CIHP is a newly established, indigenous NGO created as part of the Track 1.0 transition from ICAPs PEPFAR-supported Columbia MCAP.

CIHPs strength lies in the richness of its technical approach, program strategies and management systems from highly experienced technical staff largely inherited from ICAP NG.

CIHP will continue to work in partnership with the government of Nigeria (GON) and local organizations at all levels to support the delivery of high-quality, sustainable, comprehensive and integrated HIV/AIDS prevention, care and treatment services using a family-centered approach.

CIHP partners with the USG, other donors (GFATM) and implementing partners, GoN (Federal, State and Local), FBOs, non-governmental and CBOs and other for profit partners across six states including high HIV prevalence states of Akwa-Ibom, Benue, Cross River ,Gombe, Kaduna and Kogi.

CIHP targets a combined population using a multi-disciplinary approach to provide continuous support 55 hospital networks across six states of Nigeria.

Key CIHP approaches include: local experience and expertise; strategic partnerships; comprehensive, family-centered care in line with GHI principles; quality and evidence-driven programming; skills transfer and capacity building; advocacy for sustainability and local ownership; gender-sensitive approaches; and greater involvement of people living with HIV.

CIHP will work with GON and NGO partners, private facilities (faith based and community based organizations) to increase programmatic and financial responsibility for managing comprehensive HIV/AIDS services within an integrated health care system with the aim of demonstrating a progressive increase in local stewardship of high quality comprehensive HIV/AIDS and other health services in the six states.

Adult Care and Support

Early HIV Detection and Enrolment

CIHP will continue to support early detection by strengthening facility based HCT through point of service testing, and targeted community-based testing, prioritizing MARPS.

Provision of care and support services

PLWHIV will continue to receive the minimum care package of BCKs, psychosocial support, nursing care, OI and STI management.

Strengthening of HBC programs

HBC programs will be strengthened and expanded for improved quality and access through involvement of support group network and volunteers.

Improved quality care

Periodic quality checks conducted through the application of checklists, SOPs, Standard of Care and Model of Care assessment tools and the provision of relevant job aids to site clinicians.

Human Capacity Development:

842 HCWs will be trained in palliative care, HBC and OVC service provision

Retention in care

CIHP will strengthen patient appointment, adherence counseling and defaulter tracking systems, and fast track the decentralization process to reduce client waiting time at the clinics

Decentralization of care and treatment:

CIHP will build capacities of PHCs and their LGAs to provide devolved care and support services. CIHP will partner with private hospitals to provide HIV care and treatment services in these settings.

Special considerations for the disabled

Health facilities will be sensitized on fast-tracking services for the disabled and vulnerable populations. Home visits will also prioritize the disabled.

Considerations for injection drug users

CIHP will continue sensitization campaigns against substance abuse, and advocate for the inclusion of Naloxone in the essential drug lists of supported facilities. Screening for Hepatitis B virus co-infection, will be intensified. Negative clients will be referred for vaccination, while positive clients will be commenced on a Tenofovir based regimen

Addressing gender issues

Care and support services will also seek to address gender imbalances through linkages with CSOs and women groups. Services will also be organized to reflect sensitivity to the needs of vulnerable groups of women and children. MTA strategies encouraging male partner involvement will be encouraged.

OVC

CIHP will partner with at least thirty (30) CBO networks and health facilities to provide OVC supportive services via a family-centered approach, taking into account the individual needs of OVC and their households. Supportive services will be provided at the health facility and community levels.

Facility level VC service

HIV-infected and affected children are provided with HTC, basic clinical care, including nutritional assessments, health education, and preventive care packages (i.e., enhanced basic care kits) as part of the clinical care at health facility level. Linkages will be created between facility and community based services to ensure that OVC are identified and cross referred between the two levels for a comprehensive OVC package.

Community level VC service

At the community level,, Community Care Coalitions for OVC (CCC) a community-driven initiatives to ensure the active participation of community gatekeepers such as religious leaders, womens groups, and traditional leaders in the active identification of OVC will be supported. The CCC is a strong community reference point for the reduction of stigma and discrimination against OVC as well as prioritize selection of OVC for services..

