ECEWS will support the achievement of the partnership frame work implementation plan and overachieving goal of PERFAR II which is to entrench sustainable programs and increase host government involvement in the fight against HIV/AIDS and other priority interventions in the global health initiative. ECEWS will continue to support and partner with the host government and communities in implementing sexual prevention activities, HIV Testing and Counseling, Adult and pediatric care and support services, TB/HIV services, OVC services and Strategic Information. ECEWS will focus on health system strengthening and information use for decision making among stakeholders. Gender issues especially relating to the girl-child will be emphasized in ECEWS programming for fy12 and fy13. ECEWS plans to provide HTC services to over 87,895 individuals including MARPs by the end of fy13, Umbrella care and supports services to 49126 including 14870 HIV Infected persons and 7036 OVC. Fy13 will witness an estimated increase in reach by 30%. ECEWS will work with USG and GON to include ECEWS-supported facilities in the District Health Information System 2 (DHIS2). ECEWS will be an active participant on the USG SI Technical Working Group, supporting PEPFAR in developing and maintaining a unified national data platform for HIV services in Nigeria. ECEWS will be an active participant in the State M&E TWGs, supporting capacity building activities; the development and implementation of the States Strategic Plans. ECEWS will participate in relevant National TWGs to share and adopt best practices and lessons learnt. Program implementation will be guided be Nationally approved guidelines and tools and contribute to the overall PEPFAR Nigeria goal.

ECEWS currently provides adult care and support services in 24 sites including 14 facility and 10 community sites targeting adults and adolescents especially girls, women and MARPs identified via ECEWS HTC program. Services are provided in a continuum and include clinical services [Basic Nursing care, pain & other symptom management, Nutritional assessment and support, OI prophylaxis and treatment, Provision of multivitamins ,STI counseling and management, PwP, TB/HIV services and access to lab services], provision of Basic care kits, Home based care, psychosocial support, PHDP and other counseling services. ECEWS plans to serve 7190 PLHIV in COP 12.ECEWS BC&S program targets high burden status which fits into the overall PEPFAR and country strategy and emphasizes strong linkages between community and facility based services. Integration of HIV/AIDS services into the already existing health system, provision of standardized services of PHCs with strengthened linkages for community, defaulter tracking bi-directional referrals system are some of ECEWS strategies in improving client retention. ECEWS BC&S program has strengthened linkages with HTC and TB/HIV services for prompt referral of HIV+/co-infected persons as well as referrals linkages with other partner supported PMTCT and ART services. PLWA in care are linked with other partners and GON for food support, IGA, RH/FP while they are all encouraged to participate in support groups. Support groups will be assisted to develop and activate food banks to assist indigent clients and this will be co-ordinate with host community support. All HIV positive clients will receive CD4 counts at least every 6 months. Cotrimoxazole prophylaxis will be provided according to National guidelines. ECEWS will support integration of syndromic management of STIs and risk reduction interventions into care. All enrolled into care will receive risk assessment and behavioral counseling to achieve risk reduction. ECEWS will promote the use of nationally approved tools and SOPs in providing Palliative care and CHBC services to clients across supported sites. Site M&E officers will be trained on Data analysis and use in decision making to promote ownership and sustainability.

