HIV/AIDS 2014 national guidelines on

Transcription

HIV/AIDS 2014 national guidelines on
national guidelines on
HIV/AIDS
C ARE AND SUPPORT
2014
i
National Guidelines on HIV/AIDS Care and Support 2014
ii
National Guidelines on HIV/AIDS Care and Support 2014
iii National Guidelines on HIV/AIDS Care and Support 2014
TABLE OF CONTENT
FOREWORD.............................................................................................................................i
ACKNOWLEDGEMENTS ...................................................................................................iii
TABLE OF CONTENT ..........................................................................................................iv
LIST OF CONTRIBUTORS.................................................................................................vii
EXECUTIVE SUMMARY.....................................................................................................ix
LIST OF ABBREVIATIONS ..................................................................................................x
CHAPTER 1: INTRODUCTION.........................................................................................01
1.1 BACKGROUND ...........................................................................................................01
1.2 SITUATIONAL ANALYSIS OF HIV/AIDS CARE AND SUPPORT IN NIGERIA...01
CHAPTER 2: CONCEPTUAL FRAMEWORK FOR HIV/AIDS CARE AND
SUPPORT ...............................................................................................................................03
2.1 Introduction....................................................................................................................03
2.2 Definition .......................................................................................................................03
2.3 Guiding principles of HIV/AIDS Care and Support ......................................................03
2.4 Components of HIV/AIDS Care and Support programming and relevant interventions.. ..03
2.5 Eligibility for HIV/AIDS Care and Support ..................................................................04
2.6 Providers of Care and Support services .........................................................................05
2.7 HIV/AIDS Care and Support settings............................................................................05
Chapter 3: DELIVERY OF HIV/AIDS CARE AND SUPPORT SERVICES..................06
3.1 Continuum Of Care........................................................................................................06
3.2 Comprehensive Package Of Care And Support Interventions .......................................06
3.2.1 Medical Services .....................................................................................................06
3.2.2 Supportive services .................................................................................................06
3.2.2.1 Socio-economic services......................................................................................07
3.2.2.2 Psychological services .........................................................................................07
3.3 Care And Support In The Health Facility.......................................................................07
3.4 Community Based Care And Support Of PLHIV..........................................................07
3.5 The Minimum Package Of Care And Support Interventions For PLHIV......................08
3.6 Minimum Package Of Care And Support For PABA ....................................................08
3.7 Support Group Systems .................................................................................................08
CHAPTER 4: POSITIVE HEALTH DIGNITY AND PREVENTION (PHDP)..............10
4.1 Introduction....................................................................................................................10
4.2 Definition .......................................................................................................................10
4.3 Components of the key Elements of Positive Health, Dignity, and Prevention.............10
4.3.1 Health promotion and access ..................................................................................11
4.3.2 Sexual and reproductive health and rights ..............................................................11
4.3.3 Prevention of transmission ......................................................................................11
4.3.4 Human rights, including stigma and discrimination reduction ...............................12
4.3.5 Gender equality .......................................................................................................12
4.3.6 Social and economic support ..................................................................................12
4.3.7 Empowerment .........................................................................................................12
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National Guidelines on HIV/AIDS Care and Support 2014
4.4 Measuring Impact ..........................................................................................................12
4.5 Minimum PHDP Services for PLHIV............................................................................12
CHAPTER 5: HIV/AIDS CARE AND SUPPORT SERVICES FOR SPECIAL
POPULATIONS .....................................................................................................................13
5.1 Definition of Special Populations ..................................................................................13
5.2 Care and Support Services of the HIV Positive Child ...................................................13
5.3 Comprehensive Package of Care for HIV Positive Children.........................................13
5.4 Care and Support Services for Vulnerable Children (VC).............................................14
5.5 Care and Support Services for Women Living With And Affected by HIV/AIDS........15
5.6 Care and Support Services for PLHIV in Times of Civil Strife and Conflict................15
5.7 Care and Support Services for other Special Populations..............................................16
CHAPTER 6: POLICY AND PROGRAMMING ISSUES IN HIV/AIDS CARE AND
SUPPORT SERVICES ..........................................................................................................17
6.1 Governance ....................................................................................................................17
6.1.1 Policy, Guidelines and Regulations ........................................................................17
6.1.2 Leadership, Coordination And Collaboration .........................................................17
6.1.3 Community Participation And Ownership..............................................................18
6.1.4 Financing Care And Support Services ....................................................................18
6.2 Human Capacity Development ......................................................................................18
6.3 Administration of HIV/AIDS Care and Support Programmes......................................19
6.3.1 Medical services....................................................................................................19
6.3.2 Psychological Services .........................................................................................19
6.3.3 Socio-economic empowerment.............................................................................20
6.4 Monitoring and Evaluation (M&E) ...............................................................................20
6.5 Logistics Management ...................................................................................................20
6.6 Advocacy, Sensitization and Mass Mobilization ...........................................................20
CHAPTER 7: Nutrition For People Living With HIV .......................................................21
7.1 The Link between Nutrition and HIV/AIDS..................................................................21
7.2 Nutrition Challenges of PLHIV in Nigeria ....................................................................21
7.3 Recommended Nutrient Requirement using Local Food Sources................................. 22
7.4 Nutritional Care and Support for adults living with HIV/AIDS....................................22
7.5 Nutritional Care for HIV positive pregnant women/adolescents...................................22
7.5.1 Safe Food Handling Practices .................................................................................22
7.6 Infant Feeding Options for HIV Positive Women & Adolescents .................................23
7.6.1 Exclusive Breastfeeding..........................................................................................23
7.7 Nutritional Care for PLHIV Taking Medication or Herbal/Local Remedies ................23
7.8 Nutritional Assessment Counselling and Support (NACS) ...........................................23
7.8.1 Components of NACS ............................................................................................24
7.8.1.1Assessment............................................................................................................24
7.8.1.2 Counselling ..........................................................................................................24
7.9 Outcomes of Assessment ...............................................................................................24
7.9.1 Anthropometric .......................................................................................................24
7.9.2 Nutritional Literacy.................................................................................................25
7.9.3 Referral criteria .......................................................................................................25
7.10 Nutritional Support for PLHIV ....................................................................................25
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National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 8: MONITORING AND EVALUATION OF CARE AND SUPPORT
SERVICES..........................................................................................................................26
8.1 Introduction....................................................................................................................26
8.2 Responsibility for Monitoring and Evaluation Activities ..............................................26
8.3 Data Quality ...................................................................................................................27
8.4 Data Collection and Reporting Tools .............................................................................27
8.5 Supportive Supervision ..................................................................................................27
8.6 Data Reporting and Information flow ............................................................................28
Appendix 1: Indicator Tables.......................................................................................29-32
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National Guidelines on HIV/AIDS Care and Support 2014
LIST OF CONTRIBUTORS
NAMES
NAME OF ORGANIZATION
NAMES
NAME OF ORGANIZATION
Dawodu Yemisi
APIN
Dr. Akudo Ikpeazu
NACA
Ify Onwuatuelo
APIN
Dr. Daniel Egbule
NACA
Isah Ahmed
APIN
Dr. Emmanuel Agogo
NACA
Isah Mohammed
APYIN
Dr. Maryam Al-Mansur
NACA
Odeh F. Odeh
APYIN
Dr. Priscilla Ibekwe
NACA
Maria Jones
ASHWAN
Dr. Yinka Falola-Anoemuah NACA
Assumpta Reginald
ASWHAN
Ikeotuoye Olumaobi
NACA
Helen Aphan
ASWHAN
Hasiya Bello Raji
NACA
Dennis Onotu
CDC
Aishatu Garba
NAPEP
Dr. Obinna Ogbanufe
CDC
Ukowu Judith
NAPEP
Steven Batanda
CIHP
Dr. Emeka Asadu
NASCP
Uduak Akpan
CIHP
Mr. Zeni Franklin
NASCP
Walter Ogwuocha
CISHAN
Ombugadu Obadiah
NASCP
Yakubu Adamu
DoD
Humphrey Ubanyi
NEPWHAN
Rev. Dr. L.U. Ogbonnaya
Ebonyi State University
Martins Akinbode
NEPWHAN
Dr. Azuogu Ben
FETH Abakiliki
Ukoli Patricia
NEPWHAN
Dr. Catherine Gana
FHI360
Victor Omoshehin
NEPWHAN
Dr. Olufunlola Adedeji
FHI360
Edward Ogenyi
NEPWHAN
Moyosola Abass
FHI360
Amina S. Abdullahi
NHRC
Tanto Jobokyamba
FHI360
Fatima A. Shamaki
NHRC
Ude Emmanuel Emeka
FMARD
Mallam Doma
NINERELA+
Bridget Onyebuchi
FMOH
Gem Suleh
SMEDAN
Roselyn E. Gabriel
FMOH
Abdulmalik Muhammad
SURE-P MCH
Mrs. Gloria Onwuzirike
FMWASD
Irene Dunkwu
SURE-P MCH
Dr. Kate Anteyi
HHSS FCT
Tejiri B. Lookey
SURE-P MCH
Ella Aishatu
Asabe Gomwalk
IHVN
TB/Network
Dr. Kwame Ampomah
UNAIDS
Dr. Anthony Okwuosah
IHVN
Asuquo Francis
UNFPA
Juliet Nyior
IHVN
Dr. O. Omosehin
UNFPA
Dr. Oche Agbaji
JUTH
Dr. Biola Davies
UNICEF
Ijeoma Olso Effanga
MSH
Dr. Emeka Okechukwu
USAID
Michael Dibor
MSH
Dr. James Ezekiel
USAID
Ogunmodede Mathew
MSH
Dr. O. Oguniran
WHO
Dr. C. D. Ndukwe
NACA
Dr. M. Kamal
NACA
vii National Guidelines on HIV/AIDS Care and Support 2014
NAMES
NAME OF ORGANIZATION
NAMES
NAME OF ORGANIZATION
Azua Grace
General Hospital Gboko
Samaila Garba
Amana Rural Health
Audu Rebecca
Otukpo LGA Benue State
Gladys Ihunda
NASCP FMOH
Aja Catherine U.