Community-based OVC activities will include OVC identification, assessment, and tracking using the Child Status Index, timely referral for relevant clinical services, psychosocial support, nutrition support through food banks as well as educational support. OVC care givers will be linked to organizations like MARKETS for Household economic strengthening activities. Partnerships with Sesame Street will be explored for kids clubs.

Household economic strengthening

CIHP will continue to build on ongoing activities to enhance equity and gender approaches including male involvements that lessen the vulnerability of female OVC by increasing their access to needed services. CIHP will collaborate with relevant stakeholders such as FMWACD, and UNICEF, on OVC policies, guidelines, protocols, and harmonized implementation in line with national OVC strategic plan.

Household economic strengthening will be enhanced through establishment of linkages with organizations involved in Income Generating Activities (IGAs). This will be done with the aim to 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.

TB/HIV

Intensified TB case finding

CIHP will intensify TB case detection amongst PLWHIV by screening for TB at various HIV service points and referral of suspects for TB microscopy and free radiological diagnosis. CIHP will support high volume TB sites with fluorescence microscopy. All PLWHIV diagnosed with TB will be linked to TB treatment, through support for co-location of TB/HIV services in collaboration with the NTBLCP. Support standardized TB case finding in 34,562 new and old PLWHIV using screening tools and the treatment of TB in at least 2,212 HIV positive patients.

TBHIV prevention

TB/HIV co-infected patients will receive Cotrimoxazole prophylaxis and linked to other palliative care services for provision of BCK components. TB patients will be encouraged to bring contacts for early TB case-finding. IPT for eligible PLWHIV will be provided.

Reducing the burden of HIV in TB patients

Support will be provided to at least 82 DOTs sites to enhance PITC for TB patients and suspects. Referral linkages will be strengthened between DOTS and ART sites. High volume DOTS clinic will be upgraded for ART services in line with one stop approach. DOTS facilities will be supported to provide HTC to at least 13,246 TB clients and suspects. 345 HCW will be trained on TBHIV management, TB case detection and TBIC.

TB Infection control (TBIC)

Nosocomial transmission of TB will be mitigated through administrative and environmental control measures including developing facility TBIC plans; safe sputum collection; cough etiquettes and hygiene promotion including separation of suspects; infrastructural repairs for improved ventilation and provision of other TBIC commodities including N 95 respirators.

Improving lab diagnosis and management of MDR TB

CIHP will support the establishment of a Drug Sensitivity Testing for MDR-TB case detection. 3 Gene Expert (Xpert MTB-RIF) machines will be installed at 3 high volume TB sites. Sputum samples for MDR TB suspects will be logged to sites with DST and confirmed cases referred for management at reference hospitals. CIHP will upgrade 2 wards in selected sites to commence MDR TB management based on the availability of second line anti-TB drugs and MDR TB case burden.

Pediatric care and support

Early identification of infected children and linkage to and retention in care

Intensified case finding and enrolment of pediatric HIV cases will continue from Point-of-service testing at multiple points including pediatric wards, GOPD, immunization and labor wards. The WATCh strategy to provide HTC, and enrollment for all children of enrolled adult index cases using genealogy forms will be strengthened. CIHP will support EID by ensuring that HIV-exposed Infants have access to DBS/EID. HTC for children will be integrated into home visits; adolescent testing will be encouraged through youth friendly clinics. Child retention in care will be sustained through enhanced adherence counseling for care givers, same day mother-baby clinics, peer educator support and prioritized defaulter tracking.

Minimum care package

Following enrolment, children will receive a comprehensive package of clinical care and support services including prevention and treatment of OIs, growth and developmental monitoring, TB screening, referrals for immunization as well as VC support services. ART eligible children will be placed on treatment with routine monitoring. CIHP will strengthen the linkage between indigent children and community food banks, and link their care givers to IGAs.

Decentralization of pediatric care services

CIHP will adopt a phased approach in the devolvement of C&T services for children, starting with adolescents and progressively scaling down to younger children of 7 12 years age, 4-7 years and subsequently 2 4 years age groups, with increasing expertise and maturity at the PHCs.

Trainings/Capacity building

Health care providers at all treatment facilities and PHCs will be trained, re-trained and mentored to provide sustained high quality pediatric C&T services.

