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
Utilizing a network model with PMTCT care centers linked to secondary and tertiary "hub sites" that provide
more complex PMTCT care and lab testing, in COP08 111,500 women will receive PMTCT counseling &
testing and receive their results. A total of 106 PMTCT sites will be supported (64 sites established by the
end of COP07 and 42 sites added by the end of COP08). Sites are located in 23 states: Akwa Ibom,
Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa, Kaduna, Kano, Katsina,
Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, and Sokoto.
As part of the USG local government area (LGA) coverage strategy in PMTCT, ACTION-supported PMTCT
services in Bauchi, Lagos, and Plateau will be focused at the primary health center level. PMTCT stand
alone points of service in the network are linked to adult and pediatric ARV care through utilization of a
PMTCT consultant coordinator in each network based at the hub site, network referral SOPs, monthly
PMTCT network meetings, and incorporation of team approaches to care in all training and site monitoring.
Through this SOP, HIV+ pregnant women who require HAART are linked to an ARV point of service.
Particular emphasis is placed on the involvement of community health workers who are the primary source
of care for women in the pre and post-partum period and are integral to a program that seeks to engage
women where they seek care. This program will work closely with the care and support team to maximally
engage community based PMTCT and ARV linkages. In addition to receiving PMTCT services, each HIV+
pregnant woman will be referred to OVC services in order to facilitate care for all of her affected children.
Opt-out HCT with same day test results will be provided to all women presenting for ANC and untested
women presenting for labor and delivery. All women are provided pre-test counseling services on
prevention of HIV infection including the risks of MTCT. Partner testing is offered as part of counseling
through referral to on-site HCT centers. A step down training of couple counseling and a prevention for
positives package will be utilized in all sites. This will provide an opportunity to interrupt heterosexual
transmission, especially in discordant couples. Master trainers for HCT will train labor and delivery staff in
the use of HIV rapid tests for women who present at delivery without antenatal care.
An anticipated 5,575 HIV+ pregnant women will be identified and provided with a complete course of ARV
prophylaxis (based on ACTION's current program prevalence of slightly over 5%). HIV+ women will have
access to lab services including CD4 counts without charge. This will be available on-site or within the
network through specimen transport. Women requiring HAART for their own health care are linked to a
network ARV center. For the anticipated 2/3 of women not requiring HAART, the current WHO
recommended short course ARV option will be provided which includes ZDV from 28 weeks or ZDV/3TC
from 34/36wks, intra-partum NVP, and a 7 day ZDV/3TC post-partum tail. Women presenting in labor will
receive SDNVP and a 7 day ZDV/3TC post-partum tail. All HIV+ women will be linked post-partum to an
HIV/ARV point of service, which will utilize a family centered care delivery model whenever feasible, co-
locating adult and pediatric care and providing a linkage to family planning services. Women frequently face
barriers to facility-based treatment access as a result of demands on them for child care and to contribute to
the family economic capacity. To address this, mobile clinic outreach as described in the ARV service
provision and care and support narratives will be integrated at the community level to bring services to
women who otherwise will opt-out of care and treatment.
HIV+ women will be counseled pre- and post-natally regarding exclusive breast feeding with early cessation
or exclusive BMS if AFASS using the WHO UNICEF curriculum adapted for Nigeria. Couples counseling or
family member disclosure will be utilized to facilitate support for infant feeding choices. Consistent with
national policies on importation of infant formula and recent concerns regarding appropriate use of BMS,
ACTION will not utilize EP funds to purchase BMS. As part of OVC programming ACTION will provide safe
nutritional supplements as well as water guard, bed nets and other home based care items. HIV+ women
will be linked to support groups in their communities which will provide both education and ongoing support
around infant feeding choices and prevention for positives. PLWHA are currently employed at ACTION ARV
points of service as treatment support specialists. The use of dedicated treatment support specialists for
PMTCT in the clinic and community will be expanded based upon the successful "Mothers to Mothers"
model in Southern and East Africa. This will ensure that HIV+ women remain in care throughout pregnancy
and receive appropriate services for herself and her infant.
Infant prophylaxis will consist of single dose NVP with ZDV for 6 weeks in accordance with Nigerian
National PMTCT Guidelines. Cotrimoxazole suspension is provided to all exposed infants pending a
negative virologic diagnosis. Eight regional laboratory centers for DNA PCR have been established by
ACTION with an additional 2 planned for COP08. Testing of infants will be carried out using dried blood spot
(DBS) specimen collection. ACTION will actively participate in the national early infant diagnosis initiative by
providing DNA PCR testing of DBS at ACTION-supported labs. The source of DBS samples will include
ACTION and non-ACTION supported PMTCT sites. A systematic coordinated approach to program linkage
will be operationalized at the site level and program level including linkages to adult and pediatric ART
services, OVC services and basic care and support. Quality monitoring will be undertaken through site visits
using an existing assessment tool and routine monitoring and evaluation indicators.
ACTION will train an average of 4 HCWs from each of the 106 sites including community-based health
workers in the provision of PMTCT services and infant feeding counseling. The national PMTCT training
curriculum, national infant feeding curriculum and new national training tools currently under development
will be utilized. Under COP07, ACTION has adapted and piloted a modified version of the PMTCT National
Curriculum for traditional birth attendants (TBA) which focuses on HCT and referral of HIV+ women.
ACTION piloted this with 20 TBA in COP07 and will expand to an additional 50 in COP08. Two Trainings of
Trainers (18 trainees each) on infant feeding will conducted in conjunction with the MOH. Thus the total
direct training target is 510. ACTION will continue to collaborate with the GON and the Clinton Foundation
to conduct trainings focusing on EID procedures including specimen transport and for EID commodities.
In addition to routine monitoring and evaluation activities, ACTION will contribute to a PHE that will evaluate
best practices and document best program models for increasing the number of HIV+ pregnant women who
receive HAART. The aim is to identify which models of ART service delivery to pregnant women result in
the best uptake for PMTCT and maternal treatment interventions.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will provide counseling & testing services to 111,500 pregnant women, and provide ARV
Activity Narrative: prophylaxis to 5,575 mother and infants pairs. This will contribute to the PEPFAR goal of preventing
1,145,545 new HIV infections in Nigeria by 2009. With 106 operational sites, the PMTCT activity is in line
with the desire of the GON to have 1,200 PMTCT sites operational by 2008 and the USG's target of having
80% PMTCT coverage.
LINKS TO OTHER ACTIVITIES:
This activity is linked to care and support (3259.08), OVC (5417.08), ARV services (3255.08), laboratory
infrastructure (3256.08), condoms & other prevention (9210.08), AB (15651.08), and SI (3253.08).
Prevention for positives counseling will be integrated within PMTCT care for HIV+ women. The basic
package of care provided to all HIV+ patients will be available to HIV+ pregnant women. ACTION lab staff
will ensure that HIV testing provided within the PMTCT context is of high quality by incorporating PMTCT
sites into the laboratory QA program. ACTION will collaborate with UNICEF in the support of PMTCT
services at some sites, leveraging resources without duplication and creating a more sustainable service
POPULATIONS BEING TARGETED:
This activity targets pregnant women who will be offered HCT, HIV+ pregnant women for ARV prophylaxis
and infant feeding counseling, and exposed infants for prophylaxis and EID.
The key emphasis area is training as most supported personnel are technical experts. A secondary
emphasis area is commodity procurement as ARVs for prophylaxis and laboratory reagents for infant
diagnosis will be procured. Another secondary emphasis area is network/ referral systems as networks of
care will be supported which are critical to ensuring quality of care at the PHC level, identifying women in
need of HAART, and ensuring access to HAART within the network. In addition, partners and PABAs will be
identified for linkage to care and support services. In addition, this activity addresses gender since treatment
will be provided to women and will focus on family centric issues including male involvement in PMTCT
ACTION will be a new partner in the program area of Abstinence/Be Faithful (AB) in COP08. ACTION will
implement its AB programming activities in line with the overall PEPFAR Nigeria goal of providing a
comprehensive package of prevention services to individuals reached through a balanced portfolio of AB
prevention activities. Through the involvement of ACTION as a new partner in this activity, PEPFAR Nigeria
will extend its reach with AB services into focused communities in six states (Plateau, FCT, Benue, Kaduna
and Kano and Edo). Through its other program areas ACTION has a large population of HIV+ adults,
adolescents and children to which it is already providing services; these associated points of service will be
utilized as referral centers for any clients that may be interested in HCT as a result of AB services. In
addition, ACTION will target activities to HIV negative persons in its catchment areas in order to minimize
their risk behaviors and contribute to an overall reduction in HIV prevalence. A key age group for AB
activities is youth/young adults aged 15-24 years as this encompasses the highest prevalence age group.
The 2005 ANC survey in Nigeria indicates that among age cohorts in Nigeria, the 20-29 year old age group
has the highest HIV prevalence (4.9% compared to a national prevalence of 4.4). A good number of youth
and young adults in this age group are in tertiary educational institutions where they can be accessed for
appropriate AB messages. It is expected that a combination of prevention messaging approaches will
ensure they are reached with prevention interventions and will facilitate behavior change.
In COP08 ACTION will implement this activity at tertiary educational institutions (Polytechnics and
Universities) that are located in cities where linkages are available to treatment centers so that as AB
messages are delivered and individuals are interested in getting tested, there will be appropriate linkages
where necessary. ACTION will work principally at the educational institutions but will have spill over to the
community levels utilizing a combination of multiple strategies in this implementation. These will include; (1)
community awareness campaigns specifically focusing on Small Group Discussions (SGD) that will be
based on departmental levels; (2) school based approach which will leverage existing curricula developed
jointly by the Federal Ministry of Education and the Society for Family Health ; and (3) peer education plus
activities focusing on drama groups.
The curriculum will be used to train lecturers and guidance counselors who will now provide AB messages
in their routine teachings. Students will also receive AB messages from SGD that will be based in the
different departments. In addition, ACTION will implement this activity through the peer education plus
activities by supporting a dance drama group that will perform in these same targeted institutions. These
dramas will have culturally and age group relevant scripts written by a professional consultant using input
from the SGD. The content will be piloted for acceptability and accurateness of the messages before
performances are carried out to these institutions.
Activities conducted at the local level by ACTION will be reinforced through national level mass media
campaigns by other USG partners such as the successful Zip-Up campaign. AB messages will be balanced
with concurrent condoms and other prevention messaging where appropriate and will be integrated with
other PEPFAR services being provided at five hospital networks and their surrounding communities which
will serve as the centers for referrals for ACTION prevention activities in the coming year in the six states.
The goal of the program is to be focused on the school communities targeted and to saturate those
communities with messages conveyed in multiple fora. Utilizing such a methodology, a large number of
people will be reached with messages received via one method or another, but the target group will be
those individuals that will have received AB messaging: (1) on a regular basis and (2) via the three
strategies ACTION will employ (community awareness campaigns, school based programming and peer
education plus activities). The target for this intensive AB messaging campaign is 11,480 individuals. A total
of 700 persons made up of teachers, guidance counselors, school health care workers, and peer educators
will be trained to conduct effective prevention interventions inclusive of AB messaging.
ACTION will also collaborate with International Institute of Christian Studies (IICS) an NGO that has worked
with the Nigerian Federal Ministry of Education and has implemented effective AB services in secondary
schools in Nigeria. This program will be carried out in accordance with the USG and GoN HIV/AIDS five-
year plan. Through this mechanism ACTION will liaise with several community based organizations (CBOs),
faith based organizations (FBOs), and support groups at its facilities and surrounding communities in other
PEPFAR programming activities. These CBOs, FBOs and support groups will serve as appropriate partners
in the dissemination of balanced ABC messaging to catchment populations utilizing the peer education
model. These CBOs as secondary beneficiaries will be invited to concerts organized in these institutions so
that ABC messages would be reinforced. IICS will organize these activities in tertiary educational institutions
under the supervision of ACTION and will include activities such as dance drama presentations, musical
events and focus group discussions. In collaboration with the HCT program area, ACTION will also support
the establishment of HCT services in these institutions so that on-site HCT and condom outlet services will
be available, thereby complementing the balanced AB messaging campaign.