FETHA
Bilkisu Jibrin
NASCP FMOH
Emilia Iwu
IHVN
Rev. Sr. Cecilia Azuh
Catholic Archdiocese of Abuja
Charity Maina
IHVN
Dr. Abiaziem Grey
AIDS Health Care Foundation
Agada Godswill
CIHP
Fakande Ibiyemi
Living Hope Care
Dr. Ngozi Ifebunandu
FETHA Abakaliki
Ejike Fidelis
Min. of Education
Bar. Jumai Danuk
J. V. Danuk& Co
Abatur Charity
Fed. Med. Centre, Makurdi
Dr. Alabi Olubunmi
Wuse District hospital
Fintirima Sambo Donga
NASCP FMOH
Tsambi Yusuf
MSH Abuja
Isa Abdulalhi
NASCP FMOH
Dr. Ochigbo Sunny
UCTH Calabar
Dr. Stephen Oguche
JUTH Jos
Dr. Nwoye Boniface
FHI 360
Samuel Ajayi
UATH ,Gwagwalada
Dr. J. O. Abah
FMC Makaurdi
Dr. Amana Effiong
MSH
Abatur Charity Suteryo
FMC Makurdi
Dr. Adekoya Peters
Prosamtas Consult
Dr. Anne Ojimba
FMC Asaba
Dr. Anya Chukwuemeka
CIHP, Nyanya
Dr. Nneka Chukwurah
NTBLCP/FMOH
Prof. Olaitan Soyannwo
UCH, Ibadan
Anyanyo Ifeyinwa
FHI 360
Scholastica Ode
Hope Alive Foundation
Anaeme Afam
SMOH Awka
Biaratu Abubakar
NEPWHAN Gombe State
Enegela Joseph
CCCRN
Dr. Ofondu Eugenia
FMC Owerri
Antha Nwandu
CCCRN
Onyedum Cajetan
UNTH Enugu
Dr. Muktar Muhammad
FGH
Tunji Odedola
GAPRI
Odume Bertrand
CDC
Dr. Deborah Odoh
NASCP FMOH
Patrick Akande
APIN
Stanis-Ezeobi Winifred
CCFN
Hamza Shuaibu
USAID
Dr. Bolaji Olufunke
FMC Ido-Ekiti
Ezeugwu Ngozi
UniJos
Akolawole Franca
IHVN
Owhonda Golden
RSMOH
Ikechukwu Michael
BMSH PH
Dr. Maryam Muktar-Yola National Hospital
Ginika Egesimba
MSH
Ukwuoma Petrus
FHI 360
Ashie Mary
CIHP
Barango P.
CHAI
Linda Ikechukwu
Springs of Life
Dr. Femi Adeyemi
UNICEF
Dr. Hadiza Khamofu
FHI 360
Dr. Odafe Solomon
CDC
Dr. Felix Iwuala
ARFH
Dr. Bakunowa G Bello
NPHCDA
Adegbite
Dr. Chris Obanubi
FHI 360
Communication for
Development Centre
Odo T. I.
FMWASD
Godson Ogbuji
FML
Dr. Amuh Onyinye
Bwari Town Clinic
Dr. Uba Sabo
NASCP FMOH
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National Guidelines on HIV/AIDS Care and Support 2014
executive summary
T
he National Guidelines for HIV/AIDS Care and Support offers general recommendations for
the Care and Support of persons living with HIV/AIDS, persons affected by HIV/AIDS and
service providers. It provides a general overview of the status of HIV/AIDS Care and Support in
Nigeria with emphasis on progress made thus far.
The document has six chapters that address the key components of HIV/AIDS Care and Support thus
providing an implementable framework for the effective delivery of HIV/AIDS Care and Support
services.
The first chapter outlines the current situation of Care and Support services in Nigeria. It outlines the
achievements and scope of these guidelines.
Chapter 2 of the document presents the conceptual framework for HIV/AIDS Care and Support which
it defines as 'the holistic and comprehensive client-focused care provided by a multidisciplinary team at
all stages of the HIV/AIDS infection'. It outlines the basic principles that should guide the
implementation of Care and Support services, eligibility criteria, providers of service, outlets for Care
and Support services and the fundamental needs of the PLHIV.
Chapter 3 of the document deals with delivery of Care and Support services, and clearly describes in
details the component services of a comprehensive package of Care and Support services. It outlines
services that should be on offer at health facilities and those that ought to be provided in the community.
HIV/AIDS Care and Support services are divided into three main components: - Medical,
Psychological and Socioeconomic. In addition, this chapter defines the minimum package of Care and
Support services that should be offered to the PLHIV in the facility and in the community.
Chapter 4 defines Positive Health Dignity and Prevention and prescribes its minimum package of
interventions for PLHIV. It provides a set of interventions for health promotion, access to treatment,
sexual and reproductive health, prevention of transmission of HIV/AIDS and STIs, protection of
human rights including stigma and discrimination reduction, gender equality, socioeconomic support
and empowerment of PLHIV.
Chapter 5 provides recommendations for the Care and Support of special populations, which include
women living with, and affected by HIV/AIDS, PLHIV living in conflict zones, and children rendered
vulnerable by HIV/AIDS. It also explains why these individuals require special attention and highlights
special interventions necessary to reduce the burden of HIV/AIDS on them.
Chapter 6 describes policy and programming for HIV/AIDS Care and Support and focuses on
governance and administration of the implementation of Care and Support. It outlines the specific roles
of key stakeholders including government, NGOs, and service providers in ensuring compliance with
guidelines, provision of services, and effective monitoring and evaluation.
Chapter 7 speaks to the nutrition of the person living with HIV/AIDS and aptly describes the
relationship between nutrition and HIV/AIDS. It speaks to the goals of nutrition counseling and
recommends nutrient requirements for the PLHIV
Chapter 8 addresses monitoring and evaluation of the entire care and support programme with the
overall purpose of measuring programme results at all levels and guide towards achieving goals and
strategic objectives.
ix National Guidelines on HIV/AIDS Care and Support 2014
list of abbreviations
AIDS
ANC
ART
ARV
BMI
BF
CBO
CD4
CHAI
CHEW
CHO
CPT
CSO
CXR
DNA
DCT
DOT
DQA
FBO
FHI 360
FMOH
FP
GBV
HAART
HBC
HCT
HIV
IDUs
IEC
IGA
IMAI
INH
IPT
IPTp
ITF
ITN
KAP
LACA
LC
LGA
LLITN
LMIS
MARPs
M/C/S
MDG
M &E
MSM
MTCT
MUAC
NACA
NAPEP
NDE
Acquired Immune Deficiency Syndrome
Antenatal Care
Antiretroviral Therapy
Anti-Retroviral
Body Mass Index
Brest Feeding
Community Based Organization
Cluster of Differentiation 4
Clinton Health Access Initiative
Community Health Extension Worker
Community Health Officer
Cotrimoxazole Preventive Therapy
Civil Society Organization
Chest X-Ray
Deoxyribonucleic Acid
Data Capturing Tools
Directly Observed Treatment
Data Quality Assurance
Faith-Based Organization
Family Health International 360
Federal Ministry of Health
Family Planning
Gender Based Violence
Highly Active Antiretroviral Therapy
Home-Based Care
HIV Counselling and Testing
Human Immunodeficiency Virus
Intravenous Drug Users
Information Education and Communication
Income Generation Activities
Integrated Management of Adolescent and Adult Illness
Isoniazid
Isoniazid Preventive Therapy
Intermittent Preventative Treatment in Pregnancy
Industrial Training Fund
Insecticide-Treated Net
Key Affected Population
Local Government Agency for the Control of AIDS
Local Councilor
Local Government Area
Long Lasting Insecticide Treated Nets
Logistics Management Information System
Most At Risk Populations
Microscopy/Culture/Sensitivity
Millennium Development Goals
Monitoring and Evaluation
Men who have sex with Men
Mother- to- Child Transmission of HIV
Mid-Upper Arm Circumference
National Agency for the Control of AIDS
National Poverty Elimination Programme
National Directorate of Employment
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National Guidelines on HIV/AIDS Care and Support 2014
NEPWHAN
NGO
NPA
OIs
OR
OVC
PABA
PCR
PrEP
PEP
PEPFAR
PHC
PHDP
PLHIV
PMTCT
PPP
RH
SACA
SMEDAN
SOP
STIs
Network of People Living with HIV/AIDS
Non-governmental Organization
National Plan of Action
Opportunistic Infections
Operational Research
Orphan and Vulnerable Children
People Affected by AIDS
Polymerase Chain Reaction
Pre- Exposure Prophylaxis
Post Exposure Prophylaxis
President's Emergency Plan For AIDS Relief
Primary Health Care
Positive Health Dignity Prevention
People Living With HIV/AIDS
Prevention of Mother-to-Child Transmission
Public Private Partnership
Reproductive Health
State Agency for the Control of AIDS
Small and Medium Enterprises Development Agency of Nigeria
Standard Operating Procedure
Sexually Transmitted Infections
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National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 1: INTRODUCTION
1.1 BACKGROUND
are and Support means different things to different people, ranging from offering medical
treatment for illness, assisting people overcome challenges or simply showing empathy and
consideration to persons in need.
C
In the context of HIV/AIDS, Care and Support means catering to needs of people living with
HIV/AIDS and providing appropriate support for persons affected by it. HIV/AIDS is unique in the
sense that in addition to physical illness, the infection is associated with social issues that significantly
affect wellbeing of the PLHIV, their families and the community in which they live. For this reason,
Care and Support for persons living with HIV/AIDS should address challenges that are associated with
the disease and these could be medical, psychological or socio-economic problems. HIV/AIDS also
exerts a significant toll on families and communities of persons living with HIV/AIDS and as such,
Care and Support should include interventions that address the needs of this group.
Before discovery of Antiretroviral Therapy (ART), symptomatic HIV/AIDS infection was rapidly
fatal and the management of HIV/AIDS was limited to palliative care for the terminally ill, which
consisted almost entirely of management of pain and the more common symptoms of terminal disease.
The very short intervening period between the emergence of symptoms and death, usually six months,
contributed to the dearth of Care and Support services for PLHIV in that era. Stigma and
discrimination resulted in minimal community support for PLHIV and in many cases, being HIV
positive was a taboo.
Antiretroviral Therapy has altered the natural course of HIV/AIDS and transformed a rapidly fatal
disease to a chronic disease and as a result rather than dying, persons living with HIV/AID encounter
the challenges and other burdens associated with long term HIV/AIDS infection.
Every PLHIV in Nigeria should receive support to cope with the burden of the infection. It is the
responsibility of government and all groups engaged in providing such services to act within the
purview of their individual mandates to ensure that PLHIV access Care and Support services suitable
to their needs in a sustainable manner.
These guidelines for HIV/AIDS Care and Support provide general guidance for the design and
implementation of interventions that address the medical, psychological and socio-economic impact
of HIV/AIDS on the PLHIV, their families and communities.
1.2 SITUATONAL ANALYSIS OF HIV/AIDS CARE AND SUPPORT IN NIGERIA
The arrival of Antiretroviral Therapy in Nigeria received great excitement and the immediate priority
of government was to make this effective treatment widely available to all eligible persons, to the
extent that no plans were made for provision of non-medical Care and Support for the PLHIV. With
increased access to Antiretroviral drugs (ARVs) and with more people surviving, other implications of
living with HIV/AIDS are more pressing and the need to provide Care and Support services other than
ART has become more evident.
