Common use of Challenges Clause in Contracts

Challenges.  The increased and continuous transfer of facility staff already trained by SIDHAS on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued to provide services at no cost to the client. The SIDHAS team continued to support provision of quality HIV/AIDS services using the QMAP approach. The team supported healthcare workers with the conduct of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in identified and eligible positives being placed on ART. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state government. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV services.

Challenges.  The increased Security challenges in the state occasioned by fighting among rival cult groups, kidnappings, unexplained assassinations, armed robbery attacks and continuous transfer political unrest has made project implementation very difficult, as movement to most parts of facility staff already trained by SIDHAS on ART client managementthe state is under restriction. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued to provide services at no cost to the client. Sustained Response States Anambra The SIDHAS team continued to support provision of quality HIV/AIDS services using through the QMAP approach. The team supported teams partnered with healthcare workers with in efforts geared towards achieving the conduct second 90 in the 90:90:90 goal. As part of folder audits and review initiatives to ensure this, client escort services were supported treatment supporters in some facilities to facilitate passive enrolment of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in identified and eligible positives being placed clients on ART. This quarter, 23 ART clients ADR cases were identified across supported facilities and two others within community pharmacies. This came on the heels of an onsite orientation on pharmacovigilance to have evidence promote ADR prevention, education, screening, detection, intervention and active reporting. A total of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians 144 medication errors were documented in the above stated facilities were mentored on management of treatment failurepharmaceutical care register, and corrective measures provided to affected patients. SIDHAS Three SIDHAS-supported CBOs continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued provide OVC services this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities in the statequarter. In line with project objectivesthe SIDHAS graduation model, the state team supported the University 11 (4M, 7F) older OVC were enrolled for training into various skills of Maiduguri Teaching Hospital their choice. CBOs tracked 563 (UMTH180M, 383F) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided treatment defaulters through home visits to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarteradherence, the SIDHAS team provided technical assistance to health facilities, CBOsprevent treatment complications, and relevant state agencies, to maintain access to improve quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018life. During the period under review, a SIDHAS supported CBO the WHO-AFRO Accreditation Preparatory audit was provided TA by conducted for the state team to conduct household economic strengthening training for older OVC to prepare them for graduationNAUTH ART and PCR laboratories. The team continued laboratory was awarded a 2-star rating. The HMB supported GH Amanuke laboratory with shelves, a workbench, laboratory stools, and tables to improve service flow. Anambra ANSACA also supplied HTS commodities (50 packs of Determine, 20 packs of Unigold, and five packs of Stat-Pak) to SIDHAS-supported facilities. Local Government Implementation Team (LIT) members in its engagement with key stakeholders nine LGAs organized three data validation and collection meetings this quarter. Participation was drawn from PHCs across the respective LGAs. These meetings served as data collation points for the various LGAs. Bayelsa SIDHAS-supported health facilities in the state continued to facilitate client satisfaction through advocacy visits, joint quality service provision by facility staff. This was achieved through supportive supervisory visits and provision onsite mentoring sessions in the areas of monthly summary progress reportsclient tracking and retention, drug adherence improvement, and promotion of facility-community linkages. These efforts have resulted are expected to enhance project performance. In addition, CBOs were supported to provide psychosocial, legal, and health services to OVC. These services were provided through home visits, caregivers’ forum, kids’ clubs, support groups and at community dialogue meetings. Inaugural meeting of NDUTH Drug and Therapeutic committee meeting As part of strategies to support Gender Based Violence (GBV) interventions, the SIDHAS team supported the institutionalization of a GBV response network in the development state. The network serves as a platform for harmonizing efforts of the State Ministry of Women Affairs, uniformed officers (including the Nigeria Police), legal actors, social workers, and healthcare workers, in furthering gender equality and women empowerment. The network is expected to purvey instruments that will assure freedom from violence, and increased participation of women in decision making processes in the state. The Niger Delta University Teaching Hospital (NDUTH) attained full integration status during the quarter. An assessment of the facility showed that all of its HIV related laboratory services (Hematology, Chemistry and CD4) have been integrated into the general laboratory services. In addition, the management of the facility has taken ownership of procurement of reagents, and preventive maintenance of hematology analyzers. During the quarter, two high volume sites - FMC Yenagoa and XXXXX Xxxxxxxxx—inaugurated their drug and therapeutic committees (DTC). These committees, which are fully functional, have been established with the primary objective of promoting rational drug use among PLHIV. As a sexual positive step towards the sustenance of the state HIV/AIDS response, the Bayelsa state government, through the SACA, procured three PIMA CD4 machines and SGBV SOPPIMA CD4 test cartridges to mitigate challenges associated with sample transfer from health facilities in riverine LGAs. The CD4 machines were allocated to three hard-to-reach riverine facilities (Cottage Hospital Xxxxxxx, Brass LGA, Comprehensive Health Center Ekeremor, Ekeremor LGA and Comprehensive Health Center Ogboinbiri), across three LGAs. The state government provided logistics for the installation of the machines and training of facility staff, while the SIDHAS project facilitated the installation process as well as the finalization and dissemination training of a task-shifting policy on human resources for health for the statefacility laboratory personnel. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned response to a series of advocacy visits to the state government, the human resource gap at the pharmacy unit of some supported facilities was addressed this quarter. Five qualified National Youth Service Corps (NYSC) pharmacists were posted to TBL Igbogene, FSP Clinic Yenagoa, Cottage Hospital Otuasega, General Hospital Odi and Cottage Hospital Xxxx Xxxxxx, to support service delivery. The Governmentpharmacists have been trained onsite by the SIDHAS team to assure quality service delivery. As the lead partner in Bayelsa state, through SACA, expressed commitment to funding sample transfer, maintenance SIDHAS organized and facilitated the bi-monthly meetings of laboratory equipment, and supply of RTKs to the facilities. Through participation USAID-supported IPs that took place in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships The meeting was held between SIDHAS and collaboration with stakeholdersthe Supply Chain Management System (SCMS) project, increased the only two USAID implementing partners in the state. The last meeting reported improvement in LMIS reporting rate; timely sharing of proof of delivery (POD); and a remarkable achievement in the 2016 waste drive. Also, within the quarter, SIDHAS visibility, supported the state procurement and provided avenues for more advocacy messages supply TWG to stakeholders develop its 2016 workplan. The state procurement and supply chain management is the highest body in the state that plays an advisory role to the government on ownership medical commodity procurement and sustainability of donor funded HIV servicessupply.

