National HIV/AIDS Community Care and Support Guidelines (2020-2023)

Objectives

Provide Nigeria’s 2020–2023 national framework and minimum standards for HIV and AIDS community care and support, covering people living with HIV, people affected by AIDS, key populations and other vulnerable groups across facility, community and household settings.[1][2]The framework contributes to an AIDS-free Nigeria, seeking zero new infections and zero AIDS-related stigma and discrimination, while supporting progress towards ending AIDS by 2030.[1][3]

• Improve quality of life, survival, dignity and wellbeing by addressing the medical, psychosocial, mental, emotional, cognitive and economic effects of HIV and AIDS throughout the life course.[4][5]
• Establish equitable, person-centred and non-discriminatory care that responds to individuals’ values, family circumstances, social conditions and lifestyles.[4][6]
• Strengthen the continuum of care from HIV testing, diagnosis and enrolment through treatment initiation, adherence, retention, viral suppression and, where needed, palliative or home-based care.[7][8]
• Prioritise children, adolescents and young people, adults, older people, women, pregnant women, people with disabilities, people in prisons, key populations and people affected by HIV, with services adapted to their differing needs.[2][9]
• Promote Positive Health, Dignity and Prevention by placing people living with HIV at the centre of service design, implementation, research, monitoring and evaluation, and by supporting physical, mental, emotional and sexual health.[10]
• Address structural barriers through human rights, confidentiality, voluntary disclosure, gender equality, anti-discrimination responses, legal support, social protection and sustainable economic empowerment.[11][12]
• Integrate nutrition, mental-health care, tuberculosis, hepatitis B and C, sexually transmitted infection and other chronic-disease responses into HIV care and support.[13][14]
• Achieve 2023 coverage targets including 90% access to care and support, complete referrals, legal support for reported discrimination cases, tuberculosis screening, adherence support, prevention with positives, nutritional support, mental-health screening and mental-health interventions for identified cases.[15][16]

Implementation

Deliver comprehensive medical, psychosocial, legal, protection and economic support through an integrated, bidirectional facility-community-household continuum of care.[17][8]The approach combines hub-and-spoke networks, integrated chronic-disease care and differentiated service delivery, with referrals and communication designed to maintain continuity across health and social-service providers.[2][13]

• Use hubs with greater resources and broader service packages, linked to geographically distributed spokes, to connect tertiary, secondary and primary facilities with communities and households; establish additional hubs where access to a central hub is impractical.[8][18]
• Coordinate community care through the Ministry of Women Affairs and Social Development and equivalent state institutions, alongside health facilities, gender centres, tuberculosis community care centres, security agencies, community improvement centres, support groups, community-based organisations, faith-based organisations and enterprises.[18][19]
• Engage the Federal Ministry of Health, National Agency for the Control of AIDS, State Agencies for the Control of AIDS, Local Action Committees on AIDS, line ministries, implementing partners, civil society, communities, families and networks of people living with HIV in oversight, implementation and service delivery.[6][20]
• Deliver differentiated adherence and retention support through peer counsellors, mentor mothers, support groups, community treatment groups, fast-lane appointments, medicine delivery, buddy systems, client tracing and one-stop-shop services for key populations.[21][22]
• Screen routinely for tuberculosis, hepatitis B and C, sexually transmitted infections and mental-health conditions at diagnosis and follow-up, then provide referral pathways to specialist services where required.[23][14]
• Integrate routine mental-health screening into HIV services using brief tools including the Patient Health Questionnaire-2 and Patient Health Questionnaire-9, provide basic counselling for mild or moderate conditions, and refer severe or complex cases for specialist assessment.[24][25]
• Provide nutritional assessment, counselling and support in facility, community, outreach, support-group and home-visit settings, including referral for severe malnutrition and specialist nutrition advice.[26][27]
• Link people living with HIV and affected households to employment, skills acquisition, micro-credit, livelihood activities, social-protection schemes, health insurance, agricultural support and emergency safety nets.[11]
• Operate stigma, discrimination and gender-based-violence response mechanisms through community improvement teams and state or local Gender and Human Rights Response Teams, including confirmation of cases, moral support, referral, legal assistance and redress.[28][29]
• Monitor implementation through routine data collection, supportive supervision, care-and-support checklists, quality assurance, feedback and review meetings.[15]Data should flow from facilities and community-based organisations through Local Government Area and state structures into national systems linked to DHIS 2 and the National Vulnerable Children Management Information System.[30]
• Measure indicators monthly where specified, using registers and referral, adherence, psychosocial-support, partner-notification, gender-based-violence and social-protection tools, with disaggregation by age, sex and population group where applicable.[31][32]
• Mobilise resources through government commitment, public-private partnerships, donor collaboration, social welfare schemes and economic-empowerment mechanisms; the framework does not provide a quantified overall budget or costing model.[33]

Monitoring & Evaluation

The guideline establishes a national monitoring, evaluation and accountability approach for HIV and AIDS care and support, combining routine service monitoring, supportive supervision, data-quality assurance, indicator matrices, periodic evaluation, community participation and feedback across facility, community, household, local-government, state and federal levels.[2][34][35][15]

• Measure care quality and programme performance through chapter-level indicators, including viral-load suppression, linkage, adherence, retention, complete referrals, community-based care, legal support for discrimination cases, social-protection linkages, tuberculosis screening and treatment outcomes, prevention with positives, nutrition, mental health, gender-based-violence care and partner-notification support. Results are to be disaggregated by age, sex, population group or key-population type where specified.[36][16]
• Target 90% coverage by 2023 for access to care and support, completed referrals, legal support for reported discrimination cases, tuberculosis screening, adherence support, prevention with positives, nutritional support for eligible groups, mental-health screening and mental-health interventions for people identified with disorders.[37][15][16]
• Track a target of 100% of states having anti-stigma and discrimination legislation, using the number and percentage of states with such laws; the reported baseline for this measure is 22%, with annual review through organisational development assessments.[35][38][39]
• Collect, collate, analyse and report programme data through national data-flow arrangements. Facilities and community-based organisations summarise monthly register data for Local Government Area monitoring and evaluation units, which enter data into the national database linked to DHIS 2 and the National Vulnerable Children Management Information System. State ministries review data and provide feedback before database closure, while the Federal Ministry of Women Affairs and Social Development and Federal Ministry of Health analyse state data, produce reports and disseminate feedback.[35][30]
• Apply monthly measurement and reporting for most indicator-matrix measures at community, local-government and state levels, using care and support registers, referral forms, adherence and antiretroviral therapy registers, psychosocial-support registers, gender-based-violence tools, partner-notification and testing registers, and social-protection or savings-group records. Some matrix rows do not specify reporting frequency.[31][32][40]
• Undertake supportive supervision at local, state and national levels using standardised checklists to review service delivery and data processes, identify data inconsistencies and provide on-site capacity building. Assess data quality against validity, timeliness, relevance, completeness, integrity and precision or accuracy.[15]
• Conduct periodic process evaluations, targeted evaluations, operational research and analyses of routine data to assess implementation quality, service effectiveness, outcomes and impact, including retention in HIV and tuberculosis care, stigma and discrimination, economic empowerment, vulnerable-child support, home-based and palliative care, and mental-health management.[35][30]
• Maintain accountability through guideline-compliance monitoring, mapping and monitoring care providers, minimum standards for community-based organisations, coordination of funded non-governmental organisations, community participation in programme design and review, and legal redress under anti-discrimination provisions.[5][33][12]
• Use routine clinical monitoring and referral systems for specialised areas, including nutrition assessment, growth and weight monitoring, mental-health screening, the Patient Health Questionnaire-9 for depression assessment and treatment-response monitoring, tuberculosis screening, and follow-up of missed appointments or loss to follow-up.[41][42][14][20][43][44]

Costing & Financing

The guideline identifies resourcing, domestic commitment, donor collaboration, public-private partnerships, social welfare and economic empowerment as important for HIV and AIDS care and support, but does not provide a consolidated costed implementation plan, total budget, expenditure allocation, unit cost, quantified funding gap or economic assumptions.[5][33][15]

• Mobilise resources through increased financial commitment by all levels of government and international partners, public-private partnerships, donor collaboration, advocacy, stronger social-welfare schemes, savings and loan associations, skills development, vocational training and income-generating activities.[33]
• Prioritise financial and social support for indigent people living with HIV and other vulnerable groups, affected households, livelihoods, employment, micro-credit, agriculture, health insurance and social-protection initiatives.[11][45][33]
• Recognise financing constraints identified during guideline review, including inadequate funding for economic empowerment, donor dependency, non-budgetary or non-counterpart funding releases, poverty, unemployment and recession.[46][17]
• Reference a 1% state-government allocation for HIV and AIDS funding in the advocacy package, without specifying its monetary base, period or resulting amount.[35]
• Identify Global Fund and United States President’s Emergency Plan for AIDS Relief support for the One-Stop-Shop model, without reporting an amount or date.[22]
• Provide for monetary penalties under the HIV and AIDS Anti-Discrimination Act 2014; these are legal sanctions rather than programme-budget allocations.[12]