The IPPCTN (Implementation of Programs for the Prevention, Care and Treatment of HIV/AIDS in Nigeria) project implementing in Edo (HIV Prevalence: 5.3%) and Kano (HIV Prevalence: 3.4%) states , with a month to go to the end of FY11 has surpassed its PMTCT and HCT FY11 targets by 13% and 2% respectively, having reached 7334 pregnant women with HIV Counseling and Testing (out of a set target of 6441) and 11672 of the general population with HTC (out of a target of 11415). It scaled up in the just concluded third project year to establish PMTCT services in 4 new sites increasing the total number of focal sites from 10 to 14. In Edo, a significant PMTCT coverage of the target population was reached in all the Local Government Areas (LGAs) where focal sites were situated through outreach activities to other Primary Health Centres (PHCs). As the project plans for the two years ahead, the project in COP12 within the funding cap of US$500,000 will focus strategically on increasing PMTCT and HCT coverage in accordance with the national guidelines, strengthening sustainability efforts, and an end-of-project evaluation. In an effort to increase PMTCT coverage and based on past project experience, PMTCT service sites will be established at the PHC level in the 3 LGAs of Edo state and 5 LGAs in Kano state, within 24 additional PHCs. With accompanying intensive community mobilization efforts to reach youths, integrating HIV into RH/Family Planning, STI and Child health at focal health facilities will increase access to services by the targeted populace. Technical sustainability of the project will be achieved through the formation of a core team of trainers at each LGA for PMTCT and HCT that will include members of Community Based Organizations (CBOs).

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.)

Scale up for HCT: In order to reach 20,866 men women and youth for HCT services among the rural populace of Edo and Kano States with HIV prevalence rates of 5.3% & 3.4% respectively, the project will establish HCT units in 24 additional PHCs to provide PMTCT and provider initiated testing and counseling HCT services (in accordance with the national guidelines and algorithm) while integratiing HIV into RH/FP services. Positive clients shall be provided with appropriate prevention messages and linked to appropriate support services like HCT for family members and sex partners, counseling for discordant couples and counseling on positive lifestyles/ disclosure. Negative clients shall be supported to remain negative and where appropriate, follow up tests shall be advocated. All HCT clients will be screened for TB using standard questionnaires and based on scores, appropriate referrals will be made for TB diagnosis and treatment. Patients attending STI clinics will have access to HCT while HCT clients will be screened for STI using a standard questionnaire and referrals made as appropriate. Quality of HCT and PMTCT service provision will be maintained through National Quality Assurance CT procedures and quarterly counselors meetings. As in FY11, advocacy teams will facilitate community sensitization and mobilization targeting youths. The project will ensure the Edo state SACA M&E officer is involved in all monitoring visits to focal facilities in the state and submission of monthly data. The logistics supply management system will be strengthened by facility electronic data transfer.Sustainability: Declining funding levels over project years prevented actualization of involvement of community based organizations (CBOs) as outlined in the original FOA. In year 5 (COP12), the capacity of these CBOs in PMTCT/HCT and organizational development will be strengthened through structured mentoring sessions. Through sub-granting, they will be involved in the strengthening of community systems to ensure quality supervision and coordination of PMTCT/HCT service provision, community sensitization and mobilization in the LGA.

Planned strategies in Year 5 of the project will focuse on scaling up PMTCT for increased coverage, sustainability and evaluating impact made by the project in the last five years:LGA coverage: In order to significantly increase PMTCT coverage (addressing all the four prongs) in the focal states, Pathfinder proposes expanding to 24 additional PHCs: 3 PHCs/LGA (as per the national PMTCT guidelines of the integrated cluster model) in 3 new LGAs in Edo state and 5 new LGAs of Kano state. These facilities will offer quality PMTCT services to mother-baby pair while also ensuring integration of HIV into RH/Family Planning services. Strategies to promote demand creation that were successfully utilized in the project include cost effective outreaches to other PHCs and private clinics, community dialogue with gate keepers, men and women of the potential beneficiary communities (facilitated by Advocacy teams) and pathway-dialogue with TBAs. The project exceeded its targets in the last project year despite numerous challenges ( stigma to HIV, staff attrition, general strikes, elections, bad terrain) faced with project implementation in rural hard-to -reach areas. Decreased unit costs per patient by effective coordination, decentralizing project management to field level, effective referrals, tracking mother-infant pair mechanisms, cost effective logistics supply management systems, reduced commodity wastage, structured supervision visits and increased support from the communities are planned. 9,123 pregnant women for HCT will be the set target/year and an estimated 301 positive women linked to care and treatment programs. Project & Facility staff, Government, CBOs and communities will monitor project progress using national and NGI through existing PMTCT Facility Management Committees (Facility-Community Coalitions) and activated Ward Development Committees. A central PMTCT TOT training and step down trainings is planned using National PMTCT training curricula and facilitators for PHC, local government and CSO staff.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.