Challenges.  The increased Shortages of test kits and continuous transfer of facility staff already trained by SIDHAS CD4 reagents were experienced in Lagos State with resultant impact on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preferenceservice provision. However, Althe impact was mitigated through redistribution of commodities to high volume facilities by the state team • Stock out of Dry Blood Samples (DBS) collection kits occurred in some supported facilities in Cross River State. This was redressed through the redistribution of DBS kits among facilities as a short-Ameen clinicterm measure. Stakeholders, developed a privatecommuniqué on health commodities security to strengthen distribution of commodities in the coming quarter • There was shortage of viral load reagents at the University of Calabar Teaching Hospital (UCTH) and BMSH, Rivers State, as well as equipment breakdown at the DLHMH PCR. Samples were transferred and analyzed at Anambra State University Teaching Hospital (ASUTH) as a stop gap measure • In Rivers State, security challenges continue to impede visits and supervision to some of the facilities and communities in Eleme, Ahoada and Onelga LGAs • Stock out of HIV test kits in some facilities in Rivers State due to delayed supply of laboratory reagents and RTK’s by Chemonics to supported sites • Erratic supply of drugs and laboratory consumables by GHSC-for-profit ART sitePSM to facilities in Akwa Ibom Highlights from Sustained Response States Access During the reporting quarter, retained its clients on ART and continued to provide services activities aimed at no cost to the client. The SIDHAS team continued to support provision maintaining quality of quality HIV/AIDS services across the continuum of care were sustained across the nine supported states of Adamawa, Anambra, Bayelsa, Bauchi, Borno, Edo, Jigawa, Kano, and Yobe. In line with the goal of increasing TB case detection and treatment, the states intensified efforts in respect of TB screening. In Jigawa sates, 832 clients were screened for TB using the QMAP approachchronic care model by triage nurses. As a result, 20 HIV positive clients from two supported ART sites (Xxxxxxx Xxxxxxx Specialist Hospital (RSSH): 7 and GH Dutse: 13) were sent for GeneXpert test. All the results returned negative for MDR-TB. In addition, 23 PLHIV were placed on IPT at RSSH and FMC Birnin Kudu. Similarly, a GeneXpert machine for Myco-bacterium Tuberculosis (MTB) detection was installed at General Hospital, Ekwulobia, Anambra State by the state government. This brings the number of supported sites with GeneXpert machines in Anambra state to six, resulting in increased TB case detection from 45% to 60% in the state. Facility staff preparing TB/ DOTS Screening area at St. Xxxxxxx Xxxxxxxx Hospital, Onitsha Facility backstop reviewing Presumptive TB Register after the day’s activities at Iyi Enu Hospital, Ogidi This year’s world TB day was celebrated in conjunction with the respective state governments on March 24, 2017. The team supported healthcare workers theme, “Unite to End TB”, was marked with different events including rallies, press conferences, and active TB case finding across states. In Adamawa state, XXXXXX collaborated with the State Tuberculosis and Leprosy Coordinator (STBLC) to conduct a TB sensitization in the Internally Displaced Persons (IDP) camp in Fufore LGA of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Torothe state. The sensitization focused on TB identification, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternitytesting, and Pahlycon cliniccounselling of patients with presumptive and diagnosed TB. ART for PLHIV co-infected with TB also formed part of discussions with the IDPs. This activity resulted in identified the identification of 300 presumptive TB cases among the IDPs. Sputum samples were collected for TB diagnosis and eligible positives being placed linked for GeneXpert services. HIV tests were also carried out at the camp. At supported sites, 200 TB samples were also collected as part of World TB Day activities and linked to GeneXpert services. The state team successfully supported initiation of 210 new clients on ARTIsoniazid Preventive Therapy (IPT) during the reporting period. Activities to commemorate the World TB Day in Anambra state spanned the course of March 20 – 24, 2017 across 13 selected facilities. Activities included outdoor campaigns, active case finding within facility outpatient departments (OPD) and clinics through screening by facility triage nurses, movement to TB/DOTs unit for sputum collection and transport to lab for AFB or GeneXpert, including documentation. Findings showed that of the 645 persons screened, 143 presumptive cases were identified, with 55 TB positive individuals diagnosed using the GeneXpert technology. This quarteroutput surpassed the average number of clients per week screened and diagnosed. Efforts are ongoing by the state team to ensure all TB positive clients are started on DOTS. The SIDHAS team in collaboration with the Anambra state government also created a TB awareness video for public dissemination. The commissioner of health, 23 ART Xx. Xxx Xxxxxxx, expressed his appreciation to the USAID funded project for the support in ramping up TB awareness across health institutions in the state. As part of quality improvement and treatment adherence efforts, the Kano State team audited 21 folders at the Xxxxxxx Xxxxxxxx Specialist Hospital (15) and Rijiyar Lemo Basic Health Centre (7). The objective was to generate a list of treatment defaulters for tracking and bridging the gap in seropositive pregnant mothers not currently on ARVs. A list of five clients was generated, one from Rijiyar Lemo BHC and 4 from MMSH. The three clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12)successfully tracked and brought for ARVs. Mechanisms have been put in place to track Sensitization and reassess adherence screening ongoing at the outpatient unit of the clients ANSUTH, Awka In Yobe State, XXXXXX conducted a Continuous Quality Improvement (CQI) assessment, using the Site Improvement Monitoring System (XXXX) tool, as part of efforts to set bench marks for a possible regimen switchquality improvement in supported sites. Furthermore, clinicians in A major gap identified during the above stated assessment was poor documentation. Capacity development plans were developed together with the assessed facilities were mentored on management of treatment failure. SIDHAS continued and are currently being implemented to support DBS sample transfer to PCR laboratoriesguide the quality improvement activities. As a result of thissome of the implemented capacity development activities, Yobe state data quality has improved significantly as there were no data violations recorded against the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on in the need for IPT prescriptionstate throughout the quarter. In view a similar vein, a joint supportive supervisory visit was conducted by the FMOH/NAHSS/SIT/SIDHAS team to UBTH, ISTH, CH Uromi, UBTH, SOH, Faith Mediplex, SH Ossiomo and GH Ubiaja, in Edo State. The focus was to review implementation of this, efforts the national quality improvement plan developed by the facilities during the NIGQUAL learning meeting held in December 2016. A standard questionnaire was administered to assess quality of the improvement plan developed by the facilities. The visiting team was impressed with the high level commitment demonstrated by most facilities where the plan is being implemented. Integration Routine supportive supervisory visits during the quarter focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned client folder audits to review client documentation to ensure all viral load, TB screening and PMTCT. These exercises resulted in increased weekly identification, sample collection, and testing of eligible clients. In Anambra State, 329 