PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
By the end of COP08, the Global HIV/AIDS Initiative Nigeria (GHAIN), through collaboration with the
Government of Nigeria (GON) and Faith Based Organizations (FBOs), provided prevention of mother to
child transmission (PMTCT) services at a total of 168 PMTCT sites in all 36 states and the FCT, exceeding
the USG-PEPFAR target of 88. This was accomplished through the PEPFAR funding to support 88 sites
together with resources leveraged from Global Fund (GF).
In COP 09, GHAIN will maintain its PMTCT coverage in all 168 existing PEPFAR and GF supported sites.
The leveraged support from the Global Fund is expected to continue throughout the COP09 timeframe,
allowing for a sustained support of PMTCT services at all the sites. In COP09, GHAIN will reach 120,000
clients with PMTCT counseling and testing services (including results) with 4,000 receiving ARV
prophylaxis. PMTCT services will continue to be integrated into antenatal care (ANC) at the primary health
care (PHC) level which serves as an entry point to HIV/AIDS prevention, care and support services for
mothers, their infants, family members and the community. This is in line with the minimum package
stipulated by the Government of Nigeria (GON) and the USG strategy to provide PMTCT service coverage
at the LGA level; initially in states with high prevalence and in facilities with a high volume of ANC clients. In
addition to the over 400 health facility staff trained in COP08, 325 health care workers (HCWs) will be
trained and re-trained in COP09 in collaboration with other stakeholders (especially UNICEF) using the
National PMTCT training curriculum with additional modules on RH and infant feeding counseling (IFC). To
ensure effective decentralization and increase in coverage at the LGA level, the experience and lessons
learned from piloting the HAST (HIV/AIDS, sexually transmitted infections/reproductive health and TB)
model of providing integrated services at the LGA level in Kano and Cross Rivers states will be utilized.
Community volunteers identified by CBOs and NGOs will be trained using a specially modified national
PMTCT curriculum that incorporates reproductive health (RH) modules to render minimum PMTCT services
(linkages and referrals, awareness and demand creation for PMTCT) appropriate to their level of care.
Referral from the PHC level to secondary facilities will be provided when the need arises for higher quality
care and treatment.
GHAIN will lay emphasis on strategic prevention activities to promote options such as partner notification
and testing, treatment support and community outreach activities to cluster ANC clinics and delivery
facilities. Emphasis will also be laid on the counseling on infant feeding options (exclusive breast-feeding for
six months or breast milk substitute if Affordable, Feasible, Acceptable, Safe and Sustainable - AFASS).
Additional emphasis will be laid on the sensitization and training of traditional birth attendants (TBAs) using
the national TBA training curriculum to develop skills in conducting safe delivery practices and recognizing
early signs of obstetric complications. They will be supervised and monitored by trained health workers in
order to ensure that they refer all potential complications and HIV-positive pregnant women to the hospital
for quality and safe obstetric care/practices. They will also be used to raise awareness and create demand
for PMTCT and be linked to facilities through the GHAIN referral network. TBAs will be linked to GHAIN-
trained community pharmacists who will ensure increased access to prophylactic drugs for their HIV-
positive clients and exposed babies. This will lead to the expansion of the GHAIN network of services
through collaboration with these non-formal health service providers. Conversely, the formal health care
providers in the 168 supported facilities will be trained in line with the national PMTCT training curriculum
modified to include RH modules. This activity will strengthen the second prong of core PMTCT, which is
aimed at preventing unwanted pregnancies amongst women/couples who are HIV-infected.
To address gender issues and generate greater male involvement in PMTCT services, couple counseling
will continue to be included in the PMTCT/RH integrated trainings. This will lead to improved service
delivery, and adherence to interventions. The introduction of this new strategy into the program will further
bridge the gap of the challenges of partner disclosure and the negative consequences (domestic violence,
divorce and abandonment) that have occasionally been noted in discordant couples. Using a family-
centered approach, PMTCT service providers will promote partner testing as well as testing for any other
children in the family. In addition, the family will be encouraged to enroll all their children into OVC services
and, for those children who are HIV positive, into the facility-based pediatric care and treatment program.
Quality PMTCT service provision will be extended to clients in COP09 in line with updated
recommendations and evidence-based best practices. Project activities will be tailored towards: improving
the quality and use of Maternal Child Health (MCH) facilities; sensitizing and mobilizing communities to
create demand for PMTCT services; ensuring that routine point of service HCT with ‘opt out' option is
offered to all women presenting in ANC, labor and delivery wards and the family planning units while
encouraging male involvement; and ensuring that antiretroviral (ARV) drugs are offered to HIV-positive
pregnant women. PMTCT prophylaxis or ARV treatment for the mother's own health will be provided
according to the national guidelines. Postpartum interventions for exposed infants will be provided and
include single dose nevirapine within 72 hours of birth and zidovudine syrup for 6 weeks. CTX prophylaxis
is commenced from six weeks after birth until the child's HIV status is determined, utilizing the national
guidelines as the basis for treatment decisions. HIV testing of all partners of pregnant women will be
actively encouraged and women/couples counseled and linked to family planning services as needed. This
will be ensured through the continuation of the GHAIN supported RH-HIV integrated services. All clients
who are tested will receive results on the same day. Those who test negative to HIV will receive posttest
counseling on how to remain negative. Positive and discordant couples will be given the prevention for
positives package and provided information or referrals to address their future fertility desires (family
planning services) as well as HIV care and treatment services. Furthermore, possible scale-out of the
distribution of nevirapine pouches for exposed infants delivered outside supported facilities will improve
access to prophylaxis to these exposed infants and also strengthen the link between PMTCT and MCH
services by strengthening referrals. This will also provide opportunity for continuous counseling to couples
including prevention strategies for positives and discordant couples. GHAIN will utilize lessons learned and
best practices from other programs in ensuring that more HIV-positive mothers delivering outside health
facilities have access to single dose nevirapine in labor.
Mothers' support groups will also be used to track and support mother-infant pairs and other family
Activity Narrative: members in the communities and link them to care. GHAIN will continue to train lay counselors to provide
counseling services to pregnant mothers, thus reducing workload and burnout of regular counselors. Other
activities will include encouraging male involvement by using trained community gate-keepers to sensitize
the community with a special focus on men; encouraging men to accompany their wives to the clinic, and
ensuring that holistic services are offered to HIV-positive pregnant women and their families. Positive
pregnant women identified at the PHC level will have their CD4 done at a linked secondary facility through
sample referral. Identified HIV-positive women will subsequently be followed up at an HIV comprehensive
care center to ensure continuity of care. CD4 testing will be prioritized for pregnant women to identify those
who require ART for their own health. In addition, CTX prophylactic therapy will be provided for HIV-
positive pregnant women as indicated in the national guidelines. PMTCT services will also be geared
towards ensuring that safe obstetrical practices and universal precautions are implemented in labor and
delivery rooms.
Funding will address capacity building of health care workers on counseling, strengthening linkages with
Early Infant Diagnosis services (EID, supported under pediatric care and treatment) and support to families
on infant feeding options in accordance with the mother's choice and the national guidelines on infant
feeding. GHAIN will train and re-train pharmacists on pharmaceutical care, pharmacy best practices and
adherence counseling in PMTCT sites while collaborating with the community pharmacists to expand the
reach and quality of services at the LGA and community levels.
Joint GON/USG/GHAIN supportive supervision will be carried out to all the sites on a quarterly basis, in
addition to regular onsite mentoring and support of the sites by the FHI/GHAIN technical team. Appropriate
tools for program monitoring including National PMTCT registers will be provided to all the sites while
monthly DQA will be carried out in collaboration with the relevant state and national bodies. Feedback will
be provided to the facilities and stakeholders through the monthly M&E meetings hosted at SACA offices.
The quality of services will be assured through facilitative supervision, M&E, QA/QI analysis and QA checks
using standardized national tools developed for this purpose. In line with the ‘3 ones', GHAIN will
disseminate information through regular reporting to the GON via NACA and NASCP.
CONTRIBUTION TO OVERALL PROGRAM AREA
The scale-out of PMTCT services will significantly contribute to Nigeria's 5-year national strategic plan in
response to HIV/AIDS. This plan encourages pregnant women and their spouses to know their HIV status
with a view to reducing their risky behaviors and seek appropriate intervention and emphasizes referrals
and necessary linkages.
LINKS TO OTHER ACTIVITIES
The GHAIN supported PMTCT services relate to activities such as HVTB, HVCT, adult and pediatric care
and treatment and GHAIN supported RH-HIV integration program (supported by non-PEPFAR USAID
funds). The pregnant women attending PMTCT services and their children will be appropriately linked to
TB, ART, STIs, care and support, OVC, income generating activities, and other services according to their
needs, at the LGA level through the HAST model. There will be close collaboration with the referral
coordinators to ensure tracking of clients that are lost to follow-up.
POPULATIONS BEING TARGETED
This program will target pregnant women, ensuring that HCT (opt-out) is offered to all women presenting in
ANC clinics and in labor and delivery wards and TB patients that are pregnant. The activities will ensure that
ARV drugs are offered to HIV-positive pregnant women for PMTCT prophylaxis and/or for their own health,
utilizing national guidelines as a basis for treatment decisions. Exposed infants will be followed-up to
ensure referral for HIV early infant diagnosis testing using dried blood spots (DBS) in line with the National
Early Infant Diagnosis scale-up plan.
KEY LEGISLATIVE ISSUES ADDRESSED
This activity will strive to increase gender equity in HIV/AIDS programs. Male involvement in PMTCT will be
encouraged through sensitization, encouraging the male partners to know their HIV status and/or provide
support to their spouse. Opportunities will be sought to identify and work with other USG projects to
increase women's rights and increase women's access to income and productive resources.
EMPHASIS AREAS
Major emphasis will be placed on strengthening referral and patient tracking, while minor emphasis will be
on quality assurance, quality improvement and supportive supervision.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13034
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13034 3234.08 U.S. Agency for Family Health 6374 552.08 USAID Track $4,000,000
International International 2.0 GHAIN
Development
6706 3234.07 U.S. Agency for Family Health 4167 552.07 GHAIN $2,994,000
International International
3234 3234.06 U.S. Agency for Family Health 2771 552.06 GHAIN $2,408,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $25,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
In C0P 09 the Global HIV/AIDS Initiative Nigeria (GHAIN) will provide sexual prevention services, which
include Abstinence, Be faithful, and Condom use (AB & C) and Other Prevention by further strengthening
and supporting current implementing agencies across the country. In COP09, a combination of intervention
strategies will be employed by GHAIN such that every individual within the targeted groups will be reached
with a minimum of three interventions in line with the National Prevention Plan (NPP) minimum package
guidelines.
Abstinence only sexual prevention programs will be tailored to address 5,000 in-and-out of school youth
under the age of 15. GHAIN's sexual prevention strategies will include peer education (age peers), focus
group discussions (FGDs), and non curricula based approach (e.g., drama and HIV clubs) as part of the
minimum package. GHAIN will identify a minimum of 120 persons drawn from all project locations and equip
them with peer education and FGD skills as well as support them to form HIV clubs. Peer education will
equip selected volunteers to provide their peers with correct and complete information on HIV/AIDS
prevention while the FGDs and clubs will serve as avenues for message reinforcement and sensitization
activities using the ‘enter-educate' approach.
Sexual prevention programs with the "Be faithful to one partner" theme will target 12,727 adults using
religious gatherings (rallies), the identification of role models, and mass media approaches. In order to
achieve the above target and also contribute to the overall goal of reducing the incidence and impact of HIV
and AIDS in Nigeria, GHAIN will disseminate information on the importance of HIV counseling and testing,
partner reduction and mutual fidelity as methods of risk reduction. Faith-based community leaders and
organizations will be targeted with on-going advocacy to ensure that they reinforce correct and consistent
messages regarding HIV/AIDS prevention and stigma and discrimination, as well as promote health seeking
behaviors and address social norms and inequalities that increase vulnerability to HIV/AIDS. Religious
leaders will be mobilized and trained based on the GHAIN developed training and preaching content guide.
This will enhance their capacities to deliver HIV-related guided sermons weekly at churches and mosques.
Strategies for other prevention interventions include: FGDs, counseling and testing, condom messaging and
distribution, balanced ABC messaging, job (Female Sex Workers and clients, and road transport workers)
and social (Men who have Sex with Men - MSM) peer education, and income generating activities. The
strategy will also involve creating linkages to mobile counseling and testing (CT) and referrals to high quality
STI treatment services.
Peer educators will be used to reach most-at-risk populations (MARPs). This will be supported by targeted
audio and print educational materials and community outreach activities. Focus group discussions will
reinforce messages on the importance of correct and consistent condom use during every sexual encounter
with commercial and non-regular partners known to be HIV-positive, and between discordant couples or
partners whose status is unknown. Information regarding the critical role of HIV counseling and testing as a
risk-reduction strategy, the development of skills for vulnerable persons, the relationship between alcohol,
injecting drugs and HIV and AIDS, and the message that condoms do not protect against all STIs will also
be provided.
GHAIN will ensure that condoms are made available at over 88 sites, including counseling and testing sites
and brothels, by strengthening partnerships with the Society for Family Health (SFH) and United Nations
Fund for Population Activities (UNFPA) to obtain and distribute condoms. In addition, the project will explore
possibilities of additional product support from the Global Fund for AID, TB, and Malaria (GFATM), DFID
and other sources.
PLWHA, transport workers and men having sex with men (MSM) will be targeted for comprehensive
programming that includes programs in being faithful condom use and other prevention (OP) programs will
be. ‘Prevention with Positives' will be an important focus of sexual prevention programs in COP09.
Information will be reinforced on the importance of correct and consistent condom use during every sexual
encounter. GHAIN will train 165 persons on components of the above listed minimum package strategies to
promote HIV/AIDS prevention among MARPs, and a total of 69,545 persons will be reached through
specific population awareness, peer education models, workplace programs, provision of STI management,
and messages/interventions on vulnerability issues.
