Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12446
Country/Region: Nigeria
Year: 2010
Main Partner: Not Available
Main Partner Program: NA
Organizational Type: Unknown
Funding Agency: USAID
Total Funding: $0

The USAID Treatment follow on project will take on patients currently on Anti Retroviral therapy and who will be transitioning to the project from the close out of two USAID partners (GHAIN and CHAN) with the goal of maintaining these individuals on treatment in line with PEPFAR and Government of Nigeria guidelines. The partner (TBD) will provide comprehensive ART services to identified patients through the established treatment sites in all target states in collaboration with the GON.

Consolidating on the strengths of the previous projects, the partners will strengthen appropriate HIV services at PHC facilities through a decentralized, integrated disease management approach at the state

and LGA level, consistent with national/ district health management policies/regulations. The partner will engage relevant stakeholders to increase access not only for HIV/AIDS but also for sexual and reproductive health and TB services in Nigeria. This project will promote compliance with Care and Treatment National guidelines, the integration of prevention into care and treatment services, the promotion of adherence and treatment education, clinical monitoring, management of OIs and related laboratory services within available funding and GON policies. All patients on ART will be monitored every month for adherence and detection of any adverse drug reactions. Cotrimoxazole prophylaxis will be provided to all HIV positive patients with CD4 counts of less than 350 in line with the national clinical guidelines. TB screening will also be done using a structured symptom checklist. The partner will support the task shift of ARV refills from comprehensive to PHC facilities, following national policies and guidelines. The partners will pay particular attention to improving non ART patient retention by strengthening patient tracking, community engagement and prevention with positives. This group of care patients will be enrolled for ongoing psycho-social, medical and psychological care, prophylaxis and prevention with positives package and will have their CD4 levels and clinical picture assessed every 3-6 months or as appropriate to determine progress and eligibility for ART. The implementing partners will initiate the diagnosis and management of STIs using WHO syndromic management protocols. The partners will support the integration of HIV/AIDS services with other services such as Reproductive health (RH), Malaria in Pregnancy and Food and nutrition services for HIV positive individuals. The partners will also cater to the clinical needs of Pediatric ART patients inherited from GHAIN and CHAN with the aim of optimizing the quality of life of such children.

Funding for Care: Adult Care and Support (HBHC): $0

In COP10, community home-based care will be implemented through the engagement of community

health workers and volunteers who will conduct home visits and provide nursing and psychosocial care

services to clients in addition to providing hands-on training for family care givers. The partners will also

train family members using national palliative care guidelines on proper hygiene and sanitation, PwP, and

support for treatment adherence in the home. The follow on partners will advocate to the local and state

governments to support facility teams with funds to track defaulting clients, procure reagents for

diagnosis of OIs so that other patients can benefit from the wide range of tests available, take

responsibility for the procurement of a certain percentage of commodities such as basic care kits and

laboratory reagents.

Funding for Treatment: Adult Treatment (HTXS): $0

The implementing partners (IPs) following on from the GHAIN and CHAN projects will train healthcare workers to provide ART services to clients both old and newly initiating ART in COP 10. The partners will focus on building the capacities of facility based multi disciplinary teams to provide comprehensive adult care and treatment services through a family centred approach and in partnership with CBOs facilitate the referral of patients and families in need to relevant resources in the community. The training will also emphasize the need to address gender disparities in access to and use of health and HIV/AIDS Services. Additional trainings in management of STIs using WHO syndromic management protocols, integrated service delivery models, advanced ART care and quality assurance will be conducted.

In COP10, these partners will strengthen the capacity of clinicians to further evaluate patients in long term care for failure and initiate second line therapy, provide clinical care to Treatment Experienced patients referred from other treatment sites and refer clients for higher level care. Laboratory services will

include capacity for CD4 evaluation and patient monitoring while adherence counseling services will continue to be provided at the health facility by trained pharmacists and persons living with HIV/AIDS (PLWHAs) who work as ART aides. Patients enrolled in care or treatment will be offered on-going counseling, diagnosis of opportunistic infections (OIs), prophylaxis and treatment of HIV/AIDS-related complications including malaria and diarrhea. TB screening will be done using a structured symptom checklist. These patients will also be enrolled into the facility and community-based family support groups for continuous psychosocial support and education. All enrolled patients will be provided with a basic home care kit consisting of insecticide treated bed nets (ITNs), Water Guard, calamine lotion, and Gentian Violet and condoms as part of the prevention package.

The partners will support the policy of task-shifting and will continue to advocate for this with local authorities and hospital directors while providing the needed mentoring and support supervision. 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.

The partners will implement a series of tasks to assure high quality services and will liaise with the national ART TWG and HIVQUAL working group to adapt the quality indicators to the projects; adult Care and treatment services. State and facility based multidisciplinary teams will be trained and supported to inaugurate Quality Assurance teams which will conduct periodic clinical audits. Continuous quality improvement will be the focus of ongoing professional development efforts.

The implementing partners will also participate with other stakeholders in the National ART task team meetings as well as USG Clinical and ART technical working group meetings.

Funding for Testing: HIV Testing and Counseling (HVCT): $0

The implementing partners will provide HIV Counseling and Testing (HCT) according to standard best practices in all supported sites. In particular, pediatrics, couples and HCT services to index cases of care and support will be strengthened.

With the strategic shift in HCT focus, partners will build the capacity of collaborating health facilities to implement Provider Initiated Testing and Counseling (PITC). While at the community levels, partners will collaborate with local NGOs and FBOs to implement targeted HCT services for MARPs and for couples including for premarital HCT. The linkages of HCT clients to other prevention services, including Prevention with Positives; care and support and treatment services will be strengthened through well

coordinated two-way referral mechanism.

