In COP12, APIN will provide comprehensive HIV Care and treatment program in 38 treatment sites across 10 states of the federation. With the renewed focus on high burden populations and low coverage states APIN will activate expansion sites in Benue, Borno, Oyo and Yobe states. By the end of COP12 APIN planned to have activated 100 PHCs for the provision of PMTCT services. APIN also plans to provide integrated HTC services in DOTS centers in Lagos and Benue states. During COP11, APIN refocused its OVC and Prevention program implementation strategy by engaging thirty-six (36) Non-governmental organizations (NGOs) and community based organizations (CBOs) to provide these services at the community level in addition to the facility based services being provided in the treatment sites. Twenty-one (21) of these CBO/NGOs provide OVC services while eleven (11) provide AB services and while fourteen (14) will implement Other prevention services. A core component of APIN implementation strategy is Health system strengthening. As lead IP for SI in Borno, Lagos, Oyo and Plateau States and lead APIN for PMTCT in Lagos, Oyo and Plateau states, APIN will continue to engage those states to build their capacity in developing, implementing and monitoring the delivery of qualitative comprehensive HIV prevention, care and treatment programs.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?(No data provided.)

In COP 12 and 13, APIN will provide care and support services to 142,959 PLHIV and PABAs. APIN provides a minimum package of care and support services using a multi-disciplinary, family-centered approach and in accordance with National guidelines. These services include clinical care, provision of basic care kit, community home-based care (CHBC), Positive Health Dignity and Prevention services, psychosocial and spiritual supports. Clinical care includes nursing care; pain management; OIs and STIs prevention, diagnosis and treatment; and laboratory monitoring. A basic care kit (containing insecticide treated bed net, water vessel and purifier, IEC materials and soap) is distributed at the facilities and communities, to ensure availability to patients and their families. Positive Health Dignity and Prevention services include assessment and counseling on sexual risk reduction, ART adherence, alcohol/substance abuse, partner testing, syndromic management of STIs, and family planning/pregnancy intention. Patients are provided with or referred for family planning, cancer screening and other services, as appropriate.APIN will continue to facilitate PLHIV support groups both in the facilities and communities, including the establishment of new community-based ones. APIN will liaise with CBOs to coordinate the community-based group, improve access to care for PLHIV and their families, and deliver services in the communities through a continuum of care, in line with national guidelines. The support groups, collaborating with site teams, will follow-up patients (with telephone calls and home visits), help in defaulter tracing, and establish/strengthen linkages and referrals to economic strengthening programs to address issues around poverty. These strategies will contribute to patient retention in care, especially pre-ART patients. Efforts will be made to reduce stigma and discrimination against PLHIV in the community through awareness creation. Cross-referrals between treatment facilities and community services (including wrap-around services e.g. income generating activities, spiritual support etc.) will be strengthened using national referral tools.

In COP 12 & 13, APIN will continue to provide qualitative comprehensive OVC services to most-at-risk children (0 17yrs) who have lost one or both parents to AIDS, or those affected by the disease, or who live in areas of high prevalence and maybe vulnerable to the disease or its socio-economic effects. APIN will continue to partner with CBOs that will provide a complement of the 6 + 1 services to 12,248 OVC in COP 12 using the family-centered approach. These services include education and vocational skills training, health care, psychosocial support, shelter, protection, food and nutrition, and economic empowerment of care givers and older OVC. The goal is to support the provision of a safety net for these children by and strengthening their families capacity to care for them. Active involvement of community structures will be promoted, thereby fostering ownership and sustainability of the program.APIN will support the economic strengthening (ES) of caregivers, older OVC, households and communities by collaborating with SMEDAN (Small and Medium Enterprises Development Agency of Nigeria), a GoN agency. Linkages to ES organizations e.g. Mashiah Foundation, a collaborating FBO in Jos, will also be strengthened.There will be training and retraining of these CBOs staff and community volunteers on quality service delivery and proper documentation of all OVC activities. The CBOs will be provided with the harmonized national OVC tools, and the activities of these CBOs will be periodically monitored to ensure compliance to national guidelines and standards of practice.APIN will support the Federal Ministry of Women Affairs & Social Development (FMWASD) and the state counterparts, in collaboration with American International Health Alliance (AIHA), to conduct a situation analysis of the social welfare workforce in two (2) states with high HIV prevalence (Benue and Plateau) and help address identified gaps. The expertise of AIHA in the training of social and para-social workers will be leveraged to train OVC desk officers in the states and LGAs as well as community mobilizers. This will also help to achieve better coordination, monitoring and reporting of all OVC activities in their states/LGAs.

