SIDHAS will build on GHAIN's successes and lessons learnt to achieve three objectives:1. Increased access and improved coverage of high quality comprehensive HIV/AIDS treatment, care and related services through improved efficiences in service delivery;2. Improved quality and intergration of HIV/AIDS services; and 3. Improve stewardship by Nigerian institutions for the provision of high quality comprehensive HIV/AIDS services in over 130 public sector tertiary, secondary and primary level health facilities. SIDHAS activities will be fully aligned with GON strategies and plans in order to to streghnten government systems and optimize ownership at federal ,state and local government levels. SIDHAS is designed with focus on health systems strenghtening(HSS); service intergration;local ownership;and quality- with all interventions delivered within GON's strategic health framework and structure. Program and technical staff will work hand in hand with public sector providers and mangers at all levels of the health system to build their capacity"on the job" through program planning, implementation and M&e. The project has built in continuous quality improvement(CQI) and the graduation mechanisms to ensure a gradual systematic transition to greater GON responsibility and accountability for HIV/AIDS services. As such, SIDHAS represents a shift from an emergency response to a chronic care model that harnesses the strenghts of the health system, communities, families and individuals in manging HIV and its effects in a more sustainable manner.

In COP 12 and 13, SIDHAS will provide care and support services to 283,950 adults . SIDHAS will adopt the chronic care model to harness the strengths of the health system, communities, families and individuals in managing HIV/AIDS and mitigate its effects. SIDHAS will also adopt positive health dignity and prevention (PHDP) to empower the PLHIV/PABA to increase their health competency and enhance their capacity to care for themselves. A chronic care checklist will be used to routinely screen for important risk factors and health issues in all patient encounters.

SIDHAS care and support services to will focus on early identification of HIV- infected persons, linkages, and retention in care; reduction in HIV-related morbidity and mortality; optimizing quality of life for HIV-infected clients and their and reduction in transmission of HIV infection. Clients enrolled into care will receive a minimum care package and the basic care kit. Basic care kits will be channeled through facility and community-based support groups for distribution within specific catchment areas.

SIDHAS will maintain appointment diaries for all Pre-ART clients to identify defaulters for both co-trimoxazole and vitamin refill and a list generated daily for contact tracking. services provided will include clinical assessment, laboratory services including OI prophylaxis and treatment, nutritional assessment/support, safe water, psychosocial support (PSS), chronic care for diseases such as hypertension, diabetes, provision of condoms STI treatment, drug adherence, risk reduction, family planning behavior change communication interventions for HIV prevention as well as pain and symptom management.

The capacities of health care providers will be built on PHDP to help change the attitudes of health care workers on stigma and discrimination. SIDHAS will support community-based organizations, support groups and community volunteers to provide home-based care to PLHIV. SIDHAS will strengthen an LGA wide referral system and use referral directories to facilitate access to comprehensive services for PLHIV. SIDHAS will also support effective coordination through quarterly care and support NTWG meetings.

In COP 12 and 13, SIDHAS will support the GoN through the Ministry of Women Affairs and Social Development in coordinating care for vulnerable children. The project will support the development of OVC service standards, guidelines and SOPs, support the review and production of an advocacy tool kit; and ensure adherence to standards through joint monitoring and supportive supervision.

Services provided will be based on the needs of each child and household in each of the service areas: Health, Food and Nutrition, Education, Protection, Household Economic Strengthening, Psychosocial support, Shelter and care. Services will be provided directly or through linkages within the chronic care continuum. SIDHAS will support strengthening of referral network among service providers. ary services appropriate to age and HIV status; build family/household capacity to care for OVC and address their basic needs. Particular attention will be paid to building economic stability of households so that parents and caregivers are able to provide for their children's long term needs; retaining children in school, and working with local governments to establish strong child welfare and protection systems.

