Cooperative Agreement AID-620-A-00002 Activity Summary Implementing Partner: Family Health International (FHI 360) Activity Name: Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Activity Objective: To sustain cross sectional integration of HIV/AIDS and TB services by building Nigerian capacity to deliver sustainable high quality, comprehensive, prevention, treatment, care and related services. This will be achieved through three key result areas: 1) Increased access to high-quality comprehensive HIV/AIDS and TB prevention, treatment, care and related services through improved efficiencies in service delivery. 2) Improved cross sectional integration of high quality HIV/AIDS and TB services 3) Improved stewardship by Nigerian institutions for the provision of high-quality comprehensive HIV/AIDS and TB services. USAID’s Assistance Objective 3 (AO 3): A sustained, effective Nigerian-led HIV/AIDS and TB response Life of Activity (start and end dates): Sept 12, 2011 – Sept 11, 2016 Report Submitted by: Phyllis Jones-Changa Submission Date: July 30, 2014

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Table of contents Activity Summary...... 2 Table of contents...... 3 Acronyms and abbreviations...... 4 Executive Summary...... 6 Background...... 8 Progress in Specific Program Areas ...... 10 Program Management...... 17 State Specific Accomplishments...... 18 AKWA IBOM STATE (Tier 1 State) ...... 18 CROSS RIVER STATE (Tier 2 State)...... 19 LAGOS STATE (Tier 2 State)...... 21 RIVERS STATE (Tier 2 State) ...... 22 Maintenance States...... 23 ABIA STATE ...... 23 ADAMAWA STATE...... 24 ANAMBRA STATE...... 26 BAUCHI STATE...... 27 BAYELSA STATE ...... 28 BORNO STATE...... 29 EDO STATE ...... 30 JIGAWA STATE ...... 32 KANO STATE...... 32 TARABA STATE...... 32 Overarching Challenges...... 34 Highlights of Plans for the Next Quarter ...... 34 Appendices: ...... 35 SIDHAS M&E Datasheet for USAID Quarterly Report: April – June, 2014...... 35 SIDHAS Q3 FY 14 Achievement data by state ...... Error! Bookmark not defined. Success story ...... 41

3 Acronyms and abbreviations ANSUTH Anambra State University Teaching Hospital

CH Central Hospital

CIMCI Community Integrated Management of Childhood Illness

CME Continuing Medical Education

CMP Change Management Process

CQI Continuous Quality Improvement

CRRIF Combined Reports, Requisition and Issue Form

CTRR Counseled, Tested for HIV and Received Results

DBS Dried Blood Sample

DLMH Dr Lawrence Henshaw Memorial Hospital

DTS Dried Tube Specimen

EID Early Infant Diagnosis

EQA External Quality Assurance

FMC Federal Medical Center

FMWASD Federal Ministry of Women Affairs and Social Development

FSW Female Sex Workers

GBV Gender Based Violence

GCLP Good Clinical Laboratory Practice

GH General Hospital

HCW Healthcare Workers

HMB Hospital Management Board

INH Isoniazide

IPAC Infection Prevention and Control

IPT Isoniazid Preventive Therapy

LIT Local Government Implementation Teams

LMCU Logistics Management and Coordination Unit

MACA Mothers against Child Abandonment

4 MARP Most at Risk Population

MDR Multi Drug Resistant

MMD Media Materials Development

NASCP National AIDS and STI Control Program

NAUTH Nnamdi Azikiwe University Teaching Hospital

NBTS National Blood Transfusion Service

NEPWHAN Network of People Living with HIV/AIDS in Nigeria

NTBLCP National TB and Leprosy Control Program

OVC Orphans and Vulnerable Children

PCR Polymerase Chain Reaction

PHDP Positive Health Dignity and Prevention

PITC Provider Initiated Testing And Counseling

PLHIV People Living With HIV

PMTCT Prevention of Mother-to-Child Transmission

POWER Partnership Opportunities for Women Empowerment Realization

PTQA Program and Technical Quality Assessment

Q-MAP Quality Monitoring and Accountability Program

QRM Quarterly Review Meeting

SBAF Safe Blood for Africa Foundation

SMWA&SD State Ministry of Women Affairs and Social Development

TACA Taraba State Agency for the Control of AIDS

TBA Traditional Birth Attendants

UUTH University of Uyo Teaching Hospital

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Executive Summary Cumulative achievements in the third quarter of SIDHAS project implementation show steady progress towards reaching set targets for the current financial year. The project remained on course across the different thematic areas. Following performance results at semi-annual progress reporting, project teams together with their government counterparts instituted mechanisms for improving and sustaining performance across board.

This quarter, 54 additional sites were activated to provide comprehensive ART services. The activations were preceded by pre-activation trainings in readiness for service provision at the new sites, as well as post-activation mentoring activities to assess quality of service and supply necessary tools and commodities. PMTCT sites also benefited from the post- activation mentoring services. Other activities aimed at increasing access to available services included HTC at the facility and community levels among the general population, MARPS, and pregnant women.

Supportive supervisory visits were sustained during the quarter to ensure continuous quality improvement in service provision. On-site capacity building activities such as infection prevention and control, and continuous medical education took place. Local Government Implementation Teams (LIT) were mentored to provide quality supportive supervision to PHCs including data collation, review and validation. Facilities selected for WHO-AFRO accreditation were mentored to sustain service quality in preparation for accreditation exercise. Other capacity building events included trainings of healthcare workers (HCW) on pharmacy best practices, good clinical laboratory practices, gender mainstreaming, and isoniazid preventive therapy (IPT). Laboratory equipment including GeneXpert machines were procured and installed in supported laboratories in some states in efforts to promote provision of quality services. Three GeneXpert machines obtained from USAID were installed at NAUTH in Anambra State, GH Ogoja in Cross River State, and Braithwaite Memorial hospital in Rivers State.

SIDHAS team facilitated a training on logistics management of health commodities for Borno and Yobe facility staff. The training was conducted from June 22 – 27, 2014 in Bauchi. The aim was to address gaps in supply chain management and data collection that emerged as a result of the security challenges in the States.

As a result of support to health facilities and CBOs across the 15 states:

• 353,721 individuals from the general population (M=159,273; F=194,448) were reached with HIV testing and counseling (HTC) and received their test results • 332,876 HIV positive pregnant women were reached with HTC and received their results • 5,576 HIV positive pregnant women were initiated on ARVs for PMTCT services • 9,720 adults and children with advanced HIV infection were initiated on ART

These achievements are represented in the chart below:

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Achievements to date (% FY14 annual targets)

120 113 114

100 97

86 84 82 80

66

60

44

40

22 20

0 # of ind. who received T&C services for HIV and # of adults and children with advanced HIV infecon # ind. receiving HIV C&T and their results in TB seng received their test results newly enrolled on ART

SIDHAS teams continued to provide support to the government of Nigeria (GoN) through participation in various GoN-led meetings and technical working groups (TWGs) as well as meetings of USG IPs and GoN stakeholders organized to strengthen government participation, support and ownership. A stakeholders’ meeting organized by the FMoH/DPRS was held on April, 2 and it focused on reviewing a proposed community NHMIS data flow system. A follow up consensus building meeting was scheduled for the future. Another meeting organized by MEMS2 on June 4 reviewed proposed changes on the DHIS in alignment with the MER indicators. IPs recommended that the USG team work with the national government to initiate a review of the current harmonized DCTs to enable reporting on the MER indicators from FY15. Meetings with private sector stakeholders also held to solicit their commitment towards implementation of SIDHAS objectives especially with regard to the new PEPFAR policy.

Quarterly Review Meetings (QRM) took place across supported states this quarter. The meetings were convened by SIDHAS teams in conjunction with the state government staff and had in attendance different state level stakeholders including State Commissioners for Health. Performance charts for CQI data were disseminated to key state level stakeholders during the review meetings in all supported states excluding Borno which was not assessed due to security challenges. Participants also discussed implementation progress, challenges and developed improvement action plans to guide continuous programming.

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SIDHAS supported the Borno State Government (BOSG) through the SMoH to provide immediate medical intervention to the 27 Chibok school girls who escaped from the captivity of insurgents from June 4 – 6, 2014 in Maiduguri. The girls were provided health education, complete physical examination, risk assessment and screening for STIs, HIV, Hepatitis B and Malaria, as well as pregnancy tests. All 27 girls were found to be HIV negative.

During the reporting period, the USAID Mission Director visited the Holy Family Catholic Hospital, Ikom in Cross River State - a SIDHAS-supported site. The aim was to commission the facility which had been upgraded with a state of the art laboratory through USAID funding. Another delegation from USAID also conducted a visit to Kano state during the quarter. The SIDHAS Chief of Party also visited Anambra state from June 24 – 27, 2014, accompanied by SIDHAS project staff from the CO and FHI360HQ. The COP and team met with stakeholders such as the Commissioner for Health, the Executive Secretary of ANSACA and senior officials of AGPMPN. She also visited health facilities including ANSUTH, NAUTH Nnewi and Rock Foundation Hospital Awka.

