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.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
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
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
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 2009
ACTIVITY DESCRIPTION
In COP08, DOD program will provide PMTCT services at 20 sites (14 existing and 6 new). 12, 600 pregnant
women will receive HIV counseling and testing for PMTCT and receive their test result. 574 women will
receive a complete course of antiretroviral prophylaxis in a PMTCT setting. 100 individuals will be trained to
provide these services.
The Nigerian Military provides prevention, care and treatment to its service members and the surrounding
civilian community (constituting approximately 75% of the Military's patient load). The Department of
Defense (DOD) - Nigerian Ministry of Defence (NMOD) will provide free comprehensive PMTCT services,
which will follow the revised national guidelines (2007), at 14 existing DOD sites and 6 new expansion sites
in COP08. In COP08, the program will expand to six new sites.
A family-centered network approach will be adopted and group health information with routine "opt out"
counseling and testing will be provided to pregnant women presenting for antenatal services. Testing will
be done following the National testing algorithm with same day results. Post-test counseling will include
prevention counseling and education for both HIV+ and HIV- women. A total of 12,600 women will be
counseled, tested and receive their results. Partner testing will be promoted. DOD will support promote
couples counseling and testing to promote disclosure, address discordance and to increase support for
Infnat feeding choices. Staff will counsel clients on their disclosure of HIV status and partner/family
notification with an emphasis on client safety. Partner referrals for CT (individual and/or couple) will be
provided. Also, referrals to community-based and barracks-based support groups will be provided to HIV+
clients. Linkages will also be enhanced by counselors who are members of PLWHA support groups.
HIV testing will be offered to all women of unknown HIV status presenting for labor and delivery and in the
postpartum period. In accordance with National guidelines, a full course of ARV prophylaxis will be
provided to approximately 574 women. ARV prophylaxis will include ZDV at 28 weeks or 3TC/ZDV at 34/36
wks and single dose Nevirapine (sdNVP) in labor with a 7 day 3TC/ZDV tail . All infants born to HIV+
women will be provided with sdNVP at birth and ZDV for 6 weeks. HIV-exposed infants will be provided with
cotrimoxazole (CTX) prophylaxis from 6 weeks and will be discontinued at once confirmed HIV- and no
longer breastfeeding. Post partum women who are clinically eligible for ART will be referred for ARV
services at the sites. Family planning and other reproductive health best practices will be promoted while
linkages to OVC activities will be enhanced..
Infant feeding education and counseling will begin in the antenatal period in accordance with National
guidelines, accompanied by appropriate prevention messages and education to all pregnant women and
family members. After delivery, mothers and infants will be followed up to monitor mother's health and to
support the mother's compliance of her infant feeding option as well as to provide nutritional support for
both. DOD will actively participate in Early Infant Diagnosis (EID) using revised national guidelines (2007).
In support of DOD's commitment to build capacity and long-term sustainability in the NMOD, formal training
for an additional 100.staff comprising of 80 persons for the new sites and, 20 persons to be retrained from
the existing sites covering physicians, nurses, mid-wives and others involved in PMTCT services.
Trainings will be done in line with the revised National PMTCT training curriculum (2007). By training
uniformed members and civilian employees that are in a career track in the Government of Nigeria, this
program fosters a generation of skilled workers who are more likely to remain in the military. This
contributes to fulfilling PEPFAR goals for independent and sustainable programs.
In addition, commodities and equipment that are required in PMTCT services will be procured. Depending
on site inventories and needs, commodities may include gloves, soap or other disinfectant and other
medical consumables. Commodities will be provided to all 20 military sites through procurement by SCMS..
By the end of COP08, the DOD will support 20 NMOD sites in Edo, Benue, Borno, Cross River, Rivers,
Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, Anambra, and Niger (16 states and
FCT).
CONTRIBUTION TO OVERALL PROGRAM AREA
The DOD PMTCT program will providing HIV counseling and, testing to 12,600 pregnant women and
provide ARV prophylaxis to 574 women. This contributes to the goal of preventing new HIV infection in
Nigeria. The PMTCT services identify HIV+ women who may need HAART for their own health , thus
contributing to PEPFAR Nigeria's care and treatment goals.
LINKS TO OTHER ACTIVITIES
This activity relates to activities in ARV Services (3243.08), Laboratory Infrastructure (3244.08), Care and
Support (3247.08), OVC (5409.08, Safe Blood (5388.08), TB/HIV (3240.08) and Strategic Information
(3245.08). Pregnant women who present for counseling and testing services will be provided with
information about the PMTCT program and referred accordingly. ART treatment services for infants and
mothers will be provided through ART services. Basic pediatric care support, including TB care, is provided
for infants and children through our OVC activities.
POPULATIONS BEING TARGETED
This activity targets pregnant women and their family members. Activities also target
military personnel, civilian employees, dependents and the general population in the communities
surrounding the 20 sites. In particular,
EMPHASIS AREAS
This activity has an emphasis on building local organizational capacity and training. This activity will address
gender equity in HIV/AIDS programs by specifically targeting pregnant women and girls for counseling,
testing and treatment.
ACTIVITY DESCRIPTION:
This activity represents funding for one contracted Nigerian program officer/physician position in support of
PMTCT activities as well as extra-country technical assistance. The budget includes three FSN salaries,
overhead charges, funding required for domestic travel, training funds and allocated minor support costs.
This funding also includes support for a USMHRP HQ Technical Assistance visit for one week of in-country
support by a physician who will provide TA, continuing medical education and mentorship, particularly in the
area of early infant diagnosis (EID). TA assistance may also be provided by the USMHRP's site staff in
Kenya, Uganda and/or Tanzania.
A unique aspect of the NMOD-DOD Program is the employment of staff with past NMOD experience or
familiarity. These individuals support the military to military aspects and act as a bridge for ownership
development. Involvement of these employees as members of the USG Treatment and Clinical Working
Groups, as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD)
Clinical Working Group will hybridize US policy and implementation with NMOD/GON practices.
The program officers will work as a members of the USG Prevention and PMTCT Working Groups, as well
as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Clinical Working
Group. The program officer's responsibilities also include: 1) representing the DOD-NMOD in technical
discussions with the GON and 2) overseeing relevant technical aspects of the program, including program
management and oversight of the 20 DOD-NMOD PEPFAR site PMTCT programs. The program officer will
also ensure the expansion of EID, as appropriate, in the Nigerian Military. The program officer will work
with other Implementing Partners and the USG team to ensure a harmonized approach that is consistent
among partners and promotes the GON national treatment guidelines. S/he will liaise with other non-
governmental organizations, such as the Clinton Foundation, to ensure efforts are coordinated.
This activity represents funding for a contracted Nigerian program officer for activities in the area of
prevention through Abstinence and Being Faithful (AB) activities. The program officer spends 50% of her
efforts in AB and the other 50% of her time in Other Prevention. The budget includes one FSN salary at
50% effort, overhead charges, funding required for domestic travel, training funds and allocated minor
support costs. This funding also includes support for a Technical Assistance visit for one week of in-country
support by a seasoned prevention expert from the Walter Reed Project Kenya who will provide TA and
mentorship in the area of AB. TA assistance may also be provided by the USMHRP's site staff in Uganda,
Tanzania or HQ.
The prevention program officer will work as a member of the USG Prevention Technical Working Group, as
well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Prevention
Working Group. The prevention program officer's responsibilities also include: 1) representing the DOD-
NMOD in technical discussions with the GON and 2) overseeing relevant technical aspects of the program,
including program management and oversight of the 20 DOD-NMOD PEPFAR site prevention programs.
The prevention program officer will work with other Implementing Partners and the USG team to ensure a
harmonized approach that is consistent among partners and with the GON national guidelines.
This activity relates to activities in PMTCT (3246.08), Condoms and Other Prevention (5362.08),
Counseling and Testing (3241.08), Care and Support (3247.08), TB/HIV (3240.08), OVC (5409.08) and
ARV Services (3243.08).
Epidemiologic evidence indicates that throughout the world men and women in the military are amongst the
most susceptible sub-populations to Sexually Transmitted Infections (STIs), including HIV. In many African
countries, uniformed services report HIV prevalence rates higher than national averages. In Cameroun,
Nigeria's neighbor to the east, an HIV rate of 6.2% was reported in the military compared to 2% in the
general populations in 1993.In Malawi, 25% to 50% of army officers are already HIV positive.
HIV prevalence figures are unavailable in the public domain for Nigeria's over 150,000 strong armed forces,
since force world wide HIV testing has not been published; however Nigeria is Africa's largest contributor of
troops including military observers and civilian police to UN peace keeping missions.
The military community is also considered a high risk environment for HIV transmission. This is based on a
range of factors which include; danger and risk associated with the profession; personnel tend to be young,
single and sexually active; personnel are highly mobile and stay away from families/home communities for
extended periods; influenced by peers rather than social convention; inclined to feel invincible and take
more risks and have ready cash than other males where they are deployed and hence surrounded by
opportunities for casual and commercial sex.
It is based on this evidence, that the US Department of Defense (DOD) in partnership with the Nigerian
Military provides prevention, care and treatment to its service members and the surrounding civilian
community (constituting approximately 75% of the Military's patient load). During COP08, the U.S.
Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will continue to extend
free access to prevention services in 14 military facilities and communities.
In COP08, the program will expand to six new sites. The criteria used for expansion site selection were
established in coordination with the NMOD. Criteria include military strategic importance, geographical
coverage and the HIV/AIDS related needs of the military communities.
In addition, to these site expansions, DoD will ensure that every individual reached through this AB strategy,
will be provided with a minimum of three interventions; which will include: community awareness, peer
education and one other targeted strategy within the year. The other targeted intervention will be drawn
from PE Plus activities, workplace or vulnerability programmes.
The planned activities, which will implemented to achieve these strategies include:
Strengthen the DOD-NMOD partnership with the Armed Forces Programme on AIDS Control (AFPAC), an
existing structure which coordinates prevention services for Nigerian Armed Forces. The DOD will support
AFPAC in the training of 400 peer educators and 50 Trainer-of-Trainers on HIV/AIDS prevention by
promoting abstinence, being faithful to one's partner and correct and consistent condom use (to be funded
under OP) and skills (AB).
Training which will encourage specific promotion of AB messaging during pre-deployment and recruitment
training. All prevention messaging will include promotion of HCT and referrals will be provided to the
nearest military site providing HIV/AIDS/STI related services. An estimated total of 4,000 military and
civilian personnel will be reached by peer educators with programming on HIV/AIDS prevention through AB.
DOD will partner with AFPAC to improve and reproduce Information, Education and Communication (IEC)
materials to encourage and reinforce AB messages and information among military personnel. Materials
will be vetted through DOD and the USG Prevention Technical Working Group prior to reproduction. These
materials will be expected to reach 100.000 people whom will include both military and civilians. However,
these individuals are not counted towards DOD's AB targets since distribution of materials may not be
sufficient to consider a target "reached."
Another strategy is to increase the knowledge and build the capacity of HIV/AIDS prevention through
abstinence among in-school youth in military barracks. Utilizing existing infrastructure and indigenous
organizations such as the Society of Students Against Infectious-Diseases Trust, abstinence skills-based
training will be provided to approximately 800 in-school youth.
Efforts will focus on recruiting young girls to be trained. Funding will support logistics (e.g., manual
production), training and support for each military school to conduct abstinence-only HIV/AIDS
programming involving those trained. Training and programming will promote abstinence only messaging
and skills fostering youth empowerment and knowledge sharing to reach a total of 4,000 in-school youth.
The training will be expanded to reach out-of-school youth and will incorporate being faithful to one's partner
and condom messages (utilizing Other Prevention funds) as appropriate.