TB/HIV services will be provided to 8,849 patients in line with the 3I's. TB diagnostic capacity has been enhanced with the provision of fluorescence microscopes and digital x-ray machines. More sites will receive this support in COP 12 and 13. All TB/HIV co-infected patients will receive ART following national, regardless of CD4 count. They will be provided CPT, and the use of IPT will be piloted at Sacred Heart Hospital, Abeokuta. To prevent nosocomial infection, national guidelines on TB infection control are implemented at the sites.HTC is provided for TB suspects/patients at co-located DOTS centers in APIN-supported sites. APIN has piloted universal access to HTC for TB suspect/patients in Oyo state and is in the process of replicating this in Lagos state. This will be supported in Benue state (COP 12) and Plateau state (COP 13). HIV+ cases detected are referred to ART centers for evaluation. Cross-referrals between the DOTS centers and HIV clinics are being strengthened. APIN has provided logistics support for the distribution of TB commodities and NTBLCP supported with LMIS training in Oyo state for the national roll-out of the 6-month treatment regimen, contributing to improved supply chain management system and availability of TB drugs. This training will be provided for more states in COP 12 and 13, beginning with Benue state.Support for MDR-TB activities will include institution of routine surveillance, in line with the national expansion plan for DR-TB. The TB national and SW zonal reference labs will be supported to enable them function at bio-safety levels 3 and 2+ respectively, and to improve their quality system management for accreditation. To improve diagnosis of TB and MDR-TB, GeneXpert will be provided to 5 sites in collaboration with NTBLCP.APIN will collaborate with CBOs to implement community TB care (CTBC) in order to increase case detection and treatment success. ACSM activities will be carried out to create awareness, community involvement and participation.

APIN will provide care and support services to &exposed children through a continuum of care for the next two years. These services will include clinical/nursing care, pain management, OIs diagnosis/prophylaxis, nutritional assessment and support, end-stage care, baseline hematology, chemistry, CD4 count. These children will be provided with CTX prophylaxis, screened for TB via clinical, laboratory and radiological diagnostics. Families of enrolled children will be provided with basic care kits including water vessel, water guard, ITN, soap, ORS, latex gloves, and IEC materials. APIN will collaborate and strengthen the capacities of support groups, CBOs, to deliver care and support services, including the provision of community and HBC services. All HIV exposed infants will be given NVP soon after delivery. APIN will strengthen the linkage between facility and community OVC services to promote retention of children through collaboration with CBO. RUTF will be provided to prevent malnutrition and LTFU. HIV-infected children will be identified through HCT, PMTCT and TB programs. Expansion of more PITC outlets at all points of care and integration into the MNCH will contribute to scale of pediatric treatment. Introduction of genealogy forms will ensure the children of HIV infected adults are identified and tested. APIN will also involve Private for profit and non-profit organisations in the scale up activities. The programme will identify, renovate suitable places within the clinic as play rooms equipped with age appropriate toys and literatures. Health care workers will be trained to provide care and support services to HIV-infected/affected children. APIN will encourage facility-based support groups to decentralize and function as smaller units at various locations within the community. Formation of adolescent support group will be encouraged including training on adolescents care, PwP. The programme will provide reagents/kits, train and support lab. Scientist, technicians and non laboratorians with the appropriate skills to collect DBS specimens for EID. APIN will support and build the capacity of the FMOH, SMOH, SACA, LACA on pediatric care and support.