As part of the FHI 360 strategy for continuous technical quality improvement, a team of assessors from FHI 360 Head Office conducted an internal program and technical quality assessment of the SIDHAS project in the month of May. The exercise identified significant strengths, challenges and gaps in PMTCT, M&E, and program management and a program and technical quality improvement plan (PTQIP) was jointly developed to address operational and technical gaps identified. The assessment team interacted with SIDHAS project teams at country and 2 state offices (Abia and Anambra), government partners, service providers and beneficiaries and also held a debrief session with USAID. The implementation of the PTQIP has begun and will run through the end of FY14.

Key project implementation challenges included the insecurity in the North Eastern part of the country owing to activities of insurgents, as well as the ongoing strike by the Nigerian Medical Association which began in June 2014. These situations continue to impede service provision across supported facilities.

Background The SIDHAS project aims to sustain cross sectional integration of HIV/AIDS and TB services by building Nigerian capacity to deliver sustainable high quality, comprehensive, prevention, treatment, care and related services. This will be achieved through three key result areas: i) increased access to high-quality comprehensive HIV/AIDS and TB prevention, treatment, care and related services through improved efficiencies in service delivery; ii) improved cross sectional integration of high quality HIV/AIDS and TB services; and iii) improved stewardship by Nigerian institutions for the provision of high-quality comprehensive HIV/AIDS and TB services.

FHI 360 is implementing the project in collaboration with five core partners—Axios Foundation – logistics; Deloitte Consulting, LLP – organizational development; Association of Reproductive and Family Health (ARFH) – community-based services; Achieving Health

8 Nigeria Initiative (AHNi) – integrated services; and Howard University Pharmacists and Continuing Education Center (HU-PACE) – pharmacy. In addition to the core partners, SIDHAS procures technical assistance from the German Leprosy and TB Relief Association (GLRA) – TB/HIV collaboration; Population Council – community PMTCT operations research; and University of Nigeria (UNN) – health economics operations research.

In addition to supporting 15 state governments, 10 federal medical centers (FMCs) and 55 faith-based organizations (FBOs) to enhance facility-based integrated HIV/AIDS responses, the SIDHAS project also provides sub grants to 23 local CSOs to provide integrated community-based prevention and care services including OVC care and support.

In order to strengthen government systems and optimize ownership at federal, state and local government levels, SIDHAS strives to align its activities with GoN strategies and plans. SIDHAS support to GoN aims to ensure the delivery of quality comprehensive HIV/AIDS services in over 3, 000 public and private sector tertiary, secondary and primary level health facilities, as well as in all communities contiguous to the supported health facilities.

To contribute effectively to the achievement of project objectives, SIDHAS implements the following interventions:

1. Increasing access to services that enhance PMTCT; 2. Provision of quality HTC, including Provider Initiated Testing and Counseling (PITC), community based counseling and testing, couples’ counseling and testing; QA/QI, and referrals and linkages 3. Provision of quality ART services, including; a. Logistics management support to forestall stock-outs; b. Promotion of pharmacy best practices to optimize adherence to therapy; c. Access to high quality laboratory services to monitor disease progression and response to treatment; 4. Pediatric care and treatment for comprehensive care that includes prevention, early detection, and treatment through clinical and psychosocial support services 5. Provision of high quality care and support services, including care and support for PLHIV and OVC; 6. Promotion of collaboration between TB and HIV/AIDS services to reduce TB/HIV associated morbidity and mortality; 7. Sexual Transmission Prevention (STP) among Sex workers and Out of School Youth, through community based organizations and across the various HIV service delivery platforms that the project supports; 8. Medical transmission prevention to ensure safe medical injections, phlebotomies and related medical procedures, universal precautions, blood safety as well as related waste management; 9. Health systems strengthening to ensure that the advancement in science and health technologies deliver better, sustainable and equitable health outcomes

The next sections of the report highlight accomplishments in specific program/technical areas during April – June, 2014.

9 Progress in Specific Program Areas

PMTCT/HTC Increasing access to PMTCT services: During the quarter, efforts intensified to ensure continuous provision of quality PMTCT services to all pregnant women. This resulted in 332,876 pregnant women being counselled, tested and given results for HIV. In addition, 5,576 pregnant positive HIV women were initiated on (ARV) prophylaxis. To ensure comprehensive PMTCT services, women were tested for HIV in FP settings at SIDHAS supported sites while HIV positive women were referred for FP services from HIV service delivery points. In addition, post activation mentoring was conducted to the 733 health facilities (public and private) for PMTCT service delivery across seven states in the last quarter, and relevant guidelines including RH-HIV integration, SOPs and job aids were provided to facility staff to guide service delivery.

PMTCT Gaps Root Cause Analysis: SIDHAS and GoN staff conducted a root-cause analyses for some key gaps identified in PMTCT service delivery and documentation of services provided in states. Immediate and long-term strategies were developed based on identified factors responsible for low performance in some areas of PMTCT/EID. State offices were also supported to institutionalize recommended strategies into routine deliverables to minimize the gaps observed.

National meetings and Workshop: The team participated in a 3-day national target setting and financial gap analysis workshop in Abuja from June 9 – 12, 2014. The meeting was convened by NACA, NASCP and NTBLCP and had in attendance representatives of GoN and IPs. The aim was to discuss target setting for HIV/TB integrated service delivery, and to also analyze programmatic and financial gaps in the current GFATM program using data analysis from national and international source documents.

SIDHAS teams also participated in the national PMTCT costing meeting held in Enugu State from April 28 – 30, 2014. The goal was to familiarize participants (including state representatives from the SMoH) with spectrum projections and cost analysis models. SIDHAS also participated in the follow-on workshop which held in Lagos from June 17 – 20, 2014 to cost the national PMTCT program. The workshop resulted in the production of 2 spectrum projected plans for 2013 – 2020 which will be used for informed decisions for implementing Option B+ in national PMTCT program.

National Task Team Meetings: SIDHAS teams participated in the three-day national PMTCT task team meeting in Calabar from June 25 – 27, 2014, as well as the national RH working group (NRHWG) meeting convened in Lagos on April 23 – 24, 2014. The objectives PMTCT task team meeting were to review PMTCT updates from government, partners, and donors, to get updates from the various subcommittees. The NRHWG meeting on the other hand, aimed to deliberate on the national family planning blueprint, maternal death review (MDR) guidelines, long acting reversible contraceptives supervisory tools and Track 20 FP indicators.

EID Services: EID services continued across supported states and with strategies being put in place to address DBS sample backlogs, reagent availability, and transitioning PCR labs to

10 automated platforms. A total of 45 SMS printers were installed at selected facilities across 8 states during the reporting quarter to reduce turnaround time for results retrieval from PCR labs. A troubleshooting exercise for the SMS sending software in University of Uyo teaching hospital (UUTH) was also conducted in collaboration with CHAI.

HTC Demand Creation: Demand creation for HTC services in supported sites across the 15 states was sustained this quarter. This was achieved through multipoint testing in ANC, TB, OPD, RH/Family planning clinics and in the wards, resulting in increased number of people tested for HIV. In addition, SBC materials were distributed to all SIDHAS-supported states especially states where PMTCT services were scaled-up.

SIDHAS Technical Staff orientation: In the view of the ongoing scale up of PMTCT services across SIDHAS priority states, SIDHAS technical staff participated in a 5-day integrated multi-disciplinary training. A total of 15 (8M, 7F) staff attended the country office orientation to improve their capacities on service quality and efficient mentorship to sites. In addition, state level technical sessions held with project staff to improve quality of mentorship provided to supported sites. As part of activities, joint country and state office site visits were conducted and strategies developed for increasing couple testing and counseling, multipoint testing, documentation, and referrals and linkages.

Improving quality: In conformity with the national HTC guidelines, all activated sites received copies of the national guidelines, HTC protocols, cue cards, job aids and training manuals. Additionally, HIV rapid test kits were distributed to all the non-unification states through AXIOS for HIV testing.

ART ART Service Expansion: Expansion of ART services continued this quarter to increase access to ART and provide LGA level referral hubs in SIDHAS supported states. In total, 54 STATE Q3 Activations PMTCT sites including one inherited site received pre- Abia 12 activation multidisciplinary HTC, TB/HIV, ART, M&E, Akwa- Ibom 15 pharmacy and laboratory trainings. Following the Bayelsa 5 activations, the facilities were supplied with Cross River 15 Adamawa 3 commodities, job aids and data capturing tools. The Edo 3 table below breaks down newly activated HCC sites by Taraba 1( Inherited-Government state. House Clinic) TOTAL 54 Accelerated ART Initiation Drive: In a bid to reverse the SAPR declining trend of ART initiation in the 15 supported states, a root-cause analysis was carried out and an accelerated initiation drive commenced which focused on optimizing ART service and closing all leakages. More than 200 clients were directly placed on ART across 4 supported states of Adamawa, Akwa Ibom, Rivers and Abia as a result of the drive.

National ART Task Team Meeting: Country office SIDHAS staff participated in the two-day national ART task team meeting in Enugu from the April 16 – 17, 2014. The meeting was convened to review updates on ART activities from government, partners and donors, and to provide updates on technical modalities and resources required. Private sector engagement

11 and discussions on addressing systemic and technical deficiencies in the ART program also held. The NTTA subcommittees were also inaugurated and preliminary subcommittee reports presented. In attendance at the meeting were FMoH/HAD, NACA, IPs, Consultants from teaching hospitals, NACA and the AGPMPN.