In 2005, The Federal Government of Nigeria commenced work on the National Work Place Policy on
HIV/AIDS, in recognition of the fact that care for the PLHIV does not stop with ART. The work place
policy effectively brought the discriminatory practice of mandatory pre-employment testing for
HIV/AIDS to an end. By 2006, HIV/AIDS Care and Support became better established with the
expansion in the scope of services offered by health facilities and an increase in community-based
services.
01 National Guidelines on HIV/AIDS Care and Support 2014
The National Guidelines for HIV/AIDS Palliative Care was developed in 2006 with the sole purpose of
providing direction for HIV/AIDS Care and Support interventions. There has been a remarkable
growth in the implementation of Care and Support services since then with a marked increase in
preventive treatment of opportunistic infections using Cotrimoxazole prophylactic treatment (CPT)
and other medication.
Presently CPT is a key component of the Care and Support interventions and it has contributed
significantly in reducing morbidity and mortality of PLHIV. Other Care and Support interventions that
have received a significant boost include nutritional intervention with food-based supplements,
prevention of Opportunistic Infections through provision of safe water and distribution of long lasting
insecticide treated nets (LLITN) for prevention of diarrheal diseases and malaria respectively.
Community based Care and Support services made considerable progress in this period with more
NGOs coming on board with services ranging from redress for rights violations, nutrition support,
support for income generating activities, care for vulnerable children and support for caregivers. A
major success story is the growth of PLHIV support associations, which followed the establishment of
the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) and its state chapters. There
are numerous PLHIV associations (coordinated by NEPWHAN), some of which have evolved into
Community Based Organizations (CBOs), which provide tangible Care and Support services
However, major difficulties still exist in the implementation of Care and Support services; there are
significant gaps in coordination of Community Based Organizations, poor government ownership and
sustainability of programs. Delays exist with early enrollment of PLHIV (immediately after diagnosis)
into Care and Support programs. In addition, referral, linkage and network systems that will ensure a
robust continuum of care require strengthening to function effectively.
Furthermore, there is still the need for a well-defined national standard package for Care and Support
services and training curriculum for HIV/AIDS Care and Support. The implementation plans and tools
for quality assessment are also not standardized.
This National HIV/AIDS Care and Support guideline provides guidance for the design,
implementation, monitoring and evaluation of Care and Support services.
02 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 2:
CONCEPTUAL FRAMEWORK FOR HIV/AIDS
CARE AND SUPPORT
2.1 Introduction
are and Support is the third, but neglected pillar of Universal Access; it is central to achieving
universal access and the Millennium development goals (MDGs). Retention in care, support
and treatment is a challenge that would require efforts that ensure interaction between the
health system, the community system and social protection programs. The Care and Support services
provided to each PLHIV and their community should be need based and vary according to the different
settings and levels of HIV/AIDS prevalence. Comprehensive HIV/AIDS Care and Support services
will best delivered in an enabling environment that caters for the Medical, Psychological and
Socioeconomic needs of the PLHIV.
C
2.2 Definition
'HIV/AIDS Care and Support is the holistic and comprehensive client-focused, community centered
care provided by a multidisciplinary team at all stages of the HIV/AIDS infection.'
The primary objective of Care and Support is to reduce the burden of the disease on the PLHIV,
improve quality of life of the individual, support affected families and communities by anticipating and
addressing the medical, psychological and socioeconomic challenges of HIV/AIDS.
2.3 Guiding principles of HIV/AIDS Care and Support
These include the following: v
HIV/AIDS infection is now a chronic condition that requires a multi-disciplinary
approach and multisectoral collaboration in its management
v
Care and Support of the PLHIV should be holistic within the continuum of care
v
Meaningful involvement of PLHIV and PABA in the design, implementation and
evaluation of Care and Support services
v
Effective referral, linkage and network support systems
v
Coordinating mechanisms for Care and Support should include and position the
communities delivering and accessing, Care and Support services in leadership roles to
ensure ownership and sustainability
2.4 Components of HIV/AIDS Care and Support programming and relevant interventions.
The basic needs of PLHIV reflect the multidimensional nature of the impact of HIV/AIDS on an
individual and these needs fall within three main domains: medical, psychological and socioeconomic.
These components consist of the following interventions: Medical care for PLHIV
·
HIV/AIDS testing and counseling
·
Preventive therapy
·
Prevention of opportunistic Infections (OIs) including Tuberculosis, fungal infections; use of
Cotrimoxazole
·
Prevention of Mother To Child Transmission of HIV/AIDS (PMTCT)
·
Prevention of selected vaccine preventable diseases including hepatitis B, pneumococcal
influenza, and yellow fever
03 National Guidelines on HIV/AIDS Care and Support 2014
·
Universal safety precautions
·
Post-exposure prophylaxis (and pre-exposure prophylaxis)
·
Management of HIV/AIDS related illnesses (including Opportunistic Infections, Sexually
Transmitted Illnesses (STIs), cancer related illnesses and Tuberculosis control)
·
Antiretroviral Therapy
·
Family Planning
·
Nutritional support
·
Health education/promotion including healthy living; water sanitation and hygiene; prevention
of malaria, among others
·
Support systems such as laboratory investigations and drug management systems
Psychological support
·
Counseling
·
Initial and follow up counseling for emotional and spiritual needs, disclosure and partner
motivation
·
Community support services including support groups, peer groups, community or volunteer
outreaches and spiritual support
·
Support for caregivers
Socioeconomic support
·
Material support to meet nutrition, housing and daily living needs
·
Microcredit schemes
·
Health insurance schemes
·
Food support
·
Planning and support for orphans and vulnerable children
·
Participation of PLHIV and their families in
?
Planning and delivery of comprehensive Care and Support services
?
Reinforcing adherence, prevention and care
?
Promoting health seeking behavior
·
Human rights and legal needs
?
Addressing stigma and discrimination at health facilities, care centers, communities and
workplaces
?
Addressing issues of confidentiality and individual rights to disclosure
?
Promoting equal access to care
?
Succession planning
2.5 Eligibility for HIV/AIDS Care and Support
All persons living with HIV/AIDS including women and children are eligible for Care and Support
services throughout the entire duration of HIV/AIDS disease from the time of diagnosis irrespective of
the clinical stage of the infection. The type of Care and Support services they receive will depend on the
clinical, emotional, social and economic impact of the disease on the individual.
Families of persons living with HIV/AIDS are also eligible for Care and Support services, to cope with
the stress that results from close association with persons living with HIV/AIDS such as stigma and
discrimination, loss of income, impoverishment and the emotional burden of caring for the PLHIV.
Caregivers are equally eligible for Care and Support services to deal with stress, doubts, safety
concerns, fears, and burnout associated with HIV/AIDS infection. Finally, members of communities
are also eligible for Care and Support services that deal with fears, myths and misconceptions that fuel
stigma and discrimination.
04 National Guidelines on HIV/AIDS Care and Support 2014
2.6 Providers of Care and Support services
Care and Support for PLHIV is the responsibility of every individual. Everyone who encounters a
PLHIV should treat him with empathy and dignity. The society should reject all acts of discrimination
and stigma against PLHIV; these individuals should be supported to live a normal life.
Government and agencies of government have a major role in creating an enabling environment for
provision of meaningful Care and Support services to PLHIV. Specific organs of government that have
these responsibilities include: - the Federal and State Ministries of Health, National Agency for the
Control of HIV/AIDS (NACA), relevant line ministries such as Labour, Education, Women Affairs
and Social Development, Agriculture, Justice. Other agencies include Small and Medium Enterprises
Development Agency of Nigeria (SMEDAN), Industrial Training Fund (ITF) and others similar to the
defunct National Directorate of Employment (NDE).
Health facilities and health workers have a primary role of caring for the PLHIV who require Care and
Support to overcome health issues associated with HIV/AIDS infection. All categories of Health care
workers play important role in caring for the PLHIV.
Non health workers also play a critical role in caring for the PLHIV and are found in different sectors of
the society; they include PLHIV, family and community members, persons and groups involved in the
protection of rights of PLHIV and law enforcement agencies.
Family members and PLHIV play essential roles in providing community and home based care, which
includes management of minor ailments, treatment and psychological support, financial support and
support to access available Care and Support services.
In broad terms, providers of Care and Support services are categorized into individuals, Community
Support Organizations (CSOs), Non-governmental organizations and Governmental organizations.
The role that each of them plays will be determined by the specific needs of the PLHIV.
2.7 HIV/AIDS Care and Support settings
The main settings for HIV/AIDS Care and Support services are: ·
Health facilities
·
Homes
·
Communities (CBOs, Support Groups, Faith Based Organizations (FBOs), NGOs, etc.)
·
Work place
05 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 3:
DELIVERY OF HIV/AIDS CARE AND SUPPORT SERVICES
H
ealth and social services should be accessible for everyone living with and/or affected by
HIV/AIDS. Care and Support interventions required by PLHIV and PABA vary from one
individual to the other and are determined by the specific needs of the individual at any point in
time. PLHIV/PABA should receive access to available Care and Support services through fostering
linkages and strengthening referral systems between service providers.
3.1 CONTINUUM OF CARE
The needs of PLHIV extend from the time of diagnosis to terminal stages of the HIV infection.
ACTIVE REFERRAL NETWORK
Social and legal
support services
District hospitals,
HIV clinics, specialists
an specialized
care facilities
Health centers,
dispensaries
traditional care
Poor support and
voluntary services
Individuals
seeking or
needing care
Homes, community
services, hospices
HIV voluntary
counseling and
testing (VCT)
ACTIVE REFERRAL NETWORK
Care seeking/providing
Active Retinal
Source: Treatment Division, Family Health International
Figure 1: Continuum of HIV/AIDS Care & Support
3.2 COMPREHENSIVE PACKAGE OF CARE AND SUPPORT INTERVENTIONS
The comprehensive package of Care and Support interventions are the range of services that should be
available to PLHIV and persons affected by HIV/AIDS. These can be medical or supportive. Medical
services are those services that have a direct bearing on the health of the individual while supportive
services assist the individual to cope with the burden of the disease
3.2.1 Medical services
Medical care for PLHIV refers to those services that have a direct bearing on the health of the
individual and inclusive of laboratory and clinical management of HIV/AIDS and its medical
complications. These services include but are not limited to: HIV counseling and testing (HCT),
laboratory services, management of Tuberculosis, opportunistic infections and other medical
complications of HIV/AIDS, pain and symptoms management, Antiretroviral Therapy, Post Exposure
Prophylaxis (PEP) and Pre- Exposure Prophylaxis (PrEP), prophylaxis for Opportunistic Infections
and Tuberculosis (TB), Prevention of Mother to Child Transmission (PMTCT) as applicable.
