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.
Years of mechanism: 2008
In COP08, ICAP-CU will continue to work in the three states of Kaduna, Cross River and Benue. ICAP-CU
will also support PMTCT services in 3 additional states (Gombe, Kogi and Akwa Ibom), assisting a total of
70 (33 new, 37 existing) government (GON), mission and private health facilities to provide PMTCT services
and community outreach activities throughout 25 hospital networks. These networks, which will include
hospitals, PHC centers, and community-based service outlets, will provide HIV counseling and testing to
55,000 pregnant women, of whom at least 50,000 will receive their results and be linked into appropriate
care and treatment programs.
ICAP-CU will train health care workers (HCWs), support infrastructure, purchase equipment and supplies,
monitor, evaluate and provide supportive supervision to the sites. ICAP-CU, with other implementing
partners, will implement the PEPFAR-Nigeria LGA coverage strategy in Kaduna, ensuring the provision of
PMTCT services in at least one health facility in every local government area (LGA) for states designated
‘LGA Coverage States'. This is an essential step toward universal access to PMTCT services and moves
the program closer to the shared goal of eliminating perinatal HIV transmission. Active efforts will be made
to facilitate the public health approach in taking PMTCT services to the primary (PHCs) and community
In COP08, ICAP-CU will support comprehensive PMTCT services for communities, including marked
expansion of HIV testing for pregnant women. ICAP-CU will work to increase uptake of these services,
including routine antenatal care and facility-based deliveries. Pregnant women, especially HIV-positive
mothers, will be supported to deliver in health facilities through the provision of the national safe
motherhood program delivery kits ("mama kits"). Mother support groups will be established and/or
strengthened to increase facility-based delivery and reduce the number of women lost to follow up. Post-
delivery care and treatment for women and infants will be augmented. The use of ART for PMTCT will
follow the National PMTCT guidelines. HIV-infected women ineligible for ART will be offered a combination
of zidovudine (AZT) from 28 weeks (when feasible) or combivir from 34/36 weeks 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 6 weeks. 2,500 mother-baby pairs will receive ARV prophylaxis. Through appropriate
infant feeding counseling and follow-up, ICAP-CU will provide support for a mother's infant feeding choice
as well as provide ongoing psychosocial and adherence support. Health facilities will be supported to
provide basic laboratory services and, if not available on site, will be linked to a laboratory network model in
which CD4 testing can be performed via specimen transport systems. Exposed infants will be actively linked
to pediatric care and treatment through under-5 cards issued in labor and delivery.
The COP08 programming will emphasize provider-initiated opt-out testing with same day results at ANC,
labor and postpartum service delivery points. Partners, households and children will be linked into HCT.
ICAP-CU will actively promote community-based PMTCT services to provide doorstep HCT to pregnant
women, their partners and other household members. Clients will be counseled on the beneficial effect of
couple/partner HCT/disclosure on adherence to infant feeding choice. Eligible HIV-infected women will be
assessed and linked into care and treatment services including ART and cotrimoxazole prophylaxis (pCTX).
Other activities are enhanced pediatric care including pCTX from 6 weeks of age and promotion of best
practices for infant feeding, nutritional support and linkages to family planning services. In addition to
receiving PMTCT services, each woman will be referred to OVC services upon her HIV diagnosis in order to
facilitate care to all of her affected children.
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. ICAP-CU and its sub-partners will train
450 HCWs, using GON curricula, to provide quality services to HIV-infected pregnant women. The training
will focus on prevention messaging (including balanced ABC messaging as appropriate), STI screening and
treatment, safer sex, nutrition, malaria prophylaxis, use of ITNs and safe water. 200 additional health care
providers will be trained to educate and assist mothers make appropriate infant feeding options and
discourage "mixed feeding" practices. ICAP-CU will facilitate the government's efforts in improving infant
feeding counseling by supporting a zonal train-the-trainer on HIV and infant feeding. HIV-negative mothers
will be counseled and supported to remain HIV negative. By the end of COP08, a total of 650 HCWs will be
trained. ICAP-CU will partner with CBOs and FBOs such as TCF, CACA, GHAC, Gawon Foundation and
PLWHAs as key players to provide innovative community and home-based PMTCT services to pregnant
women. ICAP-CU will actively support innovative community-based approaches and activities to reach and
link male partners into existing services.
ICAP-CU will work in close partnership with IHVN and the Clinton Foundation on HIV infant diagnosis,
offering HIV infant diagnosis testing in line with the National Early Infant Diagnosis Initiative from 6 weeks of
age using DBS. HIV positive infants will be linked to appropriate care and treatment. A joint
USG/GON/ICAP-CU 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:
ICAP-CU and its sub-partners target states with some of the highest seroprevalence rates in Nigeria.
Providing services at the primary and secondary levels assists the GON in achieving its goal of
decentralizing PMTCT services beyond the tertiary care level. ICAP-CU will significantly contribute to an
increase in PMTCT services by supporting 37 existing and 33 additional government, mission and private
health facilities and also indirectly supporting GON ministries/programs in their rapid scale-up plans for
PMTCT. ICAP-CU will partner with local institutions with appropriate expertise and capacity to reach out
into primary facilities in line with national PMTCT scale-up plans.
The targets of 50,000 pregnant women counseled and tested and 2,500 mother-infant pairs for ARV
prophylaxis will be reached by the end of COP08. This will significantly contribute to the emergency plan
targets of 80% coverage and 40% reduction in PMTCT transmission by 2008. ICAP-CU will strengthen
national and state PMTCT programs by: support of capacity building of master trainers for PMTCT services;
production of GON approved infant feeding support tools; printing of national PMTCT registers; and support
of regular coordination meetings in collaboration with other partners at national and state levels. ICAP-CU
will also strengthen the programmatic skills of partner CBOs/FBOs in line with GON sustainability plans.
Activity Narrative: LINKS TO OTHER ACTIVITIES:
This activity is related to activities in ARV services (5404.08), Basic Care and Support (5552.08), OVC
(5547.08), counseling and testing (5550.08), SI (5541.08), Lab (5544.08), AB (15654.08) and Other
Prevention (9208.08). Provider-initiated opt-out HCT will be offered to all pregnant women at ANC, and to
their partners. Women presenting in labor 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 OVC care
and treatment services. 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, postpartum 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 HCT 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 care and treatment services, including
OVC services. Uninfected 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. Healthcare
providers will be trained on providing services while the management skills of GON policy makers and
implementers at all levels will be improved to enable them to manage programs effectively.
Emphasis, in this activity, will be on training, increasing gender equity in HIV/AIDS programs, local
organization capacity building and SI.
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.
Columbia University (CU), through this new award, proposes to extend its innovative and successful
PMTCT-Plus programming to the Kachia local government area (LGA) of Kaduna State. Kaduna State is
the 12th largest of Nigeria's 36 states, with a population of 4,652,989 and an estimated overall HIV
seroprevalence of 5.6% (as high as 10% in some communities). This intervention is focused on the Kachia
LGA with a total population of 600,000 people and an estimated HIV prevalence of 7.0% in 2005. ICAP will
provide support to at least four primary health centers (PHCs) and one referral General Hospital (GH),
Doka. The referral facility will also be targeted to provide comprehensive ART services, including TB/HIV
integration, palliative and preventive care, and early infant diagnosis via dried blood spots (DBS) for adults
and children. Key interventions at the will include: provider-initiated opt-out HIV testing with same day
results at the ANC, L&D units including postnatal wards; development of linkages between PMTCT and
reproductive and maternal/child health care continuum; strengthen linkages between PMTCT and HIV
care/treatment services at GH Doka to ensure prompt immunologic staging via CD4; follow-up of HIV
infected women with advanced disease who have initiated ART at GH Doka following the National
guidelines; partner testing; pediatric care and treatment; cotrimoxazole prophylaxis for HIV-exposed
infants/children; promotion of best practices for infant feeding among HIV-infected women via counseling for
informed decision making and linkages to programs that supply free breast milk substitute if desired;
involvement of people living with HIV/AIDS (PLWHA) in program activities; and development of linkages
between communities and health facilities. These will be carried out in collaboration with the GON and other
implementing partners and stakeholders as appropriate. (PHCs will be involved mainly in HIV counseling
and testing services, provision of ARV prophylaxis (AZT and Combivir) for those not eligible for HAART,
infant feeding counseling, referrals and linkages of mother/baby pairs to secondary health facilities and
community support groups.)
Using its model of family-centered care delivered by multidisciplinary teams, CU will support the
establishment of PMTCT-Plus programs at the 5 designated sites. CU will ensure the availability of on-site
HCT services in order to provide HIV counseling and testing (HCT) to pregnant women, their partners, and
other family members (including children). At the PHC level CU supports both PMTCT services and HCT for
the general population. ICAP will develop side labs at ANC and labor and delivery (L&D), enabling point-of-
service opt-out HIV testing with same-day results. Couples counseling and outreach to partners and older
children of HIV-infected pregnant women will be supported.
Following the National Guidelines, CU will ensure that quality ANC services will be provided to all HIV-
infected pregnant women, with a special focus on STI screening and syndromic management, promotion of
safer sex during pregnancy and post-delivery (periods of greater risk for HIV transmission), provision of
maternal and infant feeding counseling and micronutrient supplementation, malaria prophylaxis and the
provision of long-lasting insecticide-treated bed nets, immunizations, delivery preparedness and provision of
"mama packs" to encourage facility-based delivery. Linkages to family planning will be created and
strengthened. HIV support groups, peer educators, and community-based support services will also be
CU will ensure prompt clinical and immunologic staging of HIV-infected pregnant women. Training and
supportive supervision will enable ANC staff to conduct standardized clinical assessments and WHO
staging of HIV-infected women, using validated algorithms, checklists, and job aids. Immunologic staging
will be provided immediately upon HIV diagnosis via on-site CD4 testing (at the GH) or specimen referral (at
the PHCs). This staging will enable site staff to identify pregnant HIV-infected women who are eligible for
ART for treatment (as opposed to ARV prophylaxis for PMTCT), facilitating rapid and effective referrals for
treatment. PHCs will offer ARV prophylaxis only and will refer treatment eligible mothers to the GH.
CU will provide safer L&D and post-partum services. CU-supported PMTCT sites will provide quality L&D
services, HCT for women of unknown HIV status, safe obstetric practices, universal precautions, and
appropriate post-partum follow-up. Any unbooked pregnant woman that presents in labor will be offered
HCT and if positive will receive ARV prophylaxis as well as her infant. She will also benefit from infant
feeding counseling for her to make an informed decision. Staff will be provided with basic materials that
ensure universal precautions.
