Foa_Content_of_CDC-RFA-GH-24-0101.pdf

Centers for Disease Control and Prevention

Center for Global Health

Improving Integrated Surveillance Methods and Quality of Public Health Systems to Address HIV in Jamaica and Trinidad & Tobago under the President's Emergency Plan for AIDS Relief

(PEPFAR)

CDC-RFA-GH-24-0101

02/27/2024

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-24-0101. 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:

Improving Integrated Surveillance Methods and Quality of Public Health Systems to Address HIV in Jamaica and Trinidad & Tobago 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.

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)

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-GH-24-0101

E. Assistance Listings Number:

93.067 F. Dates:

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

2. Due Date for Applications:

02/27/2024 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 Strategic Information is a key priority for the Centers for Disease Control and Prevention (CDC) Caribbean Regional Program, as well as for PEPFAR and the focus countries of Jamaica and Trinidad and Tobago in general. This NOFO aims to build upon past and current activities and advance the strategic information portfolio through continued strengthening of data systems, including enhanced data quality, analysis, and reporting. The NOFO will also seek to support the development of national data protection policies to strengthen data security and privacy.

Activities are expected to ensure high-quality data are available to inform programming and move both countries towards achieving sustained HIV epidemic control. Within this new period, country ownership and sustainability will be emphasized by partnering with entities like universities or other local partners. This NOFO is intended to strengthen health information systems, including integrated surveillance systems, and improve data quality and utilization for program planning to address HIV in Jamaica and Trinidad and Tobago. Support will be provided to strengthen data collection, analysis and use at site, sub-national, and national levels. Activities will include monitoring and evaluation to inform program design and assess the effectiveness of interventions to improve program results and service delivery.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$0 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.

https://www.grants.gov/

e. Average One Year Award Amount:

$2,500,000 The Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount for Year 1 is $2,500,000. The expected number of awards is 1. 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 The goal of the Caribbean Regional program is to support the governments of Jamaica and Trinidad and Tobago to achieve HIV epidemic control, move toward the UNAIDS targets of 95- 95-95, and end HIV as a public health threat by 2030 while sustainably strengthening public health systems. The Caribbean Region continues to use evidence-based information to drive programming decisions, policies, and guidance in closing the gaps remaining to achieve and sustain the 95-95-95 targets. The greatest need being addressed is the slow achievement of diagnosing new cases, keeping people on treatment while keeping those in care virally suppressed.

Closing the remaining gaps will require embracing and elevating the best new scientific innovations and ensuring that programming is data-driven.

Developing the right strategic direction requires data that will highlight major gaps in the current approach and underscore the effect of program shifts and direction for proper alignment of resources. Strategic information activities are related but not limited to:

• Surveillance, monitoring & evaluation (M&E)

• Health information systems (HIS)

• Statistical and analytical methods and modeling

• Laboratory, survey, financial, and commodities data. These activities are all essential to providing the required information for programming to drive and monitor the HIV response and attain epidemic control.

As Jamaica and Trinidad and Tobago get closer to reaching epidemic control, it is important to 1) advance the improvement and sustainability of data systems through the continued expansion of interoperable, integrated, and robust surveillance and monitoring programs in the region and 2) build capacity for health systems strengthening.

Understanding the characteristics and needs of key and priority populations (PP), knowledge of their HIV status, antiretroviral (ARV) treatment status, and viral load suppression (VLS) rates are among the highest priorities. To address these priorities, surveillance data needs to be of the highest quality as they inform the strategies to find un-diagnosed PLHIV, get them on treatment quickly, and suppress their VLs. It is important that the health surveillance systems are strengthened and that data quality monitoring practices are improved. The goals and priorities of the NOFO include the following Strategic Information Strategies:

• Provide regional technical assistance in the strengthening, integrating, and sustaining data management and reporting systems by developing standard operating procedures and supporting data analysis and reporting for programmatic action.

• Provide technical assistance in conducting general population, key and priority population-based surveys, and program assessments and evaluations.

• Support capacity building in data management, utilization and strategic information for country ownership and sustainability by utilizing resources such as the CDC’s Health information systems training, including ILEAD, GEEKS and I4L.