Another focus of the program in COP08 will be improvement of the linkages between appropriately
balanced ABC services and HCT/HIV treatment activities. The incorporation of HIV AB messages by
lecturers who have access to this age group on a regular basis will institutionalize the AB services. In
addition prevention activities will be assimilated into points of health care service in each institution
including, family planning counseling, sexually transmitted infection management and counseling, and risk-
ACTION AB activities emphasize integration of prevention activities with treatment and care services. Use
of the community awareness campaigns, the school based programs, and peer education plus activities
(community drama, dance events, etc.) allows dissemination of AB messaging, including integration with
condom messaging, from society-attributed sources of credible information - educators, healthcare workers
and related populations of PLWA. This program will contribute to the Global HIV/AIDS Strategy by reaching
11,480 people with AB messaging and 5,740 people with abstinence only messaging in a comprehensive
approach. The activities will also address issues of stigma and discrimination through the education of
individuals and communities reached.
LINKS TO OTHER ACTIVITIES:
AB activities relate to HCT (5550.08), by increasing awareness of HIV. It also relates to care and support
activities (5552.08) through dissemination of information by home based care providers and ultimately by
Activity Narrative: decreasing demand on care services through decreased prevalence. Linkages also exist to condoms and
other prevention (9208.08) as a complementary prevention strategy and to OVC programming (5547.08) by
targeting orphans and vulnerable children.
Key populations targeted are youths (particularly university and polytechnic students), teachers and adults
accessing HCT services at either static or mobile sites within catchment areas of the treatment sites
Emphasis will be on human capacity development. AB activities promote a rights based approach to
prevention among positives and other vulnerable members of society and equal access to information and
services. Reduction of stigma and discrimination are also key features of the program.
ACTION will support the USG effort to assist the Nigerian National Blood Transfusion Service (NBTS) in the
development of a nationally-coordinated blood program to ensure a safe and adequate blood supply by
supporting four large tertiary hospitals as model blood banks to effectively utilize screened blood from NBTS
Zonal Centers for the majority (80%) of their transfusion needs by the end of COP08. These activities will be
facilitated through the provision of step-down training, proper blood storage and testing equipment, and
supplies. For their emergency transfusions as an interim measure, the four model sites will be supported to
utilize the NBTS standard donor screening questionnaire, provide full HCT services for all emergency
donors, and screen all emergency donors for the four transfusion transmitted infections (TTIs) (HIV I and II,
syphilis, hepatitis B, and hepatitis C) in accordance with NBTS policies. The model blood banks will also be
supported to carry out proper universal precautions, good laboratory practice, waste management, and
QA/QC for all serological testing. Approximately 50 other facilities supported by ACTION and carrying out
blood transfusion services will be supported to utilize the NBTS donor screening questionnaire, provide pre-
donation HCT, and implement standardized blood collection methods. Safe injection program area
resources will be leveraged to facilitate proper universal precautions and waste management.
In COP08, ACTION will work closely with NBTS and Safe Blood for Africa Foundation (SBFA) in all aspects
of its blood safety program. ACTION will support the NBTS in implementing its primary objective of
migrating fragmented hospital-based blood services to centralized NBTS-based blood services nationwide.
A key feature of this program is the development of a nationwide voluntary donor recruitment system.
ACTION will work with NBTS Centers to implement blood drives at supported facilities and surrounding
communities. To assist in the development of efficient national coordinated and centralized donor
recruitment, blood screening, and distribution systems in accordance with the Nigerian National Blood
Transfusion Policy, four selected ACTION sites which are large tertiary hospitals involved in the provision of
blood transfusion services will be supported as model blood banks linked to the nearest NBTS Center.
Model blood banks will include: University of Abuja Teaching Hospital linked to the FCT Zonal Center,
Bauchi Specialist Hospital linked to the North Central Zonal Center in Jos, University of Benin Teaching
Hospital linked to the South-South Zonal Center in Benin, and Nnamdi Azikiwe University Teaching Hospital
linked to the South-East Zonal Center in Owerri. Model blood banks will be supported to screen and bleed
donors in addition to implementing donor referrals to Zonal Centers. The NBTS/hospital blood exchange
program will put a system in place whereby NBTS will develop and implement a delivery system with these
hospitals with appropriate blood banking facilities in place. NBTS will pick up unscreened blood units that
the hospitals have appropriately collected and stored and will transport these units back to NBTS centers
where they will be screened for the four transfusion transmissible infections (TTIs) of HIV I and II, hepatitis
B, hepatitis C and syphilis using ELISA techniques. In addition to collecting unscreened units, NBTS will
deliver to these four hospitals their requested order of screened units for blood banking and use at the
facilities. NBTS will also provide monthly feedback on rates of the four TTIs found by ELISA screening of
blood units collected by each facility. Infrastructure support for these model sites will include renovation of
the site donor bay and blood bank to provide for proper ambient temperature for laboratory testing,
provision of proper blood storage refrigerators, and provision of a centrifuge and disposables for cross
Recognizing that the transition to full reliance upon the NBTS Centers for all blood products will take some
time, model sites will be supported to follow NBTS policy in the identification and collection of blood from all
donors including blood for emergency transfusions. It is anticipated that the four model sites will require
12,000 units of blood during the COP08 period with a goal of 80% (9,600 units) of these screened and
provided through the NBTS Centers. Procedures for emergency donors at the site will mirror NBTS Center
procedures to the extent possible. This will include the use of the NBTS donor screening questionnaire for
all donors with deferred as necessary based on responses, and the provision of standard HCT services to
donors using the National HIV rapid testing algorithm. In order to maintain high quality laboratory results,
ACTION will include the blood bank in its laboratory QA/QC program that involves on-site quarterly
monitoring and retraining as well as selective retesting and proficiency panels for all serologic testing.
This activity will 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 form contracting infections, especially HIV.
Proper waste management will be encouraged through the use of biohazard bags, suitable sharps
containers, and the use of incinerators. In addition, each site will have in place a Post-Exposure
Prophylaxis (PEP) protocol and starter kits in the event of an occupational exposure (described under the
ARV services narrative).
Ten staff will be trained at each of the four model sites by SBFA who in turn will utilize standardized training
modules that are appropriate to the various levels of trainees and approved by NBTS. In order to avoid
double counting, these 40 targets are counted under the SBFA blood safety narrative. For core TOT
modules developed by SBFA, ACTION will conduct step down training to 40 direct targets.
Activities in this program area will support PEPFAR and GON goals to avert new infections through
ensuring that all blood transfused at selected facilities are HIV free by instituting safe blood activities at all
sites. Screening for TTIs will provide information on prevalence among blood donors and guide future policy
formulation on TTI screening. ACTION activities will support the implementation of GON operational
guidelines for blood transfusion practice in Nigeria and actualization of a well coordinated and centralized
blood supply system in the country, while the QA program will serve as a mechanism to measure and
evaluate the success of the intervention strategy.
This activity is linked to HCT (5426.08) as directed donors and voluntary donors will be provided with full
HCT services prior to blood donation. This activity is also linked to infection control activities under injection
safety (6821.08) as a post exposure prophylaxis policy will be instituted, universal precaution supplies
including safe disposal containers will be provided, and training will be conducted. Linkages to laboratory
infrastructure (3256.08) also exist. Strategies for HIV positive donor referral to clinical ARV facilities will
promote treatment access goals and provide encouragement of donors to have HIV testing done. Linkages
to AB (15651.08) and condoms and other prevention (9210.08) will also exist as HIV prevention materials
and free condoms will be provided at the blood screening sites to encourage HIV prevention among donors.
Activity Narrative: SI (3253.08) will support data gathering related to blood donations.
POPULATIONS BEING TARGETED:
The target populations are blood donors, laboratory workers, physicians and blood donor organizers at
public facilities who will be the focus of capacity development and voluntary blood donations.
An emphasis area for this activity is training as capacity development for sustainability is a key focus.
Organizational capacity building is also a focus as capacity around blood donor drives and blood banking
abilities in facilities is strengthened. Renovations are a minor emphasis.
This activity will increase awareness and build skills around safe blood issues at facility and community
levels, reducing stigma and discrimination among health care workers. It is expected to also promote
awareness about safe blood practices in the communities and to indirectly increase the number of
volunteers available for blood donations.
In COP07, ACTION supported 46 sites in 13 states (Anambra, Edo, FCT, Nassarawa, Kogi, Niger, Kano,
Cross Rivers, Bauchi, Benue, Rivers, Delta, and Lagos) with injection safety programming. In COP08,
ACTION will collaborate with JSI/MMIS to provide safe injection programming to 106 ACTION-supported
sites in 23 states (Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo,
Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto). In
COP06 and COP07, JSI procured commodities for all sites while ACTION and JSI divided sites by state in
the provision of training and commodity management. Under COP08, JSI will provide initial training and
seed commodities to all sites, while ACTION will provide step down training and ongoing commodity
procurement and management for all sites. An ACTION program officer is dedicated to oversight of this
program area with the support of regionally based medical and nursing program officers. The focus of this
activity is to reduce exposure to blood borne pathogens, particularly HIV, and the incidence of medical
transmission of these pathogens.
Health care workers targeted for this activity include physicians, nurses, community health extension
workers (CHEWs), laboratory workers, and waste handlers. JSI will be responsible for conducting initial
training at the site level; this will include both the training of new sites and the retraining of existing sites.
ACTION will support follow-up and step down site level trainings to train an average of 8 additional staff per
site for a direct training target of 848. Physicians and nurses from the inpatient wards, clinics, labor and
delivery, and the surgical theater will be targeted. In addition, HCT counselors performing rapid tests,
laboratory scientists, blood bank staff, and waste handlers will be trained. Training topics will include BCC
strategies to reduce unnecessary medical injections, safe injection practices, proper handling and disposal
of syringes and sharps, infection control policies and practices, universal precautions, use of personal
protective equipment (PPE), protocol for post-exposure prophylaxis (PEP, see ART services), and
appropriate waste segregation, handling, and disposal. Standard curricula and IEC materials developed by
JSI/MMIS and approved by the GON will be utilized. In addition, training materials developed in the context
of the OVC program that address issues of stigma and irrational fear related to "fear of contagion" will be
included with the goal that informed health care providers and CHEWs will help inform others in the health
care and community setting of what the true risks are rather than the widely held beliefs prevalent in the
community that contribute to stigmatization. Sites will also be provided job aids and IEC materials to
encourage behavior change and sustainability.
While JSI, the main procuring IP will provide a seed stock of all commodities, ACTION will continue to
provide personal protective commodities and will take on the new role of logistic supply of recurrent stocks
of injection safety commodities for all sites. ACTION will supply color coded bin liners for waste segregation
and universal precaution supplies including gloves, eye shields, boots, and aprons. Commodities and
disposables will be procured, warehoused and distributed by ACTION. They will be provided to sites based
upon a pull system using a site level inventory control system linked to the ACTION warehouse logistics
management information system. The current system can be easily harmonized with a national or PEPFAR-
wide logistics management information system and inventory control system once implemented. In addition,
ACTION will support safe health care waste management by supporting repair of existing incinerators at
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
This activity will contribute to the reduction of medical transmission of HIV and other blood-borne diseases
by following universal precaution measures, as well as proper waste management. It will likely improve the
quality of health care and reduce stigma and barriers to comprehensive medical care for PLWHA by
addressing concerns of health workers and other hospital staff. Overall this will contribute to the USG goal
for Nigeria of the prevention of 1,145,545 new HIV infections by 2010 in Nigeria.
LINKS TO OTHER ACTIVITIES:
This activity is linked to laboratory services (3256.08), PMTCT (3257.08), ART services (3255.08), blood
safety (3258.08), HCT (5426.08) and SI (3253.08). Health care workers involved in these programs will
benefit from the training program in injection safety and the adoption of a safe needle, needle stick policy
and PEP protocol, all which will improve the safety for workers involved in these other programmatic
POPULATIONS BEING TARGETED:
Doctors, nurses, laboratory scientists, other health care workers and waste handlers are targeted for
training and services in the public sector.
KEY LEGISLATIVE ISSUES ADDRESSED:
This activity addresses issues of stigma and discrimination as the services will reduce stigma and
discrimination associated with HIV status in the health care facility setting.
