PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
ACTIVITY DESCRIPTION This activity also relates to activities in ARV services (#6690), Palliative Care (#6697), OVC (#6694), Counseling and testing (#6695), SI (#6692), Lab (#6693) and other prevention (#9208) In FY07, CU-ICAP will continue work in Kaduna (KD) and CrossRiver (CRS) States with an additional new State of Benue (BN) supporting a total of 37 (30 new, 7 existing) government (GoN), mission and private health facilities through pMTCT and community outreach activities in 10 hospital networks including PHC centers to reach 48,000 pregnant women with counseling and testing out of whom 44,758 will receive their results. CU-ICAP will directly support 22 sites (7 existing and 15 new sites) in COP07 and will also provide support to 15 additional sites by subcontracting to AIDSRelief (AR; 6) and Pathfinder International (PI; 9) to expand quality PMTCT and treatment linkages to a total 37 sites in BN, Anambra (ANB), KD, and CRS States. CU - ICAP, AR and PI will provide PMTCT services through existing government/mission facilities in those states enabling 44,758 women and their household members to be tested, collect their results and be linked into appropriate care and treatment programs. CU-ICAP and its subs will train health care workers (HCWs), support infrastructure, purchase equipment and supplies, monitor, evaluate and provide supportive supervision to the sites. It is envisaged that CU-ICAP's strategic rapid site expansion to high client load health facilities in areas of great demand and high HIV prevalence will enable it achieve and likely exceed its FY06 targets by the end of Feb. 07. FY07 programming will emphasize provider-initiated opt-out testing with same day results at ANC, labor and post partum service delivery points. Partners, household and children will be linked into C&T. Eligible HIV infected women will be assessed and linked into ART services including cotrimoxazole prophylaxis (pCTX). HIV-infected women, ineligible for ART will be offered a combination of zidovudine(AZT) from 28 weeks (when feasible and at SHF) and single dose nevirapine(SD-NVP) at onset of labor. Women presenting at labor will be offered rapid testing and if HIV-infected provided with SD-NVP. All infants born to HIV infected women will be provided with SD-NVP at birth and AZT for 7 days. Other activities are enhanced pediatric care including pCTX; promoting best practices for infant feeding, nutritional support and linkages to FP services. Identification and follow-up of HIV-infected children living within the community will be a priority with CBOs/FBOs assisting with adherence issues and defaulter tracking. CU_ICAP and its subs will train 250 HCWs, using GoN curricula, to provide quality services to HIV-infected pregnant women, with focus on primary prevention of HIV, STI screening & treatment, safer sex, nutrition, malaria prophylaxis, use of ITNs and safe water. One hundred additional health care providers will be trained to educate and assist mothers make appropriate infant feeding options and discourage "mixed feeding" practices. HIV negative mothers will be counseled and supported to remain HIV negative. At the end of COP 07, a total of 350 HCWs will be trained. CU-ICAP will partner with CBOs and FBOs such as TCF, CACA, WCH, SHI and PLWHAs as key players to provide innovative community and home-based pMTCT services to pregnant women. CU-ICAP will work in close partnership with APIN and IHVN on HIV infant diagnosis testing by PCR at 2-6 months using DBS/plasma, and early antibody testing at 9-12 months with repeat testing after termination of breastfeeding.
A joint USG/GoN/CU-ICAP team will provide ongoing M&E and supportive supervision activities and contribute to the national PMTCT program's M&E efforts.
CONTRIBUTIONS TO OVERALL PROGRAM GOAL (1495) CU-ICAP and its subs target states with some of the highest sero-prevalences in Nigeria demonstrating responsiveness to assist GoN achieve its goal of decentralizing PMTCT services beyond the Centers of Excellence approach. CU-ICAP will significantly contribute to an increase in PMTCT services by supporting 7 existing and 30 additional sites to goverment, mission and private health facilities and also indirectly support GoN ministries/programs in its rapid scale up plans for PMTCT. CU-ICAP will partner with ARS and PI, institutions with appropriate expertise and capacity, to scale out into primary facilities in line with national PMTCT scale up plans. CU-ICAP will partner with ARS and PI to reach its USAID FY01 and FY02 targets through its rapid scale up plans. The 48,000 pregnant women counseled and tested and 3,150 mother - infant pairs for ARV prophylaxis targeted for COP 07 and the remainder of the COP 06 targets will be reached by the end of COP07. This will significantly contribute to the emergency plan targets of 80% coverage and 40% reduction in MTCT transmission by
2008. CU-ICAP will help cushion the effect of the loss of GFATM round 1 grants and strengthen national and state PMTCT programs by supporting capacity building of master trainers for PMTCT services; production of GoN approved infant feeding support tools, printing of national PMTCT registers, support of regular coordination meetings in collaboration with other partners at national and Kaduna State levels. CU-ICAP and subs will also strengthen programmatic skills of partner CBOs/FBOs in line with GoN sustainability plans.
LINKS TO OTHER ACTIVITIES (962) This activity is related to activities in ARV services (#6690), Palliative Care (#6697), OVC (#6694), Counseling and testing (#6695), SI (#6692), Lab (#6693) and other prevention (#9208). Provider-initiated opt-out HIV C&T will be offered to all pregnant women at ANC, and to their partners. Women presenting in labour will have rapid HIV tests and receive single dose NVP if positive. Infants born to HIV-infected women will access ART (single dose NVP and ZDV) and CTX prophylaxis. Infant PCR HIV testing via DBS will be conducted, with HIV positive infants linked to appropriate care and treatment. PC linkages will enable HIV+ women and family members access to support groups. All pregnant women will be linked into FP services. Partner counseling/communication will be promoted through other prevention for positive activities. M&E activities at PMTCT sites will contribute to the national PMTCT program's M&E efforts using national PMTCT MIS.
POPULATIONS BEING ADDRESSED Pregnant women, post-partum mothers, their partners and household members including HIV exposed infants and HIV infected children will be targeted and supported so that they have full access to CT at multiple entry points of care. HIV infected women will be provided with PMTCT / PMTCT plus services, while HIV infected infants and children, and infected partners, will access ART services. Non infected women will be supported to remain HIV negative. CBOs, FBOs, support groups and men will also be targeted so that they participate fully in community based pMTCT services. Health care providers will be trained on providing services while management skills of GoN policy makers and implementers at all levels will be improved to enable them manage programs effectively.
KEY LEGISLATIVE AREAS This activity will promote gender equity in HIV/AIDS programs and increase access to services by the vulnerable groups of women and children. It will help increase service uptake, promote positive male norms and behaviors especially as it relates to discordant couples and help reduce stigma and discrimination through its community based activities.
EMPHASIS AREAS Major emphasis of this activity focuses on training and network/linkages. Minor emphasis includes other sectors and initiatives, commodity procurement, community mobilization/participation, IEC, supportive supervision, quality assurance and improvement.
This activity was suspended at the direction of the OGAC Prevention TWG.
ACTIVITY DESCRIPTION This activity also relates to activities in Counseling and Testing (6695), ARV services 6690, Medical Transmission Injection Safety (3.3.04), and Laboratory Infrastructure (6693).
In COP 2006, CU-ICAP supported three hospital networks in Kaduna and Cross River States to improve safe blood practices, aimed at reducing medical transmission of HIV and other infections. The support included training on universal safety precautions, good laboratory practices and safe blood systems. Equipment and supplies for safe blood activities were also provided. Forty (40) staff members at the three sites in Kaduna (General Hospital, Kafanchan) and Cross River States (General Hospital, Ogoja, Catholic Maternity Hospital, Ogoja) were trained to organize and conduct safe blood collection and post-exposure prophylaxis (PEP) procedures. CU-ICAP conducted advocacy and BCC activities to increase awareness and facilitate the adoption of positive behaviors at the sites.
