LOCATE project

LOCATE 4

The LOCATE project is a project supported through Centers for Disease Control and Prevention (CDC), President’s Emergency Plan for AIDS Relief (PEPFAR) to provide community and hospital based care and treatment using an integrated approach. It involves effective linkages (e.g. “hub and spoke” model) and service coordination to ensure continuity of comprehensive service delivery and local capacity building for stewardship to sustain services on the long term.  The project which commenced in October 2013 supported 209 facilities (including 9 facilities providing comprehensive HIV care and treatment) in three Nigerian States of Ebonyi, Enugu and Imo State. In line with USG strategic direction, 96 low yield facilities were transitioned in October 2015 to the respective state governments, leaving behind 113 facilities.

Under the LOCATE project, ECEWS  together with her partner Jhpeigo Corporation, an affiliate of John Hopkins University, is using their role as United State Government (USG) implementing partner to leverage and expand existing effort of government  and non-state partners for PMTCT. The project also explores cost-saving partnerships while engaging in periodic reviews and supporting states to generate additional resources for PMTCT response.

ECEWS is additionally working with Community Life Advancement Project – a community based organization, to promote a combination prevention approach, prioritizing youth with balanced gender-sensitive messages to address the identified barriers to prevention.  Messages and interventions are developed to target Most at Risk Population (MARP) e.g., young people especially out-of-school youth, the above-noted truck drivers, Sex Workers, MSM (Men having Sex with Men) and prison populations) and strategies focusing on abstinence and the delay of sexual debut (especially in minors and out-of-school youth), partner reduction, and being faithful as well as the distribution, correct and consistent use of condoms.

ECEWS is maximizing HIV Testing and Counseling (HTC) resources by targeting MARP (Most at Risk Population) in accordance with each state’s HIV epidemiology while strengthening Provider Initiated Testing and Counseling (PITCT) at health facilities, as an important strategy for reaching those at high risk of HIV infection, including TB patients and suspects and hospital inpatients.

In order to increase access to care and treatment including pediatrics, ECEWS is supporting the provision of ongoing health-facility and community/home-based services to optimize the quality of life for HIV-infected clients and their families, while supporting activities that decentralize services to the PHC level based on chronic care model. ECEWS is expanding access to quality antiretroviral treatment services and adherence as well as transfer necessary capacities and skills to state and site-level personnel for ensuring quality service provision through Clinical Systems Mentorship, regular clinical and laboratory evaluation and skills for prompt recognition of  treatment failure and switching of  patients as appropriate

ECEWS through the LOCATE project also supports, TB/HIV integration services, Orphans and Vulnerable Children, Laboratory Infrastructure and Strategic Information Management.

EXECUTIVE SUMMARY

Excellence Community Education Welfare Scheme (ECEWS) Local Capacity Enhancement (LOCATE) project is a 5 year comprehensive treatment, care  and support grant which commenced in June 2013 with program implementation starting from October 2013. ECEWS supported 211 entities comprising of 9secondary health facilities, 200primary health facilities and a community based organization (Community Life Advancement Program) and a Technical partner (JPHIEGO).These 211 entities supported services in 3senatorial zones of Ebonyi Central, Enugu west and Okigwe located in the three Nigerian South-Eastern States of Ebonyi, Enugu and Imo respectively; during this reporting period. The secondary health facilities were supported to provide comprehensives HIV services comprising of MTCT, HVCT, HVTB, HMBL, HMIN, HBHC, PDCS, HTXD, PDTX, HTXS, HLAB and HVSI. The primary health centers were also supported to provide PMTCT, HVCT and HVSI. ECEWS supported Community Based Organization in Enugu State to provide HVAB, HVOP and HKID services; while JHPIEGO was supported to provide Technical Assistance in area of PMTCT to all the other entities. All ECEWS sites were supported to provide Direct Service Delivery only during this reporting period.

 ECEWS LOCATE project, upon award of the CDC-RFA-GH12-1210, conducted various start-up activities including advocacy visits to all the relevant stakeholders in the targeted states (SAPCs, Permanent Secretaries in the state Ministry of Health, Directors of Public Health, State commissioners of Health, SACAs, LACAs, Community leaders etc.) to introduce the activities of LOCATE project, engage the subnational governments (states and local government areas) in the spirit of ownership that would guarantee sustainability at the end of the project. ECEWS also participated in a joint handover/takeover ceremony of inherited comprehensive sites and prevention of mother to child transmission (PMTCT) facilities from CCCRN as part of the CDC site transition process in Nigeria. Memorandum of Understanding (MoU) between ECEWS and the three States Ministries of Health were also signed along with that of sub grantees. However, delay in commencement of  program implementation of LOCATE project at site level due to the transition process as well as signing of the MoUs with State governments and sub-grantees; accounted for the poor performances in some program areas in FY14. This report entails an Annual Program Report for the period of October 01, 2013 through September 30, 2014 according to thematic units.

Locate Project FY14 Program Target/Achievement – OCT 2013-SEP 2014

INDICATOR LABEL Budget

Code

FY14

Target

Achievement Percentage Achievement
Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results) MTCT 45,892 73,657 161%
Number of pregnant women  who tested positive for HIV MTCT 750 622 83%
Number of HIV-positive pregnant women who received antiretroviral to reduce risk of mother-to-child-transmission (MTCT) during pregnancy and delivery. MTCT 622 575 92%
Number of infants who had a Virology HIV test within 12 months of birth during the reporting period MTCT 750 87 14%
Number of individuals who received testing and counseling (T&C) services for HIV and received their test results HVCT 181,164 225,965 125%
Number of active beneficiaries served by PEPFAR OVC programs for children and families affected by HIV/AIDS HKID 938 1500 160%
Number of HIV-positive adults and children receiving a minimum of one clinical service PDCS 15,458 5539 36%
Number of adults and children receiving antiretroviral therapy (ART) [current] HTXS

PDTX

10,306 2990 29%
Number of adults and children newly enrolled on antiretroviral therapy (ART) HTXS

PDTX

2,743 1237 45%
Number of HIV-positive patients who were screened for TB in HIV care or treatment setting HVTB 14,612 8443 58%

 

 

Prevention of Mother to Child Transmission (MTCT):

Goal 1: Strengthening primary prevention of HIV infection through activities such as expanding provider initiated counseling and testing programs linked with evidence based behavioral change and support programs to eliminate mother-to-child transmission

 

Strategic Objective1: To reach 45,892 pregnant women with HIV testing and counseling services; while ensuring that at least 90% receive their test results

Supported the provision of PMTCT HTC Services in Antenatal Clinic

ECEWS provided direct service delivery support (DSD) to health facilities providing PMTCT Services in FY14. Facility staff were mentored at the ANC units of supported facilities on HTC and couple counseling according to the current national guidelines. Point of service testing (POST) were established at the supported ANC units and RTKs were provided to ensure continuous provision of HTC services for both new ANC attendees and follow up attendees across the supported facilities. Relevant PMTCT service delivery registers were provided to the supported facilities and checked during regular site supervisory visits in order to identify/correct documentation gap.  All sites were provided with job aids on test to treat initiative. Quality assurance (QA) for HIV testing was carried out regularly including use of dry tube specimen (DTS) and linkage to external quality assurance (EQA) programs to ensure quality of testing services.  SOPs and job aids on the DTS quality control (QC) were provided with hands-on mentoring to HCWs on the appropriate use at all the PITC points.

Provided PMTCT Services to Clients during Labor and Delivery at the Supported Facilities

PMTCT services were integrated in all the supported comprehensive and PMTCT sites in Ebonyi, Enugu and Imo states. This involved establishment of HIV point of service testing (POST), supply of rapid test kits (RTKs), ARVs, Nevirapine dispersable tablets and PMTCT registers in labor and delivery rooms. LOCATE teams provided technical assistance to health care workers (HCWs) in the SDFs on the need to ensure all eligible pregnant women in the labour/delivery ward accessed HTC to prevent any missed opportunity. Routine commodities check to forestall stock out and and redistribution to avoid expirees were done at the labor/delivery point of service(POS) during the reporting period. DTS were provided to ensure continuous provision of quality HTC services at labor and delivery POS site.

Built the Capacity of Supported Health Care Workers to Deliver Quality PMTCT Services

During the implementation of the PMTCT services in FY 14, ECEWS observed gross knowledge gaps among the health care providers from the inherited transitioned sites from CCRN. These Knowledge gaps were addressed through “communities of Learning series” in form of Hands-on mentoring, Continuous Medical Education (CME) and clustered orientation mentoring (CLUSTROM) approach. Hands-on-mentoring and CMEs on quality documentation, provision of proper ARV prophylaxis to HIV positive pregnant women using triple regimen (TDF/3TC/EFV); instituting Test-to-Treat strategy for all pregnant women who test positive by ensuring that they get their ARV prophylaxis same day as well as proper medical waste disposal was provided to the staff of the supported facilities during this reporting period. Supported facility staff had their capacity built on meeting the need of all pregnant women that reported to the facility for PMTCT services. The staff had their capacity also built on adherence counseling, defaulter tracking, partner testing, male involvement and counseling for disclosure of HIV status to partners as a strategy for increased male involvement in PMTCT.

The capacity of the supported facilities on Laboratory/ Pharmaceutical care and supply chain management including management of RTKs, ARVs, LMIS, inventory control system, stock/pipeline tracking and monitoring, determination of QTO, stock status assessment, Spot Check were also enhanced.

Strengthened PMTCT/SRH integration

PMTCT services were integrated into existing Maternal Newborn and Child Health (MNCH) Services such that Provider Initiated Testing and Counseling (PITC) was established in Family Planning clinics in supported facilities. Two way referral systems/linkages between FP clinics and ART clinics were also maintained. LOCATE PMTCT team supported health education session on family planning in ANC/maternity in SDFs and also ensured condoms were provided to clients. The team ensured that clients accessing family planning were also offered HTC with effective referral system for those that tested positive for HIV. Relevant registers for documenting SRH/HIV integration were leveraged from the state government and delivered to the facilities as a means of strengthening linkages with the relevant government agencies.

