National Consultant for reviewing
the current CHBC guidelines
and drafting Revised CHBC Guidelines

Title:                                       National Consultant for reviewing the current CHBC guidelines and drafting Revised CHBC Guidelines in light of the recommendations

Duration of contract:             Two (2) weeks

Office location:                      National AIDS Control Program, Islamabad

Closing date:                           5^th Dec, 2014

 

TERMS OF REFERENCE:

COUNTRY: PAISTAN                         

HIV Component of GFATM Round 9

1. 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. According to NACP and UNAIDS estimates in 2013 Pakistan had about 83,468 people living with HIV (PLHIV), 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. Key populations (KP) in Pakistan include people who inject drugs (PWID), hijra, or transgender sex workers (HSW), male sex workers (MSW) and female sex workers (FSW). 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.

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 18 CHBC sites have been established. 

1.2 Community and Home Based Care (CHBC):

CHBC guidelines were developed by NACP after extensive consultations with the stakeholders, research and conceptual development to improve access to HIV care and treatment support to PLHIV and their families. As community involvement in the care and support of HIV/AIDS is of paramount importance, the CHBC has been designed as a holistic care package that links service providers with patients and families through a continuum of care. These services include medical and nursing care, access to ARV treatment, health education, socio-economic support, nutritional support, psycho-social support and housekeeping.

Evidence has supported the effectiveness of CHBC programmes in resource-constrained settings in not only enabling the PLHIV to live and die with dignity but also in reducing the prevalence of HIV, achieving the clinical and prevention benefits of HIV as well as attaining high coverage of HIV testing.

OBJECTIVE

The main objective of this exercise is to revise National Guidelines for Community and Home Based Care and draft revised guidelines in light of recommendations. These guidelines will be used to improve the quality of CHBC services offered by various CHBC centres throughout the country. These guidelines will ultimately contribute to the sustainability, improvements, and scaling-up of CHBC services.

The guidelines document will provide a summative outline of the CHBC programme in Pakistan since its inception and the extent to which the CHBC services were meeting the set objectives provide recommendations to improve the current CHBC structure and services package in the country for better health outcomes.

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:

• Systematic review of existing CHBC guidelines to identify successful good practices, to what extent the current CHBC guidelines are in conformity with meeting the CHBC objectives and are  consistent with the needs, interest and circumstances of the vulnerable and most at risk groups
• To identify cost-effective CHBC models to provide holistic services to hard reach populations (IDUs, MSM, FSW and HSWs) and bring them into the folds of care and treatment
• Identify barriers, gaps, inconsistencies and estimate their relevance in achieving set CHBC targets, and put forward recommendations for improving the CHBC service package to improve the quality of life of PLHIV and their families.

METHODOLOGY

The development exercise will define culturally relevant and acceptable regional and global CHBC guidelines that have proven effectiveness, and then develop a tool to review and revise the existing CHBC guidelines. This can be done by undertaking a literature review of global CHBC guidelines, desk review of CHBC services packages in place/, assessment of the programmatic strategies and interventions, in relation to the expected outputs and outcomes of the CHBC services.

The consultant may also conduct field visits and hold focus group discussions, community meetings and interviews with the stakeholders and implementing partners to gain appraisal of CHBC working and services. Available secondary data as well as data from other published sources or research / studies may also be used.

The detailed methodology will be developed by the consultant and agreed by National AIDS Control Programme.

DELIVERABLES

The main deliverables are:

• Draft of Revised CHBC Guidelines to be submitted for validation and review.
• Final CHBC Guidelines after incorporating inputs from the NACP.

6.      BUDGET

Total consultant work days:

• 14 days

Consultancy Period: 2 weeks  

Qualifications:

• MBBS with MPH
• At least 05 years of experience in the area of HIV and AIDS with extensive knowledge of HIV and CHBC
• At least 3 years of experience
• Excellent writing skills

Qualified candidates are requested to submit a Letter of interest, CV, to by the deadline of   5^th December, 2014.

In their Letter of Interest, candidates should highlight previous work experience relevant to the assignment, the attributes that make them suitable.