During COP12, the transition of management responsibility for former Harvard sites to APIN was concluded, and APIN provided HIV care and treatment services at 46 comprehensive sites, 100 PMTCT sites and 58 DOTS centers in 9 states. The comprehensive sites include 12 new ones that were activated during the period. In COP 13, APIN will concentrate efforts on supporting the HIV/AIDS response in 3 states (Lagos, Oyo and Plateau) where APIN has been designated the lead PEPFAR IP, in line with the USG regionalization policy. APIN and its sub-partners will target hard-to-reach communities and HIV high-burden populations for the scale-up of HIV/AIDS service delivery, as well as contribute to the strengthening of health systems to implement sustainable HIV/AIDS programs in these states.

As part of assuming the role of State Lead IP, stakeholder meetings were convened by APIN to map out strategies for successful project implementation for each state. The process for the development of a one-year state implementation plan has been commenced. There is an on-going HIV/AIDS capacity assessment, after which a capacity building plan will be developed for each state. A 5-year sustainability plan is also being developed. In order to enhance the capacity of the state to manage the program and ensure ownership and sustainability, a State Implementation Team has been constituted for each state, with inputs from all the stakeholders. The team will be responsible for planning, implementation, coordination, resource mobilization, monitoring and supervision of project activities. Also, sites that were previously managed by other IPs in the state have been transitioned to APIN and the provision of support to these sites has been commenced.

In COP 13, APIN will continue to provide a continuum of care services that will include CD4 assessment, clinical care, provision of basic care kits, prevention and management of opportunistic infections and STIs, assessment and management of pain and other symptoms, nutritional assessment and support (nutritional counseling and food demonstration and provision of therapeutic supplements), screening for TB, safe water interventions and laboratory services. Other services include supportive services (both facility- and community-based support group activities), Positive Health Dignity and Prevention (PHDP) and various types of counseling, and social care services such as stigma reduction.

Risk assessment and behavioural counseling will be provided to achieve risk reduction through individual counseling and community outreaches by PLHIV support groups and collaborating CBOs. Facilities will be supported to provide PHDP services such as HTC for family members and sex partners, counseling for discordant couples, disclosure, healthy lifestyles and positive living, prevention messages, alcohol and substance use assessment, assessment and treatment of STIs, pregnancy/family planning intentions and provision of condoms and IEC materials.

Tracking of defaulting patients will be strengthened through established tracking teams, and the use of site appointment database system. The proposed operational research on strategies to improve the retention of pre-ART clients will be conducted once the necessary approval is given. Referral networks will be established and existing ones strengthened to improve linkages to and fro the communities and the facilities through the use of national referral tools and coordination by a designated referral coordinator.

With the activation of new sites, there will be need to build the capacity of the staff at those sites to provide qualitative and comprehensive care services, and also the need to procure and distribute care commodities such as HBC kits, basic care kit (containing long lasting insecticide net, water disinfectant, water vessel, IEC materials, condoms and soap) to clients both at the facilities and communities. Fortified food supplements will be distributed to vulnerable groups such as underweight HIV+ pregnant and lactating women, mild and moderately malnourished children, and HIV+ adult patients with BMI <18.5. In addition, Cotrimoxazole prophylaxis will be provided to eligible PLHIVs according to the national guideline.

PLHIV support groups will be supported to provide home based care, track defaulting patients and provide adherence counseling to their peers. Economic strengthening for members will be done through the establishment of savings and loans associations, with possible linkages to microfinance initiatives. The operational research on the benefits of the support group membership will be conducted once the necessary approvals are obtained and the findings disseminated appropriately.

APIN will continue to support the national and state governments to carry out its coordinating and oversight functions, and to ensure that PLHIVs are provided with qualitative care services to improve their quality of life, according to national guidelines.

In COP 13, APIN will continue to provide qualitative and comprehensive 6 + 1 services in the 3 supported states (Lagos, Oyo and Benue) to all enrolled vulnerable children (VC), 0-17 years of age, and their households, in various communities using the household-centered approach on a needs basis through partnership with Community Based Organizations (CBOs).

