CONSULTANCY TO SUPPORT THE ANALYSIS OF BURDEN OF MATERNAL AND PAEDIATRIC HIV AND ITS RELATIONSHIP WITH CHILDHOOD CO-MORBIDITIES

TERMS OF REFERENCE

CONSULTANCY TO SUPPORT THE ANALYSIS OF BURDEN OF MATERNAL AND PAEDIATRIC HIV AND ITS RELATIONSHIP WITH CHILDHOOD CO-MORBIDITIES AND THE IMPACT ON CHILD MORTALITY

**Background and rationale

In 2011, more than 15 million women were living with HIV worldwide, of which about 1.5 million (10 per cent) were pregnant women. Without intervention, almost half of these women are likely to pass on infection to their children either during pregnancy, labour or breastfeeding . Despite current prevention efforts for mother-to-child transmission of HIV, every day, about 900 children are newly infected with HIV , ninety percent occurring in sub-Saharan Africa, where in some countries and communities the prevalence of HIV in women of childbearing age is about 25 per cent or more.

The past decade of antiretroviral treatment (ART) scale-up towards universal access has left children behind. Only 28 per cent of eligible children received ART compared to 57 per cent of adults in 2011. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday , of common childhood diseases such as pneumonia and diarrhoea; 30 percent die by age one and 50 per cent by the age of two years. While reducing the risk of MTCT of HIV to below 5 per cent is feasible, the ballooning of HIV-exposed uninfected children resulting from the success of PMTCT is still a major threat to child survival. Uninfected HIV-exposed children have a mortality risk twice that uninfected children born to mothers without HIV . These exposed uninfected children also have slower early growth and higher morbidity such as persistent diarrhoea, complicated malaria and pneumonia treatment failure.

Children born to HIV-positive women, whether HIV infected themselves or not, therefore are at increased risk of morbidity and mortality from common childhood illnesses and need to be identified early to effectively link them in follow up care. The international community has committed to accelerating progress on new-born, child and maternal survival, through “A Promise Renewed” (APR). This global movement aims at focusing on efforts on scaling up essential interventions to address diseases such as pneumonia, malaria, diarrhoea, and HIV, among others, to reduce child deaths. Understanding the burden of HIV disease in children from both the child survival and HIV lens; responses to date and the needed paradigm shift for moving forward, needs to be informed by careful analysis of epidemiological and maternal and child mortality data.

**Overall and specific objectives The consultant will help analyse the burden of maternal and paediatric HIV disease in sub-Saharan Africa and other epidemic typologies; determine HIV relationship to childhood-co-morbidities and impact on maternal and child mortality. More specifically, the consultant will:

1. Describe the levels, patterns and distribution of maternal and paediatric HIV in the different regions in Africa and make reference to other epidemic types;
2. Analyse the burden of, and assess the contribution of, other co-morbidities such as pneumonia, malaria, diarrhoea, meningitis, tetanus and measles, birth outcomes, among others, to child survival, mainly highlighting how they interface with HIV in different regions of Africa and make reference to other epidemic types
3. Assess child survival by maternal HIV-status (HIV-infected and non-infected mothers) and health status (nutrition, weight, and other birth complications)
4. Determine the overall impact of HIV and other co-morbidities on child mortality and by HIV-infected and HIV-exposed status.

**Approach The consultant will lead and work with a small technical working group made up of child survival and HIV programme and research experts to address the above objectives, including: a) Draft an outline of report. b) Data analysis and draft report. c) Presentation and discussion of preliminary results with UNICEF staff and technical working group as necessary. d) Revise draft report based on feedback from UNICEF staff and technical working group. e) Support the presentation and facilitation of discussions around the methodology and results of the analysis with the small technical working group and agree on key messages to inform the drafting of the priority action note. f) Support the preparation of a PowerPoint presentation for the high-level meeting to be held during the International Conference on AIDS and STIs in Africa (ICASA) conference in Cape Town, December 2013. g) Draft an article for publication in a peer reviewed journal

**Expected Deliverables 1. Draft final report 2. Meeting with the technical work group to discuss key results, assumptions and limitations 3. A PowerPoint presentation of key results for the high-level meeting 4. An article for publication in a peer-reviewed journal