Capacity building: SIDHAS participated in and provided technical support at the Rivers state driven ToT on optimization of ART on June 23, 2014. The objective was to build the capacity of identified state resource persons, ART providers and pharmacist across all comprehensive sites in the state on delivery of sustainable and optimal HIV services. Participants were drawn from public and private facilities and FBOs with 65 participants (40M, 25F) comprising doctors and pharmacists in attendance.

A 6 day integrated ART training was conducted in Bauchi State for inherited sites from Borno, Bauchi, Yobe and Taraba states from June 23 – 28, 2014. A total of 65 (40M, 25F) HCW were trained. The objectives were to provide an overview of the SIDHAS project, build capacity of participants with the necessary skills to manage, monitor and effectively program ART services despite the security constraints.

TB (Pure & TB/HIV) Capacity building: This quarter, acid fast bacilli (AFB) microscopy and good laboratory practice trainings were conducted for healthcare workers from 26 facilities in the 10 states of Abia, Adamawa, Akwa Ibom, Anambra, Bauchi, Bayelsa, Edo, Jigawa, Rivers and Taraba. The training held at the National Tuberculosis and Leprosy Training Centre (NTBLTC) Zaria from April 28 – May 9, 2014 with the objective of improving efficiencies in service delivery and bridging the gaps in the availability of AFB laboratories and TB DOTS services. Similarly, a ToT on DOTS expansion was conducted for HCW from 44 facilities in 10 states of Abia, Akwa Ibom, Anambra Bauchi, Bayelsa Cross River, Edo, Kano, Rivers, and Taraba states in Rivers and Kano states from May 26 to June 12, 2014. Participants at this training will form a pool of trainers to step down the training at the state and facility levels.

Linkage to GeneXpert services: Three GeneXpert machines obtained from USAID were installed at NAUTH in Anambra state, GH Ogoja in Cross River State, and Braithwaite Memorial hospital in Rivers state this quarter. Requisite trainings on their use and maintenance were conducted for laboratory and other clinical staff of the facilities. Consequently, an integrated TB unit was established at Braithwaite Memorial Hospital.

Technical and supportive supervisory visits to TBHIV sites: During the quarter under review, technical supportive supervisory visits were carried out to state offices and facilities to address issues of quality service provision. At least five facilities per state were visited. Service documentation at all service delivery points and level of integration of services was assessed, and identified challenges jointly addressed with recommendations to facility managements for follow up.

Community MDR-TB Program: A total of 13 MDR patients across Lagos, Cross River and Kano states are currently supported on treatment in the communities across three states. The DOTs providers conducted regular home visits to patients for daily administration of injections and oral drugs. The patients also received support on infection control within the homes, and were also provided with basic care and support kits.

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Monthly M&E meetings: Monthly M&E meetings of LGA TB and leprosy supervisors (TBLS) and facility staff held this quarter across 18 LGAs. Participants included LGA M&E officers, DOTS providers, CVs and SIDHAS staff. The meetings provided a platform to review challenges with sputum AFB examination and manpower gaps in the laboratories, as well as data collation, review and capacity development.

LABORATORY SERVICES Capacity building: Following the scale up of ART services, a 6–day training was organized for 106 (55M, 51F) medical laboratory personnel from 56 new ART sites in Abia, Bayelsa, Akwa Ibom, and Cross River states with the aim of building capacity of provision of quality laboratory services. In addition, biosafety training was conducted for 23 (12M, 11F) facility safety officers in Lagos; quality management system (QMS) training for 102 lab personnel (39M, 63F) from Abia, Lagos, Anambra, Bayelsa and Cross River States. Other trainings included good clinical laboratory practices on blood collection and handling for 69 (36M, 33F) laboratory personnel; dried tube specimen panel production training for 16 (14M, 2F) facility staff of GH Dutse in Jigawa State; PCR training for two medical laboratory scientist from Dr Lawrence Henshaw memorial hospital Calabar; and equipment maintenance training for 29 (16M, 13F) equipment users/operators from UUTH, Akwa Ibom State.

Equipment upgrade/Maintenance: As part of FHI360 strategy to strengthen ART lab services through sample transfer mechanism between hubs and spokes, new automated lab equipment were installed to support ART laboratory services at high volume hubs. Repairs of faulty machines and planned preventive maintenance were also carried out across supported facilities. Average percentage equipment functionality at the end of the quarter was 94.68% for equipment under contract agreement, with an overall functionality rating of 91.82%.

Laboratory integration/internal audit: SIDHAS laboratory teams continued to support feasible integration of ART laboratory services into routine laboratories during the quarter. Internal lab audit systems were also reviewed using the minimum package checklist provided.

External Quality Assurance: SIDHAS facilitated participation of facilities registered with National Health Laboratories Service (NHLS), South Africa, in external quality assessment (EQA) proficiency testing program. Reports obtained from previous trials have since been forwarded to participating facilities and corrective action process initiated as necessary.

Lab Accreditation preparedness: Preparations continued for the 14 selected sites for accreditation through WHO-AFRO recognition to maintain standards in all the 12 quality system essentials. As part of the support to selected sites, a 10-day peer review/lab exchange visit was conducted to seven of the supported sites in Kano, Taraba, Abia, Cross River and Edo States by trained mentors. The mentorship was geared towards the practical implementation of lab QMS and site preparedness towards attainment of WHO-AFRO recognition/accreditation standards.

SEXUAL TRANSMISSION PREVENTION (STP)

13 This reporting period, mentoring and technical guidance were provided to Bauchi, Lagos, Anambra, Abia, Cross Rivers, Bayelsa, and Akwa Ibom States on STP programme science. In response to this development, the states also supported CBOs to conduct advocacy and planning meetings with key MARPs stakeholders that included gate keepers, SACA and other USG partners to delineate sites and target population. To further improve prevention knowledge among the key populations, SIDHAS developed and distributed SBCC materials to all SIDHAS supported states.

Project teams collaborated with SACA from six states to conduct refresher trainings for CBOs and SIDHAS technical officers on STP programing. The objective was to acquaint CBOs and SIDHAS staff with the nationally approved strategies and guidelines for effective implementation of HIV prevention program among key populations at the community level. The trainings focused on appreciating scale-up best practices, programming for target populations, priority setting for targeted intervention, and implementation tools among others.

In support of the national prevention response, SIDHAS technical staff facilitated the conduct of message and media material development (MMD) workshops in Bauchi (April 24 – 25, 2014) and Abia (April 29 – 30, 2014) to develop IEC materials for patient's rights to sustainable and quality services. A total of 44 participants drawn from support groups, SIDHAS, and service providers participated in the trainings. An output of the trainings was the production of 16 creative briefs.

SIDHAS also participated in national strategy meetings including the MPPI Training of Trainers on Minimum Package of Intervention (MPPI) and implementation tools. The training held in June 3 – 5, 2014 and produced a critical mass of trainers with the requisite skills necessary for the training of state level CSOs. A follow-up meeting of the ToT on MPPI was held at NACA Conference Hall on June 24, 2004 to standardize the content of the training manual.

MEDICAL TRANSMISSION PREVENTION Blood drive and blood safety activities: Blood safety trainings were conducted in Benin and Abuja for selected supported blood banks, technical officers and ARFH during the quarter. A total of 48 (27M, 21F) persons participated in the 3-day training which also emphasized key quality issues, collaboration with NBTS and data collection tools. The training was co facilitated by national blood transfusion service and safe blood for Africa Foundation (NBTS/SBFAF). Participants also took a tour of NBTS facilities in Abuja, and met with national and zonal coordinators, to discuss challenges and progress related to access to safe blood and community blood drive.

Collaboration with the NBTS: SIDHAS teams also collaborated with the NBTS to mark the world blood donor day at the national level, ad to conduct emergency blood donation drives in support of the April 2014 Nyanya bomb blast victims. The effort yielded 23 units.

MITIGATION (CARE & SUPPORT/OVC) Support group transition: Transition of facility-based support groups to communities continued in Adamawa, Akwa Ibom, Bauchi and Taraba States. This was achieved through

14 the engagement of state NEPWHAN focal persons to conduct active sensitization of facility heads, community leaders and support groups through advocacy and community dialogue meetings.

PHDP and chronic care model implementation: Support group representatives from Adamawa, Anambra, Cross River, and Kano States were trained on Positive Health, Dignity and Prevention (PHDP) during the quarter. Consequently, PHDP messages were incorporated into support group meetings in addition to the routine administration of the SIDHAS chronic care screening checklist on members and referrals for necessary services.

Referrals and client tracking: The country office supported Abia, Anambra and Rivers States to conduct service quality improvement meetings with state level stakeholders this quarter. The meetings enabled discussions of identified gaps in referrals, linkages and client retention, as well as development and adoption of strategies for closing the gaps including defaulter tracking.

CIMCI Training: SIDHAS CO team participated in a 5-day training on Community Integrated Management of Childhood Illness (CIMCI) for Community Volunteers and CBOs in Lagos State from June 26 – 30, 2014. The objective was to enlighten the CVs and CBOs on the key household practices for effective home care visits to OVC, PLHIV and PABA in the community. A total of 15 (6M, 9F) participants attended the training.

Collaborative meeting: SIDHAS CO staff also participated in the inauguration of technical working committee on social development 2014/2015. The meeting was held at the conference hall Federal Secretariat on the June 25, 2014. The TWG will serve as a steering/think tank committee on all social development activities in the office of the Special Adviser, Social Development and Special Duties.

MONITORING AND EVALUATION Capacity building: SIDHAS participated in a DQA training organized by NMEMS2 for USG IPs on May 16, 2014 in Abuja. SIDHAS M&E and data management systems were used for the mock DQA exercise using the indicator ‘Number of adults and children newly enrolled on ART’ as proxy. Discussions focused on the data management process, review of relevant documents/documentation, and data verification. There was a 100% match between verified and reported data. A major output of the training was the interest of other participating IPs (PACT, MAPS, MSH and JSI DELIVER) in adopting SIDHAS’ data change management process (CMP) and tool.

Meetings: SIDHAS also participated in another meeting of USG IPs organized by MEMS2 on June 4, 2014 in Abuja. The aim was to review proposed changes on the DHIS in alignment with the MER indicators. IPs made recommendations that the USG team should work with the national government to immediately initiate a review of the current harmonized DCTs to enable reporting on the MER indicators from FY15.

SIDHAS SI teams participated in a stakeholders’ meeting organized by the FMoH/DPRS which held at the FMoH office on April 2, 2014. The objective was to review the proposed community NHMIS data flow. However due to the absence of major stakeholders, a

15 consensus could not be reached. As a result, the DPRS will collate further inputs on the data flow from more stakeholders and convene a follow up meeting.

As part of efforts to strengthen government support and participation in SIDHAS’ M&E operations, SIDHAS’ CO M&E team met with the Economic Adviser to the Cross River State government and Head of the State Planning Commission on June 30, 2014. The purpose was to familiarize the Economic Adviser with SIDHAS’ M&E operations in Cross River State, and to aid his understanding of SIDHAS goal and scope in the state. The Economic Adviser pledged to ensure greater involvement of the State Planning Commission through the DPRS in routine health data management activities in the state, and expressed keen interest in the deployment DHIS mobile in the state.

HSS/COMMODITY & DRUGS LOGISTICS IT solutions in management of HIV/AIDS: SIDHAS technical teams began the process developing a tablet use video aimed at showcasing the utilization of technology in the management of HIV/AIDS programs. Once completed and test run, the process will showcase the use of IT in managing other public health diseases apart from HIV/AIDS.

Dissemination of CQI data: CQI data for the second quarter were disseminated to key state level stakeholders during the program quarterly review meetings (QRM). Performance charts for the CQI data were disseminated to 14 states excluding Borno which was not assessed due to security challenges. The data is expected to guide project implementation and stakeholder decisions with respect to the state HIV/AIDS response.

Support to GoN: The Cross River State government was supported to conduct a stakeholder’s analysis of its key HIV/AIDS program players. This was necessary to inform the development of a harmonized HIV/AIDs plan for the State. The state was also supported to develop a draft health policy plan/framework, and terms of reference for coordinating bodies. The documents were finalized and the state supported to conduct the inaugural meeting of the coordinating bodies.

Disposal of expiries: In a bid to ensure that expired commodities were properly disposed of and to prevent re-entry into the system, evacuation and destruction of expired and damaged commodities was conducted in collaboration with SCMS in May 2014. The waste drive exercise was critical in ensuring timely mop up of waste from all supported facilities.

Collaboration with GoN: SIDHAS logistics teams participated in the SCMS procurement sensitization workshop for PEPFAR IPs which took place on June 12, 2014. The meeting discussed plans for continuous and improved service provision during the SCMS transition period. The team also participated in a 2-day sensitization meeting on malaria/PMTCT integration from May 26 – 27, 2014 in Cross River State. The meeting held with the Cross River Government team to discuss implementation strategies. Implementation of the strategies is currently ongoing in the state.

Support to sites: Technical assistance was also provided to supported facilities in the collation, validation and submission of facility level LMIS reports for ARVs, laboratory reagents, Rapid Test Kits and Patients per Regimen reports for the March – April 2014

16 reporting cycle. This helped to facilitate timely resupply of HIV/AIDS commodities to facilities.

Capacity building: SIDHAS logistics teams facilitated a training on logistics management of health commodities for Borno and Yobe facility staff using the national curriculum. The training was conducted from June 22 – 27, 2014 in Bauchi. The aim was to address gaps in supply chain management and data collection that emerged as a result of the security challenges in the area.

Private Sector engagement Technical assistance was provided to five state offices namely Anambra, Lagos, Abia and Bayelsa on private sector engagement during the reporting period. The teams assessed the level of private sector engagement in the various states with respect to MOU execution, as well as the level and quality of service provision. Critical private sector stakeholders like the AGPMPN and SMoH were also visited to solicit support in the successful implementation of the SIDHAS project goal. Onsite mentoring support was provided to private facilities visited with focus on the PMTCT cascade and effective recording and reporting PMTCT activities.

During the reporting period, nine private for profit health facilities in Abia state and eight in Cross River state were activated to provide comprehensive HIV/AIDS prevention, treatment, care and support services. The Integration of services, importance of documentation and sustainability of HIV/AIDS services in the facilities were emphasized during the activation process. The facility Medical Directors expressed appreciation for the activation and promised to support the services, with some making commitments to purchase CD4 lab equipment.

Program Management

USAID visits to SIDHAS states: During the reporting period, the USAID Mission Director visited the Holy Family Catholic Hospital, Ikom in Cross River State, a SIDHAS-supported site. The aim was to commission the facility which had upgraded with a state of the art laboratory through USAID funding. Another delegation from USAID also conducted a visit to Kano state during the quarter. The visit aimed at leveraging partnerships between implementing partners and Kano State government to increase access to quality comprehensive TB/HIV/AIDS services. The team paid an advocacy visit to the State Commissioner for Health, SACA Director General, and some selected USAID supported sites in the state.

SIDHAS PTQA: As part of the FHI 360 global strategy for continuous technical quality improvement, a team of assessors from FHI 360 Head Office conducted a program and technical quality assessment of the SIDHAS project, between the 12th and 23rd of May. The exercise identified significant strengths, challenges and gaps in PMTCT, M&E, and program management and a program and technical quality improvement plan (PTQIP) was jointly developed to address operational and technical gaps identified. The assessment team interacted with SIDHAS project teams at country and 2 state offices (Abia and Anambra),

17 government partners, service providers and beneficiaries and also held a debrief session with USAID. Findings showed strong technical and programmatic competencies of the project with evidence of highly skilled and committed staff. The various SIDHAS teams are working towards implementing recommendations made by the assessors.

Collaboration with GoN: The Borno State Government (BOSG) was supported through the SMoH to provide immediate medical intervention to the 27 Chibok school girls who escaped from the captivity of insurgents from June 4 – 6, 2014 in Maiduguri. The girls were provided health education, complete physical examination, risk assessment and screening for STIs, HIV, Hepatitis B and Malaria, as well as pregnancy tests. All 27 girls were found to be HIV negative and 4 out of them had malaria parasites. The exercise created an avenue for identifying those with imminent need of expert medical consultation with referral services offered to them.

Gender mainstreaming: SIDHAS continued to provide technical assistance in mainstreaming gender into different trainings and programming. States are also being supported to establish gender technical working groups. In addition, a gender portfolio review was conducted to align with PEPFAR guidelines and MER indicators. SIDHAS also participated in the national gender roundtable at the instance of AFRICARE and MSH.

CO visits to state offices: The Chief of Party paid a working visit to Anambra state from June 24 – 27, 2014. She was accompanied by the Senior Program Officer for Nigeria (from FHI360 HQ in Washington), Associate Director Lab and Health System Strengthening (HSS) and Associate Director, Program Support. The COP met with relevant stakeholders such as the Commissioner for Health, the Executive Secretary of ANSACA and senior officials of AGPMPN. She also visited health facilities such as ANSUTH, NAUTH Nnewi and Rock Foundation Hospital Awka.

State Specific Accomplishments

AKWA IBOM STATE (Tier 1 State) PMTCT/ EID/HTC/ART 15 additional ART treatment centers were activated in Akwa Ibom State. Of the 15, 10 were previously PMTCT standalone sites. Selection criteria for the sites included the local government area (LGA) HIV/AIDS prevalence rate, risk population and location. The activations are expected to increase access to available treatment services. As part of the pre-requisite for offering comprehensive ART services, a total of 196 (77M, 119F) health workers were trained in the reporting using the standard comprehensive ART curriculum. Post activation supervision and mentorship visits were also made to the 15 newly activated sites to reinforce new skills acquired.

Through community outreaches led by facilities in collaboration with traditional birth attendants (TBA), 18,157 pregnant women were reached with HIV Testing and Counseling (HTC) services. SIDHAS-supported community and faith based organizations also reached

18 1,376 adults with HTC services out of which 108 adults with advanced HIV infection were identified and referred for HIV/AIDS care and treatment services in supported sites.

Audit of 2,700 client folders was carried out across 19 comprehensive facilities this quarter to identify eligible pre-ART clients based on current initiation criteria. Gaps identified were addressed with facility focal persons. This process is expected to improve service delivery and support tracking and retention of eligible patients on care.

