Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due October 16, 2026

Strengthening Ghana Health Service laboratory services, diagnostic networks, and systems for a more effective, efficient, and sustainable response to HIV, TB, and other priority health threats Opportunity number: CDC-RFA-JG-26-0178

Contents

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 9

Agency priorities 11

Program description 14

Step 2: Get Ready to Apply 35

Get registered 36

Find the application package 37

Help applying 37

Step 3: Build Your Application 38

Application contents and format 41

Step 4: Learn About Review and Award 50

Application review 51

Award notices 58

Step 5: Submit Your Application 59

Submission requirements and deadlines 60

Step 6: Learn What Happens After Award 62

Post-award requirements and administration 63

Contacts and Support 69

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 October 16, 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:

Strengthening Ghana Health Service laboratory services, diagnostic networks, and systems for a more effective, efficient, and sustainable response to HIV, TB, and other priority health threats

Opportunity number:

CDC-RFA-JG-26-0178

Announcement type:

New

Assistance listing:

93.067 Global AIDS

Program

Key dates

Application submission deadline: October 16, Expected award and start date:

September 2027

We will inform you of your application status by the end of August 2027.

Summary This NOFO provides operational support through financial and technical resources to the Ghana Health Service (GHS)/Ministry of Health (MoH). The goal is to help them coordinate and improve laboratory capacity so they can deliver high-quality, efficient services for HIV, TB, and other priority health areas. This NOFO seeks to advance HIV testing, treatment, retention, and viral suppression in Ghana by:

• Equipping laboratories with appropriate diagnostic technologies.

• Building staff skills to manage quality laboratory services.

• Strengthening the capacity of the Government of Ghana (GoG) MoH to take full responsibility for managing laboratory services, diagnostic networks, and systems for HIV, TB, and other priority infectious diseases.

Funding details Funding type: Cooperative agreement

Expected total NOFO funding for Year 1: $500,000.

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

Expected number of awards: 1 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.

Step 1: Review the Opportunity 5

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

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.

Step 1: Review the Opportunity 6

Setting up components

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

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

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

◦ Component 1:

CDC global HIV and TB planning Q1 targets and activities.

◦ Component 2:

CDC global HIV and TB planning Q2 targets and activities.

◦ Component 3:

CDC global HIV and TB planning Q3 targets and activities.

◦ Component 4:

CDC global HIV and TB planning Q4 targets and activities.

◦ Component 5:

CDC global HIV and TB planning 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 7 https://www.cdc.gov/about/cdc/index.html

Results Based Funding CDC may fund this Cooperative Agreement using a results-based funding approach, which would rely on articulated milestones and program indicators. Under this approach, CDC may provide federal funds during a budget period based on measurable results as defined in this NOFO (e.g., articulated milestones and program indicators), in the recipient’s approved work plan, and, to the extent allowable by federal law, as may be aligned with country, HHS/CDC, and US government global health priorities. If selected for award, you will receive more detailed information about this funding approach in your NoA or in subsequently issued CDC guidance.

In furtherance of this funding approach, you will have at least 120 days after the start date of this award to collaborate with CDC and submit proposed program indicators and milestones as part of your required Evaluation and Performance Management Plan and component funding structure. Though foundational funding will be provided at the start of the project period, continued funding will be linked to verified progress towards reaching milestones providing clear checkpoints on performance and helping to ensure resources support steady documented progress. These performance results are intended both to help support your progress during the award’s period of performance and to help determine funding amounts in subsequent budget periods.

Step 1: Review the Opportunity 8

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 Ghana.

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 will not 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:

• Works to prevent disease and advance emergency response.

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

• Test 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.

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

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 not support 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 not support 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 not support 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 https://opa.hhs.gov/sites/default/files/2025-11/gender-dysphoria-report.pdf

Program description Background overview and related work Ghana has an estimated population of 34 million, and there is a widespread HIV epidemic. In 2024, an estimated 334,721 people were living with HIV, including 18,229 children and 316,492 adults 15 years and older. The overall adult HIV prevalence is estimated at 1.49% with female prevalence about 2.5 times (2.14%) higher than males (0.85%).