In COP07, CU-ICAP plans to expand into seven additional hospital networks in Kaduna Cross River and Benue states. Working closely with the National Blood Transfusion Service (NBTS) and Safe Blood for Africa (SBA), CU-ICAP will train 10 laboratory staff who are involved in blood transfusion services centrally and these in turn will provide training for at least 90 laboratory and allied health workers that are involved in blood transfusion services at their sites. To reduce medical transmission of HIV, CU-ICAP will continue to focus on prevention of transmission through unsafe medical injections; by providing and enforcing the use of vacutainers for blood collection, sharp containers for proper disposal of sharps and prevention of unsafe blood supplies by providing determine HIV test kits for the screening of every units of blood. All trainings will be based on the use of the existing National curriculum and guidelines for standardization. All site trainings will be supervised by CU-ICAP lab advisors.
Other activities for COP07 include infection prevention services to reduce occupational hazards, provision of contaminated waste and sharps collection and disposal units, and infection prevention equipments such as disposable and surgical gloves, disposable syringes, respiratory masks, and gowns. Supplies and protocols/guidelines based on GoN policy will be provided to support safe blood collection. Sites will be provided with communication materials and job aids. Quality assurance (QA)/Quality Improvement (QI) management systems will be put in place ensure the quality of the rapid HIV testing at all site. CU-ICAP will also work through local community based organizations and support groups to increase demand and awareness on safe blood practices.
This activity also includes partnerships and support to the following sub recipients for program activities: Safe Blood for Africa Project (SFA), Sustainable Health Initiatives (SHI) and HARHL Trust Nigeria.
CONTRIBUTIONS TO OVERALL PROGRAM AREA As part of a comprehensive package of services and its contribution to the national strategic plan, CU-ICAP considers it essential to prevent HIV transmission in health care settings and increase blood transfusion safety. In COP 06, CU-ICAP supported improvement of the blood transfusion network through procurement of test kits for testing donor blood. CU-ICAP also supports training activities for assuring the quality of transfusion related services and in universal precautions.
In COP 07, CU-ICAP will support the training of at least 100 health care workers to provide quality safe blood services, and will increase the availability of test kits, support personal protective equipment like hand gloves, lab coats, face shield and protective goggles to ensure that the lab staffs are adequately protected. 2400 blood bags will be screened for HIV following the national algorithm for HIV blood screening the to ensure safe blood transfusion at CU-ICAP's supported ten (10) hospital networks in line with the National Blood Transfusion policy on blood and blood product safety.
LINKS TO OTHER ACTIVITIES This activity is closely linked to 3.3.4 Injection Safety where CU-ICAP also plans to train
laboratory and allied health workers at all its supported sites. Sanitarians are trained to improve their knowledge and skills in sharp waste management practices.
With linkage to activity 3.3.12 (Laboratories), lab-based activities will support Safe Blood activities at all CU-ICAP supported sites through training, supervision, equipment maintenance and supplies.
POPULATIONS BEING TARGETED This activity targets health care workers at both public and private health sectors responsible for safe blood activities in all CU-ICAP supported health facilities. Targeted also are all persons needing blood transfusion and their relatives who have come to donate blood.
KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase awareness and build skills around safe blood issues at facility and community levels, reducing stigma and discrimination among health care workers. It is expected to also promote awareness about safe blood practices in the communities and indirectly increase the number of volunteers available for blood donations.
EMPHASIS AREAS This activity includes major emphasis on capacity development for blood safety which includes training of lab staff and provision of equipments. Minor emphasis will be on supportive supervision, and commodity procurement, IEC, policy and guidance issues.
ACTIVITY DESCRIPTION In consultation with the Federal Ministry of Health (FMOH) and John Snow Incorporated (JSI)/Making Medical Injection Safer (MMIS), Columbia University International Center for AIDS Care and Treatment Programs Nigeria (CU-ICAP) developed an infection prevention strategy to reduce HIV transmission through unsafe injections. The strategy basically includes: effective health care waste management; capacity building of health care providers to avoid unsafe injections; implementation of universal safety precautions; ensuring availability of safe injection equipments; advocacy and behavior change communication (BCC) to promote safe injections.
In COP06, CU-ICAP supported care and treatment services at 3 hospital networks (i.e. Kafanchan General Hospital, Kaduna State; Ogoja General Hospital and Catholic Maternity Hospital in Cross River State and their linked primary health centers) where infection prevention practices were enhanced and universal precautions introduced. Forty health care providers were trained on general aspects of universal safety procedures, while advocacy and BCC activities were conducted amongst health care workers on safe injections to enable adoption of safer workplace behavior.
In COP 07, CU-ICAP support will expand to additional 7 hospital networks in Kaduna, Cross River, and Benue States. Site assessments will be performed to identify gaps in knowledge, skills, and behavior among health care workers, required equipment and supplies, and to plan for safe waste disposal where needed. In COP07, CU-ICAP will collaborate with FMOH and JSI/MMIS to conduct a Training of Trainers (TOT) for 30 facility staff who will in turn train other 420 healthcare workers (i.e. injection prescribers, injection providers, sanitarians, pharmacists, nursing staff, nursing support staff and nursing/medical students who pass through these facilities) in all the sites using the revised WHO/AFRO/JSI training curriculum on injection safety, sharps waste management and handling of injection devices. In addition, contaminated waste and sharps collection units as well as nationally accepted infection prevention equipment (i.e. disposable surgical gloves, disposable syringes, respiratory masks and gowns) will be procured through existing CU-ICAP systems for these sites. CU-ICAP will also promote and facilitate behavioral change among health workers, distribute communication materials (leaflets, posters, reference guide) on safer injection practices and support government to adopt a national health care waste management plan in collaboration with JSI/MMIS.
CU-ICAP will implement these activities by partnering with local non-governmental organizations, such as Sustainable Health Initiatives (SHI) and HIV/AIDS Restoring Hope and Life (HARHL) Trust. These local NGOs have extensive experience in responding to health sector program needs including issues of safe injection, universal safety precautions and safe blood. In addition, these organizations will assist the sites to develop and implement appropriate work plans and policies using the CU-ICAP strategy for ensuring injection safety.
CONTRIBUTIONS TO OVERALL PROGRAM AREA: These activities will contribute to the overall emergency funds plans for prevention of new infections by promoting injection safety. It will also reduce exposure of health care workers to occupational hazards in the supported health services.
LINKS TO OTHER ACTIVITIES: This activity is closely linked to activities in blood safety (3.3.03), ART (3.3.11), Palliative Care (3.3.06), OVC (3.3.08), VCT (3.3.09) and PMTCT (3.3.01) to ensure that health workers under all these areas adhere to principles of safe injection and universal precautions.
POPULATIONS BEING TARGETED: This activity targets all health care workers directly (doctors, nurses, pharmacists, lab staff involved in bleeding of patients, sanitarians) and indirectly at both public and private health sectors responsible for safe injection activities in all CU-ICAP supported health facilities.
KEY LEGISLATIVE ISSUES ADDRESSED CU- ICAP will collaborate with JSI/MMIS to support government in the development of health care waste management policy. These activities would help address the stigma and
discrimination issues that are often generated by fear among health care providers. Behavior change communication activities will facilitate the adoption of safe injection practices among health care providers. The increased availability of information and services especially on universal safety precautions and PEP will also help reduce stigma and discrimination.
EMPHASIS AREAS Major emphasis area is quality assurance and improvement. Minor emphasis is on commodity procurement, workplace programs, promoting behavior change through IEC and strategic linkages with other partners and initiatives like the ‘Making Injections Safer' project.