A total of 3390 (1128M, 2262F) clients were offered PITC services across supported sites within the reporting period; 202 positives were identified and referred for enrollment into care. The integration of HIV counselling and testing into reproductive health/family planning unit and other multiple service points in the facilities facilitated the achievement of the set objective of the program.

TB (Pure TB and TB/HIV) To increase access and enhance quality TB service delivery, SIDHAS supported the scale up of IPT services to 10 additional sites. Pharmacists and clinicians from the 10 sites were trained on IPT in efforts to stem capacity gaps in service provision.

C&S/OVC Supported CBOs provided psychosocial and nutritional support to orphans and vulnerable children. Capacities of heads of households were built on identification and utilization of locally made nutritional meals. They were also introduced to recreational activities and provided access to educational support opportunities through levy waivers for VC enrolled in schools. Supported CBOs also participated in the statewide maternal and child health week with the immunization of 422 vulnerable children (185M, 237M). These activities continue to increase the number of VC served in the state.

Program Management The SIDHAS team organized a one day private sector engagement meeting in collaboration with the State and Nigeria Medical Association (NMA). The meeting had 49 Medical Directors from activated private sites in attendance. The meeting reviewed the SIDHAS mandate and terms and conditions for engaging the private sector. A total of 40 endorsements to the MOU were received from members of the private sector in attendance. The state held a quarterly review meeting within the reporting period. The objectives were to review the state HIV/AIDS program, assess milestones, identify mitigating challenges, chart a way forward for the State, and collate state-wide health data, as well as strengthening and coordinating sustainable HIV/AIDS services in the state. Stakeholders at the meeting included State HIV/AIDS/STI Control Program (SASCP), State Agency for the Control of HIV/AIDS (SACA), Hospital Management Board (HMB), State Ministry of Health (SMoH), State Ministry of Women Affairs and Social Development (SMWASD), Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), and medical superintendent/ART coordinators from supported secondary facilities.

CROSS RIVER STATE (Tier 2 State) PMTCT/EID/HTC Within the reporting period and as part of strategies to increase access to services, 64 (31M, 33F) health care workers (HCW) from 25 PMTCT sites (16 public and 9 private) were trained

19 on HTC as part of pre-scale up activities for upgrading the sites to comprehensive ART centers.

Cluster coordination meetings (CCMs) took place in 12 comprehensive sites in efforts to improve coordination and referral activities. The meetings served as platforms for reviewing referral documentation, strengthening linkages for complete referrals, and creating demand for services provision. A total of 300 facilities participated.

SIDHAS recorded a total of 50,390 persons who were CTRR. 571 HIV-positive pregnant women received antiretroviral to reduce the risk of mother-to-child transmission out of 23,094 tested for HIV during the same period. In addition, 983 adults and children with advanced HIV infection were newly started on antiretroviral therapy and 153 HIV-positive patients placed on HIV care, started TB treatment.

ART/Lab/Drugs/Pharm Capacity building activities were conducted for 67 (36M, 31F) pharmacists and community pharmacists to improve the skills and competency of pharmacists this quarter. The training focused on pharmaceutical care in HIV in supported health facilities. 75 (12M, 63F) lower cadre pharmacists and support staff were trained on ART dispensing and documentation. These trainings continue to refresh knowledge of service providers to ensure quality of services.

To enhance the quality of laboratory practices in supported sites, a quality management supervision (QMS) training was organized for 15 laboratory staff (9M, 6F). Also, external quality assessment (EQA) for HIV serology dry tube sample (DTS), Hematology, CD4 and Chemistry was conducted by supported sites registered for the exercise in the reporting quarter. Additionally, 12 microscopes and one GeneXpert machine were distributed to supported facilities, installed, and facility staff trained on its use.

TB HIV A total of 140 participants (52M, 88F) were trained on TB/HIV/Infection Prevention and Control (IPAC) this period. Twenty five facilities from the public and private sectors participated in this training. The aim was to equip health care workers with the necessary knowledge and skills for the management of TB/HIV co-infected clients and IPAC services. Also, within the quarter, 1, 689 clients were counselled and tested in supported DOTS centers while 104 co-infected clients were recorded as starting treatment in all supported facilities.

OVC The SIDHAS team together with the office of the governor’s wife facilitated a 3-day training on adolescents’ sexual reproductive health and OVC programming. This training was organized for staff of two CBOs—Mothers against Child Abandonment (MACA) and Partnership Opportunities for Women Empowerment Realization (POWER) and is expected to improve OVC programming in the state. Supported CBOs also enrolled 1,449 OVC and provided 1,543 with various services.

Program Management/HSS As part of the strategy for entrenching sustainability systems at the local government level, 12 new local implementation teams (LITs) were inaugurated. The LGA team members were assigned to facilities within their LGAs for integrated supportive supervision and integrated data management and reporting. SIDHAS plans to use the platform of LIT monthly meetings to carry out CMEs as a capacity building process for the LIT members.

20 Highlights of Plans for the Next Quarter • Conduct peer mentorship activities among WHO/AFRO preparation sites • Initiate targeted advocacy to government for support in addressing health facility renovations and generator fuelling laboratories

LAGOS STATE (Tier 2 State) PMTCT/EID/HTC As part of SIDHAS mandate to increase access to HTC, 15,008 persons in the general population were CTRR within the reporting quarter. In addition, 27,889 pregnant women were reached through the TBA outreach platform. Those that tested positive were referred to SIDHAS-supported PMTCT sites for further care.

ART/Lab/Drugs/Pharm SIDHAS worked with the Lagos State Government to obtain approval for the scale-up of two PMTCT PHCs for provision of HIV care comprehensive services. This is part of SIDHAS strategy towards increasing access to treatment services for people in the hard-to-reach areas of the state. Capacity building of health care workers from these facilities commenced within the reporting period with facility upgrades in view.

Joint mentoring visits by the quality mentoring accountability program (QMAP) backstops were conducted in all SIDHAS-supported sites to enhance quality service delivery. The QMAP teams used the opportunity to collate, verify, and enter data into the DHIS. Technical support was also provided to all health facilities on the generation of CRRIRF reports for ARVs, RTKs and dry blood spot (DBS) bundles.

Continuous onsite capacity building for HCW involved in ART service provision were sustained in ART sites through CME sessions. In all, 110 (25 M, 85 F) HCW benefitted from this activity. Similarly, a capacity building session on IPT was conducted for 61 (29M, 32F) HCW from General Hospitals (GH) Badagry and Apapa. In the same vein, 1-day cohort analysis meeting for ART coordinators and M&E officers on May 22, 2014 to review data for clients initiated on ART between 2012 and 2013. The activity fostered improved understanding of facilities on the survival rate of clients on treatment and identified challenges hampering standard of care. The cohort analysis showed a 75% survival rate of clients placed on treatment between 2012 and 2013.

Collaborative mentoring of facilities was carried out during this quarter with key staff of the LGAs and the PHC board. The exercise resulted in transfer of skills, improved services, and quality data generation and verification.

TB (Pure & TB/HIV) In order to facilitate improved TB diagnosis in communities, renovation of four PHC TB microscopy laboratories were completed in the reporting quarter. The laboratories are now functional and have commenced processing of sputum samples.

21 RIVERS STATE (Tier 2 State) PMTCT/EID/HTC This reporting period, 33,386 persons were CTRR among the general population. Among the 16,843 pregnant women CTRR, 3,845 positives were placed on prophylaxis. In addition, 205 DBS samples were sent for Polymerase Chain Reaction (PCR) assay and 107 results received from earlier samples sent returned with four positive results depicting a 96% success rate as a result of PMTCT intervention.

ART/Lab/Drugs/Pharm With the identification of 15 sites for ART activation in the State, SIDHAS supported the installation of a fully equipped AFB microscopy laboratory and GeneXpert machine at Braithwaite Memorial Specialist Hospital. This intervention will help the facility meet the high demand for testing and other laboratory services.

TB (Pure & TBHIV) In the period under review, TB patients were placed on treatment with adherence support from community volunteers, and 16 new TB suspects (7M, 9F) were identified across five communities. Continuous medical education sessions were conducted in supported facilities with focus on TB/HIV collaborative activities, eligibility criteria and indicators for IPT services.

OVC/Care and Support Services Care and support services were sustained with PHDP services deployed to various supported communities with 328 persons (102M, 226 F) reached. Orphans and Vulnerable Children enrolled into the program in the reporting quarter numbered 738 (384M, 352F). Supported CBOs provided psychosocial support to 1,781 (865M, 916F) persons, health education services to 1, 823 (888M, 935F), and nutritional support to 1567 (779M, 788F) persons in the reporting quarter. Similarly, 7,666 PLHIV and PABA (5298M, 5732F) were reached with one clinical and two supportive services in seven communities, and home based care to 61 (23M, 35F) PLHIV across three communities.

Advocacy visits to key gatekeepers were made to solicit support for OVC programming in 13 communities by CVs. Community leaders donated town halls to set up early childhood centers and supported the selection of CVs in their respective communities. Community members were also sensitized on stigma reduction and gender based violence in five communities in efforts to mitigate the impact of stigma and discrimination and gender base violence in communities.

