Request for Applications for Priorities for Local AIDS Control Efforts (PLACE) in Uganda
MEASURE Evaluation is a cooperative agreement funded by the United States Agency for International Development (USAID) and implemented by Carolina Population Center of the University of North Carolina at Chapel Hill (UNC-CH) in partnership with Futures Group International, ICF International, John Snow, Inc., Management Sciences for Health and Tulane University. MEASURE Evaluation aims to strengthen monitoring and evaluation systems and build capacity of individuals, organizations and systems to collect, analyze and use data to make decisions that will result in improved health programs and policies.
MEASURE Evaluation seeks an organization to implement the Priorities for Local AIDS Control Efforts (PLACE) protocol in up to 20 districts in Uganda. This organization is referred to below as the “local subrecipient.”
Uganda has a long history of successful HIV prevention that saw the decrease of HIV prevalence from its peak in 1990-1992 when HIV prevalence among women attending urban antenatal clinics ranged from 20% -30% to under 6% in the new millennium. Currently there is limited evidence of the effectiveness of today’s HIV prevention programs in either the general population or among most at risk populations. The 2011 Uganda AIDS Indicator Survey found that HIV prevalence in the general population increased nationally from 6.4% to 7.3% since the previous survey in 2004. Prevalence increased among both men and women and is higher in urban than in rural areas. According to modes of transmission assessments, a high proportion of new infections may be occurring in stable serodiscordant couples, but the “upstream” drivers of the epidemic are not well characterized. Given the wide variation in HIV prevalence across the country, it is likely that drivers of the epidemic are local and not only concentrated in urban and along major highways as previously thought. Consequently, effective district level responses would be most effective if they were tailored to local epidemics. Unfortunately, however, there is little information on most-at-risk populations outside of Kampala and other major urban areas.
Information available from the CRANE Survey for Kampala about the epidemic among one key population --sex workers-- warrants concern. Among a study cohort of sex workers in Kampala, baseline indicators from 1027 eligible women found high prevalence of sexually transmitted infection including HIV-- 37%; Neisseria gonorrhoeae-- 13%; Chlamydia trachomatis-- 9%; Trichomonas vaginalis-- 17%; Bacterial vaginosis-- 56%; and Candida infection--11%. Eighty percent of the women had herpes simplex virus 2 antibodies (HSV-2), 21% were TPHA-positive and 10% had active syphilis (RPR+TPHA+). Prevalent HIV was associated with older age, lack of education, sex work, street-based sex work, not knowing HIV status, and using alcohol. Less is known about other key populations who have multiple sexual partners.
In response to the increase in prevalence among the general population and the lack of information at the district level about key populations, national prevention strategies in Uganda include the objective of obtaining more information about the prevalence of infection among key populations, more outreach testing so that persons know their status, more information on the gaps in prevention for these populations and more investment into district level prevention programming for populations at highest risk. The 2011 Uganda National HIV and AIDS policy document states the following objective:
- “Government and its partners through strategic sectors will identify all populations at higher risk of infection, recognize factors that predispose them to HIV infection and develop appropriate strategies to address these.” (Reference: UGANDA National HIV and AIDS Policy 2011 p.10)
The overall aim of PLACE Uganda is to increase local and district-level capacity in Uganda to deliver and monitor effective prevention programs among most-at-risk populations, with the understanding that prevention among these populations should lead to reduced incidence in the general population. Most-at-risk populations include groups such as sex workers, their clients, and others who have two or more sexual partners in a year. Implementation of the PLACE method in Uganda addresses the need for more evidence-based HIV prevention among those most at risk of acquiring and transmitting infection. PLACE is an upstream method in that it tries to prevent transmission among the group with the highest rates of new sexual partnerships. The PLACE approach empowers district level HIV prevention and allows for local creativity and problem solving.
At the national level, implementation of the PLACE protocol will:
- Reduce gaps in strategic information related to high-risk groups.
- Facilitate district-level action plans for prevention based on empiric district-level data
- Use findings to inform national policy and to identify lessons learned for other districts
PLACE at the district level aims to increase the capacity at the district level for strategic HIV prevention. For each district, the specific objectives are:
- To identify and map priority prevention areas (PPAs) —also known as high transmission areas or “hot spots” in the district where prevention activities are needed. A PPA could be a group of truck stops along a highway, a fishing village, a rapidly growing urban slum area, a worker camp for agriculture or construction or other area with heightened risk activity.