ACTIVITY DESCRIPTION This activity also relates to activities in care and support (#6697), ARV services (#6690) and VCT (#6695), OVC (#6694) and PMTCT (#6699). In COP06, the International Center for AIDS Care and Treatment Programs at Columbia University (CU-ICAP) supported 3 hospital networks in Kaduna and Cross River States, providing HIV/AIDS care and treatment via a multidisciplinary, family-focused approach at the hospital and community level. In COP07, CU-ICAP will expand support to 12 additional hospital facilities and an estimated 25,000 HIV positive household and family members including 21,500 HIV positive patients enrolled in care. In COP07, CU-ICAP will support risk reduction and safer sex promotion activities among HIV positive clients, partners and their households. CU-ICAP will identify a dedicated staff person to oversee their risk reduction and safer sex promotion activities. CU-ICAP will build capacities of health care providers in patient education and supportive counseling to reduce the burden of sexually transmitted infections (STI), improve health seeking behaviors, and educate HIV positive patients on risk reduction, skills development for practicing sexual abstinence and/or correct and consistent use of male or female condoms and healthy life planning. Support groups, local NGOs and CBOs in each hospital network will be equipped to conduct activities for prevention for HIV positives, partners and households. Health and allied care providers will be supported to adopt positive attitudes and behaviors including safe practices to reduce their risks of exposure thus focusing on workplace prevention program for health care workers within the facilities. CU-ICAP will use available communication tools and aids for a comprehensive package of prevention activities among positives in all supported networks and linked communities. This will include training of health care and allied workers at facility and community levels to counsel and deliver appropriate BCC messages and referrals to HIV positive clients. Referral linkages for STI management for community level interventions will be a part of prevention for positives activities and In-depth discussions of prevention, skills training on disclosure to partner and negotiation of safer sex. Training will be based on a standardized Nigeria specific prevention for positives curriculum. Support groups will be assisted to develop packages including patient education materials to build and support their skills on addressing prevention topics. To achieve these BCC and communications objectives, CU-ICAP will also build the capacity of at least 10 local CBOs, NGOs and support groups, to conduct activities including BCC strategy development/adaptation and media/material review and development workshops on HIV prevention in partnership with local communications organizations. 125 facility and community based health care providers and counselors will be trained on prevention counseling. Contents will include dual protection, family planning/child spacing/personal hygiene, safe water, healthy lifestyle among others. Innovative materials from these meetings will be pre-tested and produced for use through culturally appropriate and acceptable media channels by ICAP-supported facilities, communities and partners. CU-ICAP will also distribute at least 200,000 condoms for its CBOs/NGOs (Tulsi Chanrai Foundation, GHAC, GAWON, Rekindle Hope) to support HIV positive and high risk negative clients adopt dual protection choices. These condoms will be provided by Society for Family Health. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity contributes to the 2007 targets by focusing on reaching at least 25,000 HIV-positive persons especially women and children and their household members by promoting the adoption of positive attitudes and behaviors consistent with PEPFAR 5-Year Strategy for averting new infections in Nigeria. LINKS TO OTHER ACTIVITIES This activity also relates to activities in care and support (#6697), ARV services (#6690) and VCT (#6695), OVC (#6694) and PMTCT (#6699). POPULATIONS BEING TARGETED HIV positive persons especially women and children and including their partners, children and other household members will be supported to adopt positive attitudes and behaviors to reduce the transmission of HIV, and promote positive living among infected and affected persons. Health and allied care providers also being targted. Facility based care providers and community based care organizations including their program managers and care providers will be trained to provide quality focused BCC activities that will promote the adoption and practice of positive behaviors. Most at risk negative populations will also be targeted for prevention messaging. KEY LEGISLATIVE ISSUES ADDRESSED This activity will promote gender equity especially among vulnerable groups of women and young girls through the delivery of BCC messages. By facilitating the availability of client education programs, it will contribute to the reduction of stigma and discrimination among care providers towards HIV positives. EMPHASIS AREAS Major area of emphasis will be training facility and community based care providers to HIV positive clients and their households on patient education skills and supportive counseling for prevention for positives. Minor emphasis areas are IEC to develop/adapt communication materials for patient education, supportive
counseling and job aids for health care providers. Other minor areas include commodity procurement and linkages to other sectors and initiatives and workplace prevention.
ACTIVITY DESCRIPTION This activity relates to activities in Counseling & Testing (#6695), PMTCT (#6699), ART services (#6690), TB/HIV (#6696) and OVC (#6694). In FY06, CU-ICAP supported 3 hospital networks and their communities, partnering with community-based organizations (CBOs), faith-based organizations (FBOs), and PLWHA groups to enable people with HIV/AIDS to access clinical care and support as well as laboratory and pharmacy services. In FY07, CU-ICAP will expand support to 12 new medical facilities in Cross River, Kaduna, Benue, Gombe, Akwa Ibom, Rivers and Kogi states and to 10 non-facility based outlets; for a total of 25 outlets with service provision to an estimated 21,500 patients. Following National Palliative Care Guidance and USG PC policy, CU-ICAP will provide a Basic Care Package, including clinical care, prophylaxis and management of opportunistic infections, laboratory support, counseling and adherence support, home based care, and active linkages between hospitals, health centers, and communities. The activities will be approximately 20% laboratory monitoring and OI diagnostics, 30% OI management and prevention (cotrimoxozole), and 50% Home Based Care (HBC). At the community level, services will be subcontracted to implementing agencies (IAs). Health education, counseling, and psychosocial support will promote positive living, self-care, and prevention with positives, adherence, disclosure, and outreach to household members in need of testing, care, and treatment. Home Based Care (HBC) programs will be expanded, including the provision of services such as domestic support, management of minor ailments (ex diarrhea ORS preparation and use), pain management, referral services, and counseling services. Partnerships with other IPs will be established and strengthened. CBOs and FBOs will be supported to package and distribute HBC kits (consisting of ORS, ITN, water guard, bleach, cotton wool, gloves, soap, calamine lotion, Vaseline, and gentian violet). At the facility level, CU-ICAP will support: laboratory diagnostics for OIs; procurement of drugs and supplies for care and treatment of opportunistic infections; pain and symptom management; and pharmacy services. CU-ICAP will also train and retrain, continuing medical education and clinical mentoring for adult and pediatric care utilizing manuals and SOPs developed by USG and GoN. CU-ICAP in collaboration with IHV/ACTION - University of Maryland and other partners, will develop the HIV/AIDS pediatric care training manual. On-site Clinical Advisors will support adult and pediatric care and treatment. Palliative Care providers' job aids and patient education materials will be provided. Peer Educator (PE) programs to reduce stigma, enhance adherence, and educate communities about available services will be supported. CU-ICAP will also set up quality patient appointment and tracking systems, as well as routine reporting systems for monitoring basic care and support activities. Outreach teams linking hospital programs to primary health centers and communities will be established and supported by CU-ICAP network coordinators. "Therapeutic feeding" using criteria agreed upon by the USG in-country team will be provided via referrals where possible and directly when no alternatives exist. Selection and exit criteria will be established for all therapeutic feeding programs. CU-ICAP will work with the following sub-grantees: Mothers Welfare Group, Fantsuam Foundation, Tulsi Chanrai Foundation, GAWON Foundation, Catholic Action Committee against AIDS, Rekindle Hope, Women and Children of Hope, Grassroots HIV/AIDS Counselors, Association for Reproductive and Family Health, and HARTL Trust. CONTRIBUTIONS TO OVERALL PROGRAM AREA By training at least 225 care providers including PLWHA, CU-ICAP will enhance the delivery of comprehensive basic care and support within national guidelines and protocols via a multidisciplinary family-focused approach. This activity contributes to the Emergency Plan 2007 targets by reaching at least 21,500 HIV positive persons including women and children and their households. By actively involving PLWHA and CBOs in program development and implementation CU-ICAP will facilitate strong linkages and referral networks. LINKS TO OTHER ACTIVITIES This activity links to activities in ART services (#6690), enhancing adherence and facilitating defaulter tracking and patient retention. Relationships between secondary hospitals and community-based referral facilities will be strengthened via the use of network coordinators, CBOs and NGOs. Patients not yet eligible for ART will be clinically and immunological monitored, and will receive OI prophylaxis where indicated. OVC (#6694) will be integrated into HBC activities and all clients will be encouraged to bring their household members to access VCT ((#6695)) services. Women who become pregnant will be referred to PMTCT (#6699). Insecticide treated bed nets and water guard will be provided to all patients enrolled in PMTCT and all OVCs. Partnership with other IPs will provide opportunities for leveraging resources. Patients and their families will be linked to community-based income-generating activities where available. POPULATIONS BEING TARGETED All HIV positive persons including women and children and their households will be assisted to access care and support. Positive persons in the general population will
be reached through CBOs and support groups. In order to improve access to services, HIV positive clients will be supported to access health care facilities via community-based transportation support. Facility based care providers and community based care organizations will be trained to provide quality services and facilitate the establishment/strengthening of referral networks. KEY LEGISLATIVE ISSUES ADDRESSED This activity will facilitate equitable access to care and support especially to vulnerable groups of women and children. CU-ICAP will advocate for men's involvement in care in the community and as for improved inheritance rights for women and children. This activity will foster a necessary policy changes and favorable environment for Orphans and vulnerable children programming. CU-ICAP will also advocate for stigma and discrimination reduction at the community level. EMPHASIS AREAS Major areas of emphasis will include development of networks, linkages, and referral systems. Minor areas of emphasis will include human resources, IEC, training, and linkages to other sectors and initiatives.