SIDHAS will support IAs to provide:(1) Psychosocial support including at least three of the following: disclosure issues, grief and loss, kids support groups and recreation, group counseling, home visits; (2) Educational support activities including facilitation of the enrolment of female and male OVC in schools, provision of school uniform and books etc. (3) Nutritional support for all OVC involving at least three of the following: assessment, counseling, supplementation, therapeutic nutrition (4) Health services (ART and non-ART care for infected and affected children). SIDHAS will provide preventive kits to HIV positive OVC (water guard, lidded bucket, long lasting insecticide treated nets). OVC will also access other services through referral to the relevant organizations for: (5) Child protection activities including legal support, birth registration, abuse monitoring, and child meaningful participation and collaboration with child protection networks being supported by other IPs (6) shelter, (7) household economic strengthening

SIDHAS will support the GoN in the roll out of the National OVC Management Information System at federal, state and LGA levels.

In COP 12 and 13, SIDHAS will strengthen TB/HIV collaborative activities across all operational sites To increase early TB detection and treatment among PLHIV. TB screening, diagnosis, treatment and prevention will be based on the new WHO recommendations, using the 3 Is strategy:1) intensified TB case finding among PLHIV; 2) infection control and 3) isoniazid preventive therapy, including antiretroviral therapy (ART) for people co-infected with TB. SIDHAS will leverage resources through Global Fund and the National TB and Leprosy Control Program (NTBLCP) to optimize DOTS expansion and expand from 186 sites to 215. TA and training will be provided to HIV/AIDS/TB programs managers to ensure all TB patients know their HIV status and cotrimoxazole prophylaxis for those who test HIV positive. SIDHAS will ensure all HIV positive patients are screened for TB following WHO recommended clinical algorithms during their first and follow up encounters.

Infection control will be strengthened through development of facility implementation plans based on risk assessments. Training on TB infection plan will be based on gaps identified. Committees on TB IC will be set up and supported on a quarterly basis through review meetings and continuing medical education. Performance TB/HIV indicator data will be analyzed on a monthly basis and feedback shall be provided to at all levels for decision making.

SIDHAS will continue to support Nigerias national plan to expand DR TB diagnosis and management by supporting the operations of the renovated existing specialized TB wards and labs. SIDHAS will collaborate with IHVN and TBCARE1 to leverage resource for MDR TB expansion. GeneXpert for sensitive and rapid diagnosis of both TB and Rifampicin resistant TB in designated centers will be utilized. SIDHAS will partner with TBCARE1 in COP 12 and 13 to maintain the existing community TB care projects using CBOs and community volunteers (CVs) for community sensitization and mobilization, suspect referral and treatment support. A family centered approach will be used for symptom screening of all TB patient contacts as well as household members and referring those indicated as TB suspects for diagnosis and treatment.

In COP 12 and 13, SIDHAS will support 27,223 children with facility and community based care and support services in line with national guidelines. SIDHAS will provide services that are children-focused and friendly across the following core areas: clinical care, prevention care and supportive care tailored to the specific needs of the child and the family. A minimum care package including basic care kits, clinical services and laboratory services will be supported.

Routine multipoint testing through PITC will ensure early identification of HIV- infected children. Linkage with PMTCT services to ensure follow up of mother baby pair, EID and enrolment of HIV infected babies will be strengthened. The linkages for exposed babies to the existing national EID networks shall also be strengthened. CPT, multivitamin supplementation, deworming, nutritional assessment/support, growth monitoring/developmental milestones, immunization and prevention/management of childhood illnesses will be strengthened within an IMNCH package. Early infant treatment will be instituted based on national guidelines. Strategies to ensure retention in care and treatment; reduction in HIV-related morbidity and mortality; optimizing quality of life for HIV-infected child and their families throughout the continuum of illness will be strengthened. Laboratory services for monitoring of hematological, blood chemistry and immunological status, management of opportunistic infections, age appropriate medication adherence counseling, drug side effects management, stigma reduction, psychosocial support and spiritual counseling will be provided.

HIV positive children and their caregivers will be linked with community services. SIDHAS will collaborate with Association of Community Pharmacists of Nigeria (ACPN) and the NHIS for the provision of limited PMTCT related support services under the GON NHIS on a fee-for service basis. The capacity of CBOs and support groups will be built on nutritional support to children and their families and the preparation of MIMAGROWS (A locally sourced nutritional supplement) Screening and treatment of children with acute malnutrition with RUTF will be supported through partnership with CHAI.