The use of ART for PMTCT will follow the National PMTCT guidelines. HIV-infected women who do not
meet the national eligibility criteria for ART will be offered a combination of zidovudine (AZT) from 28 weeks
or Combivir from 34/36 weeks 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 receive SD-NVP at birth and AZT for 6 weeks.
Women found via PMTCT services to have advanced HIV disease by clinical or immunologic staging will be
linked to GH Doka for the initiation of ART. While laboratory specimens will routinely be sent to the GH
Doka, patient transportation will be minimized by the use of a mobile "treatment team" which will visit the
PHC sites on a regular basis. All eligible clients will be referred to GH for ART initiation; after initiation, to
improve compliance and minimize loss to follow-up, the outreach team will visit each PHC regularly to
provide supportive supervision to trained nurses in following up patients and provide refills for ART. Blood
samples for CD4 and other routine laboratory tests will be transferred to the GH.
In addition to the support for safe infant feeding described above, HIV-exposed infants diagnosed through
the National EID system will be enrolled in care at the PMTCT site, receiving prophylactic cotrimoxazole,
growth and development monitoring, immunizations, and clinical and immunologic staging (via specimen
transfer). Infant follow-up services will be enhanced by job aids and ongoing supportive supervision by CU
pediatric clinical advisors. National EID registers will be use to follow-up exposed infants until results are
obtained through DBS. Linkages to GH Doka will enable the diagnosis and treatment of opportunistic
infections as well as access to CD4 testing and pediatric ART services. EID services using DBS will also be
introduced at the sites in conjunction with the GON and USG team.
Linkages to care and treatment services will be developed, including site-level linkages between HCT,
PMTCT, ANC, and laboratory services. Women not eligible for ART will receive ARV prophylaxis for
PMTCT, and then continue follow-up at the ANC or Maternal Child Health clinics at PHCs and at the HIV
clinics in the referral General Hospitals.
Psychosocial and adherence support services will also be implemented. HIV counseling, support groups
Activity Narrative: and peer health educator programs will be initiated at each site. Inventories of community-based resources
will be conducted, and linkages to these appropriate pre-existing local services will be developed and
strengthened. This will enhance the development of outreach and defaulter tracking services as well as
accompaniment to appointments, systems navigation, activities to promote male involvement, community
mobilization activities, and access to economic, nutritional and other support services.
Organizations/resources identified and assessed may be local non-governmental, community-based and/or
faith-based organizations, creating a network of partners. CU will initiate both facility-based and community-
based support groups, conduct community sensitization activities, provide "love letters" for partners inviting
them for HCT, and pilot home-based family HCT services. Local partner staff will attend referral network
trainings and quarterly meetings with CU-supported sites. Other PHCs within the community will also be
identified and assessed for additional support services.
CU will focus on strengthening of the health care system within the Kachia LGA. It will partner with site staff
and leadership to conduct baseline site assessments, and to develop and implement collaborative site
workplans. Physical infrastructure will be enhanced as needed to provide PMTCT-Plus services at GH Doka
including installation of generators and refrigerators and renovations (consistent with acceptable use of
CDC funding), repairs and refurbishment of clinical, laboratory, pharmacy, and medical records areas.
Furnishings, supplies, and a standard package of medical and laboratory equipment will be provided to
each site. Staff will strengthen on-site laboratory capacity as needed, ensuring site-level access to HIV
testing and hemoglobin monitoring at the PHC level, and installing chemistry and hematology analyzers and
CD4 machines at the General Hospital. Stock management, forecasting, and pharmacy operations will be
enhanced, and appropriate medical records systems (appointment books, logs, patient files/forms) and data
management will be introduced. Ongoing mentoring and supportive supervision of clinical, laboratory,
records and pharmacy/dispensary staff will be provided. In collaboration with the PHC coordinator and the
Local Government council, CU will continue to support state PMTCT coordination meetings as needed.
ICAP-CU will be a new partner in the program area of Abstinence/Be Faithful (AB) in COP08. ICAP-CU will
implement its AB programming activities in line with the overall PEPFAR Nigeria goal of providing a
comprehensive package of prevention services to individuals reached (thereby improving the effectiveness
of this messaging) through a balanced portfolio of prevention activities including condoms and other
prevention. Through the involvement of ICAP-CU as a new partner in this activity, PEPFAR Nigeria will
extend its reach with AB services as ICAP-CU will be active in six states (Akwa Ibom, Benue, Cross River,
Gombe, Kaduna, and Kogi) by the end of COP08.
ICAP-CU is currently providing prevention messages for positives (funded under care) to its large
population of adults, adolescents and children, and will add on AB messaging to these prevention activities
for increased balanced messaging.
In addition, ICAP-CU will target activities to HIV-negative persons in its catchment areas in order to
minimize their risk behaviors and contribute to an overall reduction in HIV prevalence. A key age group for
AB activities is youth/young adults aged 15-24 years as this encompasses the highest prevalence age
group. The 2005 ANC survey in Nigeria indicates that among age cohorts in Nigeria, the 20-29 year old age
group has the highest HIV prevalence (4.9% compared to a national prevalence of 4.4%). In addition, the
2005 National HIV/AIDS and Reproductive Health Survey (NARHS) demonstrated a low risk perception
(28%) among the general population and significant reports of transactional sex (11%) among young
women aged 15-29 years. This age cohort for both men and women represents the working age group in
Nigeria; it is expected that a combination of prevention messaging approaches will ensure they are reached
with prevention interventions.
In COP08 ICAP-CU will implement this activity at both the facility and community levels utilizing a
combination of multiple strategies in this implementation, including community awareness campaigns, peer
education models, peer education plus activities, and workplace activities (specifically Greater Involvement
of People with HIV/AIDS, or GIPA). Activities conducted at the local level by ICAP-CU will be reinforced
through national level mass media campaigns by other USG partners such as the successful Zip-Up
campaign. AB messages will be balanced with concurrent condoms and other prevention messaging where
appropriate and will be integrated with other PEPFAR services being provided at 25 hospital networks and
their surrounding communities which will serve as the platform for ICAP-CU prevention activities in the
coming year in six states. The goal of the program is to be focused on the communities targeted and to
cover those communities with messages conveyed in multiple fora. Utilizing such a methodology, a large
number of people will be reached with messages received via one method or another, but the target group
will be those individuals that will have received AB messaging: (1) on a regular basis and (2) via at least
three of the four strategies ICAP-CU will employ (community awareness campaigns, peer education
models, per education plus activities, and workplace programs). The target for this intensive AB messaging
campaign is 4,800 individuals. In addition, age appropriate abstinence only messaging and secondary
abstinence messaging will be conveyed to 2,400 children and adolescents, particularly focused on those
orphans and vulnerable children receiving both facility and home based support. A total of 375 health care
providers, counselors, and peer educators will be trained to conduct effective prevention interventions
inclusive of AB messaging.
ICAP-CU collaborates with several community based organizations (CBOs), faith based organizations
(FBOs), and PLWHA support groups at its facilities and surrounding communities in other PEPFAR
programming activities. These CBOs, FBOs and support groups will also serve as appropriate partners in
the dissemination of ABC messaging to other PLWHA utilizing the peer education model, and to wider
audiences through the peer education plus model and community awareness campaigns. The community
and peer education plus activities will be organized through CBOs and FBOs under the supervision of ICAP
-CU and will include activities such as drama presentations, musical events, and road shows/rallies. To
address stigma issues and in compliance with the GIPA principle, approximately 10 PLWHA from the pool
of those receiving treatment at facilities who are living openly and positively will be trained using the peer
education model on dissemination of ABC messaging. They will serve as peer educators to extended family
members and members of their support groups. These trained PLWHA will in turn reach individual cohorts
of at least 10 other persons from among their social peers. With 50 facilities (including PMTCT sites), this
will serve as an effective tool for reaching individuals in at least as many communities with balanced ABC
A community awareness strategy will also be employed to serve the catchment areas of the hospital
facilities which will be linked with community mobilization efforts promoting HCT. During static and mobile
HCT services, counselors will be disseminating balanced ABC messages to recipient communities and
clients through focused group discussions and interpersonal communication. With an HCT target of 112,500
clients getting counseled, tested and receiving their results, a minimum of this many clients will receive
balanced ABC messaging through this approach. The key messages that will be conveyed are delay in
sexual debut, secondary abstinence, mutual fidelity, prompt and complete treatment of all STIs and
promotion of need to ascertain HIV serostatus through HCT.
ICAP-CU will also implement the peer education model targeting job peers who are healthcare workers.
Healthcare workers at each site will be trained (the exact number will vary based on facility size) using
established national peer education curricula and each will be requested to form peer groups of
approximately 10 members from the healthcare worker community for dissemination of balanced ABC
messaging. It is anticipated that these healthcare workers will continually serve as conduits for age
appropriate prevention messaging not only for their work peers but also for their social peers and for all
clients with whom they come in contact.
A focus of the program in COP08 will be improvement of 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 abstinence
and be faithful, and correct/consistent condom use education 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 (general outpatient clinics, emergency services, etc.), particularly into reproductive health
Activity Narrative: services including, family planning counseling, sexually transmitted infection management and counseling,
and risk-reduction counseling.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
ICAP-CU AB activities emphasize integration of prevention activities with treatment and care services. Use
of the community awareness campaigns, the peer educator model, and peer education plus activities
(community drama, dance events, etc.) allows dissemination of AB messaging, including integration with
condom messaging, from society-attributed sources of credible information - healthcare workers and
PLWHA. This program will contribute to the Global HIV/AIDS Strategy by reaching 4,800 people with AB
messaging and 2,400 people with abstinence only messaging in a comprehensive approach. The activities
will also address issues of stigma and discrimination through the education of individuals and communities
LINKS TO OTHER ACTIVITIES:
AB activities relate to HCT (5550.08), by increasing awareness of HIV. It also relates to care and support
activities (5552.08) through dissemination of information by home based care providers and ultimately by
decreasing demand on care services through decreased prevalence. Linkages also exist to condoms and
other prevention (9208.08) as a complementary prevention strategy and to OVC programming (5547.08) by
targeting orphans and vulnerable children.
Key populations targeted are youth, OVC, PLWHA, adults accessing HCT services at either static or mobile
within catchment areas of the treatment sites, support group members and immediate families of PLWHA.
Emphasis areas include human capacity development, workplace programs and gender.