- To characterize and map high risk venues and events in each PPA where people meet new sexual partners and where outreach activities could reach people likely to acquire and transmit infection.
- To describe the characteristics of men, women and youth who visit high-risk venues and events, estimate HIV prevalence for these groups, and identify gaps in HIV prevention services (HCT, SMC, condoms, and syndromic STI management) for these people.
- To describe the characteristics of sex workers, clients of sex workers, and other most-at-risk populations
- To work with district teams to review the findings of PLACE and use the information to develop district-level action plans.
The general PLACE protocol is available on the MEASURE Evaluation Web site. It will be adapted to Uganda in consultation with the local sub-agreement and stakeholders. The PLACE protocol has five steps:
- National-Level Preparation and Protocol Adaptation and District-Level Engagement: Activities include identification of a National Steering Committee, protocol development, selection of 20 districts, piloting the protocol in Kawempe, training study supervisors, and obtaining ethical clearance. This step occurs at the national level initially but will include input from districts. National level leadership will be called upon for coordinating activities among the districts. We expect that each district will have a district level PLACE team comprised of stakeholders, M&E staff, intervention providers, health officials who can help interpret findings and take responsibility for making sure that people identified with HIV infection receive appropriate services.
- District-Level Community Informant Surveys: Brief (20 minute) community informant interviews of 200-300 knowledgeable people in each district will be conducted to identify priority prevention areas (such as a fishing village or collection of truck stops) and specific sites within these areas where people meet new sexual partners. We expect an average of 2-3 areas in each district. We expect to conduct PLACE in 20 districts. Interviewing teams must include people from the district as well as experienced interviewers.
- District-Level Site Visits and Mapping: The venues and events named by community informants will be visited and mapped in each district. We expect to visit approximately 100 venues and events per district. For each venue and event, information useful for planning outreach prevention services will be collected based on an interview with a venue informant.
- District-Level Interviews and Testing of Workers and Patrons: People who work at these venues are often among those most at risk. PLACE will offer an interview and testing to all workers at selected venues. This often includes sex workers. In addition, a representative sample of men and women socializing at venues will be surveyed and offered an HIV test. Workers and patrons are asked about their risk behaviors, their use of services, and the accessibility of services. They are asked about condom use. Testing for workers and patrons is done at the site. They receive their results at the site and are linked to care. Confidentiality of results is essential. Ethical review of the protocol must be obtained. We expect to interview and test approximately 120 workers and 600 patrons per district.
- National- and District- Level Feedback and Data Use: Activities include local district-level feedback and writing of action plans and national dissemination. Districts will be actively engaged in analysis and interpretation of results. We will work with districts to identify people in the district who will retain the skills for implementing PLACE in the future.
The PLACE team will be comprised of:
- Members of PEPFAR Strategic Information Technical Working Group. The key United States government contact is Joseph Mwangi who serves as a Principal Investigator, the national PLACE advisor and the administrative Activity Manager for contractual purposes.
- MEASURE Evaluation staff including Dr. Sharon Weir of the University of North Carolina who will serve as the technical leader for PLACE.
- The local subrecipient. The local subagreement will be with a Ugandan organization capable of managing the implementation of PLACE in the country.
- Persons representing service delivery providers.
- Representatives from the district including local persons who will participate in data collection and analysis.
During the early stages of protocol preparation, implementation of the pilot protocol, and preparation of training materials, the team will have a weekly teleconference. Draft versions of the protocol will be circulated for comments. The protocol will include a description of the data use agreement. The protocol will be shared with the Uganda AIDS Commission and the members of the PEPFAR Strategic Information Technical Working Group. The local subrecipient will facilitate discussions among key people as needed.
This activity will seek substantive participation of key national-level stakeholders. The local subrecipient will take responsibility for inviting and coordinating participation of national-level stakeholders. These include:
- Uganda AIDS Commission (UAC) – as the Government of Uganda (GOU) institution in charge of national HIV/AIDS response coordination, UAC will provide approvals and GOU leadership including district selection and mobilization.
- District Leadership—District leaders will be informed about the opportunity for PLACE in districts in Uganda and asked for advice regarding tailoring the protocol to district level needs in Uganda. Those who request that their district be included for a PLACE assessment will agree, as part of the request, to facilitate access to the district, data collection within the district, analysis and interpretation of the data and leadership in translating the results into district action plans.