Out-of-school youth will be accessed via youth centers, religious centers, recreational and the "mammy
markets". This activity will train 200 and reach 1,000 out of school youth with skills and messaging around
abstinence and being faithful, condom use. In addition, income generating skills will be incorporated into the
out- of -school AB training.
The DOD will also strengthen the capacity of existing groups such as the Officers' Wives Clubs (OWCs) to
conduct AB awareness and education activities. These OWCs have unique access to senior military
officers, personnel wives, "Magajia's (women who control the barrack accommodation blocks and mammy
markets) and other females within and around the barrack communities.
The OWCs will implement outreach events and training activities within these 20 barracks to reach 500
women at each site, totaling an estimated 10,000 women and an additional 5,000 individuals including
military personnel, their families and other civilians located within and around the barracks.
The DOD will continue to expand efforts with military based religious communities in order to reinforce AB
messaging, awareness and education. The DOD will support training through the Directorate of Islamic
Activity Narrative: Affairs and Directorate of Christian Services to reach 100 Imams and Priests from its 20 sites on HIV/AIDS
education and prevention. These Imams and Priests will conduct abstinence and marital fidelity related
forums, workshops, and activities. They will provide AB related information on a continuous basis to an
estimated number of 2,000 persons, which will include the personnel, their families and other civilians and
clergy.
AB messages will also be provided to all individuals accessing HCT, Care and Support, ARV and PMTCT
services at military sites.
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
In conjunction with other DOD activities, and those of other partners, this activity will contribute to the
provision of a comprehensive HIV and AIDS prevention package for the military population, civilian
employees, their dependents and the communities surrounding military sites. This activity will contribute to
the PEPFAR overall aim of reducing HIV infection rates in Nigeria.
LINKS TO OTHER ACTIVITIES:
Counseling and Testing (3241.08), Care and Support (3247.08), TB/HIV (3240.08), OVC (5409.08), and
POPULATIONS TARGETED:
This activity targets the military, civilian employees, their dependents, and the communities surround
military sites. In particular, this activity targets in- and out-of-school youth and youth drafted into formal
military service.
EMPHASIS AREAS:
This activity includes an emphasis on human capacity development and gender. This activity will address
gender equity in programming through activities targeting young girls and women.
ACTIVITY NARRATIVE:
In COP08, the Department of Defense (DOD) HIV Program, in collaboration with the Nigerian Ministry of
Defense (NMOD), will support blood safety activities to strengthen NMOD's support and use of the National
Blood Transfusion Service (NBTS). The DOD will pilot activities in four sites. The four pilot sites were
selected due to their proximity to an NBTS regional blood screening site.
This activity has three components. Working closely with the NBTS, the first component is to support blood
drive activities across four military sites. By promoting and facilitating access to the NBTS, the military will
support the recruitment of voluntary, non-remunerated blood donors among the barracks community in
support of national blood supply needs. Another objective is to increase the number of first-time donors and
the proportion of military and civilian personnel who are regular donors. This will be facilitated by frequent
blood drives at the sites so military personnel will not have to travel to NBTS to donate. The NMOD will also
encourage senior military officers to promote regular blood donation during officer professional development
seminars. All donors will be screened with the national blood donor questionnaire and the data remitted to
the NBTS.
The second component includes supporting sites to transport blood units collected to the NBTS. Currently,
blood donations are collected, screened and transfused at military sites. Instead of screening, storage and
distribution of blood at the four military pilot sites, the DOD will work with the sites to establish systematic
transportation of blood collections to the nearest NBTS site for processing and screening for the four
transmissible transfusion infections with ELISA. This will include the provision of hazmat mobile storage
containers to transport blood. By beginning to shift the effort of providing these services through the NBTS,
it is anticipated that over time the burden of collecting and screening blood at most of the military sites will
be transferred to the NBTS. This will also result in a reduction in the use of rapid test kits to screen blood at
military sites, saving resources for VCT and other clinical screening programs. Screened blood from NBTS
will be collected and stored at the four collaborating centers so that emergency screening with rapid test kits
is minimal. As a result of these first two activities, the military will support the NBTS in executing its
responsibility for ensuring a national, safe blood supply in Nigeria, coordinated and implemented by a single
national body. NBTS will also provide monthly feedback on rates of the four TTIs found by ELISA screening
of blood units collected by each facility.
The final component of this activity includes strengthening the capacity of military and civilian personnel in
blood safety practices. The DOD will also facilitate the training of NMOD staff through the Safe Blood for
Africa Project (SBFA) and the NBTS. Education and training in all aspects of blood safety according to GoN
national training guidelines will be provided to 12 personnel at the four pilot sites by SBFA. Step-down
training will be conducted at each site. A total of 48 health personnel will be trained through this step down.
This includes topics such as universal precautions, good clinical and laboratory practices, testing for
transfusion-transmissible infections, waste management and other such areas. Donor recruitment and
management will also be covered. QC/QA will be instituted for all processes involved in this activity. 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 pilot activity will support four NMOD sites in Lagos, Kaduna, Oyo and the FCT. It is expected that an
average of 100 units of blood from each of these sites will be screened through linkage with the NBTS
making a total of 400 units of blood.
This activity will also promote the principles of Universal Safety Precautions, such as the reduction of
unnecessary transfusions, exposure to blood, accidental injury/contamination as well as the essential
consumables and services that protect health care workers from contracting infections, especially HIV.
These universal precaution materials will include personal protective equipment such as hand gloves,
laboratory coats, masks, and other essential consumables for each site. Additionally, each site will make
provisions for the referral of staff for access to post exposure prophylaxis (PEP) when needed. PEP will be
provided through ART drugs activities. Proper waste management will be encouraged at each site through
the use of biohazard bags, suitable sharps containers, and the use of incinerators.
CONTRIBUTION TO OVERALL PROGRAM AREA:
This activity will contribute to the USG target of preventing 1,145,545 new infections by 2009 through
prevention of medical transmission of HIV by ensuring the supply of a safe and screened national blood
supply. This activity will also contribute to GoN and PEPFAR training goals by training 48 military personnel
in blood safety. This activity will help to establish routine referrals to the NBTS for blood banking services.
LINKS TO OTHER ATIVITIES:
This activity will be linked to MTCT (3246.08), HVCT (3241.08), HMIN (16943.08), HLAB (3244.08), HTXS
(3243.08) and HVTB (3240.08). All donors at the collaborating centers will be screened with the national
blood donor questionnaires and full HCT services offered. The DOD will also establish linkages with other
partners to ensure access to the full range of blood safety activities including Safe Blood for Africa and the
NBTS.
POPULATIONS BEING TARGETED:
This activity targets military and civilian personnel who are involved in blood collection, storage and
transfusion. The activity also targets the broader barracks community to increase the number of voluntary
non-remunerated blood donors.
From COP05 through COP07, the Department of Defense (DOD) HIV Program, in collaboration with the
Nigerian Ministry of Defense (NMOD), received support for injection safety through John Snow Incorporated
(JSI)/Making Medical Injection Safer (MMIS) including the provision of training and sharp boxes. In order to
strengthen injection safety practices in the Nigerian Military, the DOD will further expand infection
prevention/safety activities during COP08. Activities will support capacity building/training, safe and
effective waste management systems, ensuring availability of safe injection equipment and the promotion of
safe injections. Activities will be conducted at 14 existing DOD sites and six new expansion sites in COP08.
The DOD will continue to collaborate with JSI/MMIS in the areas of training and commodities procurement.
JSI/MMIS will train DOD master trainers personnel (TOT) centrally and these master trainers will step down
trainings at various DOD sites utilizing the JSI/MMIS curriculum for the step down trainings. At least 60
military health care personnel (e.g., physicians, nurses, pharmacists, sanitarians) will be re-trained or
trained. All safety protocols will be reviewed and distributed. To ensure sustainability, the cadre of staff
trained as trainers will conduct regular biannual refresher trainings across the 20 sites.
To supplement the limited supply of commodities that are provided by MMIS, the DOD will procure (via the
Supply Chain Management System) commodities that are required for safe injections/needle handling and
disposal. Depending on site inventories and needs, commodities may include disposable syringes,
respiratory masks, surgical gloves, waste/sharps collection units and other safe injection equipment.
Commodities will be provided to all 20 military sites.
Another component of this activity is to reprint or adapt existing educational materials (e.g., pamphlets,
brochures) on injection safety that have been produced in COP06 and COP07 by other partners such as
IHVN. Materials will be distributed at trainings and will be posted in relevant locations (e.g., laboratories,
pharmacies) at the 20 sites. Materials will include a poster on procedures for post-exposure prophylaxis.
Materials will also aim to reduce unnecessary injections.
The last component of this activity includes an assessment of each site's waste management system. As
necessary, renovations of waste-disposal pits will be conducted to ensure that pits are built to safety
standards (e.g., proper depth, width, sealed correctly). In the few sites that have incinerators, renovations
may be conducted, if necessary.
This activity will contribute to the prevention of new infections and reduction of occupational hazard
exposures among military and civilian personnel by promoting injection safety. Thus, the activities will
contribute to the overall PEPFAR goal of prevention medical transmission through injection safety.
This activity relates to activities in MTCT (3246.08), HVCT (3241.08), HMBL (5388.08), HLAB (3244.08),
HTXS (3243.08) and HVTB (3240.08).
This activity primarily targets military and civilian health care personnel who are involved in handling
needles and/or blood from patients and/or handle waste disposal.
This activity has an emphasis on local organization capacity building and human capacity development.
most suspeciable sub-populations to Sexually Transmitted Infections (STIs), including HIV. In many African
The military community is also considered a high-risk environment for HIV transmission. This is based on a
range of factors which include; danger and risk associated with the profession; personnel tend to young,
It is based on this evidence, that the U.S. Department of Defense (DOD) in partnership with the Nigerian
Military provides prevention, care and treatment to its service members and the civilian communities
surrounding military barracks and posts (constituting approximately 75% of the Military's patient load). With
COP08 funding, the U.S. Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV
Program will continue to extend free access to prevention services in 14 military facilities and communities.
With COP08 funding, the program will expand to six new sites. The criteria used for expansion site
selection were established in coordination with the NMOD. Criteria include military strategic importance,
geographical coverage and the HIV/AIDS related needs of the military communities.
In addition, to these site expansions, DoD will ensure that every individual reached through this COP
strategy, will be provided with a minimum of three interventions; which will include: community awareness,
peer education, access to condom commodities/ services and training, which will also be integrated with
existing workplace and vulnerability programmes,
AFPAC in the training of 400 peer educators and 50 Trainer-of-Trainers on HIV/AIDS prevention through
condoms and high-risk behavior reduction; this also includes AB education (funding other AB). All
prevention messaging will include promotion of HCT and referrals will be provided to the nearest military
site. An estimated total of 4,000 military and civilian personnel will be reached by peer educators with
programming on condom education and high-risk behavior reduction.
materials to encourage and reinforce correct and consistent use of condoms among military personnel.
Materials will be vetted through DOD and the USG Prevention Technical Working Group prior to
reproduction. These materials will be expected to reach 100,000 people whom will include both military and
civilians. However, these individuals are not counted towards DOD's OP targets since distribution of
materials may not be sufficient to consider a target "reached."
In collaboration with AFPAC and the Society for Family Health, the DOD-NMOD will help to strengthen male
condom distribution to the sites and within sites. In COP08, targeted condom service outlets will expand to
a total of 20 sites. The DOD, in collaboration with the Ministry of Health, will supply 20,000 female condoms
to all sites. Through prior prevention activities in COP06 and COP07, female military and civilian personnel
exhibited strong demand for female-initiated prevention strategies which included female condoms. In
partnership with the Ministry of Health and AFPAC, DOD-NMOD will also provide information, training and
skills to approximately 2,000 total persons (100 persons each site) on male and female condom use at 20
sites. A total of 10,000 across the 20 sites will be reached and have access to male and female condom
related information, training and skills.