AB activities promote a rights based approach to prevention among positives and other vulnerable
members of society and equal access to information and services. Reduction of stigma and discrimination
are also key to the program.
ICAP-CU has supported 12 hospital networks in Kaduna and Cross River States to improve safe blood
practices and reduce medical transmission of HIV and other infections. In COP08 ICAP-CU plans to expand
into 13 additional hospital networks in six states (Kaduna, Gombe, Cross River, Benue, Akwa Ibom and
Kogi), resulting in a total of 25 facilities receiving support through ICAP-CU. Blood transfusions occur at all
25 of these facilities.
In COP08, ICAP-CU will work closely with the National Blood Transfusion Service (NBTS) and Safe Blood
for Africa Foundation (SBFA) in all aspects of its blood safety program. ICAP-CU will support the NBTS in
implementing its primary objective of migrating fragmented hospital-based blood services to centralized
NBTS-based blood services nationwide. A key feature of this program is the development of a nationwide
voluntary donor recruitment system. NBTS, through the linkages its zonal centers will develop with ICAP-
CU and its supported facilities, will provide TA for blood donation drives held by these ICAP-CU supported
hospital facilities. In addition, SBFA will train nurses and medical laboratory scientists in these facilities to
recruit repeat voluntary blood donors from the ranks of current family replacement donors. In this plan ICAP
-CU will be instrumental in working with hospital management and staff at all comprehensive sites to
develop buy-in for the NBTS blood services program, to create support of blood donor organizers, and to
strengthen health facility and community focused blood drive activities. Health facilities will be supported by
ICAP-CU to work with the local Red Cross on community sensitization and blood drives.
ICAP-CU will also work through local community based organizations and support groups to increase
demand and awareness on safe blood practices. These local organizations will be supported to promote
safe blood donor drives and activities in their communities. They will also be supported to sensitize the
hospitals and communities on the need for voluntary blood donation. ICAP-CU will support the production
and distribution of IEC/BCC materials obtained from NBTS and SBFA to promote the need for voluntary non
-remunerated blood donation. In addition, ICAP-CU will work closely with facility management to establish
blood transfusion committees to oversee blood use based on national algorithms and standards in the
ICAP-CU will facilitate the development of an NBTS/hospital blood exchange program at 5 health facilities
that will be selected based on proximity to a zonal NBTS office, availability of blood banking facilities,
support infrastructure and other resources. This linkage will include regular delivery of donated units of
blood to NBTS for screening in conjunction with a regular delivery of screened units of blood to the facility.
NBTS will pick up unscreened blood units that these 5 hospitals have appropriately collected and stored
and will transport these units back to NBTS centers where they will be screened for the 4 transfusion
transmissible infections (TTIs) of HIV I and II, hepatitis B, hepatitis C and syphilis using ELISA techniques.
In addition to collecting unscreened units, NBTS will deliver to these 5 hospitals their requested order of
screened units for blood banking and use at the facilities. NBTS will also provide monthly feedback on rates
of the 4 TTIs found by ELISA screening of blood units collected by each facility. It is expected that at these
5 blood banking facilities a total of 4170 transfusions will take place. ICAP-CU will work to ensure that 80%
of blood transfusions that occur at these hospitals will be with NBTS-screened blood units, while only 20%
will be emergency transfusions whereby the hospital will screen the donors on site using rapid test kits only.
Therefore, approximately 3,340 units of blood will be collected and sent to the nearest NBTS centers for
ELISA screening as outlined.
ICAP-CU will work with all 25 of its hospitals that do blood transfusions to ensure appropriate facility-level
collection of blood. Directed and voluntary donors will be prescreened with the NBTS donor screening
questionnaire and donors will be deferred as necessary based on their responses. 10,400 blood donors will
be screened using the HCT testing algorithm, thereby utilizing the blood donor setting as another point of
service for HCT during predonation. A PEPFAR-supported evaluation of the current emergency-based
transfusion system will provide insight into rates of TTIs, including HIV, that go undetected in emergency
ICAP-CU will identify appropriate staff for training by SBFA who, in turn, will utilize standardized training
modules that are appropriate to the various levels of trainees and approved by NBTS. Through this
relationship 26 laboratory staff and other health care workers involved in blood transfusion services at ICAP
-CU supported sites will be trained by SBFA. In order to avoid double counting, these 26 targets are
counted under the SBFA blood safety narrative. For core TOT modules developed by SBFA, ICAP-CU will
conduct step down training to 225 laboratory, allied health workers and hospital management staff involved
in blood transfusion services at their sites.
Other activities for COP08 include infection prevention services to reduce occupational hazards, provision
of contaminated waste and sharps collection and disposal units, and infection prevention equipment such
as disposable and surgical gloves, disposable syringes, respiratory masks, and gowns. Quality assurance
(QA)/Quality Improvement (QI) management systems will be put in place to ensure the quality of the rapid
HIV testing at all sites. All sites will be provided with copies of the National Blood Policy, operational
guidelines for blood transfusion, SOPs and job aids to support blood safety activities. This activity also
includes partnerships and support to the following sub recipients for program activities: local red cross/red
crescent organizations 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, ICAP-CU
considers it essential to prevent HIV transmission in health care settings and to increase blood transfusion
In COP08, ICAP-CU will support the training of health care workers to provide quality safe blood services,
and will increase the availability of support personal protective equipment like hand gloves, lab coats, face
shield and protective goggles to ensure that the lab staff are adequately protected. 10,400 donors will be
prescreened according to National guidelines and 3,340 units of blood will be sent to NBTS to screen for 4
TTIs to ensure safe blood transfusion at ICAP-CU's supported sites in line with the National Blood
Transfusion policy on blood and blood product safety.
LINKS TO OTHER ACTIVITIES:
This activity is linked to Counseling and Testing (5550.08) as directed donors and voluntary donors will be
Activity Narrative: provided with full HCT services prior to blood donation. This activity is closely linked to Injection Safety
(6819.08) where ICAP-CU also plans to train laboratory and allied health workers at all its supported sites.
With linkage to Lab (5544.08), lab-based activities will support safe blood activities at all ICAP-CU-
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 ICAP-CU-supported health facilities. Targeted also are all persons 18 years of age and
above and family replacement donors.
This activity includes emphasis on institutional capacity development for blood safety which includes
training of lab staff and provision of equipment. This activity will also 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.
In consultation with the Federal Ministry of Health (FMOH) and John Snow Incorporated (JSI)/Making
Medical Injection Safer (MMIS), ICAP-CU has implemented the Safe Injection Global Network (SIGN), an
infection prevention strategy to reduce HIV transmission through unsafe injections. The strategy 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 equipment;
and advocacy and behavior change communication (BCC) to promote safe injections.
In COP07, ICAP-CU supported injection safety in the context of infection prevention and control services at
12 hospital networks in 3 states of Kaduna, Cross River and Benue. Infection prevention practices were
enhanced and universal precautions were introduced. In COP07, 450 health care providers were trained on
general aspects of universal safety procedures, while advocacy and BCC activities on safe injection were
conducted amongst health care workers to enable adoption of safer workplace behaviors. In COP08, ICAP-
CU support will expand to 13 additional hospital networks and 3 additional states (Gombe, Kogi and Akwa
Ibom). This will result in a total of 25 sites in 6 states (25 comprehensives secondary facilities).
Site assessments will be performed to identify gaps in knowledge, skills, and behavior among health care
workers, to ascertain the need for required equipment and supplies, and to plan for safe waste disposal
where needed. In COP08, ICAP-CU will collaborate with FMOH and JSI/MMIS to conduct a Training of
Trainers (TOT) for facility staff who will in turn conduct step down training to other healthcare workers (i.e.,
injection prescribers, injection providers, waste handlers and laundry workers, pharmacists, nursing staff,
nursing support staff and nursing/medical students) in all the sites using the revised WHO/AFRO/JSI
training curriculum on injection safety, sharps waste management and handling of injection devices. A total
of 900 individuals will be trained.
In addition, ICAP-CU will procure color coded bin liners for segregation of infectious waste and personal
protective equipment (i.e. disposable surgical gloves, disposable syringes, respiratory masks and gowns)
for these sites. ICAP-CU will also promote and facilitate behavioral change among health workers, distribute
communication materials (leaflets, posters, reference guides) on safer injection practices, and support
government to adopt a national health care waste management plan in collaboration with JSI/MMIS. ICAP-
CU will also support proper waste management by repairing incinerators in these sites.
ICAP-CU will implement these activities by partnering with local non-governmental organizations, including
HIV/AIDS Restoring Hope and Life (HARHL) Trust and DRPC. 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 SIGN strategy for ensuring injection safety.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
These activities will contribute to the overall Emergency Plan for prevention of new infections by promoting
injection safety. It will also reduce exposure of health care workers to occupational hazards in the supported
LINKS TO OTHER ACTIVITIES:
This activity is closely linked to activities in Blood Safety (6490.08), ART (5404.08), Palliative Care
(5552.08), OVC (5547.08), HCT (5550.08), Lab (5544.08) and PMTCT (6622.08) 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, phlebotomists, laundry
workers and waste handlers) and indirectly at both public and private health sectors responsible for safe
injection activities in all ICAP-CU supported health facilities.
The emphasis area is quality assurance and improvement and training in addition to workplace programs,
promoting behavior change through IEC and strategic linkages with other partners and initiatives like the
‘Making Injections Safer' project. ICAP-CU will also collaborate with JSI/MMIS to support government in the
development of health care waste management policy. The proposed package of injection safety activities
will help address 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.
In COP07, the International Center for AIDS Care and Treatment Programs at Columbia University (ICAP-
CU) supported 10 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 COP08,
ICAP-CU programming will expand support to 13 additional hospital facilities; these 25 hospital networks
located in 6 states (Akwa Ibom, Benue, Cross River, Gombe, Kaduna, Kogi) will serve as the platform for
ICAP-CU prevention activities in the coming year.
ICAP-CU will implement its condom and other prevention (COP) programming activities in line with the
overall PEPFAR Nigeria goal of providing a comprehensive package of prevention services to individuals
reached (thereby improving the effectiveness of this messaging) through a balanced portfolio of prevention
activities which will also include abstinence and be faithful activities. In COP08 ICAP-CU will implement this
activity at both the facility and community levels utilizing a combination of multiple strategies in this
implementation, including community outreach campaigns, peer education models, infection control
activities, STI management/treatment and workplace activities (specifically Greater Involvement of People
with HIV/AIDS, or GIPA). In COP08, ICAP-CU will support risk reduction and safer sex promotion activities
among HIV positive clients, partners and their households. The goal of the program is to be focused on the
communities targeted and to cover those communities with messages conveyed in multiple fora. Utilizing
such a methodology, a large number of people will be reached with messages received via one method or
another, but the target group will be those individuals that will have received condom/other prevention
messaging: (1) on a regular basis and (2) via at least three of the five strategies ICAP-CU will employ
(community outreach campaigns, peer education models, infection control activities, STI
management/treatment and workplace activities). The target for this intensive COP activity campaign is
23,750 individuals. ICAP-CU will identify a dedicated staff person to oversee their prevention activities.