Strong close collaboration with the government, especially at the states and local government level to strengthen HCT program coordination and monitoring and evaluation will be of particular focus.

Funding for Care: Pediatric Care and Support (PDCS): $0

In COP10, the implementing partners (IPs) will health workers and volunteers to provide pediatric HIV services including provider initiated counseling and testing to children and their family members, enrollment of HIV positive children, adolescents and their family members into care, clinical staging,CD4 evaluation, assessment for Antiretroviral therapy (ART) eligibility and provision of ARVs for eligible pediatric patients, screening for and treatment of opportunistic infections like TB, provision of prophylactic treatment of Opportunistic infections, parent-child follow up, growth monitoring, immunization, nutrition supplementation and provision of Basic Care package (ITN, water guard and water vessel). Referral for higher level of care when necessary and for other social or community based support programs will be provided.

The partners will ensure follow up of children and their care givers, promotion of hygiene and good sanitation and linking families to community based resources. Care givers will attend and participate in Peer Support Group meetings with their children. The partners will provide capacity building for adolescents on disclosure, adolescent reproductive health and positive living. Pediatric adherence counseling services as well as management of acute infections will also be provided.

Funding for Treatment: Pediatric Treatment (PDTX): $0

The partners will support identified HIV exposed and positive children with facility-based clinical care and

support. This support will be provided through the supported public and private comprehensive ART

sites. During COP10, The partners will continue supporting health facility-based care for HIV-exposed

children with the aim of extending and optimizing quality of life for HIV-infected children and their families.

In line with the PEPFAR guidance on targets for COP 10, the partner will prioritize serving patients

enrolled in previous years and minimize enrolling new children into care. The partner will adhere to

National Standard Treatment and PEPFAR guidelines.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

PMTCT intervention in COP 10 will target the primary prevention of HIV in pregnancy, before delivery and post partum stages. "Opt-out" testing and counseling with same-day test results will be provided to all pregnant women presenting at antenatal care (ANC) or labor and delivery (L&D) wards. All pregnant women will be provided post-test counseling services on prevention of HIV infection, including the risks of MTCT and their partners will be encouraged to access counseling and testing services. All positive pregnant women will have CD4 tests conducted to determine placement on ARV prophylaxis or HAART for their own health.

Pregnant women, who qualify for HAART based on their health, will receive triple therapy, while those who do not qualify, will get AZT from 28 weeks or Combivir from 34 -36 weeks, sdNVP during labor and a 7 day tail of AZT and 3TC in accordance with the national guidelines. Women presenting in labor will receive sdNVP and the 7 day tail of AZT and 3TC. Infants will receive sdNVP at birth and AZT for 6 weeks. Co-trimoxazole (CTX) prophylaxis for all HIV exposed children from the age of six weeks until proven HIV negative will be routine across sites.

HIV positive pregnant women identified in the PMTCT program will be linked into care as well as infants and children identified. Infant follow-up care linked with PMTCT activities will include nutritional counseling and support, growth monitoring, co-trimoxazole prophylaxis, HIV testing, and other care services.

In COP10, the identified implementing partners will improve coverage and quality of PMTCT service outlets and will provide training for HCWs on PMTCT, ensure the supply of PMTCT commodities to their sites, provide supportive mentoring and supervision to staff at service outlets. The IPs will provide support to select state governments in order to build their capacity to better plan, implement, supervise and evaluate PMTCT activities in the identified focal states and also will support the accelerated PMTCT Plan in COP10.

IPs will focus on integration of services into maternal and child health as well as other reproductive health, immunization and other healthcare delivery services within facilities in all states. Infant feeding messages will be incorporated into counseling for PMTCT to include information on proper and effective weaning of infants using the recommended WHO guideline. EID will be carried out using DBS at the secondary and primary level in line with the national EID scale up plan.

Funding for Laboratory Infrastructure (HLAB): $0

The implementing partners will provide Laboratory services for HIV/AIDS diagnosis, disease staging and treatment monitoring, these services will also be provided for index cases of care and support. The partnering health facilities will further be supported to develop capacity for the quality diagnosis of opportunistic infections including but not limited to TB, Cryptococcus, Pnuemocystic jiroveci pneumonia (PJP), and other fungal, parasitic and bacterial infections.

As the strategic focus in the next 5 years is to support the health system develop and sustain Quality Management Systems (QMS) in all Labs as a key strategy for sustained quality health care system, the implementing partners will support appropriate capacity development necessary to implement quality laboratory management systems and achieve National and/or International Accreditation.

Funding for Care: TB/HIV (HVTB): $0

In COP10, the implementing partners will strengthen TB/HIV collaborative activities; provide TB screening among HIV positive patients and referrals for TB treatment. Provide CTX to TB co-infected patients. Provide CT for TB patients, strengthen TB lab diagnosis. Logistics systems and capacity building for HCW. Support TB programs to provide quality TB and TB HIV services for TB patients. Build capacity of NGOs to create awareness for TB and train treatment supporters to encourage adherence. Provide support to the national and state TB programs to provide programmatic support for the MDRB TB service.

Strengthen community TB care by developing capacity of NGOs for awareness, treatment support and provision of TB treatment. Strengthen advocacy and social mobilization for TB HIV joint collaborative activity

Subpartners Total: $0
To Be Determined: NA
Key Issues Identified in Mechanism
Addressing male norms and behaviors
End-of-Program Evaluation
Increasing gender equity in HIV/AIDS activities and services
Child Survival Activities
Mobile Populations
Safe Motherhood
Family Planning