Experience has shown that individual behavioral-focused interventions are more effective when combined
with broader structural change at community and societal level. Through social mobilization and active
community participation, the program will address norms affecting the behavior of women/girls and
men/boys and inequalities between male and female roles that increase vulnerability to HIV/AIDS. GHAIN
will also mobilize communities to address norms/behaviors on cross generational and transactional sex,
promote increased male involvement in prevention activities, and timely health seeking behaviors. Issues of
stigma and discrimination will also be addressed in the intervention. Through community dialogue sessions,
members of target communities will exchange information face-to-face, share personal stories and
experiences, honestly express perspectives, clarify viewpoints, and develop solutions or responses to such
HIV/AIDS issues as stigma and discrimination, sexual transmission, medical transmission, and prevention
of HIV within positive populations. The major output of the community dialogue would be a critical mass of
advocates within each community who are well versed in HIV/AIDS and are working towards the reduction
and elimination of new HIV cases as well as stigma that fuels the epidemic. In addition, community based
organizations (CBOs), non-governmental organizations (NGOs), and influential individuals in the community
will be supported to provide age- and context-appropriate information with the aim of creating an enabling
environment for sustained behavior change. This will be implemented through training, ongoing mentoring,
and provision of technical assistance to build local capacity to design and manage innovative HIV/AIDS
programs.
GHAIN's secondary sexual prevention strategy will involve the utilization of multi media to support the
primary activities. This will entail the development and execution of multi-media campaigns, development
and distribution of SBC materials, and advocacy, capacity building, referrals, and monitoring and evaluation
of activities, as well as mentorship to implementing agencies.
Activity Narrative: Referrals and networks will be strengthened to ensure effective expanded access to clinical services for
MARPs, including referral for diagnosis and treatment of sexually transmitted infections (STI), TB (DOTS
Centers), reproductive health/family planning/PMTCT integrated services, and linking prevention services
for HIV-positive individuals to HIV treatment and care services, including counseling and testing.
COP 09 GHAIN activities will be guided by both the National Prevention Plan and National Behavior
Change Communication Strategy.
CONTRIBUTIONS TO OVERALL PROGRAM AREA
GHAIN will contribute to the overall United States Government (USG) strategic plan of building the capacity
of local organizations by working with local NGOs to carry out sexual prevention (SP) activities with MARPs
and other targeted groups in the general population. GHAIN will focus on building the capacity of local
implementing agencies to effectively carry out sustainable HIV prevention activities among MARPs,
including development and dissemination of strategic behavior communication materials, community
mobilization, condom use programs, peer education activities, counseling services, and referrals and
linkages, among other activities. The SP activities will in turn contribute to generating demands for
counseling and testing (CT) and prevention of mother to child transmission (PMTCT) services, which serve
as entry points for other services, such as antiretroviral treatment (ART) and palliative care. GHAIN will
provide support for the integration of appropriate reproductive health messages into SP programs for the
uniformed services and their dependants using non-PEPFAR funds.
As in all SP programs, activities will continue to be linked to other relevant services available in the
community. GHAIN IAs will work with the mobile counseling and testing team of GHAIN to locate and
strategically introduce services at areas identified to have concentrations of MARPs. People who test
positive will be referred for continued care along the continuum of care model. The referral coordinators of
GHAIN will record contact details of positive clients while maintaining strict confidentiality, for the purposes
of continued counseling, palliative care and contact tracking for tuberculosis (TB) screening and ART
services, if eligible. GHAIN will ensure high quality SP data through a sound information system that
precludes double counting and ensures accountability.
Beneficiaries of SP activities include youth (in and out of school), married couples, young adults, transport
workers, female sex workers, MSM, and PLWHAs.
SP activities will take into consideration gender issues related to HIV/AIDS programs through providing
equal quality prevention services without discrimination against sex, nationality, religion, creed, etc., as well
as a concerted effort to increase male involvement in HIV/AIDS activities. Strategic efforts will be made to
tailor prevention messages to match environmental requirements of target audiences. The activity will help
address male norms and behaviors while reducing violence and coercion toward females, through vigorous
campaigns to educate people on the benefits of couples' counseling and testing (CT) and mutual disclosure
of HIV status.
Sexual prevention interventions will de-glamorize social norms that promote high-risk practices such as
having multiple sex partners and sugar mummies and daddies (i.e., trans-generational sex). This will be
done by promoting images of successful, honorable and respected role models from within the communities
as being faithful to their partners. Role models will be identified and supported to promote fidelity and
discourage norms that promote coercion, cross generational sex, alcohol and substance abuse. While
emphasis will be placed on fidelity and condom promotion and distribution for MARPs, abstinence will be
stressed among in-school youth. Communication activities will also be geared towards social mobilization to
strengthen existing social, economic and political structures within the communities with an emphasis on:
training, information, education and communication; local organizational capacity development;
interpersonal communication/counseling; condom distribution; and STI management. GHAIN will continue
to strengthen the developed exit/sustainability plan for implementing agencies, both at the country and
program level, and at the individual implementing agency level to customize organizational specific plans
and schedules.
Continuing Activity: 15661
15661 15661.08 U.S. Agency for Family Health 6374 552.08 USAID Track $400,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $12,500
Table 3.3.02:
Continuing Activity: 13037
13037 3236.08 U.S. Agency for Family Health 6374 552.08 USAID Track $2,553,250
6707 3236.07 U.S. Agency for Family Health 4167 552.07 GHAIN $2,290,000
3236 3236.06 U.S. Agency for Family Health 2771 552.06 GHAIN $1,300,000
Table 3.3.03:
It has been estimated that 5% -10% of HIV infections worldwide are transmitted through the transfusion of
contaminated blood and blood products. In order to reduce the HIV epidemic due to unsafe blood
transfusions, this activity will continue to support the Government of Nigeria to implement the national blood
policy in USG-supported treatment sites. This activity involves institutional capacity development for blood
safety, universal safety precautions in handling blood and blood products, good laboratory practice and
management of medical wastes contaminated with blood or blood products.
By the end of COP08, GHAIN would have supported 30 sites and upgraded 4 model blood banks to
acceptable standards. During COP09, this activity will continue to provide support for 30 GHAIN-supported
ART sites. GHAIN will continue to support the sites empowered as model blood banks to prescreen blood
donors using the national donor questionnaire. Donors deferred will be offered full HCT. The collected
blood will be sent to the nearest National Blood Transfusion Service (NBTS) center for screening by ELISA.
It is hoped that 12,480 units of blood will be collected and about 80% of this (10,100 units), will be screened
for the four transmission transmissible infections (TTIs) through this linkage with the NBTS. These sites will,
in addition, conduct blood drives in collaboration with the NBTS. Blood collected from such donor drives will
be screened by the NBTS and distributed to sites for use. Pilot samples of blood screened with rapid test
kits for emergency transfusion will be sent to the NBTS centers for retesting by ELISA. All screening
services will be linked to pre and post test counseling services at each site. The National blood donor
questionnaire will continue to be used to screen all donors and the data submitted to the nearest NBTS
center as part of the national database.
This activity will continue to encourage blood donor drives in collaboration with NBTS centers and to
promote the principles of centralized blood transfusion services, voluntary non-remunerated blood donation
as opposed to paid donors/family replacement, and universal safety precautions. It will result in a reduction
in unnecessary transfusions, exposure to blood, and accidental injury/contamination. Additionally this
activity will provide essential consumables and services that protect the health worker from contacting
infections, especially HIV and hepatitis. These universal precaution materials include personal protective
equipment such as hand gloves, laboratory coats and other consumables which will continue to be provided
for the sites. In addition, each site will continue to make provisions for referral of staff for access to Post
Exposure Prophylaxis (PEP), which will be provided within the same health facilities, in case the need
arises.
GHAIN will support clinical meetings and seminars to medical professionals in supported sites to promote
rational use of blood and blood products. This will facilitate behavior change and compliance with the
National Blood Policy. Retraining and supportive supervision of health workers trained in COP08 will also be
done. A total of 28 health workers and waste handlers will be trained.
In order to maintain high quality laboratory results, GHAIN will continue to institute an aggressive QA/QC
program that involves on-site quarterly monitoring, retraining and proficiency in testing for the TTIs.
Blood safety will contribute to the overall program area by preventing transmission of HIV through
transfusion of blood and blood products. It will also contribute towards strengthening quality control
systems on the use of HIV test kits in the PEPFAR program.
Blood safety activity also relates to activities in HVCT, MTCT, and Adult and Pediatric care and treatment.
All deferred blood donors will be offered full HCT services after prescreening with the blood donor
questionnaire and the data are captured. Positive clients from emergency screening will be referred for
ART services using the GHAIN referral network system. GHAIN will continue to collaborate with other
partners to work with the National Blood Transfusion Service to develop a sustainable logistics plan for
continuous availability of voluntary non-remunerated blood donors (VNRBD) and fully screened blood so
that facility-level emergency screening will be minimal.
Blood safety activity targets youths, adult men and women who are potential blood donors. It will also target
health care workers for appropriate use of blood.
Major emphasis will be placed on human capacity building to link services with the NBTS on blood safety
issues. Minor emphasis will be placed on commodity and equipment procurement (test kits, equipment and
laboratory consumables), supporting emergency blood screening, and quality assurance/quality
improvement.
New/Continuing Activity: New Activity
Continuing Activity:
* Malaria (PMI)
* Safe Motherhood
Estimated amount of funding that is planned for Human Capacity Development $10,000
Table 3.3.04:
HIV infections are known to be transmitted through unsafe injection practices and medical waste disposal.
This program area supports training, waste-management systems, advocacy, and other activities to
promote medical injection safety. By the end of COP08, GHAIN would have conducted injection safety
activities in 60 comprehensive sites in 36 states and FCT. In COP 09, GHAIN will continue to support
injection safety activities in these facilities. A total of 240 health workers and waste handlers will be trained.
With technical assistance from John Snow Inc. / Making Medical Injection Safer (JSI/MMIS) project, GHAIN
will continue to apply all four major technical approaches of making injection safer to create an enabling
environment for health workers to provide quality services to clients without fear of medical accidents and
infections. The approaches will include on-site refresher trainings and capacity building, behavioral change
communication (BCC)/advocacy, procurement and supply of safe injection equipment, and health care
waste management.
GHAIN will continue to support JSI/MMIS and other USG policy partners in their efforts towards ensuring
behavior change of the communities through dissemination of the injection safety policy at the state level of
government, while focusing on ensuring behavior change of the health workers and clients towards making
medical injection safer in its supported health facilities. Strategic behavior communication (SBC) materials
produced by JSI/MMIS on injection safety will continue to be distributed to all GHAIN supported sites.
GHAIN will procure and supply safe injection equipment and other day-to-day consumables to GHAIN
supported sites within the limits of the available funding. GHAIN will continue to advocate to the facilities to
utilize the universal safety precautions in the disposal of medical waste, including use of sharp boxes, and
to support incineration of such medical waste through repairs, maintenance and provision of running costs
for existing incinerator facilities. Where incinerators are not available, GHAIN will construct incinerators
according to WHO standards. Health workers will continue to be encouraged to utilize the knowledge and
skills gained from the universal safety precaution and post exposure prophylaxis will be provided through
the ART unit. In each facility supported for injection safety activities, GHAIN will continue to focus on facility
saturation so that the entire health facility is injection safety compliant.
Injection safety will contribute to the overall program by preventing biomedical transmission of HIV and
other blood borne pathogens. Such activities will also improve the safety of the healthcare provider thus
leading to reduction of stigma to clients and making the clients feel safe and access the health system for
care and treatment of AIDS. This will result in an increase in the uptake of Counseling and Testing (CT),
Palliative Care (PC), Antiretroviral Therapy (ART), Prevention of Mother to Child Transmission (PMTCT)
and laboratory services, leading towards target achievement in all areas.
The GHAIN Injection safety program will relate to activities in Medical Transmission/Blood Safety, Sexual
Prevention activities, PMTCT, Counseling and Testing; Adult and Pediatric care and treatment services.
The linkages of all the above components will ensure compliance with principles of universal precautions
and impact not only the quality of care given to clients but also care and occupational safety of the health
care worker.
GHAIN in collaboration with JSI/MMIS will continue to provide injection safety on-site refresher trainings and
service aids to health care workers such as public health workers, doctors, nurses, pharmacists, laboratory
workers and waste handlers at the various points of service where such sharps are used, including
counseling and testing units, laboratory, phlebotomy rooms, wards, labor rooms, delivery rooms and
immunization clinics among others. Education on proper handling and use of sharps, including disposal
methods, will continue to be extended to health workers and clients outside the HIV/AIDS care arena to
enable them carry on such practices both in the health facility and even in their homes. This will add value
to the home based care of patients.
This program shall work to strengthen injection safety procedures across the GHAIN supported facilities
which will go a long way in reducing HIV/AIDS related stigma and discrimination amongst healthcare
workers. This attitude change will in turn create an enabling environment for clients to access HIV care and
treatment services.
Injection safety activity includes major emphasis on procurement of injection safety equipment/consumables
and distribution of SBC materials; health care waste management and minor emphasis on capacity building
through the training of key health care workers.
Continuing Activity: 13036
13036 9776.08 U.S. Agency for Family Health 6374 552.08 USAID Track $400,000
9776 9776.07 U.S. Agency for Family Health 4167 552.07 GHAIN $125,000
Table 3.3.05:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Care and treatment narratives were fused.