ACTIVITY DESCRIPTION: This activity also relates to ART (6690), Palliative Care (6697) , Orphans and Vulnerable Children OVC (6694),Voluntary Counseling and Testing VCT (6695) and Prevention of Mother To Child Transmission of HIV (PMTCT) (6699). In FY06, CU-ICAP provided TB/HIV services at 3 hospital networks and initiated linkages with 6 DOTS sites in Cross River and Kaduna States. In FY07 TB/HIV integration activities will be expanded at hospitals and DOTS clinic levels to provide TB services in 12 HIV comprehensive care and treatment (C&T) sites in 7 states (Kaduna, Cross River, Benue, Gombe, Akwa Ibom, Rivers and Kogi), and HIV services to 35 DOTS sites. Building on our extensive experience on TB /HIV integration in other PEPFAR focus countries and working closely with NTBLCP and state/LGA TB control programs, will provide services to TB/HIV co-infected patients through point of service laboratory support, development of SOPs/guidelines, strengthening of referrals and linkages at the facility/community levels to C&T sites. All TB/HIV co-infected patients will be provided with co-trimoxazole (CTX) prophylaxis and linked to other palliative care services. CU-ICAP will support standardized TB screening and case finding in 10,000 HIV-infected patients using structured symptom checklist and facilitate access of at least 1,500 of those patients with TB to DOTS services. DOTS facilities will be supported to provide HIV CT to clients and if positive link to C&T. TB patients will be encouraged to bring contacts for early TB case-finding and preventive therapy (IPT). 150 HIV+ patients will be provided with IPT services. TB/HIV trainings and ongoing supportive supervision will be provided to at least 60 site level staff in collaboration with NTBLCP. 35 laboratory staff will be trained in good sputum specimens collection and improve smear microscopy via enhancing infrastructure and equipment upgrade, consumables e.g. sputum containers, and enhancement of quality assurance programs. Nosocomial transmission of TB to HIV+ patients will be prevented through measures and principles such as basic hygiene, proper sputum disposal, and good cross ventilation at clinics. Facility co-location of TBHIV services is preferred to clinic co-location. The national guidelines on infection control on co-located sites will be implemented in all our sites. Services will be facilitated through fully funded joint capacity building of 60 health care providers with the GoN and UMD at the National Tuberculosis & Leprosy Training Center (NTBL), Zaria in collaboration with other TB supporting partners e.g. WHO, NLR, and GLRA. CU-ICAP will support NTBLCP in the development of clinical support tools/job aids, national registers and referral forms for recording/reporting system, and production of IEC materials. CU- ICAP will also support the utilization of the updated NTBLCP recording and reporting formats that captures HIV information by the TB program. Support will be provided to at least 35 DOTS (10 hospital and 20 non-hospital) sites to initiate and/or enhance provider-initiated HIV counseling and opt-out testing and strengthen referral linkages from the DOTS sites to care and treatment (ART) centers through partnering with CBOs/NGOs/FBOs and PLWHA groups. Collaboration will continue with GoN, other PEPFAR implementing partners and relevant organizations to rapidly scale-up TB/HIV integration activities at CU-ICAP supported sites. A TB/HIV coordinator would facilitate sites' activities in collaboration with state/LGA TB focal persons. CONTRIBUTIONS TO OVERALL PROGRAM AREA CU-ICAP will contribute to the overall program goal of enhancing integration of TB/HIV activities by enabling at least five hundred HIV-infected patients receive TB treatment As part of the sustainability plans of the GoN and inline with the 5-Year Strategy, 125 health care workers will be trained to provide TB diagnosis, treatment and/or preventive therapy to HIV-infected patients according to national standards. Likewise health care personnel in 35 DOTS facilities will be strengthened to offer provider-initiated HIV counseling and opt-out testing to TB clients and link all HIV positives clients to care and treatment centers. CU-ICAP will also ensure that GoN structures are strengthened and integrated through joint capacity building of SACA, LACA and NTBLCP, State and LGAs TB supervisors for effective program management including joint supportive supervision. CU-ICAP will help provide basic tools and equipment to reactivate non- functional DOT sites in focus states. CU-ICAP will ensure that activities are implemented with the full participation of other government partners especially GLRA and NLR to promote sustainability, facilitate equity and synergy in line with GoN plans. LINKS TO OTHER ACTIVITIES This activity also relates to ART (6690), Palliative Care (6697) , Orphan and Vulnerable Children (OVC) (6694), Voluntary Counseling and Testing (VCT) (6695) and Prevention of Mother To Child Transmission of HIV (PMTCT) (6699). The focus is on ensuring adequate and prompt linkage of TB patients and their household contacts to HIV counseling, testing, care and treatment services and also HIV patients with TB to access services at DOTS clinics. Similar services would be made available to OVCs and PMTCT clients. In collaboration with other relevant partners/organizations, CU-ICAP in FY07 will facilitate linkage of clients to other support
services such as micro credit and infant feeding services. POPULATIONS BEING TARGETED CU-ICAP will support activities to encourage all patients in related communities living with TB to bring family members and household contacts to the clinic particularly children (5 years and younger) to enhance screening and early diagnosis and prompt treatment for positive cases. In collaboration with NTBLCP and other TB supporting partners, CU-ICAP will establish TB/HIV services for clients in prisons located within the CU-ICAP designated LGAs and support linkages to care and treatment clinics. Health care workers in both public and private sectors will be trained to provide quality focused TB/HIV integrated services. KEY LEGISLATIVE ISSUES ADDRESSED CU-ICAP will work with the relevant agencies and organizations to enhance policies that will ensure that clients in Nigerian prisons located within CU-ICAP supported sites have access to adequate and integrated TB/HIV services thereby promoting equitable access to care and treatment program. CU-ICAP will also work with relevant agencies to ensure equitable access to care and treatment programs for women, children and underserved populations in all the service sites. EMPHASIS AREAS The major area of emphasis is on training of health care providers on TB/HIV integration services. Health care providers will be trained to provide counseling and testing services, care and treatment, referrals and back referrals between care and treatment centers and DOTs sites. CU-ICAP will fully fund trainings for its participants especially when organized with other partners. Minor emphasis areas are on service quality assurance and improvement, human resource, needs assessments, development, production and dissemination of IEC materials and increase community awareness and mobilization.
ACTIVITY DESCRIPTION This activity also relates to ART (6690), Palliative Care (6697), VCT (6695) PMTCT (6699) services.
In COP06, CU-ICAP assisted 3 secondary hospitals in Kaduna and Cross River States to support 600 HIV-infected and affected children (OVC) who accessed support services, care and treatment, laboratory, and pharmacy support at the hospitals, their referral networks, and surrounding communities.
n COP07, CU-ICAP will expand support to 12 new hospital networks in 7 states and to 2,786 infants and children enrolled into care and support. CU-ICAP will strengthen the coordination of PMTCT, ART and OVC services for seamless movement of HIV+ children across the various services. Support and capacity building for local NGOs, CBOs and FBOs will enable the implementation of advocacy and social mobilization, psychosocial support, home based care (HBC), and educational support. Clients and their caregivers will be linked to food and microfinance programs. OVC services (6694) will be integrated into community HBC programs. Networking with community organizations and other implementing partners will enable leveraging of resources, and trainings will enhance service delivery, capacity building and sustainability.