In COP 12 and 13, SIDHAS will maintain 125 GHAIN supported labs across all 36 states and the FCT and upgrade six PMTCT standalone sites to full laboratories to support ART services. HIV disease monitoring tests will be conducted. Laboratory tests will include HIV serology, CD4 count, hematology, clinical chemistry, VDRL, pregnancy test, and HBsAg. SIDHAS will support additional tests for OIs, pilot POC CD4 testing at the PHC level, establish and strengthen the sample referral and transfer networks and pilot the integration of the ART laboratory into general laboratory.

SIDHAS will ensure equipment maintenance through service contracts in collaboration with other IPs. LGA and facility management will be trained in planned preventive and routine maintenance and equipment contracts management. In collaboration with GoN and other partners, SIDHAS will support the deployment and training of staff, supply of commodities, and use of LMIS across all levels of service delivery. The national Proficiency Testing system will be strengthened through assistance to MLSCN, while sustaining the current PT with South Africa. Internal quality control will be enforced in routine practice and introduction of DBS and DTS in HTC sites. SIDHAS will collaborate with the SLAMTA team and MLSCN to extend WHO/AFRO level accreditation support from five laboratories to 10. National accreditation will also be supported for some secondary sites.

SIDHAS will support in-service training and re-training of lab staff according to the national guidelines. SIDHAS will collaborate with relevant stakeholders to strengthen the National strategic plan for laboratories, provide standard lab training tools and support LTWGs in the development of laboratory policies and guidelines.

In collaboration with the NTBLCP, TBCAP, CR SMoH and other partners, upgrade of MDR-TB labs in UPTH Port Harcourt and NIMR Lagos to BSL2 and BSL3 respectively will be supported to enhance MDR-TB diagnosis & increase TB case detection. Case detection capacity will also be enhance through the introduction of GeneXpert technology. SIDHAS will continue support of the FMC Jalingo PCR-EID laboratory which will be expanded to include HIV viral load testing using DBS specimen.

SIDHAS will build a government driven sustainable M&E system by promoting the Three-Ones principle that facilitates timely and complete reporting of service statistics from the communities and health facilities, through the LGA and state to national level. SIDHAS will participate in technical working groups (TWGs) and subcommittees, partner coordination fora as well as data and program review meetings. SIDHAS will support the ongoing indicator harmonization exercise, the use of electronic data management system, the national roll out of NOMIS and DHIS 2.0 and the use of LAMIS as well as the review of national data collection tools (DCTs).

In COPs 12 and 13, SIDHAS team will engage with state authorities to establish SITs, with M&E representation in all 36 states and the Federal Capital Territory (FCT). SITs will be supported to develop costed annual M&E work-plans and to coordinate the implementation of M&E activities in their respective states, with technical assistance and supportive supervision from SIDHAS technical teams. SIDHAS will deploy national DCTs to service delivery points (SDPs) and institute a data collection and reporting cycle in line with the national system. Joint monthly data validation and quarterly data quality assurance (DQA) visits will be carried out to verify data. The DQUAL (an electronic data quality assessment tool) will be deployed to support electronic transmission and aggregation of DQA scores. Data collection and validation activities will be transitioned to LGA M&E officers by COP 13, with the SIDHAS team maintaining mentoring oversight on their activities through the joint quarterly DQA exercises with state officers.

CQI tools will be integrated, addressing technical, institutional and financial sustainability. Implementation of LAMIS will be maintained in 14 comprehensive sites. SIDHAS will roll out a simplified version of LAMIS (mini-LAMIS) to better track patient level outcomes. Baseline mapping of state level master trainers and M&E training using an integrated curriculum will be conducted. SIDHAS will facilitate the conduct of operations research at selected facilities to assess cost, effectiveness and efficiency of different program models to guide implementation.

SIDHAS overarching goal is to support GoN to take ownership of the health sector and lead a sustainable response to HIV/AIDS. In line with GHI and the paradigm shift towards decentralized services, the health system strengthening building blocks will be used as guiding strategies. SIDHAS will focus on integration and sustainability and build on the earlier successes to wean program off technical support. Continuous Quality improvement systems platform will be used to track progress of health facilities, civil society organizations, LGAs and SACA/SMOH across the sustainability domains towards graduation. At the national level, SIDHAS will work with AHNis gender expert to harness on strong relationships with government agencies to support and build their leadership roles in reviewing and implementing the 2006 National Gender Policy.

