I - BACKGROUND Since the first cases of Acquired Immunodeficiency Syndrom (AIDS) in Tanzania were reported in 1983, the HIV/AIDS epidemic has evolved from being a rare and new disease to a common household problem, which has affected many Tanzanian families. Mainland Tanzania faces a generalized human immunodeficiency virus and AIDS epidemic, with an estimated 6.5% of the population infected with HIV (7.7% of adult women and 6.3 of adult men) . The epidemic’s severity differs widely from region to region, with some regions reporting a prevalence of less than 2 percent (Arusha) and others as high as 16 percent (Iringa) . The HIV epidemic on Tanzania mainland is described as generalized, meaning it affects all sectors of the population. Heterosexual sex accounts for the majority of infections (80 percent) in Tanzania mainland.
Furthermore, recent research has started to document an emerging and consolidated practice of injecting and non-injecting drug use in Eastern Africa. There is an estimated 25.000 injecting drug users (IDUs) living in Tanzania and HIV prevalence rates are estimated to be around 40% in this population – around six times the national adult HIV prevalence. The rate of infection among IDUs is thus similar to the rates found in parts of Eastern Europe and Asia. Moreover, HIV infection rates have been particularly high in female sub-samples, ranging around 64% . (Injecting) drug use is therefore contributing increasingly to the ongoing complex HIV-epidemic in Sub-Saharan Africa. No systematic estimates for HCV prevalence and for HIV/HCV co-morbidity exist so far in Tanzania.
In this context Médecins du Monde – France (MdM-F) is conducting a Rapid Assessment and Response (RAR) since April 2011 as part of its Harm Reduction program which started in the last quarter of 2010 in Temeke District, Dar-es-Salaam. This study has been appraised and agreed by the National Institute for Medical Research of Tanzania.
In the framework of this RAR a quantitative survey has started in June 2011. The principle objective of this survey among injecting drug users (IDUs) and non-injecting drug users (NIDUs) in Temeke District is to identify and to understand the HIV and HCV prevalence in different sub-samples as well as the main health risk behaviours and health care needs of the IDUs and NIDUs population in Temeke District, in order to allow an adapted operational response trough a MdM Harm Reduction Programme.
More specifically the quantitative survey aims at i.Describing the social and demographic patterns of IDUs and NIDUs ii.studying the detailed practices concerning the use of psychoactive substances iii.identifying the main risk behaviors in regard to infectious diseases iv.estimating the knowledge of the IDUs and NIDUs concerning their HIV status and their access to HIV care v.identifying the effective prevention services offered to this population vi.determining the HIV and hepatitis prevalence among IDUs and NIDUS in Temeke District
vii.allowing to analyze the risk factors for HIV, HCV and HIV/HCV co-infection through analytical statistics
II – THE RAR: MATERIALS AND METHODS This RAR is an operational research that uses a mixed methodology. This mixed methodology consists of three different parts:
Firstly, a short qualitative assessment has been conducted in order to gather detailed information on drug use patterns, access to prevention and care services and HIV and hepatitis related knowledge. This qualitative work has allowed as well improving the methodology and the questionnaire of the quantitative part. A report regarding this qualitative part of the RAR has been finalized in the month of June 2011 and is part of the essential documents for the desk review.
Secondly, a quantitative survey, using interviews with questionnaires consisting mainly of closed questions is currently conducted in Temeke District. Data collection has started on Monday 6th of June and will go on until beginning of July
Finally, the RAR includes a response part that offers to every participant of the quantitative survey information material and prevention materials, so that he or she may possibly improve his or her risk behaviour. Moreover, the participants will be referred to a health care center or a hospital if needed and they have the possibility to learn their HIV and HCV tests results.
The second part, the quantitative survey, is the main object of this consultancy. More specifically with regards to this survey it is important to note:
Study population The study population is all injecting drug users (IDUs) and heroin and/or cocaine users (NIDUs) who are living in Temeke District, who speak and understand fluently Swahili, and who agree to be included in the study after having signed their consent. Youth under 18 will have to bring a signed consent of their parents or relatives to be included within the study. Injecting drug users are defined as having injected/used at least once psychoactive substances in the last month before the interview.
Sample size A first mapping in the District has shown that there are at least a couple of hundreds injecting and non-injecting drug users living in Temeke. On the basis of these elements and considering feasibility issues, the survey aims at including at least 200 IDUs and a minimum of 100 NIDUs. In the case of the IDU sub-population a minimum of 20% should be female drug users and in the case of the NIDU sub-population a minimum of 25% should be women. Moreover, both sub-samples should include a minimum of 30% of users that are 25 years old or younger. Finally all geographical areas identified during the mapping at the end of 2010 have to be represented in the sample.
