Common use of Stewardship Clause in Contracts

Stewardship. During the review period, XXXXXX trained LGA officers and other state level stakeholders on financial management, budgeting, and costing of HIV/AIDS services. Participants were drawn from the 14 scale up LGAs and included the State Agencies for the Control of AIDS (AKSACA), State AIDS and STI Control Programs (SASCP), and executive members of the scale up LGAs. A total of 63 (46M, 17F) participants attended the training. XXXXXX continued to provide support to the GoN through participation and provision of technical assistance at task team and national level meetings. This quarter, XXXXXX participated in the National Quality Improvement Task Team (NQITT) meeting convened by the Federal Ministry of Health-led National Alliance for Health Systems Strengthening (FMoH/NAHSS). The meeting, held on January 19, 2016 in Abuja, discussed NigeriaQual (NigQual) Round 3 findings and plans for the Round 4 data collection exercise. As a follow on to this, SIDHAS facilitated a meeting with NAHSS/Bitsage to discuss data exchange between the LAMIS and NigQual software. A key output from the meeting was the need to review criteria for selecting ART, Pediatric and PMTCT client evaluation, the need for Bitsage to make NigQual a multi-user platform, and a retest of NigQual data exchange version 2.7. SIDHAS teams also participated in a meeting of Implementing Partners (IPs) organized by USAID for all its supported OVC partners on February 26, 2016 in Abuja. At this meeting, new developments in OVC programing were discussed to aid FY17 planning. Other participants at the meeting were MSH, ARFH—Local OVC Partners Initiative in Nigeria (LOPIN) project, WEWE, HIFASS, Save the Children—STEER project, and Catholic Relief Services—SMILE project. The SIDHAS team also participated in meetings at Federal Ministry of Women Affairs and Social Development (FMWASD) to discuss data issues and the need for more holistic reporting from all states. Similarly, XXXXXX participated at a two-day technical meeting of experts on girl child development and capacity building towards ending child marriage in Nigeria. The meeting took place at the Bayelsa House in Abuja from March 10 – 11, 2016. XXXXXX actively participated in and contributed to the National TB program planning activities towards commemoration of the 2016 World TB day. This year’s event was themed ‘Unite to End TB’ and held on March 24, 2016. The team also participated at zonal TB and TB/HIV review meetings, national TB/HIV working group meetings, and the international assessment of TB laboratories. As part of efforts towards engagement of public and private organizations to support project implementation, SIDHAS received drug donations in support of the community ART initiative being implemented across the 14 scale up LGAs. Organizations and individuals contributing included the outgone Chair of the Association of Community Pharmacists (ACPN), Edo State; Biofem Pharmaceuticals, Abuja; CHANMed Pharmaceutical Company Limited, Jos; XXXX Pharmaceuticals, Kano; Akwa Ibom State government through the SMOH; Pharmaceutical Society of Nigeria (PSN), Akwa Ibom State Chapter; and VIXA Pharmaceuticals, Akwa Ibom State. XXXXXX also engaged with the PSN president at a strategic meeting involving other pharmacists this quarter, with an aim to get buy-in of the umbrella body towards the involvement of pharmacists in HIV/AIDS service delivery for more sustainable outcomes. The meeting had in attendance 20 pharmacists (10M, 10F) drawn from hospital, community, industry and academic technical groups of the PSN. The PSN president appreciated USAID support through the SIDHAS project, and expressed continued commitment of Country Director HUPACE with PSN President at the meeting the association in contributing to improved health of Nigerians. A meeting of the essential drugs committee considered the inclusion of ARV drugs in the essential drug list (EDL) for secondary and tertiary health facilities. Efforts are still ongoing to advocate for the inclusion of PMTCT drugs in EDL for PHCs in Nigeria through a formal application by NACA. Advocacy visits to Directors of Pharmacy services at SMoH and Hospitals Management Board to improve on pharmacy human resources and pharmacy systems finally yielded results with more states such as Adamawa, Akwa Ibom, Kano and Xxxxxx gradually taking over the funding and leadership of performance review meetings. XXXXXX participated in the international lab monitoring mission sponsored by USAID-Washington and the Global Lab Initiative (GLI) of the WHO-Geneva from March 14 – 18, 2016. It was a TB- focused laboratory assessment mission to Nigeria which took place across six SIDHAS supported sites—University College Teaching Hospital (UCTH) Calabar, Xx. Xxxxxxxx Xxxxxxx Memorial Hospital (DLHMH) Calabar, Nigeria Institute of Management Research (NIMR) Lagos, General Hospital (GH) Lagos, University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, and PHC Rumuigbo Port Harcourt. The goal was to identify bottlenecks in TB case finding in Nigeria despite the huge investment by XxX and partners. At the end of the assessment, the team debriefed the Minister of Health and other stakeholders on the outcome of the visit. Findings from the assessment are expected to shape the roadmap for future funding by USG on TB program in Nigeria. State Level Progress This section of the report is presented in three categories—priority states, sustained response states, and north east states where project implementation is challenged by insecurity. Priority States Akwa Ibom Indicator Baseline Data FY 2016 Annual Cumulative Actual Quarterly Status – FY 20[16] Annual Performance Achieved to Date (in %) Year Value Annual Cumulative Planned target Q1 Q2 HTC_TST (DSD) FY15 396,014 304,572 441,942 171,668 270,274 145% TX_CURR FY15 22,823 34,158 24,803 25,873 24,803 73% TX_NEW FY15 12,873 18,657 6,660 3,116 3,544 36% PMTCT_STAT (Num) FY15 64,831 50,270 29,887 14,126 15,761 59% OVC_SERV FY15 21,344 10,000 11,729 4,464 7,265 117% The Akwa Ibom State team continued to sustain access to comprehensive HIV/AIDS services in the five scale up LGAs (Ikot Ekpene, Okobo, Oron, Uruan, and Uyo) through the delivery of free community health services and ART outreaches. This was facilitated through house-to-house HTS activities which reached 66,705 households. The Nigeria Police Area Command in Ikot Ekpene was one of the HTS beneficiaries, including 230 police officers and patrons of the ‘mammy market’. The state government and PSN also supported the outreaches with over-the-counter Police Command receiving SIDHAS cART Team drugs. These efforts contributed to increased access to essential health services in the priority LGAs. SIDHAS teams carried out quality improvement initiatives during the reporting quarter at supported facilities with focus on client retention. The teams carried out HIV cohort analyses and client folder audits to investigate factors responsible for poor retention at the different stages of services in the ART program. Folder audits were conducted for clients in the cohort initiated on ART within October – December 2014, whose final status at the end of a 12-month treatment period was either dead, stopped treatment or lost to follow up. Folders of 94 clients (34M, 60F) were reviewed across Ewang PHC, University of Uyo Medical Centre, University of Uyo Teaching Hospital, and the Infectious Disease Hospital, Akwa Ibom State. At General Hospital Ikono, one pre-ART client was initiated on ART while six clients, whose CD4 showed consistent decrease in value, were listed for re-evaluation for possible immunologic failure. Findings across board are expected to inform improvement strategies in HIV treatment programming. The SIDHAS team facilitated dialogue sessions for community leaders in the scale up LGAs to address HIV services for vulnerable children. The community dialogues played a key role in buy- in of the communities to care and support programs for PLHIV and vulnerable children. Other key activities that took place during the dialogue sessions included community mapping for OVC enrollment and referrals for health services, provision of shelter, food and nutrition, educational materials, and birth registrations to identified OVC. Community volunteers were identified by community leaders to support CBO led activities at the grassroots level. Community volunteers, supported by SIDHAS CBOs—SHERO and WOCLIF, conducted household vulnerability assessments to identify the most vulnerable households. Following the assessments, 11 caregivers were selected and trained in line with their preferred skill areas. Three of the caregivers were given startup materials for soap making; two others received a grinding machine each, one of which was a PLHIV blinded as a side effect of ART. Four caregivers received 80 bunches of palm fruits for oil processing; another one received a bag of crayfish as start up for trading, and one more caregiver received a bag of rice and two bags of cassava flour (gari) as startup for food stuff trading. A caregiver displaying her start up materials The SIDHAS team carried out a series of capacity building events for healthcare workers and government officials as part of efforts to sustain quality of service delivery and improved outcomes. Sixty-seven (29M, 38F) laboratory scientists across 57 comprehensive health facilities participated in a quality improvement meeting focused on ensuring laboratory best practices. The laboratory focal persons committed to ensure efficient and functional systems for sample referrals, CD4 sample analyses, results dispatch, and 100% commodity documentation and reporting rate. Select healthcare workers and CBOs also benefitted from an orientation this quarter. The orientation focused on strategies for strengthening referral and client tracking systems between facilities and communities. The exercise is expected to improve the generation of defaulters’ list and home visits by the facilities and CBOs respectively. This is expected to contribute to the long term outcome of improved client retention in care. The SIDHAS team intensified efforts towards the improvement of TB/HIV collaboration across supported facilities and communities. To this end, 30 (17M, 13F) community pharmacists were trained on determination of Isoniazid hydrazide (INH) eligibility, screening, initiation, and documentation for accurate kitting of INH. This quarter also, XXXXXX collaborated with the state government to facilitate the Integrated Health Data Management (IHDMT) meeting as well as the second semester 2015 review of health and non-health data. The data review forum was useful in providing stakeholders the opportunity to validate state-wide program data, and to disseminate information on current state level data for policy decision making processes. The validated data was presented at the national zonal data review meeting and was included into the National database for improved country level decision making. It is expected to feed into the 2015 Global AIDS Response Progress Report (GARPR). Similarly, SIDHAS in conjunction with the state government and KNCV, the USAID lead partner for TB program, facilitated a joint TB outreach program to commemorate the 2016 World TB Day. The event, which took place on March 24, 2016 in Ikot Ekpene LGA, had the theme “Find TB, Treat TB, Work together to end TB”. The event provided the opportunity for awareness creation on TB among the general population, and to collect sputum samples for analyses. Health talks, road walks, and media sensitizations were other activities featured during the day. The state team also collaborated with SASCP and the Health Finance and Governance (HFG) project to reactivate moribund TWGs (ART/Treatment, resource mobilization, and pharmacy and logistics) in the state. This is a demonstration of the state government’s commitment to sustain donor supported HIV/AIDS programs. XXXXXX supported the TWG members in reviewing the terms of reference and assigning responsibilities. The members were also sensitized on the WHO guidelines for monitoring clients and improving retention in care in the state. The State Government also demonstrated commitment to SAPC Addressing Stakeholders at the ART TWG sustainability of the SIDHAS project by funding the printing of 7,000 inventory control cards and 3,000 bin cards to aid effective inventory management. The Pharmacy and Logistics TWG took full responsibility of the process and presented the finalized documents to relevant stakeholders for immediate use. Furthermore, the Chief Medical Director of the University of Uyo Teaching Hospital (UUTH) facilitated the procurement and installation of a 165KVA generator for the facility PCR laboratory. This will address the challenge of service disruption at the laboratory which result from epileptic power supply.

