Foa_Content_of_CDC-RFA-GH-24-0072.pdf

Centers for Disease Control and Prevention

Center for Global Health

Expansion of Community HIV Response in Nigeria through Civil Society Organizations under the President's Emergency Plan for AIDS Relief (PEPFAR)

CDC-RFA-GH-24-0072

02/19/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- GH-24-0072. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

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

Expansion of Community HIV Response in Nigeria through Civil Society Organizations under the President's Emergency Plan for AIDS Relief (PEPFAR) C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

Applicants should note that a Letter of Intent (LOI) is not requested or required as part of the application for this NOFO or for any CDC PEPFAR FY24 NOFO. Applicants should not submit LOIs.

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-GH-24-0072

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

E. Assistance Listings Number:

93.067 F. Dates:

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

2. Due Date for Applications:

02/19/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph This NOFO will support civil society organization (CSO) group(s) to work with the Government of Nigeria (GoN) to expand the delivery of a comprehensive package of HIV services to sub-population groups through community-led approaches in select CDC-supported sub-national units. The NOFO targets closing service coverage gaps in adolescents and young persons (AYP) and key populations (KP) sub-groups including sex workers (SW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG). This will contribute to Nigeria’s attainment of the Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 targets, which require having 95% of people living with HIV (PLHIV) tested and diagnosed, 95% of those diagnosed placed on anti-retroviral therapy (ART), and 95% of those on ART virally suppressed. Recipient(s) will be expected to operate within community structures or develop innovative mechanisms to deliver integrated community-led HIV interventions for AYP and KP. This NOFO seeks to achieve impactful and sustainable outcomes that require implementation of innovative and efficient models of community-led prevention and treatment methods, including program monitoring and routine use of data for continuous quality improvement. The NOFO will support a shared programmatic approach that collaborates with, and builds the capacities of other community stakeholders, promotes local ownership, and contributes to Nigeria’s overall HIV epidemic control efforts.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards The expected number of awards is 1-4.

d. Total Period of Performance Funding:

$0 https://www.grants.gov/

The Approximate Project Period of Performance Funding/Estimated Total Funding for the Total 5 year Project Period is None. The Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount for years 2-5 will be set at continuation.

e. Average One Year Award Amount:

$10,000,000 The Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount for Year 1 is $10,000,000. The expected number of awards is 1-4. Exact amounts for each award under this NOFO will be determined at the time of award. Applicants are encouraged to apply to the Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount.

f. Total Period of Performance Length:

5 year(s)

g. Estimated Award Date:

September 30, 2024

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview Nigeria has made incredible progress towards meeting the UNAIDS 95-95-95 Fast-Track Targets; however, a significant number of new infections continue to arise. A majority of these new infections are due to HIV transmission among KP, accounting for 11% of new infections in the country. KP has significantly higher HIV/AIDS prevalence rates (10.9% for PWID, 15.5% for SW, 25.0% for MSM, and 28.8% for TG) compared to the general population (1.3%) (Integrated Biological and Behavioral Surveillance Survey 2020). This highlights a profound need for a programmatic response that is focused on these sub-population groups. Nigeria needs a robust KP program that maximizes equitable access to comprehensive, person-centered HIV services while ensuring community-led responses address social, cultural, and legal barriers, simultaneously reducing healthcare system-related barriers that affect the provision of HIV services to priority populations.

According to the United Nations Children and Education Fund (UNICEF) report 2021, AYP aged 10-24 years old constitute a third of the Nigerian population. This population represents the fastest rising HIV positive cases amongst women aged 15-24 years of age. They remain a top priority of focus for Nigeria with 50% of HIV positive adolescents 10-19 years of age yet to be placed on treatment.

Despite the significant gains made during the rigorous case finding driven by PEPFAR Nigeria, tagged SURGE, which led to treatment saturation in most CDC-supported states through traditional comprehensive treatment partners, substantial gaps still exist in the AYP and KP groups. These sub-population groups usually, and largely, access HIV prevention and treatment services through their networks and social groups in the communities, which have not been optimal or have been hindered by structural and institutional barriers. HIV-related stigmatization has been a hinderance for both KP and AYP sero-status disclosures and access to prevention and treatment services in traditional health facility settings. Domestic policy and the security environment have also continued to hinder KP’s ability to access comprehensive prevention, care, and treatment services.