SIDHAS staff will be co-located in GoN state offices, to ensure ongoing decentralized support and capacity building for state counterparts. Key staff of SMOH, HMB & LGA service commission will be identified for training to strengthen human resource management systems such as workforce planning, recruitment practices, and performance management, as well as HR managers able to perform these functions. Staff capacity will be built to scale up workload analysis (WLA) to 4 LGAs per COP year and to adapt Workload Indicators of Staffing Needs (WISN) to secondary health facilities. This will support the deployment of appropriate skills mix for achieve optimal effect.

.

SIDHAS will support advocacy to increase GoNs financial commitment to HIV/AIDS and other health services. The advocacies will be continuous and will target National Council of Health, Nigerian Governors Forum, Association of Local Government Areas of Nigeria, CSOs and USG. SIDHAS will support the financial and institutional capacity building for States, LGAs, secondary facilities and CSOs. SIDHAS will collaborate with NACA to conduct cost-related operational research. The capacity of GoN will be strengthened to develop workplans and budgets; prioritize activities for implementation; advocate for and manage resources; analyze budgets; retire expended funds appropriately; track and report expenditures.

It is estimated that between 5% and 10% of all HIV infections worldwide is through transfusion of contaminated blood and blood products. To reduce medical transmission of HIV, SIDHAS will facilitate screening for transfusion- transmissible infections, capacity development, universal safety precautions in handling blood and blood products, good laboratory practice and management of medical wastes.

SIDHAS will support the 30 blood safety sites and Hospital Linkage Program (HLP) to promote use of rapid test kits for the screening of all donated blood for transfusion transmissible infections (TTIs) including HIV, hepatitis B, hepatitis C, Treponema pallidum (syphilis). SIDHAS will also provide ELISA screening in selected sites in order to improve blood safety funding permitting. SIDHAS will provide support for the 4 HLP sites as a model blood banks linked to the National Blood Transfusion Service (NBTS). These sites will conduct blood donation drives in collaboration with the NBTS, promote the principles of centralized blood transfusion services, voluntary non-remunerated blood donation as opposed to paid donors/family replacement. The National blood donor questionnaire will continue to be used to screen all donors and the data submitted to NBTS center as part of the national database.

SIDHAS will work closely with health facilities and Hospital Management Boards on universal precautions and the provision of essential consumables and services that protect the health worker from contacting blood borne pathogens. The safety materials that will be provided include personal protective equipment (PPE) such as hand gloves and laboratory coats, Aprons, blood containers and other consumables (Methylated-spirit, bleach, biohazard bags, and antibacterial soaps). SIDHAS will collaborate with Safe Blood for Africa Foundation (SBFAF) and NBTS on trainings of health care workers on safe blood transfusion, commodities management, support for blood donor drive for continuous availability of fully screened safe blood to minimize emergency screening. SIDHAS will strengthen capacity of health care workers with appropriate knowledge and skills to deliver effective services.

Unsafe injection practices have been well documented as a major cause of transmission of blood borne pathogens such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). In recognition of the importance of infection prevention and control in injection safety, SIDHAS will support access to safe injection practices in all supported sites. Activities will include on-site refresher trainings and strategic behavioral change

SIDHAS will train facility supervisors and HCWs on universal safety precautions and post exposure prophylaxis (PEP) at all sites. SIDHAS will support availability of PEP drugs in all comprehensive and ART refill sites. SOPs and forms for reporting PEP will be made available in all facilities.

In order to facilitate behavior change of the health workers and clients at all supported health facilities, SIDHAS will support the federal and state ministries of health in their efforts through dissemination of the injection safety policy at all levels of government. Behavior change communication (BCC) materials on injection safety produced by John Snow Inc. /AIDSTAR One project will continue to be distributed to all supported sites and may be reproduced where unavailable. SIDHAS will strengthen capacity of health care workers through onsite or centralized training as appropriate, mentoring, coaching among others. These will equip health care workers with skills to deliver quality services to clients.

