Request for Applications to Serve as Local Implementing Partner for an Impact Evaluation of the Strategies Implemented under the Strengthening Tuberculosis Control in Ukraine (STbCU) Project

MEASURE Evaluation seeks a research organization to serve as our local partner for the purpose of data collection and management for the baseline study of strategies under the Strengthening Tuberculosis Control in Ukraine (STbCU) project.

Introduction

MEASURE Evaluation is a United States Agency for International Development (USAID) cooperative agreement headquartered at the Carolina Population Center of the University of North Carolina at Chapel Hill (UNC-CH). MEASURE Evaluation seeks to strengthen monitoring and evaluation functions and systems and build individual, organizational and national capacity to assess the effectiveness of public health interventions. MEASURE Evaluation is implemented by UNC-CH in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. 

MEASURE Evaluation seeks a research organization to serve as our local partner for the purpose of data collection and management for the baseline study of strategies under the Strengthening Tuberculosis Control in Ukraine (STbCU) project. The purpose of this Request for Applications (RFA) is to determine the organization best suited to play this role. The successful applicant will demonstrate the superior technical, logistical, and organizational capacity needed to conduct a large-scale, mixed-methods study focused on TB and HIV/AIDS control efforts. The successful applicant will be subcontracted through John Snow, Inc.

Background and Rationale

The goal of the STbCU is to decrease the burden of tuberculosis (TB) in Ukraine in partnership with the Government of Ukraine, national and international stakeholders. The project proposes implementation of strategic actions to improve the quality of TB services, including detection and treatment of TB and multi- and extensively-drug-resistant TB (MDR-TB, XDR-TB), as well as prevention and treatment for the rapid growth of TB/HIV co-infection. The project began in March 2012 and builds on over 10 years of USAID TB assistance in 10 geographic priority areas.  
 
The impact evaluation will examine the relationship between select intervention strategies implemented and changes in key outcomes. The two strategies of interest are: i) targeting social support services to improve treatment adherence among those at high-risk of treatment default; and ii) integrating services and referrals between TB facilities and HIV facilities to improve the timeliness of care and the treatment outcomes for the co-infected.  Ukraine is one of several countries struggling with high treatment default rates and rising co-infection rates, and USAID is one of many donors testing and investigating strategies to help combat these problems. Findings from this evaluation will not only have implications for the STbCU project and follow-up interventions in Ukraine, but will also add to the evidence base for TB and TB/HIV strategies more broadly. The impact evaluation requires baseline data collection in Phase 1 and follow-up data collection in Phase 2. This RFA only covers research activities for the baseline data collection in 2013.  

Study Aims and Methods

The key aims of this baseline study are: i) to measure baseline indicators for TB treatment adherence and completion of the TB/HIV cascade of services (screening, testing, treatment); and ii) to understand the screening, testing, referral, and treatment processes at TB and HIV facilities in intervention and comparison areas.  

To achieve these aims, the research will collect data using the following mixed methods:  

  • Retrospective Chart Abstraction – abstract individual client data on TB and HIV diagnosis, inpatient care, outpatient treatment, final treatment outcome, and sociodemographic data from medical records. This data will be used to analyze TB treatment adherence and outcomes; and use of TB/HIV cascade of services and treatment outcomes among the co-infected.  
  • Facility Surveys – collect information about facility services, patient volume, referral mechanisms, medicine and test kit stock-outs, and externalities.
  • Provider Interviews – map cascade of TB/HIV services, including protocols and referral practices, to understand patient flow.

Sampling

The target populations for the evaluation are TB outpatients and TB/HIV co-infected patients.  The sampling will be stratified at three levels, oblast, facility, and risk group. Treatment oblasts will be purposively selected based on STbCU interventions:  Kherson and Zaporizhska for TB Adherence and 4 targeted oblasts to be determined for TB/HIV Integration. Comparison oblasts will be matched on TB and HIV incidence, history of USAID support, history of Ukrainian Red Cross Society (URCS) activities, geography, and population characteristics including unemployment rates, livelihood, and general health status. For TB Adherence, facilities within the sampled oblasts will be selected randomly.  For the TB/HIV integration, the assumption is that 1 oblast-level TB facility and 1 oblast-level HIV facility will be targeted for integration, hence 8 facilities in the intervention and 8 in the comparison oblasts will be targeted for sampling.  

Sample Size Estimates

Research Focus

Study

Design

Data Source and

Sample Size Estimates

Data Collection Point

Client Record

Facility Survey

Provider Interview

TB Treatment Adherence

Quantitative

1780

60

 

Outpatient treatment sites in 2 intervention oblasts (Kherson, Zaporizhska) and 4 comparison oblasts (TBD)

TB/HIV Integration

Quantitative

2250

16

 

Central Oblast TB and HIV sites in 4 intervention and 4 comparison oblasts (TBD)

TB/HIV Integration

Qualitative

 

 

10

Central Oblast TB and HIV sites in up to 4 intervention and comparison oblasts (TBD)

 

Activities and Responsibilities for the Organization

The successful applicant will be responsible for the following activities:

  • Implement key aspects of the identification of comparison groups and sampling strategy, including facility listing; compilation of available oblast/raion-level economic, demographic and health data to be used for matching oblasts and facilities; and provision of information for sampling weight calculation
  • Oversee application for ethical review to local IRB and secure local permissions for data collection
  • Participate in the revision and finalization of the study instruments – chart abstraction tool, facility survey, provider interview
  • Translation and transcription of all data collection tools and interviews to and from English as needed
  • Organize and conduct the pre-test of study instruments
  • Print final instruments
  • Recruit and train the field work team, include required ethics/human subject protection training to all staff involved in survey activities
  • Conduct field work with appropriate supervisory and quality check activities  
  • Conduct data entry and management
  • Conduct appropriate quality checks at different stages of field work, data entry and data management process
  • Produce frequency distributions for the datasets
  • Prepare preliminary and final datasets with appropriate documentation; transmit encrypted datasets to UNC
  • Draft a report describing all data collection and data management procedures, supervisor observations/comments, and limitations/problems encountered
  • Participate in the writing of a series of preliminary and final reports concerning the results of the baseline study

Deliverables

  • Detailed workplan and timeline of activities
  • Final study instruments (chart abstraction tool, facility questionnaire, provider interview) in Ukrainian/Russian and English
  • Sampling frame
  • IRB approval from Ukraine institution
  • Report on pre-testing
  • Reports on training activities
  • Biweekly reports on field work preparations and progress
  • Biweekly reports on data entry and management progress, including reports of quality check results
  • Reports on supervisor observations/comments, and limitations/problems encountered
  • Frequency distributions for survey data (hard copy and on a disc; data may also be submitted electronically)
  • Cleaned and fully labeled data set (on disc and submitted electronically) in STATA or other agreed-upon software
  • A copy of the codebook and any other data documentation
  • Provision of secured storage of all completed questionnaires

Terms of Agreement:

The data collected under this SOW will be collected on behalf of MEASURE Evaluation and its sponsor, USAID, and no ownership rights to the data will vest with the sub-recipient. All data collected will be transferred to MEASURE Evaluation at UNC for secure data storage and analysis. If the sub-recipient is interested in conducting data analysis and publication, the terms of the data sharing and publication between MEASURE Evaluation and the sub-recipient will be expressed in a written agreement as part of the sub-award.
 
The period of performance for this sub-agreement will be 8 months with an anticipated start date of May 2013. 
 
All data collection, data entry, data cleaning, preliminary data analysis, and a preliminary summary report must be completed by November 30, 2013. A maximum of $225,000 USD is available for this cost reimbursement subaward; however, the financial competitiveness of proposals will be an important consideration in selecting the local implementing partner.  At the same time, cost overruns cannot be covered in subsequent increases in subagreement amounts. We therefore recommend that applicants budget realistically, but with economy. The budget should be broken down by line item.  It should include a minimum of personnel, travel, and other direct costs. It is suggested to include the CV for the Principal Investigator and any other key personnel. For travel, include the name or title of the person who will travel and the purpose of each proposed trip.

The expected timeframe for the main survey activities is presented below.

 Main Activity

Target Dates

Study preparations: IRB, sample selection, instruments

May-June 2013

Pretesting, data collector training, final instruments produced

June-Aug 2013

Fieldwork

Sept-Oct 2013

Data entry

Sept-Nov 2013

Data cleaning and processing

Sept-Nov 2013

Preliminary tabulations submitted with final dataset, codebook and documentation

Dec 2013

 

Application Requirements

Organizations wishing to serve as MEASURE Evaluation’s local implementing partner for this baseline TB study should submit a full application with the following sections:
 

1. Cover Letter  - letter should clearly identify that the applicant is responding to this RFA and stating the applicant organization’s name, address, phone numbers, URL, and main email address. There should be a contact person listed for any purpose related to this RFA.

2. Technical Proposal - the applicant should describe in detail their approach to addressing the technical and logistical requirements to conduct a facility based survey of the type and magnitude described above. This section should describe in detail how the organization will address the responsibilities and activities outlined in the sections above. The applicant should include a description of its available resources that will be used to carry out the required tasks. The applicant should also present a detailed workplan and timeline for all activities. A Gantt Chart could be used for that purpose.

3. Organizational description and experience - the applicant should provide a brief description of the overall governance structure of their organization. The applicant should present the proposed organization and governance structure for the implementation of the baseline study. The applicant should describe the number and roles/responsibilities of the staff that will implement the survey. The applicant should name the key technical and administrative/financial personnel that will be involved in the activities. It should name at least a Principal Investigator and a Chief Administrative/Financial Officer who will serve as the main technical and financial liaison persons with MEASURE Evaluation. CVs of key staff should be included in the application.

