GRAIL PROJECT TECHNICAL REVIEW At Caritas

Since 2016, Caritas Internationalis, in collaboration with its national members Caritas Nigeria, Caritas Congo ASBL and Caritas Côte d’Ivoire, as well as with UNAIDS and PEPFAR, has successfully implemented the GRAIL Project[1].

1.1 Purpose of GRAIL

The GRAIL project has been created to reinforce the role of religious leaders to support identification of HIV-positive children and their referral for proper interventions. Through GRAIL, religious leaders of faith communities are trained on pediatric HIV, including pastoral and scientific tools and information, and to deliver audience-appropriate HIV and AIDS prevention and stigma reduction messaging to their communities. The trained clergy servs as a bridge between their communities and identified health centers by leading teams of Church Health Advisors (ideally serving or retired health workers and volunteers). The teams target high risk mother and child pairs tracking their immunization status; recurrence of symptoms of communicable diseases like fevers, diarrheal disease, respiratory tract infection and skin infections. The teams are assisted by screening tools like the Bandason Checklist, and provided or referred for HIV testing, counselling and ART initiation where necessary. Co-morbidities diagnosed in children living with HIV are also managed in the referral health centers.

GRAIL has been implemented by national Caritas, namely Caritas Nigeria and Caritas Congo ASBL, where religious Pediatric HIV Champions supported community-based Medical Outreaches focused on children 0-5 and 5-10. During those Medical Outreaches, Caritas Nigeria, in collaboration with local Church Health Teams, local health facilities, Catholic Relief Services-Nigeria, and Caritas Congo ASBL provided non-invasive medical screening tests for children (malnutrition, febrile illness, Tuberculosis Risk Profiling using Tuberculosis Symptom Checklist, HIV risk profiling using Bandason Tool, etc.) which did not require needle pricks or blood samples; eye examinations for refractive errors and visual defects; and over-the-counter prescriptions for common childhood conditions (flu medicines, therapeutic foods/nutritional supplements, vitamins, work expellers, malaria prophylaxis). Moreover, Caritas Nigeria and Caritas Congo ASBL worked with the staff of the local health facility to ensure referral of children with suspected case of HIV.

1.2 Objectives

GRAIL’s main objective is to reduce 10% the treatment gap in the selected countries (Nigeria, Cote d’Ivoire and DRC) via the below activities:

a. Training sessions for Religious leaders to raise awareness and scientific based knowledge on pediatric HIV

b. Religious leaders’ Anti-stigma and discrimination messages and activities in their communities

c. Medical outreaches and medical screening

d. Community and health facility linkage

1.3 Expected outcomes

The outcomes of the GRAIL project are:

a. Increase the number of religious leaders aware of pediatric HIV.

b. Increase the number of children with access to screening and treatment

c. Reinforcing the health capacity of the health system to identify areas with high pediatric HIV treatment gaps and act upon.

1.4 Results

Over the implementation period in selected remote and hard-to-reach areas of Nigeria[2] and DRC[3], including areas affected by protracted humanitarian crisis, religious leaders reached more than 60,000 women, men and children with age-appropriate HIV messaging, referring over 22,000 children for proper HIV testing in adapted faith-based health facilities. Among them, 150 were diagnosed with HIV and put under adapted life-saving treatment.

1. Purpose and Objectives of the TOR

In order to move from a pilot to a proper sustained project approach, UNAIDS and PEPFAR suggested Caritas Internationalis to include a Technical Review of GRAIL within its 2021-2022 Work Plan for the UNAIDS-PEPFAR FBO Initiative.

The Technical Review, which will be led by Caritas Internationalis with the support of selected CI Member Organizations, an independent consultant and experts from UNAIDS and PEPFAR, should last for about 2 months. Outcomes will serve to adjust the project and develop next phase. Few aspects of amelioration could already identify:

· Data gathering and processing;

· Monitoring of referrals;

· Monitoring of stigma reduction activities.

The outcomes of the Technical Review will be used for informing the Narrative Report of Caritas Internationalis to UNAIDS for the UNAIDS-PEPFAR FBO Initiative 2021-2022 as well as for offering a scientific and sustainable basis to future GRAIL activities – in particular those aimed at reducing the pediatric HIV treatment gap through referrals done by religious leaders.

2.1 Tasks

· Identifying Caritas relevant internal and external partners (UNAIDS, PEPFAR, US Center for Diseases Control, relevant national stakeholders such as NACA and other FBOs involved in the GRAIL Project);

· Organizing and leading virtual and/or in-person interviews and field visits with Caritas IPS;

· Organizing and leading virtual and/or in-person meetings with Caritas internal and external partners

· Identifying elements of linkage between GRAIL and baby shower model

· Identifying the added value of GRAIL compared to other FBOs activities on pediatric HIV especially those financed by PEPFAR;

· Identifying GRAIL main aspects that need further assessment and amelioration including data comparison to national baseline and retention rates;

· Identifying opportunities for enhancing the project and suggesting way forward.

· Preparing the final Narrative Report for UNAIDS.

The total number of days for this consultancy is estimated at approximately 30 days. Final report to be submitted by end of June, 2022

2.2 Reporting Requirements:

1. A comprehensive report (max 20 pages plus annexes) addressing all the Technical Review and covering its objectives, illustrated with concrete examples, with clear recommendations for follow up
2. A summary report (max 5 pages) highlighting the main findings.

2.3 Requirements to a candidate:

The consultant will be selected through transparent recruitment process, based on professional experience and competence.

The consultant must have the following demonstrated experience and competences:

1. Proven experience in evaluating HIV-related multi-country programs, with special focus on pediatric HIV
2. Knowledge of the basic implementation logic of the GRAIL Project is desirable
3. Working experience in Caritas and knowledge of Caritas Confederation work
4. Understanding of Caritas principles and values (including Catholic Social Teaching) and Catholic Church structure and work in general
5. Advanced technical knowledge in evaluation methodologies and techniques
6. Strong qualitative and quantitative data collection, analysis and synthesis skills
7. Excellent English language skills, knowledge of French is desirable

[1] GRAIL stands for Galvanizing Religious Actors for better Identification and Linkage to pediatric HIV. This project, launched in 2017 by Caritas Internationalis with the support of UNAIDS and the U.S. President’s Plan for AIDS Relief (PEPFAR) has been implemented in Republic of Nigeria and Democratic Republic of the Congo in coordination and cooperation with Caritas Nigeria and Caritas Congo ASBL.

[2] South East (Enugu, Ebonyi, Imo, Abia, Riers, Cross River); South West (Edo, Ondi, Oyo, Osun, Ogun, Lagos), North Central (FCT, Kaduna, Nasarawa, Benue) and North East (Adamawa, Taraba, Bauchi, Borno, Yobe). All zones have been selected in consultation with UNAIDS Nigeria and the National Agency for the Control of AIDS considering UNAIDS Priority States, pediatric HIV prevalence and availability of faith-based health facilities.

[3] Kisangani, Ubundu, Banalia and Yangambi. All zones have been selected in consultation with UNAIDS DRC and the Programme Nationale Multisectoriel pour la Lutte contre le SIDA considering UNAIDS Priority States, pediatric HIV prevalence and availability of faith-based health facilities.