CDC-RFA-PS18-1804.pdf

Centers for Disease Control

National Center for HIV-AIDS, Viral Hepatitis, STD, and TB Prevention

TB Centers of Excellence for Training, Education, and Medical Consultation (TB COE)

CDC-RFA-PS18-1804

Application Due Date: 09/25/2017

TB Centers of Excellence for Training, Education, and Medical Consultation (TB COE)

CDC-RFA-PS18-1804

TABLE OF CONTENTS

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

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

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-PS18-1804. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

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

TB Centers of Excellence for Training, Education, and Medical Consultation (TB COE) C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-healt h-research-nonresearch.pdf.

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-PS18-1804

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

93.947 F. Dates:

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

2. Due Date for Applications: 09/25/2017, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

The date for the information conference call is set for 08/08/2017 from 2:00- 3:00 p.m. EST.

The call in information is 1.866.806.8575; passcode is 4862475.

G. Executive Summary:

1. Summary Paragraph:

CDC plans to establish and fund up to five regionally-assigned Tuberculosis Centers of Excellence (TB COE) to facilitate efforts to prevent, treat, and control TB disease and latent TB infection (LTBI) in the United States (U.S.). The TB COE will focus on two major activities:

(1) increasing knowledge, skills, and abilities for TB prevention and control through communication, education, and training activities, and; (2) improving sustainable evidence-based TB clinical practices and patient care through the provision of expert medical consultation.The funds available for these core activities will be used to support TB and LTBI communication efforts, training, education, and medical consultation activities.

https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 5

d. Total Project Period Funding: $26,690,200

e. Average One Year Award Amount: $1,334,510

f. Total Project Period Length: 5

g. Estimated Award Date: 12/04/2017

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview TB is one of the world’s deadliest diseases yet it is almost always curable if treated promptly with the correct medications. If not diagnosed and treated properly, TB disease can be fatal. In 2015, a total of 9,557 cases of TB disease were reported. While TB case counts have generally been declining in the US, eliminating TB disease will require an expansion of testing and treatment of LTBI. Although TB is spread through the air from one person to another, not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist:

latent TB infection (LTBI) and TB disease. Many people who have LTBI never develop TB disease; in these people, the TB bacteria remain inactive for a lifetime without causing disease.

But in other people, especially people who have a weak immune system, the bacteria become active, multiply, and cause TB disease.

As part of Centers for Disease Control (CDC) mission to control and eliminate TB in the U.S., the Division of Tuberculosis Elimination (DTBE) funded five TB Regional Training and Medical Consultation Centers (RTMCCs) for the previous project announcement PS13-1304.

The purpose of these Centers was to develop TB education materials, provide training and technical assistance to increase human resource development for TB programs, and provide medical consultation for complex TB cases. An evaluation of these previous TB Centers' efforts conducted in 2016 demonstrated that U.S. TB programs were satisfied with their services and 98% of programs felt Center activities should continue to be offered.

This funding opportunity builds upon the success of the previous project in providing TB training, education, and medical consultation activities to U.S. TB programs and partners. In addition to these activities, the awarded TB COE will develop and implement a plan to engage and educate private providers and other health care workers involved in TB treatment and diagnosis. In particular, awardees should have a plan to engage providers to expand LTBI testing and treatment of high-risk groups using innovative approaches.

b. Statutory Authorities This program is authorized under the sections 301 and 317E of the Public Health Service Act (42 U.S.C. Sections 241 and 247b-6), as amended.

c. Healthy People 2020 Healthy People 2020 (https://www.healthypeople.gov/2020/topics-objectives/topic/immunizati on-and-infectious-diseases/objectives) contains national objectives to improve the health of all Americans. This FOA addresses the "Healthy People 2020" focus areas of Immunization and Infectious Diseases(IID):