The services to be provided will include food and nutritional support (nutritional assessment, counseling and supplementation), and education and vocational skill training, for older and out-of-school children. The type of educational support services to be provided will include enrolment of children into non-tuition paying government schools, provision of school bags, scandals, uniforms, books, stationaries and payment of levies for VC that do not receive waivers. Older out-of-school children will be enrolled into formal skill acquisition trainings such as hair dressing, fashion designing, auto mechanic and carpentry.

Other services include healthcare (through the provision of basic care kits, such as water vessels, water disinfectants and insecticide treated nets (ITNs), and the prevention and treatment of minor childhood ailments) and rendering psychosocial support for the caregivers and the VC mainly through formation of kids/adolescent clubs which provide recreational activities and life building skills. Shelter, economic strengthening and protection services will also be provided through referral to wrap-around services. The caregivers will meet regularly at a forum, where they will be educated on the care for the children, good personal hygiene and environmental sanitation, preparation of nutritionally adequate meals using locally available foods, and also empowered with income generating activities.

APIN will partner with CBOs through an umbrella organization, Association of OVC NGOs in Nigeria (AONN) in the 3 supported states (Lagos, Oyo and Plateau). Advocacy visits will be conducted to stakeholders in these states, especially to the State Ministries of Women Affairs & Social Development (SMWASD), Commissioners for Women Affairs, Health & Education, LGA chairmen and selected community leaders. Joint assessment visits, review meetings and technical assistance will be conducted by APIN, AONN and state representatives to the CBOs. The capacity of the CBOs, SMWASD and LGA desk officers (technical and organizational) will be strengthened, via trainings and work tools provided for qualitative service delivery and better coordination. APIN will roll out the national electronic database for the management of Vulnerable Children which has been adopted by the FMWASD to its collaborating CBOs.

APIN will scale up Household Economic Strengthening (HES) at individual, household and community levels, through training of individuals on income generating activities (IGA), the establishment and strengthening of Village Savings & Loans Associations (VSLA), cooperative societies and linkages to microfinance schemes, both at the household and community levels, to achieve sustainability. APIN will continue to collaborate with key stakeholders on OVC, to promote management of qualitative OVC programming in Nigeria, through its active participation in the national OVC technical working group (TWG).

In COP 13, APIN will continue to provide support for TB/HIV services to PLHIVs in line with WHO three Is (intensified TB case finding, isoniazid prophylactic therapy and TB infection control) at all its supported comprehensive care and treatment sites and DOTS centres in the 3 supported states (Lagos, Oyo and Benue). Intensified TB case-finding among HIV patients will be carried out using the national TB screening algorithm, including TB symptom screening for all HIV+ persons at every clinic visit. To enhance TB diagnosis, fluorescence microscopes and digital x-ray machines will be provided to some high TB burden facilities to be identified in collaboration with the various State TB Control Programs. TB/HIV co-infected patients will receive TB treatment at co-located or affiliated DOTS centers, in line with national guidelines. They will also be provided with CPT in order to reduce mortality among them.

Universal access to HTC services will be scale-up for TB suspects/patients at DOTS centers in supported sites, in order to increase their HTC uptake. All HIV+ persons identified at these DOTS centers will be provided with TB treatment and linked to ART clinics for comprehensive HIV treatment and care. Isoniazid preventive therapy (IPT) will be provided for HIV patients who screen negative for TB, thereby reducing the risk of TB transmission and the mortality rate among them.

APIN will implement TB infection control measures to prevent nosocomial transmission of TB to HIV+ patient: patient education on basic hygiene, cough etiquette and proper sputum disposal, and education of facility staff on personal protective measures. Clinics and laboratories will be renovated and upgraded to ensure adequate cross-ventilation and to acceptable biosafety standards and APIN will facilitate the integration of TB infection control into the facility infection control plan.

