Botswana CDC-RFA-JG-25-0082 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 19, 2025

Provide technical assistance (TA) to support the Botswana Ministry of Health (MOH) implement policies and programs across the HIV clinical and prevention cascade under the President’s Emergency Plan for AIDS Relief (PEPFAR) Opportunity number: CDC-RFA-JG-25-0082

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 33

Get registered 34

Questions 35

Step 3: Prepare Your Application 36

Application contents and format 37

Step 4: Learn About Review and Award 47

Application review 48

Award notices 55

Step 5: Submit Your Application 56

Application submission and deadlines 57

Application checklist 59

Step 6: Learn What Happens After Award 61

Post-award requirements and administration 62

Contacts and Support 69

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 19, 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:

Provide technical assistance (TA) to support the Botswana Ministry of Health (MOH) implement policies and programs across the HIV clinical and prevention cascade under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0082

Announcement type:

New

Assistance listing:

93.067 Global AIDS

Program

Key dates

Application deadline:

February 19, 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 will provide tailored TA to the Botswana MOH to implement policies and quality programs that sustain the HIV/TB response and address equity gaps in priority populations.

The NOFO aims to improve targeted HIV:

• Capacity building and mentorship.

• Case-finding.

• Prevention.

• Care and treatment.

• Continuity of care and viral load suppression.

Activities include:

• HIV diagnosis, linkage, and continuity of stigma-free care and treatment.

• TB symptom screening, diagnostic evaluation, and prevention among people living with HIV.

• Advanced HIV disease management that includes the prevention and treatment of co-morbidities.

• Strengthening and leveraging primary health care (PHC) to support sustainability and integration of non-communicable diseases (NCDs) and HIV care, especially among people living with HIV.

• Cervical cancer prevention among women living with HIV.

Step 1: Review the Opportunity 5

• Targeted and stigma-free HIV prevention interventions, including but not limited to:

◦ Access and use of pre-exposure prophylaxis (PreP) and post-exposure prophylaxis.

◦ Screening for and providing support for people who have experienced gender-based violence (GBV).

◦ Youth responsive health services for adolescent girls and young women.

◦ Key population competent services.

• Training and mentorship for healthcare workers (HCW) in all HIV programs.

• Development and implementation of innovations, policies, and guidelines needed to sustain HIV epidemic control.

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $7,500,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1-3 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.

Step 1: Review the Opportunity 6

• 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.

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 below.

• 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 the 95-95-95 targets. According to the 2021 Fifth Botswana AIDS Impact Survey, it is estimated to be 95-98-98 for populations aged 15-64 years. The 2022 UNAIDS model estimates 97-97-99, with 95-92-99 for men over 15 years old and 99-100-99 for women over 15 years old.

This progress comes against the backdrop of longstanding efforts the country employed over the last 20 years. However, adult HIV prevalence remains high at 20.8% with 343,791 people estimated to be living with HIV. Despite the achievements recorded, both UNAIDS Spectrum estimates and program data reveal sub-population inequities.

National annual HIV incidence is estimated at 0.31% with adolescents and young women accounting for a quarter of new infections despite being only 9% of the population. Although updated risk estimates among key populations in Botswana are not yet available, their risk of HIV acquisition likely remains high with program testing data showing higher positivity rates (10%) compared to that of the general population (2.7%). Viral load suppression is at 82% among men aged 25-34 years and 83% among adolescent girls and young women.

Great progress has been made in the national HIV response; however, some challenges remain including:

• Siloed program implementation.

• Vulnerabilities associated with an aging population living with HIV.

• HIV related gaps, including:

◦ Long-term antiretroviral therapy (ART), side effects including renal failure and low bone density.

◦ Propensity for developing advanced disease complications if treatment is interrupted.

• Non-HIV related gaps, including:

◦ Chronic disease management, hypertension, obesity, renal failure, etc.

◦ Neurocognitive impairment and mental health needs.

• Inequities in both access and receipt of HIV services among certain populations and geographical areas.

Step 1: Review the Opportunity 10

• Emerging health system and operational gaps

• Inadequate human resources for health and underfunding for prevention interventions.

