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 UNCHANGED FROM FY2008
•Targets revised for COP09
ACTIVITY DESCRIPTION
The Nigerian Military provides prevention, care and treatment to its service members and the surrounding
civilian community (constituting approximately 75% of the Military's patient load). The Department of
Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will provide free comprehensive
PMTCT services, which will follow the revised national guidelines (2007), to 20 existing sites in COP09.
12,600 pregnant women will receive HIV counseling and testing for PMTCT and receive their test result.
554 women will receive a complete course of antiretroviral prophylaxis in a PMTCT setting. 50 individuals
will be trained to provide these services.
A family-centered network approach will be adopted and group health information with routine "opt out"
counseling and testing will be provided to pregnant women presenting for antenatal services. Testing will
be done following the National testing algorithm with same day results. Post-test counseling will include
prevention counseling and education for both HIV+ and HIV- women. A total of 12,600 women will be
counseled, tested and receive their results. Partner testing will be promoted. DOD will promote couples
counseling and testing to promote disclosure, address discordance and to increase support for infant
feeding choices. Staff will counsel clients on their disclosure of HIV status and partner/family notification
with an emphasis on client safety. Partner referrals for HCT (individual and/or couple) will be provided.
Also, referrals to community-based and barracks-based support groups will be provided to HIV+ clients.
Linkages will also be enhanced by counselors who are members of PLWHA support groups.
HIV testing will be offered to all women of unknown HIV status presenting for labor and delivery and in the
postpartum period. In accordance with National guidelines, a full course of ARV prophylaxis will be
provided to approximately 554 women. ARV prophylaxis will include ZDV at 28 weeks or 3TC/ZDV at 34/36
wks and single dose Nevirapine (sdNVP) in labor with a 7 day 3TC/ZDV tail. All infants born to HIV+
women will be provided with sdNVP at birth and ZDV for 6 weeks. HIV-exposed infants will be provided with
cotrimoxazole (CTX) prophylaxis from 6 weeks and will be discontinued once confirmed HIV- and no longer
breastfeeding. Post partum women who are clinically eligible for ART will be referred for ARV services at
the sites. Family planning and other reproductive health best practices will be promoted while linkages to
OVC activities will be enhanced.
Infant feeding education and counseling will begin in the antenatal period in accordance with National
guidelines, accompanied by appropriate prevention messages and education to all pregnant women and
family members. After delivery, mothers and infants will be followed up to monitor the mother's health and
to support the mother's compliance of her infant feeding option as well as to provide nutritional support for
both. DOD will actively participate in Early Infant Diagnosis (EID) as a component of its pediatric dare and
treatment program, using revised national guidelines (2007).
In support of DOD's commitment to build capacity and long-term sustainability in the NMOD, formal training
for an additional 50 staff from the existing 20 sites, covering physicians, nurses, midwives and others
involved in PMTCT services will be conducted. Trainings will be done in line with the revised National
PMTCT training curriculum (2007). By training uniformed members and civilian employees that are in a
career track in the Government of Nigeria, this program fosters a generation of skilled workers who are
more likely to remain in the military. This contributes to fulfilling PEPFAR goals for independent and
sustainable programs.
In addition, commodities and equipment that are required in PMTCT services will be procured via SCMS
($150,000). Depending on site inventories and needs, commodities may include gloves, soap or other
disinfectant and other medical consumables. Commodities will be provided to all 20 military sites.
By the end of COP09, the DOD will support 20 NMOD sites in Edo, Benue, Borno, Cross River, Rivers,
Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, Anambra and the FCT (15 states and
FCT).
CONTRIBUTION TO OVERALL PROGRAM AREA
The DOD PMTCT program will providing HIV counseling and, testing to 12,600 pregnant women and
provide ARV prophylaxis to 554 women. This contributes to the goal of preventing new HIV infections in
Nigeria. The PMTCT services identify HIV+ women who may need HAART for their own health, thus
contributing to PEPFAR Nigeria's care and treatment goals.
LINKS TO OTHER ACTIVITIES
This activity relates to activities in adult and pediatric care and treatment, laboratory infrastructure, safe
blood, TB/HIV and strategic information. Pregnant women who present for counseling and testing services
will be provided with information about the PMTCT program and referred accordingly. ART treatment
services for infants and mothers will be provided through ART services. Basic pediatric care support,
including TB care, is provided for infants and children through pediatric care and treatment activities.
POPULATIONS BEING TARGETED
This activity targets pregnant women and their family members. Activities also target military personnel,
civilian employees, dependents and the general population in the communities surrounding the 20 sites.
EMPHASIS AREAS
This activity will address gender equity in HIV/AIDS programs by specifically targeting pregnant women and
girls for counseling, testing and treatment. This activity also addresses military populations.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13149
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13149 3246.08 Department of US Department of 6400 554.08 DoD Track 2.0 $200,000
Defense Defense Program
6801 3246.07 Department of US Department of 4189 554.07 DoD Program $295,000
Defense Defense
3246 3246.06 Department of US Department of 2773 554.06 DoD $400,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Military Populations
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $60,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This activity represents funding for one contracted Nigerian program officer/physician position in support of
PMTCT activities as well as external technical assistance. The budget includes one FSN salary, overhead
charges, funding required for domestic travel, training funds and allocated minor support costs. This
funding also includes support for a USMHRP HQ Technical Assistance visit for one week of in-country
support by a physician who will provide TA, continuing medical education and mentorship, particularly in the
area of early infant diagnosis (EID). TA may also be provided by the USMHRP's site staff in Kenya,
Uganda and/or Tanzania.
The PMTCT program officer will work as a members of the USG Prevention and PMTCT Working Groups,
as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Clinical
Working Group. The program officer's responsibilities also include: 1) representing the DOD-NMOD in
technical discussions with the GON and 2) overseeing relevant technical aspects of the program, including
program management and oversight of the 20 DOD-NMOD PEPFAR site PMTCT programs. The program
officer will also ensure the expansion of EID, as appropriate, in the Nigerian Military. The program officer
will work with other Implementing Partners and the USG team to ensure a harmonized approach that is
consistent among partners and promotes the GON national treatment guidelines. S/he will liaise with other
non-governmental organizations, such as the Clinton Foundation, to ensure efforts are coordinated.
Continuing Activity: 13162
13162 9750.08 Department of US Department of 6401 554.08 DoD Track 2.0 $70,000
Defense Defense DoD Agency
9750 9750.07 Department of US Department of 4193 554.07 DoD Agency $50,000
Defense Defense Funding
This activity represents funding for a contracted Nigerian program officer for activities in the area of Sexual
Prevention. The program officer spends 100% of her efforts in AB and Other Prevention. The budget
includes one FSN salary at 100% effort, overhead charges, funding required for domestic travel, training
funds and allocated minor support costs. This funding also includes support for a TA visit for two weeks of
in-country support by a seasoned prevention expert from the U.S. Department of Navy HIV Prevention
Program and/or one of the U.S. Military HIV Research Program's PEPFAR Programs in Uganda, Kenya,
Tanzania or HQ.
The prevention program officer will work as a member of the USG Prevention Technical Working Group, as
well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Prevention
Working Group. The prevention program officer's responsibilities also include: 1) representing the DOD-
NMOD in technical discussions with the GON and 2) overseeing relevant technical aspects of the program,
including program management and oversight of the 20 DOD-NMOD PEPFAR site prevention programs.
The prevention program officer will work with other Implementing Partners and the USG team to ensure a
harmonized approach that is consistent among partners and with the GON national guidelines. The
prevention officer will also continue to support the GON in developing and implementing national prevention
guidelines (e.g., National Condom Strategy).
Continuing Activity: 13163
13163 9771.08 Department of US Department of 6401 554.08 DoD Track 2.0 $50,000
9771 9771.07 Department of US Department of 4193 554.07 DoD Agency $50,000
Table 3.3.02:
Addition of new epidemiological data
Revision of targets and emphasis areas
ACTIVITY DESCRIPTION:
Epidemiologic evidence indicates that throughout the world men and women in the military are amongst the
most susceptible sub-populations to sexually transmitted infections (STIs), including HIV. In many African
countries, uniformed services report HIV prevalence rates higher than national averages. In Cameroon,
Nigeria's neighbor to the east, an HIV rate of 6.2% was reported in 1993 among the military compared to
2% in the general population. In Malawi, it has been reported that 25% to 50% of army officers are already
HIV positive.
HIV prevalence figures are unavailable in the public domain for Nigeria's over 150,000 armed forces.
However, in 2007, the Nigerian Ministry of Health implemented an Integrated Biological and Behavioral
Surveillance Survey (IBBSS) among high-risk groups, which included the Nigerian Armed forces. This
survey sampled 1861 personnel from military barracks located in six states. The study showed that while
multiple partnerships are common among the armed forces, many do not consider themselves at risk of
HIV. HIV prevalence rates vary across states, with armed forces in FCT reported at 1.1% while in Anambra
the HIV prevalence rate among armed forces personnel was 7.6% (IBBSS 2007). Among the
predominantly male occupational groups (armed forces, police, and transport workers), armed forces
personnel consistently displayed a higher level of knowledge related to HIV risk (from 49 to 58 percent
responding correctly to five knowledge-related questions). Of the groups represented in the study, HIV
prevalence among the armed forces was consistently low, possibly due to the high reported condom use
with commercial partners.
Based on this evidence, the US Department of Defense (DOD), in partnership with the Nigerian Military, will
continue to provide prevention, care and treatment to Nigerian service members and the surrounding
civilian community, which constitutes approximately 75% of the military's patient load. In COP09, the DOD-
Nigerian Ministry of Defense (NMOD) HIV Program will continue to provide comprehensive AB and C
prevention services to 20 military facilities and their surrounding communities. In line with the National
Prevention Strategy, DOD will support the provision of a minimum of three interventions, which will include
community awareness, ‘Peer Education Plus' education and one other targeted strategy within the year that
will be drawn from a combination of workplace and vulnerability programs. The planned activities which will
be implemented to achieve these strategies, are outlined below.
In COP09, the program will continue to strengthen the DOD-NMOD partnership with the Armed Forces
Programme on AIDS Control (AFPAC), an existing structure that coordinates prevention services for
Nigerian Armed Forces. The DOD will support AFPAC in the training of 100 peer educators and 30 trainer-
of-trainers on HIV/AIDS prevention by promoting abstinence, being faithful to one's partner, correct and
consistent condom use, and effects of alcohol and drug use can have on sexual decision-making and how
this relates to HIV/AIDS prevention.
Training will be conducted to promote skills and information on AB and C during pre-deployment and
recruitment training. Prevention messaging will also include alcohol use, gender, sexual coercion, and
violence. HIV counseling and testing (HCT) and other related referrals will be made to the nearest military
site providing HIV/AIDS/STI related services. An estimated 6,500 military and civilian personnel will be
reached by peer educators with programming on HIV/AIDS prevention through AB and C.
DOD will continue to support AFPAC to improve and reproduce Information, Education and Communication
(IEC) materials to encourage and reinforce AB and C messages and information among military personnel.
Materials will be vetted through DOD and the USG Prevention Technical Working Group prior to
reproduction. These materials will be expected to reach 50,000 people, including both military and civilians.
However, these individuals are not counted towards DOD's AB or C targets since distribution of materials
may not be sufficient to consider a target "reached."
Another strategy is to increase the knowledge and build the capacity of HIV/AIDS prevention through
abstinence among in-school youth in military barracks. Utilizing existing infrastructure, teachers and
indigenous organizations will provide abstinence and sexuality life skills-based training and education to
approximately 2,500 in-school youth. Efforts will focus on recruiting teachers to be trained. Funding will
support logistics (e.g., manual production of materials), training, and support for each military school to
conduct abstinence-only HIV/AIDS programming. A total of 100 teachers will be trained in the AB
curriculum that provides abstinence only messaging and skills that foster youth empowerment and
knowledge sharing to reach in-school youth. Training expanded to reach out-of-school youth will
incorporate being faithful to one's partner and condom messages, as appropriate. Out-of-school youth will
be accessed via youth centers, religious centers, recreational venues, and "mammy markets." This activity
will reach 3,200 out of school youth with skills and messaging around abstinence and being faithful, and
condom use, as appropriate. In addition, income-generating skills will be incorporated into the out-of-school
AB and C training
DOD will continue to expand efforts with military based religious communities in order to reinforce AB
messaging, awareness and education and will support training through the Directorate of Islamic Affairs and
Directorate of Christian Services to reach 40 Imams and Priests from its 20 sites on HIV/AIDS education
and prevention. These Imams and Priests will conduct abstinence, marital fidelity and gender related
forums, workshops, and activities. They will provide AB related information on a continuous basis to an
estimated number of 5,500 persons, which will include military personnel, their families and other civilians
and clergy.
In collaboration with AFPAC and the Society for Family Health, DOD-NMOD will continue to help to
strengthen the distribution of male condoms to sites and within sites. In COP 08, targeted condom service
outlets were expanded to a total of 20 sites, which will be maintained throughout COP09. DOD, in
Activity Narrative: collaboration with the Ministry of Health, will supply female condoms to all sites. Through prior prevention
activities in COP08, female military and civilian personnel exhibited strong demand for female-initiated
prevention strategies, which included female condoms. In partnership with the Ministry of Health and
AFPAC, DOD-NMOD will also provide information, training and skills to approximately 200 total persons (10
persons each site) on male and female condom use at 20 sites. A total of 100,000 across the 20 sites will
be reached and have access to male and female condom related information, training and skills.
The DOD will also strengthen the capacity of existing groups, such as the Officers' Wives Clubs (OWCs) to
conduct AB and C related activities as well as risk-reduction awareness and education activities. These
OWCs have unique access to senior military officers, personnel wives, "Magajias" (women who control the
barrack accommodation blocks and mammy markets) and other females within and around the barrack
communities. The OWCs will implement outreach events and training activities within these 20 barracks to
reach 100 women at each site, totaling estimated 2,000 women and additional 500 individuals including
military personnel, their families and other civilians located within and around the barracks.
DOD-NMOD will support Barrack Health Committees to develop, incorporate and implement AB and
condom related activities into their yearly work plans. In addition, these 20 site-based HIV/AIDS
Committees will be supported to provide gender and male involvement related activities during military
officers/rank and file mess social recreation activities to reach 2,000 adult males across the sites
Another component is to strengthen HIV prevention through STI management within NMOD. Activities will
include improved quality of training, counseling, diagnosis and treatment services for approximately 2,000
military personnel, dependents and civilians in and around the barracks communities. Services include
diagnosis and treatment (with Pen G, ceftriaxone, azithromycin, acyclovir) for syphilis (treponema pallidum),
gonorrhea, chlamydia and herpes simplex virus. AB and C prevention messaging and condoms will be
offered to all those receiving STI diagnoses and treatment. All individuals diagnosed with STIs will be
referred to HCT and strongly encouraged to participate in regular testing.
All components will include specific efforts to include people living with HIV/AIDS (PLWHA) in activity
planning and implementation. Several PLWHA support group members have already been active in HIV
prevention activities within the military barracks; this partnership has helped to reduce stigma and
discrimination in the military community. This partnership will be further enhanced by the provision of
support to build the capacity of 10 of these PLWHA support groups, especially in the areas of leadership,
project design, management and income generating activities and businesses.
In addition, DOD will provided technical support to AFPAC and EPIC to continue implementing a micro-
finance loan program. In COP08, 100 representatives from the 3 barrack PLWHA support groups benefited
from this program and in COP09 these groups will receive ongoing support to continue providing income
generating activities to their members and other interested individuals within and around the military
communities.
AB and C messages will also be provided to individuals accessing HCT, Care and Support, ARV and
PMTCT services at military sites. Male and female condoms are provided free of charge.
In order to procure activity related commodities, $150,000 was put into SCMS ($75,000 each from AB and
Other Prevention funding lines).
By the end of COP09, the DOD will support 20 NMOD sites in Edo, Benue, Cross River, Rivers, Delta,
Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, and Anambra.
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
In conjunction with other DOD activities, and those of other partners, this activity will contribute to the
provision of a comprehensive HIV and AIDS prevention package for the military population, civilian
employees, their dependents and the communities surrounding military sites. This activity will contribute to
the PEPFAR overall aim of reducing HIV infection rates in Nigeria.
LINKS TO OTHER ACTIVITIES:
This activity relates to activities in PMTCT, Condoms and Other Prevention, Counseling and Testing, Care
and Support, TB/HIV, OVC, and ARV Services.
POPULATIONS TARGETED:
This activity targets the military, civilian employees, their dependents, and the communities surround
military sites. In particular, this activity targets in- and out-of-school youth and youth drafted into formal
military service.
EMPHASIS AREAS:
These activities focus on military populations, and gender, as specific programming is designed to reach
female military personnel and civilians as well as address male norms.
Continuing Activity: 13150
13150 5313.08 Department of US Department of 6400 554.08 DoD Track 2.0 $555,000
6803 5313.07 Department of US Department of 4189 554.07 DoD Program $150,000
5313 5313.06 Department of US Department of 2773 554.06 DoD $200,000
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $108,000
Continuing Activity: 13164
13164 9786.08 Department of US Department of 6401 554.08 DoD Track 2.0 $75,000
9786 9786.07 Department of US Department of 4193 554.07 DoD Agency $100,000
Table 3.3.03:
•Addition of new epidemiological data
•Revision of targets and emphasis areas
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $6,270,923
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Nigeria's effort at prevention of medical transmission of HIV has undergone tremendous growth since PEPFAR support. The
Government of Nigeria (GON) has equally focused more attention and emphasis on blood and injection safety.
Blood Safety
The 2003 sero-prevalence sentinel survey found a 5.1% HIV prevalence among women who had received blood transfusions
compared to 4.8% prevalence among those who had never received blood transfusions. Reliable information regarding suspected
transmission of HIV through infected blood is currently not available. A baseline survey of blood transfusion practices in the
country conducted by the GON in March 2007 confirmed a severely limited infrastructure for blood banking. With USG support,
the capacity for developing safe blood transfusion systems in Nigeria has been strengthened at the national level. However, this
national level capacity is noted to be significantly underutilized by the country. In COP08 USG/Nigeria worked to improve blood
collection techniques and utilization at the facility level, develop linkages between facilities and the national system, and
strengthen the National Blood Transfusion System (NBTS). In COP09, these activities will be sustained. It is expected that this will
result in the screening of 66,000 units of blood for the four transfusion transmissible infections (TTIs) (HIV I and II, hepatitis B,
hepatitis C, and syphilis) with ELISA in NBTS centers, and the training of 1,398 health workers across 188 sites.
The USG/Nigeria's strategies for COP08 blood safety activities are based on extensive dialogue with the technical working group
and OGAC and are in line with the USG/Nigeria 5-year plan. These strategies will continue in COP09. The last TA assessment
observed clear national policy, overall excellent quality of service but low coverage and utilization of the NBTS centers. A major
barrier to scale-up was the disconnect between hospital blood services and the NBTS. Other gaps noted were lack of skills in
blood donor recruitment, limited blood banking expertise and insufficient haemovigilance. The identified strategies for COP08 and
COP09 are: community blood drives for voluntary non remunerated donors; service linkages between the NBTS and hospitals; the
use of a national donor questionnaire nationwide to screen all donors and develop a database; and training and capacity building
of service providers.
In COP09 USG/Nigeria is emphasizing improved donor identification and blood collection practices at the facility level in line with
NBTS guidelines. A transition from family replacement and paid donors to voluntary non-remunerated donors (VNRD) in USG-
supported sites, just being implemented in COP08, will be continued and strengthened by NBTS and facility-based partners as
they work to harmonize standards of practice for donor criteria with the NBTS guidelines. In COP09, 29 USG-supported sites
identified in COP08 to develop blood banking capacity and linkages to nearby NBTS zonal centers will continue to be supported.
The ongoing NBTS hospital linkage is a significant change to the Nigerian system. Pre- and post-donation counseling, with
appropriate deferment of high risk donors and offering of voluntary HIV counseling and testing, will be conducted at the facility
level, thereby capturing a population of most at risk persons as determined by donor screening questionnaire results. QA
processes for rapid testing will be done in line with HCT QA processes at the site level. Additionally, NBTS has engaged with
facilities to retain samples of facility-collected units for transport to NBTS for ELISA testing and feedback to the management of
the health facilities on prevalence rates of the four TTIs to enhance migration to VNRD.
The NBTS will develop a logistics system to support these facilities for their transfusion needs, facilitated by technical assistance
provided by SCMS and the USG medical transmission and logistics TWGs. The NBTS will work to identify other non-PEPFAR
facilities in the catchment areas of zonal centers to develop similar partnerships. Donor blood collection will migrate from mostly
hospital-based and fragmented to centralized NBTS coordinated and regulated.
This activity will utilize the already existing USG IPs' counseling and lab staff and will leverage relationships between the facilities
and community where they work to also scale up voluntary blood donation, coordinated jointly with NBTS, the facilities and
surrounding communities. Blood obtained from blood drives and those from family donors at the facilities shall be collected
according to NBTS guidelines and will be taken by the NBTS for ELISA screening. The NBTS will develop a courier system to
regularly collect this unscreened blood and deliver screened blood to these sites based on quantities of blood needed. This
linkage will be supported by hotlines at NBTS centers where participating facilities can make requests for screened blood. NBTS
centers and associated mobile outreach clinics are now increasingly better staffed and support from USG has leveraged
additional GON funds.
In COP08 the lead technical implementing partner, Safe Blood for Africa Foundation (SBFAF), provided technical support to the
NBTS and other implementing partners (IPs) for capacity building in program development and implementation of blood safety
activities at national and site specific levels. SBFA developed a national training plan consistent with NBTS policy. Participating
staff from USG-supported hospitals, USG IPs, and NBTS were trained on phlebotomy, donor recruitment and counseling, lab
screening and blood banking, use of blood and hemovigilance, medical waste management, quality assurance/quality control
(QA/QC) for HIV serologic testing, and transport and logistics for blood safety. In line with the GON national training guidelines,
several of these trainings were developed as training of trainers (TOT). In COP09, master trainers will step down training to staff
in their respective health facilities. SBFA will lead development of standardized training manuals and production of educational
materials and job aids, and will continue to roll out TOT trainings. The NBTS will take the lead as coordinator of blood safety
activities and will host joint quarterly meetings with stakeholders in which USG partners will actively participate for programmatic
review. IPs will support the establishment of hospital transfusion committees in health facilities to further improve the facility-based
communication and knowledge on appropriate blood transfusion practices.
The NBTS donor questionnaire will be administered to all donors to screen out high risk donors and ensure that only low risk
clientele donate blood. USG supported sites will also maintain a comprehensive database on their blood transfusion services.
Data from this database and the screening questionnaires shall be routinely communicated to the NBTS in order to maintain a
national database.
Proper waste management will be promoted through collaboration with injection safety activities, the use of biohazard bags and
sharp containers, and the repair/utilization of incinerators at USG/Nigeria supported sites. The SCMS procurement role will be
expanded to support the NBTS in the purchase of supplies needed for the realization of a functional national system.
Injection Safety
A 2004 GON injection safety assessment which was supported by the USG showed that an average of 4.9 injections was given
per person per year. The assessment also showed that safety boxes were not used in three-fifths of the facilities surveyed, two
handed recapping was observed in 76% of observed injections, 45% of providers had at least one needle stick injury in the last
one year and 94% of these providers were not offered HIV post exposure prophylaxis. These findings cut across all geo-political
zones of Nigeria. Since that time the USG has supported an expanded injection safety program to respond to these challenges
through the activities of a lead technical partner - Making Medical Injections Safer (MMIS) - and 6 other IP.
The USG/Nigeria strategy for COP09 injection safety activities will continue to be based on the three part strategy of WHO/Safe
Injection Global Network (SIGN). These three SIGN strategies target behavior change of both health workers and patients,
procurement of needed safe injection commodities and facilitation of appropriate healthcare waste management. USG/Nigeria has
added training and capacity building of healthcare workers and waste handlers as a fourth strategy to improve injection practices
and occupational safety. In COP09 a total of 6,000 healthcare providers will be trained on injection safety and healthcare waste
management while 299 facilities will be reached with injection safety activities.
In COP07 a national policy on injection safety and healthcare waste management was developed with USG support. The USG
also supported the development and adaptation of the "Do No Harm" training curriculum by the GON. Infection prevention
committees were inaugurated at facility levels to provide on-site supportive supervision and ensure post exposure prophylaxis.
MMIS provided technical support to the GON and other key stakeholders (e.g. Nursing and Midwifery Council, schools of health
technology, Medical and Dental Council of Nigeria) in curriculum review and inclusion of updated safe injection issues into pre-
service and refresher trainings to ensure sustainability. Advocacy efforts were intensified for the use of retractable and non re-use
syringes through an identified Injection Safety Champion. Advocacy efforts have also resulted in the Federal Ministry of
Environment (FMOE) budgeting for healthcare waste management.
Injection safety activities are linked with Blood Safety, TB/HIV, HCT, Lab Infrastructure and ART services. In spite of the success
in the USG-supported facilities with injection safety programs, there is need for substantial scale-up of this activity in conjunction
with the continued scale-up and scale-out of healthcare services in Nigeria. This is highlighted by the wide geographical spread of
the country and the need for policy implementation at the grassroots level. In COP09 emphasis will continue to be on
consolidating the gains achieved to date and integrating the policy into the national health plan. Scale-up of the injection safety
program will continue with local government area (LGA) coverage as part of the LGA coverage plan long implemented by MMIS,
facility saturation for other IPs, and a greater focus on sustainable healthcare waste management throughout Nigeria.
In COP08, there was a strategic delineation of responsibilities among implementing partners. This will continue in COP09 to
ensure efficiency and quality of injection safety activities. MMIS will continue to work at both national and facility levels. It will
provide expertise in the area of training by conducting regular TOTs and supportive supervision to other IPs. It will take the lead
on production and distribution of educational materials and job aids. MMIS will also procure and distribute seed commodities to
other IPs such as safety boxes and retractable needles/syringes. Through MMIS, USG/Nigeria will support community
mobilization to promote oral medication instead of injectable medication through collaboration with community based
organizations and the mass media. Collaboration with the GON on collection and tracking of consumption data will also be a
focus.
In COP08, all other IPs were required to provide a minimum package of injection safety activities at facility level. This minimum
injection safety package will include: training of all health workers and waste handlers; utilization of safety boxes in all units of the
health facility; promotion of awareness of injection safety and healthcare waste management policy; establishment of infection
control committees at tertiary and secondary facilities; and the provision of color-coded bin liners at waste generation points for
segregation of waste. By conducting these activities in every department of facilities that IPs support will achieve "facility
saturation," i.e., healthcare injection safety practices and waste management will be implemented facility-wide. In COP09,
emphasis will be on supportive supervision of all sites and appropriate health care waste management.
The USG supported the GON (through the FMOE) in the development of National Healthcare Waste Management Policy, Plan
and Guidelines in COP07 and COP08. In COP09, all IPs will work to implement this plan. In addition, IPs will support the states
they are in to adapt and implement the plan as well as renovation and reactivation of incinerators for proper disposal of safety
boxes and other infectious medical waste at facility and LGA levels.
Sustainability plans will include increasing efforts to develop public private partnership for health care waste management and
involvement of private health practitioners in injection safety programs. This effort was pilot tested in two LGAs in Lagos State in
COP07. Lessons learned have informed scale up of this activity in Lagos State in COP08. Advocacy to other states in Nigeria to
emulate Lagos State best practices will be focused on in COP09. Advocacy to the GON in COP08 has yielded government
supported injection safety training in non-PEPFAR states. It has also yielded an enabling environment for local production of auto
disabled syringes. Technical support for local production of safety boxes will be intensified in COP09.
Male Circumcision
Both anecdotal evidence a recent report by UNAIDS and WHO (Male circumcision: Global trends and determinants of prevalence,
safety and acceptability, February 2007) suggest that over 90% of Nigerian males are circumcised. As part of the new emphasis
on male circumcision as a means of preventing HIV infection, USG/Nigeria will conduct a desk review in COP09 to document
prevalence of male circumcision. The desk review, which will be funded in Strategic Information, will document the incidence and
safety of methods used in Nigeria from previous research and qualitative findings. Results from the desk review will be used to
direct future programming in this area and develop strategies to enhance coverage and promote safe male circumcision practices.
Table 3.3.04:
ACTIVITY NARRATIVE:
In COP09, the Department of Defense (DOD) HIV Program, in collaboration with the Nigerian Ministry of
Defence (NMOD), will continue to support blood safety activities to strengthen NMOD's support and use of
the National Blood Transfusion Service (NBTS) as started under COP08. The DOD will conduct activities in
four sites. The 4 sites were selected due to their proximity to an NBTS regional blood screening site.
This activity has three components. Working closely with the NBTS, the first component is to support blood
drive activities across four military sites. By promoting and facilitating access to the NBTS, the military will
support the recruitment of voluntary, non-remunerated blood donors among the barracks community in
support of national blood supply needs. Another objective is to increase the number of first-time donors and
the proportion of military and civilian personnel who are regular donors. This will be facilitated by frequent
blood drives at the sites so military personnel will not have to travel to NBTS to donate. The NMOD will also
encourage senior military officers to promote regular blood donation during officer professional development
seminars. All donors will be screened with the national blood donor questionnaire and the data remitted to
the NBTS. Deferred donors will be offered HCT and data captured under HVCT.
The second component includes supporting sites to transport blood units collected to the NBTS. Currently,
blood donations are collected, screened with rapid test kits and transfused at military sites. Instead of
screening, storage and distribution of blood at the four military sites, the DOD will work with the sites to
establish systematic transportation of blood collections to the nearest NBTS site for processing and
screening for the four transmissible transfusion infections with ELISA. This will include the provision of
hazmat mobile storage containers to transport blood. By beginning to shift the effort of providing these
services through the NBTS, it is anticipated that over time the burden of collecting and screening blood at
most of the military sites will be transferred to the NBTS. This will also result in a reduction in the use of
rapid test kits to screen blood at military sites, saving resources for VCT and other clinical screening
programs. Screened blood from NBTS will be collected and stored at the four collaborating centers so that
emergency screening with rapid test kits is minimal. The goal is to make emergency screening of transfused
blood with rapid test kits <20% of the total transfusion taking place at these facilities. As a result of these
first two activities, the military will support the NBTS in executing its responsibility for ensuring a national,
safe blood supply in Nigeria, coordinated and implemented by a single national body. NBTS will also
provide monthly feedback on rates of the four TTIs found by ELISA screening of blood units collected by
each facility.
