The VU/FGH strategy for COP12 will focus on integration of program areas to create a sustainable functional HIV/AIDS service delivery units in all supported facilities. VU/FGH is committed to fulfilling the following objectives:1) Strengthen existing facilities and systems to effectively provide quality HIV-related service delivery in operational states.

a) Increase access to PMTCT services through the engagement of public and private health facilities in Niger, Kwara, and four additional high HIV burden contiguous states.b) Upgrade existing PMTCT sites to comprehensive care and treatment centers to support surrounding primary health care facilities.c) Establish results-based financing systems with health facilities to engender site ownership and responsibility in delivery of services.d) Strengthen utilization of strategic information to guide decisions in service delivery.2) Increase clinical and health management knowledge, skills of health-care workers and health administrators

a) Train and retrain health care staff in HIV Prevention, Treatment, Care and Support.b) Train site, LGA and state government workers on effective monitoring and evaluation.c) Monitor quality of service delivery and effectively mentor site staff in service provision.3) Establish and strengthen communication and coordination between health facilities and communitiesa) Strengthen linkages between communities and facilities to improve adherence, retention rates and minimize stigma.b) Create a community support system that will help identify health needs, complement HIV care and enhance quality of life of PLWHAs.c) Link primary health care centers with secondary facilities to increase access.

In COP12 FGH will continue provision of services to clients with emphasis on community based care and support built on strengthened community support systems. FGH HBC teams will continue to provide community services as well as linkage to the facilities where the patients are accessing treatment around all 11 comprehensive sites. FGH will expand services to 16 additional sites in 4 contiguous states where the burden of the epidemic is high or likely to exceed the national average, if additional funds are available.

Goals include:1. Improved care and quality of life for (PLHIV) and their families: VU/FGH will continue provision of high quality comprehensive facility and community-based adult care and support services to PLHIVs and their families, enhance patient retention and continuum of care within community support systems. Food by prescription (FBP) program will continue to be part of the standard of care in all FGH supported sites through the provision of therapeutic or supplementary food to malnourished HIV-infected clients. VU/FGH will continue treatment support services across all supported centers to provide BCP, adherence, PwP, HBC, etc through continuous patient engagement.2. Increased community support for (PLHIV):VU/FGH Care programs will leverage on state-run programs on malaria and economic strengthening activities, encourage new clients to join support groups at the facility or community levels, will map locations of clients to engage in services through a tiered CSS structure by engaging active support group clients to support provision of sustainable care services, strengthen existing (HBCW) by encouraging support group members to join CSS teams to enhance monitoring and follow-up of clients missing appointments or experiencing difficulty in treatment adherence.3. Increased number of trained health care workers and volunteers in care and support: VU/FGH will Increase the number of HBCWs & community workers to further extend services from comprehensive centers to the communities. HBCWs workers will be trained to improve client tracking, provide adherence support and basic home nursing care.

VU/FGH will continue to partner with CBOs to support OVC services in Niger and Kwara states. FGH will expand services to 4 additional states where the burden of the epidemic is high or likely to exceed the national average if funding permits.

The goals of FGH OVC program include:

1. Improved access to OVC service areas: VU/FGH will continue provision of orphans and vulnerable children (OVC) services to enrolled children in Kwara and Niger states on a prioritized case-by-case basis in the following areas: 1) Healthcare; 2) Nutrition; 3) Psychosocial; 4) Education; 5)Legal/birth registration; 6) Economic strengthening; and 7) Shelter (extreme situations only).2. Increased collaboration and involvement of local government in OVC efforts: VU/FGH will partner with state governments to leverage available resources for OVC services. Opportunities in microfinance and other economic strengthening activities will be sought with the National Poverty Eradication Program.3. Delivery of quality care and support services to OVC: VU/FGH will work with CBO partners to establish an OVC monitoring and evaluation system. VU/FGH will orchestrate routine quality control visits to evaluate OVC program performance, accurate record keeping, referral linkages, and compliance with standard operating procedures.4. Increased knowledge of OVC care and support services among community workers and volunteers: VU/FGH will provide training or re-training in implementation of OVC services including monitoring and evaluation of program activities. VU/FGH will provide training and re-training of selected partner CBO and OVC volunteers in implementation of OVC services including monitoring and evaluation of program activities. Once new CBO is selected, VU/FGH will provide additional information including CBO assessment, capacity, training plans and, where applicable, linkages that will be established.

