Background____________________________________________________________________
The epidemic in Jamaica has features of both a generalized and concentrated epidemic. As of December 2019, there were 32,617 persons or approximately 1.6% of the Jamaican adult population estimated to be infected with HIV. It is estimated that almost 16% of HIV infected persons are unaware of their status. Higher HIV prevalence has been recorded in vulnerable groups such as female sex workers (SW) (2%), MSM (29%), and persons with STIs (3.6%), homeless/drug users (5%), and prison inmates (6%). Sentinel surveillance of women attending antenatal clinics indicates that there is no significant change in the prevalence of HIV over the last decade despite prevention efforts. However, there has been a significant decline in AIDS Deaths and mother-to-child transmission of HIV, over the past decade.
Despite the stabilization of incidence seen in the ANC population, persistent behavioral, social and cultural factors continue to fuel the epidemic in high risk groups and high rates of transactional sex, and early age of sexual debut are important ingredients for further spread of HIV in the general population. Some of these behaviors are driven by increasing poverty, population dynamics, and well-established gender roles in which men are sexual decision makers.
There is an urgent need in Jamaica to increase the effectiveness of prevention programs among high risk groups to limit the spread of HIV. This requires a multi-faceted approach including school-based programs, mass media campaigns and targeted approaches for those most at risk for contracting HIV. The prevention response needs strategic information in order to improve programs aimed at preventing increased incidence of HIV. This includes information about the prevalence of HIV and other STIs as well as information about the characteristics and behaviors of key populations.
PLACE surveys among female sex workers was first implemented in Jamaica in 2002; however, it was in 2011 that for the first time they were implemented on a national scale. This survey was repeated in 2014 when over 1200 sites and events where people meet new sexual partners were identified. 485 sites with sex work and a random sample of other identified sites were visited by the NFPB HIV Outreach team. Proximate determinants of the heterosexual epidemic identified among female venue workers, female sex workers, female patrons of venues were high numbers of sexual partners, lack of condom use and untreated STI.
The most recent FSW survey was conducted in 2017. The findings indicated that there was a continuous decline in HIV prevalence among sex workers that self-identified to 2%. Of note is a shift in the epidemic, with greater HIV numbers among those who operated in enclosed venues compared to FSW who worked on the street. Another noteworthy shift was the higher numbers of positive cases among the younger age cohorts compared to the older groups. Neither of these features have been observed before and this warrants further investigation and monitoring. The staff at sex work venues continue to be a high risk group with an HIV prevalence of 3%.
Objectives
Guided by the 2017 PLACE Worker and Patron survey, the Ministry of Health and Wellness is seeking to implement the 2021 PLACE survey. This study has several objectives:
- To estimate prevalence and incidence of HIV/STI among high risk women
- To measure proximate & underlying determinants of HIV transmission
- To monitor program coverage
- To establish closer contacts with key populations in order to expand prevention and treatment services
- To determine effectiveness of prevention interventions among female sex workers
- To estimate female sex workers population size
- To understand social and sexual networks of female sex workers
The Survey_____________________________________________________________________
The implementation of this study will be guided by previously developed protocols that were tested and refined during the 2017 PLACE worker and Patron survey. Protocols include participant survey, methods to interview persons at increased risk of acquiring and transmitting HIV and Syphilis, as well as the provision of test results to participants, procedures for assuring the confidentiality of data, and quality control measures (Figueroa & Weir, 2012). These protocols have been further refined and published in PLACE in the Caribbean; Institutionalizing PLACE methodology to reach key populations in the Caribbean (Scott & Byfield, 2013).
Scope of Work
The role of the Study Lead is to guide, manage and support successful planning and implementation of the 2023 PLACE Worker and Patron survey in Jamaica. The Study Lead is also the focal point for survey-related communication between the Ministry of Health and Wellness, the National Family Planning Board – Sexual Health Agency (NFPB-SHA), the Regional Health Authorities (RHAs) and other stakeholders. As such, the Study Lead is expected to maintain and strengthen the reputation of the Ministry of Health and Wellness.
Study Oversight_________________________________________________________________
- Develop and manage the pre-study and study Implementation Plan, including division of labor, definition of roles and responsibilities, and implementation oversight.
- Apply strategic and innovative vision to overcome obstacles to implementation.
- Manage the Field Coordinators, including implementing quality assurance measures and conducting ongoing training as needed.
- Coordinate all survey activities in accordance with the PLACE Methodology – Community Informant survey, Site verification, Participant survey.
- Summarize findings of formative assessment (Community Informant Survey, Site Verification) in a written report
- Ensure adhesion to the approved study protocol and the confidentiality of all study materials.
- Gather relevant information and resources needed to ensure successful implementation.
- Engage Steering Committee/technical assistance providers as appropriate.
- Ensure reporting out on deliverables, including tools, resources, and building blocks of study design and implementation support.
- Present and discuss study progress and findings with stakeholder groups and technical committees as requested.
- Prepare final report on participant survey process, agreed on core indicators, and include key recommendations for Sex Work Programs based on survey findings
Technical Support________________________________________________________
- Study Design: Provide high quality guidance and play a lead role in:
- Preparation of study design and protocol writing.