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 This NOFO builds upon the previous NOFO (GH19-1951), Strategic Information Support Across Countries under the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria and under the President's Emergency Plan for AIDS Relief (PEPFAR). The implementation of the previous NOFO has helped advance strategies to provide targeted support for strengthening monitoring and evaluation (M&E) activities and HIS for targeted and timely program improvement; provide targeted support for developing and implementing HIV survey and surveillance activities; and provide targeted support for developing statistical methods and modeling for HIV data analysis and use at the national, subnational, site, program, laboratory, and implementing partner levels.

Through this NOFO, CDC will continue to support developing and implementing cutting-edge global strategic information activities for program monitoring and understanding the magnitude and direction of HIV epidemics. This current NOFO will continue to build on ensuring that high-quality data are available to inform programming and move the countries toward achieving sustained HIV epidemic control. It will also assist with developing robust data quality health information and improvement systems, enhancing surveillance practices, and ensuring that programming is data-driven and embraces the best in scientific innovation. Specific focus will be placed on supporting country ownership and sustainability of all the processes and programs implemented.

2. CDC Project Description

a. Approach 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

Bold indicates period of performance outcome.

Strategies and Activities

Short-Term Outcomes

Intermediate

Long-Term

Strategy 1: To provide technical assistance (TA) to two (2) countries for the strengthening, integration, and sustainability of data management and reporting systems in developing standard operating procedures (SOP), and supporting data analysis and reporting for programmatic action

Strategy 2: To support the implementation of robust surveillance, surveys, and M&E activities essential to inform public health policy and programs for key populations (KP) and priority populations (PP)

Strategy 3: To build the capacity of Ministry of Health (MoH) staff to effectively manage, analyze, and use survey, surveillance, and program data for decision-making with standardized triangulation and validation of data

Improved integration and functionality of HIV-related information management systems

Increased availability of high-quality HIV data for decision-making through integrated HIS and data management systems

Improved adherence to data quality, security, and privacy standards timeliness of program monitoring through the use of targeted metrics and indicators for the local context understanding and use of existing and new data systems (e.g., TSIS and

Improved development and compliance with M&E, surveillance, and HIS policies and frameworks integration of M&E activities in national country plans as routine activities timeliness, integration, and use of high-quality program data for evidence-based decision-making

Improved use of high-quality KP size estimates through surveys, statistical, and modeling methods capacity of staff to effectively manage, generate and analyze high-

Increased government (GOV) ownership to lead a sustained evidence-based public health program planning using high-quality data and better statistical analysis and modeling

Improved public health policies and programs for KP and PP

Reduced

HIV/AIDS

incidence and related morbidity and mortality

Strategies and Activities

Short-Term

Intermediate

Long-Term

DHIS2) for surveillance and survey development quality program data and timely reporting at all levels

i. Purpose The purpose of this NOFO is to strengthen health information systems and improve data quality and utilization for program planning to address HIV in Jamaica and Trinidad and Tobago. The support aims to strengthen data collection analysis and use at site, sub-national, and national levels through M&E to inform program design and improve program results and service delivery. It will further strengthen infrastructural and human resource capacity to enhance strategic information driving evidence-based decision-making for program improvement.

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:

• Improved integration and functionality of HIV-related information management systems

• Increased availability of high-quality HIV data for decision-making through integrated

HIS and data management systems

• Improved adherence to data quality, security, and privacy standards

• Improved timeliness of program monitoring through the use of targeted metrics and indicators for the local context

• Improved understanding and use of existing and new data systems (e.g., TSIS and

DHIS2) for surveillance and survey development

Intermediate Outcomes:

• Improved development and compliance with M&E, surveillance, and HIS policies and frameworks

• Increased integration of M&E activities in national country plans as routine activities

• Improved timeliness, integration, and use of high-quality program data for evidence-based decision-making

• Improved use of high-quality KP size estimates through surveys, statistical, and modeling methods

• Increased capacity of staff to effectively manage, generate and analyze high-quality program data and timely reporting at all levels o Reporting at all levels will include site, national, and international reporting

Long-Term Outcomes:

• Increased GOV ownership to lead a sustained evidence-based public health program planning using high-quality data and better statistical analysis and modeling