The emphasis area for this activity is training as nearly all supported personnel are technical experts who
focus on development of training materials, SOPs and the provision of training at the site level. A secondary
emphasis area is commodity procurement as supplies for safe disposal will be procured and supplied.
ACTION will provide Condoms & Other Prevention (C&OP) Activities targeting 38,600 most at risk persons
(MARPs) and support 60 community based condom outlets in locations frequented by MARPs such as bars,
brothels and truck stops in addition to the hospital based outlets co-located at HCT/ART clinics. Sites are
located in states chosen consistent with the National ARV Scale-Up Plan with the goal of universal access.
They include: Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa,
Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, and Sokoto.
ACTION will build on COP07 successes to expand prevention services and linkages to wraparound
services (e.g., family planning). At the health care facility level this will complement prevention with positives
(PwP) activities described and supported under BC&S programming. Prevention services will take place in
community settings including: skills development centers, prisons, truck stops, markets, and OVC centers
targeting out-of-school youth. ACTION will complement mobile HCT with prevention services by supporting
NGOs to establish HCT/OP sites at locales where transactional and intergenerational sex are common
using five mobile HCT vans based out of ACTION regional offices. Under COP06, the HIV Sero-prevalence
among clients tested in a mobile setting was 19.1% and 27.5% in the first quarter of COP07. ACTION will
expand prevention programs in collaboration with experienced CBOs and peer educators along the Benin-
Lagos transport corridor, targeting truck drivers and those who engage in transactional sex at overnight
motor parks, increasing the targeted truck stops from 3 to 6. This will be based on a successful Mombasa-
Kampala corridor model developed in Kenya-Uganda. A Sero-prevalence exceeding 20% is anticipated.
Under COP07, ACTION provided HCT services at Kuje, Keffi & Suleja prisons and will build on that
experience to add prevention services for the incarcerated testing HIV- and will increase the number of
prison sites served. This will be done in collaboration with and in support of the HIV/AIDS unit of the GON
Ministry of Internal Affairs. ACTION will work with a CBO experienced in dealing with prison populations to
determine feasibility of providing ARV and other services while maintaining prisoners' confidentiality.
ACTION also targets out-of-school youth via community centers and organized activities supported through
OVC programming. C&OP will be balanced with AB prevention messaging and will be offered to youth in
ACTION will implement its C&OP activities in line with the overall PEPFAR Nigeria goal of providing a
comprehensive package of prevention services to individuals reached through a balanced portfolio of
prevention activities which will also include abstinence and be faithful messages. In COP08 ACTION will
implement this activity at the community level utilizing a combination of strategies, including community
outreach campaigns, peer education models, and STI screening/management/treatment. Peer education
strategies will focus on Greater Involvement of People with HIV/AIDS (GIPA). The goal of the program is to
cover target communities with messages conveyed in multiple fora. Utilizing this methodology, a large
number of people will be reached with messages received via one method or another, but the target group
will be those individuals that will have received condom/other prevention messaging: (1) on a regular basis
and (2) via the three key strategies ACTION will employ (community outreach campaigns, peer education
models, STI screening/management/treatment). The target for this activity is 38,600 individuals. ACTION
will employ a dedicated staff person to oversee these prevention activities.
ACTION will enhance services for MARPs testing HIV- by coupling post test counseling with targeted
behavior change interventions that address individual risk. Individual counseling will include
abstinence/mutual faithfulness messages, promotion/instruction regarding correct and consistent condom
use, information education communication (IEC) materials and linkages to family planning services.
Community outreach through collaboration with PLWHA support groups will ensure that IEC materials and
counseling messages are culturally acceptable. Group counseling will be carried out in supportive settings
to discuss and promote HIV prevention behaviors including avoidance of STIs, recognition and seeking
early treatment for STI symptoms, and reduction of alcohol/illicit drug use. Condom promotion and
distribution will be coupled with prevention information about abstinence and mutual faithfulness, behavioral
change communication, and risk reduction education using peer educators. Sixty stationary condom
distribution points at locales frequented by MARPs (such as bars serving truck drivers) will be established
and maintained along with 78 situated within ART facilities making a total of 138 outlets.
Building on the model piloted in COP07, mobile HCT vans will be utilized for the provision of syndromic STI
services in conjunction with HCT services targeting truck stops and night spots frequented by MARPs. This
service will be provided by Community Heath Extension Workers (CHEWs) following standard SOPs for
syndromic STI management and will include treatment for syphilis, gonorrhea, and Chlamydia. Program
staff will work with sites to ensure appropriate linkage/referrals to STI care.
PwP strategies targeting HIV+ persons will be included in this package of services for MARPs using
approaches developed during COP07 and materials developed through USG Nigeria. ACTION will support
risk reduction and safer sex promotion activities among HIV positive clients, partners and their households.
The comprehensive package of prevention interventions will include provider and counselor delivered
prevention messages, family planning counseling, STI management and treatment, and testing of partners
and children. Lay counselors and peer educators will be mobilized for more in-depth counseling on key
prevention issues such as: sexual risk reduction, disclosure, adherence, reduction of alcohol consumption
and partner testing. Condoms and information on proper condom use will be available to all patients
attending ACTION supported ARV clinics. Other components of the comprehensive package of prevention
interventions are further described under the basic care and support program area.
Site/regional level trainings for CHEWS in STI syndromic management will be carried out by ACTION
program staff. Peer educators and PLWHAs will be trained by ACTION program staff and CBO
subcontractors using a curriculum developed by SFH focusing on truck stop and commercial sex settings as
well as a manual on Interpersonal Communications jointly developed by ACTION and SFH. General training
will include risk stratification, disclosure and couple counseling, proper condom use and syndromic STI
management training for health care workers. The direct training target is 380 persons.
As high risk and "bridge" populations contribute to HIV transmission, this activity will support the Nigerian
Federal Ministry of Health (FMOH) and EP goal of reducing new infections and thus decreasing the overall
disease burden of HIV in Nigeria by enhancing HCT with targeted prevention messages and interventions.
Targeted efforts to promote correct and consistent condom use and STI management for MARPs can
Activity Narrative: reduce the risk of HIV infection.
This activity relates to activities in AB (15651.08), care and support (3259.08), ARV services (3255.08),
OVC (5417.08), HCT (5426.08) and SI (3253.08). A challenge of this program is to successfully link those
identified as HIV positive with services. The populations being targeted often do not access services via
traditional treatment venues. The program will create a means of strengthening these linkages and will
identify through the hub and spoke model innovative strategies for creating access to treatment in
convenient venues. Targeting MARPs will help to identify persons who need referral into care, ARV services
and prevention for positives counseling which will be an important component of posttest counseling of
HIV+ persons as part of HCT services and the basic package of care. Balanced prevention messages
targeting behavior change will complement HCT for all irrespective of HIV status. OVCs will be taught family
life and sex negotiation skills.
This activity focuses on MARPs such as commercial sex workers and their clients, prisoners, out-of-school
youth, and mobile populations such as truck drivers. The prison population presents special challenges in
this regard because of potential for stigmatization in a dangerous environment. Doctors, nurses, other
health care workers in the public sector as well as PLWHA and peer educators are targeted for training.
An emphasis for this activity is human capacity development as training as nearly all supported personnel
are technical experts who focus on this at the central and site level. Community development through
linkages with CBOs and PLWHA support groups is also emphasized.
This activity also addresses the issue of stigma and discrimination since HIV counseling reduces stigma
associated with HIV status through education.
In COP07, ACTION provided comprehensive care and support services to 51,405 PLWHA through 24 sites.
In COP08, ACTION will expand this service provision to 87,725 HIV+ adults and support services to an
additional 175,450 persons affected by AIDS (PABAs) at 78 tertiary, secondary and primary health center
points of service within 28 hub and spoke model care networks in 23 states (Akwa Ibom, Anambra, Bauchi,
Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos,
Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto). $600,000 in COP07 HBHC funds are for use against
COP08 Care and Support targets as per the COP07 reprogramming exercise in July 2007. These funds
were reduced from the COP08 funding and redirected to the COP08 RFA accordingly.
In COP 08, ACTION will continue to provide lab services (CD4, hematology, blood chemistry, LFT, OI and
pregnancy testing if indicated), OI prophylaxis and treatment, nutritional assessment, pain management,
psychological, social, spiritual and home based care (HBC) to all PLWHA enrolled into care. ACTION will
provide at least one clinical service (laboratory, OI prophylaxis/management, HBC, nutritional
assessment/therapy) plus at least two other services in the domains of psychosocial, spiritual or preventive
services to all PLWHA. The laboratory services will be provided at least every 6 months with CD4 count to
monitor for change in status. Access to appropriate TB diagnostics and linkages with DOTS programs
described under TB/HIV are also provided. Care providers, including volunteers, are trained in screening for
signs and symptoms of TB such as chronic cough, weight loss, night sweats, etc. and clients with such
symptoms or signs are referred for diagnostic services. Screening for hepatitis B and malaria is supported
for all HIV+ persons if indicated. The nutritional status of PLWHA will be assessed at the initial clinical
contact and at follow-up visits. If diagnosed with malnutrition micronutrients will be offered and
referrals/linkages to wraparound services providing nutritional therapy will be given. All PLWHA will be
provided with a preventive care package including ITN, water guard, water vessel, soap, ORS sachets,
condoms and IEC materials on self care and prevention of common OIs. Prevention with positive services
provided to PLWHA include condoms and information on use, counseling on reduction of high risk
behaviors, abstinence messages, discordant couple counseling and syndromic management of STIs. A
standard formulary is provided to sites to treat common opportunistic infections and malaria.
PLWHA and PABAs will be afforded linkages to psychosocial support through participation in PLWHA
support groups and individual counseling operational at all points of service. The function of PLWHA
support groups is strengthened by an ACTION program officer with a counseling background who works
with the support groups to improve their programs and to ensure linkages between points of service and
communities. Community based and home based (HBC) patient assessments that tie in with community
clinic and mobile outreach clinical services are being expanded to bring a broader and more integrated
approach to BCS in order to better support patients at the community and home level and support retention
Services to be provided to PABAs at the clinic and community levels include: promotion of HCT; HIV
prevention education including balanced ABC services as appropriate; psychosocial support through on-site
counselors; and participation in support groups designed for family members focusing on prevention of
transmission, stigma/discrimination reduction, and serving as a treatment partner to support adherence.
Support groups will also provide linkages to spiritual support services through the active involvement of
spiritual leaders in the community. It is anticipated that many PABAs will be accessed in the community
rather than clinic setting through the community HBC program which will provide HCT access, linkages to
HIV care and other services, and peer support to PABAs as well as facilitation of home care to PLWHA by
Community HBC will be provided in each of the 78 network catchment areas ACTION supports. This is
implemented by a supervising community HBC nurse, health extension workers and volunteers. This activity
will be linked to primary prevention and HCT programs emphasizing the home based approach to these
other programs and ensuring family engagement in HBC. In addition to HBC for those requiring classic
"palliative care" interventions, HBC providers support ART adherence in the home setting through education
and addressing adherence barriers. HBC providers focus on linkage to services, ensuring that clients in
need of hospital care are able to access this care and linking family members to OVC, PMTCT, community
immunization, family planning, and TB DOTS services. ACTION will continue to utilize different models
depending upon the site preference including supplementing site staffing with dedicated HBC staff or
developing an agreement with a local NGO/CBO/FBO to provide this service. Extension workers will be
preferentially recruited from PLWHA support group memberships. These activities will be linked to the
patient's medical care source as the supervising community home based care nurse/PHC extension worker
will work under the medical direction of the site physician.
Training essential for program success will target nurses, community health extension workers (CHEWs),
counselors and PLWHA/community volunteers and is carried out by ACTION program staff at the site level
to maximize coverage. When feasible, training will be coordinated with IMAI curriculum for PHC staff and
will be harmonized to avoid redundancy. For healthcare workers, care and support training will be
coordinated with safe injection training. The total training target is 468. Standard training curricula for
healthcare workers and community volunteers have been developed by ACTION and include specific
modules on pediatric home based care. ACTION is participating in the National harmonization process to
ensure standardization of training. A quality control program focuses on assessment of knowledge at the
time of training and post-training, monitoring of metrics from HIVQUAL and from M&E indicators and
conducting field assessments. The ACTION training department analyzes these data to upgrade training
materials and to provide retraining where indicators demonstrate a gap in knowledge and implementation.