In COP12, VU/FGH will continue implementing the strategy of the Three Is: provision of isoniazid preventive therapy (IPT); intensified case finding for active TB; and TB infection control, especially in ART settings, following national guidelines. Other activities will include multi-drug resistant (MDR) TB case identification following National TB and leprosy Control Program (NTBLCP) guidelines, patient referrals to designated MDR-TB treatment facilities, strengthening TB laboratory and chest x-ray services, and basic infrastructure renovations at DOTS and TB laboratory sites.Program objectives include:1. Improve service delivery in TB-HIV care to eligible clients: VU/FGH will continue to symptomatically screen all adult and pediatric HIV-infected clients for TB during routine HIV care and treatment visits and create an active referral system between ART and TB DOTS clinics to link patients to care and treatment. VU/FGH will enhance TB diagnosis in all PHC-DOT centers using available technology in co-infected, predominantly smear negative patients including provision of LED FU microscopes at selected comprehensive sites. VU/FGH will monitor treatment completion rates, defaulter patterns and case detection rates in FGH-supported DOTS sites through linkage of NTBLCP recording systems and the PMM system of ART care and treatment.2. Increase capacity and knowledge of TB-HIV service delivery: VU/FGH will continue to improve the capacity of health facility staff to diagnose, treat, and monitor TB among HIV-infected individuals by upgrading onsite laboratory and DOTS services in all supported sites. VU/FGH will integrate TB/HIV training curriculum into routine activation training based on IMAI/ IMCI curriculum. VU/FGH will train and retrain facility staff in assessment and implementation of TB infection control per national guidelines at all sites

VU/FGH will continue provision of comprehensive, high quality, facility- and community-based pediatric care and support to HIV infected clients in all 11existing treatment sites. FGH will expand services to 16 additional sites in 4 contiguous states where the burden of the epidemic is high or likely to exceed the national average if additional funds are available.

1. Improved care and quality of life for PLHIVs (pediatric) and their families: VU/FGH will continue provision of high quality comprehensive facility and community-based pediatric care and support services in all treatment sites comprising of: periodic clinical and laboratory monitoring, growth monitoring, prevention and treatment of opportunistic infections, pain management, psychosocial and spiritual support, nutritional assessments and counseling and home-based care visits.VU/FGH will continue to provide clients with basic care kits including monthly refills of consumable kit contents and emphasize Prevention with Positives (PwP) services as a routine component of clinicalcare.VU/FGH will continue to enroll additional sites to the national (EID) program in accordance with national EID scale up plan.

2. Increased coverage and community support to PLHIVs Peads and families. HIV positive clients and their families focusing on integration of pediatric care and support with health and development programs.VU/FGH will support implementation of adolescent friendly services, such as integration of syndromic management of STIs with ongoing HIV care activities and promotion of risk reduction and PwP activities.VU/FGH will identify and enroll pediatric clients living with HIV through PMTCT program, immunization days, PITC, community outreach. FGH will train care givers on empowerment through IGA, leveraging government programs, NAPEP, microfinance schemes etc

3. Increased knowledge in pediatric care and support among healthcare workers and families: VU/FGH will train or re-train healthcare workers in child basic care and support services including elements of positive living package. VU/FGH will also train HBCWs to support services in communities

During the period covered, VU/FGH will concentrate on supporting routine diagnostics for monitoring clients on ARVs and conduct internal and external QA activities consisting of quarterly site monitoring visits using standardized monitoring tools developed by the USGPEPFAR. VU/FGH will register all comprehensive laboratories and PMTCT sites with National Laboratory External Quality Assurance Center (NLEQAC) for Proficiency Testing (PT).Strengthened laboratory facilities to support HIV/AIDS related activities.a) VU/FGH will continue supporting routine HIV/AIDS-related laboratory service-delivery activities in established comprehensive and satellite sites through continuous training and mentoring.b) VU/FGH will continue participating in USG-PEPFAR coordinated LTWG to ensure harmonization of other IPs and GON-supported laboratory programs and get on national and international accreditation.c) VU/FGH will continue to work with PEPFAR LTWG to develop common lab equipment platform appropriate for each laboratory level to ease equipment procurement, usage, maintenance and minimize reagents wastage.d) VU/FGH will conduct internal QA activities consisting of quarterly site monitoring visits using a standardized monitoring tool.e) VU/FGH will support provision of laboratory services for HTC in new PMTCT sites.f) VU/FGH will register all comprehensive laboratories with Medical LaboratoryScience Council of Nigeria to continue progress in meeting requirements for acquiring national accreditation.g) VU/FGH will provide standardized training on quality system management (QSM) to laboratory scientists in the sites to prepare for national and international (WHO-AFRO) accreditation.h) VU/FGH will continue supporting production and performance of internal quality assurance dried tube specimen (DTS) for HIV serology.i) VU/FGH will perform routine preventive and periodic maintenance of laboratory equipment for optimal performance. VU/FGH will sign contract with equipment vendors for routine maintenance and servicing.j) VU/FGH will incorporate Point-of-Care (POC) HIV Monitoring for Primary Health Centers/PMTCT sites using Cyflow miniPOC device.