Stewardship. The third key result area of SIDHAS is geared towards promoting government ownership and stewardship of project interventions. Activities by the SIDHAS team are in relation to stakeholder engagement at all levels to disseminate relevant project information, Donor strategic direction, and buy-in of relevant stakeholders. At the FY16 governance and leadership training of the SMT by XXXXXX, the leadership of the SMT signed a communique with several recommendations. One such recommendation was the need for an appeal to relevant state governments, through the national council of health (NCH), for release of funds to health and HIV services. This quarter, SIDHAS supported eight states (Jigawa, Kano, Anambra, Rivers, Akwa Ibom, Cross River, Yobe, and Bayelsa) to develop memos for presentation to the NCH in the coming quarter. XXXXXX will collaborate with the SMT to facilitate execution of the memos backed by funds allocation to health and the HIV/AIDS response. During the review reporting period, USAID in conjunction with the University Research Company (URC), conducted a workshop for PEPFAR treatment partners and representatives of the GON on Human Resources for Health (HRH). The training aimed to provide participants with easily accessible, user friendly tools to address common service delivery gaps, particularly HRH gaps. The training which held in Lagos state from December 12 – 16, 2016, drew participants from USAID, FHI360, MSH and State Governments. XXXXXX trained LGA officers supported participation of 20 persons drawn from the four priority states as well as SIDHAS staff. A next step from the training is the expected follow up on deployment of the tools and other state level stakeholders subsequent interventions. In recognition of SIDHAS strong support to GON on financial managementM&E, budgetingresearch and surveillance, and costing FHI 360 was singled out by National Agency for Control of HIV/AIDS services(NACA) as the sole IP to provide support in developing a draft protocol for the review of national HIV impact data. The protocol development meeting convened by NACA and funded by UNAIDS held from November 14 – 18, 2016 at Xxxxxx White Hotel, Abuja. Participants were drawn included representatives from the 14 scale up LGAs and included the State Agencies for the Control of AIDS UNAIDS, WHO, CDC (AKSACArepresenting PEPFAR), State Network of People Living with HIV/AIDS, National Bureau of Statistics (NBS), National Population Commission (NPC), NACA, FMOH Department of Planning Research and Statistics (FMOH/DPRS) and National AIDS and STI Control Programs Program (SASCP)NASCP).The objective was to review all relevant data sources (surveys, program data, special outreaches) and executive members come out with a reliable estimate of prevalence of HIV at national and subnational levels. This is expected to inform PEPFAR and GF target setting and program implementation. In addition, there was a review of the scale up LGAsdraft protocol, to make edits and suggest areas for improvement, as well as identify data sources for the study. A total To ensure efficient management of 63 (46MGeneXpert machines, 17F) participants attended SIDHAS met with by Challenge TB and Cepheid to discuss maintenance of and warranty for the trainingmachines at SIDHAS supported sites. XXXXXX continued Following the meeting, Xxxxxxx commenced onsite assessments and verification in order to provide support to address the GoN through participation and provision of technical assistance at task team and national level meetingsconcerns raised by XXXXXX. This quarterThe machines supported by SIDHAS requiring warranty extension are also being processed accordingly. During the quarter under review, XXXXXX participated in the National Quality Improvement Task Team (NQITT) meeting convened several meetings organised by the Federal Ministry GoN. These meetings were geared towards advancing development of Health-led National Alliance the PMTCT sector in Nigeria to align with current best practices and standards of care. Some of the meetings where XXXXXX contributed include: review of the IMAI/IMPAC training manual, development of the national integrated training manual, and national task team meeting of the PMTCT unit of the HIV/AIDS division of the FMoH. These meetings resulted in, among other things, update of the national IMAI/IMPAC training manual in line with the ‘Test and Treat All’ policy, adoption of best practices from the ‘Test and Treat’ policy by the FMoH, and deliberation on country priorities, targets and strategies for Health Systems Strengthening (FMoH/NAHSS)2017. To ensure efficient management of GeneXpert machines, SIDHAS met with by Challenge TB and Cepheid to discuss maintenance of and warranty for the machines at SIDHAS supported sites. Following the meeting, Xxxxxxx commenced onsite assessments and verification in order to address the concerns raised by XXXXXX. The meetingmachines supported by SIDHAS requiring warranty extension are also being processed accordingly. XXXXXX participated in a STOP TB partnership meeting held at the office of the Hon. Minister of Health on October 17, held 2016. The objective was to solicit increased government investment in and commitment to the TB program. A proposal was also put forward on January the need for a legislation that will restrict indiscriminate importation, sale and use of unapproved and outdated TB drugs and test kits by accelerating import waiver and other regulatory processes for TB drugs and commodities. The Minister promised to work together with the Stop TB partnership Nigeria and other partners to reduce TB related deaths, and improve TB case finding through increased budgetary allocation and disbursements. He also informed of procurement plans by the ministry for additional 100 GeneXpert machines. These are expected to be installed in the 110 PHC facilities which the ministry has earmarked for revamping. FHI360 participated in the African Network for the Care of Children affected by HIV/AIDS (ANECCA) stakeholders’ and dissemination meeting on October 19, 2016 in Abuja. The forum sought to disseminate the document “Catalysing Access to quality services for Children and adolescence living with HIV”. The document contains the existing gaps in paediatrics service delivery, discussed NigeriaQual (NigQual) Round 3 findings policy recommendations, and plans for the Round 4 data collection exerciseapproaches to quality delivery in seven African countries. As a follow on to this, SIDHAS facilitated a meeting with NAHSS/Bitsage to discuss data exchange between the LAMIS and NigQual software. A key output from the meeting was the need to review criteria for selecting ART, Pediatric and PMTCT client evaluation, The assessment highlighted the need for Bitsage a coordinated and sustained response for paediatrics AIDS. With the December 1, 2016 launch of the new integrated guidelines for treatment, prevention and care for PLHIV, SIDHAS supported the development of training materials for GoN during the quarter. The 3-day meeting which held in Enugu on from December 20 to make NigQual a multi-user platform22, 2016 led to the finalization of participants’ training manual, facilitators’ guide, training slides, and training curriculum for in-country capacity building of GoN staff and healthcare workers in the private sector in line with the new guidelines. XXXXXX participated in the e-TB Manager National Officers’ training which commenced in Kaduna, but later relocated to Abuja for security reasons. The objective of the training was to provide update on the revised e-TB manager module, and the expansion plan to cover drug susceptible TB. The quarterly zonal TB review meetings were held in the six geopolitical zones of the country. XXXXXX was represented in all the meetings from the country and state offices to provide inputs and share lessons learnt in project implementation during the review period. During the period under review, a retest of NigQual data exchange version 2.7workshop to train master trainers on these revised national health sector M&E tools was organized by NASCP at Villa Park Hotel Festac, Lagos from November 21 – 26, 2016. In attendance were key M&E officers from the national, selected states from each geopolitical zone, and representatives from various IPs as well as DOD and USAID. The workshop served to pilot the training slides and modules that would be used for further trainings in the various zones. The detailed training agenda was also developed and all the newly revised HTS, PMTCT and ART program tools were presented. Corrections to tools identified were documented for further review and follow up action. SIDHAS teams also participated in provided technical support to the FMOH and NASCP as facilitators at regional trainings on the newly revised national M&E tools. This training served to enable IPs and GoN representatives at the state level have a meeting common and improved knowledge of Implementing Partners (IPs) organized by USAID for all its supported OVC partners on February 26the various data capturing and reporting tools. The trainings held concurrently from December 7 – 12, 2016 in Abujaat Zecool Hotel Barnawa, Kaduna State and Villa Park Hotel, Festac Town Lagos. At this meetingDuring the reporting period, new developments in OVC programing were discussed XXXXXX continued to aid FY17 planning. Other participants at provide technical assistance to the meeting were MSH, ARFH—Local OVC Partners Initiative in Nigeria (LOPIN) project, WEWE, HIFASS, Save the Children—STEER project, and Catholic Relief Services—SMILE project. The SIDHAS team also participated in meetings at Federal Ministry of Women Affairs and Social Development (FMWASD) in the review of all OVC tools to discuss data issues and meet the need for more holistic current OVC program reporting from all states. Similarly, XXXXXX participated at a two-day technical meeting of experts on girl child development and capacity building towards ending child marriage in Nigeria. The meeting took place at the Bayelsa House in Abuja from March 10 – 11, 2016. XXXXXX actively participated in and contributed to the National TB program planning activities towards commemoration of the 2016 World TB dayrequirements. This year’s event was themed ‘Unite to End TB’ and held on March 24, 2016. The team also participated done through participation at zonal TB and TB/HIV review meetings, two national TB/HIV OVC M&E technical working group meetingsmeetings held from November 8 – 12, and the international assessment of TB laboratories. As part of efforts towards engagement of public and private organizations to support project implementation, SIDHAS received drug donations in support of the community ART initiative being implemented across the 14 scale up LGAs. Organizations and individuals contributing included the outgone Chair of the Association of Community Pharmacists 2016 at Best Western Hotel (ACPNStar fire), Edo State; Biofem PharmaceuticalsIkeja, Abuja; CHANMed Pharmaceutical Company Limited, Jos; XXXX Pharmaceuticals, Kano; Akwa Ibom State government through the SMOH; Pharmaceutical Society of Nigeria (PSN), Akwa Ibom State Chapter; Lagos and VIXA Pharmaceuticals, Akwa Ibom State. XXXXXX also engaged with the PSN president at a strategic meeting involving other pharmacists this quarter, with an aim to get buy-in of the umbrella body towards the involvement of pharmacists in HIV/AIDS service delivery for more sustainable outcomes. The meeting had in attendance 20 pharmacists (10M, 10F) drawn from hospital, community, industry and academic technical groups of the PSN. The PSN president appreciated USAID support through the SIDHAS project, and expressed continued commitment of Country Director HUPACE with PSN President at the meeting the association in contributing to improved health of Nigerians. A meeting of the essential drugs committee considered the inclusion of ARV drugs in the essential drug list (EDL) for secondary and tertiary health facilities. Efforts are still ongoing to advocate for the inclusion of PMTCT drugs in EDL for PHCs in Nigeria through a formal application by NACA. Advocacy visits to Directors of Pharmacy services at SMoH and Hospitals Management Board to improve on pharmacy human resources and pharmacy systems finally yielded results with more states such as Adamawa, Akwa Ibom, Kano and Xxxxxx gradually taking over the funding and leadership of performance review meetings. XXXXXX participated in the international lab monitoring mission sponsored by USAID-Washington and the Global Lab Initiative (GLI) of the WHO-Geneva from March 14 December 13 – 18, 2016. It was a TB- focused laboratory assessment mission to Nigeria which took place across six SIDHAS supported sites—University College Teaching Hospital (UCTH) Calabar2016 at DOVER Hotel, Xx. Xxxxxxxx Xxxxxxx Memorial Hospital (DLHMH) CalabarIkeja, Nigeria Institute of Management Research (NIMR) Lagos, General Hospital (GH) Lagos, University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, and PHC Rumuigbo Port Harcourt. The goal was OVC tools were reviewed and finalized; the finalized tools are to identify bottlenecks in TB case finding in Nigeria despite the huge investment be piloted by XxX IPs and partners. At the end of the assessment, the team debriefed the Minister of Health and other stakeholders on the outcome of the visit. Findings from the assessment are expected to shape the roadmap then presented for future funding by USG on TB program in NigeriaMinister’s approval. State Level Progress This section of the report is presented in three categories—priority states, sustained response states, and north east states where project implementation is challenged by insecurity. Priority States Akwa Ibom Indicator Baseline Data FY 2016 Annual Cumulative Actual Quarterly Status – FY 20[16] Annual Performance Achieved to Date (in %) Year Value Annual Cumulative Planned target Q1 Q2 HTC_TST (DSD) FY15 396,014 304,572 441,942 171,668 270,274 145% TX_CURR FY15 22,823 34,158 24,803 25,873 24,803 73% TX_NEW FY15 12,873 18,657 6,660 3,116 3,544 36% PMTCT_STAT (Num) FY15 64,831 50,270 29,887 14,126 15,761 59% OVC_SERV FY15 21,344 10,000 11,729 4,464 7,265 117% The Scale-Up LGAs—Ikot Ekpene, Uruan, Okobo, Oron, Uyo Activities aimed at ensuring a successful conduct of the Akwa Ibom State AIDS Indicator Survey (AKAIS) continued this quarter following successful engagements with state level stakeholders. XXXXXX coordinated a facilitators’ and field team continued training from December 8 – 15, 2016, while the pilot study and review of findings held from December 16 – 21, 2016, at Datty and Eejmm hotels respectively in Uyo, Akwa Ibom state. The facilitators’ training aimed to sustain bring facilitators abreast of the survey procedures and equip them with requisite skills for supervision of the survey research personnel. The pilot study served to pre-test the various survey instruments, procedures and other essential components of the survey with a view to using the outcome to improve the conduct of the main survey. All findings and lessons learned would be incorporated prior to the main survey. The pilot study took place in 226 enumeration areas across Itu, Uyo and Ibesikpo LGAs of the state, with active participation from the stakeholders. The state government demonstrated ownership of the HIV response through the provision of drugs, condoms, and facilitation of free use of community halls for epidemic control team community outreaches. Furthermore, USAID contributions and collaboration were acknowledged by the state in the AKSACA annual bulletin publication which showcased some FY16 achievements of SIDHAS. In addition to the AKAIS pilot survey, XXXXXX conducted a media materials and messages development workshop during the quarter. The workshop also aimed to train local government mobilization teams on effective interpersonal communication to aid awareness creation, and community engagement and mobilization. Materials developed included scripts for radio spots, and draft AKAIS community dialogue and community sensitization guides. The training had 124 participants drawn from 31 LGAs in Akwa Ibom state. This quarter, SIDHAS team worked to increase access to high quality comprehensive HIV/AIDS and TB prevention, treatment and care services through extensive advocacy to community stakeholders and gate keepers. These engagements were effective in strengthening collaborations with CBOs, TBAs as well as religious leaders, and in improving uptake of services, particularly in high yield locations. Efforts were also intensified in optimizing facility provider initiated testing and counselling (PITC) while focusing on epidemic control strategies across communities in the five scale-up LGAs. To this end, 26 additional PMTCT facilities were activated and scaled up to comprehensive treatment sites. This increased the number of sites providing quality comprehensive HIV/AIDS and TB services in the state to 80. Post activation mentorship was provided to ensure requisite capacity of facility staff to provide comprehensive HIV/AIDS treatment services towards the retention of 90% of PLHIV on treatment. To complement facility optimization efforts, three community pharmacies were assessed and activated to commence the community pharmacy ARV refill pilot (CPARP). The pilot aims to devolve stable clients to community pharmacies for ARV drug refill in two of the five priority LGAs, Oron and Ikot Ekpene. The team also commenced activities under the intensified pediatric case finding approach for increased HIV case detection and linkage to treatment for pediatric clients. These activities included training of facility health care workers and distribution of applicable tools to the five supported comprehensive health facilities in the state. SIDHAS also supported two quality improvement activities this quarter through effective collaboration with pharmacy stakeholders in the state. These were the Hospital Management Board (HMB) funded facility pharmacists’ performance review and feedback meeting, as xxxxx as the community pharmacists review meeting. The meeting had in attendance 30 (M:22; F:8) pharmacy staff including pharmacy technicians, where pharmaceutical care data generated across supported facilities were reviewed. These meetings have continued to serve as a platform to address service quality gaps and improve service delivery. Akwa Ibom State GBV response committee constituted XXXXXX conducted activities such as talk show and road rally to mark the 16 Days of Activism against GBV Campaign. The aim was to improve gender mainstreaming in the HIV response, and seek an end to GBV. In the same vein, key staff from all SIDHAS supported comprehensive sites in the five scale up LGAs LGAs, members of relevant agencies including the Nigerian Police Force (Ikot EkpeneNPF), Okobo, Oron, Uruan, and UyoNational Agency for the Prohibition of Trafficking in Persons (NAPTIP) through the delivery of free community health services and ART outreaches. This was facilitated through house-to-house HTS activities which reached 66,705 households. The Nigeria Police Area Command in Ikot Ekpene was one of the HTS beneficiaries, including 230 police officers and patrons of the ‘mammy market’. The state government and PSN also supported the outreaches with over-the-counter Police Command receiving SIDHAS cART Team drugs. These efforts contributed to increased access to essential health services in the priority LGAs. SIDHAS teams carried out quality improvement initiatives during the reporting quarter at supported facilities with focus on client retention. The teams carried out HIV cohort analyses and client folder audits to investigate factors responsible for poor retention at the different stages of services in the ART program. Folder audits were conducted for clients in the cohort initiated on ART within October – December 2014, whose final status at the end of a 12-month treatment period was either dead, stopped treatment or lost to follow up. Folders of 94 clients (34M, 60F) were reviewed across Ewang PHC, University of Uyo Medical Centre, University of Uyo Teaching Hospital, and the Infectious Disease Hospitalstate SIDHAS team, Akwa Ibom State. At General Hospital Ikono, one pre-ART client was initiated on ART while six clients, whose CD4 showed consistent decrease in value, were listed for re-evaluation for possible immunologic failure. Findings across board are expected to inform improvement strategies in HIV treatment programming. The SIDHAS team facilitated dialogue sessions for community leaders in the scale up LGAs to address HIV services for vulnerable children. The community dialogues played a key role in buy- in of the communities to care and support programs for PLHIV and vulnerable children. Other key activities that took place during the dialogue sessions included community mapping for OVC enrollment and referrals for health services, provision of shelter, food and nutrition, educational materials, and birth registrations to identified OVC. Community volunteers were identified by community leaders to support CBO led activities at the grassroots level. Community volunteers, supported by SIDHAS CBOs—SHERO and WOCLIF, conducted household vulnerability assessments to identify the most vulnerable households. Following the assessments, 11 caregivers were selected and trained in line with their preferred skill areas. Three of the caregivers were given startup materials for soap making; two others received a grinding machine each, one of which was a PLHIV blinded as a side effect of ART. Four caregivers received 80 bunches of palm fruits for oil processing; another one received a bag of crayfish as start up for trading, and one more caregiver received a bag of rice and two bags of cassava flour (gari) as startup for food stuff trading. A caregiver displaying her start up materials The SIDHAS team carried out a series of capacity building events for healthcare workers and government officials as part of efforts to sustain quality of service delivery and improved outcomes. Sixty-seven (29M, 38F) laboratory scientists across 57 comprehensive health facilities participated in a quality improvement meeting focused training on ensuring laboratory best practiceseffective management of post GBV care. A key outcome of the training was the constitution of the Akwa Ibom State action committee on GBV led by the Ministry of Women Affairs and Social Development (MOWSD). The laboratory focal persons committed to ensure efficient and functional systems for sample referralscommittee is tasked with engaging other relevant stakeholders, CD4 sample analyses, results dispatchidentifying GBV issues within the state HIV/AIDS response, and 100% commodity documentation and reporting rate. Select healthcare workers and CBOs also benefitted from an orientation this quarter. The orientation focused on strategies for strengthening referral and client tracking systems between facilities and communities. The exercise is expected proposing resolutions to improve the generation of defaulters’ list and home visits by the facilities and CBOs respectively. This is expected to contribute these issues through communiqués to the long term outcome office of improved client retention the State Governor and First Lady of the state. SIDHAS constituted and inaugurated a GBV response committee in care. The SIDHAS team intensified efforts towards the improvement of TB/HIV Akwa Ibom state this quarter in collaboration across supported facilities and communities. To this end, 30 (17M, 13F) community pharmacists were trained on determination of Isoniazid hydrazide (INH) eligibility, screening, initiation, and documentation for accurate kitting of INH. This quarter also, XXXXXX collaborated with the state government to facilitate the Integrated Health Data Management (IHDMT) meeting as well as the second semester 2015 review of health and non-health data. The data review forum was useful in providing other stakeholders the opportunity to validate state-wide program data, and to disseminate information on current state level data for policy decision making processes. The validated data was presented at the national zonal data review meeting and was included into the National database for improved country level decision making. It is expected to feed into the 2015 Global AIDS Response Progress Report (GARPR). Similarly, SIDHAS in conjunction with the state government and KNCV, the USAID lead partner for TB program, facilitated a joint TB outreach program to commemorate the 2016 World TB Day. The event, which took place on March 24, 2016 in Ikot Ekpene LGA, had the theme “Find TB, Treat TB, Work together to end TB”. The event provided the opportunity for awareness creation on TB among the general population, and to collect sputum samples for analyses. Health talks, road walks, and media sensitizations were other activities featured during the day. The state team also collaborated with SASCP and the Health Finance and Governance (HFG) project to reactivate moribund TWGs (ART/Treatment, resource mobilization, and pharmacy and logistics) in the state. This is a demonstration Membership comprises Policemen, Civil Defense Corps, Medical Women Association of the state government’s commitment to sustain donor supported HIV/AIDS programs. XXXXXX supported the TWG members in reviewing the terms Nigeria (Akwa Ibom Chapter), NAPTIP and Federation of reference and assigning responsibilitiesWomen Lawyers (FIDA). The members were also sensitized on committee is tasked with the WHO guidelines for monitoring clients and improving retention in care responsibility of coordinating appropriate response to incidences of GBV in the state. The State Government committee is also responsible for ensuring confidentiality of and access to medical care by GBV victims, justice for the victims, and advocacy the state government for the provision of social safety nets for vulnerable groups especially women and girls. During the period under review, SIDHAS provided technical assistance to LITs/LACA in Oron, Uruan, Uyo and Ikot Ekpene on providing effective leadership for coordination of the LGA HIV response. Owing to the understanding of LACA role in the HIV response, the LACA coordinators have committed to following up with and effectively engage SACA during SACA/LACA forums. Similarly, following continued support to the respective LACA across the five scale up LGAs, the leadership demonstrated commitment to SAPC Addressing Stakeholders at the ART TWG sustainability by facilitating conduct of the SIDHAS project by funding the printing such coordination meetings as LACA-TBA forum, LACA M&E data validation meeting, LIT/LACA team meeting, quarterly LACA LGA advisory council meetings, and LACA heads of 7,000 inventory control cards and 3,000 bin cards to aid effective inventory management. The Pharmacy and Logistics TWG took full responsibility of the process and presented the finalized documents to relevant stakeholders for immediate use. Furthermore, the Chief Medical Director of the University of Uyo Teaching Hospital (UUTH) facilitated the procurement and installation of a 165KVA generator for the facility PCR laboratory. This will address the challenge of service disruption at the laboratory which result from epileptic power supplymeetings.