By the end of COP 08, the Global HIV/AIDS Initiative Nigeria (GHAIN), in collaboration with the Government
of Nigeria (GON) and several Faith Based Organizations (FBOs), has supported the provision of
antiretroviral therapy (ART) services to over 63,000 HIV infected adults in 112 comprehensive ART sites in
36 states and the FCT. It is estimated that the number of individuals who will have accessed HIV-related
palliative care (excluding TB/HIV) at the end of the GHAIN reporting period will be 95,563. In COP 09,
GHAIN will continue to provide HIV comprehensive care and treatment services including antiretroviral
therapy (ART) to eligible patients through continued support to the existing 112 sites. GHAIN will enroll
5500 new adult patients on ART. Taking into consideration attrition rate, it is estimated that a total of 63,317
adult patients will be on ART by the end of COP 09.
GHAIN will sustain its extensive experience in supporting comprehensive ART services. In addition, GHAIN
will strengthen appropriate HIV services at PHC facilities through a decentralized, integrated disease
management approach at the LGA level, consistent with a district health management paradigm. To this
end, GHAIN will adopt a three-fold strategy: 1) enter in formal agreement with the LGA authorities to create
a multi stakeholder committee that oversees the implementation of the program in the entire LGA; 2)
contract an umbrella CBO to manage a portfolio of community based activities and 3) link community based
activities, PHC and comprehensive sites through a strong and well coordinated referral mechanism to
actualize the continuum of prevention, treatment, care and support services.
In this model of service delivery, GHAIN will engage relevant stakeholders, especially the NPHCDA and the
relevant disease control program officials to increase access not only for HIV/AIDS, but also for sexual and
reproductive health and TB services in the LGA. This model will promote compliance with care and
treatment national guidelines for that level of care, the integration of prevention into care and treatment
services, the promotion of adherence and treatment education, clinical monitoring, management of OI and
related laboratory services within the framework of available funds and GoN policies. GHAIN will also pilot
the task shift of ARV refills from comprehensive to PHC facilities, which will be closely monitored in line with
national policies and guidelines.
In COP 09, GHAIN will strengthen the capacity of both the public and private sector (where appropriate)
sites to implement harmonized quality services with strong focus on adherence, patient retention and
ensuring durability of first and second line drugs. This includes the promotion of gender equality and stigma
and discrimination reduction activities. 255 health care workers will be re-trained on ART services and the
management of opportunistic infections. At the PHC level, community health officers (CHOs), community
health extension workers (CHEWs) and nurses will be re-trained using the IMAI tools on relevant aspects of
HIV/AIDS services including ARV refill. GHAIN will re-train community pharmacists and will investigate the
possibility of engaging with private medical practitioners to support treatment at this level. Laboratory
services with CD4+ count testing capacity will be available in all sites. Pregnant women in PMTCT settings
who require ART for their own health will be referred and fast tracked into care and treatment services.
Specific focus will be paid to retention of clients not on ART by strengthening our patient tracking system,
linkages to support groups and other non ART services. Prevention for Positives will focus on primary and
secondary prevention services for all PLWHA. Within the confines of available funds and GON policies,
GHAIN will provide or refer PLWHA to preventive care services (IEC, behavioral risk and change
counseling, provision of condoms, contraceptive methods, OI prophylaxis, water sanitation, treatment
education, ITN, nutritional counseling, micronutrients supplementation), and social services within the
community. All PLWHA enrolled with GHAIN will be linked to services where trained providers offer the
syndromic management of STIs. GHAIN will ensure, within the confines of available funds and GON
policies, that comprehensive sites and PHC centers provide facility based basic care and support services
in line with the national palliative care guidelines. This includes clinical services (medical assessment,
laboratory services including OI prophylaxis and treatment, nutritional assessment, pain and symptom
relief), with basic care kit (ITN, water guard, water vessel, latex gloves, soap, condoms and IEC materials
with appropriate PwP messaging) and any other two services from the domain of HBC, psychosocial, PWP,
and other prevention services, psychosocial support, and end of life care.
GHAIN will continue to provide technical leadership in strengthening pharmacy systems and pharmacists'
capacity to contribute to the delivery of quality HIV/AIDS-related services at all levels of healthcare delivery
in Nigeria (tertiary, secondary and primary health care facilities and the communities). GHAIN will re-train
pharmacists in all comprehensive ART sites and private pharmacies in pharmaceutical care in HIV/AIDS
and best pharmaceutical practices.
Patient management and monitoring will be strengthened in selected sites using GHAIN's Lafiya
Management Information System (LAMIS). The LAMIS software will be used both for backlog as well as
real time entry of clinical and logistics management data at the ART clinic, pharmacy, laboratory and
medical records points of service. Health care workers will be re-trained and mentored to routinely use
LAMIS. The LAMIS will also be used by facility management for continuous quality assurance/quality
improvement, program evaluation and strengthening drug and commodity inventory management. At
national level, LAMIS will be used to evaluate the combined efforts of GHAIN supported care and treatment
programs, generate important outcome data from patient cohorts, monitor treatment failure, enable program
managers and government counterparts to identify priority areas for action and continuously improve the
quality of ART service delivery in Nigeria. GHAIN will monitor of the impact of new care and treatment
initiatives on service coverage, uptake and quality.
GHAIN will continue to support the national quality assurance/improvement program under the leadership of
NACA and the FMOH, including evaluation efforts of the national ART program on all service levels. This
will include the improvement of tools like HIVQUAL and the integration of national performance indicators
into the HMIS and the LAMIS.
GHAIN will hold regular, scheduled meetings with CEDPA to explore strategic referral approaches to
Activity Narrative: ensuring that all clients attending facility based care in GHAIN supported sites also have access to quality
home based care (HBC) services in 20 states where CEDPA operates namely Lagos, FCT, Kano, Cross
Rivers, Bauchi, Anambra, Edo, Taraba, Imo, Enugu, Kogi, Adamawa, Benue, Niger, Katsina, Sokoto, Kebbi,
Zamfara, Nassaraqa and Akwa Ibom. In States where GHAIN will be providing direct HBC and support,
GHAIN will work closely with established facility based PLWHA support groups and care givers to provide
HBC as part of an integrated care package to PLWHA in the 8 HAST model focus LGAs. GHAIN will also
train 500 PLHA and other volunteers to provide HBC services to PLWHA. The HBC volunteers will also
conduct advocacy for and referral to legal support, spiritual support, economic strengthening and shelter. In
addition, they will be supported to carry out stigma and discrimination reduction activities, HBC services,
psychosocial support, adherence counseling, referrals, contact tracking, basic nursing care, prevention with
positives, provision of ITNs and safe water intervention (water guard), etc. HBC providers' kits (mackintosh,
scissors, buckets, ITNs, water guard, analgesics, iodine, cotton wool, spirit, forceps, gauze) will be given to
trained health care workers, volunteers and PLWHA. GHAIN will establish fora where care providers will
meet on a regular basis to motivate each other, share experiences, and discuss various issues including
ways of managing stress and other difficult situations. In line with GHAIN's continued support of the
UNGASS MIPA principle, GHAIN will ensure that PLWHA participate actively in the planning of meetings
and other care and support activities as appropriate.
GHAIN will participate in the joint supervisory visits that will be carried out by the GON/USG. Synergies will
continue to be established with the GFATM grant to Nigeria. GHAIN will continue to strengthen its
exit/sustainability plan with the health facilities implementing comprehensive care and treatment programs
to build their capacity and to customize a specific plan and schedule for each facility.
The provision of care and treatment services through this program will contribute to strengthening and
expanding the capacity of the GON's response to the HIV/AIDS epidemic and increasing the prospects of
meeting the Emergency Plan's goal of providing life - saving antiretroviral treatment to individuals.
Decentralized services at the PHCs centers and community based institution at the LGA level will improve
equity in access to HIV care and treatment services and system strengthening at that level.
The GHAIN adult care and treatment services relate to: TB, HCT and HOP, HIV Drugs, PMTCT, HIV/RH
integration program (supported by other non-PEPFAR USAID funds); community services that supports
persons on ARV treatment (to encourage adherence; provide information to PLWHA who are not yet on
ART; and promote HIV testing, etc); community and home based care services, include vocational training,
income-generating activities, social legal protection, training and support of caregivers, etc.; and the multi-
directional referral linkages that improve psychosocial support, adherence and reduce treatment failure and
resistance.
This activity targets adult PLWHAs (male and female); TB patients who are HIV positive, pregnant women
who are HIV positive and all high risk groups that are HIV positive.
Task shifting in order to strengthen the capacity of lower level cadres at the PHC level to provide
comprehensive care services. Reduction of stigma and discrimination both among health care workers and
the general population. Promotion of gender equity in access to the care and treatment programs, by
mobilizing both males and females to avail themselves of treatment opportunities.
This activity includes major emphasis on achieving improved access through integrated disease
management (HAST approach), quality assurance/quality improvement with supportive supervision and
minor emphasis on trainings.
Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including
spaces)
FHI GHAIN requests for early release of funds to meet its unexpectedly longer lead time for procurement of
supplies and commodities, infrastructural upgrade and other activities necessary for the maintenance of
clients on treatment, care and support during the initial months of the COP 09 period. It will be appreciated if
GHAIN receives an early release of at least $3,864,681 (15%) of the funds under this program area for the
purposes stated above.
Continuing Activity: 13038
13038 3237.08 U.S. Agency for Family Health 6374 552.08 USAID Track $3,843,000
6708 3237.07 U.S. Agency for Family Health 4167 552.07 GHAIN $3,013,750
3237 3237.06 U.S. Agency for Family Health 2771 552.06 GHAIN $3,005,000
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $62,500
Table 3.3.08:
Continuing Activity: 13043
13043 3231.08 U.S. Agency for Family Health 6374 552.08 USAID Track $21,619,751
6703 3231.07 U.S. Agency for Family Health 4167 552.07 GHAIN $15,939,526
3231 3231.06 U.S. Agency for Family Health 2771 552.06 GHAIN $6,919,012
Table 3.3.09:
Government of Nigeria (GON) and Faith Based Organizations (FBOs), provided care and treatment
including antiretroviral therapy (ART) services to about seven thousand (7,000) HIV infected children in
Nigeria at a total of 109 pediatric care and treatment sites (in 9 tertiary and 100 secondary facilities) in all 36
states and the FCT, exceeding the USG-PEPFAR target of 60. This was accomplished through the
PEPFAR funding to support 60 sites together with resources leveraged from Global Fund (GF).
In COP09, GHAIN will maintain its ART coverage in all 109 PEPFAR and GF established comprehensive
ART service delivery sites across the country. The leveraged support from the Global Fund is expected to
continue throughout the COP09 timeframe, allowing for a sustained support of pediatric care and treatment
at all the sites. It should be noted that these total (PEPFAR and GF) resources will be principally focused on
maintenance and quality assurance of pediatric patients' care and treatment at all the sites. In COP09,
GHAIN will enroll 500 HIV-positive children below 15 years newly on ART; this will result in a maintenance
of 7,035 children on ART by the end of COP09, taking into consideration the attrition among children on
treatment. 8,700 children will be enrolled in clinical care for HIV/AIDS by the end of COP09.
GHAIN's pediatric program will benefit from three precepts: i) the prevention of new transmissions from
mother to child by providing prevention for positive mothers and PMTCT; ii) improved quality of pediatric
care services and the quality of life of HIV infected children; and iii) care and support to children orphaned
or made vulnerable by HIV. This pediatric program is closely linked to, and an integral part of, the health
service component of GHAIN's orphans and vulnerable children (OVC) program.
Specific strategies will include strengthening 109 facility-based pediatric teams that use provider-initiated
HCT at multiple service delivery points to increase HIV case detection among children. GHAIN will continue
to develop the capacity and confidence of health care workers in pediatric HIV/AIDS comprehensive care
services through trainings, followed by on-site mentoring and provision of pediatric job aids. Clinicians will
be trained to provide fixed dose combination (FDC) as appropriate and in line with GON treatment
guidelines, in order to improve treatment adherence and better clinical outcomes in children. A total of 500
providers will be trained in pediatric basic care and support, while 255 providers will be trained in pediatric
treatment according to national guidelines. A second strategy that will be employed is strengthening referral
linkages for continuum of care and defaulter tracking to ensure retention of children in care. GHAIN will
also establish a strong follow-up program for HIV exposed babies to provide HIV early infant diagnosis
(EID) testing using dry blood spots (DBS) in line with the National Early Infant Diagnosis Scale-Up Plan.
Breast-fed babies will be re-tested six weeks following cessation of breast feeding. HIV positive infants will
be linked to comprehensive care centers through a well-established network of care. All comprehensive
ART facilities will be encouraged to strengthen the family-centered model of care to attend to the needs of
the family as a unit, ensuring prioritization of children in clinical and laboratory service provision, and making
health facilities children friendly (with colorful wall paintings/provision of toys). A third strategy, prevention
with positives, focusing on primary and secondary prevention will be provided to all children living with HIV.
Preventive care packages will include: IEC for HIV prevention, health information and education, behavioral
risk and change counseling, OI prophylaxis, prevention and treatment of microbial infections, water
sanitation/treatment education, insecticide treated nets (ITN), nutritional counseling, micronutrients
supplementation and linkages to community social services. Fourth, quality assurance/quality improvement
(QA/QI) training will strengthen QA/QI teams in 11 focus health facilities to ensure sustainable QA/QI
systems. Each team shall be comprised of a doctor, pharmacist, laboratory scientist, nurse and medical
records staff. GHAIN will continue to strengthen the capacity of the care and treatment teams in its focus
health facilities to implement quality services with a strong focus on adherence and ensuring durability as
well as availability of first and second line drugs. Regular clinical auditing of records will be conducted to
detect ART eligible children who are not yet enrolled.
The pediatric mentorship program will engage experienced pediatric ART physicians to provide hands on
supervision, observation and random case file review to identify site-specific challenges, strengths,
weaknesses and opportunities for quality improvement. They will establish site-specific plans to accomplish
improved pediatric ART uptake and retention in care, conduct on-site training and continuous medical
education (CME) among health care providers and conduct practical demonstration and tutoring on issues
and tools not understood during training sessions and to build knowledge and skills of care providers. Intra-
and inter-facility referrals (as well as to community) for HIV services will be strengthened through a strong
follow up program for HIV exposed infants and HIV infected children. HIV exposed babies will be able to
access EID services based on the National roll out plan. Pediatric quality improvement teams at the facility
level will work on quality assurance/quality improvement as indentified during the implementation.
In COP09, GHAIN will build upon this experience by strengthening HIV services at the PHCs in eight
selected focus LGAs through training, ongoing supportive mentoring, and monitoring activities to ensure
that service quality is not compromised. A minimum of five PHCs with maternal and child health services
per LGA will specifically be targeted in order to provide access to women and children. GHAIN will work with
the FMOH and its agencies to ensure that supporting policies and guidelines are reviewed and implemented
to ensure task shifting and improved access to care and treatment services, including ARV refill at the PHC
level. GHAIN will continue to develop the capacity of community pharmacists and private medical
practitioners to provide treatment support and referral services at this level.
In COP08, GHAIN successfully used multi point testing for children and task shifting to increase case
detection of children with HIV. This strategy will benefit from HCT resources leveraged from GFATM and
Clinton Foundation. HCT resources will be prioritized to reach most at risk populations; providers will
initiate HCT of children in the nutrition clinics, out patient clinics, maternal child health (MCH) service clinics
and the pediatric wards where prevalence is usually higher than in the general population.
Growth monitoring and nutritional support will be established and strengthened at all MCH and ART sites.
Nutritional status assessments, using the measurement of mid arm circumference and weight for height to
identify those children eligible for nutritional support (ready to use therapeutic food, RUTF), will be provided
Activity Narrative: in collaboration with the Clinton Foundation.
GHAIN will continue to work with the primary health care development agency (NPHCDA) and other related
agencies to strengthen the capacity of community health officers (CHOs), community health extension
workers (CHEWs) and nurses to provide HIV/AIDS services including ARV refills at the PHCs using the
IMAI and IMCI tools. GHAIN will continue to advocate to the State Ministries of Health supporting favor of
the deployment of nurses and midwives to PHCs to ensure appropriate mix of human resources at the
PHCs.
capacity to contribute to the delivery of quality HIV/AIDS-related services at all levels of health care delivery
in Nigeria (tertiary, secondary and primary health care facilities). Pharmacists in all comprehensive ART
sites will be trained in pharmaceutical care of HIV/AIDS and best pharmaceutical practices, while also
collaborating with the community pharmacists to expand the reach and quality of patient medication
adherence counseling, drug monitoring/support and other services in support of ARV services.
ensuring that all HIV positive children attending facility-based care in GHAIN supported sites also have
access to quality home based care (HBC) services in 20 states where CEDPA operates, namely Lagos,
FCT, Kano, Cross River, Bauchi, Anambra, Edo, Taraba, Imo, Enugu, Kogi, Adamawa, Benue, Niger,
Katsina, Sokoto, Kebbi, Zamfara, Nassarawa and Akwa Ibom.
Patient management and monitoring will be strengthened to improve the quality of care in all sites in line
with USG and GON strategies. GHAIN's Lafiya Management Information System (LAMIS) software will be
used in selected sites, both for backlog as well as real time entry of clinical and logistics management data
at the clinic, pharmacy, laboratory and medical records points of service.
GHAIN will continue to support and develop the capacity of SACAs and hospital management teams to
conduct data quality assessment exercises at facilities as well as hold state-level monthly monitoring and
evaluation meetings in collaboration with all relevant IPs in the state to review progress of work and inform
planning.
Planned decentralization of services to Primary Health Care centers (PHCs) in focus states will improve
equity in access to HIV treatment and care services. GHAIN supports the GON in the
design/implementation/update of the ART-PMM system and design of the National curricula and SOP for
pediatrics. The provision of ART services through this program will contribute to strengthening and
expanding the capacity of the Government of Nigeria's (GON's) response to the HIV/AIDS epidemic and
increasing the prospects of meeting the Emergency Plan's goal of providing lifesaving antiretroviral
treatment to individuals who need it.
The pediatric care and treatment program will be linked to PMTCT activities, TB services, OVC programs,
and laboratory infrastructure.
This activity targets primarily HIV exposed and HIV infected children including orphans and vulnerable
children. Indirect targets will include PABAs and other community members, particularly caregivers of OVC,
who will benefit from the newly acquired skills of the staff of GON and other organizations.
GHAIN continues to advocate for greater access by children <15 years of age to treatment, care and
support services. GHAIN will put in place mechanisms for reduction of stigma and discrimination both
among health workers and the general population, and provide opportunities for increasing equity in access
by children to ART programs. GHAIN will continue to support the implementation of policies on task shifting
to address human resource challenges in health facilities.
This activity includes major emphasis on strengthening HIV/ART service delivery to children and OVC.
Trainings, quality assurance, quality improvement, mentorship and the involvement of the PHC level of care
in pediatric treatment care and support are important areas of emphasis of GHAIN in COP09.
GHAIN receives an early release of at least $447,084 (15%) of the funds under this program area for the
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $2,500
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $10,000
Table 3.3.10:
By the end of COP 08, the Global HIV/AIDS Initiative Nigeria (GHAIN) through collaboration with the
Government of Nigeria (GON) and Faith Based Organizations (FBOs) provided care and treatment
Nigeria in 109 comprehensive ART sites in 36 states and the FCT.
In COP 09, GHAIN will have a low CT target. It is anticipated that fewer children will be tested and enrolled
on treatment in COP09. GHAIN will enroll 500 HIV positive children below 15 years newly on ART in the
existing 109 sites in 36 states and the FCT to maintain 7,035 children on ART, taking into consideration the
attrition among children on treatment. And 8,700 children will be enrolled on clinical care for HIV/AIDS by
end of COP09.
GHAIN's pediatric program will benefit from three axes: i) the prevention of new transmissions from mother
to child by providing prevention for positive mothers and PMTCT; ii) improved quality of pediatric care
services and the quality of life of HIV infected children; and iii) care and support to children orphaned by
HIV. This pediatric program, is closely linked to and an integral part of the health service component of the
GHAIN's orphans and vulnerable children (OVC) program.
Specific strategies will include: i) Strengthening 109 facility based paediatric teams that uses provider
initiated CT at multiple service delivery points in the facility to increase HIV case detection among
children;GHAIN will continue to develop the capacity and confidence of health care workers in pediatric
HIV/AIDS comprehensive care services through trainings, followed by on-site mentoring and provision of
pediatric job aids. Clinicians will be trained to provide fixed dose combinations (FDCs), in order to improve
treatment adherence and better clinical outcomes in children.ii) Strengthening referral linkages for
continuum of care and default tracking to ensure retention of children in care. GHAIN will also establish
strong follow up program for HIV exposed babies to provide HIV early infant diagnosis testing from 6 weeks
of age using dry blood spots (DBS) in line with the National Early Infant Diagnosis scale-up plan. Breast fed
babies will be re-tested 6 weeks following cessation of breast feeding. HIV positive infants will be linked to
comprehensive care centers through a well-established network of care. All comprehensive ART facilities
will be encouraged to strengthen the family centered model of care to attend to the needs of the family as a
unit, ensuring prioritization of children in clinical and laboratory service provision, and making health
facilities children friendly (with colourful wall paintings/provision of toys) iii) Prevention for positives, focusing
on primary and secondary prevention will be provided to all children living with HIV. Preventive care
package will include: IEC for HIV prevention, health information and education, behavioral risk and change
counseling, OI prophylaxis, prevention and treatment of microbial infections, water sanitation/treatment
education, insecticide treated nets (ITN), nutritional counseling, micronutrients supplementation and linkage
to community social services. iv) Quality assurance/quality improvement (QA/QI) training and strengthen
QA/QI teams in 11 focus health facilities to ensure sustainable QA/QI system. Each team shall comprise of
a doctor, pharmacist, laboratory scientist, nurse and medical records staff. GHAIN will continue to
strengthen the capacity of the care and treatment teams in its focus health facilities to implement quality
services with strong focus on adherence and ensuring durability as well as availability of first and second
line drugs. Regular clinical auditing of records will be conducted to detect ART eligible children who are not
yet enrolled.
The pediatric mentorship program will engage experienced paediatric ART physicians to provide hands on
supervision, observation and random case file review, to identify site-specific challenges, strengths,
education (CME) among health providers and practical demonstration and tutoring on issues and tools not
understood during training sessions.and to build knowledge and skills of care providers. Intra- and inter-
facility referrals (as well as to community) for HIV services will be strengthened through a strong follow up
program for HIV exposed infants and HIV infected children. HIV exposed babies will be able to access EID
services based on National roll out plan. Pediatric quality improvement teams at facility level will work on
quality assurance/quality improvement as indentified during the implementation
In COP 09, GHAIN will build upon this experience by strengthening HIV services at the PHCs in eight
selected focus LGAs through training, ongoing supportive mentoring and monitoring activities to ensure that
service quality is not compromised. A minimum of 5 PHCs with maternal and child health services per LGA
will specifically be targeted in order to provide access to women and children. GHAIN will work with FMOH
and its agencies to ensure that supporting policies and guidelines are reviewed and implemented to ensure
task shifting and improved access to care and treatment services, including ARV refill at the PHC level.
GHAIN will continue to develop the capacity of community pharmacists and private medical practitioners to
provide treatment support and referral services at this level.
GHAIN has used successfully in COP08 the multi point testing for children and task shifting to increase
case detection of children with HIV. This strategy will be restricted by low funding for HCT but it will benefit
from CT resources leveraged from GFATM and Clinton Foundation. Should HCT resources be sufficient,
provider will initiate CT of children at the nutrition clinic, out patient clinic, MCH service clinic and the
pediatric wards.
Nutritional status assessment using the measurement of mid arm circumference and weight for height to
identify those children eligible for nutritional support (ready to use therapeutic food (RUTF)) provided in
collaboration with CHAI.
workers (CHEWs) and nurses to provide HIV/AIDS services including ARV refill at the PHCs using the IMAI
and IMCI tools.GHAIN will continue to advocate to the State Ministries of Health supporting favor of the
Activity Narrative: deployment of nurses and midwives to PHCs to ensure appropriate mix of human resources at the PHCs.
ensuring that all HIV positive children attending facility based care in GHAIN supported sites also have
access to quality home based care (HBC) services in 20 states where CEDPA operates namely Lagos,
FCT, Kano, Cross Rivers, Bauchi, Anambra, Edo, Taraba, Imo, Enugu, Kogi, Adamawa, Benue, Niger,
Katsina, Sokoto, Kebbi, Zamfara, Nassaraqa and Akwa Ibom.
Patient management and monitoring will be strengthened to improve the quality of care in all sites. GHAIN's
Lafiya Management Information System (LAMIS) software will be used in selected sites, both for backlog as
well as real time entry of clinical and logistics management data at the clinic, pharmacy, laboratory and
medical records points of service.
GHAIN will continue to support and develop capacity of SACAs and hospital management teams to
conduct DQA exercises at facilities as well as hold state monthly M&E meetings in collaboration with all
relevant IPs in the state to review progress of work and inform planning.
Planned decentralization of services to Primary Health Care centers (PHCs) in focus States will improve
Pediatrics. The provision of ART services through this program will contribute to strengthening and
increasing the prospects of meeting the Emergency Plan's goal of providing life - saving antiretroviral
treatment to individuals. Who need it.
The pediatric program will be linked to Maternal, newborn and child health programs, Nutrition unit, PMTCT
activities, Reproductive health services, TB services, OVC program, Community and home based care
program, including PLWHA support group activities
children. Indirect targets will include PABAs and other community members who will benefit from the newly
acquired skills of the staff of GON and other organizations.
GHAIN continues to advocate for greater access by children <15years to treatment, care and support
services.
GHAIN will put in place mechanisms for reduction of stigma and discrimination both among health workers
and the general population, and provide opportunities for increasing equity in access by children to the ART
GHAIN will continue to support implementation of policy on task shifting to address human resource
challenges in health facilities.
Table 3.3.11:
During COP08, the Global HIV/AIDS Initiative Nigeria (GHAIN) through collaboration with the Government
of Nigeria (GON) and Faith Based Organizations (FBOs) provided TB/HIV integrated care and treatment in
112 GHAIN supported comprehensive ART sites in 36 states and the FCT.
Three thousand eight hundred (3,800) TB patients will receive counseling and testing for HIV while 4,741
HIV-infected clients attending HIV care/treatment services will receive treatment for TB disease. GHAIN will
train 300 health workers in TB/HIV co-management.
The TB/HIV collaborative activities will be aimed at decreasing the burden of TB in HIV patients and also
HIV in TB patients. Particular emphasis will be placed on increasing TB case detection through clinical
screening in HIV/AIDS service settings, basic and fluorescent microscopy, quality assurance /improvement,
TB infection control in all service areas and linkages/referrals for multi-drug resistance (MDR) TB culture
and sensitivity and treatment. Within the resources and targets set by USG, GHAIN will also support HIV
counseling and testing for TB patients and suspects, and the referral of HIV positive TB patients to
HIV/AIDS service. GHAIN anticipates challenges in meeting the increasing needs of People living with
HIV/AIDS (PLWHA) who are co-infected with TB; it will play an active role of leveraging other funding
sources to further strengthen TB-HIV services and to explore further opportunities for increasing case
detection, treatment and linkages for MDR TB care.
GHAIN will implement joint TB /HIV activities in close collaboration with the National Tuberculosis and
Leprosy Control Program (NTBLCP), National AIDS and STI Control Program (NASCP) and other partners
based on the following strategies: intensified case finding, case holding and referral; strengthening of TB
infection control measures and advocacy, communication and social mobilization (ACSM). The
implementation of activities (including supervision and monitoring) will be according to national policies and
guidelines. PLWHA, TB patients, and communities will be involved in TB/HIV program planning and
implementation. In line with the USG strategy, GHAIN will saturate LGAs with TB/HIV services linked to
community TB care programs funded through other sources and will ensure provision of quality services
through building human and institutional capacity based on identified needs. Human and institutional
capacity will be strengthened to ensure that all TB patients have access to quality HIV diagnosis and care
and support, and all HIV patients have access to TB diagnosis, care and support.
TB/HIV collaborative activities will involve: intensified TB case finding amongst PLWHA; HIV case finding
amongst TB patients and suspects; and strengthening of TB infection control policy implementation. The
activities in HIV service points will include: clinical screening of all PLWHA for TB and referral of HIV
positive TB suspects for TB diagnosis and treatment; TB prevention education; treatment adherence
support; and stigma reduction. In TB service points the following activities will be provided: TB diagnosis
and treatment; HIV counseling and testing for TB patients and suspects; and referral of HIV positive patients
to HIV service points for HIV treatment care and support. Co-trimoxazole preventive therapy for dually
infected patients will be provided in both TB and HIV service points. In view of the current challenges in
excluding active TB in HIV positive patients and the level of health care facilities supported by GHAIN,
isoniazid (INH) preventive therapy (IPT), though important, will not be implemented in supported sites.
Referral mechanism for TB/HIV care and support including defaulter and contact tracking will be
strengthened in all the 36 states and the FCT.
Human capacity will be built through training and re-training according to national guidelines and will
include: training of TB/HIV program managers and health care workers in TB/HIV collaborative activities;
training on TB infection control; training of DOT providers on HCT; training of healthcare workers on TB/HIV
co-management (IMAI); training of medical officers on management of sputum negative TB patients;
training of medical officers and laboratory scientists on management of MDR-TB; and training of laboratory
scientists on TB/HIV quality assurance/ improvement.
GHAIN will increase community participation in TB/HIV by empowering community based organizations
(CBOs) and support groups, mobilize communities and support TB/HIV collaborative activities in the
community. This will be done through training on TB/HIV program communication and social mobilization. In
addition, GHAIN will intensify advocacy, communication and social mobilization activities through strategic
behavior communication (SBC) activities.
GHAIN will continue to maintain its membership in the National TB/HIV working group and the MDR-TB
committee and will continue to be actively involved in national TB/HIV planning, implementation, monitoring
and supervision. GHAIN will also have a particular emphasis on provision of technical assistance to the
national working groups to ensure that the MDR-TB laboratory supports are appropriate for the Nigerian
context. GHAIN will also support routine MDR-TB surveillance through the TB culture and DST facility at the
Dr. Lawrence Henshaw Hospital Calabar, which will be partially supported through other leveraged funds.
GHAIN will work with NTBLCP to strengthen monthly facility recording and reporting. Similarly individual
TB/HIV patient data will be captured in the LAMIS in selected facilities. All National TB/HIV
accomplishments can be claimed as indirect targets, while GHAIN will also put systems in place to track the
United States Government (USG)/Nigeria custom indicators for TB/HIV services.
This project will contribute towards the overall goal of reducing TB/HIV associated morbidity and mortality
by ensuring that all persons evaluated for TB disease will receive HIV counseling and testing as part of
"routine care." Those identified as HIV-infected will receive HIV care and treatment, including co-
trimoxazole and, if eligible, antiretroviral therapy (ART). All HIV-infected patients receiving HIV services will
be routinely screened for TB disease, while ensuring that all HIV positive TB suspects access TB diagnostic
services and receive uninterrupted treatment for TB disease according to national guidelines.
Activity Narrative: Appropriate linkage will be made with available services under the Global Fund when approved through
collaboration with NTBLCP, NASCP and other partners and resources will be harnessed through
partnership with key TB initiatives and donors in Nigeria such as United States Agency for International
Development (USAID)/TB-direct funds (non-Emergency Plan), International Federation of Anti-Leprosy
Associations (ILEP), Canadian International Development Association (CIDA) and TBCAP.
GHAIN will assist the NTBLCP, states and local government areas (LGAs) with implementation of TB/HIV
collaborative activities at the national, state, LGA and facility levels with adequate linkages to other services
such as ART, prevention of mother to child transmission (PMTCT) and community home-based care
(CHBC). Referral networks will be strengthened to further achieve TB/HIV collaborative activities. In
addition, GHAIN will support the strengthening of an integrated logistic system at the LGA level through
capacity building on Logistics Management Information System (LMIS)
Continuing Activity: 13039
13039 3228.08 U.S. Agency for Family Health 6374 552.08 USAID Track $2,938,654
6700 3228.07 U.S. Agency for Family Health 4167 552.07 GHAIN $2,283,000
3228 3228.06 U.S. Agency for Family Health 2771 552.06 GHAIN $1,352,000
Table 3.3.12:
In COP 08, the Global HIV/AIDS Initiative Nigeria's (GHAIN) OVC activities were primarily located in 60
comprehensive ART sites. A total of 14,922 children living with and affected by HIV had benefited from OVC
services in the 60 supported sites, which included the provision of ART to the eligible children. The support
groups and PLHA have been key entry points to OVC and the family-centred approach to service delivery,
which was promoted to increase children's retention into care.
In COP 09, GHAIN will include a community-based component to enable GHAIN OVC activities engage
closely with families and care givers. GHAIN will work with CBOs, home based care providers, PLWHA
support groups, care givers and community leaders to support existing groups in the communities, ensuring
proper integration of OVC services, thereby limiting stigma and discrimination. OVC services and activities
will aim to support children's' needs at different age groups, including in-school and out-of school activities
for both boys and girls. The services will be sensitive to local culture, age and sex differences.
Mainstreaming topics will be: life skills, HIV/AIDS prevention and Adolescent Reproductive Health (ARH)
and coping strategies for child headed households. This extended GHAIN OVC activities will be
implemented in the decentralized and integrated framework of the local governance area's (LGA) HIV/AIDS,
sexual and reproductive health and TB (HAST) model of service delivery.
One LGA will be chosen in each of the selected states (Lagos, Kano, Bauchi, Borno, Kaduna, Osun, Cross
River, Edo, Anambra) and the FCT. In COP 09, the GHAIN OVC services will target 12,000 orphaned
children and children affected by HIV/AIDS. GHAIN will ensure that OVC served in the selected states have
access to the comprehensive services of good quality provided by its existing network of supported
comprehensive sites and contracted CBOs. CBOs and community volunteers will identify OVC within the
LGAs using the adapted OVC Child Status Index and other GoN tools. Appropriate referrals will be made
and coordinated for those services not provided by GHAIN supported sites or implementing agencies (IAs)
to ensure receipt of the 6+1 package of services needed for the children to achieve their full potentials.
GHAIN will make use of its existing referral focal persons in each LGA to ensure that these linkages are
effective. The program will collaborate with LGA authorities to map the primary and secondary health
facilities, other partners, CBOs and communities to ensure that OVC access all 6 + 1 services closest to
them and according to their needs. GHAIN will work closely with CEDPA and other organizations to identify
areas of synergy in service delivery to OVC. Similarly, GHAIN will work with the USG-funded case manager
organizations and other existing programs in the LGA.
GHAIN will support the provision of the following direct services: (1) Psychosocial support including at least
three of the following: disclosure issues, grief and loss, kids support groups and recreation, group
counseling, home visits, etc; (2) Educational support activities including facilitation of the enrolment of
female and male OVC in schools, provision of school uniform and books etc.; (3) Nutritional support for all
OVC involving at least three of the following: assessment, counseling, supplementation, therapeutic
nutrition, etc.; and (4) Facilitating access to health services (ART and non ART care for infected and
affected children in GHAIN supported sites). Among prevention services, GHAIN will provide preventive kits
to OVC (water guard, lidded bucket, long lasting insecticide treated nets).
GHAIN will contract IAs (CBOs and selected LGAs implementing the HAST model) to provide, as
appropriate, the above services in line with the national plan of action for OVC and the national OVC
guidance and standards of practice. The provision of educational support will be done through block
granting mechanism. GHAIN will provide the required training to IAs. Once the OVC in the community and
facility are identified, with their families, these beneficiaries are recruited in the program and the utilization of
services monitored and evaluated by GHAIN's M&E system. GHAIN will explore funding opportunities for
counseling and testing (CT), and leverage resources from the Global Fund and Clinton Foundation, and use
its mobile CT strategy to provide services to all identified OVC and their caregivers. Infected children
identified through this strategy will be referred (through the GHAIN referral coordination mechanism) to
GHAIN supported care and support services including ART. Collaboration with Clinton Foundation currently
provides therapeutic nutritional supplementation (Ready-to-Use Therapeutic Food [RUTF] and Plumpy'nut)
for pediatric ART clients. An anticipated 6,000 OVC will receive food and nutritional supplementation
through GHAIN's OVC program.
OVCs in GHAIN program will access other services indirectly, through referral of eligible children to the
relevant organizations for: (5) Child protection activities including legal support, birth registration, abuse
monitoring, and child meaningful participation, (6) shelter, and (7) household economic strengthening and
some aspects of protection. This will be achieved through advocacy for OVC to access the services not
provided by GHAIN.
The implementation of the OVC program in COP 09 will have a positive impact on the health system.
GHAIN supported IAs will also carry out stigma reduction and discrimination prevention activities among the
general public, health care workers, and other caregivers of children. Spiritual support will be provided
through linkages to religious leaders. By so doing, GHAIN will contribute to strengthening the State, LGA
and the primary health care system. The PHC health committees and community development committees
in the selected LGAs for example will improve not just the health care services for children but also create a
platform/mechanism in the LGA and communities to protect and support OVC and adults living with
HIV/AIDS. As part of this effort, GHAIN will collaborate with partners such as UNICEF and the Ministries of
Women Affairs and Education, to facilitate the establishment of networks for legal, advocacy support, child
protection committees at the LGA and community levels to protect OVC from abuse.
Caregivers' fora will also be established. The difficult issues and complications that arise with caring for
extra children of deceased relatives stretch the capacity of untrained caregivers/ remaining parent who also
may not have sufficient material resources. These caregivers and remaining parents will be trained on home
based care for OVC to enable them provide the best possible care for the children in the homes. Special
attention will be given to the particular needs of these caregivers/parents who will also be trained on coping
strategies. It is assumed that caring for caregivers will have an immediate spillover effect to the well-being
Activity Narrative: of all children in the affected household. The total target for number of providers/caregivers trained in caring
for OVC is 600.
This project will contribute towards reaching goal of the Nigeria National Plan of Action and the USG overall
strategic five-year plan for Nigeria. It will also contribute to strengthening the national, state and local/facility
level systems for implementing quality OVC programs.
This program will also contribute to Government, local CBO and communities' capacity building. Thus,
GHAIN will continue to strengthen its exit/sustainability plan both at the country program level showing how
it will work with the local CBOs/community volunteers implementing OVC programs and the PLWHA
support groups, to build their capacity and to customize a specific plan and schedule for CBO. The plans
will include an assessment phase, customized plan for building capacity, and a set of clear objectives and
indicators for measuring capacity as well as a time line based on key benchmarks.
GHAIN will concentrate its OVC activities in the communities providing, nutritional, psychosocial and
educational support and linkages to protection and care. Educational support will be provided to OVC in
schools using block grant mechanism by engaging block grant intermediaries. However GHAIN will
establish strong linkages to health facilities providing comprehensive ART PMTCT and pediatric ART
services including primary health centers providing child survival services to ensure that enrolled OVC
receive counseling and testing/ pediatric care and treatment for those who are HIV positive as well as child
survival services. GHAIN will also establish strong linkages with other organizations providing care for
children such as UNICEF and Save the Children, the Federal and State MoWA and the LGA departments of
Women Affairs to leverage resources for the benefit of the children. Using the support of the case manager
organizations, GHAIN will leverage the resources of other USG and non-USG supported partners to ensure
that enrolled OVC access all 6+1 services according to their needs including those not provided by GHAIN,
such as such as shelter, and house hold economic strengthening.
GHAIN will provide OVC services to children living and affected by HIV/AIDS. The children will be identified
from all the communities in the HAST LGAs using community volunteers to ensure that the most vulnerable
and marginalized OVC are reached. OVC will also be identified through the PMTCT and care and treatment
services provided at supported facilities, counseling and testing, and TB-HIV programs. GHAIN will ensure
that community volunteers serving OVC are stationed in health facilities during service hours to facilitate
identification and linkage of OVC to services.
GHAIN will strengthen gender equity in HIV/AIDS care and support programs using a comprehensive
approach, addressing the specific needs of children in this regard and emphasizing male involvement in
care initiatives to ensure sustainability. GHAIN will collaborate with the Partners for Development to source
for micro-credit facilities for the indigent care givers to be able to support the children, and with other USG
implementing partners to wrap around good governance by securing services that protect the rights of the
child, enhance food supply, improve sanitation in communities, provide clean water, insecticide treated nets
(ITN) and strengthen non-HIV health services, including child health and nutrition.
This activity includes a major emphasis on child survival activities, family planning and prevention of
infections among OVC and their care givers. GHAIN will ensure that OVC receive services that will enhance
their well being and survival including but not limited to immunization against the child killer diseases as
provided by the National program on immunization; growth monitoring, oral rehydration therapy, safe infant
feeding, and education of the girl child. To safe guard the health of HIV infected and affected children,
GHAIN will provide prevention services and commodities, including safe water, targeted at common
endemic diseases. Commodities to be provided include long lasting insecticide treated nets, water
reservoirs (lidded buckets with taps) and water guard for disinfecting water. Special attention will be paid to
older children and adolescents, who will be provided with adolescent reproductive and sexual health
services as well as leadership training. GHAIN will also facilitate access to income generating activities for
out of school adolescents. GHAIN will strategically engage communities through advocacy and dialogue to
discourage gender biases and cultural practices that adversely affect marginalized OVC such as forced
marriage and female genital cutting. Access to family planning and safe delivery services will also be
facilitated for the care givers and remaining parent of OVC. It is expected that this will translate to fewer
children in the household with the attendant benefits to all household members.
Continuing Activity: 13040
13040 3229.08 U.S. Agency for Family Health 6374 552.08 USAID Track $2,865,000
6701 3229.07 U.S. Agency for Family Health 4167 552.07 GHAIN $1,115,000
3229 3229.06 U.S. Agency for Family Health 2771 552.06 GHAIN $1,758,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
Estimated amount of funding that is planned for Education $25,000
Table 3.3.13:
In COP09, HIV counseling and testing (HCT) services will be significantly scaled down, concentrated only in
comprehensive antiretroviral therapy (ART) sites, with a main focus on providing technical assistance to the
Government of Nigeria (GON) to ensure quality delivery of HCT services.
Activity Narratives
At the end COP08, Global HIV/AIDS Initiative Nigeria (GHAIN) through collaboration with the Government
of Nigeria (GON) and Global Fund to fight AIDS, TB and Malaria (GFATM) provided HIV counseling and
testing (HCT) services through 199 HCT sites, thus increasing access to HCT services nationwide and
creating the opportunity to place many more clients on ART in line with the GON strategy.
In COP09 the GHAIN HCT site and community level activities will stress: (1) providing technical assistance,
particularly in identifying most at risk persons in need of HCT, and (2) working with sites to identify and
obtain additional resources (from the GON, other donors, Global Fund, etc.) to provide commodities and
increase uptake of HCT services. GHAIN will utilize the planned PEPFAR funds to strengthen the GON's
capacity for sustainability. GHAIN will collaborate with the GFATM, GON and other donors to mobilize rapid
test kits and support the continuation of quality HCT services, focusing only in the 112 comprehensive ART
service sites within the scope of available resources. This will include technical assistance (TA) to the GON
at the national, state and local levels and capacity building for monitoring and evaluation (M&E) and
reporting. With the current funding available under HCT, use of the 9 mobile HCT (MCT) units will be scaled
back and focused on most at risk populations (MARPs). Therefore, the current MCT team will be trained to
be multi-tasking, thus, will be providing other services (in addition to HCT), such as community based
prevention and care and support services in HIV/AIDS, STIs and TB (HAST) focus LGAs at periods when
invitations/requests for HCT are low. Overall, GHAIN will work to leverage resources from the GON, and
other funders, including the private sector to carry out mobile HCT services. GHAIN will ensure a total of
17,735 clients are counseled, tested and receive their results using the serial algorithm as in COP08.
The GON, through the National Agency for the Control of AIDS (NACA) and its State counterparts (SACAs)
are planning to scale up HCT services to all local government areas (LGAs) of Nigeria, using the World
Bank funds. GHAIN will piggyback on this strategy to continue to provide technical assistance (TA) to the
GON, to provide integrated HCT services at primary health care (PHC) levels, including provider-initiated
HCT in the wards, TB clinics and the outpatient departments (OPDs). GHAIN will advocate and provide
guidance to the GON to routinely provide counseling and testing to all TB and STI clients, ensuring
appropriate referrals to other services. Based on the current system, all clients accessing HCT services will
continue to be systematically screened for tuberculosis (TB) and sexually transmitted infections (STI) using
the national/standard tools; those found to be indicative of TB/STIs will be referred for further investigations
and treatment for TB or STI as appropriate. Emphasis will also be placed on couples counseling, partner
notification and disclosure of test results as well as pre and post-test counseling for both positive and
negative clients. Furthermore, linkages between services will be strengthened to provide comprehensive
ART treatment, care and support to individuals who test positive for HIV in the community and facilities.
GHAIN has developed a referral directory of all care and support services in all the states and identified
referral focal persons to ensure an active referral system.
GHAIN will continue to use the nationally approved non-cold chain dependent serial HIV testing algorithm.
GHAIN will continue to use the SCMS mechanism of rapid test kits (RTK) supplies and will make requests
based on consumption in line with COP09 targets. To ensure quality of HCT services (especially testing),
GHAIN will provide support to sites to conduct proficiency testing and external quality control based on the
national recommendations. Trainings/retrainings will be conducted for 30 health workers during COP09.
These trainings will be conducted through the established HCT training centers, using the Nigerian national
HCT training curriculum.
In order to emphasize HIV prevention for both those who test positive as well as those testing negative,
GHAIN will assist the GON to advocate for the procurement of condoms for distribution to all HCT sites
ensuring that every client is offered condoms after post- test counseling.
This funding will go specifically towards technical assistance to the government at the national and state
levels, capacity building of counselors/testers to ensure adequate quality of services and commodity
management. GHAIN will continue to provide the GON with TA to ensure high quality HCT data collection
and collation using the National HCT-monitoring and evaluation (M&E) system designed for the GON.
GHAIN will continue to provide technical assistance to the national and state government on HCT in all the
states and FCT, and contribute 17,735 individuals counseled and tested to the overall emergency plan and
HCT targets for Nigeria. Overall, these activities contribute to the Emergency Plan's goal of providing HIV
care services to Nigerians, while preventing new infections by 2010.
This activity also relates to activities in Adult and Pediatric care and treatment, MTCT, sexual prevention,
OVC and HVTB. Linkages will be strengthened between the various components listed above to provide
total care to individuals who test positive for HIV. GHAIN has developed a referral directory of all care and
support services in all the states and identified referral focal persons to ensure an active referral system.
GHAIN will advocate for the setting-up of HCT networks in the states by the GON, in collaboration with the
United States Government (USG). GHAIN will assist the GON in developing strategies for condom
distribution in collaboration with the prevention team to ensure condoms are properly distributed to all sites
and states. Linkages will also be strengthened with care and support and orphans and vulnerable children
activities in the focus communities.
GHAIN will continue to strengthen its exit/sustainability plan both at the country and program level showing
Activity Narrative: how it will work with the health facilities implementing comprehensive HCT programs to build their capacity
and to customize a specific plan and schedule for each facility.
GHAIN will, depending on resource availability from other potential donors, carry out mobile HCT services
through leveraging of resources from the GON, and other funders, including the private sector. Such
leveraged HCT services will target the general population through mobile HCT during special events such
as World AIDS Day, Valentine's day, and Safe Motherhood day among others. Other target audiences for
these services will include most at risk adult males and females, out-of-school youth (males and females),
street youth, pregnant women, TB patients, and family members of index clients, especially discordant
couples. The infected clients will be referred to access care and support services in sites supported by other
funding agencies or sources, such as the GFATM.
This activity will address gender equity in HIV/AIDS programming through counseling messages targeted at
vulnerable young girls and women. This activity will also deal with male norms and behaviors through
vigorous campaigns to educate people on the benefits of couple HCT and mutual disclosure of HIV status.
The availability of HCT services in clinical and hospital ward settings will also help to reduce stigma and
discrimination.
This activity includes major emphasis on system strengthening, sustainability plans, while minor emphasis
on local organization capacity development, quality assurance and trainings.
Continuing Activity: 13041
13041 3230.08 U.S. Agency for Family Health 6374 552.08 USAID Track $3,703,000
6702 3230.07 U.S. Agency for Family Health 4167 552.07 GHAIN $3,879,721
3230 3230.06 U.S. Agency for Family Health 2771 552.06 GHAIN $5,075,000
Table 3.3.14:
ACTIVITY DESCRIPTION:
This activity has several components namely: forecasting and procurement, inventory management,
warehousing and quality delivery of antiretroviral (ARV) drugs and other related commodities for care,
treatment and support of an anticipated 4,000 pregnant women who need ARV prophylaxis to prevent
mother-to-child transmission, 63,317 adult and 7,035 pediatric clients on antiretroviral treatment (ART) in
COP09.
In COP 09, Global HIV/AIDS Initiative Nigeria (GHAIN) will focus on the following key areas: human
capacity building and health systems strengthening, forecasting for ARVs, opportunistic infections (OIs)
drugs, laboratory reagents and consumables, procurement, port clearance, warehousing, and distribution of
ARVs and related commodities to facilities under the project.
The first component of this activity includes forecasting and procurement of ARV drugs. As part of the
COP09 budgeting process, a forecast was jointly carried out by Ghain and SCMS and utilized to project
COP09 ARV requirements. 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. Patients are
distributed over first and second line regimen in a ratio of 99%:1%. In addition AZT, NVP and AZT/3TC for
PMTCT will be procured along with other drugs while provision has been made for PMTCT in children in the
original ART forecast. The forecast will be monitored with emerging consumption data from the facilities
quarterly and necessary adjustments will be made to the forecasts and subsequent procurements.
The following regimens will be used in COP09: First Line Adult: d4t (30mg)/3TC/NVP, d4T(30mg)/3TC/NVP,
AZT/3TC/NVP, AZT/3TC + EFV, TDF/FTC + EFV, TDF/FTC + NVP. Second Line Adult: TDF/FTC + LPVr/r,
TDF/FTC + IDV, ABC + DDI + LPVr/r. First Line Children: AZT10mg/ml + 3TC 10mg/ml + NVP 10mg/ml,
AZT100 + 3TC 10mg/ml + NVP 10mg/ml, D4T6/3TC30/NVP50, D4T12/3TC60/NVP100. Second Line
Children: ABC20mg/ml + DDi 50 + LPVr/r80/20
The procurement process is guided by USG regulations, National Treatment Guidelines, National Agency
for Food and Drug Control (NAFDAC) registration or waivers, with a view towards utilizing generic ARVs,
once they are United States Food and Drug Administration (FDA) approved. All purchases of Truvada
(TDF/FTC) and ZDV-3TC-NVP Fixed Dose will be procured via pooled procurement mechanism by SCMS
in line with OGAC's recommendation. Axios Foundation will serve as the procurement agent for the rest of
the drugs using its existing international procurement structures to explore the most cost-effective products
from reputable manufacturers with approval from WHO, USFDA, and NAFDAC. The shipping cost is about
USD0.50 for each unit price of the drugs procured, representing insurance and freight. .Timeliness in the
delivery of all orders is also a key factor in choosing suppliers.
The in-country distribution will be handled by Axios Foundation. Estimated 10% of the cost of drugs will be
used to cover distribution expenses. GHAIN and Axios have developed a functional logistics management
system to ensure consistent availability of secure and high quality ARVs and related commodities and to
properly account for the deliveries/usage. The system has a central program depot (CPD) in Abuja, with six
state program depots (SPDs) in Plateau, Edo, Kano, Lagos, Cross River and Anambra states respectively.
This structure has enabled the positioning of ARV drugs and related commodities, as proximal as possible
to the service provision sites and to the patients, and reduces the lead time for availing drugs to the
facilities. Establishment of additional SPDs may be considered during the year.
In COP 09 GHAIN will continue to implement an Inventory Management System to track logistics data
needed for the proper management of ARV drugs and other related HIV / AIDS commodities, and will
support the use of consolidated tools for managing and tracking TB, STI, Malaria, and RH-FP commodities
at the project storage facilities and service provision sites. This same system will also be used to support
the effective management of other commodities that GHAIN is not providing. In COP08, GHAIN will ensure
that Lafiya Management Information System (LAMIS) software package rolled out in selected sites is
utilized to improve the collection, analysis and utilization of logistics management data for making
appropriate programmatic and policy decisions. The LAMIS is fully operational in at least eight sites;
namely, FMC Jalingo and FMC Yola in Taraba states; Mainland Hospital, Yaba and Massey street
Childrens Hospital in Lagos state; Infectous Disease Hospital, and Murtala Mohammed Specialist Hospital
in Kano state; Maitama District Hospital and in Abuja FCT; and Calabar General Hospital in Cross Rivers
state.
In COP 09, in addition to patient management and monitoring, the LAMIS will be used in selected sites both
for backlog; as well as, real time entry of logistics management data at the pharmacy and laboratory points
of service. Pharmacists and medical laboratory scientists in these selected sites will be trained and
mentored to routinely use LAMIS for tracking drugs and diagnostics supplied and dispensed, making
forecasts, and complying with national reporting requirements. The LAMIS will also be used by facility
management for continuous quality assurance/quality improvement by providing a timely and responsive
mechanism for replenishing supplies and monitoring supply versus utilization to minimize wastage. At
national level, the LAMIS will enable program managers and government counterparts to identify priority
action areas and continuously improve the quality of ART service delivery and logistics management in
Nigeria.
Furthermore, continued integration of the Logistics Management Information System (LMIS) into the DHIS
by GHAIN in collaboration with NACA and FMOH will be on going in COP 09, to enhance the analysis of
health information at the state and zonal levels. This will ensure that LMIS information is routinely
integrated with management statistics on a monthly basis to support improved forecasting, commodity flow,
and analysis of data from all sites at state and national levels.
Activity Narrative: Guided by the memorandum of understanding with the Federal Ministry of Health (FMOH) and State Central
Medical Stores and in view of the scale-up of project activities in COP 08, and scale-out to PHCs, GHAIN
will continue to establish model warehouses/storage facilities at states and Local Governments respectively,
depending on programmatic priorities and funding conveniences. In addition, capacity will be built for
warehousing and distribution management by continuous tools development, implementation of
warehousing management systems (Tally software) and development of Standard Operating Procedures
(SOPs) manuals for warehousing and distribution at the state central medical stores. It will also consolidate
on building capacity of the government of Nigeria (GON) at the State Central Medical Stores through
centralized training, on-site / on-the-job training, supportive supervision and technical assistance. GHAIN
will continue to support the implementation of the change from Push-to-Pull inventory control management
and supply system, with the aim of building capacity at the site level to quantify and order their actual
commodity needs.
In COP09, the strategy will focus more on the integration of logistics management activities into the State
Ministry of Health (SMOH) owned medical stores, and utilize their linkages to the ART facilities. GHAIN will
continue to collaborate with Global Fund through the National Agency for the Control of AIDS (NACA)
procurement supply management unit, other stakeholders and implementing partners and GON with the
aim of improving the national distribution system. GHAIN will provide continuous mentorship for the logistics
management at the facility, as well as, ensure uninterrupted availability of commodities for service provision
by setting up a loan support and exchange arrangement for both programs, that could also expedite the
utilization of short-dated commodities to forestall their expiration on shelf. Based on identified gaps in the
operations of the logistics system, GHAIN will build partnership with private/not-for-profit sector, by sub-
contracting warehousing and distribution services at State and Local Government level. Quality
assurance/improvement and monitoring of the logistics system will continue to be maintained at all levels.
GHAIN, working in collaboration with other partners, will continue to strengthen sustainability plans by
harmonizing commodities logistics systems with the GON, and providing technical assistance and training in
forecasting, inventory management and reporting for pharmacists through on-site training and mentoring.
The long term plan is to ensure sustainability of the project logistics system.
Ghain will continue to properly dispose the expired drugs by incineration. However, Ghain hopes that with
intense systems strengthening efforts in place to forestall expiration and deterioration of commodities, the
amount of drugs expiring will be brought to a minimum.
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
Commodity availability at facility level is the cornerstone of the strategy to increase access to all drugs,
diagnostics and other related commodities for HIV/AIDS, Tuberculosis, Reproductive Health/Family
Planning, Sexually Transmitted Infections and Malaria; and this significantly contributes to the achievement
of the Emergency Plan's goals of access to care. The provision of ART and integrated disease related
services through this program will contribute to strengthening and expanding the capacity of the
Government of Nigeria's response to the HIV/AIDS epidemic, and increases the prospects of meeting the
Emergency Plan's goal of providing life-saving antiretroviral treatment to more than 350,000 individuals.
This program will also contribute to strengthening the national drug / commodity logistics and management
systems, especially as it relates to ARVs and test kits among others.
LINKS TO OTHER ACTIVITIES:
This program element relates to activities in HVCT, MTCT, HLAB and Adult and Pediatric care and
treatment. Links to these programs include covering areas such as logistics and management of test kits
(CT), ARV drugs for adults and children, drugs for opportunistic infections - Opportunistic infections (OIs),
prophylactic ARV drugs for pregnant women and infants (PMTCT).The provision of supplies for laboratory
diagnostics links directly into the ART program by providing for monitoring patient progress, toxicity levels
and clinical chemistry.
POPULATIONS BEING TARGETED:
This activity targets all health care workers directly involved in the management of ARVs and diagnostics for
ART services; TB, RH/FP, STI, and Malaria; including pharmacists, doctor, nurses; as well as, people
affected with AIDS.
KEY LEGISLATIVE ISSUES ADDRESSED:
The established drugs storage facilities in each of the GHAIN focused states and LGAs; including the HAST
LGAs, will increase access of drugs and services to the resource-poor communities, and increase gender
equity in HIV/AIDS, and other integrated diseases management programs. By this endeavor, beneficiaries
have closer access to drugs and are able to live healthier lives. Increasing access to drugs also provides a
supportive environment for women's access to income and productive resources, given an improved health
status.
EMPHASIS AREAS:
In COP 09 the major emphasis for ARV Drugs will include commodity procurement to ensure desired stock
levels in-country, while minor emphasis will be on local organization capacity development, quality
assurance, quality improvement and supportive supervision. This will be achieved through the integration of
the project‘s distribution system into the national network to ensure sustainability of the current supply chain
management system. Building upon the integrated inventory management systems implemented at the
facility levels, GHAIN will continue to provide regular on site support to sustain proper usage and will
continue to work with the GON and implementing partners to ensure the harmonization and standardization
of the tools & standard operating procedures in the pharmacy.
Continuing Activity: 13042
13042 3233.08 U.S. Agency for Family Health 6374 552.08 USAID Track $21,619,751
6705 3233.07 U.S. Agency for Family Health 4167 552.07 GHAIN $15,540,370
3233 3233.06 U.S. Agency for Family Health 2771 552.06 GHAIN $5,995,000
Table 3.3.15:
In COP09, GHAIN will provide fluorescent microscopes in ten high volume sites to support TB diagnosis.
GHAIN will also support a pilot project, linking HIV positive females of reproductive age to a tertiary health
facility for pap smear investigations for cervical cancer. GHAIN will also explore opportunities for leveraging
resources to set up a training lab to serve as its training center.
In COP08, GHAIN activated 60 labs using PEPFAR funds and leveraged resources from the Global Fund to
support an additional 52 labs. By the end of COP08, GHAIN enabled a total of 112 labs (in 9 tertiary and
103 secondary facilities) with both PEPFAR and Global Fund resources in all 36 states and the FCT. In
COP09, PEPFAR funded lab targets for GHAIN will increase to 65 labs..
In COP09, GHAIN will maintain its ART coverage in all established comprehensive ART services across the
country. Leveraged support from the Global Fund is expected to continue throughout the COP09
timeframe, which will allow for sustained support of the 112 labs in the network. Combined PEPFAR and
Global Fund resources will be principally focused on maintenance, quality assurance and commodity
supplies for these labs, with additional support for necessary training and supervision, as detailed below. An
estimated 742,376 laboratory tests will be conducted. GHAIN counts HIV serology, CD4 count, hematology,
clinical chemistry panels, VDRL, pregnancy test, HBsAg and malaria parasite as one test each. It is
envisaged that patients identified under the HIV/AIDS, sexually transmitted infections (STI)/reproductive
health (RH) and tuberculosis (TB) [HAST] model will be linked to these secondary health facilities for ART
laboratory services. GHAIN will continue to work with the National Primary Health Care Development
Agency (NPHCDA) and all other stakeholders in developing guidelines for laboratories at primary health
care level.
GHAIN will organize training and re-trainings for 205 laboratory managers/staff at all supported sites
covering HIV diagnosis, treatment monitoring, laboratory management and supervision. All trainings will
include good laboratory practices, laboratory management and quality assurance/quality control (QA/QC).
GHAIN will continue to collaborate with other USG-IPs such as IHVN-ACTION for the use of their dedicated
training laboratories. On-site trainings will also continue to be offered to site staff. Standard training tools
and curricula including the CDC/WHO HIV rapid testing, CDC/WHO CD4/Haematology/Chemistry and
CDC/WHO smear microscopy training packages adapted for use in Nigeria, will be used for these trainings.
In COP09, GHAIN will identify, upgrade and equip at least one training lab to provide didactic and hands-on
lab practicum for all of GHAIN's centralized lab trainings and be available for use by other PEPFAR IPs as
well as the Government of Nigeria (GON). Accomplishment of this will be dependent upon availability of
resources being leveraged from the GFATM, GON and other USG sources.
At the end of COP08, it is envisaged that GHAIN will, based upon program realities and availability of
resources, have 35 laboratory personnel including staff for equipment maintenance. The responsibilities of
the lab team will include overall capacity building, technical assistance and supervision of all GHAIN
supported sites. In addition, the lab team will coordinate the inventory management system for
commodities, and quality assurance programs. Other responsibilities will include promoting collaboration
and networking opportunities with other Implementing Partners (IPs), under the leadership USG TWG, and
in partnership with the GON. This expanded team will continue to be coordinated by the Director of
Laboratory Services with support from the laboratory technical staff in both Country and zonal offices.
GHAIN will continue to support CD4+ counts/lymphocytes counts, chemistry panels, hematology assays,
using automated lab equipment in all of its secondary sites. GHAIN will also support additional tests (for
OIs) in line with the national guidelines and policies. GHAIN will participate in the OI lab training that will be
provided by American Society for Microbiology (ASM), under the coordination of USG/Nigeria. In COP09,
FHI/GHAIN will continue to support the established TB culture laboratory at Dr. Lawrence Henshaw
Memorial Hospital in Calabar. FHI/GHAIN will continue collaboration and networking with the GON and the
National TB and Leprosy Control Programme (NTBLCP) to ensure the provision of quality TB laboratory
services through various quality assurance programmes. In collaboration with the FMOH, NTBLCP and the
National multi-drug resistance tuberculosis (MDR-TB) surveillance committee, TB treatment failure cases
will be linked to this laboratory. In addition, GHAIN will collaborate with these GON organizations to link this
laboratory to the national MDR-TB survey. Furthermore, GHAIN will support the enhancement of TB
diagnostic capacity at 10 high volume TB sites with the provision of fluorescent microscopes and reagents
required for staining.
In line with the USG state coverage strategy, GHAIN will offer PMTCT and TB/HIV services in all 36 states
plus the FCT. The needed laboratory support for these services will also be provided and strengthened to
ensure quality service and care. These activities are detailed in the PMTCT and TB/HIV program areas.
GHAIN currently collaborates with other USG-IPs, such as IHVN and APIN to provide viral load assays and
to offer non-routine viral load assays to its patients when clinically indicated. This collaboration is also
ongoing in the early infant diagnosis (EID) program. In COP09, FHI/GHAIN will continue to support the
established PCR-EID laboratory in Federal Medical Centre Jalingo, Taraba state. The lab will be part of the
national EID scale up program for Nigeria. FHI/GHAIN will also continue the collaboration and networking
with GON and other IPs to ensure the provision of quality PCR-EID laboratory services through various
quality assurance programmes. The Clinton Foundation currently provides support for DBS collection
materials and the sample shipment.
As part of its effort to provide high quality and sustainable laboratory services, GHAIN will continue to work
with all stakeholders, according to the national guidelines, for the development of a common laboratory
equipment platform that is appropriate for each level of care. To ensure continuous and consistent
equipment performance, FHI/GHAIN will explore further opportunities for outsourcing equipment
maintenance to achieve cost savings and quality service. To facilitate the activities of the outsourced
maintenance contracts, equipment maintenance will continue to be triaged by dedicated equipment
maintenance officers. Also, GHAIN will support the sustainability of these labs through improved lab
Activity Narrative: equipment maintenance capacity which will be achieved through training equipment maintenance engineers
who are employed by the GON. FHI will collaborate with respective vendors and other USG IPs to support
this specialized training of 18 (2 per tertiary facility) lab engineers.
GHAIN will continue to use a centralized procurement and distribution strategy to ensure that needed
reagents and consumables are available at all focus sites. To prevent stock-outs and to ensure that
appropriate stock levels are maintained at all times, each facility will be expected to have a minimum stock
level of a one month supply.
In order to continue to support the efforts of GON to improve the monitoring and evaluation systems of
public health facilities, GHAIN will link selected facilities to the LAMIS. This will feed into the District Health
Information System (DHIS) and ultimately into the National Health Management Information System
(NHMIS) of the Federal Ministry of Health (FMOH).
Clinicians and laboratory staff in the FHI/GHAIN program are trained to offer post exposure prophylaxis
(PEP) and on the standard protocol for PEP, respectively, in all sites. This activity will be on-going in all
supported facilities. SOPs for PEP are currently available in all facilities.
The essential components of a quality system will continue to be supported at each site and quality
assurance (QA) will continue to be ensured through monthly on-site visits using standardized checklists.
Reports generated from these QC/QA programs will be fed back to the sites. All non-conformities will be
addressed and remedial action taken to rectify problems in the testing process. GHAIN will be an active
partner in the USG laboratory technical working group, and will ensure a tiered system of laboratories in line
with the GON guidelines. Site monitoring visits using a standardized assessment tool developed in line with
the national guidelines, will continue to be used in the GHAIN lab QA strategy.
As part of its EQA program, FHI/GHAIN will continue collaborating with the National Health Laboratory
Services, Sandringham South Africa and other internationally recognized PT (Proficiency Testing) providers
for HIV serology, CD4, hematology and chemistry proficiency testing (PT). Results from site visits and PT
programs will be documented, reviewed and disseminated according to national data flow policies to state
and federal authorities as well as other stakeholders,. In addition, the GHAIN supported labs will buy into
the national QA program for HIV serology that will be established by GoN. Based on factors such as the
national QA/QI strategy, opportunities for leveraging resources and discussions with stakeholders, GHAIN
will work in close collaboration with the GoN and the LTWG to identify a site to pilot production, distribution
and coordination of HIV serology proficiency panels to GHAIN-supported facilities. This will inculcate a
culture of Lab QA in all supported Labs and further develop local capacity to implement the PT program in a
network of labs, while ensuring that quality of Lab services are maintained across labs supported by
GHAIN. In collaboration with the LTWG, FHI/GHAIN will support the GoN in the development and
implementation of a national laboratory accreditation program.
Finally, GHAIN will support a pilot project in one community where adult ART services are provided (with
multiple ART labs). This pilot project will link HIV positive females of reproductive age to a tertiary health
facility for pap smear investigations for cervical cancer. The health facility (yet to be determined) will be
located in the same community for ease of logistics,. Results obtained from this pilot project will improve
current programming as well as inform future program scale up depending on the availability of funding.
The provision of Laboratory services through this program will contribute to strengthening and maintaining
the capacity of the government of Nigeria's (GoN) response to the HIV/AIDS epidemic. GHAIN will continue
to work with the GoN using established national rules and guidelines on laboratory services to build the
capacity of laboratory staff at the project sites. This program will also contribute to the maintenance of
upgraded health facility infrastructure and equipment. Considering the complexity of antiretroviral therapy
(ART) and the strict requirements for standards and procedures, the laboratory component will continue to
support the established, well coordinated and efficient quality assurance, supervision and monitoring
systems at all of the GHAIN sites.
This program element relates to activities in HCT, PMTCT, Adult and Pediatric care and treatment, HVTB,
HKID and Biomedical Prevention. A referral linkage system will continue to be supported to ensure that
clients are referred from sites with limited or no laboratory infrastructure, to automated laboratory sites using
the integrated tiered national laboratory network. GHAIN will continue to implement GoN approved testing
algorithm and work with the GoN and other stakeholders on the use of non-cold chain Rapid Test Kits
(RTK) for HIV testing. GHAIN will continue to support the capacity development of counselors, both at the
CT and PMTCT sites by conducting refresher trainings on the use of the existing national algorithm for HIV
testing. GHAIN will also continue to support sputum smear microscopy and tuberculosis (TB) treatment in
all CT sites. GHAIN is currently collaborating with JSI/MMIS to provide trainings on how to make medical
injections safer, on the provision of AD needles, and on safe handling and disposal of bio-medical wastes in
all GHAIN-supported facilities. GHAIN is also collaborating with Safe Blood for Africa Foundation (SBFAF)
and National Blood Transfusion (NBTS) on blood safety related programs and trainings. These
collaborations will be sustained and strengthened in COP09
This activity will provide laboratory services to PLWHAs, (including pregnant women), HIV positive children,
tuberculosis (TB) patients (including those that are HIV positive and are eligible for ART), HIV positive
infants and other most at risk populations (MARPS). These clients will be generated from PMTCT, Care and
Treatment, mobile and facility based counseling and testing and TB-HIV programs. The Family Centered
Care Model approach will be adopted to reach the HIV/AIDS affected families.
This program element will promote increasing gender equity in HIV/AIDS by ensuring that the laboratory
Activity Narrative: services will address the needs of both males and females in all age groups. Stigma and discrimination will
be reduced by ensuring confidentiality of test results.
Major emphasis will be placed on quality assurance, quality improvement, and supportive supervision.
Minor emphasis will be placed on Laboratory infrastructure upgrades, including commodity procurement
(laboratory equipment and reagents) and local organizational capacity development through trainings and
on-site technical assistance and mentoring. GHAIN will also continue to strengthen its exit/sustainability
plan by building the capacity of laboratories implementing HIV/AIDS programs, and customize a specific
plan and schedule for each facility.
Continuing Activity: 13044
13044 5420.08 U.S. Agency for Family Health 6374 552.08 USAID Track $6,715,748
6709 5420.07 U.S. Agency for Family Health 4167 552.07 GHAIN $5,208,416
5420 5420.06 U.S. Agency for Family Health 2771 552.06 GHAIN $2,340,988
Table 3.3.16:
The GHAIN project focuses on sustainable strategic information (SI) aligned with the Government of Nigeria
National Monitoring and Evaluation framework and tailored to respond to the information needs of the
United States Government (USG). In COP 09, GHAIN will support 268 local organizations at the national
level, and in all 36 states of Nigeria and the Federal Capital Territory The following strategies form the basis
of GHAIN's M&E activities: (1) facilitate the implementation of the Three-Ones principle on M&E; (2) ensure
timeliness and quality of routine data; (3) analyze data and applying quality assurance/quality improvement
(QA/QI) best practices to promote continual program improvement; (4) undertake systems strengthening
and capacity building to promote the sustainability of M&E efforts; and (5) facilitate national efforts to obtain
up-to-date information through public health evaluation, research and surveillance activities.
GHAIN liaises closely with the Government, USG IPs and the UN to facilitate the synergistic implementation
of the Three Ones. Efforts to (1) support one national M&E system include: participation in national forums
contributing to the development of the national M&E system including the national M&E technical working
group and related subcommittees; contributing to revisions of national M&E plans for the National Agency
for the Control of AIDS (NACA)/Ministry of Health (MoH); supporting the development and deployment of
harmonized M&E tools; equipping counterpart staff with the skills to increase task shifting and take up
increased M&E responsibilities at state and Local Government Area (LGA) levels; participating in joint site
monitoring, supportive supervision and data quality assessment visits.
For COP09, the nature of technical assistance will advance to streamlining data collection efforts, increased
integration with the Federal Ministry of Heath's (FMOH's) Health Management Information System (HMIS)
and government planning/decision-making processes; enhancing the collection and analysis of drug
logistics data; and enhancing triangulated data analysis to analyze gaps, promote best practices and inform
the use of scarce resources for HIV prevention and care. To support this advancement, analytical
frameworks will be upgraded to include population variables, geo-spatial data, cost-efficiency and
effectiveness data; and other indicators of population health. Considerable effort will continue to be devoted
to building and strengthening both FMOH and NACA HMIS, with resources increasingly devoted to support
at the LGA level.
Systems strengthening aimed at ensuring (2) the timeliness and quality of data will include building capacity
of State and LGA partners on improving the flow and quality of data through the government structure at all
levels. Capacity building in data collection, quality and management will be coordinated and conducted at
each level and supported by appropriate use of IT and databases linked to the (Nigerian National Response
Information Management System (NNRIMS) and FMOH HMIS.
In COP09, GHAIN will aim to seamlessly integrate data management systems by building local and state
capacities in linking HIV/AIDS data collected through the MOH to the NNRIMS through the use of a
common database platform, the DHIS. In order to streamline data flow and improve the management of
routine service statistics and Data Quality Assurance (DQA) results, additional strategic LGA's in target
states will also be selected to use this platform, with associated capacity building and linkages to the State
Ministry of Health and State Action Committee on AIDS (SACA) M&E Officers. While the paper-based data
collection system will continue to be the foundation for all service-related data collection, parallel efforts to
roll out GHAIN's electronic medical records system (the LAMIS) will expand real-time data entry,
automatically generated national reports, and upgrade analytical capacities including patient tracking, cohort
progression, and logistics management, to secondary facilities in selected states. A strong focus on data
quality will be ongoing to ensure that accurate data is used to inform programmatic decision-making at all
levels. In COP07 and 08, GHAIN provided technical assistance to the GON on the development and
implementation of a national DQA system for ART, PMTCT, HCT, TB/HIV, pharmacy, laboratory, prevention
and Logistics Management Information System (LMIS) programs. In COP09, this support will be expanded
to include upgrading analytical capacity by integrating results from DQA activities into a customized
database for tracking of trends over time and targeting data quality technical assistance, support to GON
counterparts in analyzing DQA data, prioritizing broad areas for improvement and tailoring training and
other capacity building based on these results. GHAIN will continue refining DQA tools and processes
where needed, and increase participation in joint DQA assessments with state and local government
officials, and using systematic site monitoring on a monthly basis with these counterparts to identify and
promote best practices. Systems will be in place to partner with local/state health authorities in refresher
training on the use of DQA tools, enhancing the storage and use of results and the flow of data. At the
national level, GHAIN will participate in the national M&E TWG to build the capacity to conduct DQA
assessments, and promote consistent practices across facilities, partners and states.
A critical success factor for any M&E system is ensuring that adequate resources are devoted to (3)
analyzing data and applying QA/QI best practices to promote continual program improvement. GHAIN plans
to advance the utilization of M&E results in COP09 through activities including: creating a comprehensive
and rigorous evidence base including indicators related to service quality and accessibility; and tailoring this
evidence to the needs of managers and policy-makers through appropriate packaging and delivery in a
timely and, where possible, participatory manner. Data analysis will continue to be supported at all levels,
and conducted on a monthly basis involving facility managers and senior State Ministry of Health (SMOH)
officials. The focus of QA/QI efforts will be further decentralized to the facility level, where facility managers
and service delivery staff will actively engage in problem-solving related to identified weaknesses, and who
will then track their own progress through QA/QI tools, including run-charts, piloted and rolled out with
GHAIN support. GHAIN will provide technical assistance in selecting appropriate analysis variables and
tools to assist in interpreting performance, determining gaps and priorities, and disseminating best
practices. Data dissemination will be managed primarily through forums and information products providing
feedback of appropriately packaged and analyzed data to the GON, the USG, program managers and other
stakeholders. Monthly M&E meetings chaired by the State Action Committee on AIDS/State AIDS Program
Coordinators will continue to serve as useful forums for data collection, compilation and analysis. The
utilization of results will be enhanced by the roll-out of GHAIN's patient management software, the Lafiya
Management Information Systems (LAMIS). This software combines logistics and patient management
information together to improve routine reporting, provide more sophisticated, localized and timely analysis
for program management.
Activity Narrative: COP 09 will be a critical year for informing the shape of GON-led M&E efforts in the future. At the national,
state and LGA level GHAIN will intensify (4) systems strengthening and capacity building to promote the
sustainability of M&E efforts. GHAIN's efforts at providing technical assistance in operationalizing the
national HIV/AIDS M&E system, including collaboration with the Global Fund (GF) and integration with the
national HMIS data collection, quality and supervision mechanisms, will continue to focus on high quality,
cost-effective strategies that can be readily integrated into routine responsibilities. State- and where
feasible, LGA-level monthly M&E meetings led by government, combined with support for relevant officials
participating in supervision, will be important activities in a future sustainable national M&E system.
Increased efforts will be devoted to building the capacity of local and state partners to manage the M&E
portfolio, strengthening linkages and communication systems for the collection and exchange of HIV/AIDS-
related data and its integration into national databases for decision-making. These linkages and related
capacity building will increasingly empower authorities at the LGA level in their management and oversight
functions of HIV/AIDS-related activities. These linkages will also be of assistance in the collection,
interpretation and transmission of high quality data into the state level management information system. At
the lowest levels of service delivery (Primary Health Care clinics (PHCs)) in selected LGAs, GHAIN will
support sustainability by employing task-shifting strategies in expanding M&E capacity building for health
care providers in health systems unable to sustain dedicated M&E personnel. Senior state level officials will
be targeted for involvement in a data dissemination forum and simultaneously empowered in their M&E
coordination and management role. GHAIN will support the planning and implementation of a cost-effective
and utilization-focused HIV/AIDS M&E system with firm linkages from the local to the national level.
Sustainability will be further enhanced through the use of analytical frameworks drawing on health
economics models which integrate cost and workload analyses with service utilization and other service
demand-focused data. This will give decision-makers access to cost-effective programmatic models and
accompanying budget information, and will be packaged and disseminated appropriately to feed into state
and federal planning and budgeting processes.
In COP09, GHAIN will continue facilitating national efforts to obtain up-to-date information through public
health evaluation, research and surveillance activities. GHAIN will contribute to increasing the body of
outcome and impact level data in the country; and more specifically, generate outcome data for facility
based prevention, and care and treatment programs. GHAIN will collaborate with the GoN and other
stakeholders in a second round of the Integrated Bio-Behavioral Surveillance Survey (IBBSS). The study
will be national in scope and focus on female commercial sex workers, transportation workers, men who
have sex with men (MSM), injecting drug users, military and police, and additional high-risk groups, as
necessary. Proposed studies include cohort analyses of ART patients and HIV/TB co-infected patients, the
use of early infant diagnosis to evaluate PMTCT success, and an examination of differential outcomes
through stratification of facilities and models of service delivery. While this data will be aggregated from all
participating sites at national level, emphasis will be on making key outcome data available to health care
providers and facility managers for quality improvement efforts. GHAIN will monitor clinical and
immunological treatment failure among ART patients at selected sites to feed into the national information
system on drug resistance monitoring. Additional evaluation related efforts will be aimed at answering
specific questions related to the effectiveness of the continuum of care and OVC programs, linkages
between facility and community-based service delivery, and the integration of HIV with other health
services. Statisticians at GHAIN will continue to build capacity of national government counterparts in
conducting advanced statistical analysis on secondary data sources, including surveillance datasets and
facility-level data to answer pertinent public health evaluation questions. GHAIN staff will participate in the
design and conduct of original research as the need and opportunity arises.
This activity will enhance client/patient management and implementation of all program elements by making
quality data available at all levels for monitoring, evaluation, guiding program management and
communicating program achievements. Functional feedback mechanisms will be improved to ensure that
results of M&E activities inform program design and management, build capacity in SI at all levels and
provide tools, protocols and reports. This activity will ensure that services provided by GHAIN are of the
highest quality. Others shall include scientific publications and research and surveillance protocols. This
funding will specifically go to facility monitoring, quality assessments, Health Management Information
Systems and the use of data for decision-making. Funding emphasis will also go to Information Technology
(IT), communication infrastructure, and reporting, as well as capacity building for 404 people in SI. Funds
will be used to support studies that address evaluation questions in relation to PEPFAR-provided services,
USG reporting systems and other SI activities in 268 organizations.
SI will continue producing and facilitating the generation and use of high quality data at POS, state and
National level (especially for MTCT, HVTB; HCT; Adult and Pediatric care and treatment; ARV drugs and
LAB)
SI will target principally SI professionals working with government at the LGA, state and national level.
Others involved will include health care providers, facility managers and their directors, community- and
faith-based organizations, non-governmental organizations and international counterpart organizations.
More generally, collaborative initiatives will inform programming decisions by health workers, donors and
the GON as well as guarantee quality of service delivery to primary beneficiaries of these services.
This activity provides information to increase gender equity in HIV/AIDS program through activities such as
collecting data to show breakdown of children, women and men receiving prevention activities, treatment,
care services and developing strategies to ensure that age and gender specific representation issues are
strongly emphasized. The program area will also utilize existing partnerships to strengthen the capacity of
organizations implementing various projects/programs as well as developing the government officials'
capacity at the state and LGA level.
Activity Narrative: EMPHASIS AREA
SI will emphasize human capacity development in monitoring and evaluation, while minor emphasis will be
on sustainability and information technology.
Continuing Activity: 13045
13045 3232.08 U.S. Agency for Family Health 6374 552.08 USAID Track $2,500,000
6704 3232.07 U.S. Agency for Family Health 4167 552.07 GHAIN $2,150,000
3232 3232.06 U.S. Agency for Family Health 2771 552.06 GHAIN $2,150,500
Table 3.3.17:
