ICAP's main goal is to work in partnership with the government of Nigeria (GON) and local organizations at all levels to support the delivery of high-quality, sustainable, comprehensive HIV/AIDS prevention, care and treatment services using a family centered approach. ICAP works with the USG, other donors and implementing partners, GoN (Federal, State and Local), faith based, non-governmental and community based organizations and other for profit partners across the six states of Akwa-Ibom, Benue, Cross River, Gombe, Kaduna and Kogi targeting a combined population of 22,727,346 using a multi-disciplinary approach to support 30 hospital networks across six states of Nigeria in mostly geographically contiguous locations.

Comprehensive services provided is focused on-site implementation assistance to strengthen systems including HCT to most at risk populations, ART clinics (adult and pediatric) management, support for drugs, equipment and supply chain management, repairs of dilapidated infrastructure, medical records, referral linkages, patient follow-up, integration of prevention into care and treatment (C&Tx), involvement of PLWHA including OVCs, access to laboratory services and ARVs including first/second line regimens for adults and children using national protocols and guidelines. ICAP also strengthens linkages with entry points including: HCT, ANC, pMTCT, child welfare/under-5 clinics, TB clinics, OPDs, inpatient wards, family planning and palliative care services to enhance service uptake and improve quality of services. ICAP will also continue with the implementation of innovative WATCh (Where Are The Children) strategies piloted in COP09 to increase pediatric enrolment and improve child survival. Working closely with national TB/Leprosy Control Program and state/LGA TB control programs, ICAP support sites to provide services to TB/HIV co-infected patients through point of service laboratory support and strengthening of referrals and linkages at the facility/community levels to C&Tx sites. ICAP has also continued to foster, strengthen and expand community linkages, participation and involvement in all the sites it is presently supporting and is actively putting in place sustainable structures for program continuity at all levels. ICAP supports prevention activities (including condom distribution) at community level through capacity building for CBOs, HCWs and PHEs to ensure that the prevention minimum package is delivered to MARPS and the general population. ICAP will also support states/LGAs by providing the framework to ensure safer and more rational use of ARVs and OI medicines.

In COP10, ICAP will continue to focus on improving access to and quality of care, and program sustainability through the implementation of robust strategies in partnership with all tiers of Government. A major thrust will be through health systems strengthening and human capacity development of policy makers, state officials, providers and community members. ICAP will continue to expand its health systems strengthening plans across these states by continually motivating the states to adapt and establish a chronic care system that will ensure continuity and comprehensive care not only for HIV but to other chronic illnesses as a whole. ICAP will establish QA/QI teams with state/LGA officials who will jointly monitor program progress with state officials and administer the Model of care and Standards of Care assessment tools, including systemic approach to ensure quarterly CD4 monitoring for early enrolment, quality care and identification of treatment failure. ICAP will leverage resources from other health care services and maximize linkages to ensure quality of care to mothers and their children. ICAP will continue to build the capacity of state facility lab personnel with emphasis on quality assurance/management, providing individual on the job trainings to improve service delivery. For sustainability, state quality officers will be trained alongside Regional Lab Advisors to supervise and conduct regular lab audits in preparation for national and international accreditations. Due to the human resource challenge across ICAP supported sites, ICAP will continue to engage the service of post NYSC health providers on a transitional basis and advocate for employment and appropriate remuneration of HCWs to the governments. ICAP will facilitate the institution of innovative procurement and infrastructure repair procedures, gender mainstreaming and public-private partnerships. For sustainability, use of regional stores will be enhanced and capacity of state governments on forecasting, quantification and procurement planning and storage strengthened. LMIS and inventory control systems will be strengthened with emphasis on automation of inventory control and decentralization of logistics systems to lower level facilities. ICAP will also leverage on IPs' resources to maximize treatment costs (SCMS, partnership with Roll Back Malaria etc.) and establish linkages with community pharmacies to expand community based palliative care and referrals.

With the paradigm shift to cost effectiveness, sustainability and local ownership, ICAP M&E will focus on strengthening data quality by implementing a robust standard of care monitoring and contributing to achieving the "three ones" strategy of GoN. Attaining these fundamental goals will involve training, mentoring, joint supportive supervision and logistic support to GoN at all levels

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, ICAP supported 30 hospital networks and their communities, partnering with community-based organizations (CBOs), faith-based organizations (FBOs), and People Living with HIV/AIDS (PLWHA) groups to enable people with HIV/AIDS to access clinical care and support as well as laboratory and pharmacy services across the 6 states of Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi. In COP10, ICAP will continue to provide support to these hospital networks in the 6 states to enable them to continue to provide care and support services to 347,130 patients (57,544 new) on care and support and 35,702 (3562 new) on treatment. ICAP will continue to support health facilities to provide and improve the general quality of clinical care, support and treatment to PLWHA through strategic approaches including: training, clinical, laboratory and pharmacy service support; systems management; procurement of drugs and supplies; enhancing quality of support groups and peer health educator programs. GON will be supported to review existing guidelines, curricula and SOPs where appropriate and new ones developed where necessary to strengthen systems and technical capacities of health workers.

Provision of minimum package of care and support services:

Following National Palliative Care Guidance and USG PC policy ICAP will support state governments to provide clinical care with basic care kits plus at least 2 other complementary services in the domains of psychosocial, spiritual and preventive services to all PLWHA,.ICAP will provide a basic package of care services, including basic care kits, prevention with HIV positives, clinical care (basic nursing care, symptom & pain management, OI and STI syndromic management and prophylaxis, nutritional assessment, counseling and intervention, lab support through baseline hematology, chemistry and CD4 and follow-up, OI and STI diagnosis & treatment), psychosocial support, home based care, and active linkages between hospitals, health centers, and communities. Basic care kits (BCK) containing ITNs, water guards and vessels, soap, gloves, condoms, ORS and Salt and Sugar Solution (SSS) educational materials will be distributed to PLWHA through the health facilities. These activities will be approximately 20% laboratory monitoring and OI diagnostics, 30% OI management and prevention (cotrimoxazole), and 50% HBC (Home Based Care) and training. Patient education to promote positive living, self-care, and support adherence will be provided. ICAP will support and train HCW at the secondary and high volume PHCs on integration of syndromic management of STIs and risk reduction interventions into care

Strengthening /Establishment of Home Based Care programs :

ICAP will continue to strengthen the trained HBC teams (doctors, nurses, CHOs, Volunteer community Pharmacists, CHEW, PHEs, members of CBOs) to deliver quality focused services through the provision of HBC kits, ongoing identification of appropriate team personnel and trainings. Services will include the provision of, nursing care, symptom management of common illnesses, counseling and referral services. ICAP will ensure the packaging and distribution of standardized HBC kits (consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline, gentian violet, anti-malarial drugs etc.) to these teams for use when visiting clients. Facility based HBC focal persons will be identified in comprehensive and selected PHCs to coordinate CHBC activities. Retired health care providers within the communities will be encouraged to volunteer to lead HBC teams through existing CBOs. ICAP will establish linkages with community pharmacies to expand community based care, provide referrals and palliative care.

Provision of quality focused facility based care:

ICAP will conduct quality improvement activities and enhance service delivery through Clinical System Mentorship and HIVQUAL. Checklist, SOPs, Standard of Care and Model of Care assessment will be used in all comprehensive sites and PHCs. ICAP will also support the development and implementation of the electronic patient database to ease aggregation and retrieval of patient care and treatment data.

Human Capacity Development:

ICAP will train, retrain and mentor health care providers on HIV/AIDS care and management with emphasis on 2nd line therapy. ICAP will enhance adult care and treatment by providing ongoing site-level mentoring and supportive supervision of facility-based staff and SMOH officials to ensure program sustainability. ICAP will advocate to the state HMB and MOH for the engagement of NYSC corpers at facilities to ensure sustainable supply of human resources. Job aids and SOPs will be provided to support and enhance provider skills. ICAP will participate in the USG/GoN joint supervisory sites visits.

Trainings, clinical updates and clinical systems mentorship:

This will continue to be a critical element in ICAP's support to health care cadres during this period. Clinicians at all 30 hospitals will be assisted to identify 'most at risk' HIV-infected patients, enroll them in care and treatment, to perform appropriate clinical and laboratory staging of adults and children, and to provide comprehensive care and support, including the prompt initiation of ART for eligible patients. ICAP will provide follow-on ART/Palliative Care trainings, including ongoing CME and QA activities, for 500 health care workers (including physicians, nurses, counselors, pharmacy, and laboratory personnel) and 160 members of CBOs on palliative care. Onsite clinical mentoring will enhance quality of care and build site-level clinical and management skills for program sustainability. ART reference tools will include pocket guides, dosing cards, posters, and detailed SOPs.

Retention in care

ICAP will continue to strengthen patient appointment and defaulter tracking systems, as well as routine reporting systems for monitoring basic care and support activities. Outreach teams linking hospital programs to primary health centers and communities will be expanded and supported by ICAP network coordinators. In order to improve access to services and retention in care, HIV positive clients will be supported to remain in care through access to health care facilities via community-based transportation support by partnering with Road transport workers union. Adherence trainings and support services including disclosure support, will facilitate adherence, support patient education, enhance appointment system, and strengthen referral linkages/ defaulter tracing programs. ICAP will also strengthen its successful Peer Health Educator program, enhancing family support defaulter tracking mechanisms, and inter/intra-facility linkages. ICAP will continue to also support the adaptation of patient education materials that encourages retention in care.

Quality focused ART services.

ICAP will adopt systematic and innovative approaches to ensure timely repeat CD4 and other monitoring tests (e.g. quarterly CD4 drives) to monitor patient progress. ICAP will maintain provision of quality family focused ART services in all supported sites through the joint QAI teams. The teams will conduct quarterly QA processes with the use of SOC, and preceptor checklists. State officials trained on CSM will participate in monthly joint facility mentoring with ICAP advisors. ICAP will also support facilities to form QAI teams while advocating for this at the state level. ICAP will participate in the yearly National Care and treatment evaluation.

Systems Strengthening:

Based on FY09 experience, ICAP will provide support for infrastructural development, program management and systems strengthening, including intra-facility linkages, advocacy for health care workers retention, Management Information System, and inter-disciplinary partnerships .ICAP will place emphasis on training and mentoring health care providers to identify treatment failure and initiate 2nd line regimens as needed. Facilities will be supported through enhancement of site-level project management teams (PMTs) to build on the ICAP-model of comprehensive support, capacity-building and local ownership as mechanisms to provide sustainable high-quality HIV/AIDS care and treatment to families and communities.

Decentralization of care and treatment:

ICAP will continue to work closely with state and LGAs to prioritize the expansion and decentralization of palliative care and ART services to selected patient-preferred Primary health centers to reduce the client load on existing secondary health facility across the 6 states. ICAP will build capacities of PHCs and their LGAs to provide devolved care, support and services for asymptomatic and symptomatic clients. This package will include for all clients (symptomatic and asymptomatic patients) : supportive counseling, HIV Education, Support group meetings, and provision of BCKs, and referral for CD4 tests, OI prevention and management including symptom management, TB prevention and control, rapid screening for malnutrition and growth monitoring for under 5s, linkage of OVC to existing Food Banks at comprehensive sites, lab support for Malaria Smears, Full Blood Count, and Pregnancy Tests; in addition symptomatic patients will also get ARV refills and adherence support for TB and AR.

ICAP will work with established State primary health care development agencies to develop/adapt mechanisms to strengthen the health care systems by leveraging available HIV/AIDS resources. This decentralization will include the development/adaptation of referral protocols (for both "down" and "up" referrals), referral forms/tools, and site supervision tools.

Harmonization of Care and Treatment packages:

ICAP will continue to work closely with other PEPFAR IPs and GON to ensure compliance with National policies, curricula and guidelines. ICAP will continue to participate in the USG Technical Working Groups to address emerging treatment and care -related topics and further promote harmonization with other IPs and the GON. ICAP will continue its partnership with SCMS by allocating USD XX of its resources for care, support and treatment related procurements.

Linkages to wraparound health and allied services:

ICAP will facilitate linkages through existing and new CBO/NGO or FBOs within the communities to economic empowerment and other programs such as safe motherhood and child survival activities. Therapeutic feeding using approved selection and exit criteria will be provided via referrals where possible and directly when no alternatives exist. Facilities and communities will be supported to identify innovative approaches to sustainable food support through food banks, linkages with wraparound programs and other existing microfinance opportunities. At the community level, HBC, OVC, HCT outreaches, AB messages, patient retention mechanisms, Male sensitization for their involvement and other support services will be subcontracted to NGO and FBOs. Trained HBC providers, including PLWHA, will be supported to deliver care and support services to stable patients and family members at home.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

By training and retraining at least 660 care providers including PLWHA, ICAP will enhance the delivery of comprehensive basic care and support within national guidelines and protocols via a multidisciplinary family-focused approach. REDACTED.

This activity relates to OVC (XXXX), HCT (XXXX), PMTCT (XXXX), LAB (XXXX), sexual prevention (XXXX), TB/HIV (XXXX), Gender (XXXX), Human capacity development (XXXX) and SI (XXXX). As expansion of ART services is prioritized to rural areas, ICAP will strengthen referral channels and network mechanisms. TB/HIV linkages will be strengthened where ART and TB DOTS sites are co-located, and decentralization of ARV sites will be actively promoted in TB DOTS sites. All HIV infected patients will be screened for TB using the National algorithm while all TB patients will be offered HIV testing. ICAP will also provide onsite assistance with data management and M&E to guide quality improvement. Relationships between secondary hospitals and community-based referral facilities will be strengthened via the use of network coordinators, CBOs and NGOs. Patients not yet eligible for ART will be carefully monitored (via clinical and laboratory monitoring), and will receive OI prophylaxis and other preventive services where indicated. Women who become pregnant will be referred to PMTCT, after delivery mother-baby pairs will be referred for care and treatment/ OVC services (XXXX). Partnerships with other IPs will provide opportunities for leveraging resources. Patients and their families will be linked to community-based income-generating activities where available.

POPULATIONS BEING TARGETED:

All HIV positive persons will be assisted to access care and support. HIV positive persons in the general population will be reached through CBOs and support groups. Persons Affected By HIV/AIDS (PABAs) will be targeted and enrolled into care under the ICAP family-centered approach as will pregnant women, OVC and TB patients. Facility based care providers and CBOs/FBOs will be trained to provide quality services and facilitate the establishment/strengthening of referral networks. Health care providers in secondary and primary health facilities will be trained to deliver quality ART services.

EMPHASIS AREAS:

Areas of emphasis will include quality improvement and system strengthening human capacity development, gender and other health related wrap around. This activity will facilitate equitable access to care and support especially to vulnerable groups of women and children. ICAP will advocate for men's involvement in care and treatment in the community (FGDs, community sensitization) for improved inheritance rights for women and children. ICAP will also advocate for stigma and discrimination reduction at the community level. also emphasize quality assurance/improvement and clinical systems mentorship as part of its capacity building. ICAP personnel including national and international experts will provide skill and competency-based trainings, CME, and ongoing clinical mentoring to enable onsite staff to provide quality ARV services to patients. Services will also focus on addressing the needs of women, infants and children to reduce gender inequalities and increase access to ART services among these vulnerable groups. ARV services will facilitate linkages into community and support groups for nutritional support and micro-credit /finance activities.

