CDC-RFA-CK18-1801.pdf

Centers for Disease Control

National Center for Emerging and Zoonotic Infectious Diseases

Pan American Health Organization (PAHO) Building Capacity and Networks to Address

Emerging Infectious Diseases in the Americas

CDC-RFA-CK18-1801

Application Due Date: 05/09/2018

Signature Date

Pan American Health Organization (PAHO) Building Capacity and Networks to Address

Emerging Infectious Diseases in the Americas

CDC-RFA-CK18-1801

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Catalog of Federal Domestic Assistance (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-CK18-1801. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Pan American Health Organization (PAHO) Building Capacity and Networks to Address Emerging Infectious Diseases in the Americas C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-CK18-1801

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.099 F. Dates:

1. Due Date for Letter of Intent (LOI): N/A

2. Due Date for Applications: 05/09/2018, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

Only the Pan American Health Organization (PAHO) may apply. No other applications are being solicited.

3. Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph:

The Centers for Disease Control and Prevention announces the availability of funds for collaboration with the Pan American Health Organization (PAHO), an international public health agency that serves as the Regional Office for the Americas of the World Health Organization (WHO) as part of the United Nations system. The purpose of this NOFO is to continue assistance to PAHO in the development and implementation of coordinated plans and networks that enable national governments and regional authorities in the Americas to implement the International Health Regulations (IHR) and better address infectious diseases, particularly emerging infections, and other public health emergencies. Specific strategies and activities of this NOFO will continue to focus on improving infectious disease surveillance and https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov response, building public health infrastructure and systems, strengthening national capacities for safe patient care and clinical management, sharing knowledge, tools and other resources in support of applied epidemiology, and developing improved infectious disease prevention and control strategies.

a. Eligible Applicants: Single

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 1

d. Total Period of Performance Funding: $20,000,000

e. Average One Year Award Amount: $3,000,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 08/01/2018

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview The spread of infectious disease epidemics from country to country has become a major global health threat (e.g., SARS, H1N1, Polio, Ebola, Zika virus, etc.). As a legally binding international treaty, the International Health Regulations (IHR 2005) require the World Health Organization (WHO) Member States to detect, assess, report and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. WHO states on its website, "The implementation and monitoring of core capacities continues to present a challenge in many technical areas, including legislation, points of entry, surveillance and response, laboratory capacity, human resource development and chemical radio nuclear safety. Effective multisectoral collaboration remains a priority. WHO, its partners and States Parties need to continue working collectively to bridge identified gaps in IHR core capacities in the most efficient and effective way, using existing strategic approaches, networks and resources." (Ref: http://www.emro.who .int/international-health-regulations/about/ihr-core-capacities.html).

On September 19, 2011, the Government of the United States of America and the World Health Organization (WHO) signed a memorandum of understanding (MOU) to help WHO Member States strengthen their capabilities to support the International Health Regulations (IHR). The http://www.emro.who.int/international-health-regulations/about/ihr-core-capacities.html http://www.emro.who.int/international-health-regulations/about/ihr-core-capacities.html

MOU includes specific statements that authorize WHO and its regional offices (including PAHO) to pursue activities that improve the ability of all nations to detect, assess, report, and respond to infectious diseases quickly and accurately. WHO and its Regional Offices are at the apex of global public health organizations and thus have an exclusive status as the United States government's key partners for global public health. The U.S. Government and WHO share a commitment to strengthen cooperation in the area of global health security to ensure that the international community effectively manages public health risks. Improving the ability of all nations to detect, assess, report, and respond to infectious diseases quickly and accurately lies at the heart of the global community's ability to address all infectious disease threats, as reflected in the IHR.

PAHO is an international public health agency (established in 1902), and serves as the Regional Office for the Americas of the WHO as part of the United Nations system. As such, PAHO has a unique position among the world's health agencies as the lead technical agency for health within the Americas. The Centers for Disease Control and Prevention entered into a five-year cooperative agreement with the Pan American Health Organization (PAHO) on June 15, 2008 to assist PAHO in implementing the MOU regarding the International Health Regulations. That agreement ended September on June 14, 2013, and CDC entered another five-year agreement with PAHO on September 3, 2013. The current agreement ends September 2, 2018. This funding opportunity will continue this mutually beneficial partnership.