IID-29 Reduce tuberculosis (TB) cases IID-30 Increase treatment completion rate of all tuberculosis patients who are eligible to complete therapy IID-31 Increase the percentage of contacts to sputum smear-positive tuberculosis cases who complete treatment after being diagnosed with LTBI and initiated treatment for LTBI IID-33 Increase the proportion of adults with tuberculosis (TB) who have been tested for HIV

d. Other National Public Health Priorities and Strategies This FOA supports the following goals in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Strategic Plan Through 2020:

-Reduce rate new TB diagnoses

- Reduce rate of new TB diagnoses among racial/ethnic populations with rates above the national average

- Reduce the number of TB cases in foreign-born persons per 100,000 per year

e. Relevant Work DTBE funded five TB RTMCCs for the project period 2013-2017 (PS-1304). The RTMCCs were regionally assigned to cover all 50 states and the U.S. territories. The primary purpose of each RTMCCs was to:

Provide training and technical assistance to increase human resource development in TB programs;

Develop TB educational materials and Provide medical consultation to TB programs and providers.

The information on the previous RTMCC work can be found at https://www.cdc.gov/tb/educa tion/rtmc/default.htm.

During the RTMCC project period (2013-2016), the RTMCCs provided over 4,320 hours of training to 42,856 participants, and provided 14,971 TB medical consultations to providers managing TB patients.

2. CDC Project Description https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives https://www.cdc.gov/tb/education/rtmc/default.htm https://www.cdc.gov/tb/education/rtmc/default.htm

a. Approach

Bold indicates period of performance outcome.

Strategies and Activities

For Tuberculosis (TB) and Latent TB Infection (LTBI)

Short-term Outcomes Long-Term Outcomes

TB Knowledge, Skills, and Abilities

Develop TB and LTBI education and training courses and materials for state and local health agencies, private providers, and other TB control partners based on need

Develop TB and LTBI communication, education, and training products that are technically accurate and appropriate for target audiences based on need

Provide technical assistance to health departments and other TB control partners to develop their own TB and LTBI education and training activities

Increased capacity for TB control partners to develop and provide their own education and training activities

Increased knowledge and skills related to TB and LTBI prevention and control among health care workers

Increased number of educated and trained TB health care workers

Increased access to and use of TB educational resources

Expert Medical Consultation

Provide medical consultation services for TB disease and

LTBI

Increased provider knowledge regarding TB patient care and management

Improved TB patient

Increased adoption of sustainable evidence-based TB care and prevention

Improved quality of TB and LTBI patient care and clinical practices

Improved patient health outcomes among vulnerable/high risk population

The availability and accessibility of trained, skilled, and competent workforce to prevent and control TB in the U.S.

Provide longitudinal medical consultation as requested by providers for complex clinical cases

Collect, analyze, and share medical consultation data with appropriate partners care and management in resource- and expertise-limited programs

Identification of national trends of TB patient care needs

i. Purpose In 2015, 9,557 TB cases were reported in the United States. As one of the world’s deadliest diseases, TB is almost always curable if treated promptly and correctly. Persons with LTBI can develop TB disease. Eliminating TB will require expanding testing and treatment of LTBI.

CDC will establish up to five regionally-assigned TB Centers of Excellence (TB COE) to help control TB. TB COE core activities will be to provide TB and LTBI communication, education, training, and medical consultation activities to TB programs, private providers, and other partners involved in TB control.

ii. Outcomes By the end of this project period the awardees are expected to achieve all of the short-term outcomes as follows:

Short-term

Increased number of educated and trained TB health care workers Increased access to and use of TB educational resources Identification of national trends of TB patient care needs

iii. Strategies and Activities The awardee is expected to engage partners in TB control to implement the following strategies and activities during the project period.

