Laboratory Scientist for Rollout of Antiretrovial Therapy in Zimbabwe
The Ministry of Health and Child Care introduced antiretroviral therapy into the public sector in 2004 with the aim of reducing HIV related morbidity and mortality as well as improving the quality of life for people living with HIV in Zimbabwe. Implementation was initially guided by the Rollout of ART 2004-2007 followed by the Plan for the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe, 2008-2012 then subsequently the Plan for the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe, 2013-2017. As a result of high commitment by government and its funding, technical and implementing partners at all levels, the programme has expanded rapidly over the years, from 5 sites in 2004 to nearly 1600 sites by end of 2016, including 1566 ART initiating sites. The number of people accessing ART has increased from 11,000 to over 975,567 adults and children over the same period.
During implementation of the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe 2013 – 2017 it was noted that there were huge disparities between treatment coverage among children and adolescents when compared to adults. This realisation lead to the development of the Accelerated Action Plan for the scale up of Antiretroviral Treatment for Children and Adolescents, 2015 – 2018 which outlined interventions to help scale up access to ART care and treatment in this population. Through implementation of the scale up plan service delivery was rearranged to ensure identification of children living with HIV through various entry points as well as linkage to treatment and care and this initiative lead to an increase in CLHIV on treatment from 55,061 in 2014 to 66,159 by the end of 2016.
Against a background of the ambitious goals set by the country to achieve the MDGs by 2015 and subsequently the SDGs by 2030, the government also developed a strategic framework for public private partnerships for TB and HIV prevention, treatment, care and support (2014 – 2016), to galvanize the critical input that the private sector will play in the national response. Through this framework, several partnerships with the private sector were established during implementation of the HIV care and treatment strategy which resulted in further decentralization of services and increased ART coverage for both children and adults.
To address the following 3 key questions in terms of controlling the HIV epidemic:
- Has there been a significant change in outcomes and impact?
- Are these changes plausibly related to program impact?
- How can programs be better focused on impact going forward?
The country with support from the World Health Organization and the National AIDS Council commissioned an epi and impact review towards the end of 2016. The following were some of the key findings from the assessment undertaken:
- HIV prevalence had remarkably declined for the periods 2000-5’ 2005-10 and this decline was extending up to 2015;
- HIV incidence had significantly reduced from 1.48 in 2011 to 0.98 in 2013 and then to 0.48 in 2016;
- HIV related mortality had significantly been reduced [66% reduction in adult (15 – 49) mortality since 2003] suggesting a major impact of HIV treatment on deaths and new TB notifications [were also significantly declining;
- Overall the treatment cascade was showing low leakage with strong referral to care (97%), enrolment in care (88%) and some gaps from enrolment to newly initiating on ART (27%);
- Viral load suppression among those on treatment was relatively high (86.5%) with gaps still prevalent in viral load testing coverage (17% by end of 2016) and VL suppression among men [which was still relatively lower compared to their female counterparts];
- HIV treatment cascades among key populations was showing high leakages in comparison to the general population with significant gaps noted in the younger casual sex workers (CSWs) less than 25 years.
Findings from the proposed programme review are therefore expected to inform the development processes and strategies that the national programme should take up to steer the country towards meeting the 2020 Global UNAIDS 90 90 90 targets as well as the BE FREE framework superfast targets for children, adolescents and young people which it is party to.
Duties and Responsibilities
Scope of work
The main role for the lab scientist is to contribute to the overall review of the implementation of the Plan for the Nationwide Rollout of Antiretroviral Therapy in Zimbabwe 2013-2017 particularly focusing on the laboratory services. The lab scientist will principally focus on quality, access, effectiveness, efficiency, equity, relevance, sustainability and impact of laboratory support for HIV care and treatment, including HIV/TB co management, in Zimbabwe. More specifically, the roles of the lab scientist will include:
- To determine the current status of laboratory diagnostic and monitoring services for HIV care and treatment, including TB/HIV collaboration, in Zimbabwe
- To review key components of laboratory services, including infrastructure, human resources, financing, quality management, supply chain management and laboratory management information systems
- To review the current status of laboratory services in HIV Care & Treatment monitoring and evaluation systems including HIV surveillance and operations research
- To review the laboratory quality assurance processes and outcome- both IQC and EQA; including proficiency testing of HIV rapid testing.
- To identify and document strengths, weaknesses, opportunities and threats for the laboratory services
- To assess satisfaction levels from facilities with respect to the current laboratory services particularly with respect to turn-around time.
- To make recommendations on how laboratory services can be improved to maintain and sustain the response towards universal quality access of comprehensive services
The lab scientist will contribute towards the production of the following deliverables by the review team:
- An inception report detailing how the proposed review will be carried out;
- Comprehensive preliminary programme review report that addresses all the review objectives and detailing achievements, best practices, lessons learnt and challenges at the end of the review period;
- A debrief power point presentation to the MoHCC management and the National Partnership Forum for TB and HIV Care & Treatment;
- A final detailed report with an executive summary indicating identified and prioritized practical recommendations is to be submitted to the AIDS & TB Unit, MoHCC within a month after the end of the assignment. This should also be provided as both electronic and hard copies.
Desk review: Conduct an overall assessment of the OI/ART programme through a review of all the relevant documents including policy documents, annual reports, guidelines, plans or study reports.
- Key informant interviews: Conduct a range of interviews with key informants at all levels of the health delivery system including managers within the MoHCC, AIDS & TB Unit, DLS, PMDs, Provincial TB & HIV focal persons, Provincial Scientists, DMOs, PNOs, DNO, District Scientists, Focal persons, NAC, PLHIV, Community Health Workers, Health Training Institutions, health workers partners and key stakeholders, private sector, NATPHARM and Laboratory Logistics Unit, community leaders and the targeted beneficiaries of the services i.e PLHIV.
- Field visits: Conduct site visits to a representative sample of health facilities at different levels of the health delivery system, different geographical regions, mission hospitals and the private sector.
- The Lab Scientist will report to the team leader in charge of the review process.
- Familiar with the health delivery system in Zimbabwe;
- Good communication skills;
- Excellent writing and analytical skills.
Required Skills and Experience
- Degree in medical laboratory sciences with post graduate qualifications.
- At least 5 years of experience in working in the field of HIV and AIDS;
- At least 5 years of’ experience in Laboratory Quality Management Systems;
- At least 5 years of experience in Quality systems implementation.
- Fluent in English.