CDC program managers, PAHO administrators, and national health authorities in the Americas agree that the activities funded under the previous and current agreement have supported the requirements of the MOU, strengthened overall infectious disease surveillance and response in the Americas, improved national and regional public health infrastructure and systems, and provided critical technical assistance in support of applied epidemiology and the development of infectious disease prevention and control strategies.

b. Statutory Authorities This program is authorized under sections 301 and 307 of the Public Health Service Act, as amended [42 U.S.C. §§ 241 and 2421].

c. Healthy People 2020 HP 2020 Topic Areas: https://www.cdc.gov/nchs/healthy_people/hp2020.htm

Global Health

HIV

Immunization and Infectious Diseases Food Safety Healthcare Associated Infections Preparedness

d. Other National Public Health Priorities and Strategies The International Health Regulations (IHR) http://www.who.int/topics/international_health_regu https://www.cdc.gov/nchs/healthy_people/hp2020.htm http://www.who.int/topics/international_health_regulations/en/ lations/en/ CDC Global Health - Spotlight: International Health Regulations (2005) https://www.cdc.gov /globalhealth/ihr/index.html Global Health Security: International Health Regulations (IHR):

https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html

e. Relevant Work The CDC National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) has a critical role in helping countries in the Americas to comply with the International Health Regulations (IHR) for preventing the spread of infectious agents that threaten the U.S. and global health. NCEZID Global Strategic Objectives that are addressed by this NOFO include:

Goal 1: Health Impact - Develop and implement high-impact interventions: Objective 1: Reduce the burden of foodborne and waterborne diseases: Objective 2: Reduce the spread of antimicrobial resistant (AR) pathogens and promote safe health care

The National Center for Emerging and Zoonotic Infectious Diseases Strategic Plan, 2012- 2017: https://www.cdc.gov/ncezid/pdf/strategicplan_ncezid.pdf

Goal 2: Health Security - Enhance preparedness Global Health Security: International Health Regulations (IHR):

https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html

Goal 3: Health Capacity - Strengthen public health fundamentals A CDC Framework for Preventing Infectious Diseases https://www.cdc.gov/oid/docs/id-framework-2pageoverview.pdf

This NOFO will continue CDC collaboration with PAHO to build upon the past and current NOFO (CK13-1301.NU50). CDC-supported activities in the Americas include, but are not limited to the following:

Enhancing laboratory and surveillance capacities for the prevention and control of arbovirus and other emerging/re-emerging viruses (e.g., Zika, Dengue, Yellow Fever, WNV, ):

o Improve and enhance the capacities in the national laboratories:

o Technical support for national laboratories and regional epidemiology surveillance o Collaboration on the development and reinforcement of a regional Arbovirus

Diagnostic Laboratory Network.

Strengthening the detection, monitoring and response to Foodborne-related events through integrated surveillance in the Americas.

Supporting the implementation and expansion of HIV prevention, surveillance, care and treatment policies and interventions in the Caribbean.

Strengthening surveillance, diagnosis and clinical management capacities.

o Training of health care workers to implement PAHO guidelines on infection prevention and control in health care facilities in selected/priority countries in the Americas.

Ensuring the coordination, monitoring and reporting of CDC-funded projects and the http://www.who.int/topics/international_health_regulations/en/ https://www.cdc.gov/globalhealth/ihr/index.html https://www.cdc.gov/globalhealth/ihr/index.html https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html https://www.cdc.gov/ncezid/pdf/strategicplan_ncezid.pdf https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html https://www.cdc.gov/oid/docs/id-framework-2pageoverview.pdf integration of IHR core capacities in health systems in the Americas.

PAHO's progress in implementing IHR was reported 09/16/2016 at 55th Directing Council, 68th Session of the Regional Committee of WHO for the Americas. Reference Working Documents:

CD55/12,Rev.1: Implementation of the International Health Regulations (IHR), http://www.paho.org/hq/index.php?option=com_content&;;view=article&;;id=1279&;;Itemid =1159&;;lang=en CD55/5: Report of the End-of-biennium Assessment of the Program and Budget 2014- 2015/First Interim Report on the PAHO Strategic Plan 2014-2019, http://iris.paho.org/xmlui/bitstream/handl e/123456789/31418/CD55-5-e.pdf?sequence=1&;;isAllowed=y

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Strategies / Activities Short-term Outcomes Intermediate Outcomes Long-term

Outcomes

Strengthen the national capacity of countries in the Americas, (including regional and sub-regional networks) in the Americas to detect, verify, assess and respond to outbreaks and other public health emergencies of national and international concern (PHEICs).