Community Linkages

CIHP will work closely with its NGO/CBO/FBO partners to promote community involvement in the care of children infected and affected by HIV. Linkages will be created between health facilities and the communities to provide a minimum package of psycho-social, health, educational, nutritional support (food bank) for VC. Additional support services will be leveraged from Sesame Street and MARKETS.

Lab Services

Maintenance/Expansion of lab services:

CIHP will continue to expand lab services while maintaining existing ones by strengthening lab capacity and monitoring tests and developing 14 new labs to provide HIV lab services. Supported labs will introduce new tests to strengthen toxicity monitoring of patients on treatment. CIHP will continue to support TB diagnosis by providing 10 additional FM microscopes and safety cabinets.

Strengthening Lab Systems

CIHP will participate in the formation of a National lab plan working with National TWGs providing TA to regulatory bodies. CIHP will continue to provide TA to LGA to provide minimal lab capacity at PHC level. CIHP will continue to support the MLSCN to implement CMEs on lab quality essentials at supported states to build capacity of lab Scientists. CIHP will work with the National QA TWG to establish post market validation of HIV RTKs procured at State level and promote the formation of state lab QM teams. Integration of Lab Services

CIHP will strengthen lab service integration by strengthening linkages between ART and non ART general lab units to strengthen the national lab systems. CIHP will continue to extend training, mentoring, provision of tools to other lab units to promote integration.

Strengthening Equipment Maintenance

CIHP will continue to strengthen the capacity of SMOH and Lab personnel/engineers to maintain lab equipments. CIHP will support SMOH to develop equipment maintenance agreements for both hospital and PHCs.

Lab Quality Systems Implementation:

CIHP will continue to strengthen lab QMS in preparation for National/International accreditation by implementation of LQS/accreditation plan. CIHP sites will continue to participate in the National EQA programs for TB, CD4 and RT and use results to improve lab services. In 2012, CIHP will expand EQA participation to CBC and Chemistry testing. State Quality officers with skills in implementing QS will be used to provide supportive mentoring to other labs.

Lab Management Information Systems:

CIHP will strengthen LIS to reduce turnaround time of results and improve patient management. Lab capacity will be build to operate and maintain LIS and develop policy and SOPs on operation.

CIHP will be to continue to promote innovative approaches to health information system (HIS), monitoring and evaluation (M&E) and surveillance and survey (SS) as well as encourage local ownership of health management information system

Strengthen existing Health Information System (HIS): CIHP will collaborate with various stakeholders to support the strengthening of the national health management information system. A key fundamental principle of this strategy will be to support GoN towards attaining the three one principles; One HIV action framework; one coordinating authority and one agreed M&E system as enshrined in the national strategic framework (2010-2015). CIHP will strengthen data reporting through the three tiers of government. As lead Implementing Partner for SI in the six supported states, CIHP will encourage and support the government establishment of HMIS unit with capacity to coordinate HIS, M&E and Surveillance and survey activities, through advocacy, formation of stakeholders pressure group and development of a model LGA and State HMIS system.

Monitoring and Evaluation (M&E):

CIHP will continue to strengthen capacity at all levels for M&E by supporting the building of a critical mass of health workforce at service delivery point, community, LGA and state. CIHP will work with the states to develop and implement cost effective strategies for coordinating strategic information activities at states and local government level to ensure a harmonized data collection and information flow structure in line with National strategy.

Surveillance and Survey (SS):

CIHP will continue to participate actively in surveillance and survey related activities in Nigeria. In particular, CIHP will avail the GoN at all levels of its expertise in protocol and tool development for both behavioral and biological surveillance systems for tracking the National response. CIHP will provide additional support to GoN in the area of dissemination of findings from such surveys and work with GoN of Nigeria at all level in the analysis of surveys.

CIHP will implement activities to improve health sector leadership and governance to support transition over time to state and LGA, site MDTs, and CBOs. CIHP will build on technical support, for regional M&E, logistics, and accounting to support sites, state governments, and local CBOs/FBOs to strengthen capacity, ensure sustainability, and facilitate program activities transition.

Promoting leadership and governance

Capacity of CBOs/SMOH will be built on SI, proposal writing, project/financial management to increase their skills, enhance responsiveness with emphasis on accountability and transparency.