In line with the National Prevention Plan (NPP), in C0P 12, SIDHAS will support sexual prevention interventions including Abstinence and Be faithful (AB). A combination of intervention strategies will be employed to appropriately address the needs of the different target population groups such as adolescents and youths; occupational migrant workers such as Road Transport Workers (RTW) and People living with HIV (PLHIV).

Abstinence interventions will be tailored to address the needs of youths particularly adolescents (age 10 19 years). This activity will largely be integrated in the prevention, care and support package for Orphans and Vulnerable Children (OVC). SIDHAS will support selected CBOs to train behavior change agents (peer educators, volunteers and caregivers (family-centered approach) in life skills and improve adolescents knowledge and skills on sexual and reproductive health including HIV/AIDS prevention. The supported CBOs will reach both in-school and out-of school young people utilizing forums such as sports events and church clubs. In addition to one-to-one interactions, CBOs will disseminate prevention messages using IEC materials. The messages will emphasize both primary and secondary abstinence.

The Be faithful component will target men and women of reproductive age using the platform of the PMTCT mothers support group, the Safe Space Youth Clubs (SSYC), and the PLHIV support groups. This is with the aim of addressing the prong 1 of the PMTCT gap, and promoting positive health, dignity and prevention.

Furthermore, SIDHAS AB Prevention program will address issues relating to preventing unintended pregnancy (PMTCT prong 2); sexually transmitted infections including HIV by promoting abstinence, delay of sexual debut, be faithful, condom use and offer opportunities to practice negotiation and refusal skills. It will also seek to address the key drivers of Nigerias HIV epidemic such as low personal risk perception, multiple concurrent sexual partnerships, transactional and intergenerational sex, gender inequalities, stigma and discrimination, and accessing health services by mobilizing communities to address norms/behaviors that predispose individuals to HIV.

HTC is an entry point for HIV prevention, care and treatment. In COP12 and 13, SIDHAS will build on GHAIN and leverage on Global Fund to support established 147, HTC facilities and communities through a combination of provider and client-initiated testing and counseling. HTC will be provided at multiple service delivery points like medical, pediatric wards, outpatient units, ANC, FP, TB and STI clinics, with same-day results. SIDHAS will encourage and support couple HIV testing and counseling. SIDHAS will incorporate effective strategies to transform harmful gender norms and behaviors, empower women and girls, and engage men and boys as partners and agents of change in improving uptake of HTC services. These strategies will identify and address gender norms that affect disclosure, constrain demand for couple counseling and testing for HIV and impede sustainable uptake/utilization of HTC services women and girls.

SIDHAS will update and use the existing national referral directory developed by GHAIN to link positive clients to access treatment and other care and support services. HTC activities will be linked to community-based activities through CSOs to create demand for service uptake. SIDHAS will emphasize keeping individuals HIV negative through building capacity of health care workers as prevention advocates who will assist to translate knowledge about HIV prevention into practice by helping clients to commit to three activities to remain negative and after three months assess results and provide reinforcements. CSOs will be trained to implement the MPPI strategy. Community and outreach activities will be conducted to deliver messages on shared responsibility and interventions about keeping negative within the context of promoting health and self-esteem. SIDHAS will promote sustainability ownership, through training of responsible departments at national, state and local levels (NACA, NASCP, SACA, SASCP, LACA) in planning and managing HTC programs as well as monitoring and evaluation (M&E) and reporting. Resources will be leveraged through the GoN, private sector and other funders, to carry out mobile T&C services. SIDHAS will ensure quality control of HIV testing using DBS and or dry tube sample (DTS).

GHAINs other prevention activities focused on HIV/AIDS behavior change communication targeting audiences such as the National Union of Road Transport Workers, Female Sex Workers, and Men having Sex with Men through CSO partners. In COP12 and 13, SIDHAS will continue to implement MPPI to increase access to HTC services for MARPs and hard-to-reach populations by establishing outreach HTC through CSOs in three-high burden geopolitical zonesof Nigeria (NE, NC and SS). SIDHAS will collaborate with the partner implementing the USAID funded MARPs program to establish linkages to care and treatment. SIDHAS will work to make condoms availability at service delivery points at the health facility and the community. Community based distribution pattern will be established through supporting local CSOs and peer groups. SIDHAS will continue to collaborate with other USG partners in condom programming for supply, management and monitoring. The national monitoring and evaluation tools will continue to be used to capture data on condom forecasting, distribution, and data management.

SIDHAS will provide preventive HIV services to PLHIV through facility and community based activities by implementing the three interrelated components of positive health dignity and prevention (PHDP) as stated in the Nigerian National HIV/AIDS Prevention Plan 2010-2012 and implement prevention activities through Minimum prevention Intervention package (MPPI) strategy. PHDP will focus on safer sex, condom use and fertility desires; illness prevention through cotrimoxazole preventive therapy, adherence to ART and consistence insecticide treated nets (ITN) and support clients and strengthen self-care practices that promote good health and well-being; referral procedures for FP, PMTCT, TB, STI, mental health and other PHDP related services at community level.

It will involve education of PLHIV and their families; and training and mentoring of HCWs and PLHIV support group members to achieve greater confidence, obtain problem solving skills and lead healthy lifestyles.(E.g. reducing alcohol and tobacco use). Strategies to transform harmful gender norms and behaviors, empower females and engage males as agents of change will be incorporated.

In COP 12&13, SIDHAS will continue supporting PMTCT services in existing 182 GHAIN-supported sites and decentralize services to all ART refill PHCs particularly to reach underserved populations with high HIV prevalence. PMTCT services will be decentralized to 13 PHC clinics in COP 12 and 20 HTC sites in COP 13.

Using the WHO four pronged approach, sites will be supported to offer provider-initiated testing and counseling (PITC) at multiple service delivery points including ANCs, labour ward, PNCs and FP clinics and integrated within the INMCH settings. HIV positive pregnant women will be provided with ARV for therapy or prophylaxis in line with national guidelines. Access to CD4 testing for all HIV positive pregnant women, and point-of-care testing machines at ANCs and PHCs (where feasible) will be provided to reduce attrition along PMTCT cascade. Through Continuous Quality Improvement (CQI) ARV prophylaxis uptake and adherence will be strengthened. SIDHAS will support increased ANC attendance through outreaches and linkages to peripheral facilities and work with 20 CSOs to disseminate primary HIV prevention and PMTCT messages to women of reproductive age, encourage partner testing and provide male and female condoms. Sociocultural barriers to contraception and gender issues will be addressed through community mobilization, health education and the promotion of male involvement in family planning interventions. SIDHAS will support the development of an SSYC community service/PMTCT module that builds on members capacity to promote ANC utilization.

Trainings of HCWs at the PHCs on drug inventory management process and rational use of ARVs will be conducted and capacity will be built on adherence counseling, ARVs clinical pharmacovigilance and follow up of mother baby pairs. Safe infant feeding practices and adequate nutrition of mothers will be promoted within the ANC and postnatal clinics. In addition, women will be linked to facility and community-based support groups using the chronic care model while exposed infants will be provided EID services. SIDHAS will evaluate the effectiveness of PMTCT interventions and also work with GON to review the National Drug Policy at the PHCs level.

Continuous availability of commodities is essential to the provision of good quality services. SIDHAS will focus on training the State Ministry of Health (SMOH), Local Government Area (LGA) and facility staff on supply chain management for health commodities to ensure efficient and quality services delivery at minimum cost possible to the patients. In addition, there will be infrastructural development, integration of health commodity management at all levels and decentralization to foster ownership and sustainability of health programs by Government of Nigeria (GON).

SIDHAS will support the renovation of health commodity stores in 50 health facilities and support the integration of HIV commodities management with that of other health commodities. An additional model warehouse will be renovated to support the health facilities in the North East geopolitical zone in COP 12 to increase availability and access to commodities.

In COP 12, in line with Global Health Initiative (GHI) principles, SIDHAS will initiate discussion for the integration of the supply system of contraceptives and antituberculosis drugs to enhance logistics system strengthening for all health commodities at both the state warehouses and health facility stores. SIDHAS will also initiate the process of transitioning of supply chain management services to GON staff at the state level.