ICAP-CU will implement the peer education model targeting job peers who are healthcare workers.
approximately 10 members from the healthcare worker community for dissemination of prevention
messaging, especially focusing on infection control practices in the workplace. Health and allied care
providers will be supported to adopt positive attitudes and behaviors including safe practices to reduce their
risks of exposure. Facilities will be assisted to implement SOPs for post-exposure prophylaxis should
ICAP-CU 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 linkages
to diagnosis and treatment services for both STIs and HIV/AIDS, 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, peer educators, local NGOs and CBOs in each
hospital network will be equipped to conduct activities for prevention for HIV positives, partners and
In COP08, all ICAP-CU supported treatment sites will integrate prevention counseling and services for
people living with HIV into HIV care and treatment clinics (funded under care). Specifically, healthcare
providers and lay counselors in care and treatment settings will be trained to deliver prevention messages
during routine clinic visits using tools and job aids. In addition family planning counseling and services,
identification and treatment of STIs, and prevention counseling will be offered. Other services such as
prevention messages, promoting correct and consistent condom use will be promoted. ICAP-CU will use
available communication tools and aids to provide this comprehensive package of prevention for positives
To achieve these condom and other prevention objectives, ICAP-CU will also build the capacity of at least
20 local CBOs and support groups to conduct community outreach activities including development
workshops on HIV prevention. Through this relationship with the CBOs and support groups ICAP-CU will
provide outreach to most at risk populations such as the youth, commercial sex workers, and persons
involved in transgenerational transactional sex. Peer educators will be trained to provide one-on-one
outreach to these populations. Community outreach through activities such as HCT and condom distribution
will also be incorporated. ICAP-CU will distribute at least 400,000 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 and will be
distributed via health care facility outlets as well as via community based programming.
Two-hundred and fifty facility and community based health care providers and counselors will be trained on
prevention counseling. Training of health care and allied workers at facility and community levels will be
conducted to ensure correct counseling and appropriate BCC messages; skills training on disclosure to
partners and negotiation of safer sex will be included. Training will be based on a standardized Nigeria-
specific prevention for positives curriculum.
This activity contributes to the COP08 targets by focusing on reaching at least 23,750 HIV positive and at
risk individuals by promoting the adoption of positive attitudes and behaviors consistent with the PEPFAR 5-
Year Strategy for averting new infections in Nigeria.
This activity also relates to activities in AB (15654.08), Care and Support (5552.08), ARV services
(5404.08), HCT (5550.08), OVC (5547.08) and PMTCT (6622.08).
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
will also be targeted. 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 including out of
Activity Narrative: school youth, commercial sex workers, and persons involved in transactional/transgenerational sex will also
be targeted for prevention messaging.
Areas of emphasis include human capacity development and local organization capacity building.
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.
In COP07, ICAP-CU supported 12 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 COP08, ICAP
-CU will expand support to 13 new comprehensive health facilities in Akwa Ibom, Benue, Cross River,
Gombe, Kaduna, and Kogi states, and to 25 non-facility based outlets for a total of 50 outlets in 6 states
(Benue, Kaduna, Cross River, Akwa Ibom, Gombe and Kogi). Palliative care services will be provided to an
estimated 136,500 clients including 45,500 HIV+ patients.
In COP08, ICAP-CU will enable health facilities to provide clinical palliative care (PC) by supporting:
training; clinical, laboratory and pharmacy services; systems management; procurement of drugs and
supplies; and the expansion of support groups and peer health educator programs. ICAP-CU will also
prioritize the expansion and decentralization of palliative care services to the primary health center (PHC)
and community levels and will rapidly expand HCT services to family members via home-based care (HBC)
programs. Building on the network of care model, ICAP-CU will scale up palliative care to PHCs by
identifying at least 4 PHCs around each secondary hospital that can provide PC to stable patients. ICAP-CU
will also enable the decentralization of existing facility-based support groups, facilitating their expansion into
surrounding communities to promote acceptance and ownership, reduce stigma, and increase
Following National Palliative Care Guidance and USG PC policy, ICAP-CU-supported sites will provide a
basic package of care services, including prevention for positives (balanced ABC messaging as
appropriate), 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. ICAP-CU will provide at least one clinical service (laboratory, OI prophylaxis &
management, HBC, nutritional assessment/therapy) plus at least two other services in the domains of
psychosocial, spiritual or preventive services to all PLWHA. The activities will be approximately 20%
laboratory monitoring and OI diagnostics, 30% OI management and prevention (cotrimoxozole), and 50%
Home Based Care (including 10% pain management, psychosocial support, and end of life care). Patient
education to promote positive living, self-care, and support adherence will be provided. Other activities will
focus on prevention with HIV positives including referral for HCT of family members and sex partners,
counseling for discordant couples, provider delivered prevention messages and IEC materials on
disclosure. ICAP-CU will support integration of syndromic management of STIs and risk reduction
interventions into care. All enrolled into care will receive risk assessment and behavioral counseling to
achieve risk reduction.
Linkages to wraparound services including income generation and other programs such as safe
motherhood and child survival activities will be facilitated. Therapeutic feeding using approved selection and
exit criteria will be provided via referrals where possible and directly when no alternatives exist. Facilities
and communities will be supported to establish innovative food banks, and linkages with wraparound
programs and existing microfinance opportunities will be prioritized. At the community level, services will be
subcontracted to non governmental, community and faith based organizations. Trained HBC providers,
including PLWHA, will be supported to deliver PC services to stable patients and family members at home.
Home Based Care (HBC) programs will be expanded, including the provision of services such as domestic
support, management of minor ailments (e.g., the preparation and use of oral dehydration solution, ORS, for
diarrhea), 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 standardized
HBC kits (consisting of ORS, bleach, cotton wool, gloves, soap, calamine lotion, vaseline, gentian violet,
etc.) to each trained HBC provider for use when visiting clients. Basic care packages containing ITN, water
guard, water vessel, soap, ORS, condoms and IEC materials will be distributed to PLWHAs and PABAs
through facility and community based support groups. At the facility level, ICAP-CU 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. As expansion of ARV drug services is prioritized
to rural areas, ICAP-CU will strengthen existing referral channels and support network coordinating
mechanisms. Pharmacy and logistics management procedures will be assessed and be part of the site
development plan. PC commodities will be procured using existing supply mechanisms including the SCMS
and the Society for Family Health (SFH).
ICAP-CU will also train and retrain health care providers, including continuing medical education activities
and clinical mentoring for adult and pediatric care including opportunistic infection (OI) prevention and
treatment, pain management, and management of other clinical conditions. ICAP-CU, in collaboration with
GON, IHV/ACTION-University of Maryland and other implementing partners, will develop a HIV/AIDS
pediatric care training manual. ICAP-CU clinical advisors will enhance adult and pediatric care and
treatment by providing ongoing site-level mentoring and supportive supervision of facility-based staff. Job
aids and patient education materials will be provided to support and enhance provider skills. Peer Health
Educator programs will reduce stigma, enhance adherence, facilitate linkages and educate communities
about available services. ICAP-CU will also establish quality patient appointment and defaulter 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 ICAP-CU network coordinators. In order to improve access to services, HIV positive clients
will be supported to access health care facilities via community-based transportation support.
ICAP-CU will work with sub-grantees including: Fantsuam Foundation, Tulsi Chanrai Foundation, GAWON
Foundation, Catholic Action Committee Against AIDS, Rekindle Hope, Grassroots HIV/AIDS Counselors,
Association for Reproductive and Family Health, and HARTL Trust.
By training at least 450 care providers including PLWHA, ICAP-CU 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 COP08 targets by reaching at least 136,500 persons
affected by HIV/AIDS including 45,500 HIV positive persons including women and children and their
households. By actively involving PLWHA and CBOs in program development and implementation ICAP-
CU will facilitate strong linkages and referral networks.
This activity links to activities in ART services (5404.08), 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 carefully monitored (via clinical and laboratory monitoring), and will receive OI prophylaxis
and other preventive services where indicated. OVC (5547.08) will be integrated into HBC activities and all
clients will be encouraged to bring their household members to access HCT services. Women who become
pregnant will be referred to PMTCT (6622.08). All care clients will receive AB (15654.08) and COP
(9208.08) messaging as appropriate. Partnerships with other IPs will provide opportunities for leveraging
resources. Patients and their families will be linked to community-based income-generating activities where
POPULATIONS BEING TARGETED:
All HIV positive persons including women and children and their households will be assisted to access care
and support. HIV positive persons in the general population will be reached through CBOs and support
groups. Persons Affected By HIV/AIDS (PABAs) will also be targeted and enrolled into care under the ICAP
-CU family-centered approach as will pregnant women, OVC and TB patients. Facility based care providers
and CBOs/FBOs will be trained to provide quality services and facilitate the establishment/strengthening of
Areas of emphasis will include human capacity development, local organization capacity building and SI.
This activity will facilitate equitable access to care and support especially to vulnerable groups of women
and children. ICAP-CU will advocate for men's involvement in care in the community and for improved
inheritance rights for women and children. This activity will foster necessary policy changes and a favorable
environment for orphans and vulnerable children programming. ICAP-CU will also advocate for stigma and
discrimination reduction at the community level.
In COP07, ICAP-CU provided TB/HIV services at 12 hospital networks and initiated linkages with 35 DOTS
sites in Cross River, Benue and Kaduna States. In COP08, TB/HIV integration activities will be expanded at
hospitals and DOTS clinics to provide enhanced TB services at 25 HIV comprehensive care and treatment
sites in 6 states (Kaduna, Cross River, Benue, Gombe, Akwa Ibom and Kogi), and HIV services at 35
DOTS sites. Working closely with the national and state level technical TB/HIV working groups, NTBLCP
and state/LGA TB control programs, ICAP-CU will provide services to TB/HIV co-infected patients through
point of service laboratory support, development of SOPs/guidelines, and strengthening of screening,
referrals and linkages both within DOTS sites and between community-level health care facilities and DOTS
sites. ICAP-CU, with other implementing partners, will implement the PEPFAR-Nigeria LGA coverage
strategy in Kaduna, ensuring the provision of TB/HIV services in at least one health facility in every local
government area (LGA). This will enable the states to approach universal access to TB/HIV services in
states designated ‘LGA Coverage States'.