TB Knowledge, Skills, and Abilities: Communication, Education, and Training

Develop TB and LTBI education and training courses and materials for state and local health departments, private providers, and other TB control partners based on needs

Develop TB and LTBI communication, education, and training products that are technically accurate and appropriate for target audiences based on needs

Provide technical assistance to health departments and other TB control partners to develop their own TB and LTBI education and training activities

Expert Medical Consultation

Provide medical consultation services for TB disease and LTBI to health care providers Provide longitudinal (ongoing) medical consultation, as requested by providers, for complex clinical cases Collect, analyze, and share medical consultation data with appropriate partners

1. Collaborations

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

To accomplish the specified activities, TB COE should collaborate with the following partners:

All CDC-funded state and local TB programs including the Pacific Islands (PIs) (https ://www.cdc.gov/tb/links/tboffices.htm)

National TB Controllers Association (NTCA) and regional TB controller associations (http://www.tbcontrollers.org/)

TB education and training focal points and other TB Education and Training Network (TB ETN) and TB Program Evaluation Network (TB PEN) members (https://www.cdc .gov/tb/education/tbetn/default.htm)

U.S. panel physicians and civil surgeons, as guided by CDC (https://www.cdc.gov/panel physicians/index.html)

b. With organizations not funded by CDC:

This FOA does not require the submission of a Memorandum Of Understanding (MOU), Memorandum Of Agreement (MOA), or letters of support; however it is expected the awardees have the capacity to work with state and local health hepartment programs.

In addition, the awardees are expected to work with other relevant organizations and/or agencies as indicated to achieve the long-term outcomes indicated in the logic model outlined in this FOA, such as:

Private providers serving high-risk populations Federal Training Center Collaborative (FTCC), which currently includes the STD/HIV

Prevention and Training Centers; Viral Hepatitis Education and Training Center; Health Resources and Services Administration primary care centers; AIDS Education and Training Centers; Substance Abuse and Mental Health Services Administration; and the Addiction Technology Transfer Centers (http://nnptc.org/ftcc/)

Academic institutions (e.g., medical and nursing schools and related teaching hospitals, public health schools, and associations)

Additional partners may include: correctional agencies, Indian Health Service (IHS), Immigration and Customs Enforcement (ICE), Community Based Organizations (CBOs), Federally Qualified Health Centers (FQHCs), and other groups involved with https://www.cdc.gov/tb/links/tboffices.htm https://www.cdc.gov/tb/links/tboffices.htm http://www.tbcontrollers.org/ https://www.cdc.gov/tb/education/tbetn/default.htm https://www.cdc.gov/tb/education/tbetn/default.htm https://www.cdc.gov/panelphysicians/index.html https://www.cdc.gov/panelphysicians/index.html http://nnptc.org/ftcc/

TB control within the geographic catchment area

2. Target Populations The applicant should identify and define health care providers and others involved in TB control and patient care to target their funded TB center activities.

a. Health Disparities TB disproportionately affects persons based on race/ethnicity and country of orgin, as well as persons who have limited access to health care and services. Health disparities in HIV, viral hepatitis, STDs, and TB are inextricably linked to a complex blend of social determinants that influence populations that are most severely affected by these diseases. TB mission-driven priority areas are meant to address such disparities. Roadmaps from CDC, NCHHSTP, and DTBE guide CDC's strategic efforts and/or interventions to address such health disparities by collecting core Social Determinants of Health (SDH) data, Healthy People 2020, the National Prevention Strategy, and the HHS Action Plan to reduce and eliminate health disparities by enhancing collaboration and coordination of health disparities activities.

There is a need for the applicant to ensure that any workgroups, boards, or formation of other groups relative to this project be free of any discrimination based on race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, health literacy, and other relevant dimensions.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy The evaluation and performance measurement strategy will be used to assess the performance of the overall project and each center individually. Further details on program evaluation activities are described below. Data collected are used for center monitoring, evaluation, and improvement. Awardees will collect the required data and submit to CDC.

TB Knowledge, Skills, and Abilities: Communication, Education, and Training

Strategy 1: Develop TB and LTBI education and training courses and materials for state and local health departments, private providers, and other TB control partners based on need

Following are examples of process measures that awardees should accomplish annually.

