Consultancy to Conduct a Landscape Analysis and Needs Assessment for Introducing HIV Point-of-Care (PoC) Diagnostics Technology for Early Infant Diagnosis (EID) within National Health System

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Purpose of Activity/Assignment:

Botswana with a population of 2,324,232, is currently among a few countries in Southern Africa with the highest HIV prevalence globally, estimated at 20.7 per cent among adults (aged 15-49) in 2019. Just over a quarter (27%) of the total population are women of child-bearing age, while children under five years constitute12 per cent of the population. The annual population growth rate stands at 2.4 per cent and total fertility rate at 2.9 per cent (BDS 2017). The country has made huge strides in responding to the HIV epidemic, achieving 92-89-95 UNAIDS targets in 2019. This achievement, however, masks the fact that only 62 per cent of children living with HIV are on treatment.

Botswana is the first country in the region to provide universal free antiretroviral treatment to people living with HIV. The prevention of mother-to-child transmission of HIV (PMTCT) programme was launched in 1999 and rolled out nationwide in July 2001. In 2002, the PMTCT programme was available in all 634 health facilities that provide maternal child health services. In 2009, Botswana was the first African countries to transition from WHO Option A to Option B, and then Option B+ with recommendation of breastfeeding for the first 6 months if virally suppressed. Since then, the country’s PMTCT programme been one of the most successful HIV programmes in the region and has recorded major achievements.

Among the notable successes are: increases from 92 per cent in 2012 to 98 per cent in 2020 in the proportion of pregnant women accessing ARVs; a decline of HIV prevalence in pregnant women from 37.4 per cent in 2003 to 26.5 per cent in 2015, an increase in testing uptake of 98 per cent in 2020 and a significant reduction of mother-to-child-transmission of HIV (MTCT) rate from estimated 40 per cent at the inception of the programme in 2003 to less than 1 per cent (0.56%) in 2020. Early infant diagnosis (EID) coverage has improved over time from 49 per cent in 2016 to 82 per cent in 2020.

The role of laboratory diagnostics along the HIV care and treatment cascade and in the path to dual elimination of HIV and Syphilis is a critical step in the HIV response and requires robust clinical-laboratory interphase with strong systems in place. Evidence shows that integration of point of care (POC) EID testing into national diagnostics programmes can dramatically reduce turnaround times (from months to same day) for results to be returned to patients/caregivers and increase ART initiation rates compared to conventional laboratory systems. POC can be performed in clinics or other health care settings and results are available within hours, reducing turn-around time from sample collection to return of results.

Botswana has made remarkable investments in HIV diagnostics, care and treatment for all populations with 2 HIV reference laboratories, 8 primary hospital laboratories, 6 district laboratories, and 13 clinic laboratories serving the country. Additionally, the TB programme has placed approximately 34 Cepheid GeneXpert Machines distributed across these laboratories.

However, despite this elaborate laboratory infrastructure, a recent joint UN mission found that coverage at 8 weeks is sub-optimal, with long turnaround time for early infant diagnosis tests (2 weeks to 2 months depending on the proximity to the testing laboratory). To address bottlenecks in prolonged turn-around time and increase EID coverage to 95%, recommendations were put forward for Botswana to consider implementing near point of care EID testing to supplement the national reference laboratories. Furthermore, WHO has recently made the following recommendation “Point of Care nucleic acid testing should be used to diagnose HIV among infants and children younger than 18 months of age.” (strong recommendation; high-certainty evidence).

A robust approach to laboratory support through strategically placed point of care diagnostic devices in hard to reach areas and underserved populations can improve access and equity ensuring no child is being left behind. It is against this background, that the Ministry of Health and Wellness (MoHW) together with the National Health Laboratory (NHL), with support from UNICEF and in collaboration with key stakeholders seeks to conduct a comprehensive mapping and needs assessment to objectively assess the diagnostic capacities for these important tests and laboratory preparedness and to plan for precise interventions to address the identified bottlenecks.

To this end, UNICEF is seeking the services of an experienced national/international consultant to support the MoHW/NHL with carrying out a landscape analysis and comprehensive needs assessment to inform the introduction of PoC testing devices in Botswana, particularly in hard to reach areas, including use of already existing technologies.

Scope of Work:

Under the leadership of the MoHW (PMTCT Programme) and the NHL, the consultant will work collaboratively with a task team to conduct a comprehensive mapping and needs assessment for introducing PoC devices in Botswana. Specifically, the consultant is expected to: a. On the basis of epidemiological and demographic data on the HIV epidemic (in particular regarding mother-to-child transmission), as well as program and laboratory performance data, to objectively determine the performance of the diagnostic landscape for viral load (VL) and EID for both pregnant and breastfeeding women and infants. b. Analyse national and facility level data relevant to introducing POC diagnostics including number of HIV exposed infants (HEI) requiring testing, number of HEI who got a test within 8 weeks, turn-around time, number of tests returned to the facility/caregivers, number of children living with HIV who received their results. c. Conduct laboratory diagnostics mapping (in-country baseline needs assessment, diagnostic and laboratory waste management scoping) to identify areas that would benefit from improved access to HIV diagnostics through use of Cepheid Gene Xpert machines. d. Assess the enabling environment for introducing HIV PoC diagnostic technology for EID in the existing laboratory and health systems. e. Assess the operational requirements for implementing/scaling up POC, as well as funds and resources available for implementation/scale-up, and training and supervision capacity required. f. Develop key considerations briefing note for introducing HIV PoC diagnostic technology for EID in Botswana, including recommendations to address bottlenecks and gaps that need to be overcome for implementation and scale-up. g. Provide general recommendations for improving EID in Botswana.

Work Assignment Overview:

The indicative duration and period for the consultancy are 50 days over a four-month period. The incumbent will be supervised by the HIV/AIDS Manager and will work under the guidance of the MoHW/PMTCT Programme Manager and NHL Manager and in close collaboration with WHO and CDC. This assignment will be based in Gaborone, Botswana, with the possibility of travel within the country.

Tasks/Milestone:

Deliverables/Outputs:

Timeline (in # days)

Estimate Budget (in BWP)

1. Review available documents and relevant literature and develop an inception report outlining proposed methodology and timelines.

Inception report

5

First Payment: 40% of total

2. Organize kick-off meeting with key stakeholders of the MoHW, NHL, UN, CDC and other key partners to discuss the scope, outline and timeline, identify available resources for EID and develop an operational plan for the consultancy.

Operational plan

5

3. Collect and compile available facility level data for EID needs and programme performance, conduct laboratory diagnostics mapping and epidemiological review to assess the need in different districts and sample facilities for additional data abstraction as necessary. Implement the EID-VL product and site selection tool.

Proposed product and site selection

15

4. Assess the enabling environment and operational requirements for introducing POC technologies in the existing laboratory and health systems including policy, regulatory frameworks, current available capacity, current usage of available capacity, human resources availability, funding for PoC scale up, training and supervision capacity required, quantification of EID reagents, etc.

Draft report of findings

10

Second Payment:

40% of total

5. Organize a workshop for key stakeholders to input on proposed introduction of PoC and operational requirements.

Workshop report

5

6. Preparation of draft detailed assessment report, key considerations briefing note including recommendations for PoC introduction and recommendations for improving EID.

Draft report

7

7. Dissemination of draft documents to key stakeholders, preparation of final detailed assessment report, key considerations briefing note including recommendations for PoC introduction and recommendations for improving EID.

Final report

3

Final Payment: 20% of total

Note to Consultants:

1. Payment of professional fees will be based on submission of agreed deliverables. UNICEF reserves the right to withhold payment in case the deliverables submitted are not up to the required standard or in case of delays in submitting the deliverables on the part of the consultant. 2. Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures and will not be entitled to benefits provided therein (such as and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws. 3. Consultant will be required to complete online courses related to Ethics, Prevention of Sexual Exploitation and Abuse and Security related trainings prior to taking up the assignment and/or travel. 4. Consultant will be required to sign the Health Statement for consultants/individual contractor prior to taking up the assignment, and to document that they have appropriate health insurance, including Medical Evacuation

To qualify as an advocate for every child you will have…

• An advanced university degree (Master’s or higher) or PhD in (public health, health systems management, health laboratory, biomedical sciences, or related field). • At least 8 years’ experience working on HIV treatment/PMTCT/ Pediatric Care programming, preferably in Eastern and Southern Africa. • Experience in diagnostic and health systems strengthening, including with diagnostic technologies or working in laboratory settings. • Experience in participating and/or conducting consultations with national authorities on the processes of mapping and implementation on Point of Care (POC) devices and reporting.

HOW TO APPLY

Qualified candidates are requested to complete an application including profile to the respective advertisement online. Please indicate your ability, availability and financial proposal/quote to complete the terms of reference above.

Rates must include all expenses related to the assignment (e.g. consultancy fee), quoted in BWP for National applicants.

Applications submitted without a fee/ rate will not be considered.

If you have not been contacted within 2 months of the closing date please accept that your application was unsuccessful. Regret emails will be sent only to shortlisted/contacted candidates.

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA) and core competencies in Communication, Working with People and Drive for Results.

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UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.