Botswana CDC-RFA-JG-0081 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 24, 2025

Strengthening Botswana's national health data systems for a sustainable and government-led HIV/TB and related public health threat response through enhanced surveillance, digital health, and data analytics under PEPFAR Opportunity number: CDC-RFA-JG-25-0081

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 31

Get registered 32

Questions 33

Step 3: Prepare Your Application 34

Application contents and format 35

Step 4: Learn About Review and Award 45

Application review 46

Award notices 52

Step 5: Submit Your Application 54

Application submission and deadlines 55

Application checklist 57

Step 6: Learn What Happens After Award 59

Post-award requirements and administration 60

Contacts and Support 67

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 24, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information U.S. Centers for Disease Control and Prevention (CDC)

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Strengthening Botswana’s national health data systems for a sustainable and government-led HIV/TB and related public health threat response through enhanced surveillance, digital health, and data analytics under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0081

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

February 24, 2025

Expected award and start date: September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary This NOFO aims to strengthen the Government of Botswana’s (GOB) health data systems through tailored technical assistance efforts. You are expected to support the GOB to enhance health facility, district, and national data systems through focus on:

• Data governance and policies.

• Capacity building for data management.

• System functionality, interoperability, availability, quality, and data use.

You are also expected to collaborate with relevant stakeholders to support the GOB to ensure that comprehensive, quality HIV-related health data systems operate effectively at the facility, district, and national levels through the following strategic activities:

• Strengthen monitoring and evaluation (M&E) capacities within GOB, including data availability and reporting, quality, analytics, interpretation, and use at facility, district, and national levels.

• Enhance health informatics functionality, data security, infrastructure, and health data exchange across systems to improve patient outcomes and inform health policy and programming.

• Strengthen capacities of the GOB to conduct surveillance activities, including but not limited to clinical, population-level, and key populations. This will help to prevent, respond, and control HIV/TB and related public health threats, under the International Health Regulation (IHR) 2005 framework across all administrative levels.

Step 1: Review the Opportunity 5

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $4,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1 to 2 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Step 1: Review the Opportunity 6

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: COP Q1 Targets and Activities.

◦ Component 2: COP Q2 Targets and Activities.

◦ Component 3: COP Q3 Targets and Activities.

◦ Component 4: COP Q4 Targets and Activities.

◦ Component 5: COP Additional Targets and Activities.

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR Local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 30 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in Botswana.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work Botswana has achieved significant milestones in the fight against HIV/AIDS, having successfully reached the UNAIDS 95-95-95 targets. While these accomplishments are commendable, sustaining these gains within a government-led HIV response presents new challenges.

There is a need to enhance national data systems that support ongoing efforts through robust M&E frameworks, interoperable systems, reliable data sources, and responsive surveillance. These adaptive systems must be capable of addressing emerging challenges and ensuring that the HIV response remains effective, and data driven.

This is a follow-on NOFO to CDC-RFA-GH20-2007, which focused on electronic medical records (EMR) development and strengthening the infrastructure of health data systems. Significant progress was made in enhancing M&E activities, developing HIV surveillance systems and surveys, and promoting high-quality data use through dashboards and other tools.

An enhanced patient information management system was rolled out to over 500 government health facilities resulting in over 80% of HIV data coming from EMR. The NOFO also supported national, district, and site-level data staff and development of key components of a health information exchange platform. This resulted in varying success across use cases. However, evolving needs require further enhancements to these systems to meet GOB’s strategic priorities.

Despite progress made, GOB data systems face challenges:

• Data governance and quality: Gaps in data governance hinder maintaining consistent high data standards. Robust policies are needed to ensure the quality, security, and accessibility of health data across the system.

• Capacity enhancement: Limited analytics capacity affects data management continuity and quality. Insufficient training and a lack of advanced analytics skills, including predictive modeling, restrict the workforce’s ability to fully leverage data for decision-making.

• System functionality and interoperability: Enhancing interoperability and functionality remains crucial. Persistent integration gaps lead to data silos, obstructing comprehensive analysis and effective use. Inadequate

Step 1: Review the Opportunity 10 information technology (IT) infrastructure limits timely data transmission, reporting, and health information system operations.

• Surveillance and response: Strengthening surveillance, including case-based and public health surveillance activities, is essential for improving preparedness and response to HIV/AIDS, TB, and other related public health events. Gaps in data integration, unique identification and timeliness continue to challenge effective response.