These specific process measures are subject to change based on funding, number of awardees, and identified needs.

o Conduct a regional needs assessment to identify TB education and training needs o Deliver a minimum of 400 hours of training per year with at least 40% of in-person training o Educate and train a minimum of 400 participants in-person per year o Educate and train a minimum of 2,000 persons using distance-based learning or other innovative technology per year o Provide a minimum of 6 mini-fellowships/reverse mini-fellowships (i.e., individualized training experiences) per year o Participate in 6 TB Medical Expert Network Meetings and host one TB Medical Expert Network Meeting annually

Strategy 2: Develop TB and LTBI communication, education, and training products that are technically accurate and appropriate for target audiences based on needs o Conduct a regional needs assessment to identify TB educational product needs o Develop and implement a communication plan to reach target audiences o Develop materials based on need and CDC approval using a systematic health education process o Provide information on distribution of educational products per year

Strategy 3: Provide technical assistance to health departments and other TB control partners to develop their own TB and LTBI training activities o Provide a minimum of 100 instances of technical assistance per year.

Expert Medical Consultation

Strategy 1: Provide medical consultation services for TB disease and LTBI o Establish a network of regional TB medical experts o Develop a strategy to promote medical consultation within the region to public and private providers Strategy 2: Provide longitudinal (ongoing) medical consultation as requested by providers for complex clinical cases o Develop capacity to support ongoing medical consultation for providers in need of this service Strategy 3: Collect, analyze, and share medical consultation data with appropriate partners o Use a national medical consultation database (MCD) to describe and quantify consultations o Provide CDC and TB programs with description and number of consults

TB Knowledge, Skills, and Abilities: Communication, Education, and Training

Strategies: (1) Develop TB and LTBI education and training courses and materials for state and local health departments, private providers, and other TB control partners based on need; (2) Develop TB and LTBI communication, education, and training products that are technically accurate and appropriate for target audiences based on needs; (3) Provide technical assistance to health departments and other TB control partners to develop their own TB and

Outcomes: (1) Increased number of educated and trained TB health care workers; (2) Increased access to and use of TB educational resources

Measures:

o Deliver a minimum of 400 hours of training per year with at least 40% of in-person training o Educate and train a minimum of 400 participants in-person per year o Educate and train a minimum of 2,000 persons using distance-based learning or other innovative technology per year o Provide a minimum of 6 mini-fellowships/reverse mini-fellowships (i.e., individualized training experiences) per year o Participate in 6 TB Medical Expert Network Meetings and host one TB Medical

Expert Network Meeting annually o Provide information on distribution of educational products per year o Provide a minimum of 100 instances of technical assistance per year o Provide information on numbers of partners on email distribution lists and website visits

Expert Medical Consultation

Strategies: (1) Provide medical consultation services for TB disease and LTBI; (2) Provide longitudinal (ongoing) medical consultation as requested by providers for complex clinical cases; (3) Collect, analyze, and share medical consultation data with appropriate partners

Outcomes: Identification of national trends of TB patient care needs Measures:

o Provide CDC and TB programs with description and number of consults using a national medical consultation database (MCD)

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

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

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

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans.

For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they https://www.cdc.gov/grants/additionalrequirements/ar-25.html should be directed to:

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

Describe key evaluation questions to be addressed by these evaluations.

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

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

c. Organizational Capacity of Recipients to Implement the Approach The applicant should demonstrate experience to carry out the work described by employing the strategies and activities outlined in this funding opportunity announcement. Specifically, the applicant must have documented experience working on issues pertaining to TB prevention and control, working with TB programs, working with private health care providers, and providing medical management of TB patients. The applicant should have experience in planning, implementing, and evaluating projects. The applicant should also have experience in delivering in-person and web-based training courses, as well as developing educational resources in a variety of formats. The applicant should also provide a description of available facilities, equipment, and technologies for developing and delivering training and education activities.

The applicant should also provide a description of availability and experience in using various social media platforms to engage and reach various target audiences.

The applicant should describe a project staffing plan composed of a Principal Investigator, Executive Director, Director of Medical Consultation, and a Director of Education and Training. With the exception of the Principal Investigator, these positions are unique and as such individuals assigned to these positions cannot serve in dual roles. The Executive Director should have programmatic and fiscal management skills. The Director of Medical Consultation should have experience in diagnosing and treating TB and multidrug-resistant TB. The Director of Education and Training should have knowledge and skills in developing partnerships, trainings, and educational initiatives. The applicant's staffing plan should also include persons with TB nursing experience, as well as those who can develop and deliver trainings in a variety of formats.