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: To provide technical assistance (TA) to two (2) countries for the strengthening, integration, and sustainability of data management and reporting systems in developing standard operating procedures (SOP) and supporting data analysis and reporting

• Provide TA to the MoH for the integration and interoperability of health systems for laboratory, care and treatment, surveillance, and human resources for health or workforce information systems

• Support the scale-up of case-based surveillance, data quality, triangulation, and analysis for signaling public health responses

• Develop, implement, and provide targeted support or quality standards assessment and M&E tools for HIV Strategic Information (e.g., HIS, data collection, data analysis, survey, statistical modeling, visualization) at national, sub-national, and international levels stratified by KP and PP

• Increase the use of health information and data management systems in the analysis and reporting for programmatic action

• Use of HIV case-based surveillance data through integrated HIS and data management systems for clinical care data for decision-making

• Update and develop SOPs as necessary to govern data utilization, security and privacy, and data quality activities

• Support the MOH to enhance network connectivity to all facilities for real-time collection and transmission of patient-level data to the national health data warehouse

• Strengthen the Health Information Exchange platform to support additional interoperability use cases within MOH and between MOH and other stakeholders in the government, private sector, and community level

Strategy 2:To support the implementation of robust surveillance, surveys, and M&E activities essential to inform public health policy and programs for KP and PP.

• Support the development and implementation of program evaluations

• Implementation of general population, KP and PP population-based surveys, and program assessments and evaluations

• Development of statistical and modeling methods from analysis of population estimate and program data

Strategy 3:To build the capacity of MoH staff to effectively manage, analyze, and use survey, surveillance, and program data for decision-making with standardized triangulation and validation of data.

• Implement capacity-building activities to improve MOH’s ability to effectively manage data collection, analysis, report, and use and to improve data quality across the continuum of care across all populations, including key and priority populations, for a better understanding of the HIV epidemic and sustaining epidemic control efforts in CRO (areas of health information systems/HMIS for case-based surveillance, care and treatment, laboratory and human resource for health, M&E, and surveys)

• Build capacity of MOH to manage, monitor, and evaluate the HIV/TB programs

• Develop a standardized M&E system (including an M&E plan with clear indicators, registers, and reporting tools) to capture community-level interventions

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 will need to work collaboratively with CDC subject-matter experts – local and headquarters staff, as well as CDC-funded implementing partners and government ministries, including the MOH and other international and regional public health organizations within the region such as UNAIDS, WHO/PAHO, UNICEF, on all activities at both the national and sub-national levels. CDC country offices will assist the recipient(s) in connecting with other CDC-funded partners working in this area. The recipient(s) will ensure work is not duplicative but complimentary and supportive to other work funded by CDC.

b. With organizations not funded by CDC:

The recipient will need to work collaboratively with organizations not funded by CDC:

• United States Government (USG): Other USG agencies, namely – the United States Agency for International Development (USAID) and Health Resources and Service Administration (HRSA) have a presence that provides national program support to Jamaica and Trinidad and Tobago. Collaboration will be needed to facilitate efforts.

• Multilateral and non-governmental organizations (NGO):Multilaterals such as Global Fund at varied levels along with local NGOs/CSOs, whether funded by other PEPFAR implementing agencies or other donors, to form relationships to fulfill project outcomes.

2. Population(s) of Focus The populations of focus for technical support are national and decentralized public health institutions and their associated staff throughout the country. The key beneficiaries will be MOHs, implementing partners working with HIV/TB treatment, care, and prevention programs, and PEPFAR-supported country officials. The strategic information activities will target all populations affected by HIV and TB epidemics, including general, key and priority populations.

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 under-performing 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 $2,500,000 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 (EPHP) 1;

• Component 7 – EPHP 2.

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 the routine performance data is reviewed, cleaned, and used for program management. To this effect, the recipient should hold regular review meetings to discuss performance and use data in program quality improvement activities.

The recipient should allocate funds made available under this NOFO for both evaluation activities and performance monitoring. While the final funding amount will be agreed upon by both CDC and the recipient, a minimum of 7% of funds should be allocated for monitoring activities and 5% of funds should be used for evaluation activities. These are estimates for the total funding over the 5-year project.

PERFORMANCE MONITORING

Some anticipated PEPFAR (MER) and non-MER indicators, targets, and reporting frequencies corresponding to Year 1 of the NOFO are shown below. Applicants should also propose any additional relevant PEPFAR MER and non-MER indicators as part of their initial Evaluation and Performance Measurement Strategy.

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:

• EMR_SITE: Number of PEPFAR-supported facilities that have an electronic medical record (EMR) system within the following service delivery areas: HIV Testing Services, Care & Treatment, Antenatal or Maternity Services, Early Infant Diagnosis or Under Five Clinic, or TB/HIV Services [Target: 100%; Reporting Frequency: Annual]

Non-MER: Additional Performance Measures (Custom Indicators)

Applicants should propose additional custom performance measures to monitor the achievement of outcomes not directly measured by PEPFAR (MER) indicators. Custom indicators should include process and outcome measures directly correlated with the logic model. Below are examples of additional process and outcome measures for the strategies/activities and outcomes previously discussed in the logic model and associated sections.

• Percentage of disparate information systems linked [Target: 95%; Reporting Frequency:

Annually]

• Percentage of sites reporting improved data quality for M&E [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of sites conducting enhanced monitoring routinely [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of sites utilizing monitoring data dashboard [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of sites with established SOPs for data quality assessments (DQA) [Target:

95%; Reporting Frequency: Quarterly]

• Percentage of sites conducting DQA routinely [Target: 95%; Reporting Frequency:

Quarterly]

• Percentage of people trained in M&E and data analysis methods [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of data analyses and products that are presented and disseminated to relevant stakeholders [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of M&E activities that are conducted routinely at the national and subnational level [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of innovative data collection, management, analysis, and use methodologies are integrated into national activities [Target: 95%; Reporting Frequency: Quarterly]

• Percentage of people trained in novel statistical methods and approaches for data analysis [Target: 95%; Reporting Frequency: Quarterly] https://datim.zendesk.com/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

• Development of national report and publications within 1 year of the analysis workshop [Target: 2 products; Reporting Frequency: Annual]

Data Sources for MER and Custom Indicators: Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress, M&E, data analysis, surveillance and survey reports, and other program monitoring tools, training reports

Evaluation

The evaluation topics below are examples of areas that the recipient may be expected to answer through process or outcome evaluation(s). Applicants should include at least 1, but no more than 3 potential evaluation topic areas. Recipients will be expected to conduct a mid-term and/or end-year evaluation.

Sample Evaluation Topics:

• Effectiveness of program data quality in health facilities and community sites to provide more accurate program data for understanding patient outcomes and program [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 may include local and international conferences and forum abstract presentations, conference poster displays, manuscripts, bulletins, reports, presentations to technical working groups and stakeholder meetings, and other approved products in print and electronic media. The primary intended users of evaluation results and findings will be the wider program stakeholders. All evaluation reports will be publicly available on PEPFAR resource sites. CDC and stakeholders will use overall evaluation findings during the five-year NOFO period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement upon completion of the award. All evaluation reports will be shared with the partners involved. Before dissemination, data will be validated by comparing reports and results from quantitative and qualitative indicators with program objectives.

Evaluation report will be developed and share with CDC, country PEPFAR team and survey stakeholders.

Evaluations and strategy should align with national, PEPFAR, and agency requirements and priorities, and will be reviewed and may require approval as part of the COP/ROP. As such, the example evaluation topics listed in this NOFO may be amended based on feedback from the GHSD Bureau during the annual COP/ROP review process.

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

• How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement, including, as applicable to the award, how findings will contribute to reducing or eliminating health disparities and inequities.

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

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

• How evaluation findings will be disseminated to communities and populations of interest in a manner that is suitable to their needs.

• Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

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

• Describe key evaluation questions to be addressed by these evaluations.

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

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

Applicants should submit their initial data management plan (DMP) as part of their initial evaluation and performance measurement plan (EPMP). This should include cybersecurity plans and information about how PII will be protected when collected, stored, in transit, and in use. In addition, the initial DMP should include a description about how data will be de-identified in intermediate and final data sets.