Botswana CDC-RFA-JG-25-0083 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 19, 2025

Provide technical assistance to the Botswana Ministry of Health to implement HIV/TB policies and services for children and adolescents living with HIV including mental health and psychosocial support and pregnant and breastfeeding women under PEPFAR

Opportunity number: CDC-RFA-JG-25-0083

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 32

Get registered 33

Questions 34

Step 3: Prepare Your Application 35

Application contents and format 36

Step 4: Learn About Review and Award 46

Application review 47

Award notices 53

Step 5: Submit Your Application 55

Application submission and deadlines 56

Application checklist 58

Step 6: Learn What Happens After Award 60

Post-award requirements and administration 61

Contacts and Support 68

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 to the Botswana Ministry of Health to implement HIV/ TB policies and services for children and adolescents living with HIV including mental health and psychosocial support and pregnant and breastfeeding women under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0083

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 technical assistance (TA) to the Botswana Ministry of Health (MOH) to implement national HIV policies and provide comprehensive and quality care and treatment (C&T) services across the clinical cascade. This includes, but is not limited to, provision of quality HIV/TB services including mental and psychosocial support for adolescents and young people living with HIV, and TA for quality services for pregnant and breastfeeding women and their children.

This NOFO aims to strengthen MOH capacity to address HIV/TB data quality issues among children and adolescents and young people to close the UNAIDS 95-95-95 target gaps. Our goal is to address case finding and C&T gaps that exist among these populations. NOFO activities will include:

• Providing capacity building and clinical mentorship for healthcare workers (HCW) to provide quality HIV/TB service delivery for children, adolescents, and pregnant and breastfeeding women.

• Integrating mental health and psychosocial support into routine HIV/TB services to ensure adolescents and young people living with HIV receive comprehensive care and support.

• Developing and implementing national policies to improve quality of HIV/ TB programs, healthcare outcomes, and enhance access to C&T services.

This NOFO aims to reduce morbidity and mortality of HIV/TB and attain the UNAIDS 95-95-95 targets among children and adolescents through optimizing case finding and C&T services.

Step 1: Review the Opportunity 5

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $1,500,000 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 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 The 2022 Spectrum estimates indicate there are approximately 342,652 people living with HIV in Botswana. According to the 2021 Fifth Botswana AIDS Impact Survey (BAIS V), annual incidence and prevalence of HIV among adults aged 15 to 64 years was 0.2% and 20.8%, respectively.

Additionally, the report showed that Botswana has achieved the 95-95-95 targets, with 95-98-98 for populations aged 15 to 64 years. Despite these significant strides, Botswana continues to have among the highest HIV prevalence in the world. Incidence is highest among adolescents and young women as well as priority populations while viral load suppression is lowest among children and older men.

Botswana became the first HIV high-burden country to be certified on the path to elimination of mother-to-child transmission (eMTCT) of HIV by the World Health Organization (WHO) in December 2021. The national eMTCT program data for FY23 shows that mother-to-child HIV transmission rates have fallen below 1%.

Despite these achievements, early infant diagnosis (EID) coverage at 6 weeks and 18 months continues to be sub-optimal. The following are quarterly trends of EID coverage at 6 weeks in the past fiscal year:

• FY23 Q4: 75% (467/621).

• FY24 Q1: 63.6% (525/812).

• FY24 Q2: 65% (576/885).

• FY24 Q3: 73.6% (523/610).

Additionally, HIV is still the number one cause of adolescent death in Botswana. According to the BAIS V report, adolescents are falling behind in the treatment cascade, with only 85% knowing their status, 83% being on treatment, and 76% who are virally suppressed. The deterioration of mental health among adolescents due to COVID-19 adds on a pre-existing mental health crisis, in which approximately 20% of adolescents have symptoms of depression, 15% of generalized anxiety, and 22% have thoughts of suicide and planned it, according to the 2023 UNICEF report.

This NOFO aims to close the HIV treatment gap among the following populations by accelerating the effectiveness and sustainability of the national HIV response through a life-course approach:

Step 1: Review the Opportunity 10

• Infants aged 0 to 4 years.

• Children aged 5 to 9 years.

• Adolescents aged under 15 years.

• Adolescents living with HIV aged 15 to 19 years.

• Young people living with HIV aged 20 to 24 years.

• Pregnant and breastfeeding women.

