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: The Sustainability of HIV Services for Key Populations in Asia (SKPA)
: Nonprofits / องค์กรไม่แสวงหาผลกำไร
: 1246
: 28 October 2020
6 November 2020
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Title |
Development of comprehensive HIV Service Package for Key Populations in Bhutan and Community-Based Testing Protocol and related guidelines and SOPs (International TA) |
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Duration |
44 days |
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Period |
1 November – 31 December 2020 (extendable) |
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Location |
Bhutan, or remotely as necessary |
Background and Rationale
The Sustainability of HIV Services for Key Populations in Asia (SKPA) Program is a Global Fund Multi Country Grant program being implemented in eight countries: Bhutan, Sri Lanka, Mongolia, Philippines, Timor-Leste, Malaysia, Lao PDR and Papua New Guinea. The main aim of the SKPA Program is to promote sustainable services for key populations at scale to stop HIV transmissions and AIDS related deaths by 2030. AFAO, the national federation for the community response to HIV in Australia, is the Principal Recipient (PR) of the SKPA Program, and the country Sub Recipient (SR) in Bhutan is Save the Children.
The SKPA program has conducted a review of the packages of services (KP Service Package Review) available for Key Populations (KPs) in Bhutan which examined the extent to which the existing KP HIV service package in Bhutan is in line with the National Strategic Plan and with international/UNAIDS/WHO normative standards and guidelines. Using focus group discussions and key informant interviews, the review investigated what services are actually available to key populations considering accessibility, utilization and coverage, sufficiency of services, and opportunities and barriers for implementation and service delivery options. The report includes key recommendations to improve KP service availability and delivery and an informative assessment towards phased implementation of Community Based HIV Testing in Bhutan and recommended specific inputs for a revised package of services for KPs.
The KP Service Package Review found that the National Strategic Plan (NSP) does not currently include some potentially impactful interventions such as PrEP for men who have sex with men (MSM) and transgender people (TG), as well as harm reduction for People who inject drugs (PWID), as their implementation has not been considered feasible in the Bhutanese context. The review strongly recommended further adaptation of HIV activities to the needs and behaviors of populations at risk (outreach for each KP, stigma and discrimination, mental health, reproductive health) in the NSP and the Action Plans of the NACP.
Prevention activities for high risk women (HRWs), MSM and TGs are mainly undertaken through Health Information Service Centers (HISC) established in strategic locations in the major towns of Bhutan to strengthen HIV Testing and Counselling (HTC), specifically for clients at risk of HIV. However, the KP Service Package Review found that outreach to KPs is limited as there are only few outreach workers and they are not always adequately trained or well connected to the KP communities they are meant to serve. Currently the lay outreach workers cannot offer HIV testing on the spot. The outreach services offered by HISC, while critically important, include only a limited range of HIV and social services, crucial to the needs of KP, with little involvement of the CSOs and KP community in determining needs, availability and allocation of services.
Saliva testing is not yet practiced in Bhutan and lay workers are not able to provide testing services but must refer the clients to HISC counselors and further to health services. There are, in addition to the outreach workers at HISC, in-reach volunteers. There is the need to clarify the in-reach volunteers’ roles and their linkages with and support from HISC outreach workers and counselors. In care, treatment and support, involvement of CSOs and KP members is still limited, but planned to be expanded.
STI is not diagnosed and treated at the lower level of the health system or in HISC for KPs, but patients often need to be referred to other medical services where health workers will not always feel confident examining a patient with an anal symptom or a TG patient whose official ID card doesn’t fit her/his appearance. The implementation of HIV prevention and response activities for drug users is mainly through rehabilitation centers. The key preventive services for drug users are not available despite existing rather common opioid addiction and with reported overdoses and recurrent relapses after detoxification. There is also a need to negotiate a “public health space” at local level with the local police authorities to be able to deliver prevention and care to the groups of sex workers who mainly operate outside of reach of health networks.
The SKPA Program and Save the Children are working closely with the NACP of Bhutan to address a number of these related issues. Following the KP Service Package Review, this consultancy should lead to adoption of a revised service package that will be rolled out and which can inform the next NSP. Outreach strategy revision forms a critical aspect of this work, which will then include introduction of Community Based Testing, for which this consultancy will also develop a protocol, guidelines and SOPs.
While not part of this consultancy, the SKPA program and Save the Children are simultaneously supporting implementation of a Community Based Monitoring mechanism in coordination with APCOM, as well as activities to reduce stigma and discrimination in service delivery with the support of APN+, advocacy to improve the legal environment for access to KP services, and strengthening of CSOs to ensure sustainability of the community-based interventions and greater involvement of communities in the national disease response going forward. It will be important to ensure that these related interventions and initiatives are coordinated and work to support each other.
General objective
To develop the manual to provide detailed guidance for the provision of comprehensive high-quality differentiated HIV services to key populations at high risk for HIV, and/or those living with HIV. The consultancy will also develop a community-based testing (CBT) protocol and related guidelines and SOPs.
Specific objectives:
To detail out the comprehensive high-quality differentiated HIV services recommended in the KP Service Review Report 2020, including all related guidance, procedures and forms to deliver each intervention to KPs.
To detail out outreach and in reach strategy and guidelines for HIV/AIDS services related to KPs in Bhutan’s context, including clear roles and responsibilities of the HISCs Counsellors, ORWs and KP related CBOs in implementation of the manual/guidelines on comprehensive high-quality differentiated HIV services to key populations and PLHIV.