APIN will collaborate with the NTBLCP to conduct training on TB DOTS for facility staff in order to further improve their capacity for effective case management. There will also be training of state and LGA TB staff on LMIS in Plateau State, as has been done in Lagos, Oyo and Benue States. APIN will support TB/HIV collaborative activities and contribute to the national MDR-TB program scale-up, including institution of routine surveillance in accordance with national MDR-TB case-finding policy. The TB National reference laboratory (NIMR) will be supported to function at bio-safety levels 3, and SW (UCH) and SE (UNTH) zonal reference laboratories at level 2+; and for TB culture, drug susceptibility testing (DST) and molecular assay (Hains assay); and to improve their quality system management for WHO SLIPTA accreditation. UNTH will receive infrastructure upgrade for an MDR-TB treatment center. To improve diagnosis of TB and MDR-TB, GeneXpert machines will be provided to TB high burden sites in each state, in collaboration with STBLCP.

APIN will collaborate with CBOs to implement community TB care (CTBC) in order to increase case detection and treatment success in the 3 supported states. ACSM activities will be carried out to create awareness and to promote community involvement and participation. Community volunteers (CV) will be trained to carry out active TB case-finding in the community, screen TB suspects and contacts of TB patients for TB (and HIV) and will supervise family/community members acting as treatment supporters.

APIN will continue to provide comprehensive pediatric care and support services to all HIV positive children at all its supported sites in the 3 states (Lagos, Oyo and Benue) in COP 13. The identification of HIV-positive children will be achieved through various strategies outlined in the pediatric recruitment section of the national guidelines. HIV-exposed babies will be screened for HIV. All HIV+ children will be evaluated clinically and with laboratory investigations, and ART-eligible children provided with ART services.

All enrolled HIV-infected children will receive a minimum care package made up of clinical care, basic care kit and supportive services in accordance with national guidelines. Clinical care includes CD4/CD4% assessment, cotrimoxazole prophylaxis, nutritional assessment, nursing care, prevention and management of OIs, prevention and management of STIs, TB screening and treatment, and malaria prevention. To reduce morbidity and mortality, cotrimoxazole prophylaxis will be provided to all HIV-exposed infants, HIV-infected children and adolescents, in line with national pediatric guidelines. Pediatric care and support services will be integrated into MNCH and immunization services, and TB/HIV co-infected children referred appropriately to DOTS centers.

Nutritional assessment (using anthropometric measurement etc.) and counseling will be provided and ready-to-use therapeutic food (RTUF) given to malnourished children. Basic care kit (comprising of long-lasting insecticide net, water disinfectant, water vessel, soap, hand gloves, and IEC materials) will be provided. Older HIV-infected children and their families will receive PHDP services, including HTC services for family members (parents and siblings), prevention messages, and counseling (for HIV status disclosure, treatment adherence, high risk sexual behaviors, and assessment for STI). They will also be provided psychosocial and spiritual support as appropriate.

APIN will continue to strengthen facility- and community-based support groups for children (kids clubs). Community home-based care services will be provided, with linkages between facility and community OVC services strengthened through collaboration with CBOs. They will also be linked to youth-friendly centers and other wrap-around services in the community to ensure continuum of care. A child-friendly environment will be developed at the supported facilities by providing support for identification and renovation of suitable spaces within the clinic as play rooms and providing materials such as toys, age-appropriates books, audio-visuals and other learning materials. As the children grow to the age of 15 years, they will be migrated to the adult ART section and will continue with adult type of care. This will also promote retention in care.

Supported facilities will receive supportive supervisions and technical assistance through mentorship by program officers and sharing of updates, best practices, evidence-based clinical decision making process and implementation of national guidelines.