The final component of this activity includes strengthening the capacity of military and civilian personnel in
blood safety practices. The DOD will also facilitate the training of NMOD staff through the Safe Blood for
Africa Project (SBFA) and the NBTS. Education and training in all aspects of blood safety according to
Government of Nigeria (GON) national training guidelines will be provided to 12 personnel at the four
NMOD sites by SBFA. Step-down training will be conducted at each site. A total of 36 health personnel will
be trained through this step down training. This includes topics such as donor recruitment and
management, blood collection, as well as in counseling, including appropriate utilization of the NBTS pre-
donation screening questionnaire, leading to improved screening of all donors in all facilities. Training on the
risks associated with family replacement/ remunerated donors and appropriate clinical use of blood,
universal precautions, good clinical and laboratory practices, testing for transfusion-transmissible infections,
and other such areas will also be covered. DOD will support clinical meetings and seminars of medical
professionals to promote rational use of blood and advocate implementation of the national blood policy.
QC/QA will be instituted for all processes involved in this activity. All sites will be provided with copies of the
National Blood Policy, operational guidelines for blood transfusion, SOPs and job aids to support blood
safety activities.
This activity will support four NMOD sites in Lagos, Kaduna, Oyo and the FCT. It is expected that an
average of 100 units of blood from each of these sites will be screened through linkages with the NBTS
making a total of 400 units of blood.
This activity will also promote the principles of Universal Safety Precautions, such as the reduction of
occupational exposure to blood, accidental injury/contamination as well as the essential consumables and
services that protect health care workers from contracting infections, especially HIV. These universal
precaution materials will include personal protective equipment such as hand gloves, laboratory coats,
masks, and other essential consumables for each site. Additionally, each site will make provisions for the
referral of staff for access to post exposure prophylaxis (PEP) when needed. PEP will be provided through
ART drugs activities. Proper waste management will be encouraged at each site through the use of
biohazard bags, suitable sharps containers, and the use of incinerators.
CONTRIBUTION TO OVERALL PROGRAM AREA:
This activity will contribute to the USG target of preventing new infections through prevention of medical
transmission of HIV by ensuring the supply of a safe and screened national blood supply. This activity will
also contribute to GON and PEPFAR training goals by training military personnel in blood safety. This
activity will help to establish routine referrals to the NBTS for blood banking services.
LINKS TO OTHER ATIVITIES:
This activity will be linked to PMTCT (MTCT), HCT (HVCT), Injection Safety (HMIN), Lab (HLAB), ART
services (HTXS), and TB/HIV (HVTB). All donors at the collaborating centers will be screened with the
national blood donor questionnaires and deferred donors offered full HCT services. The DOD will also
establish linkages with other partners to ensure access to the full range of blood safety activities including
Safe Blood for Africa and the NBTS.
POPULATIONS BEING TARGETED:
This activity targets military and civilian personnel who are involved in blood collection, storage and
Activity Narrative: transfusion. The activity also targets the broader barracks community to increase the number of voluntary
non-remunerated blood donors.
EMPHASIS AREA
This activity targets military populations and health workers in military health institutions.
Continuing Activity: 13151
13151 5388.08 Department of US Department of 6400 554.08 DoD Track 2.0 $60,000
6805 5388.07 Department of US Department of 4189 554.07 DoD Program $0
5388 5388.06 Department of US Department of 2773 554.06 DoD $50,000
Estimated amount of funding that is planned for Human Capacity Development $10,000
From COP05 through COP08, the Department of Defense (DOD) HIV Program, in collaboration with the
Nigerian Ministry of Defense (NMOD), received support for injection safety through John Snow Incorporated
(JSI)/Making Medical Injection Safer (MMIS) including training and the provision of auto-disable (AD)
syringes and sharp boxes. In order to strengthen injection safety practices in the Nigerian Military, the DOD
will further expand infection prevention/safety activities during COP09. Activities will support capacity
building/training, safe and effective waste management systems, ensuring availability of safe injection
equipment and the promotion of oral alternatives. Activities will be conducted at 20 existing DOD sites.
The DOD will continue to collaborate with JSI/MMIS in the areas of training and commodities procurement.
JSI/MMIS will train DOD master trainers personnel (TOT) centrally and these master trainers will step down
trainings at various DOD sites utilizing the JSI/MMIS curriculum for the step down trainings. At least 20
military health care personnel (e.g., physicians, nurses, pharmacists, sanitarians) will be trained. All safety
protocols will be reviewed and distributed.
To supplement the limited supply of commodities that are provided by MMIS, the DOD will procure (via the
Supply Chain Management System) commodities that are required for safe injections/needle handling and
disposal; $10,000 has been allocated to SCMS for this activity. Depending on site inventories and needs,
commodities may include disposable syringes, respiratory masks, surgical gloves, waste/sharps collection
units and other safe injection equipment. Commodities will be provided to all 20 military sites.
Another component of this activity is to reprint or adapt existing educational materials (e.g., pamphlets,
brochures) on injection safety that have been produced in COP06-COP08 by other partners such as IHVN.
Materials will be distributed at trainings and will be posted in relevant locations (e.g., laboratories,
pharmacies) at the 20 sites. Materials will include a poster on procedures for post-exposure prophylaxis.
Materials will also aim to reduce prescription of unnecessary injections.
The final aspect of this activity will be to assess each site's healthcare waste (HCW) management system.
As necessary, renovations and construction of incinerators will be conducted, using WHO specifications to
ensure that HCW are treated and disposed of appropriately.
Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, and Anambra (16 states and FCT).
This activity will contribute to the prevention of new infections and reduction of occupational hazard
exposures among military and civilian personnel by promoting injection safety. Thus, the activities will
contribute to the overall PEPFAR goal of prevention of medical transmission through injection safety.
This activity relates to activities in MTCT, HVCT, HMBL, HLAB, HTXS and HVTB.
This activity primarily targets military and civilian health care personnel who are involved in handling
needles and/or blood from patients and/or handle waste disposal.
This activity has an emphasis on military populations and universal precaution.
From COP05 through COP07, the Department of Defense (DOD) HIV Program, in collaboration with the
(JSI)/Making Medical Injection Safer (MMIS) including the provision of training and sharp boxes. In order to
strengthen injection safety practices in the Nigerian Military, the DOD will further expand infection
prevention/safety activities during COP08. Activities will support capacity building/training, safe and
effective waste management systems, ensuring availability of safe injection equipment and the promotion of
safe injections. Activities will be conducted at 14 existing DOD sites and six new expansion sites in COP08.
trainings at various DOD sites utilizing the JSI/MMIS curriculum for the step down trainings. At least 60
military health care personnel (e.g., physicians, nurses, pharmacists, sanitarians) will be re-trained or
trained. All safety protocols will be reviewed and distributed. To ensure sustainability, the cadre of staff
trained as trainers will conduct regular biannual refresher trainings across the 20 sites.
disposal. Depending on site inventories and needs, commodities may include disposable syringes,
respiratory masks, surgical gloves, waste/sharps collection units and other safe injection equipment.
Commodities will be provided to all 20 military sites.
brochures) on injection safety that have been produced in COP06 and COP07 by other partners such as
IHVN. Materials will be distributed at trainings and will be posted in relevant locations (e.g., laboratories,
Materials will also aim to reduce unnecessary injections.
Activity Narrative: The last component of this activity includes an assessment of each site's waste management system. As
necessary, renovations of waste-disposal pits will be conducted to ensure that pits are built to safety
standards (e.g., proper depth, width, sealed correctly). In the few sites that have incinerators, renovations
may be conducted, if necessary.
By the end of COP08, the DOD will support 20 NMOD sites in Edo, Benue, Borno, Cross River, Rivers,
Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, Anambra, and Niger (16 states and
contribute to the overall PEPFAR goal of prevention medical transmission through injection safety.
This activity relates to activities in MTCT (3246.08), HVCT (3241.08), HMBL (5388.08), HLAB (3244.08),
HTXS (3243.08) and HVTB (3240.08).
This activity has an emphasis on local organization capacity building and human capacity development.
Continuing Activity: 16943
16943 16943.08 Department of US Department of 6400 554.08 DoD Track 2.0 $45,000
Estimated amount of funding that is planned for Human Capacity Development $8,000
Table 3.3.05:
ACTIVITY DESCRIPTION: This activity represents funding for one contracted Nigerian health care provider
for activities in Basic Care and Support. A new emphasis by DOD in COP08 and continued emphasis in
COP09 is to provide additional attention to psychosocial, spiritual, and other non-clinical support and
aspects of care. Funding will also support external technical support of BCS. The budget includes funding
for one FSN direct hire, overhead charges, funding required for domestic travel, training funds and allocated
minor support costs. This funding also includes support for a USMHRP HQ Technical Assistance visit for
two weeks of in-country support to provide TA on basic care and support, continuing medical education and
mentorship. TA assistance may also be provided by the USMHRP's site staff in Kenya, Uganda and/or
Tanzania.
A unique aspect of the NMOD-DOD Program is the implementation of the program by non-PEPFAR
remunerated staff. Support to and development of local support groups and encouragement of military
members, staff and family members to participate in community efforts to care for HIV+ patients will enable
increased programming.
The Care and Support Officer will work as members of the USG Care and Treatment Technical Working
Group, as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD) Clinical
program management and oversight of the 20 DOD-NMOD PEPFAR site Care and Treatment Programs.
The program officer will work with other Implementing Partners and the USG team to ensure a harmonized
approach that is consistent among partners and with the GON national guidelines.
Continuing Activity: 16942
16942 16942.08 Department of US Department of 6401 554.08 DoD Track 2.0 $100,000
Table 3.3.08:
•Narrative combined; Targets updated
This activity relates to activities in HCT, PMTCT, Basic Care and Support, and TB/HIV activities.
civilian community (constituting approximately 75% of the Military's patient load). During COP09, the U.S.
Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will continue to provide
free care and treatment services in 20 military hospitals.
In COP09, DOD - NMOD will provide comprehensive ART services to 9,806 adult patients. A total of 1,046
new patients will be added during the reporting period. Clinicians across the 20 sites will be assisted to
promptly initiate support for ART eligible patients, with emphasis on supporting the 6 newer primary sites.
Each site is an integrated hospital supporting HCT, laboratory, TB and other services. Linkages with both
NMOD and other partner facilities will support referral of complicated or stable patients to ease
overcrowding and maximize facility abilities. Care and support services will be provided to 18,600 HIV+
adults and will reach an additional 37,200 persons affected by AIDS (PABAs), including family members
and children.
A major component of this activity is human capacity development- both in increasing numbers of providers
and the training provided to them. The NMOD has committed to increasing and developing a sustainable
treatment program by hiring 100 new health care professionals dedicated directly for PEPFAR goals (30
each physicians and nurses, 20 each laboratorians and pharmacists). In COP09, the DOD will support the
training of an additional 100 health care workers, including doctors, pharmacists, nurses, laboratorians, site
administrators, commanders, and team leaders in the areas of ART services and 100 in care and support.
Additional temporary staff through the National Youth Service Corps (NYSC) will be utilized. In COP06,
NYSC physicians were jointly funded by the DOD and NMOD programs; in COP07-COP08, the NMOD
assumed total coverage of these salaries. Funding may be provided to expand this program in COP09.
Use of the NYSC (usually three to four per site) provides a dual purpose of training young physicians in
Nigeria in ARV services and HIV/AIDS care and support, and exposes them to the military system for
possible accession to the uniformed services or as NMOD civilian providers. Advocacy for task shifting will
be undertaken with NMOD leadership under policy activities.
Training is the second component of capacity development. The base of training has included the four
week ART training at the Infectious Disease Institute in Uganda and will continue to serve as a training
component for COP09. This will complement local training utilizing the GON national guidelines and
training manual/curriculum. A dedicated Infectious Disease physician will provide mentoring and continuing
medical education courses through centralized in-country and on-site trainings on HIV/AIDS care and
support, treatment, adherence and laboratory monitoring. Adherence counseling for ARVs and instruction
in side effects and contra-indications is part of the NMOD internal ART course and each pharmacist is
provided with initial and refresher training through this course.
The third tenet of capacity development is physical capacity. This will be increased through refurbishments
at each site as required by each site to improve patient flow and throughput. This will be accomplished
through bilateral planning of both the NMOD and DOD funding. US DOD funding has provided
refurbishments at seven sites and the NMOD has funded refurbishments at seven sites. One site was jointly
refurbished (44 NARHK) due to its size and dual use as a NMOD treatment site and as a referral center for
all of Kaduna State.
To enhance quality of care, the DOD will conduct on-site clinical mentoring via centrally located staff and
DOD HQ Technical Assistance rotations. The DOD-NMOD Technical working Group will integrate with
USG and MOH advisors to ensure that all activities and support are in compliance with National policies,
curricula and guidelines. In additional, the DOD will ensure that routine meetings with all hospital staff
involved in HIV/AIDS patient care are occurring monthly (or more frequently, as needed). This will support
monitoring and evaluation of clinical outcomes and allow for dissemination of information and lessons
learned to improve care, and will help to support participation in ongoing efforts such as HIVQUAL and
NMOD/DOD's electronic patient registry.
The DOD will support the provision of comprehensive clinical care, including OI syndromic treatment and
management of STIs (e.g., (e.g,, ceftriaxone, azithromycin, acyclovir, penicillin G ) and malaria (e.g.,
ceftriaxone, azithromycin, acyclovir, penicillin G), diagnosis and treatment as well as pain and symptom
management, through the full course of infection at all 20 hospitals. This will be accomplished by:
strengthening institutional and health worker capacity with ongoing, in-service training, providing initial
training 100 health care workers in palliative care skills as part of and in addition to ART education;
increasing the capacity of clinicians to diagnose and manage common OIs; provide psychosocial
counseling; and strengthening laboratory diagnostic facilities and pharmacy capacity through
refurbishments, equipment, training and QA/QC programming. Nutritional assessments (weight, height,
BMI) will be conducted and vitamin supplementation will be provided as appropriate. Facility based care will
be complemented using a network model through trained volunteers, nurses, health workers, PLWHAs and
family members working together both in the facilities as well as following up patients at home. Basic care
kits, including an insect treated net, water guard, water vessel, latex gloves, ORS, soap, IEC materials, and
condoms will be provided, as well as cotrimoxazole for patients as clinically appropriate according to
national guidelines.
Laboratory services provided will include CD4 ascertainment and follow up, liver function tests, hepatitis
screening and management of abnormalities (e.g., elevated liver function, decreased
hemoglobin/hematocrit). as appropriate. All patients will be screened for TB and malaria; prophylaxis,
treatment, and linkages to wraparound or other program areas will be provided as appropriate.