- Development of data collection forms, databases, etc.
- Supervise data entry and analysis
- Study Coordination: Provide high quality work for:
- Implementation planning and management.
- Strategic engagement of stakeholders (RHAs, NGOs, labs, etc).
- Organize training and logistics for training study staff and interviewers involved community informant survey, site verification and participant interviews and conduct training.
- Develop supervision plan for field operations
- Manage study budget
- Develop supplies and equipment list for procurement
- Ensure compliance with human subjects requirements.
- Development of reporting forms, study operations documents, etc.
- Data management – entry and analysis
Project Administration___________________________________________________________
- Prepare and submit accurate and timely financial reports on study expenses.
- Supervise study staff, including orientation, mentoring and performance reviews as appropriate.
- Plan and lead survey team meetings with the Steering Committee.
Other:
- Establish and maintain good working relationships with key stakeholders and implementing partners.
- Plan, conduct and evaluate workshops and/or training.
- Contribute to efforts to publish and disseminate study outcomes.
Qualifications____________________________________________________________
- Master’s degree in Demography, Public Health, Social Science, or at minimum, another Masters eg. Statistics degree with emphasis on quantitative research methods Expert knowledge of HIV and STI context in Jamaica
- Expert knowledge of PLACE Methodology
- Previous experience with Female Sex Workers
- Previous experience with national survey implementation
- Expert knowledge of SPSS or other statistical programs
- Excellent interpersonal skills and ability to establish rapport with a range of stakeholders
- Excellent Project Management skills
- Excellent reporting and technical writing skills
Reporting relationship______________________________________________________
The study will be guided by a Technical committee comprising the Senior Medical Officer (HST Unit), the Strategic Information Advisor, (HST Unit), the Adolescent Programme Manager (HST Unit), the Director, Prevention (NFPB), the Strategic Information Advisor (UNAIDS) and a representative from the National Public Health Laboratory. The Adolescent Programme Manager (HST) will provide direct supervision of the Study Lead.
Length of project________________________________________________________________
Pre-study and study implementation, data entry and preliminary analysis will be completed November 1, 2022 – July 3, 2023
Deliverables_____________________________________________________________
- Implementation Plan including brief overview of Commercial Sex Worker (CSW) surveillance in Jamaica
- Recruitment and training plan for study staff and interviewers
- Summary report of Formative Assessment activities – findings and process. This includes the Community Informant Survey and Site Verification
- Final report on participant survey process, core indicators required for reporting on HIV response among CSW, and key recommendations for Sex Work Programs
Schedule of Deliverables
| Deliverables | Due date | Cost (J$) |
| Implementation Plan including brief overview of CSW surveillance in Jamaica
|
November 18, 2022
|
20% |
| Preparation of study design and protocol writing
|
||
| Development of data collection forms and databases
|
||
| Summary report of Formative Assessment activities – findings and process. This includes the Community Informant Survey and Site Verification
|
February 20, 2023
|
20%
|
| Recruitment and training plan for study staff and interviewers |
March 20, 2023 |
15% |
| Develop supervision plan for field operations | ||
| Draft report on participant survey process, data analyzed to capture core indicators required by reporting on HIV response among FSW and to include key recommendations for sex work programmes
|
May 8,,2023 |
10% |
| Second draft report and power point presentation made at dissemination meeting
|
May 29, 2023 | 10% |
| Final report and power point presentation |
July 3, 2023 |
25% |
| Total | 100%
|
|
Special Terms and Conditions
All expenses must be stated in the budget as the total in the proposal is the final amount to be paid. All resources and documentation produced from this activity are owned by the Ministry of Health and Wellness and shall not be accessed, shared or published without the written permission of the Ministry of Health and Wellness.
Evaluation Criteria
| Evaluation Criteria | ||||||
| Max (%) | Marks Allotted | |||||
| 1. Adequacy of the proposed technical approach, methodology and work plan in responding to the Terms of Reference (20) | 20 | |||||
| 2. Financial Proposal (10) | 10 | |||||
| 3. Key professional staff qualifications and competence for the assignment: [(i+ii+iii) x weight] | a | b | c | d | e | |
| (weight)
a) Team Leader/Manager 25% b) Research Assistant 20% c) Biostatistician 20% d) Other 5% Total (criterion ii) 70% |
Ʃ(a-e)
= 70 |
|||||
| Total Points (staff): x/70 | ||||||
|
The number of points to be assigned to each of the above positions or disciplines shall be determined considering the following three sub criteria and relevant percentage weights: |
30 | a | b | c | d | e |
| 1) i. General Qualifications
Master’s degree in Demography, Public Health, Social Science, or at minimum, another Masters eg. Statistics degree with emphasis on quantitative research methods (30%) |
||||||
| 2) ii. General Experience conducting surveys (45%) | 50 | a | b | c | d | e |
| Experience in Project Management (5%) | ||||||
| iii. Experience conducting social/ behavioural/health- related surveys (20%) | 20 | a | b | c | d | e |
| Individual Total (/100) | ||||||
| Total (1+2+3) Minimum required: 80 marks | ||||||