Continued regional and national public health leadership and collaborations.

Coordinated planning, monitoring and reporting of countries' progress on IHR Core Capacities, CDC Global Health Security Agenda (GHSA) and other PHEICs.

Countries' improved surveillance and early warning capabilities for public health events.

Planning, coordination, infrastructure and resource mechanisms in place and committed to achieve and sustain IHR compliance.

All countries' public health systems in the Americas have sustained IHR core capacities for surveillance of and response to infectious diseases outbreaks and other PHEICs.

Enhance national public health laboratories' capacities to improve infectious disease detection, diagnosis, and results interpretation for arboviruses.

Enhance country capacity to conduct high-quality laboratory based surveillance for arboviruses particularly for chikungunya, dengue, More rapid and accurate laboratory testing, diagnosis and characterization of infectious diseases.

Better networking of laboratories. More countries participate in external quality control programs.

More laboratories able to provide differential testing for arboviruses.

A larger number of public health laboratories are able to test for more pathogens.

More timely identification of arboviral outbreaks.

More countries implement accreditation programs for

Laboratory capacities strengthened for diagnosis and clinical management of infectious diseases in the Americas.

Countries demonstrate IHR core capacities and GHSA priority pathogens/core diagnostics.

http://www.paho.org/hq/index.php?option=com_content&view=article&id=1279&Itemid=1159&lang=en http://www.paho.org/hq/index.php?option=com_content&view=article&id=1279&Itemid=1159&lang=en http://iris.paho.org/xmlui/bitstream/handle/123456789/31418/CD55-5-e.pdf?sequence=1&isAllowed=y http://iris.paho.org/xmlui/bitstream/handle/123456789/31418/CD55-5-e.pdf?sequence=1&isAllowed=y yellow fever and Zika. public health laboratories.

Strengthen and enhance surveillance for the prevention and control of infectious diseases in the Americas, including enteric and foodborne, HIV, HAIs and AMR.

Outbreak detection and response will be more timely. Increased ability to describe the geographic distribution, social determinants of health, and health disparities related to infectious diseases. Improved quality of surveillance indicator data.

Early detection of emerging infectious diseases. Established public health capacity, infrastructure and systems that adequately address infectious diseases.

Effective surveillance in all public health systems that result in decreased morbidity due to infectious disease.

Strengthen national capacities for safe patient care and clinical management.

Improved compliance with patient safety policies and guidelines. Reduced adverse patient exposures or risks to clinical facility acquired infectious diseases.

More institutions implement best practices for patient safety in clinical care settings.

Reduction in infectious diseases acquired in health care facilities in the Americas.

Monitor and evaluate overall program performance and the progress of individual projects or activities.

Project activities address IHR core capacities.

GHSA priorities and key strategic areas.

Strategies and activities are continued, modified or discontinued based on evaluation results. More effective reporting and monitoring system.

Effective infectious disease prevention and control strategies are advanced.

Publish and disseminate findings, program

Research findings and best practices are available and

Countries apply findings Enhanced knowledge evaluations, and lessons learned.

accessible to countries in the Americas.

and best practices. generation, innovation, and tools for improved surveillance and response.

i. Purpose This NOFO aims to protect Americans from infectious diseases by supporting implementation of the International Health Regulations in the Americas. The recipient will help strengthen the capacity of public health systems and laboratories in countries in the Americas to prevent, detect, and respond to infectious diseases and other public health emergencies.

ii. Outcomes The recipient is expected to achieve the following outcomes during the period of performance that will be in alignment with a performance goal for the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID): Protect Americans from Infectious Diseases; and in alignment with PAHO/WHO strategic cooperative framework; and the International Health Regulations (2005):

Short-term Outcomes:

Continued regional and national public health leadership and collaborations.

Coordinated planning, monitoring and reporting of countries’ progress on IHR Core

Capacities, CDC Global Health Security Agenda (GHSA) and other PHEICs.

More rapid and accurate laboratory testing, diagnosis and characterization of infectious diseases.

Better networking of laboratories.

More countries participate in external quality control programs.

Outbreak detection and response will be more timely.

Increased ability to describe the geographic distribution, social determinants of health, and health disparities related to infectious diseases.

Improved quality of surveillance indicator data.

Improved compliance with patient safety policies and guidelines.

Reduced adverse patient exposures or risks to clinical facility-acquired infectious diseases.

Project activities address IHR core capacities. GHSA priorities and key strategic areas.

