Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 10031
Country/Region: Nigeria
Year: 2010
Main Partner: LMS ProACT
Main Partner Program: Nigeria
Organizational Type: Implementing Agency
Funding Agency: USAID
Total Funding: $10,678,536

The Leadership Management Sustainability Prevention organisational system AIDS Care and Treatment LMS ProACT project is designed to develop the leadership and management capacity of health managers and their teams in health care organizations and programs to improve organizational management and operational systems and to strengthen the capacity of health workers, teams, and organizations to deliver

quality HIV/AIDS care and support services. Since 2007, the LMS ProACT project has rapidly and systematically scaled up the availability and accessibility of HIV/AIDS services in 53 sites across six states (Kogi, Niger, Kebbi, Taraba, Adamawa, Kwara) in Nigeria through a process of partnership and capacity building with indigenous public institutions providing health services at primary and secondary health facilities. In COP10 LMS ProACT will work to strengthen the capacity of state and local governments to carry out evidence based strategic and operational planning/budgeting, and advocate for resources needed to sustain their programs. Through this activity, the state and local governments will be able to coordinate wider stakeholder involvement in planning, implementing, monitoring and evaluating HIV/AIDS and TB control efforts. This should lead to improved resource mobilization, deployment and accountability which are critical elements in the initial steps towards government ownership and sustainability. LMS ProACT will support the establishment of TWGs, state supervisory teams, quality assurance and will assist the state and local government to use strategic information to develop plans that will guide the buy in of Implementing Partners and other donor agencies.

In COP10 LMS ProACT project will use a modified Leadership Development Program to develop the capacity of state ministries of health, agencies for the control of AIDS, and two health facility multi disciplinary teams in each of the six states to lead and manage HIV/AIDS prevention and control programs .Training will also emphasize the need to address gender disparities in access to and use of health and HIV/AIDS Services. Additional trainings in HCT, integrated MCH/FP/PMTCT services, Adult and Pediatric ART, basic palliative care, TB/HIV care, laboratory services, M&E and Supply Chain Management Systems and quality assurance will also be conducted. The project will implement a series of tasks to assure high quality services and will liaise with HIVQUAL working group to adapt the quality indicators to the project's M&E system. Continuous quality improvement will be the focus of ongoing professional development efforts and one of the major issues discussed at the quarterly project meetings with the state and local governments.

LMS ProACT will continue to support a minimum of 21 CCT sites in six states to provide the full spectrum of prevention, care and treatment services. HCT activities will focus on strengthening Provider Initiated Testing and Counselling services in all hospital units, PMTCT will be integrated into MCH/FP programs and will focus on providing prophylaxis and HAART for eligible clients. TB/HIV will focus on strengthening linkages between the TB and HIV programs at facility and LGA level, adult and pediatric care and treatment will be provided according to National guidelines, laboratory services will include capacity for CD4 evaluation and patient monitoring. Drugs for Opportunistic Infections, ARVs and other medical supplies procured will be distributed regularly to sites using the "Pull System" which uses site utilization data to forecast the needs for the next quarter. Essential wrap around services particularly nutrition and income generating activities (IGA) will be leveraged through networking and collaboration with other IPs

and organizations that provide these services.

LMS ProACT will work to increase the capacity of local governments to decentralize HIV/AIDS service delivery to at least two selected primary health care (PHC) facilities in each LGA. Decentralization will increase identification of persons who are HIV positive, enhance adherence to care, closer observation and minimize the burden of transportation. To address human resource gaps, LMS ProACT will continue to advocate for task shifting with local authorities and hospital directors while providing the needed mentoring, support supervision and monitoring of implementation activities. Health facilities will be assisted to use task shifting as one mechanism for rationalizing the deployment of available human resources, based on the realities at each facility.

