Under the overall guidance of UNOPS / Stop TB
Partnership’s Deputy Directo...
Under the overall guidance of UNOPS / Stop TB
Partnership’s Deputy Director, The MDR TB Consultants’ scope is focused on
ensuring required Programmatic Management of Drug-resistant TB (PMDT) policy is
met and clinical protocol and guidelines are updated to reflect not only the
WHO’s latest recommendation but also the most recent best practices.
Additionally, consultants are expected to support the NTP to develop clear
clinical eligibility for a patient’s enrollment on Short Treatment Regimen (STR)
New Regimen (NR), provide hands-on clinical training, mentor health care
providers, and implement active Drug Safety Monitoring (aDSM).
The approach (model) for the MDR TB consultant
has the following key elements: 1) Supportive partnership with NTP/Ministry of
Health (MOH), (i.e. to help not to evaluate) with shared goals; 2) Working with
the NTP/MOH to increase the number of patients who will be enrolled/initiated
on MDR TB treatment through the implementation of new guidelines for MDR TB; 3)
Focus on clinic-based mentoring; 4) Coordination with WHO, USAID partners
(Bilateral, Challenge TB (CTB), Regional Green Light Committees (rGLC) and
other technical partners and 5) Ongoing remote support and communication with
NTP. Additionally, the MDR TB Consultants will ensure all supported countries
have comprehensive STR/NR implementation plans in place (Planning).
The
purpose of this Scope of Work is to engage MDR TB Clinical Consultants to
provide technical support, both clinical and programmatic for the expansion of
STR and NR for the treatment of MDR TB in all priority countries NTPs. The goal
is to scale up STR/NR through provision of specific clinical expertise to
translate WHO guidelines into implementation at the country level, hence the
need for engagement of high level consultants with strong clinical MDR TB
management experiences.
Overall expectations
for the consultant:
To work with priority countries NTPs and
build their capacity to successfully scale up STR/NR and support the rolling
out of the new guideline for the management of MDR TB. It is expected that the Consultants
would contribute to different areas of MDR care such as updated/revised
guideline and clinical protocol, training materials for STR/NR etc. the key
functions of the consultant will be:
1: Expand and
strengthen national MDR-TB care and treatment capacity to optimize the use of
current and novel regimens
- In view of
expected changes in policies from WHO, work with NTPs and in-country partners
to ensure that the review/update of policy/guidelines is not dragged on for
long to impact on implementation and slow the momentum gained in STR/NR
implementation.
- Work with
NTP and other stakeholders to develop/review/update clinical protocols for
implementation and scale up of STR and NR.
- Support
regimens selection/design for use in healthcare facilities for treatment of
drug resistant TB cases in line with WHO recommendations and based on country
TB drug resistance profile. Incorporate recent development and discussion on
the effectiveness and safety of injectable agents (IA) into the national
discussion.
- Review and
assess the processes and capacity of NTP in all aspects of STR/NR
implementation and identify partners providing technical assistance.
2:
Strengthen active TB drug safety monitoring (aDSM)
- Ensure all
NTP implement activities developed in their aDSM roadmaps to establish/strengthen
aDSM system to be used for all patients receiving new drugs or shorter regimen
- Assess if the
system for routine recording and reporting of adverse events/severe adverse
events (AEs/SAEs) for patient’s safety exists, if not, work with NTP and stakeholders
to develop a systems for AEs/SAEs reporting based on aDSM guidelines.
- In
collaboration with MDR Clinician and NTP, assess/determine the proportional of
various drugs toxicity profile among the current MDR cohort and provide this
information to be used to expand/adjust eligibility criteria for STR and NR
inclusion.
- Provide
support to strengthen the collaboration between NTP and National PV centers and
provide support for continuous collaboration of the two entities.
- Ensure that
all MDR TB treatment sites have Audiometry, ECG monitoring machine at the sites
and all have access to diagnostic facilities for clinical biochemistry tests
critical for patients monitoring and aDSM.
3: Improve
overall Drug Resistant TB (DR-TB) case finding
- Assess
lab/diagnostic capacity on GeneXpert network, culture, DST, Second Line Probe
Assay (2nd LPA), completeness of patient outcomes and overall availability of
lab results to guide patient management and provide recommendation to
lab/diagnostic to address any identified gap.
