Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 9404
Country/Region: Nigeria
Year: 2009
Main Partner: University Research Corporation, LLC
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: HHS/CDC
Total Funding: $1,637,411

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $55,930

ACTIVITY DESCRIPTION

This activity is related to activities in ARV services, Basic Care and Support, OVC, counseling and testing,

SI, and Lab.

In COP08, URC is providing PMTCT services to 2,000 women in Enugu State through work at 12 sites.

This was implemented in coordination with the government of Enugu and the state SASCP. In COP09,

URC will continue to support and strengthen PMTCT services in all 12 sites and expand services to 3

additional sites making a total of 15 PMTCT supported sites. URC will help set up and improve linkages

between comprehensive ART sites at the primary and secondary facility. Following the national PMTCT

guidelines, the hub and spoke model will be utilized. The comprehensive sites will form the hub and the

primary cares sites will be the spokes. This will allow for increased access to diagnostic and monitoring

tests for PMTCT. Stand alone PMTCT points of service at the primary care level will be liked to adult and

pediatric care as part of a comprehensive PMTCT network.

At URC supported PMTCT service points 2,500 pregnant clients will be provided opt-out provider initiated

HIV testing, counseling and results. URC will train 12 healthcare workers to provide couple counseling

using current national training manuals. The prevention with positives package will be utilized in all sites.

This will provide an opportunity to interrupt heterosexual transmission, especially in discordant couples.

HIV testing and counselling will be provided during labor and delivery by facility supported staff. HIV rapid

tests will be used for women who present at delivery without antenatal care.

URC will support facilities to provide highly active antiretroviral therapy (HAART) to pregnant women if their

CD4 is less than 350 in accordance with the National PMTCT guidelines. For the women not requiring

HAART, the current national guidelines recommended short course ARV option will be provided which

includes ZDV from 28 weeks, ZDV/3TC from 34-36 weeks and intrapartum NVP, and a 7 day ZDV/3TC

postpartum tail. This will result in the provision of ARV prophylaxis to 125 pregnant women. All HIV-positive

women will be linked post-partum to an HIV/ARV point of service, which will utilize a family centered care

delivery model whenever feasible, co-locating adult and pediatric care and providing a linkage to family

planning services this approach will involve providing the services at the points most appropriate and

convenient including maternal and child services.

URC will ensure that all HIV-positive pregnant women gain access to the basic care package of insecticide

treated nets, water vessels, water guard and soap. URC will support the training of 12 health workers on

infant feeding using the National Infant feeding training manual. HIV-positive women will be counselled on

infant feeding practices pre and postnatally. The options will include early cessation of breast feeding,

exclusive breastfeeding or breast milk substitute feeding if acceptable, affordable, available, safe and

feasible. Couples counselling will help support and sustain the infant feeding choices. Mothers will be linked

to peer support groups within the community.

HIV-exposed infants will be provided with single dose NVP at birth and ZDV for 6 weeks in accordance with

Nigerian National PMTCT Guidelines. Cotrimoxazole suspension for all exposed infants will also be

provided from 6 weeks until definitive HIV diagnosis. Testing of infants will be carried out using dried blood

spot (DBS) specimen collection. URC will actively participate in the national early infant diagnosis initiative

by providing infants for DBS testing from 6 weeks of age.

All capacity development undertaken by URC for its PMTCT program will adhere to the Nationally approved

training curriculum and will utilize the existing trainer of trainers (TOT) in Enugu to support the training and

retraining of 40 health workers on PMTCT across all sites.

URC notes the importance of ensuring postpartum follow up for completion of prophylaxis, early infant

diagnosis, cotrimoxazole prophylaxis and referral of mothers for ongoing care, support and treatment if

indicated. URC with its partner, Vision Africa, will work with community health workers to prevent losses

outside the health facility. Within the health facility, URC will encourage the formation of multidisciplinary

teams to adapt national referral procedures and to oversee program implementation and improvement.

URC will ensure the use of the national PMTCT registers across all supported sites and work to strengthen

data collection and transmission and encourage the use of this data at the site level to improve

implementation.

The PMTCT program will work closely with the care and support program to ensure no mothers are lost to

follow-up. Particular attention will be paid to community linkages through community health workers as

many women obtain most of their pre and postpartum care from them. These workers will be trained and

supported to improve referrals to hospitals for antenatal care and to help track and refer clients for delivery.

Vision Africa will continue its work, supported by URC, in this area.

POPULATIONS BEING TARGETED

This activity targets pregnant women who will be offered HCT, HIV-positive pregnant women for ARV

prophylaxis and infant feeding counseling, and exposed infants for prophylaxis and EID.

KEY LEGISLATIVE ISSUES ADDRESSED

This activity addresses gender since treatment will be provided to women and will focus on family centric

issues including male involvement in PMTCT programming.

EMPHASIS AREAS

Major emphasis of this activity focuses on training and network/linkages. Minor emphasis includes other

sectors and initiatives, commodity procurement, and community mobilization/participation.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21684

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21684 21684.08 HHS/Centers for University 9404 9404.08 $150,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Health-related Wraparound Programs

* Family Planning

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $4,150

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Care: Adult Care and Support (HBHC): $126,500

Several new CDC partners have recently been identified through a competetive funding opportunity

announcement as approved under COP08. Many of these partners are new to the PEPFAR and/or CDC

planning and implementation processes. The amounts awarded differ significantly from the original

proposal amounts submitted by these new partners. The difference now requires the new partners, working

in conjunction with the in-country CDC office and interagency technical working groups, to revise the action

plans for FY08 and FY09. CDC is currently working closely with the new partners to assure their effective

understanding of the PEPFAR planning process and that action plans for FY08 and FY09 COP submissions

are in accordance with funding awards as well as PEPFAR goals and objectives. Detailed narrative

changes will be submitted in the January 2009 reprogramming submission.

ACTIVITY DESCRIPTION

In COP 08, URC will provide care and support services to 1,900 clients and 3,800 persons affected by

HIV/AIDS (PABAs) with 1,350 receiving ART services. In COP 09, URC will continue to serve 1,900

PLWHA and 3,800 PABAs with HIV-related care and support. Among those receiving treatment will be 450

new clients. We will work in coordination with the state government of Enugu, the health commissioner and

ENSACA, the primary HIV/AIDS program implementing agency in Enugu to continue to select health facility

sites for program implementation in the highest HIV prevalence areas of Enugu state. We plan to be

working in 10 health facilities to enhance and/or establish care and treatment services. URC will assist

facilities to effect strengthening of internal and external referrals and linkages in order to promote access

and further care and treatment of all clients through regularly scheduled meetings between the primary care

coordinator for each relevant LGA in Enugu (state, private and NGO-supported facilities). Not all service

providers or facilities will be able to offer care and treatment within their facilities. In such cases, URC will

work with the State Department of Health to develop referral linkages to ensure that clients have easy

access to services. We will be training 20 individuals in ART and HIV-related care and support, including

community workers and PLWHA to scale up home-based care and support services for people living with

HIV/AIDS.

URC will address the shortcomings of supported health facilities in Enugu through training of additional

health staff and community workers and provision of needed infrastructure improvements to health facilities

and improve coordination and synergy among agencies working on HIV/AIDS in Enugu. We will provide

care services in the range of clinical care with basic care kits, psychological, spiritual, social, preventive

services, and home-based care. Clinical care will include basic nursing and end-of-life care, assessment

and management of pain, nutritional assessment and intervention, OI prophylaxis and management, STI

diagnosis and management, and laboratory services. All enrolled clients will receive a basic care kit which

includes ITN, water vessel, water guard and ORS, latex gloves, IEC materials, condom, and soap. The

minimum care package includes the basic care kit with clinical care, plus two supportive services of those

listed above. We will conduct pain assessment and management using WHO step-ladder approach and

according to national guidelines. URC will help provide prevention support for HIV positive clients. The

Prevention with Positives (PWP) programme will address on going prevention needs for all clients including

assistance with disclosure counselling for intimate partners, partner counselling and referral, ongoing risk

reduction counselling, provision of condoms, lifestyle counselling, referral linkages to patient support groups

and ongoing counselling, screening for STI, staff will be supported using the national and international best

practice to provide PWP support. Cotrimoxazole prophylaxis will be provided according to National

guidelines. URC will integrate nutrition support into the care and support programme. This support will

include nutritional assessment using Body Mass Index (BMI) assessment for all clients to achieve this all

clients will have their height and weight measured and recorded. Further all clients with BMI less than 18

will qualify for nutrition support by prescription through the provision of high energy macro and

micronutrients. URC will strengthen referral linkages to nutritional support programmes. Patient nutrition

education and counselling will also form a major part of the support provided. URC will support clinicians at

facility level to stage and manage patients according to national standards. These will be achieved though

on site mentorship support and off site but remote training. It is estimated that the 1,350 individuals

receiving ART will display moderate or severe malnutrition and thus be provided with food and nutritional

supplementation.

