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Study of the PWID HIV/TB and Needle & Syringe Program Component

Contracting Authority: Raks Thai Foundation

Terms of Reference (ToR) for

Study of the PWID HIV/TB and Needle & Syringe ProgramComponent

 

Under the Program Title

Stop TB and AIDS through RRTTR 2018-2020 (“STAR-2”)

 

Funded by

The Global Fund to fight AIDS Tuberculosis and Malaria

 

Requisition number 

PG#111/2563

Issued dated 

13 July 2020

Purpose 

The purpose of this Terms of Reference (“ToR”) is to hire a consultancy/research/evaluation team to 1) conduct aquantitative study of the PWID that is reached in the STAR project database, 2) review and evaluate the STAR PWID health services provided by GO and CSO for the PWIDpopulation, 3) collect and analyze quantitative and qualitative data on needle and syringe (“N&S”) use among People Who Inject Drugs (“PWID”) to generate evidence on the number and type of commodities required to distribute within all STAR2 implementing provinces in Thailand, 4) review the STAR project set up for outreach services and strengths/weaknesses in reaching project results, and 4) make recommendations to improve the STAR-2 project performance in 2020 and beyond.

Project Title  

Stop TB and AIDS through RRTTR 2018-2020 (“STAR-2”) 

Funding Source 

The Global Fund to Fight AIDS, Tuberculosis and Malaria 

Require for competitive bidding 

Yes  

 

Contents in the ToR

 

1. Purpose 

 

2. Background 

7. Payment and Fees 

3. Deliverables 

8. Rights and Properties 

4. Expectations

5. Scope of Work

9. Qualifications and Required Documents

10. Contact person(s) 

6. Duration and Duty Station

 

 

​  

1. PURPOSE 

The purposes of the project study are to 

1) Conduct a follow up study using sampling techniques and structured interviews of the PWID that have been reached by the STAR project and analyze the basic characteristics, services used, satisfaction with project services and expectations that would improve the project and overall program quality. 

2) Explore and investigate the planning and delivery of STAR-2 harm reduction service by gaining a deeper understanding on the use of sterile injecting equipment by PWID, their access sources, and their injecting and social behaviors including barriers or opportunities that may influence participation in STAR-2 project activities. 

3) In the sampled provinces, conduct an open-ended and/or key informant interview of the CSO outreach team, their supervisors/manager to study how they have organized their interventions to reach the targets of reach, recruit, treatment and retain. 

4) In the sampled provinces, conduct a situational review of the key players that influence the reach and access to services of PWID under the STAR project. 

5) Produce 2 separate reports one on the quantitative study of STAR PWID participants and the second on the study of CSO field staff and the province level stakeholders. 

 

2. BACKGROUND 

 

STAR stands for Stop TB and AIDS through RRTTR framework. The STAR-2 project is operated from 2018 to 2020. It is a continuation of the STAR-1 project from 2015 to 2017. The Goal of that STAR project is to support the national goal of ending AIDS by 2030 and eliminating TB by 2035. A key strategy in reaching this goal is assuring that 90% of the people living with HIV and tested for HIV, treated and are able to reduce their viral load to a level that is no longer transmittable. In terms of realizing this strategy of the 90% of people living with HIV reached, tested, treated and retained, national programs focus on what is called “key populations”. The key populations include People Who Inject Drugs (PWID), Men of Who Have Sex with Men (MSM), Transgender Women, Female/Male Sex Workers, and migrant workers in selected occupations. 

 

The STAR project has two Principal Recipients (PR) that is the Department of Disease Control (DDC) implementing the hospital-based services mainly testing and treating of HIV and TB, and RaksThai Foundation is responsible for CSO outreach component using the peer outreach, mobile service, and referral for testing and treatment at government service facilities. The program goal is to reach the key populations in the selected provinces where there is a rate of reported HIV and/or a high level of concentration of the particular key population. 

 

The key population PWID is operating in 19 provinces that have the highest density of at risk PWID on HIV and TB cases. The approach used in reaching PWID is taken from Harm Reduction programs with an emphasis on HIV prevention, testing and treatment. The basic components of the program include:

 

• Reach in communities and through PWID visits to STAR drop in centers;

• Behavioral change communications through the Peer outreach workers;

• Condoms, needles and syringes packets;

• Referral for STI testing and treatment;

• Referral for HIV, HCV and TB testing and treatment;

• Referral for OST services;

• HCV services at drop-in centers at selected centers;

 

The CSO set up is that within the 19 provinces covered by STAR, there is one CSO that is running the outreach program with a drop in center. Outreach workers who are ex-PWID are preferred due to their understanding of the situation that PWID face and their ability to reach PWID and communicate in a common language. This is not always possible and often outreach workers with no background related to PWID are used.  The number of outreach workers varies by estimate size of PWID population.

