1. Purpose of the Consultancy
The purpose of this consultancy is to provide technical support to the Department of Health / CDC-HIV in implementing the HIV outbreak response plan in Sindh province, addressing ongoing HIV and hepatitis transmission through unsafe healthcare practices and scaling up integrated approaches for HIV, hepatitis and STIs.
2. Background
In April 2019, an outbreak of HIV among children was reported in a rural town of Pakistan (taluka or subdistrict Ratodero, district Larkana, Sindh province). In the first two months, 876 new HIV infections were reported, rising to 1100 by December 2019. The majority (82%) of infections were diagnosed among children aged under 15 years with a positivity of 5.9% compared to 0.9% positivity among adults. Of note, children aged up to 5 years had the highest burden, accounting for 79% of all infections among children. The mothers of majority of children diagnosed were HIV-negative and phylogenetic analyses indicated a multi-source rather that a single source outbreak. A series of epidemiological investigations, including matched case-control studies and interviews, pointed to nosocomial transmission namely unsafe injection, infusion and blood safety practices in healthcare settings as the major source of transmission. In response to reports of the outbreak in Ratodero, national and provincial authorities, with technical support of WHO, initiated a plan to address the situation. This included scaling up testing and treatment at health facilities, implementing index/family-based testing approaches among those diagnosed, establishment of a new HIV treatment centre in Ratodero, regulatory action against unauthorized private clinics and blood banks, improving infection prevention and control (IPC) in public health facilities, and a time-limited information and awareness campaign. HIV testing services delivered from health care facilities continued to identify new HIV infections in Larkana but also in neighboring districts. Between 2019 and 2023, 5198 new HIV patients have been registered in the three treatment centres in Larkana.
During Sep to Dec 2023, a community-based HIV testing initiative in two surrounding districts of Larkana (Jacobabad and Shikarpur) identified undiagnosed infections in both children and adults pointing to similar sources of transmission as Larkana. In July 2024, a cluster of 22 HIV infections were reported in Mirpurkhas among children ages 6 to 30 months. The preliminary investigations point to unsafe injections and blood transfusion as the main source of transmission. It is anticipated that risk factors exist widely in other areas of the province which can lead to identification of such clusters and outbreaks elsewhere.
WHO has received funding from the Global Fund through COVID-19 response mechanism (C19-RM) to support the HIV outbreak response in Sindh. Further, the government of Pakistan has announced a national hepatitis C elimination initiative which provides significant opportunities for integrating service delivery for HIV, hepatitis and STIs and addressing common risk factors.
The purpose of this consultancy is to provide technical support to the Department of Health / CDC-HIV in implementing the HIV outbreak response plan in Sindh province, addressing ongoing HIV and hepatitis transmission through unsafe healthcare practices and scaling up integrated approaches for HIV, hepatitis and STIs.
3. Planned timelines (subject to confirmation)
Start date: 1 January 2025
End date: 30 June 2025
4. Work to be performed
The consultant selected will be seconded to the Department of Health / CDC-HIV, to achieve the following outputs and deliverables.
Output 1: Support CDC-HIV in coordinating a comprehensive response to HIV outbreaks including prevention, diagnosis and treatment aspects
Deliverables:
- Review previously developed action plans on addressing the HIV outbreak and interventions implemented, and consolidate into one integrated action plan with identification of priority actions
- Develop a manual on immediate and short-term response to new or emerging outbreaks and a prioritization matrix identifying priority populations and interventions
- Revive the previously agreed multistakeholder technical working group (TWG) to strengthen the coordination and stewardship of response across a range of stakeholders including blood transfusion authority and Sind healthcare commission
- Organize capacity building activities for providers including improving linkage to care after diagnosis, reducing loss to follow-up and clinical management of adults and children.
Output 2: Lead the implementation of WHO C19 RM workplan
Deliverables:
- Collaborate closely with CDC-HIV on scale up of testing and treatment in accordance with priorities identified in the C19 RM workplan
- Coordinate with infection, prevention and control focal points at WHO and MOH to include injection safety as a core component of IPC package
- Support the achievement and reporting of indicators in Global Fund performance framework
Output 3: Support the improvement of strategic information
Deliverables:
- Conduct an in-depth review and quality check of data collection forms across different HIV service delivery sites and recording and reporting system in practice.
- Develop standardized tools for data collection, recording, analysis & reporting of programmatic data, harmonize data collection and reporting tools across HIV sites, including prevention and testing services.
- Conduct regular review of testing and treatment data from the field and ART MIS
- Conduct quarterly data review meetings with CDC-HIV and relevant stakeholders to monitor the trends and identify potential outbreaks sooner
Output 4: Support the integration of HIV self-testing (HIVST) in outbreak affected areas
Deliverables:
- Conduct stakeholder engagement to identify priority populations and distribution models for integrating HIVST in HIV outbreak response
- Develop SOPs for implementation
- Conduct training and capacity building
- Analysis the data, synthesize the results and disseminate the findings
- Develop a HIVST scale up plan based on the findings
Output 5: Support the implementation of HCV elimination programme and promote integration opportunities for HIV, HBV and STI testing
Deliverables:
- Support the development of detailed microplans for implementation of HCV elimination programme
- Support the regular review and monitoring of programme
- Support the capacity building and training activities
- Identify opportunities for integrating HIV, HBV and STI testing in HCV elimination initiative and support the implementation
5. Technical Supervision
The selected Consultant will work on the supervision of:
Responsible Officer: NPO HHS, WCO Pakistan
Manager: Public Health Specialist (Disease Control)
6. Specific requirements
· Qualifications required:
- Masters degree required. Postgraduate training in medicine, public health or relevant areas are desirable.
· Experience required:
- At least 7 years of experience in public health interventions related to HIV, hepatitis and STIs, especially testing services and working with key vulnerable communities;
- Having experience in communicable disease surveillance;
- Demonstrated experience of designing public health review, assessments, evaluations etc.;
· Skills / Technical skills and knowledge:
- Demonstrated in writing technical documents, guidelines, SOPs and proposals in English
- Excellent communicator and facilitator.
· Language requirements:
- Expert knowledge of English and local language (Read - Write – Speak).
7. Place of assignment
Islamabad / Sindh, Pakistan.
8. Medical clearance
The selected Consultant will be expected to provide a medical certificate of fitness for work.
9. Travel
The Consultant is expected to travel within Pakistan and to other countries depending on need. Travel requests will be raised in due course in coordination with NPO – HIV/Hepatitis/STIs in WHO Pakistan
Travel Location: Sindh Province
All travel arrangements will be made by WHO – WHO will not be responsible for tickets purchased by the Consultant without the express, prior authorization of WHO. While on mission under the terms of this consultancy, the Consultant will receive subsistence allowance.
Visas requirements: it is the consultant’s responsibility to fulfil visa requirements and ask for visa support letter(s) if needed.