 

Mobilized community to increase uptake of and support PMTCT services

ECEWS conducted advocacy visit to key stakeholders (SACA, LACA, State PMTCT focal persons, Community HIV Desk Officer, SMOE; and SMOH and community gatekeepers) in order to increase PMTCT service uptake in the supported states. This opened opportunity for demand creation for PMTCT services through community PMTCT outreaches. The strategic advocacies also was ECEWS plan for instituting collaborative partnership with the supported State  and Local governments which was needed for sustaining the PMTCT program especially at the community level.

        LOCATE 1LOCATE 2

Advocacy visit to Igwe of Ngwo- Uno, Udi LGA Enugu State

Conducted Community PMTCT HTC Outreaches

In order to increase access to PMTCT services in the supported communities, ECEWS LOCATE teams across the supported states identified community structures to facilitate community PMTCT approach which include community PMTCT outreaches, health care facility/TBA collaboration, and the use of male promoters in order to strengthen male involvement in PMTCT. Across the three states, LOCATE supported HCWs to conduct PMTCT outreach targeted at pregnant women, nursing mothers and their respective partners during the reporting period. This was done in conjunction with relevant government agencies like the SACA, LACA and Ward development Health committees (WDHC). ECEWS strategy was to initiate triple prophylaxis to all identified HIV positive pregnant women identified during PMTCT outreaches using the  STAT  (Same day Test And Treat) initiative and to link them to the nearest supported facilities through escort services and community volunteers.

LOCATE 3

Figure 1:The Okwuluoka of Ohia Awgu II flagging off community PMTCT outreach in Awgu 1

Supported Private Facilities, FBOs, and CBOs to Provide PMTCT HTC Services

ECEWS identified existing community PMTCT platforms at the outset of the program implementation at the supported States. Private hospitals and Faith-based Organizations with ANC and MNCH Services were identified, advocacy carried out to the management of these centers to commence   HTC for Pregnant women   and referral of HIV positive clients to the nearest LOCATE supported facilities. Technical assistance and supervisory support were provided to these entities to ensure the implementation of quality PMTCT services and compliance with the national guidelines in their MNCH (Maternal Newborn and Child Health) system during the reporting period. The SMOH of the supported States were integrally involved in the assessment and engagement of these private facilities as a way of ensuring sustainability at the end of LOCATE project.

 

Strengthened Collaboration with Traditional Birth Attendants (TBAs) for PMTCT HTC Service Delivery

At the outset of the project, ECEWS identified where the pregnant women in the community access ANC care and delivery; which were mainly at the facilities ran by community midwives and Traditional Birth attendants (TBAs). Some of these TBAs have some community health care workers especially the CHEWS/CHOs running them and were reached through the LOCATE supported heath facilities to provide PMTCT services. They were provided with hands-on mentoring on basic HIV prevention, infection control, safe motherhood, HIV counseling and testing information especially to pregnant women and their partners and for referral newly delivered mothers and their babies for follow up care during the reporting period. The key strategy for involving these TBAs was supporting and strengthening collaboration as well as escort/referral linkages with nearby SDFs. The ANC providers at the TBA sites were mentored specifically on “early warning signs” of pregnancy complication and prompt referral of such cases and that of all the HIV positive pregnant women presenting in labor to the nearest supported facilities for skilled birth delivery. They are also to refer all HIV positive mother baby/pair who delivered at their facilities to the nearest LOCATE supported PMTCT facility in order to provide ARV prophylaxis for the HEIs. The TBAs were also encouraged to ensure that all the pregnant women in their care were offered HIV screening during the course of ANC visits.

 The midyear review of the LOCATE program achievement showed less than 50% performance. This prompted the program to institute remedial plans designed to scale up the PMTCT HTC services through strategic outreaches; where the facilities were supported to conduct PMTCT specific outreaches with the communities. The sub grantees CCT and CBO (CLAP) were provided with technical assistance to specifically target communities in Enugu state with high HIV prevalence. Pregnant women were targeted during market days using trained facility staff and community volunteer testers; with identified HIV positive pregnant women referred to nearby LOCATE supported facilities for PMTCT services. The same day ARV prophylaxis were provided for willing identified HIV positive clients with proper and continuous adherence counselling in line with the LOCATE Test and Treat initiative. Follow up in the community through the facility health care providers and community volunteers to ensure completion of referral for other services in the facilities like access to CD4 and routine ANC registration and investigations to ensure retention in care. This yielded positive results that translated into meeting and exceeding the annual targets as shown in figure 1 &2 below:

 

Figure 2 Quarterly trend on PMTCT HTC uptake FY 14

As at September 30th 2014, a total of 73,657 pregnant women were offered screening for HIV (ANC, labor/delivery ward and community outreaches) which represent of 161% of the annual target. 206 were known positives at entry; while, 416 were new positives identified in FY14. Figures 1& 2 showed both the quarterly trends and annual performance in meeting the PMTCT targets.

Figure 3 Number of pregnant women with known HIV status (includes women who were tested for HIV and received their results) in FY14

 

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, sexually transmitted infections (STIs) and related opportunistic infections by improving STI management and initiating programs to provide anti-retroviral therapy (ART)

Strategic Objective2: To provide Specific PMTCT Interventions, including provision of triple Antiretroviral prophylaxis /Antiretroviral Therapy, Care and Support to 90% of identified HIV-positive pregnant women to reduce risk of Mother-to-child transmission of HIV

 

Built the Capacity of SDFs in the target communities to provide quality integrated PMTCT Services

LOCATE provided mentoring and supportive supervision to health care workers at the ANC units of supported CCT and saPMTCT sites on couple counseling, real time provision of ARV prophylaxis to identified HIV positive pregnant women as part of its test and treat strategy; according to the current national guidelines. Emphases were also placed on the routine antenatal care through health talks that focused on the safe motherhood initiative and also providing information on HIV/AIDS which included information on ARV prophylaxis, adverse drug reaction and infant feeding in the context of HIV. As part of the LOCATE PMTCT project HIV exposed Infant services, the five important events at 6 weeks postpartum were also stressed (discontinuation of Nevirapine suspension, where appropriate; initiation of co-trimoxazole preventive therapy; dried blood sample collection; immunization; and family planning) during ANC and post natal clinic.

All sites were provided with job aids on test and treat protocol. Hands-on-mentoring and CMEs on quality documentation, proper ARV prophylaxis to positive pregnant women using triple ARV regimen (TDF/3TC/EFV); instituting Test and Treat strategy for all pregnant women who test positive for HIV by ensuring that they get their ARV prophylaxis same day with proper and continuous adherence counselling; while ensuring that eligible clients were also placed on OI management. Supported facility staff had their capacity built on meeting the need of all pregnant women that reported to the facility for PMTCT services including screening for TB for all identified HIV positive pregnant women and appropriate referral for family planning services. Health education was also provided to the clients and the clients was also counselled on the importance of attending ANC, nutrition (maternal and child), PMTCT, including HTC, partner notification and disclosure. PMTCT clients that defaulted from the ANC clinics were followed up in the community, tracked back to care and were provided with ARV prophylaxis during the period under consideration. The capacity of the supported facilities on Laboratory/ Pharmaceutical care and supply chain management including management of RTKs, ARVs, LMIS, inventory control system, stock/pipeline tracking and monitoring, determination of QTO, stock status assessment, Spot Check were also enhanced.

Strengthened PMTCT Referral Systems

ECECWS supported the facilities to appoint Focal persons (FPs) whose work was to aid this process of linking the PMTCT stand-alone sites to the comprehensive site within their catchment area using the “Hub and Spoke Model”;. ECEWS supported the facilities in the process of sample log-in systems and also the enrolment of all identified HIV positive pregnant women eligible for treatment to the Hub comprehensive through “escort services” to reduce loss to follow up. ECEWS ensured that all the collected EID samples were transported from the facilities to the reference lab at Nnamdi Azikiwe Teaching hospital, Nnewi as well as ensuring that all the HIV exposed infants were enrolled in to care and those with DBS positive result were referred to the comprehensive service through escort services for early initiation of treatment in line with the current national guideline.

Provided PHDP package of care for all HIV-infected pregnant women

ECEWS built the capacity of the supported staff on proper adherence counseling, partner testing and counseling for disclosure of HIV status to partners to all identified HIV positive pregnant women as a strategy for increased male involvement in PMTCT. Adherence counselors were mentored in health facilities on provision of continuum of care to include counselling on positive living; family planning, especially dual method, and screening for sexually transmitted infections (STIs). Furthermore, real time documentation of PHDP services was strengthened. These services were provided to all HIV positive pregnant mother and their spouses accessing care at all the supported facilities. PMTCT clients that defaulted from the ANC clinics were followed up, tracked back to care and were provided with ARV prophylaxis during the period under consideration.

Ensured that all HIV exposed babies receive Nevirapine prophylaxis from birth

ECEWS provided technical support to SDFs to ensure all HEIs accessed NVP prophylaxis at birth or at other points of entry into the program according to the current national guideline. The team promoted baby friendly initiative through continuous infant feeding health education, counselling, and support at every visit along the whole continuum of PMTCT care and support. LOCATE ensured uninterrupted supply of drugs including ARV and CTX; provided Job Aids on NVP dosing, with hands-on mentoring for HCWs; and strengthened intra- and inter- facility linkages and referral of HEIs. PMTCT clients were educated on infant feeding in context of HIV and discouraged from mixed feeding as this will undermine the benefits of the Nevirapine prophylaxis.

 

Strengthened existing systems to ensure timely DBS sample collection for EID

ECEWS started EID services by focusing on mentoring the supported facility staff on proper method of collection, drying, packaging, storing and transportation of DBS samples to the PCR laboratory. This was done to ensure that valid samples are always collected by the health workers which will in turn translate to good samples that the reference labs could test. ECEWS worked out the modalities for sample transportation (Hub and Spoke model and Courier service) to the nearest reference lab as well as ensure that the results were promptly returned to the facilities. The facility staff were supported to collect DBS and these were sent to the PCR laboratory in Nnamdi Azikiwe University Teaching Hospital Nnewi. ECEWS ensured that supported staff applied proper method of collection, drying, packaging, storing and transportation of DBS samples to the PCR reference laboratory during this reporting period as part of its direct service delivery support (DSD).  ECEWS instituted quarterly monitoring of Specimen Referral System for DBS sample logging as a means of monitoring the DBS referral activities. Funds were made available to support the logistics for this sample referral system and DBS kits were supplied through the national supply chain management systems and distributed to sites. The major challenge experienced in the period under review is the nationwide unavailability of reagents for analysis at the PCR laboratories and the long turnaround time for EID test.