This activity provides services which are a high priority for the 2-7-10 Emergency Plan strategy by providing
a basic package of care services to all HIV+ adults and PABAs. The services are consistent with the draft
Guidelines for Palliative Care in Nigeria and the USG Palliative Care Policy as well as the Nigerian
Guidelines for Antiretroviral Therapy which stress home based care, symptom management, and OI
prophylaxis. Capacity development at the site level and consistency with national guidelines will ensure
As part of ACTION's integrated treatment to care model, a more seamless integration of services at all
Activity Narrative: levels of the care system is being implemented, and BC&S plays a critical role in this linkage process. Using
the Hub-and-Spoke model in site selection also leverages resources and improves referrals between
tertiary, secondary and primary health care facilities. This activity is linked to HCT (5426.08), condoms and
other prevention (9210.08), ARV services (3255.08), OVC (5417.08), TB/HIV (3254.08), lab (3256.08), and
SI (3253.08). HCT targeting most at risk populations is established proximate to BC&S points of service. All
patients are monitored and linked to ARV therapy when indicated. Services are co-located with TB DOTS
centers and ACTION staff work with sites to ensure coordination systems are in place. High quality
laboratory services supported by an ACTION facilitated laboratory QA program are available at sites. Home
based care programs will be implemented by a number of indigenous NGOs, CBOs, FBOs and PLWHA
support groups. Sub-agreements will be coordinated with other Emergency Plan IPs to ensure non-overlap
of funding and services.
Populations targeted include persons in prostitution, TB patients OVC and pregnant women. Services are
offered to adults living with HIV/AIDS and PABAs. Sites have been chosen to maximize linkages with
national TB DOTS sites and to provide services for HIV+ pregnant women identified through PMTCT.
Doctors, nurses, other health workers (public sector) as well as people living with HIV/AIDS and caregivers
of PLWHA are targeted for training.
Emphasis areas include human capacity building as capacity development for sustainability is a key focus.
Local organization capacity building and TB-related wraparound programs are another focus.
In COP07 ACTION supports integrated TB/HIV services at 44 sites and will develop 34 additional sites
under COP08 for a total of 78 comprehensive care sites. ACTION, with other implementing partners, will
implement the PEPFAR-Nigeria LGA coverage strategy ensuring the provision of TB/HIV services in at least
one health facility in every local government area (LGA) of ‘LGA Coverage' designated states. This is a
critical step toward the states providing universal access to TB/HIV services. Consistent with this strategy
and structured under a hub and spoke network model, additional stand alone TB DOTS sites will be
supported to provide HCT services for TB patients for a total of 92 sites in 23 states (Akwa Ibom, Anambra,
Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara,
Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto) in COP08. $566,700 in COP07 TB/HIV funds are
for use against COP08 TB/HIV targets as per the COP07 reprogramming exercise in July 2007. These
funds were reduced from the COP08 funding and redirected to the RFA accordingly.
The integrated management of HIV/TB co-infected patients at ACTION points of service (POS) will remain a
major focus. TB screening and diagnosis follows the National algorithm and is in line with National
guidelines. At ARV POS, patient record forms have been modified to prompt for TB screening indicators
and site level training of health workers is on utilization of symptom history including chronic cough, fever,
weight loss, or night sweats to prompt referral for TB evaluation. Chest x-ray is supported for sputum
negative patients and for candidates for INH prophylaxis. ACTION has collaborated extensively with the
National TB and Leprosy Control Programme (NTBLCP) to conduct a feasibility pilot of INH prophylaxis for
HIV-infected patients. Eligible TB/HIV patients will also receive Cotrimaxozole Preventive Therapy (CPT).
The TB DOTS sites will be supported to provide holistic patient care according to National and IMAI
guidelines. In addition, HIVQUAL will be utilized as a clinical quality indicator and improvement strategy at
sites. ACTION M&E staff support the National surveillance program by ensuring that sites properly report
incident TB cases to FMOH.
Under COP08, ACTION will support HCT for 25,000 clients being evaluated for TB at 92 DOTS points of
service. These will include stand alone DOTS centers, linked PMTCT-DOTS services in LGA-coverage
states, as well as DOTS centers at comprehensive care sites. Of these, it is expected that 10,000 of those
getting HCT will have TB. ACTION will reach a total of 6,128 TB/HIV co-infected patients with TB treatment.
Infection control at health centers is a priority to limit nosocomial transmission of TB to HIV+ patients. Basic
hygiene, proper sputum disposal, and good cross ventilation at clinics will be promoted. Facility co-location
of TB/HIV services is preferred to clinic co-location. National guidelines on infection control for co-located
sites will be implemented at all sites.
ACTION has supported the GON in carrying out preparatory HCT trainings for DOTS staff at the National
TB and Leprosy Training Centre (NTBLTC) in Zaria under COP07. In COP08, DOTS staff at targeted
centers will be trained on the National testing algorithm using the National HCT training curriculum. Training
will be conducted by ACTION HCT program staff or ACTION regional HCT master trainers. All clients
presenting to DOTS centers will receive HIV pre and posttest counseling with rapid testing carried out using
an opt-out approach to provide same day results. Those testing HIV+ will be referred for further evaluation
and care to an ARV POS within the network. Regionally based ACTION HCT program officers will ensure
referral linkage for DOTS stand alone sites.
ACTION will build on the successes of ongoing collaboration with the NTBLTC in Zaria to strengthen the
integration of high quality TB detection, diagnosis, and resistance testing with care delivery in support of the
National TB control strategy. Under COP07, ACTION partnered with the GON to train staff from every state
in Nigeria in HCT and TB diagnosis. These trainings have been jointly supported by the Global Fund (GF)
and the synergy between the two funding streams has been important in capacity development as part of
the national TB response in Nigeria. In addition, a QA program for TB smear microscopy based at the
NTBLTC has been implemented and includes: joint site visits with the FMOH or relevant state MOH for
observation/retraining, selective review of completed smear examinations for external quality assessment,
and proficiency testing with "unknown" slides provided by the QA team. The collaboration under COP08 will
focus on training in TB culture and sensitivity developed at the NTBLTC and two other ACTION regional
training laboratories under COP07. The conventional Bactec culture system is implemented using both the
MGIT 960 automated system at referral centers and the complimentary manual BACTEC tube at tertiary
and secondary sites. The microscopic observation drug susceptibility (MODS) assay is piloted as a more
scaleable alternative. In all activities infection control and safety is optimized. Focusing on sustainability, 30
lab scientists from selected ACTION and GF/GON supported sites will be trained in TB culture at NTBLTC
in COP08. A minimum of 184 TB DOTS staff from ACTION supported sites and 180 DOTS staff from
GON/GF supported sites will be trained in HCT in a TB setting and refresher trained in smear microscopy at
the NTBLTC. Twenty-eight senior site physicians will be trained in a TOT focusing on diagnosis and
management of TB/HIV co-infection. They will each train a minimum of 20 health care workers at their
respective sites for an indirect target of 560. Thus the direct training target is 422. Approximately 200
additional TB DOTS staff funded by other donors such as GLRA and MLR will also be trained.
ACTION will conduct three TB/HIV PHE activities in COP08. The first is collaboration with WHO and
NASCP to explore the use of manual MGIT at sites that link to the national TB referral center. It will evaluate
if this enhanced intervention to identify and treat TB/HIV co-infected patients decreases early mortality. It
will also determine its effectiveness for expanded culture capacity for TB/HIV co-infected persons. In
addition, ACTION will collaborate with NASCP, NTBLCP and WHO to evaluate a new cost effective MODS
technology against the standard automated MGIT system. The aim is to determine the optimal screening
tool to identify TB/HIV co-infected patients in resource restricted settings. The third PHE is also a
collaboration with NASCP, NTBLCP, and WHO to identify challenges faced by the clients from HIV/AIDS
service delivery sites in accessing TB DOTS services.
ACTION will also work with SCMS in country to procure equipment and supplies. Commodity management
of HIV test kits and supplies will be provided by ACTION using the current regional distribution system.
ACTION will upgrade facilities through infrastructure support such as basic renovations, upgrading
equipment and procuring supplies and consumables. ACTION will strengthen the pharmacy services at
supported TB DOTS sites to improve forecasting and avoid stock outs and will work with sites to recognize
if stock outs are due to facility level or government level TB logistics issues.
Activity Narrative: Training and support to improve the quality and integration of TB/HIV services are consistent with FMOH
and EP priorities. Activities will be carried out collaboratively with FMOH and state MOH to promote
sustainability through capacity development and integration into the health sector system. COP08 activities
will focus on sustainability of the national training program and the national model facility for laboratory
diagnosis and clinical care with a decreasing dependence upon ACTION technical expertise and a focus on
the training of a cadre of Master Trainers.
HCT targets in this section are not included in the testing target in the HCT narrative and those in the HCT
narrative do not overlap with these targets. This activity is linked to HCT (5426.08), BC&S (3259.08), OVC
(5417.08) and ARV services (3255.08) lab (3256.08), and SI (3253.08). ACTION will expand HIV treatment
access to community venues including DOTS centers, an approach that will also strengthen treatment
adherence for both TB and HIV and articulate TB and ARV services to promote seamless transition from TB
to HIV treatment and care. The collaboration with the NTBLTC will also include training to ensure that HCT
is available at all DOTS POS. Linkages to TB diagnosis and treatment is an important component of adult
BC&S and OVC services. Linkage to ARV services and proper management of patients requiring ARV and
TB medications is a focus.
Persons at risk, including household members, people who have documented TB, OVC, pregnant women
and PLWHA are targeted. Screening of close household members for both HIV and TB will promote a public
health strategy reaching populations at risk with diagnosis and services. ARV services are offered to HIV+
infants/children and adults with TB. Doctors, nurses, laboratory workers community outreach workers, GON
staff, and DOTS staff are targeted for training in both the public and private sectors.
Emphasis areas include construction and renovation, human capacity development, local organization
capacity building, and TB related wraparound programs. This activity focuses on the issue of wraparound as
the activity relies upon non-EP TB funding and promotes linkage with HIV-specific programs to ensure that
comprehensive services are available to TB/HIV co-infected persons.
In COP07 ACTION reached 7,203 OVC in 23 states with services. In COP08, ACTION will provide OVC
services through a comprehensive package of care to 10,000 children at a minimum of 53 sites in 23 states
(Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa, Kaduna,
Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto). This will include 5,943
HIV infected children (5,443 requiring ART) and 4,057 uninfected OVC who will be directly provided with
three core OVC services of health care, food/nutrition, and psychosocial support and linked to community
OVC providers to ensure access to the other core OVC services of shelter & care, protection, and education
when needed. $500,000 of FY07 reprogrammed funds will be applied against COP08 targets for UMD.
Health care services will include access to free lab monitoring for 500 HIV-infected children not requiring
ARV treatment including: CD4 count, hematology, and chemistry. (For those on ARVs this is covered in the
ARV services program.) The basic health care package which will be available to all of the 5,943 HIV-
infected children receiving services includes: access to appropriate TB diagnostics and linkage with GON
sponsored DOTS programs described under TB/HIV, instruction for parents/caregivers in appropriate water
purification and provision of water guard, provision of ITNs, provision of cotrimoxazole prophylaxis,
diagnosis and treatment of malaria, and symptom management including provision of pediatric formulations
of antidiarrheals/ antihelminthics/ analgesics/ antipyretics. In addition, a standard formulary will be provided
to sites to treat common OIs.