**Qualifications and Professional Experience Required: • Postgraduate degree or training in medicine, epidemiology, public health, demography, statistics or a related social science and statistical modelling • At least 10-15 years of experience in HIV and health statistical modelling techniques, data analysis and report writing, including synthesis reports • Excellent knowledge of HIV/AIDS programming and recent global commitments and political declarations, including A Promise Renewed (APR) • Excellent communication, coordination, and facilitation skills. • Strong statistical and writing skills, capable of synthesizing a complex body of evidence into meaningful political or policy recommendations. • Excellent interpersonal skills and ability to work in a team, forging relationships and producing results in multi-cultural and multi-disciplinary settings within a tight deadline • Native-level command of English required

**Duration and Fees: 30 working days starting o/a 24 June 2013. Payment will be commensurate with the consultants experience and qualifications and be made based on satisfactory submission of deliverables (see above). The contractual procedures and payment will be according to UNICEF rules and regulation

**Supervision The consultant will work closely with staff at UNICEF New York including a small technical working group relevant for this assignment.

**Duty Station Most of the work is expected to be done off-site (consultant’s place of residence) but travel to UNICEF New York and other key stakeholder meetings might be required.

General Conditions of Contracts for the Services of Consultants / Individual Contractors 1. Legal Status The individual engaged by UNICEF under this contract as a consultant or individual contractors (the “Contractor”) is engaged in a personal capacity and not as representatives of a Government or of any other entity external to the United Nations. The Contractor is neither a "staff member" under the Staff Regulations of the United Nations and UNICEF policies and procedures nor an "official" for the purpose of the Convention on the Privileges and Immunities of the United Nations, 1946. The Contractor may, however, be afforded the status of "Experts on Mission" in the sense of Section 22 of Article VI of the Convention and the Contractor is required by UNICEF to travel in order to fulfill the requirements of this contract , the Contractor may be issued a United Nations Certificate in accordance with Section 26 of Article VII of the Convention. 2. Obligations The Contractor shall complete the assignment set out in the Terms of Reference for this contract with due diligence, efficiency and economy, in accordance with generally accepted professional techniques and practices. The Contractor must respect the impartiality and independence of UNICEF and the United Nations and in connection with this contract must neither seek nor accept instructions from anyone other than UNICEF. During the term of this contract the Contractor must refrain from any conduct that would adversely reflect on UNICEF or the United Nations and must not engage in any activity that is incompatible with the administrative instructions and policies and procedures of UNICEF. The Contractor must exercise the utmost discretion in all matters relating to this contract.
In particular, but without limiting the foregoing, the Contractor (a) will conduct him- or herself in a manner consistent with the Standards of Conduct in the International Civil Service; and (b) will comply with the administrative instructions and policies and procedures of UNICE relating to fraud and corruption; information disclosure; use of electronic communication assets; harassment, sexual harassment and abuse of authority; and the requirements set forth in the Secretary General's Bulletin on Special Measures for Protection from Sexual Exploitation and Sexual Abuse.
Unless otherwise authorized by the appropriate official in the office concerned, the Contractor must not communicate at any time to the media or to any institution, person, Government or other entity external to UNICEF any information that has not been made public and which has become known to the Contractor by reason of his or her association with UNICEF or the United Nations. The Contractor may not use such information without the written authorization of UNICEF, and shall under no circumstances use such information for his or her private advantage or that of others. These obligations do not lapse upon termination of this contact. 3. Title rights UNICEF shall be entitled to all property rights, including but not limited to patents, copyrights and trademarks, with regard to material created by the Contractor which bears a direct relation to, or is made in order to perform, this contract. At the request of UNICEF, the Contractor shall assist in securing such property rights and transferring them to UNICEF in compliance with the requirements of the law governing such rights. 4. Travel If UNICEF determines that the Contractor needs to travel in order to perform this contract, that travel shall be specified in the contract and the Contractor’s travel costs shall be set out in the contract, on the following basis:

(a) UNICEF will pay for travel in economy class via the most direct and economical route; provided however that in exceptional circumstances, such as for medical reasons, travel in business class may be approved by UNICEF on a case-by-case basis.

(b) UNICEF will reimburse the Contractor for out-of-pocket expenses associated with such travel by paying an amount equivalent to the daily subsistence allowance that would be paid to staff members undertaking similar travel for official purposes.