This NOFO will focus on implementing all appropriate innovative and efficient strategies to relieve these barriers and hinderances for AYP and KP and increase their access to a comprehensive package of HIV-related services in the communities. Innovative and efficient strategies should be new, cost-effective, and within the community structure. They should also facilitate strengthening the HIV response at the community level as part of CDC programmatic efforts to localize, sustain, and prepare for the transition to host government. CDC Nigeria is currently aligning with PEPFAR’s 5-by-3 Strategy to end the HIV/AIDS pandemic by 2030.

CDC Nigeria is also working with GoN to transition the HIV program to host institutions for ownership of the HIV response across the three tiers of government (Federal, State, and Local Government). CDC Nigeria will strengthen the AYP and KP portfolio in alignment with the PEPFAR 5-by-3 Strategy by reinforcing CSO active participation in the sustainability and state ownership of the HIV response, starting with an initial batch of five states and progressively increasing with time. These states are Delta, Gombe, Imo, Nasarawa, and Oyo, selected after a GoN-led assessment of readiness for transition using standard indicators. Recipient(s) will be expected to work in collaboration with other organizations (CSO/CBO) to achieve the objectives of the NOFO.

b. Statutory Authorities This program is authorized under Public Law 108-25 (the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003) [22 U.S.C. 7601, et seq.] and Public Law 110-293 (the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008), and Public Law 113-56 (PEPFAR Stewardship and Oversight Act of 2013).

The President’s Emergency Plan for AIDS Relief (PEPFAR) has called for immediate, comprehensive and evidence-based action to turn the tide of global HIV/AIDS. The overarching purpose of this NOFO is to fund activities to prevent or control disease or injury and improve health, or to improve a public health program or service.

c. Healthy People 2030 N/A

d. Other National Public Health Priorities and Strategies Under the leadership of the Global Health Security and Diplomacy Bureau (GHSD Bureau), as part of PEPFAR, the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (HHS/CDC) works in partnership with host country governments and other key partners to assess the needs of each country and design a customized program of assistance that fits within the host nation's strategic plan in a manner consistent with the purposes of this NOFO. Goals and priorities include the following:

• Reducing the prevention and treatment gaps for adolescent girls and young women (AGYW), children, and key populations (KPs);

• Strengthening national and local programmatic, financial, and community leadership;

• Designing new partnerships with key private, public, and multi sector entities that can complement existing programs and expand reach;

• Utilizing the PEPFAR platform for broader disease surveillance and public health programming, consistent with the PEPFAR legislative and funding authority;

• Investing in the scale-up of cutting edge behavioral and implementation science to bend the curve on new infections;

• Improving the care and treatment of HIV/AIDS, sexually transmitted infections (STIs), and related opportunistic infections by improving STI management; enhancing laboratory diagnostic capacity and the care and treatment of opportunistic infections; interventions for intercurrent diseases impacting HIV infected patients including tuberculosis (TB); and initiating programs to provide anti-retroviral therapy (ART);

• Strengthening the capacity of countries to collect, use, and share surveillance data and manage national HIV/AIDS programs by expanding HIV/STI/TB surveillance programs and strengthening laboratory support for surveillance, diagnosis, treatment, disease monitoring, and HIV screening for blood safety; and

• Developing, validating, and/or evaluating public health programs to inform, improve, and target appropriate interventions, as related to the prevention, care and treatment of HIV/AIDS, TB, and opportunistic infections.

In an effort to ensure maximum cost efficiencies and program effectiveness, HHS/CDC also supports coordination with and among relevant partners. Recipients may be requested to participate in the following programmatic activities:

• Scale-up evidence-based programs to identify and close the major HIV gaps among AGYW, children, and KPs;

• Increase impact through strategic coordination and integration;

• Strengthen and leverage key multilateral organizations, global health partnerships, and private sector engagement;

• Encourage country ownership and invest in country-led plans, putting our national and local partners in the lead and actively enabling their growth through design of the program at all phases;

• Build sustainability through investments in health systems;

• Enhance health equity and reduce disparities in access to and uptake of HIV services;

• Improve performance metrics, monitoring and evaluation and the quality of related data;

and

• Promote research, development, and innovation to develop a body of knowledge, enhance awareness and increase the skills and abilities of stakeholders (research is not supported by this NOFO).

PEPFAR defines national HIV epidemic control as the point at which the number of new infections falls below the declining number of deaths among people living with HIV (PLHIV).

This definition of epidemic control does not suggest near-term elimination or eradication of HIV as may be possible with other infectious diseases, but rather suggests a decline of HIV-infected persons in a population, achieved through the reduction of new HIV infections when mortality among PLHIV is steady or declining, consistent with natural aging. Critically, however, a country will not be able to maintain epidemic control if program efforts are not sufficiently sustained and new infections are allowed to rebound or death rates to increase.

In addition to the specific activities listed in the Strategies and Activities section of this NOFO, all CDC PEPFAR cooperative agreements resulting from this NOFO may address the following activities, where and when appropriate, that focus U.S. government resources and activities toward achieving and sustaining the HIV/AIDS epidemic:

• Optimize HIV testing and treatment strategies to reach undiagnosed populations living with HIV, especially young adults, men, and KP. These strategies may include or build upon traditional methods and activities related to outbreak detection, investigation, and response, including efforts to reduce or remove evidenced barriers to services such as stigma and discrimination and inequitable gender norms. Responding to recent infections or ongoing patterns of transmission will be prioritized.

• Focus on prevention among children, adolescents, young adults, and members of vulnerable and key populations.

• Support surveillance activities and programs, along with information systems, that improve understanding of HIV epidemiology, help identify inequities and remaining gaps (e.g., societal impediments to HIV services), and inform future programming.

• Support efforts to maintain quality for laboratory systems and activities, including diagnostics and viral load measurement.

• Actively use epidemiologic, program, and financial/cost data to ensure implementation of high quality, cost-effective programs to improve partner performance and increase epidemiologic impact.

• Support country-led, sustainable programming by working with and implementing activities through local partners, including faith communities and faith-based organizations (FBOs), HIV network organizations and community-based organizations (CBOs) directly servicing communities and populations at-risk and most affected by HIV to build local capacity.

• Strengthen programmatic, financial, and community contributions by partner governments in the HIV/AIDS response.

• Support activities, interventions, and programs (e.g., including those intended to reduce or remove evidenced societal impediments to services such as stigma, discrimination, and inequitable gender norms) to find, treat, and prevent TB among PLHIV and to identify and treat HIV among people infected with TB.

• Support efforts to prevent, detect, respond, and treat infectious and non-infectious diseases that impact PLHIV and populations affected by HIV.

Any activities outside of HIV or TB activities will be consistent with the direction set forth in PEPFAR’s Five-Year Strategy, PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance, annual COPs/ROPs, or other similar forthcoming strategy, guidance, or planning documents as may be consistent with applicable law.

Geographic prioritization may change over the course of the period of performance based on the burden of disease and changing program and PEPFAR priorities.

If the scope of activities to be conducted by the recipient(s) of funds under this NOFO includes work with KP, the recipient(s) will be expected to collaborate with KP organizations in the design and delivery of appropriate optimal and quality HIV services to KP.

Any Personally Identifiable Information (PII) collected for continuity of service provision should be managed in a manner that ultimately protects individual-level data to the extent allowed by applicable law.

In addition, PEPFAR is committed to protecting children from abuse, exploitation, and neglect in order to decrease their vulnerability to HIV/AIDS. Consistent with underlying authorities, PEPFAR seeks to ensure that children and youth obtaining services through PEPFAR programming are also protected from abuse, exploitation, and neglect in CDC PEPFAR-supported programs.

To that end, because activities to be funded under this NOFO may involve children or personnel coming into contact with children, Recipients of CDC PEPFAR funds agree to ensure compliance with host country and local child welfare and protection legislation or international standards, whichever gives greater protection, and with U.S. law, where applicable. Further, Recipients of CDC PEPFAR funding are strongly encouraged to: 1) have in place policies and procedures that prohibit recipient personnel from engaging in child abuse, exploitation, or neglect; 2) consider child safeguarding in project planning and implementation to determine potential risks to children that are associated with project activities and operations; 3) apply measures to reduce the risk of child abuse, exploitation, or neglect, including, but not limited to, limiting unsupervised interactions with children; prohibiting exposure to pornography; and complying with applicable laws, regulations, or customs regarding the photographing, filming, or other image-generating activities of children; 4) promote child-safe screening procedures for personnel, particularly personnel whose work brings them in direct contact with children; and 5) have a process for ensuring that personnel and others recognize child abuse, exploitation, or neglect, report allegations, investigate and manage allegations, and take appropriate action in response to such allegations. It is also strongly encouraged that Recipients include the above provisions in any applicable code of conduct for its personnel implementing PEPFAR-funded activities.

In its work with partners, CDC seeks to help control HIV epidemics and to achieve and maintain low levels of HIV incidence and mortality. Now and in the future, viable, capable, durable, and successful local partners will play an important role in achieving and sustaining control of national HIV epidemics. To that end, CDC strongly encourages direct applications from local organizations (i.e., institutions located, registered, and managed in the country and/or sub-region where work occurs and led by national of that country and/or sub-region). U.S.-based partners working in international settings also offer unique capabilities and will continue to make important contributions. Partnerships between local organizations and U.S.-based organizations may also offer benefits and are encouraged in such cases.

This NOFO is only for non-research activities supported by CDC. Recipients may not use funds for research. Certain activities that may require human subjects review due to institutional requirements but that are generally considered not to constitute research (e.g., formative assessments, surveys, disease surveillance, program monitoring and evaluation, field evaluation of diagnostic tests, etc.) may be funded through this mechanism. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address: https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/revised-common-rule-regulatory-text/index.html#46.102.

e. Relevant Work Following the gains of the ART Surge program implemented between Fiscal Year (FY) 19 and FY21, the focus of GoN (in collaboration with PEPFAR, the Global Fund to Fight AIDS, Tuberculosis & Malaria [GFATM], and implementing partners [IPs]) is to support a high-quality, person-centered, comprehensive HIV program package and achieve epidemic control across the 36 states of Nigeria and the Federal Capital Territory. At the end of FY23, all CDC-supported states are expected to achieve HIV treatment saturation.

The accelerated scale up of life-saving ART in Nigeria, which has led most states to cross the 81% saturation target set for FY21, still leaves Nigeria with some unmet needs across pediatric, adolescent, and other high-risk sub-populations.

This NOFO aims to support access to HIV prevention, care, and treatment services to achieve epidemic control at the community level, working with CSOs with the capacity to implement programs in hard-to-reach areas with key and underserved populations. Recipient(s) are expected to have, or work with CSOs who possess, a working understanding of the PEPFAR implemented programs through existing service delivery and systems strengthening IPs and other multilaterals organizations. The recipient(s) are expected to demonstrate experience working in the following program areas:

• HIV prevention for at-risk populations

• Prevention of Mother-to-Child Transmission (PMTCT)

• HIV testing services (HTS)

• KP service

• Adolescent care and treatment services

• Laboratory services delivery

• Strategic information and monitoring and evaluation (M&E)

• Health systems strengthening

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/revised-common-rule-regulatory-text/index.html#46.102 https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/revised-common-rule-regulatory-text/index.html#46.102

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1: Use multi-faceted innovative approaches to strengthen and facilitate the uptake of community HIV-prevention services among AYP and KP in selected sub-national units

Strategy 2: Implement partnership-building strategies among stakeholders to address treatment gaps among AYP and KP, and to improve and sustain continuity of HIV care and treatment services at the community level

Strategy 3: Implement innovative project management and ethical data use approaches among stakeholders to monitor, evaluate, and improve the delivery of community-level HIV services for AYP and

KP

Strategy 4: Strengthen community-based organizations’ (CBO) capacities to develop, implement, and support sustainable community service delivery systems, and to collaboratively coordinate, monitor, and champion the AYP

Increased access to and uptake of the comprehensive package of HIV prevention and treatment services by AYP and KP in the community

Increased uptake of and maintenance on Pre-Exposure Prophylaxis (PrEP) among AYP and KP

Increased HIV literacy among AYP and KP

Improved protection against human rights infraction and violence response services for AYP and KP

Improved quality of community-led HIV prevention and treatment services for AYP and KP

Improved quality of data about community-led HIV services for AYP and KP

Increased use of routine program data to improve implementation and outputs

Increased coverage of HIV prevention and treatment services among AYP and

KP

Improved retention on treatment of AYP and KP living with HIV

Increased access to mental and psychosocial health services for AYP and KP living with HIV

Increased capacity of local government personnel to oversee and implement community HIV prevention services

Decreased HIV-related morbidity and mortality among AYP and KP

Decreased incidence of HIV and STIs among AYP and KP

Reduced incidence of stigma and discrimination among AYP and KP

Increased CBO capacity to provide and sustain HIV literacy for AYP and KP living with

HIV

Reduced barriers to accessing community site-level preventive and treatment services for AYP and KP

Improved joint coordination and monitoring of community-led HIV services for AYP and KP by government and

CBO

Reduced incidence of violence among AYP and KP and KP HIV-response at national and sub-national levels

Increased domestic investment for community-led HIV activities for AYP and KP

i. Purpose The purpose of this NOFO is to support the expansion of HIV prevention and treatment services through sustainable, collaborative, and integrated community-led approaches to sub-population groups, specifically AYP and KP where coverage gaps still exist, and to contribute to the overall achievement of HIV epidemic control in Nigeria.

ii. Outcomes CDC may require or allow applicants to propose additional related project period outcomes other than those identified in the NOFO.

Short-Term Outcomes:

• Increased access to and uptake of the comprehensive package of HIV prevention and treatment services by AYP and KP in the community o Comprehensive package as described by Nigeria’s National Guidelines for HIV Prevention, Treatment and Care 2020

• Increased uptake of and maintenance on PrEP among AYP and KP

• Increased HIV literacy among AYP and KP o HIV literacy is the capacity of AYP and KP to obtain, interpret, and understand basic HIV prevention, testing, and care information, skills, and services. It is also the competence to use such information to prevent HIV infection, further transmission, and related stigma and discrimination. It encompasses AYP and KP understanding their HIV status, ART regimen, and test results to enhance the physical, mental, and social well-being of PLHIV.

• Improved protection against human rights infraction and violence response services for AYP and KP

• Improved quality of community-led HIV prevention and treatment services for AYP and

KP

• Improved quality of data about community-led HIV services for AYP and KP

• Increased use of routine program data to improve implementation and outputs o This NOFO would result in community stakeholders increasingly using data to improve impact

Intermediate Outcomes:

• Increased coverage of HIV prevention and treatment services among AYP and KP

• Improved retention on treatment of AYP and KP living with HIV

• Increased access to mental and psychosocial health services for AYP and KP living with

HIV

o Mental and psychological health services include assessment for psychosocial wellbeing, psychotherapy, and referrals for psychiatric intervention where needed

• Increased capacity of local government personnel to oversee and implement community HIV prevention services

Long-Term Outcomes:

• Increased CBO capacity to provide and sustain HIV literacy for AYP and KP living with

HIV

• Reduced barriers to accessing community site-level preventive and treatment services for AYP and KP o Barriers include societal norms, infractions by security agencies (e.g., arbitrary arrests at social gatherings or conducting raids where KP are gathered to access services), discriminatory policies, and stigma.

• Improved joint coordination and monitoring of community-led HIV services for AYP and KP by government and CBO

iii. Strategies and Activities CDC may require or allow applicants to propose additional related strategies and activities other than those identified in the NOFO to achieve the expected Outcomes.

Strategy 1: Use multi-faceted innovative approaches to strengthen and facilitate the uptake of community HIV-prevention services among AYP and KP in selected sub-national units

• Use novel approaches to increase demand for PrEP and HIV self-testing for AYP and KP in the community.

• Implement demand creation activities that will lead to a significant increase in the numbers of AYP and KP that initiate PrEP. These activities will also include providing PrEP education and adherence support and addressing barriers to continuation on PrEP.

This will ensure that persons who initiate PrEP continue for as long as they are at risk

• Assist pregnant women from the community to access supported health facilities and traditional birth centers

• Support the provision of early infant diagnosis services for HIV exposed infants of SW and adolescent girls and young women delivered outside conventional health facilities

• Implement activities to reduce structural barriers for AYP and KP to access health services (including gender-based violence [GBV] and stigma reduction services)

• Support mental health professionals who serve AYP and KP by conducting psychosocial screening (using standardized tools), providing appropriate, direct psychological support, and facilitating escorted referrals to facilities that provide the needed services where indicated

• Develop and implement a plan to build the capacity of community health care workers on gender equity and gender-based violence prevention

• Provide support against human rights infractions through organizations such as International Federation of Women Lawyers and National Human Rights Commission

Strategy 2: Implement partnership-building strategies among stakeholders to address treatment gaps among AYP and KP, and to improve and sustain continuity of HIV care and treatment services at the community level

• Facilitate partnerships between CSOs and the government to support the active referral system for AYP and KP o Active referral is ensuring that an individual who is referred for service uptake is physically escorted to the service delivery point and the required services are either provided or an appointment is secured for services. In the rare cases where there is no physical escort, the point of contact at the receiving service delivery point is duly informed of the referral and an appointment secured. At the end of either of the processes, the referral loop is closed by receiving and documenting feedback from the service provider on service uptake

• Facilitate partnerships between CSOs and the government to support the provision of a full package of treatment services for AYP and KP in the community by ensuring that AYP and KP are provided with prevention, care, and treatment services directly, or properly linked to facilities, or a one-stop-shop for uptake of services required

• Establish drop-in centers and ensure linkages to service delivery points in different communities in the supported states using appropriate models or outlets for uptake of prevention and treatment services

• Coordinate collaborations between the government and CSOs to provide support for community-based adolescent-appropriate activities

• Support assisted disclosures of HIV status in community settings for AYP and KP

• Support treatment literacy programs and soft skill development for AYP and KP

• Work with partners implementing comprehensive HIV services in the state to support the transition to adult treatment program for AYP

• Support client-led adherence and retention approaches tailored for AYP and KP

Strategy 3: Implement innovative project management and ethical data use approaches among stakeholders to monitor, evaluate, and improve the delivery of community-level HIV services for AYP and KP

• Support implementation of appropriate health information solutions for client identification, for monitoring and reporting

• Implement community site-level data quality assessments for monitoring data collection, use, and reporting of program results o Data quality refers to data availability, accuracy, consistency, completeness, timeliness, and integrity

• Support data use for collaborative community stakeholder engagement towards ownership and sustainability

• Document use of routinely collected data to inform the design of interventions and improve service delivery on a continuous basis. This documentation should include information about a feedback loop mechanism to the community and AYP and KP clients on treatment that should be established

• Conduct community site-level supportive supervision to monitor quality of service delivery.

o Supportive supervision is the process of helping staff continuously improve their own work performance

• Develop and implement appropriate community site-level approaches to reinforce gender equity and GBV prevention and ensure correct reporting to national reporting platforms such as the National Data Repository and the National District Health Information System platform

Strategy 4: Strengthen CBOs’ capacities to develop, implement, and support sustainable community service delivery systems, and to collaboratively coordinate, monitor, and champion the AYP and KP HIV-response at national and sub-national levels

• Engage and build capacity of smaller CBOs to expand the full complement of community HIV interventions in other PEPFAR/CDC-supported states

• Build capacity and support network of stakeholder CBOs to sustain engagement with government and CSOs to increase domestic investment in the community HIV response for AYP and KP

• In collaboration with GoN, support AYP and KP networks to coordinate active monitoring of HIV prevention and treatment services in the community

• Sustain a high level of collaboration in the planning, implementation, and supervision of community-led interventions for AYP and KP

In furtherance of the underlying purposes of this NOFO, Recipient is 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.

1. Collaborations

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

The recipient(s) will be expected to collaborate with other CDC-funded implementing partners and government (such as the Nigeria Sustainability and HIV Impact and Program) entities to ensure that HIV prevention, care, and treatment activities being implemented are complementary to existing services to avoid duplication of efforts.

b. With organizations not funded by CDC:

The recipient(s) of this award will be expected to collaborate with relevant government and non-governmental organizations programming or coordinating health response targeting AYP and KP in assigned states and local government areas. Government organizations may include State Departments of Public Health, State Agencies for Control of AIDS, Local Government Health Departments, Primary Healthcare Centers, etc. All AYP and KP networks supported to provide services to these populations should be included in this collaboration.

2. Population(s) of Focus The population(s) of focus for this NOFO include AYP aged 15 - 24, and KP. Specific KP populations of focus include, but are not limited to, PWID, TG, SW, and MSM.

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) or other constitutionally protected statuses.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

In an effort to assure that activities funded through this NOFO (1) affirm and advance, as appropriate, the role of health equity and an equitable, diverse, and inclusive workforce as core principles, and (2) advance the reduction of stigma and discrimination through the promotion, consistent with applicable laws, of civil and human rights to improve the health outcomes of persons at risk of, or living with, HIV and/or TB infection, CDC PEPFAR awards resulting from this NOFO may address the following activities, where and when appropriate:

• Community involvement in the design, implementation, and monitoring of HIV and TB services.

• Training for implementing partners involved in the design, implementation, and/or monitoring of activities on stigma, discrimination, gender equitable norms, human rights, and community engagement to minimize the likelihood for activities to unintentionally increase stigma and discrimination directed towards PLHIV, people with TB, and other

KP.

• Programs to address evidenced health disparities and social barriers (e.g., HIV-related stigma) to HIV and TB services.

• Use of data to monitor disparities and implement strategies to improve access, service use, and outcomes.

iv. Funding Strategy Applicants to this NOFO are encouraged to apply to the Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount. Applications must not exceed this amount.

Component Funding: It is required that all PEPFAR-funded cooperative agreements be formulated for component funding. A component is a discrete set of activities with an associated budget. CDC will use component funding to provide funding for activities proposed in an application that received merit review but were not selected for funding in the initial award (i.e., at the onset of budget period 1) but may be funded at a later point in the budget period as programmatically necessary and as funding becomes available. Please review the following key points about component funding:

• Component funding must be setup at the time of the application. While preparing the application, applicants should review the expectations listed in the NOFO for Year 1 activities and group them under the anticipated components listed below. Only activities planned for Year 1 should be grouped into components; applicants do not need to group activities in the high-level plan for the subsequent years 2-5 of the award into components. Funding amounts and components for years 2-5 will be determined at continuation.

• Each component must be a discrete set of activities with an associated budget.

Distinguishable component budget narratives are required. Setting up components based on time (i.e., quarterly) is an appropriate distinction of activities, provided activities are clearly outlined.

• Applicants should submit the anticipated components on an SF-424A form as part of their application which shows all components for the budget period. The amounts should exactly match what is being requested for funding. Each component has its own approved amount and cannot be funded above the established amount. The combined total of all components must total the requested amount.

• If more than 4 components are proposed, multiple SF-424As will be needed. Applicants may include the first 4 components on one SF-424A form and the remaining components on a second SF-424A form. Applicants may download additional SF-424A forms and upload them as PDFs under “Budget Narrative Attachment Form” or “Other Attachments Form.” These should be clearly labeled for easy identification and included in the Table of Contents for the entire submission.

• If possible, applicants are encouraged to submit a separate budget justification for each component, but it is not a requirement. Applicants will not be deemed incomplete if separate budget justifications are not provided with the submission. A separate budget justification will ultimately be required for all components that are funded.

• Any component that is not funded at the time of a new award may be deemed “Approved but Unfunded (ABU)”. There is no guarantee that all components will be funded in a budget period as ABU components are subject to the availability of funds and the underlying legal authority for the work.

o Components may not be awarded in order. All ABU components are eligible to receive funding once (and if) funds become available.

o If funding becomes available, multiple components can be funded through the same funding action (single NOA).

o If funding is awarded for an amount less than the ABU component approved amount, it is not possible to fund the difference at a later time. Components can only be funded once.

• If, during the funding confirmation, the Program Office approves a budget that differs from what was submitted at the time of application (reflected in the budget markup), a revised budget may be required in addition to the technical review responses. If required, the revised budget is due within thirty (30) days of the start of the budget period. If required, technical review responses will also be due within thirty (30) days of the start of the budget period and must be submitted separately from revised budget applications.

Future funding for ABU components will not be awarded until a revised budget, if required, is submitted and approved by CDC.

• Once components are awarded, funds cannot be redirected between components.

However, funds may be redirected within a component between object class categories.

It is critical to ensure accountability, transparency, and programmatic performance of all U.S.

taxpayer dollars. When developing the annual work plan, please be advised that the annual COP/ROP guidance requires that CDC take decisive action if an implementing partner is underperforming programmatically during any quarter of a fiscal year.

Applicants are encouraged to consider the following in the development of their budgets and budget narratives:

For Year 1, CDC anticipates an Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award of $10,00,000 with the below listed components:

• Component 1: COP Q1 Targets/Activities;

• Component 2: COP Q2 Targets/Activities;

• Component 3: COP Q3 Targets/Activities;

• Component 4: COP Q4 Targets/Activities;

• Component 5: COP Additional Targets/Activities;

• Component 6: Emerging Public Health Priorities.

Applicants must specify a descriptive title for each corresponding column shown on the SF- 424A, followed by the total (cumulative) in the column to the far right of the SF-424A.

Applicants are encouraged to use the components listed above, but may propose alternative budget components so long as the general component funding guidance is followed.

Funding provided under this NOFO is subject to the availability of funds. The total number of years for which federal support has been programmatically approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. All future year funding will be based on satisfactory programmatic progress and the availability of funds.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

CDC expects that routine performance data are reviewed, cleaned, and utilized for program management. To this end, recipient(s) should ensure systems are in place to generate data and hold quarterly review meetings to drive programmatic performance and use of data in program quality improvement activities.

The recipient(s) should allocate funds made available under this NOFO to support evaluation activities and performance monitoring. While the final funding amount will be agreed upon by both CDC and the recipient(s), a minimum of 10% of funds should be allocated for monitoring activities and 5% of funds used for evaluation activities. These are estimates for the total funding over the 5-year project period.

PERFORMANCE MONITORING

Performance measures will include both PEPFAR (MER) and non-MER indicators. The recipient(s) will be responsible for reporting on selected MER indicators listed below as implemented at community level and should propose additional relevant non-MER custom indicators as part of their initial Evaluation and Performance Measurement Strategy.

Illustrative indicators, targets, and reporting frequencies corresponding to Year 1 of the NOFO are shown below. Applicants should note that these may be adjusted, or new targets and indicators may be identified in subsequent years based on implementation of HIV/AIDS epidemic control strategies and program priorities. Any gaps or unmet needs not fulfilled in the first year may affect the targets of the subsequent years.

Unless otherwise indicated, the reporting periods for MER indicators will mirror the PEPFAR MER indicator reporting frequency (quarterly, semi-annually, and annually). Additional information regarding MER reporting is included in the MER Guidance and resource materials, available at the following link (copy/paste into web browser to access):

https://datim.zendesk.com/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides.

PEPFAR MER Process and Outcome Measures:

• PrEP_NEW: Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period [Target: 7,227;

Reporting Frequency: Quarterly]

• PrEP_CT: Number of individuals, excluding those newly enrolled, that return for a follow-up visit or re-initiation visit to receive PrEP to prevent HIV during the reporting period [Target: 3,614; Reporting Frequency: Quarterly]

• HTS_SELF: Number of individual HIV self-test kits distributed [Target: 12,569;

Reporting Frequency: Quarterly] https://datim.zendesk.com/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• KP_PREV: Number of key populations reached with individual and/or small group-level HIV prevention interventions designed for the target population [Target: 129,094;

Reporting Frequency: Semi-annually]

• HTS_TST: Number of individuals who received HIV Testing Services (HTS) and received their test results [Target: 86,063; Reporting Frequency: Quarterly]

• HTS_RECENT: Number of newly diagnosed HIV-positive persons who received testing for recent infection with a documented result during the reporting period [Target: 5,164;

Reporting Frequency: Quarterly]

• TX_NEW: Number of adults and children newly enrolled on antiretroviral therapy (ART) [Target: 5,060; Reporting Frequency: Quarterly]

• TX_CURR: Number of adults and children currently receiving antiretroviral therapy (ART) [Target: 4,959; 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: 50; 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_PVLS: Percentage of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented in the medical or laboratory records/laboratory information systems (LIS) within the past 12 months [Target: 4,860; Reporting Frequency: Quarterly]

• GEND_GBV: Number of people receiving post-gender-based violence (GBV) clinical care based on the minimum package [Target: 1,870; Reporting Frequency: Semi-annually]

Non-MER: Additional Performance Measures (Custom Indicators)

Applicants should propose additional custom performance measures to monitor achievement of outcomes not directly measured by PEPFAR MER indicators. Custom indicators should include process and outcome measures directly correlated with the logic model. Proposed indicators will be reviewed and refined in the first 6 months of the project period to ensure they align appropriately with the goal of AYP and KP treatment outcomes, capacity building, stakeholder engagement and sustainability. Below are examples of additional output, process, and outcome measures for the strategies/activities and outcomes previously discussed in the logic model and associated narrative sections.

• Number of individuals who received HIV testing service and received a positive result [Target: 5,164; Reporting Frequency: Quarterly]

• Number of CBO workers trained in treatment support services [Target: 2,000; Reporting Frequency:…