eligible clients commenced INHidentified as a result of this exercise requested to have their viral load tests done. Results are still being expected. Furthermore, backlog of viral load samples from Cross River and Jigawa states were received at the PCR laboratories located in Xxxxxx Xxxxxxx University Teaching Hospital (NAUTH), Nnewi and Anambra State University Teaching Hospital (ANSUTH). The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state samples were analyzed and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support results dispatched to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS respective supported facilities. This effort is in line with routine viral load monitoring across board as well as attainment of the 3rd 90 in scale up LGAs. Similarly, SIDHAS viral load sample analyses were conducted capacity building activities in four treatment facilities in Bayelsa State namely GHs Brass and Nembe, and Cottage Hospitals Otuasega and Okpoama. Samples of 330 ART clients were transferred for select analysis to the Xxxxxxxxxxx Memorial Specialist Hospital (BMSH) PCR Laboratory, Port-Harcourt, Rivers state, while 233 results were dispatched to the respective facilities for necessary action by service providers. An interactive session The screening effort in the clinical management of 313 ART clients in IDP camps in Maiduguri, Borno State, resulted in the identification of 30 medication errors that were resolved along with 28 suspected cases of adverse drug reactions. Interventions were provided for the individual cases followed with the filling of 26 national pharmacovigilance forms for the ADR cases for delivery to NAFDAC. In Anambra, 67% of the HCC sites in the state documented and submitted pharmaceutical care services reports that track ADRs and interventions on challenges that hinder effective reproductive healthmedication errors, an improvement over the 32% for the last quarter. SIDHAS continued to monitor integration of HIV/AIDS services through the conduct of quarterly assessment of HIV integration was held with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilitiespharmacies using pharmacy service integration checklists/trackers. In additionYobe State, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on partitioning of the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites renovated dispensing area in the state, was provided with on-the-job mentoring GH Gashua to improve audiovisual privacy and rotation of pharmacists at ART Pharmacy in FMC Nguru are some of the quality of blood transfusion services. SIDHAS supported recommendations made to the Federal Medical Centre (FMC) Azare, IDH Bayara facility management for programmatic integration and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT effective service provisiondelivery. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA these would be achieved by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state government. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the next quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV services.

Challenges.  The increased Strike action embarked upon during the quarter by staff of Federal Medical Centre Yenagoa which commenced since August 2016 and continuous transfer of facility staff already trained by is still ongoing, affected project implementation in the facility. SIDHAS on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and team continued to provide services at no cost leverage on volunteers and adhoc staff to facilitate service provision pending when the clientstrike action is called off. • Restricted movement to riverine areas due to insecurity limited access to facilities in those locations. The SIDHAS team continued will continue to support provision be guided by security advisory from the Country Office security team Edo In Edo State, SIDHAS prioritized capacity building of quality HIV/AIDS services using the QMAP approach. The team supported healthcare workers with the conduct of folder audits and review of pre-ART registers as a strategy towards improving quality HIV service provision in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in identified and eligible positives being placed on ART. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi communityfacilities. As part of efforts aimed at this strategy, the team conducted Joint Supportive Supervisory Visits (JSSVs) to supported facilities (GHs Iruekpen, Agenebode, Igarra, Usen, Iguobazuwa, CH Auchi, and PHCs Ikhueniro and Okugbo) during which the XXXX checklist was applied as a quality assessment tool. Some of the identified gaps, such poor documentation, were immediately addressed; performance improvement plans were developed to address other areas requiring attention such as VL service uptake, client retention in care, improving PMTCT service delivery with emphasis on the provision 18-month outcome, and closing EID/ART prophylaxis gaps. Folder audits were also conducted and various registers reviewed to address gaps such as incomplete documentation in the care cards, routine CD4 and VL monitoring, EID testing for babies, early update of quality HIV services inventory tools, and daily update of worksheets. The aim was to ascertain availability of complete and valid data across the integration thematic areas. Series of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session initiatives were conducted during the quarter in line with SIDHAS focus on challenges that hinder effective reproductive health/HIV integration was held with 18 female improving skills and knowledge of healthcare workers drawn from 17 in supported facilities. To this end, SIDHAS supported a 4-day Roche system analyst training on CAP/CTM (COBAS Ampliprep)/COBAS TaqMan PCR machine November 9 – 12, 2016 in University of Benin Teaching Hospital (UBTH) PCR suite. Four (2M; 2F) medical laboratory scientists were trained on operating, maintaining, and troubleshooting of the Roche COBAS TaqMan PCR machine. This has increased the pool of facility laboratory personnel trained on PCR technology from 5 to 9. Similarly, four (3M; 1F) UBTH PCR laboratory staff and the SIDHAS lab staff participated in a training on logistics management of HIV/AIDS (PCR) commodities for facility PCR laboratory staff. The session equipped training was conducted by USAID Global Health Supply Chain Program Procurement and Supply Management (GHSP-PSM) in Lagos from November 14 – 16, 2016. Four facilities (UBTH, Faith Mediplex (FMH), Central Hospitals (CHs) Auchi and Uromi) registered for NHLS CD4 EQA program and also participated in the healthcare workers with knowledge required to support effective service integration in their facilitiesSurvey 4 Trial 40 and 41 (October and December 2016 surveys). In addition, 20 laboratory scientists reports of Trial 39 were received with all facilities scoring 100%; these were duly reviewed and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipmentfiled at the facilities. Similarly, 16 laboratory scientists EQA PT samples for HIV serology and technicians CD4 received from OASYS for the seven registered facilities (M:10UBTH, F:6Irrua Specialist Teaching Hospital (ISTH), FMH, Saint Camillus Catholic Hospital (SCCH), Xxxxxx Xxxxxxxx Hospital (SOH), CHs Auchi and Uromi) were trained analysed, and results uploaded to the OASYS website by the sites’ personnel. The team, in collaboration with FMOH, HIV/AIDS Division and Nigerian Alliance for Health System Strengthening (NAHSS), conducted a 2-day training/learning meeting on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging national quality improvement project for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two SIDHAS supported blood safety sites health care facilities in the state, was provided with on. A total of 26 (23M; 3F) participants drawn from 19 NIGQual supported health facilities participated. The learning meeting focused on service quality improvement for HIV clients and documentation. The participants developed a quality improvement plan which the facility CQI team will monitor over a 6-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting month period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct SIDHAS team facilitated a 5Micro Enterprise Fundamentals (MEF) step-day down training for 30 healthcare workers from 10 PHCs who caregivers/support group members and older OVC (51M; 243F) across Benin, Oben, Auchi and Igarra. Participants had never been trained their capacities built on PMTCT service provisionfundamentals of business development and income generating activities. It This is expected that the trained staff will to provide quality PMTCT services during ANC and refer positive clients for carean economic platform as a Launchpad to self-sustenance. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry As part of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous SIDHAS’ engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the stategovernment, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetingsa road walk to celebrate WAD 2016. The team also supported walk, led by the state government deputy speaker of House of Assembly, Xxx Xxxxxx, ended with a town hall meeting with stakeholders in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities the HIV/AIDS response in the state. In line The town hall meeting featured a stakeholders’ interactive session with project objectivespanel members from the Network of Persons Living with HIV and AIDS in Nigeria (NEPWHAN), and the state team supported Edo State Agency for the University Control of Maiduguri Teaching Hospital AIDS (UMTH) to develop its EDOSACA). The event was graced by the Deputy Governor of the state, EDOSACA, SMOH, Civil Society for HIV/AIDS sustainability roadmap during a 2-day workshopin Nigeria (CiSHAN), Local Government and Chieftaincy Affairs (LGA), and IPs represented by Achieving Health Nigeria Initiative (AHNi). Technical support was provided to ensure The discussion centred on challenges of the alignment of developed strategies with global strategies as well as budget development state HIV response and recommendations for the plansresponse going forward. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring A communique was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, drafted with resolutions reached for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned onward transmission to the state government. The Government, Governor through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to his Deputy who was present at the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues event for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV servicesnecessary action.

Challenges.  The increased Non availability of VL reagents to PCR laboratory in Jalingo limited the number of VL tests and continuous transfer analysis thus, affecting quality of facility staff already trained by care provided to the clients Borno SIDHAS on ART client managementteams continued to support the Borno State Government to provide quality comprehensive HIV/AIDS services across seven supported facilities and 10 Internally Displaced Persons’ (IDP) camps. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one Comprehensive ART and seven PMTCT sitesservices were provided through the mobile ART teams. HTS were also provided to IDPs and identified positives were enrolled into care at the camps by the mobile teams; clients current on treatment on the other hand were provided with drug refills. Other packages of care provided to PLHIV in the camps included OI drugs refill, pharmaceutical care, and clinical pharmacovigilance. A two-day onsite skills update session was conducted for two focal laboratory technicians at XX Xxxxx on sample preparation (CD4 absolute and CD4 %), incubation, initializing, loading, count check beads QC testing, sample testing and cleaning, decontamination, and machine shut down procedures. The session was integrated into one of the routine planned preventive maintenance (PPM) were transited to exercises carried out for the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued to provide services at no cost to the clientfacility. The SIDHAS team continued to support provision the North East (NE) TB emergency response initiative with TB screening of quality HIV/AIDS services using the QMAP approachall clients in supported sites and initiation of eligible clients on IPT. A 2-day onsite multidisciplinary orientation was conducted for healthcare workers in XX Xxxxxx (3F, 4M) and XX Xxxxx (1F, 4M) on IPT eligibility screening, initiation and refilling, counselling, documentation, and inventory management. The team triaging strategy used under the NE TB emergency response initiative, and the availability of INH stock in all supported healthcare workers facilities, resulted in increased IPT uptake in the affected facilities. XXXXXX also supported the state with the conduct installation of folder audits and review of pre-ART registers in selected facilities GeneXpert machines (General Hospital (GHsupplied by NACA) Toro, IDH Bayara, at State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban MaternityXxxxx Memorial Hospital, and Pahlycon clinicGeneral Hospital Biu. This activity resulted The team also provided technical assistance through a presentation on PMTCT at the WHO-organized training for newly recruited healthcare workers for hard-to-reach areas in identified and eligible positives being placed on ARTthe newly liberated LGAs in Borno. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team XXXXXX provided technical assistance to the government as well as referrals Borno State Agency for the Control of beneficiaries AIDS (BOSACA), SASCP and SMoH to available services commemorate the 2016 WAD on December 1, 2016 themed “Hands up for HIV Prevention”. As part of the WAD 2016 activities, the management of BOSACA, the State AIDS Program Coordinator (HTSSAPC), STI screening etc.and SIDHAS team, paid an advocacy visit to the management of Borno Radio and Television (BRTv). The SIDHAS team also continued sensitized BRTv management on the HIV/AIDS situation in the state and solicited its support to host various coordination meetings create awareness about the epidemic. The BRTV General Manager, Xxxx Xxxx, committed to use its radio and participation in meetings organized by other IPs providing humanitarian services in TV stations to sensitize and educate the people of Borno State. These included meetings with UN agencies such as UNICEFState on HIV/AIDS prevention, UNHCRtreatment, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), care and Action and Against Hungersupport. In view of SIDHAS intervention efforts in the stateaddition, the team participated in a group discussion with PLHIV organized by BOSACA and SASCP as part of the activities to commemorate the WAD2016 celebration in the state. National Emergency Management Agency (NEMA) also supported the celebration by providing household materials such as children clothing and milk supplements, plastic buckets, toilet soap, detergents and slippers to 103 PLHIV. XXXXXX also actively participated in various humanitarian coordination meetings such as the Protection Sector Working Group (PSWG), Health Sector Working Grouphealth sector working group, SGBV sub-sector working group, food security working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government Participation of SIDHAS in providing HTS these coordination meetings enhanced project visibility and ART services to Internally Displaced Persons (IDPs) and host communities in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement strengthened collaboration with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state government. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV serviceseffective programming.

