1. Purpose of Activity/Assignment: Background

Pre-exposure prophylaxis or (PrEP) is the use of an antiretroviral medication by HIV-negative people to reduce the risk of HIV acquisition.

As of September 2015, WHO recommends that people at substantial risk of HIV infection should be offered tenofovir disoproxil fumarate (TDF)-based oral PrEP as an additional prevention choice, as part of comprehensive prevention. Oral PrEP is highly effective at preventing HIV when used as directed.

In 2017, a global coalition of United Nations Member States, donors, civil society organizations and implementers was established to support global efforts to accelerate HIV prevention. The overarching goal of the Global HIV Prevention Coalition is to strengthen and sustain political commitment for primary prevention by setting a common agenda among key policy-makers, funders and programme implementers.

In 2017 Mozambique joined the global prevention coalition that indicates PrEP as one of the pillars for reducing the number of new infections by 2025 and in the same year, started its implementation through a pilot in Zambézia province. In 2019 it was expanded to the Nampula and Manica provinces and, in July 2021, the PrEP Guideline was launched, and the strategy expanded to the whole country.

In 2021, WHO recommended that the dapivirine ring may be offered as an additional prevention choice for women at substantial risk of HIV and, in 2022, that long-acting injectable cabotegravir (CAB-LA) may be offered as an additional prevention choice for people at substantial risk of HIV.

After more than five years of phased implementation of PrEP in the country, the Ministry of Health intends to conduct an evaluation to identify useful elements to make the initiative (PrEP offer) more effective and efficient considering different contexts of the country.

2. purpose and objectives:

To provide technical support to the National Program for STI, HIV and AIDS control of Mozambique Ministry of Health on the Mid-term review of PrEP implementation, due to:

· To document the successful activities and approaches that strengthen the capacity of PrEP implementation (individual, district, provincial and central level);

· Document lessons learned and, propose adjustments that can support PrEP implementation, if nedded;

· Document existing gaps and challenges in the current implementation model (programmatic norms, modality of delivery, information flow, data recording and reporting);

· Assess the level of knowledge and compliance with PrEP service delivery standards;

Analyze the future expectations of service providers in the implementation of PrEP in the country.

3. Methodology, Technical Approach and Specific Tasks of the Consultant

A quantitative and qualitative methodology will be used to assess PrEP implementation at all levels (central, provincial, district and health unit).

Desk review: The review team will conduct a desk review and literature review. These documents will provide background on PrEP provision in different settings.

Secondary data analysis: The review team will collect and analyze relevant existing data sources (registration instruments, monthly reports, program report) based on availability.

Online survey: The review team will apply an online survey that will analyze the experiences, as well as the successes and the main lessons learned. It will also explore areas for improvement and prospects.

Field visit: The review team will do field visit to observe activities, whenever possible to understand the different particularities and to observe interactions with the different groups. The review will be conducted in 18 health facilities in six provinces.

Key Stakeholder interviews: The review team will use key stakeholder interviews to ensure a more in-depth qualitative study that will complement the desk review and survey results.

The answers obtained through the questionnaire will be validated by direct observation of the services offered in the Health Facilities implementing PrEP

Facilitate the review report validation workshop

4. Expected Deliverables

Deliverables

Timeframe

Inception report including the consultant methodology understanding and schedule of the consultancy.

15 days after signing the contract

Desk review draft report including the tools for interview/survey and observation/Field visit

1 month after signing the contract

Conduct the Online Survey and key stakeholders’ interview

2nd month of activity

Field Visit

End of the 3rd month of activity

1st draft of the report review

Beginning of the 4th month

ToR of the validation workshop

Power Point presentation

Validation Workshop

m

Final report

After signing the contract, the consultant must submit an

1. An inception report with a more detailed consultancy chronogram.

2. Final report (in physical and electronic format, written in Portuguese) A concise and focused preliminary and final report (in physical and electronic format, written in Portuguese) should be submitted containing findings from the PrEP implementation assessment, according to the objectives defined in these terms of reference as well as concrete and specific recommendations that can add value to the PrEP Offer Guide either by strengthening the reach of more people at risk of HIV infection or by serving as analytical material for improved programmatic effectiveness in a future review.

A PowerPoint presentation (in Portuguese) with the preliminary findings and recommendations resulting from the evaluation should also be prepared and presented at a workshop to validate the outcome with the PrEP technical group and the NTP ITS, HIV/AIDS. The content of the presentations should: describe the objectives of the evaluation; explain the methodology used; summarize the findings, conclusions, and recommendations; and identify the limitations of the evaluation as well as describe any intervention needed to overcome the limitations cited.

Educational Qualifications

· Essential: Advanced university degree in medicine or related equivalent social sciences.

· Desirable: master's public Health and Knowledge in Harm Reduction in People who inject Drugs

Experience

Essential:

· At least 5 years of progressive experience in conducting reviews in health areas.

· knowledge of STI and HIV programs, as well as experience in the area of HIV/AIDS prevention;

· Experience in developing and implementing evaluation tools and electronic systems;

· Knowledge of cultural aspects and contexts of the country;

· Fluency in written and spoken Portuguese, fluency in English is an advantage;

· Required skills: organizational commitment, effective communication and professional secrecy;

· Availability to work in the MoH, DNSP, National Program for STI Control and HIV/AIDS.

Desirable:

· Experience working with international organizations such as the UN system, the Global Fund, and others.

Skills/Knowledge

· Good analytical, planning, and organizational skills

· Ability to manage stress and time

· Excellent knowledge of Microsoft Office.

· Good communication, presentation, and coordination skills

Languages and levels required

· Very good command of the Portuguese language (advanced level)

· Working knowledge of the English language (intermediate level)

Technical Supervision

· The consultant will work under the supervision of the PrEP focal point at the National Program for STI, HIV and AIDS control.

· Once a week, whenever possible will meet the WHO STI, HIV, and Viral Hepatitis Technical officer (Nurbai Calú – calun@who.int to update the progress of the consultancy

Location

National Program for STI, HIV and AIDS control in the Ministry of Health (address: Av. Eduardo Mondlane nº 1008, Maputo)

Travel –

No travel expected

Duration

Four (4) months.

Remuneration and budget

Currency: USD

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Added 8 months ago - Updated 7 months ago - Source: who.int