International Consultant - Secondary analysis of data to elaborate on barriers to PMTCT and recommendations to accelerate progress towards PMTCT and treatment outcomes for infants

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Background

Since 2012, new HIV cases among women tested during pregnancy have stabilized at a rate of 0.034% among all women registered with health facilities for antenatal care[1]. The decision of the Ministry of Health of the Kyrgyz Republic in 2007 to integrate HIV Counselling and Testing (HCT) into effective perinatal care (EPC), as well as the development and regular updating of the national clinical protocols on PMTCT based on the latest WHO recommendations in 2010 have led to this stabilization. The integration of PMTCT in routine practice in maternity hospitals also increased the coverage of HCT during pregnancy and delivery. One of the objectives of the National “HIV prevention program 2017-2021” is to reduce the transmission of HIV from mother to child to less than 2%. The use of ARVs for PMTCT during pregnancy and delivery increased threefold from 23% to 63% in 2007–2008, when the integration of this service into effective perinatal care was introduced, with the rate then gradually increasing to 87% in 2015.

The Kyrgyz Republic integrates PMTCT into EPC and early infant diagnosis (EID) in neonatal practice, which significantly improves access of mothers and newborns to essential PMTCT services. Since 2014, new HIV cases have begun to be recorded among women, mothers, and pregnant women, but who were diagnosed on seeking care for health conditions not related to pregnancy. This may relate to the diagnosis of HIV at advanced stages of the disease, which, in turn, testifies to difficulties in diagnosing HIV and too late initiation of antiretroviral therapy.

Cases of congenital syphilis in children are registered in Kyrgyzstan since 1995. Mortality of children with congenital syphilis reduced from a few cases to the absence of such cases between 2014-2018 years. Data related to congenital syphilis in children is based only on routine reporting data.

UNICEF Kyrgyzstan and its partners are committed to supporting the Government to accelerate system reforms to improve the health outcomes of women and children. In 2019 UNICEF supported the MOH conducting a “Rapid assessment of the program component of the strategy MTCT HIV and Syphilis elimination in Kyrgyzstan.” In 2020, the MOH organized a series of refresher PMTCT training to the health providers from the primary and hospital level to ensure the maintenance of the access of pregnant women and infants to the PMTCT services during the challenges of the COVID-19 pandemic. WHATS App-based assistance to pregnant women and self-HIV testing was introduced to provide pregnant women access to the testing. The feedback from the pregnant women on the barriers they experience in accessing PMTCT services was collected for further analysis and to inform interventions to improved PMTCT services. In this context, UNICEF Country Office in partnership with MOH aims to further elaborate the recommendations to accelerate the achievements in HIV prevention. The recommendations from this analysis will be contributing to the further strategic planning of "The New-born Survival and Perinatal Care program” of UNICEF. The deliverables and timelines, which are indicated in the current TOR, are in line with the plans of the MOH on strengthening PMTCT HIV and Syphilis services preparing the country for the validation for the elimination of mother-to-child transmission of HIV and/or syphilis. As such, UNICEF requires the services of an international expert to complete the above-described assignment.

[1] Report “Assessment of the PMTCT services in Kyrgyzstan”, MOH with support of UNICEF, 2018.

How can you make a difference

UNICEF seeks an individual international consultant to conduct a secondary analysis of the prevention of mother-to-child transmission of HIV (PMTCT) in Kyrgyzstan. The dataset for this analysis will include “A rapid assessment of the program component of the strategy MTCT HIV and Syphilis elimination in Kyrgyzstan”. The consultant should also conduct up to 10 informant interviews to elaborate on the barriers and recommendations to accelerate the progress in the MTCT prophylaxis and continued ARV treatment of infants in Kyrgyzstan.

Primary audience: Ministry of Health (MOH), UNICEF, health policymakers, research centers and universities, NGOs, professional associations, and development partners in Kyrgyzstan.

The consultancy aims to achieve the following specific objectives:

1. 1. 1. 1. To complete a secondary analysis of the “Rapid assessment of the program component of the strategy MTCT HIV and Syphilis elimination in Kyrgyzstan” (36 pages) along with the review of routine data to elaborate on all barriers to PMTC services and recommendations to accelerate the progress in PMTCT of HIV and Syphilis and continued ARV treatment of infants in Kyrgyzstan. The overall length of the report should be up to 20-25 maximum pages.
   2. To prepare the description of the project outlining the achievements and recommendations for the further scaling up of the approaches to improve access of pregnant women to HIV testing using WHATSAPP communication. (3-5 pages).

Scope of work

The Consultant will be responsible for the delivery of the agreed-upon outputs and respective activities for achievement of the objectives of this consultancy:

1. 1. 1. 1. To conduct up to ten individual informant interviews with health experts in HIV to identify the main barriers experienced by the pregnant women to accessing uninterrupted PMTCT services;
   2. To complete the secondary analysis of routine data and “A Rapid assessment of the program component of the strategy MTCT HIV and Syphilis elimination in Kyrgyzstan” (36 pages) to elaborate the barriers and recommendations to accelerate the progress in PMTCT and continued ARV treatment of infants in Kyrgyzstan. The overall length of the report is planned to be up to a maximum of 25pages.
   3. To prepare the description of the current achievements and outline recommendations for further testing of the small project (up to 100 cases) on the introduction of the WHATS App-based assisted - self-HIV testing of the pregnant women by the psychologist or doctor specialized in HIV. This approach is aimed at the provision of pregnant women of access to HIV testing during the limited physical access to the testing facility (3-5 pages).