Activity Narrative: A component of this activity will be supporting and maintaining links with active community-based
organizations, home-based care providers (HBCs) and faith-based organizations (FBOs) that will provide at
home follow up of patients attending ART clinics. While efforts will be strengthened to provide services to
individuals in the community who cannot access ART services, a strong component of these efforts will be
linking with local CBOs and FBOs since HBCs are limited in number at sites. Volunteers will be recruited
and trained from existing PLWHA support groups. DOD will also work with, and support, the NMOD and its
partners in further developing internal guidelines, protocols and standard operating procedures (SOPs),
using evidence-based interventions, particularly in the area of pediatric care and implementation of a
preventive-care-package.
In COP07-08, 44 Nigerian Army Reference Hospital Kaduna was provided with funding to refurbish a hall
for a vocational and economic empowerment center. Support was also provided for the training of PLWHAs
on soap making, knitting and tailoring to provide the foundation for sustainable income generation activities.
This activity focuses its efforts on young, HIV+ women. In COP09, this training activity will be expanded to
additional sites that have space to accommodate a vocational center. PLWHAs who were trained at 44 will
serve as trainers for other sites. Support will also be provided to purchase a stock of necessary materials
(e.g., soap making materials, weaving materials/equipment).
Another component of this activity is to strengthen spiritual and social services provided to those living with
HIV/AIDS in the military barracks. In COP09, DOD will continue to provide support for Imams and Priests to
provide spiritual support and/or counseling for PLWHAs and people affected by HIV/AIDS (PABAs). This
includes counseling related to a patient's fears, life views, crises, adherence and bereavement Health care
providers will provide linkages and information to reach military Imams and Priests, as well as collaborating
PLWHA support groups, during clinical care sessions. Imams and Priest will assist in increasing men's
involvement in care and encourage clients, in particular males, to participate in support groups.
In COP09, the DOD's "prevention for positives" program will be continued at all 20 military sites. Providers
at each site will provide adherence counseling, syndromic management of STIs in line with National STI
control policy and guidelines; risk assessment and behavioral counseling to achieve risk reduction; and
prevention messaging to include partner reduction and/or mutual fidelity, correct and consistent condom use
for PLWHAs, disclosure and partner testing. Condoms will be provided free of charge. Providers will
counsel clients on their disclosure of HIV status and partner/family notification with an emphasis on client
safety. Partner referrals for CT (individual and/or couple) will be provided. Also, referrals to community-
based and barracks-based support groups will be provided to HIV+ clients. Linkages to support groups and
services will also be enhanced by counselors who are members of PLWHA support groups. Referrals to
family planning services will be provided as appropriate, as well as access to pregnancy testing when
needed. Care kits for PLWHA will include preventative items, such as: an ITN, waterguard, water vessels,
soap, ORS, and condoms. These interventions will be implemented using the recently adapted HIV
Prevention in Care and Treatment Settings Prevention Package, which includes several training packages
and job aids.
NMOD and DOD participation in the USG ARV/Treatment and Care & Support Technical Working Groups
to address care and treatment issues will promote harmonization with the GON and other Implementing
Partners, thus strengthening the referral linkages and networks between partners close to NMOD sites.
The program will also establish networks for community volunteers, including People Living with HIV/AIDS,
to ensure cross-referrals. The DOD will continue to work with the GoN and other national stakeholders to
develop networks for purposes of addressing sustainability issues, stigma reduction, treatment, and
prevention activities. Linkages with other basic care partners and prevention groups (particularly prevention
for positives) will also be supported. NMOD/DOD will also participate in National ART evaluation efforts, as
well as provide input into the development of new guidelines such as the national HIV/nutrition guidelines.
Consumables and other supplies will be provided by a combination of two approaches. While the supply of
some consumables will continue to be sourced by DOD from local vendors, the majority of funding for drugs
and consumables will be invested in the Supply Chain Management Systems (SCMS). The DOD program
will continue support to the Nigerian Ministry of Defence (NMOD)-owned, contractor (SCMS) operated
warehouse developed under COP07 funding. NMOD customs agents will clear imported supplies. Under
training and supervision by SCMS contractors, the facility will distribute supplies directly to all NMOD Points
of Service. The warehouse will function as both a receiving/distribution center and as a storage facility for
buffer stock of critical items maintained in-country to protect against unforeseen shortages. This program
fully adheres to USG and FGON policies and acquisition regulations, minimizes indirect costs and
accomplishes NMOD capacity building in supply chain management. The program design ensures
continued USG visibility and accountability at all levels of implementation. DOD has allocated
DOD has allocated $1,175,000 of its Adult ARV Services budget and $400,000 of its Adult Care and
Support budget to SCMS for procurement of commodities. This amount is captured under the SCMS ARV
Services and the SCMS Care and Support activities.
By the end of COP09, DOD will support 20 NMOD facilities in Anambra, Benin, Benue, Borno, Cross River,
Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Oyo, Plateau, Rivers, and
Sokoto (15 states and FCT).
Expansion of care and treatment services will contribute to 2009 PEPFAR targets. The training of health
care workers and community volunteers will contribute to human resource development to ensure the
sustained delivery of high quality care and support and ART services in Nigeria.
This activity is linked to all prevention activities, HIV/AIDS/TB treatment and care services, drugs and
laboratory infrastructure, and SI.
Activity Narrative: POPULATIONS TARGETED:
This activity will target all adults and their caregivers in the 20 military communities served, as well as the
civilian population in the surrounding communities, who are diagnoses as HIV+ and clinically assessed as
suitable for treatment.
This activity focuses on military populations and gender by increasing women's access to income and
productive resources.
Continuing Activity: 13153
13153 3247.08 Department of US Department of 6400 554.08 DoD Track 2.0 $375,000
6802 3247.07 Department of US Department of 4189 554.07 DoD Program $851,600
3247 3247.06 Department of US Department of 2773 554.06 DoD $380,000
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $40,000
This activity relates to activities in VCT, PMTCT, Basic Care and Support, OVC and TB/HIV activities.
civilian community (constituting approximately 75% of the Military's patient load). During COP08, the U.S.
Department of Defense (DOD) - Nigerian Ministry of Defence (NMOD) HIV Program will continue to extend
free ARV services in the following 14 military facilities and communities: Defence Headquarters Medical
Center - Mogadishu Barracks (FCT), 44 Nigerian Army Reference Hospital (Kaduna), Nigerian Naval
Hospital (Ojo), 445 Nigerian Air Force Hospital (Ikeja), 82 Division Hospital (Enugu), Nigerian Air Force
Hospital (Jos), Nigerian Naval Hospital (Calabar), Naval Medical Centre (Warri), Nigerian Army Hospital
(Port Harcourt), 45 Nigerian Air Force Hospital (Makurdi), Military Hospital (Benin), 2 Division Nigerian Army
Hospital (Ibadan), Military Hospital (Maiduguri) and 3 Division Hospital (Jos).
In COP08, the program will expand to six new sites. These include: Brigade Medical Center (Sokoto),
Armed Force Specialist Hospital (Kano), 34 FAB Medical Center (Owerri), Ministry of Defence Clinic
(Abuja), Military Cantonment (Onitsha), and Headquarters Nigerian Army CAS Medical Reception Station
(Kontangora).
In COP08, DOD - NMOD will expand comprehensive ART services to recruit 2,500 new patients and
maintain 6,260 patients, reaching a total of 8,760 individuals receiving ART. Approximately 10% (850) will
be pediatric patients. Clinicians across the 20 sites will be assisted to promptly initiate support for ART
eligible patients, with emphasis on supporting the 6 new primary sites. Each site is an integrated hospital
supporting HCT, laboratory, TB and other services. Linkages with both NMOD and other partner facilities
will support referral of complicated or stable patients to ease overcrowding and maximize facility abilities.
and the training provided to them. The NMOD has committed to increasing and developing of a sustainable
treatment program in COP07 by hiring 100 new health care professionals dedicated directly for PEPFAR
goals (30 each physicians and nurses, 20 each laboratorians and pharmacists). In COP08, the DOD will
support the training of an additional 200 health care workers, including doctors, pharmacists, nurses,
laboratorians, site administrators, commanders, and team leaders. Additional temporary staff through the
National Youth Service Corps (NYSC) will be utilized. In COP06, NYSC physicians were jointly funded by
the DOD and NMOD programs; in COP07, the NMOD assumed total coverage of these salaries. Funding
may be provided to expand this program in COP08. Use of the NYSC (usually three to four per site)
provides a dual purpose of training young physicians in Nigeria in ARV services and HIV/AIDS care and
exposing them to the military system for possible accession to the uniformed services or as NMOD civilian
providers.
week ART training at the Infectious Disease Institute in Uganda (78 NMOD personnel trained through end
of COP06) and will continue to serve as a cornerstone for 2008. A dedicated Infectious Disease physician
will provide mentoring and continuing medical education courses through centralized in-country and on-site
trainings on ART clinical care, treatment, adherence and laboratory monitoring. Adherence counseling for
ARVs and instruction in side effects and contra-indications is part of the NMOD internal ART course and
each pharmacist is provided with initial and refresher training through this course.
learned to improve care.
NMOD and DOD participation in the USG ARV/Treatment Technical Working Group to address treatment
issues will promote harmonization with the GON and other Implementing Partners, thus strengthening the
referral linkages and networks between partners close to NMOD sites. The program will also establish
networks for community volunteers, including People Living with HIV/AIDS, to ensure cross-referrals. The
DOD will continue to work with the GoN and other national stakeholders to develop networks for purposes
of addressing sustainability issues, stigma reduction, treatment and prevention activities. Linkages with
other basic care partners and prevention groups (particularly prevention for positives) will also be
supported.
some consumables will continue to be sourced by DOD from local vendors, the majority (80%) of funding for
drugs and consumables will be invested in the Supply Chain Management Systems (SCMS). The DOD
program will continue support to the Nigerian Ministry of Defence (NMOD)-owned, contractor (SCMS)
operated warehouse developed under COP07 funding. NMOD customs agents will clear imported supplies.
Under training and supervision by SCMS contractors, the facility will distribute supplies directly to all NMOD
Points of Service. The warehouse will function as both a receiving/distribution center and as a storage
facility for buffer stock of critical items maintained in-country to protect against unforeseen shortages. This
program fully adheres to USG and FGON policies and acquisition regulations, minimizes indirect costs and
Activity Narrative: continued USG visibility and accountability at all levels of implementation.
By the end of COP08, DOD will support 20 NMOD facilities in Anambra, Benin, Benue, Borno, Cross River,
Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Niger, Oyo, Plateau, and
Rivers, and Sokoto (16 states and FCT).
DOD has allocated $2,100,000 of its ARV Services budget to SCMS for procurement of commodities. This
amount is captured under the SCMS ARV Services activity.
Expansion of ARV services will contribute approximately 2% of the overall 2008 PEPFAR targets. The
training of health care workers and community volunteers will contribute to human resource development to
ensure the sustained delivery of high quality ART services in Nigeria.
This activity is linked to all prevention activities (#3246.08, #5313.08, #5388.08, #5362.08, #16943.08),
HIV/AIDS/TB treatment and care services (#3240.08, #3247.08, #5409.08, #3241.08), Drugs and
Laboratory Infrastructure (#3242.08, #3244.08) and SI (#3245.08).
This activity will target all individuals in the 20 military communities served, as well as the civilian population
in the surrounding communities, who are diagnoses as HIV+ and clinically assessed as suitable for
treatment.
This activity will focus on gender issues through seamless PMTCT/ART/TB services at NMOD sites and in
collaboration with neighboring PMTCT sites to improve women's access to services, particularly in
previously underserved communities. This activity will also facilitate linkages into community and support
groups.
Continuing Activity: 13158
13158 3243.08 Department of US Department of 6400 554.08 DoD Track 2.0 $450,000
6798 3243.07 Department of US Department of 4189 554.07 DoD Program $1,950,000
3243 3243.06 Department of US Department of 2773 554.06 DoD $1,315,000
Table 3.3.09:
ACTIVITY DESCRIPTION: This activity represents funding for four full-time, contracted Nigerian program
officer positions in support of ART Treatment Services as well as additional external technical assistance.
The positions include a Clinical Treatment Physician/Clinical Manager, a Pharmacist and two Logisticians.
The budget includes four FSN salaries, overhead charges, funding required for domestic travel, training
funds and allocated minor support costs. This funding also includes support for a USMHRP HQ Technical
Assistance visit for one week of in-country support by an ART physician who will provide TA, continuing
medical education and mentorship. TA assistance may also be provided by the USMHRP's site staff in
Kenya, Uganda and/or Tanzania.
All four positions serve on various USG Technical Working Groups. The Clinical Manager sits on the USG
Care and Treatment TWG, the Logisticians sit on the Logistics TWG, and the Pharmacist participates in
both TWGs. These officers also serve on the U.S. Department of Defense - Nigerian Ministry of Defence
HIV Program's Clinical Technical Working Group to integrate US policy and implementation with
NMOD/GON practices.
The program officers' responsibilities also include: 1) representing the DOD-NMOD in technical discussions
with the GON and 2) overseeing relevant technical aspects of the program, including program management
and oversight of the 20 DOD-NMOD PEPFAR site treatment programs. The Logisticians and Pharmacist
work closely with SCMS and other partners to ensure proper drug and service forecasting for the Nigerian
Military and surrounding communities. The program officers will work with other Implementing Partners and
the USG team to ensure a harmonized approach that is consistent among partners and promotes the GON
national treatment guidelines.
Continuing Activity: 13165
13165 5400.08 Department of US Department of 6401 554.08 DoD Track 2.0 $200,000
6807 5400.07 Department of US Department of 4193 554.07 DoD Agency $200,000
5400 5400.06 Department of US Department of 2773 554.06 DoD $100,000
•Narrative combined; targets updated
This activity relates to activities in HCT, PMTCT, basic care and support, and TB/HIV activities.
In COP09, DOD - NMOD will expand comprehensive care services to 1,100 pediatric patients (0-14 years
of age). Clinicians across the 20 sites will be assisted to promptly initiate support for ART eligible patients,
with emphasis on supporting the six newer primary sites. A total of 618 new pediatric patients will be added
during the reporting period. Considering loss to follow up and mortality, an estimated 938 patients will be on
treatment at the end of the reporting period. Each site is an integrated hospital supporting HCT, laboratory,
TB and other services. Linkages with both NMOD and other partner facilities will support referral of
complicated or stable patients, or specialized needs, such as early infant diagnosis (EID) to ease
overcrowding and maximize efficient use of facility abilities. Care and support services will be provided to
1,100 HIV+ children and will reach an additional 2,200 persons affected by HIV/AIDS (PABAs), including
family members and other children.
A major component of this activity is human capacity development - both in increasing numbers of
providers and the training provided to them. The NMOD has committed to increasing and developing a
sustainable treatment program by hiring 100 new health care professionals dedicated directly for PEPFAR
goals (30 each physicians and nurses, 20 each laboratorians and pharmacists). In COP09, the DOD will
support the training of an additional 100 health care workers, including doctors, pharmacists, nurses,
laboratorians, site administrators, commanders, and team leaders in the areas of pediatric ART and basic
care and support services. Additional temporary staff through the National Youth Service Corps (NYSC) will
be utilized. In COP06, NYSC physicians were jointly funded by the DOD and NMOD programs; in COP07-
COP08, the NMOD assumed total coverage of these salaries. NMOD funding will be provided to expand
this program in COP09. Use of the NYSC provides a dual purpose of training young physicians in Nigeria in
ARV services and HIV/AIDS care and support, and exposes them to the military system for possible
accession to the uniformed services or as NMOD civilian providers.
week ART training at the Infectious Disease Institute in Uganda where pediatric treatment is covered, and
will continue to serve as a training component for COP09. This will complement local training utilizing the
GON national guidelines and training manual/curriculum. A dedicated infectious disease physician will
provide mentoring and continuing medical education courses through centralized in-country and on-site
trainings on pediatric HIV/AIDS care and support, treatment, adherence and laboratory monitoring.