URC will work with its partner Vision Africa to support home based care activities. Through this collaboration

current and volunteer providers will be accessed and trained on the provision of appropriate support within

the home. This will include identification of cases for referral, psychosocial support, patient education, basic

first aid and adherence support according to the nationally accepted guidelines. We will provide increased

clinic-based and home/community-based activities to adults or adolescent HIV-positive individuals through

the training of healthcare workers, PLWHA and community workers in adherence counseling, management

of opportunistic infections, diagnosis and relief of symptoms, psychological and spiritual support, clinical

monitoring, related laboratory services and delivery of other palliative care services to the community

including culturally appropriate end-of-life care per Nigeria's National Palliative Care Standards and

Guidelines. This program area also includes the provision of ARV drugs which will be carried out by our

partner, Crown Agents, in concurrence with the Nigerian ART guidelines.

URC will ensure that the national guidelines on antiretroviral therapy are implemented. To this end, all ART

eligible clients will be taken through a pre-ART programme. This programme will focus on patient

preparation, readiness and adherence counselling and will then be placed on the triple ART regimen of

either Tenofovir( Zidovudine)/Lamivudine( Emcitrabine)/Nevirapine(Efavirenz), the nationally recommened

first line drugs. All clients will be eligible to a CD4 test on enrollment to the programme. All clients on ART

will be monitored closely with initial haemoglobin, liver function tests, creatinine and full blood counts carried

out for all clients. At a minimum all these will be repeated one month after initiation of therapy and six

monthly thereafter. Immunological and clinical monitoring will be used to identify treatment failure, all eligible

cases placed on Didanosine (Abacavir)/Lamivudine (Emcitrabine) and a ritonavir boosted protease inhibitor

as recommended in the national guidelines with appropriate permutations depending on initial regimens,

pregnancy and morbidity status. Education & Adherence Counseling will be closely linked to treatment

initiation and maintained with every patient contact. Close links will be formed with home based care

providers to maintain adherence within the home setting. Client and family centred approaches will be used.

These include disclosure and assisted counselling, the encouragement of treatment support buddies,

Activity Narrative: patient support groups. National pre-ART & ART client attendance registers will be used to track defaulters

and those lost to follow up. Facility based community meetings with community gate keepers will be held to

help improve community treatment literacy. As part of improving and increasing the effectiveness of care,

treatment and support URC will work together with other PEPFAR partners to support the proposed

development of a national policy on task shifting. This programme, under the leadership of the Government

of Nigeria, aims to shift non essential and routine follow up of clients from physicians to nurses ( for ongoing

follow up of stable ART and pre-ART clients) and from nurses to counsellors( for adherence counselling and

support.)

URC will train 20 health care workers on site, using the national curriculums for palliative care, ART and

adherence. This training will be supplemented by on site close support mentoring to ensure proper skills

transfer and usage. Local trainer of trainers will be capacitated to provide this training. In addition URC

recognizes the work and role of the current implementing partners in Enugu and will use their current

expertise to prevent the duplication and wastage of training and other implementation resources.

There will be ongoing monitoring and evaluation of the programme using application of quality

improvement initiatives including HIVQUAL, the plan, do, study act cycle, standard setting and tracking,

best practice sites with intentional spread and collaboration is the signature hallmark of URC programmes.

In addition, on site data collected will be analyzed and used for process and programme improvement. M&E

support will be provided by URC's technical team in collaboration with site staff and USG to increase

sustainability and ownership.

URC will focus part of its programming on improvement of referral systems to improve the coordination

between lower and higher level public healthcare facilities as well as between the public and private sector.

This will be accomplished through the scheduling of regular meetings with the primary care coordinator for

each relevant LGA in Enugu state, private and NGO-supported facilities to jointly develop indicators that are

followed so that weak areas among these facilities can be addressed.

URC recognizes the importance of ensuring uninterrupted supply of drugs, laboratory and allied

commodities and will work together with its partner, Crown Agents, through the available central supply

systems. This support will supplement the national commodity supply. Locally sourced and

USFDA/PEPFAR approved commodity will be procured through this mechanism.

CONTRIBUTIONS TO OVERALL PROGRAM

Training and support to improve the quality and integration of care and treatment services are consistent

with FMOH and PEPFAR priorities and will support the strengthening of the health system. URC will hold

workshops to promote sharing of knowledge and best practices in all HIV-related services which will allow

rapid and effective spread of good practices throughout Enugu State. Our care and support program will

build on our partner, Vision Africa's network in Enugu which is affiliated with dozens of FBOs, CBOs and

CSOs in Enugu State, including Enugu State's branches of The Network of People Living with HIV/AIDS in

Nigeria (NEPWHAN) to train community workers and PLWHAs in the delivery of home-based care services.

Additionally, our work in this area will also involve training and new reporting on performance indicators as

specified by PEPFAR. This activity in the region will strengthen all reporting, accountability of facilities and

data collection in all areas of the health sector in Enugu State. The networking, sharing of best practices

and training of health and community workers in ART care and treatment services promotes sustainability.

This program seeks to increase gender equity in programming through counseling and educational

messages targeted at vulnerable women and girls. Furthermore, through gender sensitive programming and

improved quality services the program will contribute to reduction in stigma and discrimination and address

male norms and behaviors by encouraging men to contribute to care and support in the families

LINKS TO OTHER ACTIVITIES

This activity is linked to Counseling and Testing, PMTCT, TB/HIV, OVC, Human Capacity Development and

Strategic Information.

POPULATIONS BEING TARGETED

People Living with HIV/AIDS (PLWHA), their family members, caregivers and health care workers are

targeted in this activity.

EMPHASIS AREAS

The emphasis areas for this program activity includes: Capacity Building of agencies, organizations and

health facilities responsible for delivery of HIV interventions, Collaboration and coordination to improve

referral systems and availability of services and Community outreach and involvement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21689

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21689 21689.08 HHS/Centers for University 9404 9404.08 $200,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Health-related Wraparound Programs

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,075

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $354,000

Several new CDC partners have recently been identified through a competetive funding opportunity

announcement as approved under COP08. Many of these partners are new to the PEPFAR and/or CDC

planning and implementation processes. The amounts awarded differ significantly from the original

proposal amounts submitted by these new partners. The difference now requires the new partners, working

in conjunction with the in-country CDC office and interagency technical working groups, to revise the action

plans for FY08 and FY09. CDC is currently working closely with the new partners to assure their effective

understanding of the PEPFAR planning process and that action plans for FY08 and FY09 COP submissions

are in accordance with funding awards as well as PEPFAR goals and objectives. Detailed narrative

changes will be submitted in the January 2009 reprogramming submission.

ACTIVITY DESCRIPTION

In COP 08, URC will provide care and support services to 1,900 clients and 3,800 persons affected by

HIV/AIDS (PABAs) with 1,350 receiving ART services. In COP 09, URC will continue to serve 1,900

PLWHA and 3,800 PABAs with HIV-related care and support. Among those receiving treatment will be 450

new clients. We will work in coordination with the state government of Enugu, the health commissioner and

ENSACA, the primary HIV/AIDS program implementing agency in Enugu to continue to select health facility

sites for program implementation in the highest HIV prevalence areas of Enugu state. We plan to be

working in 10 health facilities to enhance and/or establish care and treatment services. URC will assist

facilities to effect strengthening of internal and external referrals and linkages in order to promote access

and further care and treatment of all clients through regularly scheduled meetings between the primary care

coordinator for each relevant LGA in Enugu (state, private and NGO-supported facilities). Not all service

providers or facilities will be able to offer care and treatment within their facilities. In such cases, URC will

work with the State Department of Health to develop referral linkages to ensure that clients have easy

access to services. We will be training 20 individuals in ART and HIV-related care and support, including

community workers and PLWHA to scale up home-based care and support services for people living with

HIV/AIDS.

URC will address the shortcomings of supported health facilities in Enugu through training of additional

health staff and community workers and provision of needed infrastructure improvements to health facilities

and improve coordination and synergy among agencies working on HIV/AIDS in Enugu. We will provide

care services in the range of clinical care with basic care kits, psychological, spiritual, social, preventive

services, and home-based care. Clinical care will include basic nursing and end-of-life care, assessment

and management of pain, nutritional assessment and intervention, OI prophylaxis and management, STI

diagnosis and management, and laboratory services. All enrolled clients will receive a basic care kit which

includes ITN, water vessel, water guard and ORS, latex gloves, IEC materials, condom, and soap. The

minimum care package includes the basic care kit with clinical care, plus two supportive services of those

listed above. We will conduct pain assessment and management using WHO step-ladder approach and

according to national guidelines. URC will help provide prevention support for HIV positive clients. The

Prevention with Positives (PWP) programme will address on going prevention needs for all clients including

assistance with disclosure counselling for intimate partners, partner counselling and referral, ongoing risk

reduction counselling, provision of condoms, lifestyle counselling, referral linkages to patient support groups

and ongoing counselling, screening for STI, staff will be supported using the national and international best

practice to provide PWP support. Cotrimoxazole prophylaxis will be provided according to National

guidelines. URC will integrate nutrition support into the care and support programme. This support will

include nutritional assessment using Body Mass Index (BMI) assessment for all clients to achieve this all

clients will have their height and weight measured and recorded. Further all clients with BMI less than 18

will qualify for nutrition support by prescription through the provision of high energy macro and

micronutrients. URC will strengthen referral linkages to nutritional support programmes. Patient nutrition

education and counselling will also form a major part of the support provided. URC will support clinicians at

facility level to stage and manage patients according to national standards. These will be achieved though

on site mentorship support and off site but remote training. It is estimated that the 1,350 individuals

receiving ART will display moderate or severe malnutrition and thus be provided with food and nutritional

supplementation.

URC will work with its partner Vision Africa to support home based care activities. Through this collaboration

current and volunteer providers will be accessed and trained on the provision of appropriate support within

the home. This will include identification of cases for referral, psychosocial support, patient education, basic

first aid and adherence support according to the nationally accepted guidelines. We will provide increased

clinic-based and home/community-based activities to adults or adolescent HIV-positive individuals through

the training of healthcare workers, PLWHA and community workers in adherence counseling, management

of opportunistic infections, diagnosis and relief of symptoms, psychological and spiritual support, clinical

monitoring, related laboratory services and delivery of other palliative care services to the community

including culturally appropriate end-of-life care per Nigeria's National Palliative Care Standards and

Guidelines. This program area also includes the provision of ARV drugs which will be carried out by our

partner, Crown Agents, in concurrence with the Nigerian ART guidelines.

URC will ensure that the national guidelines on antiretroviral therapy are implemented. To this end, all ART

eligible clients will be taken through a pre-ART programme. This programme will focus on patient

preparation, readiness and adherence counselling and will then be placed on the triple ART regimen of

either Tenofovir( Zidovudine)/Lamivudine( Emcitrabine)/Nevirapine(Efavirenz), the nationally recommened

first line drugs. All clients will be eligible to a CD4 test on enrollment to the programme. All clients on ART

will be monitored closely with initial haemoglobin, liver function tests, creatinine and full blood counts carried

out for all clients. At a minimum all these will be repeated one month after initiation of therapy and six

monthly thereafter. Immunological and clinical monitoring will be used to identify treatment failure, all eligible

cases placed on Didanosine (Abacavir)/Lamivudine (Emcitrabine) and a ritonavir boosted protease inhibitor

as recommended in the national guidelines with appropriate permutations depending on initial regimens,

pregnancy and morbidity status. Education & Adherence Counseling will be closely linked to treatment

initiation and maintained with every patient contact. Close links will be formed with home based care

providers to maintain adherence within the home setting. Client and family centred approaches will be used.

These include disclosure and assisted counselling, the encouragement of treatment support buddies,

Activity Narrative: patient support groups. National pre-ART & ART client attendance registers will be used to track defaulters

and those lost to follow up. Facility based community meetings with community gate keepers will be held to

help improve community treatment literacy. As part of improving and increasing the effectiveness of care,

treatment and support URC will work together with other PEPFAR partners to support the proposed

development of a national policy on task shifting. This programme, under the leadership of the Government

of Nigeria, aims to shift non essential and routine follow up of clients from physicians to nurses ( for ongoing

follow up of stable ART and pre-ART clients) and from nurses to counsellors( for adherence counselling and

support.)

URC will train 20 health care workers on site, using the national curriculums for palliative care, ART and

adherence. This training will be supplemented by on site close support mentoring to ensure proper skills

transfer and usage. Local trainer of trainers will be capacitated to provide this training. In addition URC

recognizes the work and role of the current implementing partners in Enugu and will use their current

expertise to prevent the duplication and wastage of training and other implementation resources.

There will be ongoing monitoring and evaluation of the programme using application of quality

improvement initiatives including HIVQUAL, the plan, do, study act cycle, standard setting and tracking,

best practice sites with intentional spread and collaboration is the signature hallmark of URC programmes.

In addition, on site data collected will be analyzed and used for process and programme improvement. M&E

support will be provided by URC's technical team in collaboration with site staff and USG to increase

sustainability and ownership.

URC will focus part of its programming on improvement of referral systems to improve the coordination

between lower and higher level public healthcare facilities as well as between the public and private sector.

This will be accomplished through the scheduling of regular meetings with the primary care coordinator for

each relevant LGA in Enugu state, private and NGO-supported facilities to jointly develop indicators that are

followed so that weak areas among these facilities can be addressed.

URC recognizes the importance of ensuring uninterrupted supply of drugs, laboratory and allied

commodities and will work together with its partner, Crown Agents, through the available central supply

systems. This support will supplement the national commodity supply. Locally sourced and

USFDA/PEPFAR approved commodity will be procured through this mechanism.

CONTRIBUTIONS TO OVERALL PROGRAM

Training and support to improve the quality and integration of care and treatment services are consistent

with FMOH and PEPFAR priorities and will support the strengthening of the health system. URC will hold

workshops to promote sharing of knowledge and best practices in all HIV-related services which will allow

rapid and effective spread of good practices throughout Enugu State. Our care and support program will

build on our partner, Vision Africa's network in Enugu which is affiliated with dozens of FBOs, CBOs and

CSOs in Enugu State, including Enugu State's branches of The Network of People Living with HIV/AIDS in

Nigeria (NEPWHAN) to train community workers and PLWHAs in the delivery of home-based care services.

Additionally, our work in this area will also involve training and new reporting on performance indicators as

specified by PEPFAR. This activity in the region will strengthen all reporting, accountability of facilities and

data collection in all areas of the health sector in Enugu State. The networking, sharing of best practices

and training of health and community workers in ART care and treatment services promotes sustainability.

This program seeks to increase gender equity in programming through counseling and educational

messages targeted at vulnerable women and girls. Furthermore, through gender sensitive programming and

improved quality services the program will contribute to reduction in stigma and discrimination and address

male norms and behaviors by encouraging men to contribute to care and support in the families

LINKS TO OTHER ACTIVITIES

This activity is linked to Counseling and Testing, PMTCT, TB/HIV, OVC, Human Capacity Development and

Strategic Information.

POPULATIONS BEING TARGETED

People Living with HIV/AIDS (PLWHA), their family members, caregivers and health care workers are

targeted in this activity.