- Ministry of Health M&E GROUP (SMER)—SMER will participate in the national PLACE steering committee and facilitate use of PLACE results in the Ministry of Health.
- U.S. government (USG) implementing partners—USG implementing partners will be represented on the national PLACE steering committee and will be consulted regarding their needs for monitoring coverage of their programs among key populations. Based on their response, the final protocol will be adapted to provide implementing partners the information they need. In addition, implementing partners will be asked to facilitate access to key populations in the districts where PLACE is implemented and offered the opportunity to participate in training and data use activities.
- December/January 2013: Identify and award subagreement to in-county organization.
- February 2013: Finalize protocols, identify all personnel, obtain ethical review, identify districts.
- February / March 2013: Implement pilot study in one district with involvement from other districts and adapt protocol as necessary.
- April / May / June 2013: Conduct data collection in districts, conduct feedback workshops and develop district action plans.
- July 2013: Conduct National Dissemination Workshop.
- August: 2013: Final report.
The period of performance for this subagreement will be up to 15 months from the date of signing, but not to go beyond March, 2014.
For each district (up to 20 districts), the local subrecipient will complete the following in collaboration with district teams:
- Identification of priority prevention areas (PPAs) in each district (2-3 per district)
- Map of high-risk venues and events in priority prevention areas (average 30 venues per PPA and 10 events per district so 100 map locations per district)
- Characteristics of venues and events (90 venues and 10 events per district)
- Indicators of extent to which services are available in priority prevention areas based on table of indicators negotiated as protocol is finalized
- Characteristics of patrons and workers at venues based on interviews (300 male patrons, 300 female patrons, 120 workers per district)
- HIV prevalence among patrons and workers at venues who were interviewed
- Analysis showing extent of access to prevention programs among workers and patrons
- Analysis showing demand for safe male circumcision
- Action plans to improve prevention at sites for each district written by district leaders based on findings
- Slide decks showing PLACE results and indicators (rather than a written report)
- Fully documented datasets for data collected from interviews with community informants, venue representatives, venue patrons and site workers
- Other deliverables as agreed upon at contract signing
At the national level, the following will be prepared:
- Protocol and translated questionnaires and training materials
- Documentation of stakeholder involvement
- Results from pilot study
- Summary of indicators from districts
- Lessons learned
- Data use and next steps
- Compilation of slide deck reports
- Overall slide deck to report on study
- Overall report and tables
- Other deliverables as agreed upon at contract signing
Organizations wishing to implement PLACE in Uganda must submit an application that describes their technical, organizational and logistical capacity to do so. The proposal should be no more than 10 pages, 1.5 spaced with 1 inch margins and 11 point Arial font. Curriculum vitae and the budget will not count against page limits.
Each proposal should contain the following sections:
- Proposal Cover Sheet that clearly identifies the proposal as responding to this RFA in its title and states the vendor’s address, phone numbers, and URL. There should also be a contact person listed for purposes related to this procurement.
- Technical Proposal that responds to each of the items listed under the Scope of Work. The applicant should describe in detail their approach to surveys of most-at-risk populations, district-level capacity building, data use for HIV prevention, and how they achieve high data quality and maintain confidentiality. The applicant should provide information on how they will secure review of their activities by a local ethics committee or formal Institutional Review Board prior to beginning work in the field, including estimates on how long it will take to complete the review process.
- Organizational description that describes the organization’s past experience with implementing PLACE and past experience with district-level capacity building. The applicant should describe permanent staff and affiliated individuals including interviewer supervisors that will implement the project. The applicant should name a project director to provide technical leadership and oversight. A curriculum vitae (CV) of no more than 3 pages each for all technical staff should accompany the proposal. Individual interviewers do not need to be named.
- Description of any constraints regarding implementing the work under the timeline described in this request.
- A detailed Budget and Budget Narrative that breaks down by line item. All salaries must be listed by proposed person including the level of effort. All travel and meeting expenses must be broken down in the budget and justified in the budget narrative.
The proposal must be submitted electronically to firstname.lastname@example.org no later than 5pm EST on January 3, 2013.
Questions will be accepted via email at email@example.com through 1pm EST on December 17, 2012. Answers will be provided via email to each declared/intended bidder by close of business December 21, 2012. A list of all questions and answers will be posted at http://www.cpc.unc.edu/measure/about/contracting-with-us.
MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through cooperative agreement GHA-A-00-08-00003-00. Views expressed in this document do not necessarily reflect the views of USAID or the United States government.