During COP11, in addition to the existing 11 sites and 43 Oyo State DOT Centers; APIN assumed management responsibility for 7 Harvard sites (UMTH, UNTH, FMC Makurdi, OLA, FMC Nguru, SSH and Nursing Home Maiduguri). During this period APIN activated 100 PHCs and also took over management responsibility of 5 former Africare sites Police Hospital, Falomo, St. Joseph Catholic Clinic, Kirikiri, Ancila Catholic Hospital, Iju, PHC Sango, Agege and AHI all in Lagos.By the end of COP11, APIN would have taken over the management of remaining Harvard transition sites of ABUTH, JUTH and its 13 satellites. In COP2012, APIN will provide support for laboratory development at 32 treatment sites (9 tertiary care, 23 secondary sites), 100 PMTCT and 43 DOT sites.APIN will upgrade equipment platforms in all PCR labs to automated systems for DNA PCR and Viral load. APIN will collaborate with the USG to develop the framework for these labs to support other IPs without the capabilities. The three (3) APIN supported DRM labs will be integrated into the national DRM program. Primary health care facilities are closely partnered with secondary and tertiary care facilities, allowing for baseline and periodic evaluation. The primary facilities provide limited lab monitoring with basic clinical, hematologic and CD4 assays using largely point-of-care technologies.In furtherance of the PEPFAR II goals, APIN will continue to collaborate with the SLMTA team to prepare the five (5) participating labs towards attaining the WHO-AFRO accreditation. In addition, APIN will collaborate with SLMTA to register and prepare five (5) more labs for accreditation. APIN will also continue to work with the MLSCN to get all APIN labs accredited nationally.APIN will continue to support the LIS at the labs with technical support from Harvard, using FileMaker Pro data software a program has been developed to support data generation, capturing and analysis. APIN will strengthen its Biomedical engineering unit by building the capacity of engineers to reduce equipment down time. In addition, APIN will collaborate with SCMS to implement pooled procurement of Lab commodities.

During COP11, in addition to the existing 11 sites and 43 Oyo State DOT Centers; APIN assumed management responsibility for 7 Harvard sites (UMTH, UNTH, FMC Makurdi, OLA, FMC Nguru, SSH and Nursing Home Maiduguri). During this period APIN activated 100 PHCs and also took over management responsibility of 5 former Africare sites Police Hospital, Falomo, St. Joseph Catholic Clinic, Kirikiri, Ancila Catholic Hospital, Iju, PHC Sango, Agege and AHI all in Lagos.By the end of COP11, APIN would have taken over the management of remaining Harvard transition sites of ABUTH, JUTH and its 13 satellites. In COP2012, APIN will provide support for laboratory development at 32 treatment sites (9 tertiary care, 23 secondary sites), 100 PMTCT and 43 DOT sites.APIN will upgrade equipment platforms in all PCR labs to automated systems for DNA PCR and Viral load. APIN will collaborate with the USG to develop the framework for these labs to support other IPs without the capabilities. The three (3) APIN supported DRM labs will be integrated into the national DRM program. Primary health care facilities are closely partnered with secondary and tertiary care facilities, allowing for baseline and periodic evaluation. The primary facilities provide limited lab monitoring with basic clinical, hematologic and CD4 assays using largely point-of-care technologies.In furtherance of the PEPFAR II goals, APIN will continue to collaborate with the SLMTA team to prepare the five (5) participating labs towards attaining the WHO-AFRO accreditation. In addition, APIN will collaborate with SLMTA to register and prepare five (5) more labs for accreditation. APIN will also continue to work with the MLSCN to get all APIN labs accredited nationally.APIN will continue to support the LIS at the labs with technical support from Harvard, using FileMaker Pro data software a program has been developed to support data generation, capturing and analysis. APIN will strengthen its Biomedical engineering unit by building the capacity of engineers to reduce equipment down time. In addition, APIN will collaborate with SCMS to implement pooled procurement of Lab commodities.