Enhancing the Service Delivery package

high quality service provision will be promoted through an integrated service package based on population health needs to reduce barriers to equitable access.

Strengthening of the Health care Workforce

CIHP will engage state/local governments to adopt measures for equitable distribution of health workforce especially in the semi-urban/rural areas. It will work with new partners -NMCN, CHPBN and NMDC to implement activities addressing HR and quality challenges across the supported states. It will support the first GON HRH summit to address issues related to an efficient and motivated workforce. CIHP will adopt a sustainable and cost effective in-service training strategy according to national guidelines.

Strengthen existing HMIS

CIHP will evolve a program tracking system including GIS mapping for all sites providing HIV care in the country to enable them provide up to date information on service coverage, HR capacity and linkages.

Strengthening procurement and logistics will improve service delivery at HF. HF will be supported to forecast and request for sufficient commodities using the MAX-MIN inventory control system.

Lab QMS will be instituted in all sites in preparation for National/International accreditation.

Advocating for a good health financing system

CIHP will advocate to states and LGAs to source funds for health services to reduce the financial burden on citizens and improve access. CIHP will strengthen capacities of finance and admin staff while working closely with other IPs and donors like PATHS2, on HSS in Nigeria to leverage resources.

Blood Safety Strategies

CIHP will promote blood safety with emphasis on strengthening facility blood transfusion committees, community awareness and blood drives, provision of blood safety items, linkage of blood banks to NBTS and building capacity of HCW. CIHP will work to implement the WHO guidelines recommending 10-20 blood donors per 1000 population in supported facilities and communities. In COP12/13, CIHP will reactivate blood transfusion committees in facilities and create new ones in newly supported sites. Blood transfusion committees will be integrated with existing safe injection and waste disposal committees to ensure efficiency and harmonization of activities.

CIHP will develop pool of low risk Voluntary National Blood Donors (VNBD) by strengthening the development of a nationwide voluntary donor recruitment system and providing technical support for blood donation drives in facilities/surrounding communities. CIHP will advocate to supported hospital managements to buy into the NBTS blood services program to create demand, provide support for blood donor organizers, and strengthen health facility and community focused blood drive activities. CIHP will continue to strengthen the use of questionnaire for donor screening and will develop with NBTS standard messages for donor counseling. Linkages between donor points and HTC will be strengthened to ensure positive donors identified receive appropriate counseling, information and linkage to C & T. CIHP will intensify community mobilization and awareness working with the Red Cross, NYSC/Road Safety club, CBOs, FBOs and support groups to sensitize on the need for VNNBD.

CIHP will support the distribution of IEC/BCC materials to promote VNBD in facilities and communities. CIHP will strengthen and partner with Club 25, a group of youths who voluntarily seek to donate a number of pints of blood before they reach 25 years. CIHP will work with club 25 in Kaduna and other states to provide awareness and promote voluntary non-remunerated blood donation their communities. Club 25 will be linked to CIHPs youth friendly activities to integrate blood safety with other services and duplicate the concept across supported states where feasible.

Safe Injection Strategies

In COP 12/13, CIHP will promote safe injections and proper disposal of infectious waste generated in all supported facilities, targeting directly HCWs in these facilities and surrounding communities. CIHP will train all HCW (doctors, nurses, lab personnel, waste handlers) in safe injections and waste disposal. CIHP will work with the lead IP in injection safety and waste disposal to train additional 320 HCW in injection safety and waste disposal. CIHP will also provide IEC materials/job aids to promote behavioral change, implementation of USP in supported facilities; protective and waste disposal commodities and devices will continue to be provided to waste handlers and other HCW. Commodities will include: industrial boots, gloves, face masks, vacutainers, protective goggles, face masks, protective aprons and lamina hoods as and others such as sharp containers, bench absorbent pads, biohazard bags, spill kits and hazard neutralization materials. CIHP will work through SCMS mechanisms to procure equipment and supplies for injection safety and waste management. CIHP will also strengthen activities of waste management committees and establish new ones in new facilities.

Behavioral change will be promoted amongst HCWs to enable adoption of safer workplace behaviors to reduce re-use of syringes and needles, promote segregation of waste, and promote sterilization and appropriate disposal of used needles. CIHP will also promote appropriate waste disposal ensuring that bio-medical and other infectious waste generated are properly disposed of by repairing existing incinerators and providing new ones where required.