The applicant should submit CVs for the Principal Investigator, Executive Director, Director of Medical Consultation, and Director of Education and Training as part of the application for this FOA. The files should be named Resumes/CVs and uploaded at www.grants.gov.

d. Work Plan The applicant should provide a detailed work plan to achieve the following strategies and activities.

TB Knowledge, Skills, and Abilities: Communication, Education, and Training To accomplish this activity, the TB COE should work with local, state, and regional http://www.grants.gov/ representatives from TB programs, including the TB education and training focal points and other TB ETN and TB PEN members. Other partners include, but are not limited to: private providers; medical/nursing schools and related teaching hospitals; public health schools and associations; regional TB controller associations; TB advisory councils; corrections agencies and staff, U.S. panel physicians and civil surgeons (as guided by CDC); members of the FTCC which currently includes the STD/HIV Prevention and Training Centers; Viral Hepatitis Education and Training Center; Health Resources and Services Administration primary care centers; AIDS Education and Training Centers; Substance Abuse and Mental Health Services Administration; and Addiction Technology Transfer Centers; Indian Health Service, Immigration and Customs Enforcement, Community Based Organizations, and Federally Qualified Health Centers.

The applicant should provide a detailed description of their plan to engage the above partners to achieve the following strategies. The description should include a communication plan using social media or other methods to deliver information on TB and LTBI.

Strategy 1: Develop TB and LTBI education and training courses and materials for state and local health departments, private providers, and other TB control partners based on need o Foster and enhance relationships with state and local public health agencies and other TB control partners o Conduct a regional needs assessment to identify TB education and training needs. Work with state and local public health agencies to identify training needs of public health workers, private providers, and other TB control partners o Develop and deliver competency-based education and training courses regarding TB and LTBI o Collaborate with state and local health agencies to develop methods for evaluating the effectiveness of the education and training activities o Provide core courses and sessions based on standardized course objectives developed in collaboration with CDC and other TB COE. These courses and sessions should include, but are not limited to, the topics of TB and LTBI clinical diagnosis and treatment, program management training, supervisor training, contact investigations, case management, TB laboratory information for non-laboratory personnel, and program evaluation o Develop specialty courses, in addition to the core courses, that are unique to the needs of the region served or the area of expertise of the TB COE o Ensure that both core and specialty courses are developed in consultation with CDC and are derived from recommendations and needs assessments from multiple sources, including: 1) CDC identified needs and priorities; 2) local and regional needs assessments; and 3) new and existing national guidelines o Monitor and evaluate training courses and document the results in annual reports. Evaluation should include measuring appropriate process indicators (e.g., trainee demographics, quality of training), immediate training outcomes (e.g., changes in knowledge, attitudes, and skills) and where possible, long-range impact (e.g., changes in provider practice behavior, changes in service delivery).

Evaluation data should be used to help improves courses o Provide a minimum of six mini-fellowships per year. The mini-fellowship is an individually tailored experience to provide participants with an opportunity to learn about TB clinical management or the role of public health and other agencies in carrying out TB control activities o Participate in six TB Medical Expert Network Meetings and host one TB Medical Expert Network Meeting annually o Award continuing education, including, but not limited to, Continuing Medical Education (CME), Continuing Nursing Education (CNE), Continuing Education Units (CEU), and Continuing Health Education Credits (CHES), when possible and appropriate for training courses

Strategy 2: Develop TB and LTBI communication, education, and training products that are technically accurate and appropriate for target audiences based on needs o Conduct a regional needs assessment to identify TB educational product needs.