In COP12 and 13, SIDHAS will support the decentralisation strategy through the states and LGAs for efficient decentralised storage and, for the dispensing of health commodities for both ART and PMTCT in PHCs. In COP13, SIDHAS will advocate for state-led partner co-ordination and, will establish an integrated health commodity distribution system for increased efficiency.

SIDHAS will work closely with GON and States Ministry of Health in the selection, forecasting and quantification processes to ensure continuous availability, prevent stock out and expiries. Staff of state and LGA will be trained on good warehouse management practices. SIDHAS in conjunction with GON will conduct joint supportive supervision visits to support the transition process

SIDHAS will scale up ART services from 124 to 130 sites in COP 12 by upgrading six PMTCT standalone sites to deliver ART. Treatment services will be designed using chronic care model, smart integration and continuum of care to improve quality of services and promote country ownership. Technical support to sites will focus on adherence, retention, strengthening facility-based continuum of care and capacity building. Early identification of treatment failure cases as well as prompt switch to next line drugs when required will be ensured. The GoN will be assisted to decentralize ART services from secondary health facilities to 55 additional PHCs by end of COP 12 and 13 making a total of 65 ART refill sites. Capacity building, refurbishment and access to essential CD4 testing will be provided. The community pharmacists program established in GHAIN will be used to support the ART decentralization. Using workload analysis tool, SIDHAS will work closely with GoN on optimizing existing staff at the PHC level for ART decentralization. Integration of HIV treatment services into hospital systems at secondary facilities will be instituted and where feasible, ART services will be integrated in outpatient clinics to optimize resources. The use of bulk sms text messaging as a platform to strengthen adherence and retention of patient in supported ART facilities will be explored.

SIDHAS will institute a multidisciplinary approach to active clinical pharmacovigilance for ARV drug therapy that involves active screening for ADRs in all supported facilities in collaboration with National Agency for Food and Drug Control (NAFDAC). CQI systems will be expanded at the facility level by improving service quality using a collaborative approach while strengthening links between the community and facility. PHC facilities will also be strengthened using the integrated service delivery model that appropriately links clinical and pharmaceutical services in the health facility and care services in the community. PHDP will be implemented within facility and community by focusing three key components of preventing onward transmission of HIV, illness prevention and gender based violence and enhancing self-care capacity.

In COP 12 and 13, SIDHAS will focus on providing children and adolescents integrated services using the family centered approach. SIDHAS will enroll HIV positive children below 15 years newly on ART and provide treatment services to 13,937 HIV infected children in ART sites in 36 states and the FCT. SIDHAS will follow up mother-baby pairs by aligning it with infant immunization schedules and strengthen referral linkages between the community, PMTCT and ART sites for continuum of care of mother-infant pair. Early infant diagnosis for HIV exposed babies will be provided by promoting testing from 6 weeks. Capacity of health care workers will be built through a combination of workshops, on-site mentoring, continuing medical education and provision of pediatric job aids, SOPs and guidelines. Health workers will be re-trained to provide fixed dose combinations (FDCs), to improve treatment adherence. The on-site mentoring program will engage experienced pediatric ART physicians to provide hands on supervision; observation and random case file review to identify site-specific challenges, strengths, weaknesses and opportunities for quality improvement

SIDHAS will promote integrated service delivery by incorporating infant and young child feeding counseling; routine child growth and development monitoring; nutritional counseling and counseling on EID into pediatric ART care and treatment services. SIDHAS will also strengthen disclosure and adherence counseling with parents and guardian through sharing of age appropriate, gender and culture sensitive information. SIDHAS will work with the primary health care development agency (NPHCDA) and other related agencies to strengthen the capacity of community health officers (CHOs), community health extension workers (CHEWs) and nurses to provide HIV/AIDS services including ARV refill at the PHCs using the IMAI and IMCI tools.

Pharmacists will be trained/re-trained on pharmaceutical care and pharmacy best practices. Community pharmacists will provide pediatric treatment supervision. Pharmacists will be trained to provide specialized medication adherence counseling, ARV clinical pharmacovigilance and support effective drugs inventory control in the pediatric ART sites.