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: 2010 2011
The Walter Reed Army Institute of Research US Military HIV Research Program (USMHRP) maintains a fully serviced agency in Abuja Nigeria. This office is known as the Department of Defense HIV Program in Nigeria (DODHPN). The office is dedicated to PEPFAR country-level management activities (partners with the CDC and the USAID). These include participation in USG technical working group activities; strategic vision development and Country Operational Plan development. In addition to the USG country- level management activities, the office also directly implements PEPFAR activities in partnership with the Emergency Plan Implementation Committee (EPIC) of the Nigerian Ministry of Defence (NMOD). The partnership is dedicated to the provision of comprehensive HIV Prevention, Care and Treatment services to the Nigerian Military personnel, their dependents and catchment populations.
The Military to Military health diplomacy & partnership that serves as the foundation of the program is providing a working model for the current efforts at development of a partnership framework for Nigeria. Key examples from this program will be factored into the design of the framework. The DOD HIV program and services are offered through 20 military sites that are located across 15 States of the Federation (Edo, Benue, Cross River, Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, and Anambra) and the Federal Capital territory. Primary target population includes military personnel, their dependents and the catchment population around the facilities. An estimated 2,200,000 people fall within this catchment population.
Human capacity development through regular training both locally and international for Military health personnel is a key HSS activity of the program that speaks to Human resources for Health issues within the military. Also a cohort of temporary National Youth Service Corps (NYSC) Personnel who had been hired to bridge human resource gaps at sites have been facilitated to be absorbed by the Nigerian Military . Also a cadre of transition (contractor) staff (site administrators and data entry clerks) is currently in service at the sites and it is anticipated that these personnel will be absorbed also by the NMOD-EPIC program in the long term. The salaries of this cadre mirror the Government of Nigeria pay scale and can be sustained by the government in the future. REDACTED. These activities are aimed at ensuring ownership and sustainability of the Nigerian Military response to the HIV epidemic and they are cross-cutting across several technical areas.
Cost efficiencies have been progressively achieved through a pooled procurement mechanism currently in use in the Nigerian PEPFAR program. ARV drugs and test kits are centrally procured while the SCMS mechanism is used to do further procurements of other commodities in a pooled fashion. Plans are in progress to commence the Government Owned-Contractor Operated (GOCO) warehousing mechanism that has cost saving attributes and sustainability potential for procurement, storage and delivery of HIV and other health related materials.
For monitoring and evaluation purposes, the program has a functional SI unit that provides technical support to the NMOD-EPIC team. Collectively they have developed harmonized tools for use in the program. Routine Data quality audits (RDQA) and data dictionaries are built into the tools to allow for similar interpretation of both the National and PEPAR indicators. Data quality assurance exercises are also conducted on a biannual basis at the sites during which the data collection sources, processes are reviewed and data integrity and reliability efforts are evaluated. Hands on training for data personnel are provided during such encounters. Dedicated data entry specialists were recruited and deployed to the sites to further improve on the data gathering and use processes with training and re-training a major feature in the units' workplan. An electronic medical records system (The Registry) is currently being developed and will soon be piloted in 10 selected sites. On complete deployment across the program, it will further simplify the data collation and use process. These activities are aimed at ensuring ownership and sustainability of the Nigerian Military response to the HIV epidemic and they are cross-cutting across several technical areas.
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ACTIVITY ONGOING FROM FY2009 • Narrative combined; Targets updated
ACTIVITY DESCRIPTION: This activity relates to activities in HCT, PMTCT, Basic Care and Support, and TB/HIV activities.
The Nigerian Military provides prevention, care and treatment to its service members and the surrounding civilian community (constituting approximately 75% of the Military's patient load). During COP10, the U.S. Department of Defense (DOD) - Nigerian Ministry of Defense (NMOD) HIV Program will continue to provide free care and treatment services in 20 military hospitals.
In COP10, DOD - NMOD will provide comprehensive ART services to a total of 11,577 adult patients. A total of 2,513 new patients will be enrolled on ART during the reporting period. Clinicians across the 20 sites will be assisted to promptly initiate support for ART eligible patients. Each site is an integrated hospital supporting HCT, laboratory, TB and other services. Linkages with both NMOD and other partner facilities will support referral of complicated or stable patients to ease overcrowding and maximize facility abilities. Care and support services will be provided to 19,700 HIV+ adults and children.