In addition to working with AFPAC, DOD-NMOD will strengthen the capacity of existing groups, such as the
NMOD Officers' Wives Clubs (OWCs), to conduct awareness and education activities regarding correct and
consistent condom use, as well as risk-reduction.
The OWCs have unique access to senior military officers, personnel wives and the "Magajia's (women who
control the barracks accommodation blocks and mammy markets). The OWCs will implement outreach
events within these 20 barracks to reach 5,000 individuals including military/civilian personnel, their families
and other civilians located within and around the barracks. The DOD-NMOD will also continue to support
indigenous, barrack based organizations to conduct OP activities, such as the Movement Against the
Spread of AIDS. These community-based organizations complement programming already occurring at
military sites, and often reach harder-to-access populations such as out-of-school youth.
The DOD-NMOD will support 20 AFPAC HIV/AIDS Committees to develop, incorporate and implement
condom related activities into their yearly work plans. In addition, these 20 site-based HIV /AIDS
Committee will be supported to incorporate condom and male involvement related activities during military
officers /rank and file mess social recreation activities to reach 1,000 adult males across the 20 sites.
Another component is to strengthen HIV prevention through STI management within the NMOD. This will
include activities to offer high quality STI services, which will include STI training, counseling, diagnosis and
treatment, for approximately 3,000 military personnel, dependents and civilians in and around the barracks
communities. Diagnosis for Syphilis (Treponema pallidum), Gonorrhea, Chlamydia and Herpes Simplex
Virus will be completed and treatment provided (Pen G, ceftriaxone, azithromycin, acyclovir).
ABC prevention messaging and condoms will be provided/offered to all those receiving STI diagnoses and
treatment. All individuals diagnosed with STIs will be referred to HCT and highly encouraged to participate
Activity Narrative: in regular testing.
All components will include specific efforts to include People Living with HIV/AIDS in activity planning and
implementation. Several PLWHA support group members are already been active in HIV prevention
activities within the military barracks; this partnership has helped to reduce stigma and discrimination in the
military community.
This will be partnership will be further enhanced by the provision of support to build the capacity of 10 of
these PLWHA support groups, especially in the areas of leadership, project design, management and
income generating activities/ businesses.
In addition, DOD will support AFPAC and EPIC to implement a micro finance loan program; the program will
begin with 50 representatives from the 10 PLWHA support groups; however, these groups will receive on
going support to continue providing income generating activities to their members and other interested
individuals within and around the military communities.
OP messages will also be provided to all individuals accessing HCT, Care and Support, ARV and PMTCT
services at military sites. Male and Female condoms are provided free of charge.
This activity will contribute to the provision of a comprehensive HIV and AIDS care package for the military
population, civilian personnel, their dependants and surrounding communities. Thus, this will contribute to
the overall aim of prevention new infections in Nigeria.
This activity relates to activities in MTCT (3248.08), HVCT (3241.08), HVAB (5313.08), HBHC (3247.08),
HTXS (3243.08), and OHPS (6504.08).
This activity is targeted at the military population, civilian personnel, their dependents and the surround
communities, including men and women of reproductive age, health care workers and community- and faith-
based organizations.
This activity has an emphasis on training, gender and local organization capacity building.
prevention through Condoms and Other Prevention (OP) activities. The program officer spends 50% of her
support by a seasoned prevention expert from the U.S. Department of Navy HIV Prevention Program and/or
one of the U.S. Military HIV Research Program's PEPFAR Programs in Uganda, Kenya or Tanzania.
harmonized approach that is consistent among partners and with the GON national guidelines. The
prevention officer will also continue to support the GON in developing and implementing national prevention
guidelines (e.g., National Condom Strategy).
This activity represents funding for one contracted Nigerian health care provider for activities in Basic Care
and Support. A new emphasis in DOD in COP08 is to provide additional attention to psychosocial, spiritual,
and other non-clinical support and aspects of care. Funding will also support extra-country technical
support of BCS. The budget includes partial salaries for two FSNs, overhead charges, funding required for
domestic travel, training funds and allocated minor support costs. This funding also includes support for a
USMHRP HQ Technical Assistance visit for one week of in-country support to provide TA on basic care and
support, continuing medical education and mentorship. TA assistance may also be provided by the
USMHRP's site staff in Kenya, Uganda and/or Tanzania.
A unique aspect of the NMOD-DOD Program is the implementation of the program by non-PEPFAR
remunerated staff. Support to and development of local support groups and encouragement of military
members, staff and family members to participate in community efforts to care for HIV+ patients will enable
COP08 emphasis as previously described.
Both program officers will work as members of the USG Care Technical Working Group, as well as serve on
the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Clinical Working Group. The
program officer's responsibilities also include: 1) representing the DOD-NMOD in technical discussions with
the GON and 2) overseeing relevant technical aspects of the program, including program management and
oversight of the 20 DOD-NMOD PEPFAR site Care and Support Programs. The program officer will work
among partners and with the GON national guidelines.
This activity will directly link with activities in AB (5313.08), Condoms and Other Prevention (5362.08),
PMTCT (3246.08), HCT (3241.08), ARV Services (3243.08), Lab (3244.08) and TB/HIV (3240.08).
The Nigerian Military provides prevention, care and treatment, including BHC, to its service members and
the surrounding civilian community (constituting approximately 75% of the Military's patient load). During
COP08, the U.S. Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will
continue to extend free access to basic care and support services in the following 14 military facilities and
communities: Defence Headquarters Medical Center - Mogadishu Barracks (FCT), 44 Nigerian Army
Reference Hospital (Kaduna), Nigerian Naval Hospital (Ojo), 445 Nigerian Air Force Hospital (Ikeja), 82
Division Hospital (Enugu), Nigerian Air Force Hospital (Jos), Nigerian Naval Hospital (Calabar), Naval
Medical Centre (Warri), Nigerian Army Hospital (Port Harcourt), 45 Nigerian Air Force Hospital (Makurdi),
Military Hospital (Benin), 2 Division Nigerian Army Hospital (Ibadan), Military Hospital (Maiduguri) and 3
Division Hospital (Jos).
In COP08, the program will expand to six new sites. These include: Brigade Medical Center Sokoto, Armed
Forces Specialist Hospital Kano, 34 FAB Medical Center Owerri, Ministry of Defence Clinic, Military
Cantonment Onitsha, and Headquarters Nigerian Army CAS Medical Reception Station Kontangora. All 20
sites also provide HIV prevention, care and treatment services. Services will be provided to 12,577 HIV+
adults and support services to an additional 25,154 persons affected by AIDS (PABAs)
In line with National guidelines and protocols, the DOD-NMOD will support the provision of palliative care
services to 12,577 PLWHA and their families in the communities in and around the military sites providing
ART. A component of this program will be supporting and maintaining links with active community-based
organizations, home-based care providers (HBCs) and faith-based organizations (FBOs) that will provide at
home follow up of patients attending ART clinics. While efforts will be strengthened to provide services to
individuals in the community who cannot access ART services, a strong component of these efforts will be
linking with CBOs and FBOs since HBCs are limited in number at sites. DOD will also work with, and
support, the NMOD and its partners in further developing internal guidelines, protocols and standard
operating procedures (SOPs), using evidence-based interventions, particularly in the area of pediatric care
and implementation of a preventive-care-package.
The DOD will support the provision of comprehensive clinical care, including OI include syndromic treatment
of STIs and malaria (e.g,, ceftriaxone, azithromycin, acyclovir, penicillin G), diagnosis and treatment as well
as pain and symptom management, through the full course of infection at all 20 hospitals. This will be
accomplished by: strengthening institutional and health worker capacity with ongoing, in-service training,
providing initial training to 72 (5 per new site; 3 per existing site) additional health care workers in palliative
care skills as part of and in addition to ART education; increasing the capacity of clinicians to diagnose and
manage common OIs; provide psychosocial counseling; and strengthening laboratory diagnostic facilities
and pharmacy capacity (see DOD lab and ARV Drug submission) through refurbishments, equipment,
training and QA/QC programming, . Facility based care will be complemented using a network model
through trained volunteers, nurses, health workers, PLWHAs and family members working together both in
the facilities as well as following up patients at home. Insect treated nets, water guards, IEC materials, and
condoms will be provided, as well as cotrimoxazole for patients as clinically appropriate.
Laboratory services provided will include CD4 ascertainment, liver function tests, hepatitis screening and
management of abnormalities as appropriate. All patients will be screened for TB and malaria; prophylaxis,
treatment, and linkages to wraparound or other program areas will be provided as appropriate.
In COP07, 44 Nigerian Army Reference Hospital Kaduna was provided with funding to refurbish a hall for a
vocational and economic empowerment center. Support was also provided for the training of PLWHAs on
soap making, knitting and tailoring to provide the foundation for sustainable income generation activities.
This activity focuses its efforts on young, HIV+ women. In COP08, this training activity will be expanded to
additional sites that have space to accommodate a vocational center. PLWHAs who were trained at 44 will
serve as trainers for other sites. Support will also be provided to purchase a stock of necessary materials
(e.g., soap making materials, weaving materials/equipment).
Another component of this activity is to strengthen spiritual and social services provided to those living with
HIV/AIDS in the military barracks. In COP08, DOD will continue to provide support for Imams and Priests to
provide spiritual support and/or counseling for PLWHAs and people affected by HIV/AIDS (PABAs). This
includes counseling related to a patient's fears, life views, crises, adherence and bereavement Health care
providers will provide linkages and information to reach military Imams and Priests, as well as collaborating
PLWHA support groups, during clinical care sessions.
In COP08, the DOD's "prevention for positives" program will be expanded to all 20 military sites. Providers
at each site will provide prevention messaging to include partner reduction and/or mutual fidelity, correct
and consistent condom use for PLWHAs, disclosure and partner testing. Condoms will be provided free of
charge. Providers will counsel clients on their disclosure of HIV status and partner/family notification with
an emphasis on client safety. Partner referrals for CT (individual and/or couple) will be provided. Also,
referrals to community-based and barracks-based support groups will be provided to HIV+ clients. Linkages
to support groups and services will also be enhanced by counselors who are members of PLWHA support
groups. Referrals to family planning services will be provided as appropriate, as well as access to
pregnancy testing when needed. HBC kits for PLWHA will include preventative items such as ITN, water
guard, water vessels, soap, ORS, and condoms will be provided.
As part of the overall facility based care and treatment, health care workers who have been trained and
have been supporting care and treatment at facilities operating since 2005 will be sent to new facilities in
the initial phases of operation to provide mentoring and continuity of services among military facilities and
monitor quality of services. Continued site support will be conducted using these preceptors as a central
care/ART QA/QC team which was developed over 2006-2007. Monitoring and evaluation of service quality,
together with a formal quality improvement mechanism, which includes regular site visits by DOD-NMOD
and appropriate partners, are essential components of this program. This will be achieved through
coordination by a newly hired Palliative Care Physician and quarterly site visits.
Activity Narrative: This activity fully adheres to USG policies and acquisition regulations and minimizes indirect costs to
accomplish the capacity building described above. International and local organizations synergize with the
Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a
sustainable manner. The program design ensures continued USG visibility and accountability at all levels of
implementation. Supply Chain Management System will be utilized to the highest degree possible to
acquire consumables and equipment. Greater than 50% of DOD's program funding for BCS will be placed
in SCMS this funding cycle.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
The expansion of care and support to an additional 6 communities, supporting 14 existing communities and
maintaining links with other partners will provide increased access of such services to currently underserved
communities and contribute towards the overall 2-7-10 PEPFAR palliative care targets and the 5-year USG
plan for Nigeria.
This activity will directly link with activities (#3246.08, #5313.08, #5388.08, #5362.08, #16943.08),
HIV/AIDS/TB treatment and care services (#3240.08, #5409.08, #3241.08), Treatment and Laboratory
Infrastructure (#3243.08, #3242.08, #3244.08) and SI (#3245.08).
This activity targets military/civilian personnel, their dependents and the general population surrounding the
20 sites. Focusing on HIV positive adults, including pregnant women, patients co-infected with TB and HIV
through seamless integration with PMTCT and TB/HIV program elements.
The emphasis will be on community involvement, training, links with other sectors, food/nutrition, community
development, network development, quality assurance and quality improvement. Targeted community
involvement will address gender issues by increasing the uptake of care and support services by women.
Community level training and involvement will reduce stigma and discrimination associated with HIV status.
This activity will also be linked to all appropriate Basic Health Care and Support (3247.08), OVC (5409.08),
HCT (3241.08) and Laboratory Infrastructure (3244.08).
civilian community (constituting approximately 75% of the Military's patient load). During COP08, the U.S.
free access to tuberculosis (TB) diagnosis and treatment services in 14 military facilities and communities.
In COP08, the program will expand to six new sites. All 20 sites also provide HIV prevention, care and
treatment services.
Approximately 20 to 30% of TB patients are HIV-infected and, conversely, it is estimated that roughly 30 to
40% of HIV-infected patients develop clinically-overt TB. Aggressive detection and treatment of TB is
important in order to reduce morbidity and mortality associated with HIV infection. In addition, aggressive
HIV counseling and testing of TB patients represents an important public health strategy which will be key in
the further identification and treatment of HIV-infection individuals.
The DOD-NMOD partnership will extend free HIV service to include screening for TB among all HIV+
identified at the military hospitals. All HIV+ clients are routinely screened by questionnaire for TB, and if
clinically indicated, AFB sputum smears examination (light or fluorescent microscopy) and radiography or
culture (Nationally accepted algorithm) if further indicated are carried out.. In addition, to improve detection
of military, dependents and civilians who are co-infected with TB/HIV, providers will initiate (opt-out)
voluntary counseling and testing. In these integrated sites, counseling and testing recommendations are
provided at each TB setting, but due to manpower and physical structure limitation, formal "one on one" CT
is provided in a single location within each site. Providers will encourage and discuss the importance of
HCT and provide referrals to the site's HCT center. Volunteers (e.g., Officers Wives Clubs, PLWHA
Support Group members) will be provided to escort patients to the CT center to facilitate access and uptake
of CT services.
During COP08, of 13,587 receiving HIV services, 100% will receive routine screening for TB at least once.
It is anticipated that at least 2717 (20% of the estimated 13,587 HIV+s screened for TB) will be diagnosed
with active TB and will require TB treatment; the same percentage will be provided with preventive therapy.
Patients co-infected with HIV/TB will be provided with TB treatment at the diagnosis military site since each
site has been designated as a Directly Observed Treatment Short course (DOTS) site. The DOD-NMOD
Program is closely coordinated with the MOH for TB control. At military facilities, TB prophylaxis will be
offered to HIV+ patients according to individual clinical need and according to national guidelines. The DOD
-NMOD partnership will utilize proven adherence strategies for patients on ARV and TB treatment.
Community health workers, community support groups and volunteers, including People living with
HIV/AIDS (PLWHAs and the Society of People Affected by TB ,SOPAT), will be trained by clinical staff and
supported to assist with patient adherence to ART and TB drugs through a buddy system.
TB infection prevention and control will be implemented using the work practice, administrative and
environmental measures. Patient and staff education will be routinely carried out to ensure program
success. Prophylaxis and treatment will be provided to eligible TB/HIV patients as appropriate. This will
involve the principles of basic hygiene, proper disposal of sputum, good cross ventilation at the clinics.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism
including quarterly site visits by DOD-NMOD and appropriate partner personnel, are essential components
of this program. To ensure continuous availability of drugs and commodities in our sites, we will strengthen
the logistic management of the states and LGA in our areas of operation.
Funding will support training of 36 additional health care staff in TB and HIV diagnosis and clinical
management to increase detection and referral of TB cases to the TB Unit among their HIV+ patients.
Clinicians and laboratory technologists at each HIV clinic and TB Unit of each military hospital will undergo
training organized in collaboration with the FMOH, national TB program and other stakeholders A TB/HIV
focal officer will be appointed to the program. The TB Officer will ensure that activities conducted provide
holistic patient care according to Integrated Management of Adolescent and Adult Illness (IMAI) guidelines.
Funding will also support improvement in laboratory capacity for TB diagnosis. Laboratory infrastructure
and equipment will be upgraded and staff trained in TB screening and diagnosis of patients infected with
HIV. This will include but not be limited to biologic hoods, microscopes, staining material and safety
equipment for staff which will complement overall HIV lab improvement under PEPFAR. The DOD-NMOD
link with government and other Implementing Partners' reference laboratories, such as ACTION (UMD) and
the TB reference facility in Zaria for laboratory training, development of SOPs and quality improvement
activities ensuring continuity of PEPFAR supported programs. Support to other National programs, such as
the NIAID supported program at the National Institute of Pharmaceutical Research and Development, will
be provided in the form of clinical samples.
This activity fully adheres to USG policies and acquisition regulations and minimizes indirect costs to
accomplish the capacity building described. International and local organizations synergize with the NMOD
to identify best practices and implement evidence based interventions in a sustainable manner. The
program ensures continued USG visibility and accountability at all levels of implementation.
CONTRIBUTIONS TO OVERALL PROGRAM AREAS:
The provision of DOTS centers on 20 NMOD sites will expand access to quality TB services. The improved
access will results in higher TB case detection and improved treatment outcomes. Through the provision of
services to 2717 TB/HIV patients, the DOD will contribute to the Emergency Plan treatment goals for
TB/HIV care in Nigeria.
Activity Narrative: Laboratory Infrastructure (3244.08) and HCT (3241.08) activities. The TB/HIV sites will be provided with all
necessary facilities to ensure holistic patient care according to IMAI guidelines. Activities will be linked to SI
systems to improve surveillance and monitoring information, and to inform policy and system strengthening
activities.
This activity targets military/civilian personnel, dependents and the general population surrounding the
military sites including those who are affected by TB/HIV, including OVC, PLWHAs and their families.
Women, in particular within the age range of 25-44, will be targeted, as there is a higher incidence of TB
among this group.
This activity includes an emphasis on human capacity development and local organization capacity building.
Improved gender balance in programming through prevention, diagnosis and treatment targeted at young
girls and women, who account for approximately 40% of TB cases in Nigeria and who have limited access
to services.
This activity represents new funding for a full-time, contracted Nigerian program officer (physician) for
TB/HIV activities as well as extra-country technical support of TB/HIV. This new request for funding
responds to the needs identified in COP06/07 Technical Assistance Visit Reports to focus additional efforts
in the area of TB/HIV. The budget includes one FSN salary, overhead charges, funding required for
USMHRP HQ Technical Assistance visit for one week of in-country support by a TB physician who will
provide TA, continuing medical education and mentorship. TA assistance may also be provided by the
The TB/HIV program officer will work as a member of the USG Care and TB/HIV Technical Working
Clinical Working Group. The TB/HIV program officer's responsibilities also include: 1) representing the
DOD-NMOD in technical discussions with the GON and 2) overseeing relevant technical aspects of the
program, including program management and oversight of the 20 DOD-NMOD PEPFAR site TB/HIV
programs. All DOD-NMOD sites are also established as TB DOTS centers. The TB/HIV program officer will
work with other Implementing Partners and the USG team to ensure a harmonized approach that is
consistent among partners and with the GON national guidelines. The program officer will spend 100% of
his/her time in this program area.
This activity represents new funding for a contracted Nigerian program officer for activities in the area of
Orphans and Vulnerable Children. This new request for funding responds to the recommendations of the
COP07 OVC Technical Assistance Team that identified a critical need to hire additional staff for OVC.
Hiring an OVC program officer will allow for the coordination of OVC services in the Nigerian Military. The
budget includes one FSN salary, overhead charges, funding required for domestic travel, training funds and
allocated minor support costs.
The OVC program officer will work as a member of the USG OVC Technical Working Group, as well as
serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Prevention and Clinical
Working Groups. The OVC program officer's responsibilities also include: 1) representing the DOD-NMOD
in technical discussions with the GON and 2) overseeing relevant technical aspects of the program,
including program management and oversight of the 20 DOD-NMOD PEPFAR site OVC programs. The
OVC program officer will work with other Implementing Partners and the USG team to ensure a harmonized
approach that is consistent among partners and with the GON national guidelines. The program officer will
also work with other agencies involved in the provision of OVC services in Nigeria, such as the Clinton
Foundation. The program officer will spend 100% of his/her time in this program area, and will link closely
with activities in Basic Care and Support.
This activity links to Care and Support, HCT, ARV Treatment and Services and TB services to provide
comprehensive services to OVCs.
The DOD/NMOD is presently in 10 sites in 8 states and the FCT including Benue, Lagos, Kaduna, Plateau,
Enugu, Rivers, Delta and Cross Rivers. By end of COP 07, the DOD/NMOD will have opened 4 additional
sites in 3 new states including Benin, Borno and Imo. In COP 08, IP will expand to 6 new sites in a total of
16 states plus the FCT. The new states include Anambra, Kano, Oyo and Sokoto. The focus of COP08
funds will be in seven sites in 4 states (Kaduna, Lagos, Enugu, Plateau) and the FCT. While OVC activities
have commenced at these sites in prior years, activities to increase quality of services provided and number
of OVCs reached at each site are necessary. The 7 existing sites include the following military facilities and
Division Hospital (Enugu), Nigerian Air Force Hospital (Jos) and 3 Division Hospital (Jos).
Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will increase efforts to
scale up OVC activities at 7 existing sites.
Locating and providing at least three services to orphans and vulnerable children (OVCs) has been a
challenge from the DOD-NMOD due to a lack of manpower within the NMOD. In COP08, the DOD-NMOD
will focus efforts to expand and enhance quality OVC programming. A full-time OVC specialist will be hired
at DOD to support these efforts and coordinate activities with the NMOD.
The DOD OVC activities encompass pediatric basic care and support, pediatric TB/HIV care and community
support for OVC in HIV affected families. In COP08, OVC services will expand the number of OVCs
reached, serving 2,600 OVCs through a network of linked services and in cooperation with other partners,
including community- and faith-based organizations serving these communities, of these OVCs reached,
628 will be HIV positive.
The DOD will provide a basic package of care that includes laboratory diagnosis and monitoring for
opportunistic infections (OIs). DOD will provide a family-centered comprehensive package of diagnosis
(including TB, malaria and diarrheal diseases), and care services (including insecticide treated mosquito
nets and water guards) to patients and clients.
In COP08, activities will focus on supporting OVCs by facilitating access to education, psychosocial
counseling and nutritional support for those most in need. Educational support will be provided based on
the assessed needs of each OVC (e.g., ensuring access to barracks-based schools, tuition support,
uniforms/books, tutoring). In sites with counseling staff, OVCs will be linked with counselors and/or social
workers. OVCs will be linked with support groups and play groups, with an emphasis on providing both
child-to-child and child-to-adult interactions. Nutritional support will be provided in line with USG and GON
guidelines. Collaborations with Clinton Foundation, SCMS and additional partners will be strengthened to
obtain nutritional commodities (e.g., Plumpynut). Select OVCs will be provided with training to acquire
income generation skills (e.g., soap making) by linking with the site's established adult income generation
programs. This activity will target older children and those children who head households. Females will be
targeted as young girls and women are often disadvantaged. Trained CBOs or FBOs who have the
capacity to scale up such activities will be selected to receive sub-grants. OVCs will also be referred to
other Implementing Partners who have services that are not provided by a particular military site.
The DOD will continue to train multi-disciplinary teams in the clinical management of pediatric HIV+ clients,
including TB and other OIs, pediatric counseling and support for treatment adherence. 200 additional staff
and volunteers, including PLWHAs, will be trained to meet the special needs of children and their
parents/care givers and provide the support needed at the community and family level. This multi-
disciplinary approach will minimize losses to follow-up and integrate prevention messaging within the
treatment and clinic activities. Further emphasis on providing a seamless service (PMTCT, HCT, ART) and
links with other providers, including PEPFAR partners and implementing partners, to support the provision
of a comprehensive range of activities will be a key focus of this activity.
The inclusion of OVC services, such as nutrition support and special pediatric counseling, will contribute to
the comprehensive care of children infected and affected by HIV/AIDS. This activity will also contribute to
overall GON targets, PEPFAR targets and USG targets for OVCs.
POPULATION BEING TARGETED:
This activity will target OVCs, families affected by HIV/AIDS, young girls and women, caregivers of OVCs
and community-based organizations (CBOs and FBOs).
The activity has an emphasis on capacity development and training, community mobilization, network
development and food and nutrition support. This activity will also address gender issues, specifically
increasing young girls' and women's access to care and support.
free access to counseling and testing (CT) services in 14 military facilities and communities. In COP08, the
program will expand to six new sites. All 20 sites also provide HIV prevention, care and treatment services.
Provider initiated (opt-out) voluntary counseling and testing will be expanded in all sites to include out
patient clinics, in-patient wards and TB clinics to improve identification of HIV+ among these populations. In
these integrated sites, counseling and testing recommendations are provided at each hospital department,
but due to manpower and physical structure limitation, formal one on one CT is provided in a single location
within each site. Providers will encourage and discuss the importance of HCT and provide referrals to the
site's HCT center. Volunteers (e.g., Officers Wives Clubs, PLWHA Support Group members) will be
provided to escort patients to the CT center to facilitate access and uptake of CT services. CT will also be
offered or linked at STI, family planning, antenatal, patient encounter activity and blood donation. All blood
donors will be able to receive their HIV status, get prevention messaging and referral to treatment, care and
support.
In addition, all individuals who test HIV+ will be referred for TB diagnosis. It is anticipated that CT services
will be accessed by 29,821 individuals by September 2009, of whom 28,401 (95%) will receive their results.
Through networking and training Local Government Area (LGA) staff (two per site), a further 2,500
individuals will access CT services indirectly.
This activity will focus on the delivery of high quality, cost-effective counseling and testing at hospital
facilities as the main entry point to a seamless service for individuals, discordant couples, partners and
families. CT services will promote "couple counseling and testing" at the service outlets. Staff will counsel
clients on their disclosure of HIV status and partner/family notification with an emphasis on client safety.
Partner referrals for CT (individual and/or couple) will be provided. Also, referrals to community-based and
barracks-based support groups will be provided to HIV+ clients. Linkages will also be enhances by
counselors who are members of PLWHA support groups.
All HCT and other HIV clinical services will link to prevention messaging for HIV+ and HIV- clients supports
under Palliative Care, AB and Other Prevention entries. This includes counseling on partner reduction,
prevention-for-positives messaging, abstinence messaging and correct and consistent condom use
messaging with condom provision (where appropriate). The integration of CT, treatment and prevention
programs will follow a family-centered, community-based approach, including a decentralized, community-
based model in partnership with the GON at all levels, utilizing a nationally accepted testing algorithm
(when adopted by GON). In COP05 - COP07, the testing algorithm is HIV screening by two parallel rapid
tests with a third rapid test kit as a tie-breaker, followed by confirmatory testing via Western blot analysis. In
COP08, internal quality control will utilize Western Blot analysis with a selection of positive and negative
patient samples as compared to positive and negative controls. Quality assurance will be completed
through externally provided panels for all sites conducting HIV diagnosis. Other partners working with the
military, such as SFH and small indigenous organizations, will be involved in this approach. Counseling and
testing centers will display the national logo in support of the National program and consistent branding.
Sites will also employ outreach HCT to increase the uptake of services by populations who do not access
CT at the military facility. Mobile CT (utilizing tents) will continue to be incorporated into ongoing activities in
the community, such as health bazaars, football matches or entertainment activities where military
personnel frequent. Four hundred and forty-five Nigerian Air Force Hospital (Ikeja) will be provided with
support to operate its mobile CT van and outreach activities.
A unique aspect of this activity with the Nigerian Military is that its CT policies include compulsory
counseling and testing for specific populations: military applicants, personnel posted overseas and those
selected for overseas training. Through PEPFAR, the DOD - NMOD partnership has ensured that
prevention messages and pre/post-test counseling is provided during compulsory counseling and testing.
Pre accession applicant testing will be supported by pushing testing availability to the initial point of entry,
providing significant advantages to the GoN and applications. Previously, counseling and results were not
always provided to new applicant. The DOD will continue to support post-test counseling for military
applicants. If the applicant is found to be positive, the individual will be counseled and referred to the
nearest ART facility for evaluation. Data collection will provide critical prevalence information for the military
eligible population. Support will expand in 2008 to the Armed Forces Programme on AIDS Control (AFPAC)
to conduct recruitment/applicant HCT.
In collaboration with AFPAC, funding will support training, and refresher training, of 226 of NMOD staff and
volunteers, including PLWHAs, in counseling and testing, mainly through location, site-based programs and
in conjunction with other partners and agencies, utilizing the national curriculum. A new emphasis in
COP08 will include the training of non-laboratory staff on the WHO/CDC HIV Rapid Test training package to
assist in addressing a lack of laboratory manpower in the military.
To ensure confidentiality, support for clinic renovations and/or the purchase of privacy screens will be
provided. This is particularly important for military settings as NMOD has had lower uptake of HCT by
senior military officers due to fear of stigma and perceived lack of privacy.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, are
essential components of this program. This includes quarterly site visits by NMOD/DOD staff and
appropriate partners.
The DOD-NMOD service will enable the identification of HIV positive individuals in an efficient and timely
manner and feed into care and treatment services for both HIV and HIV/TB. This contributes to the
Activity Narrative: PEPFAR Nigeria and GON goals of increasing access to counseling and testing, as well as linking HIV
positive individuals to ART services. In addition, HCT services will add to the prevention strategies of
averting new infections through efficient and effective post-test counseling and education.
HCT activities will be linked to activities in Abstinence/Be faithful (5313.08), Condoms and Other
Prevention (5362.08), TB/HIV (3240.08), OVC (5409.08), PMTCT (3246.08) and SI (3245,08), and will
support other partners, including GON, in delivering quality, integrated services.
This activity targets the military, civilian employees, dependents and the general population surrounding the
20 NMOD sites and in particular TB and other STI infected individuals. By networking with decentralized,
community-based services, this activity will reach a wider range of individuals unwilling, or unable, to access
services provided in more traditional settings.
This activity has an emphasis on human capacity development.
The expansion of free HCT services to additional sites and community settings will provide services access
to underserved communities and individuals and help ensure that HIV+ people are identified and linked to
ART services. This will help raise community awareness, increase gender equity and reduce stigma and
discrimination associated with HIV and AIDS. HCT data collection and analysis will contribute to improving
data at the national level.
This activity represents new funding for a full-time, contracted Nigerian program officer for HIV Counseling
and Testing (HCT) activities. This new request for funding responds to the recommendations of the COP07
HCT Technical Assistance Team to strengthen the coordination of HCT efforts within the Nigerian Military.
An emphasis in COP08 will be the training of non-laboratorians to conduct HIV testing, support of zonal
recruit testing and deployment related testing. The budget includes one FSN salary, overhead charges,
funding required for domestic travel, training funds and allocated minor support costs.
The HCT program officer will work as a member of the USG HCT Technical Working Group, as well as
serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Clinical Working Group.
The HCT program officer's responsibilities also include: 1) representing the DOD-NMOD in technical
management and oversight of the 20 DOD-NMOD PEPFAR site HCT programs. The HCT program officer
will also support the Armed Forces Programme on AIDS Control to coordinate pre- and post-deployment
HCT. The HCT program officer will work with other Implementing Partners and the USG team to ensure a
harmonized approach that is consistent among partners and promote the GON national guidelines and the
national testing algorithm. The program officer will spend 100% of his/her time in this program area.
This activity is linked to ARV services (6678.08), Strategic Information (5359.08) and Other Policy/System
Strengthening (6504.08). The Nigerian Military provides prevention, care and treatment to its service
members and the surrounding civilian community (constituting approximately 75% of the Military's patient
load). During COP08, the U.S. Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV
Program will continue to extend free ARV services in 14 military facilities and communities. In COP08, the
program will expand to six new sites.
The selection process for new sites is undertaken by meetings between the DOD and NMOD. Selection of
sites is based on population, community support/need for services, manpower availability and physical
infrastructure. Once selected, a thorough assessment to support pharmacy and logistics requirements is
completed with subsequent resolution of weaknesses as appropriate and possible. These assessments
include staffing support, staff skills/education/experience, and physical structure.
The NMOD-DOD Program will continue to utilize the SCMS for drug acquisition and logistics management
strengthening. DOD, NMOD and SCMS adhere to USG, Federal Ministry of Health (FMOH) and National
Agency for Food and Drug Administration and Control (NAFDAC) policies and requirements, and support
national treatment guidelines. Funding under the SCMS award through USAID will continue to provide
quality ARV drugs during COP08 year to treat a total of 7884 adults and 876 pediatric patients (overall total
of 8,760 patients) under the NMOD-DOD program. When possible, the Program will continue to utilize
generic drugs and add additional generics as approved and possible. In addition DOD will support
coordination for utilization of ARVs provided by the GON or Nigerian Air Force (currently over 200
individuals on NAF purchased ARVs) at NMOD sites.
In 2007, development of capacity of the NMOD (Nigerian Ministry of Defence) to house, manage and
distribute ARVs procured by the DOD through the Supply Chain Management System (SCMS) was
completed. The DOD program will continue support to the Nigerian Ministry of Defence (NMOD)-owned,
contractor (SCMS) operated warehouse developed under COP07 funding. NMOD customs agents will
clear imported supplies. Under training and supervision by SCMS contractors, the facility will distribute
supplies directly to all NMOD points of service. The warehouse will function as both a receiving/distribution
center and as a storage facility for buffer stock of drugs maintained in-country to protect against unforeseen
shortages. This program fully adheres to USG and FGON policies and acquisition regulations, minimizes
indirect costs and accomplishes NMOD capacity building in supply chain management. The program design
ensures continued USG visibility and accountability at all levels of implementation.
Pharmacy training activities are under development, and will include all aspects of drug management,
dispensing and housing. At this time, pharmacists are instructed in national treatment guidelines and
Standard Operating Procedures (SOPs) on security, quality control and storage. As with clinicians trained in
ART, pharmacists who have been trained and have been supporting treatment at facilities operating since
2005 will be sent to new facilities in the initial phases of operation to provide mentoring and ensure
continuity of services among military facilities. Continued site support will be conducted using these
preceptors as a central pharmacy Quality Assurance (QA)/ Quality Control (QC) team is developed.
SCMS and DOD have been working closely with the NMOD in training officers on quantification and
accountability tools at the NMOD level. In 2008, activities under this submission will continue to guarantee
long-term sustainability by ensuring that the necessary infrastructure, systems and technical skills are in
place for efficient forecasting, ordering, warehousing, distribution and management of quality ARVs at the
20 NMOD sites as well as at the central level procurement office of the NMOD. DOD will continue to
support and participate in the harmonization process led by the GON with regard to Logistic Management
Information System (LMIS) and Inventory Control System (ICS).
Where necessary, infrastructure improvements are undertaken to ensure the best use of resources through
leveraging counterpart funding of the NMOD and through competitive tendering. Pharmacies at the point of
drugs dispensing are modeled to provide ease of service for the patient to allow adherence counseling as
well as safe storage of the drugs within the dispensing unit. Proper housing for drugs at sites, including A/C
with thermostat controls, proper refrigeration and locked storage are instituted. Back up power supplies to
ensure proper temperature for cold chain dependent drugs will be installed.
DOD has allocated $3,800,000 of its ARV Drug budget to SCMS for procurement of commodities. This
amount is captured under the SCMS Drugs activity.
DOD activities will contribute to the effective and efficient management of the ARV services and to the
Emergency Plan's goal of providing life-saving antiretroviral treatment to more than 350,000 individuals.
This activity will directly link with ART Services (6678.08). The DoD will continue to collaborate with other
PEPFAR implementing partners for information sharing on procurement mechanisms and for sharing of
supplies when necessary. The DoD will continue to support systems strengthening and capacity building in
the NMoD.
This activity targets all health care workers directly involved in the management of ARV drugs for ART
services including pharmacists, doctor and nurses.
This activity has an emphasis on human capacity development and local organization capacity building.
This activity relates to activities in VCT, PMTCT, Basic Care and Support, OVC and TB/HIV activities.
free ARV services in the following 14 military facilities and communities: Defence Headquarters Medical
Center - Mogadishu Barracks (FCT), 44 Nigerian Army Reference Hospital (Kaduna), Nigerian Naval
Hospital (Ojo), 445 Nigerian Air Force Hospital (Ikeja), 82 Division Hospital (Enugu), Nigerian Air Force
Hospital (Jos), Nigerian Naval Hospital (Calabar), Naval Medical Centre (Warri), Nigerian Army Hospital
(Port Harcourt), 45 Nigerian Air Force Hospital (Makurdi), Military Hospital (Benin), 2 Division Nigerian Army
Hospital (Ibadan), Military Hospital (Maiduguri) and 3 Division Hospital (Jos).
In COP08, the program will expand to six new sites. These include: Brigade Medical Center (Sokoto),
Armed Force Specialist Hospital (Kano), 34 FAB Medical Center (Owerri), Ministry of Defence Clinic
(Abuja), Military Cantonment (Onitsha), and Headquarters Nigerian Army CAS Medical Reception Station
(Kontangora).
In COP08, DOD - NMOD will expand comprehensive ART services to recruit 2,500 new patients and
maintain 6,260 patients, reaching a total of 8,760 individuals receiving ART. Approximately 10% (850) will
be pediatric patients. Clinicians across the 20 sites will be assisted to promptly initiate support for ART
eligible patients, with emphasis on supporting the 6 new primary sites. Each site is an integrated hospital
supporting HCT, laboratory, TB and other services. Linkages with both NMOD and other partner facilities
will support referral of complicated or stable patients to ease overcrowding and maximize facility abilities.
A major component of this activity is human capacity development- both in increasing numbers of providers
and the training provided to them. The NMOD has committed to increasing and developing of a sustainable
treatment program in COP07 by hiring 100 new health care professionals dedicated directly for PEPFAR
goals (30 each physicians and nurses, 20 each laboratorians and pharmacists). In COP08, the DOD will
support the training of an additional 200 health care workers, including doctors, pharmacists, nurses,
laboratorians, site administrators, commanders, and team leaders. Additional temporary staff through the
National Youth Service Corps (NYSC) will be utilized. In COP06, NYSC physicians were jointly funded by
the DOD and NMOD programs; in COP07, the NMOD assumed total coverage of these salaries. Funding
may be provided to expand this program in COP08. Use of the NYSC (usually three to four per site)
provides a dual purpose of training young physicians in Nigeria in ARV services and HIV/AIDS care and
exposing them to the military system for possible accession to the uniformed services or as NMOD civilian
providers.
Training is the second component of capacity development. The base of training has included the four
week ART training at the Infectious Disease Institute in Uganda (78 NMOD personnel trained through end
of COP06) and will continue to serve as a cornerstone for 2008. A dedicated Infectious Disease physician
will provide mentoring and continuing medical education courses through centralized in-country and on-site
trainings on ART clinical care, treatment, adherence and laboratory monitoring. Adherence counseling for
ARVs and instruction in side effects and contra-indications is part of the NMOD internal ART course and
each pharmacist is provided with initial and refresher training through this course.
The third tenet of capacity development is physical capacity. This will be increased through refurbishments
at each site as required by each site to improve patient flow and throughput. This will be accomplished
through bilateral planning of both the NMOD and DOD funding. US DOD funding has provided
refurbishments at seven sites and the NMOD has funded refurbishments at seven sites. One site was jointly
refurbished (44 NARHK) due to its size and dual use as a NMOD treatment site and as a referral center for
all of Kaduna State.
To enhance quality of care, the DOD will conduct on-site clinical mentoring via centrally located staff and
DOD HQ Technical Assistance rotations. The DOD-NMOD Technical working Group will integrate with
USG and MOH advisors to ensure that all activities and support are in compliance with National policies,
curricula and guidelines. In additional, the DOD will ensure that routine meetings with all hospital staff
involved in HIV/AIDS patient care are occurring monthly (or more frequently, as needed). This will support
monitoring and evaluation of clinical outcomes and allow for dissemination of information and lessons
learned to improve care.
NMOD and DOD participation in the USG ARV/Treatment Technical Working Group to address treatment
issues will promote harmonization with the GON and other Implementing Partners, thus strengthening the
referral linkages and networks between partners close to NMOD sites. The program will also establish
networks for community volunteers, including People Living with HIV/AIDS, to ensure cross-referrals. The
DOD will continue to work with the GoN and other national stakeholders to develop networks for purposes
of addressing sustainability issues, stigma reduction, treatment and prevention activities. Linkages with
other basic care partners and prevention groups (particularly prevention for positives) will also be
supported.
Consumables and other supplies will be provided by a combination of two approaches. While the supply of
some consumables will continue to be sourced by DOD from local vendors, the majority (80%) of funding for
drugs and consumables will be invested in the Supply Chain Management Systems (SCMS). The DOD
program will continue support to the Nigerian Ministry of Defence (NMOD)-owned, contractor (SCMS)
operated warehouse developed under COP07 funding. NMOD customs agents will clear imported supplies.
Under training and supervision by SCMS contractors, the facility will distribute supplies directly to all NMOD
Points of Service. The warehouse will function as both a receiving/distribution center and as a storage
facility for buffer stock of critical items maintained in-country to protect against unforeseen shortages. This
program fully adheres to USG and FGON policies and acquisition regulations, minimizes indirect costs and
accomplishes NMOD capacity building in supply chain management. The program design ensures
continued USG visibility and accountability at all levels of implementation.
By the end of COP08, DOD will support 20 NMOD facilities in Anambra, Benin, Benue, Borno, Cross River,
Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Niger, Oyo, Plateau, and
Activity Narrative: Rivers, and Sokoto (16 states and FCT).
DOD has allocated $2,100,000 of its ARV Services budget to SCMS for procurement of commodities. This
amount is captured under the SCMS ARV Services activity.
Expansion of ARV services will contribute approximately 2% of the overall 2008 PEPFAR targets. The
training of health care workers and community volunteers will contribute to human resource development to
ensure the sustained delivery of high quality ART services in Nigeria.
This activity is linked to all prevention activities (#3246.08, #5313.08, #5388.08, #5362.08, #16943.08),
HIV/AIDS/TB treatment and care services (#3240.08, #3247.08, #5409.08, #3241.08), Drugs and
Laboratory Infrastructure (#3242.08, #3244.08) and SI (#3245.08).
This activity will target all individuals in the 20 military communities served, as well as the civilian population
in the surrounding communities, who are diagnoses as HIV+ and clinically assessed as suitable for
treatment.
This activity will focus on gender issues through seamless PMTCT/ART/TB services at NMOD sites and in
collaboration with neighboring PMTCT sites to improve women's access to services, particularly in
previously underserved communities. This activity will also facilitate linkages into community and support
groups.
This activity represents funding for three full-time, contracted Nigerian program officer positions in support
of ART Treatment Services as well as extra-country technical. The positions include a Clinical Treatment
Physician, a Pharmacist and a Logistician. The budget includes three FSN salaries, overhead charges,
funding required for domestic travel, training funds and allocated minor support costs. This funding also
includes support for a USMHRP HQ Technical Assistance visit for one week of in-country support by an
ART physician who will provide TA, continuing medical education and mentorship. TA assistance may also
be provided by the USMHRP's site staff in Kenya, Uganda and/or Tanzania.
A unique aspect of the NMOD-DOD Program is the employment of a retired military physician and a
pharmacist with past experience with the NMOD. These individuals support the military to military aspects
and act as a bridge for ownership development. Involvement of these employees as members of the USG
Treatment and Clinical Working Groups, as well as serve on the U.S. Department of Defense - Nigerian
Ministry of Defense (NMOD) Clinical Working Group will hybridize US policy and implementation with
NMOD/GON practices.
The program officers' responsibilities also include: 1) representing the DOD-NMOD in technical discussions
with the GON and 2) overseeing relevant technical aspects of the program, including program management
and oversight of the 20 DOD-NMOD PEPFAR site treatment programs. The Logistician and Pharmacist
work closely with SCMS and other partners to ensure proper drug and service forecasting for the Nigerian
Military and surrounding communities. The program officers will work with other Implementing Partners and
the USG team to ensure a harmonized approach that is consistent among partners and promotes the GON
national treatment guidelines.
This activity represents funding for three full-time, contracted positions to support Laboratory Infrastructure
activities, including two FSN salaries, overhead charges, funding required for domestic travel, training funds
and allocated minor support costs. This funding also includes support for a USMHRP HQ Technical
Assistance visit for one week of in-country support by a physician who will provide TA, continuing medical
education and mentorship, particularly in the area of nucleic acid testing. Support to and appropriate use of
a NAT laboratory for viral load and early infant diagnosis (EID) will be provided. TA assistance may also be
provided by the USMHRP's site staff in Kenya, Uganda and/or Tanzania.
The Laboratory Manager and Program Officer will work as members of the USG Clinical Laboratory
Working Group, as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense
(NMOD) Laboratory Working Group. The Laboratory Manager's responsibilities also include: 1)
representing the DOD-NMOD in technical discussions with the GON and 2) overseeing relevant technical
aspects of the program, including program management and oversight of the 20 DOD-NMOD PEPFAR site
laboratory programs including QA. The Laboratory Officer will focus on QA/QC, safety and on-site
supervision and assessment. Both positions will also support the Armed Forces Programme on AIDS
Control to coordinate pre- and post-deployment HCT. A uniformed Laboratory Officer, paid by funding from
the Nigerian Military, will also support DOD-NMOD laboratory activities. Both positions will work with other
Implementing Partners and the USG team to ensure a harmonized approach that is consistent among
partners and promote the GON national guidelines.
Defense (DOD) and Nigerian Ministry of Defence (NMOD), through the Emergency Plan Implementation
Committee (EPIC) currently provides free laboratory services in support of ART, Care and Support, PMTCT,
HCT, Blood safety, TB/HIV, and OVC programs at 10 secondary (2o) level facilities in 8 states and FCT. By
the end of COP 07, the program will expand to 4 primary (1o) sites bringing the total to 14 facilities in 11
states and FCT. In COP08, DOD-NMOD will expand to 6 1o sites bringing the total number of sites
supported in COP08 to 20 facilities in 16 states and FCT (Kaduna, Lagos, Plateau, Enugu, Benue, Cross
River, Delta, Rivers, Borno, Oyo, Edo, Kano, Sokoto, Anambra, Imo, Niger and FCT).
In support of treatment expansion, the DOD-NMOD will continue to develop and maintain laboratory
infrastructure at sites. By the end of COP 07, 14 laboratories will have been upgraded and supplied with
standardized equipment to provide quality laboratory services. All 14 laboratories will provide HIV
serodiagnosis through rapid test and advanced serologic technologies according to Government of Nigeria
National Guidelines and Policies. The DOD-NMOD provide full lab monitoring in support of ART services
and basic care and support (CD4 enumeration, clinical chemistry and hematology) using, in general,
automated systems at 20 sites (BD FACSCount, Coulter Act 5 Diff and Vitros 250/DT60) and manual
methods at 1o sites. Primary sites will be upgraded with automated equipment depending on client flow. In
COP08 the DOD-NMOD HIV program will seek accreditation by MLSCN of 6 secondary level facilities. In
COP08, the program will expand to six 1o level facilities which will provide HIV serodiagnosis through rapid
test technologies and lab monitoring with manual CD4+ enumeration, hematological and chemistry assays.
The DOD will continue to work with the PEPFAR Lab Technical Working Group for the development of a
common lab equipment platform. A tiered referral laboratory network will be established to provide
mentoring and support for facilities within the network (both military and non-military health care facilities). In
COP08, 445 NAFH Ikeja (Lagos state) will be upgraded to a tertiary (1o) level facility and will possess the
following capabilities: training, QA/QC and referral absorption capabilities. The diagnostic capability of all
laboratories will be expanded to include common OIs (TB, malaria, Candida, Cryptococcus, Strongyloides)
and STIs (syphilis, gonorrhea, Chlamydia, Herpes Simplex, and Hepatitis B). All existing and future facilities
will have either fluorescent or binocular microscopes for TB diagnosis by sputum smear microscopy. Four
facilities in different geographical zones will be equipped with Class II Biological Safety Cabinets for referred
TB culture using the BD MGIT system (or other technology under Nigerian -US referral guidelines).
Infrastructure upgrades will also include extensive electrical refurbishments (as needed) to ensure a stable
supply of power to all laboratories. Assessments of the new sites are currently being conducted by a
combined NMOD-DOD team to determine infrastructure requirements, including power and water needs.
Logistically and economically friendly power options such as solar panels are planned for primary level
facilities and other facilities as funding allows.
DOD will address the issue of safe disposal of hazardous waste by leveraging training and resources
provided by MMIS and by supplementing this with the required materials e.g. sharps boxes. Sites which do
not have access to an incinerator will be supported in the development of alternative methods of waste
disposal e.g. protected pits. All laboratories will have PEP policy and guidelines in place in association with
ART services.
During COP08 a total of 216 laboratorians will be trained, this includes 92 laboratorians at centralized
partner facilities (e.g., IHV/ACTION) and at 445 NAFH Ikeja which will continue to be developed as the tri-
service training laboratory for the Nigerian military. The existing didactic training facilities will be
supplemented with training-specific equipment and laboratory area. The latter will play a major role in
continuing education, QA/QC and refresher training of DOD-NMOD laboratorians. The training facility will
also be utilized to provide training for 100 non-EP military hospital laboratorians. Laboratorians will be
trained on Lab Safety, GLP and Quality Management, HIV diagnosis, CD4+ enumeration, Hematology,
Blood Chemistry, Documentation, Stock Management/Forecasting, Injection Safety, Blood Safety,
Microscopy, Malariology, TB and other OI/STI diagnosis. Standardized training packages (WHO/CDC)
adapted for Nigeria, e.g. HIV Rapid Testing and Direct Smear Microscopy will be utilized. Twenty
laboratorians (1 per site) will be trained as quality monitors in-country and 2 laboratorians with an overall
program oversight role will receive further Laboratory Management/QA training in conjunction with the
ACTION Project, the Walter Reed Project, Uganda, or the Walter Reed Project, Kenya. Oversight and
further centralized and on-site QA training will be provided by military consultants from the US Military HIV
Research Program. Medical equipment engineers (4) from within the Nigerian military will continue to be
trained in preventative maintenance and servicing of equipment within the DOD-NMOD HIV program.
Training provided by Co-Ag partners (APHL, ASM, ASCP, CLSI), other US agencies and IPs (ACTION,
MMIS, SBFAF) will be leveraged to ensure that laboratorians within the DOD-NMOD HIV program are
trained in a wide array of technical skills required for the delivery of quality laboratory services.
Laboratory QA activities will be further strengthened and consolidated in COP08. An internal monitoring
team comprising of experienced military laboratorians will conduct quarterly site visits using a standardized
assessment tool. This team will be empowered to take on-site corrective action and provide on-site training.
Bi-annual site visits will be conducted by external teams (US Military HIV Research Program and other
partners), and supported by the DOD centrally-employed laboratory specialists. All laboratories will
participate in an external quality assurance program managed by DOD, NMOD and the DOD-NMOD lab
technical working group. The latter will meet on a quarterly basis to review all aspects of laboratory services
including quality management. Results from site visits and proficiency testing will be sent into a centralized
system within Nigeria (supported by PEPFAR).
A two-pronged approach to supply chain management of laboratory reagents and other consumable items
will ensure that stock outages of laboratory reagents and consumables do not occur. While the supply of
some reagents will continue to be sourced by DOD from local vendors, the majority (80%) of
reagents/consumable funding will be invested in the Supply Chain Management Systems (SCMS). The
DOD program will continue support the NMOD-owned, contractor operated warehouse developed under
COP07 funding. NMOD customs agents will clear imported supplies and, under training by SCMS
contractors, distribute supplies directly to all NMOD Points of Service. The warehouse will function as both a
receiving/distribution center and as a storage facility for buffer stock of critical items maintained in-country to
Activity Narrative: protect against unforeseen shortages. DOD-NMOD currently operates a successful "pull" system based on
monthly consumption data reports sent electronically to DOD-NMOD by all sites.
In COP08, 20 DOD-NMOD HIV program facilities will provide laboratory services for 43,001 individuals
being counseled and tested (28,401 adults and adolescents, 12,600 pregnant women, 2000 children),
13,977 individuals on care and support (12 577 adults and adolescents, 1400 children) and 9,370
individuals on ART (8, 360 adults and adolescents, 1010 children). Therefore, with HIV serology, CD4+
enumeration, a chemistry panel, a hemogram, urinalaysis, STI testing, and OI testing counted as single
tests each, a minimum of 202,437 laboratory tests will be performed in COP08.
Links will be created with other implementing partners to optimize resources and strengthen the
comprehensive networks of care across all sites, including centralized laboratory training and establishing
high level laboratory services for pediatric diagnosis. DOD-NMOD will continue to participate in the national
Early Infant Diagnosis scale up plan. This relates to activities in ART treatment (3242.08; 3243.08), Care
and Support (3247.08), PMTCT (3246.08), Counseling and Testing (3241.08), Blood Safety (5388.08),
TB/HIV (3240.08), OVC (5409.08) and Strategic Information (3245.08).
TARGET POPULATIONS:
This activity targets the military, civilian employees, dependents and the communities surrounding military
sites. In particular, PLWHAs, orphans and vulnerable children, HIV+ pregnant women and HIV+ infants will
be targeted. Further specific targets will be co-infected individuals for TB and STIs.
This activity involves an emphasis on infrastructure development, training and QA, commodity procurement
and capacity development.
This activity relates to all prevention activities: PMTCT (3.3.01), Abstinence/Be Faithful (3.3.02) , Safe Blood
(3.3.03), Injection Safety (3.3.04), Condom and Other Prevention (3.3.05), HIV/AIDS/TB Treatment and
Care Services: OVC (3.3.08), ARV Drugs (3.3.10), ARV Services (3.3.11), Palliative Care services (3.3.06),
TB/HIV (3.3.07), HCT (3.3.09), and Laboratory Infrastructure (3.3.12).
civilian community (constituting approximately 75% of the Military's patient load). Strategic Information (SI)
activities will be conducted at 14 existing Department of Defense (DOD) - Nigerian Ministry of Defence
(NMOD) sites and 6 new expansion sites in COP08. The existing military sites and communities include:
Defence Headquarters Medical Center - Mogadishu Barracks (FCT), 44 Nigerian Army Reference Hospital
(Kaduna), Nigerian Naval Hospital (Ojo), 445 Nigerian Air Force Hospital (Ikeja), 82 Division Hospital
(Enugu), 347 Nigerian Air Force Hospital (Jos), Nigerian Naval Hospital (Calabar), Naval Medical Centre
(Warri), Nigerian Military Hospital (Port Harcourt), 45 Nigerian Air Force Hospital (Makurdi), Military Hospital
(Benin), 2 Division Nigerian Army Hospital (Ibadan), Military Hospital (Maiduguri) and 3 Division Hospital
(Jos).
Force Specialist Hospital Kano, 34 FAB Medical Center Owerri,
Ministry of Defence Clinic, Military Cantonment Onitsha, and Headquarters Nigerian Army CAS Medical
Reception Station Kontangora. Information strengthening and technical assistance will also be provided to
the 20 sites and to the Emergency Plan Implementation Committee and Ministry of Defence (NMOD)
Headquarters.
This Strategic Information (SI) activity has several components. At the DOD level, SI funding will support
three full time positions. These assets will coordinate DOD SI implementation efforts with the NMOD and
participate with USG Nigeria SI technical Working Group. The next component is the incorporation of
program-level reporting and the establishment of both paper-based and computerized HMIS across NMOD
HIV treatment sites. These activities will support the design and implementation of high quality, sustainable,
evidence-based interventions and programs in the following areas at 20 sites: ART Services, ARV Drugs,
Laboratory Infrastructure, HCT, PMTCT and TB/HIV. All activities will be in line with GON SI harmonization
policies and guidance as we strive to meet the three ones.
Another component of this activity includes training and capacity development of NMOD personnel in the
area of SI. By COP07, it is anticipated that 147 staff will be trained in the management and maintenance of
the SI system in areas such as data entry, analysis, data management and data quality assurance. In
COP08, the DOD-NMOD will train 12 staff at each of the 6 new sites and provide a refresher for 6
individuals from the 14 existing sites. The DOD will continue its data management and reporting refresher
training program throughout the year. The DOD will also continue to provide the NMOD with training and
technical assistance emphasizing all aspects of patient data handling: confidentiality, data security,
disciplined data entry, analysis, management and quality assurance. The program will continue to adapt
and harmonize existing paper records and processes to meet the standards of the GON. Training for DOD
specific needs will be conducted by the DOD program, while available training from IPs and GON will
support harmonization of data activities. The DOD will carry out regular site visits to ensure proper data
handling procedures are adhered to at all times.
The DOD-NMOD will expand utilization of an electronic patient registry (Government of Nigeria-approved)
and patient monitoring and management system (PMM) in all program areas. Utilizing the simple, available
and sustainable technology at the fourteen existing DOD-NMOD sites, the program will extend and develop
this system to the new six sites in COP08. This single system generates a unique PIN number to ensure
patient confidentiality while supporting patient tracking through a clinical module, a pharmacy module, a
laboratory module, a counseling module, a registration module and a financial module. These core
modules allow for tracking of all program areas through a single tool with a single interface, which has
greatly improved data quality from the input side and has improved speed of retrieval on the report
generation side. As a national unique patient numbering system is introduced, DOD will ensure
harmonization of the tracking systems. The registry will be supported by the use of networking
infrastructure that provides computer hardware, software applications and networking equipment; 4-6
additional computers per site in addition to the 5 computers and 1 server already supported and the VSAT
and networking solution provided by the NMOD and EPIC. This registry will allow for aggregated reporting
on a real time basis and will interface directly with LHPMIP, the national monitoring and evaluation tool
developed and based on the Voxiva platform.
