Terms of Reference for Conducting Operational Research on Trichiasis Surgery 15 views

Background

Trachoma is the primary infectious cause of blindness caused by the bacterium Chlamydia trachomatis. Repeated infections over many years cause inflammation of the inside of the upper eyelid, leading to scarring. This scarring causes the eyelid to turn inward (entropion), forcing the eyelashes to scratch the surface of the eye, a condition known as trachomatous trichiasis (TT). TT is a significant public health concern in Ethiopia, as it can result in visual impairment and blindness if not effectively managed. Surgery is currently the most practiced management option for TT in Ethiopia. Recently, the national program introduced epilation as a management option for certain TT phenotypes. Electrolysis is considered a management option for post-operative TT (PTT), particularly for complicated cases that do not benefit from standard surgical management, where corrective eyelid surgery is not feasible due to eyelid structure or other health conditions, or for patients who refuse surgical treatment.

However, there is little to no information on the feasibility of using electrolysis in trachoma-endemic settings at secondary and primary eye care units for the management of TT. This research aims to evaluate the feasibility, cost-effectiveness, and practicality of electrolysis for managing TT and PTT.

In addition, though surgery is the commonly practiced and effective intervention to prevent blindness in patients with TT, refusal of surgery remains a significant barrier to the elimination of trachoma as a public health problem. While quantitative studies have been conducted to assess the reasons for surgery refusal, there is a lack of in-depth qualitative research that explores the underlying factors influencing refusal from the patient side. This operational research aims to fill this gap by identifying and understanding the cultural, social, psychological, and systemic factors contributing to the refusal of TT surgery.

Objective 1

The primary objective of this study is to determine if electrolysis is a feasible, cost-effective, and easily trainable method for managing TT in secondary eye care units in Ethiopia.

Objective 2

To explore and document the reasons for refusal of TT surgery among affected populations, identify cultural, social, and psychological barriers that prevent individuals from seeking surgery, assess the role of healthcare delivery systems and community engagement in influencing surgery acceptance and provide recommendations for strategies to improve surgery uptake based on the research findings.

Scope of Work

The consultant will be responsible for:

Electrolysis:

• Designing and conducting an operational research study to evaluate electrolysis for TT management.
• Assessing the feasibility of implementing electrolysis at primary and secondary eye care units.
• Evaluating the cost-effectiveness of electrolysis compared to standard TT surgical methods.
• Determining the training requirements and scalability of electrolysis for local healthcare providers.

Refusal: The research will be conducted in regions with a high prevalence of TT, focusing on communities where surgery refusal rates are significant. The study will involve:

• Literature Review: Review of existing quantitative and qualitative studies on TT surgery refusal.
• Qualitative Data Collection: Conducting in-depth interviews, focus group discussions (FGDs), and key informant interviews (KIIs) with patients, community leaders, healthcare providers, and other stakeholders.
• Data Analysis: Thematic analysis of qualitative data to identify recurring themes and patterns that contribute to surgery refusal.
• Report Writing: Documentation of findings, including a discussion on implications for policy and practice.

Key Tasks

The consultant will perform the following tasks:

• Literature Review: Conduct a comprehensive review of existing literature on electrolysis for TT management.
• Site Assessment: Identify and assess secondary eye care units in Ethiopia for the study.
• Study Design: Develop a detailed study design including the sample size, selection criteria, and data collection methods.
• Implementation: Conduct the study, collect data, and monitor progress.
• Training: Develop and conduct a training program for healthcare providers on electrolysis techniques.
• Data Analysis: Analyze the collected data to determine the feasibility, cost, and training requirements.
• Present draft report for discussion with Orbis Ethiopia team and project steering committee
• Reporting: Prepare and submit a comprehensive report on the findings, including recommendations for future implementation.

Deliverables

The consultant is expected to deliver the following:

• Work Plan: a detailed work plan including timelines and milestones.
• Concept Note: a concept notes outlining the study’s objectives, methodology, and expected outcomes.
• Budget: a comprehensive budget detailing all costs associated with the study.
• Final Report: d detailed report presenting the findings, conclusions, and recommendations.
• Publications/publications ready manuscripts (two)

Methodology

The consultant will employ a mixed-methods approach, combining quantitative and qualitative data collection and analysis. The methodology should include quantitative and qualitative surveys, patient examination cost analysis and feasibility assessments. However, the technical service provider will present the detailed methodology for both studies.

Budget and Resources

The consultant should provide a detailed budget including procurement of all the needed equipment, consumables and supplies. However, Orbis retains the right to supply the items as needed and offer this contract for the technical service only. However, the consultant will identify and provide the comprehensive list as needed, for Orbis to make the procurement decision. Please provided quotations for both options.

Duration

The study is expected to be completed within a period of 6 to 9 months from the commencement date.

Reporting

The consultant will provide monthly progress updates to Orbis and submit a final report at the conclusion of the study. Additionally, the consultant will present the progress and final study findings during a program review meeting and is expected to submit a PowerPoint presentation of the final report.

Contact Information

For any inquiries, please contact Dawit Seyum at [email protected]