Eswatini CDC-RFA-JG-25-0074 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due March 5, 2025

Supporting the provision of person-centered, equitable, high-quality, and integrated service delivery towards a sustainable and resilient HIV/TB response in the Kingdom of Eswatini under PEPFAR Opportunity number: CDC-RFA-JG-25-0074

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 33

Get registered 34

Questions 35

Step 3: Prepare Your Application 36

Application contents and format 37

Step 4: Learn About Review and Award 47

Application review 48

Award notices 55

Step 5: Submit Your Application 56

Application submission and deadlines 57

Application checklist 59

Step 6: Learn What Happens After Award 61

Post-award requirements and administration 62

Contacts and Support 69

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 (CDC)

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:

Supporting the provision of person-centered, equitable, high-quality, and integrated service delivery towards a sustainable and resilient HIV/TB response in the Kingdom of Eswatini under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0074

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

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 support person-centered, equitable, high-quality, and integrated HIV/TB prevention, care, and treatment services at site level in alignment with the Kingdom of Eswatini’s vision toward a sustainable HIV/TB response and PEPFAR’s Five-year strategic strategy (2023-2028).

Support will enhance the demand for and delivery of services, guide implementation of guidelines, foster innovation, promote service integration, maintain quality, and improve effective data use. To prevent disruptions in service delivery, more intensive logistical and technical support may be needed to mitigate risks in areas such as laboratory diagnostic services, commodity management, and health information system implementation.

One expected outcome of this NOFO is that the intensity of support will gradually decrease with the goal of transitioning service delivery, key response functions, and clinical mentorship to the Ministry of Health (MOH) and/or other local entities over the course of the award. While investments should emphasize HIV/TB-related interventions, they should be adaptable to broader public health goals.

Support will likely focus on Manzini and Lubombo regions, but you should be able to work across all regions. Interventions and approaches should be informed through meaningful engagement with stakeholders, community organizations, beneficiaries, and affected communities.

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

Step 1: Review the Opportunity 5 https://www.state.gov/wp-content/uploads/2022/11/PEPFARs-5-Year-Strategy_WAD2022_FINAL_COMPLIANT_3.0.pdf

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $4,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1 to 3 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.

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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: COP Additional Targets and 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 30 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 quarter of 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, are not consistently 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 and 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 to 29 are particularly vulnerable. As demonstrated by the 2022 Eswatini Violence

Step 1: Review the Opportunity 10

Against Children (VAC) Survey, gender-based violence (GBV) 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.

CDC/PEPFAR currently supports the MOH through implementing partners in two administrative regions (Manzini and Lubombo) to deliver HIV and TB prevention, care, and treatment services in facilities and surrounding communities. Placement of staff, including lay cadre, intensive site-level mentorship, institutionalizing data use for continuous quality improvement (CQI), strengthening the laboratory-clinical interface, supporting community-facility linkages, and redistributing commodities to mitigate stock ruptures have been instrumental in successful program implementation.

Gaps along the clinical cascade are addressed through support for differentiated testing and treatment approaches with the goal of reaching 95-95-95 across all subpopulations, especially for children, adolescent girls and young women, men, and key populations.

The expansion of index case and social network testing and the introduction of HIV self-testing as a screening tool have effectively identified people living with HIV who did not know their status. Peer-to-peer linkage case management for newly initiating clients, teen clubs, appointment reminders, multi-month refills, and after-hours access through innovations such as automated dispensing lockers have improved treatment continuity and viral suppression.

Mortality reduction among people living with HIV is addressed through screening and management of advanced HIV disease (AHD), NCDs, and cervical cancer. PEPFAR support has allowed for special attention to the introduction and scale of newer interventions and/or regimens for TB prevention, screening, diagnosis, and treatment.

PEPFAR has supported the prevention of new HIV infections through programming to:

Prevent vertical (mother-to-child) transmission of HIV.

• Provide voluntary medical male circumcision (VMMC).

• Oral and injectable pre-exposure prophylaxis (PrEP).

Step 1: Review the Opportunity 11

• Post-exposure prophylaxis (PEP).

• Sexually transmitted infection (STI) screening and treatment.

• GBV prevention and response interventions.

This includes No Means No and LIVES training on GBV first-line responder support. Additional HIV prevention interventions targeting adolescent girls and young women include the establishment of youth-responsive services within facilities and DREAMS implementation in select Tinkhundla (districts).

Under this NOFO, you are expected to assist select health facilities and surrounding communities to pivot from a resource-intensive emergency response to a leaner approach for sustainable provision of person-centered, equitable, high-quality, and integrated HIV/TB prevention, care, and treatment services. We expect the strategies and activities you undertake to help close remaining gaps, identify challenges, and mitigate risks inherent in this change process. Some activities may transition to the MOH during the award.

Purpose The purpose of this NOFO is to support select health facilities and surrounding communities to pivot from a resource-intensive emergency response to a leaner approach for sustainable provision of person-centered, equitable, high-quality, and integrated HIV/TB prevention, care, and treatment services in Eswatini. You will be expected to help close remaining gaps, identify challenges, and mitigate risks inherent in this change process.

Some activities may transition to the MOH during the award.

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

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

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

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

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes

Long-term outcomes

Strategy 1: Support the delivery of person-centered, equitable, high-quality, and integrated health services to meet the prevention, care, and treatment needs of those at risk of, affected by HIV/TB, and living with HIV at select facility and community service points.

Strategy 2: As a risk mitigation measure, provide logistical support in areas including laboratory, commodity management, and strategic information at site level to prevent disruptions in service delivery.

Strategy 3:

Collaborate with other health service delivery institutions and organizations, community organizations, and/or groups of people living with HIV to improve patient treatment experiences.

Increased coverage and uptake of combination HIV prevention interventions.*

Increased access and linkage to and retention in HIV/TB prevention and treatment services.*

Improved patient management, care of AHD, and control of co-morbidities among people living with HIV and TB.*

Improved availability and use of data for quality improvement, contingency planning, and strategic decision-making.*

Improved ability of health workforce to deliver and monitor HIV/TB program-specific services.*

Reduced site-level stockouts of essential HIV commodities.

Improved timely delivery of laboratory results.

Improved HIV/TB-related health literacy among those at risk of HIV/TB and living with HIV.*

Reduced HIV risk behaviors.

Increased knowledge of HIV status among those at risk and living with HIV.*

Increased effective use of HIV prevention methods among those at risk of HIV.

Increased service use among survivors of

GBV.*

Sustained viral load testing coverage and suppression among people living with

HIV.*

Improved continuity of HIV and TB treatment.*

Improved quality of HIV prevention and treatment service provision.

Improved integrated chronic disease management.*

Improved capability of sites to monitor indicators, conduct CQI and implement contingency plans.*

Improved patient satisfaction with HIV services.*

Reduced HIV and TB incidence.

Reduced population-level viral load.

Reduced morbidity and mortality among people living with and affected by HIV/

TB.*

Reduced vertical transmission of HIV, syphilis, and Hepatitis B.

Reduced rates of

GBV/VAC.

Decreased HIV-related stigma and discrimination experienced by people at risk of and living with

HIV.

Improved facility competence and agility to monitor and maintain quality standards and services.*

Step 1: Review the Opportunity 13

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

Strategy 1: Support the delivery of person-centered, equitable, high-quality, and integrated health services to meet the prevention, care, and treatment needs of those at risk of, affected by HIV/TB, and living with HIV at select facility and community service points.

Required activities

• Support implementation of differentiated HIV testing strategies to close case finding gaps among children, adolescent girls and young women, pregnant and breastfeeding women, men, and key populations through innovative facility and community-based testing modalities.

• Ensure strong and timely linkages to treatment and prevention services.

• Support provision of comprehensive HIV prevention services, including:

◦ VMMC.

◦ Differentiated PrEP, PEP, STI screening and treatment.

◦ Human papillomavirus (HPV) and Hepatitis B vaccination.

◦ Condoms.

◦ Rights-based counseling.

◦ HIV education and communication risk-reduction interventions.

• Support provision of comprehensive pediatric and adult HIV care and treatment services, including:

◦ Timely initiation of ART/TB treatment.

◦ Provision of optimized HIV/TB treatment regimens.

◦ The prevention, screening and treatment for AHD, TB, and cervical precancerous lesions.

◦ Preventing vertical transmission of HIV.

◦ Care for HIV-exposed infants.

Step 1: Review the Opportunity 14

• Support integration of HIV/TB prevention, care and treatment services and other primary health care services, including chronic disease management and sexual and reproductive health services.

• Introduce, refine, and/or scale innovative, evidence-based differentiated service delivery approaches and technologies for testing, prevention, and treatment services, including use of community pharmacies, dispensing lockers, and mobile/digital applications.

• Optimize use of point of care (POC) and multiplex diagnostic platforms to enable integrated testing and inform treatment decisions at the primary care level.

• Ensure strong bi-directional community–facility referrals and linkages, including programs for orphans and vulnerable children, at-risk adolescent girls and young women, violence prevention and response, and key populations.

• Strengthen GBV and VAC prevention, referrals, and response through implementing evidence-based violence prevention interventions, providing post-violence health care services, and adopting a trauma-informed care approach for all prevention, care, and treatment services.

• Engage communities along with current and potential users in designing approaches to increase awareness, demand, and use of HIV/TB and related services.

• Ensure services are responsive to the unique needs of adolescents, youth, and key populations including female sex workers, men who have sex with men, transgender people, people who inject drugs, and incarcerated people.

• Facilitate a shift from higher intensity to lower intensity mentorship support by:

◦ Strengthening site-level competencies to monitor and maintain quality standards, services, and diagnostics.

◦ Ensuring data quality and use for program improvement.

◦ Simplifying site-level processes and procedures to facilitate efficient and effective service delivery.

Step 1: Review the Opportunity 15

Strategy 2: As a risk mitigation measure, provide logistical support in areas including laboratory, commodity management, and strategic information at site level to prevent disruptions in service delivery.

Required activities

• Monitor, manage, and redistribute commodities for key HIV/TB services at site-level and across regions to prevent disruptions in service delivery.

• Provide support to sample transport as a stop-gap measure when the national transport system faces challenges.

• Provide site-level support for Client Management Information System-related trainings and use of new modules and features to ensure data completeness, quality, and routine use for program implementation and improvement.

• Assist with facility and regional staffing plans to ensure coverage for essential health services.

• Conduct surge activities (intensified implementation efforts) to address underperformance or close specific program gaps as required or needed.

• Strengthen contingency planning at sites and within regions to anticipate and mitigate potential commodity or service delivery interruptions or challenges.

Strategy 3: Collaborate with other health service delivery institutions and organizations, community organizations, and/or groups of people living with HIV to improve patient treatment experiences.

Required activities

• Implement routine feedback systems to assess service satisfaction and barriers, solicit suggestions from recipients of care, and refine service delivery approaches based on client feedback.

• Engage in communities of practice for continuous learning and adoption of best practices for improved service delivery.

• Collaborate with other organizations to reduce HIV-related stigma and discrimination experienced by people at risk of and living with HIV.

• Develop effective collaborations across local health service delivery institutions and community organizations, including people living with

Step 1: Review the Opportunity 16

HIV and key population groups, to enable seamless linkage to and provision of comprehensive person-centered services.

• Collaborate with groups of people at risk, affected by HIV/TB, and living with HIV, the faith community, and other community-based organizations to plan, deliver, and monitor HIV/TB care and treatment services.

• Actively engage in community-led monitoring (CLM) processes and develop appropriate improvement plans in response to CLM findings.

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.

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 following related policies. 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

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

Step 1: Review the Opportunity 17 https://www.state.gov/reports-pepfar/ 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.

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 The focus populations for this NOFO include:

• Children, men, and women at risk for, affected by, or infected with HIV, TB, or related health conditions.

• Specific sub-populations may be prioritized as informed by the epidemiology, including but not limited to:

◦ Pregnant and breastfeeding women.

◦ HIV-exposed infants.

◦ Adolescent girls and young women.

◦ Men under 35 years old.

◦ Key populations.

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

Step 1: Review the Opportunity 18 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

• Regional Health Management Teams and their members, site leadership, frontline healthcare workers, and laboratory professionals.

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

• Race.

• Color.

• 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.

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

Step 1: Review the Opportunity 19 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

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.

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.

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

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

• U.S. government agencies, CDC, and other PEPFAR-supported implementing partners.

• Civil society organizations.

• Faith-based organizations.

• Non-governmental organizations involved in HIV/TB service delivery.

• Other local institutions/organizations that deliver HIV/TB services.

• Other implementing partners as identified based on the 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.

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• 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.

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

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

Step 1: Review the Opportunity 21 https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• GEND_GBV: Number of people receiving post-gender-based violence (GBV) clinical care based on the minimum package. [Target: 863;

Reporting Frequency: Semi-Annual]

• PrEP_CT: Number of individuals, excluding those newly enrolled, that return for a follow-up visit or re-initiation visit to receive pre-exposure prophylaxis (PrEP) to prevent HIV during the reporting period. [Target:

4,820; Reporting Frequency: Quarterly]

• PrEP_NEW: Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. [Target: 8,104; Reporting Frequency: Quarterly]

• TB_PREV: Proportion of ART patients who started on a standard course of TB Preventive Treatment (TPT) in the previous reporting period who completed therapy. [Target: 96%; Reporting Frequency: Semi-Annual]

• VMMC_CIRC: Number of males circumcised as part of the voluntary medical male circumcision (VMMC) for HIV prevention program within the reporting period. [Target: 2,038; Reporting Frequency: Quarterly]

• CXCA_SCRN: Number of women living with HIV on ART screened for cervical cancer. [Target: 11,475; Reporting Frequency: Semi-Annual]

• HTS_INDEX: Number of individuals who were identified and tested using Index testing services and received their results. [Target: 2,591; Reporting Frequency: Quarterly]

• HTS_SELF: Number of individual HIV self-test kits distributed. [Target:

44,637; Reporting Frequency: Quarterly]

• HTS_TST: Number of individuals who received HIV Testing Services (HTS) and received their test results. [Target: 29,830; Reporting Frequency:

Quarterly]

• PMTCT_EID: Percentage of infants born to women living with HIV who received a first virologic HIV test (sample collected) by 12 months of age.

[Target: 100%; Reporting Frequency: Quarterly]

• PMTCT_FO: Percentage of final outcomes among HIV-exposed infants registered in a birth cohort. [Target: 100%; Reporting Frequency: Annual]

• PMTCT_HEI_POS: Number of newly identified infants living with HIV with a positive virologic HIV test result returned in the reporting period, whose diagnostic sample was collected by 12 months of age. [Target: Not Assigned; Reporting Frequency: Quarterly]

• PMTCT_STAT: Percentage of pregnant women with known HIV status at antenatal care (includes those who already knew their HIV status prior to ANC). [Target: 100%; Reporting Frequency: Quarterly]

Step 1: Review the Opportunity 22

• TB_STAT: Percentage of new and relapse TB cases with documented HIV status. [Target: 100%; Reporting Frequency: Quarterly]

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

100%; Reporting Frequency: Semi-Annual]

• PMTCT_ART: Percentage of pregnant women living with HIV who received ART to reduce the risk of mother-to-child-transmission (MTCT) during pregnancy. [Target: 100%; Reporting Frequency: Quarterly]

• TB_ART: Proportion of new and relapsed TB cases living with HIV on ART during TB treatment. [Target: 100%; Reporting Frequency: Annual]

• TX_CURR: Number of adults and children currently receiving antiretroviral therapy (ART). [Target: 66,187; Reporting Frequency:

Quarterly]

• TX_ML: Number of ART patients (who were on ART at the beginning of the quarterly reporting period or initiated treatment during the reporting period) and then had no clinical contact since their last expected contact.

[Target: Not Assigned; Reporting Frequency: Quarterly]

• TX_NEW: Number of adults and children newly enrolled on antiretroviral therapy (ART). [Target: 1,093; Reporting Frequency: Quarterly]

• TX_RTT: Number of ART patients who experienced IIT during any previous reporting period, who successfully restarted ARVs within the reporting period and remained on treatment until the end of the reporting period.

[Target: Not Assigned; Reporting Frequency: Quarterly]

• PP_PREV: Number of priority populations (PP) reached with the standardized, evidence-based intervention(s) required that are designed to promote the adoption of HIV prevention behaviors and service uptake.

[Target: 90%; Reporting Frequency: Semi-Annual]

• TX_TB: Proportion of ART patients screened for TB in the semiannual reporting period who start TB treatment. [Target: Not Assigned;

Reporting Frequency: Semi-Annual]

• LAB_PTCQI: Number of PEPFAR-supported laboratory-based testing and/ or Point-of-Care Testing (POCT) sites engaged in continuous quality Improvement (CQI) and proficiency testing (PT) activities. [Target: Not Assigned; Reporting Frequency: Annual]

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

Step 1: Review the Opportunity 23

• Percentage of health facilities meeting quality standards for youth-responsive health services. [Target: 90%; Reporting Frequency: Quarterly]

• Percentage of health facilities meeting quality standards for health services that are responsive to the needs of key populations. [Target:

90%; Reporting Frequency: Quarterly]

• Percentage of elicited index contacts (sexual partners, children, partners of persons who inject drugs, and associates/peers) that are tested for HIV and linked to treatment and prevention services. [Target: 80%; Reporting Frequency: Quarterly]

• Percentage of newly identified HIV-negative eligible men 15 years and older linked to VMMC services. [Target: 75%; Reporting Frequency:

Quarterly]

• Percentage of individuals who have tested negative for HIV, received supportive HIV prevention counseling, and been offered PrEP during the reporting period. [Target: 90%; Reporting Frequency: Quarterly]

• Percentage of those seeking post-sexual violence services eligible for PEP, offered PEP, completed PEP, and received HIV testing. [Target: 90%;

Reporting Frequency: Quarterly]

• Percentage of AHD clients eligible for preemptive fluconazole prophylaxis who are initiated on fluconazole. [Target: 100%; Reporting Frequency:

Semi-Annual]

• Percentage of ART clients screened for TB with computer-aided detection who receive Xpert MTB testing. [Target: 90%; Reporting Frequency: Semi- Annual]

• Percentage of people living with HIV and hypertension whose blood pressure is controlled during the reporting period. [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 sites receiving timely (within 7 days) risk mitigation support in real or potential lab/commodity/strategic information disruptions.

[Target: 90%; Reporting Frequency: Annual]

• Percentage of supported facilities that transitioned from a high-intensity to a lower-intensity mentorship approach. [Target: Not Assigned;

Reporting Frequency: Annual]

Step 1: Review the Opportunity 24

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.

• Implementation of integrated chronic disease management: The extent to which the implementation of integrated chronic disease management improves key disease control measures (for example: viral suppression, blood pressure, HBA1c): outcome evaluation.

• Quality of care: The extent to which health facilities successfully monitor and maintain quality service delivery standards once they have transitioned from high intensity vs low intensity mentorship: process evaluation.

• Clinical mentoring: The extent to which risk mitigation efforts ensure availability of test results and prevented stock out of commodities:

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.

Step 1: Review the Opportunity 25

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 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.

Step 1: Review the Opportunity 26

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.

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 represents, 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

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

Step 1: Review the Opportunity 27 https://www.cdc.gov/grants/additional-requirements/ar-25.html 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.

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. 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.

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

Step 1: Review the Opportunity 28

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.

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,…