Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due Monday, August 31, 2026

Improving regional capacity to respond to HIV, TB, and other global health priorities in Central America Opportunity number: CDC-RFA-JG-26-0130

Contents

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 9

Agency priorities 11

Program description 14

Step 2: Get Ready to Apply 40

Get registered 41

Find the application package 42

Help applying 42

Step 3: Build Your Application 43

Application checklist 44

Application contents and format 46

Step 4: Learn About Review and Award 55

Application review 56

Award notices 63

Step 5: Submit Your Application 64

Submission requirements and deadlines 65

Step 6: Learn What Happens After Award 67

Post-award requirements and administration 68

Contacts and Support 74

Before you begin 3

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 Monday, August 31, 2026.

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/

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

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 9

Agency priorities 11

Program description 14

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

Global Health Center

Division of Global HIV and Tuberculosis

Making America safer, stronger, and more prosperous by reducing HIV, TB, and other priority disease incidence and mortality in global settings through data-driven activities and strengthened public health systems

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Improving regional capacity to respond to HIV, TB, and other global health priorities in Central America

Opportunity number:

CDC-RFA-JG-26-0130

Announcement type:

New

Assistance listing:

93.067 Global AIDS

Program

Key dates

Application submission deadline: August 31, Expected award and start date:

September 30, 2026

We will inform you of your application status by the end of September 2026.

Summary You will advance progress towards achieving the 95-95-95 targets and continue to transition site-level support to local governments in Central America (CA) for:

• El Salvador.

• Guatemala.

• Honduras.

• Nicaragua.

• Panama.

To achieve the goals of this NOFO, you will address gaps in:

• HIV prevention.

• Diagnosis.

• Life-saving treatment.

Proposed activities should facilitate country ownership while improving local capacity to:

• Make sure HIV prevention is available for populations most at risk, through the Sentinel Surveillance of STI and HIV Strategy (VICITS).

Provide testing that leads to active linkage to HIV treatment and prevention services.

Improve early HIV diagnosis through active case-finding strategies, including:

• Testing as outreach for populations most at risk for HIV.

Step 1: Review the Opportunity 5

• Index, provider-initiated, and community testing.

• Social network strategy.

• Self-testing.

Support the integration of comprehensive care and treatment services, including for HIV, TB, and other opportunistic infections.

Build capacity of healthcare workers to provide high-quality health services led by the country, and through continuous quality improvement (CQI) initiatives.

Make sure adequate data systems are used to monitor progress toward 95-95-95 targets and other global health priorities.

Support sustainable health systems that improve:

• Efficiency.

• Country ownership of the program.

• Global health security to fight priority infectious diseases and other public health threats.

Funding details Funding Type: Cooperative agreement

Expected total NOFO funding for Year 1: $20,000,000

This is the expected total Year 1 funding for all awards made under this NOFO.

Expected number of awards: 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, subject to available funds and program priorities.

Funding strategy

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

To align with the responsiveness criteria, if you request more than the Year 1 funding amount, your application will be deemed ‘non-responsive’ and will not be considered for award.

Step 1: Review the Opportunity 6

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 CDC Global HIV and TB 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 and recipient performance related to meeting milestones. Component activation and sequence may vary based on buy-ins and interagency allocations. CDC will communicate any adjustments in writing.

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: CDC global HIV, TB, and global health security Q1 targets and activities.

◦ Component 2: CDC global HIV, TB, and global health security Q2 targets and activities.

◦ Component 3: CDC global HIV, TB, and global health security Q3 targets and activities.

◦ Component 4: CDC global HIV, TB, and global health security Q4 targets and activities.

Step 1: Review the Opportunity 7

◦ Component 5: CDC global HIV, TB, and global health security additional targets and activities.

◦ Component 6: Other global health priorities.

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

• Budget narrative

• Component funding instructions for SF-424A

Global HIV and TB local organization funding preference This NOFO includes a funding preference for local organizations. Your organization will receive 30 extra points during the selection process if you provide sufficient documentation demonstrating you meet the global HIV and TB local organization definition.

Funding priority for alignment with agency priorities Before final funding decisions are made, division leadership will review awards for consistency with applicable laws and alignment with agency priorities (see Centers for Disease Control and Prevention (CDC) Priorities). To the extent permitted by law and applicable court orders, award applications which are aligned with agency priorities will receive a funding priority. For example, applications that align with America First Global Health Strategy and CDC priorities will be eligible for a funding priority.

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

Step 1: Review the Opportunity 8 https://www.cdc.gov/about/cdc/index.html

Eligibility Statutory authority This NOFO supports U.S. government (USG) HIV and TB activities that are consistent with the America First Global Health Strategy and other applicable guidance. Activities under this NOFO are authorized under applicable statutory authorities. Funding is provided through available appropriations consistent with current law. 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 President’s Emergency Plan for AIDS Relief (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. Eligibility is unrestricted. All types of organizations are eligible and encouraged to apply, including:

• 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.

Step 1: Review the Opportunity 9

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Other required qualifying factors

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

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 the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1, as referenced in the funding amounts sub-section.

• 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. Build 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://www.cdc.gov/grants/additional-requirements/ar-31.html

Agency priorities Required alignment with CDC priorities The recipient of this award must implement any funds awarded under this NOFO to effectuate program goals or agency priorities in accordance with the Centers for Disease Control and Prevention (CDC) Priorities when authorized (for a full description of the CDC Priorities please follow the provided hyperlink).

Funded activities must:

• Align with CDC’s core priorities by demonstrating a commitment to gold-standard science, transparency, and evidence-based practices.

• Support CDC’s mission to protect Americans from infectious and chronic diseases, strengthen public health systems, and advance innovation in health data and infrastructure.

• Contribute to rapid, science-driven responses to health threats, promote global health leadership, and adhere to principles of integrity, accountability, and compliance with applicable laws and federal priorities.

Consistent with CDC’s values, in carrying out any project funded under this NOFO, the recipient must adhere to the following principles where consistent with the authority and scope of the award and its activities:

• A commitment to gold-standard science and ensuring trust, transparency, and credibility: To build trust and improve CDC’s ability to lead during health crises, CDC will increase transparency, be more accountable, and follow strict, gold-standard scientific practices that are open, unbiased, and based on clear evidence.

• A commitment to global leadership: With staff in 63 countries and supporting 20 more, CDC’s Global Health Center:

◦ Fights HIV, tuberculosis, vaccine-preventable diseases, and emergency and refugee health.

◦ Detects health threats early, sends response teams, trains health workers, and provides personal protective equipment, vaccines, and medicines.

◦ Tests disease samples from around the world to prepare for flu and other serious outbreaks.

◦ Has strengthened systems to better protect people at home and abroad after the COVID-19 outbreak.

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Step 1: Review the Opportunity 11

• A commitment to ensuring rapid, evidence-based responses to crises:

During public health emergencies, ensuring rapid, science-driven responses is critical to minimizing harm, maintaining public trust, and restoring stability. To meet this goal, CDC must continue to strengthen its emergency response systems by:

◦ Streamlining internal processes.

◦ Improving risk communication strategies.

◦ Ensuring that laboratory capacity is fully equipped and tested—capable of rapidly developing and deploying scalable diagnostics during crises.

◦ Embedding structures for real-time learning, independent after-action reviews, and the application of lessons learned will ensure that each crisis response is smarter, faster, and more effective than the last.

• A commitment to vaccine safety and efficacy research: CDC will apply “gold-standard” science to all of its vaccine safety and effectiveness research. It will make vaccine data, research methods, and related datasets publicly available through simple data use agreements to improve transparency, accountability, and trust.

• A commitment to advancing our understanding of the causes of autism spectrum disorder (ASD), neurodevelopmental disorders (NDDs), and chronic disease: CDC conducts research and works with partners to better understand the causes of autism spectrum disorder, neurodevelopmental disorders, and chronic diseases. It will use new and existing data to study the rise in these conditions, including the increase in autism diagnoses from 1 in 150 to nearly 1 in 31 over the past 25 years.