Adherence counseling for ARVs and instruction in side effects and contraindications is part of the NMOD
internal ART course and each pharmacist is provided with initial and refresher training through this course.
DOD/NMOD will support the development and use of pediatric care and support guidelines and training
manuals.
at each site as required to improve patient flow and throughput. This will be accomplished through bilateral
planning of both the NMOD and DOD funding. US DOD funding has provided refurbishments at seven sites
and the NMOD has funded refurbishments at seven sites. One site was jointly refurbished (44 NARHK) due
to its size and dual use as a NMOD treatment site and as a referral center for all of Kaduna State.
curricula and guidelines. In addition, the DOD will ensure that routine meetings with all hospital staff
The DOD will support the provision of comprehensive clinical care (e.g., growth monitoring via MAC,
nutritional assessment) and syndromic management of STIs (e.g., ceftriaxone, azithromycin, acyclovir,
penicillin G), in older adolescents, if necessary, and OI diagnosis and treatment, malaria diagnosis and
treatment, as well as pain and symptom management at all 20 hospitals. This will be accomplished by:
training to 100 health care workers in care and support skills as part of and in addition to ART education;
increasing the capacity of clinicians to diagnose and manage common OIs; providing psychosocial
counseling; and strengthening laboratory diagnostic facilities and pharmacy capacity (see DOD lab and
ARV drug submissions) through refurbishments, equipment, training and QA/QC programming. Facility-
based care will be complemented using a network model through trained volunteers (e.g., PLWHA support
group members), nurses, health workers, PLWHAs and family members working together both in the
facilities as well as following up with patients at home. Basic care kits and pediatric preventive care
packages, to include an insecticide treated net, waterguard, water vessel, ORS, latex gloves, and IEC
materials will be provided, as well as cotrimoxazole for patients as clinically appropriate according to
Laboratory services provided will include CD4 ascertainment, liver function tests, hepatitis screening and
management of abnormalities as appropriate. Eight of the NMOD major sites all possess Becton-Dickinson
FACS Counts and all these devices are being retrofitted with the pediatric lymphocyte % software. All
patients will be screened for TB and malaria; prophylaxis, treatment, and linkages to wraparound or other
Activity Narrative: program areas will be provided as appropriate. According to national and USG guidelines, Early Infant
Diagnosis support coverage (PEPFAR/Clinton Foundation funded) will be expanded from the two pilot sites
(NNH Ojo and 45 NAFH Makurdi) to support the increased survival findings with EID/early initiation of
A component of this activity will be supporting and maintaining links with active community-based
home follow-up of patients enrolled in care and treatment. While efforts will be strengthened to provide
services to individuals in the community who cannot access ART services, a strong component of these
efforts will be linking with local CBOs and FBOs who are already working with the sites since HBCs are
limited in number at sites. DOD will reach out to local OVC partners to link pediatric patients to support
services. DOD will also work with, and support, the NMOD and its partners in further developing internal
guidelines, protocols and standard operating procedures (SOPs), using evidence-based interventions,
particularly in the area of pediatric care and implementation of a preventive-care-package.
In COP07-COP08, 44 Nigerian Army Reference Hospital Kaduna was provided with funding to refurbish a
hall for a vocational and economic empowerment center. Support was also provided for the training of
caregivers and PLWHAs on soap making, knitting and tailoring to provide the foundation for sustainable
income generating activities. This activity focuses its efforts on young, HIV+ women. Older pediatric
patients will be encouraged to participate. In COP09, this training activity will be expanded to additional
sites that have space to accommodate a vocational center. PLWHAs who were trained at 44 will serve as
trainers for other sites. Support will also be provided to purchase a stock of necessary materials (e.g., soap
making materials, weaving materials/equipment).
provide spiritual support and/or counseling for PLWHAs, families and PABAs. This includes counseling
related to a patient's fears, life views, crises, adherence and bereavement. Health care providers will
provide linkages and information to reach military Imams and Priests, as well as collaborating PLWHA
support groups, during clinical care sessions. Caregivers and families of pediatric patients will be targeted
for support services. Care kits for PLWHAs will include preventative items such as: an ITN, water guard,
water vessel, soap and ORS. Nutritional supplementation and support will be provided as appropriate with
national guidelines and as partner activities permit.
In COP09, the DOD's Prevention with Positives (PwP) program will be continued at all 20 military sites. For
pediatric patients, this will include encouraging HCT for patients' families. Referrals will be made to
community-based and barracks-based support groups for HIV+ clients and caregivers. Linkages to support
groups and services will also be enhanced by counselors who are members of PLWHA support groups.
Referrals to family planning services will be provided as appropriate, as well as access to pregnancy testing
when needed. Care kits for PLWHA will include items such as ITN, water guard, water vessels, soap, and
ORS. These interventions will be implemented using the recently adapted "HIV Prevention in Care and
Treatment Settings Prevention Package", which includes several training packages and job aids.
Entry of the pediatric HIV+ patient will include referrals from PMTCT, pediatric wards, TB clinics and other
areas in the facility serving children. Due to the integrated nature of the NMOD medical treatment facilities,
the children identified by the antenatal system can utilize the PMTCT component to effect a referral to the
pediatric health care provider. The laboratory, integrated into this system, serves as a catalyst for follow-up
to EID referrals. The DOD Program, through subcontracts, provides a data entry clerk and an
administrative/liaison officer to assist in referrals and follow ups. While HCT is available to parents or
physicians with a clinical request, the barracks facilitation and support groups will assist in identifying
pediatric patients for referral.
NMOD and DOD participation in the USG ARV treatment and care and support technical working groups to
address treatment issues will promote harmonization with the GON and other implementing partners, thus
strengthening the referral linkages and networks between partners close to NMOD sites. The program will
also establish networks for community volunteers, including People Living with HIV/AIDS, to ensure cross-
referrals. The DOD will continue to work with the GON and other national stakeholders to develop networks
for purposes of addressing sustainability issues, stigma reduction, treatment, and prevention activities.
Linkages with other basic care partners and prevention groups (particularly prevention for positives) will also
be supported.
will continue support to the Nigerian Ministry of Defence-owned, contractor (SCMS) operated warehouse
developed under COP07 funding. NMOD customs agents will clear imported supplies. Under training and
supervision by SCMS contractors, the facility will distribute supplies directly to all NMOD Points of Service.
The warehouse will function as both a receiving/distribution center and as a storage facility for buffer stock
of critical items maintained in-country to protect against unforeseen shortages. This program fully adheres
to USG and GON policies and acquisition regulations, minimizes indirect costs and accomplishes NMOD
capacity building in supply chain management. The program design ensures continued USG visibility and
accountability at all levels of implementation.
DOD has allocated $100,000 of its pediatric ARV Services budget and $30,000 of its pediatric Care and
Activity Narrative: CONTRIBUTION TO OVERALL PROGRAM AREA:
sustained delivery of high quality care and support and ART services in Nigeria. NMOD/DOD support of
policy development in task shifting and its implementation will improve access to care and treatment.
Provision of the PwP services will further avert/decrease HIV transmission thus contributing to PEPFAR
goal of preventing new infections.
This activity is linked to all prevention activities, TB/HIV treatment and care services, drugs, laboratory
infrastructure and SI.
This activity will target pediatric HIV positive children (0-14) and their caregivers in the 20 military
communities served, as well as the civilian population in the surrounding communities who are diagnosed
as HIV+.
This activity focuses on military populations.
Continuing Activity: 13155
13155 5409.08 Department of US Department of 6400 554.08 DoD Track 2.0 $220,000
6808 5409.07 Department of US Department of 4189 554.07 DoD Program $132,000
5409 5409.06 Department of US Department of 2773 554.06 DoD $40,000
Estimated amount of funding that is planned for Human Capacity Development $47,500
Table 3.3.10:
This activity relates to activities in VCT, PMTCT, Basic Care and Support, and TB/HIV activities.
In COP09, DOD - NMOD will expand comprehensive ART services to 1,100 pediatric patients (<2 and 2-14
years of age).. Clinicians across the 20 sites will be assisted to promptly initiate support for ART eligible
patients, with emphasis on supporting the 6 newer primary sites. Each site is an integrated hospital
will support referral of complicated or stable patients, or specialized needs, such as early infant diagnosis
(EID) to ease overcrowding and maximize efficient use of facility abilities. Palliative care and support
services will be provided to 1,100 HIV+ children and will reach an additional 2,200 persons affected by
AIDS (PABAs), including family members and other children.
treatment program in by hiring 100 new health care professionals dedicated directly for PEPFAR goals (30
administrators, commanders, and team leaders in the areas of pediatric ART and Basic Care and Support
services. Additional temporary staff through the National Youth Service Corps (NYSC) will be utilized. In
COP06, NYSC physicians were jointly funded by the DOD and NMOD programs; in COP07-COP08, the
NMOD assumed total coverage of these salaries. Funding may be provided to expand this program in
COP09. Use of the NYSC (usually three to four per site) provides a dual purpose of training young
physicians in Nigeria in ARV services and HIV/AIDS care and support, and exposes them to the military
system for possible accession to the uniformed services or as NMOD civilian providers.
this will continue to serve as a cornerstone for 2009. A dedicated Infectious Disease physician will provide
mentoring and continuing medical education courses through centralized in-country and on-site trainings on
pediatric HIV/AIDS care and support, treatment, adherence and laboratory monitoring. Adherence
counseling for ARVs and instruction in side effects and contra-indications is part of the NMOD internal ART
course and each pharmacist is provided with initial and refresher training through this course.
The DOD will support the provision of comprehensive clinical care, including OI include syndromic treatment
of STIs in older adolescents, if necessary, and malaria (e.g,, ceftriaxone, azithromycin, acyclovir, penicillin
G), diagnosis and treatment as well as pain and symptom management, through the full course of infection
at all 20 hospitals. This will be accomplished by: strengthening institutional and health worker capacity with
ongoing, in-service training, providing initial training 100 health care workers in palliative care skills as part
of and in addition to ART education; increasing the capacity of clinicians to diagnose and manage common
OIs; provide psychosocial counseling; and strengthening laboratory diagnostic facilities and pharmacy
capacity (see DOD lab and ARV Drug submission) through refurbishments, equipment, training and QA/QC
programming, . Facility based care will be complemented using a network model through trained volunteers,
nurses, health workers, PLWHAs and family members working together both in the facilities as well as
following up patients at home. Basic care kits and pediatric preventive care packages, to include insect
treated nets, water guards, IEC materials, and condoms will be provided, as well as cotrimoxazole for
patients as clinically appropriate.
FACSCounts and all these devices are being retrofitted with the pediatric lymphocyte % software. All
program areas will be provided as appropriate. Early Infant Diagnosis support coverage (PEPFAR/Clinton
Foundation funded) will be widened from the two pilot sites (NNH Ojo and 45 NAFH Makurdi) to support the
increased survival findings with EID/early initiation of treatment.
Activity Narrative: home follow up of patients attending ART clinics. While efforts will be strengthened to provide services to
linking with CBOs and FBOs since HBCs are limited in number at sites. DOD will reach out to local OVC
partners to link pediatric patients to support services. DOD will also work with, and support, the NMOD and
its partners in further developing internal guidelines, protocols and standard operating procedures (SOPs),
This activity focuses its efforts on young, HIV+ women. Older pediatric patients will be encouraged to
participate. In COP09, this training activity will be expanded to additional sites that have space to
accommodate a vocational center. PLWHAs who were trained at 44 will serve as trainers for other sites.
Support will also be provided to purchase a stock of necessary materials (e.g., soap making materials,
weaving materials/equipment).
includes counseling related to a patient's fears, life views, crises, adherence and bereavement. Health care
PLWHA support groups, during clinical care sessions. Caregivers of pediatric patients will be targeted for
support services. HBC kits for PLWHA will include preventative items such as ITN, water guard, water
vessels, soap and ORS. Nutritional supplementation and support will be provided as appropriate with
National guidelines and partner activities permit. Growth monitoring will be monitored during routine HIV
care/treatment follow-up.
Entry of the pediatric HIV+ patient will be achieved primarily through the PMTCT referral. Due to the
integrated nature of the NMOD medical treatment facilities, the children identified by the antenatal system
can utilize the PMTCT component to effect a referral to the pediatric health care provider. The laboratory,
integrated into this system, serves as a catalyst for follow-up to EID referrals. The DOD Program, through
subcontracts, provides a data entry clerk and a administrative/liaison officer to assist in referrals and follow
ups. While HCT is available as parents or physicians with a clinical request, the barracks facilitation and
support groups will assist in identifying pediatric patients for referral.
to address treatment issues will promote harmonization with the GON and other Implementing Partners,
thus strengthening the referral linkages and networks between partners close to NMOD sites. The program
will also establish networks for community volunteers, including People Living with HIV/AIDS, to ensure
cross-referrals. The DOD will continue to work with the GoN and other national stakeholders to develop
networks for purposes of addressing sustainability issues, stigma reduction, treatment and prevention
activities. Linkages with other basic care partners and prevention groups (particularly prevention for
positives) will also be supported.
This activity will target all adults in the 20 military communities served, as well as the civilian population in
the surrounding communities, who are diagnoses as HIV+ and clinically assessed as suitable for treatment.
Activity Narrative:
Table 3.3.11:
This activity represents funding for a full-time contracted Nigerian program officer (physician) for TB/HIV
activities as well as external technical support of TB/HIV. This new request for funding responds to the
needs identified in TA Visit Reports to focus additional efforts in the area of TB/HIV. The budget includes
one FSN salary, overhead charges, funding required for domestic travel, training funds and allocated minor
support costs. This funding also includes support for a USMHRP HQ Technical Assistance visit for one
week of in-country support by a TB physician who will provide TA, continuing medical education and
The TB/HIV program officer will work as a member of the USG Clinical and TB/HIV Technical Working
Groups, as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense (NMOD)
Clinical Working Group. The TB/HIV program officer's responsibilities also include: 1) representing the
DOD-NMOD in technical discussions with the GON and 2) overseeing relevant technical aspects of the
program, including program management and oversight of the 20 DOD-NMOD PEPFAR site TB/HIV
programs. All DOD-NMOD sites are also established as TB DOTS centers. The TB/HIV program officer will
work with other Implementing Partners and the USG team to ensure a harmonized approach that is
consistent among partners and with the GON national guidelines. The program officer will spend 100% of
his/her time in this program area.
Continuing Activity: 16939
16939 16939.08 Department of US Department of 6401 554.08 DoD Track 2.0 $70,000
Table 3.3.12:
•Targets revised
Department of Defense (DOD) - Nigerian Ministry of Defense (NMOD) HIV Program will continue to extend
free access to tuberculosis (TB) diagnosis and treatment services in 20 military facilities and communities.