Ensured all HEIs with positive PCR test are promptly referred to Antiretroviral Treatment (ART) clinic

ECECWS supported the facilities to appoint Focal persons (FPs) whose work was to aid this process of linking the PMTCT stand-alone sites to the comprehensive site within their catchment area as well as ensuring that all the identified HIV positive infants were enrolled in to care. Through the DBS mentor approach, LOCATE maintained a consistent drive to ensure provision of quality EID services to all eligible infants born to HIV infected mothers. Systems were put in place to review the folders of the HEIs in the program to ascertain those without evidence of DBS, positive HEIs not on therapy and to track back defaulters. These systems were designed to ensure that all the HIV positive HEIs were promptly referred to ART clinic.  Retrospective Assessment of Early Infant Diagnosis of HIV (RAEID) approach was one of the system put in place to ensure that all HEIs who missed out on EID for whatever reason were identified through a chart audit, tracked and provided with the service The PMTCT team conducted RAEID in 7 supported CCT facilities and a saPMTCT across the three maintenance states. The review period was from October 2013 to August 2014 and folders of 140 exposed infants reviewed had a number of gaps. These include absence of evidence of DBS request/result; empty care cards; inappropriate client unique identification number (ID); high defaulter rate and absence of documented date of birth, among others. Feedback on findings was provided to focal persons and heads of facilities with hands-on mentoring on the determination of DBS collection due date, using phone and calendar provided to 14 facility staff. All affected folders were flagged with sticky notes and gaps addressed.

 

Established Strong communities and PMTCT sites linkages

In order to increase access to PMTCT services in the supported communities, ECEWS LOCATE teams made effort to identify community structures to facilitate LOCATE PMTCT community approach which include community PMTCT outreaches, health care facility/TBA collaboration, and the use of male promoters in order to strengthen male involvement in PMTCT. Across the three states, LOCATE supported HCWs to conduct PMTCT outreach targeted at pregnant women, nursing mothers and their respective partners during the reporting period. This was done in conjunction with relevant government agencies. ECEWS strategy was to initiate triple prophylaxis to all HIV positive women identified during PMTCT outreaches using the  STAT  (Same day Test And Treat) initiative and linked to the nearest supported facilities. HCWs across ECEWS supported sites continued to mobilize community members through existing structures (women groups, market associations, etc.), to encourage women of child bearing age, lactating mothers and pregnant women to access PMTC services. ECEWS also established mother-to mother support group meeting especially in all the 9 comprehensive sites and 2 high volume PHCs across the supported states. This was pertinent in order to improve and strengthen PMTCT client retention as well as reduce stigmatization, among other issues. Issues bothering on partner notification/disclosure, infant feeding, family planning, and the importance of follow up for mother-baby pair were discussed during these support group meetings. Other issues discussed included the importance of DBS collection for EID, breastfeeding practices, adherence to ARV and condom usage.

622 pregnant women including known positive were found to be reactive to HIV out of which 575 (92%) were placed on Prophylaxis.

A monthly trending of the PMTCT ARV prophylaxis achievement as shown in figure 4 above revealed that series of progressive monthly increase of access to PMTCT prophylaxis services was interrupted by downward trends in the months of November and December, 2013, March and April, 2014 as well as  June and September, 2014. The Period of October to December, 2013 was the transition period. This was the period ECEWS took over the sites from the CCCRN and also marked the point of seeking for memorandum of understanding with the supported State Ministries of Health and facilities; thus clinical activities were not pursued effectively. Other possible explanations would include the festive (Christmas and New Year Holiday) period that was characterized by large migration of people and reduction in hospital activities. The downward trends observed between March and April, 2014 was due to a prolonged industrial action embarked upon by health care workers for improved pay package, while that of the period of June and September, 2014 could be attributed wholly to phased winding down of community PMTCT activities especially the community outreaches occasioned by the introduction of the a new PEPFAR program strategic shift policy that stopped demand creation in the maintenance states that ECEWS supported in FY 14.

LOCATE 4Figure 6: PMTCT FP for MCH Awgu providing health talk to nursing and pregnant mothers

A total of 87 (66%) HEIs out of 131 born in FY14 at the supported sites had their virological test done within 12 months of birth; out of which all (100%) were commenced on Nevirapine (NVP) prophylaxis according to the national guideline. Within the reporting period, a total of ninety-eight (98) DBS cards were collected across the three states and logged at the PCR Laboratory in NAUTH. 19 EID Results were received by LOCATE team out of which 3 Positive EID results (2 from Imo and 1 from Enugu) where sent to the originating site for tracking and enrolment into the pediatrics ART, as well as into the child’s follow-up services. The challenge observed was the delay in returning DBS results from the reference lab which affected the ease of updating the results of the test in the EID register as well as non-disaggregation of the PMTCT data in national tool as it is in the MER.

 

Clustered rotational mentoring (CLUSTROM) – an Innovative PMTCT skill transfer Method

Clustered rotational mentoring (CLUSTROM) approach is part of LOCATE novel strategy of integrated approach to program implementation and optimizing the available resources used to update the knowledge of HCWs on current PMTCT practices and also for skills transfer. This led to the introduction of PMTCT Cluster Champions and DBS Mentor Strategy (DMS) to facilitate rapid skill transfer to HCWs in supported facilities. ECEWS was able to build capacity of 55 Health care providers on PMTCT and EID through CLUSTROM and Continuing Medical Education (CME) meetings; of which a total of 40 HCWs are now certified Cluster Champions and DBS mentors. Furthermore, the platform was used to demonstrate dried blood sample collection, processing, packaging, storage and transportation for early infant diagnosis (EID) of HIV exposed infant (HEI), commodity distribution, including laboratory consumables, addressing the issue of quality documentation with practical demonstration using PMTCT registers, mentoring on the use of DTS for internal quality control and opportunity to encourage HCWs to link up with existing community structures to serve as a focal point of advocacy for the PMTCT awareness and demand creation program in the communities.

ECEWS also introduced PMTCT – DBS tracker tool- a novel system designed to track HEIs right from when the HIV positive woman comes to register in the ANC till the delivery day. This helped to encourage hospital delivery and to monitor the HEI until 6weeks of age for DBS sample collection. DBS focal person were mentored on the importance of early infant diagnosis as against ‘’Late infant diagnosis’’ and funds were provided to support DBS sample logging from PHCs to CCT sites.

LOCATE 5Figure 8:Facilitation on current PMTCT practices during CLUSTROM DH Awgu

  Challenges and Mitigating measures

S/N Challenges Mitigating Measures
1 Difficult terrains especially in Ebonyi State Conducted structured mentoring visits to affected facilities
2 Transfer out of trained HCWs job in some LGAs. Advocacy and dialogue with the SMOH to retain trained Staff
3 Long turnaround time for DBS Continued working with the PCR reference lab to reduce the turnaround time
 

4

Poor attitudes of HCWs to work Continuous mentoring to address these issues

 

 

HVAB: Abstinence and Be Faithful

Goal 1: Strengthening primary prevention of HIV infection through activities such as expanding provider initiated counseling and testing programs linked with evidence based behavioral change and support programs to eliminate mother-to-child transmission

 

Strategic Objective: To reach individuals in the general population with individual and/or small group interventions that are based on evidence and/or meet minimum standards

Conducted Strategic Advocacy for AB intervention for ISY

The Provision of AB Prevention services targeting In School Youths (ISY) in the Project was implemented only in Enugu State during this reporting period. An indigenous CBO- Community Life Advancement Project (CLAP) was engaged to provide AB messaging. Letters of introduction were sent to Ministry of Education (MOE), selected school principals and LACA Coordinators introducing CLAP (Community Life Advancement Project) as the Community based organization working with ECEWS. Advocacy visits were paid to Enugu State Ministry of Education and Principals of 12 schools in Udi LGA to solicit their support in the Abstinence and Be Faithful program.

 

Built Capacity of Peer Educators in the Selected Schools

Following the selection of students for training by CLAP, Onsite in-school youth training was done for 58 peer educators across 10 school based sites in Udi Local Government.  Using a home grown in-school manual adapted from the NYSC Adolescent Reproductive Health and HIV/AIDS manual, the students were trained as HIV peer educators to pass accurate and factual information to their peers and transferred acquired skills that will cause a positive behavioral change. Topics covered during the training included concept of Peer Education (Role of Peer educators); why youths were targeted for HIV prevention; overview of Adolescent Sexual and Reproductive Health; anatomy and physiology of male and female reproductive systems; introduction to Adolescence and Puberty; menstruation and conception; Sexually Transmitted Infections; HIV and AIDS; adolescent risky behavior (Sexual Violence/Rape); Teenage Pregnancy and Abortion; Relationship; Life Building Skills (Values and Value Clarification, Building self-esteem, Goal setting, Decision Making Skill, Communication skill, Assertiveness, Time management skill, Refusal skill, Negotiation skill); Alcohol and drug abuse; Abstinence; Referral and follow-up.

At the end of the training, there was an increased knowledge evidenced by the pre – post analysis (75% increase). Also, ECEWS trained class room teachers to serves as Family Life and HIV Education (FLHE) as a means of having guardians in the school that would help to sustain the achieved behavior change among the ISYs.

Provided AB Interventions targeted at In-School Youth

ECEWS adopted a mix of interventions comprising of Behavioral, Biomedical and Structural interventions; based on the National Prevention Plan (NPP) 2010 – 2012 to target In-School Youth in Enugu State.  ECEWS implemented behavioral intervention at two levels- interpersonal/peer and community. Interpersonal communication and peer education were employed at individual level interventions; community awareness and dialogue were deployed at community level intervention. 52 trained peer educators held  cohort  sessions  in group of using an  home grown in-school manual adapted from the NYSC Adolescent Reproductive Health and  HIV/AIDS manual to provide AB messaging; emphasizing on reproductive health, basic facts on HIV/AIDS and  assertiveness. BCC materials were also distributed across the 12 school sites to reinforce prevention messages. Furthermore, the trained Family Life and HIV Education (FLHE) teachers using classroom delivery approach mainstreamed HIV prevention messaging in the subjects such as Home Economics, Civic Education, Physical Health Education, integrated science and biology.  Thus, ensuring a saturation of prevention messaging that will contribute to a behavior change.