Challenges.  The increased Insufficient health manpower in government supported facilities especially pharmacist and continuous transfer of facility staff already trained by SIDHAS on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued to provide services at no cost to the client. The SIDHAS team continued to support record officers resulted in poor provision of services and documentation of service data Bayelsa The state team focused on improving quality HIV/AIDS of services using the QMAP approach. The team provided at supported healthcare workers with the conduct facilities and promoting sustainability of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in interventions by closing performance gaps identified and eligible positives being placed on ART. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescriptionprevious FY. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held line with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Governmentthis goal, the state team supported the state Ministry of Health carried out supportive supervision and mentoring visits to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to all supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 Some areas covered during the visits included contact tracing, use of IPT, pre-exposure prophylaxis (M:21PrEP), F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision integration of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings reproductive health and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.RH/HIV). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EIDother related services. Efforts aimed at achieving pharmacy service integration continued through mentoring Service quality and achievements of pharmacists and pharmacist specialists in four supported facilities were reviewed during quality monitoring and accountability program (GH Damagum, GH Fika, GH Gashua QMAP) mentoring visits using the site improvement monitoring system (XXXX) checklist. Actions points were developed to address performance gaps identified during the XXXX visits and GH Potiskum)recommendations made for improvement. XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the The state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision facilitated transfer of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two 600 ART clients’ blood samples from supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state governmentPCR laboratory at Xxxxxxxxxxx Memorial Specialist Hospital (BMSH), Port Harcourt, Rivers State for VL analysis. The Government, through SACA, expressed commitment to funding sample transfer, maintenance A total of laboratory equipment, 152 VL results were received and supply of RTKs dispatched to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held respective facilities during the quarter. This SIDHAS-supported CBOs conducted economic empowerment training for 133 (M:8; F:125) caregivers and older OVC during the quarter. The objective was to provide economic empowerment to caregivers and older OVC for improved relationships wellbeing of households and children. The training which was conducted in Sagbama and Agbia communities had participants benefitting from vocational skills in the area of soap making, confectionaries, and livestock farming, among others. The state team, in collaboration with stakeholdersthe State Director of Pharmaceutical Services, increased SMOH, conducted a joint supervisory visit to Cottage hospital (CH) Otuasega on November 16, 2016. The team supplied pharmaceutical care case note booklets and mentored the pharmacy staff on proper documentation using the booklets. The aim was to improve pharmaceutical care services through detection and intervention in drug therapy. Technical assistance was also provided to the laboratory units of Federal Medical Centre Yenagoa and Niger Delta University Teaching Hospital Okolobiri (NDUTH) on quality control and assurance; this led to 100% performance score in Survey 4 Trial 40 of CD4 quality standard assessment. The performance indicates that CD4 test results generated in the two facilities are reliable and of high quality, and comparable with those generated across several states of Nigeria. The performance score by all supported facilities in Dried Tube Specimen Proficiency Testing (DTS PT) also recorded significant improvement this quarter with 21 of the 29 testing points in the state scoring above 90%. Issues identified for low scores included incomplete filling of forms and poor interpretation of results. Identified gaps were addressed with the facility staff through onsite mentoring and retraining. SIDHAS completed continuous quality improvement (CQI) assessments for the quarter across all supported entities and developed remediation plans for all observed gaps, which included poor documentation, lack of record keeping registers and job aids, from the assessment findings. Implementation of identified gaps as documented in the capacity building plan formed part of the mentoring schedule by the QMAP team for respective facilities. A step-down training was conducted on the 20th of December, 2016 for Bayelsa State SIDHAS team to update their skills and provide them with orientation in line with the newly revised national tools on HTS, PMTCT, ART, PEP, Pharmacy, transfer and tracking. A total of 17(Male:13; Female:4) benefitted from the one-day training on indicators and tools reporting to enhance a better understanding of the use of the revised tools. XXXXXX participated in high level stakeholder meetings organised by National Product Supply Chain Management Program (NPSCMP), Department of Food and Drug Services of the FMOH. The meeting which took place on November 18, 2016 at the MOF Executive Conference Hall aimed at formally instituting Nigerian supply chain integrated project (NSCIP) in the state. The state team provided technical input into the final design of the project which is funded by USAID and other partners. The project is to be implemented by the Logistics Management Coordination Unit (LMCU) at the state as well as a similar institution at the LGA level. The project is expected to address key logistics challenges encountered on the SIDHAS visibilityproject when it eventually takes off. The meeting had in attendance the Permanent Secretary, Local Government Service Commission, Chief Medical Director, Hospital Management Board(HMB), Directors of Planning and Statistics, (HMB) and (MOH), Acting XX XXXX, SASCP, DPRS, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV servicesother IPs in the state.