Expected outcomes/Deliverables and Work Plan

Deliverables

Estimated # of days

Due date

Payment percentage from full contract

Deliverable N1

1. Based on the interview of the leading HIV experts (up to ten) to prepare a short summary of the barriers experienced by pregnant women while accessing PMTCT services.

7

20 January

30%

Deliverable N2

1. The secondary analysis of the routine data and “The Rapid assessment of the program component of the strategy MTCT HIV and Syphilis elimination in Kyrgyzstan” is conducted with the elaboration of the set of clear recommendations and plan with indicators to accelerate the progress in the preparation of the country for the validation of the elimination of the HIV and syphilis transmission to infants (20-25 pages).
2. The intermediate result of the project on the introduction of WHATSAPP communication to increase the access of pregnant women to HIV testing is documented. Recommendations for further piloting are provided based on the review of the achievements, identification of the gaps, and lessons learned. (3-5 pages).

13

10 March

70%

TOTAL

20 days online

Payment Terms

Consultancy fee to be determined at a daily rate based on the financial proposal of the interested applicants. The payment will be processed in two installments:

• 1st installment of 30% of the consultancy fee is to be paid upon provision of Deliverables 1.
• 2nd installment of 70% of the consultancy fee is to be paid upon provision of Deliverables 2.

UNICEF will provide the consultancy fee, mutually agreed upon daily rate for the duration of the contract. In all cases, Contractors/vendors may only be paid their fees upon satisfactory completion of services. In such cases where payment of fees is to be made in a lump sum, this may only be payable upon completion of the services to UNICEF’s satisfaction and certification to that effect, and any advance on the lump sum may not exceed 30% of the fees. In such cases where payment of fees is to be made in installments, the final installment may not be less than ten per cent (10%) of the total value of the contract and will only be payable upon completion of the services to UNICEF’s satisfaction and certification to that effect.

Reporting and Supervision

Day to day supervision will be performed by the Health Specialist and overall guidance and direction by Child Survival and Development Section Chief in UNICEF Kyrgyzstan in close collaboration with the designated officials of the MOH.

The incumbent needs to allocate 20 working days within the indicated period 1 January - 10 March 2021 and will be paid upon satisfactory performance of the service upon completion of each deliverable.

Performance indicators

• Technical and professional competence (will be measured by the quality of work, as well as feedback from partner organizations);
• Quality of work (timely submission of the final product to UNICEF)
• Quantity of work (completing the deliverables as indicated in the work plan above)

• Also, such indicators as work relations, teamwork, responsibility, and communication will be considered during the evaluation of the consultant’s work.

  Duty station and official travel involved

This consultancy is expected to be delivered through online work only.

A consultant is responsible for his/her own travel arrangements set out in the contract and must ensure they are made in line with UNICEF policy on entitlements for consultant travel, i.e. estimated daily subsistence allowance (DSA) and must be on UNICEF approved airlines based on economy class travel, regardless of the length of travel. DSA for official international travels shall not exceed the daily rates established for specific country regions as promulgated by the International Civil Service Commission (ICSC).

Consultants traveling on behalf of UNICEF must meet the standard trip prerequisites, including but not limited to Medical Clearance, Security Clearance, Visa and completion of BSAFE security training. Consultants are responsible for assuming costs for obtaining visas, travel insurance and other trip prerequisites.

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

This consultancy is open to individual consultants and needs to follow the submission guidelines as stipulated for submissions from individual consultants.

• Ph.D. or Master’s in the “Public health” or “International Health” with focusing on the Mother and Child Health is required;
• Minimum 3 years of the programmatic areas of expertise in the technical report writing based on the analysis of the situation or evaluation should include the following areas: Public Health or International Health with specialization in HIV/AIDS or safe motherhood/child survival;
• Experience the work with UNICEF and WHO is an asset
• Experience of work in Central Asia, particularly in Kyrgyzstan is an advantage
• Fluency in English is required. Knowledge of the Russian language is an asset

Applications must include:

• Cover letter,
• CV, and
• P-11 form[1]
• A recent writing sample of which the candidate should be the sole author, or the main named co-author, which deals with providing technical assistance and leadership in the technical report writing based on the analysis of the situation or evaluation in the following areas: Public Health or International Health with specialization in HIV/AIDS or safe motherhood/child survival,
• such as a strategy document, a peer-reviewed publication, an official report or similar.
• Daily rate.

[1] P 11 form can be downloaded from our website at http://www.unicef.org/about/employ/files/Personal_History_P11.doc

View our competency framework at

http://www.unicef.org/about/employ/files/UNICEF_Competencies.pdf

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:

Mobility is a condition of international professional employment with UNICEF and an underlying premise of the international civil service.

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.