Biomedical intervention included referral of peers for HIV counseling and testing at the nearby HFs, while referrals were made to the trained school counsellors for STI counselling. Advocacy visits to Enugu State Ministry of Education and Principals of 12 schools in Udi LGA to solicit their support in the Abstinence and Be Faithful program as well as formation of Abstinence Clubs in supported secondary schools were parts of the structural interventions


Data management for AB services

ECEWS utilized the Prevention Intervention Tracking Tool (PITT) to monitor and evaluate program progress against targets and ensured continuous quality improvement (CQI) in order to address the issue of double counting. 3,709 in-school youth disaggregated into 10-14 Male= 812; 15-19 Male=710; 20- 49 Male=0; 10-14 Female=847; 15-19 Female=1340; 20-49 Female=0; were provided with prevention intervention in accordance with the current national guidelines. The major challenge encountered on documentation during the reporting period, is the limitation in the national tool to adequately capture the age disaggregation in the new MER indicators.

 

Success Stories: Mainstreaming AB messaging into regular school curriculum

 The engagement of the relevant stakeholders in Enugu State ministry of Health and Education as well as the Principals of the school where the AB messages were being implemented resulted in the identification of Family Life and HIV Education (FLHE) teachers who were able to mainstream HIV prevention messaging in the regular school curriculum of studies.  This strategy ensured that the AB messaging gets to all the students in the supported schools which is expected to contribute significantly to observable behavior change among the youth.

HVOP: Other Sexual Prevention

Goal 1: Strengthening primary prevention of HIV infection through activities such as expanding provider initiated counseling and testing programs linked with evidence based behavioral change and support programs to eliminate mother-to-child transmission

 

Strategic Objective: To reach Most at Risk Persons (MARPs) with individual and/or small group evidence-based interventions that meet national and international standard

Advocacy for Community Support in Providing Other Prevention Program

ECEWS engaged a CBO Community Life Advancement Project (CLAP) to implement activities in this thematic area in Enugu State during this reporting period. Advocacy visits were paid to brothel owners, bar men and chairladies by ECEWS and CLAP to solicit for their support in the other prevention (OP) program. As a result of the elicited support, open community meetings were carried out in two brothels in Udi and Oji River, Enugu State. ECEWS worked with CLAP in providing a mix intervention that bordered on behavioral change, biomedical and structural interventions; targeting female sex workers and their clients. By the end of the open community meeting which had over 40 FSWs and their clients present, 25 Female Sex Workers  (FSWs) were selected for a training on Peer education to enable them reach out to their peers with information on HIV Prevention.

Conducted HIV Prevention Training for Key population- (FSW)

A three day training on condom and other prevention was done for 25 selected FSW influencers in Oji and Udi L.G.A facilitated by CLAP. The objective of the training was to build the capacities of 25 FSW as peer educators on HIV prevention and safer sex negotiation skills. An adapted PEP module was used as the training curriculum and the topics discussed included; Peer Education Strategy (Definition, roles of peer educators, qualities of peer educators and why peer education strategies are used in delivering HIV/AIDS messages and skills); HIV/AIDS (Meaning, progression, stages of the infection, modes of transmission, indirect causes or fuelling factors, impacts of HIV/AIDS, Stigma and Discrimination, HCT, How to prevent sexual and other modes of transmissions, Referrals); STIs (Meaning, types, symptoms in men and women, relationship to HIV/AIDS, Referral, treatment); Life Building Skills (Decision making, Goal setting, values and value clarifications, Negotiation skills, refusal skills, Assertiveness. Relating Life Skills to HIV/AIDS); Condom messages and Demonstration (Uses of Condom, Reliability of condoms, Correct and consistent use of condoms); Alcohol and Drug Abuse (Meaning of Alcohol and Drug Abuse, Why people take drug and alcohol, consequences of drug and alcohol abuse).

Provided Behavioral Intervention Services to FSWs and their Clients

As result of skills acquired by the trained FSW Peer Educators, they are able to reach their cohorts with condom messaging including condom distribution.  The trained FSW Peer Educators were supported to provide condoms to their peers and clients; teaching them the correct and consistent methods of using he commodity.  Community outreaches were also carried out to reach a wider audience with HIV prevention messages. Over 800 flyers were distributed to reinforce prevention messaging and more than 784 pieces of condom were given to the FWS, their peers and their clients during the FY 14 reporting period.

 

Provided Biomedical Intervention Services to FSWs and their Clients

The prevention services carried out within this reporting period included HIV counseling and testing for the key population (FSWs).  FSW and their male Clients were provided with HIV counselling and testing services. The positive clients were referred for care and support services at the nearest ECEWS supported comprehensive HIV treatment health facility.

 

Provided Structural Intervention Services to FSWs and their Clients

As a result of support from FSW gatekeepers, condom outlets were established in Udi and Oji River, Enugu State. Free condom were given to the established outlets for easy access by FSW and their Clients. Advocacy visits were also paid to the brothel owners to institutionalized “NO CONDOM, NO SHOW POLICY” as an unwritten policy in the brothels. Also Brothel Owners Association (BOA) quarterly meeting was inaugurated and were supported to hold during the reporting period. The Brothel Owners Association (BOA) served as the project advisory committee; as a means of ensuring sustainability. 

Data management for HVOP services:

ECEWS utilized the Prevention Intervention Tracking Tool (PITT) to monitor and evaluate program progress against targets and ensure continuous quality improvement (CQI) in order to address the issue of double counting. Other M&E tools used by ECEWS prevention team include printed attendance sheets, Sexual prevention activity reports, and information, education and communication (IEC) distribution forms and sheets which capture activities, location and facilitators involved. 3708 female sex workers were provided with prevention intervention in accordance with the national guidelines. This represents 70% of the FY14 Target. The annual target was not met due to delay in signing MoU with the supported state which lead to late engagement of the CBO that provided these services. The major challenge encountered on documentation during the reporting period is the limitation in the national tool to adequately capture the age disaggregation in the new MER indicators.

 

Challenges/ Mitigating Measures:

S/N Challenges Mitigating Measures
1 Difficulty with meeting clients of FSWs. CBO adopted new strategies of meeting with clients through mainstreaming their activities at night.
2 High mobility of the trained FSWs Peer Educators Expand the pool of trained FSWs Peer Educators to ensure worthy replacement for the departed colleagues

HMBL: Safe Blood for Transfusion

Goal 3:  Strengthening the capacity of the country’s health system to manage national HIV/AIDS programs by expanding HIV/STI/TB surveillance programs and strengthening laboratory support for surveillance, diagnosis, treatment, disease monitoring and HIV screening for blood safety

Strategic Objective: To ensure appropriate screening of blood for Transfusion Transmissible Infections (TTIs)

ECEWS Lab team in FY14 mentored the supported facility staff on standard blood banking and safe blood practices; encouraging voluntary blood donations and the exchange of unit of blood for already EIA screened Blood through the National blood transfusion service (NBTS); hospital linkage program while discouraging the use of paid donors and blood touting. ECEWS LOCATE team also paid advocacy visits to the state ministry of health sensitizing the leadership on rational use of blood in the hospitals; the advantages of NBTS hospital linkage for sourcing safe EIA screened blood for transfusion and the responsibilities of each stakeholder in the NBTS hospital linkage program. The Enugu LOCATE team facilitated the signing of MoU between NBTS and the State Ministry of Health prior to activation of the hospital-NBTS linkage program at ECEWS supported facilities in Enugu for program ownership and sustainability. The team also worked with NBTS zonal offices in Enugu and Imo state to link two ECEWS supported faith based hospitals; Rural Improvement Mission Hospital, Ikwo in Ebonyi state and Our Lady of Mercy Hospital, Obowo in Imo state to NBTS-hospital linkage program for unrestricted access to safe EIA screened blood units in exchange for facility bled unscreened blood units.

The teams in the supported State (Enugu, Imo and Ebonyi) partnered NBTS in commemorating the 2014 world blood donor day; created awareness on safe blood and the for voluntary blood donation. Through the hospital-NBTS linkage program, 29 pints of blood were collected by the ECEWS supported comprehensive facilities in FY14.

 

Challenges and Mitigating Measures

The challenges however encountered include; lack of adequate manpower for effective blood banking system, decayed infrastructure and lack of functional blood bank refrigerators, lack of constant power and water supply to the blood banks, relative far distance between the facilities and the nearest NBTS Centre and the negative attitude of personnel which encourages blood touting for monetary gains. These challenges form the basis for stakeholders’ engagement by the LOCATE team with the view of resolving the issues and encourage an efficient blood banking system where safe EIA screened blood can be sourced for transfusion purposes.

HMIN: Injection Safety and Health Waste Management

Goal 3:  Strengthening the capacity of the country’s health system to manage national HIV/AIDS programs by expanding HIV/STI/TB surveillance programs and strengthening laboratory support for surveillance, diagnosis, treatment, disease monitoring and HIV screening for blood safety.

Strategic Objective: To build the capacity of health care providers in blood and injection safety

The focus of ECEWS LOCATE teams in FY14 was to intensify continuous mentoring and support effort for facility staff on proper health waste collection and segregation using color-coded bin liner. The facilities were encouraged to at least use dug pit to practice burn and burying of waste according to national health waste management guideline. The dug pits in-use at the various sites were also inspected during the monitoring visits within the period. Personal Protective Equipment (PPE) were provided and replenished at regular intervals for the personnel working in the laboratories and the various POSTs in the PHCs and comprehensive sites. Mentoring on proper use and disposal of PPE was also given to the personnel in the three states. HCWs were mentored on safe injection practices and safety boxes were supplied to support the practice of disposing used sharps. HCWs were also mentored on the need to promptly dispose the sharp containers when they are ¾ full; using the burn and bury approach. HCWs were also mentored on the use and importance of post exposure prophylaxis in case of occupational accident. The PEP messaging was also reinforced during routine facility health talks and also using regular phone calls to PEP focal persons in the supported facilities. LOCATE mentored facility staff on the use spill kits & eye wash stations, injection safety, risk assessment and designation of biosafety level for all comprehensive sites as well as segregation and disposal of waste collected into the different color coded bins using dug pit. Personal protection equipment were provided to all testing points. Advocacy is on-going to SMOH and Local Government Council Health offices to ensure that pits were fenced to prevent unauthorized access by scavengers.