Challenges.  The increased Inadequate supply of commodities during the last supply circle to some sites; Cotrimoxazole for CH Auchi and continuous transfer of facility staff already trained by SIDHAS on ART client managementCD4 Cyflow reagent for UBTH, SCCH, SOH and FMH resulting in constant redistribution between sites. Bauchi State In accordance Jigawa SIDHAS, in collaboration with USAID directives and the facility transition planstate government, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to continued the Bauchi State Government this quarter. Clients from the transited sites were transferred to other SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued to provide services at no cost to the client. The SIDHAS team continued to support provision delivery of quality HIV/AIDS and TB services across eight ART and eight PMTCT supported sites in the state. HTS was provided to clients based on clinical symptomology or when requested by the client, identified HIV positives individual were placed on ART while positive pregnant women were placed on prophylaxis to reduce the risk of mother to child transmission of HIV. In order to sustain and improve quality of care for clients currently on ART, clinical assessment of clients was conducted using WHO staging, CD4 count, and VL assessment across supported facilities. Access to quality TB services for PLHIV was prioritized by screening for TB symptoms during clinical visit, and identified positives started on TB treatment. During the QMAP approachquarter, the team intensified efforts to increase access to ART services for pediatrics through client tracking and follow up on DBS testing for EID. DBS samples were collected from HEIs from six supported sites comprising five ART and one PMTCT sites and sent for EID analysis at the Aminu Kano Teaching Hospital, Kano. During the quarter, the state team sensitized and mentored supported facilities on the revised LMIS reporting templates to enable them compile and produce quality bimonthly LMIS reports. The team supported healthcare workers facilitated commodity logistics during the quarter by redistributing ARVs and laboratory commodities from health facilities with the conduct of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinicexcess commodities to sites with low stock. This activity resulted in identified was done to ensure uninterrupted service delivery whilst also preventing expiries. To this end, 136 units of TDF/3TC/EFV 300/300/600mg were resupplied to GH Birnin-Kudu and eligible positives being placed on ART. This quarter, 23 ART clients were identified 100 Rohren tubes transferred to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place GH Dutse to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failureclose stock gaps. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result carried out series of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 this quarter. This was geared towards quality improvement in services provided to PLHIV in supported facilities. The session equipped Healthcare workers from all eight SIDHAS supported ART sites were trained in three clusters on the healthcare workers with knowledge required VL platform from October 25 to support effective service integration December 30, 2016 in their facilitiesBirnin Kudu, Dutse and Ringim. A total of 34 (5F; 29M) benefited from the training which covered the current PEPFAR policy direction for HIV/AIDS, as well as best practices and approach to handling VL test results among PLHIV. In addition, 20 a one-day onsite orientation on Pharmacy Best Practice (PBP) was organized for pharmacy personnel at FMC Birnin Kudu on October 26, 2016. The orientation updated skills of the staff on pharmacy documentation, client monitoring, drug counselling and dispensing, service linkages, client retention, and intervention on drug therapy problems. A total of 11 (9M; 2F) pharmacy personnel participated in the orientation. XXXXXX supported the installation of a GeneXpert machine provided by NACA and training of medical laboratory scientists personnel on its operation and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipmentmaintenance at the GHs Jahun and Kazaure during the quarter. Similarly, The training had in attendance 16 laboratory scientists technicians and technicians scientist (M:10, F:6) were trained on XX Xxxxx (5 M; 3F); GH Kazaure (7M; 1F)). Understanding of the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites staff was enhanced in the stateuse of GeneXpert equipment for early detection of TB cases and quality treatment to clients. Following development and finalization of the state sustainability roadmap for HIV/AIDS in FY16, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported Jigawa State Government signed the narrative document for both the State government and the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting periodCenter Birnin Kudu. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It document is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In to serve as a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health guide to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment for future strategic direction towards coordinating and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gapsensuring an effective HIV/AIDS state response. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team XXXXXX also supported the state government in providing HTS to convene its first post GBV care response committee meeting. The committee membership is drawn from law enforcement agencies, Ministry of Women Affairs, female lawyers’ association, medical women association and ART services to Internally Displaced Persons (IDPs) and host communities civil society organizations in the state. In line The committee is charged with project objectives, the state team supported the University responsibility of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment facilitating shared understanding of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOPgender issues among all stakeholders, as well as the finalization coordinating an effective response to gender issues at facility and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state governmentcommunity levels. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation inaugural meeting had in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV servicesattendance eight (4M; 4F) participants.

Challenges.  The increased and continuous transfer Redeployment by the state govt. of facility staff already trained by SIDHAS on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight pharmacists from SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited sites to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other non SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART led to challenges in quality of pharmacy services provided at GHs Dutse and continued to provide services at no cost to the clientKazaure. The SIDHAS team continued commenced onsite mentoring of the pharmacy staff while advocacy to support relevant stakeholders to address this challenge is ongoing. Kano The Kano state office sustained provision of TB/HIV integration services through intensified TB case finding among PLHIV in SIDHAS supported facilities. The goal was to strengthen and institutionalize TB infection control and sputum sample referral systems for improved quality HIV/AIDS of care. The team also ensured integration of HIV services through strengthening of intra and inter facility linkages, and tracking of HIV positive clients in the facilities for care. Adult and pediatric ART services were provided to HIV positive clients during the quarter across all supported facilities in the state. To improve quality of care to eligible clients, the team facilitated prompt collection and transfer of DBS to the PCR lab for analysis, and client tracking and referrals. The objective was to improve retention in care and reduce HIV related morbidity and mortality. Care and support services to OVC and caregivers continued in the quarter with the training of 310 (M:13; F:297) caregivers and older OVC on money management and entrepreneurial skills organized by USAID MARKETS II. The step down training was conducted in four batches in four local government areas namely Fagge, Kano, Dambatta, and Gwarzo. The participants are expected to use the acquired skills to improve their wellbeing and that of the OVC in their care. As part of continuous capacity and quality improvement efforts, SIDHAS mentored and supervised healthcare workers in the provision of services at the facilities. The team also collaborated with GoN staff to conduct CQI and XXXX assessments. A total of 12 SIDHAS supported facilities were monitored and assessed using the QMAP approachCQI/XXXX assessment tool in the reporting quarter. Some of the key findings included poor infection prevention and control practices, inaccurate CRRIFF documentation and reporting - which affected timely and adequate drug resupply and poor documentation of service data. Results of the assessment were used to develop performance improvement plans for affected facilities. The team supported healthcare workers with the conduct of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in identified and eligible positives being placed on ART. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration of services in SIDHAS supported facilities, SIDHAS conducted capacity building activities for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 supported facilities. The session equipped the healthcare workers with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy electronic Logistics Management Information System (OASYSeLMIS) Proficiency Testing Program at the facility level for better data collection, management and sample logging for VL. These trainings are expected to contribute to improved quality of laboratory services within these facilities. ATBUTH, one of two supported blood safety sites in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara transmission and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing cases of treatment failure, ADR reporting, medication error, and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provision. It is expected that the trained staff will provide quality PMTCT services during ANC and refer positive clients for care. In a drive for increased ownership and sustainability, as well as promoting collaborative efforts with the Bauchi State Government, the state team supported the state Ministry of Health to validate, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. Furthermore, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provision, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEF, UNHCR, UNFPA, WHO, UNOCHA, Save the Children UK, Medicine San Frontiers (MSF), and Action and Against Hunger. In view of SIDHAS intervention efforts in the state, the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetings. The team also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities use in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital SIDHAS coordinated three Integrated Health Data Management Team (UMTHIHDMT) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources for health for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state government. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held meetings during the quarter. This improved relationships These meetings brought together stakeholders to review state level performance at SIDHAS supported facilities and collaboration with stakeholders, increased USAID discuss ways of addressing identified gaps. They also provided the opportunity to build the capacity of healthcare workers in transferring data into the NHMIS and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability development of donor funded HIV servicesRUNS charts.

