Amendment 06, DHAPP BAA 15-001.pdf

AMENDMENT 0006

BROAD AGENCY ANNOUNCEMENT (BAA)

Number DHAPP-BAA-15-001

“FY15 – FY16 Department of Defense HIV/AIDS Prevention Program:

Military Specific HIV/AIDS Prevention, Care, and Treatment Program for non-PEPFAR (President’s Emergency Plan for AIDS Relief)

Funded Countries”

The purpose of this Amendment 0006 is to incorporate the following:

NHRC/DHAPP is accepting “Concept papers” for Sierra Leone as described below through 6 July 2016.

NOTE: Each narrative is a standalone effort and should not be combined with another narrative and all the program elements (tasks) in each specific narrative must be addressed in that concept paper submission.

E-mail address for submission of Concept Papers: usn.nhrc.dhapp@mail.mil

The full solicitation is available at: http://www.grants.gov/

Eligible Applicants are requested to submit Concept Papers following the guidelines and format provided in the DHAPP BAA-15-001, Section IV.

All respondents must demonstrate the active support of the in-country military and the DoD representative in the corresponding U.S. Embassy in the planning and execution of their proposals. The selected Grantee is the Implementing Partner and will be referred to as IP in this document.

mailto:usn.nhrc.dhapp@mail.mil http://www.grants.gov/

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program for non-PEPFAR Funded Countries)

Sierra Leone: Cross Cutting In Military Settings

Phase 1 Phase 2 Phase 3

HTXS $75,000 $75,000 $75,000

HBHC $35,000 $35,000 $35,000

HVOP $50,000 $50,000 $50,000

HVCT $70,000 $70,000 $70,000

HLAB $70,000 $70,000 $70,000

HVSI $50,000 $50,000 $50,000

TOTAL $350,000 $350,000 $350,000

Proposals are requested to support Sierra Leone to reduce the number of new HIV infections and other sexually transmitted diseases among members of the Republic of Sierra Leone Armed Forces (RSLAF), their families, and the civilian communities served by the RSLAF health services. The TBD partner will work directly with the RSLFA to aggressively scale-up the military ART program to achieve 90-90-90 goals for HIV epidemic control within the military over the life of this project. Department of Defense HIV/AIDS Prevention Program (DHAPP) programming to support the RSLAF will focus on the following technical areas: 1) HIV/AIDS Care and Treatment and Tuberculosis Diagnostics and Treatment amongst HIV co-infected individuals; 2) HIV Testing Services (HTS); 3) Clinical Laboratory Support; 4) HIV Clinical Monitoring Systems and 5) HIV prevention interventions.

The TBD partner’s program should emphasize capacity building across all activities and technical areas. All proposals should detail how the partner will engage the RSLAF leadership as well as RSLAF personnel at all levels in this work; and, specifically how the partner will utilize the organizational structure of the military to strengthen the internal capacity of the RSLAF to conduct these activities. Within the proposal the partner will need to demonstrate transition of programmatic capabilities and capacity to the military over the life of the grant.

The partner must work in complete coordination with the RSLAF’s HIV prevention and health services, as well as the DHAPP/DoD Program Manager based at the US Embassy in Sierra Leone, and the DHAPP Headquarters Team. The Grantee is the Implementing Partner and will be referred to as IP in this document.

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

HIV/AIDS Care and Treatment (HTXS - $75,000 + HBHC - $35,000)

Technical Area Targets, Year 1

Indicator Label Military

Only Civilian

TX_CURR # of adults and children currently receiving ART

180 500

TX_RET % of adults and children known to be alive and on treatment 12 months after initiation of ART

85% 85%

CARE_CURR # of HIV+ adults and children who received at least one of the following during the reporting period: clinical assessment (WHO staging) OR CD4 count OR viral load

CARE_SITE Percentage of PEPFAR-supported clinical care sites at which at least 80% of PLHIV received all of the following during the reporting period:

1) clinical assessment (WHO staging) OR CD4 count OR viral load, AND 2) TB screening at last visit, AND 3) if eligible, cotrimoxazole

100% 100%

The IP will work closely with the RSLAF to aggressively scale-up ART coverage in an effort to achieve 90-90-90 goals for military personnel. Targets for HIV/AIDS care and treatment will focus on generating significant progress towards the 2nd and 3rd 90s: initiation of 90% of HIV-infected military personnel on ART and 90% viral suppression amongst military personnel taking ART.

The RSLAF currently provides HIV/AIDS care and treatment services at the 34th Military Hospital. At present, this clinical site provides care and treatment services for a very limited number of RSLAF personnel (about 81). The vast majority of clients seen at this facility are civilian patients living in the surrounding communities. In order to expand ART coverage to outlying military bases where HIV-infected soldiers cannot reasonably reach the existing military ART facility, the RSLAF will begin providing mobile ART services. The IP will work directly with the RSLAF at the one fixed site in addition to supporting the expansion and implementation of mobile ART services to achieve the military HIV care and treatment targets.

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

The IP will be responsible for:

Enrollment into HIV clinical care and treatment

Aggressive enrollment of HIV-infected military personnel into clinical care and treatment at either the current fixed site or through mobile ART outreach

Passive enrollment of HIV-infected civilians and dependents into clinical care and treatment at the current ART site

Ongoing clinical support for all Pre-ART and ART patients Clinical monitoring of all HIV+ positive patients including CD4 every 6 months, hemoglobin, creatinine, tuberculosis screening, screening for other opportunistic infections including cryptococcosis, etc.

Positive Health, Dignity, and Prevention (PHDP) services including STI screening and treatment, prevention of unintended pregnancies among women living with HIV, Nutritional assessment Counseling Support (NACS) of HIV+ patients, cervical cancer screening, alcohol screening, adherence support, condom provision, etc.

Cotrimoxazole prophylaxis for HIV positive patients, fluconazole prophylaxis for those screening positive for cryptococcal antigenemia, etc.

Universal TB screening using standard TB questionnaire at least every 6 months for 100% of HIV-infected individuals in care

Close coordination with the RSLAF to track down and follow enrolled patients that are deployed, to ensure they have their meds and continue to receive regular CD4 and other required lab checks.

Retention support including treatment literacy, active tracing and peer support for HIV+ patients, and other evidence-based retention interventions for adults, children, and pregnant women on ART

Coordination of HIV clinical care and treatment services Planning, logistics, and use of mobile ART clinics to reach military ART targets Ensuring best use of the vehicles to be purchased to support the ART mobile activity Linking RSLAF personnel, including clinical staff, to other local HIV clinical care and treatment resources provided by the MOH, PEPFAR IPs, or other relevant entities.

Promoting ongoing communication and collaboration between RSLAF clinical services and other district/provincial/national level care and treatment programs and/or government entities

Ensuring the availability of essential HIV clinical commodities through support for forecasting, responsible use, stock management, and other activities critical to ensuring a secure supply

Ensuring HIV+ patients exhibiting immunologic failure on first-line ART are screened for adherence and switched to appropriate second-line therapy (based on available population-level genotypic resistance data) when indicated

Referral for hospital admission when clinically indicated

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

In future years, as viral load capacity is developed, will support and participate in viral load testing through the mobile treatment units per current WHO and national guidelines, with reporting on:

TX_VIRAL: Percentage of ART patients with a viral load result documented in the medical record within the past 12 months

TX_UNDETECT: Proportion of viral load tests with an undetectable viral load (<1000 copies/ml)

HIV/AIDS Testing Services (HVCT - $70,000)

Indicator Label Military

Only Civilian

HTC_TST # of individuals who received HTS services for HIV and received their test results

5000 15000

The IP will work closely with the RSLAF to aggressively scale-up HIV Testing Services in an effort to achieve the 1st 90 for military personnel: 90% of all RSLAF PLHIV know their status.

Commonly, military PLHIV only access treatment at the military ART facility when they are symptomatic. In an effort to reach these men and women before they become symptomatic, HTS will focus primarily on outreach testing to larger, high HIV-burden military locations.

Outreach testing should be closely linked to the mobile ART clinic schedule, ideally with both services provided concurrently to maximize linkage. Provider-Initiated Testing and Counseling (PITC) will continue in the fixed sites for both the military and civilian cohorts.

Ensuring that any positives identified are linked to HIV care and treatment is essential to the success of the RSLAF program. The IP should work to achieve 90% linkage of HIV+ individuals identified through PITC and 85% of HIV+ individuals identified through outreach testing to HIV clinical care and treatment. The IP will monitor HIV testing yield; modifying strategies or locations that are not identifying and/or linking significant numbers of HIV positive persons to HIV care and treatment.

Outreach HTS to military bases and facilities

Diagnosing 115 military PLHIV with 85% of those diagnosed linked to HIV care and treatment services

Index-case testing for family members and dependents of HIV-infected military personnel

Index-case testing for HIV-infected spouses and dependents of military personnel

Coordination of outreach HTS with mobile ART clinic activities

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Provider-Initiated testing and counseling within military health services for both military personnel and civilians with 90% of positives diagnosed through PITC linked to HIV care and treatment services

Quality Improvement / Quality Assurance for all RSLAF HTS including continuous training and mentoring

Tracking PLHIV from HTS to clinical care and treatment services

Clinical Laboratory Support (HLAB - $70,000)

Clinical laboratories for HIV care and treatment are present at the 34th Military Hospital (the ART site) as well as in Bo. However, the capacity of the laboratories, including equipment, physical infrastructure, and personnel, vary greatly between the three sites. The IP will work with RSLAF clinical and laboratory staff in support of all HIV laboratory services.

Consumable point-of-care test devices such as serum cryptococcal semi-quantitative lateral flow assays Inventory control, forecasting, and procurement of laboratory reagents to ensure that laboratory services are uninterrupted Installation of equipment, procurement of service maintenance contracts (when applicable), and training of the laboratory staff on the use of the equipment Monitoring laboratory quality and adherence to quality systems guidelines through routine visits to each of the labs to assess achievements, review/evaluate activities, and provide recommendations with the development of improvement plans to resolve any identified problems.

Linking RSLAF laboratory services to other laboratory resources at the district, provincial, and national levels.

HIV Clinical Monitoring Systems (HVSI - $50,000)

Successful tracking of patient level data is critical to the success of the RSLAF clinical care and treatment program’s ability to monitor progress towards epidemic control. The military is a highly mobile population. Clinical HIV monitoring systems, including patient level data, will be required to ensure that RSLAF clinical staff and program managers at national and subnational levels have access to the right information at the right time in any location the patient may be seen. The IP will work with the RSLAF to support the electronic collection of patient-level data, the clinical and programmatic use of electronic data, and the reporting of site-level data to DHAPP HQ and the RSLAF leadership. All electronic medical record (EMR) work should be coordinated and aligned with MOH/MOD, clinical staff requirements, and national/international standards where they exist. The IP should state what system they intend to use for HIV clinical care and treatment; how the data collected within this system will be accessed by the RSLAF clinical staff and leadership; and, how the IP will responsibly protect military data from dissemination outside of RSLAF and DHAPP.

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Staffing support and mentoring of existing RSLAF staff for data entry, information technology assistance, data managers, etc. to fill any gaps where the RSLAF is unable to provide sufficient staff

Procurement of necessary hardware and software, aligned with the national and international laboratory standards and guidelines

Training and on-the-job mentorship of RSLAF clinical staff on the use of any clinical monitoring system at site and national/program levels

Ensuring confidentiality and security of data, in line with MOD, MOH, and national guidelines

Quality Assurance / Quality Improvement for all data collection, reporting, and use.

Timely, accurate reporting of all indicators required by the RSLAF and DHAPP Securing all patient-level and site-level data from dissemination outside of

Sierra Leone Military and DHAPP without prior approval from RSLAF Support for data entry, cleaning, reporting, and use Implementation of clinical monitoring system, including maintenance of network infrastructure (if necessary)

Other Prevention (HVOP - $50,000)

Indicator Label Military Only Civilian Total

PP_PREV Number of individuals from priority populations who completed a standardized HIV prevention intervention, including the specified minimum components, during the reporting period

6000 0 6000

In the first year of this effort, the IP will work with the Military and other partners to select a few target or “hotspot” locations/sites in geographically prioritized regions based on available HIV prevalence data. Sites defined as hotspots include but are not limited to;

presence of a military camp with a large number of soldiers, high HIV/STI prevalence, observed high frequency of multiple sex partners, emergence of small towns with venues where soldiers and FSW fraternize, high priority locations for Military, places with poor access to prevention services for new recruits, and sites with a combination of families and FSW. Proposed activities to reduce HIV risk at the selected locations will include STI screening and care, provision of HIV risk reduction education, alcohol harm reduction, and condoms. In addition, activities will include mobile HIV testing/counseling and linkage/referral to civilian and military care centers of 100% of positive HIV results.

Amendment #0006, DHAPP BAA-15-001 (FY15 – FY16 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

WORK PLANS

Grantee must submit annual, programmatic and financial, work plans to DHAPP Program Manager and DHAPP HQ (Budget breakdown per activity and for program management is required). Work plans include activities implementation timeline, including the M&E ones.

REPORTING

Quarterly Fiscal Reports: Grantee must submit quarterly programmatic and financial reports to DHAPP in order to monitor expenditures according to the program area(s) [HVAB; HVOP; etc]. The report template will be provided by DHAPP. Submit 30 calendar days after each reporting period (3/31, 6/30, 9/30, and 12/31).

Interim Progress: Indicator Report: This report shall summarize progress in relation to the approved Work Plan as well as monitor grant deliverables. The Grantee shall submit quarterly indicator reports in accordance with the format provided by the Program Office within 45 calendar days following the end of the reporting period: 12/31, 3/31, 6/30 and 9/30. The Recipient shall provide reports in accordance with the template provided by

NHRC

Reports will follow DHAPP Headquarters and Country Team Templates