FGH will continue to support strategic information activities for providing the necessary evidence-base to guide program implementation in FGH states of operation. FGH will expand services to 16 additional sites in 4 contiguous states where the burden of the epidemic is high or likely to exceed the national average if additional funds are available.

1. Established Reporting and Monitoring and Evaluation (M&E) systems in all sites: FGH will train staff and support use of national M&E tools at sites, adopt the use of DHIS platform as the national reporting system in service delivery points. FGH will continue to strengthen states to utilize HIV/AIDS data, train site staff at LGA and PHCs on use of HIV/AIDS program monitoring tools as well as provide continuous mentoring and feedback.2. Improved data quality and sustainable M&E efforts: VU/FGH will work in line with GoN SI polices and guidance to support PFIP and fulfill all obligations of USG and national government reporting requirements.3. Improved service quality through compliance monitoring and performance measurement: VU/FGH will conduct periodic review of program monitoring and service quality data to help support design and implementation of high quality and sustainable programs. FGH will train site staff on CQI activities and build their capacity to implement and integrate QI activities into routine activities in HIVcare.

4. Improved utilization of available program data for Evidence-based decision in planning and program Improvement (Operations Research): VU/FGH will continue to utilize program data to identify effective strategies, the gaps in programming, new innovations that can improve access or quality of services and to establish the cost effectiveness or otherwise of the current interventions.

5. Improved national Surveillance and research activities: VU/FGH will continue to avail its services to the GoN in the design and conduct of large population-based surveys to help define magnitude and monitor trend of HIV infection in the country, studies among high-risk population groups that involve determination of size of MARP groups as well clinic-based studies for monitoring drugresistance among patients receiving antiretro-viral therapy.

VU/FGH will continue to provide in-service training for health care facility staff in the following areas:1. ART Adult: Train and retrain doctors nurses, pharmacists, technicians, CHEWS, medical records staff and other health workers in various aspects of HIV/AIDS service delivery including task-shifting of responsibilities to lower cadre health workers.2. ART Pediatric: Train two doctors and four nurses on pediatric HIV care in VU/FGH supported facilities.3. TB/HIV: VU/FGH will continue to improve capacity of health facility staff to diagnose, treat, and monitor TB among HIV-infected individuals by upgrading onsite laboratory and DOTS services. FGH will integrate TB/HIV training curriculum into routine activation training for treatment and PMTCT sites based on IMAI/ IMCI curriculum.4. BC&S: HBCWs workers will be trained on improved client tracking, adherence support and basic home nursing care, including child basic care and support services and positive living package.5. PMTCT: FGH will build capacities of health workers in delivery of PMTCT services. TBAs will continue to be trained on provision of HTC services and referral of HIV-infected pregnant women to the nearest VU/FGH treatment site.6. Lab: FGH will provide standardized training on quality system management to laboratory scientists in the sites to prepare for national and international accreditation.7. HTC: VU/FGH will partner with LGA PHC coordinators to train, coordinate and implement targeted community HTC strategy. VU/FGH will implement quality assurance/quality control (QA/QC) program that provides on-site evaluation, proficiency testing, and linkage to a reference laboratory.8. SI: VU/FGH will train staff and support use of national M&E tools at sites, and adopt the DHIS platform as the national reporting system in service delivery points. VU/FGH will continue to strengthen states to utilize HIV/AIDS data, train site staff at LGA and PHCs on use of HIV/AIDS PMM tools as well as provide continuous mentoring and feedback.9. OVC: VU/FGH will provide training in implementation of OVC services, including program M&E activities.