 

In addition to the outreach worker, each province level office will have field officers and a field coordinator who support the outreach workers and also coordinate with local offices related to the program.

 

Due to the illegality of drug use in Thailand, both the outreach worker and the PWID must constantly  avoid encounters will law enforcement officials. Distribution of needle and syringes is also categories as an illegal act of facilitating/supporting drug use. There is also strong stigmatization towards drug users that can be found not only in the general public, but also public health officers, and many local community leaders.

 

To maintain the confidentiality of PWID participating in the program, a Unique Identification Code (UIC) is used collecting PWID numbers and basic data on reach and testing. The information is collected at the province level and sent to Raks Thai Foundation office in Bangkok. On the other hand the hospitals that conduct HIV testing, require the disclosure of personal identification number that is used to code receipt of services, including testing and treating. 

 

Implementation areas are 

• North region is Chiang Mai (2 areas: OZONE and TDN), Chiang Rai, Mae Hong Son, Tak

• Central region is Bangkok (2 areas: Raks Thai and OZONE), Pathum Thani, Nonthaburi, Samut Prakan

• Southern region is Surat Thani, Phatthalung, Trang, Songkhla, Yala, Pattani, Narathiwat, Satun, Nakhon Sri Thammarat

• Northeast region is Khon Kaen, Kalasin

 

 

While in all locations CSO outreach programs provide NSP and condoms, there are only 6 provinces where there are HCV testing and treatment located at the CSO drop in centers.  PrEP and oral fluid screening has just begun and is in limited number of areas.

 

Although this needle and syringe distribution is not banned in Thailand, the overall policy environment around it has been contentious. The integrated HIV/STI biological and behavioral surveillance (IBBS) data from 2010 documented that 95 percent of PWID reported the use of sterile injecting equipment at last injection. The 2010 IBBS data also showed that only 17% of all needles and syringes were sourced from harm reduction programmes, while the remained were bought in pharmacies or were obtained from friends. This increased to 24% in 2016, an estimation based on program data. Unfortunately, there is no standard way of capturing pharmacy sales of needles and syringes and these are not reported in the total numbers of needles and syringes distributed in the country. Therefore, the average number of needles and syringes distributed to the estimated total PWID population in 2014 through 42 distribution sites was 14—short of the national target of 88. 

 

 

STAR has also used mobile teams that have CSO and hospital members going to communities for on-site information, counseling and testing. 

 

 

3. 

DELIVERABLES 

 

The objectives of this study are to: 

 

3.1. Results of the sampled quantitative study of PWID participating in the STAR program that show at population characteristics, past and current behaviors related to drug use, risks of HIV infections, health seeking awareness/behaviors, utilization of project services and reason for high/low use of services, services/approach that would increase satisfaction with services and lead to recommending peers to participate in the program.  This data should be analyzed by region, age, sex and history of program participation.

3.2. Key findings and recommendations to improve harm reduction service and plan for procurement of appropriate quantities’ and type of sterile injecting equipment 

3.3. As a part of data analysis to estimate the number of needle and syringes used by PWID in selected sub-populations and also to estimate the number of PWID remaining within the project areas (province/district). 

3.4. Report on the data collection findings and recommendations regarding the STAR program set up in the studies provinces, providing information on the coverage of the outreach team, gaps in area coverage, skills and knowledge to deliver services, and provincial level management and monitoring of interventions to increase effectiveness.

3.5. Report on the data collection findings of key informant interviews of key stakeholders at the provincial level, thatshould include at a minimum public health provider, community leaders and law enforcement officers.

3.6. Final presentation and publishable report that is in Thai and English.

 

 

4. EXPECTATIONS 

 

The expectations of this Study are: 

4.1 Work collaboratively and productively with Raks Thai Contact Person(s) and STAR-2 staff to collect quantitative and qualitative data according to a prescribed methodology and tools with PWIDpopulations. 

4.2 Analyze data and prepare a report with key findings including recommendations to improve the harm reduction service and plan for procurement of appropriate quantities’ and type of sterile injecting equipment 

4.3 To identify procurement and supply chain management of NSP for PWID

4.4 To identify comprehensive NSP program under STAR-2 and in the future program

4.5 To identify behavior change communication for PWID in the aspect of needle and syringe sharing

4.6 To identify NSP usage rate per head 

4.7 To review NSP policies and come up with practical recommendations  

4.8 Publishable quality reports in Thai and English that reflect the discussions described in “Deliverables” section above, delivered in electronic versions. 