• A commitment to modernizing public health infrastructure and enhancing our approach to health data: CDC will modernize public health infrastructure to create a faster, more efficient health system that can detect and respond to outbreaks in real time. This effort includes:

◦ Replacing data silos with integrated systems.

◦ Using advanced technology.

◦ Strengthening partnerships with states to ensure shared responsibility and strong local health data systems.

◦ Emphasizing collaboration across federal and state partners, resilient and adaptable systems, and accountability for funded programs to ensure they align with these priorities and federal requirements.

Step 1: Review the Opportunity 12

• Conflicts of interest: CDC will deprioritize funding programs with conflicts of interest and ensure its work is based on transparent, unbiased science.

• Immigration: CDC funds will not be used to support or encourage illegal immigration, consistent with federal law.

• Protecting life and the family: CDC funds will not be used to support elective abortions, consistent with the Hyde Amendment, and will promote maternal health, the dignity of life, and strong families.

• Ending disorder on America’s streets: CDC will prioritize evidence-based programs that reduce homelessness, drug use, and public disorder. It will support comprehensive services for people with serious mental illness and substance use disorder. CDC will deprioritize housing first strategies, harm-reduction or safe consumption sites, or related activities. To the extent allowable by federal law, CDC intends to give priority to grantees in States and municipalities that have laws and policies that support and enforce CDC’s priorities.

• Gender ideology and protecting children: CDC will not fund medical interventions for minors seeking gender transition and will define sex based on biological criteria.

• DEI: CDC will deprioritize DEI initiatives based on group identity and focus on merit-based, evidence-driven approaches to improve health outcomes.

• Parental rights: CDC will support policies that protect parental authority, promote transparency, and give parents greater control over their children’s education.

The recipient must demonstrate ongoing compliance with the full description and listing of CDC values and priorities, in all programs that are authorized to advance them, through program design, implementation, reporting, and evaluation.

Failure to meaningfully align funded activities with the applicable requirements may result in corrective action, additional reporting requirements, or other enforcement actions consistent with federal grant regulations found at 2 CFR Part 200 and the terms and conditions of this award. The full CDC Priorities Statement can be found here: Centers for Disease Control and Prevention (CDC) Priorities .

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

Step 1: Review the Opportunity 13

Program description Background overview and related work History of the program CDC supports program activities in the five previously identified countries in CA. These countries have committed to achieving the 95-95-95 goals by 2030.

Together, these nations have:

• 46 million people with an estimated 139,000 living with HIV, including 4,500 new HIV infections in 2022.

• A regional average of 42% of people receiving a late HIV diagnosis and Advanced HIV Disease (AHD).

• A concentrated HIV epidemic with a:

• Low prevalence (<1%) among the general population.

• Higher prevalence (>5%) among populations at most risk.

The previous award (GH002261) worked with CDC and the respective CA Ministry of Health (MoHs) to:

• Increase HIV prevention services among populations at most risk.

• Increase HIV testing and effective linkage through:

• Targeted outreach.

• Index testing.

• Provider-initiated testing.

• Targeted community testing.

• Improve clinical outcomes among people living with HIV by:

• Starting treatment early.

• Optimizing treatment regimens.

• Managing AHD.

• Providing intensified adherence counseling.

• Using differentiated service delivery (DSD) models.

• Strengthen availability of viral load tests to increase VL suppression (VLS).

• Respond to other global health priorities.

Step 1: Review the Opportunity 14

Lessons learned to date Lessons learned show that versatility, clear communication, and maintaining relationships with key regional interest holders have been vital for sustaining and carrying out the HIV response in CA.

Past work at each site shows that countries need to adapt guidelines and standards to fit their local context. This helps them make the best use of their available resources, especially when working with populations at greater risk for HIV.

Targeted strategies Targeted HIV strategies include the VICITS, also known as the Clinicas Amigables (CLAM) strategy.

This is a prevention initiative for populations at most risk that offers:

• Pre-exposure prophylaxis (PrEP).

• Post-exposure prophylaxis (PEP).

• STI diagnosis and treatment.

It also uses the MoH’s information system to monitor data trends in STI and HIV prevention and diagnosis, as well as indicators related to HIV risk.

Policy and programmatic barriers While the region has made advances in closing the gap in the first 95, policy and programmatic barriers to widespread testing vary by country, leading to high levels of late diagnosis.

These include:

• Noncompliance with testing guidance.

• Lack of self-testing availability.

• Suboptimal levels of index testing.

• Gaps in outreach to populations most at risk for HIV.

• Lack of active case-finding plans.

• Running out of test kits.

• Age restrictions for testing.

• Legal restrictions for HIV testing by certified non-clinical and peer providers.

Step 1: Review the Opportunity 15

• “Certified non-clinical” means a person who is trained and approved to do certain health tasks but is not a doctor, nurse, or other medical clinician.

• Complicated counseling requirements and testing forms.

Gaps in linkage to treatment For the second 95, all countries have major gaps between diagnosed people living with HIV and those on treatment. This means there are gaps in linkage to treatment after diagnosis, and in continuity of treatment, for people living with HIV.

These gaps grow because of:

• Geographical availability of services.

• People living with HIV in rural areas must travel long distances to get treatment.

• Limited growth and use of DSD models.

• Lack of services designed for people who are hard to reach, including:

• People in remote and hard-to-reach areas.

• Indigenous communities.

The third 95 has shown a steady increase in the percentage of people living with HIV who are virally suppressed over the past ten years. It is relatively high across the region, ranging from 90% - 93%, except for Nicaragua.

However, gaps in diagnosis, linkage, continuity of treatment, and VL coverage (VLC) show that all countries need significant progress to reach epidemic control.

Next steps Through this NOFO, you are expected to support respective MoHs in CA, as well as other key interest holders, to address identified gaps by:

• Introducing and scaling up lifesaving interventions.

• Facilitating the adoption of these interventions into government-led response strategies.

• Advancing sustainable health systems to combat HIV, TB, and other infectious diseases and global health threats.

• Supporting sustainable, country-led, data-driven efforts.

• Using evidence-based program implementation to prevent and contain infectious disease outbreaks before they reach the U.S.

Step 1: Review the Opportunity 16

• Using data to inform coordinated efforts with the private sector and faith-based organizations.

• Using data to determine site and above-site level interventions, including if additional interventions may be adapted or added based on:

• Evolving epidemiological contexts.

• Updates in global health guidance and standard international recommendations.

• National priorities.

Purpose The purpose of this NOFO is to support MoHs and other key interest holders in CA to close remaining gaps in HIV prevention, testing, care, and life-saving treatment.

It is also intended to help strengthen national systems to monitor potential outbreaks and global health security threats.

This should be achieved by:

• Introducing and scaling up effective standard guidelines and new site-level and above-site interventions.

• Accelerating achievement of the 95-95-95 targets.

• Advancing the integration and sustainability of government health systems.

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.

Step 1: Review the Opportunity 17

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:

Strengthen HIV prevention and testing services for populations at most risk through targeted, evidence-based, and country-owned initiatives.

Strategy 2:

Support effective linkage strategies to appropriate services for all populations that receive HIV testing through country-owned initiatives.

Strategy 3:

Support provision of lifesaving care and treatment services for people living with HIV through country-owned initiatives.

Strategy 4:

Strengthen national data systems to build sustainable, resilient health services capable of responding to global health priorities.