Community home based care (HBC) for children is in need of extensive development in Nigeria. Under
COP07, ACTION updated its HBC curriculum to include modules on HBC for children. HBC for children will
be linked to HBC for adults and provided in all 28 network areas under COP08, so that at least 1,000
children of the 10,000 total target receive pediatric specific HBC. This is implemented by a supervising
community HBC nurse, health extension workers and volunteers. This activity will be linked to primary
prevention and HCT programs emphasizing the home-based approach to ensure that family members at
risk including other children in the household are tested and counseled. This strategy supports family
engagement in HBC and identifies family members in need of HIV care. In addition to HBC for those
children requiring classic "palliative care" interventions, home based care staff support parents with ART
adherence for children in the home setting through education and addressing adherence barriers. Home
based care staff focus on linkages to services, ensuring that clients in need of hospital care are able to
access this care and linking family members to PMTCT, community immunization, family planning, and TB
DOTS services. ACTION will continue to utilize different models depending upon the site preference
including supplementing site staffing with dedicated home based care staff or developing agreements with
local NGOs/CBOs/FBOs to provide this service. Extension workers will be preferentially recruited from the
PLWHA support group membership. HBC will be linked to the child's medical care source as the
supervising community home based care nurse/PHC extension worker will work under the medical direction
of the site physician.
Access to food and nutrition support is a major need for children. Leveraging support from the Clinton
Foundation, ACTION will provide comprehensive nutritional support for OVCs through the provision of
fortified cereals, Kwashi-pap & PlumpyNut, targeting HIV-infected children as well as HIV-exposed infants
weaning after exclusive breast feeding. This will include nutritional assessment and counseling as well as
multivitamins/mineral supplementation. In the provision of nutritional supplements, ACTION will build the
capacity of care givers by providing raw materials and instructions so that Kwashi-pap can be prepared by
them at home. ACTION will prioritize partnering with new USG-supported wraparound services in states
where it is co-located with these activities.
ACTION has worked in COP07 to strengthen psychosocial support for children by improving the quality of
counseling available for HIV-infected children at points of service through training focused on counseling of
children. In COP08 ACTION will expand this training and will utilize a psychologist to train Master Trainers
(10 very experienced counselors) in a curriculum developed by University of Maryland and recently piloted
in Zambia. This curriculum includes formal child development, socialization, limit setting, pediatric
counseling, diagnosis disclosure, grief and loss, and adherence to medications. Each of these master
trainers will be supported to conduct regional trainings and provide on-site mentoring. This step down
training and mentoring will include not only HBC and facility based providers but will also focus on improving
psychosocial support for OVC in orphanages. ACTION partners with community OVC providers including
the Sisters of the Poorest of the Poor, the Anglican Church and the Mothers Welfare Group in provision of
OVC services to OVC in their homes and to OVC in orphanages. Through these partnerships this step
down training will ensure improved provision of psychosocial services not only to OVC in their homes but
also to OVC in orphanages who are awaiting family placement.
In addition to HIV-infected children and HIV-exposed infants, ACTION will support community OVC
providers to serve HIV uninfected but affected children, particularly orphans, directly providing food/nutrition
and psychosocial support as detailed above. Linkages with community NGOs and faith based
organizations as well as traditional community OVC providers will be established for community based HCT
for orphans in order to identify positive ones that need to be enrolled into care and also access to other core
OVC program services including: shelter and care, protection, education/vocational training, and economic
opportunities/strengthening. A tracking/referral form will be utilized to ensure that each child has access to
these key core program services. ACTION will provide services for adult HIV negative PABAs through
counseling and provision of a preventive care package. These kits will be supplied by SFH and will be
distributed at the site level and through community HBC.
Training of health workers and community volunteers will be conducted primarily at the site level to ensure
maximum coverage in the most cost effective manner. The TOT and regional counseling trainings are
described above. The total training target is 358. Upgrading training in the issues of HIV for NGOs engaged
in OVC services and for social workers will target improved understanding of the stigma surrounding HIV
positive children and the need to integrate healthy HIV positive children into mainstream social and school
settings without fear due to lack of understanding of risks surrounding HIV transmission in school-aged
This activity provides services which are a high priority for the 2-7-10 EP strategy by providing core OVC
services to all HIV+ children. The services are consistent with the National OVC Standard of Practice and
Activity Narrative: OVC National Plan of Action. Capacity development at the site level and consistency with national
guidelines will ensure sustainability. Capacity development will be achieved through regional training and
This activity is linked to HCT (5426.08), ARV services (3255.08), TB/HIV (3254.08), AB (15651.08), lab
(3256.08), and SI (3253.08). HCT services will be available to HIV affected family members (PABAs) in
need of HIV testing including in-home HCT through HBC services. All patients are monitored and linked to
ARV therapy when indicated. OVC services such as psychosocial support for families and symptom
management promotes ARV adherence. Home based care programs will be implemented by a number of
indigenous NGOs, CBOs and FBOs. Sub-agreements will be coordinated with other EP IPs to ensure non-
overlap of funding and services. Services are co-located with TB DOTS centers and ACTION staff work with
sites to ensure coordination systems are in place. High quality laboratory services supported by an ACTION
facilitated laboratory QA program are available at sites. This will include EID available in all catchment
areas (see lab narrative).
OVC services are offered to HIV positive infants and children, children orphaned by HIV, caregivers of OVC
and HIV/AIDS affected families. Doctors, nurses, social workers, care givers, teachers, family members and
other health workers in the public and private sector are targeted for training. Community groups including
CBOs, NGOs and FBOs will be targeted for training, linkages and identifying OVCs.
Emphasis is placed on training and human resources as capacity development for sustainability is a key
focus and much of the community linkages are through partners. In addition, community mobilization and
infrastructure development of CBOs/FBOs is critical for the identification and care of OVC.
This activity addresses the area of wraparounds as activities will strengthen/develop linkages between
HIV/AIDS services and other sectors for food resources. The activity also addresses the key area of stigma
and discrimination as training of health care workers and community volunteers will reduce stigma.
In COP08 ACTION will provide Counseling & Testing (HCT) services to 157,000 people at 121 points of
service (POS). $655,000 of COP07 reprogrammed funds will be applied against COP08 targets. HCT
services will be supported at 78 ART POS, 28 PMTCT and HCT sites, and 15 HCT stand alone sites for a
total of 121 service outlets in 23 states (Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo,
FCT, Gombe, Imo, Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun,
Plateau, Sokoto). With a mobile HCT van in 5 regions, ACTION will collaborate with indigenous NGOs to
offer testing to most at risk persons (MARPs) using a mobile strategy linking HCT to Condoms and Other
Prevention (C&OP) activities. HCT carried out at an additional 92 TB DOTS POS will be supported under
the TB/HIV program.
HCT services will be provided by trained counselors using the national testing algorithm and opt-out
approach in accordance with the national HCT SOP and testing strategy. The national "Heart to Heart"
branding logo will be utilized at all POS. Counseling and IEC materials will focus on abstinence, be faithful,
and consistent and correct condom use (ABC). In addition, IEC materials will include information promoting
couple counseling and counselors will be trained on partner based approaches to counseling. Discordant
couples will receive a package of services including safer sex behavior messages, condoms and
information targeting both positive and negative partners. This activity will be linked to PwP (prevention with
positives) as detailed in the Basic Care & Support narrative. Whenever feasible, client witnessed testing will
be carried out to encourage client confidence in the result. Intensive advocacy for implementation of HIV
testing by non-laboratorians has taken place, thus counselors will carry out rapid tests in most settings. To
ensure the quality of test results, laboratory program officers assist with training and a QA program focused
on rapid test monitoring is in place. Prevalence will be monitored regularly to optimize targeted screening of
populations with high rates of infection.
Posttest counseling for those testing negative will focus on prevention using a balanced ABC approach, and
partner testing will be encouraged. Based on risk assessment, a follow-up testing interval will be
recommended. Posttest counseling for those testing positive will include PwP counseling which also
includes balanced ABC messaging as appropriate. Counselors are trained to encourage disclosure to
spouse and sexual partners while addressing potential negative consequences of such disclosure. PLWHA
treatment support specialists are employed at ART treatment sites to ease the referral and linkages for
newly diagnosed clients. Newly identified HIV+ clients at free standing or community based HCT centers will
be linked to HIV care centers in the network.
Hospital-based HCT services will be provided in all tertiary, secondary and primary health facilities
supported by ACTION. These services will be available to all individuals within the institution and the
catchment area of the facility. HCT services will be emphasized throughout facilities, and particularly to
MARPs such as STI patients. Other strategies to increase access and target HCT in facilities will be the
training of health care providers to facilitate the provider initiated HCT approach. HCT staff will round
regularly on the wards to identify inpatients in need of HIV testing in collaboration with medical staff. For
those health facilities providing blood transfusion services, all potential blood donors will be offered HCT at
the facility and receive standard HCT services as part of pre-donation screening. In addition, HCT staff will
support DOTS center staff in the provision of HCT services to patients presenting for evaluation as detailed
in the TB/HIV narrative.
Community based mobile HCT services will be expanded, with one van based at each of the five ACTION
regional offices, to assist hospital based HCT teams that frequently provide HCT in the community setting
and to link HIV+ patients identified to the points of service. The M&E staff will compile data on rates by
target population and venue and use data to guide systematic screening strategies. Under COP06, the HIV
seroprevalence among clients tested in a mobile setting was 19.1% and this has risen to 27.5% in the first
quarter of COP07, demonstrating the ability to identify communities at high risk of HIV acquisition and
transmission. Another strategy to increase access to HCT outside of facilities is to train and equip HBC
teams to provide home-based HCT to family members of HIV+ HBC clients. In addition, 15 community
based testing sites will be developed through collaborations with indigenous NGOs and local public health
clinics. The NGOs will establish stationary HCT sites and utilize the mobile HCT van at truck stops and
other venues appropriate to access hard to reach MARPs as detailed in the C&OP narrative. Those testing
HIV+ will be linked to care within the network. MARPs testing HIV- will be linked to C&OP services offering
education, counseling, social support, and syndromic STI management.
The M&E system will be primarily ledger based to maximize time devoted to service provision and facilitate
services in the primary health center and community mobile settings. Aggregate data will be reported to the
ACTION regional M&E program officer monthly. A referral tracking system for HIV+ clients has been
developed and will be utilized. The quality assurance (QA) strategy for counseling will include posttest client
surveys, quarterly site monitoring visits using an existing quality assessment tool, and routine reviewing of
M&E data. A major metric of the QA process will be the percentage of positives entering care. Feedback to
sites will occur quarterly with targeted refresher courses and regional TA for those needing capacity
building. An extensive laboratory QA program (described under lab program area) is in place to ensure the
accuracy of HIV rapid testing. Test kits and disposables will be warehoused by ACTION and provided to
sites based on a pull system using site level inventory control systems linked to ACTION's logistics
management information system. The current system can be easily harmonized with the national test kit
logistics management information system and inventory control system once implemented.
Under COP07, a cadre of master trainers drawn from sites was developed. ACTION program staff and the
Master Trainers will use the National HCT Training Curricula and SOPs for regional and site level training.
Training will target staff from new and existing sites, ensuring that refresher training is provided and couples
counseling is integrated at all sites. A minimum of 3 staff from each HCT POS will be trained for a direct
target of 363. This target will include the identification and training of 30 new Master Trainers from the 5
ACTION regions. They will conduct step-down trainings to reach 5 additional counselors each for a total
indirect target of 150. Training to facilitate the provision of HCT at DOTS POS is described under the
TB/HIV Program Area.
This activity supports the national HCT scale up plan by promoting the accessibility of HCT services using a
FMOH approved training curriculum and procedures. HCT services are essential to identifying HIV+ people
Activity Narrative: to meet national prevention goals and the national ARV/HIV care scale-up goals. HCT services will target
most at risk persons to maximize this impact. The activity will support the FMOH and EP goal of having high
quality HIV testing available at all sites.
This activity is linked to care and support (3259.08), OVC (5417.08), ARV services (3255.08), condoms &
other prevention (9210.08), AB (15651.08), lab (3256.08) and SI (3253.08). PwP counseling and a
prevention care package will be integrated with posttest counseling for HIV+ persons. Access to care
services and ARV services will be provided. Other at risk family members including vulnerable children will
be identified through community based HCT approaches and referred to services. In appropriate settings,
testing will be carried out by counselors with training and oversight by ACTION laboratory staff. HCT sites
are incorporated into the laboratory QA program to ensure that HIV testing is of high quality.
This activity serves children, youth and adults in the general population who will be offered HCT. However,
special focus will be given to MARPs, including commercial sex workers, discordant couples, mobile
populations, partners/clients of commercial sex workers and those who abuse alcohol and other
substances. Training targets health care workers, counselors and community volunteers.
An emphasis for this activity is human capacity development as nearly all supported personnel are technical
experts who focus on this at the central and site level. Other areas of emphasis include local organization
capacity building and SI. This activity addresses the issue of stigma and discrimination since HIV
counseling reduces stigma associated with HIV status through education.
In COP08 ARV drugs will be procured so that ARV treatment can be provided to 55,057 adults (17,998
new) and 5,443 children (2,000 new) at 78 clinical sites in 23 states in Nigeria. $1.3 Million of COP07
reprogrammed funds will be applied against COP08 targets. Sites are located in states chosen consistent
with the National ARV Scale-Up Plan with the goal of universal access and include: Akwa Ibom, Anambra,
Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, and Sokoto. This support is an increase from the 44 ARV
treatment sites supported under COP07.
The first component of this activity includes forecasting and procurement of ARV drugs. It is estimated that
90% of patients begun on EP-provided ARVs will be adults and the remaining 10% will be children. Patients
on ARVs include those started on ARVs in prior years, patients in care who roll over into treatment, and
newly diagnosed patients needing ART. Overall, it is assumed that 8% of both adults and children begun on
ARVs during prior years will ultimately require second line treatment under COP08.
ACTION will follow the Nigerian ARV Guidelines in the provision of ARV regimens for adults and children.
The regimen mix has been forecasted based on current utilization and balancing best clinical evidence with
scalability. PEPFAR and FDA-approved generic formulations will be utilized whenever available. For all
regimens, a three-month buffer stock is maintained to minimize the likelihood of problems with drug
supplies. ACTION staff develop ARV projections, and plan procurements accordingly. In COP08 a minimum
of 50% of ARV procurement and shipping of has been budgeted for SCMS in order to provide support to
efforts to build a centralized capacity related to drug procurement and distribution. A standing open
purchase order for up to 50% has also been established with IDA Foundation as a backup. Based on
current drug unit costs, an additional 5% for procurement and 5% for shipping has been added to the
budget for both SCMS and IDA Foundation. Both SCMS and IDA inspect drugs for authenticity and test
selected batches prior to accepting for shipping. SCMS and IDA certify packaging and storage conditions
during shipping and provide insurance to the point of delivery at the frontier. Drug procurement will follow
USG regulations, National Treatment Guidelines, and comply with requirements for NAFDAC registration or
Although collaboration with the FMOH may facilitate some sites being provided with first line ARV
formulations through Global Fund support, the full cost of ARV drugs required to care for new and
maintenance ARV patients has been budgeted in the COP at this time. Should FMOH be able to provide
first line ARV formulations, targets will be adjusted accordingly, and ACTION will ensure access to
alternative first line and second line ARVs, pediatric formulations, and wrap around services including lab
monitoring. Similarly, collaborations with the Clinton Foundation may result in the procurement of pediatric
formulations and second line adult ARVs. In that case, a similar procedure will be followed. Coordination
with the FMOH to plan site targets will ensure a single comprehensive HIV care program although there
may be multiple ARV sources. The key principle adopted by ACTION is that all patients receive equal high
quality clinical, laboratory, and community services regardless of the drug source.
The second component of this activity includes expediting commodities through the port of entry, followed
by storage, distribution, and management of the commodities. This includes site assessment of pharmacies
and storage facilities with corrective recommendations and actions. Needed site renovations for proper
security and storage conditions in pharmacy stores will be undertaken by ACTION. Training of site
pharmacists for drug commodity management using a computer or card-based inventory control system at
the site level and training in proper drug storage will be carried out. Storage and distribution of ARVs,
maintenance of a site level commodities management system, and instruction to site staff regarding the
system, has been subcontracted to the Axios Foundation. Axios documents proper storage conditions at the
central warehouse, regional warehouse, and site levels. With an expansion of ARV access to community
venues including mobile clinics, local health centers, DOTS centers, and community pharmacies, logistical
management of ART drugs will require increasingly sophisticated monitoring strategies. The success of
such approaches is vital to increasing adherence and avoiding patient default which program evaluations
have shown is often linked to distance traveled from home to the ARV center.
Quality control involves routine monitoring visits by ACTION staff from the central Abuja office or from
regional offices to all sites every six months to review the implementation of SOPs and to compare reported
usage based on monitoring and evaluation data with local manifests and pharmacy logs. The ACTION
training department analyzes data for patterns of deficiencies as well as individual site deficiencies in order
to improve training and target weaknesses to address through retraining.
UMD has allocated $10,684,000 of its ARV Drugs budget to SCMS for procurement of commodities. This
amount is captured under the SCMS Drugs activity.
This activity supports the scale up of ARV treatment in Nigeria, a major priority for the FMOH. Through
these activities, ACTION will continue to strengthen the structure of its ART drug procurement system, in
accordance with PEPFAR goals in order to ensure cost effective and accountable mechanisms for drug
procurement and distribution. Furthermore, efforts to build local capacity through infrastructure building and
training mechanisms are consistent with PEPFAR 5-year goals to enhance the capacity of supply chain
management systems to respond to rapid treatment scale-up. Additionally, through procurement via SCMS,
ACTION seeks to provide support to efforts to build capacity related to drug procurement and distribution.
This activity also supports the ARV program for adults and children as well as the PMTCT program for
provision of ARVs to pregnant women and infants..
This activity relates to activities in TB/HIV (3254.08), ART services (3255.08), and strategic information
(3253.08). This activity will maintain significant linkages with PMTCT (3257.08) and ART services through
the procurement of ARV drugs for individuals served by these programs. Additionally, linkages to TB/HIV
activities will be developed and maintained. The supply chain management system will serve to provide
drugs to ART sites that are providing TB services in conjunction with ART services. SI activities will provide
crucial information for M&E as well as efficacy of the drug regimens, which may impact drug procurement
Activity Narrative: POPULATIONS BEING TARGETED:
The primary targets of these activities are health care workers, including program managers doctors,
nurses, and pharmacists who are involved in the drug procurement and distribution process. Furthermore,
by building mechanisms for drug procurement, these activities seek to target PLWHA, both adults and
children, who are in need of or already receiving ART care.
Human capacity development is an emphasis area. Training initiatives have been incorporated into these
activities in order to build the local human resource capacity to manage a sustainable drug procurement and
distribution system. Other areas of emphasis include the development of SI management, through M&E
activities, to provide feedback on the cost effectiveness of these drug procurement activities. SI
management also ensures accurate drug projections in order to prevent stock-outs.
ACTION will provide ARV services and lab monitoring to 60,500 individuals, including 55,057 adults (17,998
new) and 5,443 children (2000 new). In COP07 ACTION supported ARV services at 44 sites and under
COP08 will develop 34 more sites for a total of 78 sites: 28 tertiary or large secondary hospital "hub" sites,
25 smaller secondary hospitals, and 25 primary health centers (PHC) and DOTS satellite sites using the
hub-and-spoke model. $700,000 for COP07 reprogrammed funds will be applied against COP08 targets.
Sites will be located in 23 states (Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT,
Gombe, Imo, Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau,
Sokoto). Sites are chosen jointly with the GON to complement the national scale-up plan being supported
by Global Fund (GF) and other IPs. Services at PHC and DOTS satellite sites are provided using three
different strategies to ensure quality of care and network linkages: physician and lab assistant team travels
from the "hub" site on selected days; nurse-managed PHCs/DOTS with nurses trained using the IMAI
national curriculum; and physician/lab assistant team utilizes mobile site/van equipped with CD4 and basic
lab equipment to visit PHCs on selected days. An alternative model employs a physician or nurse-led team
with transport of samples back to the hub site for lab testing. The choice of best model will depend on
which one provides timely and high quality results with good patient adherence. In all models of community
outreach a portable pharmacy is employed to deliver ARVs to patients at the community level.
Currently, 9% of ACTION-supported ARV patients are children; this will be increased to 10-15% under
COP08. Pediatric ARV care will be expanded to all supported tertiary and secondary hospitals and selected
PHCs. ACTION will collaborate with GON to adapt and expand the IMCI curriculum to facilitate quality
pediatric ARV care at the PHC level. ACTION staff participate actively in National ARV Guideline
Committees. Guidelines for adults and pediatrics were updated in 2007 for consistency with WHO 2006
guidelines. A corresponding National ARV SOP has been developed. ACTION ARV services are in line with
GON guidelines. Non-ART and ART eligible clients will be enrolled into care and will receive regular clinical
monitoring including CD4 count. ACTION supports PLWHA support groups to facilitate adherence and to
provide IEC materials. All sites are supported to employ treatment support specialists - PLWHA who
participate in patient education, client advocacy, and home visits to track defaulters. All ARV clients receive
care services including prevention for positives activities (e.g., balanced ABC messaging, couples
counseling), ITN, water guard, malaria diagnosis/treatment, OI prophylaxis/diagnosis/treatment (including
TMP/SMX), pain/symptom medications, and psychosocial support including linkages to community and
facility-based support groups. Home based care programs provide linkages between the medical home and
PMTCT stand-alone points of service (POS) link to adult and pediatric ARV care through utilization of a
network PMTCT coordinator based at the hub site. A specific referral SOP is used to ensure that HIV+
pregnant women who require HAART for their own care are linked to an ARV POS. Leveraging support
from the Clinton Foundation for test kits and specimen transport, EID will be available at PMTCT POS under
COP08 to improve the identification of HIV+ children for linkage into ARV services. In addition, community
based testing of children will be carried out in the OVC program.
ACTION uses ART expertise to ensure high quality care using a two-pronged didactic and experiential
training approach. Using expert staff from established POS as resource persons, 320 staff (physicians,
nurses, counselors, pharmacists) from COP08 POS will participate in central or regional trainings on adult
and pediatric ARV care, adherence counseling, and/or pharmacy SOPs. All training will include approaches
for prevention for positives integrated into the clinic and community setting. Adapted IMAI/IMCI manuals will
be used to step down trainings for secondary, PHC and DOTS sites. The curricula used were developed by
ACTION and other IPs and are being harmonized into National curricula appropriate for training various
cadres. Bedside teaching is also a component of ongoing education. IHV/UMD adult and pediatric HIV care
specialists are posted in Nigeria as preceptors. In addition, a preceptor program brings volunteer physicians
with extensive HIV experience from other US and European institutions, and also uses expert on-site staff
as preceptors. ACTION has developed 3 regional training centers which are equipped with training venues
adjacent to large clinical care facilities where best practices are modeled. Following completion of the basic
curricula, staff spend two weeks at the regional training center participating in case conferences and
bedside teaching. As follow-up, preceptors are periodically posted to sites to ensure sustainability of high
quality care. A clinical training center in Abuja provides a model clinic that integrates physician, nurse,
treatment support, pharmacy and community outreach teams to provide experiential training in a holistic
model clinic setting in order to demonstrate feasible and functional strategies bridging community to care.
Metrics collected in the context of this model approach provide an objective measure for refining best
practices that can then be successfully introduced more widely.
ACTION supports 4 regional training labs (described under ARV Lab). These facilities will train 400
additional lab scientists working at GON and GF-supported sites (i.e., non-PEPFAR supported sites) in ARV
lab monitoring including good lab practices, HIV rapid testing, automated CD4, hemogram and chemistries.
This will serve to increase the quality and sustainability of ARV services outside of PEPFAR-supported
A clinical QA program in ACTION's Training Department uses objective measures of health care team
capacity based on knowledge assessment of individual providers, metrics from SI analysis, and onsite
observational assessment of clinical practice and community linkages. Collaboratively with the USG and
GON, ACTION carries out site program review visits. The QA program has site level clinical QA
coordinators assigned at each POS who perform structured periodic chart reviews that are incorporated into
the QA assessment process. Site level CareWare aggregate data is evaluated and feedback provided.
ACTION supports training of medical officers in IAPAC and GALEN certification as HIV specialists and other
clinical staff in expanded support roles under the treatment team concept. Based on gaps in knowledge
identified the Training Department refines/updates training materials for new and ongoing training activities.
ACTION will also facilitate and actively support onsite standardized HMIS using GON forms and National
electronic platforms and will provide onsite assistance with data management and M&E to guide quality
Sites are supported to carry out renovations to ensure clinic facilities are adequate and particularly that
pharmacy store and dispensing areas are able to store ARVs consistent with manufacturer guidelines.
ARVs are procured as described in the ARV drugs narrative. ACTION will partner with Clinton Foundation
and GF as appropriate to leverage resources for providing ARVs to patients. In this scenario, ACTION
provides pharmaceutical commodity management and ensures access to alternative first line and second
Activity Narrative: line ARVs, pediatric formulations, and wraparound services including lab monitoring and high quality clinical
care. Coordination with the FMOH to plan site targets will ensure a single comprehensive HIV care program
although there may be multiple ARV sources. Additionally, sites receive training, a standard SOP, and
emergency prophylaxis starter kits for post-exposure prophylaxis to address occupational HIV exposure of
health care workers.
UMD has allocated $3,086,000 of its services budget to SCMS for procurement of commodities.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
At the end of COP08 ACTION will be providing ART services to 60,500 people, contributing to
GON/PEPFAR targets for Nigeria. ACTION will build the skills of at least 720 care providers thus
contributing to national sustainability plans.
This activity is linked to drugs (5429.08), HCT (5426.08), HVOP (9210.08), OVC (5417.08), HBHC
(3259.08), TB/HIV (3254.08), PMTCT (3257.08), lab (3256.08), and SI (3253.08). Patients on ART will be
linked to home based care and support and community and social services. TB/HIV linkages will be
strengthened; all HIV infected patients will be screened for TB using the National algorithm. ACTION will
also provide onsite assistance with data management and M&E to guide quality improvement. HCT
targeting MARPs is established proximate to ARV POS. Using a network model, linkage to ARV services for
HIV+ women identified through PMTCT and HIV-infected infants are in place. Quality lab services supported
by an ACTION-facilitated lab QA program are available at comprehensive sites while manual lab methods
or specimen transport systems will be established for primary health center satellites.
ARV services are offered to HIV positive infants, children and adults living with HIV/AIDS. Doctors, nurses,
and pharmacists are targeted for training in both the public and private sectors. Health workers and
laboratorians at non-PEPFAR supported sites will be targeted by offering dedicated central ARV training.
An emphasis will be placed on human capacity development through training and local organization
ACTION will support ARV Services, BC&S, OVC, TB/HIV, PMTCT, and HCT programs by building lab
infrastructure and training staff to accurately diagnose, stage and monitor patients. ACTION will monitor
laboratories through its QA/QC activities to ensure high quality results while upgrading the infrastructure at
new sites. A minimum of 1,057,434 lab tests will be performed in COP08. ACTION will continue to be at the
forefront of EID scale up and expanded viral load testing for adults based on an algorithm being evaluated
with the FMOH. $350,000 of COP07 reporgrammed funds will be applied against COP08 targets.
ACTION will support lab services at 151 individual points of service using a network model to provide
appropriate lab capacity and patient support at comprehensive sites as well as HCT stand alone and DOTS
sites. An integrated tiered referral lab network with mentoring by trained lab personnel in existing hub sites
has been established. This includes the use of appropriate technology at all service levels, using the USG-
PEPFAR Lab Technical Working Group equipment platform as a guide. At the tertiary or large secondary
hospital level, 28 network reference or hub labs provide high throughput hemogram, clinical chemistry, and
CD4 assessment services. Ten of these provide virology services and 3 of these provide TB culture. At the
small secondary and primary level, an additional 25 labs provide patient monitoring and diagnostic
capability including HIV rapid testing, hemogram, and CD4 count. Thus, a minimum of 53 labs will have the
capacity to perform HIV testing and CD4 measurement (26 tertiary, 18 secondary, nine primary). At 25 other
sites where ARV services will be provided, labs are equipped to provide HIV rapid testing, hemogram
(including lymphocyte count), and collect/package samples for transport to a more advanced lab in their
network. Novel approaches for access to lab services such as five mobile laboratories on HCT vans will be
piloted to provide high quality on-site lab services to small PHC sites. Services at HCT stand alone and TB
DOTS points of service are limited to HIV rapid testing. This approach facilitates the rapid scale up of ART
services at all tiers of health care facilities.
ACTION has 23 local lab program staff assigned to six units (Field Operations and Commodities, Special
labs, QA/QC, TB, Training and Maintenance) and five regional offices. ACTION has an aggressive QA/QC
program with specially trained lab staff dedicated to carrying out on-site quarterly monitoring, retraining, and
overseeing a proficiency panel testing program. QA monitoring is carried out jointly with the FMOH or
SMOH responsible for the point of service. Tools and expertise will continue to be shared with other IPs and
with the GON and technical support will be provided to the Medical Lab Science Council of Nigeria
(MLSCN). ACTION has expanded site lab capability to screen for Hepatitis B, to diagnose additional OIs
such as Cryptococcus, and screen for common STIs including syphilis. TB culture capacity has been
developed at three of ACTION's sites using the Bactec system. The microscopic observation drug
susceptibility (MODS) assay will also be piloted at these sites and is described under TB/HIV. ACTION will
coordinate with Global Fund supported initiatives in the roll out of TB culture capacity in Nigeria to maximize
Eight regional virology laboratories in seven states (Sokoto, Kano, Plateau, FCT (two), Edo, Anambra, and
Akwa Ibom) have been established by ACTION. Under COP08, one additional virology lab (Gombe state)
will be developed for a total of nine. These laboratories focus on EID regionally using the DBS collection
method described under PMTCT. ACTION has played a key role in the EID roll out in COP07, utilizing the
ACTION training and reference lab at PLASVIREC to provide QA for the national EID pilot and providing
training in proper DBS collection and transport. All PCR labs supported by ACTION will participate in the
CDC DBS DNA PCR proficiency program. ACTION is actively collaborating with the Clinton Foundation
(CF) and the FMOH to develop EID SOPs and is carrying out testing of samples from sites that are
geographically proximate including those supported by other IPs, GON, and the Global Fund. The CF also
supports procurement of DNA test kits and DBS collection supplies and transport of specimens/results. In
addition to EID, virology labs carry out viral load for selected patients identified through a standard clinical
algorithm. Leveraging expertise in viral sequencing, ACTION will develop a HIV genotyping and drug
resistance testing facility in COP08 which will be readily accessible to the USG and other IPs and serve as
a regional resource for West Africa.
Four training laboratories have been developed as national resources by ACTION and placed zonally (FCT,
Kano, Edo, Plateau States). These laboratories are each configured with a didactic and a lab bench training
venue with standard equipment utilized at EP sites for CD4 measurement, hemogram, and chemistry as
well as teaching microscopes. The training laboratories are staffed with a master lab trainer and assistant,
but utilize local site lab experts to serve as resource persons for specific trainings to promote sustainability.
The regional lab training centers will be used to train personnel from new sites and offer refresher training
guided by QA results to staff from existing sites. Centralized trainings will include: Good Lab Practices
(GLP), HIV diagnosis, pediatric diagnosis, viral load estimation, CD4 staging, hematology, blood chemistry,
record keeping and storage. This is followed up by refresher trainings carried out at sites. 566 lab staff will
be trained. Training laboratories established by ACTION have been and will continue to be utilized by the
FMOH, public private partnerships, and other IPs for capacity development for national ARV scale up,
PMTCT, and TB priorities. These facilities will also be used to train200 scientists for ARV monitoring
(described under ART Services) and an additional 400 lab scientist from other organizations (not counted
under IHVN training targets). The National TB and Leprosy Training Centre in Zaria (Kaduna State) is
supported by ACTION, and serves as a fifth training lab supporting the National TB and Leprosy Control
Programme. This facility and the regional training laboratories will provide training for 594 TB DOTS staff
and 28 physicians as direct targets (described under TB/HIV).
ACTION will work with the USG and MLSCN for accreditation of 18 laboratories. Regional labs and those
critical to PHEs will be the first to be accredited. Through the PEPFAR lab working group (LTWG) ACTION
will work with the MLSCN to integrate its QA/QC activity into a sustainable national QA program including a
national EQA program. For procurement of lab reagents ACTION will utilize SCMS and local vendors.
ACTION maintains a warehouse and distribution system in-country. To maintain lab equipment, ACTION
has two biotech engineers on staff who provide training, installation, routine preventive maintenance,
trouble shooting and regular calibration. The availability of spare parts and back up equipment at ACTION's
warehouse in Abuja allows for prompt response to site needs. PEP is available at all ACTION supported
labs. Waste management and disposal, including TA to sites on procurement of a proper incinerator, is a
key component of training and site activation.
Sites are located in states consistent with the National ARV Scale-Up Plan with the goal of universal access
to HIV services. They include: Akwa Ibom, Anambra, Bauchi, Benue, Cross River, Delta, Edo, FCT, Gombe,
Activity Narrative: Imo, Jigawa, Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto.
EID regional availability will strengthen PMTCT, OVC and ARV Services. Testing for OIs will strengthen
BC&S. Regional training and Virology laboratories established by ACTION will support other IPs,
particularly for PMTCT and ARV. ACTION will train lab personnel and healthcare providers from TB labs of
other IPs and FMOH DOT centers, strengthening both HCT and TB. Through Public Private Partnership,
private industry supported labs benefit from ACTION's training and QA/QC program. These activities will
provide essential lab services to people living with HIV/AIDS, HIV positive pregnant women, HIV positive
infants, and HIV positive children. The QA/QC program of ACTION will strengthen the overall quality
initiatives of the GON.
These activities will be linked to activities in PMTCT (3257.08), OVC (5417.08), ARV Services (3255.08),
Blood safety (3258.08) and SI (3253.08). Tests for opportunistic infections and training in theses techniques
will strengthen BC&S (3259.08), HCT (5426.08), and HIV/TB (3254.08). ACTION will collaborate with the
Clinton Foundation in EID and pediatric ARV scale up.
These activities will provide essential lab services to people living with HIV/AIDS with or without co-infection
with TB, HIV+ pregnant women, HIV+ infants, and HIV+ children. Lab workers will benefit from the Lab
Training centers and developed SOPs and training curriculum. As part of a Public Private Partnership,
industrial health care providers will benefit from ACTION's training and QA/QC program.
An emphasis for this activity is human capacity development for sustainability through in-service training,
supportive supervision and quality assurance/improvement for laboratorians. Also emphasized is
infrastructure development through lab renovations for new sites, local organizational capacity building, and
ACTION will strengthen Strategic Information (SI) under the "One M&E Framework" by supporting
standardized HIV program reporting systems and Health Management Information System (HMIS)/Patient
Management Monitoring (PMM). In COP07 ACTION is supporting SI activities in 121 sites in 23 states
Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto). In COP08 it is
expected that ACTION will support SI activities in 151 sites in 23 states, including 78 ART and full service
sites, 28 PMTCT/HCT sites, 15 HCT only sites, and 30 DOTS sites providing HCT services.
Effective use of paper-based data (using national paper-based systems) and electronic data will be
promoted in clinical, laboratory, and pharmacy settings to enhance the enrollment, follow-up, assessment,
and referral/linkages to other services (e.g. TB, STI, home-based care, etc.) for all clients in HIV care.
National registers and data tools will be used at all service delivery points. Funds will be used to provide
information technology (IT) infrastructure and CAREWare at ART sites with capacity for automation. For
ART sites where there is other donor support, data collection and indicator reporting will be harmonized and
one reporting system will be used in accordance with the national guidelines and indicators. Evaluations
using data collected through facility-based services and community-based services will be performed to
provide evidence-based decisions for program quality, impact, and effectiveness. A goal of these
evaluations is to better integrate the outputs of SI data into clinically relevant reports that will facilitate
patient management and encourage improved data recording by clinical staff. Continuous quality
improvement (QI) (HIVQUAL) will be implemented in coordination with USG at all points of service where
appropriate. This will provide readily available quality metrics and individual patient data to site staff which
will enhance site staff investment in the M&E process.
To this end the ACTION SI team is working with HRSA to facilitate direct download of laboratory data
electronically from laboratory equipment rather than depending on manual data entry of electronic
information. Reports that record serial laboratory data in tabular or graphic form will strengthen patient care
practice by streamlining data reporting in a user friendly fashion. Additional means of developing site-based
tools to promote accurate laboratory data reporting to support patient care and treatment is vital to QI and
where possible clinical data to support patient care at the site such as through CAREWare will be
emphasized. This data will also be employed to monitor loss to follow-up, treatment adherence and other
key metrics of clinical quality that will guide improved assessment, training, retraining and help define best
practices and strategies.
