Background
Tajikistan is at the concentrated epidemic stages of an HIV/AIDS, with an estimated 16,321 people living with HIV by end of 2016. Disease control strategies for HIV/AIDS are guided by the National Program to fight with HIV/AIDS. Key goals of the program include reducing the HIV/AIDS epidemic and containing concentrated stage as well as improving health status of the people living with HIV. The project aims at providing increased access to HIV/AIDS prevention, treatment and care services and laying the foundation for stabilizing the country’s epidemic. The current HIV/AIDS project is supporting a variety of service delivery points for PWID, SWs, MSM and prisoners. It is also the only source of funding for (i) strengthening HTC services in the country for key population, (ii) expanding the prevention programs for KP and ensure accessibility of preventive commodities, (iii) providing with high-quality ARV and opportunistic treatment, care and support, and (iv) removing legal barriers to access to HIV services for KP. Targets included in the current grant are in line with the ones set by the National HIV/AIDS Program 2017-2020 and considered essential to slow and halt the epidemic in the country.
UNDP is a key partner to the Global Fund to Fight AIDS, Tuberculosis and Malaria and is the UN Agency assuming the role of Principal recipient of the HIV GF grants in Tajikistan. As Principal recipient for GF, assisting the country to meet its main goals in reducing mortality and morbidity from the deadly disease, UNDP Tajikistan Office is responsible for the financial and programmatic management of the GF grant as well as for the procurement of health and non-health products. In all areas of implementation, it provides capacity development services to relevant national institutions, sub recipients and implementing partners.
Prevention of an HIV/AIDS epidemic in Tajikistan is one of the top-priority tasks in the country at the present time. Available evidence indicates that HIV is spreading rapidly in the country. According to the official statistics of the National AIDS Prevention and Control Center (National AIDS Center), the number of HIV+ cases has increased from 2 in 1991 to 8750 in January 2017. HIV + cases are registered in 66 out of 68 districts of the Republic and the number of mortality cases among HIV positive people is 1968 people (22.5%). The current number of people living with AIDS is 758 (508 men, 250 women). According to the reports of NAC, the vast majority of the reported HIV cases are of men (70%) of the age group 15-39. In the last couple of years, the HIV testing has been scaled up and more HIV cases has been detected among key populations including PWID, Sex workers, prisoners and MSM. According to the epidemiological statistics for 2016, the breakdown of the ways of transmission is as follows: injecting – 17.27%; sexual – 64.62%; unknown - 13.12% and vertical - 4%.
As globally, the control of HIV infection is a concern in Tajikistan. The use or substitution of inadequate treatment regimens, insufficient dosing, and especially, patients’ non-adherence to ARV treatment are the most frequent and important reasons that have been associated with the inability to control infection. In particular, treatment adherence is one of the most important factors for ensuring effectiveness; however, there still a number of cases/patients having problems maintaining continuity of therapy for any period. The informal observations relate the factors associated with failure to take prescribed medication mainly to the patients’ personal motivation, support systems, the health service providers’ organizational skills, and whether the therapy is convenient.
Duties and Responsibilities
Goals and objectives:
The purpose of this assessment is to determine the quality and effectiveness of antiretroviral therapy with an emphasis on the following aspects:
- Conducting assessment of quality of ART program, including:
- Correctness of initiation of ART for a patient and selection of ART regiment;
- Clinical management of treatment of HIV positive patients and management of side effects;
- ART monitoring: clinical and laboratory monitoring; monitoring of treatment regiments;
- Monitoring of drug resistance and indicators of early warning;
- Co-infection of HIV / TB, HIV / Hepatitis B / Hepatitis C: treatment and monitoring.
- Identify main barriers to access to ART;
- Assess poor quality of treatment regiments’ monitoring;
- Conduct training on accurate quantification of ART drugs;
- Optimization of AIDS center’s organigram for improving the quality of ART program.
Duties and responsibilities:
Quality assessment of ART programme implementation, including:
- Timeliness and beginning of ART among patients and selection of regimen;
- Clinical management of treatment among HIV-infected patients and management of side effects;
- Monitoring of ART programme: clinical and laboratory monitoring; monitoring of treatment regimens. Recommend frequency of VL testing and determination of CD4 counts for patients with various needs and at different disease stages;
- Regimens: appropriateness of availability of specific number of treatment regimens and recommendations to reduce their number. Optimization of regimens. Consider the possibility of including Dolutegravir (including possibility of drug procurement at a price not exceeding the price of other drugs of preferred first-line regimens) that is in the list of preferred first-line regimens.
Identification and analysis of barriers hampering the scale-up of ART programme in the country till the end of 2020 and ART adherence issues through the following:
- Meetings with representatives of PLHIV;
- Meetings and interviews with representatives of service providers (doctors);
- Meetings with representatives of NGOs involved in HIV area and PLHIV;
- Meetings with representatives of TB services (TB, reproductive health, dermatovenerologic and narcological centers);
- Development of a model for provision of medical services differentiated for needs of individual patients (stable and unstable patients), including frequency of visits to clinics and receipt of ARV drugs.
Study of normative legal documents regarding ART provision and recommendations on necessity of their revision or development of new documents:
- Protocols on care and treatment provision;
- National programme and UNDP proposal for the GF grant.
Study of organograms of MHSPP structures and entities engaged in provision of services within the framework of ART programme. Recommendations for optimization:
- Recommend on integration of HIV services (clinical examination and distribution of ARV drugs) at the level PHC facilities;
- Develop a model of redistribution and delegation of responsibilities between doctors and nurses in the course of service provision to PLHIV.
Jointly with Lab Consultant study the issues of improving access to laboratory testing for VL and CD4:
- Analysis of conducted tests (quality of conducted tests);
- Possibility of conducting these tests (collection, transportation, delivery and due date of test results).
Based on the assessment, develop an ART scale-up plan according to UNAIDS 90-90-90 strategy and launch of “Test and Start” model considering indicators of the new GF project and National HIV/AIDS Programme. Provide recommendations on Module Treatment, Care and Support of new HIV grant of the GF.
For detailed information, please refer to annex 2- Terms of Reference of the below link.
Competencies
Corporate Competencies:
- Demonstrates integrity by modelling the UN’s values and ethical standards;
- Promotes the vision, mission, and strategic goals of UNDP;
- Displays cultural, gender, religion, race, nationality and age sensitivity and adaptability
- Treats all people fairly without stigma and discrimination;
- Fulfills all obligations to gender sensitivity and zero tolerance for sexual harassment;
- Strong interpersonal skills, communication and diplomatic skills;
- Openness to change and ability to receive/integrate feedback;
- Excellent public speaking and presentation skills.
Functional Competencies:
- Extensive knowledge of ARV treatment regiments and WHO protocols;
- Extensive knowledge of WHO and UNAIDS recommendations and guides on ART and HIV program.
- Excellent communication skills;
- Excellent analytical skills;
- Strong oral and writing skills.
Required Skills and Experience
Education:
- University degree in medicine, public health, or other relevant areas. Specialized education on HIV treatment will be an asset.
Experience:
- Proven experience of a minimum of 5 years of clinical work or working on medical settings related to ART program;
- Experience of working at the international level, preferably with UN experience. Knowledge and familiarity of the United Nations system, its evaluation and programming processes;
- Sound experience in clinical and laboratory research and studies of HIV/AIDS programs, especially in ARV treatment;
- Proven experience in research and analysis in HIV/AIDS programme, in particular, an advanced experience in antiretroviral therapies study.
Language:
- Excellent knowledge of English with proven writing skills; excellent knowledge of Russian or Farsi (Tajik) language.
Application Procedure:
Please follow the link to the Individual Consultant Procurement Notice:
UNDP is committed to achieving workforce diversity in terms of gender, nationality and culture. Individuals from minority groups, indigenous groups and persons with disabilities are equally encouraged to apply. All applications will be treated with the strictest confidence.