EMPHASIS AREAS

The emphasis areas for this program activity includes: Capacity Building of agencies, organizations and

health facilities responsible for delivery of HIV interventions, Collaboration and coordination to improve

referral systems and availability of services and Community outreach and involvement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21699

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21699 21699.08 HHS/Centers for University 9404 9404.08 $365,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Health-related Wraparound Programs

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,075

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $19,000

ACTIVITY DESCRIPTION

University Research Co., LLC (URC), in COP09, will serve 190 children with HIV-related care and support,

150 receiving treatment. Among these will be 100 newly initiating on treatment. URC will work in

coordination with the state government of Enugu, the health commissioner and ENSACA, the primary

HIV/AIDS program implementing agency in Enugu to continue to select health facility sites for program

implementation in the highest HIV prevalence areas of Enugu state. URC plans to be working in 10 health

facilities to enhance and/or establish pediatric care and treatment services. URC will assist facilities to effect

strengthening of internal and external referrals and linkages in order to promote access and further care and

treatment of all clients through regularly scheduled meetings between the primary care coordinator for each

relevant LGA in Enugu (state, private and NGO-supported facilities). URC will work with the State

Department of Health to develop referral linkages to ensure that clients have easy access to services. URC

will train 10 individuals in pediatric HIV-related care and support, including community workers and PLWHA

to scale up home-based care and support services for people living with HIV/AIDS and health workers in

dried blood spot collection.

URC will address the shortcomings of supported health facilities in Enugu through training of additional

health staff and community workers and provision of needed infrastructure improvements to health facilities

and improve coordination and synergy among agencies working on HIV/AIDS in Enugu. URC will provide

care services in the range of clinical care with basic care kits, psychological, spiritual, social, preventive

services, and home-based care. Clinical care will include basic nursing and end-of-life care, assessment

and management of pain, nutritional assessment and intervention, and laboratory services. All enrolled

clients will receive a basic care kit which includes ITN, water vessel, water guard and ORS, latex gloves,

IEC materials and soap. The minimum care package includes the basic care kit with clinical care, plus two

supportive services of those listed above. Pain assessments will be conducted and managed using WHO

step-ladder approach and according to national guidelines. Cotrimoxazole prophylaxis will be provided to

all paediatric clients according to national guidelines.

The needs of adolescents will also be catered for in URC's support to the pediatric program in Enugu state.

URC will work with partners to ensure that facilities provided child and adolescent friendly services through

dedicated paediatric service days and modification of infrastructure to create child friendly spaces.

Psychosocial support of the older child will also be catered for by mentoring and supporting health care

workers and guardians. URC will utilize available technical support from other implementing partners and

government advisors.

URC will work toward the integration of nutritional support into the care and treatment program. This support

will include nutritional assessment using growth monitoring and assessment cards and charts. Those

children that qualify for nutritional support (an estimated 150 children) will receive high energy macro and

micronutrients. URC will strengthen referral linkages to nutritional support programs and will collaborate with

these programs by providing gap support for nutritional supplements. Caregiver nutrition education and

counselling will also form a major part of the support provided. URC will support clinicians at the facility level

to stage and manage patients according to national standards. This will be achieved though on site

mentorship support and off site but remote training. URC will emphasize early and appropriate referral of

guardians to programs that support economic empowerment as poverty is the major factor in malnutrition.

Further, all children will be supported to get the recommended childhood immunizations and treatment of

childhood illnesses by ensuring that HIV services are provided in the maternal and child settings.

URC recognizes the importance of ensuring the prompt diagnosis of all HIV exposed infants, using early

infant diagnosis (EID.) The Clinton HIV AID Initiative (CHAI) and PEPFAR support the National EID

program in Nigeria and URC will help setup and or improve linkages to this program. URC will help ensure

that health workers are trained on proper dried blood spot collection and onward transmission as part of the

National EID program.

URC will work with its partner Vision Africa to support home based care activities. Through this

collaboration, HBC providers will be accessed and trained on the provision of appropriate support within the

home. This will include identification of cases for referral, psychosocial support, patient education, basic first

aid and adherence support according to the nationally accepted guidelines. URC will provide increased

clinic-based and home/community-based activities to HIV-positive children through the training of

healthcare workers, PLWHA and community workers in adherence counseling, management of

opportunistic infections, diagnosis and relief of symptoms, psychological and spiritual support, clinical

monitoring, related laboratory services and delivery of other palliative care services to the community

including culturally appropriate end-of-life care per Nigeria's National Palliative Care Standards and

Guidelines. This program area also includes the provision of ARV drugs which will be carried out by a URC

partner, Crown Agents, in concurrence with the National Pediatric ART Guideline.

URC will help ensure that the national guidelines on pediatric antiretroviral therapy are implemented. This

program will focus on patient preparation, readiness, education and adherence counselling and all clients

will then be placed on the triple ART regimen for children as contained in the national guidelines

(Zidovudine( Stavudine)/Lamivudine)/Nevirapine (Efavirenz)). All clients will have baseline CD4

count/percent on enrollment to the program and follow-up. All clients on ART will be monitored closely with

baseline hematology and chemistry. At a minimum all these will be repeated one month after initiation of

therapy and six monthly thereafter. Immunological and clinical monitoring along with CD4 count/percent will

be used to identify treatment failures with all eligible cases placed on ART.

Adherence counseling of guardians will be linked to treatment initiation and maintenance with initial, one

month and six monthly counselling sessions. Close links will be formed with HBC providers to maintain

adherence within the home setting. A family-centered approach will be used. For children, proper

preparation of the guardian is crucial. National client attendance registers will be used to track defaulters

and those lost to follow up. Facility-based community meetings with community gate keepers will be held to

help improve community treatment literacy. As part of improving and increasing the effectiveness of care,

treatment and support URC will work together with other PEPFAR partners to support the proposed

Activity Narrative: development of a national policy on task shifting. This program, under the leadership of the Government of

Nigeria, aims to shift non essential and routine follow up of clients from clinicians to nurses (for ongoing

follow up of stable clients on ART) and from nurses to counselors (for adherence counseling and support.)

URC will train 10 health care workers on site, using the national curricula for pediatric care and treatment.

This training will be supplemented by on site mentoring to ensure proper skills transfer and usage. Local

facilitators will be used to provide this training. URC will collaborate with the current implementing partners

in Enugu and will use their current expertise to minimize the duplication of training and implementation of

activities.

The ongoing monitoring of the program as implemented will play a critical role in improvement initiatives.

The use of data, the application of quality improvement initiatives including the "plan, do, study act" cycle,

standard setting and tracking, best practice sites with intentional spread and collaboration is the signature

hallmark of URC programs. URC will strengthen the national data capture and reporting systems at site

levels. In addition, on-site data collected will be analyzed and used for process and program improvement.

This support will be provided by URC's technical team in collaboration with site staff to increase

sustainability and ownership.

URC recognizes the importance of ensuring uninterrupted supply of drugs, laboratory and allied

commodities and will work together with its partners Crown Agents, through the available central supply

systems. This support will supplement the national commodity supply. Locally sourced and

USFDA/PEPFAR approved commodities will be procured through this mechanism.

CONTRIBUTIONS TO OVERALL PROGRAM AREA

Training and support to improve the quality, scale-up and integration of pediatric care and treatment

services are consistent with FMOH and PEPFAR priorities. The aims are to increase access of services to

HIV+ children through a concerted effort to improve linkages and referral systems between maternal and

child health clinics, PMTCT and nutrition services by setting up functional and documented systems for

referral of children into care programs. Additionally, URC will be using Vision Africa's radio programming

and network of community and PLWHA groups to increase community outreach in Enugu state to help bring

these children into health facilities as well as bringing services out to the home. An overall focus on

improved referral systems and community linkages with health facilities will ensure sustainability.

LINKS TO OTHER ACTIVITIES

This program activity is also linked to Counseling and Testing, PMTCT, OVC, TBHIV, Adult CT, and

laboratory infrastructure.

POPULATIONS BEING TARGETED

HIV-exposed and infected children (under 15) and their families/caregivers.

Healthcare providers working with children.

EMPHASIS AREAS

The emphasis areas for this program are:

Capacity building of health facilities and organizations responsible for delivery of HIV interventions.