CIHP will key into the Integrated USG approach to expiry management by participating in all waste drive process to ensure proper management of expiries of laboratory reagents and drugs. CIHP will participate in the implementation of NPHCDA Health Care Waste Management (NHCWM) framework in collaboration with stakeholders.

CIHP will provide the minimum prevention package to individuals with messages on Abstinence and be faithful (AB), through participatory activities such as community outreaches, interpersonal communication activities, counseling and youth focused programs. Messages promoting abstinence (primary and secondary) and mutual fidelity will be provided to the appropriate target groups. Prevention messages targeting MARPs, including condom promotion will be supported.

CIHP will target activities to HIV negative persons in its catchment areas in order to minimize their risk behaviors and contribute to an overall reduction in HIV prevalence. AB activities for youth/young adults aged 15-24 years, the highest prevalence age group, will be supported. 12,212 individuals will be reached with intensive AB messaging. In addition, 11,233 children and adolescents will be reached with age-appropriate abstinence only and secondary abstinence messaging with particular focus on VC.

A total of 455 HCWs, counselors, and peer educators will be trained to conduct effective prevention interventions inclusive of AB messaging.

Community-based approach

CIHP will partner with CBOs, (FBOs , and PLWHIV groups at its facility and community levels in the dissemination of AB messaging using the peer education model, and to wider audiences through the non curricula based school approach and community awareness campaigns. Activities will include role plays, youth and kids clubs, debate and quiz competition and rallies. To address stigma issues and in compliance with the GIPA principle, at least 10 PLWHIV from the pool of those receiving treatment at facilities who are living openly and positively will be trained as role models to disseminate AB messages.

Facility-based approach

AB messages will be disseminated through HCWs who will continually serve as conduits for age appropriate prevention messaging not only for their work peers but also for their social peers and for all clients with whom they come in contact using the prevention with positives intervention tool. Prevention activities will be integrated into other points of service in each health facility (GOPD, TB, STI clinics, RH and youth friendly clinics).

HIV Testing and Counseling

In COP 12/13, CIHP will support HTC in at least 181 entities including 55 secondary hospitals, PHCs, and CBOs with strong linkages to 13 non-hospital facilities in six states. Activities will focus on MARPs; scale up of PITC , expanded access to couple HTC services and mobile HTC services including Home based testing.. At least 149,523 individuals including MARPs will receive counseling & testing (in a non-TB/non-PMTCT setting) and receive their results annually.

Reaching MARPs: Innovative approaches will be instituted to reach MARPs in supported states. CIHP will expand access to HTC outreach services in high risk communities; 10 additional stand alone sites will be established in high burden communities.

Community linkages and communication: referral linkages will be strengthened at the facility and community levels; youth-friendly centers will continue to be strengthened. Condom distribution supported by CIHP will be implemented by CBO partners.

HTC Quality Assurance and linkages: CIHP HTC team will work with the Federal and State governments to ensure quality of HIV testing by participating in all QA initiatives. Testing will be conducted with current National testing algorithm. CIHP will strengthen its QA supervision and mentoring to implement GON QA/QC procedures.

Task shifting strategies: As part of CIHPs strategy of promoting task shifting CIHP will promote the use of lay counselors to conduct HIV testing at the facilities and communities. 421 lay counselors will be trained to conduct testing and increase uptake of services annually.

HTC integration with MNCH and TB services: CIHP will integrate HTC into existing MNCH, family planning and TB DOTs services in supported facilities to expand access to prevention services. TB DOT providers and other service providers at these points will be trained to provide HTC services and referrals.

Strengthen linkages and M&E systems: CIHP will strengthen HTC linkages with C & T and other community services. M&E systems will be strengthened through provision of National data capturing tools to ensure documentation and record keeping. 421 HTC providers will be trained in documentation and reporting.

CIHP will partner with supported health facilities and CBOs to promote safer sex, risk reduction activities, correct and consistent condom use skills and STI management through strategic activities such as community outreaches, IPC activities, capacity strengthening, counseling and youth focused programs as part of the prevention package.