APIN as lead Implementing Partner for PMTCT in Plateau, Lagos and Oyo States, will work with the State and Local Government to strengthen their capacity, towards increasing PMTCT coverage in conformity with the National Strategic Health Development Plan (NSHDP).This is in line with the GHI utilizing HSS.APIN will build the capacity of different cadres of Health care workers in partner sites to provide both HIV and non HIV services to address existing manpower gaps in service delivery, including primary, secondary and tertiary sites across Government, Private and faith based facilities by conducting trainings in administration, finance, Monitoring and evaluation, Quality improvement and HIV medicine.APIN will support weak or none existent sites systems for sourcing, procuring, storing and distributing drugs and commodities which were at sites. The National Health Survey (NHS) assessment indicates that the pharmaceutical management system has mixed performance results in Nigeria and implementation of drug related policies lags behind. APIN will strengthen the state systems by supporting the Government to appropriately select and access procure, store, distribute, appropriately products for HIV and none HIV services.APIN will continue to scale up the provision of comprehensive HIV care in treatment services in secondary Health facilities as well as expand PMTCT services to PHCs in a cluster model in States where it is lead IP.Through its partners on the MEPI Grant to support Medical education Programs in the country, APIN is currently supporting review of the various curriculums that are used in training at these institutions to reflect current information especially in HIV Medicine and infectious Diseases APIN will draw on this experience to support Pre-service training of undergraduate Medical students and schools of Nursing and Midwifery.APIN will continue to advocate to management of its partner institutions to absorb staff that were being supported by the Program into the government pay roll. This has already commenced in some of the partner tertiary and secondary health facilities and several of them will still be transited in the COP year.

In COP12 APIN will provide blood safety services in 33 treatment centers. APIN will work in collaboration with the National Blood Transfusion Services (NBTS), and Safe Blood for Africa Foundation (SBFA) to build the capacity of health care workers in these sites to provide qualitative blood safety services. This will be done by conducting training of trainers in collaboration with NBTS and SBFA on appropriate clinical use of blood and other topics. This pool of trainers will be supported to step down the training at their various sites. APIN will also continue to support the hospital linkage program of the NBTS for appropriate screening of blood with EIA for the four (4) TTIs. APIN will continue to make advocacy to management of APIN supported tertiary institutions to collaborate with NBTS in ensuring that the practices of family replacement donors is completely replaced by voluntary non remunerated donors. Site management will also be encouraged to promote best practices, pay more attention to upgrading infrastructure for blood banking at their facilities, support training to effectively link up with the NBTS and contribute to the nationally coordinated blood banking system.In COP11 APIN collaborated with other stakeholders to participate in a forum where issues on blood safety APIN were discussed. One of the outcomes was an activity that pooled samples of transfused blood from different sites and centrally tested for transfusion transmissible infections (TTIs) to determine the percentages of TTIs detected in transfused blood. This has formed an evidence based advocacy tool to convince policy makers on the importance of EIA for screening for the four (4) TTIs instead of the prevalent use of RTKs in donor testing. In COP12 APIN will support eleven (11) blood banks with EIA capabilities for screening for the four (4) TTIs. APIN will continue to work with NBTS to support Social mobilization and health promotion messaging through media driven campaign for donor recruitment. Facilities will be supported to carry out outreaches with linkage to community based HTC for blood donation awareness and recruitment.

APIN will continue to implement injection safety in all supported sites in 9 states (Borno, Benue, Enugu, Kaduna, Lagos, Plateau, Ogun, Oyo and Yobe). This activity provides the initiation of intensive training program in injection safety practices for HCWs at all APIN sites. APIN will continue to build the capacity of sites in collaboration with AIDSTAR to provide HIV/AIDS care and treatment activities in a medically safe environment. During COP11, APIN conducted a series of trainings including a TOT on the newly approved infection prevention, control in clinical setting, with hand hygiene and phlebotomy components. This TOT was further stepped down by all the sites with support from APIN.APIN will support sites to make provision for referral of staff for access to post exposure prophylaxis (PEP). PEP will be provided through ART drug activities. APIN will support the USG Health Care Waste Management (HCWM) strategy by adopting the integrated approach to expiry management at all facilities. APIN will collaborate will other stakeholders to develop and implement the HCWM framework. APIN will also support advocacy for the approval of the HCWM plan, policy and guidelines. Proper waste management will be encouraged at each site through the use of biohazard bags, suitable sharps containers, and the use of incinerators. This activity will support procurement and maintenance of incinerators where applicable within funding limit. APIN will also work with AIDSTAR to procure and distribute injection safety commodities to all sites.

During COP11, APIN refocused its Abstinence and Be faithful implementation strategy by engaging eleven (11) Non-governmental organizations (NGOs) and community based organizations (CBOs) to provide services at the community level. These NGOs and CBOs (CAHLI Jos, CCC Jos, TMVF Maiduguri, SWAAN Enugu, Karale Lagos, Humanity Lagos, PAC Ogbomosho, AHI Lagos, Patriots Abeokuta, AHP Makurdi and AFI Ifo, Ogun State) are spread across six (6) states of Borno, Enugu, Lagos, Ogun, Oyo and Plateau.In COP12 APIN will implement AB activities at community level utilizing the minimum prevention package strategy as contained in the National Prevention Plan. The goal of the program is to provide a comprehensive package of prevention services to individuals reached through a balanced portfolio of prevention activities, including abstinence and be faithful messaging (HVAB).APIN will build the capacity of the NGOs and CBOs to target the general population using a combination of biomedical, behavioral and structural interventions. HVAB messages promoting abstinence, mutual fidelity and addressing issues of concurrent and multiple sexual partnerships will be balanced with concurrent condoms and other prevention messaging where appropriate and will be integrated with treatment and care services in our treatment sites. APIN will collaborate with PLWHA support groups at these sites to build their capacity to implement AB activities among its members and surrounding communities. As in previous COP years, APIN will continue to focus on improving the integration of prevention activities into the HIV care and treatment settings.A key age group for HVAB activities is youth/young adults aged 15-24 years as this encompasses the highest prevalence age group. Age-appropriate abstinence only messaging and secondary abstinence messaging will be conveyed to this group particularly focusing on those orphans and vulnerable children receiving both facility and home-based support. APIN targets to reach 61,558 individuals from the general population with individual and/or small group level HIV preventive interventions that are based on evidence and/or meet the minimum standards required.

In COP12 APIN will continue to support the provision of comprehensive HIV counseling and testing (HTC) services in 76 facility-based and 5 stand-alone centers in 10 states while expanding services to high burden locations within the states. APIN will adopt the test-to-treat strategy and focus on MARPs, clients and their partners presenting to the health care facilities will be offered PITC at all service delivery points, testing of exposed children and family members of PLWHA.To further increase coverage, APIN will scale up CHCT and pediatrics HTC. APIN will continue to integrate HTC into TB DOTS centers in Oyo and Lagos State and expand to Benue state in COP12. HTC will also be offered to patients receiving TB services at each of the APIN sites. APIN will use mobile HTC to reach high prevalence and hard to reach communities.To ensure improved quality of service at the sites, APIN will continue to strengthen referrals and linkages, provide strong M&E and conduct Regional HTC Quality assurance meetings with the counselors. Individuals identified as positive at APIN sites will be referred to PMTCT and ART clinics for treatment and palliative care services. APIN sites will continue to use family counseling sessions and love letter strategies to encourage partners of HIV-infected patients to access HCT so that couples receive HIV counseling and testing together.Condoms will be made available at all HTC sites in conjunction with the delivery of ABC messages. The Society for Family Health (SFH) will supply condoms. APIN will continue to promote task shifting by training and utilizing lay counselors to provide quality HCT services at the community level. HTC services will also be integrated into other HIV prevention, care, and treatment services both in facilities and communities and also into other health services like SRH, MNCH and STI, home-based HTC for partners and families of PLHIV or TB. Where necessary, refresher training will be conducted for counselors using the National HIV training curriculum. HIV testing is performed with rapid test assays and same day results are given using the National testing algorithm.APIN will continue to support the quarterly National HCT Task Team meetings.

During COP11, APIN refocused its Other Prevention implementation strategy by engaging fourteen (14) NGOs/CBOs to provide services at the community level in addition to the facility based services being provided in 18 treatment sites. These NGOs and CBOs (Mashiah, HALT AIDS, ARFH, CAHLI Jos, CCC Jos, TMVF Maiduguri, SWAAN Enugu, Karale Lagos, Humanity Lagos, PAC Ogbomosho, AHI Lagos, Patriots Abeokuta, AHP Makurdi and AFI Ifo, Ogun State) are spread across six (6) states of Borno, Enugu, Lagos, Ogun, Oyo and Plateau.In COP12, APIN will continue to implement COP activities at both the facility and community levels utilizing the minimum prevention package strategy as contained in the National Prevention Plan. APIN partners will target (MARPs), including outpatient STI patients, border traders (like Saki), fashion designers, young male market agents, and motor mechanics. APIN will also target high risk communities like Kuramo and provide intervention and educational materials based on community-specific risks. In addition to comprehensive counseling on HIV prevention and risk reduction, HIV-infected individuals identified through this activity will be referred for palliative care and evaluation for ART eligibility. An emphasis on men with high-risk behaviors through these community-based efforts will also enhance prevention efforts and facilitate access to their partners.APIN will continue to focus on improving the integration of prevention activities into the HIV care and treatment settings; specifically, healthcare providers and lay counselors in care and treatment settings will be trained to appropriately deliver integrated ABC prevention messages and incorporate the messages into routine clinic visits using IEC materials and job aids. An appropriate balance of ABC will be tailored to the needs and social situation of each individual client in its presentation. In addition to the integration of such services into the HIV-specific treatment setting, prevention activities will be assimilated into other points of service in each health facility GOPD, SRH, MNCH and STI services. The target for Condom and other prevention is 30,058 individuals.

Currently, APIN support comprehensive PMTCT program at 43 service outlets in 9 states. Opt-out testing and counseling with same-day test results will be provided to all pregnant women presenting for antenatal care (ANC), labor and delivery (L&D) for the next two years. APIN will achieve this through scale up of services to PHCs, strengthening decentralization, Provider Initiated Testing and Counseling (PITC); Integration of PMTCT services into maternal and child welfare clinics immunization clinics (MNCH); Introduction of genealogy forms; Involvement of Private for profit and non-profit organisations. APIN will adopt the hub and spoke model to strengthen referral system and linkages using the National referral form. Health care workers will be trained and supported to offer HCT, infant feeding counseling and PMTCT using the revised National guidelines. Post-test counseling services on prevention of HIV infection will be encouraged. APIN will support couple counseling by encouraging pregnant women to bring their husband. Family planning and cervical screening of all pregnant women will be supported. The program will address stigma, male norms and behaviors through identification, sensitization and education of members of NURTW, Okada riders association and others in collaboration with CBOs. SOP which addresses special concerns of the adolescent will be developed. Emphasis will be on community PMTCT which supports the development of network of secondary or primary PMTCT clinics, including TBAs. APIN will collaborate, support and build the capacity of all stakeholders state LACA, SACA, SMOH, involved with the delivery of PMTCT services through regular meetings, trainings and workshops. APIN will support reduction of LTFU through use of adherence counseling tool. Mentoring of clinicians and other health workers will be done by program officers using the program monitoring tool. Regular training of the health workers from the states and Local government areas on timely data collection, collation and reporting will be conducted. Data collected will be used in conjunction with funders to improve service delivery. APIN will provide HTC to 110,108 pregnant women and ARV prophylaxis to 3,612 HIV+ve pregnant women.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.

Pharmacovigilance :1. Our adverse drug events (toxicity) forms have been superimposed with the NAFDAC PCV forms, this will improve capturing Pharmacovigilance information, and Pharmacovigilance committee has been set up at all facility to improve awareness, documentation and management2. Our training modules include one for pharmacists, to be adopted for training of pharmacists across Nigeria, as well as technicians training module that will train dispensers and other healthcare workers in drugs logistics and reporting.3. The purpose of the Drug Information Center (DIC) is to serve health care professionals throughout Nigeria by answering critical questions on drug use and its possible side effects. The DIC routinely responds to inquiries regarding appropriate therapy for specific patients; adverse reactions to drugs; efficacy of drugs; drug interactions; intravenous additive incompatibilities; biopharmaceutic and pharmacokinetic parameters of drugs; dosing in renal failure; and information on new drugs. It serves as a hotline for public access to drug information; thus plays a vital role in providing outstanding health care to the citizens of Nigeria.B. Strengthen Supply Chain ManagementIn line with the goal to strengthen PEPFAR supported system, APIN will:Quantify for all ARVs, OIs and Lab consumables that are used across the APIN sites; help make requisitions, distribute, track and send quarterly reports of all drugs and consumables.APIN already has a virtual system to track and monitor all its commodities at the APIN Central Warehouse and at the site level. APIN will support the GON in setting up the virtual stock management system at federal central medical stores. APIN will work closely with GON to take over the management of federal medical stores in Oshodi.APIN will also offer technical support to GON sites and some FBOs in the area of quantification, forecasting and reporting of ARVs and labs consumables. This will help strengthen the system. In addition, APIN will continue to strengthen its relationship with the states and help in the collection of data using the NNRRIMS platform.

During COP11, APIN assumed management responsibility for 7 Harvard sites (UMTH, UNTH, FMC Makurdi, OLA, FMC Nguru, SSH and Nursing Home Maiduguri), in addition to the initial 7 Harvard transitioned sites NIMR, LUTH, UCH, Adeoyo, Eleta, GH Ogbomosho and GH Ijebu-Ode and the start-up sites -Sacred Heart Catholic Hospital in Lantoro, Ogun State and Primary Health Center-Iru on Victoria Island, Lagos, Mushin General Hospital, Onikan General Hospital, 43 UCH Oyo State DOT Centers. During this period APIN activated 100 PHCs and also took over management responsibility of 5 former Africare sites Police Hospital, Falomo, St. Joseph Catholic Clinic, Kirikiri, Ancila Catholic Hospital, Iju, PHC Sango, Agege and AHI all in Lagos.By the end of COP11, APIN would have taken over the management of remaining Harvard transition sites of ABUTH, JUTH and its 13 satellites. In COP2012, APIN will provide support for treatment at 32 treatment sites (9 tertiary care, 23 secondary sites), 100 PMTCT and 43 DOT sites. This activity will provide ART services to a total of 74,321 eligible adult patients by the end of the reporting period. Treatment will also be provided for eligible pregnant women at the secondary facilities and the PHCs. APIN will continue to scale up treatment services focusing on high burden low coverage populations. We will also support early detection and treatment while increasing focus on the treatment of children and women.APIN will continue to use the hub and spoke model for service delivery. APIN will also continue to support the decentralization program of the GON which promote the expand provision of treatment services to the primary health centers. APIN will explore the possibility of a pilot program on cervical cancer screening among patients in some selected sites.ART patients are monitored 6 monthly for lab exams, and pick up drugs monthly. We will also strengthen our monitoring for treatment failure. Harmonization of data collection for M&E will be coordinated with USG and GON efforts. APIN will continue to employ the use of electronic clinic and lab records to provide data for high-quality patient management and centrally coordinated program monitoring.

APIN currently provide pediatric treatment at 43 service outlets in 9 states. This includes 3 facilities previously supported by Africare in Lagos. APIN plan to increase pediatric treatment in the next two years is through scale up of services to PHCs, strengthening decentralization process, identification of pediatric HIV infection through Provider Initiated Testing and Counseling (PITC); Integration of pediatric services into maternal and child welfare clinics immunization clinics (MNCH) at all pediatric service outlets; Introduction of genealogy forms to ensure the children of HIV infected adults are identified and tested; involvement of Private for profit and non-profit organisations to ameliorate the hardship encountered due to incessant industrial strikes by government owned health facilities. Adolescent are usually missed in the care for HIV services and these are most vulnerable group. APIN already has the adolescent support group at NIMR; this will be replicated at other sites. In addition, counselors and other health care workers will be trained on the care for adolescents in HIV, PwP. Standard Operating Procedures (SOP) which addresses special concerns of the adolescent will be developed. Tracking teams inclusive of patients and support groups will be strengthened at all sites. ART eligible children will be provided ART and followed every 6 months for CD4% enumeration. Adherence counseling tool, containing sets of critical issues to be discussed with the patients will be developed for use by counselors and pharmacist. Mentoring of clinicians and other health workers at site level will be done by program officers in Pediatric care and treatment as well as other service delivery using the program monitoring tool. Regular training of the health workers from the states and Local government areas on timely data collection, collation and reporting will be conducted. Data collected will be used in conjunction with funders to improve service delivery. To ensure sustainability, APIN will collaborate, support and build the capacity of all stakeholders LACA, SACA, FMOH, SMOH, involved with the delivery of Pediatric services through regular meetings, trainings and workshops.