CU-ICAP's pediatric programming has 5 elements: enhancing PMTCT effectiveness; supporting pediatric HIV diagnosis; enhancing pediatric case finding and referral to care and treatment; and ensuring comprehensive care and treatment services, including ART, for HIV-exposed and infected children. In FY07, CU-ICAP's health care for OVC will include prophylaxis of opportunistic infections (OIs), management of OIs and other illnesses, and ART for eligible patients. Facilities will also receive support and training to collect, prepare, and transport dried blood spots (DBS) for infant diagnosis, to be performed at laboratories supported by other implementing partners.
To achieve these objectives and overcome challenges faced in COP06, CU-ICAP will provide infrastructural support and training for clinical staff using GON pediatric protocols, guidelines and SOPs. Family focused care and elements of pediatric care will also be woven into each ART training. Procurement of drugs and supplies for pediatric care will continue, as will pharmacy training and supervision.
CU-ICAP will work through local partners to provide educational support e.g., school levies to most at-need children following clearly identified selection criteria. CU-ICAP will also work with Fantsuam Foundation (FF), MWG and GAWON Foundation to provide therapeutic nutrition for malnourished children and motherless infants. They will provide home based primary care, psychosocial support and link OVC to health facilities for basic health care needs by providing transport and other support. These partners will also provide OVC services and will support peer education at primary and secondary schools. In addition CU-ICAP along with her local partners will set up a monitoring system using the nationally approved tools that allows the monitoring of services provided directly by CU-ICAP; by referral from CU-ICAP to another organization.
At the community level, subcontracts with the following organizations will provide family focused OVC services and linkages to hospital and allied services: MWG, FF, TCF, GAWON, Catholic Archdiocese of Ogoja (CACA), Grassroots HIV/AIDS Counselors and ARFH and other CBOs and PLWHA groups.
CONTRIBUTIONS TO OVERALL PROGRAM AREA y training 250 care givers and health care providers, CU-ICAP, through partnership with organizations listed below, will enhance the delivery of quality services to a cumulative 2,786 OVC that are/will be enrolled in basic care and support programs such as health, educational and vocational support, psychosocial support and food and nutrition. All these activities will improve the lives of the OVC in line with the national plan of Action on OVC and the National Strategic Framework and contribute to meeting the PEPFAR primary and supplemental direct targets. CU-ICAP will leverage resources through advocacy and training in partnership with GON and other IPs to contribute to the indirect targets. Fifty policy makers and key decision makers in the health and education sectors will be reached by advocacy efforts.
LINKS TO OTHER ACTIVITIES This activity also relates to activities in ART (6690) and Palliative Care (6697) in that all children infected with HIV will be monitored and placed on ART when indicated. HIV-exposed and infected children will be placed on prophylactic Cotrimoxazole (CTX) from six weeks or as soon as diagnosis is confirmed. Also OVC and their households will be provided with insecticide treated bed nets and water guards for safe and clean water by partnering with SFH. Household members of OVC will be referred for VCT (6695) and women enrolled in PMTCT (6699) will be provided with intermittent treatment prophylaxis for malaria prevention and their children referred for OVC services.
POPULATIONS BEING TARGETED This activity targets the general population especially infants and young children and other at-risk children in HIV infected and affected families. The entry point for OVC in the general population will be CU-ICAP's partner organizations. HIV positive infants and children, HIV-infected pregnant or breast feeding women and malnourished patients will be assisted to access care and support. Health and allied care providers in clinical and non clinical settings will be trained to provide services to OVC. Community and facility based volunteers, traditional birth attendants and support groups programs, will be used to increase access to care and support especially to the underserved.
KEY LEGISLATIVE ISSUES ADDRESSED CU-ICAP will advocate equal access to education and improved legal and social services such as the protection of inheritance rights for women and children, especially the girl child, and increased gender equity in HIV/AIDS programming. CU-ICAP will advocate for increased access to income and productive resources and education for women. This activity will foster necessary policy changes and ensure a favorable environment for OVC programming. CU-ICAP will support CBO and FBO partners to leverage resources for micro-credits and microfinance activities to support OVC care givers and other areas of focus. CU-ICAP will advocate for free education for HIV-infected children and will work to provide interim arrangements for school fees or other supports where needed.
EMPHASIS AREAS CU-ICAP major area of emphasis will be the development of networks, linkages and referral system. Minor areas of emphasis will include commodity procurement, linkages with other sector and initiatives, training and food/nutrition support.
ACTIVITY DESCRIPTION This activity also relates to activities in ART services (#6690), Care and support (#6697), TB/HIV (#6696), OVC (#6694), and PMTCT (#6699). In COP06, CU-ICAP supported HIV counseling and testing (HC&T) at 3 hospitals and 10 non-hospital facilities (2 VCT sites, 6 DOTS sites, 2 stand-alone VCT centers) in Kaduna and Cross River States. In COP07, this support will increase to a total of 45 HC&T sites (15 secondary hospitals, 10 non-hospital facilities and 20 other DOTS facilities) in 7 states including Benue. At least 57,000 individuals will receive counseling & testing and receive their results. 250 health care providers and laboratory staff at facility and community levels will be trained to provide services in the 45 HC&T outlets in the 7 states. CU-ICAP's HC&T support has 4 themes: supporting provider-initiated opt-out HIV testing (PIHCT) in high risk populations especially TB/DOTS sites, adult and pediatric inpatient wards, and OPDs; expanding access to VCT centers; strengthening opt-out HC&T in the ANC setting; and promoting case-finding via the family-focused approach to HIV/AIDS care and treatment. In FY07, CU-ICAP will support HC&T training using the National curriculum, and will provide ongoing mentoring to enhance providers' skills. Counselors will have access to training to improve their skills to provide adequate ‘couple counseling'. Refresher trainings will be provided to site staff as needed. CU-ICAP will support the use of multidisciplinary teams including lay counselors where appropriate, and will pilot the use of student nurses as counselors in selected training institutions. An "open access" approach will be promoted to ensure that C&T is available to all patients utilizing a facility. Within the hospital, CU-ICAP will foster referral linkages between C&T services and ART clinics and will ensure quality implementation of C&T data management and reporting systems. VCT services will promote ‘couple counseling & testing' at the service outlets. In addition post-test counseling resources, such as support groups and peer educators, will support disclosure when appropriate and address the special issues facing discordant couples. Post-test counseling for HIV-negative patients will emphasize primary prevention; that for HIV-infected patients will focus on appropriate ‘prevention for positive' messages to reduce risk of HIV transmission from HIV+ individuals. Condom education and distribution will be supported by CU-ICAP and implemented by CBO partners. Condoms will be supplied by the Society for Family Health (SFH) and distributed to CBOs for use in condom education activities. Laboratory QA will be provided by CU-ICAP Laboratory Advisors to ensure quality HIV testing. CU-ICAP will continue to support VCT services at 45 service outlets. The national ‘Heart to Heart' logo will be used at VCT sites for integration with national branding of HIV testing services. CU-ICAP will strengthen linkages between HC&T and ART sites and will provide trainings to improve monitoring and evaluation. CU-ICAP will support community-level VCT services through identified CBOs/FBOs, IEC and outreach initiatives, further strengthening the network of HC&T available to the community. CU-ICAP will ensure that secondary and primary healthcare facilities are key partners in these networks. Testing activities will be based on new national testing algorithms using non cold chain dependent test kits. CU-ICAP will continue to store test kits centrally in a secure warehouse in Abuja and distribute to sites as needed. Technical assistance will be given to sites to ensure appropriate storage, record keeping and forecasting. CU-ICAP will support the utilization of the updated NTBLCP recording/reporting formats that capture HIV information by the TB program. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will contribute to the overall 2007 emergency funding plans by enabling 15 secondary hospitals, 10 non-hospital facilities and 20 other DOTS facilities in 7 states (a total of 45 service outlets) to provide access to HC&T services to at least 57,000 people who will also receive their results and have access to care and treatment, including ART if/when needed. 250 health care providers and laboratory staff at facility and community levels will be trained to provide services in the 45 HC&T outlets in the three states. CU-ICAP will continue to support and participate in the harmonization process led by the GoN with regard to LMIS and ICS for test kits. LINKS TO OTHER ACTIVITIES This activity also relates to activities in ART (3.3.11), Palliative Care (3.3.06), TB/HIV (3.3.07), OVC (3.3.08), VCT (3.3.09) and PMTCT (3.3.01). The PIHCT and VCT activities in the sites supported by CU-ICAP will encourage the enrollment of patients and family members into care through multiple entry points. HC&T activities will be made available in all the TB/DOT sites in and around the facilities. CU-ICAP will also support community VCT linked to the hospital networks, enabling referral of HIV positive clients to the hospitals to access care and treatment as appropriate. POPULATIONS BEING TARGETED This activity targets the general population especially young women and other at risk groups such as patients with TB. CU-ICAP will encourage counseling and testing among family and household members using a family focused approach at multiple entry points. Community based and faith based
organizations/facilities will be trained to provide CT to increase access in non-clinical settings. The availability of trained volunteers will further increase uptake. KEY LEGISLATIVE ISSUES ADDRESSED Community mobilization/ behavior change communication support will educate targeted populations, especially young people and couples, on the importance of VCT and couple counseling/disclosure of HIV status and will facilitate positive male norms and behaviors. PIHCT/HC & T using multiple entry points and the "open access" approach in the health facilities will help reduce stigma and discrimination. CU-ICAP will promote the training of facility and non-facility based staff. EMPHASIS AREAS The major emphasis area is training. Minor emphasis areas are commodity procurement, quality assurance and improvement, logistics support, community mobilization and participation, network and referral linkages.