To develop clear procedures in overall management of the ORWs and their reporting mechanisms to the HISCs and CBOs for effective monitoring and evaluation of the targeted interventions.
To develop procedures to ensure linkages and referral pathways between key population networks and CSOs to Health Information and Service Center (HISC) and National HIV, AIDS and STIs Control Program (NACP).
To develop a CBT protocol and related guidelines and SOPs, which should take into account lessons learned and best practices from other countries in the region and include, but not be limited to:
Background, rationale, aims and objectives of the CBT demonstration project;
CBT model, revision of testing algorithm and design based on innovative approaches (HIV self-testing, assisted self-testing, index testing, digital innovation) that is cost effective, test kits, pilot test population and sample size calculation;
Test procedures, PEP, quality assurance, referral mechanism, confirmatory test, enrolment in treatment and care;
Infection prevention, control, healthcare and waste management;
Recording and reporting requirements, data collection tools, procedures, quality, storage and assessment;
Informed consent and confidentiality processes;
Ensuring criteria for selection of lay providers, selection process, training and certification, and development of training materials;
Detailed CBT implementation plan, flow chart, implementation activities, timeline, monitoring, evaluation, dissemination of the plan, and related guidelines and SOPs;
Detailed monitoring and evaluation plan for the CBT pilot with clear objectives, key questions and agreed indicators.
Scope of the wok
The International Technical Assistance (ITA) in close collaboration with National Technical Assistance (NTA) will work with the NACP and SCI-Bhutan to develop the detailed comprehensive HIV Service Package for Key Populations in Bhutan including the outreach activities and relevant SOPs/guidelines. The comprehensive service package and out-reach strategy should be in line with overall national health policy. The details of the consultancy activities, deliverables and timeline are specified in the Table 1.1 below.
The international consultant in close collaboration with the national consultant will work with the NACP through SCI-Bhutan to develop the CBT protocol and relevant SOPs to implement the demonstration project of the Community Based HIV and STIs testing among the key populations in two major urban centers (Thimphu and Phuentsholing) of Bhutan through the Health Information and Service Center (HISC) and the national KP CSOs and networks with clear outreach and reporting mechanisms. The international consultant will assist the national consultant to carry out the desk review and formulation of the inception report.
The consultants will review the KP Service Package Review Report, other national reports, National HIV/AIDS Strategic Plan (2018-2023) of the Ministry of Health, similar protocols and SOPs, best practices, lessons learnt documents in the region and other countries. The international consultant shall supplement and guide the desk review and support formulation of the inception report by the national consultant. In general, the CBT protocol should be feasible and adaptable to Bhutan’s context.
Table 1.1 - Consultancy Activities, Deliverables and Timeline:
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Activities |
Duration of Consultancy |
Outputs/ Deliverables |
Deadline/ Duration |
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7 days |
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15 days |
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3) Revision of drafts and national stakeholder workshop
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15 days |
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|
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7 days |
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TOTAL |
44 days |
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The PR, SR and NACP and key national stakeholders for SKPA will form a Project Working Group (PWG), chaired by the NACP. The PWG will oversee and endorse all critical stages of the assignment and ensure a comprehensive and holistic approach.
The NACP as the lead implementing partner for the CBT and KP service provider will supervise the consultant on a day to day basis and provide the technical guidance based on its local expertise in the field.
The NACP will render all support in terms of institutional arrangements not limiting to issue of office orders, arrangements of meetings, and necessary logistics during the field visits for the consultants and other such facilities deemed necessary for the smooth completion of the assignment.
The PWG will monitor the progress of the assignment on a timely basis and provide feedback to the NACP where relevant.
The cost associated with the NTA will be supported by the SKPA Multi-Country Grant under the Global Fund support to the Region.
Other administrative costs such as for training, stationaries, monitoring and supervision, if needed will be directly managed by the NACP, DoPH, MoH from the fund allocated by the SKPA to NACP.
The day-to-day management of the consultant will be handled by NACP under the guidance of the PWG. Therefore, the consultant will work closely with the NACP for relevant information and inputs into all stages of the assignment.
The NACP will report to the PWG on the overall progress of the assignment on a timely basis and share the final draft reports with the SR for onward submission to the PR.
The ITA should submit the final report to the NACP copied to SC-Bhutan for the formal endorsement of the Ministry of Health.
On finalizing the report with the SR and PR, NACP will seek formal endorsement from the High-Level Committee (HLC) of the Ministry of Health to integrate the comprehensive KP service package to overall health system for future sustainability
Selection Criteria
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Qualification, Skills, Experience and Role |
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Essential
Desirable
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Time Scheduling
The consultant(s) will be contracted for a maximum of 44 working days between 1 November and 31 December 2020.
Client
SR Contact Person:
Karma Doma Tshering, SR Program Manager
Chang Geydaphu, GPO Box. 281, Thimphu, Bhutan
https://bhutan.savethechildren.net
Telephone number: +975-2323419/ +975-2325599 (Ext 108) | Fax +975-2322290
Email: karma.tshering@savethechildren.org
Skype: karmadt
PR Contact Person:
Tim Kerr (SKPA Senior Officer and Bhutan Country Lead)
Australian Federation of AIDS Organisations
Email: Tim.Kerr@afao.org.au
Closing Date: 6 November 2020