3.2.2 Supportive services
Supportive care consists of a broad range of services and aims to improve quality of life of these
individuals by empowering them to cope with the social and economic burden of HIV/AIDS. It
addresses issues of inequality, social isolation, poverty, stigma and discrimination and seeks to
mitigate the emotional stress that is associated with HIV/AIDS.
06 National Guidelines on HIV/AIDS Care and Support 2014
3.2.2.1 Socio-economic services
PLHIV and PABA should have access to interventions that empower them to cope with the social and
economic challenges of HIV/AIDS.
These interventions include
·
Schemes for mitigation of stigma, discrimination and social exclusion
·
Skill acquisition, income generation and empowerment
·
Access to basic education and literacy programmes
·
Social welfare schemes that improve access to nutritional support, housing and medical
services
·
Access to affordable health insurance
·
PLHIV support groups and associations
·
Access to legal protection
3.2.2.2 Psychological services
These services consist of a broad range of interventions that cater primarily to the emotional,
psychological and spiritual wellbeing of PLHIV and PABA. They include HIV/AIDS counseling
services inclusive of couple counseling and adherence counseling, Mental Health services and
Spiritual counseling.
3.3 CARE AND SUPPORT IN THE HEALTH FACILITY.
Health facility based Care and Support services refer to services that offered in the health facility
usually by trained health care professionals. These are services that; maintain physical and
psychological health, monitor progression of illness, delay onset of HIV/AIDS–related infections and
initiate linkages with community-based resources. They include:
·
HCT services for HIV/AIDS screening and diagnosis
·
Periodic clinical & laboratory monitoring of CD4/lymphocyte counts, Viral load and resistance
monitoring.
·
Laboratory services for the diagnosis of Opportunistic Infections and Tuberculosis.
·
Psychological/mental health services with emphasis on counseling services
·
Health education for Positive Health Dignity and Prevention (PHDP), personal and food
hygiene, use of ITNs, early recognition and reporting of illness, improved health seeking
behavior and provision of safe water treatment
·
Treatment of intercurrent infections and conditions that may be unrelated to HIV/AIDS disease
·
Appropriate treatment of opportunistic infections, malignancies and other illnesses
·
Prophylaxis (CPT, IPT, PMTCT, PEP and PrEP)
·
Assessment for ART eligibility, treatment education and adherence support.
·
ART initiation and monitoring,
·
Pain management
·
Provision of family planning services
·
Nutritional assessment, counseling and support
·
Effective linkages and networking with community resources and referral for: homebased/community care,
3.4 COMMUNITY BASED CARE AND SUPPORT OF PLHIV
The community can play an important role in the Care and Support of PLHIV. This role will depend on
the specific needs of the individual. Community based Care and Support is usually complimentary to
care obtained in the health facility. Caregivers play a pivotal role in caring for the PLHIV in the
community and these could be family members, friends or volunteers at the community level.
Community based Care and Support services should include:
·
Basic nursing care at home, with training for caregivers
·
Health and treatment education
07 National Guidelines on HIV/AIDS Care and Support 2014
·
Adherence support and monitoring
·
Nutritional assessment counseling and support
·
Counseling and community mental health services
·
Access to PLHIV support groups for peer support
·
Linkage to other community-based services including legal protection, skills acquisition
schemes, income generation and social welfare
·
Access to basic amenities including potable water, shelter
·
PHDP
3.5 THE MINIMUM PACKAGE OF CARE AND SUPPORT INTERVENTIONS FOR
PLHIV
The minimum package of Care and Support interventions describes the basic unit of interventions
every PLHIV should receive at either the facility or community level.
At the facility, the minimum package for PLHIV at each encounter should include:
·
Counseling for PLHIV and when possible attach them to a treatment supporter
·
Assessment of eligibility for ART
·
Cotrimoxazole Preventive Therapy for all eligible persons
·
Screening for Tuberculosis
·
Linkage with a community PLHIV support group and other community-based services
·
Provision of a basic self-care preventive kit on enrolment (The kit should usually include a
lidded bucket, water purifier and a long-lasting insecticide-treated net.)
·
Provision of PHDP services (STI and risk assessment, condom education and supply, sexual
and reproductive health and family planning referral, adherence counseling, alcohol and
substance abuse assessment)
For the PLHIV presenting initially to a community-based organization the minimum package of care
should include:
·
HIV/AIDS counseling and when possible testing
·
Provision of supportive service obtainable in that organization
·
Referral to a health facility for comprehensive medical assessment and management
3.6 MINIMUM PACKAGE OF CARE AND SUPPORT FOR PABA
'A Person Affected by HIV/AIDS&AIDS (PABA) may be a person living with, caring for, and/or a
dependent of a PLHIV.'
All PABA should receive: ·
Appropriate counseling at each encounter at the facility or the community
·
Referral to appropriate Community Based Organization for socioeconomic support
3.7 SUPPORT GROUP SYSTEMS
Definition of a Support Group:
'A support group is a group of people who come together to share experiences about their common
issues, provide peer support for one another as well as engage their communities to foster convenient
environment for their welfare'.
Support groups are based in the health facility or the community.
Types of support group include amongst others:
·
General Support Groups (Everybody)
·
Mother -to -Mother support groups
·
Singles support groups
·
Adolescent support groups
·
Women support group
08 National Guidelines on HIV/AIDS Care and Support 2014
·
Kids clubs
·
Discordant couples
Activities:
1. Treatment adherence support among members and tracking of defaulters and bringing them
back to care.
2. Mentorship of new PLHIV
3. Community involvement and advocacy towards stigma reduction, prevention, Care and
Support.
4. Monthly meeting for members.
5. Economic empowerment among members (e.g. Skills SLA)
6. Health talk and life-skill.
7. Peer education.
8. Provision of voluntary services at the facility and community levels
09 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 4:
POSITIVE HEALTH DIGNITY AND PREVENTION (PHDP)
4.1 Introduction
ositive health dignity and prevention (PHDP) emphasizes the importance of placing persons
living with HIV/AIDS (PLHIV) at the center of managing their health and well-being.
HIV/AIDS services need to include PLHIV in the conception, design and implementation of the
services meant for them. PHDP highlights PLHIV as key players in the solution to the long-standing
challenge of HIV/AIDS transmission prevention. PHDP advocates that all stakeholders in HIV/AIDS
prevention should work towards meeting the broad health needs of PLHIV – by supporting their
physical, mental, emotional and sexual health – and upholding their dignity. When this is done within a
human rights framework, the resultant enabling environment will decrease the chances of new
HIV/AIDS infections. PLHIV therefore become “active participants” and not “passive targets” in the
response to HIV/AIDS in all contexts.
P
4.2 Definition
'Positive Health Dignity and Prevention (PHDP) is defined as a set of actions that help people living
with HIV/AIDS to live longer and healthier lives.'
Core Values and Principles
Positive Health, Dignity and Prevention is defined by people living with HIV/AIDS and guided by the
following values and principles:
v
People living with HIV/AIDS should be leaders in the design, programming, implementation,
research, monitoring and evaluation of all programmes and policies affecting them
v
A human rights approach is the foundation of Positive Health, Dignity and Prevention
v
Preventing HIV/AIDS transmission is a shared responsibility of all individuals irrespective of
HIV/AIDS status
v
Sexual and reproductive health and rights should be recognized and exercised by everyone
regardless of HIV/AIDS status
Table 1:Key elements of PHDP
·
Health promotion and access
·
Treatment access
·
Sexual and reproductive health and rights
·
Prevention of transmission of HIV/AIDS and other sexually
transmitted infections (STIs)
·
Protection of human rights, including stigma and discrimination
reduction
·
Gender equality
·
Mental Health support
·
Social and economic support; and
·
Empowerment of people living with HIV/AIDS
·
Measuring impact
4.3 COMPONENTS OF THE KEY ELEMENTS OF POSITIVE HEALTH, DIGNITY, AND
PREVENTION
The concept of PHDP recognizes that various elements of the approach are relevant to interventions
at the community level and the facility level.
10
National Guidelines on HIV/AIDS Care and Support 2014
Facility and Community PHDP
Skills Building
for Income
Generating
Activities
Mental Health Care
Legal Support
Spiritual Support
Referral Services
Facility PHDP
Community PHDP
Provider Initiated Prevention Messages
for PLHIV
Reinforcing Provider Initiated Prevention
Messages for PLHIV
Direct Services
Safe Water, Food,
and Nutritional
Counseling
Condoms and
Family Planning
Commodities
IES on STI
prevention,
family planning,
health promotion, HIV transmission prevention
Continued
Post-Test Counseling
Alcohol Reduction and other
Substance
Abuse Support
Psychosocial
Support, Palliative Care
Treatment
Adherence
Counseling
Table 2 : Facility and Community PHDP
4.3.1 Health promotion and access
·
HIV/AIDS Counseling and Testing (HCT)
·
Provider-initiated counseling and testing and community counseling and testing under
conditions of informed consent and confidentiality
·
Antiretroviral therapy (ART), including clinical monitoring, adherence support, access,
availability and quality assurance
·
Health education for living well
·
Treatment literacy
·
Psychosocial wellbeing, including building self-esteem and confidence
·
Mental health
·
Preventing disease progression and further infections/prophylaxis for Tuberculosis (TB) and
opportunistic infections (OIs)
4.3.2 Sexual and reproductive health and rights
·
Sexual and reproductive health care services
·
Maternal health
·
Family planning
·
Prevention and treatment of sexually transmitted infections (STIs), including hepatitis B &C
·
Sex and sexuality education and services
4.3.3 Prevention of transmission
·
Transmission literacy
·
Harm reduction (drugs and alcohol)
11
National Guidelines on HIV/AIDS Care and Support 2014
·
Prevention of parent to child transmission
·
Palliative care
4.3.4 Human rights, including stigma and discrimination reduction
Ensuring confidentiality of status
Safe and voluntary disclosure (“to create an environment of open communication and equality in
relationships”)
Autonomy of the individual (“i.e. choice as to when, and if, to initiate ART”)
Legal literacy, advocacy and activism
Enabling environment, including protective laws
Shared responsibility
4.3.5 Gender equality
Gender-based violence prevention and management
Women's rights
Economic empowerment
4.3.6 Social and economic support
Social and economic support, including for caregivers
Food and water security
Health and social protection for children and adolescents living with HIV/AIDS
Education and awareness
4.3.7 Empowerment
Meaningful involvement of people living with HIV/AIDS, including positive leadership Participation
and advocacy
Social mobilization and community engagement
Linking to other social justice and development movements
4.4 MEASURING IMPACT
Continued and/or increased funding for Positive Health, Dignity and Prevention programs
Building evidence and sharing lessons learned
Indicators for monitoring and evaluation
4.5 MINIMUM PHDP SERVICES FOR PLHIV
PHDP messages and services should be routinely offered to all PLHIV attending Care and Support
services in both clinic and community settings. Messages and services should include as a minimum:
·
Promote and preventive recommendations (status disclosure, partner testing, safe sex with
condom promotion/distribution and alcohol/substance use reduction)
·
Adherence assessment, counseling and treatment support
·
Family planning and safe pregnancy counseling
·
STI assessment, diagnosis and treatment
·
Referral to community-based programs for relevant non-clinical services
12 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 5:
HIV/AIDS CARE AND SUPPORT SERVICES FOR
SPECIAL POPULATIONS
5.1 DEFINITION OF SPECIAL POPULATIONS
ll People Living with HIV/AIDS should have access to HIV/AIDS Care and Support services
suitable to their needs and circumstances, and these services should be affordable and
accessible. There are however, certain populations that require special attention to ensure
equity in access to services.