ACTIVITY UNCHANGED FROM FY2009 ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, ICAP supported OVC services as follows: appropriately identifying OVC who are not receiving services; providing a holistic family centered approach to care of OVC; providing educational support; services for adolescent OVC (including creating exit strategy at 18 and appropriate prevention message with reproductive health services); providing nutritional assessments and support; providing health care services for HIV infected and affected children; and providing enhanced psychosocial support at both facility and community levels. ICAP further assisted 30 secondary hospitals and 24 CBOs in Kaduna, Benue, Akwa Ibom, Kogi, Gombe and Cross River States to support 6559 HIV-infected and affected children (OVC) to access health care, and other related services at the hospitals, their referral networks, including building community coalitions to boost services in surrounding communities.

In COP10, OVC services will be provided for 7,215 new children and adolescents and 74 caregivers. These OVC will include HIV positive and HIV-negative children of PLWHA or HIV affected orphans. ICAP will also continue to support 24 CBOs/FBOs/NGOs to provide community OVC services in the same states

ICAP family-focused approach is applied not only at the facility level but also at the community and home levels through care services. Community based programming leads to identification of OVC through awareness campaigns, support groups, and community-based HCT. OVC are also identified through provider initiated counseling and testing of children accessing care in health facilities following national norms regarding counseling and consent of minors. Once OVC have been identified, ICAP's OVC program focuses on providing an appropriate balance of services in the facility, community and home settings.

ICAP OVC programming has several key elements: appropriately identifying OVC who are not receiving services; providing a holistic family centered approach to care of OVC and adolescents; providing educational support; nutritional assessments and intervention; providing health care services for HIV infected and affected children; providing psychosocial support at both facility and community levels and activating linkages to economic strengthening activities.

In COP10, ICAP will continue to implement strategies to increase enrolments of OVC and uptake of services. Some of these include: chart reviews of adult PLWHA on treatment to identify children not enrolled and reached with services; weekly reporting systems for OVC tracked and enrolled into care and treatment, provision of basic care kits (BCK) targeted at OVC and their care givers. ICAP will continue to provide nutritional support to OVC and work with the GON in partnership with MARKETS - a USG IP to leverage resources for providing therapeutic and supplementary foods respectively for OVC diagnosed with malnutrition. Through leveraging resources in COP09 with MARKETS; nutritional support was provided to OVC and caregivers with Richfil - a locally processed family cereal, in Cross River State. MARKETS also conducted a TOT and have sponsored two CBOs in Cross River State to train up to 300 OVC Caregivers on IGAs. In COP10, ICAP will continue to leverage on this collaboration to support OVC and their caregivers on nutrition and economic strengthening. ICAP will also explore linkages to other community-based food and microfinance programs through supported CBOs to promote sustainability and household food security. Economic strengthening opportunities for female OVC caregivers will be prioritized. ICAP will continue to facilitate the establishment of community driven "food bank" initiatives in comprehensive facilities to provide nutritional support to OVC. Food Banks will be supported to build capacities in food drives and stock management; reporting mechanism for OVC beneficiaries of the food banks, will also be strengthened the. Partnerships will be explored to help expand and sustain these innovative food banks to continue to serve OVC and their adult family members. The possibility of linking severely malnourished children to time-limited feeding programs will be explored where availability of and proximity to such programs allow. ICAP will continue to identify and leverage state and local government support mechanisms to further ensure the sustainability and ownership of these initiatives.

Health care services for OVC will continue to emphasize high quality of service delivery, reaching all tracked OVC with clinical services including de-worming with anti-helminthics, malnutrition screening and intervention, ongoing monitoring of growth and development. OVC services will be extended and integrated into identified adolescent clinics to be supported by ICAP. Other areas of emphases will be linkage to immunization, malaria treatment, screening and referrals for TB when indicated, cotrimoxazole prophylaxis (CPT) following national guidelines, diagnosis and management of common and life threatening childhood illnesses As a way of ensuring preventive care at the home level, basic care kits comprising of LLITNs, soap for effective hygiene, water guard and water cans procured from SFH (another USG supported IP) will be distributed to all clients. ICAP will also continue to work through local partners to provide educational support (e.g., school levies, uniforms, school bags and writing materials) to most in-need children following selection criteria locally adapted by the OVC CCC (OVC Community Care Coalition), with guidance from the national OVC Vulnerability Index. Through ICAP support, some of these CBO partners will also continue to provide peer education programming at primary and secondary schools and through targeted outreach activities to reach in- and out- of school adolescents.

ICAP enables the implementation of advocacy and social mobilization, psychosocial support, home based care (HBC), and educational support for OVC and their households through its support and capacity building of local NGOs, CBOs and FBOs, The psychosocial support provided to OVC and their care givers, is multifaceted and comprehensive; it includes counseling on stigma and discrimination, disclosure, grief, and recreational activities. OVC services are also integrated into community HBC programs. Networking with community organizations and other implementing partners enables leveraging of resources and enhances service delivery and sustainability.

ICAP will also continue to build capacities of these local community and faith based organizations such as Fantsuam Foundation, Tulsi Chanrai Foundation (TCF), GAWON Foundation, Catholic Archdiocese of Ogoja (CACA), Grassroots HIV/AIDS Counselors, ARFH, other CBOs and PLWHA groups to provide family-focused OVC services. These NGOs/CBOs/FBOs provide home based primary care, psychosocial support, nutritional support and links for OVC to health facilities for basic health care needs by providing transport and other support. Training and supportive supervision of health care cadres and CBOs/FBOs members, will be a vital element in ICAP's COP10 strategies. Health care workers in all 30 hospitals will continue to be trained on OVC to enable them to identify HIV-infected and non infected children, to link them into Care and treatment as appropriate. Social workers/ nurses focal persons for OVC will continue to be identified in all comprehensive sites. Onsite clinical mentoring will enhance quality of OVC care and management skills for program sustainability. OVC flow chart, posters, and detailed SOPs will be provided to the sites to support quality improvement and facilitate the delivery of optimal Care and support services for services.

In COP10, ICAP will provide training for additional 194 care providers including, counselors, and community/HBC providers using GON National guidelines, OVC National Plan of Action and SOPs. In addition ICAP and local partners will set up a monitoring system using the nationally approved tools that allows the monitoring of services provided directly by ICAP and/or by referral from ICAP to other organizations.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: ICAP, in partnership with other organizations, will provide training and scale up of OVC services that will enhance the delivery of quality services to 7, 125 OVC and their caregivers enrolled in core programs such as health, educational support, psychosocial support, and food and nutrition. All these activities will improve the lives of OVC reached in line with the national plan of action on OVC and the National Strategic Framework, and will contribute to meeting PEPFAR goals.

LINKS TO OTHER ACTIVITIES: This activity relates to activities in ART (XXXX), Lab (XXXX), Palliative Care (XXXX), TB/HIV (XXXX), AB (XXXX), and SI (5541.09). HIV-exposed and infected children will be placed on prophylactic cotrimoxazole (CTX) following National guidelines. Household members of OVC will be referred for HCT (5550.09) and children of women enrolled in PMTCT (XXXX) will be offered HCT as well as referred for OVC services. Policy makers and key decision makers in the health and education sectors will be reached by advocacy efforts. POPULATIONS BEING TARGETED: This activity targets infants, young children, in- and out of school adolescents and other at-risk children in HIV infected and affected families. It also targets the households, including caregivers of OVC. The entry point for OVC in the general population will be ICAP supported sites and partner organizations. Health and allied care providers in clinical and community settings will be trained to provide services to OVC. Community and facility based volunteers, traditional birth attendants and support group programs, will be used to increase access to care and support especially to the underserved.

EMPHASIS AREAS ICAP's area of emphasis will be Community-based services for HIV-infected/affected children (0-17 years), Direct and Supplemental Services, Wraparounds (food, nutrition, IGA, water, and education) and Commodities (water guard, bed nets, etc.). Efforts will continue on improving and sustaining networks, linkages and referral systems as well as capacity development and food/nutrition support. In addition, ICAP will advocate equal access to education and improved legal and social services such as the protection of inheritance rights for women and children, especially for female children, and increased gender equity in HIV/AIDS programming. ICAP will advocate for increased access to income and productive resources for HIV infected and affected women and care givers. This activity will foster necessary policy changes and ensure a favorable environment for OVC programming. In COP10, ICAP support will continue to enhance equity and gender approaches that lessen vulnerability of female OVC by increasing their access to education, care and other support services. Increasing involvement of men in caring for OVC will also be emphasized.

None

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09 ICAP's supported HIV counseling and testing (HCT) at 55 sites including 30 secondary hospitals,20 primary health centers and 5 non-hospital facilities (five stand-alone VCT centers) in six states of Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi. In 2009, HCT activities were streamlined in these states to focus on the most at risk (MARPs) population.

In COP,10 ICAP will continue to support activities focusing on most at risk populations in selected sites within the six states. In COP10, ICAP will continue to provide targeted HIV counseling and testing services in a total of 55 HCT sites (30 secondary hospitals, 20 primary health centers and 5 non-hospital facilities (five stand-alone VCT centers) in six states Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi. Included within the non-hospital facilities are linkages to health facilities. At least 13,200 most at risk individuals will receive counseling & testing (in a non-TB/non-PMTCT setting) and receive their results. ICAP's HCT support has 5 themes: supporting provider-initiated opt-out HIV testing (PICT) in all health care facilities, including TB DOTS sites; providing HCT services throughout health care facilities by strengthening point of service (POS) testing in both inpatient and outpatient settings; expanding access to HCT centers; strengthening opt-out HCT in the ANC setting; and promoting case-finding via the family-focused approach to HIV/AIDS diagnosis, care, and treatment.

Human Capacity Development

ICAP will ensure quality HCT services through the implementation of training courses for staff and volunteers. In COP 09, 125 individuals, including health care providers and laboratory staff at the facility and community levels, were trained to provide services in over 100 HCT outlets in the six states. In COP 10 , ICAP will consolidate efforts in improving the quality of HCT services and enhancing the skills of health care providers by providing consistent mentoring and monitoring of HCT services. Capacities of health care providers will be further strengthened by providing training and retraining courses on HCT using the National HCT Training curriculum. Focus will be on the quality of post test counseling information. Counselor reflection forms and client exit interviews will be used as tools to ensure that adequate information are made available to clients. Counselors will continue to have access to CHCT training to improve their skills to provide adequate couple counseling and testing following the best practices protocol in all supported sites. HCT Refresher trainings will be provided to site health care providers as needed. ICAP will encourage state ownership, participation and site maturity by training state and facility based supervisors to mentor and build the skills of health care providers thereby improving the quality of HCT services. In addition to the HCT specific training, ICAP will also provide trainings to improve monitoring and evaluation.

Strategic approaches

Reaching most at risk population

Innovative approaches will be instituted to effectively reach and focus on the most at risk populations. the risk assessment checklist will continue to be used as part of counseling tools to identify most at risk persons presenting in facilities and communities as well. Emphasis will be on the quality of service delivery to clients at all level of service provision. ICAP will support selected local nongovernmental organizations to partner with NYSC-trained peer educators in selected sites to reach the student population (especially at tertiary institutions around each region). Existing youth-friendly centers in supported states will be strengthened to provide information (written, audio-visuals) on HCT to young people in and out of school, following the standardized consent procedures where necessary. ICAP will maintain access to HCT outreach to high risk communities in already established long distance truck drivers' parks in Benue State and Ogoja prison. ICAP will collaborate with outreach teams from nongovernmental and faith based organizations to ensure regular outreach to communities, and persons most at risk. ICAP will continue to support the use of multidisciplinary teams including lay counselors where appropriate to promote 'one stop' HCT services.

Community linkages and communication

The national 'Heart to Heart' logo will continue to be used at HCT sites for integration with national branding of HIV testing services. ICAP will continue to support community-level HCT services through identified CBO/FBO outreach initiatives, targeting mainly most-at-risk-population, further strengthening the network of HCT available to the community. ICAP will ensure that secondary and primary healthcare facilities are key partners in these networks. Referral linkages will continue to be strengthened within and outside ICAP's implementing agencies by making available referral tools in all the HCT points and ensure proper application of those tools.. HCT services at the communities will enjoy strong linkages with other services. ICAP will continue to strengthen the single sitting approach at all supported facilities and ensure availability of protocols, SOPs, and risk assessment checklist to HCT service providers. Existing Independent HCT centers will be strengthened, to provide targeted HCT services to the MARPs.

At all health facilities, the Provider-Initiated-Counseling and-Testing (PITC) approach will be promoted to ensure that HCT is available to all patients utilizing a facility. ICAP will foster linkages of HCT services to treatment, care and support services within and across programs and between other implementing partners using standard referral tools, ensuring quality implementation of HCT data management and reporting systems.HCT services will promote couples counseling and testing at the service outlets with a special emphasis on HCT for discordant couples. In addition, post test counseling resources, such as support groups and peer educators, will support disclosure when appropriate and address the special issues facing discordant couples. ICAP will continue to work with PLHAs and support groups to increase the uptake of pediatric HCT services. Posttest counseling for HIV-negative patients will emphasize primary prevention; that for HIV-infected patients will focus on appropriate prevention for positive messages to reduce risk of HIV transmission from HIV+ individuals. Posttest counseling for clients shall include appropriately balanced messaging, including abstinence, be faithful, and information on correct and consistent condom use. Male and female condom distribution will be supported by ICAP and implemented by CBO partners. Condoms will be supplied by the Society for Family Health (SFH) and distributed to CBOs for use in condom education activities. IEC materials on HCT and prevention messaging will be available to all clients.

Lab Quality Assurance and linkages

ICAP lab advisors will work with the state government mechanisms to assure Laboratory QA and quality HIV testing. HIV testing will be conducted using the new National serial testing algorithm. ICAP will continue to store test kits centrally in a secure warehouse in Abuja and distribute to sites through state and facility storages as needed. Technical assistance will be given to sites to ensure appropriate storage, record keeping and forecasting. ICAP will continue to ensure targeted HCT services in the face of limited number of Test kits. HCT protocols in this regard will focus on diagnostic testing for symptomatic patients in the facilities, and the MARPs at the community level. Recognizing the challenges of limited testing, ICAP will continue to advocate and collaborate with GoN to ensure that government puts in place plans to expand services for clients within the shortest possible timeframe. ICAP will work closely with the SCMS mechanisms in country to procure equipment and supplies for its supported HCT sites and to participate in the GON-led harmonization process of the LMIS system in Nigeria. ICAP will work closely with the federal and state governments through the Federal and state ministries of health, NACA and SACAs in the six states to enable them provide HCT support across health facilities. ICAP will partner with states with free MCH policy to provide technical assistance for HCT services for pregnant woman. ICAP will also explore partner with the Global Fund supported health facilities to ensure service linkage and promote quality of counseling and testing services.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

This activity will contribute to the overall COP10 maintenance plans by providing access to HCT services to at least 13,200 most at risk persons who will also receive their results. HIV positive clients will be provided with access to care and treatment, including ART when needed. 138 individuals, including health care providers and laboratory staff at facility and community levels, will be trained and retrained to provide services. ICAP will continue to support and participate in the harmonization process led by the GON with regard to Global Fund, LMIS and ICS for test kits and other related service delivery issues.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in ART (XXXX), Palliative Care (XXXX), TB/HIV (XXXX), OVC (XXXX), HCT (XXXX) and PMTCT (XXXX). The HCT activities in the sites supported by ICAP will encourage the enrollment of patients and family members into care through multiple entry points. ICAP will also support community HCT linked to the hospital networks, enabling referral of HIV positive clients to the hospitals to access care and treatment as appropriate.

POPULATIONS BEING TARGETED:

This activity targets the most at risk population such as women in the reproductive age group, young people, truck drivers, who are mostly male and sex workers; ICAP will promote pediatric and family testing to family and household members of HIV+ clients using a family focused approach at multiple entry points. Community based and faith based organizations/facilities will be targeted for training to provide HCT to increase access in non-clinical settings to most at risk groups.

EMPHASIS AREAS:

Emphasis areas include human capacity development, increasing gender equity in HIV/AIDS programs, local organization capacity building and SI. As part of its human capacity development and sustainability efforts, HCT refresher trainings will be conducted for facility based service providers. Site HCT focal persons will receive HCT supervision training to help oversee activities. ICAP will also support consistent and regular monitoring and onsite mentoring at all sites to ensure sustainability and maintenance of quality services, ICAP will support HCT activities targeted at increasing male enrolment and MARPs. Lay persons will be trained in rapid HIV testing and counseling to increase access to more clients. Activities will also focus on using gender transformative approaches through counseling, behavior change communication and other program interventions to address and deliberately include women and men in activities that query gender norms and masculinity especially as it relates to reproductive health and HIV/AIDS. Health and other related care providers trainings will include gender transformative skills training to enable them identify and implement gender relational activities that will focus on integrating engaging men and boys with efforts to empower women and girls. For sustainability and maintenance of quality data collection, reporting and reviewing, ICAP will continue to build the capacity of state and site staff in quality data collection, program monitoring and evaluation. ICAP will also support the capacity building and use of community volunteers for different aspects of data collection. The quality of counseling at points of service, especially post test counseling, will be monitored. Close supervision and monitoring will check for adherence to protocols and strengthen referral linkages from HCT. The training and quality of HCT provided by TB health providers at TB sites will be monitored and strengthened. ICAP will also support improving the capacities of LGA and state M&E focal persons to effectively revitalize the HIVMIS across the different service delivery levels.

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, ICAP has expanded support to a total of 30 health facility networks in the six high-prevalence states of Gombe, Akwa Ibom, Cross river, Kaduna, Benue and Kogi. By the end of COP09, ART will have been provided to a cumulative of 3200 children (including 536 new).

During COP 10 ICAP will strategically focus on reaching HIV positive children needing care and treatment (C&Tx) through various innovative approaches which include: support of pediatric HIV diagnosis; enhanced pediatric case finding and referral to care and treatment; ensuring comprehensive C&Tx services, including ART, for HIV-exposed infants (HEI) and HIV-infected infants and children; and providing enhanced psychosocial support at both facility and community levels. Following National Palliative Care Guidance and USG PC policy, ICAP-supported sites will provide a basic package of care services, including basic care kits, prevention with positives counseling for parents, clinical care (nursing care, growth monitoring, under 5 immunization services, neuro-developmental screening and monitoring; pain management, OI and STI treatment and prophylaxis, nutritional assessment and support, lab- baseline hematology, chemistry and CD4 percentage and follow up, OI and STI diagnosis- psychosocial support, provision of Cotrimoxazole, home based care, and active linkages between hospitals, health centers, and communities.

ICAP family-focused model of care is an optimal platform for pediatric case-finding and referrals. ICAP uses adult care and treatment venues as additional entry points for pediatric services, utilizing a genealogy form that ensures that HIV-positive adults are asked about the HIV status of their children at each visit. In COP 10, targeted testing will be done using skilled CBOs to ensure that children of adult in care and treatment are tested and linked to care.

In COP10 ICAP support for pediatric diagnosis will continue to include: enhancing linkages between PMTCT programs and those supporting OVC and ART services; supporting EID via dried blood spot (DBS) testing; initiating and expanding routine opt-out pediatric testing at inpatient and outpatient wards (including OPDs, casualty wards, well baby immunization clinics, child welfare venues, and adolescent/youth-friendly clinics) following national norms regarding counseling and consent of minors; and providing training, supplies, and laboratory support for HIV testing. DBS is collected from ICAP supported Nationally approved EID sites; ICAP will continue to partner with Clinton Foundation to ensure regular supply of DBS materials to all sites and shipment of samples /collection of results to and from National PCR labs.

In COP09, several challenges were identified as limiting pediatric uptake of care and treatment services. These include: poor linkage between PMTCT and services for HEI; poor uptake of PICT for children of HIV infected adults in ICAP-supported C&Tx programs, OVC programs and within points of medical services for children especially sick children; also there was a lack of segregation of pediatric care data into exposed and infected status which is responsible for lack of determination of proportion of HIV infected children receiving HAART among others. A "WATCh"("Where are the Children") task force was initiated to put in place mechanisms that will identify innovative strategies to reach the children within the shortest timeframe and bring them into much needed C&Tx. The overall aim of the WATCh strategies is to develop systems to improve identification; enrollment and retention into care of HEI and infected children into care and treatment, including treatment with HAART. These interventions will be further expanded upon in COP10 and include: strengthening linkages between antenatal care, maternity and Exposed Infants, ollow up clinics, strengthening the tracking and follow up of HEI, strengthening universal "low hanging" PICT for children of HIV infected adults in C&Tx, OVC , and hospitalized children. This will involve having a minimum of 2 point of service testing for children in all comprehensive sites (in the Pediatric wards and immunization clinics). ICAP will continue to ensure monthly reporting of PICT performed on children of HIV infected adults in care and health services care points (reporting by categories and use of # of admissions would also help evaluate coverage). ICAP will further ensure that strategic approaches including chart reviews and monthly M&E reporting are used to determine program-level performance monitoring of HAART initiation among eligible HIV-infected children on a monthly basis. Also regular chart reviews will be conducted on records of HEIs and HIV-infected children to ensure that all DBS positive Infants are linked to treatment appropriately.

ICAP will also ensure that Pediatric clients (both HIV exposed and infected) have priority for defaulter tracking. To further ensure that the children of adult in care and treatment are tested and the positive linked to care and treatment, ICAP will use skilled CBOs for targeted testing and to provide escort services of HIV positive children to comprehensive sites.

Enrolment into care and treatment

In COP10, 3,060 HIV-infected infants and children will be enrolled in care, and carefully staged, both at baseline and at subsequent follow up visits. Following clinical and immunologic staging, those not yet eligible for ART will receive clinical services including ongoing monitoring, charting and plotting of growth and development, screening and prophylaxis (IPT) for TB when indicated, cotrimoxazole prophylaxis (CPT) following national guidelines, and diagnosis and management of opportunistic infections as needed. Ready-to-Use-Therapeutic Feeding" (RUTF) using criteria agreed upon by the USG in-country and GON team will be provided at facility and community level via referrals where possible. Parents/caregivers of HIV-infected children (regardless of children' HIV status) will receive a standardized "preventive care package" including basic care kits, ITN water guard, water vessel, ORS, soap and gloves. Infants and children who are eligible for ART will receive appropriate first and/or second-line therapy accompanied by careful monitoring for toxicity and efficacy and by intensive adherence support. To improve retention in care for children ICAP will continue to advocate for communal support of transport reimbursement/food items for indigent children as well as link caregivers to IGA (income generating activities) in all the comprehensive sites

Decentralization of pediatric care and treatment services

In COP10 ICAP will continue to build capacities of pilot comprehensive PHCs to link to referring hospitals to support HIV/AIDS programs and provide onsite ART refills and follow up for stable patients, at the PHC level. Experienced nurses and community health officers identified in high volume pilot PHCs will be further trained to deliver quality focused pediatric C&Tx services including conduct nutritional assessments and monitor growth and development, provide drug refills based on a symptom checklists, provide CTX and micronutrients, psycho-social and disclosure support, and referral to the comprehensive treatment sites as needed. ICAP will work with local State primary health care agencies to develop/adapt job aids and SOPs for providing HIV care and treatment at the PHC. Pediatric ART services in COP 10 will include having a minimum package of care for infected children at all ICAP sites. This minimum package of care for infected children will include: follow up schedule, WHO staging, growth and development monitoring, TB screening at every visit, CD4 baseline and repeat every 3 months, DBS testing, CTX prophylaxis, immunization, Multivitamins, anti-helminthics, antibiotics (Ampiclox, Co-trimoxazole, and erythromycin), ITN and antimalarials for treatment, basic care kits, baseline investigations and nutritional assessment, food supplement, infant feeding counseling and confirmatory HIV test at 18 months.

This minimum package of care for HIV infected children in the PMTCT-only sites is in line with the decentralization of pediatric ART services to smaller sites (PMTCT only) and will bring ARV treatment, care and support services closer to families and communities. This will require building the capacity of the health care workers at the primary and secondary sites to scale up pediatric ART services at these sites. In the PMTCT only sites where there is no CD4 machine, ICAP will continue to support CD4 sample logging using the same channel of sample logging with the PMTCT, TB and Adult ART services.

Human Capacity Development

Training and supportive supervision of health care cadres will be a vital element in ICAP's COP10 program. Clinicians at all 30 hospitals will be assisted to identify HIV-infected children, to enroll them in C&Tx, to perform appropriate clinical and laboratory staging of these children, and to provide comprehensive care and support, including the prompt initiation of ART for eligible children. ICAP will also train PHCs staff to encourage task shifting in the care of HIV positive children. ICAP will conduct pediatric ART trainings, ongoing CME and QA activities for 232 clinicians and allied health care providers (including 100 for ART and 132 for Palliative care) who will support pediatric C&Tx. ICAP trainings will reinforce the need for opt-out testing for pediatric inpatients, pediatric TB patients, adolescent patients and children suffering from malnutrition and common illnesses which are also warning signs of HIV infection. Trainings will also focus on second line and regimen changes for children who are already on ARVs. Additional training and support will enhance the specialized counseling, patient education, and linkages required in early infant diagnosis programs. Adherence trainings and support services will be provided at each site. This will facilitate adherence assessment and support including group counseling, disclosure counseling, patient/family/caregivers education, appointment diary system, referral linkages, patient follow-up, provision of support tools (dosage guides, reminders etc.), linkages to community-based adherence support and retention in care programs.

Clinical Systems Mentoring and Quality of Care

Onsite clinical mentoring will enhance quality of care and build site-level clinical and management skills for program sustainability. ART reference tools will include pocket guides, dosing cards, posters, and detailed SOPs. ICAP will support quality improvement/quality assurance mechanisms to facilitate the delivery of optimal C&Tx services. ICAP will also facilitate and actively support onsite standardized HMIS using GON forms and provide onsite assistance with data management and M&E to guide quality improvement measures.

Harmonization of Activities

In COP10, ICAP will continue to work closely with other PEPFAR IPs and GON to ensure compliance with National policies, curricula and guidelines, and continue to participate in the USG Clinical Working Group to address emerging treatment-related topics and further promote harmonization with other IPs and the GON.

Community Linkages

In COP10 ICAP will continue to work closely with its 24 NGO/CBO/FBO partners to promote community involvement, provide HIV prevention activities and linkages to wraparound activities, and facilitate adherence among HIV positive community members. ICAP will continue to strengthen/establish children support groups as part of the psychosocial support.

ICAP will also continue to provide nutritional support through partner CBOs to all 3,790 (?) HIV + children on ART. Support will include provision of RUTF as needed and other nutritional support. ICAP will also expand its successful Peer Health Educator program, enhancing targeted family counseling and testing, defaulter tracking, and inter/intra-facility linkages. ICAP will continue to ensure that HEI and HIV-infected infants and children are linked into OVC services. Prevention for positives messaging will include a balanced ABC approach messaging for adolescents infected with HIV. All HIV positive infected children/adolescents will be linked to home based care and support, community and social services for referrals for food and education assistance, economic empowerment, and other wraparound services.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

One of the pioneers of family-focused multidisciplinary HIV/AIDS treatment in resource-limited settings, REDACTED.

LINKS TO OTHER ACTIVITIES:

This activity relates to HBHC (XXX), OVC (XXX), HCT (XXX), PMTCT (XXX), HVOP (XXX), TB/HIV (XXX), AB (XXX), and SI (XXX). As expansion of ART services is prioritized to rural areas, ICAP will strengthen referral channels and network mechanisms. Children on ART will be linked to home based care and community and social services. TB/HIV linkages will be strengthened where ART and TB DOTS sites are co-located, and co-location of new ARV sites will be actively promoted in TB DOTS stand-alone sites. All HIV infected children will be screened for TB using the National algorithm while all children infected with TB will be offered HIV testing. Children will be also linked to other child survival programs. ICAP will also provide onsite assistance with data management and M&E to guide quality improvement.

TARGET POPULATIONS:

HIV positive children, will be provided access to pediatric ART services. Health care providers in secondary and primary health facilities will be trained to deliver quality ART services.

EMPHASIS AREAS:

Emphasis areas are quality assurance/improvement and supportive supervision. ICAP personnel including national and international experts will provide skill and competency-based trainings, CME, and ongoing clinical mentoring to enable onsite staff to provide quality ARV services to children infected with HIV. Emphasis areas also include training, human resources issues, referral networks, infrastructure support, linkages to other sectors and initiatives. Services will also focus on addressing the needs of women, infants and children to reduce gender inequalities and increase access to ART services among these vulnerable groups. ARV services will facilitate linkages into community and support groups for nutritional support and other wrap around services. ICAP will strengthen the integration of HIV Pediatric packages into existing MCH and child survival services. This will be achieved through: decentralization of care of HEIs and integration of HEIs clinics into existing MCH services in PHCs.

None

ACTIVITY UNCHANGED FROM FY2009 ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: With the successful scale up of ART care program by many Governments and international partners/donors, focus has shifted to quality of care, cost effectiveness, sustainability and government ownership. These paradigm shifts clearly necessitate new and robust approach to HIV care monitoring and evaluation. ICAP Nigeria has adequately positioned itself for these new demand and shift by pursuing programs and activities involving development of tools and M&E guides, adopting best practices in M&E, promoting participatory monitoring and evaluation (PME), improving the quality of data and strengthening collaboration with the GON in the implementation of the " Three Ones" strategy

In COP09, ICAP provided strategic information (SI) management services to 158 entities in six states (Kaduna, Benue, Cross River, Akwa Ibom, Kogi and Gombe). These included primary health centers (PHCs) providing a combination of PMTCT, TB/HIV and/or HCT, 24 CBO's and 30 secondary hospitals provide comprehensive HIV/AIDS programs. In COP10, ICAP will continue to build upon the successes and the lessons learnt from previous year to sustain and improve on the SI support to all supported entities across supported states.

ICAP M&E team with COP09 funding consist of 28 technical staff and a crop of facility based data clerks and medical record Officers that support the system to implement M&E activities for patient monitoring and management (PMM), Quality Management (QM) and Program Monitoring and Evaluation (PME). The ICAP M&E team has supported the implementation of basic site patient tracking (using national paper-based systems) for care and treatment, including the identification and harmonization of indicators and definitions, and the adaptation and printing of data collection tools. M&E activities include the initiation of a paper-based records system, strengthening facility M&E system, regular data collection and verification to meet reporting and data quality requirements, tracking referrals and linkages to ICAP-supported hospitals for HIV care and treatment services and introduction /support of new advances in HIV care monitoring and evaluation.

ICAP also uses electronic aggregate database to facilitate site monitoring activities, assist reporting, monitor quality of services provided, and enhance programmatic evaluation. ICAP will continue to upgrade the data entry, reporting and data quality features of the aggregate database to meet both local and international need. In addition, ICAP will continue to provide technical support to other ICAP supported countries that have signified interest in adapting the ICAP Nigeria database for use. ICAP will complete the development and commence the implementation of patient level database in COP10 to improve data and efficiency in patient monitoring and evaluation and ultimately quality of care received by patient. Using in-country networks and available technologies, ICAP is building a strong Patient Management Monitoring (PMM) system harmonized with the Government of Nigeria's (GON) emerging national PMM system. ICAP has effectively continued to participate and key into the GON "Three ones" strategy of one National M&E strategic framework, one coordinating body and one reporting system. This has led to ICAP continued active participation in LHIPMIP (Voxiva platform), HIVQual and membership of both State and National M&E Technical working groups.

In COP10, ICAP M&E staff will increase regularly scheduled mentoring and supervisory visits to all supported entities to build capacity, strengthen data quality and implement robust quality and standard of care monitoring and evaluation. In addition, they will strengthen M&E system, including constant and correct use of the National PMM tools and guidelines, proper medical record keeping, efficiency of data flow, referral coordination, and use of standard operating procedures, in line with the USG SI and GON data quality assessment/improvement (DQA/I) and capacity building plan. In COP10, ICAP will strengthen the capacity of States Ministries of Health (SMOH), States AIDS Control Agency (SACA) and Local Government AIDs Control Agency (LACA)M&E officers to provide leadership in collection collation, transmission and use of data for decision making. Joint on-site technical assistance with more frequent follow-up monitoring visits will be conducted by ICAP and GON to reinforce and ensure that standards and best practices are adhered to while ensuring that quality data is used at the grassroots by all stakeholders particularly facilities, communities and Local Government Council in supported states.

Emphasis will be placed on strengthening the state systems to ensure that data collected at facilities is reviewed, shared and used by service points, facilities, Local Government council and states for strategic planning to improve program quality and inform programmatic decisions, thus ensuring ownership of the data and sustainability of M&E activities. We will build the capacity of LACAs through training, mentoring, supportive supervision and logistic support to implement robust HIV surveillance activity in their local government. The SMOH/SACA will have their capacity built to provide leadership on management and use of data. Furthermore, we will develop and implement a robust system for tracking patients adherence and retention in care.

ICAP Nigeria M&E unit will drive the process for development and implementation of quality improvement and standard of care indicators to promote quality of patient care and ensure sustained standard in care in all supported sites. ICAP will continue to support the implementation of the HIVQUAL and clinical systems mentorship platforms.

In COP10, ICAP will maintain the current level of staff with very minimal addition of 3 new State M&E coordinators for Cross Rivers, Akwa Ibom and Kogi. These new addition will substantially position ICAP Nigeria to provide leadership in all ICAP supported state to implement the fullest the "Three Ones" strategies. The number will bring the total number of ICAP M&E team to 31. These 31 staff will be supporting six states having 128 Local Government Areas with over 150 ICAP supported entities. The State M&E Coordinators will provide support in the strengthening of state and facility M&E system and assist the Regional Advisors in the planning and implementation of M&E activities in the State and Region.

ICAP M&E staff will train service providers in appropriate record-keeping and provide ongoing technical assistance to facility personnel to enhance site capacity to keep and review completed service delivery forms/registers, and to implement data quality assurance systems. In COP10, in addition to service providers, we will train M&E Officers from LACA in HIV care monitoring with emphasis on understanding indicators, data collection, data collation, data transmission, data quality, data use and supervision. Also supervisory councilors from the Local Government will additionally be trained on data use and dissemination to enable them drive the process for data use in decision making and policy formulations. At the State level, M&E officers of the SACA and SMOH will be trained in HIV care monitoring, data collation, data use, dissemination, supervision and coordination. In addition, ICAP will work with supported states to develop M&E work plan. In COP10, ICAP will train and provide ongoing technical assistance to at least 582 individuals at ICAP-supported facilities (strategic information staff of secondary hospitals, primary health care facilities, DOTS sites, CBOs, NGOs, and PLWHA groups, LACA, SMOH, SACA and supervisory councilors) to enter and manage the information required to monitor program performance, evaluate quality, and identify areas in which program services can be strengthened and formulate policies. This number comprises 256 LACA M&E Officers, 48 SACA/SMOH M&E Officers and 128 supervisory councilors for health in Local the Government. Also, 150 facility and CBOs staff will be provided refresher comprehensive M&E training. Funds will be used to train facility medical records officers and data clerks in basic computer skills, data management and general M&E. Service delivery staff will be trained on monitoring quality of service using appropriate quality management (QM) tools. Service providers will also be supported to complete medical records and registers in an accurate and timely manner. In addition, ICAP will provide technical assistance to 158 local organizations and facilities, 128 local government and 6 States Ministries and SACAs enabling them to strengthen their own monitoring and evaluation activities.

ICAP will continue to support additional M&E activities, including monthly feedback meetings with facilities and GON at all levels and regular quality checks on data and other services via adapted QM tools. Support will be provided to GON as necessary, and evaluation protocols will be developed and implemented. State M&E officers will participate in the monitoring processes and the training programs in order to instill a sense of ownership and ensure sustainability of these efforts. Additionally, the SI team will continue to be active participants in the SI working group established and coordinated by USG-Nigeria.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: Correct and consistent data collection will contribute to the measurement of the achievement of the GON/PEPFAR care and treatment goals. It will be utilized to strengthen systems for increased and rapid expansion, planning and sustainability purposes. In addition, it will provide appropriate information to assess quality of care provided to PLWHA's and PABA's.

LINKS TO OTHER ACTIVITIES: M&E is concerned with the collection of data on all services provided to improve program activities and enhance reporting. Thus, this activity will relate to activities in PMTCT (XXXX), adult basic care and support (XXXX), TB/HIV (XXXX), OVC (XXXX), HCT (XXXX), sexual prevention (XXXX), ARV services (XXXX), ARV drugs (XXXX), lab (XXXX), blood safety (XXXX) and injection safety (XXXX). ICAP will also conduct public health evaluations of selected interventions during the COP09 year as well as routine evaluation of the PMTCT service delivery and decentralization of ART services to PHCs.

POPULATIONS BEING TARGETED: The population being targeted includes the M&E officers in partner implementing organizations and various CBO/FBO/NGO/PVO and medical records officers in health facilities Local Government, SMOH and SACA. The various cadres of service providers will also be provided with technical assistance to enhance accurate record keeping.

EMPHASIS AREAS: Emphasis areas include human capacity development, system strengthening and SI.

By collecting data about relative numbers of men and women accessing prevention, care, and treatment services, strategic information will be available to inform the development of strategies to mitigate gender inequity. Strategic information also enables programs to assess the effectiveness of referrals and linkages to wraparound programs providing food support, microfinance initiatives, and reproductive health services (and other required services). Data will routinely be used to assess and enhance program quality and program effectiveness.

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

According to the World Health Organization (WHO), Health systems that function well, have certain shared characteristics that include; 1)good procurement and distribution systems that actually deliver interventions to those in need, 2) sufficient health workers with the right skills and motivation, 3) financing systems that are sustainable, inclusive, and fair and 4) health care costs that should not force impoverished households even deeper into poverty.

In COP09, ICAP leveraged its available resources to contribute to the strengthening of the health care delivery system primarily in the six states of Gombe, Cross River, Kogi, Kaduna, Akwa Ibom, and Benue by supporting activities addressing the above parameters and more. In COP10, ICAP will continue to focus and expand its health systems strengthening plans across these states by continually motivating the states to adapt and establish a chronic care system that will ensure continuity and comprehensive of care not only to HIV but to other chronic illnesses as a whole.

Strategic Approaches

Promoting leadership and governance: ICAP is working at the Federal State and local government levels and at the leadership levels of the not for profit health facilities to ensure that requisite policy frameworks and guidelines exist and/or are developed to support the provision of effective oversight, coalition building, regulation, attention to system-design and accountability. By also promoting the establishment of program management teams (PMT) across all 30 supported health facilities, ICAP is encouraging innovation, which is supported by consistent technical assistance, policy and accountability. In COP10,ICAP will train PMT teams on leadership, management and team building, and also build capacity of state and local government level authorities on health program management. Joint work plans will be developed with the state authorities with periodic review. ICAP will continue to establish/maintain subcontracts with facility and community based organizations to further increase their overall management skills, enhance responsibility and promote accountability. ICAP will work closely with the government of Kaduna and Cross River states to jointly design, implement, monitor and evaluate the devolvement strategy to decentralize ART care and treatment to pilot PHCs in conjunction with the LGAS/new state primary health care development agency (SPHCDA) where they exist.

Enhancing the Service Delivery package: One of the main objectives of ICAP HSS is to contribute significantly to assist the 6 states, their LGAs, communities and people they serve to maintain quality health services that deliver safe, comprehensive, integrated and continuous interventions at the optimum resource level. To achieve this, ICAP is working in conjunction with other stakeholders at the state and facility levels to develop a package of integrated services based on a picture of population health needs, of barriers to the equitable expansion of access to services, and available resources such as money, staff, medicines and supplies. ICAP will advocate to states and local governments to strengthen site support and establish new health facilities thereby increasing access to health services. ICAP will also advocate through CBOs to states and LGAs, to create a forum to identify barriers to care and ways of addressing them.

ICAP is also working through a network of over 24 NGOs/CBOs/FBOs to create a demand for services, by reducing cultural, social, financial and gender barriers to care. The community networks and linkages provide the required forms of social engagement in planning, implementation, monitoring and in overseeing service performance. In COP10, ICAP will continue to support and expand the provider network to ensure service delivery as close to the client as possible, facilitate an individual continuity of care where needed between communities and facilities; and to avoid unnecessary duplication and fragmentation of services.

ICAP will partner with private sector organizations (MTN, GLO, Mobile etc) to support service provision in ICAP supported sites where feasible. The community networks will continue to enhance intra and inter facility referral systems; facilitate effective linkages between different levels and types of provider including hospitals. ICAP will continue to train and retrain health care providers at facility and community based levels to deliver various facets of chronic care to patients and their households in a continuous manner. ICAP envisages that at least 4118 providers will be trained in the reporting period.

Strengthening of the Health care Workforce: ICAP will support the development/enhancement of a well-performing workforce that is adequately trained, efficient and resourceful within available resources. ICAP will also continue to work; and dialogue with the respective state/local governments to identify mechanisms to ensure an equitable distribution of health care providers especially to the semi-urban and rural areas. At the provider level, ICAP will support increasing the competencies of providers to deliver services and acquire mentorship skills. The effectiveness of the State mentorship teams will be improved by building their capacity to conduct and facilitate trainings and promote cross training. ICAP will also respond to the demand of all the six states to build their skills to enable the states expand the clinical mentorship approach system wide. To achieve this, ICAP is working with both arms of government and its private not for profit partners to develop/adapt a clinical mentorship initiative that will focus on bolstering facility capacity to provide general quality health services. ICAP Nigeria has already begun this process using CSM approaches in COP09 when it strengthened skills and expertise of 60 State MOH/LG staff in Kaduna and Cross River states to provide mentorship and support facilities in high quality care delivery, as well as effective devolution of care to PHCs. In COP10, additional 120 State MOH/LG staff in Kogi, Akwa Ibom, Benue and Gombe states will be trained to carry out mentoring activities. The strategic approach involves simultaneous capacity building at the state and facility level, to government and non-government actors as an integral part of ICAP's transition strategy. ICAP Nigeria will continue to support capacity building efforts at the Federal level, and will coordinate with other IPs as needed to meet the goals of the FMOH and NACA. Specific activities include support for the development of National Guidelines on CSM and expertise building within the FMOH, and participation in the roll out plan /Technical Working Groups. ICAP will also share its regional expertise by participating and supporting the development of pre-service and in-service training on CSM and HIV C&T; ICAP will partner with selected universities to sponsor selected nurses from ICAP supported sites, for pre service trainings to build their skills to task shift and provide the much needed human resource capacity especially at the sub-urban and rural areas. Such nurses, after completion of their trainings will pilot structured task-shifting activities. ICAP will further continue to work with both Federal and State Ministries of Health/ LGAs in the development of non-traditional cadres and task shifting plans (TBAs, PHEs, and CHEWs).

To make the work environment more conducive, ICAP will continue to develop and strengthen infrastructure systems in both comprehensive and urban PHCs to allow for their continued and more efficient use. Dilapidated state-supported stores, clinics, labs, TB sites, Laboratories, and PHCs will be repaired or renovated (which will include partitioning, wall plastering, worktops, tiling, plumbing, electrical works etc.) as the case may be. ICAP will further improve all ICAP supported work environments by providing resources such as computers, ACs, office furniture, required for improved service delivery. To efficiently and speedily carry out the foregoing, ICAP will use the services of state based in-service or retired facility repair consultants in all regions.

ICAP will support the implementation of QA/QI standards at the state/facility level; quality improvement teams will be established at the central, regional and facility levels. The goal of QA/QI teams is to ensure that agreed program standards are implemented and performance is consistently enhanced in all ICAP supported programs/sites with a view to ultimately making the program/site sustainable.

Support for a well-functioning health information system: ICAP will continue to support the establishment of a robust MIS that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. A foundational principle of this framework is data-driven continuous quality improvement at all levels. Thus, tools and their application are a crucial part of implementing the strategy. ICAP will continue to work with the states to implement identified strategic approaches including use of models and standards of care checklists to enhance competency and quality. ICAP will continue to build capacity of the provider, team, and site levels at different phases of site development, ranging from site start up to site maintenance/maturation level. Emphasis will be placed on strengthening the system to ensure that data collected at the site is shared and used by site service delivery staff for strategic planning to improve program quality and inform programmatic decisions, thus ensuring ownership of the data and sustainability of M&E activities. ICAP will build capacity of State MOH/LG staff on M&E plan development, DQA, reporting and site supervision.

Furthermore, robust systems for tracking patients and monitoring adherence will be developed. ICAP will expand its hybrid of paper and e-based data system and will continue to work closely with ICAP NY, to adapt a patient level database. In COP09, minimal additional M&E staff including site data entry persons were hired in order to sufficiently address the greater level of M&E activities across all programs. Regional and one Central M&E assistants are assisting the Regional M&E advisors and Central M&E team in the development and refinement of M&E materials. They provide support in the development and establishment of a systematic procedure for patient M&E including collecting, collating and reporting all data tracked by the ICAP Nigeria program. Finally, ICAP supported pharmacy staff will begin a pharmaco-vigilance initiative, collecting data that will assist with patient management, medication toxicity tracking, and adherence monitoring. These data will be correlated with routine M&E data for additional insights into the program.

Strengthening of the procurement, logistics and supply chain management system: A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.

Infrastructure and logistics

REDACTED.

Staff of these state central stores will be retrained in current approaches to logistics and supply chain management using national curricula. In COP10, ICAP will also continue to supply Standard Operating Procedures (SOPs) and National Guidelines to guide quality ARV management across different thematic areas in an integrated approach.

Advocating for a good health financing system: ICAP will continue to advocate to states and LGAs to raise adequate funds for health, in ways that will ensure that people can use needed services, and are protected from impoverishment associated with having to pay for health services. ICAP will also continue to advocate to the six states and their LGAs to identify, recruit and post new health care providers to the rural and semi-urban areas with performance based incentives. In COP10, ICAP will continue to build on its advocacy which in COP09 resulted in Benue, Kaduna and Gombe states renovating facilities and procuring some of the reagents and supplies for use in the labs and pharmacies. REDACTED.

Harmonization and Leveraging resources: ICAP will work closely with other implementing partners and donors to facilitate and support donor coordination activities at the state level to ensure judicious use of resources, synergize activities based on areas of comparative advantages, and avoid duplications and wastages. ICAP will also facilitate donor/partner coordination for in selected states to support an integrated approach to health care delivery thereby strengthening the overall health system.

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ICAP will promote biomedical prevention through the promotion of blood safety; targeting directly health care workers at ICAP supported facilities, blood recipients and blood donors at the facilities. Specifically, ICAP will emphasize training to build human capacity in blood safety services and create awareness on safe blood and blood product to end users through IEC; institutional capacity development for blood safety which includes training of personnel, institute safe blood collection procedures, provision of commodities, increase community awareness, and strategic linkages with other partners. ICAP will also collaborate with the National Blood Transfusion Services (NBTS) to promote blood safety.

Blood transfusion safety is a practical and feasible approach to averting new HIV infections. This entails supporting the training of clinicians, laboratory personnel and other health care workers on safe blood collection procedures, implementation of a hospital linkage with the NBTS while developing a pool of low risk voluntary, non-remunerated blood donors, and reducing unnecessary transfusion.

In COP09, ICAP expanded support for blood safety to a total of 30 hospital networks in six States (Kaduna, Gombe, Cross River, Benue, Akwa Ibom and Kogi). Working closely with the National Blood Transfusion Service (NBTS) and Safe Blood for Africa (SBA), ICAP has trained 20 laboratory staff involved in blood transfusion services, enabling and supporting these in turn to provide training for at least 285 laboratory and allied health workers involved in blood transfusion services at their sites: a total of 240 individuals will be trained by the end of COP10.

Training: In COP 10, ICAP will continue to work closely with the National Blood Transfusion Service (NBTS) and Safe Blood for Africa Foundation (SBFA) in all aspects of its blood safety program. ICAP will support refresher training for HCW in facilities to recruit repeat voluntary blood donors from the ranks of current family replacement donors.

Develop a pool of low risk voluntary, non-remunerated blood donors: ICAP will collaborate with NBTS in the development of a nationwide voluntary donor recruitment system. NBTS and ICAP will provide technical support for blood donation drives held at ICAP supported hospital facilities. ICAP will be instrumental in working with hospital management and staff at the comprehensive sites to develop buy-in for the NBTS blood services program, to create support for blood donor organizers, and to strengthen health facility and community focused blood drive activities.

To increase community involvement ICAP will support all 30 health facilities to work with the local Red Cross on community sensitization and blood drives. Additionally, local community based organizations and support groups as well as faith based organizations will be targeted to increase demand and awareness on safe blood practices. These local organizations will be supported to promote safe blood donor drives and activities in their communities and to sensitize the hospitals and communities on the need for voluntary blood donation. ICAP will support the distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for voluntary non-remunerated blood donation.

Safe blood collection procedures and screening: ICAP will work with all the 30 hospitals that do blood transfusions to ensure appropriate facility-level collection of blood. ICAP will continue to monitor the already developed NBTS/hospital blood exchange program at 5 blood centers that were supported in COP09 based on proximity to a zonal NBTS office, availability of blood banking facilities, support infrastructure and other resources supplied by ICAP. This linkage will continue to provide regular delivery of donated units of blood to NBTS for screening with ELISA technique in conjunction with a regular delivery of screened units of blood to the facility.

Directed and voluntary donors will be prescreened with the NBTS donor screening questionnaire and donors will be deferred as necessary based on their responses. Deferred donors will be offered HCT. It is anticipated that 2860 blood donors will be screened using the HCT testing algorithm, thereby utilizing the blood donor setting as another point of service for HCT during pre-donation. ICAP in collaboration with supported facilities will send unscreened blood units that these 5 hospitals have appropriately collected and stored to NBTS centers where they will be screened for the 4 transfusion transmissible infections (TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA techniques. Therefore, approximately 2,600 units of blood will be collected and sent to the nearest NBTS centers for ELISA screening as outlined. In addition to collecting unscreened units, NBTS will deliver to these 5 blood centers screened units for blood in exchange for the unscreened units which will then be stored for use at the facilities. NBTS will also provide monthly feedback on rates of the 4 TTIs found by ELISA screening of blood units collected by each facility.

It is expected that at the 5 blood banking centers a total of 900 transfusions will take place. ICAP will work to ensure that 80% of blood transfusions that occur at these hospitals will use NBTS-screened blood units, while only 20% will be emergency transfusions whereby the hospital will screen the donors on site using rapid test kits only. ICAP will support the NBTS in implementing its primary objective of migrating fragmented hospital-based blood services to centralized NBTS-based blood services nationwide.

Reduce unnecessary blood transfusion: ICAP will work closely with facility management to strengthen existing blood transfusion committees to oversee blood use based on national algorithms and standards in the health facilities.

Quality assurance (QA)/Quality Improvement (QI) management systems

Quality assurance (QA)/Quality Improvement (QI) management systems will be put in place to ensure the quality of the rapid HIV testing at all sites. All sites have been provided with copies of the National Blood Policy, operational guidelines for blood transfusion; ICAP will continue to provide sites with SOPs and job aids to support blood safety activities. This activity also includes partnerships and support to the following sub recipients for program activities: local red cross/red crescent organizations and HARHL Trust Nigeria.

Monitoring and Evaluation

ICAP will support monitoring and evaluation activities and use data to develop or update strategic plans and identify strategies to ensure long-term sustainability. In the area of blood safety, ICAP will continue to support the 30 comprehensive secondary health facilities to improve safe blood practices and reduce medical transmission of HIV and other infections.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

These activities will contribute to the overall Emergency Plan for prevention of new infections by promoting blood safety; ICAP will also support the training of health care workers to provide quality safe blood services, and will increase the availability of regular voluntary non remunerated blood donors.

LINKS TO OTHER ACTIVITIES:

This activity is closely linked to activities in ART (XXXX), Palliative Care (XXXX), OVC (XXXX), HCT (XXXX), Lab (XXXX) and PMTCT (XXXX) to ensure that health workers under all these areas adhere to principles of blood safety and universal precautions. With linkage to Lab (XXXX), lab-based activities will support safe blood activities at all ICAP supported sites through training, supervision, equipment maintenance and supplies

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Injection Safety

In COP 10, ICAP will continue to promote biomedical prevention through the promotion of safe injections and proper disposal of infectious waste generated in all facilities it supports, targeting directly health care workers at ICAP in these facilities and surrounding communities. Specifically, ICAP will continue to train and retrain all health care providers (doctors, nurses, lab personnel, waste handlers) to build capacity in safe injections and will continue to provide IEC materials geared towards behavioral change, and instituting safe injections. Additionally, waste management committees will be constituted/further supported where existing in all 30 comprehensives secondary facilities and surrounding PHCs to enforce proper disposal of waste. ICAP will further facilitate the regular availability of commodities, increase community awareness, and strategic linkages with other partners and initiatives like the Making Medical Injections Safer (MMIS) project. ICAP will also collaborate with the MMIS to support government in the distribution and implementation of National safety injection and healthcare waste management policy.

While injection is a necessary mode of providing treatment, contraception and immunization, contaminated injections add to the burden of illness. Reused syringes and needles, lack of sterilization, suboptimal collection and disposal of used needles as well as lack of training, standards of procedures lead to the exposure to HIV and other blood borne pathogens. In response and joint consultation with the Federal Ministry of Health (FMOH) and MMIS, ICAP has implemented the Safe Injection Global Network (SIGN) strategy, an infection prevention strategy to reduce HIV transmission through unsafe injections. In COP09, ICAP supported injection safety in the context of infection prevention and control services at 30 hospital networks in 6 states of Kaduna, Cross River and Benue, Gombe, Kogi and Akwa Ibom. Infection prevention practices were enhanced and universal precautions were introduced. By the end of COP 10, 150 health care providers will be trained on injection safety including general aspects of universal safety procedures and health care waste management, while advocacy and BCC activities on safe injection were conducted amongst health care workers to enable adoption of safer workplace behaviors.

In COP 10, ICAP will continue to focus and expand on these strategies to effect change in injection practices. These include: training to build the capacity of health care providers on safe injections, advocacy and behavior change communication (BCC) activities to promote safe injections, improvement of health care waste management plans, implementation of universal safety precautions, and provision of necessary commodities for safe injection and waste disposal.

Training to build human capacity and effect behavior change: Training will be based on the National Training manual adapted from WHO Do-No-Harm. Trainers trained in COP09 by MMIS have stepped down training to 1,450 health care workers. The training focused on safety standards of procedures on safe injections, waste management as well as behavior change to prevent unsafe and overuse of injections, observe consistent universal precautions, and appropriate health care waste management. Health care workers were trained as supervisors and were given the responsibility to provide supportive supervision to their peers in the area of safer injection practices and proper waste disposal. Trained supervisors will continue to be mentored by trained ICAP focal persons while also advocating to hospital managements to sustain the supply of safe injection commodities.

ICAP will also continue to promote and facilitate behavioral change among health workers through supportive supervision, distribute communication materials (leaflets, posters, reference guides) on safer injection practices, and support government to adopt a national health care waste management plan in collaboration with JSI/MMIS. This will also address stigma and discrimination issues that are often generated by fear among health care providers. Behavior change communication activities will facilitate the adoption of safe injection practices among health care providers.

Improve health care waste management: In COP10, ICAP will continue to focus on promoting effective waste management in 30 comprehensive secondary health facilities across the 6 states ICAP will implement these activities by partnering with a local non-governmental organization, HIV/AIDS Restoring Hope and Life (HARHL) Trust. This local NGO has extensive experience in responding to health sector program needs including issues of safe injection, universal safety precautions and safe blood. In addition, these organizations will assist the sites to develop and implement appropriate work plans and policies using the SIGN strategy for ensuring injection safety.

Provide commodities: ICAP will continue to procure color coded bin liners for segregation of infectious waste and personal protective equipment (i.e. disposable surgical gloves, disposable syringes, respiratory masks and gowns) for these sites. ICAP will also support proper waste management by procuring waste disposal units as well as supply locally constructed incinerators in selected sites based on needs. ICAP will partner with local governments in ensuring proper waste disposal in PHC centers by training the HCW in these sites on proper waste handling and disposal. PHCs will be linked to secondary facilities with waste disposal units and an efficient transport system designed or augmented where available for timely shipment of infectious waste for proper disposal.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

These activities will contribute to the overall National Plan for prevention of new infections by promoting injection safety. It will also reduce exposure of health care workers to occupational hazards in the supported health services. ICAP will also support effective waste disposal through the procuring of waste disposal units for selected health facilities.

LINKS TO OTHER ACTIVITIES:

This activity is closely linked to activities in ART (XXXX), Palliative Care (XXXX), OVC (XXXX), HCT (XXXX), Lab (XXXX) and PMTCT (XXXX) to ensure that health workers under all these areas adhere to principles of safe injection and universal precautions. With linkage to Lab (XXXX), lab-based activities will support Injection safety activities at all ICAP supported sites through training, supervision, equipment maintenance and supplies.

ACTIVITY UNCHANGED FROM FY2009 ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: In COP09 ICAP programming has expanded support to a total of 30 hospital networks located in 6 states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna, Kogi). In COP 09 ICAP implemented a balanced portfolio of prevention activities which has also included abstinence, be faithful and condom and other prevention (C&OP) programming activities in line with the overall PEPFAR Nigeria goal of providing a comprehensive package of prevention services to individuals reached. ICAP implemented these activities at both the facility and community levels utilizing a combination of multiple strategies including community outreach campaigns, interpersonal communication ,infection control activities, implementing PwP intervention at the facility level, STI management/treatment and workplace activities (specifically Greater Involvement of People with HIV/AIDS, or GIPA).

In COP10 ICAP will provide support to a total of 30 hospital networks and 24 CBOs. These facilities will served as the platform for ICAP minimum prevention package that provides individuals with messages on Abstinence, Be faithful ,correct and consistent condom use skills and STI management through strategic activities such as community outreaches, interpersonal communication (IPC) activities, counseling and youth focused programs. ICAP will continue to support abstinence (primary and secondary), mutual fidelity, risk reduction and safer sex promotion activities among 53,536 individuals. The targets will be people living with HIV/AIDS (PLWHA), in- and out of school youths, transport workers and people affected by AIDS. They will receive abstinence, be faithful and condom /other prevention messaging on a regular basis via activities such as community outreach campaigns, non curricula based school approach (i.e drama, interpersonal communication, infection control, STI management/treatment, and essential life skills training )

ICAP will reach these targeted communities with messages of delaying sexual debut or adopting secondary abstinence through IPC ,noncurricula school based approach and essential life skills training .ICAP will encourage PLWHAs and caregivers to engage in productive income generating activities by providing them with training on essential life skills and referring them to other partners. PLWHAs-Peer Health Educators will continue to be supported to help other PLWHAs acquire skills for positive living through PwP activities. .

Health and allied care providers will be further supported to adopt positive attitudes and behaviors including safe practices to reduce their risks of exposure. Facilities will be assisted to implement SOPs for post-exposure prophylaxis (PEP) should exposure occur. Job aids and behavior communication materials on universal safety precautions and PEP will be provided to support prevention at health facilities and care givers at the community.

BCC strategies/Material development and review In COP10,ICAP will continue the provision of correct and appropriate behavior communication materials and job aids to support different target groups to adopt and maintain healthy lifestyles and reduce risky behaviors for primary and secondary prevention. These behavior communication materials and job aids will be reviewed during materials review workshops in partnership with community based organizations, PLWHAS, health care workers, care givers and MARPS whose contributions will be incorporated. BCC materials from all thematic areas will be pre-tested, produced and distributed for use by all ICAP-supported facilities and partners. ICAP will continue to support the Prevention with Positives (PwP) intervention with the provision of communication tools and aids to provide a comprehensive package of PwP activities in all supported facilities and linked communities. A total of 682 facility and community based health care providers, counselors and regional community network coordinators will have their capacities built on prevention counseling. Contents will include partner counseling and testing, disclosure, dual protection, linkage to existing family planning and child spacing services, personal hygiene, safe water use, and healthy lifestyle. These will strengthen PWP intervention at the facility and community levels. ICAP will support the provision of STI instruments and reagents (VDRLI, swabs and culture plates) STI drugs and human resources to assist the treatment and management of sexually transmitted infections. PWP intervention will be strengthened through integration with other areas such as OVC and HBC. Referral linkages between family planning and ART clinics will be strengthened across all ICAP supported sites. In COP10, ICAP will continue the distribution of at least 2,000,000 condoms through its 24 CBOs/NGOs and 30 comprehensive sites to enable HIV positive and high risk negative individuals to adopt dual protection choices. These condoms will be provided by Society for Family Health.

Human Capacity Development: ICAP will build capacities of health care workers in prevention and supportive counseling to reduce the burden of sexually transmitted infections (STI), improve health seeking behaviors and linkages to diagnosis and treatment services for both STIs and HIV/AIDS, and educate HIV positive patients and PABAs on risk reduction, skills development for practicing sexual abstinence and/or correct and consistent use of male or female condoms, and healthy life planning. Referral linkages for STI management will also be strengthened as a component of preventive services. Support groups, peer educators, local NGOs and CBOs in each hospital network will be equipped to conduct prevention activities for HIV positives persons, their partners and households.

In COP10,capacity building activities will also target both health care providers in ICAP supported sites as well as staff of CBOs/NGOS / FBOs with special focus on those accessing most at risk populations (MARPs) i.e.PLWHA, youth, transport workers, MSM, commercial sex workers and injecting drug users ( in states where they are found) and persons involved in trans-generational transactional sex. These care providers will be empower these groups with knowledge and skills to negotiate and adopt safer sex, reduce high risk activities and improve good health seeking behaviors. Supportive behavioral change activities will target all individuals accessing ICAP supported facilities, especially discordant couples and communities at large with a special focus on MARPs. As part of targeting MARPs, ICAP will continue to support youth focused activities such as CBO youth centers, HCT youth friendly centers and pediatrics adolescent clinics using youth friendly behavioral interventions such as prevention counseling, essential life skills which include refusal and negotiation skills, community role plays , debate and quiz competitions intending to empower young people to adopt healthier lifestyles. Quarterly focus group discussions will be conducted to get feedback from PLWHA, OVC and PABA on the impact of ICAP supported HIV treatment and care program in selected states.

ICAP will train a total of 682 health care workers (including 250 on AB messages and 432 on other prevention) at facility and community levels to deliver appropriate BCC messages during routine clinic visits using tools and job aids, and provide referrals to HIV infected individual to enter care and treatment services. Health care workers at the facility and community will have their skills enhanced to discuss prevention through Abstinence, Be faithful, correct and consistent condom use with non marital partners, correct STI treatment, partner notification ,safer sex negotiation and addressing barriers to accessing health care services such religious beliefs and cultural practices. This will be augmented by building the capacity of at least 24 local CBOs, NGOs and support groups, to conduct activities to promote identified BCC strategies across their communities.

Facility-based approach In COP 10 all ICAP supported treatment sites will strengthen the integration prevention counseling and services for people living with HIV into family planning clinics as part of the PwP intervention. The proper management of sexually transmitted diseases will be supported through the timely identification and treatment of STIs, and partner notification and prevention counseling will be offered. Services such as prevention messages, promoting correct and consistent condom use will be promoted. ICAP will use available communication tools and aids to provide this comprehensive package of prevention for positives activities. Support groups will be assisted with patient education materials to build and support their skills on addressing prevention topics. ICAP will provide effective support for communication and behavioral change in partner notification practices through training and changing the delivery of care.

Community based approach ICAP will continue to strengthen its partnerships with community based organizations and link to communities through peer health educators, mothers forum, community role plays and support groups. Identified community, faith-based and non-governmental partners will be provided assistance to conduct community outreach activities including community dialogues, community rallies, quiz and debate competitions and other community mobilization approaches through innovative approaches to disseminate information and promote discussions around safe sex behaviors, risk reduction approaches, promote abstinence and partner reduction in selected audiences/target groups.

Prevention programs for MARPs will remain a priority in COP10. capacities of CBOs will be built to also address behavior change in the areas of abstinence and be faithful, condoms and other prevention, stigma, gender empowerment, male involvement in PMTCT, in HIV care and treatment and other related issues. CBOS will be supported to deliver prevention messages and skills to MARPS (Youths, MSM, IDU, CSW ,transport workers) in the community. In COP10, ICAP will ensure capacity of CBO partners and support groups are built for ownership purposes through development and distribution of BCC materials in all thematic areas to reflect local content. Capacity building of CBOs in leveraging resources from the communities and encouragement of CBOs to partner with other organizations to strengthen HIV/RH programs and for sustainability of the program. Build capacity of CBOs to identify, plan and implement activities that address policy issues with policy makers on issues like stigma and discrimination, gender inequity, support male involvement in HIV treatment and care, PMTCT and other RH issues.

Strengthen gender mainstreaming at community and facility levels. In COP 10, ICAP will identify CBOs to implement specific gender main streaming interventions and buy-in via financial and educational support; these CBOs will identify target audiences (male/female) per activity/intervention. ICAP will identify state based teams that will review, adapt and adopt training modules and BCC materials to ensure that gender issues are adequately reflected. Cross- cutting and holistic approaches to program activities will be adopted. ICAP will develop checklist for possible areas of expansion of supported CBOs' activities and expand supported CBOs' program focus to reach wider range of activities. Approaches to be used to strengthen gender at community and facility levels include repeated community dialogues, communication skills training for women, CBOs and HCWs and risk assessments and targeted outreaches and testing.

Supporting Male Involvement ICAP will advocate to facilities management to support male involvement by fast-tracking access to health care for men who visit facilities with their partners/families. Expand male-focused activities further than HCT to FGDs, safer sex practice sensitization, etc. CBOs will be supported to work with men influencers in communities to mobilize men to support HIV/AIDS and Reproductive health initiatives

CONTRIBUTIONS TO OVERALL PROGRAM AREA: REDACTED.

LINKS TO OTHER ACTIVITIES: This activity also relates to activities in AB (15654.08), Care and Support (5552.08), ARV services (5404.08), HCT (5550.08), OVC (5547.08) and PMTCT (6622.08).

POPULATIONS BEING TARGETED: HIV positive persons, especially women, their partners, adolescents, children and other household members will be supported to adopt positive attitudes and behaviors to reduce the transmission of HIV, and promote positive living among infected and affected persons. Health care providers will also be targeted. Facility based care providers and community based care organizations including their program managers and care providers will be trained to provide quality focused BCC activities that will promote the adoption and practice of positive behaviors. Most at risk negative populations including out of school youths, commercial sex workers, and persons involved in transactional/transgenerational sex will also be targeted for sexual prevention activities.

EMPHASIS AREAS Areas of emphasis include human capacity development and local organization capacity building. Advocacy will be intensified to men in communities in ICAP supported sites, for support to their vulnerable partners and involvement in HIV treatment and care, HIV Counseling and testing; women will be empowered with knowledge and communication skills so as to make informed decisions. Support groups will occasionally be segregated by sex to enable participants freely speak of their issues and find solutions that are most appropriate for them. This activity will promote gender equity especially among vulnerable groups of women and youths. By facilitating the availability of client education programs, it will contribute to the reduction of stigma and discrimination among care providers towards HIV positives clients.

None

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP10, ICAP will continue to work in the six states of Kaduna, Cross River, Benue, Kogi, Akwa Ibom and Gombe.

A total of 107 existing Government of Nigeria (GoN) mission and private health facilities will continue to receive support to provide PMTCT services and community outreach activities through 30 hospital networks and 77 PHCs.

ICAP will train health care workers (HCWs), support infrastructure, purchase equipment and supplies, monitor, evaluate and provide supportive supervision to the sites. Efforts will be made to facilitate the public health approach in taking PMTCT services to PHCs and community levels as essential steps towards universal access and the shared goal of eliminating peri natal transmission.. In COP10, ICAP will work to increase uptake of PMTCT services, including routine antenatal care and facility-based deliveries. ICAP will support PMTCT activities through: HCT for all pregnant women (ANC, labour and postpartum period); ARV interventions dispensed in ANC and maternity for HIV+ women; integrated group counseling into other health services attended by pregnant women and women of childbearing age; provision of services for well/or sick children (Immunization clinic), linkages to family planning and sexually transmitted infections (STIs) clinics; and promote integration of HAART in MCH and at PHCs using trained locum/mobile doctors, to provide 'one shop' services; and reduce delays in initiating HAART at comprehensive sites. Pregnant women, especially HIV-positive mothers, will be supported to deliver in health facilities through the provision of the national safe motherhood program delivery kits ("mama kits"). Mothers-2-Mothers (M2M) support groups will be established and/or strengthened at comprehensive and high volume PHC sites to increase facility-based delivery and reduce the number of women lost to follow up. ICAP will support and train mentor mothers who will spearhead these M2M support groups at PMTCT sites. Mentor mothers will conduct peer counseling to newly diagnosed HIV+ pregnant women, adherence counseling to women on ARV prophylaxis or HAART, provide information on minimum package of care for exposed infants and support defaulter tracking for positive mother-baby pairs. The use of ART for PMTCT will follow the National PMTCT guidelines. ICAP will provide support for psychosocial and adherence issues and for mothers infant feeding choices through appropriate infant feeding counseling. HAART eligible women will be enrolled at the nearest comprehensive site by referral and linkages. Health facilities will be supported to provide basic laboratory services and, if not available on site, will be linked to a laboratory network model in which CD4 testing can be performed by logging samples through specimen transport systems supported with motorbikes. ICAP will provide support for CD4 capability to high volume PHCs . ICAP will expand the use of hand held haemoglobinometers to all the PHCs to monitor women who are on AZT. Exposed infants will be actively linked to pediatric care and treatment through under-5 cards issued in labor and delivery. Women who test negative will receive prevention counseling and appropriate support to remain so.

ICAP will emphasize group counseling and opt-out testing with same day results at ANC, labor and postpartum service delivery points. Partners, households and children will be linked into HCT. ICAP will actively promote community-based PMTCT services through CBOs, to provide "doorstep" counseling services to pregnant women, their partners and other household members. Clients will be counseled on the beneficial effect of couple/partner HCT/disclosure on adherence to infant feeding choice. Eligible HIV-infected women will be assessed and linked into care and treatment services including ART and cotrimoxazole prophylaxis (CTX). Other activities are enhanced pediatric care including CTX from 6 weeks of age and promotion of best practices for infant feeding, nutritional support and linkages to family planning services. In addition to receiving PMTCT services, each woman will be referred to OVC services upon HIV diagnosis to facilitate care to all of her affected children. ICAP will actively encourage male circumcision as a preventive measure especially in Kaduna and Gombe states.

Identification and follow-up of HIV-infected and exposed children living within the community will be a priority with CBOs/FBOs assisting with adherence issues and defaulter tracking. ICAP will continue to implement a basic minimum package of care services to exposed infants at PMTCT/HCT-only sites. This would ensure that exposed infants are linked into care and prevent loss to follow up. Minimum package include: simplified Exposed Infant registers for data capturing, prophylactic ARV syrups (NVP and AZT) within exposed infant/immunization clinic, growth monitoring, nutritional assessment/infant feeding counseling, child survival strategies counseling DBS at 6wks, HIV C&T services at immunization clinics and for women with unknown HIV status. To implement these services at the PHC level, ICAP will develop minimum training package adapted from the National pediatrics and PMTCT training manuals to train PHC staff. ICAP will advocate to the National Primary Health Care Agency on the inclusion of HIV/AIDS information on road to health charts to help identify HEIs.

ICAP and its sub-partners will train 715 HCWs, using GON curricula, to provide an enhanced package of quality MCH services to HIV+ women. The training will focus on prevention messaging (including balanced ABC messaging),on STI screening/treatment, cervical cancer screening, safer sex, malaria prophylaxis, minimum package of care for exposed infants including child survival strategies, use of ITNs and safe water. It is estimated that about 15% of babies born to HIV-positive women will become HIV infected through breastfeeding. To reduce this risk, ICAP will empower providers to give unbiased infant feeding counseling to mothers based on WHO/GoN recommendations (exclusive breastfeeding, use of BMS based on AFASS criteria). ICAP will support govt efforts through zonal training of trainers on HIV and infant feeding, infant feeding meetings and reprinting of finalized Infant National guidelines. Additional health care providers will be trained to educate and assist mothers make appropriate infant feeding options and discourage "mixed feeding" practices..

Home deliveries remain a very strong preference among many communities in Nigeria as 2/3rds of pregnant women either deliver with birth attendants or in their homes (DHS: 2005, Piper CJ; 1997). In order to reduce the number of HIV positive mothers and their exposed infants lost after home deliveries, ICAP will support GoN to develop a National TBA curriculum to enhance their quality of service at the grass root level. ICAP will also support community sensitization, organization and capacity building of xxx TBAs across communities surrounding PMTCT sites in the six ICAP- supported states. TBAs will be trained on basic HIV prevention and infection control, safe motherhood, HIV counseling and testing information especially to pregnant women and their partners; and for referral support of newly delivered mothers and their babies for follow up care. Retired midwives and health care providers will be identified to monitor effective identification and referrals of pregnant women, newly delivered mothers and their exposed infants to nearby PMTCT sites for enrolment into care. TBAs will be involved in "Men Taking Action" activities to enhance community support.

ICAP will address the critical challenge of limited/lack of male partner involvement in PMTCT services and will strengthen male involvement through gender transformative activities. Through 'Men taking Action' MTA , ICAP will work with CBOs to increase service uptake, promote positive male norms and behaviors, especially as it relates to discordant couples, and help reduce stigma and discrimination through community based activities. These activities include community education and behavioral change communication (EBCC),"Mobile'' outreach VCT at male-friendly HIV/AIDS events, use of trained community leaders/gate keepers to conduct EBCC and deliver accurate messages related to PMTCT and VCT to male partners of pregnant women attending ANC and to men in the general community. At the end of the sessions, men will be encouraged to undergo rapid HIV testing with HIV+ male partners' appropriate referrals for TB and CD4 screening to nearby health facilities, and linkage into care. ICAP will also encourage facility managers to make their MCH men friendly for HCT and utilizing mainly male counselors where feasible.

ICAP will work in close partnership with GoN on HIV early infant diagnosis (EID), offering HIV infant diagnosis testing in line with the National EID initiative from 6 weeks of age using DBS. HIV positive infants will be enrolled and linked to appropriate care and treatment. ICAP will support GON at training HCWs on EID at PHCs and in the finalization of EID training curriculum. A joint USG/GON/ICAP team will provide ongoing M&E and supportive supervision activities and contribute to the national PMTCT program's M&E efforts. ICAP is also earmarking USD125, 000 for procurement of goods and supplies through the SCMS mechanism

CONTRIBUTIONS TO OVERALL PROGRAM GOAL:

ICAP and its sub-partners target states with some of the highest seroprevalence rates in Nigeria. Providing services at the primary and secondary levels assists the GON in achieving its goal of decentralizing PMTCT services beyond the secondary care level. ICAP will significantly contribute to an increase in PMTCT services by supporting 107 existing secondary and primary health care facilities government, mission and private health facilities and also indirectly supporting GON ministries/programs in their rapid scale-up plans for PMTCT.

ICAP will strengthen national and state PMTCT programs by: support of capacity building of master trainers for PMTCT services; production of GON approved infant feeding support tools; support adaptation of IMAI Document for HCWs at the PHCs,printing of national PMTCT registers; support of regular coordination meetings in collaboration with other partners at all government levels. ICAP will also strengthen the programmatic skills of partner CBOs/FBOs in line with GON sustainability plans.

LINKS TO OTHER ACTIVITIES:

This activity is related to activities in ARV services, Basic Care and Support, OVC, counseling and testing, SI, Lab, and Sexual Prevention. Provider-initiated opt-out HCT will be offered to all pregnant women at ANC, and to their partners. Women presenting in labor will have rapid HIV tests and receive single dose NVP if positive. Infants born to HIV-infected women will access ART (single dose NVP and ZDV) and CTX prophylaxis. Infant PCR HIV testing via DBS will be conducted with HIV positive infants linked to appropriate OVC care and treatment services. PC linkages will enable HIV+ women and family members access to support groups. Pregnant women will be linked into FP services. Partner counseling/communication will be promoted through sexual prevention activities. M&E activities at PMTCT sites will contribute to the national PMTCT program's M&E efforts using national PMTCT MIS.

POPULATIONS BEING ADDRESSED:

Pregnant women, postpartum mothers, their partners and household members including HIV exposed infants and HIV infected children will be targeted and supported so that they have full access to HCT at multiple entry points of care. HIV infected women will be provided with PMTCT/PMTCT plus services, while HIV infected infants and children, and infected partners, will access care and treatment services, including OVC services. Uninfected women will be supported to remain HIV negative. CBOs, FBOs, TBAs, support groups, and men will also be targeted so that they participate fully in community based PMTCT services. Healthcare providers will be trained on providing services while the management skills of GON policy makers and implementers at all levels will be also improved.

EMPHASIS AREAS:

Emphasis will be on training, increasing gender equity in HIV/AIDS programs, human capacity development and SI.

Equipping women with IGAs, communication skills and legal Aid counseling, will promote gender equity in HIV/AIDS programs and increase access to services by the vulnerable groups of women and children. Emphasis will also be on primary prevention of HIV infection and prevention of unintended pregnancies among women living with HIV. HCT services will be integrated in RH/FP services while all PMTCT clients will be referred to access RH/FP services post-delivery. The health status of HIV+ women will be further enhanced by actively screening them for TB and cervical cancers. Recognizing the impact of male involvement on a woman's access to PMTCT and VCT services, ICAP will use MTA strategies to enhance partner testing, endorsement of infant feeding choices, and engagement in care.

From a public health view, tasks can be shifted from more specialized to less specialized HCWs. At comprehensive/ high volume PMTCT/HCT-only sites, "Mentor Mothers", will be trained to spearhead Mothers to Mothers (M2M) support groups. They will also be trained to participate in peer/adherence counseling, minimum package for HEIs and tracking of defaulting mother-infant pairs, thus further leveraging task-shifting. At the State government level, ToTs will build capacity of State and local government PMTCT Task Force and also provide an opportunity for task shifting and promote sustainability by engaging state personnel in clinical systems mentoring activities at sites.

In COP10, under 'PEPFAR Nigeria's accelerated PMTCT plan', ICAP, 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.

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, the ICAP continued to expand its laboratory network model across the six states of Kaduna, Benue, Cross River States, Gombe, Akwa Ibom and Kogi enabling 30 hospital networks to support HIV/AIDS care and treatment programs. ICAP's experience in COP09 will inform programmatic and infrastructure maintenance, health system strengthening, service integration and quality improvement plans in COP 10. In COP09, baseline laboratory assessments for additional sites revealed infrastructural deficiencies including lack of electricity and potable water, obsolete equipment and testing methods, severe staffing shortages and under-skilled staff. Internal and external lab quality system audit also revealed the need for improved lab quality management system, service integration as well as limited sustainability plan.

Phased approach to lab development and maintenance

ICAP Laboratory support plan estab+lished a logical step-wise approach to phasing in the services needed by HIV/AIDS care and treatment programs. Phase I provides the "minimum package" elements of a functioning lab: electricity, running water, adequate interim space, training and supervision, reorganization of labs as needed, ability to perform HIV testing, complete blood counts, simple chemistries and CD4 capability. Phase II includes the introduction of analyzers, the initiation of standard QA/QC systems, the expansion of capacity to include additional chemistry tests, urinalysis, malaria parasite, STI screening tests, pregnancy tests, stool microscopy, urinalysis and blood cultures, Hepatitis B and C screening and liver function tests where feasible, REDACTED., as well as the introduction of protocols to collect and prepare dried blood spot (DBS) samples for use in early infant diagnosis (EID). All 30 comprehensive labs in the secondary facilities have completed the phase 1 package. ICAP will continue to support and expand services for the diagnosis of the following opportunistic infections: Malaria, TB, Hep.B and Hep C among others. ICAP will also continue to participate in the National EID scale up plan, sending DBS specimens to appropriate laboratories supported by other PEPFAR implementing partners. ICAP will provide support mechanisms following the close out of the Clinton Foundation support for sample collection materials and transportation of specimens/results and also key into any alternative DBS transport system adapted where it is not feasible/appropriate to provide transport. For quality purpose, ICAP lab advisors will also provide supportive supervision on DBS collection, to identify gaps and provide corrective measures. In COP 10, ICAP plans to continue to maintain all services provided in COP09, enhance the capacity of national and state for lab improvement and support while strengthening the lab quality management system in preparation for National/International accreditation

Human Capacity Development

In COP 10, ICAP will continue to fully fund training on diagnostic testing and immunologic monitoring, good laboratory practices (GLP), monitoring quality assurance and biosafety. It will continue to coordinate and fully fund formal didactic training sessions and share training resources to avoid duplication. ICAP will implement its lab system mentoring strategies in all comprehensive sites labs; strategies will include: training of ICAP lab advisors on QA monitoring and mentoring; orientation on new focus on quality and lab mentoring; strengthening on-site supervision and shoulder assessments by lab advisors; increasing mentoring time on site, train lab policy makers (MOH lab directors, state quality officers) to provide supportive mentoring; strengthen lab advisors participation in lab activities on clinic days (sample collection, processing, analysis, documentation and result dispatch).

On-the-job training will continue to be enhanced by job aids, standard operating procedures (SOPs) and diagnostic algorithms as well provision of one-on-one on the job training for all lab staff to improve the quality of service. ICAP will train all available trainable lab personnel regardless of specialty or area of lab service provision, to address the challenges of lab personnel shortages at some of these facilities and encourage qualitative service integration. ICAP will continue to support task shifting by training of non lab personnel in rapid HIV testing with appropriate monitoring and supervision. ICAP will build the capacity of all RLA, lab quality officers and State quality officers on quality assurance.

ICAP will work closely with the PEPFAR/GON lab technical working group for the development of common lab equipment lists, procure appropriate equipment as back up or replacement for faulty or aged equipments in some of the labs that it supports.

Systems Support

As a way of strengthening other area of labs services outside of ART, ICAP will advocate with State Ministry of health, health service management board as well as individual hospital management board to renovate/repair areas of labs where other services are provided to meet the standard of the ART labs. In addition, ICAP will also advocate to these bodies to employ or redeploy lab personnel to high volume sites and some sites with acute shortage of lab staff.

In COP09, ICAP supported four high volume PHCs to provide minimal monitoring investigations using simple auto analyzers. ICAP will continue to support and maintain these PHC labs while also ensuring quality. ICAP will also continue to support mobile lab teams which had begun during COP09, to extend lab services to very remote/hard to reach communities and rural PHCs in the States it supports. ICAP will partner with local governments in repairing PHC labs as well as providing TA on equipping the labs with basic lab equipments (hematocrite centrifuges for PCV, microscopes for malaria parasites, urine and stool microscopy).

In COP09 ICAP supported the National TB program to improve on the quality of TB diagnosis by equipping four high volume TB smear microscopy sites with fluorescence microscopes. This has greatly increase TB case detection following the sensitivity of this technique. In COP10, ICAP plan to equip four additional TB smear microscopy sites with fluorescence microscopes and 70 train lab scientists/technicians on TB diagnosis using the fluorescence microscopy technique and provide reagents. These sites will be enrolled for the National TB microscopy EQA program to ensure the quality of fluorescence microscopy.

Health Waste Management

ICAP will ensure that all bio-medical waste generated from all its supported sites will be properly disposed of by supporting and installing waste disposal units in six comprehensive secondary health facilities,, provision of locally fabricated/constructed incinerators to TB smear microscopy sites, procuring and regularly supplying sharp containers, bio-hazard bags. ICAP also procure protective equipment to lab staff including: lab coats, face masks, goggles, gloves, and laminar protective hoods; boots and gloves are also being procured for waste disposal handlers. ICAP will continue to work closely with the SCMS mechanisms in country to procure equipment and supplies for its supported laboratory sites.

Quality Assurance/Quality Control processes

ICAP wil participate in the USG/GON EQA program and will support the active integration of recommendations/guidelines at its sites and state levels. ICAP will strengthen its Quality management system in all its supported sites. This will be achieved by first sensitizing all hospital management on the need to improve the lab quality system, encourage the formation of lab quality management teams in all hospitals who will provide organizational guidance for all quality components, train all service providers on quality assurance and train quality officers to conduct regular vertical audit. All ICAP regional lab advisors will be trained alongside their State quality counterparts to conduct regular vertical audit and follow up with non-compliance and corrective actions. ICAP will also strengthen the internal quality assurance program, work with service providers to review, adapt and distribute all quality related documents like quality manuals, general and specific SOPs not only for ART related services but for other tests conducted in all health facilities as part of its lab specific systems strengthening actions. All lab personnel will be supported and encourage to read, understand and adhere to SOPs by conducting regular on the job CME on the SOP subjects.

ICAP quality advisor and one regional lab advisor trained on preparation of serology panels will continue to prepare serology panels to be used for daily/weekly quality control for rapid HIV testing as well as kit lot/batch monitoring at sites .Facility based quality officers will be trained to serve as EQA focal persons and will be responsible for distributing closed serology panels to testing personnel at the PHCs level during their monthly supervisory visits to the PHCs zoned to their facilities.

Daily quality control will be run for CBC, Chemistry and CD4 and lab personnel will be trained to use LJ charts to monitor deviation.

Eight ICAP supported state facility labs participated in the German National CD4 EQA program in COP09. ICAP will continue to encourage more labs to participate in this and other EQA programs for quality improvement and assurance purposes. ICAP will key into the National EQA program organized by Axios with support from USG/GON/National reference laboratory. In COP10, ICAP plans to prepare 10 of its supported labs for National accreditation and two of these with any of the WHO approved accreditation body

ICAP will continue with regular assessment of the quality of rapid HIV testing done in remote PHCs and stand alone HCT using various QA tools which will include regular supervisory visits to provide mentoring, regular use of controls, competency assessments after training, biweekly proficiency testing and regular refresher trainings. ICAP will continue to support PEP programs in all its sites by emphasizing the availability of this service in all its lab training.

ICAP laboratory program is currently supported by a regional lab advisor from HQ who provides regular TA to in country lab team. The in country team is comprised of one Associate Director for laboratory services,, one central lab advisor (supervises all lab activities from the central office), one central biomedical engineer, one lab QA advisor and and six regional lab advisors who provides onsite supervision, on the job training for facility lab personnel as well as ensuring regular supply of lab reagents and commodities as well as the quality of service provision. This lab team will continue to work closely with the Lab TWG and the national and state MOHs to ensure that at least 10 ICAP supported labs gains National accreditation through the lab regulatory body (MLSCN). ICAP lab team will continue to support and participate actively in the Lab quality assurance IPs meetings

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

In COP10, ICAP will use EP funds to support and maintain 30 hospital labs using the strategies described above. To facilitate the USG/GON health systems strengthening and sustainability plans., 352 laboratory staff will be trained on the provision of high-quality lab services. Trainings will be stepped down to laboratory technicians and assistants from the primary health centers. 70 lab technicians will be trained on ZN-staining/AFB identification to enhance TB diagnosis at the DOT sites. By ensuring appropriate training, supervision, equipment, maintenance and supplies, all 30 hospital labs will be strengthened to support these institution's rapidly-growing adult and pediatric HIV/AIDS care and treatment programs.

LINKAGES TO OTHER ACTIVITIES:

This activity also relates to activities in ART (XXXX), Palliative Care (XXXX), OVC (XXXX), VCT (XXXX), TB/HIV (XXXX) and PMTCT (XXXX). These services will directly support these activities by enabling 80,775 people access to HIV/AIDS testing and 3562 HIV positive adults, and 589 infants and children on treatment, and an additional 3360 HIV positive mothers to access HIV/AIDS care and treatment.

TARGET POPULATIONS:

General populace with special emphasis on high risk groups (TB co-infections). HIV monitoring of HIV positives and diagnosis of HIV exposed especially vulnerable groups of women, infants and children. Pregnancy and syphilis tests will be provided to women. Lab monitoring for 115,710 HIV positives and 3,360 HIV positive mothers includes a projected total estimate of 561,323 tests consisting of 71,000 LFTs, 74,360 CBCs, 218,121 CD4 counts, 30,000 sputum exams, 8,108 PCRs for EID and 161,550 HIV testing including tests in PMTCT and TB patients. Health workers will be trained in providing quality laboratory and testing services including collection, transport and tracking of samples and results especially to and from primary healthcare centers and other partner networks. CBOs/FBOs will be trained in using rapid test kits based on national algorithms.

EMPHASIS AREAS:

REDACTED.

v

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, ICAP's procurement of antiretroviral (ARV) drugs and OI medicines and distribution to 30 comprehensive health facility networks (inclusive of 107 and 70 TB DOTS service points ) has led to increased access to antiretroviral (ARV) drugs and OI medicines and the delivery of quality, family focused comprehensive HIV care and treatment services in 6 states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna and Kogi states). In COP 10, ICAP will continue to work with the SCMS to provide support to ensure HIV commodity security. Beyond expanding access to ARVs and OI medicines, ICAP will provide the framework to ensure safer and more rational use of these medicines.

Expansion of the supply chain and logistics system:

In COP09, ICAP strengthened collaboration with the USG team for forecasting, quantification, pooled procurement and delivery of ARVs and other clinical supplies for all supported sites. ICAP also developed the capacity of site pharmacists, technicians and store officers in appropriate logistics management of ARVs, OI drugs and related commodities. In COP 10, ICAP will continue to collaborate with the USG team and the GON to achieve Nigeria's long term objectives under the HIV National response. ICAP will continue to procure ARV and OI drugs (through the UNICEF supply division, SCMS and direct procurements). Procurements will be needs based and will include detailed forecasting, quantification and procurement plans for PMTCT, pediatric and adult care, treatment including PEP. Product selection will continue to be based on existing national treatment guidelines using drugs with FDA approval or tentative approval which are National Agency for Food and Drug Administration and Control (NAFDAC) registered or have received a waiver. ICAP will strengthen logistics support to sites to facilitate prompt, efficient and effective distribution of ARV and OI drugs and other commodities to sites using the procured ICAP truck and vehicles in addition to third party logistics companies e.g. FEDEX. To support the provision of ARV services in hard to reach areas, ICAP will continue to strengthen existing referral channels, support network coordinating mechanisms and strengthen the decentralization of logistics systems to lower level facilities.

Systems strengthening:

REDACTED.

In COP 09, ICAP laid the framework to strengthen state logistics systems. As part of this plan, ICAP has identified the use of state medical stores for HIV drugs and commodities to ease distribution challenges and build capacity of state facilities in supply chain management. Store managers of these stores received training in logistics management of ARV, OI drugs and related commodities. For sustainability and maintenance of logistics and timely supply, ICAP will continue to use these state medical stores in COP10 and further strengthen their supply chain management skills. REDACTED.Staff of these state medical stores will be trained and retrained in current approaches to logistics and supply chain management. ICAP will also strengthen the state logistics system through continued partnership with the states and private organizations to provide logistics support to supported sites.

In COP 09, ICAP strengthened site inventory control and logistics systems by the introduction of revised LMIS tools. In COP 10, ICAP will continue to strengthen the LMIS and inventory control systems with emphasis on automation of inventory control and LMIS systems.

REDACTED.

Additionally, ICAP will continue to provide first and second line ARV drugs and promote adherence by increasing access to ARV fixed dose combinations (FDCs) for pediatric and adult clients. ICAP will strengthen the delivery of pharmaceutical care services to clients by the use of pharmaceutical care tools at service delivery points and will strengthen ARV Adverse Drug Reaction monitoring and reporting at sites to improve patient care. ICAP will also establish linkages with community pharmacies to expand community based care, provide referrals and palliative care.

ICAP will continue to provide technical assistance and build the capacity of health care workers in the delivery of quality pharmaceutical care to PLWHAs, logistics management of ARV and OI drugs and related commodities, record keeping etc through trainings, on site mentoring and supportive supervision. ICAP will continue to use a state-endorsed pharmacy technician in-service training course and support the participation of site pharmacy staff in the pharmacy council endorsed trainings. Pharmacists at every site will continue to participate in multidisciplinary team ART training activities.

Harmonization of Procurement Mechanisms: ICAP will continue to leverage on the economies of scale provided through the utilization of the Partnership for Supply Chain Management (SCMS) for ARV drug procurement as SCMS increases its services in Nigeria. ICAP will continue to work closely in conjunction with other implementing partners, the GON and the Global Fund to harmonize and institute a nationwide supply chain and logistics management system that will not only cater for ART drugs but will increase efficiency and effectiveness of distribution of other commodities and supplies especially procured by governments at all levels. Key areas in need of further integration with the GON program such as medical records systems, personnel, monitoring and evaluation, and supply chain management systems will continue to be strengthened during the COP10 year.

Quality Assurance and Systems Monitoring: ICAP has integrated quality assurance, monitoring and evaluation systems into its existing logistics system. ICAP's procurement and store managers provide technical assistance across sites. REDACTED. ICAP will continue to work in conjunction with NAFDAC where required and after consultation with GON and USG, to arrange for the destruction of all expired drugs and other commodities recovered from all the facilities as necessary. In addition, ICAP will also support the NAFDAC pharmacovigilance program at sites and increase ARV ADR monitoring and reporting from sites.

Leveraging resources: The cost per patient may increase in COP10 as more patients on the first line will be moved to tenofovir based regimens due to the need the de-emphasize stavudine usage; and as more patients will require second line regimens. ICAP will seek to minimize such cost increases by continuing to utilize generic drugs and leverage cost savings through joint procurement mechanisms through the SCMS. It is envisaged that as more generic ARV drugs obtain FDA approval or tentative approval as well as NAFDAC registration or waiver, they will replace more expensive versions. ICAP will also continue to partner with the Clinton Foundation and the GON/Global Fund to utilize opportunities to reduce the cost of approved drugs. ICAP will continue to participate in and support the harmonization process led by the GON in line with one national program at all levels for sustainability. To promote sustainability of state ART programs, ICAP will provide technical assistance and capacity building to its supported states on forecasting and quantification and procurement planning of ARV and OI drugs and related commodities. ICAP will also partner with existing National programs for the provision of commodities for PLWHAs e.g. the Roll Back Malaria Program for anti malarial drugs. In addition, ICAP will continue to work towards sustainability by strengthening existing structures and building capacity of health care providers in all health facilities that it supports. As expansion of ARV drug services is prioritized to rural areas, ICAP will strengthen existing referral channels and support network coordinating mechanisms.

Columbia has allocated XXXXXX of its ARV Drugs budget to SCMS for procurement of commodities. This amount is captured under the SCMS Drugs activity.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

In COP10, ICAP activities under ARV drugs will support the PEPFAR goals of ensuring a continuous supply of ARV drugs to HIV infected adults and children who require treatment. By the end of COP10, 35,702 people will be receiving ART at ICAP-supported sites, thus contributing to the national goal of treating 350,000 patients by Sept 30, 2010.In COP10, 4,151 individuals (3,562 adults and 590 children) will newly initiate ART.

LINKS TO OTHER ACTIVITIES:

This activity also relates to activities in ART (XXXX), Palliative Care (XXXX), OVC (XXX), HCT (XXXX), PMTCT (XXXX) and TB/HIV (XXX) for the provision of HIV/AIDS related commodities needed in those services.

POPULATIONS BEING TARGETED:

Health care workers especially pharmacists, doctors and nurses, logisticians, pharmacy technicians and store keepers will acquire skills to manage ARV drugs appropriately along the supply chain.

EMPHASIS AREAS:

Emphasis areas include human capacity development and gender equity. Due to the staffing challenges at the sites, ICAP will continue to encourage the use of volunteer pharmacists from private pharmacies especially on clinic days at supported sites; encourage the use of Post NYSC and consultant pharmacists in the more rural areas where the volunteers are not available. ICAP will continue to support the use of pharmacists in already established sites as mentors to PHCs, decentralized and outreach sites. These pharmacists will be trained using existing national training curricula. Drug forecasts will continue to be driven by disaggregated data provided by the ICAP Monitoring &Evaluation unit and equal access to ARV and OI drugs for males, females and other vulnerable groups such as children will be ensured.

ACTIVITY UNCHANGED FROM FY2009

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In COP09, ICAP provided TB/HIV services at 30 comprehensive hospital networks and initiated linkages with 70 DOTS sites in six states namely Cross River, Benue, Kaduna, Gombe, Akwa Ibom and Kogi States.

In COP10, TB/HIV integration activities will be strengthened at existing hospitals and DOTS clinics to provide enhanced TB services at 30 HIV comprehensive care and treatment sites in the 6 states, and HIV services at 70 DOTS sites. Working closely with the national and state level TB/HIV technical working groups, National TB Leprosy Control Program (NTBLCP) and state/LGA TB control programs, ICAP will provide services to TB/HIV co-infected patients through point of service laboratory support, development of SOPs/guidelines, and strengthening of TB screening, referrals and linkages both within DOTS sites and between community-level health care facilities and DOTS sites. ICAP, with other implementing partners, will strengthen the existing PEPFAR-Nigeria LGA coverage strategy in Kaduna, ensuring the provision of quality TB/HIV services in at least one health facility in every local government area (LGA). This will enable supported states to sustain universal access to TB/HIV services in states designated 'LGA Coverage States'.

ICAP approach to TB/HIV collaborative activities will focus on the ''three I's'': Intensified TB case finding among PLWHAs, Izoniazid Preventive Therapy (IPT) and TB infection control.

Intensified TB case finding

ICAP will intensify TB case detection amongst HIV infected patients (both adults and children) by screening for TB at various Point-Of-Service (such as VCT, PMTCT, OPD and wards); conduct TB screening of contacts of smear positive index cases; use of fluorescent microscopy and support the radiological diagnosis of TB. ICAP will strengthen TB/HIV referrals by utilizing LGATBLS, TB/HIV focal persons and Peer Health Educators for escort services within and between facilities as appropriate. In collaboration with states TBCP, provide TB microscopy and treatment services in 30 comprehensive sites in 6 ICAP supported states. Non HIV positive members of CBOs will be encouraged to act as TB treatment supporters. ICAP will support standardized TB screening and case finding in 19,181 HIV infected patients using structured symptom checklists and the National algorithm. SOPs and IEC materials will be developed on intensified case findings. Refreshers trainings will be conducted for relevant health care workers.

IPT

All TB/HIV co-infected patients will be provided with cotrimoxazole (CTX) prophylaxis and linked to other palliative care services and Prevention with Positive messaging (including balanced ABC messaging as appropriate, STI and FP services). Adherence support and counseling will continue to be strengthened through facility counselors and Peer Health Educators at both facility and community level.

ICAP will facilitate access to TB DOTS services for co-infected patients identified through ART clinics and will facilitate access to HIV treatment and care for co-infected patients identified through TB DOTS clinics. It is expected that this will result in the treatment of TB in at least 4,070 HIV positive patients. DOTS facilities will be supported to provide HCT to at least 2383 clients, of which it is expected that 650 will be diagnosed with HIV. TB patients will be encouraged to bring contacts for early TB case-finding, and HCT preventive therapy (IPT). 50 HIV+ patients will be provided with IPT services in line with the GoN guidelines.

Five ICAP TB/HIV advisors and six state TB program counterparts will be provided with formal TB/HIV training to enhance their productivity. A total of 60 ICAP staff and facility-based medical officers will undergo refresher training on x-ray diagnostic skills. A total of 60 ICAP staff and facility-based laboratory officers will be retrained on good sputum specimen collection and laboratory AFB sputum smear diagnosis to enhance their diagnostic capabilities. Refresher HCT trainings will be provided for TB care providers to ensure quality of counseling and testing. Service provision will also be improved through capacity building of health care providers with the GoN and other USG implementing partners and ILEP partners through training programs conducted at TB training laboratories. Across the various TB/HIV training activities it is expected that a minimum of 183 individual trainees will be directly retrained in collaboration with NTBLCP. In addition to current practices, ICAP will implement the national guidelines for External Quality Assessment.

Infection control

Nosocomial transmission of TB will be mitigated through attention to principles of TB infection control, including administrative and environmental control measures such as clinic design, good ventilation, appropriate TB infection control materials, patient triage, staff training, and enforcement of basic hygiene and proper sputum disposal. Patient and staff education on infection control measures will be routinely carried out to ensure program success. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on infection control will be implemented in all ICAP supported sites. There will be also onsite trainings of triage nurses on fast tracking to enable identified co-infected patients receive care as soon as possible and reduce risk of nosocomial transmission of infections. Peer Health Educators (PHE) will be trained and retrained to include and reinforce positive prevention messages including cough etiquette in health talks. IEC materials and job aids will be developed /adapted and distributed to reinforce behavior change messages. ICAP will support NTBLCP in the development of clinical support tools/job aids, national registers and referral forms for recording/reporting systems, and in the production of IEC materials. ICAP will also support the utilization of the updated NTBLCP recording and reporting formats that captures HIV information by the TB program.

Support will be provided to at least 70 sites to enhance provider-initiated HIV counseling and opt-out testing for TB patients and suspects and strengthen referral linkages from the DOTS sites to care and treatment (ART) centers through partnering with CBOs/NGOs/FBOs and PLWHA groups. The TB DOTS sites will be supported to provide holistic patient care according to National and IMAI guidelines. Sites will be assisted to put in place and/or improve defaulter tracking mechanisms. ICAP will also support the state TB programs to put in place 3 BSL 2 culture units by upgrading a selected lab; sputum collection and sample logging under cold chain for suspected MDR TB patients will be performed for culture and drug sensitivity test at designated referral centers. Strong referral services will be provided to link MDR TB cases for hospitalization during intensive phase. ICAP will support upgrading of 2 selected clinics, procurement of second line anti TB drugs for management of MDR TB patients on continuation phase. ICAP will procure respirators for health workers working in MDR TB sputum collection. Laboratory and TB/HIV central advisor and relevant regional TB/HIV advisor will undertake a study tour to a well established MDR TB center in south Africa to learn from best MDR TB services practices. ICAP will continue to strengthen TB/HIV integration activities at supported sites. TB/HIV advisors will facilitate sites' activities in collaboration with state/LGA TB focal persons.

REDACTED. To ensure continuous availability of drugs and commodities in supported sites, ICAP will strengthen the logistics management of the states and LGAs in areas of operation.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

ICAP will contribute to the overall program goal of enhancing integration of TB/HIV activities by enabling at least 4070 HIV-infected patients to receive TB treatment. As part of the sustainability plans of the GoN and in line with the 5-Year Strategy, at least 120 health care workers will receive TB orientation refresher training. ICAP will also ensure that GoN structures are strengthened and integrated through joint capacity building of SACA, LACA and NTBLCP, states, and LGA TB supervisors for effective program management including joint supportive supervision. ICAP will help provide basic tools and equipment to reactivate non-functional DOTS sites in focus states. ICAP will ensure that activities are implemented with the full participation of other government partners especially GLRA and NLR to promote sustainability and facilitate equity and synergy in line with GoN plans.

LINKS TO OTHER ACTIVITIES:

This activity also relates to ART (xxxx), Palliative Care (xxxx), Orphans and Vulnerable Children (xxxx), Voluntary Counseling and Testing (xxxx) and PMTCT (xxxx), AB (xxxx) and sexual prevention (xxxx). The focus is on ensuring adequate and prompt linkage of TB patients and their household contacts to HIV counseling, testing, care and treatment services, to ensure that all HIV patients are screened for TB, and to enable all HIV-infected patients with TB to access services at DOTS clinics. Similar services will be made available to OVCs and PMTCT clients. In collaboration with other relevant partners/organizations, ICAP in COP10 will facilitate linkage of clients to other support services such as micro credit and nutritional support.

POPULATIONS BEING TARGETED:

ICAP will support activities to encourage all patients in related communities living with TB to bring family members and household contacts to the clinic, particularly children (six years and younger), to enhance screening, early diagnosis and prompt treatment for positive cases. In collaboration with NTBLCP and other TB supporting partners, ICAP will establish TB/HIV services for clients in prisons located within the ICAP supported LGAs, and facilitate linkages to care and treatment clinics. Health care workers in both public and private sectors will be retrained to provide high quality TB/HIV integrated services. Other targeted populations will include OVC, pregnant women and PLWHAs.

EMPHASIS AREAS:

A major area of emphasis is on human capacity development through the retraining of health care providers on TB/HIV integration services. Health care providers will be trained to provide counseling and testing services, care and treatment, screening for TB, and referrals between care and treatment centers and DOTS sites. Other emphasis areas include local organization capacity building, SI and gender.

ICAP-CU will work with the relevant agencies and organizations to enhance policies that will ensure that clients located within ICAP-CU supported sites have access to adequate and integrated TB/HIV services thereby promoting equitable access to care and treatment programs, especially for women, children, underserved and incarcerated populations in all the served states.