A total of 203 supported sites comprising of 9 secondary and 194 primary sites in Enugu, Ebonyi and Imo state were supported with color coded bin liner for waste segregation. The team mentored 135 HCWs on proper HCWM especially on proper use and safe disposal of skin piercing devices (needles) using sharp containers.   85 HCWs were mentored on how to ensure that individuals who have spills, needle stick injuries, abrasive injuries or exposure to blood or blood products managed the exposure according to the PEP SOP and report the incident to their heads or PEP focal persons within 72 hours.

4 females and 2 males were provided with Post Exposure Prophylaxis (PEP) ARV prophylaxis for non-occupational exposure (Rape/assault) while an occupational exposures was promptly managed following the PEP guideline and SOP for documentation and administration of ARV prophylaxis in FY14.

HBHC: Adult Care and Support

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, sexually transmitted infections (STIs) and related opportunistic infections by improving STI management; enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART)

Strategic Objective: To  support the provision of PHDP services namely condoms, sexually transmitted infection (STI) management, family planning, adherence counseling in targeted health facilities and community support groups for People Living with HIV/AIDS

Provided Positive Health Dignity Prevention (PHDP) services to supported Clients

LOCATE teams in the supported states provided PHDP services to all clients in the program. PHDP services were provided as part of other supportive services required for optimal management of HIV infected clients. These services included the provision of laboratory services at the comprehensive sites as well as by linkage for the PHCs; integration of Family Planning FP services, provision of condoms and psychosocial/spiritual support; management of Sexually Transmitted Infections (STIs) and adherence Counselling in the supported health facilities and community support groups for PLWH. At the comprehensive sites, the focal facility staff in charge of the adherence unit were taken through mentoring sessions on PHDP; including explanations on what PHDP service represents, its importance to positive living, and the need to report services provided to clients. They were also mentored on the use of the PHDP registers supplied to these comprehensive sites and were enjoined to ensure clients receive PHDP service at every clinic days.

Provided Treatment adherence support

During the reporting period, LOCATE care and support team worked hard to ensure that all the clients identified as being HIV positive were enrolled in to care. This is done in order pursue an effective support for bi-directional referrals and linkages between facility and home/community based services for HIV-infected persons, thus, ensuring early identification of HIV-infected persons and initiating them on ART, particularly the HIV positive pregnant women. Adherence counselors were mentored in health facilities on provision of continuum of care to include counselling on positive living; family planning, especially dual method, and screening for sexually transmitted infections (STIs).

This was done to build the capacities of the Health Care workers in the supported facilities to provide quality counseling and adherence services that would optimize response to ART, opportunistic infection diagnosis, management and OI commodity logistics. The adherence tools and SOP were provided to facilities that did not have them and the facility staff mentored on how to complete the register. Clients were offered counselling services including couples, as well as  adherence counseling and were encouraged to bring their children to the facilities for testing as part of the family oriented approach to HIV management adopted by ECEWS in the LOCATE project implementation. The reporting period also witnessed mentoring activities on the usage of reporting tools, like PHDP register, Referral register, Adherence counseling register, monthly palliative care performance reporting tools.

Instituted client tracking in the community (ART, PMTCT) as a means of Client retention

The care and support team worked strategically to ensure tracking of clients identified as being HIV positive for enrolment into HIV care and treatment program as well as tracking defaulters. LOCATE teams set up retention strategies including buddy-pairing of support group members and involvement of support group members in client tracking. During the month under review, the LOCATE project team supported treatment and adherence support group meeting in Comprehensive Care and Treatment (CCT) sites.  CCTs were supported to be able to track defaulted clients through phone calls and home visits following the supported treatment and adherence support group meeting.

Conducted Support Group Activities

LOCATE project supported facility-based support groups in FY 14. For the reporting period, the support groups domiciled in the 9comprehensive facilities across the supported states met across the three maintenance states. The meetings were geared towards strengthening support groups in the facilities as a means of greater involvement of PLHIV in service delivery, empowering support group to provide psychosocial and spiritual support to members, and also make them to actively support the facility in client tracking and community home based-care. Discussions at these meetings cut across adherence and adequate diet. Members were charged to strictly keep to their drugs time and endeavor to adhere to treatment and other health care appointments. Psychosocial support was provided for support group members during this month’s meetings. The support group meeting also offered opportunity for experience sharing on the importance of disclosure, drug adherence and Basic facts on HIV as well as the identification of treatment support partners to ensure drug adherence among members. Mother to mother support groups geared towards ensuring retention in care of mother baby pair as well as improve partner disclosure and reduce stigma and discrimination, were also established in 9comprehensive and 2high volume PMTCT sites during this reporting period.

 

Provided Mentoring and integrated supportive supervision for healthcare workers

Mentoring and site supervision visits were done across ECEWS/LOCATE sites by state thematic leads to ensure qualitative service delivery. Supported staff were mentored on the use of co-trimoxazole and INH for prophylaxis. ECEWS procured and distributed lab consumables (Laboratory reagents, DBS packs, DTS samples and colored bin liners for health care waste management) in the supported comprehensive sites and PHCs to support laboratory services for all the enrolled clients in FY14. Systems were set up to monitor the utilization and maintenance of these procured commodities to avoid wastages. ECEWS provided ARVS, OI drugs and INH to the supported facilities which were dispensed to eligible clients during this reporting period. Under the LOCATE project national reporting tools and structure was adopted for routine patient management and monitoring purposes. State, LGA M&E and supported facility M&E officers were mentored on national data collection tools. Data validation exercise, on site mentoring and supervision were carried out across board. Emphasis were paid to adherence to HTC/PMTCT SOPs and proper documentation, real time documentation of referrals and follow up for feedback from the comprehensive facility. The importance of community advocacy and mobilization to the community leaders in other to enhance client in take to their facility thereby increasing their target on community outreaches in the community were stressed. At the PHCs, Officers In-Charge (OICs) were encouraged to involve their subordinate in the activities and programs of ECEWS, to enable them act in their absence. Mentoring was provided to supported PHC staff on how to document on the PMTCT ARV register and other registers, DBS sample collection, packaging and storage. The importance of couple counseling was also emphasized and strengthened across supported facilities. Action points and area of technical assistance was documented in the facility mentoring book.

Conducted Continuous Quality Improvement (CQI) Activities

In the reporting period chart review to identify clients who were due for repeat CD4, those without baseline CD4 and those eligible but on ARVs was carried out in the facilities across the ECEWS supported states. The exercises were done by first sorting out the folders of clients who missed their appointments dates in order to track them back to care and treatment. The capacity of ECEWS staff was built on CQI process as part of the plan to set up CQI team at the supported comprehensive sites. ECEWS teams continued to ensure HIV counseling and testing with same day result and prophylaxis at ANC; use of DTS to ensure the quality of HIV testing, CD4 calendars to monitor the quality of care given to the clients and performance feed back to the supported facilities. Triaging of clients to reduce waiting time as well as implementing same day appointment system for mother-baby pair was strengthened during this reporting period. The State M&E teams initiated clients chart review using the CAT tool in the comprehensive sites. Retrospective assessment of EID (RAEID) was conducted on folders of HEIs at the Supported SDFs during this reporting period.

 Challenges/ Mitigation Measures:

S/N Challenges Mitigating Measure
1 High level of stigmatization and discrimination in Okigwe senatorial zone Worked with the support groups to reduce stigma through setting up community support group

 

5539 adults and 343 children received a minimum of one clinical care during the FY14. This represents 36% of the annual target. This target was not met because of delay in starting the project year. Lack of finer age/sex disaggregation in the national data capturing tools, incomplete documentation in clients’ folders as well as lack of functional EMR at supported sites were among the challenges encountered during data reporting

 

HTXS: Adult Treatment

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART).

Strategic Objective: Initiate and retain eligible adults and children on ART

LOCATE project pursued regular mentoring and supervisory visits to supported facilities to strengthen delivery of quality and sustainable ART services in FY14. The Clinicians were mentored on diligent filling of the ART care card and the PMM forms in the folders newly enrolled clients. Technical assistance was also provided to the HCWs on counseling the client (adherence, nutrition, positive living etc.) indications for IPT, routine nutritional assessment using client’s weight and BMI as well as linkages between maternity and ART clinic to ensure that all PMTCT clients were properly linked to the ART clinic for enrolment. Eligible clients were placed on ART while those due for refill were served. Systems were set up to monitor newly enrolled clients for adverse drug reactions as well as to ensure that intra-facility linkages between TB, PMTCT and ART units and establishment of POST at the GOPD and medical wards were also strengthened.  Eligible clients were placed on ART while those already on therapy had their refills. PMM tools were deployed to the SDPs in the COCTs. Triaging of clients to reduce waiting time as well as implementing same day appointment system for mother-baby pair was strengthened during this reporting period. LOCATE employed on site mentoring and CMEs to build the capacity of the supported facility staff on the CQI processes. The implementation challenges of the CQI activities included limited funds to procure out-sourced trainings.  A total of 49 clients (Adults= 16 males, 31 females; Pediatric =1 male, 1 female) were identified to have failed first line drugs and were placed on a second line regimen. This represents approximately 2% of all the clients currently on therapy in the program. LOCATE’s strategy for early identification of adverse drug reaction (ADR) included provision of the ADR forms to the supported facilities, mentoring of the supported clinical staff on ADR and  client empowerment through drug use education as part of the pre-treatment/follow-up adherence counselling. LOCATE reports all identified ADR cases to the NAFDAC pharmaco-vigilance system. National ART tools were used across supported comprehensive sites.

Current on ART was calculated using the PEPFAR guideline by subtracting number of clients on ART lost to follow up, plus lost to death, transferred out and stopped treatment from number that had ever been initiated on treatment in a given supported comprehensive site. Pregnant women on treatment are reported as a subset of the adult female category initiated on treatment. Double counting was streamlined as the facility staff had good understanding of the indicators and were mentored on real time documentation. 2820 adults and 170 pediatrics (Males =883; Females = 2107) are currently on ART. 2990 adults and pediatrics were known to be alive and treatment 12 months after initiation of therapy.

 

PDCS: Peadiatric Care and Support

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART).

