Consultants Strengthening and capacity building for the National HIV Prevention Programme in Mauritius

P a g e 1 | 3 Terms of Reference Strengthening and capacity building for the National HIV Prevention Programme in Mauritius Background The HIV epidemic in Mauritius remains a concentrated among HIV high risk key populations, namely people who inject drugs (PWID) – 21%, Transgenders (TG) – 28.4%, Prison inmates – 17.3%, MSM – 17.2% and sex workers – 15%. HIV prevalence among adults aged 15 – 49 years was 1.7% in 2020. Antenatal sentinel surveillance of HIV in public health settings, suggests that, in 2020, HIV infection rate was around 1% among pregnant women in the country. There has been very little change in the HIV prevalence over the 12 years, remaining constant between 2018 and 2021. A significant decline in the HIV incidence of 34% was observed between 2010 and 2021 (24% decline between 2010 and 2015, and 13% decline for the period 2016 – 2021). In 2014, the declining incidence rate was plateauing and has been since on a mild upward trajectory. In the same vein, new HIV infections declined by 32% between 2010 and 2021 (23% between 2010 and 2015, and 12% between 2016 and 2021). Disaggregated data shows a 51% decline in new HIV infections among children aged 0 – 14 years, while for adult women and men a drop of 29% and 33%, respectively. According to estimates from UNAIDS Spectrum the total number of people living with HIV in the country, in 2021, was around 14,000. The latest estimates for the Country HIV cascade are as follows: 51% of people estimated to be HIV know their status; 64% of those who know their status are on treatment; and 45% of those who are on ART are virally suppressed. A major cause of concern which puts at risk all investment in the programme is the loss-to-follow of patients. In fact, a calculation among patients who had a viral load test in 2022, showed a suppressed viral load as high as 77,4%). The reverse side of the coin is a high rate of Lost-to-follow-up patients, approximately 26%. The HIV National Action Plan (NAP) for 2023-2027 acknowledges and is based on the premises that preventing new HIV infections is central to ending the HIV / AIDS epidemic. Notwithstanding a wide array of effective HIV prevention tools and methods and efforts to massive scale-up of HIV treatment in recent years, progress in reducing new infections in adults has been lacking. To redress the low performance, especially referring to the 95-95-95 targets, overhauling actions are planned. These are, however, not limited to revision of HIV services guidelines and protocols (HIV testing, referral for ART initiation, monitoring of viral load suppression), improvement of linkage between community led services (peer educators/navigators) and HIV clinical services for ART initiation and follow-up. Capacity building of health care providers and community actors to leverage the HIV prevention programme is also critical. It is against this background that the Ministry of Health and Wellness wish to avail technical support of WHO. Rationale As delineated in the current HIV NAP the prevention component of the national response will focus on awareness creation primarily in educational establishments, youth centres and in the workplace, prevention of mother to child transmission and harm reduction (methadone substitution therapy and needle and syringe exchange program), as well as pre- and post-exposure prophylaxis, and condom distribution. P a g e 2 | 3 A contextual analysis carried out in the margin of the development of the current HIV NAP concluded that the prevention sub-program, as presently implemented, is not adequate to address the weaknesses of the response. Implementation of a wide range of prevention are conducted in silos with no synergy among them. A vivid illustration is the harm reduction program which is separated and not connected to the treatment program. However, the only linkages that are visible relates to the PMTCT and the condom programs in view of the interactions between the family planning clinic and the antenatal clinic. The weakest link within the national response is undoubtedly the educational programs. Interactions and collaborative efforts among the entities engaged in health promotion is rare. In some cases, anecdotal evidence abounds that conflicting message are conveyed to the same audience from distinct health promotion and education providers. Inadequate knowledge of essential information about HIV remains low in particular. This contributes to high levels of misconceptions about the virus and attributed for the persisting high levels of HIV-related stigma. Stigmatisation poses a major disincentive for PLHIV to access HIV services. Improving the level of HIV awareness (across all strata, including health care establishments, workplaces, educational establishments and community faith-based organisations) would be essential to fight HIV-related stigma and discrimination and motivating people to utilise HIV services. HIV response is heavily skewed towards treatment as compared to prevention. Furthermore, both treatment and prevention are addressed as being mutually exclusive, and thus impacting negatively on the overall program delivery. The poor referral system between the prevention and the treatment programs is a major disfunction. In fact, the referral system is vital and an enabling mechanism for the prevention program to provide effective support to the treatment program. Objectives With the view to reducing at least 25% new HIV Infections among the key populations, adolescents and young persons, and the general population by 2027, ensuring prompt diagnosis of HIV infections and referring HIV positive persons to effective care and treatment to enable them to attain viral suppression and remain virally suppressed to reduce risk of transmitting HIV is of essence. HIV negative persons will be supported with appropriate prevention services to sustain the negative status. Under the current NAP, early diagnosis of HIV infections will be promoted through effective deployment of differentiated HIV testing services as prescribed by the testing policy. To prevent HIV negative people from becoming infected, combination prevention strategies will be deployed widely across the country, with priority given to places with the largest burden of disease and among populations at greatest risk of HIV. Description of duties • Elaborate an inception report • Identify strengths and weaknesses of the HIV Prevention program • Undertake a knowledge gap analysis and training needs assessment for HIV Prevention (including core competencies) • Develop a comprehensive HIV prevention strategy using WHO and other international guidelines and guide formulation of standard operating procedures and job aids to facilitate effective prevention programing. • Assist in strengthening specific capacities among the different stakeholders to implement combination prevention interventions. P a g e 3 | 3 • Advise on appropriate linkages to be set up among the different prevention components and forum for regular interaction between the key implementers of the different components. • Develop tailor-made training modules on the several focus areas of the HIV Prevention Strategies, including STIs, Addictology, Sexual Reproductive Health • Roll out a training of trainers programme on HIV Prevention for both Ministries of Health personnel, as well as NGOs and civil society • Develop a roadmap and recommendations for strengthening the linkages between the prevention and treatment strategies and interventions. Deliverables • Training needs assessment report • Training modules on HIV Prevention contextualized to local settings • Submit an End of Mission report to WHO, including road map and recommendations Duration 60 Working days, as from 28 August 2023, and which can be undertaken in 2-3 phases (according to the agreed inception report). Required qualification Essential: A master’s degree in Medicine and/or Public Health, health promotion or other health related sciences, from an accredited/recognized institute. Desirable: Additional training/s in the areas of in the field(s) of HIV Prevention Experience: Essential: At least five years of combined national and international experience in health promotion, HIV prevention policy, planning, management and development of national programmes related to HIV and AIDS. Desirable: Experience working with WHO or UN agencies Functional Knowledge and skills • Good knowledge of the current context and international recommendations regarding the fight against HIV/AIDS • Demonstrate and proven experience in designing and implementing HIV Prevention programmes • Demonstrate collaboration, innovative, analytical and problem-solving skills • Ability to support policy level dialogue, advocacy, communication with partners • Proven track-record in organizing capacity building and policy dialogue events in the health sector Languages Essential: Expert knowledge of English. Knowledge of French would be an asset.