During COP12, in addition to the existing 18 sites and 43 Oyo State DOT Centers; APIN assumed management responsibility for the 15 remaining Harvard sites namely: ABUTH, JUTH and its 13 satellites. In COP2012, APIN provided support for laboratory development at 34 treatment sites (9 tertiary care, 25 secondary sites), 100 PMTCT and 58 DOT sites. During this period, APIN also commenced the activation of comprehensive ART laboratory services at 15 new health facilities namely: General Hospital Lassa, GH Ngala, GH Briyel, GH Ugba, GH Obarike Ito, GH Idekpa, Police Hospital Falomo, Ancilla Hospital, St. Kizito, Family Health Center Oke-Ilewo, Seventh Day Adventist Hospital Ile-Ife, Baptist Medical Center Shaki, St Virgillus, GH Gashua, and CHC Madagali distributed across 7 states (Benue, Plateau, Borno,Yobe ,Ogun,Oyo Lagos). APIN will continue to strengthen its existing laboratory systems and build the capacity of the new ones to provide quality services.

APIN will continue to collaborate with the USG to develop the framework for PCR lab network to support other IPs without the capabilities. The three (3) APIN supported Drug Resistance Monitoring (DRM) labs will be integrated into the national DRM program, while working with FGON to develop a develop HIVDR prevention and assessment strategies in accordance with WHO recommendations. A systematic approach will also be established to ensure the attainment of WHO accreditation for these sequencing laboratories. 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. Following the huge success recorded in our in-house biomedical maintenance program, APIN plan to expand this service to make it more effective.

In furtherance of the PEPFAR II goals, APIN will continue to collaborate with the SLMTA team to prepare the six (6) participating labs towards attaining the WHO-AFRO accreditation. In addition, APIN will collaborate with SLMTA Nigeria team to register and prepare five (5) more labs for the next round of WHO SLIPTA program. APIN will also continue to work with the MLSCN to get all APIN labs accredited nationally using a structured approach to cascade the gains of the WHO-AFRO SLIPTA program to all the labs. APIN will continue to support the LIS at the labs with technical support from our data management team, using FileMaker Pro data software a program that 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.

Having temporarily taken over the responsibility of procuring EID lab commodities for the PEPFAR PMTCT programs, APIN will continue to collaborate with partners to ensure adequate quantification and timely ordering and delivery of these commodities. In addition, APIN will collaborate with SCMS to implement pooled procurement of Lab commodities and support the commodity unification program. APIN will develop inventory system software while also adopting the national LMIS tools to strengthen laboratory inventory management.

During COP 13, APIN will scale up electronic medical records to 30 supported secondary and high volume primary health care facilities in the 3 states of operation that do not presently have that capability in line with CDC Nigeria requirements. This will involve supply of computers and accessories, computer skills and database management training for identified focal persons at the sites. Data staff from existing supported sites will receive training to further build their capacity in data cleaning and management. APIN will scale up biometric patient registration using finger print capture to all CDC supported HIV service delivery points in the three states of operation, to avoid double counting of clients receiving services, allow for easy transfer of clients between service delivery points without loss of clinical data and reduce the percentage of self-transfers counted as loss to follow up. Due to staff attrition and postings; APIN will conduct 2 basic database management trainings for new hires at the sites during the year. Each service delivery point will receive at least 2 data aquality Audits will be conducted in collaboration with SMOH and SACA staff during the year.

APIN will support the each state of operation to establish a multi stakeholder quality management infrastructure at the ministry of health which will provide strategic direction on HIV care and service quality issues at the state in line with the national HIV quality framework. Each HIV service delivery point in the state will be supported to measure the quality of care provided to patients and mentored to implement quality improvement activities. Quarterly state level review meetings will be supported to facilitate peer learning, spread of change and best practises deriving from implementation of quality improvement activities. Trained QI coaches from older APIN sites will support state government staff to coach QI focal persons at sites. Due to staff attrition and postings; APIN will conduct 2 quality improvement trainings for new hires at the sites during the year

APIN will provide technical support to LGA and State M&E desk officers in all 3 states to analyse the M&E data from the state electronic data ware house (DHIS2.0). This will enable states to make evidenced based programme management and policy decisions regarding their HIV response. Clinical and M&E staff will be mentored on simple data analysis to further promote data use at service delivery points. Due to staff attrition and postings; APIN will conduct 2 monitoring and evaluation trainings for new hires at the sites during the year. M&E and programme area focal persons at newly activated sites will be trained on using the national data collection tools.