All 20 sites also provide comprehensive HIV prevention, care and treatment services.
Approximately 20 to 30% of TB patients are HIV-infected and, conversely, it is estimated that roughly 30 to
40% of HIV-infected patients develop clinically-overt TB. Aggressive detection and treatment of TB is
important in order to reduce morbidity and mortality associated with HIV infection. In addition, aggressive
HIV counseling and testing of TB patients represents an important public health strategy to further identify
and treat HIV-infected individuals.
The DOD-NMOD partnership will extend free HIV services to include screening for TB among all HIV+
identified at 20 military hospitals. All HIV+ clients are routinely screened by questionnaire for TB. If
clinically indicated, AFB sputum smears examination (light or fluorescent microscopy) is conducted and
radiography or culture (nationally accepted algorithm) if indicated are carried out. In addition, to improve
detection of military, dependents and civilians who are co-infected with TB/HIV, providers will initiate (opt-
out) voluntary counseling and testing. In these integrated sites, counseling and testing recommendations
are provided at each TB setting, but due to manpower and physical structure limitation, formal "one on one"
CT is provided in a single location within each site. Providers will encourage and discuss the importance of
HCT and provide referrals to the site's HCT center. Volunteers (e.g., Officers Wives Clubs or People living
with HIV/AIDS (PLWHA) Support Group members) will be provided to escort patients to the CT center to
facilitate access and uptake of CT services.
During COP09, of 19,538 receiving HIV services, 100% will receive routine screening for TB at least once.
It is anticipated that at least 3,907 (20% of the estimated 19,538 HIV+s screened for TB) will be diagnosed
with active TB and will require TB treatment; the same percentage will be provided with preventive therapy.
Patients co-infected with HIV/TB will be provided TB treatment at the diagnosing military site since each site
has been designated as a Directly Observed Treatment Short course (DOTS) site. The DOD-NMOD
Program is closely coordinated with the MOH for TB control. At military facilities, TB prophylaxis (INH),
provided through the National DOTS program, will be offered to HIV+ patients according to individual clinical
need and according to national guidelines. The DOD-NMOD partnership will utilize proven adherence
strategies for patients on ARV and TB treatment. Community health workers, community support groups
and volunteers, including PLWHA and the Society of People Affected by TB, (SOPAT), will continue to be
trained by clinical staff and supported to assist with patient adherence to ART and TB drugs through a
buddy system.
TB infection prevention and control will be implemented using work practice, administrative and
environmental measures. Patient and staff education will be routinely carried out to ensure program
success. Prophylaxis and treatment will be provided to eligible TB/HIV patients as appropriate. This will
involve the principles of basic hygiene, proper disposal of sputum and good cross ventilation at the clinics.
Refurbishments and remodeling of facilities, such as open air/ventilated waiting areas will be provided.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism
including quarterly site visits by DOD-NMOD and appropriate partner personnel, are essential components
of this program. To ensure continuous availability of drugs and commodities in the sites, the Program will
strengthen the logistic management of the states and LGA in the areas of operation.
Funding will support training of 40 additional health care staff in TB and HIV diagnosis and clinical
management to increase detection and referral of TB cases to the TB Unit among their HIV+ patients.
Clinicians and laboratory technologists at each HIV clinic and TB Unit of each military hospital will undergo
training organized in collaboration with the Federal Ministry of Health (FMOH), the national TB program and
other stakeholders. A TB/HIV focal officer will be appointed to the program. The TB Officer will ensure that
activities conducted provide holistic patient care according to Integrated Management of Adolescent and
Adult Illness (IMAI) guidelines.
Funding will also support improvement in laboratory capacity for TB diagnosis. Staff will be trained in TB
screening and diagnosis of patients infected with HIV. Laboratory infrastructure and equipment will be
upgraded, via provision of biologic hoods, microscopes, staining material and safety equipment for staff,
which will complement overall HIV lab improvement under PEPFAR. The DOD-NMOD will link with
government and other Implementing Partners' reference laboratories, such as ACTION (UMD) and the TB
reference facility in Zaria for laboratory training, development of SOPs and quality improvement activities
ensuring continuity of PEPFAR supported programs. Support to other National programs, such as the
NIAID supported program at the National Institute of Pharmaceutical Research and Development, will be
provided in the form of clinical samples.
This activity fully adheres to USG policies and acquisition regulations and minimizes indirect costs to
accomplish the capacity building described. International and local organizations synergize with the NMOD
to identify best practices and implement evidence based interventions in a sustainable manner. The
program ensures continued USG visibility and accountability at all levels of implementation.
A total of $100,000 from this program area has been allocated to SCMS for the procurement of TB/HIV
commodities, and is reflected in the SCMS TB/HIV program area narrative.
Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, Sokoto, Kano, Imo, and Anambra (15 states and FCT).
Activity Narrative: CONTRIBUTIONS TO OVERALL PROGRAM AREAS:
The provision of DOTS centers on 20 NMOD sites will expand access to quality TB services. The improved
access will result in higher TB case detection and improved treatment outcomes. Through the provision of
services to 3,907 TB/HIV patients, the DOD will contribute to the Emergency Plan treatment goals for
TB/HIV care in Nigeria.
This activity will also be linked to all appropriate Basic Health Care and Support, Laboratory Infrastructure
and HCT activities. The TB/HIV sites will be provided with all necessary facilities to ensure holistic patient
care according to IMAI guidelines. Activities will be linked to SI systems to improve surveillance and
monitoring information, and to inform policy and system strengthening activities.
This activity targets military/civilian personnel, dependents and the general population surrounding the
military sites including those who are affected by TB/HIV, including OVC, PLWHAs and their families.
Women, in particular within the age range of 25-44, will be targeted, as there is a higher incidence of TB
among this group.
This activity has an emphasis on military populations.
Continuing Activity: 13154
13154 3240.08 Department of US Department of 6400 554.08 DoD Track 2.0 $188,094
6795 3240.07 Department of US Department of 4189 554.07 DoD Program $396,600
3240 3240.06 Department of US Department of 2773 554.06 DoD $650,000
Estimated amount of funding that is planned for Human Capacity Development $45,000
free access to HIV counseling and testing (HCT) services in 20 military facilities and communities. All 20
sites also provide HIV prevention, care and treatment services. In COP09 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 to provide commodities
and increase uptake of HCT services.
Provider initiated (opt-out) voluntary counseling and testing will be conducted in all sites to include out
patient clinics, in-patient wards and TB clinics to improve identification of HIV+ among these populations. In
these integrated sites, counseling and testing recommendations are provided at each hospital department,
but due to manpower and physical structure limitation, formal one-on-one CT is provided in a single location
within each site. Providers will encourage and discuss the importance of HCT and provide referrals to the
site's HCT center. Volunteers (e.g., Officers Wives Clubs, PLWHA Support Group members) will be
provided to escort patients to the HCT center to facilitate access and uptake of HCT services. HCT will also
be offered or linked at STI, family planning, antenatal, patient encounter activities and blood donations. All
blood donors will be able to receive their HIV status, get prevention messaging and referral to treatment,
care and support.
In addition, all individuals who test HIV+ will be referred for TB diagnosis. It is anticipated that 8,500
individuals will be tested for HIV and receive their results. Twenty-five individuals will be trained in
counseling and testing according national and international standards. This activity will focus on the delivery
of high quality, cost-effective counseling and testing at hospital facilities as the main entry point to a
seamless service for individuals, discordant couples, partners and families. HCT services will promote
"couple counseling and testing" at the service outlets. Staff will counsel clients on their disclosure of HIV
status and partner/family notification with an emphasis on client safety. Partner referrals for HCT (individual
and/or couple) will be provided. Also, referrals to community-based and barracks-based support groups will
be provided to HIV+ clients. Linkages will also be enhanced by counselors who are members of PLWHA
support groups.
All HCT and other HIV clinical services will link to prevention messaging for HIV+ and HIV- clients supported
under Palliative Care, AB and Other Prevention entries. This includes counseling on partner reduction,
prevention-for-positives messaging, abstinence messaging and correct and consistent condom use
messaging with condom provision (where appropriate). The integration of HCT, treatment and prevention
programs will follow a family-centered, community-based approach, including a decentralized, community-
based model in partnership with the GON at all levels, utilizing the nationally accepted testing algorithm. In
COP09, internal quality control will utilize Western Blot analysis with a selection of positive and negative
patient samples as compared to positive and negative controls. Quality assurance will be completed
through externally provided panels for all sites conducting HIV diagnosis. Other partners working with the
military, such as SFH and small indigenous organizations, will be involved in this approach. Counseling and
testing centers will display the national logo in support of the National program and consistent branding.
Sites will also employ outreach HCT to increase the uptake of services by populations who do not access
HCT at the military facility. Mobile HCT (utilizing tents) will continue to be incorporated into ongoing
activities in the community, such as health bazaars, football matches or entertainment activities where
military personnel frequent. Four hundred and forty-five Nigerian Air Force Hospital (Ikeja) will be provided
with support to operate its mobile HCT van and outreach activities.
A unique aspect of this activity with the Nigerian Military is that its HCT policies include compulsory
counseling and testing for specific populations: military applicants, personnel posted overseas and those
selected for overseas training. Through PEPFAR, the DOD - NMOD partnership has ensured that
prevention messages and pre/post-test counseling is provided during compulsory counseling and testing.
Pre accession applicant testing will be supported by pushing testing availability to the initial point of entry,
providing significant advantages to the GON and applications. Previously, counseling and results were not
always provided to new applicants. The DOD will continue to support post-test counseling for military
applicants. If the applicant is found to be positive, the individual will be counseled and referred to the
nearest ART facility for evaluation. Data collection will provide critical prevalence information for the military
eligible population. Support will continue in 2009 to the Armed Forces Programme on AIDS Control
(AFPAC) to conduct recruitment/applicant HCT.
In collaboration with AFPAC, funding will support training, and refresher training, of 25 NMOD staff and
volunteers, including PLWHAs, in counseling and testing, mainly through location, site-based programs and
in conjunction with other partners and agencies, utilizing the national curriculum. An emphasis in COP09
will include the training of non-laboratory staff on the WHO/CDC HIV Rapid Test training package to assist
in addressing a lack of laboratory manpower in the military.
To ensure confidentiality, support for clinic renovations and/or the purchase of privacy screens will be
provided. This is particularly important for military settings as NMOD has had lower uptake of HCT by
senior military officers due to fear of stigma and perceived lack of privacy.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, are
essential components of this program. This includes quarterly site visits by NMOD/DOD staff and
appropriate partners.
DOD has allocated $25,000 of its HCT budget to SCMS for procurement of commodities. This amount is
captured under the SCMS HCT activity.
Activity Narrative: By the end of COP09, the DOD will support 20 NMOD sites in Edo, Benue, Borno, Cross River, Rivers,
The DOD-NMOD service will enable the identification of HIV positive individuals in an efficient and timely
manner and feed into care and treatment services for both HIV and HIV/TB. This contributes to the
PEPFAR Nigeria and GON goals of increasing access to counseling and testing, as well as linking HIV
positive individuals to ART services. In addition, HCT services will add to the prevention strategies of
averting new infections through efficient and effective post-test counseling and education.
HCT activities will be linked to activities in Abstinence/Be faithful, Condoms and Other Prevention, TB/HIV,
PMTCT and SI, and will support other partners, including GON, in delivering quality, integrated services.
This activity targets the military, civilian employees, dependents and the general population surrounding the
20 NMOD sites and in particular TB and other STI infected individuals. By networking with decentralized,
community-based services, this activity will reach a wider range of individuals unwilling, or unable, to access
services provided in more traditional settings.
Continuing Activity: 13156
13156 3241.08 Department of US Department of 6400 554.08 DoD Track 2.0 $225,000
6796 3241.07 Department of US Department of 4189 554.07 DoD Program $710,833
3241 3241.06 Department of US Department of 2773 554.06 DoD $440,000
Estimated amount of funding that is planned for Human Capacity Development $16,000
Table 3.3.14:
•Patient numbers updated
This activity is linked to ARV services, Strategic Information, and Other Policy/System Strengthening. The
Nigerian Military provides prevention, care and treatment to its service members and the surrounding
free ARV services in 20 military facilities and communities.
All drug orders are based on projections of patient numbers as determined by annual forecast conducted in
August 2008 in conjunction with SCMS and USG Logistics Technical Working group. The NMOD-DOD
Program will continue to utilize the SCMS for drug acquisition and logistics management strengthening.
DOD, NMOD and SCMS adhere to USG, FDA, Federal Ministry of Health (FMOH) and National Agency for
Food and Drug Administration and Control (NAFDAC) policies and requirements, and support National
Treatment Guidelines. Funding under the SCMS award through USAID will continue to provide quality ARV
drugs during COP09 year to treat a total of 9,805 adults and 938 pediatric patients (overall total of 10,743
patients) under the NMOD-DOD program. All purchases of Truvada (TDF/FTC) and ZDV-3TC-NVP Fixed
Dose Combination will be bought via SCMS pooled procurement mechanism in line with OGAC's
guidelines. When possible, the Program will continue to utilize generic drugs and add additional generics as
approved. In addition, DOD will support coordination for utilization of ARVs provided by the GON or
Nigerian Air Force (currently over 200 individuals on NAF purchased ARVs) at NMOD sites.
Procurement will be through SCMS. The total funding for DOD's ARV drug area is $3,726,323. Breakout
includes $2,500,000 to SCMS and $1,226,323 to DOD.
The DOD program will continue to provide support to the NMOD-owned, contractor (SCMS) operated
warehouse developed under COP07-08 funding. NMOD customs agents will clear imported supplies.
points of service. The warehouse will function as both a receiving/distribution center and as a storage
facility for buffer stock of drugs maintained in-country to protect against unforeseen shortages. This program
continued USG visibility and accountability at all levels of implementation.
Pharmacy training activities are under development, and will include all aspects of drug management,
dispensing and housing. At this time, pharmacists are instructed in national treatment guidelines and
Standard Operating Procedures (SOPs) on security, quality control and storage. As with clinicians trained in
ART, pharmacists who have been trained and have been supporting treatment at facilities operating since
2005 will be sent to new facilities in the initial phases of operation to provide mentoring and ensure
continuity of services among military facilities. Continued site support will be conducted using these
preceptors as a central pharmacy Quality Assurance (QA)/ Quality Control (QC) team is developed.
SCMS and DOD have been working closely with the NMOD in training officers on quantification and
accountability tools at the NMOD level. In 2009, activities under this submission will continue to guarantee
long-term sustainability by ensuring that the necessary infrastructure, systems and technical skills are in
place for efficient forecasting, ordering, warehousing, distribution and management of quality ARVs at the
20 NMOD sites as well as at the central level procurement office of the NMOD. DOD will continue to
support and participate in the harmonization process led by the GON with regard to Logistic Management
Information System (LMIS) and Inventory Control System (ICS).
Where necessary, infrastructure improvements are undertaken to ensure the best use of resources through
leveraging counterpart funding of the NMOD and through competitive tendering. Pharmacies at the point of
drugs dispensing are modeled to provide ease of service for the patient to allow adherence counseling as
well as safe storage of the drugs within the dispensing unit. Proper housing for drugs at sites, including A/C
with thermostat controls, proper refrigeration and locked storage are instituted. Back up power supplies to
ensure proper temperature for cold chain dependent drugs will be installed.