A
PLHIV who fall under the category of special populations include women, especially pregnant women,
children, the elderly, physically challenged persons, people in conflict situations, internally displaced
persons (refugees & migrants) and military personnel on special missions. Other special populations
include Intravenous Drug Users (IDU's), Key Affected Populations (KAP) and blood transfusion
dependent persons such as people suffering with sickle cell anemia, refractory anemia or bone marrow
depression, etc.
Children are a special group because they are often dependent on adult caregivers and guardians for
their wellbeing and in most cases are unable to make critical decisions that affect their lives. In many
cases, the welfare of the child is inextricably intertwined with that of the parents, adult caregivers and
guardians and as such provision of Care and Support should as much as possible be inclusive of care of
the family. Vulnerable children (VC) require special care and every effort should be made to ensure that
they are placed in stable homes with caring and responsible adults who provide basic protection and
guidance. The preferred approach to the Care and Support of children is a family centered approach.
5.2 CARE AND SUPPORT SERVICES OF THE HIV POSITIVE CHILD
The Care and Support of the HIV positive child is complicated by the complex nature of the effects of
HIV/AIDS on the child. The design and implementation of Care and Support interventions for children
living with HIV/AIDS should recognize these peculiarities.
With regard to children, the following are important considerations: §
Clinical course of HIV/AIDS is usually more rapid in children, with the majority of them dying
in the first two years without definitive treatment with ART.
§
Conclusive diagnosis of HIV is complex in children under the age of 18 months.
§
Infant nutrition poses a great challenge in the early months of the child's life especially with the
risk of mother to child transmission of HIV via breast milk.
§
Children are almost entirely dependent on adults for survival.
§
The whole family is affected because the diagnosis of HIV/AIDS in a child often leads to
discovery of the HIV status of other members of the family, with attendant psychosocial
problems.
§
Communicating with children requires special techniques to determine their feelings and
needs.
A comprehensive plan for the Care and Support of HIV positive children should be family centered and
delivered by a competent multidisciplinary team of experts with good understanding of the
complexities of managing children.
5.3 COMPREHENSIVE PACKAGE OF CARE FOR HIV POSITIVE CHILDREN
Care and Support of the child with HIV/AIDS should consist of a comprehensive package of care (in
line with the National Pediatric treatment guidelines) that aims at providing complete protection from
the effects of HIV/AIDS and ensures the following:
NationalGuidelines
Guidelineson
onHIV/AIDS
Hiv/Aids Care
Careand
andSupport
Support2014
2014
09 National
13
·
All HIV exposed infants should have access to appropriate prophylaxis and technologies for
early diagnosis of HIV/AIDS.
·
All HIV positive children under 24 months should be placed on antiretroviral therapy.
·
Provisions should be made to take care of other medical needs such as immunizations,
treatment of Opportunistic Infections of all HIV positive children.
·
All children should receive counseling appropriate to their age.
·
HIV positive children and caregivers should have access to nutritional support.
·
HIV positive children of school age should not be denied access to education because of being
HIV positive.
·
Families and caregivers of the HIV positive child should empowered to cater for the welfare of
the child.
·
All HIV positive children should be protected from stigma and all other discriminatory
practices because of their HIV status.
·
Community systems should be strengthened to provide protection and material support for
children living with HIV/AIDS.
5.4 CARE AND SUPPORT SERVICES FOR VULNERABLE CHILDREN (VC)
'The child rendered vulnerable by HIV/AIDS can be described as one who, because of death or
disability of one or both parent resulting from HIV/AIDS, is prone to abuse or deprivation of basic
needs, care and protection, and thus disadvantaged relative to peers. '
Care and Support of the Vulnerable Child (VC) should focus primarily on strengthening the capacity of
families to protect and care for them by:
·
Implementing measures that prolong the lives of surviving parents or caregivers and ensure
that they have unhindered or even preferential access to essential medical care
·
Providing comprehensive HIV/AIDS related health care services for all members of the family
who require care
·
Ensuring that adults who care for the VC whether they are parents or guardians have access to
opportunities for economic empowerment such as income generation activities (IGA) and
vocational training
·
Implementing measures that allow universal access to education support for VC as an
additional way of reducing the economic burden for indigent caregivers and guardians
·
Ensuring that all families with VC have access to regular and qualified psychosocial support to
reduce the emotional pressures and stress associated with HIV/AIDS
·
Implementing measures for sustainable food and nutrition support for all members of the
family-adults and children alike
·
Establishment of mechanisms that provide VC sustainable shelter in the context of the family
14 National Guidelines on HIV/AIDS Care and Support 2014
·
Providing or ensuring access to legal rights aid and assistance for families and caregivers of the
VC for protection against discriminating practices
5.5 CARE AND SUPPORT SERVICES FOR WOMEN LIVING WITH AND AFFECTED BY
HIV/AIDS
In most African societies, women are the homemakers and they play a central role in stabilizing
families and maintaining its health. There is evident need to keep women healthy and safe for the sake
of their health and the stability of the family.
All women with HIV/AIDS should have free access to health facility based services for the
management of HIV/AIDS. They should receive basic and ongoing HIV/AIDS counseling support that
includes disclosure counseling, adherence counseling, routine preventive treatment of opportunistic
infections including Tuberculosis diagnosis and treatment, and a comprehensive package of ART for all
eligible women.
As well as ensuring that they receive ART for their own health, programmes that offer HCT to pregnant
women should be strengthened to improve access to routine HIV/AIDS counseling and testing for all
pregnant women. All women who test positive should be linked to a Prevention of Mother to Child
Transmission (PMTCT) programme.
In addition to improving access to responsible spiritual care and effective psychotherapy, all women
who are infected and affected by HIV/AIDS, should have access to effective and appropriate
community based support services to reduce the burden of HIV/AIDS and improve standards of living.
Women in households with HIV positive individuals should receive training on basic home-based care
of HIV positive persons to enhance their roles as caregivers. They should also receive vocational
training and improved access to other income generating activities for economic empowerment of the
individual and their household.
Women living with or affected by HIV/AIDS should have access to legal aid and protection from
domestic violence and abuse.
Systems ought to be strengthened to deliver community education aimed at changing gender norms that
disenfranchise women and girls and discourage access to community health and vocational services.
5.6 CARE AND SUPPORT SERVICES FOR PLHIV IN TIMES OF CIVIL STRIFE AND
CONFLICT
Conflict and civil strife refer to wars, civil disobedience and in recent times intensified terrorist
activities during which time there are disruptions in law and order and administration of key organs of
government and civil society. PLHIV who are trapped in conflict zones are particularly vulnerable
because they are cut off from HIV/AIDS Care and Support services.
Care and Support of PLHIV during periods of strife and conflict requires special interventions that
guarantee that ongoing Care and Support services continue uninterrupted.
Arrangements should be made using emergency relief organizations to supply medicines and
commodities to PLHIV in refugee and internally displaced persons camps.
PLHIV support organizations should be encouraged to develop emergency plans for ensuring
continuity of treatment for its members during periods of strife and civil disorder.
PLHIV in displaced persons camps should receive appropriate education and counseling on positive
living and adherence counseling.
Mobile clinics should be established as a component of relief materials to take medicines to persons
trapped in conflict zones and they should offer medicines for HIV/AIDS treatment and care.
15 National Guidelines on HIV/AIDS Care and Support 2014
5.7 CARE AND SUPPORT SERVICES FOR OTHER SPECIAL POPULATIONS
These include Intravenous Drug Users (IDUs), and blood transfusion dependent persons and prisoners.
IDUs and other special persons in this category should have access to HCT. Counseling should also
include risk reduction and adherence to ART. They should also have access to support groups. Other
medical care and ARVs should be provided.
Blood transfusion dependent persons are continually at risk of re-infection. Therefore, every effort
should be made to ensure that blood and blood products used for transfusion are properly screened and
certified safe.
16 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 6:
POLICY AND PROGRAMMING ISSUES IN HIV/AIDS
CARE AND SUPPORT SERVICES
T
he implementation of HIV/AIDS Care and Support programs will require effective policy,
collaboration and coordinated inputs of a large number of stakeholders including governments
at all levels, international and local NGOs, association of PLHIV, Community Based
Organizations (CBOs), Civil Society Organizations (CSOs) and families.
While there will be multiple stakeholders involved in provision of HIV/AIDS Care and Support
programs, there are agencies that should provide leadership for the coordination of the implementation
of Care and Support interventions. There should be clear and unambiguous policy and guidelines for
the offer of HIV/AIDS Care and Support services and government has the responsibility for not only
providing this but ensuring compliance.
6.1 GOVERNANCE
In the context of HIV/AIDS Care and Support, governance involves the control and regulation of
interventions for the Care and Support of persons living with HIV/AIDS in a manner that ensures
access to safe, dignified and quality Care and Support services. Governance for HIV/AIDS Care and
Support operates at different levels, and is not restricted to government. It operates at the level of
government and its agencies, local and international HIV/AIDS Implementing organizations, private
sector, health facilities, PLHIV Networks and all other bodies and persons involved in Care and
Support of PLHIV.
6.1.1 Policy, Guidelines and Regulations
The Federal Government should ensure that there are clear policies and guidelines for the provision of
HIV/AIDS Care and Support.
Government and its partners should ensure widespread dissemination and compliance with the
guidelines.
Government should establish systems for effective public private sector partnership for Care and
Support services.