Challenges.  The increased and continuous transfer Delay in the re-opening of facility staff already trained by SIDHAS on ART client management. Bauchi State In accordance with USAID directives and the facility transition plan, eight SIDHAS supported health facilities (one ART and seven PMTCT sites) were transited to the Bauchi State Government this quarter. Clients from the transited sites were transferred to other some SIDHAS supported sites based on their preference. However, Al-Ameen clinic, a private-for-profit ART site, retained its clients on ART and continued by the state government due to provide insecurity has hampered access of HIV services at no cost to the clientaffected communities Yobe XXXXXX conducted joint supportive supervisory visits with the state government to the supported five health facilities, CBO, and relevant state agencies in efforts to maintain access to quality HIV/ AIDS, TB and related services in the state. The visits focused on ARV prophylaxis to pregnant women that tested HIV positive, EID, and laboratory support services. The SIDHAS team continued to support provision of quality HIV/AIDS services using the QMAP approach. The team also supported healthcare workers with the conduct of folder audits and review of pre-ART registers in selected facilities (General Hospital (GH) Toro, IDH Bayara, State Specialist Hospital, Xxxxxxxx Xxxxxx Balewa University Teaching Hospital (ATBUTH), Urban Maternity, and Pahlycon clinic. This activity resulted in identified and eligible positives being placed on ART. This quarter, 23 ART clients were identified to have evidence of immunologic failure (XX Xxxx – 4, ATBUTH – 7, IDH Bayara – 12). Mechanisms have been put in place to track and reassess adherence of the clients for a possible regimen switch. Furthermore, clinicians in the above stated facilities were mentored on management of treatment failure. SIDHAS continued to support DBS sample transfer to PCR laboratories. As a result of this, the average turnaround time improved from 4 weeks to 2 weeks. Efforts aimed at increasing INH uptake continued this quarter through sensitization of clinicians in SIDHAS supported sites on the need for IPT prescription. In view of this, efforts focused on capacity development activities targeting triage units, clinicians and pharmacist in IDH Bayara, ATBUTH, Urban Maternity, GHs Tafawa Balewa and Dass. Pharmacy focal persons in the above stated sites were assigned to review client documentation to ensure all eligible clients commenced INH. The SIDHAS OVC program within the state continued efforts of graduating older OVC. A list of older OVC compiled was used as an advocacy tool to relevant government (state and local) and community stakeholders. Advocacy efforts paid off as the Bauchi Emirate Council has expressed interest to continue providing support to the graduated OVC within Bauchi community. As part of efforts aimed at improving the provision of quality HIV services and the integration reorganization of services in SIDHAS GHs Potiskum and Gashua, during the renovation of these facilities by the state government to ensure uninterrupted provision of HIV/AIDS, TB and related services. Inventory management of ARV and Cotrimoxazole was also supported facilities, SIDHAS conducted capacity building activities at GH Damagum and GH Fika for select service providers. An interactive session on challenges that hinder effective reproductive health/HIV integration was held with 18 female healthcare workers drawn from 17 supported facilitiesimproved access to ARVs by pregnant women. The session equipped linkage of pregnant women from ANC to pharmacy was further strengthened through escort services provided by PLHIV support groups. Viral load testing services commenced during the healthcare workers quarter with knowledge required to support effective service integration in their facilities. In addition, 20 laboratory scientists and technicians (M:15, F:5) were trained on sample logging for TB analysis using GeneXpert equipment. Similarly, 16 laboratory scientists and technicians (M:10, F:6) were trained on the One World Accuracy System (OASYS) Proficiency Testing Program and sample logging for VL. These trainings are expected to contribute to improved quality orientation of laboratory staff on VL sample collection and other logistics. To this end, VL samples were collected and transported to UMTH for testing. The results received provided more insight into the clients’ response to treatment thus, assisting in improving clinical care provision to the clients. Gender mainstreaming activities also continued during the quarter with focus on mentorship to healthcare workers, provision of support services within these facilitiesto victims of sexual and GBV, PEP to sexually assaulted clients, and appropriate documentation of SGBV services. ATBUTH, one of two supported blood safety sites The data from facilities in the state, was provided with on-the-job mentoring to improve the quality of blood transfusion services. SIDHAS supported the Federal Medical Centre (FMC) Azare, IDH Bayara and ATBUTH to conduct DTC meetings during the reporting period. The meetings were aimed at addressing quarter revealed cases of treatment failure, ADR reporting, medication error, both sexual and patient adherence to medication. The meeting also followed up on recommendations from the previous meeting. Pharmacy staff in the 17 supported ART sites were mentored on inventory management of ARV/OIs during the transition period of SCMS. BACATMA/SASCP was supported to conduct a 5-day training for 30 healthcare workers from 10 PHCs who had never been trained on PMTCT service provisionphysical violence. It is expected that knowledge gained by staff through mentorship will help improve quality of services to the SGBV victims. SIDHAS supported the CBO (GESDI) to train additional 80 OVC on HES as part of efforts to reduce the vulnerability of OVC and secure their socio-economic status. This has brought the total number of older OVC trained and graduated in the state to 150. SIDHAS team conducted a joint CQI assessment with the SMT using XXXX tools after which capacity building plans were developed to address identified gaps. Facility healthcare workers were also provided orientation during supportive supervisory visits on quality improvement activities. The orientation focused on quality documentation of services provided, data mop-up and DQA with the goal to improve service and data quality across supported sites. The outcome of cohort analysis and XXXXX conducted during the mentoring visits necessitated strategic client tracking in order to improve the retention rate. Government of Nigeria staff will provide quality PMTCT services during ANC