Foa_Content_of_CDC-RFA-GH-24-0105.pdf

Centers for Disease Control and Prevention

Center for Global Health

Technical Assistance to Deliver Comprehensive HIV/AIDS Prevention, Care and Treatment Activities in the Republic of Cote d’Ivoire under the President Emergency Plan for AIDS Relief

(PEPFAR)

CDC-RFA-GH-24-0105

03/25/2024

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-24-0105. 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:

Technical Assistance to Deliver Comprehensive HIV/AIDS Prevention, Care and Treatment Activities in the Republic of Cote d’Ivoire under the President 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.

CDC has retired the Risk Assessment Questionnaire Requirement and applicants are no longer required to submit the CDC Risk Questionnaire as part of their NOFO application. CDC 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) continues to conduct the review of risk posed by applicants described in Phase III Review and may ask for additional information prior to the award based on the results of the review. Risk Questionnaires that are submitted will not be included in this risk review.

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-GH-24-0105

E. Assistance Listings Number:

93.067 F. Dates:

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

2. Due Date for Applications:

03/25/2024 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 build on previous PEPFAR support under the HHS/CDC HIV treatment program in Côte d'Ivoire (CI) to ensure continuity of comprehensive HIV/AIDS services to an existing pool of clients receiving HIV/AIDS care, support, and/or treatment. The program will also continue expanding access to HIV/AIDS services while building the capacity of national structures and contributing to sustainable service delivery within the health sector in CI.

Specifically, it will seek to increase national capacity to maintain and build on gains in the response toward the HIV/AIDS epidemic by providing technical assistance to the decentralized entities of the national Ministry of Health, Public Hygiene, and Universal Health Coverage (MSHPCMU). By the end of the project, the recipient(s) should be able to demonstrate measurable improvement in the capacity of the Ministry of Health, Public Hygiene, and Universal Health Coverage to deliver quality HIV prevention, care, and treatment services in CI and sustain a basic HIV service package.

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:

$4,000,000 The Approximate Total Fiscal Year Funding/Average One Year Award Amount/Approximate Average Award amount for Year 1 is $4,000,000. 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 The preliminary results of CI’s recent 2021 census estimated a population of 28,096,651 permanent residents with a growth rate of 2.9% between 2014 and 2021 (National Institute of Statistics – INS, 2021 Census). Most of the population resides in cities with 15,152,232 (53.9%) people living in cities compared to 12,944,419 (46.1%) in rural areas. The census confirmed the percent of males (52.2%, 14,669,207) is higher than females (47.8%, 13,427,444). The estimated Ivorian population under age 15 is 11,271,234, or 42.2%.

The 2023 Joint United Nations Program on HIV/AIDS (UNAIDS) estimates show that CI’s adult (15-49) HIV prevalence is estimated at 1.82%, compared to 2.9% as reported in the 2017/2018 population-based HIV Impact Assessment (PHIA) among 15- to 64-year-olds. Much higher estimates exist among female sex workers (FSW) and men who have sex with men (MSM) (10.2% and 10.7% respectively). The same spectrum model estimates that in 2022, there was a total of 407,595 people living with HIV (PLHIV), including 20,981 children living with HIV (CLHIV) and approximately 15,000 pregnant women who need antiretrovirals (ARVs). The annual incidence of HIV is 0.03%, resulting in 8,978 new HIV infections in 2022 (1,639 among children). An estimated 9,952 AIDS-related deaths occurred in 2022 in CI (1,075 among children).

CI has made substantial progress toward controlling the HIV epidemic over the past two decades. The number of PLHIV on antiretroviral therapy (ART) nationwide increased from 4,536 in 2004 to 292,663 in 2022. Of these, 250,138 PLHIV (85%) are receiving ART at 516 ART facilities and the military primary sub-national unit (PSNU) supported by PEPFAR as of FY23Q2. While the success of the initiation of lifelong antiretroviral therapy for all HIV-infected pregnant women is contributing to progress towards achievement of the first 95 of the UNAIDS’s 95-95-95 goals among women living with HIV (85% know their status), significant gaps remain in the first 95 among CLHIV (only 44% know their status) and men living with HIV (74% know their status). In PEPFAR-supported sites which account for 85% of all CLHIV on ART, over 98% of all CLHIV are on dolutegravir (DTG)-based regimens. This has resulted in a significant but still sub-optimal improvement in viral load suppression (VLS) among children from 66% (FY21Q1) to 87% (FY23Q2) at PEPFAR-supported sites, driving an increase in national VLS among children from 66% (CY2020) to 77% (CY2022). Persistent systemic barriers include insufficient integration of HIV services in the basic care package, limited ownership/engagement of providers, lack of fidelity in the implementation of policies and guidelines, limited accountability, and extensive donor/partner support in service delivery.

This NOFO should primarily support the Government of Cote d’Ivoire (GoCI) to ensure that client-centered direct service delivery to all PLHIV and those at risk for HIV are in line with national guidelines and PEPFAR strategic objectives by providing high quality and targeted technical assistance and capacity building to the decentralized entities (primarily the health districts) of the MSHPCMU. This includes assessing Cote d’Ivoire’s health system at the decentralized levels and providing creative solutions to fill gaps in the system, particularly related to the areas of service delivery, workforce capacity and development, the medical product supply chain, health information systems, financing and leadership/governance for the delivery of quality and sustainable HIV services.