All TB/HIV co-infected patients will be provided with cotrimoxazole (CTX) prophylaxis and linked to other
palliative care services and prevention messaging (including balanced ABC messaging as appropriate).
ICAP-CU will support standardized TB screening and case finding in 13,150 HIV infected patients using
structured symptom checklists and the National algorithm. ICAP-CU will facilitate access to TB DOTS
services for co-infected patients identified through ART clinics and will facilitate access to HIV treatment and
care for co-infected patients identified through TB DOTS clinics. It is expected that this will result in the
treatment of TB in at least 3,700 HIV positive patients. DOTS facilities will be supported to provide HCT to
at least 14,000 clients, of which it is expected that 4,000 will be diagnosed with TB. TB patients will be
encouraged to bring contacts for early TB case-finding, preventive therapy (IPT) and HCT. 150 HIV+
patients will be provided with IPT services.
Five ICAP-CU TB/HIV advisors will be provided with formal TB/HIV training to enhance their productivity. A
total of 115 ICAP-CU staff and facility-based medical officers will undergo retraining on x-ray diagnostic
skills. A total of 95 ICAP-CU staff and facility-based laboratory officers will be retrained on good sputum
specimen collection and laboratory AFB sputum smear diagnosis to enhance their diagnostic capabilities.
Service provision will also be improved through capacity building of health care providers with the GON and
other USG implementing partners and ILEP partners through training programs conducted at TB training
laboratories. Across the various TB/HIV training activities it is expected that a minimum of 185 individual
trainees will be directly reached in collaboration with NTBLCP. In addition to current practices, ICAP-CU will
implement the national guidelines for External Quality Assessment.
Nosocomial transmission of TB will be mitigated through attention to principles of TB infection control,
including administrative and environmental control measures such as clinic design, good ventilation,
appropriate patient triage, staff training, and enforcement of basic hygiene and proper sputum disposal.
Patient and staff education on infection control measures will be routinely carried out to ensure program
success. Facility co-location of TB/HIV services is preferred to clinic co-location. The national guidelines on
infection control will be implemented in all ICAP-CU supported sites. ICAP-CU will support NTBLCP in the
development of clinical support tools/job aids, national registers and referral forms for recording/reporting
systems, and in the production of IEC materials. ICAP-CU 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 60 DOTS (25 hospital and 35 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. The TB DOTS sites will be supported to provide holistic patient care according to National and IMAI
guidelines. Sites will be assisted to put in place and/or improve defaulter tracking mechanisms. ICAP-CU
will also support the state TB programs to put in place functional mechanisms to identify and manage drug
resistant TB. Collaboration will continue with GON, other PEPFAR implementing partners, ILEP partners
and relevant organizations to rapidly scale-up TB/HIV integration activities at ICAP-CU supported sites.
TB/HIV coordinators will facilitate sites' activities in collaboration with state/LGA TB focal persons.
ICAP-CU will also work closely with the SCMS mechanisms in country to procure equipment and supplies
for its supported TB/HIV integration sites. ICAP-CU will upgrade facilities through infrastructure support
such as basic renovations, upgrading equipment and procuring supplies and consumables (e.g. sputum
containers). To ensure continuous availability of drugs and commodities in supported sites, ICAP-CU will
strengthen the logistics management of the states and LGAs in areas of operation.
ICAP-CU will contribute to the overall program goal of enhancing integration of TB/HIV activities by enabling
at least 3,700 HIV-infected patients to receive TB treatment. As part of the sustainability plans of the GON
and in line with the 5-Year Strategy, at least 185 health care workers will be trained. ICAP-CU will also
ensure that GON structures are strengthened and integrated through joint capacity building of SACA, LACA
and NTBLCP, states, and LGA TB supervisors for effective program management including joint supportive
supervision. ICAP-CU will help provide basic tools and equipment to reactivate non-functional DOTS sites in
focus states. ICAP-CU will ensure that activities are implemented with the full participation of other
government partners especially GLRA and NLR to promote sustainability and facilitate equity and synergy
in line with GON plans.
This activity also relates to ART (5404.08), Palliative Care (5552.08), Orphans and Vulnerable Children
(5547.08), Voluntary Counseling and Testing (5550.08) and PMTCT (6622.08), AB (15654.08) and COP
(9208.08). The focus is on ensuring adequate and prompt linkage of TB patients and their household
contacts to HIV counseling, testing, care and treatment services, to ensure that all HIV patients are
screened for TB, and to enable all HIV-infected patients with TB to access services at DOTS clinics. Similar
services will be made available to OVCs and PMTCT clients. In collaboration with other relevant
partners/organizations, ICAP-CU in COP08 will facilitate linkage of clients to other support services such as
micro credit and nutritional support.
ICAP-CU will support activities to encourage all patients in related communities living with TB to bring family
Activity Narrative: members and household contacts to the clinic, particularly children (five years and younger), to enhance
screening, early diagnosis and prompt treatment for positive cases. In collaboration with NTBLCP and other
TB supporting partners, ICAP-CU will establish TB/HIV services for clients in prisons located within the
ICAP-CU supported LGAs, and facilitate linkages to care and treatment clinics. Health care workers in both
public and private sectors will be trained to provide high quality TB/HIV integrated services. Other targeted
populations will include OVC, pregnant women and PLWHAs.
A major area of emphasis is on human capacity development through the 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, screening for TB, and referrals between care and treatment centers and
DOTS sites. Other emphasis areas include local organization capacity building, SI and gender.
ICAP-CU will work with the relevant agencies and organizations to enhance policies that will ensure that
clients located within ICAP-CU supported sites have access to adequate and integrated TB/HIV services
thereby promoting equitable access to care and treatment programs, especially for women, children,
underserved and incarcerated populations in all the served states.
In COP07, ICAP-CU assisted 12 secondary hospitals in Kaduna, Benue and Cross River States to support
2,786 HIV-infected and affected children (OVC) to access health care, and other related services at the
hospitals, their referral networks, and surrounding communities. In COP08, ICAP-CU will expand support to
13 new hospital networks in 6 states (Kaduna, Cross River, Benue, Akwa Ibom, Kogi and Gombe), for a
total of 25 sites providing OVC services. During COP08, OVC services will be provided to 8,000 OVC
including adolescents and caregivers. These OVC include HIV-positive children either on ART or not yet
eligible for ART, and HIV-negative children of PLWHA or HIV affected orphans.
The ICAP-CU family-focused model of care utilizes a genealogy form that captures all children within the
family of HIV-positive adults accessing TB/HIV, ART, PMTCT and BC&S services. This family-focused
approach is applied not only at the facility level but also at the community and home levels through care
services. Community based programming leads to identification of OVC through awareness campaigns,
support groups, and community-based HCT. OVC are also identified through provider initiated counseling
and testing of children accessing care in ICAP-CU supported facilities following national norms regarding
counseling and consent of minors. Once OVC have been identified, ICAP-CU's OVC program focuses on
providing an appropriate balance of services in the facility, community and home settings.
ICAP-CU OVC programming has several key elements: appropriately identifying OVC who are not receiving
services; providing a holistic family centered approach to care of OVC; providing educational support;
providing nutritional assessments and support; providing health care services for HIV infected and affected
children; and providing enhanced psychosocial support at both facility and community levels. Health care
services for OVC will include ongoing monitoring of growth and development, screening and prophylaxis
(IPT) for TB when indicated, cotrimoxazole prophylaxis (CPT) following national guidelines, and diagnosis
and management of opportunistic infections as needed. Also, as a component of ICAP-CU's HBC program,
basic preventive care packages comprised of ITNs, ORS sachets, soap for effective hygiene, water guard
and water cans procured from SFH (another USG supported IP) will be given to all clients.
Through its support and capacity building of local NGOs, CBOs and FBOs, ICAP-CU enables the
implementation of advocacy and social mobilization, psychosocial support, home based care (HBC), and
educational support for OVCs and their households. The psychosocial support provided to OVC, including
their care givers, is multifaceted and comprehensive, including counseling on stigma and discrimination,
disclosure, and grief, and recreational activities. OVC services are also integrated into community HBC
programs. Networking with community organizations and other implementing partners enables leveraging of
resources and enhances service delivery and sustainability. ICAP-CU provides capacity building to
community and faith based organizations such as Fantsuam Foundation, Tulsi Chanrai Foundation (TCF),
GAWON Foundation, Catholic Archdiocese of Ogoja (CACA), Grassroots HIV/AIDS Counselors, ARFH and
other CBOs and PLWHA groups to provide family-focused OVC services. These CBOs/FBOs provide home
based primary care, psychosocial support and links for OVCs to health facilities for basic health care needs
by providing transport and other support. Through ICAP-CU support some of these partners will also
provide peer education programming at primary and secondary schools.
In COP08 ICAP-CU will work through local partners to provide educational support (e.g., school levies,
school supplies) to most at-need children following clearly identified selection criteria. ICAP-CU will also
provide nutritional support to OVC and will work with the GON in partnering with Clinton Foundation, as
appropriate, to leverage resources for providing therapeutic food for OVC diagnosed with malnutrition.
Furthermore, OVC and their caregivers will be linked to the USG-supported education and nutrition
wraparound activities in states like Cross River where they will be co-located with CU-ICAP. For
sustainability and household food security, linkages to other community-based/faith-based food and
microfinance programs through the CBOs/FBOs listed above will be explored. Training provided to care
providers through PMTCT programming, such as infant feeding counseling and follow-up, will enhance the
counseling, patient education, and linkages that are required for appropriate care of OVC. Such
strengthening of the coordination of pediatric services (PMTCT, ART) with OVC allows for seamless
movement of clients across these various services.
To achieve these objectives ICAP-CU will provide infrastructure support and training for 200 care providers
including clinical staff, counselors, and community/HBC providers using GON National guidelines, OVC
NPoA and SOPs. In addition ICAP-CU and local partners will set up a monitoring system using the
nationally approved tools that allows the monitoring of services provided directly by ICAP-CU and/or by
referral from ICAP-CU to other organizations.