62,191 individuals will be reached with risk reduction and safer sex promotion activities, correct and consistent condom use messages, communications skills & condom negotiation, partner notification and good health seeking behavior. The target groups will include MARPS, PLWHIV, PABA, and out of school youths; they will receive COP messaging on a regular basis in a non-curricular based approach.

Positive Health Dignity and Prevention Interventions (PHDP)

CIHP will support the PHDP interventions with the provision of job aids, IEC materials, and prevention commodities including the provision of STI screening tools and treatment commodities. A total of at least 432 facility and CBO care providers will have their capacities built on PHDP activities.

Facility-based Approach

The integration of prevention counseling and other services\\ for PLWHIV into FP, STI and MNCH clinics will be supported as part of the PHDP interventions. CIHP will support the provision of job aids, IEC and prevention commodities to promote facility based combination prevention activities. Facilities will be assisted to implement pre and post exposure prophylaxis (PEP) where exposures occur. Job aids and BCC materials on universal safety precautions and PEP will be provided to support prevention at health facilities.

Community based approaches

CIHP will build on partnerships with CBOs to provide appropriate interventions through peer health educators, mothers groups, community role models, and pressure and support group networks.

Supporting Male Involvement

Male involvement will be encouraged through male friendly initiatives for men who accompany their families to clinics. Other expanded male-focused activities will be promoted through FGDs, safer sex practice sensitization. CBOs will be supported to mobilize men to support HIV/AIDS and RH initiatives through community specific initiatives.

Scaling up PMTCT and HIV Exposed Infant Services

CIHP rapidly scale up and expand access to PMTCT services in public and private facilities across all sites especially the high HIV prevalence states of Akwa Ibom, Benue and Kogi CIHP through its lead IP role and build capacity of state partners to coordinate, implement and monitor PMTCT programs across five states. Minimum package of care services to HIV-exposed infants will be provided at PMTCT sites.

Capacity building and Implementation of the current PMTCT Guidelines

ART for PMTCT will follow the National Pediatric/PMTCT guidelines. 5,463 mother-baby pairs will receive ARV prophylaxis and counseling for safer breast feeding practices. HAART will be provided for 1,092 eligible (20%) pregnant women at the nearest comprehensive sites and high volume PHCs. 912 HCWs will be trained using GON curricula, to provide enhanced package of quality MNCH services.

Support GoN on safe Voluntary Medical Male Circumcision (VMMM)

CIHP will encourage safe VMMM where applicable as a preventive measure especially in Kaduna and Gombe states.

Support GoN to integrate and expand PMTCT service package

In line with GHI focus of service integration, CIHP will pilot a comprehensive Well-Mother package in high volume HF, to improve health of women. This package targets the leading causes of maternal and newborn mortalities and focuses on safe motherhood services, FP, STIs screening and management, malaria prevention.

Strengthening Community PMTCT services and Male Involvement

At least 150 TBAs linked to PMTCT sites will be trained annually to support PMTCT services. CIHP will strengthen the MTA Initiative to promote male support for PMTCT services.

Strengthening PMTCT management information system

CIHP as the Lead IP for M&E, will coordinate and contribute to the national PMTCT programs M&E efforts through the five states.

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

Supply Chain Management Systems

In COP 12/ 13, CIHP will work with the SCMS and other in-country coordinating mechanisms to provide first and second line ARVs for adult and pediatric clients. CIHP will continue to strengthen local logistics systems, by strengthening the state logistics management systems and renovating SMOH-owned medical stores. Procurements will include site level logistics data, forecasting, quantification and procurement plans for all HIV program areas. Product selection will be based on existing national treatment guidelines using drugs with FDA approval or tentative approval which are NAFDAC registered or approved. CIHP will strengthen logistics support to sites to facilitate prompt, efficient and effective distribution of ARV and OI drugs and other commodities. CIHP will continue to integrate quality assurance, M&E systems into its existing logistics system and continue to increase capacity of site staff in logistics management of ARVs and related commodities, documentation and reporting and inventory management best practices.