4.9 Availability of raw data and data processing tables that was documented from primary source of information. 

4.10 Electronic files that can be used for further analysis of data. 

4.11 Oral presentations of the findings to Raks Thai Contact Person(s)and STAR-2 staff and to external audience. 

 

 

5. SCOPE OF WORK 

 

The consultancy firm/group will be responsible for planning, conducting, and communicating all aspects of the operational research in collaboration with Raks Thai Contact Person(s) and STAR-2 staff 

to get the expected result as specified in the scope of work includes the following activities:

 

5.1. Consultant reviews existing information on the STAR project and know about the deliverable. Develop methodology and associated tools according to the objectives to conduct a study in 19*provinces. Then meet with Raks Thai to agree on the study design, workplan, methodology, data collection according to the interview questions, and the study area/data collection operation plan, including provide the above details to Raks Thai, finalized plan before signing the contract.

5.2. Consultant must prepare budget details as required for Raks Thai disbursement criteria before the implementation of the plan.

5.3. The consultant will receive the approval from Raks Thai Foundation regarding the methodology and proposed data collection instruments. Once approved the consultant must process the study details with the respective national level research ethic bodies.  

5.4. Due to the sensitive of the information the consultant must consult closely with Raks Thai staff and the implementing CSOs in selection of samples of PWID participants for interviews. Schedules for field work must be consulted with the teams. 

5.5. The consultant needs to present that following to Raks Thai before the actual implementation of each stage:

a) Detailed methodology and data collection instruments;

b) Confirmation of approval by the ethic review committee;

c) Data frequency tables and plans for analysis;

d) Key findings

e) Draft reports.

f) Final reports

g) Official presentation 

 

Particular areas of interest to be covered in the analysis include:

• The number of needles and syringes required by PWID

• Injecting frequency and sharing practices

• Understand whether sharing of needles is still common occurrence, and link with drug types used by PWID

• How PWID access N&S and financial capacity to purchase needles and syringes from other sources if other sources are identified

• Types of drugs being used in each implementing area, including any potential shift from injectable to non-injectablemethods/drugs.

• Beneficiary experience of using STAR2 needles (size and quality) and whether different products should be procured in the future

• HIV transmission risk relating to partners of PWID and estimate of partner population

 

The interview with Government officers including, but not limited to the following offices:

1 Local Tumbol promotion hospital if they have provide services toPWID in the past;

2 Local hospitals (provincial hospital and hospital) 

3 Health Officials in charge of OST

4 Community leaders in the area that have implemented the project to look at the stigma and discrimination to PWID issues.

5 The Division of AIDS and STI (DAS) 

6 The Division of Tuberculosis (DTB)

7 The Narcotics Control Management Center (NCMC)

8 Office of The Permanent Secretary

9 Thanyarak Instititute and hospitals

10 Government officers under Ministry of Justice (MOJ)

11 The Provincial Police Narcotics Suppression Unit (PPNSU)

12 The Royal Thai Police Narcotics Suppression Bureau (NSB)

13 The Office of Narcotics Control Board (ONCB)

14 Dreamlopment staff as one partner for HCV services;

15 Foundation for AIDS Rights. 

16 Beneficiaries of the project

 

5. DURATION and DUTY STATION

 

Duration

The period expected for the planning, data collection, and data analysis and report is 5 months between 1st August, 2020 to 20thDecember, 2020.

 

 

DELIVERABLE 

DETAILS 

DEADLINE 

1.

Submission of Proposal  

Please include:  

• Cover letter/expression of interest 

• A complete profile of the firm/organization/group, highlighting previous experience and expertise in areas listed in the “Qualifications” section detailed in the below section.

• CVs of any other key team members who will be the part of the research/ evaluation team.  

• At least one writing sample, ideally report the firm/organization/group has lead authorship on.  

 

July 15th-2020 

2.

Interviews  

n/a 

July 2020 

3.

Award of Contract (I)

 Contract to be signed 

July 2020 with 

Starting Date: August 2020 

4.

Raks Thai Consultations and document review  

 Initial consultations will begin this week and extend throughout the duration of the planning period 

August 2020 

5.

Review/develop studyframework, analysis framework and sampling frameworks  

•  Consultant to review existing documents from the baseline and mid-term evaluation and make any required revisions 

•   Study framework, analysis framework and sampling framework  

August

2020 

6.

Data Collection 

Instruments 

(Review/Revise/Develop)

Fieldwork (Data 

Collection) Plan 

Completed

Data Collectors Training 

Completed

• Consultant to review existing data collection instruments from the baseline and mid-term evaluation and make any required revisions   

• Fieldwork logistics and schedule (i.e. in Excel) 

• Fieldwork manual including data collectors’ training guide

• Data collectors training agenda 

• Data collectors’ training report  

• Pilot of tools  

August 2020 

9. Fieldwork Completed (II)Data Collected

Fieldwork completion reports  

Cleaned, raw data in two formats: Excel and a stats software format (e.g. SPSS or STATA) if possible

September to October 2020 

11. Analyzed data (III)

Populated performance measurement framework with analyzed data  

November 2020

13. Draft Study 

Report 

 

Revised data analysis framework document 

Draft report 

First week of December 2020

14. Final Study 

Report (IV)

Finalized data analysis framework document 

Excel spreadsheets, or SPSS/Stata scripts with clear, easy to understand notes 

Final report in Thai and English

Final summary PPT in Thai and English

20 December 2020

 

* The above timeline is negotiable and subject to change based on consultation with Raks Thai Contact Person(s), and STAR-2 staff.