ICAP-CU, in partnership with other organizations, will provide training and scale up of OVC services that will
enhance the delivery of quality services to 8,000 OVC enrolled in core programs such as health,
educational support, psychosocial support, and food and nutrition. All these activities will improve the lives
of OVC reached in line with the national plan of Action on OVC and the National Strategic Framework, and
will contribute to meeting PEPFAR goals.
This activity relates to activities in ART (5404.08), Lab (5544.08), Palliative Care (5552.08), TB/HIV
(5551.08), AB (15654.08), and SI (5541.08). HIV-exposed and infected children will be placed on
prophylactic cotrimoxazole (CTX) following National guidelines. Household members of OVC will be
referred for HCT (5550.08) and children of women enrolled in PMTCT (6622.08) will be offered HCT as well
as referred for OVC services. Policy makers and key decision makers in the health and education sectors
will be reached by advocacy efforts.
This activity targets infants, young children, adolescents and other at-risk children in HIV infected and
affected families. It also targets the households, including caregivers, of OVC. The entry point for OVC in
the general population will be ICAP-CU supported sites and partner organizations. Health and allied care
providers in clinical and community settings will be trained to provide services to OVC. Community and
facility based volunteers, traditional birth attendants and support group programs, will be used to increase
access to care and support especially to the underserved.
Activity Narrative: EMPHASIS AREAS
ICAP-CU's area of emphasis will be the development of networks, linkages and referral systems as well as
capacity development and food/nutrition support. In addition, ICAP-CU will advocate equal access to
education and improved legal and social services such as the protection of inheritance rights for women and
children, especially for female children, and increased gender equity in HIV/AIDS programming. ICAP-CU
will advocate for increased access to income and productive resources for HIV infected and affected women
and care givers. This activity will foster necessary policy changes and ensure a favorable environment for
In COP07, ICAP-CU supported HIV counseling and testing (HCT) at 45 sites including 10 secondary
hospitals, 20 primary health centers and 15 non-hospital facilities (two VCT sites, six DOTS sites, seven
stand-alone VCT centers) in Kaduna, Benue and Cross River States. In COP08, this support will increase to
a total of 50 HCT sites (25 secondary hospitals, 25 non-hospital facilities which are CBO/FBO based with
their associated mobile testing) in six states including Benue, Kaduna, Cross River, Akwa Ibom, Gombe and
Kogi. Included within the non-hospital facilities are linkages to private health facilities. At least 112,500
individuals will receive counseling & testing (in a non-TB/non-PMTCT setting) and receive their results. This
will include HCT for a minimum of 2500 non-remunerated blood donors. ICAP-CU's HCT support has 5
themes: supporting provider-initiated opt-out HIV testing (PIHCT) in all health care facilities, including TB
DOTS sites; providing HCT services throughout health care facilities by strengthening point of service
(POS) testing in both inpatient and outpatient settings; expanding access to HCT centers; strengthening opt
-out HCT in the ANC setting; and promoting case-finding via the family-focused approach to HIV/AIDS
diagnosis, care, and treatment.
ICAP-CU will ensure quality HCT services through the implementation of training courses for staff and
volunteers. In FY08, 350 individuals, including health care providers and laboratory staff at the facility and
community levels, will be trained to provide services in these 50 HCT outlets in the six states. ICAP-CU will
support HCT 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 and testing following the best practice protocol in all supported sites. Refresher trainings will be
provided to site staff as needed. In addition to the HCT specific training, ICAP-CU will also provide trainings
to improve monitoring and evaluation.
Innovative approaches will be instituted to reach as many people as possible, especially the most at risk
populations. ICAP-CU will support local nongovernmental organizations to partner with NYSC-trained peer
educators in each region to reach the student population (especially at tertiary institutions around each
region). Existing youth-friendly centers in supported states will be strengthened to provide information
(written, audio-visuals) on HCT to young people in and out of school, following the standardized consent
procedures where necessary. ICAP-CU will work to provide training of Youth Corp Volunteers as lay
counselors for HCT services through community outreach programs which could easily serve as their
required community development activity and provide a much needed service. ICAP-CU will also expand
access to HCT outreach to high risk communities such as long distance truck drivers' parks, regular motor
parks, prisons, artisans (e.g., auto mechanics), and out of school youth including the female population.
ICAP-CU will support outreach teams from nongovernmental and faith based organizations to ensure
regular outreach to communities, churches and mosques to promote HCT. ICAP-CU will support the use of
multidisciplinary teams including lay counselors where appropriate, and will pilot the use of nursing and
health technology students as counselors in selected training institutions. ICAP-CU will also facilitate the
training of lay counselors in rapid testing especially in churches and mosques. The national ‘Heart to Heart'
logo will be used at HCT sites for integration with national branding of HIV testing services. ICAP-CU will
support community-level HCT services through identified CBO/FBO outreach initiatives, further
strengthening the network of HCT available to the community. ICAP-CU will ensure that secondary and
primary healthcare facilities are key partners in these networks.
At all health facilities, an "open access" approach will be promoted to ensure that HCT is available to all
patients utilizing a facility. ICAP-CU will foster linkages of HCT services to treatment, care and support
services within and across programs and between other implementing partners using standard referral
tools, ensuring quality implementation of HCT data management and reporting systems. HCT services will
promote couples counseling and testing at the service outlets with a special emphasis on HCT for
discordant couples. In addition, posttest counseling resources, such as support groups and peer educators,
will support disclosure when appropriate and address the special issues facing discordant couples. Posttest
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. Posttest counseling for clients shall include appropriately balanced messaging, including
abstinence, be faithful, and information on correct and consistent condom use. Male and female condom
distribution will be supported by ICAP-CU 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. IEC
materials on HCT and prevention messaging will be available to all clients.
Laboratory QA will be provided by ICAP-CU laboratory advisors to ensure quality HIV testing. HIV testing
will be conducted using the current interim National testing algorithm and will change to the new testing
algorithm once it is approved. ICAP-CU 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. ICAP-CU will work closely with the SCMS mechanisms in country
to procure equipment and supplies for its supported HCT sites and to participate in the GON-led
harmonization process of the LMIS system in Nigeria.
This activity will contribute to the overall 2008 emergency funding plans by enabling 25 secondary hospitals
and 25 non-hospital facilities in six states (a total of 50 service outlets) to provide access to HCT services
to at least 112,500 people who will also receive their results. HIV positive clients will be provided with
access to care and treatment, including ART when needed. Three hundred and fify individuals, including
health care providers and laboratory staff at facility and community levels, will be trained to provide
services. ICAP-CU will continue to support and participate in the harmonization process led by the GON
with regard to LMIS and ICS for test kits.
This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), TB/HIV (5551.08), OVC
(5547.08), HCT (5550.08) and PMTCT (6622.08). The HCT activities in the sites supported by ICAP-CU will
encourage the enrollment of patients and family members into care through multiple entry points. ICAP-CU
will also support community HCT linked to the hospital networks, enabling referral of HIV positive clients to
the hospitals to access care and treatment as appropriate.
Activity Narrative: This activity targets the general population especially young women and other most at risk populations such
as truck drivers and sex workers. ICAP-CU will target the provision of HCT services to family and household
members of HIV+ clients using a family focused approach at multiple entry points. Community based and
faith based organizations/facilities will be targeted for training to provide HCT to increase access in non-
clinical settings. The availability of trained volunteers will further increase uptake.
Emphasis areas include human capacity development, increasing gender equity in HIV/AIDS programs,
local organization capacity building and SI.
In COP07, The International Center for AIDS Care and Treatment Programs at Columbia University (ICAP-
CU) supported procurement and distribution of antiretroviral (ARV) drugs for 10 hospital networks and two
primary health centers in three states. In COP08, ICAP-CU will expand antiretroviral therapy (ART) services
support to 13 additional hospital networks, resulting in coverage in 6 states (Akwa Ibom, Benue, Cross
River, Gombe, Kaduna and Kogi states). A total of 25,000 patients will be on ART by the end of the program
ICAP-CU supports a supply chain management system to ensure a 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. Product selection is based on existing national
adult and pediatric treatment guidelines. ICAP-CU will continue to work closely with the UNICEF Supply
Division, which presently procures ARV drugs for ICAP Nigeria, handles customs clearance and delivers to
a secure warehouse at the ICAP-CU office in Abuja. Quantities procured are based on effective and
efficient forecasting mechanisms in place at the central and regional offices. ICAP-CU will procure
additional delivery trucks or arrange delivery via bonded transport agencies to facilitate prompt and efficient
delivery of drugs and other commodities to regional offices and sites. As expansion of ARV drug services is
prioritized to rural areas, ICAP-CU will strengthen existing referral channels and support network
coordinating mechanisms. Pharmacy and logistics management procedures will be assessed and will be
part of the site development plan for each new site. ICAP-CU will also leverage the economies of scale
provided through the utilization of the Partnership for Supply Chain Management (SCMS) for ARV drug
procurement as SCMS increases its services in Nigeria.
ICAP-CU has integrated quality assurance, monitoring and evaluation systems into its existing logistics
system. ICAP's procurement and store managers provide technical assistance including: training
pharmacists in forecasting, stock management, record keeping, quality assurance, and distribution; and
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, ICAP-CU uses a
state-endorsed pharmacy technician in-service training course, and trains key staff on record keeping for
ARV drug storage and distribution at points of service. Pharmacists at every site participate in
multidisciplinary team ART training activities. In COP08, ICAP-CU will assess pharmacy capacity in all new
sites, working 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 (SOPs) in line with national SOPs will be provided to guide
quality ARV drug management. The cost per patient may increase in COP08 as some patients fail first-line
regimens and as treatment-experienced patients from distant ART facilities transfer to local ICAP-CU
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. ICAP-CU will also continue to partner with the Clinton
Foundation and the Global Fund to utilize opportunities to reduce the cost of approved drugs. ICAP-CU 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, ICAP-CU 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, ICAP-CU will strengthen existing referral
channels and support network coordinating mechanisms.
Columbia has allocated $800,000 of its ARV Drugs budget to SCMS for procurement of commodities. This
amount is captured under the SCMS Drugs activity.
In COP08, ICAP-CU activities under ARV drugs will support the PEPFAR goals of ensuring a continuous
supply of ARV drugs to HIV infected adults and children who require treatment. In COP08 16,537
individuals (14,883 adults and 1,654 children) will newly initiate ART. By the end of COP08, 25,000 people
will be receiving ART at ICAP-supported sites, thus contributing to the national goal of treating 350,000
patients by Sept 30, 2009.
