Scope of Work for Pilot Test of the MEASURE Evaluation Know-Your-Response: HIV-Prevention Toolkit, Greater Accra Region, Ghana

MEASURE Evaluation has been requested by USAID to develop tools and pilot test systems for tracking national HIV-prevention responses. The Know-Your-Response (KYR) toolkit was conceptualized by the PEPFAR General Population and Youth Prevention Technical Working Group in collaboration with the MEASURE Evaluation project in response to the UNAIDS Strategic Guidance for Evaluating HIV Prevention programs.

Background

MEASURE Evaluation has been requested by USAID to develop tools and pilot test systems for tracking national HIV-prevention responses. The Know-Your-Response (KYR) toolkit was conceptualized by the PEPFAR General Population and Youth Prevention Technical Working Group in collaboration with the MEASURE Evaluation project in response to the UNAIDS Strategic Guidance for Evaluating HIV Prevention programs. The toolkit addresses three key concepts that are critical for an improved understanding of the HIV-prevention response – location, scale, and needs – and helps provide answers to the following pertinent questions: Who is doing what and where? Who is being reached by HIV-prevention programs? How many are being reached? Are the needs of key populations at higher risk of HIV exposure being met in settings where they are located? The toolkit collects information about HIV-prevention interventions beyond what is being implemented by the President’s Emergency Plan for AIDS Relief (PEPFAR).

The purpose of this RFA is to seek applications for a local implementing partner to implement a pilot test of this toolkit in Greater Accra, Ghana.

The MEASURE Evaluation KYR-Prevention toolkit consists of these main components:

  1. Policy Checklist
  2. Strategic Information Checklist
  3. Program Implementers Core Questionnaire
  4. Program Implementers Module for Key Populations at Higher Risk of HIV Exposure
  5. District Questionnaire - a. Health Facility Module and b. Government Non-Health Sector HIV-Prevention Module

Objectives of the KYR Tools

The primary objectives of the KYR tools are:

  • To assess the extent to which prevention interventions match current HIV-transmission patterns
  • To focus on geographic areas where HIV is spreading most rapidly
  • To Cover technical recommendations for populations at higher risk of HIV exposure
  • To permit a geographic mapping of the national/subnational HIV-prevention response

It is hoped that the information collected will permit a gap analysis of the national/sub-national HIV-prevention response and provide information needed by countries to guide an adjustment (as needed) and prioritization of HIV-prevention programs and interventions, with a view to delivering HIV-prevention services to people and places where they are most needed.

Objectives of the Pilot Test

The overall goal of the pilot test is to improve the usefulness, validity and reliability of the data that are collected using the KYR-Prevention tools. Specifically, the pilot test objectives are:

  1. To identify and eliminate problems in the KYR tools and enable corrective changes or adjustments to be made before actually collecting data from the target populations.
  2. To permit a thorough test of the logistical arrangements and planned statistical and analytic procedures to enable MEASURE Evaluation to assess their usefulness for the data.
  3. To determine whether data collected via the tools yield the information that is needed to assess the extent to which prevention interventions match current HIV-transmission patterns, are focused on geographic areas where HIV is spreading most rapidly, and cover technical recommendations for HIV-prevention among populations at higher risk of HIV exposure.
  4. To share the results of the pilot test with key stakeholders who will be using the data in order to determine whether the KYR tools provide the data they need to answer their questions.

Toolkit Components to be Pilot Tested:

1. Policy Checklist (3 pages)

The Policy Checklist provides a broad view of the policy environment for HIV prevention by collecting information from decision makers on the extent to which policy actions for moving towards prevention goals and the scaling up of prevention interventions have been addressed in a given country. The Policy Checklist also assesses the extent to which policy actions related to HIV-prevention take into consideration gender and Positive Health, Dignity and Prevention principles. Policy Checklists are presented for each of the four HIV epidemic scenarios listed below:

  • Low-level scenarios: HIV prevalence levels below 1% and where HIV has not spread to significant levels within any subpopulation.
  • Concentrated scenarios: High HIV prevalence in one or more sub-populations such as men who have sex with men and transgender people, injecting drug users, or sex workers and their clients but the virus is not circulating in the general population.
  • Generalized scenarios: HIV prevalence levels between 1-15% in pregnant women attending antenatal clinics, which implies that HIV is sufficiently prevalent in the general population to enable the epidemic to be driven by sexual networking.
  • Hyper-endemic scenarios: HIV prevalence greater than 15% in the adult population driven through extensive heterosexual multiple concurrent partner relations with low and inconsistent condom use.

As epidemic scenarios may vary across regions/provinces within a given country, the checklists may have to be adapted to local conditions to reflect the epidemic scenario that exists in the Greater Accra Region of Ghana. It is anticipated that the Policy Checklist will be administered to 10-15 policy makers.

2. Strategic Information Checklist (3 pages)

The Strategic Information Checklist assesses the extent to which the existing information system addresses the three main categories of activities related to strategic information for the HIV prevention response: (a) surveillance of HIV and sexually-transmitted infections; (b) monitoring and evaluation; and (c) research. The Strategic Information Checklist also includes information needs relevant to assessing the degree of integration of gender and Positive Health, Dignity and Prevention principles into HIV-prevention programming.

 It is anticipated that the Strategic Information Checklist will be administered to 10-15 individuals who are producers, users and financiers of strategic information related to HIV/AIDS, health information and other social statistics at the national, regional, and district levels. These key informants should include those involved in collecting HIV surveillance data, monitoring and evaluation specialists, representatives from national HIV/AIDS programs, the Ministry of Health, and potential users of the information in government ministries, donor agencies and development partners such as multilateral and bilateral agencies (e.g., the Global Fund, UNAIDS, USAID-PEPFAR, WHO, DFID, etc.), and health-related advocacy groups. 

3. Program Implementers Core Questionnaire (19 pages)

The Program Implementers Core Questionnaire is used to undertake a situation analysis of the HIV-prevention response and permits an analysis of gaps in the geographic coverage and scope of HIV-prevention activities and the geographic mapping of the HIV-prevention response. The overall goal of the Program Implementers Core Questionnaire is to provide the evidence base to inform the selection and prioritization of prevention interventions that are needed to have an impact on HIV incidence and prevalence.

The Program Implementers Core Questionnaire collects basic information about the organization; and for each of the organization’s projects that currently conduct HIV-prevention activities, data are collected on:

  • Type of HIV-prevention activities implemented in the past 12 months
  • Financial resources expended for HIV prevention activities in the past 12 months
  • Sources of funding for HIV-prevention activities implemented in the past 12 months

In addition, the Program Implementers Core Questionnaire collects information on the number of people reached with HIV-prevention activities by the organization by district of residence and sex for all activities combined.

The Program Implementers Core Questionnaire is to be administered to all implementers/organizations working on HIV/AIDS project activities in a given country/region/province in which the KRY tools are implemented. Program implementers may include government, non-governmental organizations, civil society, community groups, faith-based organizations, the private sector, and others.

4. Program Implementers Module for Key Populations at Higher Risk of HIV Exposure (24 pages)

The Program Implementers Module assesses the nature and comprehensiveness of the programmatic response for key populations at higher risk of HIV exposure, thereby permitting an analysis of actual gaps between location, needs and scale of these priority populations and current programmatic efforts to address their needs. 

The Program Implementers Core Questionnaire is to be administered to all implementers/organizations working on HIV/AIDS project activities in a given country/region/province in which the KRY tools are implemented.

5a. District Questionnaire: Health Facility Module (28 pages)

The Health Facility Module of the District Questionnaire collects information from district health officers regarding HIV interventions that are based at private and public health facilities. The objectives of this module are to assess the extent to which district-level health facilities address technical HIV-prevention recommendations and to determine barriers and facilitators to full implementation of technical recommendations. 

5b. District Questionnaire: Government Non-Health Sector HIV-Prevention Module (19 pages)

The objectives of this Questionnaire are to assess the extent to which district-level services address technical HIV-prevention recommendations, and to determine barriers and facilitators to full implementation of those recommendations. The Questionnaire should be administered to district health officials who are knowledgeable about HIV/AIDS activities in the education, uniformed services, prison, refugees and displaced persons camp/settlement, and mental health sectors. It is unlikely that there is one district official who has all of this information and can answer this Questionnaire alone. Therefore, the relevant sections of the Questionnaire may have to be completed by multiple officials who work in the specific sectors covered by the questions in the Module.

The Module is subdivided into five sections:

     (a) Public School HIV-prevention Activity Checklist

     (b) HIV Prevention/Support for Uniformed Personnel/Services

     (c) HIV Prevention/Support for Prison Populations

     (d) HIV Prevention/Support for Refugee/Displaced Populations

     (e) Checklist of HIV-prevention services for mental health institution populations

The Module should be administered to 3-5 knowledgeable district officers in each study district.

Methodology

The study methodology will entail:

  • Administering Toolkit components and documenting comments, questions, concerns related to implementation
  • Validating the information provided by program implementers and District Health officials
  • Conducting debriefing meetings/focus group discussions/in-depth interviews with Toolkit respondents in order to determine whether appropriate questions are being asked, detect potential problems with the instruments in the KYR toolkit, and improve them
  • Data analysis and report writing
  • Mapping the geographic coverage of HIV-prevention programs (this is a negotiable item. GIS expertise is an advantage in the application but not strictly required)
  • Organizing a dissemination seminar for key stakeholders to be held in Accra, Ghana in June-July, 2013

Activities and Responsibilities of the Local Implementing Partner

The Local implementing partner will be responsible for the following activities:

  • Collaborating with the Ghana AIDS Commission to implement the study
  • Compiling a list of all HIV prevention program implementers working in all 10 districts of Greater Accra, Ghana (in collaboration with the Ghana AIDS Commission)
  • Identifying respondents for the Policy Checklist, Strategic Information Checklist, Program Implementers Core Questionnaire, Program Implementers Module, and District Questionnaire
  • Training data collectors
  • Producing printed final questionnaires for the agreed-upon sample size for each instrument in the KYR toolkit
  • Pilot testing the KYR toolkit in collaboration with the Ghana AIDS Commission
  • Carrying out the agreed upon number of interviews
  • Drafting a report describing the pilot test results, data collection procedures, supervisor observations/comments, and limitations/problems encountered
  • Data entry for all instruments in the Toolkit (including variable and value labels)
  • Producing frequency distributions from the data set(s)
  • Selecting participants for the debrief meetings/focus group discussion/in-depth interviews in order to obtain feedback on each data collection instrument
  • Conducting and audio-recording the debrief meetings/focus group discussions/in-depth interviews using the agreed-upon interview/discussion guide developed for that purpose
  • Producing a draft report of the debrief meetings/focus group discussions/ in-depth interviews
  • Revising the draft report of the debrief meetings/focus group discussions/in-depth interviews based on comments received
  • Contributing to the preliminary and final KYR analysis reports and maps of the geographical coverage of HIV-prevention interventions, as per mutual agreement and in collaboration with the Ghana AIDS Commission
  • Working with the Ghana AIDS Commission and MEASURE Evaluation to host a dissemination seminar in Accra for key stakeholders

The resulting report(s), quantitative data and qualitative data will be the property of MEASURE Evaluation and USAID. MEASURE Evaluation reserves the right to edit and rewrite the report of the focus group discussions and in-depth interviews at its sole discretion and/or not to publish the report.

Timing

Final dates will be agreed upon once the successful local implementing partner is identified. It is expected that the data collection should be completed by but not later than April 2013 and the double data entered (quantitative) and transcribed (qualitative) data received by MEASURE Evaluation no later than May, 2013. Research organizations are requested to submit a timeline based on the following activities.

Activities

  • Adapting the instruments to the Ghanaian context
  • Submitting protocol for local IRB approval
  • Conducting interviewer training
  • Revising and printing data collection instruments
  • Programming Data Screens for Data entry
  • Data collection/fieldwork
  • Data entry, transcription, and editing
  • Draft report describing survey process submitted
  • Planning and conducting debrief meetings/focus group discussions/in-depth interviews
  • Preliminary analysis and report of debrief meetings/focus group discussions/in-depth interviews
  • Producing tabulations and maps for KYR report
  • Drafting preliminary KYR report in collaboration with MEASURE Evaluation and the Ghana AIDS Commission
  • Finalizing KYR report in collaboration with MEASURE Evaluation and the Ghana AIDS Commission
  • Conducting dissemination seminar

Outputs

  • Timeline of activities and deliverables
  • Documentation of local IRB approval 
  • Final KYR instruments adapted to the Ghanaian context including guide for debrief meetings/focus group discussions/in-depth interviews
  • Report of debrief meetings/focus group discussion
  • Cleaned and fully labeled KYR data set (on CD or submitted electronically) in STATA or SPSS & relevant documentation
  • A copy of the codebook and any other data documentation
  • Frequency distribution of KYR data (electronic copy)
  • Dissemination/data use workshop report & action plans
  • Maps depicting geographic location of current HIV-prevention programs (as agreed)
  • Report describing data collection procedures, supervisor observations/comments, and limitations/problems encountered
  • Data quality report from the testing of different data collection methodologies
  • Monthly reports of the progress of the study to cover the periods indicated below
  • Written contributions to the final KYR analysis report, as per mutual agreement
  • Budget

Separate budgets should be submitted for:

(a) Quantitative component of the study (Program Implementers Core Questionnaire, Program Implementers Module, District Questionnaire – Health Facility Module, District Questionnaire – Government non-Health Sector HIV-prevention Module)

(b) Qualitative component of the study (debrief meetings/focus group discussions/in-depth interviews; Policy Checklist; Strategic Information Checklist, data verification)

(c) Dissemination seminar in Accra

Selection Criteria for Proposals:

Proposals will be reviewed based on their overall technical merit. The following criteria will be used:

  • Technical merit of proposed overall approach to pilot test implementation in Greater Accra, Ghana
  • Relevance of questions proposed for inclusion in the discussion guide for the debrief meetings/focus group discussions/in-depth interviews
  • Technical merit of the proposed methodology for validating program Implementers' and district health officers' reports including strength of sampling strategy and justification of sample size)
  • Technical merit of proposed methodology for ensuring a complete and up-to-date list of program implementers in each district in the Greater Accra Region
  • List of potential respondents (titles and organizations only) for the following instruments:
    - Policy Checklist (at least 8 proposed respondents)
    - Strategic Information Checklist (at least 8 proposed respondents)
    - District officers for the Government Non-Health Sector HIV-Prevention Module of the District Questionnaire (at least 3 proposed respondents)
  • Ethical procedures
  • Demonstrated capacity and experience of the organization to conduct similar surveys and to complete activities within the stipulated timeline
  • Demonstrated technical expertise in quantitative and qualitative interviewing and GIS. GIS expertise is an added advantage in the application, though not strictly required. The local research organization will work in conjunction with Ghana AIDS Commission and MEASURE Evaluation geographic and spatial analysis staff to produce the relevant maps.
  • Qualifications and experience of key personnel
  • Budget clarity and justification

Quotation

Interested and qualified research organizations should present applications directly to MEASURE Evaluation. All applications must be received no later than January 11, 2013. Questions on the RFA will be taken up to December 3rd, 2012 and answers will be posted to the Web site no later than December 5th. Questions and Proposals may be submitted electronically to measure_rfp@unc.edu with a copy to Beth Sutherland (beth_sutherland@unc.edu)

All applications are to include:

  1. General approach to pilot test of toolkit instruments in the Greater Accra Region of Ghana
  2. Proposed questions (approximately 6) for inclusion in the discussion guide for the debrief meetings/focus group discussions/in-depth interviews with Toolkit respondents
  3. Proposed methodology for validating program implementers’ and district health officers’ reports for Program Implementers Tool and District Questionnaires
  4. Methodology for ensuring the Program Implementers Core Questionnaire and Module are administered to a complete and up-to-date list of program implementers in each district in Greater Accra, Ghana
  5. List of potential respondents (titles and organizations only) for the following instruments:
    i. Policy Checklist (at least 8 proposed respondents)
    ii. Strategic Information Checklist (at least 8 proposed respondents)
    iii. District officers for the Government Non-Health Sector HIV-Prevention Module of the District Questionnaire (at least 3 proposed respondents)
  6. Detailed budget
  7. Resumes or curriculum vitae of the Principal Investigator, field supervisors, and other key personnel
  8. Detailed description of data entry procedures, including software to be used and details of quality control procedures and procedures for data editing and cleaning
  9. A detailed description of ethical procedures
  10. Statement of organizational capacity including reports of similar surveys coordinated in the past three years.