Stewardship. During the review period, XXXXXX trained LGA officers and other state level stakeholders on financial management, budgeting, and costing of HIV/AIDS services. Participants were drawn from the 14 scale up LGAs and included the State Agencies for the Control of AIDS (AKSACA), State AIDS and STI Control Programs (SASCP), and executive members of the scale up LGAs. A total of 63 (46M, 17F) participants attended the training. XXXXXX continued to provide support to the GoN through participation and provision of technical assistance at task team and national level meetings. This quarter, XXXXXX participated in the National Quality Improvement Task Team (NQITT) meeting convened by the Federal Ministry of Healtha two-led National Alliance for Health Systems Strengthening (FMoH/NAHSS). The meeting, held on January 19, 2016 in Abuja, discussed NigeriaQual (NigQual) Round 3 findings and plans for the Round 4 data collection exercise. As a follow on to this, SIDHAS facilitated a meeting with NAHSS/Bitsage to discuss data exchange between the LAMIS and NigQual software. A key output from the meeting year cost extension was the need to review criteria for selecting ART, Pediatric and PMTCT client evaluation, the need for Bitsage to make NigQual a multi-user platform, and a retest of NigQual data exchange version 2.7. SIDHAS teams also participated in a meeting of Implementing Partners (IPs) organized approved by USAID for all the SIDHAS project. This extends the project period of performance from September 12, 2011 through September 11, 2018, with total estimated funding of $448,350,899. In line with this approval, the SIDHAS team commenced development of modifications for project sub awardees whose subcontracts were originally slated to terminate in June 2015 to align implementation timeframes and obligate additional funding for continued implementation of project activities through September 2018. Hygeia Foundation, the contractor managing private for-profit facilities in Rivers State, notified SIDHAS management of its supported OVC partners on February 26decision to opt out of the SIDHAS project effective June 30, 2016 in Abuja2015 due to strategic business decisions made by its Board of Directors. At this meetingIn addition, new developments in OVC programing were discussed the Evidence to aid FY17 planning. Other participants at the meeting were MSH, ARFH—Local OVC Partners Initiative in Nigeria Action (LOPINE2A) project, WEWEimplemented by Pathfinder International, HIFASS, Save transitioned private health facilities to SIDHAS in the Children—STEER project, scale-up LGAs as part of its closeout activities in accordance with the directives from USAID. Two batches of training were conducted for State Management Teams (SMT) on leadership and Catholic Relief Services—SMILE projectgovernance this quarter. The SIDHAS team also participated in meetings at Federal Ministry of Women Affairs and Social Development (FMWASD) to discuss data issues and the need for more holistic reporting from all states. Similarly, XXXXXX participated at a two-day technical meeting of experts on girl child development and capacity building towards ending child marriage in Nigeria. The meeting took place at the Bayelsa House in Abuja from March 10 – 11, 2016. XXXXXX actively participated in and contributed to the National TB program planning activities towards commemoration primary objective of the 2016 World TB day. This year’s event Leadership and Governance Training was themed ‘Unite to End TB’ enhance capacity of key stakeholders on leadership and held on March 24, 2016. The team also participated at zonal TB and TB/HIV review meetings, national TB/HIV working group meetings, and the international assessment of TB laboratories. As part of efforts towards engagement of public and private organizations to support project implementation, SIDHAS received drug donations in support of the community ART initiative being implemented across the 14 scale up LGAs. Organizations and individuals contributing included the outgone Chair of the Association of Community Pharmacists (ACPN), Edo State; Biofem Pharmaceuticals, Abuja; CHANMed Pharmaceutical Company Limited, Jos; XXXX Pharmaceuticals, Kano; Akwa Ibom State government through the SMOH; Pharmaceutical Society of Nigeria (PSN), Akwa Ibom State Chapter; and VIXA Pharmaceuticals, Akwa Ibom State. XXXXXX also engaged with the PSN president at a strategic meeting involving other pharmacists this quarter, with an aim to get buy-in of the umbrella body towards the involvement of pharmacists governance in HIV/AIDS service delivery programming, and to design a sustainability roadmap for more sustainable outcomesimplementation of the SIDHAS project as it enters into its final phase. The meeting had first batch took place in attendance 20 pharmacists (10MAbuja from May 10 – 12, 10F) drawn 2016 with participation from hospitalKano, communityJigawa, industry Borno, Bauchi, Adamawa, and academic technical groups of the PSNYobe States. The PSN president appreciated USAID support through the SIDHAS projectsecond batch held in Lagos from May 17 – 19, and expressed continued commitment of Country Director HUPACE with PSN President at the meeting the association in contributing to improved health of Nigerians. A meeting of the essential drugs committee considered the inclusion of ARV drugs in the essential drug list (EDL) 2016 for secondary and tertiary health facilities. Efforts are still ongoing to advocate for the inclusion of PMTCT drugs in EDL for PHCs in Nigeria through a formal application by NACA. Advocacy visits to Directors of Pharmacy services at SMoH and Hospitals Management Board to improve on pharmacy human resources and pharmacy systems finally yielded results with more states such as Adamawastakeholders from Lagos, Edo, Akwa Ibom, Kano Cross River, Bayelsa, Rivers and Xxxxxx gradually taking over Anambra states A total of 78 participants comprised of the Honourable Commissioners for Health, Permanent Secretaries, XXXX XX/Executive Secretary/Program Managers, and the SASCP Coordinators from the supported states were in attendance. Communiques seeking to increase government funding and leadership ownership of performance review meetings. XXXXXX participated the HIV programs in the international lab monitoring mission sponsored supported states were developed from the meetings and signed by USAID-Washington and all the Global Lab Initiative (GLI) CoH for presentation to the respective state governors. During the quarter, sustainability roadmap development meetings were held in 11 of the WHO-Geneva from March 14 – 1813 supported tertiary hospitals. These facilities did not participate in previous state level sustainability roadmap meetings owing to their reporting structures. The roadmaps for the tertiary facilities, 2016when finalized, are expected to be endorsed by the FMOH. It was a TB- focused laboratory assessment mission to Nigeria which took place across six SIDHAS supported sites—University College Teaching Hospital (UCTH) Calabar, Xx. Xxxxxxxx Xxxxxxx Memorial Hospital (DLHMH) Calabar, Nigeria Institute Development of Management Research (NIMR) Lagos, General Hospital (GH) Lagossustainability roadmap for the two outstanding facilities, University of Port Harcourt Teaching Hospital and Federal Medical Centre Yola, are scheduled to take place in the coming quarter. SIDHAS continued to provide ongoing technical support to the GoN through participation in national technical committee meetings. One of such meetings was the national technical committee meeting on the review of the national HIV epidemiology and impact data convened by the National Agency for Control of AIDS (UPTHNACA). The meeting which took place on April 15, 2016, in Abuja, had in attendance representatives from NACA, FMOH, USG, other donors and implementing partners in the country. The purpose was to discuss the proposal by NACA to embark on a project to triangulate existing surveillance and program data in order to regularize the HIV prevalence at both national and sub-national levels. The meeting also sought to model the AIDS impact using SPECTRUM software to feed in the proposed new projections of the HIV prevalence. As a follow on to the release of consolidated HIV guidelines, the SIDHAS team supported the FMoH during a 4-day National HIV tools review meeting. The aim was to review draft versions of the HIV Data Capture and Reporting Tools (DCRTs) Port Harcourtand make amendments based on current thinking such as the TAS and Option B+ interventions. Draft DCRTs and user manuals for all relevant program areas were developed by stakeholders for finalization by the FMoH through coordinated efforts. The SIDHAS team participated in the joint USG/PEPFAR Nigeria Laboratory and treatment TWG quarterly meeting that held on June 27, 2016 in Abuja. The meeting brought together PEPFAR implementing partners and critical stakeholders to review performance on Viral Load (VL) uptake in the priority LGAs, and PHC Rumuigbo Port Harcourtshare innovative strategies and plans for improving uptake of the service. The goal was forum provided specific guidance and direction to identify bottlenecks IPs on short and medium term measures for expanding VL testing, as well as draft VL networking and sample referral systems for effective collaboration. These strategies have been deployed in TB case finding all supported states. XXXXXX participated in Nigeria despite the huge investment first ART task team meeting for 2016 convened by XxX and partnersthe Hon. At the end of the assessmentMinister for Health in Abuja on April 5 – 6, the team debriefed the Minister of Health and other stakeholders on the 2016. A key outcome of the visitmeeting was the approval and inauguration of a reconstituted National ART Task Team for 2016-2018 by the Hon. Findings from Minister. A follow on preparatory meeting on the assessment are expected to shape implementation of VL scale up plan was convened by the roadmap for future funding by USG Care and Treatment Division of National HIV/AIDs (NASCP) of FMOH on TB program in NigeriaApril 7, 2016 at the Royalton Hotel, Abuja. State Level Progress This section of the report is presented in three categories—priority states, sustained response states, and north east states where project implementation is challenged by insecurity. Priority States Akwa Ibom Indicator Baseline Data FY 2016 Annual Cumulative Actual Quarterly Status – FY 20[16] Annual Performance Achieved to Date (in %) Year Value Annual Cumulative Planned target Q1 Q2 HTC_TST (DSD) FY15 396,014 304,572 441,942 171,668 270,274 145% TX_CURR FY15 22,823 34,158 24,803 25,873 24,803 73% TX_NEW FY15 12,873 18,657 6,660 3,116 3,544 36% PMTCT_STAT (Num) FY15 64,831 50,270 29,887 14,126 15,761 59% OVC_SERV FY15 21,344 10,000 11,729 4,464 7,265 117% The Scale-up LGAs—Ikot Ekpene, Uruan, Okobo, Oron, Uyo This quarter, the Akwa Ibom State team continued to sustain community level sensitization and outreach activities aimed at increasing access to comprehensive available HIV/AIDS services in the five scale up LGAs (Ikot Ekpene, Okobo, Oron, Uruan, and Uyo) through the delivery of free community health services and ART outreaches. This was facilitated through house-to-house HTS activities which reached 66,705 households. The Nigeria Police Area Command in Ikot Ekpene was one of the HTS beneficiaries, including 230 police officers and patrons of the ‘mammy