1. Statement of good health Before commencing work, the Contractor must deliver to UNICEF a certified self-statement of good health and to take full responsibility for the accuracy of that statement. In addition, the Contractor must include in this statement of good health (a) confirmation that he or she has been informed regarding inoculations required for him or her to receive, at his or her own cost and from his or her own medical practitioner or other party, for travel to the country or countries to which travel is authorized; and (b) a statement he or she is covered by medical/health insurance and that, if required to travel beyond commuting distance from his or her usual place or residence to UNICEF (other than to duty station(s) with hardship ratings “H” and “A”, a list of which has been provided to the Contractor) the Contractor’s medical/health insurance covers medical evacuations. The Contractor will be responsible for assuming all costs that may be occurred in relation to the statement of good health.
2. Insurance The Contractor is fully responsible for arranging, at his or her own expense, such life, health and other forms of insurance covering the term of this contract as he or she considers appropriate taking into account, among other things, the requirements of paragraph 5 above. The Contractor is not eligible to participate in the life or health insurance schemes available to UNICEF and United Nations staff members. The responsibility of UNICEF and the United Nations is limited solely to the payment of compensation under the conditions described in paragraph 7 below.
3. Service incurred death, injury or illness If the Contractor is travelling with UNICEF’s prior approval and at UNICEF's expense in order to perform his or her obligations under this contract, or is performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval, the Contractor (or his or her dependents as appropriate), shall be entitled to compensation from UNICEF in the event of death, injury or illness attributable to the fact that the Contractor was travelling with UNICEF’s prior approval and at UNICEF's expense in order to perform his or her obligations under this contractor, or was performing his or her obligations under this contract in a UNICEF or United Nations office with UNICEF’s approval. Such compensation will be paid through a third party insurance provider retained by UNICEF and shall be capped at the amounts set out in the Administrative Instruction on Individual Consultants and Contractors. Under no circumstances will UNICEF be liable for any other or greater payments to the Contractor (or his or her dependents as appropriate).
4. Arbitration (a) Any dispute arising out of or, in connection with, this contract shall be resolved through amicable negotiation between the parties.

(b) If the parties are not able to reach agreement after attempting amicable negotiation for a period of thirty (30) days after one party has notified the other of such a dispute, either party may submit the matter to arbitration in accordance with the UNCITRAL procedures within fifteen (15) days thereafter. If neither party submits the matter for arbitration within the specified time the dispute will be deemed resolved to the full satisfaction of both parties. Such arbitration shall take place in New York before a single arbitrator agreed to by both parties; provided however that should the parties be unable to agree on a single arbitrator within thirty days of the request for arbitration, the arbitrator shall be designated by the United Nations Legal Counsel. The decision rendered in the arbitration shall constitute final adjudication of the dispute.

1. Penalties for Underperformance Payment of fees to the Contractor under this contractor, including each installment or periodic payment (if any), is subject to the Contractor’s full and complete performance of his or her obligations under this contract with regard to such payment to UNICEF’s satisfaction, and UNICEF’s certification to that effect.
2. Termination of Contract This contract may be terminated by either party before its specified termination date by giving notice in writing to the other party. The period of notice shall be five (5) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a total period of less than two (2) months and ten (10) business days (in the UNICEF office engaging the Contractor) in the case of contracts for a longer period; provided however that in the event of termination on the grounds of impropriety or other misconduct by the Contractor (including but not limited to breach by the Contractor of relevant UNICEF policies, procedures, and administrative instructions), UNICEF shall be entitled to terminate the contract without notice. If this contract is terminated in accordance with this paragraph 10, the Contractor shall be paid on a pro rata basis determined by UNICEF for the actual amount of work performed to UNICEF’s satisfaction at the time of termination. UNICEF will also pay any outstanding reimbursement claims related to travel by the Contractor. Any additional costs incurred by UNICEF resulting from the termination of the contract by either party may be withheld from any amount otherwise due to the Contractor under this paragraph 10.
3. Taxation UNICEF and the United Nations accept no liability for any taxes, duty or other contribution payable by the consultant and individual contractor on payments made under this contract. Neither UNICEF nor the United Nations will issue a statement of earnings to the consultant and individual contractor.

How to apply:

Qualified candidates or institutions are requested to submit a cover letter, CV and P-11 form (which can be downloaded from our website at http://www.unicef.org/about/employ/index_53129.html) topdconsultants@unicef.org by 14 June 2013 with subject line: Consultancy to support the analysis of burden of maternal and paediatric HIV and its relationship with childhood co-morbidities and the impact on child mortality. Please indicate your ability, availability and expected daily fee/rate to undertake the terms of reference above. Joint applications of two or more individuals are not accepted.