Sexual Transmission Prevention Using the minimum prevention package intervention (MPPI), a total of 180 (105M, 75F) out of school youths (OSY) were reached across seven communities. HTC services were provided to 138 (83M, 55F) OSY during peer sessions with no positives. In addition, 2,110 units of condoms were distributed to 569 (409M, 160F) persons 11 communities during cohort sessions.

Program Management A quarterly review meeting of the SIDHAS project was held within the reporting period to discuss and proffer solutions to the achievement of project goals. CQI assessment data

22 were also disseminated during the meeting. As part of the process for supporting effective supervision at PHCs, the State Primary Health Care Management Board facilitated a refresher training LIT members. The process kick-started supportive supervisory visits by LIT members to PHCs.

Maintenance States ABIA STATE PMTCT/EID/HTC This quarter, a joint team comprising of staff from FHI360 country office and the Federal Ministry of Health (FMoH) supported the installation of SMS printers in 8 ART sites acting as hubs and spokes for PMTCT/EID services in Abia State. Relevant facility health care workers (HCW) were also trained on the use and maintenance of the printers.

Ongoing capacity building for local government implementation team (LIT) members continued this quarter. Orientation was provided in such areas as supportive supervision, Q- MAP mentoring, collection and validation of monthly summary forms (MSF), and monthly reimbursement request forms (MRRF) for PHCs.

ART/Lab/Drugs/Pharm As part of initial scale-up activities, an integrated ART training was conducted for HCW from the 12 proposed sites with the aim of equipping them with necessary knowledge and skills for quality ART service provision. A total of 27 (15M, 12F) HCW from the 12 sites and existing facilities were trained including 14 doctors, 12 nurses and a senior community health extension worker (SCHEW). Post-activation mentoring and supervision visits were conducted following the activations to ensure quality service delivery in line with the existing SOPs and national guidelines. The visits also targeted retrieval and validation of monthly summary forms (MSF).

Healthcare workers were trained in different service areas during the reporting period. The trainings were part of routine activities aimed at ensuring continuous quality of provision in supported sites. A total of 130 (33M, 97F) HCWs were trained on provision of quality laboratory services, good clinical laboratory practice, pharmacy best practices, and skills enhancement for pharmacy care and HCT. All the trainings were conducted to build the capacity for quality HIV care, treatment and support services in target sites.

Client folder audits were carried out in 13 ART sites during the reporting period. A total of 601 client folders were audited in collaboration with key facility staff like the ART doctor, M&E officer or the facility tracking team leader. Necessary actions were taken to address the identified gaps.

TB (Pure TB & TBHIV) In order to improve quality of service provision in TB settings, orientation activities were conducted for 10 LGA TB and Leprosy Supervisors (TBLS) this quarter. Focus was on service quality and the use of HTC data collection tools. The platform was also used to and

23 to enhance mobilization of the community people to DOTS centers, a capacity building orientation was held for from 10 priority LGAs in Abia State within their localities.

Medical Prevention Blood donation drives were also conducted by a supported CBO in collaboration with the Nigerian Blood Transfusion Services (NBTS) during the quarter. The exercise had 650 participants who were sensitized; 17 blood donors were screened and 11 units of blood collected and taken to the NBTS blood bank.

C&S/OVC A total of 982 (525M, 457F) OVC were enrolled and provided services including health education, counselling and testing, and birth certificates. Child protection committees were also set up and commissioned in five communities in three LGAs by one of the supported CBOs during the period. Community volunteers also had their capacities built by the CBOs on effective referral and linkages, home visits, care and support as well as escort services. SIDHAS teams provided technical support to Abia SACA to build the capacity of 11 Civil Society Organizations (CSO) on quality provision of community HIV/AIDS prevention and mitigation services. The state team also collaborated with the Abia State Ministry of Women Affairs and Social Development (MWA&SD) to train 43 (5M, 38F) persons comprising HCW, community pharmacists and CBO staff on gender mainstreaming, referral, and client tracking.

HSS/PM/SI/Gender SIDHAS staff supported the state government to develop a 3-year State Plan of Action (SPA) for vulnerable children. Other participants at the forum included Ministries of Health, Justice, Agriculture, National population council (NPoPC), and Planning Commission and Information.

SIDHAS continued gender mainstreaming activities in the state with the training of 40 (20M, 20F) GoN staff. Participants at the training are expected to lead processes of integrating gender into all areas of service provision in supported facilities and at the community level.

Highlights of Plans for the Next Quarter • Conduct monitoring and mentoring Q-MAP visits to all supported sites in state • Continue routine monthly data validation and reporting in DHIS, LAMIS and NOMIS

ADAMAWA STATE PMTCT/EID/HTC As part of efforts to increase access and geographical coverage of PMTCT services in Adamawa State, three new HIV Comprehensive Centers (Cottage Hospitals Guyuk, Toungo and Mayo Belwa) and two PMTCT sites (PHC Uba and PHC Kwarhi) were activated during the quarter. Focal persons were identified and mentored on use of relevant SOPs, national guidelines and Job aids to ensure the provision of high quality HIV/AIDS services. A total of 11,308 pregnant women were counseled, tested and received results (CTRR) out of which 170 tested positive and 162 commenced prophylaxis.

24 A total of 8,917 clients were CTRR through sustained outreaches among the general populations, out of which those who tested positive and were referred for enrolment into care and treatment. HTC services were provided to 128 brothel and non-brothel based female sex workers (FSW) and results provided; 13 tested positive and were referred to the Specialist Hospital, Yola through the escort model strategy for enrollment into care and treatment.

Samples for 159 infants were sent to the EID laboratory, Jalingo and 220 results received. Of the received results, 17 tested positive. All results were dispatched to the respective facility EID focal persons for onward communication with caregivers and initiation of those positive on ART.

ART/Lab/Drugs/Pharm Services Expansion of access to ART services continued with the activation of three additional HCC sites, thus, bringing the total number of HCC sites in the state to 12. A total of 1,023 clients were enrolled into care and 664 newly initiated on ART.

Chronic care/PHDP was conducted across all the comprehensive sites to equip facility staff with requisite skills for quality health care services. A total of 7,027 HIV positive clients were screened with chronic care checklists and documented into the chronic care registers.

Pharmacy personnel from supported sites received a two day training on ARV dispensing and documentation with a total of 25 (8M, 17F) pharmacists trained. A Logistics cluster meeting was also conducted with four PHCs and 7 (1M, 6F) HCWs had their capacity built in reporting and requisition of HIV/AIDS commodities using CRRIRF. The quarterly pharmacy focal persons’ peer review meeting was also conducted on the June 18, 2014 at the State Ministry of Health with 12 participants (10M, 2F) in attendance.

TB (Pure TB & TBHIV) To ensure effective integration of TB into HIV services, the engaged TB/HIV volunteers have continued to sustain efforts towards improving TB case detection by facilitating complete referrals of identified suspects within the communities. A total of 112 samples were linked to the Specialist Hospital Yola by the TBL supervisors for Gene Xpert analysis. Of these, 11 tested positive and 2 MDR cases were recorded.

Counseling and testing activities were sustained in TB DOTS and RH units across all the supported sites during the quarter. A total of 1,101 clients were CTRR at DOTS units; 216 tested positive and were referred to the ART unit for enrolment into care and treatment. LGA TBL supervisors were also mobilized to support the linkage of co-infected clients from unsupported stand-alone sites to SIDHAS-supported sites. Consequently, a total of 106 co- infected clients started TB treatment during the reporting period.

As part of SIDHAS’ commitment in supporting NTBLCP and strengthening the integration of TB and HIV/AIDS services in Nigeria, renovation work effectively started at MDR- TB ward at FMC Yola. With the contractor mobilized, equipment and personnel were deployed to the site. The overall completion rate of the work at the end of the quarter was estimated at 95% following the review of performance against set milestones.

25 Sexual and Medical Prevention A training of peer educators among the MARPS (FSW) was carried out by a SIDHAS CBO, Centre for Health and Development in Africa (CHEDA) to increase demand for chronic care. A total of 10 peer educators (FSW) were trained among which seven were brothel based and three non-brothel based.

C&S/OVC Supported CBOs conducted caregivers’ forum which had 30 caregivers (17M, 13F) in attendance. The CBOs also served 450 OVC (250M, 200F) with educational materials, and psychosocial and nutritional support.

HSS/PM/SI/Gender The state M&E team collaborated with AdSACA and SASCP to conduct the monthly M&E meetings. The monthly meetings provided a platform to collate and verify data, and address implementation challenges. In addition, an inaugural meeting of the integrated health data management team (IHDMT) was supported. The meeting had 32 members drawn from different organizations and partners (SMoH, ASPHCDA, ASASCP, WHO, FHI360, UNICEF, UNFPA, GAVI, PPFN, and ARFH) in attendance. This structure is expected to facilitate a unified state M&E system as well as quality data management.

A quarterly review meeting aimed at reviewing the implementation of the SIDHAS project held during the quarter. The meeting which held on June 13, 2014 had 30 persons (22M, 8F) drawn from the State Ministry of Health, Hospitals Services Management Board, AdSACA, and other implementing agencies. An immediate output of the meeting was the formation of a State Health Advocacy Committee charged with the responsibility of meeting with the State Governor and other relevant stakeholders on critical issues impinging on the successful implementation of health services in the state including HIV/AIDS.