including SASCP Coordinator, XXX X&X officers, and refer positive clients XXXXXX M&E officer attended a 7-day training on revised national M&E tools in Kaduna as part of the mandate of the SIDHAS project to build the capacity of stakeholders including GoN staff. A total of four state M&E team members benefitted from the training which they are expected to step- down to facility M&E officers in the state. A key outcome of the training was the development of harmonized national M&E tools for carethe country. In a drive for increased Yobe State SIDHAS team sustained engagement with key stakeholders through advocacy visits and project implementation activities aimed towards project ownership and sustainability. An advocacy visit was paid to the newly appointed Executive Director, as well as promoting collaborative efforts Xxxx XXXX, to seek the continued support of the agency towards the SIDHAS project and HIV/AIDS services in the state. The Yobe SACA also led the review of the draft state sustainability roadmap developed with support from the Bauchi State GovernmentSMT. The state government demonstrated commitment to the SIDHAS project and state HIV/AIDS response with a commitment to scale up ART services to 15 additional PMTCT sites in the state. This commitment was made during the commemoration of the 2016 WAD in Damaturu. The event which was attended by the Hon. Commissioner for Health, had other key stakeholders including the state team supported the state Perm Sec Ministry of Health to validateHealth; Executive Secretary, finalize and cost the Health Sector Development Strategic Plan 2016-2020. This has ensured incorporation of quality HIV care provision into the strategic plan. FurthermoreYOSACA; Executive Secretary PHCMB, continuous engagement with the state government has resulted in the recruitment and posting of pharmacists and record officers to some SIDHAS supported sites to close HR gaps. Borno State As part of efforts towards ensuring quality HIV service provisionMedical Director, the state team continued with its QMAP approach to supported facilities. The team conducted a workshop on household economic strengthening for caregivers and 22 (M:21, F:1) older OVC. This workshop is expected to enhance participants’ knowledge on developing care plans for households. SIDHAS continued in its collaborative efforts with the state government at all levels in ensuring the provision of quality HIV services. One of such collaborations was the active participation of the team in the “Safe Home” committee meetings and HIV screening of wives and children of insurgents that have been rescued. The team provided technical assistance to the government as well as referrals of beneficiaries to available services (HTS, STI screening etc.). The SIDHAS team also continued to host various coordination meetings and participation in meetings organized by other IPs providing humanitarian services in Borno State. These included meetings with UN agencies such as UNICEFSpecialist Hospital Damaturu, UNHCR, UNFPANEPWHAN, WHOLine Ministries and LACA representatives in attendance. The government stakeholders actively participated in joint facility supportive supervision visits, UNOCHAmonthly M&E, Save the Children UKTWG meetings, Medicine San Frontiers (MSF)data review meetings and CQI assessments. The mentoring and supportive supervision visits to health facilities resulted in prompt resolution of issues of health facility staff attitude to work, improved coordination of HIV services by SACA, and Action and Against Hunger. In view maintenance of SIDHAS intervention efforts good working relationship with key stakeholders in the state, state on the team participated in the Protection Sector Working Group (PSWG), Health Sector Working Group, SGBV sub-sector working group, and IPs/SEMA/NEMA coordination meetingsSIDHAS project. The team stakeholders were also provided periodic update on project activities through monthly summary progress reports. SIDHAS also supported the state government in providing HTS and ART services to Internally Displaced Persons (IDPs) and host communities in the state. In line with project objectives, the state team supported the University of Maiduguri Teaching Hospital (UMTH) to develop its HIV/AIDS sustainability roadmap during a 2-day workshop. Technical support was provided to ensure the alignment of developed strategies with global strategies as well as budget development for the plans. Yobe State During the quarter, the SIDHAS team provided technical assistance to health facilities, CBOs, and relevant state agencies, to maintain access to quality HIV services in the state. Supportive supervision, orientation and mentoring was provided to facilities on documentation, adherence counselling, triaging, TB/HIV, PMTCT, and EID. Efforts aimed at achieving pharmacy service integration continued through mentoring of pharmacists and pharmacist specialists in four supported facilities (GH Damagum, GH Fika, GH Gashua and GH Potiskum). XXXXXX also supported repairs of laboratory equipment, fixing of faulty ACs and an inverter in the GeneXpert laboratory at FMC Nguru, for continued provision of quality laboratory services. FMC Nguru was also supported to develop a costed sustainability roadmap 2016 -2018. During the period under review, a SIDHAS supported CBO was provided TA by the state team to conduct household economic strengthening training for older OVC to prepare them for graduation. The team continued in its engagement with key stakeholders in the state through advocacy visits, joint facility supportive supervisory visits and provision of monthly summary progress reports. These efforts have resulted in the development of a sexual and SGBV SOP, as well as the finalization and dissemination of a task-shifting policy on human resources health sector operational plan for health humanitarian services for the state. In line with the SIDHAS transition plan, two supported health facilities (GHs Buniyadi and Gashua) were transitioned to the state government. The Government, through SACA, expressed commitment to funding sample transfer, maintenance of laboratory equipment, and supply of RTKs to the facilities. Through participation in TWG and monthly M&E meetings, the state team maintained collaboration with stakeholders and built capacity of SACA and other SMT members on data validation, data use, and drug and commodity logistics. The team also participated in special events such as World Blood donor day which held during the quarter. This improved relationships and collaboration with stakeholders, increased USAID and SIDHAS visibility, and provided avenues for more advocacy messages to stakeholders on ownership and sustainability of donor funded HIV services2017.