Strategic Objective: To provide HIV care including TB screening to adult and children living with HIV

In the period under review, LOCATE project teams continued to strengthen POST at the pediatric ward as a means of ensuring that all the children sick enough to be admitted to the hospital were offered HTC. This is also to support the integration of HTC in all pediatric service delivery points.

This ensured that all children, sick enough to be admitted into the supported hospitals, were offered HTC services on an opt-out basis. Facility staff were mentored on the use of the genealogy form to track children of positive clients for testing and provided routine testing of children of positive adults during outreach services in order to increase pediatric uptake. Point of Service Testing (POST) was established at the pediatric wards and clinicians were mentored on TB screening for children using TB symptom check list (TBSCL) as well as placing eligible clients on co-trimoxazole preventive therapy using the CME platform. Pediatric clients and care givers were also provided with care and support services that included Adherence counseling, Psychosocial support, Immunization services, Nutritional counseling and provision of Birth certificate to the infants in the VC program. Pediatric clients were followed up for repeat CD4 test and defaulters were tracked. Eligible clients were placed on co-trimoxazole prophylaxis. HCWs were mentored on documentation using child follow up register and clinicians were sensitized on the need to ensure all positive children 5 years or less are initiated on ART while older ones are constantly assessed for eligibility. National tools were deployed across all sites to aid in collecting data and validation of clients on pediatric care. This was  aimed  at  establishing the number of clients  lost to follow up (LTFU), lost to death, transferred out and those that stopped treatment from those that had ever been initiated on treatment in a given supported comprehensive site. The emphasis is to track and return back the clients that had defaulted/LTFU. Pediatric clients have benefitted from LOCATE supported home based care program including home visits by trained facility staff and vulnerable children kid’s club activities in the community.

LOCATE continued to support the GON in increasing the available pool of skilled man-power for the provision of pediatric HIV services through the process of mentoring and Continuing Medical Education(CME) program at the supported facilities.

PDTX: Paediatric Treatment

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART)

 

Strategic Objective: Initiate and retain eligible adults and children on ART

ECEWS continued to support hands on mentoring for clinicians at supported comprehensive sites to ensure that identified eligible pediatric clients were commenced on treatment in FY14. LOCATE conducted weekly mentoring and supervisory visits to supported facilities in order to strengthen delivery of quality and sustainable ART services. Technical assistance (TA) was provided to the supported facility staff on proper filling of the client initial clinical evaluation form and assessment of clients with TB symptom check list at each visit to identify children eligible for IPT, routine nutritional assessment of all exposed infants and infected children using MUAC, HC and weight as well as linkages between maternity and ART clinic to ensure that all HEIs are properly linked to the ART clinic for enrolment. The use of PHDP register by adherence officers and the need to always look out for ADR for clients on ART were also emphasized.  Intra-facility linkages between pediatric wards, TB, PMTCT and ART units and establishment of POST at the MNCH and immunization clinics are also strengthened. Pediatric testing was prioritized in the out-patient units and outreaches. All these were aimed at increasing peadiatric enrolment. The EID results were monitored closely to ensure early initiation of HIV positive children on therapy. Emphasis was also placed on proper enrolment of clients, repeat CD4 analysis for pediatric clients on Care in order to identify those that will transit to treatment, ensuring all HIV positive children 5years and below were initiated on ART Chart reviews were used to monitor the clients on therapy in order to identify treatment failures early. The supported facility staff were mentored on the clinical and immunological changes that could suggest treatment failure and offer solutions including adherence reviews, opportunistic infection reviews as well as change of therapy. A total of 2 pediatric clients (Male =1, Female =1) were identified to have failed first line drugs and were placed second line regimen.  A total of 95 pediatric clients (41% of the annual target) were newly initiated on therapy within the reporting period.

 

HTXD: Antiretroviral Drugs

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART)

 

Strategic Objective: To provide by the end of FY15 period antiretroviral treatment in line with current  national guidelines to adults and children with advanced HIV disease with at least 90% of adults and children with HIV still on treatment 12 months after initiation of antiretroviral therapy

The LOCATE logistics systems is in adherence to National and International standards practice FIFO (First in First Out) and FEFO (First Expire First Out) to ensure the no stock out rule was applied in FY14.  Pharmacy focal persons were mentored on the proper documentation of LMIS tools in ARV and INH documentation. To prevent stock out of commodities, redistribution of RTK and ARV’s took place to enable the SDF continue their services. Other activities by the thematic unit included retrieval, validation and submission of ARVs and INH CRRIRFs. The provision of Isoniazid Preventive Therapy for TB prevention in HIV/AIDS clients was fully implemented across ECEWS supported ART sites in the state and consumption reports of the drug at the supported ART sites was generated and submitted promptly. Logistic team also carried out collation of bimonthly unified LMIS stock report from all ECEWS supported site and submitted the combined report, requisition, issue and receipt forms (CRRIRF), Patient Per Regimen (PPR) for all ECEWS PMTCT/ART sites on time. Stock out of commodities is monitored using monthly consumption data and replenishment timelines of commodities. Stock outs are reported as represented in submitted CRRIRFS and documented with regards to replenishment timelines. This is collated and cumulatively derived per year (as required). This helps in tracking of the number of emergency order notes present from all supported site and the reasons for the order; to enable LOCATE implement corrective action for improvement. LOCATE adhered strictly to reporting timelines to ensure that there is no stock outs in all its supported facilities. LOCATE also routinely monitors the degree of completeness of its report by using triangulation of data derived from the Last Mile Distribution provided by SCMS, facility level delivery notes and consumption data from CRRIRFS.

 

HVTB: TB/HIV Collaboration

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART).

Strategic Objective: To provide HIV care including TB screening to adult and children living with HIV

Increasing case detection of TB

With the aim of universal access of TB/HIV collaborative services for PLHIVs, ECEWS team provided Technical Assistance on case detection of TB by strengthening TB case finding within health facilities through application of revised TB symptoms checklist distributed in all Physician consulting rooms and TB-DOTs units in ECEWS supported facilities. Furthermore, clinicians across the comprehensive SDFs were mentored on the use of the TB screening checklist, frequency of screening (at every visit for all clients, adult, exposed and infected client including all HIV positive pregnant women), and documentation on the ART care cards. ECEWS intensified the effort to scale up the use of GeneXpert diagnostic services through effective linkages. The GeneXpert sites close to ECEWS supported facilities were identified, ECEWS supported DOTs stand-alone sites mapped and linked to the comprehensive sites for TB microscopy services and the comprehensive sites linked to the GeneXpert centers. The supported facility staff were also mentored on community TB screening as part of integrated services during community outreaches. TB suspects obtained from the community TB screening were referred for Sputum AFB and GeneXpert testing.

Reducing new cases of TB in PLHIV

ECEWS set up strategies to ensure that all HIV positive clients were screened for TB at each clinic visit.  This was done to support early identification and treatment of TB among PLHIVs as a proactive measure for reducing transmission of TB especially at the clinic settings. Across all supported comprehensive SDFs, all facility clinicians have been sensitized on identifying and prescribing INH through the IPT strategies for all eligible clients and IPT eligibility criteria job aids were deployed in all consulting rooms. The IPT was provided to the comprehensive sites and clinicians charged to ensure that PLHIV were adequately provided with them following.

POST were created at DOTs unit of supported facilities and RTKs provided in order to ensure that clients on anti TB and other TB services are offered HTC at the DOTs site at no cost. Appropriate registers for documentations were provided and mentorship on their usage provided to the DOTs officers across the supported facilities. ECEWS ensured availability of CPT for HIV positive clients co-infected with TB and presently, all supported comprehensive site do not have stock out of CTX. TBIC activities at the facility level were strengthened by facilitating setting up of TBIC committees, development of TBIC policies/plans and dedicated Focal person for cough triage in all 9 supported comprehensive facilities. LOCATE also supported the TBIC communities to hold regular quarterly meetings and evolve strategies to address identified gaps in TBIC.

Improving treatment outcomes for TB in target community

ECEWS strengthened linkages between DOTS clinics in the community and nearest ART sites as well as GeneXpert centers in order to ensure that all TB clients were provided with qualitative services. Referral and linkages were strengthening via the established referral loop and ensuring that all referred clients completed the referral processes. DOTs sites in supported communities have been empowered to provide HTC services.

ECEWS continued to work with the state TB officer and the TBL officers in the supported LGAs, to chart way forward on how to revitalize the TB units across all ECEWS supported sites and creating a ‘one stop shop’ approach in the DOTs sites.

Reducing stigma and increasing support for TB clients in the communities

Advocacy visits were paid to state TBLCO to advocate for better TB/HIV Collaboration in the supported communities and to solicit for TB/HIV collaborative activities within this reporting period. ECEWS advocated for more TB treatment awareness in the supported communities as a means of reducing the stigma people infected with TB face. Such TB awareness creation activities would be integral part of any community mobilization activities in the supported communities

HVTB Data Management

Data for TB screening were documented in the TB symptom checklist and clients’ ART Care cards provided at the supported facilities. These data were updated in the TB screening register during each visit by the M&E officers. Clients were counted once during their last documented visit to avoid double counting. TBIC activities at the facility level were strengthened at the supported facilities. LOCATE through the support of the State TB control program in Imo and Ebonyi was able to activate 2 DOTS site at Our Lady of Mercy Hospital, Obowo, Imo State and MCH/CHC Okposhi, Ebonyi in FY 14. Point of service testing (POST) was established at the DOTs unit and RTKs provided in FY14. A total of 8443 PLHIV were screened for TB symptoms at the last clinical visit during the reporting period.

 

HVCT: HIV Counseling and Testing

Goal 1: Strengthening primary prevention of HIV infection through activities such as expanding provider initiated counseling and testing programs linked with evidence based behavioral change and support programs to eliminate mother-to-child transmission

 

Strategic Objective: To support the provision of quality HTC services to MARPs, couples, other vulnerable populations and the general population across health facilities 

Conducted Mobile/Community based outreaches to increase HTC uptake

ECEWS conducted strategic community mapping to identify other areas for provision of HIV services during this reporting period. The essence of this activity was to identify service delivery points within the supported community as well as key beneficiaries including MARPS. Community mobilization activity was carried out to stimulate and scale up activities for HTC and PMTCT across the three states; in a view to refer positive clients to ECEWS LOCATE supported sites. The reporting period was characterized by series of Mobile HIV Testing and Counseling outreaches conducted in conjunction with the respective State SACA. ECEWS also tagged on other government program including the World AIDS Day activities as well as the Maternal and Child Health Week to reach out to community for support towards the delivery of PMTCT/HTC services during this reporting period. MHTC Volunteers were identified in the supported communities. These volunteers were mentored on documentation of results from outreaches across the supported LGAs as well as referral of HIV positive clients, particularly pregnant women, identified during the community outreaches. The MHTC Volunteers created awareness about HTC and PMTCT across various communities where they provide the services. Market women were also sensitized on HTC especially for pregnant women using the local dialects.