Highlights of Plans for the Next Month • Integrate newly activated sites into SIDHAS support systems and structures • Sustain advocacy to state government for support in addressing program implementation challenges

ANAMBRA STATE PMTCT/EID/HTC As part of efforts to improve the quality of PMTCT and EID services, Anambra State University Teaching Hospital (ANSUTH) conducted onsite trainings for 44 staff (15M, 29F) of the O&G unit. The facility EID focal person was also mentored on DBS collection from exposed babies. Samples from 13 exposed infants were collected and sent for PCR test; 68 DBS results were collected for various facilities with all testing negative.

ART/Lab/Drugs/Pharm During the review period, technical assistance and monitoring visits were undertaken to IAs and health facilities in the state. Laboratory consumables were provided to comprehensive

26 sites and re-distributions done where necessary. Waste drives were carried out at all supported facilities to mop up expired reagents, test kits, consumables and reagents to ensure quality lab service delivery. Inventory lists have been forwarded to SCMS Awka for eventual disposal.

The SIDHAS team and their GoN counterparts facilitated the conduct of review meetings and onsite trainings during the reporting period. These included a data review meeting on pharmaceutical care which aimed to build facility staff capacity to address drug therapy problems, including medication errors, and adverse drug reaction (ADR). Onsite orientations were also conducted for doctors and nurses to acquaint them with WHO staging for children, ART initiation criteria, preferred ARV option and case studies in order to enhance their understanding of the WHO staging. In addition, a QMS/lab safety training was conducted for 17 (10M, 7F) lab scientists from 12 facilities with the aim of building capacity provision of quality lab services.

TB (Pure TB & TBHIV) Activities aimed at facilitating adoption of the INH prophylaxis regime were sustained this quarter. Healthcare workers from 16 supported facilities had their capacities built on the provision of quality TB/HIV, IPAC and IPT services. A total of 24 (14M, 10F) relevant facility staff were trained.

During the reporting period also, TB/HIV data review meetings were held across supported sites. In addition, newly engaged TB/HIV volunteers were mentored on the use of the chronic care checklist and the TB indicator template to facilitate the process of support to facilities.

C&S/OVC Supported CBOs supported the provision of birth certificates to 312 OVC by the National Population Commission in 4 LGAs. Home visits were made by community volunteers to PLHIV and OVC; and academic performance of OVC monitored in schools were they are enrolled.

The SIDHAS team supported the Federal Ministry of Women Affairs and Social Development, Association of OVC Network in Nigeria, and relevant line ministries in Anambra State in the development of a three-year Anambra State Strategic Action Plan for vulnerable children. The framework is expected to ensure the protection of the most vulnerable children and reduce child poverty in the state.

Highlights of Plans for the Next Quarter • Continue on-site mentoring on pharmaceutical care documentation, pharmacy best practice, pharmacy service documentation and logistics management • Advocacy visits to health facility management on the need to increase the HR especially pharmacists in some supported facilities

BAUCHI STATE PMTCT/EID/HTC/ART

27 During the reporting quarter, 21,092 pregnant women were CTRR across SIDHAS supported sites and 570 positives were placed on prophylaxis. Additionally, 419 clients from SIDHAS supported sites were newly initiated on ART treatment out of which seven paediatrics started ART during the quarter.

Community sensitization activities aimed at increasing uptake of HTC and ANC services were conducted during the quarter. In Katagum LGA, communities were mobilized and sensitized on HCT, TB and increased ANC. SIDHAS-supported CBOs also conducted HTC for MARPs with 86 people (1M, 85F) counselled and tested for HIV out of which 7 (1M, 6F) tested HIV positive. They were all referred to SIDHAS supported sites for further care.

During the reporting period, the state team also improved its collaboration and referral strategy with supported health facilities. A total of 137 DBS samples were collected and sent to the designated EID laboratory at FMC Gombe for PCR analysis; 62 (4 HIV+) results have been received so far while 75 are still pending. The four children who tested positive have already been enrolled on treatment.

Community sensitization on injection safety was held at Durum and Yelwa Domiciliary (Bauchi LGA) with 52 (14M, 38F) participants were in attendance. In addition, 125 MARPs (46M, 79F) were counselled and tested for HIV with nine females testing positive and referred appropriately for ART services. A total of 9,048 pieces of condoms were distributed to the FSWs; 12 FSWs have completed cohort sessions and 40 peers have completed 6 cohorts’ sessions and have graduated.

C&S/OVC During the reporting period 555 OVC (312M, 243F) were enrolled into care, and 2,085 (1,180M, 905F) provided with at least one service. Birth certificates were issued to 230 OVC, and 386 benefited from psychosocial services. Furthermore, 4,138 PLHIV and PABA were provided with health education; and 275 PLHIV and 17,585 PABA were reached with one minimum care.

Kids’ club meeting was conducted in Durum community with 48 children (26M, 22F) in attendance. The discussion was on the importance of hand hygiene, and a demonstration was conducted for the children. A total of 456 OVC also received school materials within the month.

Highlights of Plans for the Next Quarter • Conduct regular onsite monitoring and mentoring visits to sites • Collection of Lab, pharmacy, & M&E monthly and bimonthly reports from facilities. • Advocacy visits to State GoN stakeholders on the need to increase the HR in supported facilities.

BAYELSA STATE PMTCT/ EID/HTC

28 Efforts to increase access to comprehensive ART services continued during the quarter with the upgrade of five PMTCT sites. Provision of ART services has since commenced in those sites bringing the total number of supported ART sites in the state to 17.

SIDHAS teams supported the integration of HTC services into all family planning service points in five newly activated ART sites and in DOTS centers in select facilities. Achievements within the reporting quarter also include 4,730 pregnant women and 4,031 general population reached with HTC services.

SIDHAS supported the processing of 15 EID samples during the reporting period. Nineteen results for already processed samples were received within the same period. All results were negative.

In the period under review, 129 defaulters were identified and tracked from Cottage Hospital Otuasega, General Hospital Odi, Cottage Hospital Okoloba, Niger Delta University Teaching Hospital (NDUTH) and the Federal Medical Center Yenagoa. Fifty clients have so far returned into the treatment system with tracking continuing for the outstanding numbers.

TB/HIV Three directly observed treatment (DOTS) centers were activated in three comprehensive sites this quarter, and two others activated at Comprehensive Health Centers Egbemo- Angalabiri and Otuoke to provide TB microscopy services. The aim is to address challenges faced by facilities in riverine areas where high cost of transportation and unpredictable weather conditions hamper movement of samples. Reagents, consumables, and equipment as well as requisite technical assistance were provided to the facilities.

Care and Support As part of efforts to improve the quality of HIV care and treatment in supported-facilities, 2,353 PLHIV received chronic care screening and positive health and dignity prevention (PHDP) services. Tuberculosis (TB) suspects were identified and referred to the microscopy and GeneXpert laboratory for sputum AFB microscopy and GeneXpert technological diagnosis while 38 PLHIV were diagnosed with TB and placed on anti TB medication.

To fully equip health care workers at SIDHAS supported facilities with the requisite knowledge and skills to implement and monitor quality HIV services, a total of 125 HCW (41M, 84F) received training on HTC, TB/HIV, lab services, blood collection and handling, pharmaceutical care, and pharmacy best practices.

BORNO STATE ART Peer review meetings for pharmacy focal persons held during the quarter in supported sites. The meeting provided the forum for facility pharmacy focal persons to share successes and challenges experienced in project implementation. The focal persons were also mentored on the generation and validation of pharmacy tools. Based on feedback received from the meeting, the SIDHAS team has set up a system to ensure timely retrieval of well documented bimonthly and monthly reports which serve as a measure to communicate on field updates.

HSS/Lab services

29 During the reporting period, the Borno team conducted series of capacity building exercises in an effort to strengthen the capacity of facility staff. A training on DBS collection, proper handling and sample transportation, and GCLP for Lab personnel and other HCWs from all supported sites in Borno State was conducted in Jamil Guest Palace in Bauchi from 8th to 14th June, 2014. A total of 44 participants (27 M, 17F) from 21 supported sites in the state attended the training. In addition, 36 participants (33M, 3F) made up of lab and pharmacy staff from 11 ART sites were trained on health commodity logistics to improve their capacity on the appropriate use of the SOP manual as a tool for keeping accurate records and transmitting timely reports as a means to ensuring constant commodity supply.

SI/M&E The state conducted its first monthly M&E meeting during the quarter with participation from the 13 supported sites and one CBO. The meeting which had 14 (10M, 4F) participants in attendance provided a forum for discussing with facilities in hard to reach areas occasioned by the security situation in the state, as well as collection and documentation of facility data. The monthly meetings are expected to continue as the security situation allows.

Program Management During the reporting period, the state government provided two vehicles (Peugeot 504 station wagon and a Toyota pickup van) to Borno SACA (BOSACA) to ease logistics for site supervisory and mentoring visits. This was as a result of series of advocacy visits to the government in that regard, and showcases the commitment of government to take ownership of the project.

Overarching Challenges • Security situation in the state continues to hinder mentoring and on-site visits to most sites especially those outside Maiduguri metropolis

EDO STATE PMTCT/EID/HTC General Hospitals, Agbede, Afuze and Specialist Hospital, Ossiomo were activated to provide comprehensive HIV/AIDS services this quarter. Similarly, GH Ekpoma was activated for PMTCT services. Post activation mentoring exercises were conducted to provide hands- on mentoring of HCWs in service provision to clients and on documentation of service delivery at the various point of service. The state now supports 41 facilities in HIV/AIDS care and treatment services.

