Eswatini CDC-RFA-JG-25-0073 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due March 5, 2025

Strengthening the technical capacity of the Ministry of Health to deliver a sustainable and resilient response to HIV/TB and related public health threats in the Kingdom of Eswatini under PEPFAR Opportunity number: CDC-RFA-JG-25-0073

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 31

Get registered 32

Questions 33

Step 3: Prepare Your Application 34

Application contents and format 35

Step 4: Learn About Review and Award 45

Application review 46

Award notices 53

Step 5: Submit Your Application 54

Application submission and deadlines 55

Application checklist 57

Step 6: Learn What Happens After Award 59

Post-award requirements and administration 60

Contacts and Support 67

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 March 5, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

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

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information U.S. Centers for Disease Control and Prevention

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Strengthening the technical capacity of the Ministry of Health to deliver a sustainable and resilient response to HIV/ TB and related public health threats in the Kingdom of Eswatini under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0073

Announcement type:

New

Assistance listing:

93.067 Global AIDS;

93.494 Global

Tuberculosis

Key dates

Application deadline:

March 5, 2025

Expected award and start date:

September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary We expect you to provide technical assistance to the Eswatini Ministry of Health (MOH) national and regional structures to strengthen programmatic leadership and oversight capacities toward ending HIV as a public health threat in Eswatini by 2030. The technical assistance you provide should systematically increase MOH ownership, accountability, and capacity to provide quality services to maintain gains made in the HIV response and accelerate progress to close remaining gaps.

You will be expected to support the MOH to:

• Conduct strategic planning and develop policies, guidelines, and implementation plans.

• Strengthen health workforce capacity through development and implementation of innovative training, data-driven clinical mentorship, and continuous quality improvement (CQI) approaches, tools, and processes.

• Introduce evidence-based interventions.

• Foster innovation.

• Coordinate activities.

• Provide oversight and performance monitoring of HIV/TB and related programs.

Additionally, you will be expected to strengthen organizational, financial, and technical capacity of select local entities. Emphasis should be placed on designing interventions that can be integrated into routine health delivery platforms, used across program areas, and eventually sustained through domestic funding.

Step 1: Review the Opportunity 5

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $3,500,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1-2 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

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

Funding strategy

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

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Step 1: Review the Opportunity 6

Setting up components

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

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

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

◦ Component 1: COP Q1 Targets and Activities.

◦ Component 2: COP Q2 Targets and Activities.

◦ Component 3: COP Q3 Targets and Activities.

◦ Component 4: COP Q4 Targets and Activities.

◦ Component 5: Global TB Activities.

◦ Component 6: Central Initiative Funds (buffer component if needed).

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

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR Local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 20 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

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

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

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

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work With a population of 1.2 million, the Kingdom of Eswatini is one of the countries most heavily impacted by the HIV epidemic. Nearly a one in four adults aged 15 years and older are living with HIV. The latest national population-based HIV impact assessment, SHIMS3 2021, demonstrated significant progress towards the ambitious UNAIDS 95-95-95 targets ahead of the global 2025 benchmark. Of people aged 15 years and older living with

HIV:

• 94% are aware of their HIV status.

• 97% of those aware of their HIV status are on antiretroviral therapy (ART).

• 96% of those on ART are virally suppressed.

At a population level, viral suppression has surpassed the UNAIDS target of 86% for both men and women. Furthermore, mother-to-child transmission of HIV has dropped from 6.3% in 2017 to 1.2% in 2022.

Great progress has been made. But to avoid significant consequences in the future, these gains must be sustained and remaining gaps for all populations must be closed. Significant gaps in HIV case-finding persist among:

• Young women ages 15 to 24 years.

• Men ages 25 to 34 years.

• Children under 15

• The military.

• Key populations.

Many men ages 25 to 34 years are not linked to or consistently receiving ART.

Children on ART are yet to reach 95% viral suppression (except those aged 5 to 9).

Women are disproportionately affected. Among people ages 25 to 29, HIV prevalence is more than five times higher among women compared to men.

More than half of women aged 35 to 49 are living with HIV.

Though the rate of new HIV infections has dropped by nearly half between 2016 and 2021, approximately 4,000 individuals aged 15 above are newly infected with HIV annually. Incidence remains higher among women at 1.11%, a rate nearly seven times that of 0.17% for men. Young women aged 15-19 are particularly vulnerable. As demonstrated by the 2022 Eswatini Violence

Step 1: Review the Opportunity 10

Against Children Survey, gender-based violence persists as a risk factor for new infections. One in 12 females aged 13 to 24 reporting having experienced sexual violence at least once in their lifetime.

HIV-related deaths have also reduced, from about 10,000 in 2005 to 3,100 in 2022. However, with an aging population of people living with HIV, co-infections, and co-morbidities such as TB, cervical cancer, and non-communicable diseases (NCDs) must be addressed to further reduce morbidity and mortality.

These successes have been achieved with extensive investments from PEPFAR and other donors. Currently, PEPFAR supports service delivery at the site level through two comprehensive clinical implementing partners, each covering two regions. Support consists of staff, equipment, and supplies, as well as intensive clinical mentorship conducted by roving teams of technical experts. Mentorship teams:

• Provide on-site trainings.

• Support CQI activities.

• Facilitate the introduction of new products, such as HIV self-tests.

• Assist with implementation of new processes such as service integration.

• Reinforce routine data use and reporting.

• Strengthen the lab-clinical interface.

• Troubleshoot areas of underperformance.

At the regional level, these implementing partners collaborate with the Regional Health Management Teams to strengthen supportive supervision, coordinate regional program reviews, redistribute commodities to mitigate stock ruptures, and facilitate referrals and linkages. At the national level, they provide technical support to the Eswatini National AIDS, TB Control Program, Cancer Control, and Quality Management Program, among others.

To achieve 2030 global HIV targets, focus remains on maintaining viral suppression, decreasing mortality among people living with HIV, and reducing incident infections (particularly among adolescent girls and young women).

In the context of transforming from an emergency response to a sustainable approach within a budget-constrained environment, the Eswatini MOH intends to take on service delivery, mentorship, CQI, and program monitoring activities that have been historically conducted by implementing partners.

This shift will require an evolution of interventions toward simplicity, efficiency, and alignment with government processes.

Step 1: Review the Opportunity 11

If awarded, you will provide technical assistance to the MOH to strengthen, design, and implement a training and mentorship approach to sustain the gains attained in bringing Eswatini within reach of ending HIV as a public health threat. You will assist in:

• Updating program strategies and guidelines.

• Institutionalizing the use of virtual platforms.

• Developing processes to introduce new interventions and address identified gaps.

• Establishing partnerships with local training institutions and professional organizations.

• Strengthening MOH capacity to provide quality management, oversight, and performance monitoring of HIV/TB and related programs at regional and national levels.

Finally, you may work with other local health service delivery entities to strengthen organizational, financial, and technical capacity for HIV/TB and related program implementation and monitoring in alignment with MOH guidance.

Purpose The purpose of this NOFO is to enhance the technical capacity of the MOH and other local entities to effectively respond to HIV/TB and related public health threats in the Kingdom of Eswatini. The overall goal is to incrementally increase MOH ownership, accountability, and capacity to coordinate and monitor performance of service provision. This will be achieved by focusing on enhancing the skills, knowledge, and technical resources necessary for effective planning, implementation, monitoring, quality management, and improvement of integrated HIV/TB and other related public health programs.

Step 1: Review the Opportunity 12

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

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

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

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

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1: Support MOH on strategic planning and development of policies, guidelines, and implementation plans.

Strategy 2: Support MOH to strengthen health workforce capacity through development and implementation of innovative training, data-driven mentorship, and CQI approaches, tools, and processes.

Strategy 3:

Strengthen MOH capacity to provide oversight and performance

Improved MOH competencies to efficiently develop, implement, and oversee compliance to policies, strategies, and guidelines.*

Increased availability and use of virtual platforms and in-person capacity building approaches to strengthen health workforce collaboration and service provision.*

Increased availability and use of virtual platforms for patient engagement and service delivery.*

Improved MOH structures for governance, management, and practices to lead the HIV/TB response at all levels efficiently and effectively.

Improved health workforce technical expertise to deliver high-quality, equitable, and integrated HIV/TB/ NCD health services.*

Improved program performance through regular program monitoring reviews using data-driven, standardized processes.*

Improved MOH ownership and accountability of HIV/ TB response implementation.*

Improved MOH capacity to drive programmatic, political, and system transformations to build pathways to sustainability.*

Improved resilience of community-based entities with increased capacity for diversified and sustained financial resource generation.*

Step 1: Review the Opportunity 13

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes monitoring of HIV/TB and related programs.

Strategy 4:

Strengthen organizational, financial, and technical capacity of local health service delivery entities.

Improved competencies and technical expertise of health workforce to lead and implement evidence-based HIV/ TB programming and conduct CQI activities.*

Improved MOH capacity to conduct routine supportive supervision, oversee program performance, and provide effective mentorship.*

Improved MOH political leadership in planning and implementing a sustainable national HIV response roadmap.*

Improved technical capacity of community-based local entities to manage and deliver high-quality HIV/TB services.*

Improved financial and management capacity and practices of community-based entities to manage grants, diversify income, and increase access to new funding opportunities.*

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

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

Step 1: Review the Opportunity 14

Strategy 1: Support MOH on strategic planning and development of policies, guidelines, and implementation plans.

Required activities

• Provide technical support for MOH leadership to implement the sustainability roadmap in collaboration with other stakeholders.

• Support developing and implementing a government-led mentorship framework to guide technical oversight of HIV/TB and related health services.

• Support updating and developing national guidelines/policies and other strategic documents as required across the whole HIV/TB prevention, care, and treatment cascade and related health services.

• Support the development of a strategy/framework and implementation plan for integrating voluntary medical male circumcision (VMMC) into routine services.

• Support developing patient and health workforce-related education materials addressing HIV/TB program gaps.

• Support the development, adoption, and/or execution of health statutes, regulations, and policies, including those related to emerging and or innovative service delivery approaches and technologies. This includes TB case-finding strategies and broader access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

Strategy 2: Support MOH to strengthen health workforce capacity through development and implementation of innovative training, data-driven mentorship, and CQI approaches, tools, and processes.

Required activities

• Help MOH to build capacity of national programs and Regional Health Management Teams to provide technical leadership for the HIV/TB response.

• Support development of tools, standard operating procedures (SOPs), and standards to guide the implementation of a government-led and owned mentorship program.

• Provide training and mentorship for service delivery mentors on the new MOH mentorship frameworks and tools.

Step 1: Review the Opportunity 15

• Support MOH to establish and standardize the use of digital platforms:

◦ To strengthen virtual learning and simplify service delivery for the health workforce.

◦ For recipients of care to directly interface with their medical records to enhance ownership of their health.

• Support MOH to develop streamlined systems for integrated chronic disease management using insights from HIV/TB programming.

• Support the MOH Quality Management Program to review and revise the existing quality management frameworks to ensure they remain relevant to the current program needs.

• Support MOH to develop tools and SOPs for CQI interventions to improve HIV/TB/NCD and related health service delivery.

• Provide training for the health workforce on implementation of the national quality management/CQI framework.

• Support in-service and pre-service curricula content development, updates, and integration in collaboration with MOH HIV/TB/NCD clinical programs and in-service and pre-service training institutes.

• Collaborate with health professional councils/boards to ensure that HIV/ TB and related content is included in continuous professional development.

• Provide technical assistance to the MOH to implement the VMMC integration strategy/framework, including supporting the development and maintenance of health worker knowledge and skills necessary for competent, safe, and quality assured service delivery.

• Provide technical assistance to the MOH to implement emerging and or innovative service delivery approaches and technologies such as TB case-finding strategies and broader access to PrEP and PEP.

Strategy 3: Strengthen MOH capacity to provide oversight and performance monitoring of HIV/TB and related programs.

Required activities

• Provide technical and subject matter expertise support for service delivery across the HIV/TB/NCD prevention, care, and treatment continuum.

• Support MOH to develop and improve program monitoring tools and processes.

Step 1: Review the Opportunity 16

• Support MOH to conduct routine program reviews to enhance use of data for patient management, program planning, CQI, and decision-making at all levels.

• Provide technical support to MOH to develop standardized processes for supportive supervision, quality monitoring, and CQI by programs.

Strategy 4: Strengthen organizational, financial, and technical capacity of local health service delivery entities.

Required activities

• Develop and/or adapt and implement organizational, financial, and technical capacity-building models and frameworks for local health service delivery entities to improve their ability to sustainably provide quality HIV/TB and related services. These entities may include:

◦ Non-governmental organizations (NGOs).

◦ Faith-based organizations (FBOs).

◦ Community-based organizations (CBOs).

◦ Police.

◦ Correctional services.

• Support the adaptation and implementation of the standardized government-led mentorship program, ensuring that minimum national standards of HIV/TB and related service quality are met.

• Support routine program reviews to enhance data use for patient management, program planning, CQI, and decision-making.

• Provide ongoing technical backstopping for program implementation and service delivery approaches.

• Support use of digital platforms to strengthen virtual learning and service quality for the health workforce.

• Conduct capacity maturity evaluation to assess the changes in capacity and sustainability of CBOs/FBOs over the project period.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Step 1: Review the Opportunity 17

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

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

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

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

Step 1: Review the Opportunity 18 https://www.state.gov/reports-pepfar/

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations Focus populations for this NOFO include:

• The general population, including people living with and affected by HIV/ TB who are impacted by infectious and non-infectious threats in the Kingdom of Eswatini.

• National program managers.

• National program officers and technical leads.

• Regional Health Management Teams.

• MOH mentors and supervisors.

• MOH senior management team.

• Leadership and technical staff of local entities that deliver HIV/TB services such as NGOs, CBOs, FBOs, police, and correctional services.

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

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

Step 1: Review the Opportunity 19 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

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.

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

Step 1: Review the Opportunity 20 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Collaborations If funded, we will expect you to collaborate with:

• MOH and relevant departments.

• Other Government of the Kingdom of Eswatini line ministries and parastatals, including but not limited to:

◦ Ministry of Education and Training.

◦ Deputy Prime Minister’s Office.

◦ Ministry of Sports, Culture and Youth Affairs.

◦ Ministry of Tinkhundla and Administration.

◦ Ministry of Information.

◦ Communication, and Technology.

◦ National Emergency Response Council for HIV and AIDS (NERCHA).

• United States Government (USG) agencies, CDC and other PEPFAR-supported implementing partners.

• Multilateral institutions including WHO, UNICEF, UNAIDS, and Global Fund.

• Training, academic, and other research-based institutions.

• Relevant professional organizations and institutions (for example, Medical and Dental Council, Nursing Council).

• Local entities that deliver HIV/TB services such as NGOs, CBOs, FBOs, police and correctional services.

• Other implementing partners as identified based on evolving landscape and priorities.

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

Step 1: Review the Opportunity 21

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

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

In your application budget, you should allocate at least 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 5-year project.

Required performance measures

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

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

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

These include process and outcome measures that directly correlate with the logic model.

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

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

Step 1: Review the Opportunity 22 https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

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

• Percentage of eligible health facilities providing HIV services receiving mentorship support using the MOH mentorship framework. [Target: 95%;

Reporting Frequency: Annual]

• Number of SOPs and tools for program performance, monitoring, management, and quality management developed and implemented.

[Target: 10; Reporting Frequency: Annual]

• Percentage of targeted healthcare workers trained in clinical guidelines, mentorship framework, quality improvement and integrated chronic disease management, disaggregated by training approach (onsite, offsite, and virtual platforms). [Target: 90%; Reporting Frequency: Quarterly]

• Percentage of supported health facilities with quality improvement projects that met expected improvement benchmarks for targeted program processes/outcomes. [Target: 80%; Reporting Frequency:

Annual]

• Percentage of designated health facilities implementing new MOH guidelines on the use of computer-aided diagnosis (CAD). [Target 80%;

Reporting Frequency: Semi-Annual]

• Number of local organizations supported that have met performance benchmarks for capacity building maturation indices. [Target: 4;

Reporting Frequency: Annual]

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress reports, surveillance and survey reports, and other program monitoring tools.

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term evaluation.

• The extent to which the TA provided improved processes for program oversight, monitoring and guideline development and implementation:

process evaluation.

Step 1: Review the Opportunity 23

• The extent to which the support provided to the Ministry of Health effectively strengthened the health workforce capacity in developing and implementing innovative training, data-driven mentorship, and CQI approaches, tools, and processes: outcome evaluation.

• The extent to which the technical support built the capacity of local entities in program design, implementation, monitoring, and support as well as financial stewardship where appropriate: outcome evaluation.

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

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

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If

Step 1: Review the Opportunity 24 awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

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

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

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

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

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

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

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

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

Evaluation activities You must carry out specific evaluation activities.

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

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

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

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

Step 1: Review the Opportunity 25

Describe:

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

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

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

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

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

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

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

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

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

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

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

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

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

Step 1: Review the Opportunity 26 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

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

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

*Relevant period of performance outcomes*

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

Step 1: Review the Opportunity 27

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

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

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

Step 1: Review the Opportunity 28 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

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

Step 1: Review the Opportunity 29 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

Salary rate limitation As of January 2024, the HHS/CDC salary rate limitation is $221,900. This salary rate limitation does not apply to PEPFAR funds, which are part of an appropriation from the U.S. Department of State; but to the extent that HHS/ CDC funds are added to an award, this limitation applies. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use program income for the purposes and under the conditions of the award. Find more about program income at 45 CFR 75.307.

Program-specific limitations

CDC PEPFAR terms and conditions You can find a list of PEPFAR-specific terms and conditions on our website.

They apply to all PEPFAR awards, so we strongly encourage you to read them and ask questions if you need more information. These terms and conditions will apply if you are selected for an award so you should confirm that you are able to comply with them prior to applying.

Host country laws and regulations If funded, you are expected to follow applicable host country laws and regulations related to the strategies under this NOFO; if there are conflicts with this award, contact the Grants Management Officer.

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

Step 1: Review the Opportunity 30 https://www.ecfr.gov/current/title-45/part-75#p-75.403(d) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307 https://www.cdc.gov/grants/documents/PEPFAR-Terms-and-Conditions.pdf

Step 2:

Get Ready to Apply

In this step

Get registered 32

Questions 33

Get registered You must be registered in both SAM.gov and Grants.gov to apply.