market’. The state government and PSN also supported the outreaches with over-the-counter Police Command receiving SIDHAS cART Team drugs. These efforts contributed to increased access to essential health services in the priority LGAs. SIDHAS teams carried out quality improvement initiatives during the reporting quarter at supported facilities with focus on client retention. The teams carried out HIV cohort analyses and client folder audits to investigate factors responsible for poor retention at the different stages of services in the ART program. Folder audits Innovative strategies were conducted for clients in the cohort initiated on ART within October – December 2014, whose final status at the end of a 12-month treatment period was either dead, stopped treatment or lost to follow up. Folders of 94 clients (34M, 60F) were reviewed across Ewang PHC, University of Uyo Medical Centre, University of Uyo Teaching Hospital, and the Infectious Disease Hospital, Akwa Ibom State. At General Hospital Ikono, one pre-ART client was initiated on ART while six clients, whose CD4 showed consistent decrease in value, were listed for re-evaluation for possible immunologic failure. Findings across board are expected to inform improvement strategies in HIV treatment programming. The SIDHAS team facilitated dialogue sessions for community leaders in the scale up LGAs to address HIV services for vulnerable children. The community dialogues played a key role in buy- in of the communities to care and support programs for PLHIV and vulnerable children. Other key activities that took place during the dialogue sessions included community mapping for OVC enrollment and referrals for health services, provision of shelter, food and nutrition, educational materials, and birth registrations to identified OVC. Community volunteers were identified by community leaders to support CBO led activities at the grassroots level. Community volunteers, supported by SIDHAS CBOs—SHERO and WOCLIF, conducted household vulnerability assessments to identify the most vulnerable households. Following the assessments, 11 caregivers were selected and trained in line with their preferred skill areas. Three of the caregivers were given startup materials for soap making; two others received a grinding machine each, one of which was a PLHIV blinded as a side effect of ART. Four caregivers received 80 bunches of palm fruits for oil processing; another one received a bag of crayfish as start up for trading, and one more caregiver received a bag of rice and two bags of cassava flour (gari) as startup for food stuff trading. A caregiver displaying her start up materials The SIDHAS team carried out a series of capacity building events for healthcare workers and government officials deployed as part of efforts towards achieving the first 90%. In Okobo and Ikot Ekpene LGAs, HIV testing was targeted at schedules of clients during weekends and late evenings in their homes. Identification and tracking of clients due for viral load testing in supported facilities, as well as strengthening of community-facility linkages for active follow-up and close monitoring of HIV exposed infants (HEIs) lost to sustain quality of service delivery follow-up (LTFU) were also done. CBOs were supported to initiate sexual network tracing and improved outcomes. Sixty-seven (29Mtargeted population testing in prisons, 38F) laboratory scientists across 57 comprehensive health facilities participated in a quality improvement meeting focused on ensuring laboratory best practices. The laboratory focal persons committed to ensure efficient and functional systems for sample referralsbrothels, CD4 sample analyses, results dispatchdrinking bars, and 100% commodity documentation and reporting ratefacilities of traditional birth attendants (TBA). Select healthcare workers and CBOs also benefitted from an orientation As part of efforts towards achieving the third 90 target for epidemic control, 27 facilities commenced viral load services this quarter. The orientation focused on strategies for strengthening referral and client tracking systems between facilities and communitiesThis increased the number of sites providing viral load services in the state from 8 to 35. The exercise is expected quarter also recorded improved turnaround time for the number of viral load specimens sent and results received from 18% in April to improve 87% in May. Facilities were supported to set up functional drug therapeutic committees (DTC) to review viral load results and take appropriate treatment actions in the generation management of defaulters’ list and home visits by the facilities and CBOs respectivelyclients. This is expected resulted in the transition of three clients from 1st to contribute 2nd line regimen within the review period in GH Xxxx Xxxx. This quarter, the state team held a quarterly review meeting with stakeholders to review the long term outcome project scorecard and sensitize them on the implementation of improved the test and start (TAS) policy in the scale-up LGAs. A key decision arrived at during the meeting, was to effectively manage the client retention load that will arise as a result of TAS implementation in care. The SIDHAS team intensified efforts towards the improvement of TB/HIV collaboration across supported facilities and communitiesthrough differentiated care. To this end, 30 four community pharmacy ARV refill centers were established in the state to manage expectations that will potentially arise from increased client load. The State AIDS Control Agency and State AIDS and STI Control Program representatives were in attendance in the meeting. Four new community pharmacies (17M, 13Ftwo each in Oron and Ikot Ekpene LGAs) community pharmacists were trained on determination of Isoniazid hydrazide (INH) eligibility, screening, initiation, and documentation inaugurated as pilot sites for accurate kitting of INHARV refills this quarter. This quarter also, XXXXXX collaborated with brought to 30 the state government to facilitate number of community pharmacies directly participating in the Integrated Health Data Management (IHDMT) meeting as well as the second semester 2015 review of health and non-health data. The data review forum was useful in providing stakeholders the opportunity to validate state-wide program data, and to disseminate information on current state level data for policy decision making processes. The validated data was presented at the national zonal data review meeting and was included into the National database for improved country level decision making. It is expected to feed into the 2015 Global AIDS Response Progress Report (GARPR). Similarly, SIDHAS in conjunction with the state government and KNCV, the USAID lead partner for TB program, facilitated a joint TB outreach program to commemorate the 2016 World TB Day. The event, which took place on March 24, 2016 in Ikot Ekpene LGA, had the theme “Find TB, Treat TB, Work together to end TB”. The event provided the opportunity for awareness creation on TB among the general population, and to collect sputum samples for analyses. Health talks, road walks, and media sensitizations were other activities featured during the day. The state team also collaborated with SASCP and the Health Finance and Governance (HFG) project to reactivate moribund TWGs (ART/Treatment, resource mobilization, and pharmacy and logistics) epidemic control drive in the state. This is a demonstration of These efforts created access to HIV services to 49,975 households across the state government’s commitment to sustain donor supported HIV/AIDS programs. XXXXXX supported the TWG members in reviewing the terms of reference and assigning responsibilities. The members were also sensitized on the WHO guidelines for monitoring clients and improving retention in care priority LGAs in the state. Emphasis on contact tracing and testing of partners of index clients resulted in provision of HIV Testing Services (HTS) to 45 of the 50 index clients’ partners identified during the quarter. Furthermore, five health facilities in Okobo (Utine Nduong Primary Health Centre (PHC), Mbokpu Oduobo PHC, Odobo PHC, Eweme Model PHC and Xxx Xxxxx Maternity) were designated as drug pick-up sites. These will be activated for service provision in the next quarter. Strategies towards stigma reduction among PLHIV were mapped out during community dialogue sessions this quarter. The community interventions resulted in expansion of care and support services to vulnerable children. This was achieved through increased enrollment of OVC into care, and provision of services such as educational, nutritional, psychosocial, shelter, household economic empowerment and legal services to the identified OVC. Keying into XXXXXX’s partnership action agenda for the control of the epidemic, the SIDHAS team collaborated with Xxxx Xxxx State Government and the Society for Family Health (SFH) to activate a one-stop-shop (OSS) for MARPS in Uyo. The OSS was activated in June 2016 and has provided HIV services to more than 30 clients. This strategy underscores WHO recommended health sector priority interventions for MARPs, and addresses issues of stigma and discrimination. It also demonstrated commitment ensures the provision of composite HIV/AIDS services that include HTS, ARV supply, referrals, and STI management to SAPC Addressing Stakeholders at MARPs. This quarter, the ART TWG sustainability of Evidence to Action (E2A) project, implemented by Pathfinder International, transited seven PMTCT sites to the SIDHAS project by funding the printing as part of 7,000 inventory control cards and 3,000 bin cards to aid effective inventory managementits closeout activities. The Pharmacy and Logistics TWG took full responsibility of sites which are private for profit, are located in the process and presented the finalized documents to relevant stakeholders for immediate use. Furthermorefour scale-up LGAs; (Oron (2), the Chief Medical Director of the University of Uyo Teaching Hospital Eket (UUTH) facilitated the procurement and installation of a 165KVA generator for the facility PCR laboratory. This will address the challenge of service disruption at the laboratory which result from epileptic power supply.1), Ikot Ekpene,

