TERMS  OF  REFERENCE  FOR  ROUND  2  OF  THE  INTEGRATED  BIO-­‐BEHAVIORAL  
SURVEILLANCE  SURVEY  FOR  KEY  POPULATIONS  IN  LESOTHO  
 (Female  Sex  Workers  and  Men  who  have  Sex  with  Men)    
 
1.0  BACKGROUND  
According   to   the   Lesotho   Demographic   Health   Survey   (LDHS,   2014),   HIV   prevalence   amongst  
Basotho  women  and  men  aged  15-­‐49  has  increased  from  23%  in  2009  to  25%  in  2014.    This  can  
be  attributed  to  a  rise  in  new  cases  of  HIV  infection,  prolonged  life  expectancy  of  those  who  are  
on  HIV  treatment,  and/  or  a  combination  of  both.    HIV  trends  in  Lesotho  indicate  an  increased  
HIV  testing  coverage  from  81%  in  2004  to  94%  in  2009  and  2014.  
 
Although  the  epidemic  is  generalised  in  Lesotho,  in  reality  the  infection  is  unevenly  spread  within  
the   population   and   is   positively   correlated   with   socioeconomic   status.   For   instance,   29.7%   of  
Basotho  females  ages  15-­‐49  are  HIV  positive  compared  to  their  male  counterparts  at  18.6%;  HIV  
prevalence  is  higher  in  the  urban  areas  (30.0%)  compared  to  rural  areas  (21.8%),  (LHDS,  2014).  
Furthermore,   women   and   men   in   the   highest   wealth   quintile   were   found   to   have   lower   HIV  
testing   coverage   rates   than   women   and   men   in   the   lowest   four   wealth   quintiles,   on   average  
87.6%  and  92.6%  respectively.  Overall,  the  HIV  prevalence  rates  amongst  the  populations  at  high-­‐
risk  remains  a  major  concern  in  Lesotho.  The  Ministry  of  Health/UNAIDS  Country  Progress  Report  
(2015)  indicates  Sex  Workers  (79.1%),  Factory  Workers  (42.7%),  Men  who  have  Sex  with  other  
Men  (MSM)  (32.9%)  and  Prison  Inmates  (31.4%)  are  the  most  affected  populations.  
 
Although   efforts   are   being   made   by   the   Government   of   Lesotho   in   collaboration   with  
Development   and   Implementing   Partners   to   provide   comprehensive   HIV   prevention;   treatment  
and  care  programs  targeting  these  populations,  the  lack  of  reliable  strategic  information  impedes  
effective   planning,   decision   making   and   programming.   Population   Services   International   (PSI),  
with  funding  from  PEPFAR,  conducted  the  first  Integrated  Bio-­‐Behavioural  Surveillance  Survey  
(IBBS1)  in  Lesotho  in  2013.  PSI  conducted  the  study  in  urban  areas  of  Maseru  and  Leribe  districts  
and  focused  on  Female  Sex  Workers  (FSW)  and  MSM  with  410  and  318  participants  respectively.    
Generally,  the  main  focus  of  the  study  was  to:  1)  estimate  the  population  size  of  FSW  and  MSM,  
2)  determine  HIV  and  Sexually  Transmitted  Infections  (STIs)  prevalence  amongst  FSW  and  MSM;  
and  3)  establish  factors  that  impede  FSW  and  MSM  from  accessing  health  services.    
 
 
 
 
 
 
 

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The   results   of   the   IBBS1   study   revealed   that   these   target   groups   are   very   susceptible   to   stigma,  
discrimination  in  addition  to  HIV  and  STIs;  all  of  which  contribute  to  a  reluctance  to  seek  health  
services.  Below  is  a  summary  of  the  findings  from  the  IBBS1  study.  
 