ECEWS; an indigenous partner provides a full spectrum of OVC services and care to 3070 OVC aged 0 17yrs, including children who have lost one or both parents to HIV/AIDS, who are directly affected by the disease or live in areas of high HIV prevalence in 13 community based sites in Akwa Ibom and Cross River States. In COP 12, ECEWS will target serving 6,118 OVC through partnership with 10 PLHIV CBOs within the target communities to provide need based services in a family centred approach to households of OVC using the CSI tools. Services will include provision of Preventive care kits (LLITNS, water purifiers & instructions, water vessels), support for IMCI, NACS, school attendance and performance monitoring, provision of educational materials and block granting of textbooks, home visits for HBC services. Kids/adolescent clubs for HIV preventive messages, counselling, reproductive health issues and building of life skills.ECEWS also provides other services including free birth certificates for OVC in care and linkage of CBOs to Child Protection Network (CPN), strengthen protection of OVC by sensitization of CBOs and other stakeholders on relevant conventions and policies on the rights of the child and IGA/HES. ECEWS in collaboration with SMWA and Social Development has provided shelter and protection services for homeless OVC.Organisational capacity of partner CBOs have been built on leadership and governance, financial management, human resource management and strategic information culminating in the receipt of PEPFAR small grant for provision of educational support to OVC in care by a supported CBO. ECEWS in collaboration with USAID Markets also trained Care Providers on micro-enterprise and homestead farming fundamentals and step down trainings conducted for all supported volunteers. The project will continue to build the economic capacity of caregivers to provide for the needs of their children; retaining them in school, and working with local governments and community to establish strong child welfare and protection systems.Supportive supervision and routine QI visits have been carried out to enhance service delivery according to national guidelines and standards of practice. National M&E tools are used in reporting OVC data across supported CBOs in target communities.ECEWS currently collaborates with FMWAs and SMWAs in monitoring and reporting of OVC activities, with regular feedback to host communities for ownership and sustainability.

ECEWS TB/HIV services are provided in line with the NSF II and national guidelines in 7 facility based sites in Akwa Ibom State. ECEWS plans to identify, provide CPT and link for DOTS and ART 150 HIV infected TB patients in COP 12. In the last 12 months, 207 HIV infected TB patients were identified, provided with CPT and linked to TB DOTS and ART. ECEWS has intensified TB case finding via administration of WHO TB symptom checklist on 84% of PLHIV currently in care.TB infection control committees have been constituted and are currently implementing facility specific infection control plans. ECEWS has completed minor renovation to enhance TB infection control in UNIUYO Medical Centre. ECEWS collaborates with NTBLCP and GLRA to ensure adequate provision of TB drugs, CPT, reagents and consumables to supported sites.ECEWS continues to partner with PEPFAR IPs to facilitate QA programs to ensure quality of services. ECEWS master trainers and NTBLCP team trains and work with TB DOTS staff to ensure that HIV testing and sputum microscopy services provided are qualitative and according to national TB infection control and bio safety practices. TB diagnostics QA program; joint supervision visits with the SMoH and FMoH, selective review of completed smear examinations and panel testing are conducted periodically.ECEWS prints and utilizes nationally approved DCT tools in the provision and documentation of services across sites. ECEWS will participate in national TB-HIV TWG meetings and trainings and share reports based on the revised TB/HIV indicators.ECEWS currently utilizes a two-way referral system with appropriate completion monitoring. Community sites are linked with facilities and home based care services are provided to co-infected clients. ECEWS will strengthen linkages and referrals for TB/HIV services and community TB care (CTBC) services will be provided for co-infected. ECEWS plans to strengthen linkages and referrals for TB/HIV services and community TB care (CTBC) services will be provided for co-infected clients. Tracking teams will be used for TB treatment defaulters as such reducing incidence of Multi Drug Resistant (MDR) and Extensively Drug Resistant (XDR) tuberculosis.