Collaboration and coordination to improve referral systems and availability of services. This program will

also increase gender equity in programming through counseling and educational messages targeted at girls

and boys. Furthermore, through gender sensitive programming and improved quality services the program

will contribute to reduction in stigma and discrimination and address male norms and behaviors by

encouraging men to contribute to care and treatment in families. Emphasis on child survival strategies and

TB identification and referral will also be included in this activity. Community outreach and involvement as

described above.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $45,000

ACTIVITY DESCRIPTION

URC with its partners will review facility pediatric care and support and related registers and patient records

to establish baseline HIV-related pediatric care and support uptake in each new facility. We will enhance or

establish 10 centers for HIV-related pediatric care and support. In FY 2009, we expect to be serving 212

children with HIV-related care and support, including testing using Early Infant Diagnosis techniques. We

will be training 10 individuals in HIV-related pediatric care and support, including community workers and

PLWHA to scale up home-based care and support services for people living with HIV/AIDS. We will also

train community workers and counselors in dried blood spot preparation of sample for Early Infant Diagnosis

and laboratory and community workers in DNA PCR for EID testing. We will mobilize our network of

community groups to train health and community workers in ART, prevention and treatment of OIs in

children and other HIV-related complications including malaria and diarrhea, pain and symptom relief and

nutritional assessment and support. The mobilization of these community groups and workers will help to

increase access to pediatric care and support services and will serve to bring more children in for treatment

care and support through improved linkages with PMTCT and maternal and child health clinics. Our

program will include providing the necessary equipment and infrastructure upgrades needed for at least one

laboratory in Enugu State to accurately perform EID. Our M&E staff will work to ensure proper reporting on

pediatric treatment and care indicators, including those diagnosed using EID and receiving results.

CONTRIBUTIONS TO OVERALL PROGRAM AREA

Training and support to improve the quality, scale and integration of pediatric care and treatment services

are consistent with FMOH and PEPFAR priorities. The aims are to increase access of services to HIV+

children through a concerted effort to improve linkages and referral systems between maternal and child

health clinics, PMTCT and nutrition services by setting up functional and documented systems for referral of

children into care programs. Additionally, we will be using Vision Africa's radio programming and network of

community and PLWHA groups to increase community outreach in Enugu state to help bring these children

into health facilities as well as bringing services out to the home. An overall focus on improved referral

systems and community linkages with health facilities will ensure sustainability.

LINKS TO OTHER ACTIVITIES

This program activity is also linked to Counseling and Testing, PMTCT, OVC and laboratory infrastructure.

POPULATIONS BEING TARGETED

HIV-exposed and HIV-infected children (under 15) and their families

EMPHASIS AREAS

The emphasis areas for this program are:

1.Capacity building of health facilities and organizations responsible for delivery of HIV interventions

2.Collaboration and coordination to improve referral systems and availability of services

3.Community outreach and involvement

as described above.

Early Funding Narrative (if early funding needed, justify here; must be less than 1,000 characters, including

spaces)

New/Continuing Activity: Continuing Activity

Continuing Activity: 21699

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21699 21699.08 HHS/Centers for University 9404 9404.08 $365,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Gender

* Addressing male norms and behaviors

Health-related Wraparound Programs

* Child Survival Activities

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $2,500

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $92,500

ACTIVITY DESCRIPTION

In COP 08, URC is providing HCT in TB settings to 2,500 clients and providing TB treatment to 250 clients

at 10 sites. URC is supporting enhancement of laboratory and x-ray services for HIV/TB cross-testing at

these 12 health facilities. URC is working to ensure that every ART site has a DOTS site and all DOTS

sites are being expanded to include HCT services. URC is also assisting in provision of anti-TB drugs,

laboratory commodities and reagent procurement and distribution.

In COP 09, URC will continue to support all TB/HIV activities from COP 08 and will expand HCT services in

three additional DOTS sites in line with the National TB and Leprosy Control Program (NTBLCP) to focus

on strengthening the integration of high quality TB and HIV care delivery. URC will counsel, test and

provide HIV test results to 350 clients in TB settings, treat 225 HIV+ individuals for TB disease and screen

300 HIV+ individuals for TB. Over the course of the year, URC will train 15 health workers at HIV counseling

and testing outlets to provide TB treatment. DOTS site personnel will be trained in HIV diagnosis using HIV

rapid kits and be educated in referring HIV+ individuals to comprehensive care for assessment including for

ARV treatment eligibility. URC will assist facilities to effect strengthening of internal and external referrals

and linkages in order to promote access and further screening of both HIV and TB clients. Not all service

providers or facilities will be able to offer HIV testing within their facilities. In such cases, URC will work with

the State Ministries of Health to develop referral linkages to ensure that clients have easy access to

services. Linkages between counseling and testing sites and sites offering ART treatment will also be

developed and improved.

URC will also provide the necessary training and infrastructure upgrades for laboratories to ensure that TB

diagnosis is performed correctly including training on x-ray diagnostics and sputum microscopy training.

URC will implement the three I's which involve increased TB case finding among HIV positive patients,

isoniazide preventive therapy (IPT) in ART centers, and TB infection control in all our facilities according to

the national guidelines. URC will also support MDR TB management and prevention and basic

infrastructure renovations at DOTS sites and TB laboratories.

URC will continue to partner with PEPFAR IPs specializing in laboratory programs to facilitate Quality

Assurance programs in ensuring quality services. TB-supported lab staff will be trained using the national

AFB microscopy training manual and QA guidelines will be incorporated. The external quality assessment

program will be implemented through on-site visitation of all supported sites, slide re-reading through

blinded re-checking and proficiency testing using five stained and five unstained panel slides. The capacity

of laboratory will be strengthened through additional commodity support (e.g. staining reagents and

equipment) to Government of Nigeria sites. URC placed $12,500 into the SCMS mechanism for commodity

and logistical support in this area. Facilities will be upgraded to permit easy workflow and safe working

practices. Adequate attention will be provided to the disposal of laboratory waste and other effluents.

National guidelines on infection control on co-located sites will be implemented in all 13 supported sites and

URC will also provide necessary training to ensure that the National TB treatment algorithm is followed at all

participating sites. URC will provide palliative care to TB/HIV co-infected patients including other

opportunistic infections and will refer appropriately for ART. Cotrimoxazole Preventive Therapy (CPT) will

be provided to eligible TB/HIV patients as a component of basic care and support. HCT in DOTS sites will

be established at the secondary and primary health center levels with linkages to tertiary centers to provide

accessibility of services to patients.

POPULATIONS BEING TARGETED

TB suspects, TB patients, PLWHA and their family members. Healthcare workers will be targeted on TB

infection control.

CONTRIBUTIONS TO OVERALL PROGRAM

Training and support to improve the quality and integration of TB/HIV services is consistent with FMOH and

PEPFAR priorities. The focus of the URC TB/HIV program is on the provision of HCT in DOTS centers,

referral of TB/HIV patients to TB treatment and ART services. Focus on improved referral systems,

technical capacity development and improved health services in facilities will ensure sustainability and will

greatly improve all services across the health sector.

EMPHASIS AREAS

LINKS TO OTHER ACTIVITIES

This activity is also linked to Counseling and Testing, ART care and treatment, OVC, PMTCT and Strategic

Information

New/Continuing Activity: Continuing Activity

Continuing Activity: 21705

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21705 21705.08 HHS/Centers for University 9404 9404.08 $150,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Construction/Renovation

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Care: Orphans and Vulnerable Children (HKID): $18,500

ACTIVITY DESCRIPTION

In COP09, URC is working in a total of 12 satellite sites in Enugu state. For COP09, a full package of

Orphaned and Vulnerable Children (OVC) services will be provided to 83 OVC. All 83 children (41 males

and 42 females) will receive at least 3 core services from URC. It will also provide 83 OVC with food and

nutritional supplement. URC will train 10 providers/caregivers in COP09.

The 3 core services to be provided include food and nutrition, health care and psychosocial support. URC

will provide referral linkages to the other core services including shelter and care, protection and education

and vocational training. URC will use a multifaceted approach to increase access to HIV counseling and

testing and provide a family-focused approach to the care of OVC. We will use the clinical and community

health workers as entry points to HIV preventive services. All OVC and their households will be assessed

by URC and its sub partner Vision Africa for the specific household needs and provided with psychosocial,

nutritional, educational support and health care support where necessary.

URC will use rights-based family focused approach as outlined in the national OVC guidelines with child

and wider community participation. In addition URC will work to ensure equal service provision to boys and

girls to maintain a gender balance and ensure quality, integrated and holistic approach that will leverage on

the partnerships with PEPFAR and non-PEPFAR partners.

The psychosocial support provided to the OVC will include frequent home visits by our facility trained

community volunteers from Vision Africa and our partners Primary Health Centres (PHC) for assessment of

health status, counselling on stigma, grief, disclosure and coping mechanism to further help in reducing

their vulnerability to HIV.

URC will strengthen the existing structures to build child support groups in all support PHCs and expand

their activities to include periodic social/recreational and educational play activities with the involvement of

both infected and uninfected children as a way to address the issue and concerns surrounding stigma and

discrimination. URC will further build the capacity in the team and at the PHC to establish adolescent

programmes for infected and affected children.

URC will provide nutritional assessment, nutritional demonstration activities and associated support to and

help ensure adequate primary health care for OVC. This will be anchored on enhanced psychosocial

support at both facility and community levels. The nutritional services to be provided by URC will include

nutritional assessment using the growth monitoring strategies and micronutrient supplementation. URC will

work with the Clinton HIV AIDS Initiative (CHAI) for provision of therapeutic food supplements and also with

other PEPFAR-supported organization offering food programmes for OVC.

Adequate health care will include strengthening linkages and referrals to other facility services including

maternal and child health, inpatient and outpatient departments. Community-based HIV prevention services

will be strengthened to ensure referral to facilities for OVC households through a family-centered opt-out

approach to HCT services for all children less than 18 years of age and their caregivers.

All OVC households will receive a preventive care package containing insecticide treated nets (ITN), water

guard, water vessel, ORS sachets, and information education and communication materials on self care

and prevention of common infection as outlined in the Government of Nigeria (GON) guidelines.

URC will provide good supportive counseling for children and adolescents. URC will intensify collaboration

with GON and other stakeholders to ensure prompt diagnosis of TB in children and facilitate provision of

pediatric TB formulations. In addition, URC will collaborate with National Programme on Immunization to

ensure delivery free and appropriate immunization to all OVC under 5 years. URC will ensure birth

registration for OVC and roll out of a child protection policy for all our PHCs in collaboration with appropriate

GON agencies and other community based organizations (CBOs.) URC will also participate in advocating

the GON in Enugu State for welfare services for OVC. Linkages to Vision Africa and other URC partners will

ensure the full provision of community and HBC services to OVC clients.

URC will build the skills of CBO staff and community health workers and home based care providers to

identify children who are vulnerable and to provide them with appropriate services. URC will contribute in

this way to strengthening the regional system to ensure sustainability and effectiveness of OVC

programming.

URC will adopt use of the subjective rating scales in Child Status Index to assess vulnerability and provide

services. In collaboration with CBOs, FBOs and other OVC programs, and in particularly Vision Africa, URC

will ensure that OVCs receive comprehensive care and support services with emphasis on decentralization

of these services to the community and home levels.

Monitoring and evaluation of the URC OVC program will be consistent with the national plan for patient

monitoring. URC M&E specialists and OVC focal persons will conduct team site visits at least quarterly

during which there will be evaluations of OVC services provided, the utilization of National patient

management monitoring (PMM) tools and guidelines, proper medical record keeping, referral coordination,

and use of standard operating procedures by the HBC and facility providers. Frequent follow-up monitoring

visits will be provided to address weaknesses when identified during routine monitoring visits. Each of

these activities will highlight opportunities for improvement of the OVC programme.

URC will facilitate the training of 10 health care workers in OVC programme implementation using nationally

recognized and approved curriculum and the existing training systems including regional partner and

government trainers. Health care workers will be trained in COP09 using national guidelines and OVC

standards of practice. Specific training relevant to each level of HCW will be provided at each PHC for at

least one doctor, one nurse and one counselor.

CONTRIBUTION TO OVERALL PROGRAM AREA:

Scaling-up OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of

care to 400,000 children infected and affected by HIV/AIDS in Nigeria. The OVC activity will contribute to

the URC overall comprehensive package of care for PLWHAs by ensuring that children's specific needs are

Activity Narrative: met. Training activities will contribute to overall program sustainability by building the knowledge and skill

base across all supported sites.

LINKS TO OTHER ACTIVITIES:

URC activities in OVC are linked to HCT, ARV, services PMTCT, ARV drugs, laboratory, AB TB/HIV

Pediatric care and treatment and SI to ensure that OVC are provided a continuum of care. Linkages to

URC's subpartners and other CBOs will ensure the full provision of community and HBC services to OVC

clients.

POPULATION BEING TARGETED:

This activity targets infants, young children, adolescents and other at-risk children in HIV infected and

affected families. It also targets the households, including caregivers, of OVC. Health and allied care

providers in clinical and community settings will be trained to provide services to OVC.

EMPHASIS AREAS:

The activity has an emphasis on human capacity development through training and commodity

procurement. Other areas of emphasis include wraparound services (food, immunizations) and SI.

The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to

both male and female OVCs in any IP-supported PHCs.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Child Survival Activities

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $3,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $23,215

THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY DESCRIPTION

In COP08, URC is providing HCT to clients in Enugu State at 12 sites. The project uses provider initiated,

routinely offered, opt-out models to maximize uptake of HCT services at the healthcare facilities. Facility-

based testing is fully integrated with other health services. Point of service testing is made available in the

General Outpatient Departments (GOPD), Inpatient Wards, ANC and Immunization Clinics as well as

TB/DOTS clinics. URC actively links all HIV positive clients to care. From all points of service, clients are

referred to receive basic care and support services.

In COP09 URC will continue to support the HCT activities carried out in COP08. URC expects to counsel,

test and provide HIV test results to 2,500 clients through these facilities, including results for TB. The URC

HCT activities will also stress: (1) providing technical assistance, particularly in identifying most at risk

persons in need of HCT, and (2) working with sites to identify potential additional resources (from the GON,

other donors, Global Fund, etc.) to provide commodities and increase uptake of HCT services in all points of

service in the facilities. Over the course of the year, URC will train 17 health workers in HIV counseling and

testing using the national HCT training curriculum. HIV testing will be conducted using the national serial

testing algorithm. An ongoing quality assurance/quality control program which consists of quarterly

proficiency testing and blinded re-checking will be linked to a reference laboratory. URC will work with the

USG and GON laboratory technical working group and other partners to ensure an effective quality

assurance/control (QA/QC) program. URC will ensure that trained counselors are available at HCT sites,

especially PMTCT sites to provide couples counseling and testing following standard protocols and

procedures as a means of reducing HIV transmission in sero-discordant couples/partners. Client-witnessed

testing will be carried out to encourage client confidence in the test results. In this case, same day results

will be provided for the clients. URC will assist facilities to effect strengthening of internal and external

referrals and linkages in order to promote access and further care and treatment of all clients. URC will

work with the State Department of Health to develop referral linkages to ensure that clients have easy

access to services. Linkages between counseling and testing sites and sites offering ART treatment will

also be developed and improved. URC will mobilize partnerships with community based organizations

(CBOs), civil service organizations (CSOs) and faith based organizations (FBOs) and train community

workers and PLWHAs to access, inform and encourage the most vulnerable populations in Enugu such as

commercial sex workers, long-distance truck drivers and patrons of STI clinics. URC will establish detailed

guidelines for referral and cross-referral for HCT with prenatal care, TB DOTS programs, PMTCT and ART

services and will provide infrastructure upgrades to ensure adequate space and training for counseling and

testing, including any necessary infrastructure support such as basic renovations, upgrading equipment and

procuring supplies and consumables. The monitoring and evaluation (M&E) staff will work with sites to

ensure that all HIV counseling and testing is properly reported to the Federal Ministry of Health (FMOH).

POPULATIONS BEING TARGETED

The counseling and testing component of URC activities will target most-at-risk populations (MARPs) such

as commercial sex workers, truck drivers, men who have sex with men (MSM), discordant couples and

migrants.

CONTRIBUTIONS TO OVERALL PROGRAM

This activity supports the national HCT scale-up plan by promoting the accessibility of HCT services using

the FMOH-approved training curriculum and procedures. HCT services are essential to identify HIV positive

people to maximize this impact. Training and support to improve the quality, scale and integration of

counseling and testing services are consistent with FMOH and PEPFAR priorities. The aims are to scale up

access and provision of counseling and testing services to those most-at-risk in Enugu state, followed by

increased numbers of HIV+ people on ARVs, referrals to TB, STI, PMTCT and other clinics, improved lab

services performing HIV screening tests and ultimately, improvement of the overall health system, including

functional referrals among clinic areas and between facilities and communities.

EMPHASIS AREAS

The emphasis areas for this program activity are building of organizations and health facilities responsible

for delivery of HIV interventions;

improvement of referral systems within health facilities, between health facilities and from the community;

community outreach and involvement; training; and access to most-at-risk populations. This project will

also increase gender equity and programming through HIV counseling and testing, targeting adults,

especially women of child-bearing age and men who do not routinely present to health care facilities. The

activities will also support mobilization and palliative care programs targeted at reducing stigma and

discrimination in project communities and encourage support and care of PLWHA.

LINKS TO OTHER ACTIVITIES

URC HCT program will be linked ART, PMTCT, TB/HIV and Strategic Information. In addition, positive

clients will be referred into basic care and support services, TB/HIV and PMTCT services. Strategic

Information programs will support data capture and facilitate feedback for further programming. HCT

program will strengthen HIV prevention and palliative care in Enugu State and improve utilization of URC

and other USG-supported care and treatment services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21693

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21693 21693.08 HHS/Centers for University 9404 9404.08 $125,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $17,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Treatment: ARV Drugs (HTXD): $232,766

ACTIVITY DESCRIPTION

In COP 09, URC expects to be serving a total of 1,500 individuals (1,350 adult clients including clients

referred from PMTCT and 150 paediatric clients) with antiretroviral (ARV) drugs in Enugu State including

900 from COP 08. URC, together with its partners, will facilitate training of care providers in the use of ARV

using the nationally approved curriculum.

URC will provide ARV drugs in concurrence with the Nigerian National Treatment Guidelines for HIV and

AIDS Treatment and Care in Adolescent, Adults and Paediatrics. All drug orders will be based on

projections of patient numbers as determined by annual forecast conducted in August 2008 in conjunction

with the SCMS and USG Logistics Technical Working group. URC will utilize the recommended first line

regimen for ART in Nigeria Tenofovir/Emcitrabine/Nevirapine (Efavirenz). The first two drugs come as a

fixed dose combination called Truvada and this improves drug adherence - the most important variable for

treatment success. The second line regimen to be used will be Abacavir (Didanosine)/ Emcitrabine and

Ritonavir boosted Lopinavir (Kaletra). URC anticipate a second line rate of approximately 2%, while 98% of

clients will be on the first line regimen. Paediatric clients will be on the nationally recommended combination

of Zidovudine/Lamivudine/Nevirapine(Efavirenz). We anticipate a second line rate of less than 1% for

children. A small proportion of single drug or double drug substitute will be maintained to counter adverse

side effects associated with the first line for adults (renal impairment for Tenofovir, and Anaemia for

Zidovudine).

URC will purchase the drugs in accordance with USG, FDA and National Agency for Food and Drug

Administration and Control (NAFDAC) regulations or waiver. All purchases of Truvada (TDF/FTC) and ZDV-

3TC-NVP Fixed Dose will be purchased via pooled procurement mechanism by SCMS, in line with OGAC's

recommendation. Our partner, Crown Agent, will procure, distribute and provide consistent oversight for the

supply chain management of the remaining drugs.

In COP09, URC will collaborate with the Clinton Foundation for the receipt of second line adult and all the

pediatric drugs. URC will also work closely with the Government of Nigeria to leverage resources for the

sites supported by both PEPFAR and GON..

URC will work to strengthen the logistics capability of public sector healthcare facilities in Enugu. We will

work with the Central Supply Mechanism (SCM) to ensure that the desired products are supplied to Nigeria

based on an agreed delivery schedule. A quarterly ordering schedule will be adhered to, based on 12 month

lead-in forecasting. The adjusted forecasting will be based on the use of data on consumption, stock use,

storage, patient numbers both new and old, default rates and will use the state of the art quantification tools

as developed by Crown agents, SCMS, implementing partners and the Government of Nigeria (GON).

URC will work at the site level to help identify ARV drug needs by using nationally approved paper based

logistics management tools. We will define the needs and develop a work plan that will clearly define the

activities needed to forecast one year ahead, do quarterly drug ordering based on forecasts, collect and

utilize data, train staff, assess the supply chains and follow up the performance of actual drug delivery

systems.

URC will undertake capacity building activities to raise the performance levels and deliver sustainable

improvements in the management and technical skills of pharmaceutical and procurement practitioners in

Nigeria. At the site level, URC will mentor pharmacy based staff to implement the nationally approved ARV

and allied drug management systems. This includes improving the reporting on consumption, drug ordering

and re-ordering and maintenance of emergency stock levels. Our team, led by the Clinical Services advisor

will work with the sites to understand treatment needs.

POPULATIONS BEING TARGETED

People Living with HIV/AIDS (PLWHA), health care providers, pharmacists.

CONTRIBUTIONS TO OVERALL PROGRAM

As URC undertakes these activities, we will also be raising performance levels and deliver sustainable

improvements in the management and technical skills of procurement practitioners and managers in Nigeria

in addition to strengthening the procurement capacity and skill level at all participating health facilities. This

includes significant, sustainable improvements in procurement systems, staff competency in forecasting,

documentation and reporting, system set-up and maintenance.

EMPHASIS AREAS

The major emphasis area for this program activity is capacity building of agencies, organizations and health

facilities involved in delivery of HIV intervention.

LINKS TO OTHER ACTIVITIES

This activity is also linked to PMTCT, TB/HIV, OVC and Strategic Information

New/Continuing Activity: Continuing Activity

Continuing Activity: 21697

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21697 21697.08 HHS/Centers for University 9404 9404.08 $365,000

Disease Control & Research

Prevention Corporation, LLC

Table 3.3.15:

Funding for Laboratory Infrastructure (HLAB): $610,000

ACTIVITY DESCRIPTION

URC, with its partners, will conduct assessments of laboratories serving targeted facilities to establish

baseline capacity for HIV-related testing. Such items as the specific staffing of the in-country laboratory

program, the number of staff working within the program, the organization of these staff, their

responsibilities and how they support the lab sites will be determined as a part of the assessments. Given

the data collected during the assessments, and in consultation with the USG PEPFAR Nigeria Laboratory

Technical Working Group (LTWG), we will then develop a plan to equip and train 15 laboratory personnel in

5 laboratories serving the target communities in Enugu State. Using the standard training packages already

developed, or being developed by the PEPFAR Nigeria Team, URC will train appropriate laboratory

personnel in good laboratory practice, HIV testing, TB testing, specimen handling and processing,

laboratory safety, QA/QC, biomedical waste and disposal, preventive maintenance for all equipment,

documentation, data collection and reporting. We expect that our participating laboratories will conduct

6,960 tests in: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring during

the reporting period. We expect that out of 6,000 HIV tests conducted at our facilities, there will be 960 CD4

tests performed. We will also link with the national EID scale-up plan to make use of existing PCR labs as

well as the Clinton Foundation DBS collection supplies and transport support to carry out Early Infant

Diagnosis using DNA PCR for 80 children. The URC team will make improvements needed in laboratory

facilities, including ensuring adequate space, power, ventilation, plumbing, cabinets, biological safety

cabinets, safety measures, cold storage, waste disposal facilities, etc. We will supply high TB workload

sites with fluorescent microscopes or fluorescent adapters for TB and malaria diagnosis.

We will ensure effective routine operation of laboratories to support HIV and opportunistic infection

diagnoses, staging of persons with HIV and monitoring clinical response and drug resistance across Enugu

state, including overseeing regular quality assurance of laboratory services. We will work to establish a

tiered laboratory system from public healthcare centers to referral centers, including the institution of

support supervision and QA/QC. We will work with the PEPFAR-Nigeria Lab Technical Team for

development and implementation of QA/QC programs/policies. Quarterly QA/QC lab site monitoring visits

will be conducted using a standardized assessment tool developed by USG PEPFAR- Nigeria LTWG.

Reports from proficiency testing and site monitoring visits will be sent into a centralized system, that will be

developed and supported by the PEPFAR- Nigeria LTWG. Strengthening of laboratory capacity will be

conducted concurrently with routine operation of laboratories to support HIV testing and treatment programs

across Enugu state, in order to ensure achievement of program goals while delivering sustainable

improvements in the management and technical skills of laboratory staff.

URC will work with the USG, Medical Lab Science Council of Nigeria (MLSCN), hospital management and

the FMOH/SMOH towards local accreditation of some of our laboratories by the MLSCN. URC will also

support HIV post exposure programs (PEP) at all sites. We will provide guidelines for minimum as well as

ideal site requirements and will assess Laboratory Information Management System (LIMS) needs in

Enugu. We will then recommend an action plan for the purchase and implementation of LIMS if feasible

and at selected sites. Site staff will be trained - initially on a pilot basis and then gradually rolling out as the

appropriate levels and capabilities become clear.

URC will consult with the PEPFAR-Nigeria Lab Technical team on selection of equipment for supported

sites. We will develop specifications for equipment and supplies, including liaison as appropriate with the

PEPFAR-funded Partnership for Supply Chain Management (SCMS) on supply, installation and

maintenance requirements.

POPULATIONS BEING TARGETED

Laboratory personnel as well as adults and children needing HIV-related testing

CONTRIBUTIONS TO OVERALL PROGRAM

Training and support to improve the quality and function of laboratories supporting HIV testing is consistent

with FMOH and PEPFAR priorities. Improvements in laboratory infrastructure, equipment, supply systems

and personnel training will significantly improve the effectiveness of all health sector areas that require

testing of any kind. Building more effective laboratories will result in more accurate and reliable diagnosis of

HIV and other diseases as well as better monitoring of ART and HIV+ patients for more effective,

appropriate and sustainable care and treatment for people living with HIV and those at risk. Additionally,

URC employs a method of collaborative sharing of best practices across facilities which will serve to better

link higher and lower level laboratories and health facilities with each other for more effective referral

processes overall and will facilitate better and more functional linkages between these facilities whether

they be public, private, NGO-supported or otherwise. These improvements in communication and referral

systems serve to promote sustainability of quality programs.

EMPHASIS AREAS

The emphasis areas for this program activity are capacity building of facilities responsible for delivery of HIV

interventions, infrastructure enhancement and quality improvement as described above.

LINKS TO OTHER ACTIVITIES

This activity is linked to Counseling and Testing, ART care and treatment, PMTCT, TB/HIV and Strategic

Information.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21701

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21701 21701.08 HHS/Centers for University 9404 9404.08 $300,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Construction/Renovation

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16:

Funding for Strategic Information (HVSI): $60,000

In COP 09, URC will focus its Strategic Information (SI) efforts on creating and/or enhancing Health

Management Information Systems and monitoring and evaluation (M&E) systems. URC and its partners

will conduct an assessment of the types and functional levels of Health Management Information Systems

across participating health facilities. URC will work to institute or enhance these systems such that they can

be integrated across URC-participating sites and, linked into the Logistics Health Program Management

Information Platform (LHPMIP), the broader national health information system. Training will be provided to

two organizations in set-up and management of Health Management Information Systems (HMIS). URC

utilizes an intentional spread best practice model to entrench high quality service implementation and

delivery. Under this approach, key sites are identified and rapid and intense logistic and implementation

support is provided, using the site staff as leaders. Performance of these sites will be monitored and where

deemed satisfactory, supported to train other sites to launch their own initiatives to lead to an expanding

intentional spread cascade of best practice.

URC subscribes to the "three ones" principle and will champion the institutionalization of the "third one" at

the state level. This will be achieved through continuous engagement of the Enugu State Action Committee

on AIDS (ENSACA) and the corresponding Local Action Committee where our supported facilities are

located, to build their capacities. Compliance with the Government of Nigeria's (GON) national HIV strategic

plan will be placed at the centre of all our SI efforts, in order to contribute to the national M&E framework. In

addition URC will work under the federal and zonal coordinating bodies of the Federal Ministry of Health,

HIV and AIDS Division ENSACA and will abide to the responsibilities of stakeholders as enshrined in Enugu

State's Strategic Plan (2006-2010).

URC will continue to enhance our program's M&E system to collect data on all relevant indicators and

ensure data quality. Routine reporting and communication of PEPFAR results will follow PEPFAR

guidelines. We will track specific program-level indicators as well as PEPFAR indicators using harmonized

national tools for data collection. Training on general M&E will be provided to 10 individuals to support data

collection and reporting. The training will be based on a Nationally approved training curriculum. Two local

organizations will be provided with technical assistance on strategic information activities in COP09.

Generation of valid, reliable and consistent data continues to be a challenge. URC will engender a culture of

quality improvement in all SI processes. This will be achieved through regular training and retraining of data

officers at the supported sites in Enugu. Our technical team will work to optimize the workload associated

with reporting to minimize duplicate data entry. Data reconstruction exercises will be undertaken and the

opportunity afforded by this exercise will be used to provide onsite mentorship. Feedback and local use of

data will help in entrenching the quality approach to SI. URC will also organize data quality workshops for

health facility/community focal staff and ENSACA M&E focal persons on the basics of data quality and how

to conduct checks to ensure data quality is maintained. These sessions will ensure all players have a

thorough understanding of the PEPFAR Data Quality Toolkit (which includes the Monitoring and Evaluation

Systems Strengthening Tool, the Data Quality Assessment Tool and the Data Quality Assurance Tool for

Program-level Indicators) and how they can use the toolkit to evaluate their own M&E systems. Facilities will

be able to address and share their data quality issues.

The URC technical staff will team up with state officials to undertake, at a minimum, quarterly field

monitoring visits to improve data quality, mentor field staff, and promote local ownership of the program.

URC recognizes the contribution of state actors and implementing partners (PEPFAR and non-PEPFAR) at

community level, tertiary, secondary and primary facilities in developing M&E capacities. URC will contribute

to the current policy and operational discourse aimed at improving these systems. Further, URC will avoid

duplication of effort by adopting national and partner data collection and distribution tools. URC notes the

existence of Patient Management and Monitoring (PMM) systems developed by partners like Global

HIV/AIDS Initiative Nigeria (GHAIN) and will endeavour to utilize this and other similar systems. URC will

work with our oversight home office, CDC, to locate, identify, and adapt existing best practices.

URC notes the place of its regional activities in the larger national response and will work as part of the pilot

and implementation phase of the HIVQUAL ® monitoring and quality improvement system. Sites will be

supported to analyze and utilize locally generated information to improve service provision processes. URC

has developed over several decades, proven principles of quality improvement, which include the use of

standard setting, on site mentorship and training, intentional spread models, attention to logistics support

and focused incremental quality improvement approach. A critical aspect is defining quality from the

perspective of the consumers, health providers, and state actors which will serve as a basic guide for all our

Quality Improvement (QI) initiatives.

POPULATIONS BEING TARGETED

Health facility M&E, program managers/decision makers and other organization staff involved in the HIV

program.

CONTRIBUTIONS TO OVERALL PROGRAM

Improvements in data collection and reporting systems strengthens the health sector's capacity overall. It

increases the effectiveness of HIV-related services by drawing on important groups of data to plan and

implement HIV programs based on more reliable, documented health needs of the population. The greater

accessibility of important health-related data will serve to influence health policy and programs in the region

of interest and in the country of Nigeria as a whole.

EMPHASIS AREAS

The major emphasis area is human capacity development and local organizational strengthening.

LINKS TO OTHER ACTIVITIES

This activity is also linked to laboratory infrastructure, counseling and testing, PMTCT, OVC, and care and

treatment.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21703

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21703 21703.08 HHS/Centers for University 9404 9404.08 $25,000

Disease Control & Research

Prevention Corporation, LLC

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $15,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Subpartners Total: $0
Vision Africa: NA
Crown Agents: NA
Cross Cutting Budget Categories and Known Amounts Total: $63,300
Human Resources for Health $4,150
Human Resources for Health $2,075
Human Resources for Health $2,075
Human Resources for Health $2,500
Human Resources for Health $2,500
Human Resources for Health $3,000
Human Resources for Health $17,000
Human Resources for Health $15,000
Human Resources for Health $15,000