IBBS1     HIV   Syphilis   Fear   to   access   Difficulty   to   Estimated  
prevalence   healthcare   negotiate   Population   size  
services   condom   use   (15-­‐49)  
with    
FSW:         Regular  client:   National:  5,986  
Maseru   73.3%   27.9%   20%   9.5%   1,621  
Maputsoe   70.4%   26.3%   7.8%   7.4%   978  
MSM:         Main  partner:   National:10,845  
Maseru   31.1%   3.8%   17.3%   9.0%   2,562  
Maputsoe   35.4%   7.1%   3.8%   3.3%   1,662  
 
The  2nd  round  of  IBBS  (IBBS2)  will  be  implemented  by  Pact  Lesotho  with  the  financial  support  of  
Global  Fund  to  Fight  AIDS,  Tuberculosis  and  Malaria  (GFATM).  In  appreciation  of  expanded  efforts  
to  reduce  HIV  and  Tuberculosis  (TB)  in  Lesotho  (e.g.  the  adaption  and  launch  of  the  Test  and  Treat  
efforts  and  TB  Engage  Guidelines  in  2016)  as  well  as  trends  and  patterns  of  the  HIV  epidemic  as  
evidenced  by  the  LDHS,  2004,  2009  and  2014;  the  2nd  round  of  IBBS  has  adjusted  some  of  the  
IBBS1  objectives,  definitions  and  methodologies;  and  retained  others  for  comparison  purposes.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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2.0  OBJECTIVES  OF  THE  IBBS  

The  main  objective  of  the  study  is  to  assess  the  vulnerability  of  FSW  and  MSM  to  HIV/AIDS,  TB  
and  STIs.  Specifically,  it  will  do  the  following:  
 
2.1  Estimate  the  population  size  of  MSM  and  FSW  across  Maseru,  Leribe,  Mafeteng  and  Butha  
Buthe  districts.  
2.2  Evaluate  the  risk  state  for  HIV,  sexually  transmitted  infections  (STIs),  and  TB  among  MSM  and  
FSW,  including  individual  and  environmental  risk  factors.  Notably:    
2.2.1   Describe  the  characteristics  of  the  MSM  and  FSW  populations.  
2.2.2   Identify   sexual   behaviours,   including   number   and   type   of   sexual   partners   and  
frequency  of  condom  use,  among  MSM  and  FSW.  
2.2.3   Assess  the  reproductive  health  of  MSM  and  FSW.  
2.2.4   Determine   the   extent   and   severity   of   stigma   felt   by   MSM   and   FSW,   with   special  
reference  to  human  rights  violations  experienced  by  members  of  these  populations.  
2.2.5   Assess   the   knowledge   of   HIV/AIDS,   TB   and   STIs   among   MSM   and   FSW   as   well   as  
exposure  to  prevention  and  treatment  interventions.  
2.2.6   Identify  HIV,  TB  and  STI  prevention  needs  among  MSM  and  FSW,  including  challenges  
to   accessing   health   services,   prevention   and   treatment   services,   and   insights   for  
adapting  awareness  messages.    
2.2.7   Estimate  the  prevalence  of  HIV,  TB,  Hepatitis  B  and  syphilis  among  MSM  and  FSW.    
2.3  Estimate  the  rate  of  TB  infection  among  MSM  and  FSW  living  with  HIV.      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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3.0  STUDY  POPULATION  
Below  are  the  operational  definitions  of  the  two  study  populations  used  in  IBBS1  study:  

Target  group   Definition  

Female  Sex  Workers   FSW  are  defined  as:  women  aged  15  years  and  above  who  have  
lived  in  Lesotho  for  at  least  3  months  and  report  having  been  paid  
in  cash  or  kind  for  sex  with  a  male  within  the  last  6  months.  
Men  who  have  Sex  with   MSM  are  defined  as:  men  aged  15  years  and  above  who  have  lived  
other  Men   in  Lesotho  for  at  least  3  months,  and  who  report  having  had  sexual  
relations,  (either  oral  or  anal)  with  another  male  in  the  12  months  
preceding  the  survey.    

4.0  METHODS  
The  study  should  employ  both  quantitative  and  qualitative  methods,  with  respondent  driven  
sampling  (RDS)  used  for  the  survey  respondent  selection.  The  protocol  should  adhere  to  the  
design  of  IBBS1  as  much  as  possible  to  enable  a  comparison  of  the  findings;  and  should  also  
adhere  to  the  Lesotho  testing  guidelines/  algorithms.      

4.1  Methods  used  in  IBBS1  

The  applicants  are  expected  to  elaborate  on  research  methods  below  including  any  other  they  
may  propose  to  use  to  demonstrate  how  the  methods  will  respond  to  the  study  set  objectives.  

