Despite the successes of the Nigerian ART surge program in increasing the treatment coverage in surge and non-surge states, data reveals that a considerable gap in treatment coverage still exists in some Sub-National Units and Sub-populations such as; paediatrics, adolescents, Key Population (KP), pregnant and breastfeeding women. This RFA seeks to support the Government of Nigeria (GoN) to achieve HIV epidemic control within age and sex bands, retain in care all PLHIV and ensure viral suppression. Our Accelerated Comprehensive AIDs Response for Epidemic Control and Sustainability (¿CARES) project will implement a hybrid of facility and community-based interventions and leverage the current ART surge program to address the remaining gaps. This project will build on gains of our successful program: Improving Comprehensive AIDS Response Enhanced for Sustainability (iCARES), which rapidly scaled up HIV case identification in Benue surge state from a weekly median of 125 to a consistently over 700 new cases per week; while accounting for 30% (358,556) of CDC Nigeria treatment current with 95% of clients retained and 95% virally suppressed.
To implement a mixed model of efficient HIV testing and linkage approaches in facilities and communities, APIN will use data-driven evidence to identify HIV positives in the communities, implement social network strategy for KPs’, maximize Index Testing and Provider Initiated Testing and Counseling at facilities, as well as expand PMTCT case finding to communities. Furthermore, we will implement tested, innovative, and client-centric interventions for optimal PLHIV treatment continuity, Advanced HIV Disease management, and durable viral suppression by utilizing TEST and START and differentiated service delivery models. APIN will use Artificial Intelligence and Next Generation Analytics to mitigate interruption in treatment, optimize ART regimen, enhance adherence for viral suppression, screen, diagnose, and manage AHD; while providing quality services and empowerment for OVC with their households and communities. Similarly, to prevent new HIV infections through evidence-based interventions at facility and community levels, we will deploy a combination of prevention strategies that include biomedical, behavioural and structural, targeting drivers of the epidemic. APIN will provide reliable and timely lab services to diagnose, control, prevent, and monitor HIV and other diseases by scaling up its Viral Load and EID testing infrastructure and deploying the LIMS-EMR-NDR data exchange to reduce the turnaround time of results. We will optimize TB and other opportunistic infection diagnoses among PLHIV, cervical cancer screening using HPV among Women Living with HIV and integration of NCDs with HIV. In addition, QI learning networks on case finding, retention and viral suppression, community scorecards, situation room dashboards, and QI collaborative will be deployed to implement QI approaches for tracking and optimized health outcomes at the patient, facility, and community levels. Furthermore, to increase GoN’s leadership, governance, and investment in HIV programs, th
e Sustainability Index Dashboards will be used as an advocacy tool for improved Government ownership and domestic funding. The capacity of GoN and CSOs staff will be built to monitor and drive the HIV program as well as ensure accountability.
¿CARES project would be implemented by a team of long-standing collaborators led by APIN: the first indigenous and leading PEPFAR treatment partners in Nigeria, with grantees from Government, Universities, FBOs, Private Sector and CBOs, including KP-led. APIN will deploy her networks, technology, infrastructure, human resources, financial and management systems in a coordinated and adaptive manner to achieve epidemic control within age and sex bands among subpopulations, reduce HIV incidence, morbidity and mortality, and sustain GoN ability and capacity to manage and own HIV program.