One such approach is Operation Triple Zero (OTZ): Zero missed appointments, zero missed doses, and zero viral load. The OTZ initiative supports adolescents and young people living with HIV with treatment adherence, retention, and viral suppression. Additionally, this initiative includes economic strengthening, mental health and psychosocial support activities.

This NOFO builds upon existing programs, including pediatric components of CDC-RFA-GH20-2008 and children living with HIV activities under CDC-RFA- GH20-2034. This NOFO aligns with Botswana’s national clinical guidelines and policies. Some successes through these existing NOFOs include efforts to strengthen EID through joint prevention of mother-to-child transmission (PMTCT) trainings, enhanced supervisory and mentorship visits in collaboration with the MOH, and optimizing primary prevention of HIV infection through activities such confidential counseling and testing programs; including same day antiretroviral therapy (ART) initiation for children.

Additionally, continued efforts to support ongoing mentorship on electronic medical records (EMR) use and cohort monitoring for tracking infant testing is key. This also includes one-on-one coaching sessions focused on data collection, reporting, data quality, and data assurance of PMTCT services.

Supporting treatment retention among children and adolescents living with HIV, including mental health and psychosocial support through OTZ, is critical.

Through this NOFO, you will address the HIV C&T gaps that exist among children and adolescents living with HIV and pregnant and breastfeeding women to ensure equitable and quality HIV/TB care services, including mental and psychosocial well-being. Some activities include:

• Providing capacity building and clinical mentorship for HCW.

• Integrating mental health and psychosocial support into routine HIV/TB services for adolescents and young people living with HIV.

• Developing and implementing national policies to improve quality of HIV/ TB programs.

Step 1: Review the Opportunity 11

Through this NOFO you will support the Botswana MOH efforts to eliminate vertical transmission of HIV, enhance case identification and timely treatment services for children, and support activities to reduce HIV/TB morbidity and mortality among adolescents and young people.

Purpose The purpose of this NOFO is to address the HIV C&T gaps that exists among children, adolescents and young people living with HIV in Botswana. This also includes all pregnant and breastfeeding women to ensure continuum of care for children as a baby-mother pair. This NOFO aims to ensure equitable, sustainable, quality HIV/TB services including mental and psychosocial well-being of children, adolescents, and young people.

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.

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1: Optimize HIV/TB case identification of children and adolescents (less than 15 years old) to ensure timely initiation of ART, TB preventive therapy, and TB treatment.

Increased self-awareness of status and uptake of HIV/TB services.*

Increased TB screening and case identification.*

Improved competency of HCW in pediatric

Improved health outcomes for children, adolescents, and young people.*

Increased uptake of TB preventive therapy and treatment.*

Improved quality of HIV/TB services.*

Reduced HIV/TB incidence.

Reduced HIV/TB morbidity and mortality.

Reduced vertical transmission of HIV.*

Step 1: Review the Opportunity 12

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 2:

Strengthen MOH capacity to improve retention and treatment outcomes for adolescents and young people living with HIV, including provision of mental and psychosocial support services and economic empowerment activities.

Strategy 3: Support prevention of vertical transmission of HIV for pregnant and breastfeeding women and their infants with perinatal HIV services tailored to improve maternal, newborn, and child survival, and to eliminate pediatric

HIV.

and adolescent HIV management.*

Increased uptake of the OTZ interventions.*

Improved access to and uptake of mental health and psychosocial services.*

Increased EID coverage.*

Improved monitoring of children with perinatal HIV until final outcome.*

Increased screening, access, and uptake of pre-exposure prophylaxis (PrEP) among pregnant and breastfeeding women and their eligible partners.*

Improved use of EMR and appointment and tracking systems.*

Improved compliance to pregnant and breastfeeding women re-testing guidelines.*

Increased family engagement and support in pediatric HIV/TB management.*

Increased adherence and retention for adolescents and young people living with HIV.*

Increased viral load coverage and suppression for adolescents and young people living with HIV.*

Increased accurate, timely, and complete reporting for mother-baby pair cohort.*

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

Increased employment opportunities and income generation for young people living with HIV.

Improved self-reported self-esteem, confidence, and social skills.

Improved socioeconomic status and financial independence of young people living with HIV.

Reduced rates of HIV stigma-related self-reported depression.

Reduced rates of suicide among adolescents and young people.

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.

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: Optimize HIV/TB case identification of children and adolescents (less than 15 years old) to ensure timely initiation of ART, TB preventive therapy, and TB treatment.