Research findings and best practices are available and accessible to countries in the

Americas.

Intermediate Outcomes:

Countries’ improved surveillance and early warning capabilities for public health events.

More laboratories able to provide differential testing for arboviruses, and a larger number of public health laboratories are able to test for more pathogens.

More timely identification of arboviral outbreaks.

Early detection of emerging infectious diseases.

More institutions implement best practices for patient safety in clinical care settings.

Strategies and activities are continued, modified or discontinued based on evaluation results.

Countries apply findings and best practices.

iii. Strategies and Activities Strategies and activities of this NOFO will focus on strengthening the national capacity of public health systems and laboratories in countries (including regional and sub-regional networks) in the Americas to: 1) detect, verify, assess and respond to outbreaks and other public health emergencies of national and international concern (PHEICs); 2) improve infectious disease detection, diagnosis, and results interpretation for arboviruses; and conduct high-quality laboratory based surveillance for arboviruses particularly for chikungunya, dengue, yellow fever and Zika; 3) enhance surveillance for the prevention and control of infectious diseases in the Americas, including enteric and foodborne, AMR and HIV; 4) strengthen national capacities for safe patient care and clinical management; 5) Monitor and evaluate overall program performance and the progress of individual projects or activities; and 6) publish and disseminate findings, program evaluations, and lessons learned. These strategies and activities align with NCEZID Global Strategic Objectives:

Goal 1: Health Impact - Develop and implement high-impact interventions:

Develop, implement, and conduct projects to enhance infectious disease surveillance, response, prevention, and control.

Strengthen the detection, monitoring and response to Foodborne-related events through integrated surveillance in the Americas.

Train health care workers to implement PAHO guidelines on infection prevention and control in health care facilities in selected/priority countries in the Americas.

Support the implementation and expansion of HIV prevention, surveillance, care and treatment policies and interventions in the Caribbean.

Enhance laboratory and surveillance capacities for the prevention and control of arbovirus and other emerging/re-emerging viruses (e.g., Zika, Chikungunya, Dengue, Yellow Fever, WNV, AMR, HAIs, etc.):

o Improve and enhance the capacities in the National laboratories.

o Strengthen surveillance, diagnosis and clinical management capacities.

o Technical support for national laboratories and regional epidemiology surveillance o Collaboration on the development and reinforcement of a regional Arbovirus

Diagnostic Laboratory Network.

Goal 2: Health Security - Enhance preparedness

Early assessment and notification of urgent public health events through appropriate response and IHR channels.

Ensuring the coordination, monitoring and reporting of CDC-funded projects and the integration of IHR core capacities and CDC Global Health Security Agenda (GHSA) in health systems in the Americas.

Goal 3: Health Capacity - Strengthen public health fundamental

Strengthen regional and national public health networks and inter-sectorial co- operation;

also collaborate with other health organizations, academic institutions, and community groups as appropriate to accomplish program activities.

Strengthen regional and national public health leadership and collaboration.

Monitor and evaluate overall program performance and the progress of individual projects or activities.

Publish and disseminate findings, program evaluations, and lessons learned.

Strengthening surveillance, diagnosis and clinical management capacities.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

The applicant must describe how it will collaborate with CDC programs and other key CDC-funded agencies and organizations to address the strategies and activities described in the CDC Project Description.

The recipient is required to collaborate with CDC (including its established in-country offices/programs in the Americas) to plan, budget, implement and evaluate all program activities.

CDC will provide general guidance for planning, funding, implementing and evaluating program strategies and activities. The recipient is encouraged to collaborate with other CDC-funded organizations with expertise in proposed program activities as needed.

b. With organizations not funded by CDC:

The applicant must provide a list of organizations (including regional and sub regional partnerships) it plans to collaborate with and an explanation of how each collaboration will aid in implementing activities. The applicant must describe the history of working and collaborating with governmental, non-governmental, UN and other international organizations as it relates to the proposed program strategies and activities. The applicant must have Memoranda of Agreements (MOA), Memoranda of Understanding (MOU), letters of commitment, or service agreements as required by United States of America and the World Health Organization as part of the United Nations System. Applicants must name the file “MOUs/MOAs” and upload it as a PDF file at www.grants.gov The recipient is required to collaborate with WHO Member States, Ministries of Health. It is encouraged to collaborate with social security agencies, other government institutions, non-governmental organizations, academic institutions, community groups, and others to to accomplish program activities that strengthen national and local health systems and improve the health of the peoples of the Americas. Documentation of agreements should describe the scope of work, intensity, duration, specific activities, and which parties are responsible for each specific http://www.grants.gov/ activities.

2. Target Populations People living in and traveling to and from the Americas.

a. Health Disparities The strategies and activities of this NOFO respect the dignity and diversity of individuals, groups and countries; and promote fairness and justice by eliminating differences that are unnecessary and avoidable. Funded programs should include people with disabilities in all aspects of the program (e.g., advisory boards, planning committees, project staff, consultants, target populations, etc.). Applicants should include and, where appropriate/applicable, specifically address the needs of tribal organizations; vulnerable populations (pregnant/lactating women, unaccompanied children, and the elderly); non-English speaking populations; lesbian, gay, bisexual, and transgender (LGBT) populations; and people with limited health literacy.

For additional information about disability inclusion, go to: http://www.cdc.gov/ncbddd/disab ilityandhealth/disability-inclusion.html.

iv. Funding Strategy There is no funding formula, ceiling or floor on particular activities for each of the budget years.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy The overall CDC Evaluation and Performance Measurement Strategy will focus on both process and outcome evaluation. Process evaluation is conducted to monitor activities during the implementation and operation of a program. Outcome evaluation examines the longer-term successes and accomplishments of a program.

CDC will work the recipient to ensure each project has performance measures that are feasible and consistent with NOFO strategies/activities, outputs and outcomes. Process evaluation will include CDC conducting the following activities:

Collaborate on proposed project work plans and budgets prior to submission to CDC for funding, and recommend adjustments as needed.

Periodically monitor progress to ensure projects are being implemented as planned to achieve expected outcomes.

Conduct technical reviews of annual progress reports based on performance measures, http://www.cdc.gov/ncbddd/disabilityandhealth/disability-inclusion.html http://www.cdc.gov/ncbddd/disabilityandhealth/disability-inclusion.html and recommend grantee actions as needed.

CDC will use the following measures to track implementation of recipient strategies and activities, and progress on outcomes:

Strategy 1: Strengthen the national capacity of countries in the Americas, (including regional and sub-regional networks) in the Americas to detect, verify, assess and respond to outbreaks and other public health emergencies of national and international concern (PHEICs).

Outcomes (within the 5-year period of performance): Continued regional and national public health leadership and collaborations. Coordinated planning, monitoring and reporting of countries? progress on IHR Core Capacities, CDC Global Health Security Agenda (GHSA) and other PHEICs. Countries?

improved surveillance and early warning capabilities for public health events.

Strategy-1 Activities Performance Measures Outcome Measures

Ensure coordination, monitoring and reporting of activities proposed in the project

Number of staff supporting the project throughout its entire duration (target =1)

Project related technical and administrative requirements duly fulfilled according to deadlines

Enhance the regional coordinated capacity to support response to public health events of national or potential international concern and to assess specific risks

Number of countries that are implementing Epidemic Intelligence from Open Sources (EIOS) to strengthen early warning surveillance capacities (target = 5)

Number of countries implementing EIOS that show demonstrated improvements in detecting outbreaks earlier

Promote the integration and sustainability of essential public health functions (core capacities defined in the IHR) within the health systems

Number of countries with existing planning and financing mechanisms that enabled them to apply and comply with IHR provisions (target =8)

Increased number of countries applying and complying with IHR provisions

Revisit the institutional positioning and functioning of the National IHR Focal Point Offices

Number of countries with national IHR Focal Points reflected in emergency response plans (target =8)

Number of National IHR Focal Point response teams setup and actively engaged in a PAHO-instituted regional response network

Support regional and sub-regional partnerships and contribute to global activities

Number of resolutions related to IHR approved by the PAHO Directing Council (target =4)

Number of PAHO public health related agreements with member states that align with IHR priorities.

Strategy 2: Enhance national public health laboratories? capacities to improve infectious disease detection, diagnosis, and results interpretation for arboviruses. Enhance country capacity to conduct high-quality laboratory based surveillance for arboviruses particularly for chikungunya, dengue, yellow fever and Zika.

Outcomes (within the 5-year period of performance): More rapid and accurate laboratory testing, diagnosis and characterization of infectious diseases. Better networking of laboratories. More countries participate in external quality control programs. More timely identification of arboviral outbreaks. More laboratories able to provide differential testing for arboviruses, and a larger number of public health laboratories are able to test for more pathogens. More timely identification of arboviral outbreaks.