Through fixed small grants, LMS ProACT project will develop the capacity of 12 grass root civil society organisations in six states to deliver community based HIV/AIDS/TB services linked with health facilities. The grants will provide CBOs in six states with technical assistance and funds to address one of the three categories of services: home based care for PLAs (including community-facility-community referrals) OVC care and support, and HIV prevention programs. LMS ProACT prevention strategy involves both primary prevention-Abstinence, Be faithful (AB) and other prevention programs (OPP) and secondary prevention (PwP). Prevention programs will be strengthened to promote low risk among in school and out of school youths and most at risk populations (MARPS). A gender analysis will also be conducted to determine gender disparities that need to be addressed in the prevention programs. Other focus areas include population awareness campaigns, community outreach, peer education models and workplace programs. LMS ProACT COP10 activities are targeted at State and Local governments, health providers, facility managers, CBOs and other individuals in the community in LMS supported states that are involved in the state's HIV response.

Funding for Care: Adult Care and Support (HBHC): $933,040


Funding for Care: Orphans and Vulnerable Children (HKID): $932,000


Funding for Treatment: Adult Treatment (HTXS): $1,482,750


Funding for Testing: HIV Testing and Counseling (HVCT): $95,000


Funding for Care: Pediatric Care and Support (PDCS): $137,500


Funding for Treatment: Pediatric Treatment (PDTX): $75,625


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


Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $1,236,670


Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $1,135,598


Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $2,272,532

Activity modified in the following ways: EID services is reported under pediatric treatment and care

Using the revised National PMTCT Guidelines, 12,000 pregnant women will be counseled, tested and receive their results and 552 HIV positive pregnant women will receive ARV prophylaxis. LMS will train 70 health care workers (in addition to the 220 trained in COP09) to work in ANC clinics and delivery wards. In COP10 LMS- will continue the activities initiated in the 36 project-supported PMTCT sites in Kogi, Niger, Adamawa, Taraba, Kebbi and Kwara States during COP 09. PMTCT services will be initiated at 7 additional PHC health facilities in these existing states. This makes a total of 43 PMTCT sites in COP10. In COP09 the project focused on building the capacities of facility based multi disciplinary teams to increase testing and counseling, treatment and prophylaxis for pregnant women and their infants, provide them and their families the appropriate protection and care to reduce the risk of HIV infection or mitigate transmission and negative health effect and in partnership with CBOs facilitated the referral of pregnant positive clients and their families to community based resources. In COP10 LMS ProACT will use a modified Leadership Development Program (LDP) to develop the capacity of state ministries of health, LGA, agencies for the control of AIDS, and two health facility multi disciplinary teams in each of the six states to better plan, lead and manage PMTCT programs .Training will also emphasize the need to address gender disparities in access to and use of health and HIV/AIDS Services. In COP09 the project supported the hosting of the quarterly PMTCT TWG meeting in Niger State to ensure better coordination and mobilization of resources for state level PMTCT interventions. To ensure universal access, the project also supported the mapping of PMTCT services availability in all Local Government Areas in this state. In COP 10, LMS ProACT in collaboration with four State ministries of health and other donor agencies will support the setting up of PMTCT TWG which will serve as a coordination platform for PMTCT activities in the states.

LMS-Pro-ACT will continue to focus on the scale-up of integrated MCH/FP/HIV services to health facilities in 4 states in order to bring about a reduction in the number of unwanted pregnancies in HIV positive women as well as an improvement in maternal and child health outcomes. This will result in a total of 6 states that have been supported to integrate MCH/FP into HIV services. One health facility will be selected per state to pilot the integration process. The capacity of health facilities to carry out integrated MCH/FP/HIV services at all service delivery points will be strengthened. Health workers from selected health facilities will be trained on integrated MCH/FP/HIV services. The state ministries of health will be involved in every step of the integration process and advocacy to leverage family planning commodities and other resources from partner organizations like Society for Family Health, PPFN, UNICEF and UNFPA will be strengthened and sustained.

Activities to improve male involvement in PMTCT will continue in COP10. LMS-Pro-ACT will strengthen

community engagement activities that address maternal and child health issues that result in improved collective health outcomes. The project will support the state ministries of health in the organization and implementation of community town hall meetings with male peer groups and traditional leaders where issues around maternal and child health and HIV stigma and discrimination will be discussed.