FGH activities will support the Nigerian Federal Ministry of Health (FMOH), and emergency plan goal of reducing new infections and thus decreasing the overall disease burden of HIV in Nigeria by enhancing HCT with targeted prevention messages and interventions. Integration of AB activities with prevention, treatment and care services will be emphasized. Use of the community awareness campaigns, school based programs, and peer education plus activities (community drama, dance events, etc.) allows dissemination of AB messaging, including integration with condom messaging, from socially-credible sources of information (educators, healthcare workers and related populations of PLWHA).FGH will provide prevention programs in collaboration with experienced community-based organizations NGOs(SYDOCK)in Kwara and peer educators to reach commercial sex workers (CSWs) and other individuals along the Olorun Kanbi community along Ilorin Jebba Road transport road, Lambata community in GAWU transport road, including truck drivers and those who engage in transactional sex at overnight motor parks. It is anticipated that seroprevalence among this group exceeds 20%. The number of targeted truck stops will be maintained at 2sites FGH will also targets out-of-school youth via community centres and organized activities supported through OVC programming. Condoms and other prevention programming will be balanced with AB prevention messages for youth in these settings.

VU/FGH will continue to focus on providing high quality provider-initiated HIV testing and counseling services (HTC) to adult and pediatric patients in all supported facilities. All new clients will receive HTC services in line with the national testing algorithm.

HTC program objectives include:

1. Increase knowledge of HIV status through effective testing and counseling services: VU/FGH will maintain ongoing HTC service-delivery activities at comprehensive and satellite sites in line with the Nigerian HTC Guidelines. These include Provider initiated HTC at health care facilities, Opt-out HTC for patients receiving treatment for TB at sites with TB-DOTS centers, Point-of-service testing in the antenatal care (ANC) center and inpatient wards, outreach HTC targeting MARPS and couple testing and counseling. VU/FGH will implement Couples HIV Testing and Counseling (CHTC) services to encourage partner reduction and fidelity in concordant HIV negative couples and reduce HIV transmission in sero-discordant couples.2. Increase enrollment into care and treatment through established referral systems and ownership of HTC programs: VU/FGH will strengthen referral systems by partnering with state HIV/AIDS care agencies to map all available state care and treatment services. This information will be utilized in all PHCs to link HIV-positive patients to care and treatment services, and HIV negative-patients to prevention services. VU/FGH will actively utilize site-based referral forms and registers to track proportion of clients successfully linked to care and treatment.3. Strengthen local capacity for delivery of quality HTC services: VU/FGH will partner with LGA PHC Coordinators to coordinate and implement targeted community outreach HTC strategy among MARPs. This will include several quality assurance (QA) methods to create efficient HTC programs ensuring quality service delivery in collaboration with the state ministries of health/SACAs. VU/FGH will implement a quality assurance/quality control (QA/QC) program that provides on-site evaluation, proficiency testing, and linkage to a reference laboratory.

FGH will support risk reduction and safer sex promotion activities among HIV-positive clients, partners, and members of their households. The comprehensive package of prevention interventions will include provider and counsellor delivered prevention messages, family planning counselling, STI management and treatment, and testing of partners and children. Lay counsellors within the community, including peer educators will be mobilized for more in-depth counselling on key prevention issues such as: sexual risk reduction, disclosure, adherence, reduction of alcohol consumption, and partner testing. Condoms and information on proper condom use will be available in community settings of MARPs..These services will be linked to facility based PwP interventions. FGH supported sites will integrate prevention with positives (PwP) activities including: adherence counselling; syndromic management of STIs in line with National STI control policy and guidelines; risk assessment and behavioural counselling to achieve risk reduction; counselling and testing of family members and sex partners; counselling for discordant couples; and IEC materials and provider delivered messages on disclosure.

Site level trainings for Nurses& CHEWS in STI syndromic management will be carried in Kwara & Niger states& supported PHCs. Peer educators & PLWHAs will be trained by FGH CLO/C&S program Officers and NGO subcontractors using a curriculum developed by FGH CLO focusing on truck stop and commercial sex settings as well as a manual on interpersonal communications, General training will include risk stratification, disclosure and couple counselling, proper condom use, and syndromic STI management training for health care workers.

FGH will build on its past successes of collaboration with the Nigerian government through the NPHCDA, NACA and participation of state governments to provide PMTCT services to the rural and under-served populations using a cluster-model approach by saturating PHC service delivery points around a Hub-secondary health facility. All the existing 11 hub sites and over 100 satellite sites will continue to provide PMTCT services. In addition, FGH will expand services to 16 additional sites in 4contiguous states where the burden of the epidemic is high or likely to exceed the national average, if additional funds are made available in COP12. VU/FGH will continue to engage private health clinics to provide non-profit PMTCT services to a large proportion of underserved population as well as leverage on the existing community health structures to improve PMTCT service uptake, retention, linkage to treatment and mainstreaming with other reproductive health services.The goals of FGH PMTCT program include:1. Increased PMTCT coverage and effectiveness: VU/FGH will adopt a family-centered approach for HTC of pregnant women, increase child testing at pediatric service delivery points, including use of Immunization days.