States will be provided financial and technical support to hold quarterly data validation meetings involving all HIV service delivery facilities including those who are not supported by IPS especially the private sector. This will allow the state to report a more robust and complete HIV data and contribute to better reporting of the national HIV response. APIN will also strengthen the states M&E TWG by providing financial and technical support for quarterly meetings

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 supported sites to provide qualitative blood safety services. Training gaps at the facilities will be identified and appropriate training connducted for HCW responsible for blood transfusion services in collaboration with NBTS and SBFA on appropriate clinical use of blood and other topics. Trained HCW will be supported to step down the trainings 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.Support will be provided for institutions to collaborate with NBTS in ensuring that the practices of family replacement donors is completely replaced by voluntary non remunerated donors. Advocacy to hospital managers to 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 will be intensified.

Support will be provided for new facilities with blood banks to upgrade RTK based tests to 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 implement injection safety in all supported sites in 3 states (Lagos, Plateau and Oyo). This activity provides the initiation of intensive training program in injection safety practices for HCWs at all 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. APIN will conduct series of trainings including a TOT on the newly approved infection prevention and control in clinical setting, with hand hygiene and phlebotomy components. This TOT will be 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 renovation and construction of incinerators where applicable within funding limit. APIN will also work with AIDSTAR to procure and distribute injection safety commodities to all sites.

The AB prevention programs will be implemented utilizing the minimum prevention package strategy in line with the National prevention plan and will focus on delivering key prevention messages including abstinence and be faithful messaging to target key populations consisting of in and out of school youths, intending couples, outpatient STI patients, border traders, fashion designers, young male market agents, and motor mechanics and MARPS. APIN will partner with existing CBOs in Plateau, Oyo and Lagos states (Karale Lagos, Humanity Lagos, PAC Ogbomosho, AHI Lagos etc.) to reach population for AB messages within the communities, schools and other key places like markets. 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 build the capacity of the NGOs and CBOs to target MARPs, including using a combination of biomedical, behavioral and structural interventions. As in previous COP years, APIN will continue to focus on improving the integration of prevention activities into the HIV care and treatment settings.

APIN will collaborate with PLWHA support groups at these sites to build their capacity to implement AB activities among its members and surrounding communities.Support will be provided for the training of youth peer educators to serve as role models to help in the provision of prevention messages to a wide range of audience especially youths aged 15-24 years old.

APIN will support the provision of facility-based comprehensive HIV counseling and testing (HTC) services, outreach campaigns, stand-alone HTC centers in 3 states while expanding services to high burden locations within the states. The HCT outreach campaigns will target hard to reach areas and will focus on MARPs, clients and their partners. Individuals 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 at facilities;support will be provided for the establishment of multiple HCT points within facilities and integration of prevention into broader RH/MNCH services. APIN will support the integration of HTC into TB DOTS centers in Oyo, Lagos and Plateau states to enable patients receiving TB services get counselled and tested for HIV.

Individuals identified as positive during outreach campaigns and facilities will be referred to PMTCT and ART clinics for treatment and palliative care services. APIN sites will continue to use family counselling sessions and love letter strategies to encourage partners of HIV-infected patients to access HCT so that couples receive HIV counselling and testing together.

To ensure improved quality of service at the sites, APIN will strengthen referrals and linkages, provide strong M&E and implement HCT quality assurance programs in line with the National HCT quality assurance guidelines.

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 counsellors to provide quality HCT services at the community level. For new facilities without HIV service delivery experience and where necessary, refresher training will be conducted for counsellors using the National HIV training curriculum. HIV testing will be 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 as part of contributions to National scale up response.

APIN will continue to provide support for prevention implementation strategy by engaging NGOs and CBOs to provide services at the community level in addition to the facility based services being provided in existing 46 treatment sites and additional new sites to be activates.These NGOs and CBOs (Mashiah, HALT AIDS, ARFH, CAHLI Jos, CCC Jos, Karale Lagos, Humanity Lagos, PAC Ogbomosho and AHI Lagos) are spread across three (3) states of Lagos, Oyo and Plateau.