Strategy 5:

Coordinate with respective MoHs to

Increased availability of comprehensive HIV services for all populations.*

Improved effective linkage to appropriate HIV services for all populations.*

Increased early treatment initiation among people living with HIV.*

Increased progress towards 95 targets across CA.*

Enhanced national capacity to use strengthened health systems to manage priority infectious disease threats.*

Increased adoption of USG-supported strategies within national guidelines and manuals.*

Increased use of comprehensive HIV services by all populations.*

Sustained effectiveness of prevention services for populations at most risk of HIV.*

Reduced late HIV diagnosis among people living with HIV who are newly diagnosed.*

Increased achievement of 95 targets across CA.*

Improved health outcomes for people living with HIV.*

Increased VLC among people living with

HIV.*

Increased adherence to appropriate HIV services for all populations.*

Improved management of priority diseases using an integrated health system.*

Increased sustainability of USG-

Increased country ownership of HIV and TB programs.

Reduced HIV incidence.

Reduced HIV morbidity and mortality.*

Sustained VLS among people living with

HIV.*

Sustained resilient health systems that safeguard global health security and reduce the burden of HIV, TB, and other public health threats.

Step 1: Review the Opportunity 18

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes advance adoption and scale-up of U.S.

government (USG)-supported global health initiatives.

supported strategies at the national level.*

Strategies and activities This section elaborates on the strategies described in the logic model. It provides priority activities and details about how we expect you to implement your program.

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

Strategy 1: Strengthen HIV prevention and testing services for populations at most risk through targeted, evidence-based, and country-owned initiatives.

Priority activities:

• Support MoH and community-based organizations in the implementation of the VICITS or CLAM strategy. The packages include:

◦ Tailored counseling.

◦ Providing PrEP.

◦ Improving STI diagnosis and treatment.

◦ Targeted HIV testing.

◦ Linking to treatment.

◦ Supporting the national health information system.

• Expand availability to HIV testing among undiagnosed people living with HIV by supporting evidence-based active case finding strategies, including:

◦ Testing as part of outreach for populations at most risk of HIV.

◦ Index testing services.

◦ Provider-initiated testing.

◦ Community testing.

Step 1: Review the Opportunity 19

• Identify and address hotspots of vertical transmission of HIV, as well as of pediatric cases.

• Strengthen MoH’s capacity to monitor and address late HIV diagnosis.

• Develop and strengthen relationships with faith-based organizations.

• Collect detailed data at each site and use epidemiological methods to monitor and analyze trends in HIV testing interventions by modality, location, and other factors.

• Use this information to guide targeted responses and improve program implementation.

Strategy 2: Support effective and innovative linkage strategies to appropriate services for all populations that receive HIV testing through country-owned initiatives.

Priority activities:

• Support MoH to develop or scale-up solutions to track linkage of people who test negative for HIV and are at substantial risk of infection to prevention services. This includes PrEP and PEP, and people who test positive to treatment services.

• Support implementation of these solutions, including training of healthcare workers and monitoring, and integration into broader MoH healthcare and information systems.

• Ensure linkage to care for new HIV cases within seven days of HIV diagnosis.

Strategy 3: Support provision of lifesaving care and treatment services for people living with HIV through country-owned initiatives.

Priority activities:

• Strengthen MoH capacity to deliver comprehensive, integrated HIV services.

◦ This includes Rapid ART initiation and AHD management.

• Diagnose and treat opportunistic Infections, provide TB/HIV coinfection care, and achieve VLS.

• Enhance the implementation of the AHD package of care.

Step 1: Review the Opportunity 20

◦ This means ensuring routine CD4 testing for populations at higher risk.

◦ The focus is on people initiating ART, returning to care, or failing ART.

• Address critical gaps in TB screening, diagnosis, preventive therapy, treatment initiation or completion, to reduce morbidity and preventable mortality among people with HIV.

• Expand differentiated and client-centered HIV services.

◦ This includes six-month appointment spacing and six-month multi-month dispensing.

• Reduce HIV-related mortality from preventable causes.

• Use detailed data at each site and use epidemiological analysis to identify gaps, guide targeted improvements, and optimize program performance.

Strategy 4: Strengthen national data systems to build sustainable, resilient health services capable of responding to global health priorities.

Priority activities:

• Implement CQI Initiatives to improve service quality.

• Support country-led workforce development through targeted operational systems support.

• Update national guidelines in coordination with other organizations.

• Strengthen national health information systems.

Monitor potential outbreaks and broader health outcomes.

• Upgrade and equip laboratories with diagnostic and data management tools.

• Strengthen national surveillance systems, including digital reporting and data integration.

Strategy 5: Coordinate with respective MoHs to advance adoption and scale-up of USG-supported global health initiatives.

Priority activities:

• Train healthcare and laboratory staff in disease detection, case reporting, and biosafety.

• Develop and disseminate standard operating procedures for outbreak investigation and response.

Step 1: Review the Opportunity 21

• Support coordination mechanisms among national infectious disease and emergency response programs.

• Strengthen supply chain systems for diagnostics, medicines, and infection prevention supplies.

• Support implementation of quality assurance programs for diagnostics and clinical care.

• Strengthen community engagement and improve risk communication to support sustained prevention and response efforts.

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 interest holders, 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 the global HIV and TB program, CDC assesses progress toward epidemic control using epidemiologic measures and supports sustainable, country-led systems capable of maintaining gains and advancing broader global health security objectives.

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

• HIV-related deaths are declining.

• New infections are 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.

During your award we may ask you to conduct additional activities to reach and maintain epidemic control and/or to ensure resilient and country-led health programs, consistent with the scope of this NOFO and the related policies below. In alignment with the America First Global Health Strategy, which emphasizes efficiency, sustainability, and self-reliance, this may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), related opportunistic infections and other infectious diseases, especially among those most affected as defined in HHS/CDC Global HIV and TB, Department of State, bilateral

Step 1: Review the Opportunity 22

MOUs, subsequent implementation plans and/or other related USG guidance.

◦ Promoting sustainable, country-led approaches to managing HIV/ AIDS and TB and empowering national and local interest holders to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new cooperative relationships with private, public, local, faith based and multi-sector entities that can complement and expand the reach of existing programs.

◦ Enhancing and expanding laboratory, surveillance, and information systems and using the USG supported platform for broader disease surveillance and public health programs in ways that align with CDC Global HIV, TB, and other infectious disease program goals and initiatives. Where aligned with the award scope, these platforms may also be leveraged for cross-cutting surveillance, laboratory, and information-system strengthening across multiple health programs.

◦ Enhancing efforts to prevent, detect, respond to, and treat other diseases to keep America safe from infectious threats by supporting surveillance and outbreak response systems.

Related policies

• If awarded, and as applicable to the work and this NOFO and consistent with law, proposed work should align with:

• The America First Global Health Strategy [PDF] .

◦ CDC priorities statement.

◦ CDC’s mission to:

▪ Protect Americans from infectious and chronic diseases.

▪ Strengthen public health systems.

• Advance innovation in health data and infrastructure.

Additionally, applicants should show how their work:

• Contributes to rapid, science-driven responses to public health threats.

• Promotes global health leadership.

• Adheres to principles of integrity, accountability, and compliance with applicable laws and applicable USG priorities.

• USG global health annual planning guidance and approved implementation plans coordinated through GHSD.

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Step 1: Review the Opportunity 23 https://www.state.gov/wp-content/uploads/2025/09/America-First-Global-Health-Strategy-Report.pdf

• HHS policies and the approved activities and targets in the global HIV and TB Planning Processes, as appropriate, except as otherwise agreed between GHSD and HHS.

• All proposed work, activities, and budgets should align or be adjusted to align with bilateral USG and host country Memorandums of Understanding (MOUs), subsequent implementation plans and related guidance.

• To the extent consistent with law and applicable regulations, ensure the Child Safeguarding Principles, or substantively similar standards, are incorporated into programming that includes contact with children, to protect children and youth from abuse, exploitation, and neglect to the greatest extent possible in such global HIV and TB-supported programs.

• All statutory and policy requirements for foreign assistance, including related to abortion. HHS must keep full and complete records demonstrating that compliance approaches and systems are proactive, preventive, part of routine program administration, and tailored to local legal and policy contexts. Routine site-level program monitoring is required. For more information, please visit Protecting Life in Foreign Assistance.

• Recipients should keep up with the latest guidelines, guidance, and policies found on USG sites including Whitehouse.gov, HHS.gov, CDC.gov, and Department of State Bureau of Global Health Security. Also, the Notice of Award (NoA) will include important terms and conditions that also apply to this award.

Geographic focus Geographic prioritization may change over the course of the period of performance. CDC will work with the recipient(s) on any adjustments throughout the period of performance.

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 as well as milestones achieved in each performance period.

Communities served Under this NOFO communities served include people living with or at increased risk for HIV/AIDS, TB, or other priority diseases that can negatively affect the goals of keeping Americans safer, stronger, and more prosperous.

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

Step 1: Review the Opportunity 24 https://www.federalregister.gov/documents/2026/01/27/2026-01519/protecting-life-in-foreign-assistance https://www.state.gov/bureaus-offices/under-secretary-for-foreign-assistance-humanitarian-affairs-and-religious-freedom/bureau-of-global-health-security-and-diplomacy/

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.

Coordination If funded, we will expect you to coordinate with:

• The CDC CA office.

• Other CDC-funded implementing organizations working across the HIV continuum of care, on above-site support, and global health security initiatives.

You will also be expected to coordinate with:

• National Public Health Institutes.

• MoH, including National HIV Programs and National Epidemiology Centers.

• Other non-CDC, USG-funded implementing organizations.

• International agencies.

• HIV Country and Regional Coordination Mechanisms.

• Civil society groups and faith- and community-based organizations.

• Other organizations that coordinate to respond to HIV, as well as the detection, prevention, and containment of outbreaks and other health priorities.

We encourage you to work with local, U.S.-based, and international organizations to complement efforts that:

• Lower costs.

• Improve program effectiveness.

• Strengthen country leadership.

• Sustain programmatic gains.

Such coordination should also accelerate progress toward the 95-95-95 targets and other objectives of the America First Global Health Strategy.

Through the global HIV and TB program, CDC works with organizations to help prevent HIV and TB infection, provide life-saving treatment to people

Step 1: Review the Opportunity 25 living with HIV and/or TB, and reduce HIV-and TB-related deaths. We encourage our recipients to coordinate with local organizations, U.S.-based organizations, and international organizations. The goal of this coordination is to complement efforts to lower costs, make programs more effective, enhance national capacity, sustain the gains, and accelerate progress towards epidemic control including where appropriate, programmatic treatment cascade goals related to diagnosis, treatment, and viral suppression that are intended to contribute to HIV epidemic control and towards ending TB.

Data, monitoring, and evaluation CDC strategy CDC collects and reports on indicators to measure progress toward achieving the activities and outcomes funded under this award. CDC will also use results for program planning, improvement, accountability, and reporting.

CDC will share the results with key parties. These indicators may include or align with broader USG global health metrics where appropriate, reflecting CDC’s integrated approach to HIV, TB, and global health-security outcomes.

CDC will work with you throughout the life of an award to ensure that all activities and expected outcomes align with your strategies and goals, and those of the USG.

You should dedicate some of award funds to evaluate and monitor the performance of your project. You and CDC will agree on the final funding amount, but we expect that you will dedicate approximately 5 to 10% of your project’s funding to monitoring, reporting, and evaluation activities.

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

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

Step 1: Review the Opportunity 26

Required performance measures

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

• USG standard indicators, which are common to all awards. These standard indicators are based on the scope of the work proposed in the NOFO. You can find additional information regarding indicator reporting in the guidance and resource materials, available at this MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by the standard indicators. These include process and outcome measures that directly correlate with the logic model.

The indicators and targets shown below may change before the 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.

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

• Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period.

◦ Target: 5,531

◦ Reporting Frequency: Quarterly

• Number of individuals who received HIV Testing Services (HTS) and received their test results.

◦ Target: 72,624

◦ Reporting Frequency: Quarterly

• Number of individual HIV self-test kits distributed.

◦ Target: 26,707

◦ Reporting Frequency: Quarterly

• Number of individuals who were identified and tested using Index testing services and received their results.

