines provides a basis for developing strategies to ensure that all pregnant women have access to
needed and optimally effective PMTCT services. This program addresses stigma and male norms and
behaviors through the encouragement of partner notification and bringing other family members in for HCT.
Infant feeding counseling, including on the appropriate use of exclusive breastfeeding or exclusive use of
breast milk substitute (BMS) where AFASS is available, will be in line with the National PMTCT Guidelines.
Referrals to income generating activities (IGAs) will also be provided to women as a part of palliative care
and counseling activities.
LINKS TO OTHER ACTIVITIES
This activity is also linked to counseling and testing, OVC, adult and pediatric care and treatment, sexual
prevention, biomedical prevention, SI and gender. Pregnant women who present for HCT services will be
provided with information about the PMTCT program and referred to the PMTCT program if they are eligible
for these services. ART services for HIV-infected infants and mothers will be provided through adult and
pediatric treatment services. Basic pediatric care and support, including support for chosen feeding option
and TB care, is provided for all infants and children through pediatric care and treatment and OVC activities;
all exposed infants identified through PMTCT services will be linked to these OVC services. Pregnant
women are at high risk for requiring blood transfusion. Personnel involved in patient care will be trained in
universal precautions as a part of injection safety activities. Additionally, these activities are linked to SI,
which provides support for monitoring and evaluation of the PMTCT activities and QA/QI initiatives.
New/Continuing Activity: Continuing Activity
Continuing Activity: 22510
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
22510 22510.08 HHS/Centers for AIDS Prevention 9692 9692.08 $225,000
Disease Control & Initiative, LTD
Prevention
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $28,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In COP09, the Harvard School of Public Health (Harvard) plans to move over four of its PEPFAR supported
sites to APIN, Ltd (APIN). The sites include Lagos University Teaching Hospital (LUTH), Nigerian Institute
of Medical Research (NIMR), Onikan Women's Hospital (OWH), and Mushin General Hospital (MGH). The
activity narrative reflects the transfer of targets from Harvard to APIN. The activities will build on the
structure and systems put in place through Harvard. APIN will maintain a strong collaboration with Harvard
University. Since HVAB and HVOP activities are combined, the narratives for the 2 corresponding sections
have been merged.
During COP08, APIN assumed management responsibility for 2 sites (Sacred Heart Catholic Hospital in
Lantoro, Ogun State and Primary Health Center-Iru on Victoria Island, Lagos) and is adding 4 additional
sites (LUTH, NIMR, OWH, and MGH) during COP09. APIN will continue sexual prevention programming
activities at all 6 sites in line with the overall PEPFAR Nigeria goal of providing a comprehensive package of
prevention services to individuals reached, thereby improving the effectiveness of this messaging, through a
balanced portfolio of prevention activities, including abstinence and be faithful messaging (AB) along with
condoms and other prevention (C&OP; ABC in combination). APIN will assist PEPFAR Nigeria in extending
its reach of ABC services through the APIN supported sites. Through its other program areas, APIN has a
large population of HIV-positive adults, adolescents and children to which it is already providing services;
this group forms part of the core target population for age appropriate ABC messaging that is provided by
APIN through its prevention with positives (PwP) activities including sexually-transmitted infection (STI)
screening and management, condom provision, sexual risk reduction, disclosure, adherence, reduction of
alcohol consumption, and testing of sex partners and children in the HIV clinic setting. In addition, APIN will
target activities to HIV-negative persons in its catchment areas in order to minimize their risk behaviors and
contribute to an overall reduction in HIV prevalence.
In COP09, APIN will implement ABC activities at both the facility and community levels utilizing the
minimum prevention package strategy as contained in the National Prevention Plan. This package includes:
1) community outreach campaigns; 2) peer education; 3) infection control activities; and 4) STI
management/treatment. The goal of the program is to focus on targeted communities and saturate those
communities with messages conveyed in multiple fora. Utilizing such a methodology, a large number of
people will be reached with messages received via one method or another; however, the target group will
be those individuals that will have received C&OP messaging: (1) on a regular basis; and, (2) via at least 3
of the 4 strategies employed by APIN.
AB activities conducted at the local level by APIN will be reinforced through national-level mass media
campaigns by other USG partners, such as the successful Zip-Up campaign. AB messages promoting
abstinence and mutual fidelity, and addressing issues of concurrent and multiple sexual partnerships will be
balanced with concurrent condoms and other prevention messaging, where appropriate and will be
integrated with treatment and care services in our 6 sites.
A key age group for AB activities is youth/young adults aged 15-24 years as this encompasses the highest
prevalence age group. This age cohort, for both men and women, represents the working age group in
Nigeria; it is expected that a combination of prevention messaging approaches will ensure they are reached
with appropriate interventions.
APIN will collaborate with community-based organizations (CBOs) and PLWHA support groups at its
facilities and surrounding communities in other PEPFAR programming activities. These support groups will
utilize peer education model and community awareness campaigns to disseminate ABC messaging to other
PLWHA and to wider audiences. Support group activities will include the dissemination of prevention
information for HIV-infected individuals (funded under basic care and support) as well as community
outreach to high-risk populations to encourage HIV counseling and testing (HCT) and healthy behaviors,
including recommendations for partner notification and condom use. For HIV-negative individuals, trained
counselors will provide education on HIV/AIDS transmission, risks, and risk reduction strategies including
HIV testing.
A community awareness strategy will also be employed to serve catchment areas of the hospital facilities,
which will be linked with community mobilization efforts promoting HCT. During static and mobile HCT
services, counselors will be disseminating balanced ABC messages to recipient communities and clients
through focused group discussions and interpersonal communication. Key messages that will be conveyed
include: delay in sexual debut, secondary abstinence, mutual fidelity, prompt and complete treatment of all
STIs, and promotion of need to ascertain HIV serostatus through HCT.
APIN sites will target most at risk populations (MARPs), including outpatient STI patients, border traders,
young male market agents, and motor mechanics. APIN's HCT site at PHC-Iru on Victoria Island serves the
Kuramo area, a community with a large number of MARPs where most residents are sex- and bar-workers,
and have HIV prevalence greater than 60%. Prevention activities at these clinics provide condoms and
educational materials targeting the risks faced by this population in particular. In addition to comprehensive
counseling on HIV prevention and risk reduction, HIV-infected individuals identified through this activity will
be referred for palliative care and evaluation for ART eligibility. An emphasis on men with high-risk
behaviors through these community-based efforts will also enhance prevention efforts and facilitate access
to their partners.
A focus of the program in COP09 will be continued improvement of the integration of prevention activities
into the HIV care and treatment settings; specifically, healthcare providers and lay counselors in care and
treatment settings will be trained to appropriately deliver integrated ABC prevention messages and
incorporate the messages into routine clinic visits using IEC materials and job aids. An appropriate balance
of ABC will be tailored to the needs and social situation of each individual client in its presentation. In
addition to the integration of such services into the HIV-specific treatment setting, prevention activities will
be assimilated into other points of service in each health facility (general outpatient clinics, emergency
services, etc.), particularly into reproductive health services including family planning counseling, STI
Activity Narrative: management and counseling, and risk-reduction counseling.
This funding will also be used to support the procurement and distribution of written prevention messages
and condoms. The materials will provide patients and clients with HIV prevention information using the
"ABC" model, including information about healthy behaviors, safer sexual practices, PMTCT, and condom
usage. Prevention messages will also include information about other STIs. Condoms will be offered to all
individuals at all sites and will be provided to APIN by the Society for Family Health (SFH).
The target for the AB messaging campaign is 3,645 individuals. In addition, age-appropriate abstinence
only messaging and secondary abstinence messaging will be conveyed to children and adolescents,
particularly focused on those orphans and vulnerable children receiving both facility- and home-based
support. The target for this intensive activity campaign (condom and other prevention) is 7,197 individuals.
Additional staffing and training of counselors will also be provided by this funding, including a dedicated full-
time staff person. This activity will provide support for training of 112 individuals in AB messaging. An
additional 99 individuals will be trained to promote HIV/AIDS prevention through other behavior change
beyond abstinence and/or being faithful, including condom promotion and STD prevention.
ABC programming emphasizes local organization capacity building, human capacity development and
efforts to increase gender equity in HIV/AIDS programs. These activities also promote a rights-based
approach to prevention among positives and other vulnerable members of society and equal access to
information and services. Reduction of stigma and discrimination are also key to the program. Through ABC
activities, we place major emphasis on community mobilization and participation, as an element of outreach
for prevention efforts. Additionally, we place major emphasis on training as well as infrastructure and human
resources in order to build the capacity of counselors and providers in a full range of prevention strategies.
We also reinforce that information, education and communication are essential elements of outreach to high
-risk populations, and that developing networks for linking these activities to HCT, PMTCT, and other ART
activities serves as a source of prevention information.
These activities address gender equity issues by providing equal access to prevention services for men and
women. In some cases, our activities seek to target men who may be at high risk for HIV in order to
promote condom use as a means of prevention and access to services for their sexual partners. Male-
targeted counseling seeks to address male norms and behaviors in order to encourage safer sexual
practices. Strong prevention programs that accommodate the array of societal and cultural norms can also
help reduce stigma and discrimination. The provision of such services at the community level will serve as
an important platform from which general HIV/AIDS information can be provided and risk reduction
strategies discussed.
POPULATIONS TARGETED:
Key populations targeted are the healthcare community in treatment facilities, PLWHA, youths and adults
accessing HCT services at either static or mobile within catchment areas of the treatment sites, high-risk
populations, support group members and immediate families of PLWHA. Other target populations include
discordant couples, pregnant women and religious leaders. Targeting these populations is important to
encourage safe sexual practices, HCT and other prevention measures. Health care workers will also be
targeted for training on the most effective prevention measures for various risk groups.
CONTRIBUTION TO OVERALL PROGRAM AREA
These prevention activities are consistent with PEPFAR's goals for Nigeria, which aim to support a number
of prevention strategies as a comprehensive prevention package. In order to be maximally effective, the
prevention messages developed at different sites will be tightly targeted to various high-risk groups that they
serve. Furthermore, these activities are consistent with the PEPFAR 5-year strategy, which seeks to scale-
up prevention services, build capacity for long-term prevention programs, and encourage testing and
targeted outreach to high-risk populations. The establishment of networks and referral systems from
prevention efforts at the community level to PMTCT and HIV care and treatment will help facilitate the scale-
up of the overall program. Additionally, the long term sustainability of the prevention portfolio is more
assured as APIN, a Nigerian organization, assumes management responsibility for more sites previously
managed by Harvard.
LINKS TO OTHER ACTIVITIES:
ABC activities relate to HCT, by increasing awareness of HIV. They also relate to adult and pediatric care
and support activities through dissemination of information by home-based care providers and ultimately by
decreasing demand on care services through decreased prevalence. Linkages also exist to OVC
programming by targeting OVC. The provision of such services at the community level will serve as an
important platform from which general HIV/AIDS information can be provided and risk reduction strategies
discussed. This program area also links to Strategic Information (SI) as all progress will be monitored by the
SI programming and to Gender as specific programs will be targeted to be gender-appropriate.
Continuing Activity: 22511
22511 22511.08 HHS/Centers for AIDS Prevention 9692 9692.08 $90,000
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $64,000
Table 3.3.02:
Continuing Activity: 22512
22512 22512.08 HHS/Centers for AIDS Prevention 9692 9692.08 $50,000
Estimated amount of funding that is planned for Human Capacity Development $32,000
Table 3.3.03:
Several new CDC partners have recently been identified through a competetive funding opportunity
announcement as approved under COP08. Many of these partners are new to the PEPFAR and/or CDC
planning and implementation processes. The amounts awarded differ significantly from the original
proposal amounts submitted by these new partners. The difference now requires the new partners, working
in conjunction with the in-country CDC office and interagency technical working groups, to revise the action
plans for FY08 and FY09. CDC is currently working closely with the new partners to assure their effective
understanding of the PEPFAR planning process and that action plans for FY08 and FY09 COP submissions
are in accordance with funding awards as well as PEPFAR goals and objectives. Detailed narrative
changes will be submitted in the January 2009 reprogramming submission.
In COP09, the Harvard School of Public Health (Harvard) plans to move four of the HSPH PEPFAR
supported sites to APIN Ltd. (APIN). The sites include Lagos University Teaching Hospital, Nigerian
Institute of Medical Research, Onikan Women's Hospital, and Mushin General Hospital. This activity
narrative reflects the transfer of targets from Harvard to APIN. The activities will build on the structure and
systems put in place through Harvard. APIN will maintain a strong collaboration with Harvard.
ACTIVITY DESCRIPTION
In COP08 APIN+ provided comprehensive adult care and treatment (ACT) services in 1 site and care and
support at a second site. In COP09, APIN will take over the provision of high quality ARV and basic care
and support services to eligible adult patients at a total of 6 sites; 5 comprehensive ART sites (2, tertiary
and 3 secondary facilities and 1 PHC located in three states of Lagos and Ogun. This will provide ART
services to a total of 13100 adults (8200 new) at the end of the reporting period. Facility-based palliative
care services will be provided to approximately 8250 ART ineligible PLWHA and 13100 ART eligible
PLWHA making a total of 21350 PLWHA clients. People Affected By HIV/AIDS (PABAs) will be reached
through the community and home based care (HBC) of the PLWHA clients.
Patients are identified through HCT services. All HIV-infected individuals are clinically pre-assessed for
eligibility for ARV treatment (ART). Patients who are ineligible for ART are provided with continuous clinical
monitoring and basic care and support services. ART-eligible patients are provided with ART services, in
accordance with a standardized programmatic protocol, which follows the current National ART guidelines.
All HIV+ patients are provided with palliative care services, which are consistent with the Nigerian Palliative
Care Guidelines. A network model of care will be used for service delivery.
ART-ineligible individuals that are enrolled in care will have periodic follow-up to identify changes in
eligibility status. Scheduled physician visits for all are at 3, 6, and 12 months and every 6 months thereafter.
ART patients follow the same clinical visit schedule with more intensified monitoring and pick up drugs
monthly. For all patients, at each visit, clinical exams, hematology, chemistry, viral load, and CD4
enumeration are performed when indicated. All tertiary site labs perform the necessary lab assays.
Secondary and primary sites with limited lab capability send samples to an affiliated tertiary site lab for
analysis. Electronic clinic and lab records provide data for high quality patient care and centrally coordinated
program monitoring. As additional medical needs of patients are identified through clinic visits, they will be
provided with clinical services by clinicians or referred for specialty care as necessary. HIV+ individuals will
be provided with cotrimoxazole prophylaxis according to national guidelines. Diagnostics for common OIs
may include bacterial infections, fungal infections, and protozoal infections. All HIV+ patients will be also
symptomatically screened for TB and confirmed with laboratory and radiological diagnostics as indicated
APIN will support integration of syndromic management of STIs and risk reduction interventions into care.
All PLWHA will be provided with a basic care kit including clean water kits, ITN, and IEC materials on
positive living. Pain assessment will also be conducted by clinicians and HBC providers and analgesics will
be provided. Commodities distributed as a part of the palliative care services are procured centrally through
the APIN Abuja program office and APIN Central Medical Stores in Lagos. Distribution of commodities to
individual sites is coordinated through supply chain mechanisms in place for laboratory test kits and ART
drugs. During COP09, APIN will collaborate with Harvard and SCMS for the procurement and distribution of
specified OI drugs.
Activities will also focus on PWP services. All enrolled into care will receive risk assessment and behavioral
counseling to achieve risk reduction. Condoms will also be provided to prevent STIs and re-infection.
Patients are also encouraged to refer family members for HCT. ART patients are provided ART education &
adherence counseling prior to and during ART provision, which follows the National Curriculum for
Adherence Counseling. ART patients are encouraged to have a treatment support partner to whom he/she
had disclosed status to improve adherence and to optimize care.
APIN will encourage support groups and CBOs to mobilize communities to provide HBC services. Site HBC
activities will be supervised by a hospital team. Facility-based and community-based HBC teams partner to
provide a continuum of HBC services depending on client needs. When ART patients miss scheduled clinic
visits or bed ridden clients are reported by the community HBC team, the site HBC team provides follow-up
according to a program based SOP, utilizing a HBC kit provided to these outreach teams. The provider HBC
kit includes ORS, bleach, cotton wool, gloves, soap, calamine lotion, vaseline, gentian violet etc. The team
will provide basic medical assessment and management of symptoms, basic nursing care, nutritional
assessments, domestic support and psychosocial support and make appropriate referrals. HBC teams will
also provide refills of cotrimoxazole, paracetamol, additional clean water kits and additional ITNs to patients
and their families.
All sites focus on the integration of adult care and treatment (ACT) services for all patients regardless of the
source of funding for different components of treatment. TB diagnosis and treatment is provided to all
patients via facility co-location of DOTS centers and/or referral of HIV+ patients into ART from DOTS sites.
ART-eligible patients identified through HCT conducted for all TB patients at DOTS sites will be provided
with ART.
Activity Narrative: Clinical staff at APIN and Harvard sites meet monthly for updates and training. Each site has a clinic
coordinator and senior clinical officer who are responsible for approving drug regimen switching. As clinical
training needs are identified for new sites or new staff at existing sites, through Harvard, APIN provides
training on regimen switching and other relevant topics. In COP09, APIN will make use of the
comprehensive Quality Improvement (QI) Plan incorporated by Harvard using standardized quality
indicators. This includes periodic external site assessments and chart reviews as well as quarterly internal
reviews, based on electronic databases. This QI Plan has been harmonized with HIVQual activities for
participating sites and will continue to be implemented in COP09.
For patients enrolled through the GON National ART Program, we anticipate GON provision of 1st line ARV
drugs and PEPFAR support for ACT services. As patients require alternative or 2nd line drugs, they will
receive PEPFAR provided drugs. GON provision of 1st line drugs allows for additional ACT targets. APIN
will partner with Harvard, Clinton Foundation and Global Fund as appropriate to leverage resources for
providing ARVs to patients. The site investigators and project managers will actively participate in the GON
National ART program. Harmonization of data collection for M&E will be coordinated with USG and GON
efforts. APIN will continue to participate in the USG coordinated Clinical Working Group to address
emerging topics in ARV service provision and to ensure harmonization with other IPs and the GON.
The program will identify, collaborate with and strengthen the capacities of support groups and CBOs, to
deliver palliative care and home based care services. Supported CBOs will provide a range of facility and
HBC services, including prevention for positives, clinical care, prophylaxis and management of OIs,
adherence counseling, psychosocial and spiritual support, and active linkages between hospitals, health
centers, and communities. Through counselors and clinicians at all sites, APIN will provide referrals for TB,
family planning, safe motherhood, and other wrap-around services as appropriate.
APIN will provide training to HCWs and lab scientists working at GON and GF supported sites. APIN will link
up with Harvard in the use of its training lab and linkages with the National Public Health Lab to train them in
ARV lab monitoring. This will serve to increase the quality and sustainability of ACT outside of PEPFAR-
supported sites. APIN will support policy development and implementation of task shifting to improve
access to care and treatment services for PLWHAs. A total of 197 health care and non-health care workers
will be trained in palliative care, including HBC, in line with the National Palliative Care Guidance and the
USG Palliative Care policy.
This funding will support the personnel, clinic and lab services for training of 253 people in ART, monitoring
of 21,350 adults at the end of COP09, which includes 8,200 new adult patients.
This program seeks to increase gender equity in programming through counseling and educational
messages targeted at vulnerable women and girls. Furthermore, through gender sensitive programming and
improved quality services the program will contribute to reduction in stigma and discrimination and address
male norms and behaviors by encouraging men to contribute to care and support in the families.
The care and treatment components of these activities target HIV-infected adults for clinical monitoring and
ART treatment. The operational elements of these activities (M&E, health personnel training, infrastructural
supports, technical assistance and quality assurance) target public and private program managers, doctors,
nurses, pharmacists and lab workers at PEPFAR sites. The expansion of ART services to secondary health
facilities will increase access to necessary services in poor communities.
CONTRIBUTION TO PROGRAM
ACT activities are consistent with the PEPFAR goal of scaling up capacity to provide ARV drugs, care and
treatment services and lab support to serve more HIV+ people. APIN will continue to support the expansion
of ARV services into more local areas by developing a network of secondary or primary health care clinics
providing ART services that are linked to tertiary health care facilities. These networks will ensure that
facilities are able to develop linkages, which permit patient referral from primary health centers and the
provision of specialty care support. In addition, palliative care services will be provided to 21,350 PLWHA
and 42,700 PABA for a total of 64,050 people served. The program will also contribute to strengthening
human capacity through training of health workers, community workers and PLWHAs and their families.
Additionally, as part of our sustainability building efforts, APIN will receive technical assistance and support
from Harvard to assume program management responsibility for the adult care and treatment Activities.
This will include the implementation of a plan to transition site oversight, management and training over to
APIN. The goal of such efforts is to provide for greater assumption of responsibility for management and
implementation of PEPFAR programming by Nigerian nationals through an indigenous organization.
This activity is linked to ART drugs, OVC and Pediatric ART Care and Treatment for pediatric care, PMTCT,
TB/HIV to provide ART to patients with TB, Lab to provide ART diagnostics, HCT as an entry point to ART,
and SI (HVSI) will provide the GON with crucial information for use in the evaluation of the National ARV
program and recommended drug regimens. This program is linked to PMTCT services to optimize the
PMTCT by providing ART to eligible pregnant women.
Continuing Activity: 22513
22513 22513.08 HHS/Centers for AIDS Prevention 9692 9692.08 $100,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $11,780
Estimated amount of funding that is planned for Water $21,178
Table 3.3.08:
Continuing Activity: 22509
22509 22509.08 HHS/Centers for AIDS Prevention 9692 9692.08 $290,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,890
Table 3.3.09:
Continuing Activity: 22515
22515 22515.08 HHS/Centers for AIDS Prevention 9692 9692.08 $50,000
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.10:
If continuing, paste your COP08 narrative here and put one of the following at the beginning of your
narrative:
sites to APIN Ltd. (APIN). The sites include Lagos University Teaching Hospital, Nigerian Institute of
Medical Research, Onikan Women's Hospital, and Mushin General Hospital. The activity narrative reflects
the transfer of targets from Harvard to APIN. The activities will build on the structure and systems put in
place through Harvard. APIN will maintain a strong collaboration with Harvard University.
In COP08 APIN+ provided comprehensive pediatric care and treatment (PCT) services in 1 site. In COP09,
APIN will take over provision of high quality ARV and basic care and support services to eligible pediatric
patients at a total of 5 sites; 5 comprehensive ART sites (2 tertiary and 3 secondary facilities) located in two
states of Lagos and Ogun. This will provide ART services to a total of 1050 children (700 new) at the end of
the reporting period. Facility-based palliative care services will be provided to approximately 413 ART
ineligible children and 1050 ART eligible children for a total of 1463 pediatric PLWHA clients. People
Affected By HIV/AIDS (PABAs), including caregivers of pediatric PLWHA, will be reached through the
community and home based care (HBC) services; therefore, it is expected that a total of 4389 individuals
will access services (1463 pediatric PLWHA and 2926 PABA).
Patients are identified through PMTCT and HCT services including facility based, mobile, and family
centered strategies. Early infant diagnosis (EID) is performed for children =18 months utilizing DNA PCR at
2 tertiary level sites, Secondary and primary sites send samples to an affiliated tertiary site lab for analysis.
All HIV+ children are clinically pre-assessed for eligibility for ARV treatment (ART). Patients who are
ineligible for ART, are provided with continuous clinical monitoring and basic care and support services.
ART-eligible patients are provided with ART services, in accordance with a standardized programmatic
protocol, which follows the 2005 revised National ART guidelines. All HIV+ patients are provided with
palliative care services, which are consistent with the Nigerian Palliative Care Guidelines.
ART-ineligible children that are enrolled in care will have periodic follow-up to identify changes in eligibility
status. Scheduled physician visits for all are at 3, 6, and 12 months and every 6 months thereafter. ART
patients follow the same clinical visit schedule with more intensified monitoring and pick up drugs monthly.
For all patients, at each visit, clinical and lab exams. All tertiary site labs perform the necessary lab assays.
Secondary and primary sites with limited lab capability send samples to an affiliated tertiary site. Electronic
clinic and lab records provide data for high quality patient care and centrally coordinated program
monitoring. As additional medical needs are identified through clinic visits, patients will be provided with
clinical services by clinicians or referred for specialty care as necessary. HIV+ children will be provided with
a package of preventative care services, including cotrimoxazole prophylaxis according to national
guidelines and referrals to the National Vaccination program for childhood vaccinations. Diagnostics for
common OIs may include: Candida albicans, protozoal infections, and gastrointestinal parasites. All HIV+
children will be also symptomatically screened for TB and confirmed with TST, laboratory and radiological
diagnostics as indicated. HIV+ children are also provided with nutritional counseling and supplements,
including multivitamins, growth monitoring, and care for childhood illnesses. All HIV+ children and their
caregivers will be provided with a basic care package including clean water kits, ITN, and IEC materials.
Pain management assessments will also be conducted by clinicians and HBC providers and analgesics will
be provided. All HIV+ children are linked into the system of OVC services in order to ensure a continuum of
care.
Commodities distributed as a part of the palliative care services are procured centrally through the APIN
Abuja program office and Central Medical Stores in Lagos. Distribution of commodities to individual sites is
coordinated through supply chain mechanisms in place for laboratory test kits and ART drugs. During
COP09, APIN will collaborate with Harvard, SCMS for the procurement and distribution of specified
pediatric OI drugs.
All enrolled into care will receive risk assessment and behavioral counseling to achieve risk reduction.
Caregivers for HIV+ children are provided ART EAC prior to and during ART provision, which follows the
National Curriculum for Adherence Counseling. ART EAC is reinforced with PLWHA support groups at each
site, which serve all HIV+ patients and their families. APIN will partner with support groups and CBOs to
mobilize communities provide HBC activities.
Facility-based and community-based HBC teams partner to provide a continuum of HBC services
depending on client needs. When ART patients miss scheduled clinic visits or bed ridden clients are
reported by the community HBC team, the site HBC team provides follow-up according to a program based
SOP, utilizing a HBC kit provided to these outreach teams. The HBC includes ORS, bleach, cotton wool,
gloves, soap, calamine lotion, vaseline, gentian violet. The team will provide basic medical assessments of
signs and symptoms, basic nursing care, nutritional assessments and psychosocial support and make
appropriate referrals. HBC teams will also provide refills of cotrimoxazole, paracetamol, additional clean
water kits and additional ITNs to patients and their families. Site HBC activities will be supervised by a
hospital team.
All sites focus on the integration of PCT services for all patients regardless of the source of funding for
different components of treatment. At each site support is provided for the management of electronic data
and patient medical records for use in the provision of clinical care. TB diagnosis and treatment is provided
to all patients via facility co-location of DOTS centers and/or referral of HIV+ patients into ART from DOTS
sites. ART-eligible patients identified through HCT conducted for all TB patients at DOTS sites will be
provided with ART.
Clinical staff at APIN and Harvard sites meets monthly for updates and training. Each site has a clinic
coordinator and senior clinical officer who is responsible approving drug regimen switching. As clinical
training needs are identified for new sites or new staff at existing sites, through APIN, Harvard provides
training on regimen switching and other relevant topics. During COP09 APIN will scale up the Harvard
initiated QA/QI activities to all supported sites using standardized quality indicators. This will include
Activity Narrative: periodic external site assessments and chart reviews as well as quarterly internal reviews, based on
electronic databases.
For pediatric patients enrolled through the GON National ART Program, we anticipate GON provision of 1st
line ARV drugs and PEPFAR support for PCT services. As patients require alternative or 2nd line drugs,
they will receive PEPFAR provided drugs. GON provision of 1st line drugs allows for additional PCT targets.
APIN will partner with Harvard, SCMS, Clinton Foundation as appropriate to leverage resources for
efforts. APIN will provide technical assistance and training expertise to the National ART program's training
program in 2009. APIN will continue to participate in the USG coordinated Clinical Working Group to
address emerging topics in ARV service provision for children and to ensure harmonization with other IPs
and the GON.
The program will identify and strengthen the capacities of support groups and CBOs to deliver pediatric
palliative care, OVC services and HBC services. Through counselors and clinicians at all sites, APIN will
provide referrals for TB, wraparound services and child survival programs as appropriate.
APIN will support training of site-based HCWs and lab scientists working at GON and GF supported sites in
EID techniques. A total of 103 health care and non-health care workers will be trained in PCT services in
line with the National Pediatric ART Guidelines and the National Training Curriculum.
This funding will support the personnel, clinic and lab services for training of 106 people, monitoring of 1463
pediatric patients at the end of COP09, which includes 700 new pediatric patients. A total of 1050 patients
will be provided with pediatric ART services.
Through the provision of ITNs, provision of malaria smears, TB screening and linkages to TB DOTS
programs, we also provide focus on malaria and TB wrap-arounds. We will also provide emphasis on child
survival wrap-around programming, through the provision of clean water kits, growth monitoring, nutritional
supports, treatment of OIs and other illnesses, and counseling for caregivers on hygiene and nutrition for
HIV-infected children.
The care and treatment components of these activities target HIV+ children for clinical monitoring and ART.
The operational elements of these activities (M&E, health personnel training, infrastructural supports,
technical assistance and quality assurance) target public and private program managers, doctors, nurses,
pharmacists and lab workers at PEPFAR sites. The expansion of PCT to secondary health facilities will
increase access to necessary services in poor communities.
PCT activities are consistent with the PEPFAR goal of scaling up capacity to provide ARV drugs, care and
treatment services and lab support to serve more HIV+ children. APIN will continue to support the
expansion of PCT services into more local areas by developing a network model. These networks will
ensure that facilities are able to develop linkages, which permit patient referral from primary health centers
and the provision of specialty care support. A tiered structure for ARV provision and monitoring established
through Harvard provides a model for additional expansion efforts in COP09 in order to meet PEPFAR
treatment goals. In addition, pediatric palliative care services will be provided to 1463 HIV+ children and
2926 PABA for a total of 4389 people served. The program will also contribute to strengthening human
capacity through training of health workers, community workers and HIV+ children and their families.
from Harvard to assume program management responsibility for the PCT Activities. This will include the
implementation of a plan to transition site oversight, management and training over to APIN. The goal of
such efforts is to provide for greater assumption of responsibility for management and implementation of
PEPFAR programming by Nigerian nationals through an indigenous organization.
This activity is linked to ART drugs (HTXD), OVC (HKID) and Adult ART Care and Treatment (HTXS) for
pediatric care, PMTCT (MTCT), TB/HIV (HVTB) to provide ART to patients with TB, Lab (HLAB) to provide
ART diagnostics, HCT (HVCT) as an entry point to ART, and SI (HVSI) will provide the GON with crucial
information for use in the evaluation of the National ARV program and recommended drug regimens. This
program is linked to PMTCT services to optimize the PMTCT by providing ART to eligible pregnant women.
Table 3.3.11:
In COP09, the Harvard School of Public Health (Harvard) plans to move over 4 of its PEPFAR supported
ACTIVITY DESCRIPTION:
In COP09, APIN sites will identify HIV infected patients through PMTCT, HCT centers and ART centers and
hospitals and outreaches. These sites constitute a network of delivery points in 3 states (Lagos, Ogun and
Oyo) and include 2 tertiary hospitals, 3 secondary hospitals, 1 PHC and 43 DOTS centers. In COP9, APIN
plans to execute a universal coverage strategy in Oyo state, by providing support for TB-HIV services in all
state government supported DOTS centers throughout the state. This is an essential step toward universal
access to TB/HIV services, and will focus on developing programming at the secondary and primary level.
All HIV-infected individuals are clinically pre-assessed for eligibility for ART treatment; it is expected that
700 HIV positive clients will be screened for TB in COP09. TB screening by sputum examination is
conducted according to national guidelines. The13,100 new and maintenance patients already on ART will
also be monitored for TB. All 852 HIV infected women from our 5 treatment sites will be assessed for ART
eligibility and screened for TB. The TB clinics at 2 of our sites are National TB centers offering the
government DOTS program. At all of our associated DOTS clinics, we will implement HCT for 9,700 clients
presenting to the DOTS center. In all, it is expected that 2,825 TB/HIV co-infected patients will be identified
and will receive treatment for TB and be linked to Harvard and APIN ART clinics for evaluation of eligibility
for ART and provision of care and treatment.
The National Tuberculosis Reference Laboratory (NTRL) will provide an important resource to APIN sites in
strengthening their capacity for TB diagnosis and cross-training of health care workers in TB/HIV. The
NTRL will provide screening for MDR-TB. TB services provided at these clinics will be integrated with ART
services and HCT in order to promote the development of a comprehensive system of care for individuals
with HIV/TB co-infection. This will be part of the 148 health care workers in both HIV and TB clinical and
laboratory settings to be trained in COP09. APIN TB/HIV program officers and facility staff will be provided
with formal TB/HIV training to enhance their productivity, including retraining on x-ray diagnostic skills and
co-management of TB/HIV for clinicians; and retraining on good sputum specimen collection and laboratory
AFB sputum smear diagnosis for laboratory technicians. There will also be training on TB infection control
and HCT. A dedicated TB program officer provides TB expertise to all Harvard and APIN sites and is
responsible for training efforts and reporting of TB patients to the NTPLCP.
APIN will implement the global 3 "I"s strategy in COP09 through intensive TB/HIV case finding amongst HIV
positive patients, TB infection control in all ART sites and INH Prophylaxis Therapy (IPT). APIN will prevent
nosocomial transmission of TB to HIV+ patients through such measures and principles such as basic
hygiene, proper sputum disposal, and good cross ventilation at clinics. Facility co-location of TB/HIV
services is preferred to clinic co-location. The national guidelines on TB infection control on co-located sites
will be implemented in all sites. Patient and staff education on infection control measures will be routinely
carried out to ensure program success. APIN will upgrade facilities as needed through infrastructure support
such as basic renovations and space modification to ensure effective infection control, upgrading equipment
and procuring supplies and consumables (e.g. sputum containers).
To date, more than 30% of APIN+ clinic attendees present with pulmonary tuberculosis. Depending on
clinical status, many patients will be treated for TB prior to receiving ART, following the NTBLCP Guidelines.
Concurrent ART and TB treatment follows the National guidelines. All co-infected patients will receive co-
trimoxazole according to national guidelines. IPT will be provided through the ART clinics following the
global 3 "I"s principle and the national guidelines. The TB DOTS sites will be supported to provide holistic
patient care according to National and IMAI guidelines. Cross-referrals and linkages between TB and HIV
programs will be strengthened.
APIN home-based care providers will track family members and contacts of TB patients who are at risk of
developing TB and get them screened for TB, as well as HIV. This will result in higher TB case detection
and increased HCT uptake. They will also provide adherence support for TB and ARV drug treatment. Site
support groups will be involved in community mobilization and will include TB education in their outreach
messages.
At NIMR, APIN will provide technical assistance in the implementation of MDR-TB and XDR-TB surveillance
activities in Nigeria. TB diagnostic capacity will include culture, PCR, and sequencing for resistance testing.
In COP09, APIN will work with 43 DOTS centers at secondary sites in all LGAs of Oyo state. These DOTS
centers will be linked with two tertiary care sites for specialty care. At each DOTS center, we will provide
HCT for TB patients and support the provision of broad HIV/TB services for all patients served, including
referrals to ART centers for patients identified as HIV infected. To ensure continuous availability of drugs
and commodities in supported sites, APIN will partner with Harvard and other USG PEPFAR team members
to strengthen logistics management within the states where it works.
EMPHASIS AREAS:
Emphasis areas include gender and health-related wrap around activities. This activity will increase gender
equity by focusing on strategies which seek to reach an equitable number of co-infected men and women.
Furthermore, it seeks to provide additional focus on support for pregnant women who have TB/HIV.
Through data collection and patient surveillance from this activity, APIN will be able to show the breakdown
of men and women who are accessing TB diagnostics and treatment services. Outreach activities and
patient counseling also seek to address stigma and discrimination and increase access to information,
education and TB diagnosis and treatment for women and girls with HIV. In addition, APIN will focus on
providing linkages to wrap around services for TB, which will focus on MDR-TB detection and treatment.
Focus will also be places on intensified case detection through developing linkages with community based
Activity Narrative: health care facilities to build capacity for TB screening.
POPULATIONS BEING TARGETED:
This activity targets adults and children with HIV and TB co-infection by providing a mechanism for critically
important TB diagnosis and treatment both prior to the initiation of ART and also during the course of ART
therapy. Newly enrolling ART patients will be prescreened for TB in COP09 and TB that develops in
patients who are currently on ART therapy will be diagnosed and treated. All HIV infected pregnant women
participating in APIN PMTCT programs will also be eligible for TB diagnosis and treatment under this
program. TB patients at DOTS clinics will be screened for HIV. Their family members and contacts will also
be targeted for TB and HIV screening.
CONTRIBUTION TO OVERALL PROGRAM:
The provision of TB diagnostics and treatment within participating ART facilities is consistent with the
PEPFAR goal of ensuring that all facilities offering ART develop the ability to diagnose TB and provide
nationally accepted DOTS sites within their facility. There will a deliberate attempt to locate HCT in DOTS
centers so as to increase detection of co-infected TB/HIV patients. At these facilities, APIN estimates that it
will provide clinical treatment for TB to 2825 patients with HIV/TB co-infection either prior to or during their
ART therapy, thus contributing significantly to the 2009 PEPFAR goals. At all APIN sites referral to TB
DOTS sites that are co-located will be provided. The provision of TB diagnosis and treatment, infrastructure
building and health care personnel training under this program will work towards building and maintaining
Nigerian National tuberculosis treatment capacity.
Additionally, as part of the sustainability building efforts, APIN will receive technical assistance and support
from Harvard to assume program management responsibility for the TB/HIV Activities. This will include the
This activity also relates to activities in HCT, Adult Care and Treatment, Pediatric Care and Treatment,
PMTCT and OVC. Through this activity linkages between participating treatment sites and the National
Tuberculosis Reference Laboratory will be provided. Additionally, linkages to potential patient populations
through outreach initiatives, HCT activities, and ART services will improve utilization of care opportunities
created through PEPFAR funding. This activity is linked to care and support and ART services because TB
diagnosis and treatment are provided as a part of patient palliative care and support at sites which also
provide ART. A high TB co-infection rate has a major impact on ART management.
Continuing Activity: 22514
22514 22514.08 HHS/Centers for AIDS Prevention 9692 9692.08 $510,000
Estimated amount of funding that is planned for Human Capacity Development $60,000
Table 3.3.12:
Table 3.3.13:
In COP09, the Harvard School of Public Health (Harvard) plans to move over four of its PEPFAR-supported
sites to APIN Ltd. (APIN) an indigenous NGO. The sites include Lagos University Teaching Hospital,
Nigerian Institute of Medical Research, Onikan Health Center, and Mushin General Hospital. The activity
In COP09, APIN plans to support provision of comprehensive HIV counseling and testing (HCT) services to
at-risk individuals, delivered through 49 service outlets (5 comprehensive sites, 1 Primary Health Care
(PHC) and 43 Directly Observed Treatment (DOT) centers) in 3 states (Lagos, Ogun and Oyo). When
including TB sites, 10,200 individuals (3,774 males and 6,426 females) will receive HCT and receive their
results; when excluding TB sites, the number that will be counseled, tested and receive results is 4,500
(1,665 males and 2,835 females). Targeted populations include most-at-risk populations (MARPs), clients
presenting to the health care facilities, blood donors, and family members of PLWHA. Provider-initiated HIV
testing is utilized as an additional strategy to reach clients at the health care facilities. The sites will include
DOT centers in at least one health facility in every local government area (LGA) in Oyo State. In COP09 the
APIN HCT site and community level activities will stress: (1) providing technical assistance, particularly in
identifying most at risk persons in need of HCT, and (2) working with sites to identify and obtain additional
resources (from the GON, other donors, Global Fund, etc.) to provide commodities and increase uptake of
HCT services.
In COP08, APIN supported provision of comprehensive HIV counseling and testing (HCT) services to at-risk
individuals, delivered through 45 service outlets (1 comprehensive site, 1 PHC and 43 DOT centers) in 3
states (Lagos, Ogun and Oyo).
Individuals identified as positive at APIN sites will be referred to PMTCT and ART clinics for treatment and
palliative care services. Prevention for HIV positive individuals will be incorporated into HCT activities
including promotion of HCT for family members and sex partners, counseling for discordant couples,
counseling on healthy lifestyles and positive living, prevention messages and Information, Education &
Communication (IEC) materials on disclosure. APIN sites use family counseling sessions and "love letter"
strategies to encourage partners of HIV-infected patients to access HCT so that couples receive HIV
counseling and testing together. Counselor training will include couple HIV counseling and testing (CHCT)
to strengthen this program. Pediatric patients that are identified at testing points of service will be enrolled
into the APIN supported OVC program and ART as necessary. HCT will also be offered to patients
receiving TB services at each of the APIN-supported sites throughout TB/HIV program activities. HCT is
offered to blood donors as per Blood Safety activities. Patients identified as HIV-infected are provided with
referrals to ART and palliative care services.
APIN will use the National "Heart to Heart" logo at supported HCT sites so as to reflect the integration within
the national program. At all HCT outlets, patients are provided with IEC materials on HIV prevention and
referrals for ART services and palliative care as appropriate. The materials will address HIV prevention
using the "ABC" model, providing information about healthy behaviors, safer sexual practices, STI
prevention, PMTCT, and condom usage. The sites will also provide HIV testing as well as pre- and post-test
counseling and condom distribution.
HCT services are also provided in community settings in conjunction with projects in Lagos state that serve
specific MARPs including: outpatient STI patients, bar workers, and sex workers. Mobile HCT services
coordinated through PHC-Iru will be used to reach these populations. Activities targeting these populations
are linked with APIN sites to provide referral linkages to PMTCT, Palliative HIV/TB and ART services
depending on eligibility for ART.
Condoms will be made available at all HCT sites in conjunction with the delivery of ABC messages. The
Society for Family Health (SFH) will supply condoms. Training of 20 individuals in counseling and testing
will use the new National serial testing algorithm and will educate trainees on appropriate counseling
messages specific to the different high risk groups with which they work. Refresher training will be provided
to a subset of the target trained during the year, particularly after final revision of the National training
curriculum. HIV testing is performed with rapid test assays and same day results are given. Following HIV
diagnosis with the National testing algorithm, immunoblot confirmation will be provided during assessment
for ART in line with the national algorithm. This is done by HIV laboratories at APIN-supported
comprehensive ART treatment centers.
To meet up with the increase demand for services, non-laboratorians, including nurses, counselors and lay
counselors will be trained to provide counseling and testing services at one visit using finger prick. These
will be supervised by laboratory scientists and the quality of testing would be ensured by proficiency testing
and quarterly supervisory visits. The University College Hospital (UCH) Virology lab supported through
Harvard will establish and coordinate a regular QA/QC program to insure that HIV serologic testing at APIN-
supported HCT centers meets national and international standards. This lab will also ensure coordination of
HIV testing standard operating procedures (SOPs) and provide regular training for new lab personnel. The
USG team will be providing APIN with rapid test kits that will be managed by the pharmacy logistics team in
Lagos and stored and distributed from the APIN central medical stores warehouse. APIN in collaboration
with Harvard will continue to harmonize the logistics process with GON Logistics Management Information
System (LMIS) and Inventory Control System (ICS) activities.
These activities will also address gender equity issues by providing equitable access to HCT services for
men and women. In some cases, the activities seek to target men who may be at high risk for HIV in order
to provide a mechanism for HCT as a means of prevention and access to services for their sexual partners.
Male targeted counseling seeks to address male norms and behaviors in order to encourage safer sexual
practices. Counseling also seeks to address sexual norms and issues of HIV related stigma and
Activity Narrative: discrimination.
TARGET POPULATIONS:
These activities target adults for HIV counseling and testing, particularly those from MARPs, as described
above. Targeting these populations is important to encourage utilization of HCT services and provide ART
for eligible HIV-infected individuals. Counseling provided through these activities also seeks to target
PLWHA who are newly diagnosed by encouraging them to bring their partners and other family members in
for HCT. In addition, target populations include orphans and vulnerable children.
CONTRIBUTION TO OVERALL PROGRAM AREA:
APIN HCT activities are consistent with the PEPFAR 2009 goals for Nigeria, which aim to increase uptake
of HCT by supporting HCT centers, which are linked to treatment and care services, to target MARPs. By
continuing to support and build the capacity of HCT centers and provide linkages to treatment and care
centers, these activities will be able to meet the increasing utilization of these services, expected to result
from HCT outreach initiatives identifying infected individuals. The network of HCT centers linked to HIV
services and care will provide a sustainable network for infected and affected individuals in APIN
catchments areas.
from Harvard to assume program management responsibility for these HCT activities. This will include the
This activity also relates to activities in Adult Care and Treatment, Pediatric Care and Treatment, Sexual
Prevention, TB/HIV, and OVC. APIN will link with the Harvard's network of community, research-based, and
tertiary care institutions, which should provide sustainable and high quality HIV and related services to the
communities served. Furthermore, both primary and satellite APIN sites are linked in order to provide
laboratory and specialty care support, as related to the HCT activities.
Continuing Activity: 22516
22516 22516.08 HHS/Centers for AIDS Prevention 9692 9692.08 $140,000
Estimated amount of funding that is planned for Human Capacity Development $1,000
Table 3.3.14:
sites to AIDS Prevention Initiative Nigeria, Limited. (APIN Ltd). The sites include Lagos University Teaching
Hospital, Nigerian Institute of Medical Research, Onikan Women's Hospital, and Mushin General Hospital.
The activity narrative reflects the transfer of targets from Harvard to APIN Ltd. APIN Ltd. will support the
management of the Central Medical Store (CMS) for both Harvard and APIN Ltd. supported sites. The
activities will build on the structure and systems put in place through Harvard. APIN Ltd. will maintain a
strong collaboration with Harvard.
Through these activities, APIN Ltd. will provide antiretroviral (ARV) drugs to 13,100 adult and 1,050
pediatric patients at six APIN Ltd. sites in three states (Lagos, Ogun and Oyo), all of which are
comprehensive antiretroviral treatment (ART) sites serving pregnant women, adults and children. Two of
the six sites are also supported by the Government Of Nigeria (GON) with close to 14% of patients
receiving ARV drugs from GON. At all sites APIN Ltd. will provide prevention of mother to child treatment
(PMTCT) drugs including all prophylaxis options and triple drug ART regimens for eligible pregnant women
consistent with the national PMTCT and ART guidelines. Thus, a total of six APIN Ltd. sites will be providing
ARV drugs through ART or PMTCT services.
All drug orders are based on projections of patient numbers as determined by annual forecasts conducted
in August 2008 in conjunction with the Harvard/APIN Ltd country team, SCMS and USG Logistics Technical
Working group. The determining factors were rate of patient enrollment, weight class of patients affecting
drug dosage, gender, rates of toxicity, and rates of failure. Our rates of drug ordering and estimation of
buffer stock needs have been informed by our experience with lengthy and variable order to delivery times,
global shortages, splitting of most orders, delays in National Agency for Food, Drug Administration and
Control (NAFDAC) registration and lengthy clearance of drugs in country. As a result, our drug forecasts
and orders had been adjusted to accommodate with an increase in buffer stocks. This year, we have buffer
stocks for approximately 3-5 months for all of the requisite PMTCT, first and second line ARV drugs. Based
on patient baseline data, fixed dose combinations (FDC) of CBV+EFV/NVP will be used for first line
regimen; patients with anemia or Hepatitis B/C will be placed on TDF+FTC+NVP/EFV. Other first line
alternative regimens and second line regimens will be dictated based on individual patient data or history.
FDC and generic drugs will be used preferentially. Currently 7% of patients on ART are on second-line and
93% on first line regimens. APIN Ltd. will receive technical assistance from Harvard and Northwestern
University for drug ordering and supply chain management. Drug usage updates are provided to all APIN
Ltd. and Harvard investigators by email on a monthly basis.
APIN Ltd. will purchase the drugs in accordance with USG, FDA and National Agency for Food and Drug
Administration and Control (NAFDAC) regulations as well as with the 2007 National Standard Treatment
Guidelines. In COP09, APIN Ltd. will continue to collaborate with the Clinton Foundation for the receipt of
second line adult and all the pediatric drugs. APIN LTD. will also work closely with the Government of
Nigeria to leverage resources for the sites supported by both PEPFAR and GON. All purchases of Truvada
(TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be procured via pooled procurement mechanism by SCMS
in line with OGAC's recommendation. The rest of the drugs will be purchased via IDA and other
procurement mechanisms. Drugs will be shipped to APIN Ltd.'s Central Medical Stores (CMS) in Lagos,
from where they will be distributed to sites in accordance with the internal supply chain management
system, which is collaboratively managed by APIN Ltd. and Harvard. APIN Ltd. maintains a subcontract with
Fed-Ex to provide monthly distribution to all site pharmacies. An electronic bin card system is utilized to
track and monitor drug stores and the distribution..
APIN Ltd. has developed standard operating procedures (SOPs) for supply chain management, drug usage,
drug regimen tracking, drug distribution, warehouse storage, waste management and individual pharmacy
site management. These SOPs are also used for procurement and distribution of opportunistic infection (OI)
drugs and certain lab supplies and test kits.
Capacity building and training for individual site pharmacies is ongoing to support pharmacy management
and implementation of the National ART Program. APIN Ltd. and Harvard are participating in the ART
harmonization process with the GON. The goal of these activities is to facilitate the pharmacies' ability to
scale up capacity as patient utilization of ARV increases. Assessments of all facilities to determine
infrastructure needs have been conducted in COP07 and COP08 and will continue in COP09 for new sites.
These site capacity assessments have been the basis for efforts to strengthen the supply chain
management system for new sites. Ongoing assessments ensure sustainability of pharmacies and supply
chain management at the sites. All site pharmacists have participated in regular training sessions and work
with site data managers in providing regular supply chain information electronically to our central pharmacy.
The computerized supply chain information system linked through APIN Ltd. to patient clinical records also
provides reporting data for monitoring & evaluation (M&E) efforts at each site. In COP08, additional
logistician and supply chain management staff were hired to provide additional support in the
implementation of the supply chain management system.
Our long-term goal is to support a sustainable supply chain management system for ART program that
incorporates and bolsters existing Nigerian institutional structures. Continued collaboration with the GON
procurement efforts contribute to this goal. APIN Ltd. will also continue its efforts in systems strengthening
the existing pharmacies by sending technical staff from APIN Ltd. and Harvard to assess procedures within
these units. Recommendations for drug storage, equipping of pharmacies and minor renovations will be
considered. All APIN Ltd. pharmacists will complete the IDA ARV training program. Pharmacists hold
meetings on a quarterly basis and training updates are provided. Pharmacists and their data entry staff also
participate in the electronic data tracking system; regular training in computer entry and database
management are also provided by in country and US-based program management staff.
Activity Narrative: EMPHASIS AREAS
Emphasis areas include proper commodity and logistics system management and development of the
human capacity. 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.
The primary target 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 people living with HIV/AIDS
(PLWHA), both adults and children, who are in need of or already receiving ART care.
Through these activities we will have provided ARV drugs to 14,150 patients at 6 ART service outlets. In
addition, we have scaled up our PMTCT activities with 6 points of service providing access to PMTCT
services for 852 women. Through these activities, we will continue to strengthen the structure of the APIN
Ltd. ARV drug procurement system, as described above, in accordance with PEPFAR goals in order to
ensure cost effective and accountable mechanisms for drug procurement and distribution. Such capacity
building activities will focus on the transition of supply chain management from Harvard to APIN Ltd..
Furthermore, efforts to build local capacity through infrastructure building and training mechanisms are
consistent with PEPFAR 5-year goals to enhance the capacity of supply chain management systems to
respond to rapid treatment scale-up. Additionally, through procurement via SCMS, we seek to provide
support to efforts to build national capacity related to drug procurement and distribution.
Additionally, as part of our sustainability building efforts, APIN Ltd. will receive technical assistance and
support from Harvard to assume program management responsibility for the ARV Drug activities. This will
include the implementation of a plan to transition site oversight, management and training over to APIN Ltd..
The goal of such efforts is to provide for greater assumption of responsibility for management and
This activity also relates to activities in TB/HIV, Adult Care and Treatment, Pediatric Care and Treatment,
and Strategic Information. Through this activity, we will maintain significant linkages with PMTCT and Adult
and Pediatric Care and Treatment through the procurement of ART drugs for individuals served by these
programs. Additionally, we will develop and maintain linkages to TB/HIV activities, with expansion focusing
on co-locating ARV sites with existing DOTS sites. 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.
Table 3.3.15:
sites to APIN Ltd. (APIN). The sites include Lagos University Teaching Hospital (LUTH), Nigerian Institute
of Medical Research (NIMR), Onikan Health Center, and Mushin General Hospital. The activity narrative
reflects the transfer of targets from Harvard to APIN. The activities will build on the structure and systems
put in place through Harvard. APIN will maintain a strong collaboration with Harvard University.
In COP09, APIN will take over 4 APIN+/Harvard labs at a tertiary care institution and research institute. We
also propose to add additional expansion sites by building the infrastructure and capacities of 1 lab in
secondary health facilities in Lagos state to have capabilities for hematology, automated chemistry
analyzers, and laser-based lymphocyte subset enumeration. In COP08, we will expand the capacity of 1
lab in a primary health facility in Lagos state. We also expanded the capacity of the lab at Sacred Heart
Catholic Hospital, a secondary health facility in Ogun state, to have capabilities for hematology, automated
chemistry analyzers, laser-based lymphocyte subset enumeration and viral load assay.
By the end of COP09, HIV rapid testing will be performed at the HCT centers with the labs providing
supervisory roles. All 5 ART sites will have western blot capacity to confirm HIV status prior to initiation of
ART. HIV serology, hematology, chemistries, and CD4 enumeration will be supported at all secondary
hospitals with referral to the tertiary labs for PCR diagnostics and viral loads. Primary health care facilities
are closely partnered with secondary and tertiary care facilities, allowing for baseline and periodic
evaluation with full lab monitoring. The primary facilities provide limited lab monitoring with basic clinical,
hematologic and CD4 assays. We will screen for TB by sputum and/or pulmonary X-ray at all ART sites. We
will also provide screening for STIs, including Syphilis and Chlamydia at all of our sites. Our 2 labs with
infant PCR diagnostic capabilities (NIMR, LUTH) will continue to assist other PEPFAR IPs, using dried
blood spots (DBS) to test specimens from distant satellite sites.
Standardized lab protocols were developed in previous COP years by Harvard to accompany the clinical
protocols. Computerized lab results were also linked with patient records. In order to ensure continuity of
care and services, these protocols will continue to be implemented at APIN sites. These protocols include
provisions for the disposal of biomedical waste in accordance with good laboratory practices. Quality
assurance /quality control (QA/QC) policies have been developed and detailed annual assessments of all
lab activities are conducted. Quarterly QA/QC lab site visits are conducted by the APIN project
management team with technical assistance from Harvard and will use a standardized assessment tool
developed in Nigeria by the Lab Technical Working Group (LTWG). Results from the proficiency testing and
site visits will be sent into a centralized system within Nigeria, developed and supported by the PEPFAR
LTWG. External Quality Assurance (EQA) for lab tests was established in COP07 by Harvard and is
operational for CD4, HIV, HCV and HBV serology, chemistries, VL and HIV DNA PCR diagnostics through
individual lab registration with UK-NEQAS and CAP. We intend to continue this with all APIN labs. All PCR
labs will participate in the CDC Atlanta DBS DNA PCR proficiency program (EID QA). We provide support
for lab staff persons (based at sites), responsible for implementation of lab protocols, data entry and
performance of lab tests. In addition, we provide support for 3 APIN staff who provide technical assistance
to sites. We will continue our efforts to increase our laboratory technical staff in order to address increased
training and laboratory needs for the overall PEPFAR program.
Regular lab training allows the development of high quality lab standards in our PEPFAR labs and this has
been networked to our secondary and primary labs with specific tailoring to the needs and skills at each
level. In conjunction with Harvard Lab Infrastructure activities, staff at APIN sites will be linked to biannual
trainings provided on specific techniques/topics integrating QA/QC, good lab practices and lab safety.
Through Harvard, competency monitoring/evaluations and refresher trainings will be provided within
individual labs. APIN also provides support for a lab at NIMR (Lagos) which is a comprehensive hand-on
training center with lecture room capacity and personnel skilled in training. This training center provides
training in all areas, with special focus on viral load and drug resistance testing. Post Exposure Prophylaxis
(PEP) protocols have been implemented at each of our labs, supported under our ART drugs activities. In
COP09, we will continue our efforts to increase our laboratory technical staff in order to recruit staff
responsible for lab QA, lab training and monitoring for APIN.
A laboratory information system (LIS) will be implemented at sites, with appropriate capabilities, to
streamline the capture of lab data to minimize transcription errors and facilitate data entry and results
output.
We will participate in LTWG monthly meetings to ensure harmonization with other IPs and the GON,
including the development of a common lab equipment platform (appropriate for each lab level).
Procurement of lab reagents is structured in two ways. Reagents available in Nigeria will be procured
directly by the sites from specific distributors. Labs will be advised to maintain a 3 month reagent buffer.
Most reagents needing importation will be ordered at Harvard and shipped to the APIN Central Medical
Stores warehouse in Lagos. PEPFAR funding supports procurement of lab equipment, generators and
water purifiers necessary for lab work at APIN sites. Equipment costs for labs can be high in the first year,
but represents significant infrastructure development. Maintenance costs include minimal renovation costs
for some labs, replacement of small lab equipment and training costs for additional personnel.
APIN will perform 267,086 tests in COP09, including HIV diagnosis and tests for disease monitoring
including CD4 enumeration, PCR diagnosis of infants and VL, which provide support for ARV treatment for
13,100 adult and 1,050 pediatric patients at APIN sites in Lagos and Ogun states. In addition, we seek to
train199 lab staff members in COP09.
This program seeks to address gender equity by building the capacity of labs at affiliated sites to conduct
Activity Narrative: testing related to PMTCT. Increased lab capacity will permit the sites to provide equitable treatment for both
women and men. We also place emphasis on TB services as our lab activities include the provision of
support for TB and HIV diagnostics at 43 TB DOTS sites in Oyo state.
This program targets public and private health care workers with training to maintain high quality lab
standards. Laboratory diagnostics and monitoring supported through these activities also target PLWHAs
who are provided with treatment through our Adult and Pediatric Care and Treatment activities.
These activities contribute to the goal of maintaining high quality services as the PEPFAR program
expands. Training lab staff will assist in building the human resource capacity of our sites to provide
sustainable lab support to sites providing high quality HCT and ART treatment. Two labs at a tertiary care
hospital and research institute will have the capacity to perform early infant diagnosis (EID) by HIV DNA
PCR. These labs are also linked to PMTCT sites, to provide a mechanism for EID as a part of the PEPFAR
supported national scale-up plan (consistent with 2009 PEPFAR objectives for Nigeria). APIN will partner
with Harvard, GON and Clinton Foundation for procurement of EID test kits and specimen collection
supplies and transportation of DBS/results to and from testing labs. The NIMR PCR lab will provide QA
support for the EID program in the southern half of Nigeria (through retesting). Through a tiered system of
labs at tertiary, secondary and primary sites we are able to ensure that patients at community based
primary facilities are provided with a full complement of lab monitoring as a part of ART treatment and care.
Our training activities include management and competency training, which seeks to build sustainability.
from Harvard to assume program management responsibility for our Lab Infrastructure activities. This will
include the implementation of a plan to transition site oversight, management and training over to APIN. The
goal of such efforts is to provide for greater assumption of responsibility for management and
These activities relate to activities in PMTCT, Counseling & Testing, Palliative Care TB/HIV, Adult Care and
Treatment, Pediatric Care and Treatment and OVC. Our labs are crucial in providing adequate HIV
diagnostics in PMTCT, HCT, OVC, Palliative care and ART services. Furthermore the lab provides other
diagnostics such as OIs. As a part of this activity, we seek to build linkages between labs and our patient
care sites in order to ensure that lab information is fed back into patient records for use in clinical care. Our
SI activities provide support in M&E, including data management of testing results.
Continuing Activity: 22507
22507 22507.08 HHS/Centers for AIDS Prevention 9692 9692.08 $200,000
Estimated amount of funding that is planned for Human Capacity Development $85,000
Table 3.3.16:
In COP09, the Harvard University plans to move over four of its PEPFAR supported sites to APIN, Ltd
(APIN). The sites include Lagos University Teaching Hospital (LUTH), Nigerian Institute of Medical
Research (NIMR), Onikan Women's Hospital (OWH), and Mushin General Hospital (MGH). Forty-three DOT
(Directly Observed Treatment) centers in Oyo State will also be supported. The activity narrative reflects the
transfer of targets from Harvard to APIN. The activities will build on the structure and systems put in place
through Harvard. APIN will maintain a strong collaboration with Harvard University.
During COP08, APIN assumed management responsibility for 2 Harvard sites, Sacred Heart Catholic
Hospital in Lantoro, Ogun State and Primary Health Center-Iru on Victoria Island, Lagos. In COP09, APIN
will take over provision of OVC services at an additional 4 sites (LUTH, NIMR, OWH, and MGH). In COP09,
APIN will provide support for SI activities at all 6 sites (3 ARV, 2 PMTCT sites, 1 PHC, and 43 DOT sites).
The activities include: data management and data quality assurance, monitoring and evaluation (M&E),
health management information systems (HMIS) and operational research studies in all supported sites.
Funds will also be utilized to continue building the capacity of site staff in the above areas in order to
promote effective use of data to improve services and programs as well as influence policy. In addition, a
major goal in the coming year is to further achieve sustainability. In order to attain that goal, APIN will
receive technical assistance from Harvard in the area of data expertise. APIN staff, which includes a
database specialist, IT specialist, an M&E Officer, and an M&E Consultant, will assist the sites with on-site
clinical, pharmacy, laboratory and project reporting. In line with the PEPFAR-Nigeria indigenous capacity-
building strategy, APIN, in collaboration with Harvard, will strengthen local capacity at primary, secondary
and tertiary health facilities. A major goal of our activities this coming year is to further: 1) build M&E
capacity at the local level; 2) promote increased utilization of data in evidence-based decision making; 3)
evaluate clinical outcomes and intervention efforts; and 4) evaluate program outcomes.
The APIN program will utilize a relational database system developed through Harvard PEPFAR. The
database is linked by a unique patient ID number and contains data required for patient management and
monitoring (PMM). The electronic database is functional and fully harmonized to the GON PMM forms to
allow for full integration into the broader Nigerian national health information system. The database will be
strengthened to track linkages for prevention-care-treatment or the continuum of HIV services. Throughout
the transition of activities from Harvard to APIN, we will continue to use the APIN+/Harvard forms and
databases which were developed under COP funding to Harvard in previous grant years. The APIN/Harvard
forms collect clinical visit, pharmacy pick-up, laboratory assessment, toxicity, virological/immunological
failure and discontinuation information for adult and pediatric care and treatment as well as PMTCT
services. At present, OVC data are collected using GON registers, but we are working to develop electronic
forms, which are fully harmonized with the GON forms, and will allow for more efficient reporting. The
program has also developed a number of utilities to maximize the efficient use of data for improved patient
management, data quality, reporting and program management. This includes a treatment response utility,
which provides a graphical display of patients' CD4 counts, viral loads (as clinically necessary), and drug
pick-up history, as well as a loss to follow-up utility, which serves as an early warning system for patients
that miss drug pick-ups. Information is generated and used for site and program-specific evaluation of
services, such as assessment of CD4 counts, viral load (as clinically necessary), adherence, and loss to
follow-up.
APIN will continue to maintain computer hardware and software provided by Harvard to support sites as
services are being maintained. SOPs are in place to govern data entry, security, management and reporting
based on the ARV treatment and care protocol. Refinement of instruments and databases is ongoing to
accommodate program reporting requirements from Harvard, USG and the GON. The PMM forms are
stored in the patient hospital folders and kept in locked file cabinets. National registers are also in use at
APIN-supported sites. Data from PMM forms and relevant registers are entered into the databases by
trained data entry staff at the respective sites. The data are then uploaded to a password protected web
server, accessible to authorized personnel and data managers at the Nigerian sites and at APIN/Harvard.
Data managers prepare timely reports for GON and USG using the electronic databases. Facility-based
data are reported using harmonized national reporting system. The Boston and Nigerian data management
team and the M&E officer provide regular feedback on data collected and on reports to the sites. Site M&E
committees are in place to implement an annual M&E plan; M&E results are fed back to the sites to promote
systems improvement.
APIN will continue to improve its good working relationships with state-level M&E staff through regular
communication, on-site monitoring activities, active work at capacity-building, championing the "Three
Ones" at the state level, and participation in routine state-level monitoring and reporting events that include
non-APIN supported sites in the states. These actions are designed to encourage state M&E officers'
participation in strategic information activities and expand their capacity in data collection, management,
reporting and strategic utilization. This involvement will build the capacity of the state-level staff and
promote sustainability. The SI team of APIN and Harvard will continue to participate actively in the National
M&E technical workgroup (TWG) and the USG-Nigeria SI TWG and respond to the goals of the one
national reporting system.
In COP09, APIN will scale up the quality improvement (QI) activities to all the APIN sites, building on the
Harvard supported internal QI initiative, designed at collecting qualitative and quantitative data regarding
indicators on the provision of adult, pediatric and PMTCT services at each site. In order to continually
improve and monitor data quality, each site will be visited regularly by APIN M&E staff throughout COP09;
on-site TA and supportive supervision will be provided. Regular inter-site interactions will be encouraged,
facilitated by APIN+/Harvard personnel. In COP08, all supported sites constituted M&E committees; these
committees meet to evaluate the site M&E data and use the information towards improving quality of care
and making evidence-based clinical decisions. In COP09, sites will work on fully developing QA/QI
committees to conduct quarterly reviews of quality of care. During COP09, we will continue to encourage
and monitor the activities of the site M&E and QA/QI teams. We are also working on developing a database
utility that will allow the sites to quickly pull out data on patients that are lost to follow-up, showing signs of
Activity Narrative: toxicity or failure, or that may require other focused attention, to further improve quality of care. Finally,
HIVQUAL using additional QI indicators is being implemented in six selected APIN supported sites.
In COP09, 49 local organizations will be provided with technical assistance for strategic information
activities and 161 individuals will be trained in database management, monitoring and evaluation (M&E),
surveillance, and HMIS. The APIN central office will conduct 10 training sessions centrally. In addition,
regional data management trainings for personnel working with medical records and patient data will be
conducted on a regular basis. Data management and M&E modules will be incorporated into respective
technical training for other disciplines such as clinicians, nurses, pharmacists and laboratory staff etc.
These activities emphasize monitoring, evaluation, and reporting through data collection, data analysis, data
use and data dissemination. Emphasis is placed on strategic information, human capacity development and
local organization capacity-building.
This activity will highlight gender issues by providing gender disaggregated data on patients accessing
HIV/AIDS related services. Through this analysis, we will be able to contribute to national surveillance on
utilization of HIV services and impact of HIV intervention on both sexes. This data will be essential to the
development of outreach, treatment programs and education to reach an equitable number of men and
women.
TARGETED POPULATIONS:
The SI activities target program managers and M&E officers, site coordinators and principal investigators to
provide them with skills and tools for programmatic monitoring/evaluation. The data collection and
management components of these activities target medical record staff, data staff, and other health care
workers who are involved in the implementation of these processes. Lastly, the M&E and capacity-building
efforts target implementing organizations, including private, community-based and faith-based organizations
involved in the provision of ART, HCT, pediatric and adult BC&S, TB/HIV and PMTCT services.
CONTRIBUTIONS:
SI activities supported by APIN are consistent with the 2009 PEPFAR goals to build indigenous capacity-
building in the area of SI. APIN SI activities are consistent with these goals in that funding will be used to
strengthen local capacity in the area of database management, data analysis, data use, M&E and QA/QI.
Harvard will also provide SI support to its local administrative office, central pharmacy and warehouse.
Additionally, as part of our sustainability building efforts, APIN with technical assistance and support from
Harvard will assume program management responsibility for the SI activities. The goal of such efforts is to
provide for greater assumption of responsibility for management and implementation of PEPFAR
programming by Nigerian nationals through an indigenous organization.
These activities are linked to PMTCT, OVC, TB/HIV, HCT, ART, and Basic Care & Support Services, where
SI is used for M&E and QA/QI. In M&E activities, APIN will link to the National M&E TWG and Nigeria
MEMS. Additionally, through the provision of IT support and data management personnel, APIN will
provide linkages between all supported sites as related to data sharing and HIV surveillance in PEPFAR
program areas. Through operational research studies, APIN will collaborate with Harvard, FMOH, other
GON representatives, NNART committee and the NIAID/NIH.
Continuing Activity: 22506
22506 22506.08 HHS/Centers for AIDS Prevention 9692 9692.08 $50,000
Table 3.3.17:
