Context

Access to HIV testing services in LMICs has experienced dramatic growth over the last two decades, to the extent that more than 600 million people in 122 LMICs were reported receiving an HIV test between 2010 and 2014. Despite these achievements, over 40% of all people living with HIV (PLHIV) are unaware of their status and, by 2020, 14 million additional PLHIV (almost double current figures) need to be identified to meet the ambitious global treatment targets. To meet these targets, testing coverage needs to be ramped up especially among populations (i.e. key populations, men, adolescents and young people in high HIV prevalence settings) unreached by current testing methods.

HIV self-testing (HIVST) provides a platform to reach more first-time testers and facilitate frequent re-testing, particularly among those with high ongoing risk who are not reached by current testing methods. With conventional approaches, a third party provider (e.g. counsellor, nurse, community health worker etc.) serves as an intermediary in administering the test and interpreting results. This intermediary step often dis-incentivizes many from testing to avoid the potential risk of stigma and discrimination. With HIVST, tests can be performed and interpreted discreetly and in private. All individuals with a positive result must then undergo further testing with a complete validated testing algorithm for diagnosis from a trained provider.

Emerging evidence from Unitaid-funded STAR demonstration project, addressing key research questions required to take HIVST to scale in LMICs, show very high uptake among underserved populations and high linkage to care following diagnosis. These results, combined with those from other studies, have led WHO to strongly recommend countries to incorporate HIVST as an additional approach to HIV testing services (as reflected in guidelines issued December 2016).

However, the HIVST market is fraught with several market shortcomings on both the supply and demand side. The market in LMICs is not established, with less than 1 million tests/year, representing a very small and unattractive market when compared to the _~100million test/year market for professional use of HIV rapid diagnostic test. Procurement through the Unitaid-funded demonstration project accounts for a vast majority of these HIVST volumes. Although strong country appetite to scale-up HIVST exists, the price of emerging HIVST kits remain largely unaffordable, restricting ability of countries and funders to scale-up their use. Insufficient and unpredictable demand from countries in turn perpetuates high prices and limits incentives for suppliers to enter the market and continue product improvement.

On this basis, Unitaid is looking to establish more effective HIV testing strategies for underserved people in LMICs. It seeks to do this by supporting supply side interventions and demand generation with the overall goal of substantially increasing HIV testing rates particularly in underserved populations.

Current Call for proposals and examples of specific opportunities

Under this call, Unitaid is soliciting proposals for the following interventions:

Create and accelerate demand and adoption of HIVST in early-adopter countries

Interventions are needed to:

1. stimulate demand, and
2. drive widespread adoption of HIV self-testing at scale through various delivery models.

This will involve working with relevant civil society groups, communities living with the disease, and local partners. Implementation in countries will be catalytic in nature and time-bound, and transition to longer-term donor and/or domestic funding sources should be secured.

The expected impact of this call is to increase testing among previously unreached high-risk population groups, and overall efficiency of HIV testing programmes.

Proposals submitted should clearly demonstrate the fit with the objectives set out above, the expected impact and value for money as well as the complementarity and added value to similar projects in this area.

Given the current prevention gap for population groups potentially benefiting from self-testing, synergistic interventions to promote linkage to HIV prevention for those testing negative (such as pre-exposure prophylaxis) could also be included in the proposals as an optional complementary intervention.

Process for proposal submission

When developing a proposal, please note the following resources:

• Answers to frequently asked questions relevant to proposal development
• Unitaid’s preliminary rationale for working in this area for intervention

Unitaid works through market-based interventions to achieve global market and public health impact. Proposals should clearly demonstrate the use of innovative and sustainable approaches to preventive HIV treatment in high-risk groups. Demonstrated articulation with national programmes or other scale-up partners will therefore be key. Unitaid notes that this call may share some common elements or activities with other recent calls, and welcomes approaches that outline a coherent, integrated approach (e.g., to child health).

Proposals for research projects, small-scale demonstration projects or projects in a single country are unlikely to be supported by Unitaid funding in this call. In the exceptional case that intervening in a single country would have global impact; the proposal should include clear evidence to demonstrate this. Applicants should be clear about the underlying assumptions made in their proposed approach, and should highlight any major risks or other factors that may affect the delivery of results. Finally, proposals are expected to outline a lean, concrete and clear pathway to results and impact.

The proposed implementing agency needs to demonstrate capacity/prior experience implementing large-scale multi-country projects of this nature, and engaging with civil society groups as lead organization.

Important dates

Please note: A proposal is considered submitted only once you receive an e-mail message of confirmation of receipt from Unitaid (Please note that this is not an automated message and confirmation will be sent after verification of your submission not earlier than 8 January 2018 and typically within one working day from receipt of a proposal).

Submission and format of proposals

Proposals, including all annexes, should be submitted electronically to proposalsunitaid@who.int.

A full proposal consists of the following documents:

• Proposal form with scanned version of signed Front page [template DOC, 130 KB]
• Annex 1: Log frame [template XLS, 50 KB]
• Annex 2: Timeline GANTT chart [template XLS, 113 KB]
• Annex 3: Budget details [template XLS, 70 KB]
• Annex 4: Organizational details and CVs of key team members [no template]
• Annex 5: Support Letters (not mandatory) [no template]
• Annex 6: Declaration of relevant interest  [no template]
• Annex 7: Applicable ethics, anti-discrimination and environmental policies [no template]
• Annex 8: Declaration regarding tobacco entities [no template]
• Guidance on Impact Assessment

Please note that our email system accepts messages up to 7 MB in size. For submissions exceeding this size, please consider splitting attachments in several messages.

Queries

Your proposal and potential queries receive personal attention: submitting your application at least a day before the deadline allows providing feedback on its completeness. You will receive answers to your queries at any one stage of the application review process. Please send your queries to Grant Application Manager at proposalsunitaid@who.int.

Assessment and notification

After assessment of the proposals and endorsement by the Unitaid Board, all applicants will be officially notified as to whether they will be invited to develop a full grant agreement for Unitaid funding.

You will find further guidance in the Unitaid proposal process document.