2. Increased collaboration with community leaders and local partners to create demand for services: VU/FGH will involve community leaders and local organizations to establish and strengthen community-based health committees, linkages, improve male involvement and engender ownership.

3. Capacity building for Healthcare providers: VU/FGH will build the capacities of the different cadres of health workers involved in the delivery of PMTCT services. TBAs will continue to be trained on how to provide HTC and refer HIV positive pregnant women to the nearest FGH treatment site.

4. Integration with Reproductive Health and other services: We will integrate PMTCT services with reproductive health, malaria program and other services in line with the Global Health Initiative principles. These services will be available at all hub sites in order to provide our clients with a qualitative and robust maternal and child health package.As part of our strategy to increase the uptake of HTC at antenatal clinics in supported PMTCT facilities, we shall defray/absorb antenatal booking/registration fees for all pregnant women. In addition, we shall ensure that communities served by the health facilities are adequately informed of this benefit/privilege through local media outlets and strategically placed IEC materials.

ARVs will be sourced by SCMS for VU/FGH ART patients.

As of COP 11, VU/FGH supports care and treatment services in seven comprehensive sites in Niger state, Kwara state and the Federal Capital Territory, and their feeder PHCs. In COP 12, four additional PMTCT sites will be upgraded to bring total number of comprehensive sites to eleven. Upon availability of additional funds, in COP12 VU/FGH will add 16 number of comprehensive sites in 4 contiguous high HIV/AIDS burdened states.VU/FGH will continue to provide antiretroviral therapy (ART) per national guidelines, collaborate with the state ministries of health to train a core group of trainers on provision of quality HIV/AIDS comprehensive services and continue to mentor healthcare staff in service quality improvement.Objectives of FGH treatment program are:

1. Access to quality ART and improved adherence to treatment for HIV-infected individuals: VU/FGH will support provision of uninterrupted ART following national guidelines to HIV-infected adults in 27 comprehensive centers. Patient adherence and partner support will be enhanced by the community component of the program (see Adult Care and Support for more detail).

2. Strengthen local capacity in ART delivery and sustainability of services: FGH will continue to support the state ministries of health in training core group of trainers on ART and decentralization, utilizing the Integrated Management of Adult Illnesses (IMAI) curriculum for implementation and support of services in VU/FGH supported sites. In addition to training, VU/FGH will implement a performance-based funding mechanism to increase site ownership and responsibility of HIV/AIDS services, empowering and rewarding health care facilities for quality service delivery.

3. Improve ART service delivery through decentralization at PHC facilities: VU/FGH will decentralize drug pick-ups and task-shifting responsibilities to PHC level to improve patient compliance, expand access and minimize burden at comprehensive facilities. VU/FGH will strengthen mentoring roles of staff at the comprehensive facilities thereby maximizing staff output, and enhancing communication between facilities.

VU/FGH will continue to support child-friendly pediatric treatment services in seven comprehensive treatment sites in Niger state, Kwara state and FCT. In COP 12, four existing PMTCT sites will be upgraded to comprehensive facilities thereby bringing the total number of comprehensive sites to eleven. Subject to availability of additional funds, VU/FGH will provide HIV treatment and care services to 16 additional sites in 4 high HIV/AIDS burden contiguous states.Program Objectives for pediatric treatment are:1. Improve access to Anti-Retroviral Therapy (ART) for eligible HIV-infected children: VU/FGH will continue to provide ART per national treatment guidelines to HIV-infected pediatric clients at 11 care and treatment sites. VU/FGH will identify and enroll pediatric clients living with HIV through the PMTCT program, provider-initiated counseling and testing services, and targeted community outreach.

2. Improve adherence to treatment and retention of HIV-infected children on antiretroviral therapy: VU/FGH will improve retention of enrolled pediatric clients through monthly adherence counseling, youth-friendly support groups and linkage to OVC programs. VU/FGH will assure uninterrupted ART services by establishing electronic reminders, creating effective client tracking systems and providing regular adherence counseling to clients and their caregivers.

3. Increase knowledge and skills in pediatric HIV/AIDS care and treatment among national healthcare workers focusing on best practices: VU/FGH will train and re-train clinical site staff in accordance with national guidelines and in line with principles outlined in the Integrated Management of Childhood Illnesses (IMCI) concept.