Given these challenges, Botswana has identified the need to prioritize new strategies and targeted approaches that are sustainable, comprehensive, and relevant to address equity gaps. Strengthening health systems remains key to sustaining the response and driving the Government of Botswana (GOB) towards attaining the country’s goal of 99-99-99 (97% population level viral suppression) for all age/sex bands and key and priority populations by 2030.

This is a follow-on NOFO to CDC-RFA-GH20-2008, which aimed to:

• Provide tailored and integrated site-specific support to MOH programs to close the HIV/TB prevention, treatment, diagnostic, and data gaps.

• Ensure that all women living with HIV receive cervical cancer screening and treatment for pre-cancerous lesions.

• Develop a mentorship program for HCW.

You should leverage existing platforms to contribute to GOB’s efforts to revitalize PHC by supporting the integration of:

• HIV services into traditional non-HIV service points such as mobile stops and facility outreach.

• NCD services into HIV service points.

• HIV prevention interventions across PHC service points.

GOB’s goal is to build a sustainable and equitable national public health response to HIV/TB for all; therefore, you should also prioritize strengthening national health systems key to HIV service delivery, including:

• Expanding the National Mentorship Program using continuous quality improvement approaches.

• Supporting capacity building for facility-based interventions.

• Expanding and institutionalizing program best practices within national platforms.

• Strengthening government ownership and stewardship across all levels of the health delivery system.

You should provide comprehensive, tailored, and integrated TA to support sustainable GOB HIV clinical programs at the national, district, and facility level that address the following priority areas:

• Person-centered, population targeted HIV/TB care and treatment services.

Step 1: Review the Opportunity 11

• PHC and NCD integration into HIV care.

• Mortality reduction interventions among people living with HIV, including:

◦ TB prevention, treatment, and notification.

◦ Cervical cancer prevention and treatment.

• Quality management systems strengthening.

• Targeted case-finding.

• Evidence-based interventions for HIV prevention, including:

◦ Optimizing PrEP uptake and continuation.

◦ Supporting clinical services for youth and gender programs including youth responsive services, GBV, and Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS).

◦ Supporting key population programming.

• Supporting capacity building and mentorship of HCW.

We expect these activities will contribute to GOB’s vision for a well-integrated and sustainable HIV response to close coverage gaps across the clinical and prevention cascades for HIV in all populations by 2030.

Purpose The purpose of this NOFO is to support the Botswana MOH in strengthening public health programs and related systems to achieve and sustain HIV epidemic control for all populations.

The NOFO aims to provide TA by strengthening the National Mentorship Program as well as integration and sustainability structures. This will support comprehensive HIV prevention services for all and close coverage gaps across the clinical cascade for HIV/TB among priority and key populations at multiple levels.

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.

Step 1: Review the Opportunity 12

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.

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1: Support GOB to strengthen case-finding and the continued adoption and implementation of emerging evidence-based interventions for HIV prevention.

Strategy 2: Support GOB to strengthen provision of person-centered, comprehensive services across the continuum of care for HIV-infected people.

Strategy 3: Support GOB to continue implementation of a well-institutionalized National Mentorship Program for effective and evidence-based delivery of equitable, high-quality HIV care and prevention services across the continuum of care.

Strategy 4: Support GOB to strengthen integration of NCD

Increased compliance to national guidelines and standards.*

Improved HIV case finding and linkage to same-day ART.*

Improved management of advanced HIV and co-morbidities among people living with

HIV.*

Increased cervical cancer prevention among women living with HIV.*

Increased competencies of HCW to provide comprehensive and quality HIV services.*

Improved use of e-learning platforms among HCWs.*

Increased access and uptake of HIV prevention services.*

Increased TB screening and case identification among

Improved quality of HIV clinical services.*

Improved patient health outcomes.*

Improved adherence to ART and continuity in care among people living with HIV.*

Improved analysis and use of data for decision-making.*

Increased uptake of TB preventive therapy and treatment among people living with

HIV.*

Improved viral load coverage and suppression among people living with

HIV.*

Improved PrEP coverage among eligible populations.*

Sustained gains of the government-led HIV response.*

Reduced HIV incidence.