Strategy-2 Activities Performance Measures Outcome Measures

Support countries and member states to enhance the timely detection of emergent and re-emergent arboviruses

Number of comprehensive reviews of laboratory capacity conducted in national public health laboratories, related to arboviral molecular and serological testing, including documentation management, biosafety, biosecurity, equipment and other components of the quality assurance systems (target=6) Number of laboratories receiving critical reagents and supplies for yellow fever testing (target=20) Number of countries receiving critical reagents and supplies for chikungunya, dengue and Zika testing (target=25) Number of laboratories that participate in annual External Quality Assurance Programs (EQAP) for molecular and serological detection of arboviruses (target=25) Number of laboratories implementing a new (for the laboratory) molecular or serological assay for arboviral surveillance or differential diagnosis (target=10) Number of laboratories trained in the detection of potentially emerging and re-emerging arboviruses, including dengue, Zika, chikungunya, and yellow fever viruses (target=20)

% of countries reporting arboviral data to PAHO on time for at least 90% of epi weeks (target 80%)

Number of laboratories with capacity to detect Mayaro or Oropouche virus (target 15)

Foster the integration and Tool for the integration of laboratory Increased number of national public active participation of national public health laboratories to the Arbovirus Diagnosis Laboratory Network

(RELDA)

detection and epidemiological data from the national surveillance systems generated and implemented in selected countries (target=3) Number of RELDA members receiving training and reagents for sequencing and phylogenetic analysis under the VIGENDA project.

Number of technology transfers performed between RELDA members for the production of key in-house reagents for arboviral diagnostics (target=2) Number of countries attending RELDA annual meeting (target 20) health laboratories fully integrated to RELDA (target 25): # testing for YF in human samples. (target 20) # testing for Chik, Zika and dengue (target 25) Number of countries providing arboviral genetic sequences to Vigenda (target 10) Participating RELDA laboratories correctly identify >90% of each sample in EQA proficiency test for arboviruses

Strategy 3: Strengthen and enhance surveillance for the prevention and control of infectious diseases in the Americas, including enteric and foodborne, HIV, HAIs and AMR.

Outcomes (within the 5-year period of performance): Outbreak detection and response will be more timely.

Increased ability to describe the geographic distribution, social determinants of health, and health disparities related to infectious diseases. Improved quality of surveillance indicator data. Early detection of emerging infectious diseases.

Strategy-3 Activities Performance Measures Outcome Measures

Activity 3.1: Strengthen detection, monitoring and response to Foodborne related events: Implementation of Integrated Surveillance in Enteric and Foodborne Disease

Support PulseNet Latin America and the Caribbean participating countries to establish and develop programs of integrated surveillance for foodborne and other enteric diseases:

Support countries prioritizing pathogens under surveillance;

conduct training in integrated surveillance

Number of participating countries implementing at least one intervention with the shared data (target 4) Number of countries trained in integrated surveillance systems (target tbd)

Earlier detection and response to foodborne and waterborne events.

Earlier implementation of control measures that reduce the burden of enteric diseases in human populations.

Better monitoring of trends to understand the epidemiology of enteric diseases

Strengthen laboratory network in PulseNet Latin America and the Caribbean to build capacity for the detection of foodborne disease using high resolution molecular

A growing number of laboratories in the PulseNet Latin America Network are applying WGS for routine public health surveillance (target 8 with LoAs) Multiple PulseNet LAC participants

Increase in number of laboratories implementing integrated surveillance of foodborne diseases and antimicrobial resistance through

WGS

All members of PNLAC have subtyping. have received training on the analysis of WGS by using a gene-by-gene analysis approach- whole genome multi-locus sequence typing (wgMLST) (target 5) equipment to perform whole genome sequencing and trained staff.

Activity 3.2: Strengthen Detection, Monitoring and Response to Antimicrobial Resistance in Latin America and the Caribbean

Strengthen country capacity for an integrated AMR surveillance, including emerging resistance mechanisms, notification and reporting Develop and implement training programs for data collection and reporting of AMR at national and regional levels

Number of countries with National Action Plans (NAPs) in place to contain antimicrobial resistance, integrating laboratory and epidemiological data, including AMR along the food chain (target 7) Number and % of laboratory facilities, designated in the national action plan for AMR or through a government-led surveillance system that conducts antibiotic susceptibility testing (AST) and reports susceptibility data to a designated national body in the last 6 months (# tbd) Annual Reports of RELAVRA containing data from Latin America and Caribbean countries prepared

Declines in AMR incidence among infections caused by specific pathogens (e.g., proportion of BSIs caused by CRE) Declines in proportion of AMR infections among specific populations (e.g., neonatal sepsis Increase the number of countries that monitor and report data on antimicrobial resistance in isolates collected from animal and food.