Quantitative  Methods   Qualitative  Methods  

•   Survey  of  MSM  and  FSW   •   Key  informant  interviews  (KII)  
•   Laboratory  testing   •   In-­‐depth  interviews  with  FSW  and  
•   Wisdom  of  the  masses   MSM  
•   Unique  object  method   •   Focus  Group  Discussions  (FGDs)  with  
•   Social  Event   FSW  and  MSM  

4.2  Sample  Size  

Applicants  should  propose  sample  size  calculations,  for  each  geographic  location,  along  with  the  
parameters   used   (alpha,   beta,   baseline   prevalence   of   key   variables,   and   percent   of   change  
expected  to  see)  for  the  FSW  and  MSM  survey  component.    In  addition,  the  applicants  must  detail  
how   many   KIIs   and   FGDs   will   be   carried   out   for   each   target   population   (MSM   and   FSWs)   by  
district.  
 
 
 

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4.3  Data  Collection  Techniques  and  Tools  

Applicants  are  requested  to  describe  how  they  will  conduct  pre-­‐survey  mapping  of  the  FSW  and  
MSM  populations,  how  they  will  recruit  the  survey  respondents  using  RDS,  manage  survey  sites  
in   the   field,   including   enumerator   supervision   and   data   quality,   collect   test   samples   for   HIV,  
Hepatitis  B  and  Syphilis,  ensure  data  security,  manage  medical  waste  disposal,  and  co-­‐ordinate  
with  local  authorities.    
 
They  are  also  expected  to  describe  how  they  will  manage  each  of  the  qualitative  components  of  
the  study  (KII  and  FGDs):  How  they  will  recruit  participants?  What  materials,  if  any,  will  you  use  
for  recruitment  (these  will  need  to  be  submitted  to  the  Ethics  Committee)?  Where  will  you  hold  
the   interviews   and   FGDs?   In   addition,   the   successful   applicant   will   describe   what   measures   will  
be  taken  to  ensure  the  privacy  and  confidentiality  of  those  participating  in  both  the  surveys  and  
the  qualitative  discussions.  
 
Once  Pact  Lesotho  has  received  and  approved  the  final  protocol  and  tools  from  the  successful  
applicant,  that  research  organization  will  present  them  to  the  MOH’s  Research  Ethics  Committee  
(REC)  of  the  MOH  in  Lesotho  for  their  approval.  The  study  shall  not  begin  until  the  protocol  is  
approved   by   Pact   and   by   the   MOH   Research   Ethics   Committee   as   well   as   the   applicant’s  
Institutional  Review  Board  where  necessary.    
   
The  successful  research  organization/consultants  will  be  responsible  for  the  recruitment,  training  
and  supervision  of  a  team  of  enumerators.  Applicants  for  the  IBBS2  should  propose  the  number  
of  enumerators  according  to  their  sample  size  calculations  and  the  number  of  interviews  to  be  
conducted  in  a  day  (factoring  in  down  time  between  interviews  and  travel  time).  Training  for  the  
enumerators   should   be   described   in   the   application   (contact   hours,   topics   to   be   covered,  
practical  exercises,  etc.).  

4.4  Data  Management  and  Analysis    

Applicants  should  describe  the  plan  for  quantitative  data  checking,  entry,  and  cleaning  as  well  as  
for  analysis.  The  successful  applicant  will  be  expected  to  produce  descriptive  statistics  (frequency  
tables  and  mean  and/or  standard  deviation)  for  all  variables,  and  results  of  regression  analysis  
for  selected  variables.  Similarly,  the  application  should  include  a  description  of  how  the  applicant  
will  collect,  capture,  and  analyse  the  qualitative  data.  
 
4.5  Collaboration  and  Supervision    
The  selected  research  organization  is  responsible  for  data  quality  supervision  during  field  work  
and  ensuring  that  all  research  methods  are  being  followed  as  designed.  Pact  Lesotho  will  work  
with  the  selected  organization  and  an  IBBS2  Study  Committee  to  ensure  that  all  activities  and  
deliverables  are  supervised  and  reviewed  for  quality  assurance  as  well  as  technical  clearance  and  
approval.    

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The  MOH  will  be  represented  on  the  study  committee  and  the  successful  research  group  should  
consider   having   at   least   one   Co-­‐Principal   Investigator   from   the   MOH   as   well.   The   SI   TWG   of   the  
MOH  will  collaborate  with  Pact  to  monitor  various  steps  of  the  IBBS2  such  as  reviewing  the  survey  
tools  and  protocol,  observing  field  work,  review  of  the  data  analysis  plan,  reports,  factsheets  and  
Power  Point  slides;  and  coordinating  the  dissemination  of  the  study  findings.    
 
The   International   Organisation   for   Migration   (IOM)   is   planning   to   conduct   an   IBBS   study   on  
migrant  mineworkers  this  year.  The  research  team  selected  for  the  FSW  &  MSM  IBBS2  may  be  
requested  to  coordinate  with  the  IOM  study  team  to  avoid  duplication  and  ensure  comparability.  

4.6  Dissemination  of  the  Study  Findings  

The   Applicant,   in   collaboration   with   Pact   and   MOH   SI   TWG,   will   disseminate   the   IBBS   survey  
results  at  three  levels:  
i)   Summary   findings   shared   with   MSM   and   FSW   via   Pact’s   partners   as   well   as   with   other  
institutions  that  work  with  the  target  groups.    
ii)   Aggregated   results   will   be   shared   with   national   level   stakeholders,   including   the   MOH,  
NGOs,  donor  agencies  and  others  working  on  HIV  and  AIDS  and  TB  in  Lesotho.    
iii)  Results  disaggregated  by  district  with  key  stakeholders  in  the  four  study  districts.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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5.0  EXPECTED  DELIVERABLES  

The  key  deliverables  for  the  successful  research  organisation  include,  but  not  limited  to,  the  
following:  

Deliverables   Proposed   Timelines  

payment  
proportion  
-­‐   Inception   Report     including   -­‐   15   days   following   signing   of   the   -­‐   10%  
Implementation   Schedule   of   the   contract  
Study  
-­‐   Final   versions   of   the   Study   -­‐   One  month  following  signing  of  the   -­‐   5%  
Protocol   and   Tools   for   Ethical   contract    
Approval.   Note:   research   tools  
must   be   in   both   Sesotho   and  
English  
-­‐   Final  Enumerator  Training  Report   -­‐   Two   weeks   after   approval   of   the   -­‐   5%  
highlighting   “Hotspots”   and   the   protocol   and   the   questionnaires   by  
Training  Programme  approved  by   Pact  and  MOH  REC    
the  Study  Committee  
-­‐   Two   progress   reports   (one   mid   -­‐   First:  75  days  after  the  signing  of  the   -­‐   10%  
survey;   and   the   last   after   contract.    
completion   of   the   field   work)   to   -­‐   Last:   15   days   following   completion   -­‐   5%  
be   approved   by   the   Study   of  the  field  work  
Committee  
-­‐   Preliminary   survey   report   to   be   -­‐   45   days   following   the   completion   of   -­‐   10      
approved  by  the  MOH  SI  TWG     the   field   work   and   approval   of   the  
last  progress  report  
-­‐   Power   point   presentation   slide   -­‐   Within   30   days   of   the   field   work   -­‐   5%  
for   key   stakeholders’   (data   collection)   completed   and   at  
dissemination   workshop   to   be   least   one   week   before   the   date   of  
approved   by   the   Study   dissemination  
Committee  
-­‐   Draft   survey   report   and   cleaned   -­‐   Within   45   days   of   the   field   work   -­‐   20%  
data  sets  to  be  approved  by  MOH   completed  
SI  TWG  
-­‐   Final   reports,   summary   reports,   -­‐   By   180   days   of   the   contract   signed   -­‐   30%  
Final  PPT  slides,  Meeting  notes  to   (the   final   technical   deliverables   are  
be  approved  by  SI  TWG   required   to   be   submitted   least   15  
days   prior   to   the   date   of   expected  
final   payment;   and   receiving  
technical  clearance  is  must.  

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6.0  DURATION  OF  THE  STUDY  

The  study  is  expected  to  take  between  6  and  8  months  including  field  work.  
 
7.0   MANAGEMENT  OF  THE  CONSULTANCY  
Pact  Lesotho  Country  Director  shall  provide  direct  oversight  of  the  study.  The  Monitoring  and  
Evaluation,  Reporting  and  Learning  Manager  shall  be  responsible  for  contract  management  and  
coordination  of  the  study.    Pact  Head-­‐Quarters  will  ensure  technical  oversight  through  provision  
of  an  IBBS  study  expert  to  be  assigned  as  one  of  the  Co-­‐Principal  Investigators  of  the  study.  
 
The  IBBS2  will  be  commissioned  to  an  external  consultancy.  The  contracted  Applicant  for  this  
work  will  have  the  following  professional  qualifications:  
•   An  organization  or  individual  with  proven  record  of  conducting  IBBS  studies  in  Lesotho  
or  in  the  Southern  Africa.  
•   Have  extensive  knowledge  of  HIV/AIDS,  TB,  MSM  and  FSW  programming,  or  
interventions.  
•   Approved  by  the  Global  Fund  prior  to  being  contracted  by  Pact  Lesotho  to  undertake  
the  assignment.  
 
8.0   QUALIFICATIONS  OF  THE  IBBS  TEAM  LEADER  
Work  experience  
•   Experience  developing  and  conducting  bio-­‐behavioural  research  studies  of  HIV  and  TB  
•   Research  experience  in  Lesotho  or  Southern  Africa.  
•   Experience  leading  mix-­‐methods  in  a  study.  
•   Staff  who  are  fluent  in  Sesotho.  
•   A  history  of  successful  research  ethics  applications  for  studies  of  key  populations.  
•   Experience  in  working  and  managing  relations  with  multiple  stakeholders.  
 
Essential  knowledge  and  skills  required  to  meet  the  demands  of  the  assignment  
•   Master’s  degree  or  higher  in  Social-­‐sciences,  Research  Methods,  Public  Health  or  related  
field.  
•   Field-­‐level  knowledge  of  Key  population  groups  (MSM  and  FSW)  and  HIV  and  AIDS;  and  
TB  is  a  must.  
•   Project  Management  experience  and  ability  to  meet  deadlines  is  essential.  
•   Excellent  analytical  and  report  writing  skills.  
•   Knowledge  of  the  civil  society  /NGO  sector  and  Global  Fund  projects.  
•   Exceptional  diplomacy  and  cross-­‐cultural  skills.  
•   Facilitation  &  presentation  skills.  
•   Good  written  and  oral  communications  skills  
 
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9.0   PAYMENT  SCHEDULE    

Payment   shall   be   issued   based   on   the   approval   of   the   deliverables   by   the   MOH   Research   Ethics  
Committee,  IBBS2  Study  Committee  and  MOH  SI  where  applicable  Pact  Lesotho  as  articulated  in  
section  “5”  –  Expected  Deliverables.  
 

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10.0   CRITERIA  FOR  THE  EVALUATION  OF  THE  PROPOSALS    

Capability  and  Experience  of  the  Applicant  
Evidence   of   Applicant   capability   and   relevant   experience   in   the   execution   of   projects   of   a  
similar  nature,  including  the  nature  and  value  of  the  relevant  contracts.  The  Applicant’s  past  
performance  on  donor-­‐funded  contracts  will  be  considered  as  a  criterion  in  the  evaluation  of  
the  Applicant’s  Technical  Proposal.  Pact  reserves  the  right  to  contact  the  references  as  well  
as  other  sources  to  check  references  and  past  performance.    
Criteria   Description     Marks    
General  understanding  of  the   Has  demonstrated  understanding  of   5  
TOR     the  proposed  IBBS  study  and  
assignment  
Organizational  Capacity   Demonstrated  professionalism  and   5  
capacity  as  evidenced  in  the  Applicant’s  
profile  and  has  a  record  of  winning  
significant  relevant  awards  of  a  similar  
nature  in  the  region    
Evaluation  Design  and   Has  demonstrated  a  sound   40  
Methodology   understanding  of  the  local  context  in  
response  to  designing  an  appropriate  
and  sound  technical  design  and  
methodology  for  conducting  the  IBBS  
study  for  FSW  and  MSM  
Financial  Proposal   Feasibility  of  financial  proposal   30  
presented  
Team  Composition   Proposed  team  members  have  the   15  
requisite  skills  to  conduct  the  
assignment  as  well  as  previous  
experience  in  conducting  surveys  of  a  
similar  nature  
References     Reference  letters  (2)  of  past   5  
performance  from  clients  served  by  the  
Applicant    
Total  Points     100  
 

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