A major component of this activity is human capacity development - both in increasing numbers of providers and the training provided to them. The NMOD has committed to increasing and developing a sustainable treatment program by hiring 100 new health care professionals dedicated directly for PEPFAR goals (30 each physicians and nurses, 20 each laboratory scientists and pharmacists). In COP10, the DOD will support the training of an additional 100 health care workers, including doctors,
pharmacists, nurses, laboratory technicians, site administrators, commanders, and team leaders in the areas of ART services and 100 in care and support. Additional temporary staff through the National Youth Service Corps (NYSC) will be utilized. The base of training has included the three week ART training at the Infectious Disease Institute in Uganda and may continue to serve as a training component for COP10. This will complement local training utilizing the GON national guidelines and training manual/curriculum. Adherence counseling for ARVs and instruction of side effects and contra-indications is part of the NMOD internal ART course and each pharmacist is provided with initial and refresher training through this course. DOD will collaborate with the NMOD and the Institute of Human Virology, School of Medicine, University of Maryland to set up a Clinical Training Centre at the Nigerian Army Reference Hospital, Kaduna. The centre will provide didactic and clinical training for Health Care Workers and also serve as a mentorship site. It is envisaged that the centre when fully operational will provide the Nigerian Military with sustainable on-going in service capacity building. In order enhance quality of care; the DOD will conduct on-site clinical mentoring via centrally located staff and DOD HQ Technical Assistance rotations. Dedicated Infectious Disease physicians will provide mentoring and continuing medical education courses through centralized in-country and on-site trainings on HIV/AIDS care and support, treatment, adherence and laboratory monitoring.
The third tenet of capacity development is infrastructural capacity building. This will be increased through refurbishments at each site as required by each site to improve patient flow and throughput. This will be accomplished through bilateral planning of both the NMOD and DOD funding. To date US DOD funding has provided refurbishments at seven sites and the NMOD has funded refurbishments at seven sites. One site was jointly refurbished (44 NARHK) due to its size and dual use as a NMOD treatment site and as a referral center for all of Kaduna State. Additional infrastructural upgrade will be carried out at the 44 NAHRK to accommodate the Clinical Training Centre.
The DOD-NMOD Technical Working Group will integrate with USG and MOH advisors to ensure that all activities and support are in compliance with national policies, curricula and guidelines. In addition, the DOD will ensure that routine meetings with all hospital staff involved in HIV/AIDS patient care occur monthly (or more frequently, as needed). This will support monitoring and evaluation of clinical outcomes and allow for dissemination of information and lessons learned to improve care In COP 2010, the DOD will implement a Quality Improvement Program (QIP) consisting of an annual cross sectional Outcomes & Evaluation (O&E) exercise, the GON/USG supported HIVQual monitoring and quarterly Continuous Quality Improvement (CQI) activities in order to improve and institutionalize quality interventions. Activities will include standardizing patient medical records to ensure proper record keeping, evaluations of infection control, monitoring the utilization of National PMM tools and guidelines, efficiency of clinic services, referral coordination, and use of standard operating procedures across all disciplines and continuity of care at all supported sites. On-site technical assistance (TA) with more
frequent follow-up monitoring visits will be provided to address weaknesses when identified during routine monitoring visits.
Laboratory services provided will include CD4 ascertainment and follow up, liver function tests, hepatitis screening and management of abnormalities (e.g., elevated liver function, decreased hemoglobin/hematocrit) as appropriate. All patients will be screened for TB and malaria. Prophylaxis, treatment, and linkages to wraparound or other program areas will be provided appropriate.
In COP10, the DOD's "prevention for positives" program will be continued at all 20 military sites. Providers at each site will provide adherence counseling, syndromic management of STIs in line with National STI control policy and guidelines; risk assessment and behavioral counseling to achieve risk reduction; and prevention messaging to include partner reduction and/or mutual fidelity, correct and consistent condom use for PLWHAs, disclosure and partner testing. Condoms will be provided free of charge. Providers will counsel clients on their disclosure of HIV status and partner/family notification with an emphasis on client safety. Partner referrals for CT (individual and/or couple) will be provided. Also, referrals to community-based and barracks-based support groups will be provided to HIV+ clients. Linkages to support groups and services will also be enhanced by counselors who are members of PLWHA support groups. Referrals to family planning services will be provided as appropriate, as well as access to pregnancy testing when needed. Care kits for PLWHA will include preventative items, such as: an ITN, Waterguard, water vessels, soap, ORS, and condoms. These interventions will be implemented using the recently adapted HIV Prevention in Care and Treatment Settings Prevention Package, which includes several training packages and job aids.
NMOD and DOD participation in the USG ARV/Treatment and Care & Support Technical Working Groups to address care and treatment issues will promote harmonization with the GON and other Implementing Partners, thus strengthening the referral linkages and networks between partners close to NMOD sites. The program will also establish networks for community volunteers, including People Living with HIV/AIDS, to ensure cross-referrals. The DOD will continue to work with the GoN and other national stakeholders to develop networks for purposes of addressing sustainability issues, stigma reduction, treatment, and prevention activities. Linkages with other basic care partners and prevention groups (particularly prevention for positives) will also be supported. NMOD/DOD will also participate in National ART evaluation efforts, as well as provide input into the development of new guidelines such as the national HIV/nutrition guidelines.
Consumables and other supplies will be provided by a combination of two approaches. While the supply of some consumables will continue to be sourced by DOD from local vendors, the majority of funding for drugs and consumables will be invested in the Supply Chain Management Systems (SCMS). The DOD
program will continue support to the Nigerian Ministry of Defense (NMOD)-owned, contractor (SCMS) operated warehouse developed under COP07 funding. NMOD customs agents will clear imported supplies. Under training and supervision by SCMS contractors, the facility will distribute supplies directly to all NMOD Points of Service. The warehouse will function as both a receiving/distribution center and as a storage facility for buffer stock of critical items maintained in-country to protect against unforeseen shortages. This program fully adheres to USG and FGON policies and acquisition regulations, minimizes indirect costs and accomplishes NMOD capacity building in supply chain management. The program design ensures continued USG visibility and accountability at all levels of implementation.
A component of this activity will be supporting and maintaining links with active community-based organizations, home-based care providers (HBCs) and faith-based organizations (FBOs) that will provide at home follow up of patients attending ART clinics. While efforts will be strengthened to provide services to individuals in the community who cannot access ART services, a strong component of these efforts will be linking with local CBOs and FBOs since HBCs are limited in number at sites. Volunteers will be recruited and trained from existing PLWHA support groups. DOD will also work with, and support, the NMOD and its other partners in further developing internal guidelines, protocols and standard operating procedures (SOPs), using evidence-based interventions, particularly in the area of pediatric care and implementation of a preventive-care-package. DOD has allocated $1,175,000 of its Adult ARV Services budget and $400,000 of its Adult Care and Support budget to SCMS for procurement of commodities. This amount is captured under the SCMS ARV Services and the SCMS Care and Support activities.
By the end of COP10, DOD will support 20 NMOD facilities in Anambra, Benin, Benue, Borno, Cross River, Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Oyo, Plateau, Rivers, and Sokoto (15 states and FCT).
CONTRIBUTION TO OVERALL PROGRAM AREA: Support of ART services will contribute to achieving 2010 PEPFAR targets and goals. The training of health care workers and community volunteers will contribute to human resource development to ensure the sustained delivery of high quality care and support and ART services in Nigeria.
LINKS TO OTHER ACTIVITIES: This activity is linked to all prevention activities, HIV/AIDS/TB treatment and care services, drugs and laboratory infrastructure, and SI.
POPULATIONS TARGETED: This activity will target all adults and their caregivers in the 20 military communities served, as well as the
civilian population in the surrounding communities, who are diagnoses as HIV+ and clinically assessed as suitable for treatment. EMPHASIS AREAS: This activity focuses on improving quality of care for those on ART, promoting adherence and measuring clinical outcomes.
ACTIVITY ONGOING FROM FY2009 • Targets revised for COP10
ACTIVITY DESCRIPTION The Nigerian Military provides prevention, care and treatment to its service members and the surrounding civilian community (constituting approximately 75% of the Military's patient load). The Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will provide free comprehensive PMTCT services, which will follow the revised national guidelines (2008), to 20 existing sites in COP10. 15,000 pregnant women will receive HIV counseling and testing for PMTCT and receive their test result. 600 women will receive a complete course of antiretroviral prophylaxis in a PMTCT setting. 120 individuals will be trained to provide these services.
A family-centered network approach will continue to be used and group health information with routine "opt out" counseling and testing will be provided to pregnant women presenting for antenatal services. Testing will be done following the National testing algorithm with same day results. Post-test counseling will include prevention counseling and education for both HIV+ and HIV- women. Partner testing will be promoted. DOD will promote couples counseling and testing to promote disclosure, address discordance and to increase support for infant feeding choices. Staff will counsel clients on their disclosure of HIV status and partner/family notification with an emphasis on client safety. Partner referrals for HCT (individual and/or couple) will be provided. Also, referrals to community-based and barracks-based support groups will be provided to HIV+ clients. Linkages will also be enhanced by counselors who are members of PLWHA support groups.
HIV testing will be offered to all women of unknown HIV status presenting for labor and delivery and in the postpartum period. In accordance with National guidelines, a full course of ARV prophylaxis will be provided to approximately 600 women. ARV prophylaxis will include ZDV at 28 weeks or 3TC/ZDV at 34/36 wks and single dose Nevirapine (sdNVP) and AZT/3TC in labor with a 7 day 3TC/ZDV tail. All HIV positive clients will be commenced on cotrimoxazole prophylaxis commencing after the first trimester and stopping at 36 weeks gestation. All infants born to HIV+ women will be provided with sdNVP at birth and ZDV for 6 weeks. HIV-exposed infants will be provided with cotrimoxazole (CTX) prophylaxis from 6 weeks and will be discontinued once confirmed HIV- and no longer breastfeeding. Post partum women who are clinically eligible for ART will be referred for ARV services at the sites. Family planning and other reproductive health best practices will be promoted while linkages to OVC activities will be enhanced.
Infant feeding education and counseling will begin in the antenatal period in accordance with National
guidelines, accompanied by appropriate prevention messages and education to all pregnant women and family members. After delivery, mothers and infants will be followed up to monitor the mother's health and to support the mother's compliance of her infant feeding option as well as to provide nutritional support for both. DOD will actively participate in Early Infant Diagnosis (EID) as a component of its pediatric care and treatment program, using revised national guidelines (2007).
In support of DOD's commitment to build capacity and long-term sustainability in the NMOD, formal training for an additional 120 staff from the existing 20 sites, covering physicians, nurses, midwives and others involved in PMTCT services will be conducted. Trainings will be done in line with the revised National PMTCT training curriculum (2007). By training uniformed members and civilian employees that are in a career track in the Government of Nigeria, this program fosters a generation of skilled workers who are more likely to remain in the military. This contributes to fulfilling PEPFAR goals for independent and sustainable programs.
In addition, commodities and equipment that are required in PMTCT services will be procured via SCMS ($150,000). Depending on site inventories and needs, commodities may include gloves, soap or other disinfectant and other medical consumables. Commodities will be provided to all 20 military sites.
By the end of COP10, the DOD will support 20 NMOD sites in Edo, Benue, Borno, Cross River, Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, Anambra and the FCT (15 states and FCT).
CONTRIBUTION TO OVERALL PROGRAM AREA The DOD PMTCT program will providing HIV counseling and, testing to 15000 pregnant women and provide ARV prophylaxis to 600 women. This contributes to the goal of preventing new HIV infections in Nigeria. The PMTCT services identify HIV+ women who may need HAART for their own health, thus contributing to PEPFAR Nigeria's care and treatment goals.
LINKS TO OTHER ACTIVITIES This activity relates to activities in adult and pediatric care and treatment, laboratory infrastructure, safe blood, TB/HIV, FP, Malaria, Cervical cancer screening and strategic information. Pregnant women who present for counseling and testing services will be provided with information about the PMTCT program and referred accordingly. ART treatment services for infants and mothers will be provided through ART services. Basic pediatric care support, including TB care, is provided for infants and children through pediatric care and treatment activities. Linkages to OVC services will be made for orphans and vulnerable children.
POPULATIONS BEING TARGETED This activity targets pregnant women and their family members. Activities also target military personnel, civilian employees, dependents and the general population in the communities surrounding the 20 sites.
EMPHASIS AREAS This activity will address gender equity in HIV/AIDS programs by specifically targeting pregnant women and girls for counseling, testing and treatment.
In COP10, under 'PEPFAR Nigeria's accelerated PMTCT plan', DoD, will strengthen its support to PMTCT service delivery by implementing activities that further improve the coverage and quality of PMTCT services. These activities will be directed towards increasing utilization of PMTCT services at existing service outlets through demand creation in collaboration with community resources and ensuring the upgrade of existing supported PHCs offering stand alone HIV counseling and testing to render at least minimal package of PMTCT services. In order to leverage resources, priority will be given to PHCs located in the selected focal states with presence of other donor agencies and in local government areas already earmarked for HSS support through GFATM. Where new sites are envisioned, those that are used for national ANC sero-sentinel surveys but yet to commence PMTCT services as well as PHCs located in communities with high HIV prevalence rates above the National average will be given priority.
