Terms of Reference s26

UNICEF UKRAINE TERMS OF REFERENCE

National consultant for the development of the Clinical Guideline on Prevention of Mother-to Child Transmission of HIV (PMTCT)

Level: NO-B

Duration: 25 October – 25 December 2014, two months.

1. Purpose of Special Service Agreement:

To develop the Clinical Protocol “Prevention of Mother-to-Child Transmission of HIV”.

Background Despite a good progress in the coverage of services on prevention of mother-to-child transmission (PMTCT) in Ukraine, there are serious issues and challenges that remain not addressed. There are some substantial systematic gaps in a programme management, including quality of HIV counselling and testing and quality of and access to PMTCT services for women at high risk for HIV infection, especially those, who use injection drugs.

Low uptake of health services, including antiretroviral treatment (ART) among female HIV- positive women who inject drugs is a well-recognised problem. Because drug-using pregnant women often receive prenatal care only towards the end of their pregnancy or attend a clinic for the first time for the delivery, they miss out on the possibility of taking the both preventative course of ART and standard ART. Maintaining access to ART for women with treatment indications remains a priority in Ukraine. Close to 50% of pregnant women still received less effective monotherapy ART course and 5% of women received no ART. Close to 15% of women who were diagnosed late and received much less effective ART or not received it at all, had an IDU history. A quarter of them had an IDU partner. The MTCT rate was 4.1% among women receiving antenatal combination of three ART (cART) and 22.9% among untreated women.1

Whereas there has been good success in delivering medical services, less attention has been paid to the other interventions, and there remain challenges even to further sustained progress in medical component of the PMTCT strategy that would allow reaching the 2015 goal of elimination of mother-to-child transmission rate. Ongoing gaps include late access of services by marginalized women, often tied to stigma; difficulty in accessing multiple systems of care; weak systems of follow up of HIV-positive women after delivery; inadequate support for social services to meet the special needs of HIV-infected pregnant women and new mothers; and gaps in health care worker knowledge and attitudes about the needs of this population.2

National PMTCT protocols are consistent with WHO/EURO recommendations, however, having been updated in 2007. Ukraine has adopted the Option B/B+, as outlined in the 2012 WHO Programmatic Update on the Use of ARVs for Treating Pregnant Women and Preventing HIV

1 Dr Claire Thorne, UCL Institute of Child Health, University College London. Report on injecting drug use in pregnant HIV- positive women in Ukraine: data from the Ukraine European Collaborative Study and the Cohort Study of HIV-infected childbearing women. September, 2012.

2 R.J. Simonds, 2012 Ukraine National AIDS Programme Assessment PMTCT Summary Report,

1 Infection in Infants. To support the planning and implementation of Option B/B+, and to help Ukraine in scaling up more effective interventions and programmes to achieve the goals of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, there is a need in revision of the outdated existing guidelines and development of a new clinical protocol on PMTCT.

Revision and development of a new protocol on PMTCT, initiated by UNICEF started to be develop in a close collaboration with the State Service on HIV and Other Socially Dangerous Diseases in 2013. In accordance with the officially approved by the Cabinet of Ministers procedures, the Clinical Protocol has to correspond to the modern international policies and practices, including first of all the WHO recommendations regarding the postnatal continuation of ART and opioid substitution treatment for women with respective indications. There is a need in the national consultant with knowledge of international best practices and standards in PMTCT and understanding of a national health and social system structure and functions to develop a Clinical Protocol as an evitable part of the regulation in PMTCT.

It is expected that the Clinical Protocol, when approved by the Ministry of Health, will serve as a regulation in the area of PMTCT that should contribute to the formulation of the future PMTCT interventions related to the pregnant women, including most at risk and vulnerable to HIV in a context beyond the medical.

2. Objectives of the Special Service Agreement with expected results / outcome / products /sub products/outputs:

The objectives are:  To ensure the existing modern WHO recommendations in the area of PMTCT are carefully examined and compared with the existing national policies and practices;  To ensure the modern international strategies and recommendations in the respective area are reflected in a consolidated national Clinical Protocol on PMTCT with focus on the most at risk and vulnerable to HIV drug-using pregnant women;  To ensure the national Clinical Protocol is approved by the Ministry of Health.

Results expected: - The national Clinical Protocol on PMTCT is in compliance with the recommended international standards; - Clinical Protocol is approved by the the Ministry of and Health; - Clinical Protocol on PMTCT used for routine practice providing integrated medical and social services for pregnant women, including vulnerable to HIV, and children born to them.

Outputs:

1. Draft of the Clinical Protocol, including desk-review of the modern WHO recommendations and practices presented at the Working Group on PMTCT in accordance with the approved by the State Service on HIV timetable of the development of regulation; 2. Presentation of the updated Clinical Protocol on PMTCT at the Forum of the specialists for its approval. 3. Submission of the Clinical Protocol on PMTCT to the authorities (State Service on HIV and the Ministry of Health) for approval.

2 3. Delivery dates based on the work plan (to be approved by UNICEF HIV/AIDS Officer):

 Report on desk-review of the modern WHO recommendations and comparison with the national existing policies and practices – 10 November, 2014;  Power Point presentation Draft of the Clinical Protocol at the Working Group on PMTCT – 20 November, 2014;  Presentation of the Clinical Protocol on PMTCT at the Forum of the specialists for its approval – 25 November 2014;  Final report with the final version of the Clinical Protocol on PMTCT submitted to the Ministry of Health for approval - by 25 December, 2014.

4. Details of how the work should be delivered:

The consultants have to develop and submit to UNICEF monthly reports and final report.

5. Performance indicators for evaluation of results:

The evaluation of results will be based on the following indicators:  Technical and professional competence (will be measured by the quality of product provided to UNICEF and feedback from UNICEF and the State Service on HIV/AIDS and Other Socially Dangerous Diseases)  Quality of work (timely submission of the monthly reports and final product to UNICEF)  Quantity of work (completing the assignments indicated in parts 2, 3, and 4 above)  In addition such indicators as work relations, responsibility and communication will be taken into account during the evaluation of the consultant’s work.

6. Qualifications/specialized knowledge/experience required to complete the task:

a. An advanced university degree in Medicine/Public Health, an academic degree in medical sciences is an asset; b. At least five years of practical experience in HIV/AIDS area, including management of the national projects in the area of HIV and experience in teaching activity; c. Recorded experience of development of regulation (clinical protocols and guidelines), education and training materials in the area of PMTCT; d. Knowledge of international best practices and standards in PMTCT and understanding of a national health and social system structure and functions and national procedures related to the regulation development; e. Strong writing, organisational, communication and managerial skills; f. Basic knowledge of English and fluent in Ukrainian, as the Protocol has to be developed in Ukrainian.

7. Definition of supervision arrangements:

Consultant will be supervised by the HIV/AIDS Officer, UNICEF Ukraine.

3 8. Description of official travel involved:

Travels are not envisaged.

9. UNICEF recourse in the case of unsatisfactory performance: In the event of unsatisfactory performance, UNICEF reserves the right to terminate the Agreement. In case of partially satisfactory performance, such as serious delays causing the negative impact on meeting the programme objectives, low quality or insufficient depth and/or scope of the assessment completion, UNICEF is entitled to decrease the payment by the range from 30 to 50%.

10. Support provided by UNICEF:

Technical assistance, consultations, funding.

The deadline for submission of applications is 24 October 2014. Only short-listed candidates will be contacted.

Applicants that fulfil the above requirements are requested to complete the United Nations Personal History Form (P. 11) available at www.unicef.org/employ and submit it together with a CV and a cover letter describing your professional interests in working for UNICEF. Applications should be sent to: UNICEF Office, 1, Klovskiy Uzviz, Kyiv, Ukraine Fax No. 380-44-230-2506 E-mail: [email protected], [email protected] , (Please indicate ‘Consultant for the development of the Clinical Guideline’ in the subject of your application)

UNICEF does not charge any fees or request money from candidates at any stage of the selection process, nor does it concern itself with bank account details of applicants. Requests of this nature allegedly made on behalf of UNICEF are fraudulent and should be disregarded.