APPEL A MANIFESTATION D’INTERET : Réalisation d’une étude bio-comportementale au sein de la population usagère de drogues au Bénin et au Togo At Médecins du Monde

1_CONTEXT

According to the 2021 UNODC report, the number of drug users is expected to increase exponentially in Africa in the coming years, particularly for reasons of demographic change. This increase will in fact lead to an increase in needs in terms of access to services, particularly health. One of the recommendations of the report is therefore to develop integrated actions, centered on people and based on human rights, and to provide specific responses in terms of HIV prevention, treatment and care for PUDs. The second generation surveillance survey (ESDG), integrating people who use drugs (PUD), carried out in 2022, in Benin and Togo, revealed the following information.

• In Benin: the size of injectable PUD (PUDI) is estimated at 804 people, including more than 25% (206 people) in Cotonou. This estimate only takes into account the injected mode, although it only represents a small part of the different modes of drug consumption. Mapping of consumption sites also made it possible to identify 253 sites in the country, including 99 in Cotonou. The prevalence of HIV among PUDIs is estimated at 2.1% (compared to 2.2% in 2017, showing stagnation for 5 years). In the general population, the prevalence of HIV amounts to 1.2%. These results remain fragmentary, to the extent that the survey only considers injectable PUDs (PUDI), while the community expertise of BORNES, CSO responsible for the implementation of the activities of the Global Fund (NFM3) on the HIV/PUD component, shows a significant number of PUDs consuming products via other routes (oral, inhaled, smoke, etc.).
• In Togo, the estimated size of injecting drug user populations is 4,863, including 3,637 in Greater Lomé. According to the programmatic mapping of key populations (PS, MSM and IDU) and porters in Togo in 2022, HIV prevalence is estimated at 3.6%, twice as high as the general population (1.9%). It varies greatly by gender since HIV prevalence is 15.1% among female drug users (representing approximately 10% of the population), compared to 2.4% among men according to the ESDG.

Afin de compléter les ressources existantes, il s’agira d’obtenir des données plus complètes sur la prévalence du VIH, des troubles mentaux, de la tuberculose ainsi que des hépatites B/C, des violences sexuelles, chez les PUD, quel que soit leur mode de consommation dans les deux pays.

Médecins du Monde (MdM) est une ONG médicale de solidarité internationale créée en 1980. Elle intervient en France et à l’international sur 6 combats politiques, dont la réduction des risques pour laquelle elle a développé une expertise. De 2015 à 2023, Médecins du Monde (MdM) a mené un projet de Réduction des Risques (RdR) en Côte d’Ivoire. Pendant six ans, il s’est déroulé uniquement à Abidjan. Puis, pendant les trois dernières années, il s’est élargi à trois autres villes de l’intérieur du pays. Ce projet a contribué à la réduction de la prévalence du VIH et de la Tuberculose au sein de la population usagère de drogues tout en améliorant l’accès aux soins et en luttant pour la décriminalisation des pratiques. Enfin, la capitalisation des acquis de ces trois phases de projet a justifié l’obtention d’un financement de L’Initiative pour travailler à l’extension au niveau national et à la dissémination au niveau régional (Togo et Benin) des trois modèles d’approche RdR mis en œuvre en Côte d’Ivoire.

Dans le cadre de la mise en œuvre de ce projet régional, il est important de compléter les données sur les PUD déjà existantes dans les deux pays. Ainsi, sur la base d’une revue approfondie des données disponibles au niveau national en collaboration avec les autorités sanitaires, une enquête bio-comportementale sera réalisée par pays, afin de collecter les données manquantes et/ou pour lesquelles la méthodologie, la définition des termes, etc. ont besoin d’être améliorés. Cet appel à manifestation d’intérêt est lancé pour le recrutement d’une structure/équipe de consultance pour la réalisation de cette enquête bio-comportementale.

2_BREVE PRESENTATION DU PROJET

Le projet vise à disséminer les expertises de réduction des risques (RdR) en direction des personnes usagères de drogues (PUD) en Afrique de l’Ouest francophone, à partir des expertises acquises par Médecins du Monde (MdM) et ses partenaires en Côte d’Ivoire. Il sera mené en consortium avec Coalition PLUS, l’ANCS et des partenaires de mises en œuvre au Bénin : BORNES, au Togo : EVT et la Plateforme des OSC VIH/santé.

3_DESCRIPTION DE LA MISSION DE CONSULTANCE

As part of this project, MdM is looking for a consultancy team to carry out a bio-behavioral study aimed at documenting the needs of people who use drugs (PUD) in Togo and Benin. This study aims to enable institutions in these countries to adapt their responses in terms of prevention and health care for this high-risk and highly stigmatized population. The results of the study will also serve as a basis for the implementation of a Risk Reduction (RdR) program for PUDs.

Main objective :

Estimate the seroprevalence of HIV, HBV, HCV, active pulmonary tuberculosis, and mental disorders, gender-based violence, among heroin and cocaine/crack users in Togo and Benin.

Specific objectives :

• Define the socio-demographic profile and consumption of PUDs in Togo/Benin;
• Identify the health needs of users, particularly in terms of prevention and treatment of HIV, viral hepatitis, TB and mental health pathology;
• Evaluate the main risk behaviors for transmission of HIV, HBV, HCV and TB;
• Analyze the knowledge, attitudes and practices of PUDs regarding these infections
• Evaluate access to screening and treatment for HIV, HBV, HCV and TB;
• Estimate the size of the DU population in Togo/Benin.
• Set up a questionnaire to conduct a quantitative survey and write a study protocol

4_BUDGET

The total budget available for this mission is a maximum of  30,000  euros including tax per country , all costs included including unforeseen costs (maximum 5%), and training costs for agents prior to the implementation of activities in the field.

5_RESEARCH PROFILE

The skills required for the mission are:

• Knowledge of the issues of harm reduction among PUDs, as well as the institutional and legal context of drug use in Togo and Benin
• Ability to work in contact with vulnerable people, particularly people who use drugs
• Knowledge of Togo/Benin, knowledge of the region would be an asset
• Knowledge of the health system in Togo/Benin
• Solid experience in qualitative and quantitative data analysis methods
• Mastery of statistical data processing software
• Excellent writing, analysis and synthesis skills
• Perfect command of French, mastery of local languages ​​would be an asset

6_INDICATIVE CALENDAR

Deadline for expressing interest:

30/06/2024

Deadline for a full proposal:

15/07/2024

Desired date for the start of the mission:

30/07/2024

Desired date for the “field” phase:

01/09/2025

Desired date for submission of the final report:

01/03/2025

This schedule is indicative and may be subject to modification.