Strengthening and quality improvement activities aimed at providing quality PMTCT services to clients in supported health facilities will continue in COP10. The project will continue to train health care workers in provider-initiated testing and counseling (PITC) to be offered during ANC, labor and the immediate post- delivery period. Lay counselors will be trained and facilitated to carry out PMTCT counseling and support newly recruited PMTCT parents to adhere to prophylaxis and infant feeding practices. This will reduce workload on the health care providers. The project will offer same-day HIV counselling, testing and results to clients. Spouse/Partner and family testing will be encouraged so that PMTCT becomes the entry point to family-centered HIV care, support and treatment (PMTCT plus). CD4 testing will be done on every positive pregnant woman. Those with CD4 count >350 will be referred for ART-HAART for their disease while those with CD4 count of 350 and above will receive Zidovudine (AZT) from 28 weeks or (AZT/3TC) Combivir from 34 weeks. In labour, all positive pregnant women, except those on HAART, will receive sdNVP + Combivir with a 7-day Combivir tail. All HIV positive pregnant women will be given sdNVP tablet to take home on their first ante-natal visit, with instructions to swallow the tablet when labour begins and before they report to hospital for delivery. Women who receive no antenatal care during their pregnancy or who have had only limited antenatal care but presented to the facility with unknown HIV status will receive C&T during labor and if positive, will receive sdNVP and 7-day Combivir tail according to national guidelines. The project will ensure the mother's CD4 count results are available the same day to guide commencement of HAART if >350 or PMTCT prophylaxis if 350 and above. Pregnant women will be counseled on infant feeding options and supported to adhere to chosen option. Expectant positive mothers will be encouraged to disclose their HIV sero status and the PMTCT services they are receiving to their spouses and to request the spouses to come with them to the clinic at the next visit for family counselling and testing. Food and nutritional supplements will be leveraged from non- Pepfar implementing partners to supply malnourished pregnant and lactating positive women. Infants of HIV positive women will receive NVP syrup at birth and AZT for six weeks. All HIV-exposed infants will be followed up in the post-natal period and provided with cotrimoxazole prophylaxis from 6 weeks of age until their HIV status is confirmed negative and are no longer exposed to risk of HIV infection through breast milk. Cotrimoxazole prophylaxis will be continued if the children are confirmed HIV positive. All HIV-exposed infants will be referred for EID at 6 weeks and followed up with care and treatment depending on their HIV result. EID activities started in COP09 will be enhanced in COP10 to cover most of the PMTCT clinics supported by the LMS Associate project.

All HIV positive mothers receiving project-supported PMTCT services will be encouraged to exclusively

breast feed their infants for six months as this strategy will reduce mother to child transmission of HIV while not stigmatizing HIV positive mothers. HIV positive mothers who meet the AFASS criteria will be supported and guided on safe infant feeding. Health workers will be taught that recent research has demonstrated far better outcomes for exclusively breastfed infants of HIV positive mothers even in more affluent situations. Replacement feeding is often associated with an increase in morbidity and mortality from malnutrition, diarrheal diseases and respiratory infections among HIV exposed infants. In addition to receiving PMTCT services, each mother-baby pair will be registered with the health facility referral coordinator for linkage and access to community HIV/AIDS services like follow-up and support of mother- baby pairs, OVC services, on-going adherence counselling, HBC and others. This will enable the Home Based Care Volunteers to give psychosocial support, nutrition education and leveraging nutritional foods, and child growth monitoring.

LMS-Pro-ACT in COP10 will continue to train and support clients who had accessed PMTCT services as Peer Support Coordinators in antenatal care (ANC) settings helping newly recruited PMTCT families to understand and appreciate the benefits of PMTCT services and to adhere to the counselling and prophylaxis information given to them. The peer support coordinators will be positive role models to reduce stigma and act as champions for HIV positive pregnant women to ensure that they are not discriminated against during their antenatal and maternity care. The peer support coordinators will share their own experience with newly diagnosed pregnant HIV positive mothers and how they are coping. This will support new pregnant HIV positive mothers to come to terms with their own HIV status and reduce "self-stigma". Through the work of peer support groups, TBAs and engagement of spiritual leaders, the project will reduce drop-outs from PMTCT services and increase adherence to ARV prophylaxis and safer infant feeding choices. The Nigerian-adapted curriculum for training TBAs will be used to equip TBAs with knowledge and skills to support PMTCT services in the community. Because many pregnant women will attend ANC but deliver at a different facility or more likely deliver at home in the community, introducing mechanisms for use of ARVs particularly Nevirapine in the community, if this is possible, will also greatly increase the accessibility of PMTCT. Every pregnant HIV positive mother at first antenatal visit will be given a tablet of Nevirapine to take home but will be educated on the importance of skilled delivery.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: Activities in this area will strengthen the capacity of the states and health facilities to provide integrated MCH/FP/HIV services. The capacity of health facilities as well as health workers to provide ARV prophylaxis, counseling and support for improved maternal nutrition and safe infant feeding, and additional HCT and support as included in PMTCT plus activities will be strengthened. This area will also improve male involvement in PMTCT services as well as contribute to improved health outcomes of