 

Integrated HTC services at DOTs sites

LOCATE provide support to strengthen HTC services at the DOTs service delivery points. This involved strategic advocacy to the managements of the supported facilities to provide both space and HCWs for the integration processes. The officers-in-charge of the DOTs sites were provided with hands-on training on HTC and documentations as well as RTKs for the service delivery. Advocacy visits were paid to PHC coordinators especially in Imo and Enugu state to get their buy-in the HTC integration at the DOTs sites.

 

Integrated HTC services at Family Planning clinics

In order to support SRH/HIV integration, LOCATE prevention team worked with the family planning clinics to integrate HTC services. Point of Service (POS) for HTC were established at the family planning clinic and Staff mentored to offer family planning services to mothers seeking family planning services as well as during immunization days in the clinics.

 

Strengthened HTC services at the supported Health facilities

HCT services were provided through a two pronged approach -provider initiated and client initiated HIV Counseling and testing services across the supported health facilities and one CBO.  Hands on mentoring on nationally approved serial testing algorithm (determine, unigold and stat-pak), protocols and SOPs was provided to for Health workers via cluster meeting and mentoring visits. Pedal bins were also provided to the supported sites to ensure appropriate disposal of medical waste generated. Laboratory consumables, relevant PMM tools, condoms and Information Education and Communication (IEC) materials also were distributed to the facilities.  HIV RTKs were supplied to the supported sites by SCMS based on bi-monthly LMIS information.

Furthermore, dried tube specimens (DTS) were distributed to HFs as controls to ensure qualitative testing. The reporting period also featured the mentoring of the supported facilities on conducting effective referral network in order to increase in the number of persons counselled and tested especially on PMTCT. Issues bordering on offering STI screening especially testing pregnant women for syphilis were addressed during the mentoring sessions.

Strengthened Community structures for HTC services

LOCATE continued to intensify efforts towards mobilizing community structures to strengthen demand creation for PMTCT and HTC services.  For instance, advocacy visit was paid to the village Head of Ngwo Uno, Udi Local Government Area of Enugu State, to solicit his support in increasing demand for PMTCT services. Current effort is geared towards extending PMTCT service to the TBAs and private hospitals within the supported communities. ECEWS teams identified TBAs in the communities and were able to successfully link the identified TBAs to ECEWS supported sites within their communities.

 

Assured Quality of HIV Testing

Quality assurance (QA) for HIV testing was carried out regularly using dry tube specimen (DTS) and External Quality Assurance (EQA) programs. DTS specimens were used for preparation of Proficiency Test (PT) panels and Quality Control (QC) materials across supported facilities in Ebonyi, Enugu and Imo states. SOPs, Serial testing algorithm, and Job aids on using DTS for PT and QC were provided with hands-on mentoring to HCWs on their appropriate use at all the testing points.

Assured Quality of HTC Data

The supported facilities were provided with National HTC tools including the client intake forms, HTC registers and HTC monthly summary forms. HTC data were transcribed from the client intake form into the HTC registers by the facility M&E officers. Monthly summary forms were generated from the registers and shared with the IP and Local Government M&E officers.

A monthly trending of the HTC achievement as shown in figure 7 below showed flattened trends in the months preceding June, 2014. Strategies to address this situation was proffered during a midyear strategic program review of ECEWS LOCATE Project activity in June, 2014. ECEWS implemented focused community HTC outreach to scale up testing activities in order to meet the FY 14 targets. Community outreach activities were targeted towards higher educational institution, market women association and special occasion like the popular Women August meeting in the three maintenance states. The facility PITC strategies were also strengthened to ensure that every person seeking health care at the supported facilities had access to HIV Testing and counselling. These strategies were wholly pursued in the months of June to August, 2014. Figure 7 below also showed downward trending of the HTC achievement immediately after August, 2014. This is attributed to winding down of community HTC outreaches occasioned by the introduction of the new PEPFAR Strategic program policy shift that stopped demand creation in the maintenance states that ECEWS supported in FY 14.

 

Challenges/ Mitigating measures:

S/N Challenges Mitigating Measures
1 Low client intake in some facilities Conducted community outreaches.
2 Poor attitude of facility staff Conducted advocacy and sensitization visits to SMOH

 

 

HKID: Orphans and Vulnerable Children

Goal 1: Strengthening primary prevention of HIV infection through activities such as expanding provider initiated counseling and testing programs linked with evidence based behavioral change and support programs to eliminate mother-to-child transmission

Built Capacity of the CBOs-Community Life Advancement Program (CLAP) in target communities to provide quality services to vulnerable children

ECEWS engaged an indigenous CBO- Community Life Advancement Program (CLAP) during the reporting to provide Vulnerable Children services. VC services was implemented in Enugu State during the period under review; targeting all HEI, PABA and HIV infected children. LOCATE team in Enugu supported this CBO to deliver these services as well as build the capacity of other community organizations including community volunteers to respond appropriately the needs of the vulnerable child in their community.

Identified and Train Family Resource Volunteers (FRVs) in Aninri, Enugu State to support services to Vulnerable Children

ECEWS strategy for the care of VCs in the community included the mobilization and support for community-led initiatives as an integral part of sustainable VC program. In line with this strategy, 5 Family Resource Volunteers (FRVs) in Aninri LGA, Enugu State were trained on vulnerable household identification, assessment and enrolment of VC; at the onset of the program. The Family Resources Volunteers (FRVs) were made to understand the relationship between HIV/AIDS and development and how it affects the growth of children in their community. CLAP team taught the volunteers how to assess a household using House Hold Vulnerability Index (HHVI) tool as well as how to know the exact needs of a child using the Child Status index (CSI) forms. The Family Resources Volunteers (FRVs) were also taught how to use the vulnerable child enrollment card.

The training included a field visit which the FRVs the opportunities to practice what they were taught under the close supervision of CLAP and ECEWS staff. The average pre-test score was 28% while the average post test score was 72% showing an average increase in knowledge of 44%.

Goal 2: Prevention of secondary infection with HIV and other opportunistic infections among HIV infected people through improvement in the care and treatment of HIV/AIDS, enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for concurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART)

Strategic Objective: To reach Most at Risk Persons (MARPs) with individual and/or small group evidence-based interventions that meet national and international standard

Supported the Vulnerable children to utilize services available within their communities

The trained FRVs started enrollment of vulnerable households while CLAP team supervises the enrollment process so as to make sure that the assessment and enrolment of the VC were in accordance with the national standards. Kids’ club meetings were started and supported during the reporting period.  The meetings were part of the strategy to actively engage vulnerable children in the community. During the Kids’ club meetings, children of 0-12 years were taught on assertiveness, good personal hygiene while those of 13-17 years discussed life building skills like refusal skills and negotiation skills.

FRVs in conjunction with CLAP and ECEWS team conducted home visits to the enrolled VC during the period under review. The visits served to observed the children at the home and encourage the caregivers to support the children to have a balanced life. The team emphasized the importance of placing age appropriate farm work on the children to the caregivers. All the enrolled VCs were provided with psychosocial support at the point of enrollment in form of counselling and the caregivers were encouraged to create time for their children. The children enrolled into the VC program during this reporting period were provided with free HIV testing and also reached with health education. Referral linkages were established between the VCs in the community and Cottage Hospital, Aninri- an ECEWS supported health facility site in Aninri LGA, Enugu State. The caregivers and older VC were also given health education and tips on how to regularly check the VC and understand common changes in their body systems; the importance of seeking medical assistance early as well as keeping good personal and environmental hygiene.

 

Supported Caregivers’ Meeting

CLAP project team and FRVs conducted Caregivers meeting at different location in the supported communities. The first Care giver meeting took place at Central Primary School Uhueze in Nenwe, Aninri LGA, Enugu State. The meetings provided the opportunity for the care givers to understand the objectives of the VC program in their community, enlightening the caregivers on the implications of child vulnerability as to households as well as nutrition education for the caregivers especially on the identification of locally available nutritious food materials in their communities (most of them were farmers), preparation and preservation food materials, as well as infant and young child feeding (IYCF). ECEWS supported CLAP to form and organize an orientation meeting for 10 CDC members of Nenwe community of Aninri LGA on Child Protection and Development of Community Action Plan.

Assured Quality of VC Data Management

Relevant data capturing tool were provided to the CBO and the CBO was also supported to report the VC services using the national NOMIS system for M&E. ECEWS enrolled 1500 Vulnerable Children in FY14. This represents 160% of the annual target. ECEWS through the supported CBO enrolled the VCs based on the great need in the community before the release of the annual target.

 

HLAB: Laboratory Services

Goal 3:  Strengthening the capacity of the country’s health system to manage national HIV/AIDS programs by expanding HIV/STI/TB surveillance programs and strengthening laboratory support for surveillance, diagnosis, treatment, disease monitoring and HIV screening for blood safety                                                                                                                                                                                                                                        

Strategic Objective: To build the capacity of health care providers in laboratory quality related activities and support Laboratory Quality Management System (LQMS) towards National/International Accreditation

Although none of the ECEWS supported laboratories has been given any accreditation by any recognized national, regional or international regulatory bodies. However, ECEWS have conducted baseline quality management system audits in the 9 supported comprehensive sites across the three states using the WHO-AFRO Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklist in FY14. The LOCATE laboratory team reviewed and commenced the implementation of some recommendations meant to correct identified deficiencies in the quality management system being implemented at the 9 supported facilities in FY14. The state ministry of health, state hospitals management board and facility staff were all sensitized on quality management system implementation across all ECEWS supported comprehensive facilities in the three states. The LOCATE laboratory team developed and deployed some quality forms, job aids, process flowcharts and standard operating procedure for use across the supported sites in the three states in FY14.