In COP13, 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) and other key drivers of the epidemic. APIN will also target high risk communities like trailler parks, garages and brothels 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.

APIN will support Lagos, Plateau and Oyo states to scale up PMTCT services integrated into other RH/MNCH services in public and private health facilities; the PMTCT scale up plan will target communities, PHCs, secondary health, tertiary and private medical facilities. At least 70 new PHCs and 32 secondary facilities will be targeted for activation for PMTCT services in the first year of the grant.

The grant will support implementation of strategies to reduce the rate of new infections among women and men of reproductive age groups by leveraging on prevention programs addressing delay in sexual debuts, safe sex practices and other prevention methods. Targeted HCT in ANC will be supported to identify pregnant women infected with HIV and appropriate ARV prophylaxis or treatment for maternal disease will be offered. Disease monitoring will be implemented to support PMTCT intervention by providing CD4, Viral load, chemistry,heamatology, TB and STI screening for pregnant women where appropriate and indicated.

The grant will also support the strenghtening of health systems as well as build the capacity of state officer to manage, cordinate and implement PMTCT programs in their respective states. Support wil be provided for a functional state PMTCT TWG to support the implementation and coordination of PMTCT programs in the states. Additional emphasis will also be placed on working with the states towards greater ownership of programs, improved funding and sustainability of programs with gradual handover of program and sites to be managed and funded wholly by states.

The goal of the Pharmacy unit remains to strengthen systems to select, procure, store, track, distribute and provide ARTs.

APIN currently rents and utilizes a facility for warehousing in Lagos. A major thrust of APINs sustainability plan in terms of Commodity Logistics (warehousing, storage and distribution) is to partner with an indigenous organization to handle warehousing and the Logistics of commodity distribution across facilities. This will substantially reduce the cost for warehousing, storage and distribution. The regionalization of implementing partners to states of the Federation, has led to APIN working in 3 states (Lagos, Oyo and Plateau). APIN has identified with the states through strategic meetings the areas that require significant attention towards building capacity and ensuring sustainability of service provision in the states.

APIN Pharmacy/Supply Chain Management Unit will seek to enhance the capacity of the State Central Pharmacy and Logistics team in warehousing, drug distribution and monitoring. Central level trainings in Warehouse Management, Inventory management and Logistics Management of Health Commodities (LMHC) will be conducted for appropriate personnel.

APIN will continue to provide mentorship and direct on-site, hands-on competency development of Pharmacists and Pharmacy Technicians, on clinical care and management of HIV/AIDS patients using pharmacy curriculum modules, the FMOH Logistics Management of HIV/AIDS Commodities, and the Site, and warehouse management handbook by JSI. APIN will also embark on renovation of existing state and facility warehouses as required.

APIN will continue to support the provision of Pharmacovigilance services by providing trainings build capacity identified facility state level personnel, and ensuring the collation and submission of reports to the National Pharmacovigilance Centre in NAFDAC. The APIN Drug Information Centre (ADREC) will continue to answer queries regarding HIV medicines in an unbiased and evident based manner. APIN aims to extend the services of ADREC to other IPs and the public. APIN will continue to create and sustain the awareness of ADREC through periodic newsletters on issues of HIV/AIDS. The incorporation of pharmacovigilance activities within ADREC will reduce the number of discrepancies between NAFDAC ADR and APIN toxicity reports. ADREC will be positioned to also act as a resource for the training of state and National DIC staff.

APIN will build on the gains of its ART program implementation to scale-up ART in the 3 supported states (Lagos, Oyo and Benue) in COP 13. HTC services will be scaled up at all APIN supported sites. Baseline evaluations will be done to determine eligibility for ART and to provide for the management of opportunistic infections and other co-morbidities. Patients will also receive scheduled monitoring of CD4, haematological and chemistry parameters and viral load.

Patients with CD4 count <350 will be commenced on first line ARVs, in accordance with national guidelines. Follow-up care instituted to ensure adherence to treatment while evidence of adverse drug reactions and failures are actively monitored. Clinicians at the sites will be mentored for effective patient management and sites will be supported to hold monthly clinical review meetings to discuss patient management and challenges across all program areas and to plan solutions to address them. Adherence counseling will be offered to new patients initiating ARVs and intensified to support existing patients on medications. Patient escort services will be used from point of diagnosis to the comprehensive sites in order to promote retention of patients in care.

APIN has already started provided full support to comprehensive sites that were recently transitioned to it by other partners, in Lagos (4 sites) and Plateau (3 sites) because of the USG rationalization program. In COP13, APIN will activate additional ART sites in order to scale up ART services in the 3 states focusing on high-burden, low-coverage populations. Working with the State HIV/AIDS program, priority sites for HIV/AIDS service delivery will be identified. The activation process will involve baseline assessment of the facilities, infrastructure upgrade, provision of clinic and laboratory equipment to support service delivery, staff trainings in all aspects of patient care and setting up of laboratory and M&E systems. As part of the scale-up, APIN is engaging sub-partners that are specifically targeting the private sector for HIV/AIDS service provision. APIN is also undertaking a special project to provide ART services hard-to-reach communities within Jos metropolis in Plateau State through a faith-based group. A total of 23 private faith-based facilities within these communities have been identified and are currently being assessed. After this, the facilities will be upgraded and equipment and supplies provided. Training for commencement of HCT and subsequently some will commence PMTCT and ART services. They will be linked in a hub-and-spoke model of service delivery. A key challenge faced by patients to remain in care is the socioeconomic burden of seeking care at secondary and tertiary facilities; this will be eased by decentralizing ARV services to PHCs using the hub and spoke model of service delivery. Patients that meet the set national criteria will be referred downward to PHCs close to their place of residence.

The strategies for capacity building will be hinged on increased joint supportive supervision for ART service delivery with the officials of the State Control Program, training of health care workers and provision of technical assistance to sites, provision of on-site mentoring and supervision. The capacity of the officials of the State Program will also be developed to carry out these functions in order to promote program sustainability.

In COP 13, the comprehensive treatment and care sites in the 3 supported states (Lagos, Oyo and Benue) will continue to be provided with support to implement pediatric treatment in accordance with national guidelines. As part of the strategy to improve pediatric enrolment, PITC will be offered at multiple points within the facility: childrens outpatient clinics and emergency rooms, infant welfare and immunization clinics, and postnatal clinics. HTC was also expanded to children of HIV-positive women. The genealogy form will also be used at the sites to ensure that all the children of HIV+ women are screened for HIV. Information on HTC for their children will be provided to these women during clinic visits and support group meetings and through CBOs collaborating with APIN on OVC service provision. Enrolled OVC and their siblings and other family members will be offered PITC.

HIV-exposed infants will be routinely followed up and provided with ARV prophylaxis as appropriate, as well as cotrimoxazole prophylaxis. Systems have been put in place for the collection and transportation of DBS samples to PCR laboratories for EID, and to ensure a short turn-around-time for DNA PCR results that allows for prompt diagnosis and initiation on ART of exposed infants. HIV-positive children less than 2 years will be promptly enrolled into the pediatric treatment program through the implementation of the test and treat policy for this category of children, in line with national guidelines. Children of ages 2-5 years are initiated on ART at a CD4% of <25% while those of ages 5-15 years are initiated at a CD4 count of < 350. First line ARVs are commenced for newly diagnosed children while care is taken to identify those exposed to maternal prophylaxis and ARV combinations adjusted accordingly.

Clinical and laboratory monitoring of the children will be done in line with national guidelines. Growth monitoring chart and anthropometric measurement will be used to ensure adequate weight gain as treatment progresses. Nutritional education will be given to care givers and food supplement (Grandvita product) provided to malnourished children. Children on treatment will be monitored closely for adverse drug reactions.

Training of health care providers on the pediatric guidelines will be conducted while there will be supportive supervision for ART service delivery and provision of technical assistance and on-site mentoring.