Title: National Consultant for development of National guidelines for Voluntary Counseling and Confidential Testing.
Office location: National AIDS Control Program, Islamabad
TERMS OF REFERENCE:
COUNTRY: PAISTAN
HIV Component of GFATM Round 9
- CONTEXT
1.1 HIV Situation:
HIV/AIDS is becoming a devastating reality in Pakistan. Like other Asian countries, the HIV epidemic has moved from a ‘low prevalence, high risk’ to a ‘concentrated’ epidemic in the early to mid-2000s among key populations. The trend of concentrated HIV epidemic among key populations (KP) in Pakistan continues to be driven by people who inject drugs (PWID), with HIV prevalence at 27.2% in 2011. After PWID, prevalence was highest among hijra, or transgendered sex workers (HSW) at 5.2% followed by male sex workers (MSW) (16%). Among the key populations identified in the country, female sex workers (FSW) exhibit the lowest HIV prevalence of 0.6%. Adolescents, orphans and youth have also been marked as vulnerable to contracting the disease. The geographic trend of the epidemic began with surveillance and programming initially in the major urban cities and provincial capitals with subsequent expansion to the smaller cities and towns.
Evidence also suggests that certain other populations groups are also highly vulnerable and have shown signs of being infected. These populations include: spouses/intimate partners of PWID, MSW and HSW, imprisoned populations, street-associated adolescents and persons in certain occupational settings, including some cases of nosocomial infection. Migrant workers and their spouses are also increasingly vulnerable and were among the first HIV cases detected in Pakistan and continue to be the largest infected population group in the Khyber Paktunkhwa province. While evidence overwhelmingly calls for a focus on key populations and those at risk, it is essential that prevention strategies and HIV education programs be sustained for the general population.
According to NACP and UNAIDS estimates in 2013 Pakistan had about 83,468 people living with HIV, of which 7,568 PLHIV were registered in the 18 HIV centres and of the total registered patients 3,211 adult PLHIV and 70 children were on ART. Recent trends have shown a decline in the number of PLHIV registered at HIV treatment centres and those on ART. On the average, in 2012-2013 about 33 PLHIV were started on ART per month as compared to 40-45 patients reported in the 2012 GARPR. Relative to the estimated number of PLHIV in the country, the number of registered PLHIV within the health care system remains low. HIV treatment, care and support facilities are available through 18 HIV treatment centres, 5 paediatric AIDS centres, 16 VCCT and 11 prevention of parent to child transmission (PPTCT/PMTCT3) sites. Under Global Fund Round 9 till now 11 CHBC sites have been established. Majority of the treatment, care and support facilities are confined to key cities.
1.2 Voluntary Counselling and Testing Centers:
Counselling and testing services are offered within government health clinics and hospitals. Individuals who wish to undertake HIV testing often have to negotiate complex, overcrowded facilities. Lack of separate VCCT centres, limited staff capacity, restricted service operation hours, lack of privacy and internal hospital policies often serve as major barriers to service uptake and reduces the uptake of services by individuals on a walk-in basis.
The number of VCCT services being conducted in donor funded programs are also limited and mostly community based. VCCT is an essential part of HIV services delivery packages but with limited coverage. There has been increasing reliance on these services to meet the needs of key populations however many have closed down, after donors exit.Reliance on donor funds raises the issues of sustainability of programs, loss of trained human resource and vital data.
Effective testing services, pre HIV test counselling and post HIV test counselling are the backbone of HIV service delivery packages, establishing the linkage to care and improving the quality of life of PLHIV. National VCT guidelines are needed to put in place a standard, quality and effective VCT infrastructure that can be uniformly practiced in the health sector.
2. OBJECTIVE
The main objective of this exercise is to draft and develop National Guidelines for Voluntary Counseling and Confidential Testing and National HIV testing strategies. These guidelines will be used to assess the quality of VCT services offered by various VCT centres throughout the country and bring them in conformity with set nationals standards as well as introduce uniformity in the quality of services offered by the VCT centres. These guidelines will ultimately contribute to the sustainability, improvements, and scaling-up of VCCT services.
The guidelines document will provide a summative outline of the VCCT programme in Pakistan since its inception and the extent to which the VCCT services in the country are in conformity with set international guidelines and provide a road map to evaluate and improve the current VCCT structure in the country for better health outcomes.
3. QUESTIONS
The exercise of guidelines development should identify good and effective practices, successful guid-lines models, and recommend culturally appropriate, country specific guidelines that should cover/address the following areas:
- To what extent are the current National VCCT practices relevant in terms of the country’s HIV epidemic stage and are the VCCT services protocols consistent with the needs, interest and circumstances of the vulnerable and most at risk groups
- To identify cost-effective models to test hard to reach populations (IDUs, MSM, FSW and HSWs) and bring them into the folds of care and treatment
- To what extent have the targeted population, and national authorities accepted responsibility for VCCT, and are the VCCT services considered friendly and effective by KAP? How will they be modified to increase acceptability and improve quality against set uniform standards?
- Compare the existing services and practices of the providers with the set international standards and current SOPs; and set future guidelines for quality compliance.
- The VCCT guidelines should be in line with the needs of the general population and risk groups and be able to contribute to national strategies and priorities
4. METHODOLOGY
The development exercise will define culturally relevant and acceptable regional and global VCCT guidelines that have proven effectiveness, and then develop a questionnaire/tool to evaluate the existing practices in the VCCT centres. This can be done by undertaking a literature review of global VCCT standards, desk review of VCCT services packages in place/, assessment of the programmatic strategies and interventions, in relation to the expected outputs and outcomes of the VCCT services.
The consultant will conduct field visits and hold focus group discussions, community meetings and interviews with the stakeholders and implementing partners. They are also encouraged to use available secondary data and information outlined below as well as data from other published sources or research / studies.
The detailed methodology will be developed by the consultant and agreed by National AIDS Control Programme.
5. DELIVERABLES
The main deliverables are:
- Draft VCCT Guidelines to be submitted for validation and review.
- Final VCCT Guidelines after incorporating inputs from the NACP.
6. Time frame:
Total consultant working days:
Consultancy Period: 1 month
7. Qualifications:
- MBBS with MPH
- At least 08 years of experience in the area of HIV and AIDS with extensive knowledge in HIV testing and counseling
- Prior working experience in tools and checklist development.
- Having publication in international journals.
- Excellent writing skills
Qualified candidates are requested to submit a complete profile, to by the deadline of 1st Dec, 2014.