Comparative cost analysis of the current HIV testing strategies versus RDT-based in Belarus and Kazakhstan

1. Background information on the project and assignment

The EECA is one of the three regions globally where the HIV epidemic is increasing[1]. Late HIV diagnosis is common in countries of the EECA region and is often related to late confirmation of HIV test results. It can often take months between the first test to confirmatory test results and, consequently, people are lost to follow-up, resulting in delays to treatment initiation.

For the funding allocation 2021-2024, Global Fund country grants emphasize the scale-up of differentiated testing strategies for key populations, especially increased access and uptake of community-based triage testing, self-testing and improving the linkage to care for key populations. However, very few countries have formalized new approaches in their national policies and practices and most do not include technical support for this process in their national grants. Of twelve (12) countries in the EECA region, only Moldova and Kyrgyzstan have updated their national testing strategy/guidelines, while a further four (4) – Kazakhstan, Tajikistan, Ukraine and Uzbekistan – have revised their testing strategies to simplify confirmation stages but have retained the Western blot.

Aligning national policies with the latest WHO guidelines on HIV testing services requires a bolder effort towards simplification and decentralization of HIV testing services and decentralization of confirmation of test result services to district and local levels where appropriate. The countries of the EECA region have a strong, but often rigid, vertical and fragmented health system structure inherited from the Soviet system. This creates resistance at central level towards decentralization, and integration, of services at lower levels of service delivery. Unlike other regions, EECA countries require a gradual transition approach to consider the potential extra costs and implications for services other than HIV specialized services.

Therefore, it is critical to ensure preparatory interventions for implementation of changes that may occur through updating HIV testing strategies (including revised functional responsibilities of institutions at different levels, capacity building, etc.).

A comparative cost analysis of the current testing strategies versus RDT-based and potential gains from the transition to a simplified testing policy that is proposed in two selected countries under this grant that will help decision-makers in the critical process of proceeding to a reform of decentralizing HIV testing services.

In the context of the above, PAS Centre is seeking an international consultant to lead the comparative cost analysis of the current HIV testing strategies versus RDT-based in Belarus and Kazakhstan.

1. Scope of work

The scope of this assignment is to provide a comparative cost analysis of the current HIV testing strategies versus RDT-based in Belarus and Kazakhstan.

1. Objectives of the assignment

The international consultant will work closely with national HIV/AIDS program Coordinators from Belarus and Kazakhstan. The PAS Center in collaboration with the WHO country offices will facilitate the consultant’s access to the necessary information and to the specialists relevant to the task.

The consultant will be contracted for:

1. Elaboration the Costing Methodology for HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs;
2. Estimation of HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs in Belarus and Kazakhstan (the whole testing chain with its elements: tests, human resources, laboratory costs, maintenance, operation, transportation etc);
3. Comparative cost analysis of the current HIV testing strategies versus RDT-based in Belarus and Kazakhstan.
4. Presentation of the Report of economic advantages and disadvantages respectively for the current HIV testing strategies and RDT-based strategy to argue the opportunities for efficiency and increase the access to HIV testing in Belarus and Kazakhstan at country level and revision if necessary in accordance with the recommendations of national partners.

The final product will include the Reports of the comparative cost analysis of the current HIV testing strategies versus RDT-based in Belarus and Kazakhstan (separately for each country).

Travel-related costs for in-country missions (subject to need) will be covered directly by the PAS Center.

Estimated LOE – 20 days.

1. Reporting requirements

The Consultant will work under the guidance and direct supervision of Coordinator of the PAS Center. The consultancy work is expected to be conducted in close cooperation with the national HIV/AIDS program Coordinators from Belarus and Kazakhstan. The Consultant will report and submit all deliverables to the national HIV/AIDS program Coordinators from Belarus and Kazakhstan and PAS Center. The deliverables will be produced in Russian language.

1. Qualification requirements and basis for evaluation

The Qualification requirements and basis for evaluation (evaluation criteria) and selection of the consultant аrе:

General qualifications (30 points):

• Advanced university degree in public health or health economic health or similar fields
• At least 5 years of international experience (preferably in Eastern European and Central Asian countries) in evaluating efficiency / cost-effectiveness / cost-benefit;

Adequacy for the assignment (50 points):

• Knowledge and experience in costification, estimation and comparative analysis of costs in the field of health, experience in the field of HIV/ AIDS is an advantage;
• Extensive working experience as international technical advisor in Financing and Health System Strengthening;
• Knowledge of WHO guidelines related to HIV testing;
• Understanding of health systems in the EECA region;
• Previous experience working for the GF funded grants in the region is an asset.

Language and other qualifications (20 points):

• Very good communication and presentation skills with government and other stakeholders;
• Knowledge of Russian language;
• Excellent drafting skills Russian, and ability to synthesize complex information and issues.

1. Duration of the assignment

The consultancy will take place from August 01, 2022 to October 31, 2022.

Estimated LOE – 20 days.

1. Deliverables

The Consultant is expected to produce the following deliverables:

• the Reports of economic advantages and disadvantages respectively for the current HIV testing strategies and RDT-based strategy in Belarus and Kazakhstan (separately for each country).
• Appendices: Charts, field visits, people interviewed, documents reviewed etc.

[1] [1] http://aidsinfo.unaids.org/?did=554c9b9c05b5b281750af202&r=world-continents&t=2019&tb=c&bt=undefined&ts=0,0&cl=UNAESA,UNAWCA,UNAAP,UNACAR,UNAEECA,UNALA,UNAMENA,UNAWCENA&cr=r&ct=2019&cav=Population: All ages&aid=577290fa9888f63937b6b1e6