Individual Consultant to develop a planning approach to rapid and modern diagnostics at sub national level in three TB-REP countries

I. Background information on the project and assignment

Despite notable progress in the past decade, TB is still of public health concern in most of the countries within the WHO European Region. The Eastern European region has the highest rates of drug-resistant TB (DR-TB) in the world. According to WHO estimates, 17% of new TB cases and 53% of previously treated cases in the region had rifampicin-resistant TB (RR-TB) in 2017, compared to global figures of 3.5% and 18%, respectively. TB in Eastern Europe and Central Asia Project on Advancing People-Centered Quality TB Care – From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes (TB-REP 2.0 Project), funded by the Global Fund (GF) and implemented by Centre for Health Policies and Studies (PAS Center) as Principal Recipient jointly with the project partners, has been supporting EECA countries to tackle high burden of TB and MDR TB and bring TB care closer to patients. TB-REP 2.0 is focusing on strengthening people-centered approaches in TB care through sustainable transformation of the health systems and meaningful involvement of communities and civil society.

TB-REP 2.0 has been approved for a 3-year period, from 2019 to 2021. The project is covering eleven countries with high incidence of TB in EECA region, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine, Uzbekistan. It is a multi-partner project implemented by the PAS Center, as the principal recipient in collaboration with the WHO Regional Office for Europe (WHO Europe), TB Europe Coalition (TBEC), TBpeople and Global TB Caucus.

TB-REP countries have very high burden of drug resistance, therefore, it is crucial that all persons to be evaluated for TB are tested with modern, WHO-recommended rapid diagnostics and the patient’s DST profile is known prior to or at start of the treatment, including rapid DST to second-line drugs for RR/MDR-TB patients. While Xpert MTB/RIF, automated Mycobacteria Growth Indicator Tube (MGIT) and second-line Line Probe Assay (LPA) are in use and have been significantly scaled up in the past few years in all countries concerned, substantial variations exist in the coverage of needs at sub-national level, especially in rural areas, as well as in terms of specimen and patient referral practices. These drawbacks lead to incomplete or/and delayed diagnosis of DR-TB, administration of ineffective treatment, and result in further risks of amplification and spread of drug-resistant strains.

To support countries in the implementation of the existing guidance on early and modern diagnosis and ensuring equitable access to rapid molecular diagnosis testing as the first diagnostic test for all people with presumptive TB, the project will provide technical assistance to assess the existing capacity of diagnostic network and develop and operationalize at subnational level a planning approach of rapid and modern diagnostics. The project intends to rollout this approach in three TB-REP 2.0 countries at the level of districts. The approach will consist in joint teams of international and local TA to build a sustainable approach to resource planning and capacity planning that would ensure rational use of investments in new diagnostic methods.

In the context of the above, PAS Centre is seeking an international consultant or team of consultants to support selected countries in assessing the rapid diagnostic testing needs at sub-national level.

II. Scope of work

The scope of this assignment is to provide technical assistance to national TB programs from selected countries in strengthening their TB diagnostic network by developing and operationalising a planning approach to rapid and modern diagnostics at sub-national level towards universal access to rapid testing to detect MTB and rifampicin resistance in line with latest World Health Organization recommendations.

Three EECA countries covered by TB-REP 2.0 are considered for this TA. The selection of countries will be confirmed at the preparatory stage.

III. Objectives of the assignment

The specific objectives of this assignment are to: (i) conduct a situational analyses of the TB diagnostic network with focus on WHO-recommended rapid diagnostics for tuberculosis

to inform instrument placement, sample referral, geographical prioritization, integration of testing for targeted investments and programing to meet country priority needs, and (ii) develop detailed estimates of the real needs in Xpert network configuration (number and placement of MTB/RIF and MTB/RIF Ultra) and tests as the initial investigations for diagnosis of TB and RR-TB in target countries, by each region and district / basic TB management unit (BMU).

The Consultant is expected to:

• Map the TB diagnostic network using available data sources, including laboratory and program reports and health and demographic survey.

• Analyse the current status of GeneXpert platform (as well as planned procurement of new instruments) including: structural and functional profile of the TB diagnoses network (number of facilities, level of service, relationship of every level of laboratory with the NTP, etc.), GeneXpert instrument placement, workload and capacity utilization of existing testing sites, distance to regional center, referral for Xpert testing, sample referral and transportation, etc.

• Understand the use of Xpert testing, access and services availability, limits and challenges.

• Analyse and identify the differences between regions.

• Develop a needs estimation / planning tool for rapid and modern diagnosis at sub-national level.

• Assess the intensity of case finding activity at sub-national level.

• Collect data from all TB basic management units (BMUs) in country, including but not limited to: population; distance to the regional center; persons tested for diagnostic purpose; active TB cases notified.

• Estimate Xpert tests needs for each BMU and define the additional needs for GeneXpert network configuration on the basis of the estimated number of tests needed for each BMU taking into account of the distances to the regional laboratories and potential alternative referral points.

The final product will include a report with the results of the assessment and needs estimations per region and master file with all calculation for GeneXpert platform scale up.

All activities will be conducted in close cooperation with the country NTP team, including local consultants selected in each country. The Consultant will lead the work on GeneXpert network assessment at the country level in three TB-REP 2.0 countries. The consultant has to ensure that all critical steps of the assessment will be consulted with national stakeholders.

Any travel-related costs for in-country missions will be covered directly by the PAS Center.

IV. Methodology and approach

The approach, assumptions and results will be discussed and coordinated with the targeted country NTP at the central and regional level.

The collection of date from sites will be performed under the oversight and coordination of NTP. Data will be collected from all TB basic management units (BMUs) from the rural districts, small towns and oblast centers in the country.

The methodology will be coordinated with PAS Center and the NTP in target country. The consultant is expected to propose a detailed work plan for the requested assignment, including tasks, deliverables and timeline for the national consultant.

V. Reporting requirements

The Consultant will work under the guidance and direct supervision of the Program Coordinator of the PAS Center. The consultancy work is expected to be conducted in close cooperation with the NTP and country teams in 3 targeted countries. The Consultant will report and submit all deliverables to the PAS Center and NTP. The deliverables will be produced in English or Russian language.

VI. Qualification requirements and basis for evaluation

The Qualification requirements and basis for evaluation (evaluation criteria) and selection of the consultant (the group of consultants will submit their proposal as a team) аrе:

General qualifications (30 points):

· Advanced university degree in public health, healthcare management or similar fields

· At least 10 years of professional experience in the area of public health and health policy

Adequacy for the assignment (50 points):

• A minimum of 7 years of progressive experience in TB programs management in countries with high burden of drug resistance

• Work experience in management of TB lab network, provision of technical and management support to TB laboratories will be considered an asset

• Experience with the introduction of rapid WHO-recommended laboratory diagnostic technics for TB and DR-TB in Eater-Europe and Central Asian Countries

• Familiarity with administrative systems and health care systems in EECA region countries

• Proven understanding of TB systems organization in ECCA countries and demonstrated capacity to undertake analysis related to TB systems

• Previous experience working with international organizations and/or national agencies implementing externally funded programs and projects is an asset

Language and other qualifications (20 points):

· Proficiency in Russian and English (spoken and written;

· Advanced computer skills;

· Excellent communication and analytical skills, including report writing;

· Ability to work independently, respond to feedback in a timely and professional manner, and meet deadlines.

VII. Duration of the assignment

The consultancy will take place from October 2020 to February 2021. Period for conducting country visits will be coordinated with the TB-REP team at the PAS Center and deadlines mutually agreed upon contract signature.

VIII. Deliverables

The Consultant is expected to produce the following deliverables for each of 3 selected countries:

· Assessment methodology coordinated with country NTP and detailed workplan for the assignment

· Needs estimation / planning tool for rapid and modern diagnostics sub-national – region and district / BMU (excel template)

· TB diagnoses network (GeneXpert) situational analyses draft report with summary findings

· Final report with needs estimations desegregated per region and district / BMU and network configuration and master file with all calculation for GeneXpert scale up

All deliverables need to be presented in English or Russian as agreed at the planning stage.