This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), OVC (5547.08), HCT
(5550.08), PMTCT (6622.08) and TB/HIV (5551.08) for the provision of HIV/AIDS related commodities
needed in those services.
Health care workers especially pharmacists doctor and nurses, will acquire skills to manage ARV drugs
appropriately along the supply chain.
Emphasis areas include human capacity development.
In FY07, ICAP-CU continued to support multidisciplinary family-focused HIV/AIDS care and treatment,
including antiretroviral therapy (ART), at 12 sites, including 10 Government of Nigeria (GON) secondary
hospitals and 2 PHCs in rural and semi-urban areas of Kaduna, Benue and Cross River States. In COP08,
ICAP-CU will expand support to 13 new hospitals in high-prevalence states Gombe, Akwa Ibom, and Kogi,
totaling 25 sites in 6 states. By the end of COP08 ART will have been provided to a cumulative 25,000
patients, including 22,500 adults (14,883 new) and 2,500 children (1,654 new). Implementation of the
PEPFAR-Nigeria LGA coverage strategy in the program areas of PMTCT and TB/HIV, designed to ensure
the provision of PMTCT and TB/HIV services in at least one health facility in every local government area
(LGA) of 6 identified states, will increase the reach of adult and pediatric ART services in these states as
well through referral networks.
The ICAP-CU model emphasizes comprehensive support, capacity-building and local ownership as
mechanisms to provide sustainable high-quality HIV/AIDS care and treatment to families and communities.
Facility support begins with systematic site assessments and the initiation of site-level project management
teams (PMTs). Community outreach and education begins early in the process, and links between
hospitals, community leaders, and community-based organizations are facilitated to share information about
new services, ensure transparency, and elicit community support for HIV/AIDS care and treatment.
Based on FY07 experience and initial site assessments, ICAP-CU anticipates the need to support
necessary infrastructure activities (generators, bore holes, renovations) at all facilities in line with the USG
PEPFAR guidelines. Staffing shortages suggest that support for facility staff, following USG and GON
guidelines, will also be important. Support for program management and systems strengthening, including
within-facility linkages, documentation/record-keeping, and inter-disciplinary partnerships, will be key to the
initiation and sustainability of chronic care systems.
Training and supportive supervision of all health care cadres will be a vital element in ICAP's COP08
program. Clinicians at all 25 hospitals will be assisted to identify HIV-infected patients (see HCT narrative),
to enroll them in care and treatment, to perform appropriate clinical and laboratory staging of adults and
children, and to provide comprehensive care and support, including the prompt initiation of ART for eligible
patients. ICAP-CU will provide ART training, including ongoing CME and QA activities, for 500 physicians,
nurses, counselors, pharmacy, and laboratory personnel, 125 of whom will also be trained to support
pediatric care and treatment. Onsite clinical mentoring will enhance quality of care and build site-level
clinical and management skills for program sustainability. ART reference tools will include pocket guides,
dosing cards, posters, and detailed SOPs. ICAP-CU will continue to implement innovative training and
clinical mentoring activities, including ongoing support for the successful South-to-South pediatric training
initiative in South Africa, intensive clinical mentoring workshops at the Stephen Lewis Foundation program
in Uganda, clinical mentoring seminars, and the adaptation of ICAP's Clinical Mentoring toolbox for use in
Nigeria. ICAP-CU works closely with other PEPFAR IPs and GON to ensure compliance with National
policies, curricula and guidelines. ICAP-CU will continue to participate in the USG Clinical Working Group to
address emerging treatment-related topics and further promote harmonization with other IPs and the GON.
Adherence training 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. ICAP-CU
will also expand its successful Peer Health Educator program, enhancing family counseling and testing,
defaulter tracking, and inter/intra-facility linkages.
ICAP-CU will facilitate onsite 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, and access to laboratory services. ART for adults and children will be provided using National
protocols and guidelines. ICAP-CU will support both first and second-line ART. As the program and cohorts
mature, we anticipate increasing need for second-line ART, and will place special emphasis on training and
mentoring health care providers to identify treatment failure and initiate second-line regimens when needed.
ICAP-CU will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for
providing antiretroviral drugs to patients. Non-ART eligible individuals will be enrolled into care and will
receive regular clinical monitoring.
To enhance uptake and quality of services, ICAP-CU will provide routine opt-out testing and provider
initiated testing and will strengthen linkages with entry points including: HCT, ANC, PMTCT, TB clinic, under
-5 clinic, GOPD, inpatient ward, family planning, STI clinic and palliative care services. Efforts will be made
to ensure that HIV-exposed infants and HIV-infected infants and children are identified through multiple
points of entry and linked into OVC and treatment services. Other activities will include strengthening the
family-centered approach to care via the use of genealogy forms, co-located services, family counseling,
provider-initiated counseling and testing for partners and family members, and the use of Peer Health
Using the HIV health network model, ICAP-CU will work to establish and strengthen links between primary
(PHC) and secondary health facilities, PLWHA groups, NGO/FBOs, and communities. ICAP-CU will also
identify and build capacities of pilot comprehensive PHCs to link to referring hospitals to support HIV/AIDS
programs and provide onsite ART at the PHC level. This decentralization will include the
development/adaptation of referral protocols (for both "down" and "up" referrals), referral forms/tools, and
site supervision tools. Communication between hospital based providers and PHCs will be facilitated.
Health Teams in PHCs will be trained. This will ensure patients' access to, and utilization of, comprehensive
continuity care and support.
ICAP-CU will work closely with NGOs/FBOs to promote community involvement, provide HIV prevention
activities and linkages to wraparound activities, and facilitate adherence among HIV positive community
members. Prevention for positives messaging will include a balanced ABC approach messaging. All
PLWHA will be linked to home based care and support, community and social services for referrals for food
and education assistance, livelihood opportunities, and other wraparound services. ICAP-CU will support
quality improvement/quality assurance mechanisms to facilitate the delivery of optimal care and treatment
services. ICAP-CU will also facilitate and actively support onsite standardized HMIS using GON forms and
Activity Narrative: provide onsite assistance with data management and M&E to guide quality improvement measures.
Columbia has allocated $500,000 of its ARV Services budget to SCMS for procurement of commodities.
This amount is captured under the SCMS ARV Services activity.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
One of the pioneers of family-focused multidisciplinary HIV/AIDS treatment in resource-limited settings, at
end of COP08 ICAP-CU will be providing ART services to 25,000 people, contributing to the GON/PEPFAR
targets for Nigeria. ICAP-CU will build the skills of at least 500 care providers thus contributing to national
LINKS TO OTHER ACTIVITIES:
This activity relates to HBHC (5552.08), OVC (5547.08), HCT (5550.08), PMTCT (6622.08), HVOP
(9208.08), TB/HIV (5551.08), AB (15654.08), and SI (5541.08). As expansion of ART services is prioritized
to rural areas, ICAP-CU will strengthen referral channels and network mechanisms. Patients on ART will be
linked to home based care and support and community and social services. TB/HIV linkages will be
strengthened where ART and TB DOTS sites are co-located, and co-location of new ARV sites will be
actively promoted in TB DOTS stand-alone sites. All HIV infected patients will be screened for TB using the
National algorithm while all TB patients will be offered HIV testing. ICAP-CU will also provide onsite
assistance with data management and M&E to guide quality improvement.
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
Emphasis areas are quality assurance/improvement and supportive supervision. ICAP-CU personnel
including national and international experts will provide skill and competency-based trainings, CME, and
ongoing clinical mentoring to enable onsite staff to provide quality ARV services to patients. Emphasis
areas also include training, human resources issues, referral networks, infrastructure support, linkages to
other sectors and initiatives. Services will also focus on addressing the needs of women, infants and
children to reduce gender inequalities and increase access to ART services among these vulnerable
groups. ARV services will facilitate linkages into community and support groups for nutritional support and
micro-credit /finance activities.
In COP07, the International Center for AIDS Care & Treatment Programs at Columbia University (ICAP-CU)
continued to expand its laboratory network model in Kaduna, Benue and Cross River States, enabling 10
hospital networks to support HIV/AIDS care and treatment programs. In COP08, ICAP-CU will support an
additional 15 secondary hospital labs for a total of 25 labs (all secondary level facilities) in 3 additional
states (Kogi, Akwa Ibom and Gombe). This will enable 118,125 people to access HIV/AIDS testing. It will
also support 25,000 HIV-positive adults, infants and children on treatment, 20,500 HIV positive adults,
infants and children not on treatment and 2,500 HIV positive mothers to benefit from HIV/AIDS care and
treatment services. At total of 548,750 lab tests will be conducted during COP08.
ICAP's experience in COP07 will inform expansion plans in COP08. In COP07, baseline laboratory
assessments revealed infrastructural deficiencies including lack of electricity and potable water, obsolete
equipment and testing methods, severe staffing shortages and under-skilled staff. This will continue to be a
challenge in COP08. ICAP-CU'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, malaria parasite,
STI screening tests, pregnancy tests, stool, urine and blood cultures, Hepatitis B and C screening 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 early infant
diagnosis (EID). ICAP-CU will participate in the National EID scale up plan, sending DBS specimens to
appropriate laboratories supported by other PEPFAR implementing partners. ICAP-CU will collaborate with
Clinton Foundation for sample collection materials and transport of specimens/results.
Lab staff will be trained in the use of already designed specimen shipment forms and other identified
mechanisms to track samples and results among ICAP-CU lab network and other partner networks. In
COP08, ICAP-CU will continue to fully fund training on diagnostic testing and immunologic monitoring, good
laboratory practices (GLP) and biosafety. ICAP-CU will also support urban Primary Health centers,
especially in the saturation plan states of Gombe and Kaduna States, to provide basic monitoring
investigations using manual method/simple auto-analyzers via the development of mini labs (FBC,
chemistry, and CD4). ICAP-CU will strengthen existing shipment flows from rural PHCs to the
comprehensive site/urban PHC mini labs closest to them. ICAP-CU will also support the development of
mobile lab teams to extend lab services to very remote/hard to reach communities and rural PHCs (Gombe
and Kaduna). ICAP-CU will ensure that all bio-medical waste generated from all its supported sites will be
properly disposed of by supporting renovation of hospital incinerators, provision of autoclaves to sites
without existing incinerators, procuring and regularly supplying sharp containers, bio-hazard bags. ICAP-CU
will continue to work closely with the SCMS mechanisms in country to procure equipment and supplies for
its supported laboratory sites.