Sample method The sampling methodology is based on an approach in two phases.
a.)In the first phase a snowballing methodology has been conducted. Therefore 8 key informants have been defined. The key informants are told to refer as many other drug users (injecting drug users or heroine/cocaine users) as possible to the DIC. Every user coming to the DIC for participating will be asked to refer as well as many users as possible from his own social networks.The DIC will be opened for 2 weeks for the inclusion of drug users in this first phase. b.)In a second phase targeted sampling will be conducted by the team in order to diversify the sample by inviting people from under-represented camps and in order to include for example more women or injectors, in order to meet the targets set in the chapter on sample size in terms of gender, age, origin and injecting/non-injecting use. This second phase will be conducted during 2 weeks after the analysis of the first 50% of the sample.
The questionnaire is containing 52 items wit around 70 questions on different aspects of drug use, risk behaviours, sexuality, prevention and treatment access and HIV and HCV knowledge.
The survey data entry tool has been developed on SPHYNX software.
III OBJECTIVES AND ROLE OF CONSULTANCY The consultant will conduct the statistical analysis of the epidemiological data that has been gathered during the quantitative survey among drug users in Temeke District. He/she is asked to provide a final report – in English language - on these findings.
More specifically the consultant should establish his own data base in an adapted software after receiving the data base on SPHYNX, in order to be able to work with the most adapted tool and in order to have a cleaned data pool. The first analytical step should look into the descriptive statistics and simple distribution of prevalence for HIV and HCV infection as well as the other items of the questionnaire such as drug use patterns, risk behaviours, experiences of overdose and access to prevention and treatment services.
The descriptive analysis should as well look into the differences in terms of prevalence figures in the different sub-samples such as injectors, non-injectors, female and male and younger and older users.
In a following step a uni- and multivariate analysis should look into the significant risk factors for HIV infection, HCV infection and HIV/HCV co-infection.
IV – EXPECTED OUTCOME/PRODUCT A final written report in English is expected. The report without annexes must not exceed 40 pages and should include: 1) Executive Summary (5 pages maximum) 2) Introduction and background 3) Materials and methods 4) Limits of study 5) Results: descriptive and analytical epidemiology 6) Conclusions and recommendations 7) Annexes including main treatment tables
An oral presentation to MdM HQ is expected beginning of October.
V- BIBLIOGRAPHY AND DOCUMENTATION MdM will provide the consultant with relevant documents and information on IDUs in Tanzania and MdM project in Temeke Municipality, and especially with: - Presentation of the project - Literature Review prepared by MdM in November 2010 on Substance use and HIV/AIDS in Tanzania - Main scientific publications regarding substance abuse and HIV in Tanzania - Minutes and Presentation of MdM workshop on HR held in Dar Es Salam in November 2010 - MdM MoU with the Ministry of Health - Results of the mapping of IDUs camps implemented by MdM in Temeke Municipality end of 2010 - Final report of qualitative research in the framework of the RAR
VI - ORGANISATIONAL ASPECTS The work will be coordinated by the Desk Officer in charge of Tanzania, in collaboration with the person in charge of the development of the questionnaire and the data base on SPHYNX together with the field team. The first draft will be read by those two persons and in addition by somebody from the field team in Tanzania as well as the mission responsible and the technical VIH referent. A briefing at MdM HQ is planned at the beginning of the consultancy.
A proposition in response to these TOR may be sent at the following email address doi.applications@medecinsdumonde.net under the reference: Tanzania/RAR/consultancy
The deadline for reception of the application offers is July 15th 2011 COB.
The offer application should include: - Understanding of the ToR - Detailed technical offer including methodology, number of days split for each task, forecasted schedule - Detailed financial offer (Daily cost, number of days, …): total budget should include all taxes. - Two references of previous works/reports in the same area - Consultant’s curriculum/personal history - Availability of the consultant
V - PREVISIONAL PLANNING AND ESTIMATED BUDGET
The deadline for the final version of the report is of the 30th September 2011. The following planning may be used as an indication for the consultants’ proposition. Tasks Working days Expected results Desk review on drug use and HIV in Sub-Saharan Africa- especially Tanzania 1
Statistical analysis of the data base 8
Report writing 7 First draft of final report in English language- Expected the X September Integration of comments from MdM collaborators 2 Final report in English language
The budget should be comprised between 5.000 and 7.500 euros (incunding all taxes).
VI - PROFILE OF CONSULTANT → Epidemiologist → Experiences in the analysis of surveys in the field of HIV/AIDS a strong advantage → Knowledge and experience in the field of Harm Reduction highly appreciated → Fluent in written English
Consultancy in descriptive and analytical epidemiology
![Consultancy in descriptive and analytical epidemiology]()
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