◦ Target: 9,058

◦ Reporting Frequency: Quarterly

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

Step 1: Review the Opportunity 27 https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• Number of adults and children currently receiving antiretroviral therapy

(ART).

◦ Target: 32,994

◦ Reporting Frequency: Quarterly

• Number of adults and children newly enrolled on antiretroviral therapy

(ART).

◦ Target: 2,969

◦ Reporting Frequency: Quarterly

• 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

• Number of ART patients who experienced an 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

• 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: 95%

◦ Reporting Frequency: Quarterly

• Number of women living with HIV on ART screened for cervical cancer.

◦ Target: 1,971

◦ Reporting Frequency: Semi-Annual

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

◦ Target: >90%

◦ Reporting Frequency: Semi-Annual

• Proportion of ART patients who started on a standard course of TB Preventive Treatment (TPT) in the previous reporting period who completed therapy.

Step 1: Review the Opportunity 28

◦ Target: >95%

◦ Reporting Frequency: Semi-Annual

• Proportion of ART patients screened for TB in the reporting period.

◦ Target: >95%

◦ Reporting Frequency: Semi-Annual

• Proportion of ART patients diagnosed with TB who start TB treatment in the reporting period.

◦ Target: >95%

◦ Reporting Frequency: Semi-Annual

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

• Number of USG-supported health workers providing HIV direct service delivery, as well as total spending on these workers.

◦ Target: 257

◦ Reporting Frequency: Annual

• Percentage of CDC-supported sites that monitor index testing cascade.

◦ Target: 95%

◦ Reporting Frequency: Quarterly

• Percentage of newly diagnosed individuals linked to HIV care and start treatment within 7 days.

◦ Target: >95%

◦ Reporting Frequency: Quarterly

• Number of adverse events occurring to people living with HIV that are on treatment following notification (disaggregated by type of event).

◦ Target: <2

◦ Reporting Frequency: Quarterly

• Percentage of people who received oral PrEP who have discontinued or interrupted PrEP due to a serious ARV-associated toxicity in the last 12 months.

◦ Target: <5%

◦ Reporting Frequency: Quarterly

Step 1: Review the Opportunity 29

• Percentage of people living with HIV who were lost to follow-up and then who were re-engaged into treatment that are still active TX_CURR at 6 months.

◦ Target: >90%

◦ Reporting Frequency: Semi-annual

Data sources for standard and custom indicators Data sources may include:

• Registers.

• Tally sheets.

• Electronic and paper patient records.

• Quarterly progress reports.

• Surveillance and survey reports.

• Site Improvement Through Monitoring Systems (SIMS) indicators. As part of programmatic implementation, you can find more information on the Core Essential Elements in the SIMS Implementation Guide.

• CDC CA region specific tools to monitor site-level performance. Site-level implementing organizations are provided CA-specific tools for routine monitoring of USG standard and custom indicators.

• Global Health Security reporting requirements.

• 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 expect you to conduct a mid-term evaluation.

• Extent that the program’s prevention, testing, and treatment strategies, including index testing, self-testing, and PrEP, have been implemented as intended: Process Evaluation

• Extent to which the program reached key expected intermediate-term outcomes, as described in the logic model: Outcome Evaluation

Evaluation data sources Data sources may include:

• Registers.

• Tally sheets.

Step 1: Review the Opportunity 30

• Electronic and paper patient records.

• Recipient progress reports.

• Focus groups.

• In-depth interviews.

• Surveys.

• Other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations, if allowable.

• Conference poster displays, if allowable.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and interest-holder meetings.

• Other approved products in print and electronic media.

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

CDC and interest holders will use overall evaluation findings during the five-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 USG 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, global HIV and TB, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it accounts for agreements made during annual USG global-health planning processes coordinated by GHSD.

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

Step 1: Review the Opportunity 31

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

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

Additionally, explain:

• How findings will contribute to reduce barriers to accessing health and related services, as relevant.

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

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

• How you…