The applicant should describe their organization’s past experience in successfully organizing and conducting large scale, national studies in Ukraine, particularly related to TB, HIV, or other clinical services. The applicant should provide a description of past projects (up to 5, with no more than 1 page description per project; these pages will not count to overall length of the application). The demonstrated capacity to do high quality work will be a crucial consideration. Preference will be given to those organizations that have either an institutional review board (IRB) of reference or a Federal Wide Assurance (FWA) formalizing the institution’s commitment to protect human subjects in the course of research.

4. Budget - a detailed line-item budget should be prepared based on the tasks/responsibilities described above. They should be presented in Ukraine Hryvnia and U.S. Dollars and can be supplied in a separate spreadsheet. It should include, but not be limited to: 

Personnel costs:  List number, daily rate and number of workdays for each category of staff (e.g., interviewer, supervisor, data entry clerk, statistician, drivers).  Please provide justification and a description of responsibilities for each category of staff.

Per diem:  List daily rate and number of workdays for each category of staff (e.g., interviewer, supervisor, data entry clerk, statistician, driver).

Transport:  List number of vehicles and number of days needed, estimated mileage and fuel cost per mile, vehicle maintenance and/or rental, if necessary.

Materials:  Questionnaire production (Unit cost per questionnaire * number of printed copies); interviewers’ equipment; other equipment and material used for data collection and management.

Miscellaneous: List any other costs. 

5. Financial/accounting structures and practices - the applicant should provide key information related to their financial/accounting procedures. It should submit an explanation of how the applicant calculates any indirect costs (if charged in the budget). The applicant should also describe the accounting software that they employ. The applicant should provide its last two annual financial reports. The annual financial reports will not count against the overall length requirements described in section Application Parameters below.

Questions

The question submission period has closed. 

  1. Question: Facilities definition. Apart from the state owned medical organizations dealing with diagnostics and treatment of TB and HIV there exist numbers of NGO organizations that administer, in particular, issues of screening in cases of both diseases. In that regard, while preparing the rfq we'd like to understand does the scope of the project on that stage encompasses only state facilities or includes all existing service providers at each particular site? 

    Answer: For this application, please assume state level facilities only

  2. Question: Financial reports. An official financial report of our organization is in Ukrainian language. Do we need to translate it to English? National tax system does not imply any official financial reporting provide by state tax administration. So such a report will be issued as our company's internal accounting providing annual turnover and with company's seal. 

    Answer: If the report is not available in English, perhaps you could provide a short summary in English to accompany the original.

  3. Question: IRB approval. Taking into account Ukrainian legislative system, there is no official body that issues any officially recognized papers of such a matter. Thus, the overview of the general approach might be done by the National Health administration though it does not imply any official document as a result of such an action. Perhaps it might resolve in a letter of support having no legal power. Would that approach suffice for the IRB approval demand? 

    Answer: Yes

  4. Question: Organizational support. Patients' screening and treatment data is highly confidential. The only feasible way to access it is the official supervision under the national health ministry and its local branches. That might require some assistance from USAID or MEASURE Evaluation project in terms of letters of support, for example. May we consider such a possibility on that stage? 

    Answer: Yes

  5. Question: As we understood, the more detailed information about sample and the geography of the study will be provided during the first phase of the study activities? 

    So, for now, our technical proposal should include a general scheme  and schedule of the project's implementation? 

    Answer: STbCU builds on a history of USAID-supported TB work in 10 administrative target areas:  7 oblasts (Dnipropetrovsk, Donetsk, Kharkiv, Kherson, Luhansk, Odessa and Zaporizhya); 2 cities (Kyiv and Sevastopol); and 1 autonomous republic (Republic of Crimea).  The intention of STbCU is to focus activities in these 10 areas, potentially expand to 2 additional oblasts by end of project, and target some policy work at the national level.  

    For the purposes of the impact evaluation, we are interested in the Social Support program and the TB/HIV Integration efforts.  The selection of intervention sites is not yet final, and the selection of comparison sites will be done with input from MEASURE, STbCU, and the RFA awardee.  Below is what we know and what we anticipate (subject to change).  For the technical proposal, make clear in your proposal what assumptions you’ve made regarding potential site selection and the effect on budgets and travel given the potential geographic scope.  

    Social Support:  Kherson and Zaporizhya are the 2 intervention oblasts.  We anticipate selecting 3 comparison oblasts.  For the purposes of the proposal, you may assume that 2 oblasts will most likely be selected from the STbCU target oblasts and 1 outside.  Our intention is to select comparison sites with similar TB rates, facility characteristics, population characteristics.

    TB/HIV Integration:  4 grants are to be awarded to different agencies operating in 4 different target oblasts.  At this point we do not know which oblasts will receive these grants nor which will serve as comparison sites.   Our intention is to select 3 comparison oblasts (2 within the STbCU targets and 1 outside) with similar TB rates, HIV rates, facility characteristics, population characteristics.

Deadline

All proposals must be received electronically by close of business on April 15, 2013.  Proposals should be emailed to amoore@jsi.com.

MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through cooperative agreement GHA-A-00-08-00003-00. Views expressed do not necessarily reflect the views of USAID or the United States government.