(Annual report available)

Develop and establish a regional AMR surveillance network for invasive fungal diseases that provides data for decision making, which will contribute to the global network.

Develop concept paper on the principles of AMR surveillance in fungal diseases Number of laboratories assessed in their capacity for fungal detection, characterization and antifungal susceptibility determination (target 5)

Principles of AMR surveillance in fungal diseases incorporated into countries National Action Plans Plans developed to address gaps in laboratory capacity for fungal detection and characterization

Strengthen country capacity for rational use of antimicrobials, including the implementation of operational, multidisciplinary, antimicrobial stewardship

Number of countries with an AMR-specific communication strategy in place, the use of evidence generated from AMR surveillance to inform antibiotic use practices Number of countries with specific

Report of the Implementation of antimicrobial stewardship policies within targeted countries.

Number of countries that develop national antimicrobial stewardship program and policies programs.

targets for antibiotic prescribing, including systems or incentives to encourage appropriate behaviors (target 3) Number of countries creating standard treatment guidelines informed by local data (tbd)

Activity 3.3: Strengthen HIV Surveillance and Strategic Information

Provide regional leadership and support for the implementation and expansion of HIV prevention, surveillance, care and treatment policies and interventions in the Caribbean

HIV administrative specialist audits and develops financial reports for the CDC cooperative agreement Staff/consultants support implementation and ongoing monitoring of PEPFAR indicators

Number of supported countries with national care and treatment policies aligned with WHO 2016 Guidelines (e.g. that include differentiated models of care and treatment for all

PLHIV).

Provide support for the update and implementation of national policies and protocols aligned with WHO guidelines including differentiated models of care and key population friendly services

Jamaica, Trinidad and Tobago national plans revised and updated Follow meetings with stakeholders on the HIV/STI response in Trinidad and Tobago and key regional partners, to review the progress Review/training to improve the differentiated models of care at treatment sites for key populations

Number of supported countries with national care and treatment policies aligned with WHO 2016 Guidelines (e.g. that include differentiated models of care and treatment for all

PLHIV).

Provide direct support to strengthen national capacity for HIV strategic information to monitor progress of Fast Track targets

Number of supported countries with up-to-date (<1 year old) care and treatment cascade Number of CDC priority countries conducting annual review of progress against fast track/2020 targets

Number of CDC priority countries that meet 90-90-90 targets by 2020

Ensure linkages and alignment to the WHO/UNAIDS global and regional strategies and plans, in particular priorities for the PEPFAR Caribbean Regional Program.

Number of countries including new prevention targets in their national strategic plans Number of countries implementing HIVDR surveillance according to WHO recommendations

Number of supported countries including new prevention targets in national strategic plans or program monitoring reports.

Support countries in Number of countries advancing toward Number of supported countries strengthening their national capacity to support the WHO ?treat all? policy, improving efficiency and sustainability of the HIV response and improving strategic information.

the implementation of ?treat all?

Key indicators reported by CDC priority countries align with GAM, Caribbean Regional Strategic Framework for HIV, PEPFAR and National Strategic Plans developing Road Maps for Implementation of Treat All.

Strategy 4: Strengthen national capacities for safe patient care and clinical management.

Outcomes (within the 5-year period of performance): Improved compliance with patient safety policies and guidelines. Reduced adverse patient exposures or risks to clinical facility-acquired infectious diseases. More institutions implement best practices for patient safety in clinical care settings.

