The Community in ACTION (CIA) project is being implemented by the Institute of Human Virology Nigeria (IHVN) through a public private partnership with the National Primary Health Care Development Agency (NPHCDA) and Solina Health Ltd. (SHL) to integrate PMTCT and strengthen comprehensive health services at Primary Health Care (PHC) centres including their surrounding communities.

CIA works through PHC facilities as PMTCT care centers linked to secondary and tertiary centers providing more complex PMTCT services in Nasarawa, Benue, Niger states and Abuja. CIA will scale up to 44 PHCs and 16 secondary facilities in Benue and Niger states with a focus on integration of comprehensive PMTCT services and community-based interventions that will achieve virtual reduction in MTCT. CIA employs community resources for demand creation, client follow up and to expand access. For sustainability, capacity for PMTCT is built at national and sub-national levels by strengthening networks of PHCs and the coordination roles of the FMOH and SMOH in the 16 states where IHVN is lead implementing partner to hold coordination meetings and other strategic activities. In support of the Three Ones, CIA will extend the National Health Management Information System to the PHC level. A uniform unique patient identification s for all PHC clients that links mother infant pairs is used to track clients who access service and National registers used for data collection at sites. A Site Case Manager Data Base that incorporates elements from the client specific data collection tool (DCT) will be maintained at the PHC and regional office for client tracking within the community and between facilities in the PHC cluster.

CIA will support the Three Ones Framework of the Government of Nigeria (GON) by extending the National Health Management Information System (NHMIS) to the PHC level to support service delivery and data sharing. To achieve this, all clients would be given uniform unique patient ID system that links mother infant pairs and ensures the tracking of clients who access different points of service, revised data collection tools (DCTs) will be deployed to sites and site staff trained in standardized completion of these forms. CIA will support GONs collaboration with Measure Evaluation to review and harmonize PMTCT DCTs to capture required data and plan for roll out in project states.

A Site Case Manager Data Base that incorporates elements from the client specific DCT is maintained at the PHC and regional office for client tracking within the community and between facilities in the PHC cluster. Indicator reports are generated and employed to monitor site specific performance, address deficiencies, guides program strategy and improve training. Support would be provided to GONs National Reporting Systems in the collection, review, and submission of quality client and program data, while ensuring linkages between Federal, State and Primary health Centres/Community Based Organizations quality improvement processes through the lead implementation partner concept.

For sustainability, the lead IP concept for PMTCT Strategic Information (SI) will be employed to build the capacity of State AIDS and STIs Control Program and State ACTION Committee on AIDS in the establishment of and M&E oversight systems, site monitoring use of data for decision making and to jointly develop and disseminate training tools and to develop a protocols for reporting, forecasting for DCTs and logistics planning and delivery of DCTs.

Community in action (CIA) will support the capacity of Government of Nigeria (GON) at the national and state level by its role as lead IP for PMTCT in 16 states by strengthening the networking of PHCs and the coordination roles of SMOH and FMOH and support State and Federal Ministries of Health to hold meetings and other strategic activities to ensure oversight and foster ownership.

CIA will support the finalization of the new PMTCT guidelines and subsequent printing of the guidelines and undertake capacity building on it. The FMOH will be supported to print training manuals as well TOTs and step training that will follow.

At the state level IHVN as a lead IP in PMTCT will support 16 states and develop the capacity of State AIDS and STI Control Program (SASCP) and State Action Committees on AIDS (SACA) in the areas of coordination, planning, implementation and monitoring of PMTCT programs as well commodity logistics.

CIA will develop a memorandum of understanding with each state leadership to secure political buy in, foster accountability and sustainability and gear the state into effectively taking ownership of the PMTCT program.

Community in action will support SASCP and SACA to identify and convene a meeting of other implementing partners and other stakeholders implementing PMTCT program in the seven states to establish a framework for actualizing PMTCT. Community in action will support the establishment of a state PMTCT task team. This task team will be supported to hold monthly meetings. As part of its sustainability plans community in action will support the SACAs/SASCPs to develop a costed scale up plans that will serve as an advocacy tool to policy makers in the state to increase funding for PMTCT program and foster ownership of health programs by the respective state government.

Community in action will support the state technical working group to convene a monthly meeting to review program implementation, analyze gaps and suggest way forward.

In COP 12, Community in ACTION (CIA) will utilize the Hub, Spoke Cluster model with PHC linked to secondary and tertiary centers. CIA will work with Ward Development Committees for demand creation to provide HCT to 173,312 pregnant women in Nasarawa, Benue, Niger, and FCT. Focus will be on integration, comprehensive PMTCT services and community-based intervention.

Health system will be strengthened through National Health Monitoring Information System, human and infrastructural capacity building. Coordination will be by a Site-based Case Manager (SCM) team to increase access, facility delivery and retention in care.

All HIV positive mothers will receive HAART using the test and treat approach. PMTCT State Coordinators will be appointed to provide support to the sites. Geographic information system map of services, Mother-mentors, MHW and peer educators will be employed. Exposed babies will receive co-trimozaxole prophylaxis; EID, Action meal and Pediatric follow-up. The SCM team data base will be used for follow up of clients and exposed babies to increase retention..

Partners of HIV infected women, other children and wives will be provided T&C. Positive Health and Dignity Program (PHDP) messages will be integrated within PMTCT care. Encounters with clients accessing immunization or medical services will be tracked using a unique identifier including linkages for social and OVC services. NPHCDA capacity in the areas of program and financial management will be developed and annual monitoring to ensure compliant with US federal and Nigerian government requirements..

This activity is linked to adult and pediatric care and treatment, OVC, laboratory infrastructure, and will create a sustainable structure through the state lead IP program.

Target population - Pregnant women accessing Antenatal care services; HIV exposed infants and family members.

Areas of emphasis - Integration, comprehensive services, training, referrals and community-based intervention This will focus on male involvement.

Sustainability - Strengthening coordination roles of FMOH, and SMOH in states where IHVN is lead IP. Production and dissemination of PMTCT guideline and other related activities at all levels.

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.