Required activities:

• Implement person-centered, targeted, and equitable HIV case finding modalities and improve effective linkage to same-day ART initiation for children and adolescents.

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

• Implement and scale up a comprehensive, quality, integrated, and person-centered HIV differentiated service delivery model (e.g., multi month dispensing, advanced HIV care and opportunistic infections management, etc.) for children and adolescents.

• Develop and implement demand creation activities and HIV/TB services literacy for children, adolescents.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the clinical mentorship program for HCWs on quality service delivery for pediatric and adolescent HIV management.

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

• Support the MOH to sustain implementation of optimized pediatric ART (Pediatric Dolutegravir).

• Develop and implement an innovative and effective adolescent to adult care transition plan.

Step 1: Review the Opportunity 14

• Implement routine quality assurance/continuous quality improvement initiatives at site level to improve quality services across the continuum of HIV care.

• Strengthen EMR utilization, pediatric and adolescent clinical cascade data quality in public health facilities.

Strategy 2: Strengthen MOH capacity to improve retention and treatment outcomes for adolescents and young people living with HIV, including provision of mental and psychosocial support services and economic empowerment activities.

Required activities:

• Strengthen and scale up OTZ implementation to reduce missed doses, missed appointments, and viral load among adolescents and young people living with HIV (ages 10 to 24).

• Develop, implement, and integrate innovative mental and psychosocial services into routine HIV care to ensure adolescents and young people living with HIV receive comprehensive support.

• Strengthen facility-based peer-led groups through teen clubs to improve adherence to ART retention and viral suppression.

• Implement innovative family centric approaches at public health facilities to ensure a supportive home environment for children and adolescents that encourages adherence to HIV/TB treatment and retention.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the clinical mentorship program for HCWs to enhance their ability to deliver clinical care, as well as emotional and psychosocial support to adolescents and young people living with

HIV.

• Establish and maintain tailored appointment and tracking systems that encompass a family-centered approach for pediatric ART clients.

• Strengthen EMR utilization, adolescents and young people living with HIV retention and treatment outcomes data quality in public health facilities.

Step 1: Review the Opportunity 15

Strategy 3: Support prevention of vertical transmission of HIV for pregnant and breastfeeding women and their infants with perinatal HIV services tailored to improve maternal, newborn, and child survival, and to eliminate pediatric HIV.

Required activities:

• Design and implement innovative strategies to ensure high coverage of 6-week postpartum attendance, HIV-exposed infant testing at 6 weeks, and final infant HIV status results (outcome) after completion of breastfeeding.

• Design and implement innovative, comprehensive, and evidence-based EID program activities to optimize EID coverage at 6 weeks. Strengthen retesting of pregnant and breastfeeding women and at postnatal care to ensure compliance to the national guidelines.

• Develop innovative strategies to improve screening, access, and uptake of PrEP at sexual and reproductive health (SRH) settings, child welfare clinics, and other service delivery points for pregnant and breastfeeding women and their eligible partners.

• Implement innovative tools and technologies to track mother-baby pairs through expansion and use of EMRs across HIV services including SRH settings including strengthening data quality for this cohort.

• Develop and implement cost-effective, innovative, and sustainable capacity building activities through the clinical mentorship program and through other platforms for HCWs on quality HIV service delivery for pregnant and breastfeeding women and their infants.

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 16

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 17 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:

• Priority populations.

• Infants aged 0 to 4 years (clinical services).

• Children aged 5 to 9 years (clinical services).

• Adolescents aged under 15 years (clinical and OTZ package of services).

• Adolescents living with HIV aged 15 to 19 years (OTZ package of services only).

• Young people living with HIV aged 20 to 24 years (OTZ package of services).

• Pregnant and breastfeeding women.

• HCW.

• Medical officers.

• Health education assistants.

• Healthcare auxiliary.

• Lab officers.

• Nurses, nurse prescribers and dispensers, and midwives.

• Data clerks.

• Monitoring and Evaluation (M&E) officers.

• Caregivers and guardians.

Step 1: Review the Opportunity 18

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:

• CDC funded partners who are:

◦ Implementing HIV/TB prevention, C&T, laboratory, and strategic information activities.

◦ Strengthening HIV/TB continuous quality improvement capacity in Botswana.

◦ Implementing HIV/TB and related public health programs.

• Other U.S. Government-funded PEPFAR agencies (e.g., USAID and Peace Corps) and implementing partners.

• Government of Botswana entities and Ministries, including but not limited to:

◦ MOH.

◦ Botswana Public Health Institute.

◦ Ministry of Education.

◦ Ministry of Nationality, Immigration, and Gender Affairs.

◦ Ministry of Defense.

◦ District Health Management Teams.

◦ 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.

◦ Global Fund and their implementing partners.

• Civil society organizations, academic institutions, communities, and other relevant stakeholders.

Step 1: Review the Opportunity 20

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 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.

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://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

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 (all should be disaggregated for children [0-9], adolescents [10-19], and young people [20-24]). You can propose any additional relevant MER indicators as part of your initial Evaluation and Performance Measurement Plan.

• HTS_INDEX: Number of individuals who were identified and tested using index testing services and received their results [Target: 2,165; Reporting Frequency: Quarterly]

• HTS_TST: Number of individuals who received HIV Testing Services (HTS) and received their test results. [Target: 19,198; Reporting Frequency:

Quarterly]

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

1,267; Reporting Frequency: Quarterly]

• TX_NEW: Number of adults and children newly enrolled on antiretroviral therapy (ART). [Target: 954; Reporting Frequency: Quarterly]

• TX_CURR: Number of adults and children currently receiving antiretroviral therapy (ART). [Target: 2,153; 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_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]

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

Step 1: Review the Opportunity 22

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

• PMTCT_STAT (including PMTCT_STAT_POS): Percentage of pregnant women with known HIV status at antenatal care (includes those who already knew their HIV status prior to ANC). [Target: 100%; Reporting Frequency: Quarterly]

• PMTCT_ART: Percentage of pregnant women living with HIV who received ART to reduce the risk of mother-to-child-transmission (MTCT) during pregnancy. [Target: 100%; Reporting Frequency: Quarterly]

• PMTCT_EID: Percentage of infants born to women living with HIV who received a first virologic HIV test (sample collected) by 12 months of age.

[Target: 100%; Reporting Frequency: Quarterly]

• PMTCT_HEI_POS: Number of newly identified infants living with HIV with a positive virologic HIV test result returned in the reporting period, whose diagnostic sample was collected by 12 months of age. [Target: Not Assigned; Reporting Frequency: Quarterly]

• PMTCT_FO: Percentage of final outcomes among HIV-exposed infants registered in a birth cohort. [Target: 95%; Reporting Frequency: Annual]

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 adolescents and young people living with HIV enrolled in OTZ program in the past quarter. [Target: 80%; Reporting Frequency:

Quarterly]

• Percentage of adolescents and young people who missed an appointment within the past month (≤28 days). [Target: Not Assigned;

Reporting Frequency: Monthly]

• Percentage of adolescents and young people who defaulted within the past month (missed ART pick-up). [Target: Not Assigned; Reporting Frequency: Monthly]

• Percentage of adolescents and young people living with HIV who were trained on economic empowerment curriculum who have accessed job

Step 1: Review the Opportunity 23 opportunities and vocational trainings in the past quarter. [Target: 80%;

Reporting Frequency: Quarterly]

• Percentage of adolescents and young people living with HIV who report experiences of HIV-related discrimination in healthcare settings in the past month. [Target: Not Assigned; Reporting Frequency: Monthly]

• Percentage of adolescents and young people living with HIV who report feelings of sadness in the past month (pull data from PHQ-9 or other survey). [Target: Not Assigned; Reporting Frequency: Monthly]

• Percentage of HCW trained in adolescent and young people HIV care management in the past 12 months. [Target: 90%; Reporting Frequency:

Annual)

• Percentage of caregivers, guardians, and family members who were trained in HIV care and support for adolescents and young people.

[Target: 90%; Reporting Frequency: Quarterly)

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 an end-term evaluation.

• The effect of prevention programs on HIV incidence rates among pregnant and breastfeeding women: outcome evaluation.

• The extent to which OTZ has contributed to expected health outcomes such as treatment adherence, retention, and viral suppression : outcome evaluation.

• The extent to which scale-up of implementation of the current strategies has impacted HIV case-finding and treatment initiation among children:

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.

Step 1: Review the Opportunity 24

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.

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.

Step 1: Review the Opportunity 25

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).

• 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.

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

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.

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.

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

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

Step 1: Review the Opportunity 27

Table: Sample work plan 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.

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

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

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.

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:

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

Step 1: Review the Opportunity 29 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

◦ 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.

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.