Stewardship. During The sixth (6th) meeting of the review periodSIDHAS Project Advisory Committee (PAC) convened on March 9, XXXXXX trained LGA officers 2017 in Abuja, at the NACA office. In attendance were all PAC members except the Executive Secretary of the NPHCDA who sent in his regrets. In addition, the Director Public Health, FMOH, was represented by the National Coordinator, NTBLCP. The meeting was significant due to the fact that all of the committee members were new following leadership changes at the GON as well as within the SIDHAS project. The meeting therefore served as an inaugural meeting for all members including the PAC Chair. The SIDHAS top management utilized the opportunity to orient the PAC members and other also provided updates on project implementation progress from inception to date. The presentation also highlighted some project implementation challenges and made recommendations for consideration by the PAC. Key resolutions from the meeting included a consensus to pay advocacy visits to six (6) select state level stakeholders on financial management, budgeting, and costing of governors to advocate for improving HIV/AIDS financing. As part of activities to promote sustainability, SIDHAS provided technical support to eight of its 13 states and worked with NACA to develop and submit a memo to the 59th National Council of Health which held at the International Conference Centre, Umuahia, Abia State from the January 23 – 27, 2017 with the theme: National Health Policy: A Tool for Achieving Universal Health Coverage (UHC). The council was chaired by the Honourable Minster of Health and had in attendance 801 delegates from the health sector. The prayer of the memos was to build state ownership and sustainability of state HIV programs through the development and funding of state sustainability roadmaps. This was an action step from a workshop organised by SIDHAS in FY16 to build leadership and governance capacity of the heads of the SMT in the 13 SIDHAS supported states. All the memos were combined and approved as follows: The earmarking of at least 0.5% to 1% of the monthly Federation allocation to states for financing the implementation of the HIV/AIDS sustainable roadmaps. This is in line with the KR3 of the SIDHAS project. Furthermore, DLHMH TB Reference Laboratory was officially handed over to the National TB and Leprosy Control Program (NTBLCP) on February 14, 2017 as directed by XXXXXX. The event was witnessed by representatives of SIDHAS, State Ministry of Health (SMOH), State Agency for the Control of AIDS (SACA), Federal Ministry of Health (FMOH), Institute of Human Virology Nigeria (IHVN), and the management of DLHMH. The state governor was represented by the commissioner of health, Xx. Xxxxxx Xxxxxxx, who used the opportunity to emphasize on the successful partnership between the Cross River state government and USAID through the FHI 360 in establishing and managing the TB Reference laboratory, as well as capacity building of the laboratory personnel. The honorable Commissioner for Health also announced that the state governor, Senator (Professor) Xxx Xxxxx, had approved absorption of the three Medical Laboratory Scientists and the facility engineer into the state civil service commission. These personnel had been hitherto supported by USAID through the SIDHAS project. The Commissioner of Health appealed to the USAID funded SIDHAS project to support upgrade of the ART laboratory in DLHMH for structural and service integration of the viral load services. In her ending remarks, the Commissioner said, “Indeed USAID/FHI360 have touched the lives of our people in a remarkable way”. Left: Handover of the lab from FHI 360 to NTBLCP. Centre: Handover from NTBLCP to the Cross River state government. Right: Front view of the DLHMH reference lab FHI 360 Country Director Xx X. Chiegil at model PHC Kuchigoro SIDHAS supported the National TB and Leprosy Control Program (NTBLCP) with planning for the World TB Day. The team also participated in the commemoration of the World TB day which took place on March 24, 2017. Part of the support provided included procurement of 550 reflective vests which were branded with TB messages for the event. In addition to raising TB awareness during the event, all the 13 state offices also engaged in active TB case finding. Preliminary results of this approach to active TB case finding using the world TB day platform, showed the following yield of TB and HIV patients from the one- week exercise: 4,214 individuals (M: 1,976; F: 2,238) were screened for TB; 749 (M: 315; F: 434) presumptive cases were identified; 1,012 (M:480; F:532) presumptive TB patients were tested for HIV of which 117 (M: 55; F: 62) tested positive for HIV; 161 (M: 45; F: 116) were linked to services. Final data is being collated and will be shared as soon as they are ready. Members of the WTBD planning committee, comprising the FMOH (NTBLCP) and representatives of TB program stakeholders including FHI360, planned and executed a medical outreach at an IDP camp and launching of a GeneXpert suite at a PHC Centre Kuchigoro, in the FCT, by the Honorable Minister of Health. The NTBLCP also engaged stakeholders in Abuja in week long activities as part of activities to mark the World TB Day. These included a sensitization road walk in reflective jackets, sensitization on the negative effects of TB disease and service locations, development of the rapid advice on the new formulation of childhood anti TB drugs, and strategies to adopt in improving control of childhood TB in Nigeria control in the country to strategize ways of intensifying TB case detection among children. National Coordinator, NTBLCP, and a SIDHAS staff teaching children the right way to cough during a WTBD event The meeting was held on March 16, 2017 towards the operationalization of the support plans for the EQUIP Demonstration Project. Participants were drawn from the 14 scale various USAID and CDC funded Implementing Partners (IPs). Discussions held to conclude on operationalization of the support from EQUIP in the areas HIV Self-testing (HIVST) approach to complement the existing HIV testing strategies towards reaching the “first 90”. Multi-month dispensing and a review of the viral load value chain analysis and various challenges facing viral load implementation were discussed by participants. A follow up LGAs meeting with Wits Lab (EQUIP Consortium Lab partner) with Lab TWGs is being expected. Within the quarter, SIDHAS team worked with USAID in a series of planning meetings leading to the development of COP17 strategies. Contributions from SIDHAS included current strategies deployed for epidemic control on the priority LGAs; methodology development to COP17 planning, strategies and included the State Agencies analysis on how locations were prioritized for the Control epidemic control; formulation of AIDS (AKSACA), State AIDS and STI Control Programs (SASCP)assumptions, and executive members analysis of SIDHAS program data in the scale up LGAsand priority States. XXXXXX participated in this quarter’s National Care and Support Technical working group meeting held on January 12 and 14, 2017 at NACA office. Highlights of the meetings included review and inputs for finalization of the care and support section of the National Strategic Plan 2017-2021, sharing of reports and feedback from the nutrition and mental health subcommittees, and review and finalization of the national care and support monitoring and reporting tools. XXXXXX also participated in the review of the national guideline for nutritional care and support for PLHIV. XXXXXX participated at the Domestic Violence Response Committee meeting at the Xxxxxxx Xxxxxxx Cultural Centre, Abuja on March 9, 2017. This committee was inaugurated in February 2017 by the Presidency to ensure all GBV cases are aptly and promptly responded to in a coordinated and dignifying manner. The SIDHAS team, though not an implementing partner in the FCT, was nominated by USAID to attend and provide feedback to mission. The committee is charged with responsibility in four core areas: improving coordination, cooperation and communication among members; capacity development; operations publicity, awareness and advocacy; and monitoring, evaluation and long-term planning. As a post-graduation strategy, the SIDHAS OVC program monitors the wellbeing of OVC and their caregivers who have been graduated from the program for at least six months. This is being done to ascertain stability and resiliency these beneficiaries outside PEPFAR support. A total PEPFAR OVC Tracer Study is being coordinated by the USAID funded 4 Children Project to gather data on this. The SIDHAS team is expected to participate in the study. As part of 63 (46M, 17F) participants attended initial activities for the training. XXXXXX continued to provide support to the GoN through participation and provision of technical assistance at task team and national level meetings. This quarterstudy, XXXXXX participated in the National Quality Improvement Task Team (NQITT) meeting convened by the Federal Ministry of Health-led National Alliance for Health Systems Strengthening (FMoHstudy design/NAHSS). The meetingmethodology workshop which held in Abuja from February 22 – 24, held on January 19, 2016 in Abuja, discussed NigeriaQual (NigQual) Round 3 findings and plans for the Round 4 data collection exercise. As a follow on to this, SIDHAS facilitated a meeting with NAHSS/Bitsage to discuss data exchange between the LAMIS and NigQual software2017. A key output from Tracer Study protocol was developed at the meeting was end of the need workshop and will be submitted to review criteria National Health Research Ethics Committee (NHREC) for selecting ART, Pediatric and PMTCT client evaluation, the need for Bitsage to make NigQual a multi-user platform, and a retest of NigQual data exchange version 2.7approval. SIDHAS teams XXXXXX also participated in a meeting of Implementing Partners the USG (IPsUSAID and CDC) organized by USAID OVC costing study design workshop for all PEPFAR OVC IPs which held in Abuja on March 24, 2017. Data from the costing study is expected to help the USG refine the budgeting process for the OVC program in Nigeria. It will also will tie-in with ongoing efforts to determine a series of 'gold standard' packages of services that respond to different categories of child and household vulnerability. The study will collect spending data on the various service packages from sampled USAID and CDC partners operating in the selected study states of Lagos, Kaduna, Benue, Nasarawa, FCT, Cross River and Rivers. The study will also examine partners’ expenditures in the various services they provide, how partners are currently allocating expenditures across the various service areas and will also document key contextual factors that contribute to cost drivers at specific locations/sites/facilities. A qualitative component of the study will help define service packages implemented by each IP, and help understand contextual factors that drive costs and better explain why these contextual factors influence costs. The international women’s day was commemorated on March 8, 2017. As part of events marking the day, SIDHAS conducted a cursory analysis of its supported OVC partners staff and recipients of intervention such as HTS, PMTCT and ARVs. There was awareness on social media and within the SIDHAS project on protecting women and children from violence and insecurity. XXXXXX also attended the national quantification planning meeting with other stakeholders from February 2627 – 28, 2016 in 2017 at CHAI office, Abuja. At this meeting, new developments in OVC programing were discussed to aid FY17 planning. Other participants at a step by step plan for the meeting were MSH, ARFH—Local OVC Partners Initiative in Nigeria (LOPIN) project, WEWE, HIFASS, Save upcoming national quantification exercise for 2017 was done by reviewing the Children—STEER project, and Catholic Relief Services—SMILE project. The SIDHAS team also participated in meetings at Federal Ministry of Women Affairs and Social Development (FMWASD) to discuss data issues ARV & OI forecast spreadsheet and the need assumption building worksheet. SIDHAS data was also presented for more holistic reporting from all states. Similarly, XXXXXX participated at a two-day technical meeting of experts on girl child development and capacity building towards ending child marriage use in Nigeria. The meeting took place at the Bayelsa House in Abuja from March 10 – 11, 2016. XXXXXX actively participated in and contributed to the National TB program planning