About UNICEF: Employment

Consultancy on implementing PMTCT and paediatric HIV Care, Support and Treatment in Low Prevalence and Concentrated Epidemic settings, New York Headquarters

1. Introduction
HIV infection remains a public health concern in low and concentrated epidemic settings where there has been an important proportion of childbearing women infected over the years. While worldwide, about 50% of persons living with HIV are women, in Sub-Saharan Africa this proportion is about 60%. In Asia the proportion of persons living with HIV who are women increased from less than 20% in 1990 to about 35% in 2007. In general, low prevalence and concentrated epidemic settings are characterized by diverse epidemiological patterns in terms of modes of transmission and populations at risk.

In most countries in Asia, the Middle-East and Northern Africa, and the CEE/CIS HIV is spread through needle sharing among IDUs, unprotected sex between CSWs and their clients and unprotected sex between MSM. Not discounting important differences, the HIV epidemic in most countries in these regions shows strong similarities. Prevalence rates are low in the general population and among young people - mostly less than 0.1 per percent - and high among most-at-risk populations which include intravenous drug users (IDUs), commercial sex workers (CSWs) and their clients and men who have sex with men (MSM).

The vast majority (75-90 per cent) of HIV positive women in these regions are infected by their partners who engage in high risk behavior. Of the new HIV infections reported in Eastern Europe and Central Asia in 2006, about 62% were attributable to injecting drug use. In the region it is estimated that about 35% of HIV-positive women were infected through use of contaminated injecting drug equipment and about 50% are infected during unprotected sex with drug-injecting partners (EuroHIV, 2006a). In Asia, migration and poverty compound this situation as housewives and young women who were previously considered at low risk are being infected by migrant husband and partners returning from overseas. Poverty may force some women to resort to transactional sex. In China, an increasing number of women are injecting drug users and about 56% of them in some cities are also sex workers. In Middle East and North Africa, most infections are due to unprotected paid sex and the use of contaminated drug injecting equipment. Apart from Sudan where unprotected heterosexual intercourse is the main route of transmission, in several other countries most HIV positive women are infected by husbands or boyfriends who had acquired HIV through injecting drug use or paid sex.  

The HIV epidemics in Latin America remain generally stable, changing little in the past decade, but HIV transmission in the region is occurring mainly among men who have sex with men, sex workers, and (to a lesser extent) people who inject drugs.  In many Latin American countries, the HIV epidemic remains concentrated in subpopulations such as men having sex with men, injecting drug users and their partners, sex workers, prisoners and mobile populations. These populations are highly stigmatized by society and often lack access to health and other social protection services.  Furthermore, health systems are not well-adapted to their needs. 

Increasing numbers of women are becoming infected with the virus in several countries in the region and in five countries HIV prevalence is higher among females than males: Trinidad and Tobago, Dominican Republic, Haiti, Belize and Guyana.  In Uruguay, unprotected sex is estimated to account for two thirds of newly reported HIV cases, with most women becoming infected by male sexual partners who acquired HIV during unprotected sex with another man or through use of contaminated needles or syringes. In the Caribbean young girls are at high risk of exposure to HIV.

Even in low and concentrated epidemic settings, PMTCT represents the main entry point to HIV-related prevention, care, support and treatment services for the majority of childbearing women and their children. PMTCT offers an opportunity to provide HIV BCC and IEC on HIV in general, for childbearing women to know their HIV status, specific PMTCT-related medical interventions and Pediatric HIV CST for their children. In addition, when innovative approaches are used to get men involved, PMTCT represents a gateway to HIV testing and counseling, and other HIV prevention, care, support and treatment services for male partners, especially for MARP.

On one hand, most women in resource-limited settings have access to available primary care services through antenatal, delivery and postnatal care services. Maternal, newborn and child health (MNCH) services offer a range of health interventions that are known to be effective in reducing maternal and child morbidity and mortality. These interventions include routine antenatal, delivery and postnatal care for women and newborn care, family planning, immunization and nutrition services for their children which are central to achieving the Millennium Development Goals (MDGs) 4 and 5. On the other hand, MNCH services represent the platform for the delivery of PMTCT and paediatric HIV CST services which are critical to achieving the MDG 6. Indeed while PMTCT goals cannot be reached without strengthening existing MNCH services, expansion of PMTCT and paediatric HIV CST interventions has a significant impact on achieving the MDGs 4, 5 and 6. In addition, the effectiveness of the interventions can be multiplied by aligning and integrating PMTCT and Pediatric HIV CST with efforts that address the needs of MARPs and their partners.

Therefore, the provision of PMTCT and paediatric HIV CST as an integral component of MNCH services, even in low prevalence and concentrated epidemic settings provide essential additional benefits besides HIV infections averted. By targeting objectives beyond infections averted, PMTCT and paediatric HIV CST will improve HIV free survival of all infants born to HIV-infected mothers irrespective of their HIV status. More importantly, it will reduce maternal mortality, and improve overall maternal and child health and survival irrespective of the HIV status.  

Governments are beginning to show leadership and take decisive actions in order to prevent new infections and fulfill their commitment to international agreements like the Millennium Development goals and the Convention of the Rights of the Child. Increasingly, governments are adjusting their HIV and AIDS prevention, care, support and treatment strategies to better respond to the dynamics and characteristics of their epidemics. Programs addressing the needs of MARPs are now the main thrust of most national action plans.

In most countries experiencing a low and/or concentrated epidemic, Prevention of Mother to Child Transmission and Pediatric HIV CST interventions are not seen as priority components of the overall response to the epidemic and play a relatively minor role in the HIV and AIDS prevention, care, support and treatment strategies. 

So far, political commitment is still weak, sometime inexistent in these settings, partly due to the lack of documented evidence and related specific advocacy tools to enhance better understanding of the issues by policy makers. Similarly, planners in low-prevalence countries may not recognize the social and health effects of the epidemic or it potential for escalation, and officials may (unwittingly) erect barriers for those living with HIVAIDS to recognize their condition, or to access services to which they are entitled. As a consequence, there is a lack of enabling policy, and context-adapted evidence-based programmatic guidance. In light of the epidemiologic pattern of disease and the many demands put on an often frail and under-resourced health care system, it is of critical importance to implement PMTCT and Pediatric HIV interventions in a rational and strategic manner and to ensure that the benefits transcend beyond the HIV response. This might requires different focus and strategies than those recommended to high prevalence settings. To date, there is little guidance on how to plan for, implement, monitor and evaluate PMTCT and Pediatric HIV CST interventions in low and concentrated epidemic settings.

2. Objectives
The ultimate objective of this assignment is to create greater awareness among governments of the benefits of PMTCT and Pediatric HIV CST in low and concentrated epidemic settings, and assist governments to accelerate strategic planning and implementation of PMTCT and Pediatric HIV CST interventions that prioritizes the needs of those most at risk of HIV infection and ensures that the impact transcends the HIV response and contributes to achieving the MDGS 4, 5 and 6.

The specific objectives of the consultancy are:
a) To develop an advocacy document that positions PMTCT and Pediatric HIV CST interventions as critical components of the package of health interventions essential to reducing maternal and child morbidity and mortality in low and concentrated epidemic settings. The document will advocate for the importance and benefits of implementing PMTCT and paediatric HIV CST as an integral component of MNCH services and linking them with MARPs interventions to maximize impact, and emphasize the opportunities the introduction of PMTCT and Pediatric HIV CST presents to improve and strengthen MNCH care services. 
b) To develop evidence-based operational guidance on planning, implementation and monitoring of comprehensive PMTCT and Pediatric HIV CST interventions in low prevalence and concentrated HIV epidemic settings. The document will also provide guidance on creating critical linkages between PMTCT and Pediatric HIV CST services with interventions for populations most at risk of HIV infection, and innovative evidence-based approaches to testing and counseling that enhance primary prevention and to the prevention of unintended pregnancies among HIV-infected women.

3. Specific activities
a) Undertake a rapid desk review of global guidance on implementation of PMTCT and Pediatric HIV CST and its specific recommendations for low and concentrated epidemic settings in all regions (ROSA, EAPRO, MENA, ESARO, WCARO, TACRO, CEE/CIS)
b) Undertake desk review of and consultations with organizations implementing models of PMTCT and Pediatric HIV CST in low prevalence and concentrated epidemic setting in all regions (ROSA, EAPRO, MENA, ESARO, WCARO, TACRO, CEE/CIS)
c) Undertake a desk review of existing guidance on PMTCT in low prevalence and concentrated epidemic settings – if available
d) Develop an advocacy kit to seek for commitment of global/regional partners and national governments to positioning PMTCT and paediatric HIV CST as essential interventions in reaching the MDGs 4, 5 and 6 in low and concentrated epidemic settings. The document will provide the rationale for scaling up PMTCT and paediatric HIV CST programmes in low and concentrated epidemic settings focusing on its contribution to reaching MDGs 4, 5 and 6
e) Develop evidence-based guidance for the planning, implementation and monitoring and evaluation of PMTCT and paediatric HIV CST in low and concentrated epidemic settings
f) Facilitate the organization of a workshop gathering select number of experts and program managers from government and partner organizations to review the advocacy document and the guidelines
g) Produce final drafts of the advocacy document and the guidelines based on workshop results
h) Power point master presentation on the process including key action messages for relevant constituencies  - governments, donors, implementing partners, etc

Activities/ Time Frame / Deliverables
1. Rapid desk review of global guidance on PMTCT implementation and Pediatric HIV CST and its specific recommendations for low and concentrated epidemic settings;  desk review of and consultations with organizations implementing models of PMTCT and Pediatric HIV CST in low prevalence and concentrated setting;  desk review of existing guidance on PMTCT in  low prevalence and concentrated epidemic settings  
20 working days 
Report summarizing findings including policy and legal frameworks, and strategic approaches to implementation (programme management, planning, service delivery and M&E)

2. An advocacy document to seek for commitment of global partners and national governments to position PMTCT and paediatric HIV CST as essential interventions in reaching the MDGs 4, 5 and 6 in low and concentrated epidemic settings
5 working days 
2 to 3 pager advocacy document
Leaflets

3. Evidence-based guidance for the planning, implementation and monitoring and evaluation of PMTCT and paediatric HIV CST in low and concentrated epidemic settings
20 working days
Guidance document providing guidance on policy direction, planning, strategic approaches to implementation, monitoring and evaluation 

4. Support organization of a workshop gathering  select number of experts and programme managers from governments and partner organizations to review the advocacy document and the guidelines
3 working days
Meeting report summarizing key recommendations for the finalization of the advocacy kit and the guidelines
Production of advocacy messages to be included in an advocacy kit for (internal) review and of final drafts of the advocacy document and the guidelines based on workshop results. Power point master presentation on the process including key action messages for relevant constituencies 
15 working days
Final advocacy kit and guidelines

Total: 61 working days 

4. Qualifications required:
EDUCATION: Advanced university degree in public health (MD plus MPH or PhD) and demonstrated experience and autonomy in research, including programme assessment and operational research 

WORK EXPERIENCE:
• At least 5 years of relevant professional work experience at international levels in epidemiologic research, programme, planning and management; Knowledge of public health and communication
• Proven understanding of and experience in the latest developments in Maternal, Newborn and Child Health (MNCH), and HIV and AIDS programming
• Proven understanding of and experience in the latest developments in the Prevention of Mother-To-Child Transmission of HIV
• Experience in implementing and/or evaluating PMTCT and Paediatric HIV CST, especially in low prevalence and concentrated epidemic settings, is strongly recommended

LANGUAGES: Fluency in English and excellent writing skills in English are strongly recommended

OTHER SKILLS AND ATTRIBUTES: 
• Demonstrated excellent epidemiology research training, and public health track record through publication in international peer-reviewed journals – strong communication, writing and analytical skills
• Ability to conceptualize new research approaches on various operational areas, include literature review, study protocol development, data analysis and writing of reports

Interested candidates are invited to send a United Nations Personal History form and CV to: Pearlene Fields (pfields@unicef.org), with a copy to Rene Ehounou Ekpini (rekpini@unicef.org) by Monday February 15th.