ACTION conducts quarterly data analysis meetings at each supported site to ensure data quality and
provide recommendations for improvements. On-site TA with more frequent follow-up monitoring visits will
be provided to address weaknesses when identified during routine visits. Randomly selected individual
patient records will be reviewed across tools as one method of assessing accuracy. Data quality
improvements at the local level supported by ACTION will ensure accurate data provision to the Nigerian
National AIDS surveillance and information system as well as state and local governments.
Since 2000, with support from CDC, ACTION assisted the Federal Ministry of Health (FMOH) in developing
and implementing the National PMTCT Monitoring Information System (PMTCT MIS) in Nigeria. ACTION
will continue to technically support the GON as needed in software maintenance of the national system and
will continue to work with GON on a mechanism to align the PMTCT MIS and PMM systems effectively to
improve follow-up and continued care for HIV-infected women and their exposed infants.
In addition, ACTION facilitates the provision of site level data to SACA and SMOH for state level
surveillance activities. ACTION is engaged in providing TA to the State ACTION Committees on AIDS
(SACAs) and State Ministries of Health (SMOH) in the implementation of the Nigerian National M&E System
(NNRIMS). SACA and SMOH staff are invited to every SI training activity supported by ACTION that takes
place within their states. TA through joint field monitoring visits will also be explored. Each ACTION state
level point of service has a representative to the SACA. State level data for the NNRIMS is reported by the
SACA to the National Agency for the Control of AIDS on AIDS (NACA). In addition to state level support,
ACTION SI staffs collaborate on a regular basis with NACA and NASCP on development and review of
National data collection tools and guidelines. It is anticipated that the USG-supported VOXIVA system will
complement the NNRIMS when the VOXIVA web-portal becomes operational. ACTION will support the
implementation of this system at appropriate points of service. Additionally, ACTION will ensure the
reproduction and distribution of NNRIMS and patient registries at supported sites. The SI team will continue
to be active participants on the SI working group established and coordinated by USG-Nigeria.
ACTION program staff will provide training to 369 individuals in monitoring and evaluation (M&E),
surveillance, and HMIS. Trainees will include record clerks, M&E officers, clinicians, pharmacists, nurses,
laboratorians, NGO staff/counselors. Emergency Plan (EP) funding will be used to train health care
providers and medical data personnel on data collection, data use and reporting. Site level M&E staffs are
hired through the hospital or health center personnel system. While sites are asked to provide for M&E
staffing, temporary staffing support is available to new sites that must agree at program initiation to list
these staff in the budget request for the institution for the next fiscal year. Dedicated M&E program staffs
are posted at ACTION regional offices to implement site data quality control/quality assurance activities. In
addition, program staffs are based at larger treatment sites to ensure accuracy and completeness of PMM
data. In COP08, ACTION will hire additional SI program assistants to facilitate development and refinement
of M&E materials and provide support in the development and establishment of a systematic procedure for
patient monitoring and evaluation including collecting, collating and reporting data tracked by the ACTION
Nigeria program. An SI staff member will be dedicated to public health evaluations as listed below.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
Strengthening SI will enable timely, transparent, and quality data reporting of substantial portions of 2008
EP targets for Nigeria and will, through collaboration with the GON, establish one standardized system to
monitor the National HIV program. Planned public health evaluations (PHEs) will guide decisions in
improving program implementation and scale-up and will be defined and coordinated with the USG team in-
country. The following PHE are proposed (funded under their respective program areas): evaluation of the
referral system at the National TB Training Center, Zaria; capacity for early diagnosis of TB and MDR-TB in
the current scale up (TB/HIV); mobile radiography for TB diagnosis (TB/HIV); improving loss to follow-up
through the PMTCT cascade for HIV+ women and their infants; evaluating care outcome of HIV/AIDS
Activity Narrative: services at primary health centers utilizing trained and mentored Nurses or Community Health Officers
Of interest is evaluating barriers to care and access to care for HIV positives identified and referred through
HCT. ACTION will work to promote effective use of patient data by care providers to ensure best practices
of HIV care. These activities will contribute to improved use of information strategically at all levels. This
activity also contributes to Nigeria's 5-Year National Strategic Framework's (2005-2009) emphases on
documenting best practices on ART, HCT, PMTCT, OVC, etc., on information linkages between sites and
services, on one standardized reporting framework, and on program evaluations through increased
involvement of local evaluation officers.
SI activities are cross-cutting and relate PMTCT (3257.08), blood safety (3258.08), AB (15651.08),
condoms and other prevention (9210.08), basic care and support (3259.08), TB/HIV (3254.08), OVC
(5417.08), ARV services (3255.08), and lab (3256.08). Linkages between these program activities will be
strengthened to improve efficiency and effectiveness of services in order to catalyze the formation of
networks of care.
This activity targets health care providers in best practices of information use and reporting. Provision of TA
targets host country government workers. HMIS and program evaluations target general population and
people affected by HIV/AIDS receiving services supported by the ACTION Project.
This activity includes an emphasis on human capacity development and SI.
This activity will look at gender equity trends within service sites by collecting data to show breakdown of
women and men receiving prevention activities, treatment, and care services and by analyzing HCT client
data to assess service uptake among couples/partners.
This activity is linked to the Counseling and Testing (5426.08), ART Services (3255.08), Basic C&S
(3259.08), PMTCT (3257.08), OVC (5417.08), and Other Prevention (9210.08) program areas.
ACTION will support the efforts of the Nigerian FMOH and nursing educational sector in strengthening the
skills of nurses for the national response to the HIV/AIDS epidemic in the country in line with the Health
Sector National Strategic Framework for HIV/AIDS. Nurses constitute the highest number of health care
workers in Nigeria and spend the highest number of hours with patients. However, there has not been a
specific program to address the weak nursing knowledge in HIV care that exists country wide. If adequately
trained and empowered to utilize learned skills, nurses could render more appropriate care for PLWHAs and
contribute meaningfully to mitigating the impact of HIV/AIDS as well as to sustaining the efforts supported
by the Emergency Plan. As the number of patients accessing ART services continues to increase without
an exponential increase in the number of doctors, especially in primary and secondary sites, doctors are
overworked and patient access to care is sub-optimal. With proper training, nurses can be utilized to
address the personnel challenges faced by ART sites.
This activity is aimed at establishing an HIV care nurse training program at the practice and nursing
education level to address the weaknesses that exist in the skill levels of nursing professionals in Nigeria in
a sustainable manner. This training will be tied in with an integrated care strategy being implemented at the
model HIV Clinical Training Clinic at University of Abuja Teaching Hospital at Gwagwalada. The care model
employs a care team strategy that upgrades the role of the nurse in care provision and frees the physician
to address patient management challenges rather than focusing on onerous paper work. A care team
consisting of a physician, several nurses, adherence counselors, and pharmacy staff work together to
facilitate efficiency and quality of patient care. A community liaison links the team and the patient to
community-based services targeting improved treatment access, adherence, nutrition, safe water and home
-base care. Evaluation of this model and expanded training of other sites in an evidence-defined care
model will help shape policy for operationalizing the IMAI/IMC approach.
In COP07, ACTION collaborated with FMOH, Nursing & Midwifery Council of Nigeria and other USG
partners, LMS in particular, to develop a standard HIV/AIDS curriculum for nurses in practice. A pilot TOT
was conducted for 45 trainers drawn from different facilities at all tiers of the healthcare system. Under
COP08, this training will be rolled out regionally to nurses in practice. In addition, the curriculum will be
adapted for incorporation in the standard education of nursing students country-wide and a pilot training for
nursing instructors conducted.
The standardized curriculum, developed through a South-South collaboration with Ethiopia, was developed
under COP07 for the training of nurses in practice. The curriculum was crafted to focus on specific skills
sets and knowledge needs identified by the Nursing and Midwifery Council of Nigeria and Nigerian nursing
educators. The curriculum incorporates the FMOH/NACA adopted IMAI/IMCI approach to HIV/AIDS care
with emphasis on such nursing skills as: aseptic technique, injection safety, universal precautions, nursing
triage, nursing assessment, follow up of stable ARV patients with prescription re-authorization, monitoring
for ARV adverse effects and treatment efficacy, adherence/general counseling, and linkages with
community care and other services. In addition, HIV palliative care is emphasized including treatment of
minor ailments (such as thrush, malaria, and diarrhea) using standing orders developed and approved by
supervising physicians. Through the training, nursing skills are enhanced to provide counseling for
prevention, HCT, disclosure/partner notification and other support services. As many of these skills are
transferable, the ability of nurses to manage and care for patients with other chronic disease conditions is
Under COP08, the 45 Master Trainers trained in COP07 will be supported to conduct 5 regional trainings
targeting 150 nurses drawn from mostly primary and secondary health facilities within the ACTION "Hub
and Spoke" and Global Fund "cluster" networks. Both trainers and trainees will be certified and earn
continuing education credits which the Nursing and Midwifery Council will be encouraged to consider as a
requirement for license renewal for those in practice. This will foster a culture of professional development
for Nigerian nurses. The IHV-Nigeria Training Department will oversee assessments and monitor for quality
and coordinate and strengthen training materials and activities.
Through advocacy by ACTION, the USG, and others, the Nursing and Midwifery Council of Nigeria has
mandated nursing schools to include HIV/AIDS nursing in their training curricula and has identified the need
to standardize the content of these curricula. The HIV/AIDS nursing training curriculum developed under
COP07 will be adapted by the Council as the model curriculum for HIV/AIDS nursing education under
COP08. ACTION will support meetings with key stakeholders to carry out the adaptation for nursing
students and support an initial pilot TOT for 25 nursing school faculty. In addition, nursing school
administrators will be encouraged to incorporate clinical rotations at ACTION and other IP supported
hospital and community based sites into their curriculum to enhance hands on experience for students. One
-hundred and seventy five people will be trained as part of this activity. Management structure and logistics
for the training program will be through USG funding to LMS (#6383), who will also lead the expansion of
the fellowship design for other health care workers.
ACTION currently supports ARV services at 44 sites and will develop 34 additional sites under COP08 for a
total of 78 sites structured under a hub and spoke network model. Twenty-eight hub sites are affiliated with
25 smaller secondary hospital sites and 25 additional primary health center ARV sites so that routine care of
stable patients can be available at the community level. These primary health center sites already have
established referral relationships with existing ARV sites at the secondary or tertiary level and will be
strengthened under COP08 to provide ARV in a more accessible location. Most of these sites are staffed
by nurses. ACTION anticipates that at least half of the primary health centers will be developed as "nurse
managed" ART sites with oversight from the affiliated hubs. These are ideal settings where this training
could be focused initially. The fellows will not be limited to Action supported sites, as the program is
designed to provide supports across PEPFAR and beyond. The states will also be broad and expanding
with the eventual objective a national training designed for support to a range of facility types with
Sites were selected in line with the National ARV Scale-Up Plan with the goal of universal access. They
include: Akwa Ibom, Anambra, Bauchi, Benue, Cross Rivers, Delta, Edo, FCT, Gombe, Imo, Jigawa,
Activity Narrative: Kaduna, Kano, Katsina, Kogi, Kwara, Lagos, Nasarawa, Niger, Ogun, Osun, Plateau, Sokoto.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Curriculum development and implementation will lead to capacity development at the site level and nursing
schools. This is consistent with national guidelines to ensure sustainability. ACTION staff will ensure that
there is a step down training with trainees from various hospitals using the Training Centers in Benin, Kano ,
Jos and Abuja. The GON and other IPs will also utilize the curriculum and other trainers developed to
further step down the trainings with development of a cohort of trainers across the country.
This activity focuses on training, as capacity development for sustainability is a key focus. This activity also
focuses on training curriculum and module development, provision of additional training resources for
trainers and trainees for step down training in hospitals, and human resources, as manpower shortfalls to
address HIV care needs will be addressed. This activity addresses "Twinning" as a South to South
partnership with another African country was utilized to develop the curriculum.