ICAP-CU will work closely with the PEPFAR lab technical working group for the development of a common
lab equipment list and will procure appropriate equipment for the different lab levels that it supports. It will
continue to coordinate and fully fund formal didactic training sessions and share training resources to avoid
duplication. On-the-job training will continue to be enhanced by job aids, standard operating procedures
(SOPs) and diagnostic algorithms. 220 laboratory staff will be trained in GLP, HIV serology, and CD4
enumeration among others. Additional training on microscopy for AFB using the new nationally adapted
WHO/CDC AFB smear microscopy training packages will be conducted at 50 DOTS sites to identify TB/HIV
co-infections. TOT lab management training which will be offered by CDC/APHL will be provided for 2 ICAP
lab advisors who will in turn step down the training to 25 site level lab supervisors to enhance lab
management skills. ICAP-CU will also support the training of back-up Lab Scientists to provide services
when regular ones are on annual leave or posted to different facilities. All available trainable lab personnel
will be trained on all analyzers, regardless of specialty, to address the challenges of lab personnel
shortages at some of these facilities. ICAP-CU will continue to advocate for and support the training of non
lab personnel in rapid HIV testing at all sites.
ICAP-CU will continue to participate in the QA/QC national networks discussions and will support the active
integration of recommendations/guidelines at its sites and state levels. ICAP-CU will also develop and
implement QA/QC plans at all supported labs using national guidelines/tools where available. ICAP-CU will
institute a robust 4 - pronged Quality Assurance management program in all its supported sites. These
components will include quarterly site monitoring visits, use of proficiency testing panels, survey of rapid
tests and equipment/results performance in the field and sample retesting. Results of the quarterly QA
activities will be made available to a national centralized system (supported by PEPFAR). ICAP-CU will
regularly assess the quality of rapid HIV testing done in remote PHCs and stand alone VCT using various
QA tools which will include regular supervisory visits to provide mentoring, regular use of controls,
competency assessments after training, biweekly proficiency testing and regular refresher trainings. ICAP-
CU will continue to support PEP programs in all its sites by emphasizing the availability of this service in all
its lab training.
ICAP- CU laboratory program is currently supported by a regional lab advisor from the HQ who provides
regular TA to in country lab team. The in country team is comprised of one senior lab advisor, one central
lab advisor (supervises all lab activities from the central office), one central biomedical engineer, and two
regional lab advisors. An additional five lab advisors are expected to join the team before the end of
COP07. This lab team will work closely with the LTWG and the state MOH to ensure that at least 8 ICAP-
CU supported labs gain local lab accreditation through the national lab regulatory body (MLSCN).
In FY08, ICAP-CU will use EP funds to support 25 hospital labs using the phased approach described
above. To facilitate the GoN scale up plans, 245 laboratory staff will be trained on the provision of high-
quality lab. Trainings will be stepped down to laboratory technicians and assistants from the primary health
centers. Sixty lab technicians will be trained on ZN-staining /AFB identification to enhance TB diagnosis at
the DOT sites. ICAP-CU will also strengthen the laboratories at new sites by renovating space and facilities
Activity Narrative: (within the existing hospital building space), and enhancing their diagnostic abilities. By ensuring
appropriate training, supervision, equipment, maintenance and supplies, all 25 hospital labs will be
strengthened to support these institution's rapidly-growing adult and pediatric HIV/AIDS care and treatment
LINKAGES TO OTHER ACTIVITIES:
This activity also relates to activities in ART (5404.08), Palliative Care (5552.08), OVC (5547.08), VCT
(5550.08), TB/HIV (5551.08) and PMTCT (6622.08). These services will directly support these activities by
enabling 118,125 people access to HIV/AIDS testing and 25,000 HIV positive adults, infants and children on
treatment, 20,500 HIV positive adults, infants and children not on treatment and an additional 2500 HIV
positive mothers to access HIV/AIDS care and treatment.
General populace with special emphasis on high risk groups (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 45,500 HIV positives and 2,500
HIV positive mothers includes a projected total estimate of 548,750 tests consisting of 116,000 LFTs,
116,000 CBCs, 119,250 CD4 counts, 5000 sputum exams, 2500 PCRs for EID and 190,000 HIV testing
including tests in PMTCT and TB patients. Health workers will be trained in providing quality 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.
Emphasis areas include commodity procurement, training, quality improvement/assurance, supportive
supervision, upgrading of infrastructure and development of referrals, network/linkages.
The Monitoring and Evaluation (M&E) component of ICAP-CU programs enables the assessment of
progress towards program goals/objectives and supports quality improvement activities. It strengthens
medical records and patient information systems, improves data management and data quality, and
enhances clinical services at ICAP-CU-supported sites.
In COP07, ICAP-CU provided strategic information (SI) management services to 42 sites in three states
(Kaduna, Benue and Cross River). These included primary health centers (PHCs) providing a combination
of PMTCT, TB/HIV and/or HCT, and 10 secondary hospitals providing comprehensive HIV/AIDS programs.
In COP08, ICAP-CU will provide support for SI management to a total of 89 entities (70 sites and 19 CBOs)
in six states (Cross River, Kaduna, Benue, Gombe, Akwa Ibom and Kogi states). The 70 sites include 25
secondary hospitals providing comprehensive services (increased from 10 in COP07) plus satellite PMTCT,
TB DOTS and HCT sites.
Currently ICAP-CU's M&E team, with COP07 funding, consists of 16 ICAP technical staff and 24 data clerks
(facility based) that support systems to monitor program activities and report on indicators required for
national and USG reporting. The ICAP M&E team has supported the implementation of basic site patient
tracking (using national paper-based systems) for care and treatment, including the identification and
harmonization of indicators and definitions, and the adaptation and printing of data collection forms. M&E
activities include the initiation of a paper-based records system, regular data collection and verification to
meet reporting and data quality requirements, and tracking referrals and linkages to ICAP-CU-supported
hospitals for HIV care and treatment services.
ICAP-CU also uses an electronic database to aid comprehensive patient tracking, facilitate site monitoring
activities, assist reporting, monitor quality of services provided, and enhance programmatic evaluation.
Using in-country networks and available technologies, ICAP-CU is building a strong Patient Management
Monitoring (PMM) system harmonized with the Government of Nigeria's (GON) emerging national PMM
system. ICAP-CU will fully participate in the GON to roll out the new national on-line real time data system
(Voxiva platform) and implementation of HIVQual at all sites where applicable. 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) for these activities.
The monitoring and evaluation component of the ICAP-CU PEPFAR program enables the assessment of
progress towards program goals/objectives and supports quality improvement for all activities. It
strengthens medical records and patient information systems, improves data management and data quality,
and enhances clinical services at ICAP-CU supported sites. In COP08, ICAP-CU staff will carry out
regularly scheduled monitoring visits to all sites during which they will evaluate M&E activities including the
utilization of National PMM tools and guidelines, proper medical record keeping, efficiency of data flow,
referral coordination, and use of standard operating procedures, in line with the USG SI data quality
assessment/improvement (DQA/I) and capacity building plan. On-site TA with more frequent follow-up
monitoring visits will be provided to address weaknesses when identified during routine visits. This will
ensure continued quality data collection, data entry, data validation and analysis, and dissemination of
findings across a range of stakeholders. It will: ensure compilation of complete and valid HIV patient
treatment/ARV data; enhance analysis of required indicators for quality HIV patient treatment program
monitoring and reporting; and provide relevant site-specific TA to develop targeted data QI plans. Emphasis
will be placed 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. Furthermore, robust systems for tracking patients
and monitoring adherence will be developed.
In COP08, additional M&E staff (including site data entry persons) will be hired in order to sufficiently
address the greater level of M&E activities across all programs. Ideally, ICAP will hire eight additional full
time staff (for a total of 24) and 26 facility-level data clerks (for a total of 50). Out of the eight additional ICAP
core staff to be hired, three staff will be based in Abuja, including a database programmer/developer, a data
analyst, and a quality management advisor. The database programmer's primary responsibility will be to
develop a database application for HMIS collection and storage of aggregate and patient-level data for
monitoring and evaluation of HIV clinical programs. The data analyst will merge and clean large datasets in
Access, Excel or SAS format across ICAP-supported HIV prevention, care and treatment sites for use in
routine monitoring and evaluation, and will also conduct descriptive and multivariate analysis of collected
aggregate and patient-level data. The quality management advisor will lead the planning and
implementation of service quality and data quality protocols across ICAP-CU supported sites in Nigeria and
will ensure compliance with the protocols. Two regional M&E advisors will be hired to lead the M&E team in
ICAP-CU's regional office in the planning, implementation and review of M&E activities at ICAP supported
health facilities. Three regional M&E assistants will assist the regional M&E advisors in the development
and refinement of M&E materials and provide support in the development and establishment of a systematic
procedure for patient monitoring and evaluation including collecting, collating and reporting all data tracked
by the ICAP Nigeria program.
ICAP-CU M&E staff train service providers in appropriate record-keeping and provide ongoing technical
assistance to facility personnel to enhance site capacity to keep and review completed service delivery
forms/registers, and to implement data quality assurance systems. In COP08 ICAP-CU will train and
provide ongoing technical assistance to at least 250 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. 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. Service providers will also be supported to complete medical records and
registers in an accurate and timely manner. In addition, ICAP-CU will provide technical assistance to 89
local organizations and facilities, enabling them to strengthen their own monitoring and evaluation activities.
ICAP-CU will continue to support additional M&E activities, including monthly feedback meetings with
facilities and GON at all levels and regular quality checks on data and other services via adapted QM tools.
Support will be provided to GON as necessary, and evaluation protocols will be developed and
Activity Narrative: implemented. State M&E officers will participate in the monitoring processes and the training programs in
order to instill a sense of ownership and ensure sustainability of these efforts. Additionally, the SI team will
continue to be active participants in the SI working group established and coordinated by USG-Nigeria.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Correct and consistent data collection will contribute to the measurement of the achievement of the
GON/PEPFAR care and treatment goals. It will be utilized to strengthen systems for increased and rapid
expansion, planning and sustainability purposes.
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 (6622.08), adult basic care and
support (5552.08), TB/HIV (5551.08), OVC (5547.08), HCT (5550.08), AB (15654.08), condoms and other
prevention (9208.08), ARV services (5404.08), ARV drugs (5493.08), lab (5544.08), blood safety (6490.08)
and injection safety (6819.08). ICAP-CU will conduct evaluations of PMTCT service delivery and
decentralization of ART services to PHCs.
The population being targeted includes the M&E officers in partner implementing organizations and various
CBO/FBO/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.
Emphasis areas include human capacity development and SI.
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.