Ghana serves as a CDC Regional Office that supports West African programs.

The office puts evidence-based interventions into practice to reach, test, treat, and retain people in care in settings with the highest HIV burden. It also works with national agencies to support sustained epidemic control.

Laboratory services and systems are essential for an effective and sustainable response to HIV, TB, and other infectious diseases. Ghana maintains a network of tiered laboratories with different diagnostic capabilities, from district-level facilities to national reference institutions encompassing governmental, quasi-governmental, and private facilities. There are three zonal Public Health Laboratories (PHLs), which have a mandate to conduct surveillance for priority diseases including TB and HIV, among others. The National Public Health Reference Laboratory (NPHRL) provides supervisory oversight to the three PHLs. The GHS has three laboratory tiers:

• Tertiary-level laboratories, consisting of the NPHRL and teaching hospital laboratories.

• Secondary-level laboratories, including regional hospital laboratories and zonal PHLs.

• Primary-level laboratories, located in district hospitals, sub-district facilities, and health centers.

Testing laboratories currently provide diagnostic support to 757 antiretroviral therapy (ART) sites and 7,445 health facilities offering HIV testing services (HTS). Among the HTS sites, 7,180 provide antenatal care and prevention of vertical transmission.

Ghana continues to face challenges in enhancing public health laboratory services and systems in support of HIV services. The current transport system for moving specimens from lower-tier health facilities to designated referral laboratories lacks standardization and relies heavily on donors. There are persistent operational gaps such as ad-hoc transport arrangements, delayed

Step 1: Review the Opportunity 14 sample delivery, and compromised specimen integrity. Manual data entry in electronic templates leads to errors at testing laboratories, and manual data entry in the e-Tracker leads to errors at ART clinics. Further, ART clinics cannot obtain immediate laboratory results to inform patients of treatment, but instead they wait weeks, if not months, to receive results.

The National AIDS and Sexually Transmitted Infections Control Programme (NACP) leads Ghana’s health sector response to HIV/AIDS by developing and putting policies into practice, coordinating interventions, and providing comprehensive care and support services.

In the last five years, the GoG has improved its laboratory services and systems with support from CDC and other interest holders.

• Molecular testing platforms used for near-point-of-care HIV early infant diagnosis (EID) and viral load (VL) testing are now integrated with the e- Tracker system.

• Barcoding, now available in 15 ART facilities across the three U.S.

Government (USG)-supported regions, enables staff to identify samples by scanning. This advancement has significantly reduced the risk of human transcription errors when recording sample information.

• Targeted mentorship has supported three HIV VL laboratories in improving the quality and timeliness of their diagnostic services and results reporting.

• Operational support is helping the NACP maintain the e-Tracker system, particularly in areas related to electronic test requests, results transmission, and instrument interfacing.

• Specialized technical support is helping to develop an indicator dashboard for real-time HIV VL and EID specimen testing performance analysis.

This NOFO aims to strengthen Ghana’s laboratory services, diagnostic networks, and systems for HIV, TB, and other priority diseases. These improvements will support a more effective and sustainable response that meets the country’s current and changing health needs under the GoG’s management.

Step 1: Review the Opportunity 15

Purpose The purpose of this NOFO is to:

• Strengthen laboratory services, diagnostic networks, and systems to better support those HIV testing, treatment, and retention activities that align with national strategies and the 95-95-95 global targets.

• Increase the GoG’s capacity to lead and manage an effective and sustained response to HIV, TB, and other diseases of public health concern by supporting diagnostic technologies, skilled staff, and efficient systems.

Activities will cover laboratories and testing centers across Ghana’s tiered health sector system, in cooperation with the GHS.

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

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

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

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

Step 1: Review the Opportunity 16

Table: Strategies and outcomes

Strategies Short-Term Outcomes

Intermediate Outcomes Long-Term Outcomes

Strategy 1 :

Support development, coordination, and implementation of effective and comprehensive capacity-building strategies for laboratory networks, point of care testing, and data management in support of clinical services.

Improved availability and use of training plans, standard operating procedures, and curricula for laboratory staff.*

Improved quality of services through established mentorship and supportive supervision mechanisms.*

Increased use of standardized tools for baseline quality assessments.*

Improved knowledge and practice of continuous quality improvement (CQI) processes for quality laboratory services, data analysis, and result utilization at all levels of implementation.*

Improved timeliness of review and updates to relevant laboratory policy, standards, and coordination mechanisms.*

Increased coverage for HIV diagnostic and VL testing.*

Decreased turnaround time (TAT) for HIV diagnosis and VL testing. *

Improved implementation of regular internal audits, external quality assessment (EQA) and proficiency testing (PT) participation, and QI projects to address laboratory service delivery gaps.*

Improved interoperability of clinical and laboratory data systems.*

Improved coordination and governance structures for laboratory systems strengthening.*

Improved use of geographic information system (GIS) for the specimen referral system.*

Increased efficiency, accuracy, and reliability of laboratory services and systems across all levels in support of HIV, TB and broader public health programs.*

Increased national and sub-national level capacity to implement and manage quality laboratory services and systems.

Improved programmatic effectiveness and efficiency of the national HIV program to achieve epidemic control.

Increased national capacity for disease diagnostics, surveillance, and response. *

Strategy 2 :

Develop and implement an institutionalized national quality assurance (QA)/quality improvement (QI) system to improve service delivery quality across clinical and laboratory services.

Strategy 3 :

Strengthen health systems and key policy requirements to enhance the national coordination of and response to HIV, TB, and other public health threats.

Step 1: Review the Opportunity 17

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

Strategy 1: Support development, coordination, and implementation of effective and comprehensive capacity-building strategies for laboratory networks, point of care testing, and data management in support of clinical services.

Priority activities:

• Work with the GHS to develop and operationalize a national quality management strategic plan.

• Support the GHS to strengthen and scale up a country-based HIV rapid test quality assurance program.

• Strengthen GHS capacity to enroll eligible HIV rapid testing sites nationwide in the PT program.

• Support corrective and preventive action plans for each Dried Tube Specimen - Proficiency Testing period.

• Work with the GHS to conduct joint supportive supervision and operational support visits.

• Support the GHS in establishing regional databases to monitor QI systems across all supported sites.

• Strengthen GHS capacity to conduct diagnostic network CQI. This CQI process will provide real-time insight on HIV VL and EID testing capacity, based on the Diagnostic Network Strategic and Implementation Plan.

• Support the GHS in reviewing and revising the national HIV VL and EID scale-up and operational plan.

• Build capacity among GHS staff and non-staff to conduct training on HIV and other priority diseases for testing.

• Support development and use of training plans, standard operating procedures, and curricula for laboratory staff, point of care testers, and

Step 1: Review the Opportunity 18 data managers on HIV diagnostics, VL and EID testing, data management, and biosafety.

Strategy 2: Develop and implement an institutionalized QA/ QI system to improve service delivery quality across clinical and laboratory services.

Priority activities:

• Build technical capacity for regional and district laboratory points of contact to carry out critical activities that strengthen Laboratory Quality Management Systems and CQI programs.

• Evaluate and make improvements to the existing Laboratory Information Systems (LIS) and integrate with the patient transactional database.

• Build NACP capacity to conduct supportive supervision and operational support visits to all testing sites.

• Strengthen National and Zonal Public Health Reference Laboratories to provide leadership to regional Testing Laboratories to carry out VL CQI activities.

• Provide technical and operational assistance to establish, monitor, and track performance of the national specimen transport system, which moves specimens from collection sites to testing laboratories for sustained epidemic control.

• Strengthen quality management systems and CQI processes in HIV drug resistant testing laboratories.

• Coordinate and provide operational support to conduct bi-monthly mentoring and performance monitoring of all laboratories that participate in national EQA programs.

Strategy 3: Strengthen health systems and key policy requirements to enhance the national coordination of and response to HIV, TB, and other public health threats.

Priority activities:

• Support roll-out of service directories and network maps such as GIS maps to improve coordination and TAT.

• Provide operational support to map out and strengthen the tiered laboratory network for HIV diagnosis and monitoring (from point of care to regional and reference laboratories) including during disease outbreaks.

Step 1: Review the Opportunity 19

• Support the GHS in the establishment of a national laboratory accreditation roadmap tied to the HIV program.