ECEWS currently provides paediatric care and support services for 45 HIV exposed and 284 HIV infected children across 14 Health facilities in Akwa Ibom and Cross River States. Plans are to provide services to 591 paediatric clients in COP 12. Continuum of services to be provided are Clinical services including access to EID and CD4 estimation, OI management, BCKs and other support services. ECEWS recruitment strategies include intensified HTC Program for mothers and children during immunization, PITC at MCH clinics and outreaches to TBAs targeting HIV exposed infants for EID services. All paediatric clients are provided with TB screening and linkage to DOTs, while eligible HIV infected children are linked to ART services. ECEWS provides basic nursing care, OI prophylaxis and management , antimalarial, antihelminths, antipyretics, pain management, NACS, TB screening, access to Lab services, LLITNs, water purifiers, weighing pans, MUAC tapes for supported sites for management of HIV infected children.ECEWS targets adolescent clients with PHDP and also link clients to OVC program for community services. ECEWS currently integrate the PDCS program into the broader MCH services and procure food supplements/RUTF for malnourished clients. Community food bank is being promoted in supported sites. ECEWS has strengthened linkages with other facility and community sites to provide holistic services to the clients in a continuum including linkages to IgA, food support, kids club, adolescent PLHIV support groups etc. Private health facilities with high client turn over will be engaged to provide free HTC and HIV care services. ECEWS provides supportive supervisions to care providers and emphasises the use of nationally approved care & support SOPs and tools for documentation and reporting..ECEWS promotes adherence counselling during visits, Defaulter tracking and enhances easy transition of Paediatric clients into adult care and support program for clients turning 16 years old. ECEWS will scale up EID services access to all sites and will promote paediatric ART uptake in line with overall PEPFAR goals. ECEWS participates in National care and support TWGs to promote synergy and experience sharing.

ECEWS currently supports a standardized HIV indicator reporting systems across 57 sites in Akwa Ibom, Cross River and Abia States; harmonization of data collection and reporting across sites with other donor-supported activities in line with the principle of One M&E Framework and in accordance with the national guidelines. ECEWS will work with USG and GON to include ECEWS-supported facilities in the District Health Information System 2 (DHIS2). ECEWS will be an active participant on the USG SI Technical Working Group, supporting PEPFAR in developing and maintaining a unified national data platform for HIV services in Nigeria. ECEWS will be an active participant in the State M&E TWGs, supporting capacity building activities; the development and implementation of the States Strategic Plans.Funding will be used to provide IT infrastructure which will include laptop computers and internet modems for 14 facility-based sites to facilitate and enhance timely and qualitative data collection, aggregation and reporting. One M&E Focal Person will be selected each from all 57 supported sites and trained along with LACA M&E Officers across 17 L.G.As in 3 target states on data collection, aggregation, analysis and reporting across the relevant National Data Capturing Tools for supported Technical Program Areas and on the use of IT for electronic documentation, analysis and reporting/dissemination of site-level data to all relevant stakeholders.Monthly central M&E meetings will be held across the 3 focus states for all site M&E Focal Persons in collaboration with the states SACA for the purpose of data collation and analysis.ECEWS S.I Team along with SACA and SMoH M&E Staff will conduct regular joint monitoring and supervisory visits to all sites in order to build relationships and capacities within the states as part of DQA activities.Program performance assessment across all supported technical areas will be performed to provide evidence-based decisions for program quality, impact, and effectiveness. ECEWS will also work with site administrators and staff to improve their knowledge and understanding of the data from their sites to enhance site information use for decision making and planning.

ECEWS will target 11,692 individuals including youths (aged 10-24) especially girls and vulnerable children who engage in casual sex with multiple partners, widows, divorced/separated and married couples who engage in multiple sexual relationships.Program implementation will focus on structural, behavioral and biomedical interventions utilizing a combination prevention intervention. CP interventions will focus on strategies like Community awareness campaigns, Peer education model, non-curriculum school-based approach and promotion of HTC. Mainstreaming of intervention activities via HIV abstinence clubs and FBO group meetings will be prioritized for sustainability. Using evidence based age appropriate & population specific curricula, targets will be reached with risk reduction counseling and education; [FLHE manual for lower secondary school, NYSC Adolescent RH/HIV prevention manual for upper secondary school and AHI training manual for adolescents friendly health services].An adapted version from the CRS faithful House manual will be utilized to reach other populations in Faith Based Organizations. Interventions will target to delay sexual debut and enhance adoption of secondary virginity as well as reinforce relevant life skills among in-school youths, while promoting mutual fidelity, partner reduction and HTC among young adults and married couples.Programs are currently implemented in 10 schools and 10 churches in Akwa Ibom, Cross River and Abia states and has reached a total of 2378 individuals in the last 12 monthsECEWS will promote the use of standardized manuals and tools with supportive supervision and refresher trainings provided to reinforce messaging. Referrals will be made for counseling and testing for all beneficiaries while appropriate linkages with condom service outlets and OVC programs will prioritize for relevant services.

Program monitoring plans will emphasis the use of appropriate combination prevention mix in reaching targets and evaluations will seek possible behavior change and adherence to risk reduction plans.

ECEWS will target to provide HTC to 23, 616 individuals and 60, 000 individuals in fy12 and fy13 respectively in Akwa Ibom, Cross River and Abia States. ECEWS currently targets MARP populations, STI and TB suspects/patients, children, couples and general population in Akwa Ibom, Cross River and Abia States (HIV prevalence of 10.9%, 7.1% and 7.6% respectively, sentinel survey 2010). In the past twelve (12) months, 21,464 individuals have been counseled and tested for HIV in focus states. ECEWS adopts the provider- Initiated and client- initiated approaches in testing and counseling MARPs and the general population .PITC is provided in TB and STI clinics, ANC settings (where PMTCT services are absent), outpatient and inpatient wards. Home based testing will be provided for partners and family members of HIV-positive patients. ClientInitiated testing and counseling is adopted at stand-alone sites and by outreach/mobile teams to MARPs. Couples HTC and pediatric testing will be scaled up across ECEWS supported sites via targeted outreaches to high prevalence communities and health facilities to promote the test to treat strategy.PITC and client initiated approaches have resulted in testing of 12,614 and 8,790 individuals respectively in the last 12 months. 14 HCWs were trained on HTC using the national curriculum, while refresher training was provided to previously trained forty (40) HCWs. ECEWS employs the nationally approved serial testing algorithm across all supported sites. STI/TB suspects and HIV positive persons identified via HTC are being referred using a 2 way referral system and clients are provided with escort services for intra facility referrals. A referral directory is deployed in all supported sites and follow-up calls and home visit are used to track client not yet enrolled into care. Population specific BCC materials and condoms are distributed during community mobilization campaigns and outreaches to markets, parks, religious groups and brothels based on clients' individual needs. This activity is aimed at creating demand for HTC. ECEWS quality assurance program includes the use of nationally approved SOPs, Supportive Supervision, Client exit and counselor reflection forms , DTS and EQA.

ECEWS will target 6,611 individuals (female sex workers and their clients, transport workers, police, soldiers, STI suspects/patients, female students in higher institution and PLWH) in Akwa Ibom, Cross River and Abia states for sexual prevention intervention. Targets are major drivers of the epidemic in Nigeria and are engaged in transactional sex and multiple concurrent partnerships with FSW having limited ability to negotiate for safer sex. Program implementation will focus on structural, behavioral and biomedical interventions utilizing a combination prevention intervention. ECEWs will employ evidence based adapted peer education plus model for intervention with sex workers, transport workers, uniformed service personnel and youths. Strategies will include community awareness campaigns, peer education model, risk reduction counseling, and promotion/provision of HTC and syndrome management of STIs. HCWs will be trained using the FMOH syndrome management of STI guideline to provide STI counseling and treatment to target populations. MARPs will be linked or provided with HTC. Risk reduction strategies will include partner reduction, negotiation for safer sex and consistent and proper use of condoms. HIV awareness campaigns will be intensified to increase risk perception among beneficiaries and increase demand for HTC, care and treatment. Using appropriate mix and dose of combination prevention intervention 8057 individuals including 830 commercial sex workers have been reached in the last 12 months. Condom availability is enforced across service outlets via the use of LMIS in procurement and supply chain management. Program monitoring visits, review meetings, observation of peer sessions and mentoring on condom demonstration and distribution and proper documentation are major strategies used to promote quality assurance. ECEWS will promote the use of standard tools to aid implementation of the combination prevention intervention with Job aids on risk reduction counseling and standard PEP manuals to guide peer educations. Supportive supervision and refresher trainings will be supported to reinforce messaging and access to condoms and BCC materials will be enhanced via strengthening of existing service outlets.