Improved NCD control among people living with HIV.

Reduced cervical cancer incidence among women living with HIV.

Reduced HIV-related morbidity and mortality.

Step 1: Review the Opportunity 13

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes and HIV care through the PHC approach.

people living with

HIV.*

Improved clinical management and treatment of NCDs among people living with HIV.*

Improved documentation, timely reporting, and review of data.*

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.

The following are strategies and the required activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Strategy 1: Support GOB to strengthen case-finding and the continued adoption and implementation of emerging evidence-based interventions for HIV prevention.

Required activities:

• Strengthen adoption, implementation, and compliance with national HIV testing and prevention regulations, policies, and guidelines.

• Strengthen HIV case identification using targeted high-yield testing strategies, immediate ART initiation for HIV-positive individuals, and linkage to prevention services for all HIV-negative individuals.

• Support the development and scale up of testing strategies, including but not limited to HIV self-testing and index testing with a focus on hard-to-reach groups, such as key populations.

• Optimize PrEP uptake and continuation for focus populations, including but not limited to adolescent girls and young women and key populations.

Step 1: Review the Opportunity 14

• Support adoption and scale of emerging PrEP options for eligible populations.

• Support increasing access to and uptake of post-exposure prophylaxis for eligible populations.

• Support the enrollment and provision of clinical services for adolescent girls and young women in the DREAMS program.

• Support the MOH and other key stakeholders to optimize delivery of comprehensive and responsive health services for adolescents and youth.

• Support sensitization, identification, and provision of high-quality response services for GBV survivors that are in alignment with the national policies.

• Strengthen key population programming through high impact case finding and key population-competent, person-centered treatment and prevention services.

• Support capacity building of HCW on key population service delivery competencies.

• Support the development and implementation of cost effective, sustainable in-service training for HCW on HIV/TB testing and prevention services.

Strategy 2: Support GOB to strengthen provision of person-centered, comprehensive services across the continuum of care for HIV-infected people.

Required activities:

• Strengthen adoption, implementation, and compliance with the national HIV care and treatment, regulations, policies, and guidelines.

• Support development and implementation of innovative strategies to ensure same-day ART initiation for all newly identified HIV-positive individuals.

• Support viral load monitoring with appropriate and timely clinical action for unsuppressed individuals.

• Support development and implementation of differentiated strategies to monitor ART initiation, adherence, and continuity in care for focus populations including but not limited to female sex workers, men who have sex with men, adolescents and young adults, and men.

• Support the development and implementation of innovative strategies to ensure individuals who interrupt treatment return to care.

Step 1: Review the Opportunity 15

• Strengthen management of advanced HIV disease and co-morbidities among people living with HIV.

• Implement innovative strategies to improve TB screening, case identification, appropriate linkage to preventive therapy and TB treatment as per national guidelines.

• Strengthen cervical cancer prevention through awareness creation and the provision of timely and friendly cervical cancer screening using but not limited to human papilloma virus DNA screening and visual inspection with acetate, and treatment of precancerous lesions among women living with HIV.

• Support the development and implementation of cost-effective, sustained in-service training for HCW on HIV/TB care and treatment services.

Strategy 3: Support GOB to continue implementation of a well-institutionalized National Mentorship Program for effective and evidence-based delivery of equitable, high-quality HIV care and prevention services across the continuum of care.

Required activities:

• Strengthen the delivery of HIV/TB services and prevention through capacity building including skill transfer and mentoring of HCWs.

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

• Support MOH in providing ongoing training and mentorship for HCWs on HIV stigma and discrimination prevention.

• Support the enhancement of HCW problem solving, diagnostic, and clinical decision-making skills.

• Strengthen use of electronic medical records for documentation, reporting of services received, and patient management.

• Strengthen data analysis, interpretation, and use by HCWs for program and service improvement.

• Support HCW learning opportunities through expansion and use of the Extension for Community Healthcare Outcomes (ECHO) virtual mentorship platform and other e-learning platforms.

• Support continuous skills and professional development for HCW to establish a cascaded pool of mentors within the districts.

Step 1: Review the Opportunity 16

• Create platforms and opportunities for regular dissemination and implementation of best practices.

• Facilitate periodic review of program data specifically focusing on program performance to identify quality gaps and institute real-time continuous quality improvement initiatives as evidenced by best practices.

Strategy 4: Support GOB to strengthen integration of NCD and HIV care through the PHC approach.

Required activities:

• Support GOB and other stakeholders to strengthen the country’s PHC revitalization efforts through development and implementation of a comprehensive, integrated, and person-centered HIV/NCD service model at all tiers of the PHC delivery system.

• Support the development and implementation of cost effective, sustainable in-service training for primary HCW on integrated health care services.

• Strengthen integrated HIV/NCD services between health facilities and the community interphase.

• Strengthen the role of MOH in coordinating and providing technical oversight of the NCD/HIV integration.

• Strengthen adoption, implementation, and compliance with the NCD/HIV integration guidelines and treatment protocols.

• Support the strengthening and institutionalization of interventions needed to optimize HIV and NCD clinical outcomes for an aging HIV population in Botswana.

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.

Step 1: Review the Opportunity 17

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 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.

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

Step 1: Review the Opportunity 18 https://www.state.gov/reports-pepfar/ 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 https://www.state.gov/reports-pepfar/

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:

• General population.

• People living with HIV aged over 15.

• Priority populations:

◦ Adolescents and young women.

◦ Men.

• Key populations:

◦ Female sex workers.

◦ Men who have sex with men.

◦ People who inject drugs.

◦ People in prisons and other closed settings.

• HCW.

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.

Step 1: Review the Opportunity 19

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.

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:

• CDC funded partners who implement:

◦ HIV service delivery, prevention, care and treatment, laboratory, and strategic information activities.

◦ Other public health programs related to HIV/TB.

• U.S. Government-funded PEPFAR agencies (e.g., U.S. Agency for International Development, Peace Corps, etc.).

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

Step 1: Review the Opportunity 20 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

• GOB entities, including but not limited to the:

◦ MOH.

◦ Ministry of Local Government.

◦ National AIDS and Health Promotion Agency.

• Private organizations implementing related public health programs.

• Multilateral partners, including but not limited to:

◦ World Health Organization.

◦ United Nations Children’s Fund.

◦ Joint United Nations Program on HIV/AIDS.

◦ United Nations Population Fund.

◦ Global Fund and their implementing partners.

• Other stakeholders, including but not limited to civil society organizations and private partners, focusing on strengthening the national HIV response.

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.

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

Step 1: Review the Opportunity 21

In your application budget, you should allocate at least 5% of funds for monitoring activities and 3% 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.

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 Below, we show some anticipated MER indicators, targets, and reporting frequencies for the first year. You can propose any additional relevant MER indicators as part of your initial Evaluation and Performance Measurement Plan.

• PrEP_NEW: Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. [Target: 7,582; Reporting Frequency: Quarterly]

• HTS_INDEX: Number of individuals who were identified and tested using Index testing services and received their results. [Target: 9,545; Reporting Frequency: Quarterly]

• HTS_SELF: Number of individual HIV self-test kits distributed. [Target:

13,093; Reporting Frequency: Quarterly]

• HTS_TST: Number of individuals who received HIV Testing Services (HTS) and received their test results. [Target: 123,442; Reporting Frequency:

Quarterly]

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

Step 1: Review the Opportunity 22 https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• HTS_TST_POS: Number of individuals who received HIV Testing Services received a positive test result. [Target: 3,358; Reporting Frequency:

Quarterly]

• TB_ART: Proportion of new and relapsed TB cases living with HIV on ART during TB treatment. [Target: 100%; Reporting Frequency: Annual]

• TB_PREV: Proportion of ART patients who started on a standard course of TB Preventive Treatment (TPT) in the previous reporting period who completed therapy. [Target: 100%; Reporting Frequency: Semi-Annual]

• TB_STAT: Percentage of new and relapse TB cases with documented HIV status. [Target: 100%; Reporting Frequency: Quarterly]

• TX_CURR: Number of adults and children currently receiving antiretroviral therapy (ART). [Target: 197,212; Reporting Frequency:

Quarterly]

• TX_ML: Number of ART patients (who were on ART at the beginning of the quarterly reporting period or initiated treatment during the reporting period) and then had no clinical contact since their last expected contact.

[Target: Not Assigned; Reporting Frequency: Quarterly]

• TX_RTT: Number of ART patients who experienced IIT during any previous reporting period, who successfully restarted ARVs within the reporting period and remained on treatment until the end of the reporting period.

[Target: Not Assigned; Reporting Frequency: Quarterly]

• TX_NEW: Number of adults and children newly enrolled on antiretroviral therapy (ART). [Target: 4,935; Reporting Frequency: Quarterly]

• TX_TB: Proportion of ART patients screened for TB in the semiannual reporting period who start TB treatment. [Target: 100%; Reporting Frequency: Semi-Annual]

• GEND_GBV: Number of people receiving post-gender-based violence (GBV) clinical care based on the minimum package. [Target: 1,336;

Reporting Frequency: Semi-Annual]

• CXCA_SCRN: Number of women living with HIV on ART screened for cervical cancer. [Target: 24,597; Reporting Frequency: Semi-Annual]

• CXCA_TX: Percentage of cervical cancer screen-positive women who are living with HIV and on ART eligible for cryotherapy, thermocoagulation or LEEP who received cryotherapy, thermocoagulation or LEEP. [Target:

90%; Reporting Frequency: Semi-Annual]

• KP_PREV: Number of key populations reached at least once with individual and/or small group-level HIV primary or secondary prevention interventions designed for the target population. [Target: 2,093;

Reporting Frequency: Semi-Annual]

Step 1: Review the Opportunity 23

• TX_PVLS: Percentage of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented in the medical or laboratory records/laboratory information systems (LIS) within the past 12 months.

[Target: 98%; Reporting Frequency: Quarterly]

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

• Number of HCWs in participating facilities who received mentorship in prioritized clinical areas in the past quarter (data collected after each mentorship session and entered into DHIS2 tool). [Target: Not Assigned;

Reporting Frequency: Quarterly]

• Proportion of identified gaps/issues addressed by mentorship in all participating facilities in the past month (Denominator: all gaps/issues identified in that month). [Target: 70%; Reporting Frequency: Monthly]

• Proportion of active HIV individuals screened for NCDs in a health facility in the past quarter. [Target: 90%; Reporting Frequency: Quarterly]

• Proportion of active HIV individuals screened for mental health in the past quarter. [Target: 90%; Reporting Frequency: Quarterly]

• Proportion of active HIV individuals with NCDs who received treatment for respective NCDs in a health facility in the past quarter. [Target: 100%;

Reporting Frequency: Quarterly]

• Proportion of health facilities that are implementing integrated NCD and HIV management in the past quarter. [Target: 100%; Reporting Frequency: Quarterly]

• Number of guidelines/policies developed and approved in the past 12 months. [Target: Not Assigned; Reporting Frequency: Annual]

• Percentage of targeted healthcare workers trained in various products in clinical guidelines, mentorship framework, quality improvement, and integrated chronic disease management in the past quarter (through any platform, including but not limited to ECHO). [Target: 90%; Reporting Frequency: Quarterly]

• Percentage of health facilities with quality improvement projects that demonstrate improvement of desired program processes/outcomes in the past 12 months. [Target: 80%; Reporting Frequency: Annual]

• Percentage of health facilities implementing youth responsive services in the past 6 months. [Target: 90%; Reporting frequency: Semi-Annual]

Step 1: Review the Opportunity 24

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.

• The effect of the improvement of the continuum of care on the HIV clients’ clinical outcomes: outcome evaluation.

• The effect of the clinical mentorship program on the quality of HIV services: outcome evaluation.

• The effect of the prevention interventions on HIV incidence in Botswana:

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

Step 1: Review the Opportunity 25 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.

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.

Step 1: Review the Opportunity 26

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).

• 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.

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

Step 1: Review the Opportunity 27 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

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.

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.

Step 1: Review the Opportunity 28

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.

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.

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

Step 1: Review the Opportunity 29 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

• 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.

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…