Strategy-4 Activities Performance Measures Outcome Measures

Ensure the coordination, monitoring and reporting of activities proposed in the project

Number of staff supporting the project throughout its entire duration (target 2)

Project?s related technical and administrative requirements duly fulfilled according to deadlines

Support regional and sub-regional partnerships to enhance infection control through elaboration and implementation of regional recommendations for safe care and isolation of patients and decrease the HAI disease burden including AMR

Number of new institutions supporting the Latin American and Caribbean IPC expert?s network (target 10)

Formal LAC IPC experts network established and/or formal institutional agreement signed

Support Countries to build and implement of national policy, guidelines and tools for strengthening IPC capacities for decrease of HAI burden including AMR and containment of communicable disease when it presents at health care facility

Number of countries supported in strengthening national, multidisciplinary IPC programs in developing national policies, guidelines for IPC programs (target 18) Number of facilities supported in implementing multi-modal strategies for facility-specific IPC programs (tbd) Number of IPC professionals certified or trained by a recognized university/ institutions in the region with PAHO Support (target 170)

Final policy published and available at country level Number of health care workers trained

Support countries to build capacity of surveillance and

Number of countries in the region through PAHO support with active, National reports of HAI Surveillance available outbreak investigation and containment of health care associated infection standardized national systems to track and improve priority healthcare-associated metrics, including HAIs (target 15)

Strategy 5: Monitor and evaluate overall program performance and the progress of individual projects or activities.

Outcomes (within the 5-year period of performance): Project activities address IHR core capacities. GHSA priorities and key strategic areas. Strategies and activities are continued, modified or discontinued based on evaluation results.

Strategy-5 Activities Performance Measures Outcome Measures

Provide technical assistance in the design, conduct, and evaluation of projects and activities.

Ensure all projects use effective performance measures.

Staff assigned to monitor and report progress project activities throughout performance period. (target =1) All project activities that have specific indicators and time lines for achievement.

Annual Progress Reports include performance-based data and measurable progress.

Continuation of activities and funding decisions based on analyzable data and documented need.

Strategy 6:.Publish and disseminate findings, program evaluations, and lessons learned.

Outcomes (within the 5-year period of performance): Progress reports produced and disseminated. Findings and best practices shared.

Strategy-6 Activities Performance Measures Outcome Measures

Publish/disseminate reports on improved infectious disease surveillance, prevention and control strategies.

Number of project activity findings published and disseminated (target tbd).

Number of reports presented on project activity findings.

Number of targeted countries showing improvements in infectious disease surveillance, prevention and control strategies.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant) Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, within the first 6 months of award, as described in the Reporting Section of this NOFO.

c. Organizational Capacity of Recipients to Implement the Approach The applicant must have demonstrated capacity in the following areas:

Experience in advancing public health and the detection, control and prevention infectious diseases in the Americas.

Formal relationship with WHO member countries and territories in the Americas to advance International Health Regulations.

Organizational strategic plan, including achieving and sustaining IHR core capacities in the Americas.

Infrastructure with established regional branches/country offices in the Americas.

Established organizational capacity and networks to address infectious diseases in the

Americas.

Collaborating and cooperating with Ministries of Health and other public health partners to address infectious disease control and prevention in the Americas.

Administrative management of multiple complex funding sources with stringent tracking/monitoring and reporting requirements.

Established public health policies, priorities and action plans to address regional health problems in the Americas.

Promotion of health equity and human rights, and reduction of health disparities.

d. Work Plan Work plans will be developed by PAHO in-country partners in collaboration with CDC partners.

https://www.cdc.gov/grants/additionalrequirements/ar-25.html

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

f. CDC Program Support to Recipients (THIS SECTION APPLIES ONLY TO

COOPERATIVE AGREEMENTS)

To support implementation of the IHR, CDC will conduct the following activities:

Assist in analysis of regional, national, and local resources in the Americas devoted to infectious diseases.

Identify areas for implementation of infectious disease activities consistent with the purpose of this cooperative agreement.

Cooperate with and provide technical assistance to country partners to design, develop, implement, and conduct projects to enhance infectious disease surveillance, response, prevention, and control.

Collaborate to establish performance measurements for assessing and documenting progress on strategic activities and outcomes.

Provide technical support and training in the development of national policies, guidelines and tools.

Collaborate with other health organizations, academic institutions, and community groups as appropriate to accomplish program activities.

Assist in the analysis and interpretation of data generated from projects.

Participate in the dissemination of program information and data.

Collaborate to compile and publish accomplishments, best practices, and lessons learned.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism: 93.099

3. Fiscal Year: 2018

4. Approximate Total Fiscal Year Funding: $3,903,312

5. Approximate Period of Performance Funding: $20,000,000

This amount is subject to the availability of funds.

Estimated Total Funding: $20,000,000

6. Approximate Period of Performance Length: 5 year(s)

7. Expected Number of Awards: 1

8. Approximate Average Award: $3,000,000 Per Budget Period

9. Award Ceiling: $0 Per Project Period

This…