• Digital health solutions: Limited availability and use of digital health tools, including mobile technology, restrict effective patient management, data collection, and health system efficiency. Integrating advanced analytics and predictive modeling into digital health strategies is crucial.

This NOFO focuses on the following strategies:

• Improving data governance and policies: Ensuring high-quality, accessible, and secure data for decision-making at all levels.

• Strengthening M&E capacities: Enhancing the capacity of government institutions in M&E, digital health, and analytics for a sustainable, government-led HIV response.

• Enhancing system functionality and interoperability: Strengthening the health information exchange framework and upgrading IT infrastructure including but not limited to hardware, software, networking, and storage to improve integration and functionality of health data systems.

• Leveraging digital health solutions and advanced analytics: Integrating clinical data with innovative digital health solutions, modernization efforts, and advanced analytics to improve patient outcomes and inform policy decisions.

• Strengthening surveillance and response capabilities: Optimizing detection and response to new HIV infections, monitoring drug resistance, and refining central reporting requirements in alignment with national priorities. Strengthening case-based surveillance and other surveillance activities will enhance GOB’s ability to respond effectively to public health events.

• Supporting a government-led HIV program: As Botswana fully transitions to a government-led HIV response, this NOFO emphasizes using national systems for program accountability and community engagement, ensuring sustainability. This will contribute to the alignment of national health priorities and international reporting requirements.

This NOFO will provide technical assistance to GOB, focusing on strengthening national data systems through improved governance, capacity

Step 1: Review the Opportunity 11 building, and systems enhancement. Efforts include integrating digital health solutions and enterprise architecture for interoperable, scalable, and sustainable health information systems. Predictive modeling will be enhanced for program optimization. Collaboration with stakeholders and partners will ensure coherent implementation and prevent duplication of efforts.

Purpose The purpose of this NOFO is to support GOB capacity for a sustainable and government-led response to HIV and related public health threats through improved workforce development, data governance, system functionality, interoperability, and use. This NOFO aims to sustain progress beyond the 95-95-95 targets by focusing on optimizing surveillance systems, digital health integration, and data analytics to ensure reliable, quality, and evidence-based data for decision-making and reporting.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes

Long-term outcomes

Strategy 1: Support GOB to strengthen M&E capacities, data governance and quality at all levels of the health care system.

Strategy 2: Support GOB to enhance national health data systems’ functionality, infrastructure, integration, data exchange, and innovative technologies.

Strategy 3: Support GOB to strengthen surveillance systems to prevent, detect, and control HIV/TB and related public health threats across all levels of the health system.

Increased capacity of the GOB to collect and analyze accurate, complete, and timely health data.*

Improved adoption and compliance to data governance policies and regulations.*

Improved functionality and use of EMR systems and other e-health solutions.*

Improved integration and interoperability of health data systems for continuous improvement and innovation in healthcare delivery.*

Improved timely detection and response to new HIV infections and related public health threats.*

Increased competencies of GOB staff on M&E, surveillance, and informatics.*

Improved stakeholder coordination through the Botswana Health Data Collaborative (BHDC).*

Improved alignment of GOB systems with global HIV standards and reporting requirements.*

Increased use of health data for planning, programming, and policy formulation by GOB and stakeholders.*

Improved integration and government ownership of health information systems.*

Improved data security, privacy, and ethical use at all levels.*

Improved exchange of health data between facilities and central databases.*

Improved patient health outcomes.

Decreased HIV/ TB-related morbidity and mortality.

Sustained HIV epidemic control.

Enhanced government ownership and accountability.*

Step 1: Review the Opportunity 13

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

Strategy 1: Support GOB to strengthen M&E capacities, data governance and quality at all levels of the health care system.

Required activities:

• Strengthen GOB systems to align with all HIV global reporting standards and requirements, including but not limited to UNAIDS, Global Fund, PEPFAR, and WHO.

• Strengthen adoption, implementation, and compliance to the national data management acts, regulations, policies, and frameworks.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the strategic information mentorship program and other training platforms for M&E staff on data collection, analysis, and reporting.

• Support Ministry of Health’s (MOH) leadership and coordination of strategic information, clinical services, and laboratory arms of the GOB National Mentorship Program.

• Develop and implement data quality management and continuous quality improvement policy and systems to routinely identify and address data quality gaps at all levels.

• Review and upgrade data collection, analytics, and visualization tools and patient-centric systems to ensure consistency and accuracy.

• Develop and standardize indicators and disaggregation across the health system in line with strategic priorities.

• Conduct regular data review meetings to assess progress and facilitate data use and decision making.

• Support streamlining of reporting processes to ensure timely submission of data.

• Develop and maintain a repository of standard operating procedures (SOPs).

• Provide technical support to the Data Use Technical Working Group (TWG) under the BHDC.

Step 1: Review the Opportunity 14

Strategy 2: Support GOB to enhance national health data systems’ functionality, infrastructure, integration, data exchange, and innovative technologies.

Required activities:

• Strengthen adoption, implementation, and compliance to the national digital health acts, regulations, policies, and frameworks.

• Conduct periodic health informatics infrastructure and performance assessments across the healthcare system to identify areas of improvement and develop remediation plan.

• Support implementation of the national enterprise architecture framework to integrate various health information systems.

• Implement necessary upgrades to IT infrastructure to support digital health interventions including data interoperability.

• Strengthen use of alternative technologies to achieve rapid results in data exchange and integration, including but not limited to direct secure messaging.

• Develop, update, and ensure compliance to standardized protocols for health data exchange across different systems and healthcare levels.

• Facilitate enhancement, integration, and use of EMR systems across all levels of the healthcare system ensuring robust data security measures are in place to protect patient information.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the strategic information mentorship program and through other training platforms for health informatics staff focusing on different areas. This is including but not limited to innovative digital health solutions, data science techniques, and machine learning.

• Provide technical support to the Digital Health TWG under the BHDC to ensure alignment and cooperation in health informatics initiatives.

• Strengthen the capability and functionality of the national health data repository to store, exchange, and analyze data.

Step 1: Review the Opportunity 15

Strategy 3: Support GOB to strengthen surveillance systems to prevent, detect, and control HIV/TB and related public health threats across all levels of the health system.

Required activities:

• Strengthen adoption, implementation, and compliance to the international surveillance guidelines (including unique identification), national policies and frameworks including but not limited to the WHO recommended standards and the integrated disease surveillance and response.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the strategic information mentorship program and through other training platforms for public health surveillance staff. This will focus on different areas, including but not limited to:

◦ Field epidemiology.

◦ Event-based surveillance.

◦ Case-based surveillance.

◦ IHR 2005 requirements.

• Support development and implementation of standardized protocols for population-based surveys and public health surveillance, including but not limited to:

◦ HIV drug resistance.

◦ Recent infection surveillance.

◦ Case-based surveillance.

◦ Mortality surveillance.

◦ Sentinel surveillance.

• Strengthen use of predictive modeling approaches for prevention, detection, and control of HIV/TB and other potential public health threats.

• Strengthen surveillance data management systems for real time availability of data and rapid response to HIV/TB and other public health threats.

• Conduct periodic surveillance system infrastructure and performance assessments across the healthcare system to identify areas of improvement and develop remediation plan.

Step 1: Review the Opportunity 16

• Provide technical support to the Civil Registration and Vital Statistics TWG under the BHDC to ensure alignment and cooperation in health informatics initiatives

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.state.gov/reports-pepfar/ and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include, but are not limited to:

• Health information staff:

◦ Assistant health officers.

◦ Developers.

◦ System administrators.

• Program M&E personnel:

◦ M&E officers.

◦ Data managers.

◦ Data analysts.

◦ Data entry clerks.

◦ Healthcare workers.

◦ National and district health managers.

◦ Survey and surveillance personnel.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

◦ Surveillance officers.

◦ International classification of diseases coders.

• People living with HIV in Botswana.

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 19 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If funded, we will expect you to collaborate with:

• U.S. Government agencies, such as:

◦ U.S. Agency for International Development.

◦ Department of State.

◦ Peace Corps.

• GOB:

◦ MOH Departments (M&E, District Health Management Teams, etc.)

• Other Botswana line ministries, departments, and agencies, including, but not limited to:

◦ Department of Civil Registration.

◦ Ministry of Local Government.

◦ Botswana Public Health Institute.

◦ National AIDS and Health Promotion Agency.

• CDC-funded partners who:

◦ Implement HIV/TB prevention and care and treatment activities.

◦ Support strengthening health data system’s capacity in Botswana at the district and national levels.

◦ Implement other public health programs as it relates to HIV.

• Data use implementing partners.

• Non-government organizations.

• Other stakeholders and partners.

• Development partners including:

◦ WHO.

◦ UNICEF.

◦ UNAIDS.

Step 1: Review the Opportunity 20

◦ United Nations Population Fund.

◦ Global Fund.

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 5% of funds for monitoring activities and 5% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

These include process and outcome measures that directly correlate with the logic model.

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year. You may also propose custom indicators.

• Percentage of health facilities implementing standardized data collection and quality assurance protocols within the past quarter. [Target: 80%;

Reporting Frequency: Quarterly]

• Percentage of all strategic information staff across the country who have received strategic information mentorship within the past quarter.

[Target: 80%; Reporting Frequency: Quarterly]

• Percentage of health facilities with timely, accurate, and complete reports provided to the national reporting platforms/repository in the past month. [Target: 95%; Reporting Frequency: Monthly]

• Percentage of health facilities using enhanced, government led EMR systems for all points of care and to support data interoperability through the health information exchange in the past quarter (denominator: eligible sites within the government data network).

[Target: 90%; Reporting Frequency: Quarterly]

• Percentage of people living with HIV who are on antiretroviral therapy using mobile health solutions for patient-centered services in the past quarter. [Target: 20%; Reporting Frequency: Quarterly]

• Percentage of the surveillance reports for the previous month which were disseminated to relevant health stakeholders. [Target: 90%;

Reporting Frequency: Monthly]

• Percentage of relevant staff members who were trained on most up-to-date predictive modeling technology for disease outbreak prevention and control in the past 12 months. [Target: 90%; Reporting Frequency:

Annual]

• Percentage of trained staff members who are using predictive modeling to inform and implement updated disease outbreak and public health

Step 1: Review the Opportunity 22 threat response plans at all levels in the past 12 months (i.e., relevant SOP posted, all staff are aware of their roles and associated strategies for response, etc.). [Target: 90%; Reporting Frequency: Annual]

• Percentage of M&E/strategic information units across the country (e.g., team of data clerks at site level and MOH M&E team at national level) which reported the completion of a comprehensive data review on a quarterly basis (at a minimum) at all levels. [Target: 90%; Reporting Frequency: Quarterly]

• Proportion of planned system enhancements on EMR, data warehouse and other applications that are completed in a timely manner with minimal errors (as per approved workplan). [Target: 100%; Reporting Frequency: Quarterly]

• Proportion of health information systems solutions transmitting data to the national data warehouse with less than 5% of errors. [Target: >95% errors; Reporting Frequency: Annual]

• Proportion of districts with timely (within a week of initial report) detection, investigation, and response to outbreaks and global health threats. [Target: >95% districts with timely response; Reporting Frequency: Bi-Annual]

• Number of new use cases developed to enhance systems interoperability for information exchange. [Target: 2; Reporting Frequency: Annual]

• Number of health facilities where lab/EMR data exchange is in production by end of year 1. [Target: 15; Reporting Frequency: Annual]

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress reports, surveillance and survey reports, and other program monitoring tools.

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term and end-term evaluation.

• Extent to which the data governance policy has been adhered to by all users of public health data systems in the country: process evaluation.

• Extent to which the collaboration between GOB and stakeholders has led to alignment of health information systems initiatives with national

Step 1: Review the Opportunity 23 health strategies and sustainable government-led responses: process evaluation.

• Extent to which integration and interoperability of health information systems have contributed to improved patient outcomes and efficiency of healthcare delivery: outcome evaluation.

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Step 1: Review the Opportunity 24

Include the following elements in your evaluation and performance measurement plan.

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

Step 1: Review the Opportunity 25

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

Step 1: Review the Opportunity 27

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 28 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

Salary rate limitation As of January 2024, the HHS/CDC salary rate limitation is $221,900. This salary rate limitation does not apply to PEPFAR funds, which are part of an appropriation from the U.S. Department of State; but to the extent that HHS/ CDC funds are added to an award, this limitation applies. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use program income for the purposes and under the conditions of the award. Find more about program income at 45 CFR 75.307.

Program-specific limitations

CDC PEPFAR terms and conditions You can find a list of PEPFAR-specific terms and conditions on our website.

They apply to all PEPFAR awards, so we strongly encourage you to read them and ask questions if you need more information. These terms and conditions will apply if you are selected for an award so you should confirm that you are able to comply with them prior to applying.

Host country laws and regulations If funded, you are expected to follow applicable host country laws and regulations related to the strategies under this NOFO; if there are conflicts with this award,…