AMENDMENT 08 - N00244-17-S-FO02 (DHAPP PEPFAR FUNDED).pdf

AMENDMENT 0008

FUNDING OPPORTUNITY ANNOUNCEMENT (FOA)

Number N00244-17-S-FO02

“FY17 – FY18 Department of Defense HIV/AIDS Prevention Program:

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

Funded Countries”

The purpose of this Amendment 0008 is to incorporate the following:

DHAPP is accepting “Concept Papers” for Burundi as described below through 11 April 2018.

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 N00244-17-S-FO02, 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 #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program for PEPFAR Funded Countries)

Burundi: Cross Cutting In Military Settings

Phase 1 Phase 2 Phase 3 Phase 4

HVCT $150,000 $150,000 $150,000 $150,000

HTXS $238,515 $238,515 $238,515 $238,515

PDCS $35,527 $35,527 $35,527 $35,527

PDTX $31,608 $31,608 $31,608 $31,608

PMTCT $100,000 $100,000 $100,000 $100,000

HVOP $422,555 $422,555 $422,555 $422,555

OHSS $85,000 $85,000 $85,000 $85,000

HLAB $150,000 $150,000 $150,000 $150,000

HVTB $50,000 $50,000 $50,000 $50,000

TOTAL $1,263,205 $1,263,205 $1,263,205 $1,263,205

Proposals are requested to support Burundi to reduce the number of new HIV infections and other sexually transmitted diseases among members of the Burundi Defense Forces (BNDF), their families, and the civilian communities served by the BNDF and help the military reach the UNAIDS 90-90-90 goals. The TBD partner will work directly with the BNDF in the military HIV Prevention, Care and Treatment program and increase the BNDF’s capacity to deliver comprehensive and quality HIV treatment and prevention in a sustainable and cost effective way. Department of Defense HIV/AIDS Prevention Program (DHAPP) programming to support the BNDF will focus on the following technical areas: 1) HIV Prevention; 2) HIV Testing Services (HTS); 3) Prevention of Mother-to-Child Transmission (PMTCT); 4) HIV/AIDS Care and Treatment; 5) Clinical Laboratory Support; and 6) HIV Clinical Monitoring Systems

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 BNDF leadership as well as BNDF 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 BNDF 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 BNDF’s HIV prevention and health services, as well as the DHAPP/DoD Program Manager based at the US Embassy in Burundi and the DHAPP Headquarters Team. The Grantee is the Implementing Partner and will be referred to as IP in this document. Dollar amounts, budget codes, and implementing strategy are subject to change in alignment with the annual Country Operational Plan (COP) process conducted by President’s Emergency Plan For AIDS Relief (PEPFAR) each year.

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

HIV/AIDS Prevention

Technical Area Targets, Year 1

Indicator Label Military

Only Civilian Total

PP_PREV # of the priority populations (PP) reached with the standardized, evidence-based intervention(s) required

13,775 5,225 19,000

The IP will strategically target sub-populations within the military and other priority populations (ie: AGYW near FSW hotspots and military bases) as defined by the Burundi OU team in the COP process with a written plan for identifying the specific sub-populations.

The intervention package for adults will include the following:

• Promotion of relevant prevention and clinical services and demand creation to increase awareness, acceptability, and uptake of these services.

• Information, education, and skills development to: reduce HIV risk and vulnerability;

correctly identify HIV prevention methods; adopt and sustain positive behavior change; and promote gender equity and supportive norms and stigma reduction.

• Referral to or provision of HIV testing; facilitated linkage to care and prevention services;

and/or support services to promote use of, retention in, and adherence to care.

• Condom and lubricant (where feasible) promotion, skills building, and facilitated access to condoms and lubricant (where feasible) through direct provision or linkages to social marketing and/or other service outlets.

Data collection requires reliable tracking systems that are designed to count the number of one-on-one encounters or participation in group interventions and that reduce double-counting of individuals in a reporting period. Data should be collected at every encounter/point of service and aggregated in time for PEPFAR reporting cycles. This indicator only counts those interventions at the individual and/or group level.

HIV/AIDS Testing Services

Indicator Label Military

Only Civilian Total

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

10,252 12,433 22,685

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

91 270 362

TB_STAT Percentage of new and relapse TB cases with documented HIV status

100% 100% 100%

TB_STAT_POS # of of new and relapse TB cases 0 32 32

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program with known and new HIV+ status

The IP will work closely with the BNDF and DHAPP HQ to 1.) target HIV testing to populations with high risk and high HIV seropositivity; 2.) begin conversations to transition routine, low-risk HIV testing to the BNDF; and 3.) regularly review (weekly) programmatic data in order to constantly inform programming and refine strategy to identify more PLHIV.

Ensuring that any positives identified are linked to HIV care and treatment is essential to the success of the BNDF program. Therefore, the IP should work with the BNDF to create/maintain a system to follow-up and document successful linkages into care, even if the linkage is into the MoH care system. The IP should work to achieve 95% linkage of HIV+ individuals identified for both BNDF members and civilians. 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. The IP will ensure that all HTS is conducted via finger prick method.

The IP will work closely with the BNDF to ensure that all patients with presumptive TB or TB disease receive HIV testing and provide immediate access to ART for patients, with the goal of providing universal ART coverage among HIV-infected TB patients and universal TB screening for all HIV-infected individuals.

The IP will be responsible for:

Targeted testing to geographic locations and populations with high risk and high

HIV seropositivity Utilize a risk screening tool to help identify high-risk individuals for testing Index-case testing/partner notification for spouses and other sexual partners of HIV+ individuals Training healthcare providers on partner notification

Index-case testing/partner notification for children under 15 of HIV+ females

100% testing of all TB-infected clients (both military and civilian) treated in military health services

Training healthcare providers on HIV self-testing (HIVST) (how to direct assisted and unassisted testing and in what modalities/circumstances it is most effective)

Creating HIVST resource package to be distributed with each self-test that has education and linkage information for military facilities

Provider-Initiated testing and counseling within military health services for both military personnel and civilians who are at high risk with 95% of positives diagnosed through PITC linked to HIV care and treatment services

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

Tracking PLHIV from HTS to clinical care and treatment services for same day initiation

Transition Peace Keeping mission testing which contributes to low yield for military to the BNDF

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Prevention of Mother-to-Child Transmission

Indicator Label Target

PMTCT_STAT # of pregnant women with known status (includes women who were tested for HIV and received their results)

5,653 (100%)

PMTCT_ART # of HIV+ pregnant women who received ART to reduce risk for mother-to-child-transmission during pregnancy

(100%)

PMTCT_EID # of infants born to HIV-positive women who had a virologic HIV test done within 12 months of birth

(100%)

The IP will support all BNDF ART sites to ensure that 1) all pregnant women are aware of their HIV status; and 2) all HIV+ pregnant women are initiated and retained on ART to reduce risk for mother-to-child transmission during pregnancy.

Supporting BNDF clinical services to screen all pregnant women attending military health services for HIV Initiating all HIV+ pregnant women on ART; with a focus on adherence and retention during pregnancy and post-partum Quality Assurance / Quality Improvement of BNDF PMTCT services Ensuring post-partum neonatal ART prophylaxis per existing Option B+ guidelines Routine Early Infant Diagnosis of exposed infants based on existing WHO guidelines to include EID virological testing at 4-6 weeks of age and serologic testing at 9 months of age

Support PMTCT counseling and ancillary support to include breastfeeding Routine opt-out HIV testing for partners (including partner notification options for all sexual partners) of pregnant women to identify HIV serodiscordant couples

Begin discussions to transfer PMTCT low yield testing to the BNDF

HIV/AIDS Care and Treatment

Indicator Label Military Civilian Total

TX_NEW # of adults and children newly enrolled on ART

92 223 315

TX_CURR # of adults and children currently receiving ART

449 1,495 1,944

TX_RET # of adults and children known 102 250 352

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program to be alive and on treatment 12 months after initiation of

ART

TX_PVLS # of ART patients with a viral load result documented in the medical record and/or laboratory information systems (LIS) within the past 12 months with a suppressed viral load (<1000 copies/ml)

356 1,184 1,540

TX_TB The proportion of ART patients screened for TB in the semiannual reporting period who are receiving TB treatment.

90/449 299/1,495 389/1,944

TB_ART The number of HIV-positive new and relapsed TB cases on ART during TB treatment

0 32 32

TB_PREV The number of ART patients who completed a standard course of TB preventive therapy

305 1,017 1,322

GEND_GBV # of people receiving post- Gender Based Violence (GBV) clinical services minimum package.

0 10 10

FPINT_SITE # of HIV service delivery points supported by PEPFAR that are directly providing integrated voluntary family planning services

- - 8

The IP will work closely with the BNDF to scale-up the HIV Care and Treatment program and increase the BNDF’s capacity to deliver comprehensive and quality HIV care and treatment in a sustainable and cost effective way.

The IP will work closely with the BNDF to continue to provide quality and comprehensive HIV/AIDS care and treatment services at the Kamenge Military Hospital and the Akabanga Clinic in Bujumbura, the Akabanga Clinics in military region #2, 3, 4 and the Mudubugu Peace Keeping Training Center throughout the country. The IP will continue to practice Test and Start (starting ART immediately upon HIV diagnosis) for BNDF military members and for civilians.

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Enrollment into HIV clinical care and treatment

Aggressive enrollment of HIV-infected military personnel nationwide and HIV-infected civilians in scale-up districts into clinical care and treatment

Passive enrollment of HIV-infected civilians and dependents into clinical care and treatment in non-scale-up districts.

Ongoing clinical support for all ART patients Supporting the BNDF with multi-month scripting (minimum 3 months) Clinical monitoring of all HIV+ positive patients including CD4 at baseline, viral load at first 6 months and then every 12 months thereafter, 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, etc.

Cotrimoxazole prophylaxis for HIV positive patients, fluconazole prophylaxis for asymptomatic cryptococcal antigenemia with CD4<100 cells/uL, Isonizaid Preventive Therapy, etc.

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

Close coordination with BNDF to track down and follow enrolled patients that are deployed, to ensure they have their meds and continue to receive regular viral load (SMS VL results and education) and other required lab checks and ensure that they are included in data reporting back to BNDF during deployment (ie: counted as part of TX_CURR cohort, VL result recorded, etc.)

Medication adherence and 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 Organize a comprehensive training program for HIV curriculum targeting officers from the MDNAC "Ecole Paramédicale Militaire" in the view of enhancing their capacities for addressing HIV prevention, care and treatment activities once hired by Military Hospital and Akabanga clinics

Planning, logistics, and monitoring of ART clinics to reach military ART targets

Promoting ongoing communication and collaboration between BNDF 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

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

Referral for hospital admission when clinically indicated Transitioning first-line ART to Tenofovir Lamivudine Dolutegravir (TLD) in all BNDF facilities Conducting and documenting index patient testing for all HIV-infected clients

Index-case testing/partner notification for all sexual partners (not just spouses) and children under 15 of HIV+ women

Clinical Laboratory Support

Clinical laboratories for HIV care and treatment are present at Kamenge Military Hospital and the Akabanga Clinic in Military Region #1. The IP will work with BNDF clinical and laboratory staff in support of all HIV laboratory services.

Inventory control, forecasting, and procurement of laboratory reagents to ensure that laboratory services are uninterrupted 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 BNDF laboratory services to other laboratory resources at the district, provincial, and national levels

Building capacity in the BNDF for BNDF staff to take full ownership of lab functionality

Working with the military on an aggressive timeline towards full lab accreditation

HIV Clinical Monitoring Systems (Strategic Information)

Successful tracking of patient level data is critical to the success of the BNDF 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 BNDF 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 BNDF to support the collection of patient-level data, the clinical and programmatic use of data, and the reporting of site-level data to DHAPP HQ and the BNDF leadership. All medical record (EMR) work should be coordinated and aligned with PEPFAR, 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 BNDF clinical staff and leadership; and, how the IP will responsibly protect military data from dissemination outside of BNDF and DHAPP.

Amendment #0008, N00244-17-S-FO02 (FY17 – FY18 DHAPP: Military Specific HIV/AIDS Prevention, Care, and Treatment Program

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

Training and on-the-job mentorship of BNDF 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 BNDF, DHAPP, and PEPFAR disaggregated by military and civilian and all other MER 2.0 required disaggregation

Securing all patient-level and site-level data from dissemination outside of BNDF and DHAPP without prior approval from BNDF

Support for data entry, cleaning, reporting, analyzation, and use Implementation of clinical monitoring system, including maintenance of network infrastructure (if necessary)

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