DOD activities will contribute to the effective and efficient management of the ARV services and to the
Emergency Plan's goal of providing life-saving antiretroviral treatment to more than 350,000 individuals.
This activity will directly link with ART Services (6678.08). The DoD will continue to collaborate with other
PEPFAR implementing partners for information sharing on procurement mechanisms and for sharing of
supplies when necessary. The DoD will continue to support systems strengthening and capacity building in
the NMoD.
This activity targets all health care workers directly involved in the management of ARV drugs for ART
services including pharmacists, doctor and nurses.
This activity has an emphasis on military populations, and renovations of a government-owned warehouse
to store and distribute ARVs for the Nigerian Military.
Continuing Activity: 13157
13157 3242.08 Department of US Department of 6400 554.08 DoD Track 2.0 $325,000
6797 3242.07 Department of US Department of 4189 554.07 DoD Program $300,000
3242 3242.06 Department of US Department of 2773 554.06 DoD $200,000
Construction/Renovation
Table 3.3.15:
This activity represents funding for three full-time, contracted positions (one Senior Laboratory Manager,
two Laboratory Officers) to support Laboratory Infrastructure activities, including three FSN salaries,
overhead charges, funding required for domestic travel, training funds and allocated minor support costs.
This funding also includes support for a USMHRP HQ Technical Assistance visit for two weeks of in-country
support by a laboratorian who will provide TA, continuing medical education and mentorship, particularly in
the area of nucleic acid testing. Support to strengthen appropriate use of a NAT laboratory for viral load
and early infant diagnosis (EID) will be provided. External TA may also be provided by the USMHRP's site
staff in Kenya, Uganda and/or Tanzania.
A unique aspect of the NMOD-DOD Program is the employment of staff with past NMOD experience or
familiarity. These individuals support the military to military aspects and act as a bridge for ownership
development. Involvement of these employees will integrate US policy and implementation with
The Laboratory Manager and Program Officers will work as members of the USG Clinical Laboratory
Working Group, as well as serve on the U.S. Department of Defense - Nigerian Ministry of Defense
(NMOD) Laboratory Working Group. The Laboratory Manager's responsibilities also include: 1)
representing the DOD-NMOD in technical discussions with the GON and 2) overseeing relevant technical
aspects of the program, including program management and oversight of the 20 DOD-NMOD PEPFAR site
laboratory programs including QA. The Laboratory Officers focus on QA/QC, safety and on-site supervision
and assessment. All positions will also support the Armed Forces Programme on AIDS Control to
coordinate pre- and post-deployment HCT. A uniformed Laboratory Officer, paid by funding from the
Nigerian Military, will also support DOD-NMOD laboratory activities. Both positions will work with other
Implementing Partners and the USG team to ensure a harmonized approach that is consistent among
partners and promote the GON national guidelines.
Continuing Activity: 13166
13166 5389.08 Department of US Department of 6401 554.08 DoD Track 2.0 $200,000
6806 5389.07 Department of US Department of 4193 554.07 DoD Agency $200,000
5389 5389.06 Department of US Department of 2773 554.06 DoD $200,000
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
•Targets and emphasis areas are revised for COP09
•Establishment of an additional Military Training center at 44 Nigerian Army Reference Hospital Kaduna
(44NARHK), Kaduna State
•Addition of external proficiency testing across all sites
•Addition of PCR and viral load capacity at one laboratory
•Support for training of laboratorians working at sites not supported by PEPFAR
•Increase in TB diagnostic capacity
Defense (DOD) and Nigerian Ministry of Defence (NMOD), through the Emergency Plan Implementation
Committee (EPIC) currently provide free laboratory services that support ARV Treatment, Basic Care and
Support, PMTCT, HCT, Blood safety, and TB/HIV by upgrading laboratory infrastructure, improving
laboratory systems and training laboratory personnel to accurately diagnose, stage and monitor patients.
Presently, DOD is supporting free laboratory services at 14 individual points of service. It utilizes a network
model to provide appropriate laboratory capacity and patient support at 4 tertiary, 9 secondary and 1
primary care sites as well as HCT stand alone sites, STI clinics and DOTs sites carrying out HCT. These
sites are located in Benue, Borno, Cross River, Delta, Edo Enugu, Kaduna, Oyo, Plateau, Rivers States and
FCT. By the end of COP08, the DOD-NMOD would have activated 6 additional sites in Kaduna, Kano,
Anambra, Imo, Rivers and Sokoto states bringing the total to 20 facilities in 15 states and FCT.
By the end of COP09, DOD-NMOD will support a total of 20 lab sites (4 tertiary, 14 secondary and 2
primary). One of the facilities will be upgraded to start providing virology services through PCR-based
testing. This will support viral load and HIV DNA testing for the Nigerian Military. In support of treatment
expansion, the DOD-NMOD will continue to maintain and sustain laboratory infrastructure and develop
capacity for self-sustaining lab activities at sites. By the end of COP 08, 20 laboratories will have been
upgraded and supplied with standardized equipment, appropriate lab diagnostic reagents and consumables
to provide prompt and improved quality of medical care and reliable patient monitoring. All 20 laboratories
will provide HIV sero-diagnosis through rapid testing, according to Government of Nigeria National
Guidelines and Policies. Two sites (445 NAFH, Ikeja; DHQ-MC, Mogadishu Barracks) will have EIA and
Western Blot regularly run for referred cases and QA. The DOD-NMOD will continue to provide full lab
monitoring that will support ART and basic care and support, including CD4 enumeration, clinical chemistry
and hematology. Lab monitoring will,, in general, use automated systems at 18 sites (BD FACSCount,
Sysmex and Vitros 250/DT60 and Wet Chemistry using Microlab 300 semi auto-analyzer and
spectrophotometer as back up). In COP09, the DOD-NMOD HIV program will seek accreditation of 4
tertiary and 6 secondary level laboratories by MLSCN.
Presently, three laboratory staff support laboratory field activities, one in each of our three high throughput
sites (Makurdi, Kaduna and Enugu). In COP09, site level laboratory staff will increase to 9.The NMOD is
currently supporting the HIV program with 20 laboratory staff and promised to increase this number. These
staff are currently spread across 14 sites.
The DOD will continue to work with the PEPFAR Lab Technical Working Group for the development of best
laboratory practices, the National QA Program, in joint site monitoring activities and in the customization of
training packages. A tiered referral laboratory network will be established to provide mentoring and support
for facilities within the network (both military and non-military health care facilities). In COP09, Nigerian
Navy Reference Hospital -Ojo (NNRH), Lagos State and 44 NARH Kaduna, Kaduna State will be upgraded
to provide capabilities for QA/QC and referral absorption capacity. The diagnostic capability of 18
laboratories to diagnose and monitor common OIs (TB, malaria, Candida, Cryptococcus,) and STIs
(syphilis, gonorrhea, Chlamydia, Herpes Simplex, Hepatitis B and Hepatitis C) will be maintained and
strengthened to include a QA/QC program. All existing facilities will have either fluorescent or light
microscopes for malaria detection and TB diagnosis by sputum smear microscopy. Four facilities in different
geographical zones will be equipped with Class II Biological Safety Cabinets. These site capacities will be
enhanced in TB specimen management, documentation and transportation. Sites will also serve as
specimen transporting centers to the TB National/Zonal center for all TB samples collected from USDOD-
NMOD sites that required further laboratory investigations.
Infrastructure upgrades will also include internal configuration of the lab with appropriate furniture, and
extensive electrical refurbishments (as needed) to ensure a stable supply of power to all laboratories.
Logistically and economically, friendly power options such as solar panels are planned for all the facilities.
Basic laboratory equipment will be procured, such as solar energy operated refrigerators, bench centrifuges
with safety locks, water baths, PCR and PCR related equipment.
DOD will continue to address the issue of safe disposal of hazardous waste by leveraging the training and
resources provided by MMIS and by supplementing this with the required materials (e.g. sharps boxes,
mobile auto-claves and mobile incinerators). Sites will also be supported in the development of alternative
methods of waste disposal (e.g. protected pits). All laboratories will have a PEP policy and guidelines in
place.
In COP09, laboratory customized training modules in CD4, Clinical Chemistry, Hematology and laboratory
management developed by the USG lab coalition partners will continue to be used for the training of
laboratory personnel. Appropriate step down training will be conducted to the site level by trained Master
trainers. In COP09, 44 NARH Kaduna will be developed as a second regional training center for the military.
The lab will be configured with a didactic training venue, a wet training lab, and equipped with standard
equipment utilized at DOD-NMOD program sites, similar to that of the 44 NAF Hospital lab in Ikeja. Each of
the regional training centers will be staffed with one master trainer, a lab scientist and an administrative
officer. The training centers will be used to offer refresher training to staff from existing sites. Refresher
training will be guided by results of site QA/QC assessment visits. A total of 150 laboratorians will be
Activity Narrative: trained, both centrally and on site. Centralized training will be conducted at both 44 NARH Kaduna and 445
NAFH Ikeja. The two military training centers will play a major role in continuing education, QA/QC and
refresher training of DOD-NMOD laboratorians. The training facilities will also be utilized to provide training
for 400 non-EP military hospitals, GON State house hospital laboratorians.
Laboratorians will be trained centrally on Lab Management, Lab Safety, GLP and Quality Management,
Records and Documentation, HIV diagnosis, CD4+ enumeration, Hematology, Blood Chemistry, specimen
management, packaging and transportation, Stock Management/Forecasting, Injection Safety, Blood
Safety, Microscopy, Malariology, TB and other OI/STI diagnosis. Twenty laboratorians (1 per site) will be
trained as in-country quality monitors and 4 laboratorians, with an overall program oversight role, will
receive further Laboratory Management/QA training in conjunction with the DAIDS, and Walter Reed Project
in, Uganda, or Kenya. Oversight, and further centralized and on-site QA training, will be provided by military
consultants from the US Military HIV Research Program. Medical equipment engineers (9) from within the
Nigerian military will continue to be trained in preventative maintenance and servicing of equipment within
the DOD-NMOD HIV program. Training provided by Co-Ag partners (APHL, ASM, ASCP, CLSI), other US
agencies and IPs (MMIS, SBFAF) will be leveraged to ensure that laboratorians within the DOD-NMOD HIV
program are trained in a wide array of technical skills required for the delivery of quality laboratory services.
DOD training centers and lab officers will continue to serve as a resource for other IPs, and the HIV AIDS
Division of FMOH.
Laboratory QA activities will be further strengthened and consolidated in COP09. DOD-NMOD sites will key
-in to USG harmonized QA/QC programs. A generic SOP for all lab activities will be developed by DOD
laboratory specialists, in collaboration with the USHMRP Quality Assurance Officer, and distributed to all
program sites for customization and adaptation for use. An Internal Proficiency program will continue to be
administered on bi-weekly basis in all sites. Proficiency panel on HIV serology, CD4, Clinical Chemistry,
hematology, and TB will be distributed to sites bi-annually. Quality of laboratory data will be improved on by
the introduction of an electronic data capturing system. An internal tri-service monitoring team comprising
of experienced military laboratorians will conduct quarterly site visits using a standardized assessment tool.
This team will be empowered to take on-site corrective action and provide on-site training. Bi-annual site
visits will be conducted by external teams (US Military HIV Research Program and other partners), and
supported by the DOD centrally-employed laboratory specialists. A tri-service monitoring team will meet on
a quarterly basis to review all aspects of laboratory services, including quality management. The Joint USG
Lab technical Working Group Assessment team will visit two selected DOD-NMOD sites bi-annually.
A two-pronged approach to supply chain management of laboratory reagents and other consumable items
will ensure that stock-outs of laboratory reagents and consumables do not occur. While the supply of some
reagents will continue to be sourced by DOD from local vendors, the majority of reagents/consumable
funding will be invested in the Supply Chain Management Systems (SCMS) in the amount of $1,000,000.
The DOD program will continue to support the NMOD-owned, contractor operated warehouse that was
developed under COP08 funding. NMOD customs agents will clear imported supplies and, under training by
SCMS contractors, distribute supplies directly to all NMOD Points of Service. The warehouse will function
both as a receiving/distribution center as well as a storage facility for a buffer stock of critical items that will
be maintained in-country to protect against unforeseen shortages. DOD-NMOD currently operates a
successful "pull" system based on monthly consumption data reports sent electronically to DOD-NMOD by
all sites.
By the end of COP09, the DOD will support 20 NMOD sites in Anambra, Benue, Borno, Cross River, Delta,
Edo, Enugu, Imo, Kaduna, Kano, Oyo, Plateau, Rivers, Rivers States, and Sokoto and FCT (15 States and
In COP09, 20 DOD-NMOD HIV program facilities will provide laboratory services for 25,038 individuals
being counseled and tested (11,500 adults and adolescents, 12,600 pregnant women, 938 children,), for
19,538 individuals who are in care and support (18,600 adults and adolescents, 1,100 children) and for
10,744 individuals on ART (9,806 adults and adolescents, 938 children). Therefore, with HIV serology,
CD4+ enumeration, a chemistry panel, a hemogram, urinalysis, STI testing, and OI testing counted as
single tests each, a minimum of 167,895 laboratory tests will be performed in COP09.
Links will be created with other implementing partners to optimize resources and strengthen the
comprehensive networks of care across all sites, including centralized laboratory training and the
establishment of high level laboratory services for pediatric diagnosis. DOD-NMOD will continue to
participate in the national Early Infant Diagnosis scale up plan. This activity relates to activities in ART
treatment, Care and Support, PMTCT, HCT, Blood Safety, TB/HIV, Sexual Prevention and Strategic
Information.
TARGET POPULATIONS:
This activity targets the military, civilian employees, dependents and the communities surrounding military
sites. In particular, PLWHAs, HIV+ pregnant women and HIV+ infants will be targeted. Further, specific
targets will be for individuals co-infected with TB and STIs.
This activity involves an emphasis on military populations and renovation.
Continuing Activity: 13159
13159 3244.08 Department of US Department of 6400 554.08 DoD Track 2.0 $800,000
6799 3244.07 Department of US Department of 4189 554.07 DoD Program $1,115,000
3244 3244.06 Department of US Department of 2773 554.06 DoD $350,000
Estimated amount of funding that is planned for Human Capacity Development $500,000
This activity relates to all prevention activities: PMTCT (3.3.01), Abstinence/Be Faithful (3.3.02) , Safe Blood
(3.3.03), Injection Safety (3.3.04), Condom and Other Prevention (3.3.05), HIV/AIDS/TB Treatment and
Care Services: OVC (3.3.08), ARV Drugs (3.3.10), ARV Services (3.3.11), Palliative Care services (3.3.06),
TB/HIV (3.3.07), HCT (3.3.09), and Laboratory Infrastructure (3.3.12).
civilian community (constituting approximately 75% of the Military's patient load). Strategic Information (SI)
activities will be conducted at 14 existing Department of Defense (DOD) - Nigerian Ministry of Defence
(NMOD) sites and 6 new expansion sites in COP08. The existing military sites and communities include:
Defence Headquarters Medical Center - Mogadishu Barracks (FCT), 44 Nigerian Army Reference Hospital
(Kaduna), Nigerian Naval Hospital (Ojo), 445 Nigerian Air Force Hospital (Ikeja), 82 Division Hospital
(Enugu), 347 Nigerian Air Force Hospital (Jos), Nigerian Naval Hospital (Calabar), Naval Medical Centre
(Warri), Nigerian Military Hospital (Port Harcourt), 45 Nigerian Air Force Hospital (Makurdi), Military Hospital
(Benin), 2 Division Nigerian Army Hospital (Ibadan), Military Hospital (Maiduguri) and 3 Division Hospital
(Jos).
In COP08, the program will expand to six new sites. These include: Brigade Medical Center Sokoto, Armed
Force Specialist Hospital Kano, 34 FAB Medical Center Owerri,
Ministry of Defence Clinic, Military Cantonment Onitsha, and Headquarters Nigerian Army CAS Medical
Reception Station Kontangora. Information strengthening and technical assistance will also be provided to
the 20 sites and to the Emergency Plan Implementation Committee and Ministry of Defence (NMOD)
Headquarters.
This Strategic Information (SI) activity has several components. At the DOD level, SI funding will support
three full time positions. These assets will coordinate DOD SI implementation efforts with the NMOD and
participate with USG Nigeria SI technical Working Group. The next component is the incorporation of
program-level reporting and the establishment of both paper-based and computerized HMIS across NMOD
HIV treatment sites. These activities will support the design and implementation of high quality, sustainable,
evidence-based interventions and programs in the following areas at 20 sites: ART Services, ARV Drugs,
Laboratory Infrastructure, HCT, PMTCT and TB/HIV. All activities will be in line with GON SI harmonization
policies and guidance as we strive to meet the three ones.
Another component of this activity includes training and capacity development of NMOD personnel in the
area of SI. By COP07, it is anticipated that 147 staff will be trained in the management and maintenance of
the SI system in areas such as data entry, analysis, data management and data quality assurance. In
COP08, the DOD-NMOD will train 12 staff at each of the 6 new sites and provide a refresher for 6
individuals from the 14 existing sites. The DOD will continue its data management and reporting refresher
training program throughout the year. The DOD will also continue to provide the NMOD with training and
technical assistance emphasizing all aspects of patient data handling: confidentiality, data security,
disciplined data entry, analysis, management and quality assurance. The program will continue to adapt
and harmonize existing paper records and processes to meet the standards of the GON. Training for DOD
specific needs will be conducted by the DOD program, while available training from IPs and GON will
support harmonization of data activities. The DOD will carry out regular site visits to ensure proper data
handling procedures are adhered to at all times.
The DOD-NMOD will expand utilization of an electronic patient registry (Government of Nigeria-approved)
and patient monitoring and management system (PMM) in all program areas. Utilizing the simple, available
and sustainable technology at the fourteen existing DOD-NMOD sites, the program will extend and develop
this system to the new six sites in COP08. This single system generates a unique PIN number to ensure
patient confidentiality while supporting patient tracking through a clinical module, a pharmacy module, a
laboratory module, a counseling module, a registration module and a financial module. These core
modules allow for tracking of all program areas through a single tool with a single interface, which has
greatly improved data quality from the input side and has improved speed of retrieval on the report
generation side. As a national unique patient numbering system is introduced, DOD will ensure
harmonization of the tracking systems. The registry will be supported by the use of networking
infrastructure that provides computer hardware, software applications and networking equipment; 4-6
additional computers per site in addition to the 5 computers and 1 server already supported and the VSAT
and networking solution provided by the NMOD and EPIC. This registry will allow for aggregated reporting
on a real time basis and will interface directly with LHPMIP, the national monitoring and evaluation tool
developed and based on the Voxiva platform.
The DOD will continue to participate in the relevant PEPFAR working groups aiming to develop and
implement credible, cost-effective SI policies and systems, harmonized with other IPs, Nigerian Ministries
and USG agencies. The program will continue to support the NMOD's Information Monitoring TWG. The
DOD will also continue to participate in national surveys, and in the development and regular use of
standardized qualitative methodologies for service assessments to ensure a consistent approach across all
HIV service providers. Implementation of National and PEPFAR supported data program such as
HIVQUAL have full NMOD-DOD support with the full time involvement of a Nigerian medical officer in the
planning and implementation of HIVQUAL from the NMOD level down to each service delivery facility.
Monitoring and evaluation of service quality, together with a formal quality improvement mechanism,
supported by the centrally-employed DOD specialist and appropriate partners, are essential components of
this program. Regular use of data (including sharing information on individual sites, programs and partners)
as part of the routine management process at all levels (site, organization, PEPFAR Team) is the
cornerstone of evidence-based improvements and will encourage and sustain data quality, and ensure
service quality throughout the program. The SI program is designed for sustainability and it is hoped that
the NMOD will take over additional SI activities as the program matures.
During COP08, discrete surveillance activities will be commenced in order to better describe the poorly
Activity Narrative: understood epidemiology of disease prevalence within the Nigerian Military. The first of two surveillance
initiatives will analyze the association of HIV infection and the pre, intra and post deployment education
provided to, testing and risk behavior activities of Nigerian Military members who have been deployed both
domestically and internationally. The second will describe the current prevalence of transfusion transmitted
infections (HIV-1, HIV-2, HCV, HBV and Treponema pallidum) within the NMOD. Results of these studies
will inform the NMOD, GON and USG of areas of strength and weakness and support strategy development
for targeted interventions.
Improvement in SI management capacity, and further staff development and training within the NMOD,
EPIC, AFPAC and 20 sites, will ensure effective data use and management at organizational, work group
and individual levels. This activity will contribute towards the GoN and USG strategy for the provision of
quality, relevant and timely information for decision-making. This information will serve as a resource in
developing plans that enhance the cost-effectiveness of the operations and management of the NMoD.
Strategic Information activity relates to all prevention activities (#3246.08, #5313.08, #5388.08, #5362.08,
#16943.08), HIV/AIDS/TB treatment and care services (#3240.08, #3247.08, #5409.08, #3241.08) and
Treatment and Laboratory Infrastructure (#3243.08, #3242.08, #3244.08).
This activity targets national level policy makers in the military, the GoN and national organizations, such as
the National Agency for the Control of HIV/AIDS, as well as community-based organizations, faith-based
organizations, and healthcare workers, specifically all staff undertaking data entry, at the national and local
levels.
The DOD SI activities include an emphasis on HMIS and on capacity development, infrastructure, training,
and policy and guidelines. This activity also helps to address the issue of gender equity in HIV/AIDS
programs as data collected can help to inform any gender imbalances in programming.
Continuing Activity: 13160
13160 3245.08 Department of US Department of 6400 554.08 DoD Track 2.0 $569,000
6800 3245.07 Department of US Department of 4189 554.07 DoD Program $250,000
3245 3245.06 Department of US Department of 2773 554.06 DoD $393,500
Table 3.3.17:
This activity represents funding for four full-time, contracted positions for Strategic Information (SI) activities.
This includes a Senior HMIS Officer, Monitoring and Evaluation Officer, SI Program Assistant and
Data/Software Advisor to support SI activities for the U.S. Department of Defense (DOD) - Nigerian Ministry
of Defence NMOD) HIV Program. In COP09, the DOD-NMOD will support activities at 20 sites in 15 states
plus the FCT. The budget includes support for three FSN salaries and one expatriate advisor salary,
These four positions will work in coordination with CDC SI staff and USAID Strategic Information staff
members who will have the USG Nigeria Team lead for SI issues and directly provide joint quality
assurance/quality improvement (QA/QI) strategies and programmatic monitoring to the Nigerian Ministry of
Defence. The DOD SI Team will also work as members of the USG SI Technical Working Group. The
Officers' roles also include: 1) representing the DOD-NMOD in technical discussions with the GON and 2)
overseeing relevant technical aspects of the program, including program management and oversight of the
20 DOD-NMOD PEPFAR site SI programs.
The DOD SI Team will work with other Implementing Partners and the USG team to ensure a harmonized
approach that is consistent among partners and the GON. The team will also support SI activities of the
USG and GON, including the continued implementation of the HIVQUAL quality improvement project and
Voxiva/LHPMIP.
Continuing Activity: 13167
13167 9916.08 Department of US Department of 6401 554.08 DoD Track 2.0 $200,000
9916 9916.07 Department of US Department of 4193 554.07 DoD Agency $200,000
Estimated amount of funding that is planned for Human Capacity Development $48,000
The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its fifth
year in implementing PEPFAR activities. The DOD Program implements directly with the Nigerian Military.
This type of implementation ensures direct capacity building within an agency of the Federal Government of
Nigeria. Through this partnership, the impact of this program is felt on multiple levels- developing a strong
USG relationship with another branch of the Nigerian Government; building capacity of the indigenous
partner through joint implementation of activities; offering a cost effective model for implementation through
a direct USG-GON collaboration, and supporting both the military and civilian communities.
The NMOD-DOD PEPFAR Program is governed by a Steering Committee (SC), co-chaired by the Minister
of State for Defence (MOSD) and the US Ambassador to Nigeria, whose membership includes
representatives of both militaries, the Federal Ministry of Health (FMOH) and the National Agency for the
Control of AIDS (NACA). The NMOD funds these meetings, held three times a year since 2005. The
Emergency Plan Implementation Committee (EPIC), subordinate to the SC, is comprised of two NMOD
personnel per treatment site along with the EPIC headquarters and the DOD HIV Program Office. This
committee directs the implementation of the program through quarterly meetings and is funded by DOD.
The DOD maintains daily contact with the EPIC headquarters on all aspects of program implementation.
Through this partnership, the MOSD has directed the EPIC to harmonize with all other partners and funding
streams of the Nigerian Military to ensure complete synergy among programs and to ensure coordinated
and complementary use of resources.
Due to the formalization and strengthening of HIV infrastructure in prior COP years, EPIC was able to
clearly articulate their needs and successfully received its fourth annual operating budget from the GON
(2008 funding- $3.4 Million USD). In addition, the NMOD has hired 100 new health care providers (HCPs).
Both the operational funds and new HCP personnel are specifically for PEPFAR implementation.
civilian community (constituting approximately 75% of the Military's patient load). During COP09, the
NMOD-DOD HIV Program will continue to extend free prevention, care and treatment services in 20 military
facilities and communities.
In COP09, DOD will focus primarily on supporting the NMOD in developing, implementing and reviewing
policies on reducing the incidence and prevalence of HIV/AIDS in military communities. Other activities will
include continuing support for training on administrative policy and systems strengthening activities, and the
provision of training and development for the NMOD. Support to three target organizations (NMOD, EPIC
and the Armed Forces Programme on AIDS Control) will include addressing high-risk issues such as
peacekeeping and other international deployments as well as internal deployments.
At the local level, the DOD will support training and development activities for 200 individuals at 20 sites
plus the three target organizations mentioned above, in centralized and site-specific settings, targeted at
individual and work-group development in management, budgeting, logistics, project planning,
implementation, and monitoring and evaluation. By training uniformed members and civilian employees at
all levels who are on a career track in the GoN, the program fosters a generation of trained workers who are
more likely to remain with the military for the long term. As these employees are promoted, individuals are
not only technically trained, but also receiving management and oversight capability strengthening. This
clearly fulfills PEPFAR program goals for independent operation and oversight roles.
Other specific interventions at sites will include mobilization of local military communities to address male
norms and behaviors regarding cross-generational and transactional sex and support for the development
of military policy to prevent sexual violence and coercion. CBOs will be strengthened in their efforts to
reduce the stigma associated with HIV status and to reduce discrimination faced by those with HIV or AIDS.
Policies toward capacity building and NMOD ownership of PEPFAR activities will continue in COP09 with
the NMOD's initiative to store, manage and distribute supplies (ARVs, reagents, other consumables)
procured through the Supply Chain Management System (SCMS). Movement toward central acquisition
and distribution will decrease operating costs and the use of cash accounts at each site. The DOD program
will continue support policy development for implementation of the NMOD-owned, contractor (SCMS)
operated warehouse developed under COP07 funding, as well as the linkages of NMOD customs agents
with NAFDAC, federal customs authorities and the Ministry of Foreign Affairs. The program design will
ensure continued USG visibility and accountability at all levels of implementation. The NMOD ownership of
the program is supported through the integrated approach of PEPFAR implementation, the formation and
strengthening of NMOD HIV structures, application of an operating budget, increases in HCPs and logistics
improvements. The stewardship transfer, which is projected within the next two years, will contribute to a
sustainable program.
Within Nigeria, in addition to its commitment to the PEPFAR Team and its technical working groups on
policy and guideline development, the DOD will continue to be involved with organizations responsible for
responding to the HIV/AIDS epidemic through national policy development, implementation and
coordination activities. These organizations include the Federal Ministry of Health, HIV/AIDS Division
(HAD), the National Agency for the Control of AIDS (NACA), and the Global Fund.
Delta, Enugu, the Federal Capital Territory (FCT), Imo, Kaduna, Kano, Lagos, Oyo, Plateau, Rivers and
DOD activities will foster a strong USG relationship with another branch of the Nigerian Government; build
the capacity of indigenous partner through joint implementation of activities; offer a cost effective model for
implementation through a direct USG-GON collaboration, and support both the military and civilian
Activity Narrative: TARGET POPULATIONS:
This activity targets both military and civilian populations, including health care workers, administrators and
community liaisons at each site as well as Nigerian Ministry of Defence leaders and commanders, the
Steering Committee and Implementation Committee and others who are involved directly with policy
development.
This activity includes emphasis on military populations.
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.18:
ACTIVITY DESCRIPTION: In COP08, the DOD increased its technical staff to provide increased technical
and programmatic oversight to the U.S. Department of Defense (DOD) - Nigerian Ministry of Defense
(NMOD) HIV Program. In COP09, the program will continue to provide prevention, care and treatment
services at 20 sites in 15 states and the Federal Capital Territory. The Nigeria DOD HIV Program has
planned for full staffing at 31 positions in FY2008, the same staffing level as COP08. This is in line with the
movement from PEPFAR 1 (an emergency phase) to PEPFAR 2 (sustainability phase).
The COP08 staffing plan includes 3 USDH hires that are comprised of the Director, Executive Officer and
Program Manager. The latter two positions are secured through interagency personnel agreements. A
further breakdown of total staff includes 29 Locally Employed Staff (employed as contractors and FSNs), of
which 15 technical staff are funded under specific program. Remaining staff under M&S include 5 drivers
and 11 administrative staff. All positions are agreed upon through an interagency staffing process.
The M&S budget also includes operational funds (e.g., office lease, utilities, vehicle fuel), M&S-related
equipment, M&S-related staff inclusive of all associated costs, M&S staff-related travel, M&S staff-related
training and residential leases and post allowances for 3 USDH M&S positions.
DOD ICASS and CSCS costs are included in accordance with COP09 guidance.
Continuing Activity: 13168
13168 3264.08 Department of US Department of 6401 554.08 DoD Track 2.0 $1,961,613
6815 3264.07 Department of US Department of 4193 554.07 DoD Agency $1,605,000
3264 3264.06 Department of US Department of 2773 554.06 DoD $1,550,000
Table 3.3.19:
