HHS/CDC will put out a Funding Opportunity Announcement to invite implementing partners to apply for

funds to provide comprehensive HIV/AIDS services in FY 2010. Partners receiving HHS/CDC funding

must place a clear emphasis on developing local indigenous capacity to deliver HIV/AIDS related services

to the Nigerian population and must also coordinate with activities supported by Nigeria, international or

USG agencies to avoid duplication. Partners receiving HHS/CDC funding must collaborate across

program areas whenever appropriate or necessary to improve service delivery and must continue

activities in HIV services that are currently ongoing in the PEPFAR program, in order to ensure no break

in services to clients.

The partner will implement activities both directly and, where applicable, through sub-grantees; the

partner will, however, retain overall financial and programmatic management under the oversight of

HHS/CDC and the strategic direction of the Office of the U.S. Global AIDS Coordinator. The partner must

show measurable progressive reinforcement of the capacity of currently supported tertiary, secondary and

primary health facilities to respond to the national HIV epidemic as well as progress towards the

sustainability of activities.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local implementing partners, to continue to implement HIV care and support programs in underserved areas of Nigeria. Basic Health Care package services that may be included by the award recipient include: basic medical, laboratory and nursing care, adherence counseling, prevention for positives, linkage to psychosocial support through participation in PLWHA support groups and individual counseling operational at points of service with transportation, communication and referrals, pain and symptom management, and provision of community home based care (HBC). Provision of clinical care will include prevention and treatment of OIs and other HIV/AIDS-related complications including malaria and diarrhea (providing access to commodities such as pharmaceuticals, insecticide-treated nets, safe water interventions and related laboratory services), prevention of cervical cancer, pain and symptom relief, and nutritional assessment and support including food.

The recipients will be expected to provide palliative and home based care both at the facility level and in communities with an appropriate combination of models which will be utilized depending upon the site preference. The RFA will supplement site staffing with trained PLWHAs and volunteers from communities to provide this service. An identified trained Basic Care and Support Program Officer with a counseling background at each facility will work with support groups to improve educational and support programs, and coordinate linkage of the facility points of service to the communities.

Training essential for program success and sustainability will target doctors, nurses, health aids, counselors, PLWHAs and community volunteers. This training will be conducted by RFA program staff at the site level to maximize coverage. Training will be done using the training manual which is being developed with the GON by current large treatment partners through PEPFAR support. All HBC providers will receive a provider's manual describing methods of assessment, diagnosis, treatment, management and referral for HIV related symptoms. This will ensure all PLWHAs, including HIV positive pregnant women as well as all TB/HIV patients, get the correct care and the same quality of care across the sites. There will also be Standard Operating Procedures for Basic Care and Support at all service outlets.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity provides services which are a high priority for the President's Emergency Plan by providing a basic package of care for all PLWHA including HIV positive pregnant women and TB/HIV patients. The services are consistent with the Guidelines for Palliative Care in Nigeria as well as the Nigerian Guidelines for ART which emphasize HBC, symptom management, and OI prophylaxis. Capacity development at the site level and consistency with national guidelines will ensure sustainability. RFA identified staff will contribute to development of a national palliative care training curriculum, identified as a priority by the Government of Nigeria (GON).

LINKS TO OTHER ACTIVITIES: This activity is linked to HVCT (12972.09), HVOP (12969.09), PMTCT (12968.09), HVTB (12971.09), HKID (14087.09) and HTXS (14089.09). HCT will target at risk populations including all pregnant women and all TB patients. All patients are monitored and linked to ARV therapy when indicated. Care and Support services such as psychosocial support and symptom management promotes ARV adherence. Prevention for Positives which includes counseling and condom availability will be integrated into this activity. Services are co-located with TB Directly Observed Treatment Services (DOTS) centers with referrals from other DOTS centers. RFA identified staff will work with sites to ensure effective referral/linkage and coordination systems are in place. High quality laboratory services supported by CDC/RFA facilitated laboratory QA program will be available at sites.

POPULATIONS BEING TARGETED: Services are offered to all PLWHAs including HIV positive TB patients and pregnant women identified through TB DOT Centers and PMTCT programs, respectively. Doctors, nurses, other health workers, PLWHAs and volunteer caregivers of PLWHA are targeted for training. The volunteers participate in providing HBC services as well as adherence counseling.

EMPHASIS AREAS: The emphasis area for this activity is training as capacity development for

sustainability is a key focus.

COVERAGE AREAS: TBD when awarded.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local implementing partners, to continue to implement HIV OVC programs in underserved areas of Nigeria. It is expected that the recipients will continue to provide support to HIV/AIDS affected and infected children (0-17) and their families/households in an integrated and holistic manner that improves the children's overall well-being, through household-centered approaches that link OVC services with HIV-affected families (through linkages with PMTCT, palliative care, treatment, etc.) and strengthen the capacity of the family unit (caregiver), along with strengthening community structures that protect and promote healthy child development.

Other services to be provided under this intervention include safe water (by promoting the use of Water Guard) and malarial prevention through the use of Long-lasting Insecticide Treated Nets (LLITNs). Nutritional and educational support will be provided either directly or through linkages to other USG partners providing such services as appropriate. OVC care providers may have access to income generating skill building through these awards, and community members will be recruited to serve as mentors to aid OVCs receiving services. These activities will be achieved in line with the National Guidelines and Standard Operating Procedures (SOPs).

CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity is a high priority intervention area for the President's Emergency Plan by providing a comprehensive package of services to children orphaned or rendered vulnerable by HIV/AIDS, including those infected with HIV. It is also a priority for the GON. Its components, especially the human resource capacity development aspect, will enhance sustainability and the development of health care systems in Nigeria.

LINKS TO OTHER ACTIVITIES: This activity will be linked with HVCT (12972.09), HTXS (14089.09), PMTCT (12968.09), HVTB (12971.09), HVOP (12969.09), HVSI (14091.09), and HLAB (14090.09). HCT services will be accessible to all family members and relations of the HIV infected children as necessary. Children that qualify for either ART or TB treatment will be linked to the most proximal outlets for these services. Since some of

the services will be implemented by local indigenous NGOs, CBOs and FBOs, sub-agreements will be coordinated with relevant IPs to ensure non-overlap of funding, services and reporting. The OVC services will be implemented in coordination with the GON, other relevant IPs and the GFATM.

POPULATIONS BEING TARGETED: OVC services are primarily targeted at care givers, OVC/PLWHAs and their affected families. The capacity development activities cover the facility based staff like doctors, nurses, and other health care workers. In the community, training is targeted at NGOs, CBOs, FBOs and volunteers. However, the direct beneficiaries of the services are HIV positive infants and children, as well as children orphaned or made vulnerable by HIV/AIDS.

EMPHASIS AREAS: The major area for this intervention is training and human resources development in order to ensure the delivery of comprehensive services to Orphans and Vulnerable Children.

COVERAGE AREAS: TBD when awarded.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local

implementing partners, to provide infrastructure, maintenance, training clinicians and other providers,

exams, clinical monitoring and management of opportunistic infections, related laboratory services, and

community-adherence activities. The recipient will also be expected to maintain facilities that provide

ART services, provide clinical monitoring of management of opportunistic infections, provide laboratory

services, and provide community adherence programs

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local

implementing partners, to continue to implement HIV care and support programs for children in

underserved areas of Nigeria. Basic Health Care package services that may be included by the award

recipient include: basic medical, laboratory and nursing care, pain and symptom management, and

provision of community home based care (HBC). Funds are to be used for the continuation of ongoing

health facility-based and community based care for HIV-exposed and infected children aimed at

extending and optimizing quality of life for HIV-infected clients and their families throughout the

continuum of illness through provision of clinical, psychological, spiritual, social, and prevention services.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local

implementing partners, to provide infrastructure, maintenance, training clinicians and other providers,

exams, clinical monitoring and management of opportunistic infections, related laboratory services, and

community-adherence activities for children in underserved areas of Nigeria. The recipient will also be

expected to maintain facilities that provide ART services, provide clinical monitoring of management of

opportunistic infections, provide laboratory services, and provide community adherence programs.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA to continue improvements in creating a safe blood supply for Nigeria. Award recipients will be expected to continue to provide blood safety activities through supporting nationally-coordinated blood program to ensure a safe and adequate blood supply including infrastructure and policies, donor recruitment activities, blood collection, testing for Transfusion Transmissival Infections (TTIs), storage and distribution of blood, appropriate clinical use of blood, transfusion procedures and hemovigilance, training and human resource development for transfusion.

CONTRIBUTION TO OVERALL AREA: This activity will enhance blood safety program implementation through support to the NBTS. This will allow for continued strengthening of the Nigerian NBTS after the conclusion of the Track 1.0 award mechanism.

LINKS TO OTHER ACTIVITIES: This activity is linked to HVCT (12972.09), HLAB (14090.09) and injection safety

EMPHASIS AREAS: This activity has an emphasis in capacity building for staff.

TARGET POPULATION: This target population will be health care workers for training and advocacy in appropriate transfusion practices.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local implementing partners, to implement the prevention of sexual transmission portfolio, specifically in the condoms and other prevention program, currently being provided in underserved areas in Nigeria. Recipients will be charged with the provision and implementation of prevention through education on abstinence among in and out of school youths, targeted interventions among high-risk groups [Men having sex with men (MSM), Female sex workers (FSW), transport workers (TW), uniformed servicemen, injecting drug users (IDU's), prison population and such other vulnerable populations as would be identified]. Activities will be designed to achieve clear behavior change objectives, address social norms and structural barriers to prevention and use biomedical interventions relevant to the population and setting.

Clients will be the focus of messages aimed at reducing HIV transmission in high risk populations including correct and consistent condom-use messages. Existing support groups or associations of People Living With HIV/AIDS (PLWHA) will have access to condoms and be targeted with 'prevention for positives' messages (funded under care) and skills on positive living, to reduce transmission and re- infection. This activity will provide referrals to basic care and support services as well as ARV services for those identified to be in need.

This activity will provide training to PLWHA as peer educators and lay counselors to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful. This RFA will strengthen the developed sustainability plan both at program and country level and will collaborate with other existing implementing partners to build capacity and reach proposed indicators.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity will support the GON to increase local capacity to provide prevention services to most-at-risk populations.

LINKS TO OTHER ACTIVITIES: This activity also relates to activities in HBHC (12970.09), HVTB (12971.09), HVCT (12972.09) and HTXS (14089.09). This activity provides community outreach to individuals identified as high risk for acquiring HIV and directs them into counseling and testing. Those who test positive will be referred to PMTCT services, HIV treatment services as well as care & support services as appropriate.

EMPHASIS AREAS: This activity has an emphasis on gender equity and addressing male norms and behaviors.

TARGET POPULATION: This activity will target Most At Risk Populations, HIV positive pregnant women and PLWHA.

COVERAGE AREAS: TBD when awarded.

The recipients will be responsible for supporting PMTCT services in previously unserved clinical outlets. Counseling and testing with the "opt out" and will be provided to all pregnant women presenting at antenatal services. HIV infected women will be counseled on risks of HIV transmission and goals of the PMTCT program. They will be encouraged to bring partners and other family members for counseling and testing. HIV infected women eligible for ART will be provided with ART following the National guidelines. All participating laboratories will either have the capability of clinical HIV assessment including CD4 determination to ascertain ART eligibility by national and international ART criteria or will refer women to such services at another HIV service outlet in the geographic area. HIV infected women ineligible for initiation of ART will be offered combination of zidovudine from 28 weeks and single dose nevirapine at onset of labor as per the national guidelines. Women presenting at labor will be offered rapid testing and if HIV infected provided with single dose nevirapine. All infants born to HIV infected women will be provided with single dose nevirapine at birth and zidovudine for 6 weeks. After delivery, mothers and infants will be followed to monitor the mother's health and determine HIV status of the baby. Infant diagnosis of HIV will be by referral to qualified PEPFAR laboratories performing PCR if not available at the site, and if found positive the baby will continue to be monitored for eligibility for ART and per medical indications, be provided with cotrimoxazole prophylaxis.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: With 30 sites in 4 states, the above described activity is in line with the USG`s target of having 80% coverage for PMTCT across the country.

LINKS TO OTHER ACTIVITIES: This activity is also linked to HVOP (12969.08), HBHC (12970.08), HCT (12972.08), HKID (14087.08), HVTB (12971.08), HTXS (14089.08) and joint awards for these program areas are anticipated. Prevention for positives counseling will be integrated within PMTCT care for HIV+ women

POPULATIONS BEING TARGETED: This activity targets pregnant women who will be offered HIV counseling and testing, HIV+ pregnant women who will be offered ARV prophylaxis and infant feeding counseling, and HIV+ infants who will be offered ARV prophylaxis and infant HIV diagnostic testing.

EMPHASIS AREAS: The PMTCT service has an emphasis on Human Resources and Local Organization Capacity Development.

COVERAGE AREAS: TBD when awarded.

These funds are to be used by the award recipients of FY10 HHS/CDC RFA to support PMTCT, CT, TB/HIV and ART treatment/services through the development of laboratory infrastructure at health facilities within Nigeria. Recipients will be expected to continue strengthening of laboratory systems and facilities to support HIV/AIDS-related activities including purchase of equipment and commodities and provision of quality assurance, staff training and other technical assistance.

The basic infrastructure at each facility will be enhanced to ensure constant electrical power and water. Labs will be equipped with automated CD4, hematology and blood chemistry equipment. Supplies for manual CD4 determinations will be available as a backup. HIV diagnosis will be performed at all sites using the GON approved rapid testing algorithm. All labs will have light microscopy for diagnosis of OIs (including TB). Funding will be used to support didactic and wet lab technical training of laboratory staff. Along with technical training, all staff will receive instruction in lab safety, good laboratory practices, record keeping and reagent/specimen storage. Standardized training curriculums currently exist (or are under development) for each of these areas and will be utilized. On-site refresher training will be provided to all laboratorians on a yearly basis. The quality of testing at all labs will be monitored through an extensive quality assurance (QA) program, including training of all staff on QA, proficiency testing and quarterly supervisory site visits (using a standardized evaluation tool). To facilitate these activities, two laboratorians will be responsible for coordinating training (as master trainers) and QA activities.

CONTRIBUTION TO OVERALL PROGRAM: Enhancement of additional labs in Nigeria will contribute to the goal of maintaining high quality lab services as the number of patients provided with testing and treatment continues to rise. These labs will

support the identification and monitoring of new patients for ART therapy. Development of a new lab facility to deliver training supplements the over all lab capacity in Nigeria.

LINKS TO OTHER ACTIVITIES: Having a strong laboratory infrastructure, with appropriately trained/supervised staff, within healthcare facilities provides support for many of the other EP program areas. Laboratory staff play a vital role in training those individuals performing HIV diagnostic testing in PMTCT (12968.09) and Counseling and Testing (12972.09) programs. Appropriately equipped labs allow for identification of HIV positive adult and children, ART Services (14089.09) and OVC (14087.09) and support monitoring of those with TB/HIV coinfection (12971.09).

POPULATIONS BEING TARGETED: This activity will provide essential laboratory services to adults living with HIV/AIDS, HIV positive pregnant women, HIV positive infants and HIV positive children. Laboratory workers from the public sector will be targeted with technical training.

EMPHASIS AREAS: This activity includes emphasis on renovation (specifically laboratories at healthcare facilities) and on training, development of network/linkages/referral system and quality assurance.

These funds are to be used by the award recipients of the FY10 HHS/CDC RFA, with emphasis on local implementing partners, to implement an HIV care and support program in underserved areas of Nigeria. Funds will be used to increase access to high quality TB services for HIV-infected individuals including pregnant women and children and to increase access to quality HIV testing at DOTS centers. The award recipients will be expected to establish or improve TB/HIV service provision in about 5 facilities with potential to expand to other facilities if funding is available. Continued provision of clinical monitoring, related laboratory services, treatment and prevention of tuberculosis (including medications), as well as screening and referral of TB clinic clients for HIV testing and clinical care is expected. The location of current HIV/TB activities includes general medical settings, HIV/AIDS clinics, home-based care and traditional TB clinics and hospitals.

The FY10 HHS/CDC RFA award recipients will establish and maintain TB laboratory capacity at all program sites in collaboration with the National TB program and facility staff to ensure timely and

accurate diagnosis of TB in HIV-infected individuals. Specific TB diagnostic laboratory support will include equipment upgrades (e.g. light microscopes and commodities for sputum smear microscopy) and training for 20 laboratory technicians from program sites which will focus on improving basic microscopy techniques. Support is to be provided for a quality assurance/quality control (QA/QC) system in collaboration with the National TB and Leprosy training center. This QA/QC system will involve qualified personal who will regularly visit sites to evaluate practices, microscopy proficiency testing and blind rechecking of a sample of slides. Funds will also be allocated for hiring a dedicated TB/HIV program officer who is responsible for providing strategic and technical direction to TB/HIV program implementation. S/he will also work with other GoN and Emergency Plan partners to promote synergy and to limit redundant efforts related to TB/HIV.

CONTRIBUTION TO OVERALL PROGRAM AREA: The activities supported with these funds are in line with both the Government of Nigeria and Emergency Plan strategy for addressing HIV/AIDS as well as the dual TB and HIV epidemic in Nigeria. A key component of these strategies is to identify the need to improve HIV care by providing TB screening services and linkage to TB care as appropriate for HIV infected individuals. Regular screening for TB and a strong linkage to quality TB diagnostic and care services will identify these high-risk individuals who will benefit from access to TB and HIV care and treatment, thus supporting the National HIV/AIDS strategy and contributing to the care and treatment objectives of the Emergency Plan. Funds will also be used to routinely provide HIV counseling and testing services to TB patients. The HHS/CDC RFA award recipient should be uniquely positioned to provide services to underserved populations due to its history of working with and in the rural community along with other indigenous partners.

LINKS TO OTHER ACTIVITIES: These TB/HIV activities are related to HVCT (12972.08), PMTCT (12968.08), HVOP (12970.08), HBHC(12970.08), HKID (140870.08), and HTXS (14089.08).

EMPHASIS AREAS: To achieve success in this activity emphasis will be placed on the development of network linkages and referral systems between TB and HIV programs. In addition, emphasis will be placed training, infrastructure, human capacity, quality assurance/improvement/and supportive supervision as explained above.