children and families directly affected by HIV/AIDS.

LINKS TO OTHER ACTIVITIES: This activity relates to the HVCT where every effort will be made to counsel and test every pregnant woman that visits the project-supported health facilities through the PITC approach and if positive enrolled into care to utilize the PMTCT services provided (15645.08). Adult Care and Support will be provided in terms of basic investigation like CD4 count for women that are positive, diagnosis and treatment of OIs, malaria, Urinary tract infection and provision of ITN and water guard (15642.08), and ARV drugs for prophylaxis (12414.08).

POPULATIONS BEING TARGETED This activity focuses on pregnant women and their families from the communities served by project supported sites (19 in COP09)

EMPHASIS AREAS This activity addresses gender concerns related to the specific HIV/AIDS-related care and treatment needs of pregnant women. Many gender issues have been reported in relation to PMTCT services ranging from rejection by spouses and families to Gender Based Violence. The project will train health workers to appreciate gender issues and ways they can be mitigated. The activity emphasizes developing the capacity of a wide range of persons (health personnel, mothers' peer support groups, PLWHA and TBAs) to increase testing, counseling and treatment and prophylaxis for pregnant women and their infants, to provide them and their families the appropriate protection and care to reduce the risk of HIV infection or mitigate transmission and negative health effects.

This activity will address the need to counsel and test pregnant women in order to prevent future HIV infections, to the mother, child or spouse/partner. Male involvement will be encouraged through various strategies including partners testing together and sensitizing men through the fora that are appropriate to them. Pregnant women accessing PMTCT services will be counseled on FP to enable them make informed decisions on future pregnancy. HIV-exposed infants will be followed up in young children clinics where they will receive routine immunizations, nutritional counselling and growth monitoring. Malnourished mothers and their children will receive nutritional supplementation leveraged from the Clinton Foundation and the community-food basket to be established through the peer support coordinators.

In COP10, under 'PEPFAR Nigeria's accelerated PMTCT plan', LMS ProAct, will strengthen its support to PMTCT service delivery by implementing activities that further improve the coverage and quality of PMTCT services. These activities will be directed towards increasing utilization of PMTCT services at

existing service outlets through demand creation in collaboration with community resources and ensuring the upgrade of existing supported PHCs offering stand alone HIV counseling and testing to render at least minimal package of PMTCT services. In order to leverage resources, priority will be given to PHCs located in the selected focal states with presence of other donor agencies and in local government areas already earmarked for HSS support through GFATM. Where new sites are envisioned, those that are used for national ANC sero-sentinel surveys but yet to commence PMTCT services as well as PHCs located in communities with high HIV prevalence rates above the National average will be given priority.

Funding for Laboratory Infrastructure (HLAB): $1,805,200


Funding for Treatment: ARV Drugs (HTXD): $352,621


Funding for Care: TB/HIV (HVTB): $160,000


Subpartners Total: $0
Axios Foundation: NA
Cross Cutting Budget Categories and Known Amounts Total: $2,174,647
Construction/Renovation $0
Education $299,951
Food and Nutrition: Commodities $149,976
Food and Nutrition: Policy, Tools, and Service Delivery $224,963
Gender: Gender Based Violence (GBV) $449,927
Human Resources for Health $899,854
Water $149,976
Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services
Increasing women's legal rights and protection
Child Survival Activities
Military Populations
Safe Motherhood
Workplace Programs
Family Planning