• Provide technical capacity for maintenance of functional laboratory dashboards to track performance and coverage.

• Assist NACP in integrating LIS data with national health data platforms (District Health Information System-2 (DHIS2/e-Tracker) for timely reporting and policy review.

• Build sustainable human capacity for next-generation sequencing, in line with the national strategy.

• Support the forecasting, quantification, and procurement planning of HIV test kits and reagents.

• Document and disseminate best practices and lessons learned for national and regional learning.

• Conduct mid-term and annual evaluations of established laboratory systems to support continuous improvement.

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

Step 1: Review the Opportunity 20 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 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] [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:

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Step 1: Review the Opportunity 21 https://www.state.gov/wp-content/uploads/2025/09/America-First-Global-Health-Strategy-Report.pdf

• 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.

• 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

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

Step 1: Review the Opportunity 22 https://www.federalregister.gov/documents/2026/01/27/2026-01519/protecting-life-in-foreign-assistance 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/ 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.

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 cooperate with:

• GHS.

• Noguchi Memorial Institute for Medical Research.

• Ghana AIDS Commission.

• Other USG Agencies and Departments.

• National Public Health Reference Laboratory.

• Teaching hospitals.

• Other relevant USG-funded organizations.

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

Step 1: Review the Opportunity 23

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 10% 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.

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 link.

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

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Step 1: Review the Opportunity 24 https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides 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 USG-supported testing sites, both laboratory-based testing and point-of care, engaged in CQI and PT activities. [Target: 100;

Reporting Frequency: Annually]

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

• Percentage of laboratory personnel correctly performing sample reception, sample analysis, and laboratory test result transmission to requesting facilities. [Target: 75%; Reporting Frequency: Quarterly]

• Number of panels prepared at regional level and sent to facilities.

[Target: 100; Reporting Frequency: Semi-Annually]

• Number of panels returned from facilities. [Target: 100; Reporting Frequency: Semi-Annually]

• Number of corrective action plans put into practice. [Target: 100;

Reporting Frequency: Semi-Annually]

• Percentage of laboratories able to perform VL tests for one or more consecutive weeks. [Target: 100%; Reporting Frequency: Quarterly]

• Number of samples transported through the Specimen Transfer system for VL testing. [Target: 10,000; Reporting Frequency: Quarterly]

• Number of specimens received for testing at all USG-supported testing sites, both laboratory-based and point-of-care sites within a given testing category. [Target: 10,000; Reporting Frequency: Quarterly]

• Number of data quality assessments conducted within a 12-month period. [Target: 1; Reporting Frequency: Annually]

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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.

• Other program monitoring tools.

Evaluation Below are 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 and an end-term evaluation.

• Facilitators and barriers to facility teams using routine data to identify gaps and track improvements: process evaluation.

• Extent to which CQI interventions affected service indicators (e.g., TAT, error rates, client satisfaction): outcome evaluation.

• Extent to which laboratory data is accurate, timely, and integrated with national reporting systems (e.g., DHIS2, LIS): outcome evaluation.

Evaluation data sources Data sources may include:

• QA/QI assessment reports, dashboards, and registers.

• Standard operating procedures.

• Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) scorecards.

• Audit reports.

• Quality management system tracking database.

• LIS and DHIS2 data.

• Monthly summary forms.

• Data validation reports.

• Interoperability assessments.

• EQA and PT results.

• Laboratory performance dashboards.

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• Pre- and post-test assessments.

• Competency evaluation checklists.

• Mentorship logs.

• Data review meeting minutes.

• Registers.

• Tally sheets.

• 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 abstract forum 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.

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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.

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

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

Evaluation activities You must carry out specific evaluation activities.

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

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

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

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

Describe:

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

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan For all public health data you plan to collect, you must have a data management plan (DMP). For a definition of “public health data” and more information about CDC’s policy on the DMP, see Data Management and Access.

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

Submit your initial DMP with your application and include:

• The data you will collect or generate and what its sources will be.

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

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

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

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

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

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

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

CDC and the global HIV and TB program will inform you of data you need to share with us and how and when it should be shared.

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures.