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Terms of references for the assessment of necessity to implement PrEP in Romania

21.10.2021

CONTEXT

The abrupt departure of technical and funding agencies in 2010, lead, over the next few years to the reduction or even disappearance of most HIV prevention and support services for key populations (e.g. harm reduction, MSM prevention, PLHIV psycho-social support). Although access to ARV treatment is universal in Romania, the domestic funding on prevention is extremely low. Two NGOs have managed to maintain some services for PWID through international funds and from small occasional funding from local authorities, while prevention services designed for MSM have ceased altogether. Currently, the Government is in the process of approving the new HIV/AIDS National Strategic Plan, but given the pandemic context and under-funding of the health sector, in the absence of robust data and evidence-based cost standards for prevention interventions, there are little chances that the Plan will be adequately funded. Thus, the Regional Grant will complement the efforts that will be made in Romania through the current Global Fund Transition grant in order to elaborate and implement a robust, evidence-based mechanism focused on budget optimization and strategies to maximize the limited available funds.

The HIV prevention component is underfunded due to very limited legislative recommendations. At the local authorities level the prevention interventions are very few and most of the time concentrated around „international days” (e.g. AIDS, TB, ASD, breast feeding) with almost no strategies nor new approaches. Limited funds for this prevention campaign is also an important barrier in implementing targeted strategies for communities. In this context, the HIV cases are increasing year by year in the last 4 years and most affected vulnerable groups are MSM and IDUs. At the moment in Romania there are few NGOs delivering HIV prevention services for MSM but none of them can offer sustainable services because their activity is project based and depends mostly on the available international funds without any support from the public funds.

Pre-exposure prophylaxis (PrEP) is discussed as an additional HIV prevention method targeting different key populations, with focus on MSM. So far, PrEP has not been approved in Romania and only little is known about the acceptability of PrEP among MSM  or other groups living in the country, although PrEP is strongly recommended by WHO since 2015, and is deemed an essential HIV service that should be formally implemented in Romania. The anecdotal data shows that there are patients who buy PrEP  (on, but also off the licence mostly) from outside Romania based on medical doctor prescriptions issued in Romania. And in the last year there are signals from the medical infection diseases institutes that there is willingness to explore the possibility of accessing this prophylaxis.

According to EMIS 2017 – The European Men-Who-Have-Sex-With-Men Internet Survey, in Romania, less than 1% (excluding HIV diagnosed men) were taking PrEP. What is more, Romania ranks on the lowest part of the clasament regarding the PrEP knowledge (27-39% know about it).

A qualitative study conducted by Romanian Angel Appeal (at the beginning of 2020) shows that while most of the people involved in the study were informed regarding PEP, only few knew about PrEP. As for the people who knew about PrEP, their main concern was the prohibitive costs for the available medicine. The general impression is that PrEP is highly inaccessible and extremely expensive.

During July 2019 – December 2021 Romanian Angel Appeal Foundation in partnership with the following NGOs: ”ARAS”, ”Eu sunt!Tu? Association”, and ”UNOPA” is implementing the Project “Sustainability of Services for key populations in EECA region (#SoS_project)”. The project is financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria. The program is being developed simultaneously in 14 countries in Eastern Europe and Central Asia (Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine, Uzbekistan), under the coordination of The Foundation of Alliance for Public Health (Ukraine).

The project goal is to improve the financial sustainability of HIV interventions delivered by civil society organizations among key populations and people living with HIV (PLHIV) in Romania.

MISSION GOAL

This consultancy aims to investigate the acceptability for PrEP, to identify factors influencing the acceptability and to develop a roadmap for oral PrEP and other formulations/products introduction in Romania by engaging a range of stakeholders (e.g. the 4 P’s, policy makers; potential PrEP users; providers; private sector) around how to effectively offer PrEP for those who can benefit from PrEP

ACQUISITION PROCESS

  1. Acquirer: Romanian Angel Appeal Foundation
  2. Location: the mission will be held in Bucharest and a few other towns in Romania. The activities can be delivered through on-line platforms.
  3. Type of consultants: national and international independants consultants
  4. Name of the project : #SOS_Project: Partnership for sustainable public policies in the area of HIV/AIDS prevention
  5. Type of the contract: consulting services
  6. Mission objectives

Objective 1. To find out what are/could be the barriers in accessing the prophylaxis and how they can be overcome.

Objective 2. To explore current use of PrEP, likelihood of future use and indicators of potential PrEP candidacy.

  1. G. Services and deliverables – 26 days

Services provided:

  1. Development of analysis methodology (strategy and tools for data collection and analysis) – 3 days
  1. Desk review of epidemiological data and policy documents (e.g. HIV treatment guidelines)- this  will be critical in order to  understand the policy development and programmatic implications for PrEP’ introduction and eventual roll-out – 3 days
  1. Interviews with stakeholders (min 10 interviews) – the consultant should pay particular attention to the interviewing of stakeholders (e.g.: MOH, National Health Insurance Company, Institute of infection disease “Matei Bals”, Infectious diseases Hospital “Victor Babes”, NGOs, beneficiaries targeted etc.) – 10 days.
  2. Focus groups (noTBD) – the main purpose for this approach is to explore the information and the perceptions of targeted beneficiaries about PrEP – 10

Within this contract the consultant will provide the next written deliverables based on the services provided:

  1. A research Methodology – should contain proposed data collection methods, instruments and calendar of implementation.
  2. An inception report – should contain logic intervention of the programme (based on desk study), an assessment plan, and a list of reviewed documents.
  3. Weekly status report with data collected– the report will include information collected.
  4. Final report – should include:
  • Executive summary (not more than 2-3 pages)
  • Evaluation purpose
  • Evaluation methodology
  • Main findings (context, informations at the grass route level, limits in accessing)
  • Protocol developed
  • A commentary piece for publication on how PrEP could be introduced in Romania as part of a public health approach
  • Conclusions and recommendations – Annexes (including list of stakeholders consulted during the study, record of interviews and focus groups conducted, survey forms and aggregate findings, bibliography etc.)

 

  1. Miscellaneous

The total number of days will be 26 during November and December 2021.

Mission coordination and evaluation will be provided by RAA’s project team.

The payment will be based on the deliverables and after the evaluation of the documents by RAA’s project team.

  1. Performance of the contract

The Consultant will provide the Services in accordance with the provisions set forth in the Contract, including, but not limited to, compliance with the delivery date of the Services and the RAA’s satisfaction with the compliance of the provided services.

The consultant will carry out the activity independently but in collaboration with the coordinator of the consulting mission, in accordance with the provisions of Art.7 (3), corroborated with Art.114 (2) letter g of the Romanian Fiscal Code.

  1. Contributions

The Romanian Angel Appeal Foundation and the Ministry of Health will provide the Consultant with the available information and materials and will provide support in facilitating the meetings between the Consultant and other specialists, in case of need.

  1. Mandatory minimum expertise of the staff involved in the consultation

Essential Skills:

  • Must hold a postgraduate degree;
  • Must have at least 10 years professional work experience in research area or similar assessment;
  • Must have at least 5 years professional work experience in HIV/AIDS area (similar PrEP assessment is an advantage)
  • Extensive conceptual and methodological skills and experience in applying qualitative and quantitative research evaluation methods;
  • Experience in reporting, and monitoring is desired but not essential;
  • In country or regional similar work experience will be an added advantage;
  • Excellent communication skills necessary for building rapport with stakeholders, facilitating participation.

Desirable qualifications:

  • Excellent written and verbal skills in English language.
  • Prior experience in the region is an added advantage.
  • Knowledge of the local language (Romanian) is desirable.
  1. Selection criteria

The applications will be evaluated based on the technical and financial offers.

Each application will consists of following documents:

  • Resume;
  • Samples from the previous assignments;
  • Financial and technical offer;
  • Signed GDPR agreement;
  • Two minimum referrals (email and phone numbers).

A list of candidates will be prepared after the 1st stage of selection. Only the top 3 candidates will be contacted for interviews.

The applications will be submitted to the following addresses: camelia.raita@raa.ro and irina.zamfirescu@raa.ro not later than 6th of 28 October 2021.

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