HSS/Lab/Drugs/Logistics/Pharmacy CH Auchi and Uromi and UBTH laboratories participated in the CD4, haematology and chemistry EQA-PT scheme; surveys 1 & 2/trials 25 & 26, trials 0114, 0214 & 0314 and sample 1, 2 & 3 respectively. Reports of previous month PT trials received were sent to the participating sites for review, recording and filling.

SIDHAS participated in the regional procurement and supply management TWG meeting for states in Phase 2A unification project. Representatives of different implementing partners and state partners attended from the six states under the unification region. Discussions

30 centered on linkage of PMTCT sites to comprehensive ART sites for CD4 analysis and the need for states to identify personnel to be assigned to State Logistics Management and Coordination unit (LMCU).

Prevention Supported CBOs reached 272 FSWs with MPPI in six cohort sessions this quarter. HTC was also conducted for the cohort group members and their results provided. Community mobilization was conducted as part of the HTC intervention and the opportunity used to educate the communities on HIV/AIDS.

C&S/OVC The state OVC TWG meeting held at the conference hall of the State Ministry of Women Affairs and Social Development (SMWASD) on May 8, 2014. In attendance were representatives from the line ministries, Child Rights lawyers and activists, CSOs and CBOs working on OVC in the State, NEPWHAN, CISHAN, IPs (AHNI, CRS) and the media. The terms of reference of the State Improvement Team was highlighted and reviewed. The team is charged with drawing up an improvement plan that would guide the activities of the TWG.

A community dialogue on stigma reduction and gender-based violence was held at Oben community on May 14, 2014 with a total of 23 persons (16M, 7F) in attendance. Discussions at the event focused on the harmful effects of female genital mutilation. The community leaders pledged their support and promised to disseminate the knowledge acquired from the dialogue session. The support group coordinator openly disclosed her status and sensitized all present on the need to show love and care to PLHIV.

SI/M&E Onsite mentoring and technical assistance were provided to facility focal persons on correct and quality data capturing using the national harmonized tools especially in the inherited facilities. As a requirement for the SAPR submission, cohort analysis of patients initiated on ART between October 2012 and March 2013 was conducted across eight comprehensive facilities. Due diligence was observed to ensure all necessary records and source documents were reviewed.

Gender/Program Management The state quarterly review meeting held with the stakeholders from June 11 – 12, 2014 in Benin City with the theme closing gaps in FY14 SIDHAS Implementation. A total of 42 (27M, 15F) participants drawn from GoN, supported health facilities, HMB, SMoH, SACA, and NEPWHAN were in attendance including the Honourable Commissioner for Health. An action plan to be implemented in the quarter was developed at the meeting.

The state program team conducted advocacy visits/sensitization exercise to the management of Local Government Council. The exercise was to ensure quality service delivery at supported PHCs and smooth implementation of the SIDHAS project in line with USG policies.

Technical assistance and mentoring visits in financial and institutional domains were provided to two CBOs to address gaps in their capacity building plans (CBP); use of financial accounting software; and development on organizational budgets and annual cash flows.

31 Highlights of Plans for the Next Quarter • Complete data migration process and LAMIS rapid backlog data entry in the inherited sites • Work with the Ministry of Budget and Planning, SACA and SASCP on developing a financial sustainability road map for HIV/AIDS for Edo State Government

JIGAWA STATE PMTCT/EID/HTC Facility staff in SIDHAS-supported facilities were mentored on service flow, service documentation, and provision of continuous quality ART/PMTCT services. Chronic care screening equipment such as blood pressure monitors, weighing scales with height measurements, and BMI charts, were also supplied to all comprehensive sites. In addition, ART/PMTCT folder audits were conducted in selected comprehensive sites across the state with the aim of improving HIV/AIDS management.

During the reporting period, CT services were activated in TB settings for 6 PMTCT sites in the state. Adverse drug reactions were observed in three clients on TDF 3TC EFZ. The regimen was withdrawn accordingly.

OVC/Care and Support Transitioning of facility support groups to communities of members’ residence was concluded this quarter in Jigawa State. This is expected to fully integrate PLHIV into their communities, encourage community support for PLHIV, and discourage stigma and discrimination. The supported CBO also enrolled 7,450 OVC and provided 6,833 with a minimum of one service.

KANO STATE PMTCT During the reporting period, the SIDHAS team together with their GoN counterparts conducted rapid site assessments of 10 PMTCT sites for upgrade to ART sites. The assessment findings revealed viability of all assessed sites for provision of comprehensive ART services. Routine joint supportive supervisory visits were made to 12 facilities to mentor facility staff on the appropriate use of the PMTCT service flow chart and identified documentation errors in different points of service. A major challenge confronting most of the health facilities visited is that of human resources for health concerning which the state team continues to advocate to the state government.

ART Continuous Medical Education (CME) meetings across SIDHAS supported facilities in a bid to improve performance on ART retention rate. Facility staff were mentored on provision of high quality adherence education and support for all clients, as well as effective identification and tracking of defaulting clients. As part of efforts to ensure continuous quality, supported health facilities committed to adopt a close systematic approach in monitoring of client retention in HIV care.

TARABA STATE PMTCT/EID/HTC

32 As part of efforts aimed at closing identified PMTCT prophylaxis gaps among HIV positive pregnant women, care providers from supported PMTCT sites were supported to mobilize pregnant women within their catchment communities to access services. Other strategies adopted included test and treat, and contact tracking and escort services for all HIV positive pregnant women. A total of 9,881 pregnant women were counselled and tested for HIV and received results. Of these, 501 positive pregnant women received ARVs to reduce the risk of MTCT.

ART/Lab/Drugs/Pharm Services During the reporting period, due to continued routine and post activation mentoring of ART activities, 1,142 children and adults were newly initiated on ART. Administration of the chronic care checklist continued across supported facilities and communities in the State and a total of 3,669 positive adults and children were provided with minimum of one clinical service.

Logistics Technical Working Group (LTWG) meeting was held by the state government during the reporting period. As part of support from the state government, SIDHAS supported sites were supplied RTKs for HTC activities in facilities and communities. The state team also collaborated with the Director of Pharmaceutical Services and the Health Services Management Board to conduct the quarterly Pharmacists peer review meeting with 11 participants (9M, 2F) from ART sites in attendance.

TB (Pure TB & TBHIV) During the reporting period 1,198 individuals were CTRR in DOTS settings out of which positive cases were identified and enrolled into care. Another 15,724 clients were screened for TB out of which 1,229 TB suspects were identified and referred for further investigation. Similarly, 1,058 had AFB tests; 161 TB cases were confirmed, while 388 cases were commenced on TB treatment.

Care & Support/OVC Supported CBOs with other stakeholders in the state held peer review meetings to review performance, share experiences and develop strategies for improved service delivery. The CBOs also enrolled 1,710 new OVC and provided 3,669 eligible persons with a minimum of one care service. Transition of support groups from facilities to communities commenced in four facilities—GH Gembu, GH Bali, GH Wukari and FMC Jalingo, this quarter. Full implementation of the process will be sustained as well as subsequent scale up to other HCC catchment communities.

HSS/PM/Gender SIDHAS teams and their government counterparts held a QRM to review project performance. The meeting identified causes for performance gaps and developed strategies to close gaps in efforts to improve project results. As part of routine activities, continuous quality improvement assessments were conducted with supported IAs and CBOs to monitor progress along the critical domains. Following the assessments, capacity building plans were developed to address identified gaps and to ensure continuous improvement. Resource mobilization and gender trainings were also conducted for CBOs and health

33 facilities respectively with 24 persons (14M, 10F) trained on gender mainstreaming and reporting.

Overarching Challenges • Ambiguity in the wordings of data element on ‘previously known positive’ on the NHMIS MSF and interpretation in the user manual tends to affect the quality of PMTCT data, particularly as it relates to uptake of ARV prophylaxis. SIDHAS is embarking on extensive data review and onsite mentoring to mitigate this challenge. Ultimately, SIDHAS will work with the DPRS to remove the ambiguity in the tools. • Security challenges continue to hinder access to program data and provision of direct supportive supervision to supported sites in Borno, Yobe and parts of Adamawa state. SIDHAS continued to rely on the G-SIT to provide support in such hard to reach areas. Data quality remains a major concern in affected states. • The ongoing strike by the Nigerian Medical Association which began in June 2014 affected service provision across supported facilities. •

Highlights of Plans for the Next Quarter • Develop FY15 workplans in collaboration with state government counterparts • Prepare towards the planned mid-term evaluation of the SIDHAS project • Intensify effort at improving reporting rate amongst supported IAs, and quality of PMTCT data • Collaborate with USG, GoN and other partners to ensure tracking of MER indicators begins at the turn of FY 15 • Facilitate the dissemination of R-HFA reports and eMTCT plans for 8 supported states • Continue supporting GoN’s effort to establish a single centralized national DHIS instance/data base • Support state teams to operationalize integrated health data management • Continue technical and financial support on the implementation of IBBSS activities

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