Consultant

Needed: Consultant – Quality Of Care Study

Ministry Of Health,  HIV/STI/Tb Unit

Background:

Jamaica has an estimated HIV prevalence of 1.6% among the general population. It is estimated that 29,000 persons are currently living with HIV in Jamaica; but approximately 16% are unaware of their status. Between January 1982 and December 2015, thirty-four thousand one hundred and twenty-five (34,125) cases of HIV were reported to the Ministry of Health. Of these, 9,517 (27.9%) are known to be deceased.

The National HIV/STI Programme began monitoring cases of advanced HIV in July 2005 to reflect the need for treatment at an earlier stage of disease. Persons with advanced HIV include persons with CD4 count <350.  In 2015, six hundred and eighty-six (686) persons with advanced HIV (349 males and 337 females) were reported compared to 764 in 2014.

The AIDS mortality rate has declined from 25 deaths/100,000 population in 2004 to just over 9 deaths/100,000 population in 2015 which represents a 64% decrease since the inception of universal access to ARVs in 2004. Additionally, Spectrum modelling estimates also confirm this declining trajectory of AIDS deaths, but suggest that there may be several deaths that are not being reported as our reported deaths are only approximately 21% of the estimated number of deaths.In addition to the introduction of public access to antiretroviral treatment in 2004, scaling up of the national VCT programme and use of rapid test kits allowing for earlier diagnosis, availability of prophylaxis against opportunistic infections and improved laboratory capacity to conduct investigations such as CD4 counts, viral load and PCR tests are believed to have contributed to the decrease in deaths. However, although Jamaica has successfully increased access to treatment and care services; analysis of data related to viral suppression shows approximately 20% of PLHIV on treatment being undetectable. Failure to adhere to treatment and care is a barrier to further reducing AIDS morbidity and mortality. Treatment is currently provided through the Ministry of Health free to the public at twenty four adult clinics, and three NGO facilities. The guidelines for treatment have been updated to reflect the 2015 WHO Guidelines which recommend the initiation of treatment for all PLHIV once diagnosed. In order to encourage adherence the clinicians providing treatment, must be aware of and adhere to the National Guidelines. An assessment of the clinicians’ knowledge and use of current clinical management guidelines highlight one of the causes in the gap in the continuum of care and will inform the planning of training for this category of staff.

Objectives of Survey

1. To determine the compliance of clinicians treating PLHIV at treatment sites with the current treatment protocol including documentation practices
2. To identify the factors which facilitate ARV initiation and/or viral suppression
3. To establish level of awareness of the HIV Treatment protocols among clinicians treating PLHIV at treatment sites
4. To determine factors which influence clinicians diverting from the national Guidelines
5. To determine PLHIV perception of quality of care.

Qualifications

• Medical Degree from a recognized institution
• The expert must have a minimum of five (5) years medical clinical experience in the health sector and a proven HIV/AIDS experience.
• A graduate degree in Public Health or other equivalent qualification will be an asset.
• Must have good understanding of the Multi-sectoral approach to the HIV/AIDS response.
• Demonstrated knowledge and academic credentials in the field of public health/ HIV treatment, care and support/ HIV counselling/HIV/AIDS training.

Responsibilities

Scope of Work

The consultant will develop the methodology including site selection and sample size with the assistance of the M&E unit, MOH.

Relevant information will be extracted from dockets and from an interviewer-administered survey with clinicians in order to assess their knowledge and reported practice of current guidelines. Triangulation of the data collected from the clinicians with the information collected from the dockets will allow for verification of self-reported behaviour/compliance with guidelines.

Services to be assessed will include:

1. Clinicians’ attitude toward care of PLHIV and key populations, specifically MSM,TG, CSW and adolescents
2. Knowledge and use of treatment guidelines
3. Knowledge and use of lab monitoring guidelines
4. Knowledge and use of WHO staging
5. Knowledge and use of referral protocols
6. Provision of positive prevention message, including family planning
7. Knowledge and use of treatment site database
8. Knowledge of TB screening protocol
9. Knowledge of PEP protocol

A small random survey of clients will be done; using focus groups, to provide the patients’ perception of their care received, perceived gaps and recommendations to improve same. As they are the key beneficiaries, it is important to assess how they define quality of care to inform the training of clinicians. 

A written report will be submitted detailing the findings of the study, analysis of the results and a plan to improve the quality of care offered by clinicians in order to improve patient outcome and improve viral suppression rates and recommendations on standard of care being provided to PLHIV by clinicians compared to updated treatment guidelines.

Key Deliverables

1. A detailed workplan outlining the timeline for completion and payment required for each deliverable
2. Methodology to be used for quantitative data collection
3. Quantitative instrument to collect relevant information from dockets, clinicians regarding their knowledge of treatment protocol and perceived barriers to the provision of care.
4. Submission of Progress reports
5. Submission of Final report

Note

The Consultant will report directly to the Director, Treatment, Care and Support.

The contract period will run from August – October 2017.

Applications must be addressed to: Senior Director, Human Resource Management & Administration, Ministry of Health, 10a Chelsea Avenue, Kingston 5.

We thank all applicants for their interest; however, only shortlisted candidates will be contacted.

Contact

Senior Director

Human Resource Management & Administration

Ministry of Health

10a Chelsea Avenue,

Kingston 5.

Email: jobapplications.moh@gmail.com

Base Salary: Undisclosed