Pharmaceutical care services

CIHP will strengthen delivery of pharmaceutical care services to clients by the use of pharmaceutical care tools at service delivery points and will promote adherence by increasing access to ARV fixed dose combinations (FDCs) for pediatric and adult clients. To strengthen ARV ADR reporting and monitoring at supported sites, CIHP will conduct a training of trainers (TOT) on pharmacovigilance and will support the set up of state and facility pharmaco-vigilance teams. SOPs will be provided to guide quality pharmaceutical care implementation for PLWHIV. CIHP will provide technical assistance and build the capacity of health care workers in the delivery of quality pharmaceutical care to PLWHA, pharmacy documentation etc. through trainings, on site mentoring and supportive supervision. CIHP will also provide technical support on management of expired drugs at supported sites. CIHP will support non-monetary incentives for health care workers, through sponsoring the participation of site pharmacy staff and CIHP staff in the Pharmacists Council of Nigeria endorsed trainings and conferences.

Access and Integration

At least 12 new comprehensive sites (private and public facilities) will be activated to expand access to underserved area with high HIV prevalence. Gender equity will be promoted for increased access to services for women and children.

Support GoN for National Guidelines review

National ART guidelines will be reviewed with FGoN to reflect the new WHO ART guidelines.

Integration of care

Service integration will be encouraged through co-location of services such as TB/HIV, MCH and RH services.

Linkages to wraparound health

VL testing for treatment failure suspects will be ensured through partnerships. Also partner with 30 CBOs to provide community based HTC, OVC, HBC, and PPHD services

Decentralization C&T

Services will be decentralized to additional PHCs for ART pick up for stable patients.

Quality: Management of Treatment Failure, ARV Resistance and Pharmacovigilance

Treatment failure suspects will be identified through the use of structured checklist and algorithms; repeat CD4 testing will be instituted for patients. State and facility pharmaco-vigilance teams will be established.

Provision of quality focused facility based care

Periodic quality checks conducted through the application of checklists, SOPs, Standard of Care assessment tools. Facility level quality Improvement teams will be strengthened to promote ownership of quality process.

Retention in care

Patient appointment and tracking systems will be strengthened through electronic patient database and PE programs for adherence and defaulter tracking respectively.

ARV drugs-Supply Chain Management:

First and second line ARVs will be provided through SCMS. Capacity of site staff will be built in logistics management of ARVs, inventory management and pharmacy best practices.

Laboratory services

At least 14 new labs (for 12 new sites and 2 existing) will be developed to provide HIV lab monitoring services. Services will focus on QMS, equipment maintenance and laboratory information systems.

Human Capacity Building:

ART/Palliative Care and Adherence support start up and refresher trainings will be conducted for at least 1,775 clinicians and HCWs (933 for ART and 842 for Palliative care /adherence trainings).

Pediatric treatment

CIHP will strengthen the implementation of the gains of watCh (Where are the children) strategies through periodic charts review and defaulter tracking of both HIV-exposed infants and infected infants to ensure increase pediatric enrolment and improve the quality of pediatric ART. CIHP will enhance early identification of HIV infection status to reach HIV positive children through various approaches including, pediatric HIV diagnosis; focused pediatric case finding and referral to C&T; comprehensive C&Tx services and ART for HIV-exposed infants (HEI) and HIV-infected infants following the revised national pediatric ART guidelines. CIHP will provide basic package of care, including: BCK, counseling for parents/care givers and psychosocial support, clinical care, growth monitoring, linkages to under-5 immunization services and other services, pain management, OI management, nutritional assessment, early youth development and youth friendly initiatives, lab- baseline, provision of Cotrimoxazole, IPT, HBC. CIHP will use adult care and treatment venues as additional entry points for pediatric services, through thr genealogy form to ensure that HIV-positive adults are encouraged to bring their children for HIV testing at facility. In COP 12/13, targeted testing will be strengthened using skilled CBOs to ensure that children of adult index cases in C&T are tested and linked to care.

Early Infant diagnosis: CIHP will support early identification of HIV exposure and pediatric diagnosis through scale up of EID via dried blood spot sample collection to newly activated PHCs.

Decentralization of services: CIHP will support devolvement of pediatric ART services to PHCs. Services provided will include: ART refill, adherence support, supportive counseling, HIV Education, support group meetings as well as the full basic care package.

Retention in care and treatment: CIHP will strengthen patient appointment and defaulter tracking systems and routine reporting systems for monitoring basic care and support activities. Strategies will include: joint mother-child appointments; improved counseling and peer educator support and treatment preparation before initiation of ART.