- Support in
the review of the diagnostic algorithm and optimization of the available lab/diagnostic capacity to
increase DR TB case finding.
- Work with
NTP and partners to expand the number of treatment sites that enroll patients
on STR/New regimen (scale up). Support in the development of DR-TB
decentralization plan for DR-TB services to ensure national wide access to DR
TB treatment.
- Support with
the increase in number of patients enrolled on STR and NR. Based on eligibility
criteria, support NTP and partners to periodically revise estimated number of
patients eligible for enrollment into STR/NR.
- Coordinate
with GDF and in-country procurement and supply chain (PSM) partners to ensure
quantification and forecasting figures for second line drugs, specially drugs
included in the new treatment regimen and companion drugs match the needs and
patient scale up plan. This is critical given the uncertainties about
quantities of drugs included in the STR and NR as programs work to design
effective and safe regimen, the needed to maintain stock levels, avoid stock
outs, and avoid over-ordering of drugs that will be needed.
4: Provide
training and mentoring in all areas to enhance the capacity to scale up STR/NR
and strengthen aDSM
- Develop/review/update
training material for service providers (doctors, nurses, consilium members,
supervisors and national PV center staff) to ensure they reflect current
recommendations and practices.
- Provide
hands on clinical training during workshops or one-on-one mentoring to
healthcare providers and NTP staff on optimal introduction and use of STR and NR
as part of the MDR TB treatment.
- In
collaboration with MDR TB clinicians, review and discuss MDR TB patient’s
clinical profile and determine those that would be eligible for STR and NR.
Ensure all eligible patients are enrolled and plan for scale up.
- Provide
ongoing remote support and communication with NTP and MDR TB Clinicians to
ensure timely clinical decisions are reached and patient management proceed
smoothly.
- Enhance
capacity of Consilium or Clinical Review Panels/Committees to systematic
documentation of clinical case decisions (both meeting minutes and in clinical
files) and support clinician managing patients at treatment sites. Ensure that
Consilium or Clinical Review Panels/Committee have formal Terms of References
(ToR) that clearly defined functions, responsibilities and meeting schedules.
5: Support
the improvement of quality of MDR TB treatment
- Support the
development and implementation of
patient-centered TB and MDR-TB quality service delivery sites and a
system for monitoring these sites.
- Work with
countries to develop, implement and scale up ancillary care packages to improve
MDR-TB patient treatment outcomes.
- Support the
development of TB adherence assessment tool and assist with its implementation.
Briefing and coordination
- At the end of each mission, consultant
will brief the Stop TB Partnership, the NTP, key stakeholders and Ministry of
Health officials on key findings and discuss mission main recommendations.
- Discuss the specific need for further
technical assistance on STR/NR implementation and potential partners to provide
needed consultancy.
- In countries where USAID has seconded
In-country GF Advisor, consultant is required to work with them for activity
implementation including discussions with MoH, NTP officials and partners.
Reporting
- Prepare a brief narrative maximum
2-pages (Trip Report) with highlights from the short term technical assistance
visit (STTA) with immediate action items to be submitted within 2-weeks of the
TDY
- If training was conducted, prepare a
training report with: total number of national TB program staff and health
workers (by gender) trained, training materials used during the workshop and
pre and post-training improvement in knowledge
- Technical Report- with the
recommendations to address the identified gaps in conjunction with Stop TB
Partnership, the NTP and any in country partners. The technical report should include:
number of patients (if any) that consultant has provided clinical review,
patient profile reviews, discussion with clinicians about adverse event
management on these patients and treatment option for patients who are newly
initiated on or continuing NR). Also finalized or reviewed or developed
clinical protocols and guidelines for STR/NR and adverse event management can
be annexed to the technical report. The report should also provide concrete and
feasible recommendations with a responsible person and a timeline. These
recommendations will be monitored for their level of implementation and
achievement.
The
MDR TB Clinical Consultants will support ALL USAID priority countries around
the world. Therefore, travel should be expected for over 30% of the time.