ACTIVITY DESCRIPTION This activity is linked to Counseling and Testing (#6695), PMTCT (#6699), ARV services (#6690), Care and support (#6697), OVC (#6694) and TB/HIV (#6696) In FY06, Columbia University-International Center for AIDS Care and Treatment Programs (CU-ICAP) supported procurement and distribution of antiretroviral (ARV) drugs for 3 hospital networks in 2 states. In FY07, CU-ICAP will expand antiretroviral therapy (ART) services support to 12 additional hospital networks, resulting in coverage in 7 states (Cross River, Kaduna, Benue, Gombe, Akwa Ibom, Rivers and Kogi states) and provide ART to a cumulative 10,340 patients. CU-ICAP supports a supply chain management system (SCMS) to ensure continuous supply of ARV drugs with FDA approval or tentative approval, and which are National Agency for Food and Drug Administration and Control (NAFDAC) registered or have received a waiver. All ARV drugs procured follow Government of Nigeria (GoN) treatment guidelines. UNICEF procures ARV drugs, handles customs clearance and delivery to a secure warehouse at the CU-ICAP office in Abuja a CU-ICAP van delivers ARV drugs to sites. CU-ICAP will continue to discuss the utilization of the Partnership for Supply Chain Management (PFSCM) for ARV drugs procurement as PFSCM increases its services in Nigeria. CU-ICAP has integrated quality assurance, monitoring and evaluation systems into the SCMS. CU-ICAP's procurement and store managers provide technical assistance including: training pharmacists in forecasting, stock management, record keeping, quality assurance, and distribution; providing infrastructure support for pharmacies and storerooms, including renovation, refurbishment, and provision of equipment, supplies and job aids. In addition to the hands-on training above, CU-ICAP uses a State-endorsed pharmacy technician in-service training course, and trains key staff on record keeping for ARV drugs storage and distribution at points of service. Pharmacists at every site participate in multidisciplinary team ART training activities. CU-ICAP will assess pharmacies' capacity in all new sites towards secure storage and stock management. Renovations and refurbishments will include the addition of partitions to create private adherence counseling space, repairs to walls, doors, and ceilings, installation of air conditioners, refrigerators, shelving and other storage, and security elements such as bars and locks. Standard Operating Procedures in line with national SOPs will be provided to guide quality ARV drugs management. Cost per patient could grow as some patients fail 1st-line regimens, and as treatment-experienced patients from distant ART facilities transfer to local CU-ICAP-supported hospitals. To minimize such cost increases and support the GoN desire to utilize generic drugs, as generic ARV drugs obtain FDA approval or tentative approval as well as NAFDAC registration or waiver, they will replace more expensive versions. CU-ICAP will continue to participate in and support the harmonization process led by the GoN in line with one national program at all levels for sustainability. In addition, CU-ICAP will work towards sustainability by strengthening existing structures and building capacity of health care providers in all health facilities that it supports. As expansion of ARV drug services is prioritized to rural areas, we will strengthen existing referral channels and support network coordinating mechanisms. CONTRIBUTIONS TO OVERALL PROGRAM AREA In FY07, CU-ICAP activities under ARV drugs will support PEPFAR goals of ensuring continuous supply of ARV drugs to HIV infected adults and children who require treatment. In COP07 7,540 individuals (6,820 adults and 720 children) will newly initiate ART. By the end of COP07, 9,340 adults and 1,000 children will have initiated ART, a cumulative total of 10,340 patients thus contributing to the national goal of treating 350,000 patients by 2008. LINKS TO OTHER ACTIVITIES This activity also relates to activities in ART (3.3.11), Palliative Care (3.3.06), OVC (3.3.08), VCT (3.3.09) and PMTCT (3.3.01) and TB/HIV (3.3.07) for the provision of HIV/AIDS related commodities needed in those services. POPULATIONS BEING TARGETED Health care workers especially pharmacists doctor and nurses, will acquire skills to manage ARV drugs appropriately along the supply chain. KEY LEGISLATIVE ISSUES ADDRESSED None EMPHASIS AREAS Major emphasis area is commodity procurement. Other minor emphasis areas include training, logistics, infrastructure support and quality assurance, quality improvement, and supportive supervision.