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 Over these past two decades, CDC through PEPFAR has been supporting the GoCI in responding to the HIV epidemic. The support was provided through a variety of implementing partners, including facility and community-based service delivery partners, technical assistance, and institutional partners. The collaboration resulted is a rapid scale-up of comprehensive HIV prevention, treatment, and care services nationwide and CDC was, up until recently, the main agency supporting clinical services in the public health sector for PEPFAR. Activities funded under the cooperative agreement (CoAg) with the MHSPCMU were mainly focused on strengthening the capacity of the ministry in leadership, coordination, and management of the response at the central level because of inability to directly fund these decentralized levels (health regions and districts) which do not have financial autonomy. This challenge resulted in weaknesses of these entities to effectively lead, coordinate, and oversee the implementation of HIV services explaining gaps in reaching epidemic control in many of the PEPFAR supported districts.

The recipient(s) will work primarily in collaboration with, and support MSHPCMU’s local health departments (health districts) in Cote d’Ivoire to improve the breadth, scale, and quality of HIV service and prevention, care and treatment services delivered throughout the country and ensure the sustainability of their program(s) either through capacity building of their own organization or other organizations. The term “capacity building” means the provision of information, technical assistance, training, and technology transfer for individuals and organizations to improve the delivery and effectiveness of HIV services. Capacity building might 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 focus on host government health agencies, local non-governmental organizations, points of service delivery, or health care professionals working at facilities not receiving direct support. To promote sustainability, recipient(s) will have clearly defined capacity development plans with measurable outcomes.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strategy 1: Provide technical assistance to strengthen human capacity and systems to deliver quality HIV services at the regional and district levels

Strategy 2: Provide technical assistance to improve clinical and community service delivery practices for HIV prevention, care, and treatment services

Strategy 3: Support MSHPCMU to improve coordination, planning and supervision of HIV services at the regional, district, site and community levels

Increased knowledge and skills of health care workers (HCW) on HIV prevention, care, and treatment

Improved management of health care workforce for the delivery of HIV

Improved fidelity in the implementation of policies, guidelines, and procedures for HIV service

Improved reliability of the decentralized supply chain systems for HIV commodities

Improved management of information systems and continuous quality improvement (CQI)

Improved HIV case finding, linkage, and treatment for PLHIV sub-populations

Improved access to and quality of HIV prevention, care, and treatment availability of quality HIV data to inform decision-making leadership, oversight, and accountability of HIV at the regional, districts, site, and community levels

Sustained identification, linkage to treatment and ART initiation for PLHIV sub-

Sustained implementation of quality clinical and community HIV

Reduced risk of HIV infection among vulnerable

Increased viral load coverage (VLC) and VLS among PLHIV, pregnant or breastfeeding women (PBFW), infants, children and

KP

Increased decentralized level

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes systems for HIV coordination, planning and accountability of regional and district health management teams to deliver quality HIV services ownership of national HIV response

i. Purpose The purpose of this NOFO is to increase the local capacity and sustainability of the response to the HIV epidemic in CI by providing technical assistance to MSHP central and decentralized entities to coordinate, plan, supervise and monitor the delivery of quality HIV services. This will improve the health regional and district’s management capacity and functioning for planning, oversight, coordination, integration of HIV and other health services. The recipient(s) should work with selected regions’ and districts’ health management teams to develop annual plans for improving HIV services.

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 knowledge and skills of HCW on HIV prevention, care, and treatment services

• Improved management of health care workforce for the delivery of HIV services

• Improved fidelity in the implementation of policies, guidelines, and procedures for HIV services

• Improved coordination, planning and accountability of regional and district health management teams to deliver quality HIV services

Intermediate Outcomes:

• Improved HIV case finding, linkage, and treatment for PLHIV sub-populations

• Improved access to and quality of HIV prevention, care, and treatment services

• Improved leadership, oversight, and accountability of HIV at the regional, districts, site, and community levels

Long-Term Outcomes:

• Sustained identification, linkage to treatment and ART initiation for PLHIV sub-

• Sustained implementation of quality clinical and community HIV services

• Reduced risk of HIV infection among vulnerable populations

• Increased VLC and VLS among PLHIV, PBFW, infants, children and KP

• Increased decentralized level ownership of national HIV response

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:Provide technical assistance to strengthen human capacity and systems to deliver quality HIV services at the regional and district levels

• Assess the existence and capacities of the pool of regional and district trainers in HIV prevention, care and treatment services

• Train/refresh the pool of regional and district trainers on up-to-date national policies, guidelines and procedures on HIV prevention, care, and treatment services

• Support districts to conduct district-level training of providers in collaboration with service delivery implementing partners

• Establish a structured quality assurance approach for training to ensure fidelity of the training of the front-line workers at facility and community sites

• Provide ongoing mentorship and technical assistance for training on HIV services