The DOD will continue to participate in the relevant PEPFAR working groups aiming to develop and
implement credible, cost-effective SI policies and systems, harmonized with other IPs, Nigerian Ministries
and USG agencies. The program will continue to support the NMOD's Information Monitoring TWG. The
DOD will also continue to participate in national surveys, and in the development and regular use of
standardized qualitative methodologies for service assessments to ensure a consistent approach across all
HIV service providers. Implementation of National and PEPFAR supported data program such as
HIVQUAL have full NMOD-DOD support with the full time involvement of a Nigerian medical officer in the
planning and implementation of HIVQUAL from the NMOD level down to each service delivery facility.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism,
supported by the centrally-employed DOD specialist and appropriate partners, are essential components of
this program. Regular use of data (including sharing information on individual sites, programs and partners)
as part of the routine management process at all levels (site, organization, PEPFAR Team) is the
cornerstone of evidence-based improvements and will encourage and sustain data quality, and ensure
service quality throughout the program. The SI program is designed for sustainability and it is hoped that
the NMOD will take over additional SI activities as the program matures.
During COP08, discrete surveillance activities will be commenced in order to better describe the poorly
understood epidemiology of disease prevalence within the Nigerian Military. The first of two surveillance
initiatives will analyze the association of HIV infection and the pre, intra and post deployment education
provided to, testing and risk behavior activities of Nigerian Military members who have been deployed both
domestically and internationally. The second will describe the current prevalence of transfusion transmitted
Activity Narrative: infections (HIV-1, HIV-2, HCV, HBV and Treponema pallidum) within the NMOD. Results of these studies
will inform the NMOD, GON and USG of areas of strength and weakness and support strategy development
for targeted interventions.
Improvement in SI management capacity, and further staff development and training within the NMOD,
EPIC, AFPAC and 20 sites, will ensure effective data use and management at organizational, work group
and individual levels. This activity will contribute towards the GoN and USG strategy for the provision of
quality, relevant and timely information for decision-making. This information will serve as a resource in
developing plans that enhance the cost-effectiveness of the operations and management of the NMoD.
Strategic Information activity relates to all prevention activities (#3246.08, #5313.08, #5388.08, #5362.08,
#16943.08), HIV/AIDS/TB treatment and care services (#3240.08, #3247.08, #5409.08, #3241.08) and
Treatment and Laboratory Infrastructure (#3243.08, #3242.08, #3244.08).
This activity targets national level policy makers in the military, the GoN and national organizations, such as
the National Agency for the Control of HIV/AIDS, as well as community-based organizations, faith-based
organizations, and healthcare workers, specifically all staff undertaking data entry, at the national and local
levels.
The DOD SI activities include an emphasis on HMIS and on capacity development, infrastructure, training,
and policy and guidelines. This activity also helps to address the issue of gender equity in HIV/AIDS
programs as data collected can help to inform any gender imbalances in programming.
This activity represents funding for three full-time, contracted positions for Strategic Information (SI)
activities. This includes an SI Manager, SI Program Assistant and Hardware/IT Officer to support SI
activities for the U.S. Department of Defense (DOD) and the Nigerian Ministry of Defense NMOD). In
COP08, the DOD-NMOD will support activities at 20 sites in 16 states plus the FCT. The budget includes
support for one expatriate SI Manager and two FSN salaries, overhead charges, funding required for
domestic travel, training funds and allocated minor support costs.
These three positions will work in coordination with CDC SI staff and USAID Strategic Information staff
members who will have the USG Nigeria Team lead for SI issues and directly provide joint quality
assurance/quality improvement (QA/QI) strategies and programmatic monitoring to the Nigerian Ministry of
Defense. The DOD SI Team will also work as members of the USG SI Technical Working Group. The SI
Manager's also include: 1) representing the DOD-NMOD in technical discussions with the GON and 2)
overseeing relevant technical aspects of the program, including program management and oversight of the
20 DOD-NMOD PEPFAR site SI programs.
The DOD SI Team will work with other Implementing Partners and the USG team to ensure a harmonized
approach that is consistent among partners and the GON. The team will also support SI activities of the
USG and GON, including the continued implementation of the HIVQUAL quality improvement project.
The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its
fourth year in implementing PEPFAR activities with the US Military HIV Research Program (USMHRP)
directly implementing with its counterpart, the Nigerian Military. This type of implementation ensures direct
capacity building within an agency of the Federal Government of Nigeria. Through this partnership, the
impact of this program is felt on multiple levels- developing a strong USG relationship with another branch
of the Nigerian Government; building capacity of the indigenous partner through joint implementation of
activities; offering a cost effective model for implementation through a direct USG-GON collaboration, and
supporting both the military and civilian communities.
The NMOD-DOD PEPFAR Program is governed by a Steering Committee (SC), co-chaired by the Minister
of State for Defence (MOSD) and the US Ambassador to Nigeria, whose membership includes
representatives of both militaries, the Federal Ministry of Health (FMOH) and the National Agency for the
Control of AIDS (NACA). The NMOD funds these meetings, held three times a year since 2005. The
Emergency Plan Implementation Committee (EPIC), subordinate to the SC, is comprised of two NMOD
personnel per treatment site along with the EPIC headquarters and the DOD HIV Program Office. This
committee directs the implementation of the program through quarterly meetings and is funded by DOD.
The DOD maintains daily contact with the EPIC headquarters on all aspects of program implementation.
Through this partnership, the MOSD has directed the EPIC to harmonize with all other partners and funding
streams of the Nigerian Military to ensure complete synergy among programs and to ensure coordinated
and complementary use of resources.
Due to the formalization and strengthening of HIV infrastructure in COP06, EPIC was able to clearly
articulate their needs and successfully received its third annual operating budget from the GON (2007
funding- $1.5 Million USD). In addition, the NMOD is hiring 100 new health care providers (HCPs). Both the
operational funds and new HCP personnel are specifically for PEPFAR implementation.
civilian community (constituting approximately 75% of the Military's patient load). During COP08, the
NMOD-DOD HIV Program will continue to extend free prevention, care and treatment services in 14 military
facilities and communities. In COP08, the program will expand to six new sites.
In COP08, DOD will focus primarily on supporting the NMOD in developing, implementing and reviewing
policies on reducing the incidence and prevalence of HIV/AIDS in military communities. Other activities will
include continuing support for training on administrative policy and systems strengthening activities, and the
provision of training and development for the NMOD. Support to three target organizations (NMOD, EPIC
and the Armed Forces Programme on AIDS Control) will include addressing high-risk issues such as
peacekeeping and other international deployments as well as internal deployments.
At the local level, the DOD will support training and development activities for 200 individuals at 23 sites, in
centralized and site-specific settings, targeted at individual and work-group development in management,
budgeting, logistics, project planning, implementation, and monitoring and evaluation. By training uniformed
members and civilian employees at all levels who are on a career track in the GoN, the program fosters a
generation of trained workers who are more likely to remain with the military for the long term. As these
employees are promoted, individuals are not only technically trained, but also receiving management and
oversight capability strengthening. This clearly fulfills PEPFAR program goals for independent operation
and oversight roles.
Other specific interventions at sites will include mobilization of local military communities to address male
norms and behaviors regarding cross-generational and transactional sex and support for the development
of military policy to prevent sexual violence and coercion. CBOs will be strengthened in their efforts to
reduce the stigma associated with HIV status and to reduce discrimination faced by those with HIV or AIDS.
Policies toward capacity building and NMOD ownership of PEPFAR activities will continue in COP08 with
the NMOD's initiative to store, manage and distribute supplies (ARVs, reagents, other consumables)
procured through the Supply Chain Management System (SCMS, #6706). Movement toward central
acquisition and distribution will decrease operating costs and the use of cash accounts at each site. The
DOD program will continue support policy development for implementation of the NMOD-owned, contractor
(SCMS) operated warehouse developed under COP07 funding, as well as the linkages of NMOD customs
agents with NAFDAC, federal customs authorities and the Ministry of Foreign Affairs. The program design
will ensure continued USG visibility and accountability at all levels of implementation. The NMOD ownership
of the program is supported through the integrated approach of PEPFAR implementation, the formation and
strengthening of NMOD HIV structures, application of an operating budget, increases in HCPs and logistics
improvements. The stewardship transfer, which is projected within the next two years, will contribute to a
sustainable program.
Within Nigeria, in addition to its commitment to the PEPFAR Team and its technical working groups on
policy and guideline development, the DOD will continue to be involved with organizations responsible for
responding to the HIV/AIDS epidemic through national policy development, implementation and
coordination activities. These organizations include the FMoH, NACA, the National AIDS and STD Control
Program (NASCP), and the Global Fund.
Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Niger, Oyo, Plateau, Rivers
and Sokoto (16 states and FCT).
DOD activities will foster a strong USG relationship with another branch of the Nigerian Government; build
the capacity of indigenous partner through joint implementation of activities; offer a cost effective model for
implementation through a direct USG-GON collaboration, and support both the military and civilian
communities.
This activity targets both military and civilian populations, including health care workers, administrators and
Activity Narrative: community liaisons at each site as well as Nigerian Ministry of Defence leaders and commanders, the
Steering Committee and Implementation Committee and others who are involved directly with policy
development.
This activity includes emphasis on in-service training contributing to human capacity development and local
capacity building. Other emphasis includes gender issues, such as addressing male norms and behaviors,
and on reducing stigma and discrimination.
ACTIVITY DESCRIPTION: In COP08, the DOD is increasing its technical staff to provide increased
technical and programmatic oversight to the U.S. Department of Defense (DOD) - Nigerian Ministry of
Defense (NMOD) HIV Program. In COP08, the program will expand from 14 to 20 sites in 16 states and the
Federal Capital Territory. To successfully expand the DOD program, the DOD HIV Program Nigeria has
planned for full staffing at 29 positions in FY2008, an increase of 6 staff.
The COP08 staffing plan includes 3 USDH hires that are comprised of the Director, Executive Officer and
Program Officer. The latter two positions are secured through interagency personnel agreements. A further
breakdown of total staff includes 26 Locally Employed Staff (employed as contractors and FSNs), of which
16 technical staff are funded under specific program. Remaining staff under M&S include 5 drivers (one to
support the USG PEPFAR Lagos office) and five administrative staff. All positions are agreed upon through
an interagency staffing process.
A unique aspect of the DOD-NMOD Program is the recruitment and employment of several retired military
personnel and civilians with past experience with the NMOD. These individuals support the military to
military aspects and act as a bridge for ownership development. Involvement of these employees as
members of the USG Technical Working Groups, as well as the DOD-NMOD Technical Working Groups,
will hybridize US policy and implementation with NMOD/GON practices.
The M&S budget is also inclusive of operational funds (e.g., office lease, utilities, vehicle fuel), M&S-related
equipment, M&S-related staff inclusive of all associated costs, M&S staff-related travel, M&S staff-related
training and residential leases and post allowances for 3 USDH M&S positions. In addition, the budget is
inclusive of a new driver position to support DOD, CDC and USAID PEPFAR activities in the region; this will
enhance coordination of technical assistance and programmatic oversight for all agencies. An armored
vehicle to support the USG PEPFAR Nigeria Lagos office is budgeted through the Supply Chain
Management System.
DOD ICASS and CSCS costs are included in activity (7216.08) and (7227.08), respectively, in accordance
with COP08 guidance.