** The above timeline is tentative and subject to change based on the impact of how the COVID-19 outbreak will have on the availability of consultants and the fieldwork.

 

6. PAYMENT AND FEES 

 

Payment: 

Consultants are asked to provide a draft financial proposal along with their technical proposal for consideration. Raks Thai offers competitive consultancy rates in keeping with market value and international NGO standards. 

 

The study budget available under this ToR for proposal in LUMPSUM including travel and logistic expenses is 5,000,000 Thai Baht and contract/ agreement will only be determined once applications are received and judged for quality.   

 

• First payment(I): After signing of contract agreement with RaksThai (20%)  

• Second payment (II): Submission of Inception Report which includes research/ study framework design (including draft analysis framework) and tools & methodologies (40%)  

• Third payment (III): Data Collection and Submission of analyzed data and study Report draft report (20%) 

• Fourth and Final payment (IV): Submission of Final Study Report & PowerPoint presentations and final analysis framework approved by Raks Thai (20%)  

 

7. RIGHTS AND PROPERTIES 

 

Raks Thai owns the data, rights, and property for all products under these Terms of Reference. Dissemination of products and services owned by Raks Thai is subjected to written permission from an authorized person of Raks Thai. The sharing or distribution of products or any other contents or documents produced under these ToR without permission from Raks Thai is not allowed. 

 

Raks Thai will not be responsible for any harms or claims, liabilities, suits, actions (including charges, disbursements and reasonable fees of counsel), proceedings, damages, expenses and obligations of any kind that be incurred by the consultancy firm/group or asserted against the consultancy firm/group , its officers and employees, by or on behalf of any person on account of, based or resulting from, arising out of (or which may be claimed to arise out of) the willful acts or omission of the consultancy firm/group and its agents, employees, research sites, assignees, transferees, delegates or successors, for which the consultancy firm/group retains responsibility.

 

8. QUALIFICATIONS AND REQUIRED DOCUMENTS 

 

Qualifications:

 

9.1 A consultancy firm/group with 5-15 years of experience in the research and/or evaluation field, including experience in quantitative and qualitative data collection, analyzing quantitative and qualitative data, and report writing. 

9.2 Experience in developing research tools and methodology that have met requirements of the Research Ethics Committee in Thailand. 

9.3 Experience in research/evaluation specific with the PWIDpopulations or other hard to reach populations.

9.4 Demonstrated experience in data collection, data analysis (quantitative and/or qualitative), report drafting and editing, computer skills and experience with data analysis using statistical computing tools (Excel, SPSS, STATA, NVIVO), communication skills, time management skills and cultural sensitivity.

9.5 Applicant should have a relevant degree in social sciences, international development, statistical sciences, or another related field.

9.6 Knowledge of gender issues in development, particularly regarding SRH and GBV including relevant international human rights standards; and operational is preferred.

9.7 Fluency in English and Thai.

 

Required documents: 

Interested organizations are requested to submit proposals including the following documents: 

1 Cover letter including the consultant’s/firm’s suitability for the assignment and current contact information. 

2 CV of team leader and members including contact details of 2 referees from former employers of the consultant(s). If the lead consultant is planning to recruit subcontractors for conducting this assignment in Thailand to support the data collection from various sites, data entry and dataset development, please state this in your application and provide details (cost, expertise, expected role of each consultant, etc.).

3 A technical proposal - Detailed response to ToR, with specific focus addressing the purpose and objectives of the assignment, methodology to be used and key selection criteria (max. 2 pages).

4 A financial proposal- Detailed budget breakdown based on expected daily rates and initial work plan.

5 Initial draft of the proposed work plan.

6 At least one writing sample, ideally reports the firm/organization/group has lead authorship on. A writing sample of previous works and/or experience of no more than 5 pages related to HIV/TB on PWID populations.

 

9. CONTACT PERSON(S)

Place for document submission

All required documents must be email to Raks Thai contact persons no later than 14 August 2020 by 23:59 (11:59 pm) Bangkok time.

 

Submission of all documents is by e-mail to:

Name: Naowarat Inthuprapha

Email: naowarat@raksthai.org

Phone: 02 2656815

Contact : Place for document submission All required documents must be email to Raks Thai contact persons no later than 14 August 2020 by 23:59 (11:59 pm) Bangkok time. Submission of all documents is by e-mail to: Name: Naowarat Inthuprapha Email: naowarat@raksthai.org Phone: 02 2656815


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