activities towards commemoration of the 2016 World TB dayexercise. This year’s event was themed ‘Unite will ensure adequate plans are made for the currents patients on ARV and new ones to End TB’ and held be initiated on March 24, 2016the project. The team also participated at zonal TB and TB/HIV review meetingsin the revised logistics system implementation planning meeting on March 21, national TB/HIV working group meetings, and the international assessment of TB laboratories2017. As part of efforts towards engagement of public and private organizations to support project implementation, SIDHAS received drug donations in support of the community ART initiative being implemented across the 14 scale up LGAs. Organizations and individuals contributing included the outgone Chair of the Association of Community Pharmacists (ACPN), Edo State; Biofem Pharmaceuticals, Abuja; CHANMed Pharmaceutical Company Limited, Jos; XXXX Pharmaceuticals, Kano; Akwa Ibom State government through the SMOH; Pharmaceutical Society of Nigeria (PSN), Akwa Ibom State Chapter; and VIXA Pharmaceuticals, Akwa Ibom State. XXXXXX also engaged with the PSN president at This was a strategic meeting involving other pharmacists this quarter, with an aim to get buy-in of the umbrella body towards the involvement of pharmacists in follow on proposed new inventory control system for HIV/AIDS service delivery commodities in Nigeria. During the meeting, a synchronized roadmap for more sustainable outcomes. The meeting had in attendance 20 pharmacists (10M, 10F) drawn from hospital, community, industry SOP review and academic technical groups roll out of the PSN. The PSN president appreciated USAID new inventory system was developed and activities to support through the SIDHAS project, and expressed continued commitment of Country Director HUPACE with PSN President at the meeting the association in contributing to improved health of Nigerians. A meeting of the essential drugs committee considered the inclusion of ARV drugs in the essential drug list (EDL) for secondary and tertiary health facilities. Efforts are still ongoing to advocate for the inclusion of PMTCT drugs in EDL for PHCs in Nigeria through a formal application by NACA. Advocacy visits to Directors of Pharmacy services at SMoH and Hospitals Management Board to improve on pharmacy human resources and pharmacy systems finally yielded results with more states such as Adamawa, Akwa Ibom, Kano and Xxxxxx gradually taking over the funding and leadership of performance review meetings. XXXXXX participated in the international lab monitoring mission sponsored by USAID-Washington and the Global Lab Initiative (GLI) of the WHO-Geneva from March 14 – 18, 2016. It was a TB- focused laboratory assessment mission to Nigeria which took place across six SIDHAS supported sites—University College Teaching Hospital (UCTH) Calabar, Xx. Xxxxxxxx Xxxxxxx Memorial Hospital (DLHMH) Calabar, Nigeria Institute of Management Research (NIMR) Lagos, General Hospital (GH) Lagos, University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt, and PHC Rumuigbo Port Harcourt. The goal was to identify bottlenecks in TB case finding in Nigeria despite the huge investment by XxX and partners. At the end of the assessment, the team debriefed the Minister of Health and other stakeholders on the outcome of the visit. Findings from the assessment are expected to shape the roadmap for future funding by USG on TB program in Nigeriaimplementation were teased out. State Level Progress This section of the report is presented in three categories—priority states, states and sustained response states, and north east states as well as a summary of SIDHAS interventions so far in the North East where project implementation is has been challenged by insecurity. Highlights from Priority States Akwa Ibom Indicator Baseline Data FY 2016 Annual Cumulative Actual Quarterly Status – FY 20[16] Annual Performance Achieved to Date (in %) Year Value Annual Cumulative Planned target Q1 Q2 HTC_TST (DSD) FY15 396,014 304,572 441,942 171,668 270,274 145% TX_CURR FY15 22,823 34,158 24,803 25,873 24,803 73% TX_NEW FY15 12,873 18,657 6,660 3,116 3,544 36% PMTCT_STAT (Num) FY15 64,831 50,270 29,887 14,126 15,761 59% OVC_SERV FY15 21,344 10,000 11,729 4,464 7,265 117% The Akwa Ibom State team continued to sustain access to comprehensive HIV/AIDS services in Access During the five scale up LGAs (Ikot Ekpenereporting period, Okobo, Oron, Uruan, and Uyo) through the delivery of free community health services and ART outreaches. This was facilitated through house-to-house HTS activities which reached 66,705 households. The Nigeria Police Area Command in Ikot Ekpene was one of the HTS beneficiaries, including 230 police officers and patrons of the ‘mammy market’. The state government and PSN also supported the outreaches with over-the-counter Police Command receiving SIDHAS cART Team drugs. These efforts contributed to increased access to essential health services teams in the priority states—Akwa Ibom, Cross River, Lagos and Rivers—intensified activities towards increasing access to services and achieving epidemic control in the scale-up LGAs. SIDHAS teams carried out quality improvement initiatives during the reporting quarter at supported facilities with focus on client retention. The teams carried out HIV cohort analyses and client folder audits to investigate factors responsible for poor retention at the different stages of services in the ART program. Folder audits were conducted for clients in the cohort initiated on ART within October – December 2014Strategies employed included Epidemic Control (EC) outreaches, whose final status at the end of a 12-month treatment period was either deadfacility optimization, stopped treatment or lost to follow up. Folders of 94 clients (34M, 60F) were reviewed across Ewang PHC, University of Uyo Medical Centre, University of Uyo Teaching Hospitaltargeted hot spot testing, and the Infectious Disease Hospitalsexual network testing, Akwa Ibom State. At General Hospital Ikono, one pre-ART client was initiated on ART while six clients, whose CD4 showed consistent decrease in value, were listed for re-evaluation for possible immunologic failure. Findings across board are expected to inform improvement strategies in HIV treatment programming. The SIDHAS team facilitated dialogue sessions for community leaders in the scale up LGAs to address HIV services for vulnerable children. The community dialogues played a key role in buy- in of the communities to care and support programs for PLHIV and vulnerable children. Other key activities that took place during the dialogue sessions included community mapping for OVC enrollment and referrals for health services, provision of shelter, food and nutrition, educational materials, and birth registrations to identified OVC. Community volunteers were identified by community leaders to support CBO led activities at the grassroots level. Community volunteers, supported by SIDHAS CBOs—SHERO and WOCLIF, conducted household vulnerability assessments to identify the most vulnerable households. Following the assessments, 11 caregivers were selected and trained in line with their preferred skill areas. Three of the caregivers were given startup materials for soap making; two others received a grinding machine each, one of which was a PLHIV blinded as a side effect of ART. Four caregivers received 80 bunches of palm fruits for oil processing; another one received a bag of crayfish as start up for trading, and one more caregiver received a bag of rice and two bags of cassava flour (gari) as startup for food stuff trading. A caregiver displaying her start up materials The SIDHAS team carried out a series of capacity building events for healthcare workers and government officials as part of efforts to sustain quality of service delivery and improved outcomes. Sixty-seven (29M, 38F) laboratory scientists across 57 comprehensive health facilities participated in a quality improvement meeting focused on ensuring laboratory best practices. The laboratory focal persons committed to ensure efficient and functional systems for sample referrals, CD4 sample analyses, results dispatch, and 100% commodity documentation and reporting rate. Select healthcare workers and CBOs also benefitted from an orientation this quarter. The orientation focused on strategies for strengthening referral and client tracking systems between facilities and communities. The exercise is expected to improve the generation of defaulters’ list and home visits by the facilities and CBOs respectively. This is expected to contribute to the long term outcome of improved client retention in care. The SIDHAS team intensified efforts towards the improvement of TB/HIV collaboration across supported facilities and communities. To this end, 30 (17M, 13F) community pharmacists were trained on determination of Isoniazid hydrazide (INH) eligibility, screening, initiation, and documentation for accurate kitting of INH. This quarter also, XXXXXX collaborated with the state government to facilitate the Integrated Health Data Management (IHDMT) meeting as well as the second semester 2015 review of health and non-health data. The data review forum was useful in providing stakeholders the opportunity to validate state-wide program data, and to disseminate information on current state level data for policy decision making processes. The validated data was presented at the national zonal data review meeting and was included into the National database for improved country level decision making. It is expected to feed into the 2015 Global AIDS Response Progress Report (GARPR). Similarly, SIDHAS in conjunction with the state government and KNCV, the USAID lead partner for TB program, facilitated a joint TB outreach program to commemorate the 2016 World TB Day. The event, which took place on March 24, 2016 in Ikot Ekpene LGA, had the theme “Find TB, Treat TB, Work together to end TB”. The event provided the opportunity for awareness creation on TB among the general population, and to collect sputum samples for analyses. Health talks, road walks, and media sensitizations were other activities featured during the day. The state team also collaborated with SASCP and the Health Finance and Governance (HFG) project to reactivate moribund TWGs (ART/Treatment, resource mobilization, and pharmacy and logistics) in the state. This is a demonstration of the state government’s commitment to sustain donor supported HIV/AIDS programs. XXXXXX supported the TWG members in reviewing the terms of reference and assigning responsibilities. The members were also sensitized on the WHO guidelines for monitoring clients and improving retention in care in the state. The State Government also demonstrated commitment to SAPC Addressing Stakeholders at the ART TWG sustainability of the SIDHAS project by funding the printing of 7,000 inventory control cards and 3,000 bin cards to aid effective inventory management. The Pharmacy and Logistics TWG took full responsibility of the process and presented the finalized documents to relevant stakeholders for immediate use. Furthermore, the Chief Medical Director of the University of Uyo Teaching Hospital (UUTH) facilitated the procurement and installation of a 165KVA generator for the facility PCR laboratory. This will address the challenge of service disruption at the laboratory which result from epileptic power supplyactivities.