ACHIEVE

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The ACTION TO CONTROL HIV EPIDEMIC THROUGH EVIDENCE (ACHIEVE) is a CDC Nigeria funded project of the Institute of Human Virology Nigeria (IHVN) under the PEPFAR 3 program. EHAI currently is a sub-recipient of IHVN implementing the ACHIEVE project in 3 Local Government Areas (LGA) of Nasarawa State and Kwali LGA of the FCT. Under the ACHIEVE project, EHAI provides technical and programmatic support to pre-identified health facilities within these LGAs to ensure they provide HIV services of the highest quality to their clients. The project is offering HIV prevention, care and treatment services to Adults and Pediatrics clients, Pregnant Women (PMTCT), Key Population and Vulnerable Children. sustain patients on ART and support a minimal increase through passive enrollment on ART.

The following objectives guide the implementation of the ACHIEVE project with a focus on actualizing the global vision of 90-90-90

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Reaching and Finding New HIV Positive Clients

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Linking all PLHIV to Treatment

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Retention in Care and Achieving Viral Suppression

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Yield-Based approach will be adopted over Utilization-Based approach to identify over 2,000 new HIV positive clients in this COP year. Mentoring of counsellors will be intensified in order to improve eliciting of previous testing from clients. Unique identifiers including biometrics will be rolled out for all identified HIV Testing Services (HTS) positives clients who will be retested at point of initiation on treatment. Some of the activities that will achieve this objectives include:

  • Testing sexual partners and family members of index patients
  • Yield-based testing for Provider Initiated Testing and Counseling (PITC) at non-HIV specialty clinics (STI, Emergency etc.)
  • Testing Strategies with Key Populations
  • Enhanced Testing for PMTCT Services e.g. mapping and linking TBAs with proximal PHCs
  • Enhanced Testing for Adolescents and Vulnerable Children which involves HTS for school and out of school clients as well as active tracking of social network of positives identified

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  • Using Model Patient Navigators for linkages
  • Improving HTS Documentation through Instant Redeemable Coupon (IRC)
  • Quality and timely HIV Treatment
  • Strengthening TB/HIV Linkage through intensified case finding, linkage after diagnosis, Isoniazid Preventive Therapy (IPT), Infection Control (IC) and strengthening Sputum Sample Logistics
  • Active Engagement of Community Structures for Effective Community and Facility Referral System
  • Establish bidirectional linkage for OVC
  • Programming for Adolescent Girls and Young Women (AGYW)

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  • Strengthen and scale up the following in all priority LGAs: Community Treatment Initiative, Community Pharmacy for ART, the use of Community-based Support Groups and Community ART Groups and facilitating Group Couriers for ARV pick- ups.
  • Activation, strengthening and Scale up of Adolescent-friendly clinics with special focus on transitioning patients from Paediatric to Adolescent-friendly Treatment Clinics by developing and deploying trainings and Standard Operating Procedures. This will also involve structured transition-preparedness sessions involving peer-led Support Groups.
  • Facility Differentiated Models of Care (support off hour consultations and drug pickups or shift duties)
  • Monitoring for Viral Suppression
  • Improving health through technology solutions introducing by strengthening the implementation of Electronic Medical Record

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These strategies below have also been put in place to ensure successful implementation of the project as well as the actualization of set goals and targets:

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Strengthen Laboratory Capacity, Networks and Quality Management Systems

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Develop and Support Sustainability Plan to Increase the Government of Nigeria’s (GoN) Investment

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Support Facilities and Health Care Workers (HCWs) to Deliver and Monitor High Quality Services

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  • Existing laboratory networks for viral load (plasma), EID (DBS), CD4 and TB GeneXpert samples will be streamlined to key into the National Integrated Sample Referral Network (NiSRN)
  • Real-time reporting of laboratory results and data will be done electronically via LIMS, GX alert and BLIS
  • Institutionalizing laboratory quality management program
  • Implement availability/use of controls for routine HIV testing (LabQual) through the following:
    • Support the NEQAL in developing DTS for distribution as well as establishing regional national laboratories that would be trained to produces DTS under the guidance and quality control of NEQAL to support the program in Nigeria;
    • Develop appropriate SOPs for the process as a template that can be modified by facilities according to their local infrastructure;
    • Review test results of selected institutions to ensure appropriate controls are being utilized and identify gaps to address through re-training or advocacy. ACHIEVE’s 100% HTS points will implement the Rapid Test Kits Quality Improvement Initiative – RTKQII.
  • Support NEQAL to negotiate an efficient transportation system for the PT panels distribution
  • Support the piloting of electronic (e.g. SMS) relay of test results to minimize turnaround time and to collate results centrally
  • Support NEQAL in database development to accurately capture the exercise including the PT panels’ results.

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  • Support set up of functional National Reference Lab coordinated through NCDC
  • Support GON through NCDC to set up a functional laboratory equipment calibration/certification and maintenance program.
  • Build oversight capacity of GoN to manage the national HIV program
  • Support GoN to develop all relevant policies and guidelines
  • Identify program staffing needs in facilities and communities – advocate for digitalized Health Care Worker Registries.
  • Facilitate increased GoN direct facility-level financing and investment
  • Leverage investments in HIV-related services.

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Support Facilities and Health Care Workers (HCWs) to Deliver and Monitor High-quality services through:

  • Conducting quarterly Data Quality Assurance and Continuous Quality Improvement activities at facilities
  • Providing cost-effective service delivery
  • Ensuring all high-volume facilities utilize electronic medical record (EMR)
  • Building the capacity of front-line HCW to use program data for quality services
  • Developing and implementing an Evaluation and Performance Measurement Plan (EPMP) to include:
    • Performance Monitoring Strategy
    • Data Source and Collection
    • Evaluation Strategy

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