Additional topics and audiences for products should be based on guidance of

CDC

o Develop and implement a communication plan to reach target audiences o Submit product proposals to CDC for approval prior to developing educational materials o Develop high quality TB and LTBI educational materials through the use of the systematic health education process (steps of the process include: needs assessment, development, field-testing, implementation, and assessing effectiveness) o Create materials in multiple formats (e.g., print and electronic formats) to meet the varied needs of the intended target audiences o Use innovative technologies to develop products to reach a variety of audiences o Develop a marketing and distribution plan for all products. TB COE should assume responsibility for initial production, marketing, and distribution of products. Products that are appropriate for national audiences should be distributed nationally. TB COE may submit products needed in larger quantities through the CDC DTBE clearance process. If approved, CDC will consider being responsible for printing and distribution of these materials.

o Award continuing education, including but not limited to, CME, CNE, CEU, and CHES, when possible and appropriate for educational products o Note: Materials developed by the TB COE must be in the public domain and cannot be copyrighted. Furthermore, CDC reserves the right to review and make changes to materials or products produced by the TB COE.

Strategy 3: Provide technical assistance to health departments and other TB control partners to develop their own TB and LTBI training activities o Provide a minimum of 100 instances of technical assistance per year o Develop the training capacity of state and local TB programs and assist the TB program’s TB Education and Training Focal Points with HRD activities.

Technical assistance can be provided via telephone, e-mail, written consultation, or in person. Technical assistance can also be provided onsite for less experienced training coordinators or where greater needs and fewer resources are available. The TB COE will provide technical assistance, but will not be the principal organizer of training activities. As such, the TB COEs will be responsible for providing facilitator-led training and materials for use by these programs, as well as the provision of technical assistance on how to utilize and fully implement these materials to build capacity within the TB programs.

Expert Medical Consultation The second major activity of the TB COE is to provide medical consultation through a real-time consultation process within their assigned region. TB COE will provide physician and nurse consultation for appropriate screening, evaluation, diagnosis, management, and treatment of TB patients and persons with suspected TB disease and LTBI as well as address questions on any other TB-related topics raised by health practitioners. TB COE should also endeavor to build the capacity of state and local programs to provide medical consultation services for local providers.

Strategy 1: Provide medical consultation services for TB disease and LTBI o Conduct a needs assessment in the assigned region for current and future needs regarding consultation related to the medical evaluation and management of persons with TB disease and LTBI o Develop a strategy to promote medical consultation to public and private providers within the region o Establish a network of regional TB medical experts o Provide real-time medical consultation, in assigned region, to physicians and other providers on the diagnosis and treatment of active TB disease, including multidrug resistant (MDR) TB and extensively drug resistant (XDR) TB.

Consultation should also be provided on the diagnosis and treatment of LTBI, including persons presumed to be infected with drug resistant strains of Mycobacterium tuberculosis o Ensure medical consultations are informed by the most up-to-date practices and guidelines and apply standard-of-care medical consultation practices o Implement a plan to support and build capacity of local providers to care for both routine and complex TB patients from beginning to completion of TB treatment, as well as appropriately evaluate and medically manage persons with LTBI o Develop a strategy, in collaboration with CDC, to adequately provide medical consultations to panel physicians (physicians overseas who perform medical screening for applicants for U.S. immigration) and share the volume and processing of these in-coming calls among the TB COE o Provide medical consultations to panel physicians on the diagnosis and treatment of active TB disease, including MDR and XDR TB cases

Strategy 2: Provide longitudinal medical consultation as requested by providers for complex clinical cases o Develop a strategy to promote ongoing medical consultation for providers in need of this service o Provide structured, longitudinal (ongoing) medical consultation for clinical cases and contacts (e.g. drug-resistant TB disease) or in other specific circumstances as requested by state and local TB programs o Develop a plan to work with state programs and CDC as requested to identify inpatient TB treatment facilities for complex TB patients

Strategy 3: Collect, analyze, and share medical consultation data with appropriate partners o Use a national Medical Consultation Database (MCD) to describe and quantify consultations in collaboration with CDC and other TB COE o Provide CDC and TB programs with description and number of cases consulted upon o Use the MCD to generate MCD reports for stakeholders and CDC o Use the MCD to define local and national medical consultation needs and identify gaps in training/education o Evaluate the effectiveness of the medical consultation service and document the results of the evaluation in the annual reports

To achieve the above strategies, the TB COE should have a plan to engage and collaborate with CDC and other TB partners as follows:

Engage and communicate frequently with regional stakeholders through a variety of methods (e.g., e-mail, newsletters, webinars, phone, in-person meetings)

Form a Regional Advisory Group to provide guidance to the TB COE on annual work plans. The group should meet three to four times annually (in-person or by conference call) and should consist of 10-15 members of which the majority of the members should represent TB Control Programs. The Advisory Group should reflect diversity in professional discipline (e.g., TB controllers, program managers, nurse consultants, medical consultants, or TB education and training focal points), geography, and TB program morbidity

Develop and maintain a website that is Section 508 compliant. The website should contain, at minimum, a list of courses and materials offered by the TB COE, as well as ordering information for education and training materials and products. In addition, electronic versions of products developed by the TB COE should also be posted on the website. The following Section 508 website provides comprehensive information: www.section508.gov

Attend and actively participate at the TB ETN, TB PEN, TB Education and Training Focal Point Meeting, the National TB Conference (NTC), and FTCC conferences and workgroups

Participate in monthly conference calls with CDC and other TB COE, annual meetings, and ongoing consultations. Annual meetings with CDC include: site visits, the round robin (annual meeting with CDC and all TB COE), meetings held in conjunction with the NTC, the TB ETN/PEN conference, and any other meetings or conferences CDC determines to be necessary. These meetings should be attended by the Principal Investigator, Executive Director, Director of Education, and Director of Medical Consultation of each TB COE. TB COEs should communicate directly with the designated CDC TB COE team as the CDC’s main point of contact and keep the CDC team apprised of all activities.

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

Consistent with applicable grants regulations and policies, CDC expects the following to be http://www.section508.gov included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

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

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

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

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

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

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

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

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

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

COOPERATIVE AGREEMENTS)

CDC/DTBE will ensure the committment of a project officer, a technical advisor for training and education activities, and a technical advisor for medical consultation. Other CDC staff with subject matter expertise will be available to assist in the planning, implementation, and evaluation of this project. CDC will participate on regularly scheduled calls initiated by the awardee that are relative to this project. CDC/DTBE may share project findings, evaluation results, lessons learned, and best practices with the awardee.

B. Award Information

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

2. Award Mechanism: U52

3. Fiscal Year: 2018

4. Approximate Total Fiscal Year Funding: $5,338,040

5. Approximate Project Period Funding: $26,690,200

This amount is subject to the availability of funds.

Estimated Total Funding: $26,690,200

6. Total Project Period Length: 5 year(s)

7. Expected Number of Awards: 5

8. Approximate Average Award: $1,334,510 Per Budget Period

9. Award Ceiling: $0 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor: $0 Per Budget Period

11. Estimated Award Date: 12/04/2017

12. Budget Period Length: 12 month(s)

Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Direct Assistance Direct Assistance (DA) is not available through this FOA.

C. Eligibility Information

1. Eligible Applicants Eligibility Category: Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"

Additional Eligibility Category:

2. Additional Information on Eligibility

3. Justification for Less than Maximum Competition

4. Cost Sharing or Matching Cost Sharing / Matching Requirement: No

5. Maintenance of Effort

Maintenance of effort is not required for this specific program.

D. Application and Submission Information

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System:

All applicant organizations must obtain a Data Universal Numbering System (DUNS) number.

A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/ webform/ displayHomePage.do. The DUNS number will be provided at no charge.

If funds are awarded to an applicant organization that includes sub-recipients, those sub-recipients must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as a recipient. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov.

c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site. Registration information is located at the “Get Registered” option at www.grants.gov.

All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible.

Step System Requirements Duration Follow Up 1 Data

Universal Number System

(DUNS)

1. Click on http:// fedgov.dnb.com/ webform

2. Select Begin DUNS search/request process

3. Select your country or territory and follow the instructions to obtain your

1-2 Business Days

To confirm that you have been issued a new DUNS number check online at (http:// fedgov.dnb.com/ https://www.grants.gov/ http://fedgov.dnb.com/webform/displayHomePage.do https://www.sam.gov/portal/public/SAM/ https://grants.gov/ https://www.grants.gov/ https://www.grants.gov/ https://www.grants.gov/ http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform

DUNS 9-digit #

4. Request appropriate staff member(s) to obtain DUNS number, verify & update information under DUNS number webform) or call 1-866-705-5711

2 System for Award Management

(SAM)

formerly Central Contractor Registration

(CCR)

1. Retrieve organizations DUNS number

2. Go to www.sam.gov and designate an E-Biz POC (note CCR username will not work in SAM and you will need to have an active SAM account before you can register on grants.gov)

3-5 Business Days but up to 2 weeks and must be renewed once a year

For SAM Customer Service Contact https://fsd.gov/ fsd-gov/ home.do Calls:

866-606-8220

3 Grants.gov 1. Set up an individual account in Grants.gov using organization new DUNS number to become an authorized organization representative (AOR)

2. Once the account is set up the E-BIZ POC will be notified via email

3. Log into grants.gov using the password the E- BIZ POC received and create new password

4. This authorizes the AOR to submit applications on behalf of the organization

Same day but can take 8 weeks to be fully registered and approved in the system (note, applicants

MUST

obtain a

DUNS

number and

SAM

account before applying on grants.gov)

Register early!

Log into grants.gov and check AOR status until it shows you have been approved

2. Request Application Package Applicants may access the application package at www.grants.gov.

3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this notice of funding opportunity at www.grants.gov. If Internet access is not available, or if the online forms cannot be accessed, applicants may call the CDC OGS staff at 770-488- 2700 or e-mail OGS ogstims@cdc.gov for assistance. Persons with hearing loss may access CDC telecommunications at TTY 1-888-232-6348.

http://fedgov.dnb.com/webform http://www.sam.gov https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://www.grants.gov mailto:ogstims@cdc.gov

4. Submission Dates and Times If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by

OGS.

a. Letter of Intent Deadline (must be emailed or postmarked by) Due Date for Letter of Intent: N/A

b. Application Deadline Due Date for Applications: 09/25/2017 , 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume.

Date for Information Conference Call

The date for the information conference call is set for 08/08/2017 from 2:00- 3:00 p.m. EST.

The call in information is 1.866.806.8575; passcode is 4862475.

5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa)) /Homepage.aspx.

Applicants may follow either of the following processes:

Complete the applicable assurances and certifications with each application submission, name the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov

Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa))/ Homepage.aspx

Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply to all applications submitted to CDC by the applicant within one year of the submission date.

Duplication of Efforts Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (i.e. grant, cooperative agreement, or contract) submitted to another funding source in the same fiscal year.

Programmatic overlap occurs when (1) substantially the same project is proposed in more than https://www.grants.gov http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx https://www.grants.gov http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx one application or is submitted to two or more funding sources for review and funding consideration or (2) a specific objective and the project design for accomplishing the objective are the same or closely related in two or more applications or awards, regardless of the funding source. Budgetary overlap occurs when duplicate or equivalent budgetary items (e.g., equipment, salaries) are requested in an application but already are provided by another source.

Commitment overlap occurs when an individual’s time commitment exceeds 100 percent, whether or not salary support is requested in the application. Overlap, whether programmatic, budgetary, or commitment of an individual’s effort greater than 100 percent, is not permitted.

Any overlap will be resolved by the CDC with the applicant and the PD/PI prior to award.

Report Submission: The applicant must upload the report in Grants.gov under “Other Attachment Forms.” The document should be labeled: "Report on Programmatic, Budgetary, and Commitment Overlap.”

6. Content and Form of Application Submission Applicants are required to include all of the following documents with their application package at www.grants.gov.

7. Letter of Intent A Letter of Intent (LOI) is not requested or required as…