ACTIVITY DESCRIPTION This activity relates to Palliative Care (#6697), OVC (#6694), VCT (#6695), PMTCT (#6699), TB-HIV integration (#6696), HVOP (#9208) and SI (#6692). In FY06, CU-ICAP initiated multidisciplinary family-focused HIV/AIDS care and treatment, including antiretroviral therapy (ART), at three Government of Nigeria (GoN) secondary hospitals in rural and semi-urban areas of Kaduna and Cross River States. In FY07, CU-ICAP will expand support to 12 new hospitals in high-prevalence states including Benue Gombe, Akwa Ibom, Rivers and Kogi states, providing ART to a cumulative 10,340 patients, including 9,340 adults (6,820 new in COP07) and 1,000 children (720 new in COP07). Clinicians at all 15 hospitals will be assisted to promptly initiate and support ART for eligible patients. CU-ICAP will provide ART trainings, including ongoing CME and QA activities, for 250 physicians, nurses, counselors, pharmacy, and laboratory personnel, 125 of whom will also be trained to support pediatric care and treatment. On-site clinical mentoring will enhance quality of care and build site-level clinical and program management skills for program sustainability. ART reference tools will include pocket guides, ART dosing cards, posters, and detailed SOPs. CU-ICAP works closely with PEPFAR implementing partners and GoN to ensure compliance with National policies, curricula and guidelines, where available. Additionally, CU-ICAP will continue to participate in the USG coordinated Clinical Working Group to address emerging treatment-related topics and further promote harmonization with other IPs and the GoN. Adherence trainings and support services will be provided at each site. These will facilitate adherence assessment and support including individual and group counseling, patient education, enhanced appointment system, referral linkages, patient follow-up, provision of support tools (dosage guides, reminders etc), linkages to community-based adherence support and defaulter tracing programs. CU-ICAP will facilitate on-site implementation assistance to strengthen systems, including ART clinic management, medical records, referral linkages, patient follow-up, integration of prevention into care and treatment, involvement of PLWHA, access to laboratory services and ARVs including first line/second line regimens for adults and children using national protocols and guidelines. To enhance uptake and quality of services, CU-ICAP will strengthen linkages with entry points including: HC&T, ANC, pMTCT, TB clinics, under-5 clinics, OPDs, inpatient wards, family planning, STI clinics and palliative care services. Based on FY06 experience and initial site assessments, the need for significant infrastructure support, including generators, bore holes, and renovation is anticipated. Staffing shortages suggest that support for facility staff, following USG and GoN guidelines, will also be critically important. Using the ART health network model, CU-ICAP will work to establish and strengthen links between primary (PHC) and secondary health facilities, PLWHA groups, non-governmental and faith-based organizations, and communities. This will ensure patients' access to, and utilization of, comprehensive HIV/AIDS care and support and continuity of care and treatment. CU-ICAP will support 15 hospitals in FY07, allowing 6,820 adults and 720 children to newly initiate ART. By end-FY07, a total of 10,340 people will have accessed ART in CU-ICAP-supported programs. CONTRIBUTIONS TO OVERALL PROGRAM AREA One of the pioneers of family-focused multidisciplinary HIV/AIDS treatment in resource-limited settings, CU-ICAP's programs are characterized by: integration with national plans and guidelines; comprehensive care services throughout the continuum of HIV disease; attention to adherence, psychosocial issues, and community concerns; and the involvement of people living with HIV/AIDS. Using this quality focused approach, CU-ICAP will provide access to ART services to 10,340 people (9,340 adults; 1,000 children), 7,540 (6,820 adults and 720 children) newly initiating ART in FY07, contributing to the GoN/PEPFAR targets for Nigeria. CU-ICAP will build the skills of at least 250 care providers at secondary and primary health care levels, thus contributing to national sustainability plans and to the USG/GoN plans to devolve ART care and provide services closest to where clients live. By promoting non-segregation of services and clients in ART clinics especially at the GoN supported sites of Barau Dikko Hospital in Kaduna State and NKST Hospital Mkar in Benue state, CU-ICAP will actively support the service harmonization goal of USG/GoN. LINKS TO OTHER ACTIVITIES This activity relates to Palliative Care (#6697), OVC (3.3.08), VCT (#6695), PMTCT (#6699), HVOP (#9208), TB-HIV integration (#6696) and SI (#6692). As expansion of ARV drug services is prioritized to rural areas, we will strengthen existing referral channels and support network coordinating mechanisms. Through a strong referral/network linkage, patients on ART will be linked to home based care and support, community and social services for referrals for food and education assistance, and livelihood opportunities and other wrap-around services. Other preventive services include safe water promotion via water guard provision, CTX prophylaxis, pain/symptom alleviation, and psychosocial and spiritual support. TB/HIV linkages will be strengthened
where ART and TB-DOT sites are co-located, and co-location of new ARV sites will be actively promoted in TB-DOT stand-alone sites. Patients will receive counseling and education on preventing secondary transmission of HIV ("prevention with positives"). CU-ICAP will also facilitate and actively support on site standardized HMIS using GoN forms and provide on-site assistance with data management and M&E to guide quality improvement. KEY LEGISLATIVE ISSUES ADDRESSED Services will focus on addressing the needs of women, infants and children to reduce gender inequalities and increase access to ART services among most vulnerable groups. ARV services will facilitate linkages into community and support groups for nutritional support and micro-credit /finance activities. POPULATIONS BEING TARGETED Ongoing technical assistance will be provided to national and state-level policy makers. PLWHA, especially the vulnerable groups of women and children, will be provided access to ART services. Health care providers in secondary and primary health facilities will be trained to deliver quality ART services. EMPHASIS AREAS Major emphasis area is quality assurance/improvement and supportive supervision. CU-ICAP personnel including national and international experts will provide skill and competency-based trainings, CMEs, and ongoing clinical mentoring to enable on site staff provide quality oriented ARV services to patients. Joint USG/GoN/CU-ICAP teams will facilitate supportive supervision. CU-ICAP will step down trainings to nurses/CHEWS to deliver ART services especially at primary health facilities. Minor emphasis areas are training, human resources issues, referral networks, infrastructure support, linkages to other sectors and initiatives. CU-ICAP will follow Nigerian and USG guidelines to address urgent human resource needs through subcontract arrangements made with hospitals and State MOHs for supernumerary staff at locally-appropriate salaries. Facility renovations where needed will comply with all USG regulations.
ACTIVITY DESCRIPTION (6693): This activity also relates to activities in ART (6690), HBHC (6697), OVC (6694), VCT (6695), TB/HIV (6696) and PMTCT (6699). In FY06, the International Center for AIDS Care & Treatment Programs at Columbia University (CU-ICAP) initiated a laboratory network model in Kaduna and Cross River States, providing 3 hospital networks to support HIV/AIDS care and treatment programs. In FY07, this model will support an additional 12 secondary hospital labs, enabling 57,000 people to access HIV/AIDS testing, 9,963 HIV positive adults, infants and children on treatment, 14,323 HIV positive adults, infants and children not on treatment and 3800 HIV positive mothers to access HIV/AIDS care and treatment services. Baseline assessments revealed infrastructural deficiencies including lack of electricity and potable water, obsolete equipment and testing methods and severe staffing shortages and under-skilled staff. CU-ICAP's response to these challenges has been multi-pronged and includes development of the Laboratory Network Model, a detailed Laboratory Support plan, and support for renovation and training. The Laboratory Support plan established a logical step-wise approach to phasing in the services needed by HIV/AIDS care and treatment programs. Phase I provides the "minimum package" elements of a functioning lab: electricity, running water, adequate interim space, training and supervision, reorganization of labs as needed, ability to perform HIV testing, complete blood counts, simple chemistries and manual CD4 enumeration. Phase II includes the introduction of analyzers, the initiation of standard QA/QC systems, the expansion of capacity to include additional chemistry tests, urinalysis, parasitology, cultures, and liver function tests where feasible, and the completion of renovation and refurbishment activities as well as the introduction of protocols to collect and prepare dried blood spot (DBS) samples for use in infant diagnosis. CU-ICAP will send specimens to appropriate laboratories supported by other PEPFAR implementing partners especially the IHV ACTION program. CU-ICAP will bear shipping, testing and other related costs involved in this process. Lab staff will be trained in the use of already designed specimen shipment forms and other identified mechanisms to track samples and results among CU-ICAP lab network and other partner networks. In FY07, CU-ICAP will continue to fully fund training on diagnostic testing and immunologic monitoring, good laboratory practices (GLP) and biosafety. By harmonizing equipment with other PEPFAR implementing partners and national government standards, CU-ICAP will continue to coordinate and fully fund formal didactic training sessions, share resources and avoid duplication. On-the-job training is enhanced by job aids, standard operating procedures (SOPs) and diagnostic algorithms. 150 laboratory staff will be trained in GLP, HIV serology, and CD4 enumeration among others. Additional training on microscopy for AFB will be conducted at 35 DOTS sites to identify TB/HIV co-infections. TOT lab management training will be provided for 17 lab supervisors to enhance lab management skills. CU-ICAP will continue to participate in the QA/QC national networks discussions and support the active integration of recommendations/guidelines at its sites and state levels. CONTRIBUTIONS In FY07 CU-ICAP will use emergency plan funds to support 15 labs in hospital facilities using the phased approach described above. Referral protocols for the health networks will be strengthened, and the laboratory network model will be implemented. To facilitate the GoN scale up plans, 150 laboratory staff will be trained on the provision of high-quality lab testing for patients with HIV/AIDS at different health facility levels. Trainings will be stepped down to laboratory technicians and assistants from the primary health centers by secondary facility trained laboratorians. 35 lab technicians will be trained on ZN- staining /AFB identification to enhance TB diagnosis at the DOT sites. ICAP will also strengthen the laboratories at new sites by renovating their space and facilities (within the existing hospital building space), and enhancing their diagnostic abilities to include urinalysis, electrolytes, and basic microbiology/parasitology. These activities will position the labs to contribute significantly to the delivery of quality HIV care/ treatment programs at CU-ICAP assisted sites. By ensuring appropriate training, supervision, equipment, maintenance and supplies, all 15 hospital labs will be strengthened to support these institution's rapidly-growing HIV/AIDS care and treatment programs (include pediatric) in response to the GoN approach to sustainable quality lab services. LINKS This activity also relates to activities in ART (6690), Palliative Care (6697), OVC (6694), VCT (6695), TB/HIV (6696) and PMTCT (6699). These services will directly support these activities by enabling 57,000 people access to HIV/AIDS testing and 9,963 HIV positive adults, infants and children on treatment, 14,323 HIV positive adults, infants and children not on treatment and 3800 HIV positive mothers to access HIV/AIDS care and treatment. Provider-initiated-testing at point of service in ANC wards will be promoted, with point-of-service testing in TB clinics, inpatient wards, and STI clinics. Phase II activities at the General and Catholic Maternity Hospitals, Ogoja, and General Hospital Kafanchan will include the initiation of clinical and
laboratory protocols for the collection, preparation, storage and transport of DBS samples for infant diagnosis at identified government supported zonal centers with PCR machines. POPULATIONS General populace with special emphasis on high risk groups especially TB co-infections. HIV monitoring of HIV positives and diagnosis of HIV exposed especially vulnerable groups of women, infants and children. Pregnancy and syphilis tests will be provided to women. Lab monitoring for 24,286 HIV positives and 3800 HIV positive mothers includes a projected total estimate of 138,020 tests consisting of 26,300 LFTs, 26,300 CBCs, 25,920 CD4 counts, 2,500 sputum exams and 57,000 HIV testing including test in TB patients. A TB Directly Observed Therapy (DOTs) site will be opened in a prison facility close to the Ogoja General Hospital to promote equity and facilitate access to this special population. Health workers will be trained in providing quality oriented laboratory and testing services including collection, transport and tracking of samples and results especially to and from primary healthcare centers and other partner networks. CBOs/FBOs will be trained in using rapid test kits based on national algorithms. KEY LEGISLATIVE ISSUES Increasing access to HCT through multiple entry points and non hospital based and DOTs sites and with the assistance of volunteers will contribute to reduction of stigma and discrimination with increased awareness and linkages to care, support and treatment. Lab monitoring provides the background to assure the quality of ART services rendered. EMPHASIS AREAS One major emphasis area is commodity procurement, while training, quality improvement/assurance, supportive supervision, upgrading of infrastructure and development of referrals, network/linkages constitute the minor areas. Joint USG/GoN/CU-ICAP teams will provide supportive supervision to sites. QA teams will ensure compliance with national and/ or best practice standards. The CU-ICAP approach to renovation is consistent with USG regulations. Construction, as defined in the PHS Facilities Manual (e.g. any activity which increases area or cubage) is not performed. Equipments and bulk reagent will be purchased locally with approval from the head office while HIV test kits will be sourced through the CDC for quality assurance and standardization. Consumables will be purchased quarterly from local vendors subject to availability.
ACTIVITY DESCRIPTION This activity relates to activities in PMTCT (##6699), Adult Basic Care and Support (#6697), TB-HIV (#6696), OVC (#6694), VCT (#6695), and ART Services (#6690). The Monitoring and Evaluation (M&E) component of CU-ICAP programs enables the assessment of progress towards program goals/objectives and support quality improvement activities. It strengthens medical records and patient information systems, improves data management and data quality, and enhances clinical services at CU-ICAP-supported sites. In COP 06, CU-ICAP's M&E team initiated systems to monitor program activities using indicators (which are also used for national and USG reporting) and supported the implementation of basic site patient tracking (using national paper-based systems) for care and treatment at 3 hospitals in 2 states (Kaduna and Cross River). M&E staff identified and harmonized indicator definitions, adapted/produced and printed data collection forms; trained service providers in appropriate record-keeping; provided ongoing technical assistance to facility personnel to enhance site capacity to keep and review completed service delivery forms/registers, and implement data quality assurance systems. In COP 07, the M&E infrastructure required to support rapid program expansion will be put in place at an additional 12 secondary hospitals and other PMTCT, VCT and DOTS sites in 7 States (Cross River, Kaduna, Benue, Gombe, Akwa Ibom, Rivers and Kogi states). An electronic database will be used to aid comprehensive patient tracking to facilitate site monitoring activities, assist reporting, monitoring quality of service being provided and aid evaluation. M&E activities will include setting up a strong paper-based records system, regular data collection and verification to meet reporting and other M&E requirements and tracking referrals and linkages to CU-ICAP supported hospitals for HIV care and treatment services when appropriate. Both paper and electronic systems implemented at program sites will be in line with GoN harmonization policies and goals in this area. COP 07 funds will be used to train facility medical records officers and data clerks in basic computer skills, data management and general M&E. Service delivery staff will be trained on monitoring quality of service using appropriate Quality Management (QM) tools. In addition, M&E staff (including site data entry persons) will be hired. Furthermore, robust systems for tracking patients and monitoring adherence will be developed. Logistic support will include the printing and distribution of required forms and purchase of computers with relevant software packages (for data management at the sites). Emphasis will be on creating a system to ensure that data collected at the site is used by site service delivery staff for strategic planning to improve program quality and inform programmatic decisions, thus ensuring ownership of the data and sustainability of M&E activities. Other M&E activities e.g., organizing monthly feedback meetings with facilities and Government of Nigeria (GON) at all levels, conducting regular quality checks on data and other services through the use of adapted QM tools will continue to be supported. Support will be provided to GON as necessary and evaluation protocols will be developed and implemented. Additionally, our SI team will continue to be active participants on the SI working group established and coordinated by USG-Nigeria. CONTRIBUTIONS TO OVERALL PROGRAM AREA CU-ICAP's will train and provide on-going technical assistance to at least 150 individuals at ICAP-supported facilities (Strategic Information staff of secondary hospitals, primary health care facilities, DOTS sites, CBOs, NGOs, and PLWHA groups) to enter and manage the information required to monitor program performance, evaluate quality, and identify areas in which program services can be strengthened. Service providers will also be supported to complete medical records and registers in an accurate and timely manner. In addition, CU-ICAP will provide technical assistance to 16 local organizations, enabling them to strengthen their own monitoring and evaluation activities. Data will contribute to the measurement of the achievement of the GON/PEPFAR care and treatment goals and will be utilized to strengthen systems for increased and rapid expansion, planning and sustainability purposes. LINKS TO OTHER ACTIVITIES M&E is concerned with the collection of data on all services provided to improve program activities and enhance reporting. Thus, this activity will relate to activities in PMTCT (#6699), Adult Basic Care and Support (#6697), TB-HIV (#6696), OVC (#6694), VCT (#6695), and ART Services (#6690). POPULATIONS BEING TARGETED The population being targeted includes the M&E officers in partner implementing organizations and various Community Based Organizations, Faith Based Organizations, NGO/PVO and medical records officers in health facilities. The various cadres of service providers will also be provided with technical assistance to enhance accurate record keeping. KEY LEGISLATIVE ISSUES ADDRESSED By collecting data about relative numbers of men and women accessing prevention, care, and treatment services, strategic information will be available to inform the development of strategies to mitigate gender inequity. Strategic information also enables programs to assess the effectiveness of
referrals and linkages to wraparound programs providing food support, microfinance initiatives, and reproductive health services (and other required services). Data will routinely be used to assess and enhance program quality. EMPHASIS AREAS Major emphasis area is HMIS. Minor emphasis areas are analysis, reporting, evaluation, QA/QI, local organization capacity development, training, IT and communications infrastructure and other SI activities.