Within the reporting period, the LOCATE teams in Enugu, Ebonyi and Imo states intensified mentoring on workstation arrangement, cleaning and de-cluttering of laboratory space, regular update of Equipment service records, daily preventive maintenance chart, inventory control records and temperature charts for various temperature dependent appliances and the laboratory’s ambient in all the comprehensive sites and the PHCs. The teams also reiterated good, timely and appropriate documentation of laboratory activities across the supported laboratories and sites.

Implemented IQC/IQA Using Dried Tube Specimen (DTS)

ECEWS followed a strict adherence to the use of DTS as internal quality control for routine HIV testing and as internal quality assessment samples in the IQA Program for quality assurance and improvement through inter-facility comparison in FY14. HIV serology internal quality assessment (IQA) program for all HCT POSTs in supported PHCs, institution of daily internal quality control (IQC) across all platforms in all the supported sites, periodic review of assay records were all strategies set up by the ECEWS lab team to ensure quality of service delivery. Within the reporting period, DTS were distributed to all supported sites for use as IQC samples during their routine HIV testing. Also documentations were monitored to ensure that DTS analyzed were documented on the HIV testing worksheets.

Instituted Robust Equipment Management System

The LOCATE team monitor equipment performance across the supported sites through the weekly equipment status updates provided by the teams in the three states. Within the reporting period, preventive maintenance was carried out on the Lab equipment installed in the supported comprehensive Hospital, as part of the strategies to assure the quality of results from the machines, improve the equipment performance and sustain uninterrupted service delivery in the facilities. ECEWS team also mentored supported staff of at the comprehensive sites on good clinical laboratory practice, effective daily/routine equipment maintenance to ensure optimal functioning of all laboratory equipment.

Supported Good Laboratory Information Management System

Within the month, the LOCATE team in Enugu conducted a remote site mentoring for supported sites where the HCWs were mentored on proper documentation on source documents such as inventory control cards, bin cards, daily worksheets etc. via text messaging and phone calls. The outcomes and findings of the remote site mentoring were followed up during the actual site visits and identified challenges addressed. This process of remote supervision facilitated a prompt compilation and reporting of lab CRRIRF by all ECEWS supported facilities. The LOCATE team also conducted onsite mentoring session for supported sites on proper documentation of LMIS tools which enhanced the sites’ inventory control system.

Maintained Proper Laboratory Supply Chain Management System

ECEWS focused on reactivation and sustenance of high quality laboratory services across supported sites in FY14. This involved the implementation of several quality assurance procedures like establishment of effective supply logistics/inventory control system following first expiry first out ”FEFO” principle in the utilization of commodities in all supported sites and mentoring/strengthening of the “hub and spoke” sample logging system for EID and CD4 tests in place across supported PMTCT sites. Within the reporting period, LOCATE team across the three states ensured commodities are available to keep services uninterrupted in all supported sites through direct site supply, redistribution and leveraging from where stocks are in excess. Laboratory consumables and reagents were promptly distributed to the comprehensive sites and the PMTCT sites and laboratory commodities were replenished across the POSTs in the supported sites and the distribution of RTKs by SCMS to all supported sites in the states were closely monitored to avoid inappropriate supplies.

Supported Early Infant Diagnosis (EID) Linkage Program

The LOCATE team across the three states intensify the tracking of HEIs using the DBS tracking tool to identify and ensure unrestricted access EID services. Mentoring of DBS collectors and distribution of DBS bundles kits to support uninterrupted service delivery to all HEIs in all supported facilities under LOCATE. Supported facility staff were identified and trained as DBS mentors through the process of on-the-job training strategy. The capacity of the DBS mentors were built on how to collect blood from the vein using vacutainer pressure technique and collection of DBS from HIV exposed infants.

 

Provided Strategic Monitoring and Supervision as a means of Laboratory Sustainability Plan.

The laboratory team intensified supportive supervision, program monitoring and mentoring visit while leveraging on every opportunities like cluster meetings and use of communication technology to mentor the facility staff on relevant areas of laboratory services. LOCATE supported sites were mentored to document lab services using the nationally approved Government of Nigeria (GoN) tools. LACA M/E Officers were supported by ECEWS using the State M/E cluster meetings platform to work closely with their respective facility lab staff to ensure proper documentation on all tools including those of logistics. This strategy ensures that data especially from the supported lab s in the state were accurately reported. FY 14 also featured a joint monitoring visit by CDC, the State MoH, ENSACA and ECEWS in Enugu state. ECEWS supported the State ministry of Health and ENSACA to ensure that identified gaps during the monitoring visit were properly addressed in the spirit of sustainability and the state ownership of the program activities. The team also distributed the 3-types of color coded bin liners, sharp containers/safety boxes to all supported sites, observed practice and inspected dug waste disposing pits for compliance with national guideline. ECEWS supported 9 comprehensive sites with capacity to perform clinical laboratory test. The challenges however were low staff capacity, staff attrition, decayed infrastructure and insufficient power supply.

 

HVSI: Strategic Information

Goal4: Strengthening the capacity of health care personnel in managing, developing, validating and/or evaluating public health programs to inform, improve and target appropriate interventions, as related to the prevention, care and treatment of HIV/AIDS, TB and opportunistic infections

Strategic Objective1: To build the capacity of health care workers in HIV/AIDS management

Provided Mentoring and integrated supportive supervision for healthcare workers

Mentoring and integrated supervisory activities provided by ECEWS SI team in FY 14 focused on addressing identified critical gaps in knowledge among the medical record staff of the supported facilities in the three states. The team identified focal M&E persons & Data Entry Clerks in the supported comprehensive sites and provided mentoring on data collation, validation and on the monthly summary forms to Strategic information unit Staff across the supported States. The team conducted data check in registers, addressed observed poor entries on the registers, distributed needed PMM tools to supported facilities (PMTCT HTC Register, PMTCT ARV Register, PMTCT ARV + Maternal, HTC Register and Child Follow up register) so as to support in the effective documentation of services provided at those sites during the routine mentoring visits. The mentoring exercise offered the opportunity of identifying data management gaps and best possible ways of addressing them offered to the supported sites. Facility staff were also mentored on the usage of EMR software.

 

 

Reactivated the Electronic Medical Record Systems at the Comprehensive Sites

The SI unit reactivated the Medical Record unit of the comprehensive sites that stopped updating on the EMR due to outage of power. Data was updated and a mechanism was set up by the unit for tracking the functionality of the electronic record system on weekly basis. The facilities were supported to organize the medical record filling systems in order to enhance quality data storage and retrieval. The SI unit collected and documented longitudinal and latitudinal markers of geo coordinates of supported sites during this reporting period.

Conducted CD4 Cohort/Client Retention Analysis

One of the ways to measure program outcome is through quarterly assessment of ART client’s performance measured by CD4 cohort data analysis report. Information of clients initiated at a given time is analyzed make inferences about clients retention in the program, adherence and repeat CD4 count improvement as a result the drug they are given. The SI unit designed and disseminated to the states the tools to effective carry out this activity. The CD4 cohort analysis conducted in FY 14 showed that the clients were not maximally utilizing the CD4 retesting services. This galvanized into setting up strategies including the use of CD4 testing calendars as reminder tool to ensure that clients were aware of the time for their repeat CD4 test.

Provided Patient Monitoring and Management Tools

The SI unit provided data capturing and patient monitoring and management tools to all the supported facilities in LOCATE implementation States. Supported facility staff were mentored on the use of these tool. Routine mentoring and supervisory visits to the supported facilities offered the unique opportunity to ascertain the use of utilization of these tools and the level of accurate documentations using these tool. The SI unit is constantly monitored the existing patient’s management and monitoring tools across all supported thematic areas to ensure they met the data capturing requirement of the program.

This was done as a means of ensuring that LOCATE data collection tools were in line with the national reporting tools and the tools in supported sites adequately cover all needful indices for reporting and patient management. The exercise also ensured that obsolete tools were not reprinted or deployed to the facilities. Required tools were also distributed across supported sites.

Strategic Objective 2: To provide technical assistance and support to Nigerian governmental and/or non-governmental organizations to build capacity and ensure sustainability within these organizations to manage quality comprehensive HIV service programs within their geographic areas of program implementation.

Provided Technical Support to the Supported CBO- Community Life Advancement Program (CLAP)

CLAP is a community based organization engaged by ECEWS to carry out prevention and community activities under the LOCATE project. SI unit maintained regular mentoring and supervisory support to the CBO to ensure proper documentation, data storage and data retrieval. The CBO was provided with program forms, registers and data entry spreadsheet by the SI unit.

Participated in TWG meetings at the State and National Levels

As part of the ‘three one’ obligation to Government of Nigeria, the SI unit participated in the State M&E TWG organized by the SACA of the supported States. LOCATE SI unit participated in the CDC/IP quarterly performance meeting, National DQA in Enugu as well as cluster meetings organized by various thematic technical working group meetings. The SI unit took the lead at all joint Site supervision and mentorship visits that took place in the supported states in FY 14.

Conducted Monthly Data Collection and Reporting

LOCATE M&E team adopted a new approach to successfully verify and collect quality data across the states. This system was instituted in collaboration with the LACA M&E Officers to jointly visit the sites, verify documented data, mentor facility staff and collect activity data. Furthermore, monthly cluster meetings were organized on LGA basis across supported States where facility staff from each of the PHCs brought their data capturing tools; HTC Register, ANC HTC Register, General ANC Register, PMTCT ARV Register, Partners Register, and Child Follow up register for validation of collected data. The meeting also serve as avenue to distribute data capturing tools and mentoring on the use of the PMM tools and opportunity to mentor LG M&E Officers on data capturing, documentation and reporting. To key into the PEPFAR database, the team entered the facility services covering all the supported sites in the three supported States into the DHIS platform.  The unit collated, verified, cleaned and entered service statistics in the reporting spreadsheet for all thematic area in 209 supported facilities across three states.

Provided Data Feedback/Review to the supported Health Facilities

Periodic data feedback to LOCATE program staff and facility patient management team in supported facilities was a major activity for FY 14; thus ensuring that data used for informed decision making at both programmatic and facility levels. The SI unit provided feedback on program performance in ECEWS offices and during PMT and CME meetings that hold once every month in supported entities.

During the meetings, the update on the facility target versus monthly achievement in the month were shared and provided platform for discussing on improving quality of service and increase in the facility monthly achievements.