UNICEF UKRAINE
TERMS OF REFERENCE
National consultant for the development of the Guideline and Protocol on Prevention of
Mother-to Child Transmission of HIV (PMTCT) (obstetrician-gynaecologist)
Duration: July - November 2013, five months
1. Purpose of Special Service Agreement:
To revise and develop the relevant part of the guideline (Order of the Ministry of Health, Ministry
of Education and Science of Ukraine, Ministry of Family, Youth and Sport of Ukraine, State
Penitentiary Department of Ukraine and the Ministry of Labour and Social Policy of Ukraine #
№740/1030/4154/321/614а, approved 23.11.2007) and the Clinical Protocol on Obstetric Care
“Prevention of Mother-to-Child Transmission of HIV” # 716 of 14.11.2007).
Background
Despite a good progress in the coverage of services on prevention of mother-to-child transmission
(PMTCT) in Ukraine, there are serious issues and challenges that remain not addressed. There are
some substantial systematic gaps in a programme management, including quality of HIV
counselling and testing and quality of and access to PMTCT services for women at high risk for
HIV infection, especially those, who use injection drugs.
Low uptake of health services, including antiretroviral treatment (ART) among female HIVpositive women who inject drugs is a well-recognised problem. Because drug-using pregnant
women often receive prenatal care only towards the end of their pregnancy or attend a clinic for
the first time for the delivery, they miss out on the possibility of taking the both preventative
course of ART and standard ART. Maintaining access to ART for women with treatment
indications remains a priority in Ukraine. Close to 50% of pregnant women still received less
effective monotherapy ART course and 5% of women received no ART. Close to 15% of women
who were diagnosed late and received much less effective ART or not received it at all, had an
IDU history. A quarter of them had an IDU partner. The MTCT rate was 4.1% among women
receiving antenatal combination of three ART (cART) and 22.9% among untreated women.1
Whereas there has been good success in delivering medical services, less attention has been paid
to the other interventions, and there remain challenges even to further sustained progress in
medical component of the PMTCT strategy that would allow reaching the 2015 goal of
elimination of mother-to-child transmission rate. Ongoing gaps include late access of services by
marginalized women, often tied to stigma; difficulty in accessing multiple systems of care; weak
systems of follow up of HIV-positive women after delivery; inadequate support for social services
to meet the special needs of HIV-infected pregnant women and new mothers; and gaps in health
care worker knowledge and attitudes about the needs of this population.2
National PMTCT protocols are consistent with WHO/EURO recommendations, however, having
been updated in 2007. Ukraine has adopted the Option B/B+, as outlined in the 2012 WHO
Programmatic Update on the Use of ARVs for Treating Pregnant Women and Preventing HIV
Infection in Infants. To support the planning and implementation of Option B/B+, and to help
Ukraine in scaling up more effective interventions and programmes to achieve the goals of the
1
Dr Claire Thorne, UCL Institute of Child Health, University College London. Report on injecting drug use in pregnant HIVpositive women in Ukraine: data from the Ukraine European Collaborative Study and the Cohort Study of HIV-infected
childbearing women. September, 2012.
2
R.J. Simonds, 2012 Ukraine National AIDS Programme Assessment PMTCT Summary Report,
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Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and
Keeping their Mothers Alive, there is a need in revision of the outdated existing guidelines and
development of a new clinical protocol on PMTCT.
New guideline and protocol on PMTCT has to correspond to the modern testing policies and
outline a new approaches introducing integration of HIV testing, treatment, and care services for
drug using pregnant women, including the postnatal continuation of ART and opioid substitution
treatment for women with respective indications. This is crucial for preventing maternal and
pediatric morbidity and mortality, MTCT and poor outcomes in HIV-exposed infants, including
those associated with maternal illness and orphanhood.
It is expected that the revised regulation in the area of PMTCT should contribute to the
formulation of the future PMTCT interventions related to the pregnant women, including most at
risk and vulnerable to HIV in a context beyond the medical.
2. Objectives of the Special Service Agreement with expected results / outcome /
products /sub products/outputs:
The objectives are:
 To revise a of existing regulation in part related to the management of pregnant women
- Order of the Ministry of Health, Ministry of Education and Science of Ukraine, Ministry
of Family, Youth and Sport of Ukraine, State Penitentiary Department of Ukraine and
the Ministry of Labour and Social Policy of Ukraine # №740/1030/4154/321/614а,
approved 23.11.2007) (hereinafter Guideline) – part I, II, III and IV
 The Clinical Protocol on Obstetric Care “Prevention of Mother-to-Child Transmission
of HIV” # 716 of 14.11.2007); (hereinafter Clinical Protocol) – Clinical scenarios of
PMTCT; Delivery Management, PMTCT in HIV infected pregnant women with active
tuberculosis and Management of drug using pregnant women:
 To update the existing regulation, developing the respective parts of the mentioned above
guideline and protocol.
Results expected:
- Revised and updated Guideline and Clinical Protocol on PMTCT are corresponded to
the recommended international standards;
Outputs:
1. Review of the existing Guideline and Clinical Protocol in parts of management of pregnant
women;
2. Presentation of the results of revision of the respective parts of existing regulation
(guideline and clinical protocol on PMTCT) at the Working Group;
3. Presentation of the updated parts related to the management of pregnant women of the
guideline and clinical protocol at the Working Group .
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The final Guideline revised and developed has to contain the following parts:
I.
General Provisions outlining the medical and social sectors interrelations and division
of responsibilities;
II.
Organization of HIV Prevention among Women, including counselling and testing
issues
III.
Organization of Family Planning Services for HIV Infected People, including a
method of contraception for HIV-positive women, medicines contraindications and drug
interactions
IV.
Organization of Medical and Social Services to HIV Infected Mothers, Women in
Childbirth and Women Recently Confined:
 Organization of out-patient health and social services to HIV infected pregnant
women;
 Organization of in-patient health care for HIV infected pregnant women, women in
childbirth and women recently confined, including a rapid testing on HIV in labour;
 Organization of health and social services for children born to HIV infected mother,
including algorithm of confirmation of HIV diagnosis among children.
V.
Organisation of integrated medical and social services for most at risk and
vulnerable to HIV drug using women
VI.
The Procedures for Prevention of Mother-to-Child Transmission of HIV in the
Facilities of the State Criminal Executive Service of Ukraine
VII.
-
Provision of Health Care and Social Support to HIV Infected Children:
General Provisions
HIV diagnostics in children
Out-patient clinical medical services to HIV infected children
In-patient health care to HIV infected children
Rehabilitation and sanatorium or resort treatment for HIV infected children
Health care for children in pre-school facilities, secondary schools, schools of general
education, vocational training schools and higher educational institutions all level of
accreditation of all forms of ownership
Medical follow-up for HIV infected orphans and children deprived of parental care in
institutions (children’s home of the MOH of Ukraine, orphanages and boarding schools
of the MOES of Ukraine, boarding schools of the Ministry of Social Policy and
alternative forms of families)
Medical and social support on the basis of multidisciplinary approach
Social follow-up for HIV infected children
-
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The final Clinical Protocol revised and developed has to contain the following parts:

Clinical Classification of HIV Infection in Adults

Examination of pregnant women

Clinical scenarios of PMTCT

Contraindications to ARV therapy in pregnant women
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
Delivery Management

PMTCT in HIV infected pregnant women with active tuberculosis

Management of drug using pregnant women:






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Assessment of drug addiction and withdrawal symptoms in pregnant women
Impact of psychoactive substances and withdrawal syndrome during pregnancy
Counseling and treatment of patients with drug addiction
Management of HIV infected pregnant women, who turned to the clinic at delivery and
had not received antenatal care
Pain management
Management of the newborns with neonatal withdrawal syndrome
Treatment of withdrawal syndrome in the newborn infants

Rapid Testing on HIV Algorithm
3. Delivery dates based on the work plan (to be approved by UNICEF HIV/AIDS
Officer):
 Monthly reports (by the 5th day of the following month);
 Report on revision of the existing Guideline with recommendations of updates– 20 July,
2013;
 Presentation on the analysis of the respective parts of existing Guideline at the Working
Group on development of new regulation – 25 July, 2013;
 Draft of the Guideline – August, 2013;
 Report on revision of the perspective to the parts of existing Clinical Protocol with
recommendations of updates– 10 August, 2013;
 Presentation on the analysis of respective parts of existing Clinical Protocol at the
Working Group on development of new regulation – 20 August, 2013;
 Draft of the Clinical Protocol – September, 2013;
 Presentation on the draft of the respective part of the Clinical Protocol, related to the
management of pregnant women, at the Working Group on development of new
regulation – 25 September, 2013;
 Final report with the final version of the Guideline and Clinical Protocol - by 20
November, 2013.
4. Details of how the work should be delivered:
The consultants have to develop and submit to UNICEF monthly reports and final report.
5. Performance indicators for evaluation of results:
The evaluation of results will be based on the following indicators:
 Technical and professional competence (will be measured by the quality of product provided
to UNICEF and feedback from UNICEF and the Ministry of Health, UCDC and State Service
on HIV/AIDS and Other Socially Dangerous Diseases)
 Quality of work (timely submission of the monthly reports and final product to UNICEF)
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 Quantity of work (completing the assignments indicated in parts 2, 3, and 4 above)
 In addition such indicators as work relations, responsibility and communication will be taken
into account during the evaluation of the consultant’s work.
6. Qualifications/specialized knowledge/experience required to complete the task:
a. An advanced university degree in Medicine and academic degree in medical sciences;
b. At least ten years of practical experience in HIV/AIDS area, including practical experience of
work with HIV-positive women;
c. Recorded experience of development of regulation (clinical protocols and guidelines),
education and training materials in the area of PMTCT related to the issues of obstetricsgynaecology and management of pregnancy;
d. Strong writing, organisational and managerial skills;
e. Experience of work and good relationship with the state partners (regional health care
institutions, local AIDS Centres, UCDC and State Service on HIV/AIDS and Other Socially
Dangerous Diseases) and HIV-services organisations;
f. Knowledge and understanding of the newest international experience and recommendations
in the area of PMTCT;
7. Definition of supervision arrangements:
Consultant will be supervised by the HIV/AIDS Officer, UNICEF Ukraine.
8. Description of official travel involved:
Travels may be envisaged to the project sites within the country. The local travel will be paid
separately. No travel shall be undertaken prior to completing the UN Basic and Advanced
Security in the Field Courses. The consultant is required to certify being covered by
medical/health insurance.
9. UNICEF recourse in the case of unsatisfactory performance:
In the event of unsatisfactory performance, UNICEF reserves the right to terminate the
Agreement. In case of partially satisfactory performance, such as serious delays causing the
negative impact on meeting the programme objectives, low quality or insufficient depth and/or
scope of the assessment completion, UNICEF is entitled to decrease the payment by the range
from 30 to 50%.
10. Support provided by UNICEF:
Technical assistance, consultations, funding.
The deadline for submission of applications is 10 July 2013.
Only short-listed candidates will be contacted.
Applicants that fulfil the above requirements are requested to complete a
United Nations Personal History Form (P. 11) which is available at a web5
site www.unicef.org/employ and submit it together with a resume/CV and
a cover letter describing your professional interests in working for UNICEF.
Applications should be sent to:
UNICEF Office, 1, Klovskiy Uzviz, Kyiv, Ukraine
Fax No. 380-44-230-2506
E-mail: ttarasova@unicef.org , vlupan@unicef.org (Please indicate National consultant
(obstetrician-gynaecologist) in the subject of your application)
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