All organizations engaged in the provision of HIV/AIDS Care and Support services should ensure that
services offered are in line with the provisions of the national guidelines for HIV/AIDS Care and
Support.
Faith Based Organizations (FBOs), CBOs and PLHIV support groups should engage community
groups and unorthodox medicine practitioners as well as faith healers to limit the proliferation of false
claims, inappropriate practices and harmful practices
Civil society organizations and the legislative arms of government should work together to enact
binding anti-stigma laws and these should be enforceable by relevant agencies.
The Ministry of Labour and Productivity should actively monitor and enforce the implementation of
the work place policy in both the public and private sectors
6.1.2 LEADERSHIP, COORDINATION AND COLLABORATION
Government should exercise overall leadership and oversight for the implementation of HIV/AIDS
Care and Support services in Nigeria.
17 National Guidelines on HIV/AIDS Care and Support 2014
Government at all levels should establish and implement mechanisms for effective coordination of
Care and Support services.
All HIV/AIDS Implementing Agencies especially those engaged in providing funding for
international and local NGOs in the country have the responsibility to coordinate the activities of
NGOs funded by them in line with national guidelines.
Faith Based Organizations (FBOs) and CBOs are encouraged to strengthen and work with other
existing community structures to ensure effective coordination and implementation of HIV/AIDS care
& support services.
HIV/AIDS treatment centers and health facilities should strengthen effective linkages with community
based HIV/AIDS Care and Support services.
6.1.3 COMMUNITY PARTICIPATION AND OWNERSHIP
The community is the closest milieu to the client and for services to have an impact on both PLHIV and
PABA, the community has to participate and own the programme. There is also need to engage
community stakeholders in the design, implementation, monitoring and evaluation of HIV/AIDS
programmes
6.1.4 FINANCING CARE AND SUPPORT SERVICES
Government at all levels and international partner organizations should increase financial commitment
to the provision of HIV/AIDS Care and Support services.
Public Private Partnership (PPP) and donor collaboration should be encouraged to enhance resource
mobilization for HIV/AIDS Care and Support services.
Government, private organizations and donor agencies should strengthen capacity of PLHIV support
groups to leverage financial resources for the delivery of HIV/AIDS Care and Support service.
Government should strengthen community and facility level social welfare schemes to respond to the
Care and Support needs of indigent PLHIV and PABAs.
PLHIV support groups should engage in constructive advocacy for increased government funding for
HIV/AIDS Care and Support services.
6.2 HUMAN CAPACITY DEVELOPMENT
There is evidence of poor collection and analysis of data as well as implementation due to inadequate
capacity in the public sector and CBOs. There is also inadequate capacity of support groups to play
their role in the national response. A recent review highlighted the need for capacity building and
1
community systems strengthening .
Government should provide necessary support to develop and strengthen human capacity including
training, mentoring, supervision and provision of equipment for the delivery of comprehensive
HIV/AIDS Care and Support services.
The development and review of a national curriculum for training of care providers in HIV/AIDS Care
and Support should be the responsibility of Government and it should facilitate the incorporation of
HIV/AIDS education in the curricula of schools from primary to tertiary levels.
All NGOs, CBOs and Faith Based Organizations (FBOs) should ensure regular training for HIV/AIDS
Care and Support personnel in their service according to the national guidelines.
PLHIV Support Groups should provide literacy seminars on treatment Care and Support for its
members.
1
NACA, Mid Term Review of the Nigerian HIV/AIDS response, 2013.
18 National Guidelines on HIV/AIDS Care and Support 2014
6.3 ADMINISTRATION OF HIV/AIDS CARE AND SUPPORT PROGRAMMES
The needs of the PLHIV are myriad and they cut across different disciplines making it difficult for any
single service provider to address all of them. Consequently, all organizations involved in the Care and
Support of PLHIV will be required to work in collaboration with each other in a coordinated manner to
ensure that most of the needs of PLHIV are met.
The needs of the PLHIV are covered under the following main headings: medical, psychological, and
socio-economic. For each category of needs, the organizations that are best positioned to address them,
should take the lead in providing such services.
Government agencies responsible for supervising and coordinating the provision of HIV/AIDS Care
and Support services should ensure the availability of and adherence to appropriate guidelines.
6.3.1 Medical services
The FMOH and NACA in collaboration with all counterpart agencies in the other tiers of government
should work with HIV/AID Implementing Partners and stakeholders to accomplish the following:
·
Develop and enforce compliance with national guidelines for HIV/AIDS Care and Support in
Nigeria.
·
Review and ensure compliance with other guidelines for implementation of other interventions
such as ART, PMTCT, CPT, IPT for Tuberculosis, IPT for Malaria in Pregnancy, HCT etc.
·
Procure commodities and essential drugs including ARVs, drugs for Opportunistic Infections,
HIV test kits and reagents.
·
Establish a functional logistics management system that ensures regular and uninterrupted
supply of HIV medicines and other commodities.
·
Strengthen human and infrastructural capacity of health facilities to provide comprehensive
medical services for all PLHIV.
·
Improve access of PLHIV and PABA to community health insurance schemes
·
Establish programmes for education and orientation of family members and caregiver on the
basic management of HIV/AIDS related OIs.
6.3.2 Psychological Services
Government at all levels, implementers of HIV/AIDS care, and support programmes should establish
strong systems for promoting the mental and psychological health of PLHIV.
Stakeholders including government, civil society organizations, community-based organizations and
PLHIV support groups have the duty to develop and implement anti stigma and discrimination plans.
Implementers of HIV/AIDS Care and Support programmes have the responsibility to work with
religious groups to develop safe and realistic spiritual practices relating to issues around cure of
HIV/AIDS and adherence to medical treatment.
HIV/AIDS Care and Support programmes should commit to establishing strong and viable mental
health programmes that include a robust and comprehensive HIV/AIDS counseling programme and
unlimited access to mental health services.
6.3.3 Socio-economic empowerment
Government and major HIV/AIDS implementing agencies should adopt a deliberate policy of
encouraging the formation of PLHIV support groups and networks.
19 National Guidelines on HIV/AIDS Care and Support 2014
PLHIV and their families that have material needs should have access to economic empowerment
schemes that improve their capacity to cater to their financial needs.
Governments should strengthen its social welfare schemes and extend services of these schemes to
indigent PLHIV. Households of PLHIV should be strengthened to provide basic essential services to
family members especially children.
Government backed poverty reduction schemes such as National Directorate of Employment (NDE),
Subsidy Re-Investment and Empowerment Programme (SURE-P) and National Poverty Eradication
Program (NAPEP) should implement support policies that are favorable to PLHIV and their families.
Civil society organizations and multi-national organizations should invest in schemes that provide
economic empowerment for HIV/AIDS affected households such as income generating activities,
cooperative low interest loans to family members and vocational skills acquisition for PLHIV.
6.4
MONITORING AND EVALUATION (M&E)
Monitoring and Evaluation is an essential component of HIV/AIDS and AIDS Care and Support. The
purpose of M&E is to keep activities on track and ensure that they are in line with overall programme
goals.
Government should lead and supervise the establishment of functional systems for M&E of HIV/AIDS
Care and Support services.
Government and stakeholders should ensure that appropriate structures, including staff training, are in
place for effective M&E systems.
Government and stakeholders should establish functional mechanisms for analysis and utilization of
M&E data.
6.5 LOGISTICS MANAGEMENT
Government should strengthen logistic and commodity management systems that ensure that
commodities for HIV/AIDS Care and Support services are well managed and readily accessible to the
end users.
Government and stakeholders should strengthen an integrated Logistics Management Information
Systems (LMIS) for effective management of commodities for HIV/AIDS Care and Support services
and to ensure accountability.
6.6 ADVOCACY, SENSITIZATION AND MASS MOBILIZATION
Focused advocacy is essential for successful implementation of HIV/AIDS Care and Support services.
Necessary steps should be taken to ensure that at every level of government there is adequate public
commitment to the provision of Care and Support for PLHIV.
Government and relevant stakeholders should develop a national advocacy package for HIV/AIDS
Care and Support services. A package that addresses issues such as provision of legal backing for
policies for HIV/AIDS Care and Support, increased public involvement in the Care and Support of
PLHIV, implementation of work place policies, community involvement in HIV/AIDS Care and
Support services and increased financial commitment to HIV/AIDS Care and Support.
Government and stakeholders at all levels should plan and implement sensitization and mass
mobilization campaigns on HIV/AIDS Care and Support. The objective of this campaign is to increase
community awareness of the benefits of Care and Support for the PLHIV.
20 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 7: Nutrition For People Living With HIV
7.1 The Link between Nutrition and HIV/AIDS
Adequacy of nutritional status enhances the immune system. The figure below illustrates that a wellnourished person has a stronger immune system for fighting infections and coping with
HIV/AIDS&AIDS.
Good Nutrition
(Good food intake,
maintenance of weight and
muscle tissue, good
microutdent status)
Strengthening of the
Immune System’s
(ability to fight HIV
and other infections)
Management of HIVrelated Complications
(e.g mal absorption,
diarrhea, lack of
appetite, weight loss)
Increased Resistance
to Infections
(e.g. diarrhea,
tuberculosis,
respiratory infections)
Figure 2 : Relationship between nutrition and HIV/AIDS
2
7.2 Nutrition Challenges of PLHIV in Nigeria
Malnutrition is a serious problem that aggravates the spread of HIV/AIDS. HIV/AIDS prevalence in
Nigeria is stabilizing but malnutrition is still a problem. The NDHS 2013 shows that 37% of children
3
aged less than five years were stunted, 29% were underweight and 18% were wasted . It is clear that
malnutrition negatively affects an optimal immune function, thus increasing the susceptibility of
victims to high morbidity and mortality. Adults living with HIV/AIDS&AIDS may suffer from loss of
appetite, difficulty in eating due to oral infections. It is important therefore, that the provision of quality
Care and Support for People Living with HIV/AIDS (PLHIV) should include nutritional counseling
Care and Support.
The goals of the nutritional counseling Care and Support for PLHIV should include:
·
Improvement of nutritional status
·
Ensuring adequate nutrient intake
·
Preventing food and water-borne diseases
·
Enhancing quality of life and prolong survival
2
Adapted from Ellen G. PIWOZ and ELIZABETH A. PREBLE, HIV&AIDS and Nutrition; A Review of the literature and
Recommendations for Nutritional Care and Support in sub-Saharan Africa. Washington D.C.: Academy for Educational
Development (AED), 2000.
3
National Population Commission. Nigerian Demography and Health Survey, 2013
21 National Guidelines on HIV/AIDS Care and Support 2014
This section of the HIV/AIDS Care and Support guideline focuses on Nutrition & specifically
addresses the following objectives:
v
To provide consistent and evidence-based recommendations for nutritional response to
HIV/AIDS
v
To assist in improving the nutritional status of PLHIV
v
To provide users (service providers, PLHIV, caregivers) evidence-based information on quality
nutritional Care and Support
v
To assist in the improvement of the quality of life of PLHIV through maintaining a healthy
lifestyle
7. 3 Recommended Nutrient Requirements Using Local Food Sources:
Energy giving foods: yam, cassava, plantain, rice, bread, maize, potatoes (Irish and sweet) and
cocoyam
Sugars and Sugary Foods: sugar cane, honey, sweets, jams, marmalade, sugar cakes (Alewa) and
cookies
Fats and Oils: palm oil, groundnut oil, cottonseed oil, soybean oil, shea butter and margarine.
Dietary Fiber: garden eggs, maize, fruits, vegetables, cassava, yam, sweet potatoes, and cocoyam
Body Building Foods (Protein Rich Foods): Beans, groundnuts, pigeon peas, soya bean, Bambara
nuts, meat, eggs, fish and milk (including yoghurt, wara (local cheese)
Protective Foods: jews mallow (ewedu), spinach, water-leaf, bitter-leaf, zogale (moringa), ugu, oha,
sorrel, cassava leaf, worowo, amunututu, sokoyokoto, ujuju, elemionu, kerenkere, afang, okazi,
gbologi, ayakwa, okro, carrot, green peppers, onions. Avocado pears, local pears (Ube), bananas,
guavas, mangoes, oranges, pawpaw, pineapple
7.4 Nutritional Care and Support for adults living with HIV/AIDS
Key points to note:
To keep healthy, Adults with HIV/AIDS&AIDS: ·
Need to do light exercises
·
Should use anti-retroviral (ARVs) if prescribed
·
Early identification and treatment of symptoms is essential.
·
Periodically check their nutritional status (weight, BMI), hemoglobin level determined and
recorded
PLHIV found to have weight loss of more than 10% in the last three months, should have their diet
intake and history of illness assessed.
PLHIV should increase the amount and the frequency of eating nutritious meals rich in energy, protein
and essential micronutrients.
7.5 Nutritional Care for HIV positive pregnant women/adolescents
·
Family members should support pregnant adolescents and women living with HIV/AIDS to
access appropriate health and nutrition services
·
They should be given priority at meals to eat enough of the right foods
·
They should not restrict food intake during the last months because of fear of having a big baby
or obstructed labor
·
Those who expend energy on household or agricultural work should also increase their energy
intake or reduce workload and have adequate rest.
7.5.1 Safe Food Handling Practices
·
Wash and keep food preparation surfaces, utensils, and dishes clean
·
Wash all fruits and vegetables, avoid eating raw food, cook foods thoroughly especially meats
and chicken.
·
Avoid storing cooked food without a fridge; serve all food immediately after preparation
·
Drink clean and safe water,
·
Do not use bottles with teats to feed children, use cup and spoon instead
22 National Guidelines on HIV/AIDS Care and Support 2014
7.6 INFANT FEEDING OPTIONS FOR HIV POSITIVE WOMEN & ADOLESCENTS
According to the national PMTCT guideline and the Nigerian Infant and Young Child Feeding (IYCF)
policy, all HIV positive pregnant women should be on ART throughout their pregnancy and up to one
week after cessation of breastfeeding. HIV positive breastfeeding mother should not breastfeed their
baby for more than 12 months.
7.6.1 Exclusive Breastfeeding
Mothers need to know that breast-feeding,
·
Gives infants all the nutrients they need, Protects infants and children from diseases other than
HIV/AIDS and breast milk is easily digestible.
·
Lowers the risk of transmitting HIV/AIDS
·
Increases risk of HIV/AIDS transmission if the mother has a breast infection (e.g. mastitis or
cracked and bleeding nipples)
Breastfeeding mothers should:
·
Be given information to make BF as safe as possible, receive nutrition counseling, be taught
good positioning and attachment
·
Put the baby to the breast immediately (within half an hour) after birth
·
Breastfeed exclusively until 6 months of age
·
Avoid mixed feeding
·
Introduce complementary foods at the age of 6 months
·
Be taught that infant mouth problems such as mouth ulcers and candidiasis (oral thrush)
increase the risk of HIV/AIDS transmission.
7.7 NUTRITIONAL CARE FOR PLHIV TAKING MEDICATION OR HERBAL/LOCAL
REMEDIES
Various medications may produce side effects such as taste changes, loss of appetite, vomiting, nausea,
and diarrhea, which can negatively affect food intake, nutrient absorption and metabolism leading to
weight loss.
It is important, therefore, for service providers to be aware of food/drug and nutrient/drug interactions
in order to minimize negative side effects.
7.8 NUTRITIONAL ASSESSMENT COUNSELLING AND SUPPORT (NACS)
Nutritional Assessment, Counseling and Support (NACS) is an essential strategy and component of
Care and Support for PLHIV.
NACS should be conducted at every setting where Care and Support is provided to PLHIV in the
Community or Facility.
In the community, this assessment and necessary interventions should be carried out during home
visits, support group meetings and other community outreach activities.
The Facility assessment should be carried out on the clients at each clinic visit at PHC, secondary and
tertiary centers.
Specialist advice for complicated cases may be sought from dieticians and nutritionists at secondary or
tertiary health facilities or at state ministries or local government departments.
Note: Inpatient treatment may be appropriate for patients with severe malnutrition.
23 National Guidelines on HIV/AIDS Care and Support 2014
7.8.1 Components of NACS
7.8.1.1 Assessment
The counselor should work with the client (PLHIV) to assess the following.
Nutritional status
·
Weight, height; and then calculate BMI for adults and mid upper arm circumference (MUAC)
for children and pregnant women
o Use of the height/weight chart for adults or WHO Road to Health chart for children
o Compare findings with previous records
·
General wellbeing and functioning
·
Appetite
·
Any nutritional or health problems
Dietary Practice
·
24- hour Dietary recall of food intake and related problems
·
Occurrence of drug/food related interactions
·
Clinical (in relevant settings): Clinical assessment for signs of malnutrition
7.8.1.2 Counselling
The key Issues for Nutritional Counselling of PLHIV should be based on the principles of PHDP. They
should be provided with information on: ·
Good dietary practices including information about food groups, balanced diets, local dietary
options etc.
·
Positive Health Dignity and Prevention (PHDP) practices including: o Water and Sanitation Hygiene (WASH)
o Food hygiene
o Safe storage, preparation and preservation of animal products, fruits and vegetables
o Smoking and alcohol use
o Opportunistic infections
o Family planning and child spacing
o Lifestyle modification including exercise,
o Support group membership
o Positive mental attitude
·
Awareness and prevention of food/drug interactions and how to prevent or minimize side
effects of medications and herbal remedies.
o Note instructions on drug/BMS packaging.
o Consult relevant health professionals when queries arise.
·
Attend conferences, seminars meetings and workshops where issues on HIV/AIDS& AIDS are
been discussed
·
PLHIV need IEC materials that address dietary issues
For complicated or specialized dietary issues requiring medical nutrition therapy, Please consult the
dietician.
7.9 OUTCOMES OF ASSESSMENT
7.9.1 Anthropometric
Categories of anthropometric assessment
·
Undernourished/underweight
·
Normal
·
Overweight
24 National Guidelines on HIV/AIDS Care and Support 2014
Assessment outcome
BMI
<18.5
(Underweight)
18.5
24.9
(Normal)
11.5-12cm
(Normal)
25 – 29.9 >30
(Overweight) (Obese)
>40
(Morbidly
obese)
MUAC
<11.5cm
>13cm
(Under
(Underweight)
(Overweight)
5)
MUAC
<23cm
(Pregnant (Underweight)
Women)
Table 3: Outcome of Anthropometric Assessment
7.9.2 Nutritional Literacy
Poor Nutritional Literacy is defined as the inability to understand the importance of good nutrition in
maintaining health.
7.9.3 Referral criteria
PLHIV assessed and identified to be clinically undernourished will meet the following criteria: ·
Adult BMI< 18.5
·
Children under 5 (MUAC) < 11.5cm
·
Pregnant women (MUAC) <23cm
7.10 NUTRITIONAL SUPPORT FOR PLHIV
Support includes but not limited to the following:
·
Goal setting/Planning
·
Food demonstration using locally available food options
·
Innovative agricultural practices like kitchen gardens, food banks etc.
·
Food rehabilitation using Ready-To-Use therapeutic foods for severe malnutrition, food
supplies from CBO's etc.
·
Follow up.
·
Referral and linkage (in cases of malnutrition, food insecurity: - food not readily available for
the family e.g. less than on regular meal per day.)
25 National Guidelines on HIV/AIDS Care and Support 2014
CHAPTER 8:
MONITORING AND EVALUATION OF
CARE AND SUPPORT SERVICES
8.1 Introduction
onitoring and Evaluation (M&E) is an essential component of HIV/AIDS Care and Support
activities. The overall purpose of monitoring and evaluation is to measure programme
results at all levels and guide toward achieving the goals and strategic objectives.
Information obtained through M&E can be used to demonstrate to programme managers and policy
makers that programme efforts had measurable effects and inform future programming/planning.
M
Monitoring is a routine process used to verify step-by-step progress of the programme at various levels
to see whether activities are being implemented as planned, ensuring accountability, and identifying
successes and challenges related to the intervention activities. It also provides resources for evidencebased planning through timely feedback to relevant authorities. Monitoring is best carried out using
well-defined indicators meant to measure the input, process, and outputs of the intervention.
Evaluation is carried out periodically to determine and document the extent to which results are
attributable to the intervention, measured through the outcome and impact indicators. It is concerned
with identifying reasons for success and failure of a programme. It addresses future options,
challenges, strategies and priorities for the continuous process of development.
Monitoring and Evaluation involves the collection, collation, analyzing, report writing and feedback
on various thematic activities. The feedback provides information for informed policy development,
guidelines and implementation of the programme.
8.2 Responsibility for Monitoring and Evaluation Activities
The Federal Ministry of Health (FMOH) will maintain the central management information system
database and provide technical assistance to the states, health facilities and CBOs for continuous
monitoring of the HIV/AIDS Care and Support programme.
NACA has the responsibility of coordinating the adaptation, development and review of the guidelines,
indicators and data capturing tools (DCT) that guide the collection of HIV/AIDS Care and Support data
at various levels. HIV/AIDS Care and Support data reporting will follow the national data flow and
reporting timelines as stipulated in the National Health Information System Policy.
Process evaluations will be conducted periodically to assess the quality of HIV/AIDS Care and
Support implementation at all levels. The overarching purpose of process evaluation is to guide
programmatic implementation and aid in appropriate redirection of human resources and commodities
to meet the national targets. Evaluation of the level of implementation and quality of services will focus
on the ability of all facilities and CBOs to meet the minimum service delivery and reporting
requirements.
Targeted evaluations and other operational research (OR) including complex analysis of the routine
Care and Support data will be used to periodically evaluate the effectiveness of services and
intervention outcomes and impact in Nigeria. Some of the areas of interest include but not limited to: ·
HIV/AIDS retention of care,
·
HIV/AIDS related stigma and discrimination.
These evaluation activities will be conducted by the FMOH in collaboration with other stakeholders
and implementing partners.
26 National Guidelines on HIV/AIDS Care and Support 2014
8.3 Data Quality
The Federal Ministry of Health will ensure all implementing sites are provided with the National
Monitoring and Evaluation tools:
·
Registers (see Annexes)
·
Summary forms (see Annexes)
·
Standard Operating Procedure (SOP)
·
Guidelines and Training Manuals
For proper completion of the registers and forms at the sites, the Federal Ministry of Health and other
stakeholders shall provide trainings at all levels (National, State, LGA, health facility and CBO) on
appropriate data collection and reporting system which feed into the National Health Information
System.
Quality assurance, quality control and quality improvement mechanisms will be disseminated to
health facilities and CBOs.
The heads of the health facilities and CBOs will be responsible for: ·
Ensuring an internal routine check of the registers being completed by the site team
·
Providing regular supportive supervision and mentoring to the site team completing the
registers and monthly summary forms.
Using a standardized data quality checklist, a systematic plan for periodic external data quality
assurance (DQA) check will be conducted by the Federal/State/Local Government Ministry of Health
and other stakeholders. This will ensure data availability, consistency and validity. The on-site
activities during DQA should: ·
Check for the availability of the registers and monthly summary forms
·
Review of site registers and summary forms for completeness and accuracy
·
Check for the availability and use of guidelines and SOP
·
Check patient and data flow
The FMOH or SMOH in collaboration with relevant stakeholders should conduct monitoring and
supervisory visits quarterly and DQA at least twice every year using a standardized checklist. At each
of the visits, onsite mentoring and supportive guidance should be provided. At the end of the M & E
visits, feedback should be provided to the entire site team.
8.4 DATA COLLECTION AND REPORTING TOOLS
In order to adequately capture the indicators mentioned above, and monitor the Care and Support
programme, the following DCTs were developed for recording and reporting Care and Support
services.
·
National Care and Support Enrollment Form
·
National Care and Support Community Screening Checklist
·
National Care and Support Service Form
·
National Care and Support Service Register
·
National Care and Support Summary Form
8.5 SUPPORTIVE SUPERVISION
There will be regular local, state and national M & E supportive supervision for all Care and Support
services in Nigeria. This ensures that data collected on HIV/AIDS Care and Support programmes in
Nigeria are valid, consistent, accurate, timely and reliable for informed programme decision-making.
A system to periodically monitor the quality of Care and Support services and data will be developed
by all local programs and monitored by external resource persons (designated as Site Support
27 National Guidelines on HIV/AIDS Care and Support 2014
Supervisors) at the LGAs, State, and National level. A National Care Quality process will be developed
to address quality issues.
During each on-site supportive supervision visit, the standardized Care and Support checklist will be
applied to review the services and data collection process. This in-depth review will ensure
identification of inconsistencies in data collection; collation and transmission to the next level of data
flow and serve as an opportunity for on-site capacity building process for the service providers.
To ensure the effectiveness of this supportive supervision, relevant cadre of health care providers and M
& E specialists should be identified and then trained, on how to provide supportive supervision, to Care
and Support sites within their locality.
At the state and LGA levels, the State AIDS Program Coordinator and LGA Department of Health
HIV/AIDS Focal Person should be identified.
8.6 DATA REPORTING AND INFORMATION FLOW
Health facilities and CBOs are to summarize all information in the Care and Support registers into the
summary forms at the end of every month. The summary forms will be checked and signed by the
supervisor before they are submitted to the M & E unit of the LGA health office.
The Local Government M & E officer, and the LGA data management team will then enter the data
from all the facilities within the LGA into the national database (DHIS)
The SMOH will review the data from the LGAs; provide feedback to the LGAs before the database
closes.
FMOH will analyze all data from the States, write report and provide feedback to all levels. FMOH
should share the reports with Implementing partners and other stakeholders at national levels including
National Agency for Control of AIDS (NACA).
Implementing Partners supporting Care and Support services at various levels are to key into this
information flow and strengthen the LGAs and State monitoring mechanism.
28 National Guidelines on HIV/AIDS Care and Support 2014
29 National Guidelines on HIV/AIDS Care and Support 2014
Indicator
Level
Outcome
Sex
(male/female)
Age
(0-5, 5-15; 15+)
Pregnant women
Proportion of
undernourished
PLHIV
attitudes towards
people living with
HIV/AIDS
Sex
(male/female)
Age
(15-19; 20-25;
25-49)
Pre-ART/ ART
Sex
(male/female)
Age (<15; 15+)
Proportion of adults
and children with
HIV/AIDS known to
be in care 12 months
after enrollment into
HIV/AIDS care
Proportion of women
and men aged 15–49
who report
discriminatory
Disaggregation
Indicator
Proportion of women and men aged 15–49 who
report discriminatory attitudes towards people living
with HIV/AIDS
Denominator: number of adults and children who
enrolled in HIV/AIDS care who were expected to
achieve 12-month outcomes within the reporting
period.
3-5 years
Annual
Annual
Proportion of adults and children with HIV/AIDS
known to be in care 12 months after enrollment into
HIV/AIDScare
Numerator: Number of adults and children with
HIV/AIDS, still alive and in care 12 months after
enrollment into HIV/AIDS care
Frequency
Definition
Appendix 1: Indicator Tables i
Population based survey
(NDHS)
Routine Facility
&Community data
National Registers
(needs to be included
in the Monthly
Summary form.
Data Source
30 National Guidelines on HIV/AIDS Care and Support 2014
Indicator
Level
Outcome
Sex
(male/female)
Age (<18; 18+)
Number of PLHIV
provided with a
minimum of one
clinical service
Setting:
(Community
/Facility)
Sex:
(male/female)
Age:
(<18; 18+)
Setting
(Community
/Facility)
PLHIV/PABA
Sex
(male/female)
Age (<18; 18+)
Number of eligible
adults and children
(PLHIV& PABA)
provided with a
minimum of one
care service
Number of PLHIV
provided with
minimum package
of Positive Health
Dignity &
Prevention (PHDP)
interventions
Disaggregation
Indicator
Numerator: Number of People Living with HIV/AIDS
(PLHIV) reached with a minimum Package of Positive
Health, Dignity and Prevention (PHDP) Interventions
Number of PLHIV reached with a minimum package
of prevention interventions and services that include
evidence based behavioral and biomedical
interventions designed to protect the health of the
infected person and reduce the spread of HIV/AIDS to
their sex partners and children (PHDP) as defined in
the National Care & Support Guideline
Numerator: Number of adults and children provided
with a minimum of one care service
The number of all individuals receiving care services
through from facilities and/or Community Based
Organizations. An individual should receive at least
one care service to be counted. Care service could be
clinical, preventive or supportive
Definition
Appendix 1: Indicator Tables ii
Monthly
Monthly
Monthly
Frequency
Routine Facility
&Community data
Routine Facility
&Community data
Routine Facility
&Community data
Data Source
31 National Guidelines on HIV/AIDS Care and Support 2014
Indicator
Level
Setting
(Community
/Facility)
Sex
(male/female)
Age (<18; 18+)
Number of eligible
adults and children
(PLHIV&PABA)
receiving food
and/or other
nutrition services
Setting
(Community
/Facility)
Sex
(male/female)
Age
(<18; 18+)
Proportion of
clinically
undernourished
PLHIV identified
Setting
(Community
/Facility)
Sex
(male/female)
Age
(<18; 18+)
Setting
(Community
/Facility)
Sex
(male/female)
Age
(<18; 18+)
Number of People
L i v i n g w i t h
HIV/AIDS receiving
Adherence Support
Proportion of
clinically
undernourished
PLHIV who
received
therapeutic and/
or supplementary
food
Disaggregation
Indicator
Numerator: Number of clients who received food
and/or nutrition services during the reporting
period
The number of clients who received supplemental
food (for nutritionally vulnerable clients),
therapeutic and supplementary food for OVC whose
HIV/AIDS status is negative or unknown, food
security support and/or nutrition services during the
reporting period.
Denominator: The number of PLHIV that received
anthropometric assessment during the same
reporting period
Numerator: The number of all PLHIV, including
adults, children, and pregnant women and lactating
mothers, that were undernourished at any point during
the reporting period,
The proportion of PLHIV in care and treatment who
were identified as clinically undernourished at any
point during the reporting period
Numerator: Number of People Living with HIV/AIDS
receiving Adherence Support
Number of People Living with HIV/AIDS receiving
Adherence Support
Definition
Appendix 1: Indicator Tables iii
Monthly
Monthly
Monthly
Monthly
Frequency
Routine Facility
&Community data
Routine Facility
&Community data
Routine Facility
&Community data
Routine Facility
&Community data
Data Source
32 National Guidelines on HIV/AIDS Care and Support 2014
Setting
(Community
/Facility)
Sex
(male/female)
Age (<18; 18
Proportion of
PLHIV GBV
suspects
identified
Setting
(Community
/Facility)
Sex
(male/female)
Age (<18; 18
Setting
(Community
/Facility)
Sex
(male/female)
Age
(<18; 18+)
Number of PLHIV
screened for gender
based violence
(GBV)
Proportion of
PLHIV GBV
suspects referred
for GBV related
services
Disaggregation
Indicator
Denominator: Number of PLHIV GBV suspects
identified
Numerator: Number of PLHIV GBV suspects
referred for GBV related services
Proportion of PLHIV with a reported episode of
gender related violence and or abuse referred for
GBV services
Denominator: Number of PLHIV screened for
gender based violence
Numerator: Number of PLHIV GBV suspects identified
Proportion of PLHIV assessed for gender violence
and or abuse with a reported episode of gender
related violence and or abuse
Numerator: Number of PLHIV screened for gender
based violence
The number of PLHIV or assessed for of gender
related violence and or abuse
Definition
Monthly
Monthly
Monthly
Frequency
Routine Facility
&Community data
Routine Facility
&Community data
Routine Facility
&Community data
Data Source
Note: For Care and Support indicators relating to Vulnerable Children (VCs) please refer to the National VC Guidelines
Indicator
Level
Appendix 1: Indicator Tables iv