• Support the development a tool to support the region and district officers in rationalizing the deployment and management of health care workers providing HIV services

Strategy 2:Provide technical assistance to improve clinical and community service delivery practices for HIV prevention, care, and treatment services

• Assist regional and district health management teams in the enforcement of HIV policies and guidelines with the goal of improving HIV services and outcomes

• Review, update or develop regional and district-level clinical guidelines, training materials, job aids, program reports, and evaluating other support labs and services

• Assist regions and districts in planning, conducting, and evaluating HIV programs and activities

• Support regions and districts for documenting, evaluating, and disseminating best practices for HIV-related service provision in the community and health systems

• Provide technical assistance to perform evaluations and analysis of data for HIV services

• Support the development and implementation of program quality assurance, quality improvement, and quality of care standards for HIV services at the regional and district levels

• Support district level and facility-based systems to manage HIV commodities

• Support the implementation of the national sample transportation systems at the regional and district levels for all sites

• Support program evaluations using qualitative and quantitative techniques, to assess the impact of HIV prevention, care and treatment programs and interventions on specific populations such as PLHIV, adults and children

Strategy 3:Support MSHPCMU to improve coordination, planning and supervision of HIV services at the regional, district, site, and community levels

• Train regional and district health management team on effective leadership and sound management practices

• Assist region and district health management teams in planning and organizing standing coordination meetings to review HIV and other health related data to inform program changes

• Support region and districts to develop guidelines and tools for an effective integrated supervision for HIV and other health care services

• Support regions and districts to develop supervision plans

• Train region and district health management teams in conducting integrated or thematic supervisions

• Train regions and district health management teams to analyze supervision and/or other quality assurance data to inform program improvement

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:

• The MSHPCMU at the central and decentralized levels, including the Directorate General for Health, the National HIV/AIDS Control Program (PNLS), the health regions and health districts and the sites.

• The Ministry of Family Women and Children (MFFE) through the National OVC Care Program (PNOEV)

• CDC-funded clinical IPs to help return and maintain clients in care.

• CDC-funded community IPs to ensure care continuum at the community level.

• CDC-funded laboratory IPs to support laboratory activities.

• CDC-funded civil society organizations (CSOs) as applicable

• UNAIDS

b. With organizations not funded by CDC:

The recipient will be expected to collaborate with non-CDC-funded CSOs; non-CDC funded PEPFAR recipients (including USAID and DoD IPs); Global Fund, WHO, and UNICEF.

2. Population(s) of Focus The population(s) of focus for this NOFO include primarily health region and district officers, and secondarily PLHIV, children <15, PBFW, Women of childbearing age, Men aged 15 years and older, KPs (MSM, FSW, transgender women [TGW], people who inject drugs [PWID]) as pertains specifically to clinical and community service delivery.

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 $4,000,000 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: COP Special Funds Target/Activities.

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 5% 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 non-MER indicators, targets, and reporting frequencies corresponding to Year 1 of the NOFO are shown below. Applicants should also propose any additional relevant 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.

Currently, reporting on PEPFAR monitoring, evaluation, and reporting (MER) indicators is not applicable to the scope of this NOFO, although that is subject to change in future project years.

Some custom (non-MER) indicators, targets, and reporting frequencies corresponding to Year 1 to 5 of the NOFO are shown below. The applicant should also propose additional relevant custom 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.

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. Below are examples of additional process and outcome measures for the strategies/activities and outcomes previously discussed in the logic model and associated sections.

• Number of health care workers trained in HIV prevention, care and treatment services to serve in the regional health management team: [Target: 100; Reporting Frequency: Quarterly]

• Number of health care workers trained in HIV prevention, care and treatment to serve in the district health management team [Target: 200; Reporting Frequency:

Quarterly]

• Number of heath care workers trained in HIV services: [Target 1500; Reporting Frequency: Quarterly]

• Number of supervisions conducted to assess the quality of training [Target: 240;

Frequency: Quarterly]

• Number of coordination meetings held in the health regions [Target: 40; Reporting Frequency: Quarterly]

• Number of coordination meetings held in the health districts [Target: 80; Reporting Frequency: Quarterly]

• Number of health regions with annual health plans, including HIV [Target: 10;

Reporting: Annual]

• Number of health districts with annual health plans, including HIV [Target: 20;

Reporting: Annual]

• Number of supervisions conducted by health regions [Target: 40; Reporting:

Quarterly]

• Number of supervisions conducted by health districts [Target: 80; Reporting:

Quarterly]

• Number of supervision guidelines and tools for regions and districts produced and disseminated [Target: 2; Reporting: Annual]

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

Evaluation

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:

• Extent to which regional health management teams (RHMT) and district health management teams (DHMT) conduct effective supervision of HIV services [Outcome Evaluation]

• Effect of improved coordination on HIV indicators at the supported districts [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.

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.

https://www.cdc.gov/grants/additional-requirements/ar-25.html

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. Finally, where data collected or generated under this award may be sought by PEPFAR or CDC, recipient(s) will be informed about the need to share such information and how to send such information to PEPFAR or CDC.

c. Organizational…