HAB HRSA-22-018 (H89) RWHAP Part A Emergency Relief_Final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau Division of Metropolitan HIV/AIDS Programs

Ryan White HIV/AIDS Program Part A HIV Emergency Relief Grant Program

Funding Opportunity Number: HRSA-22-018

Funding Opportunity Type(s): Competing Continuation Assistance Listings (CFDA) Number: 93.914

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: October 06, 2021

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: June 11, 2021

Chrissy Abrahms Woodland Director, Division of Metropolitan HIV/AIDS Programs Telephone: (301) 443-1373 Fax: (301) 443-5271 Email: CAbrahms@hrsa.gov

Authority: 42 USC §§ 300ff-11 to -20 and 300ff-121 (sections 2601–2610 and 2693 of the Public Health Service (PHS) Act).

mailto:CAbrahms@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2022 Ryan White HIV/AIDS Program (RWHAP) Part A HIV Emergency Relief Grant Program. The purpose of this program is to provide direct financial assistance to an Eligible Metropolitan Area (EMA) or a Transitional Grant Area (TGA) that has been severely affected by the HIV epidemic. This competition is open only to Part A jurisdictions to provide RWHAP services in the geographic service areas described in Appendix B. Eligible jurisdictions may apply for an amount up to the defined funding ceiling listed in Appendix B, which represents a level five percent above the final FY 2021 award.

Funding Opportunity Title: Ryan White HIV/AIDS Program Part A

HIV Emergency Relief Grant Program Funding Opportunity Number: HRSA-22-018 Due Date for Applications: October 06, 2021 Anticipated Total Annual Available FY 2022 Funding:

$630,000,000, of which approximately $11,200,000 will be used for priority funding, and $51,000,000 will be available for Minority AIDS Initiative funding.*

Estimated Number and Type of Award(s): Up to 52 grants Estimated Award Amount: Varies, see Appendix B Cost Sharing/Match Required: No Period of Performance: March 1, 2022, through February 28, 2025 (three years) Eligible Applicants: RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to meet the eligibility criteria as defined in the statute are eligible to apply for these funds.

See Section III-1 of this notice of funding opportunity (NOFO) for complete eligibility information.

*Estimated annual available funding level based on current projections.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

All interested applicants are encouraged to participate in a technical assistance (TA) webinar for this funding opportunity. The purpose of this webinar is to assist potential applicants in preparing applications that address the requirements of this funding notice. Participation in the pre-application TA webinar is optional.

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Thursday, July 29, 2021 Time: 2 p.m. to 4 p.m. ET Call-In Number: 1-833-568-8864 Meeting ID: 161 128 0187 Passcode: 08815036 Weblink: https://hrsa-gov.zoomgov.com/j/1611280187?pwd=cU02Y0lCUkh6bnBqQ2c3eEZoZDZZZz09 Playback Number: The recorded webinar will be available on the TargetHIV website.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1611280187?pwd=cU02Y0lCUkh6bnBqQ2c3eEZoZDZZZz09 https://hrsa-gov.zoomgov.com/j/1611280187?pwd=cU02Y0lCUkh6bnBqQ2c3eEZoZDZZZz09 https://targethiv.org/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: A

APPENDIX: B

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Ryan White HIV/AIDS Program (RWHAP) Part A HIV Emergency Relief Grant Program. The purpose of this program is to provide direct financial assistance to an eligible metropolitan area (EMA) or a transitional grant area (TGA) that has been severely affected by the HIV epidemic. Grant funds assist eligible jurisdictions to develop or enhance access to a comprehensive continuum of high quality, community-based care for people with HIV who are low-income through the provision of formula, supplemental, and Minority AIDS Initiative (MAI) funds. The goal is to provide optimal HIV care and treatment for people with HIV who are low-income, uninsured, and underserved, to improve their medical outcomes.

RWHAP Part A recipients must use these funds to provide comprehensive primary health care and support services throughout the entire designated geographic service area. Your application must address the entire service area, as defined in Appendix B.

Comprehensive HIV care consists of core medical services and support services that enable people with HIV to access and remain in HIV primary medical care to improve their health outcomes. Based on an annual assessment of the services and gaps in the HIV care continuum within a jurisdiction, HIV Planning Councils/Planning Bodies (PCs/PBs) and RWHAP recipients identify specific service categories to fund. Funded service categories should facilitate improvements at specific stages of the HIV care continuum.

RWHAP Part A EMAs and TGAs must use grant funds to support, further develop, and/or expand systems of care to meet the needs of low-income people with HIV within the EMA/TGA, and strengthen strategies to reach disproportionately impacted subpopulations. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) requires EMAs/TGAs to collect and analyze data to identify needs, set priorities, make allocations, and validate the use of RWHAP funding. A comprehensive application should reflect on how you have used those data to develop and expand the system of care in EMA/TGA jurisdictions. HRSA encourages innovation and collaboration with other agencies and organizations to maximize impact on health outcomes and effectively meet the needs of people with HIV within the EMA/TGA.

Important Notes:

• Multi-Year Funding: HRSA HAB has transitioned the RWHAP Part A program from an annual competitive application program to a three-year funded program effective in FY 2022. In this new three-year period of performance, eligible applicants will submit a competitive application in the first year (FY 2022), and non-competing continuation (NCC) progress reports for years 2 and 3 (FY 2023 and FY 2024, respectively). The normalized score from the objective review of the demonstration of additional need provided in the competitive application during the first year of the three-year period of performance will be utilized to

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calculate the discretionary supplemental award in the second and third years.

HRSA HAB stresses the importance of this section, given its effect on the multi-year funding. See the Summary of Funding section for additional details.

• HIV Care Continuum: Eligible applicants will need to provide an HIV care continuum (HCC) that is diagnosis-based using the Centers for Disease Control and Prevention (CDC) definitions. Data are posted on TargetHIV to facilitate the development of the diagnosis-based HIV care continuum. See the Demonstrated Need and Work Plan sections for additional details.

• Unmet Need: HRSA HAB updated the estimation methodology used to determine unmet need for HIV-related services. Eligible applicants will need to provide estimates using the new Unmet Need Framework with their applications.

See the Demonstrated Need section for additional detail, and reference TargetHIV for training materials and tools related to estimating and reporting Unmet Need.

• Subpopulations of Focus: This is a new component of the Needs Assessment section in the NOFO, which requires eligible applicants to identify three subpopulations of focus using a data-driven process, including their specific needs, and subsequently discuss approaches to addressing those needs in the Methodology and Work Plan sections.

• Integrated Plan: The updated Integrated HIV Prevention and Care Plan guidance and plan submission for calendar years 2022 – 2027 was postponed due to the unprecedented Coronavirus Disease 2019 (COVID-19) pandemic;

see the June 17, 2020 letter for additional detail. An updated Integrated HIV Prevention and Care Plan guidance was issued in June 2021, with submission of the plans targeted for December of 2022.

• Indirect Costs: Negotiated indirect cost rate agreement or other indirect cost documentation will only be required to be submitted in the competitive application. However, if documentation expires during the period of performance the recipient is required to submit the updated agreement.

The following information will assist you in understanding and completing your FY 2022 application:

• Policy Clarification Notices: Information on the RWHAP and HAB Policy Clarification Notices (PCNs) are available online at http://hab.hrsa.gov/manageyourgrant/policiesletters.html. Please note that the following PCNs have been updated:

o 15-01 Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Part A, B, C, and D – updated as of 09/01/2020 o PCN 15-02 Clinical Quality Management and FAQs- updated as of 09/01/2020 https://www.cdc.gov/hiv/pdf/policies/progressreports/cdc-hiv-preventionprogressreport.pdf https://targethiv.org/library/hrsa-22-018 https://targethiv.org/library/topics/estimating-unmet-need-hiv-primary-medical-care https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/dcl-hiv-prevn-care-plan-guidance-postponment-6-2020.pdf http://hab.hrsa.gov/manageyourgrant/policiesletters.html https://hab.hrsa.gov/sites/default/files/hab/Global/HRSA-HAB-PCN15-01.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/HRSA-HAB-PCN15-01.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/HAB-PCN-15-02-CQM.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/clinicalqualitymanagementfaq.pdf

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• Allowable Services and Service Category Definitions: Core medical services are listed in Section 2604(c)(3) of the PHS Act. Support services allowed under RWHAP Part A are limited to services that are needed for people with HIV to achieve their health outcomes, as defined by the RWHAP. The service definitions effective for awards issued on or after October 1, 2016, are listed in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds.

• Core Medical Services Waiver: RWHAP Part A funds are subject to Section 2604(c) of the PHS Act, which requires that not less than 75 percent of the funds remaining after reserving funds for administration and Clinical Quality Management (CQM) be used to provide core medical services. You may seek a waiver of the core medical services requirement. You may submit a waiver request prior to submission of the grant application, with this application, or up to four months after the budget period start date. Submission should be in accordance with PCN 13-07 Uniform Standard for Waiver of Core Medical Services Requirement for Grantees Under Parts A, B, and C. You can find sample letters to fulfill the requirements of the Core Medical Services Waiver at https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf.

In addition, your RWHAP Part A core medical services waiver request must include funds awarded under MAI. HAB will not consider a waiver request that does not include MAI funds. If you submit the core medical services waiver request and allocation table with the application, both should be included as Attachment 10. The waiver request counts toward the 100-page limit.

• Agreements and Compliance Assurances: The agreements and assurances, found in Appendix A of this NOFO, require the signature of the Chief Elected Official (CEO), or the CEO’s designee. Assurances are required to be submitted with the competitive application and the NCC progress reports. Include the assurances as Attachment 2.

2. Background

This program is authorized by 42 USC §§ 300ff-11 to -20 and 300ff-121 (sections 2601– 2610 and 2693 of the Public Health Service (PHS) Act). The Ryan White HIV/AIDS Program (RWHAP) provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people with HIV. The program funds grants to states, cities, counties, and local community-based organizations to provide care and treatment services to people with HIV to improve health outcomes and reduce HIV transmission among hard-to-reach populations.

The RWHAP has five statutorily defined Parts (Parts A, B, C, D and F) that provide funding for core medical, support services, and medications; technical assistance;

clinical training; and the development of innovative models of care to meet the needs of different communities and populations affected by HIV.

https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/13-07waiver.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/13-07waiver.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/samplereqwaiverletters.pdf

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An important framework in the RWHAP is the HIV care continuum, which depicts the series of stages a person with HIV engages in from initial diagnosis through their successful treatment with HIV medication to achieve viral suppression. Supporting people with HIV to reach viral suppression not only increases their own quality of life and lifespan, it also prevents sexual transmission to an HIV-negative partner.

The HIV care continuum framework allows recipients and planning groups to measure progress and to direct HIV resources most effectively. RWHAP recipients are encouraged to assess the outcomes of their programs and should work with their community and public health partners to improve outcomes across the HIV care continuum. HRSA encourages recipients to use the performance measures developed for the RWHAP at their local level to assess the efficacy of their programs and to analyze and improve the gaps along the HIV care continuum.

Strategic Frameworks and National Objectives

National objectives and strategic frameworks like the Healthy People 2030, the HIV National Strategic Plan: A Roadmap to End the HIV Epidemic (2021 – 2025); the Sexually Transmitted Infections National Strategic Plan for the United States (2021 – 2025); and the Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021 – 2025) are crucial to addressing key public health challenges facing low-income people with HIV. These strategies detail the principles, priorities, and actions to guide the national public health response and provides a blueprint for collective action across the federal government and other sectors. The RWHAP supports the implementation of these strategies and recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, with these strategies to extent possible.

Expanding the Effort: Ending the HIV Epidemic

According to recent data from the 2019 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2015 to 2019, HIV viral suppression among RWHAP patients who have had one or more medical visits during the calendar year and at least one viral load with a result of <200 copies/mL reported, has increased from 83.4 percent to 88.1 percent.

Additionally, racial/ethnic, age-based, and regional disparities reflected in viral suppression rates have significantly decreased.1 For example, the disparities in viral suppression rates between Black/African Americans and white clients have decreased since 2010.2 These improved outcomes mean more people with HIV in the United States will live near normal lifespans and have a reduced risk of transmitting HIV to others.3

In February 2019, the Ending the HIV Epidemic in the U.S. (EHE) initiative was launched to further expand federal efforts to reduce HIV infections. This 10-year

1 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2019.

http://hab.hrsa.gov/data/data-reports. Published December 2020. Accessed December 2, 2020.

2 Black/African American clients went from 79.4 percent viral suppression in 2015 to 85.2 percent in 2019, while 88.3 percent of white clients were virally suppressed in 2015 and 91.8 percent in 2019 3 National Institute of Allergy and Infectious Diseases (NIAID). Preventing Sexual Transmission of HIV with Anti-HIV Drugs. In:

ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Mar 29]. Available from:

https://clinicaltrials.gov/ NCT00074581 NLM Identifier: NCT00074581.

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://health.gov/healthypeople https://www.hiv.gov/federal-response/hiv-national-strategic-plan/hiv-plan-2021-2025 https://www.hiv.gov/federal-response/hiv-national-strategic-plan/hiv-plan-2021-2025 https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2019.pdf https://www.hhs.gov/about/news/2020/02/26/hhs-awards-117-million-to-end-hiv-epidemic-in-the-united-states.html http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

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initiative seeks to achieve the important goal of reducing new HIV infections in the United States to fewer than 3,000 per year by 2030. The initiative promotes and implements four strategies to substantially reduce HIV transmissions – Diagnose, Treat, Prevent, and Respond. The initiative is a collaborative effort among key HHS agencies, primarily HRSA, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

For the RWHAP, the EHE initiative expands the program’s ability to meet the needs of clients specifically focusing on linking people with HIV who are either newly diagnosed, diagnosed but currently not in care, or are diagnosed in care but not yet virally suppressed to the essential HIV care and treatment and support services needed to help them achieve viral suppression.

Using Data Effectively: Integrated Data Sharing and Use

HRSA and CDC’s Division of HIV/AIDS Prevention support integrated data sharing, analysis, and utilization for the purposes of program planning, conducting needs assessments, determining unmet need estimates, reporting, quality improvement, enhancing the HIV care continuum, and public health action. HRSA strongly encourages RWHAP recipients to:

• Follow the principles and standards in the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action.

• Establish data sharing agreements between surveillance and HIV programs to ensure clarity about the process and purpose of the data sharing and utilization.

Integrated data sharing, analysis, and utilization of HIV data by state and territorial health departments can help further progress toward reaching the HIV National Strategic Plan goals and improve outcomes on the HIV care continuum.

HRSA strongly encourages complete CD4, viral load (VL) and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems to benefit fully from integrated data sharing, analysis, and utilization. State health departments may use CD4, VL, and nucleotide sequence data to identify cases, stage of HIV disease at diagnosis, and monitor disease progression. These data can also be used to evaluate HIV testing and prevention efforts, determine entry into and retention in HIV care, measure viral suppression, monitor prevalence of antiretroviral drug resistance, detect transmission clusters and understand transmission patterns, and assess unmet health care needs. Analyses at the national level to monitor progress toward ending the HIV epidemic can only occur if all HIV-related CD4, VL, and HIV nucleotide sequence test results are reported by all jurisdictions. CDC requires the reporting to the National HIV Surveillance System (NHSS) all HIV-related CD4 results (counts and percentages), all VL results (undetectable and specific values), and HIV nucleotide sequences.

http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf

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Program Resources and Innovative Models

HRSA has a number of projects and resources that may assist RWHAP recipients with program implementation. These include a variety of HRSA HAB cooperative agreements, contracts, and grants focused on specific technical assistance (TA), evaluation, and intervention activities. A list of these resources is available on TargetHIV. Recipients should be familiar with these resources and are encouraged to use them as needed to support their program implementation.

An important technical assistance resource is the RWHAP Recipient Compilation of Best Practices Intervention Strategies (Best Practices Compilation). The Best Practices Compilation is currently under development, but will present strategies that have been implemented in real world settings and that improve outcomes along the HIV care continuum. The RWHAP Best Practices Compilation will be an easily searchable resource to support recipients’ work and the needs of the people served by the

RWHAP.

In addition, many RWHAP Special Projects of National Significance (SPNS) projects have demonstrated promising new approaches for linking and retaining priority populations into care. As resources permit, RWHAP recipients are encouraged to review and integrate these tools within their HIV system of care in accordance with the allowable service categories defined in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds. Examples of these resources include:

• E2i: Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV E2i uses an implementation science approach to evaluate and understand existing and new intervention strategies that can be used in RWHAP provider settings. Once interventions or strategies are demonstrated and evaluated using implementation science, manuals, guides, interactive online tools, publications, and instructional materials are developed and disseminated for replication and integration into RWHAP provider settings.

• Integrating HIV Innovative Practices (IHIP) Resources on the IHIP website include easy-to-use training manuals, curricula, case studies, pocket guides, monographs, and handbooks, as well as informational handouts and infographics about SPNS generally. IHIP also hosts TA training webinars designed to provide a more interactive experience with experts, and a TA help desk exists for you to submit additional questions and share your own lessons learned.

• Replication Resources from the SPNS Systems Linkages and Access to Care There are intervention manuals for patient navigation, care coordination, state bridge counselors, data to care, and other interventions developed for use at the state and regional levels to address specific HIV care continuum outcomes among hard-to-reach people with HIV.

https://targethiv.org/help/ta-directory https://targethiv.org/bestpractices https://targethiv.org/bestpractices https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://targethiv.org/e2i https://targethiv.org/e2i https://targethiv.org/ihip https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care

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• Dissemination of Evidence Informed Interventions The Dissemination of Evidence-Informed Interventions initiative ran from 2015-2020 and disseminated four adapted linkage and retention interventions from prior SPNS and the Minority HIV/AIDS Funds (MHAF) from the HHS Secretary’s Office initiatives to improve health outcomes along the HIV care continuum. The initiative produced four evidence-informed care and treatment interventions (CATIs) that are replicable, cost-effective, capable of producing optimal HIV care continuum outcomes, and easily adaptable to the changing health care environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

HRSA HAB also recognizes the importance of addressing emerging issues, as well as supporting the needs of special populations. To help recipients in responding to these critical issues, HRSA HAB funds projects to provide technical assistance and resources for recipients. Examples of projects include:

• Building Futures: Supporting Youth Living with HIV

• The Center for Engaging Black MSM Across the Care Continuum (CEBACC)

• Using Community Health Workers to Improve Linkage and Retention in Care

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: Competing Continuation.

HRSA will provide funding in the form of a grant.

The amount of funding awarded to each RWHAP recipient will be determined according to a formula calculation for formula and MAI funding, and a normalized competitive score for discretionary awards for supplemental funding, including priority funding, as described in the Summary of Funding section below.

2. Summary of Funding

In FY 2022, HRSA estimates approximately $630,000,000 to be available to fund 52 RWHAP Part A recipients. Approximately $11,200,000 will be used for priority funding, and $51,000,000 will be available for MAI funding. You may apply for no more than the published ceiling amount in Appendix B. HRSA established ceiling amounts based on current funding with a five percent increase to accommodate fluctuations in formula and supplemental funding. The actual amount available will not be determined until the enactment of the final FY 2022 federal appropriation. This program notice is subject to the appropriation of funds and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner.

The RWHAP Part A provides non-discretionary formula grants that include MAI funds, and discretionary supplemental awards. These funds assist eligible areas in developing https://targethiv.org/deii https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/cebacc https://targethiv.org/chw

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or enhancing access to a comprehensive continuum of high quality, community-based care for people with HIV who are low-income within the EMA/TGA and strengthening strategies to reach minority populations. HRSA awards two-thirds of the funds available for EMAs and TGAs according to a formula that is calculated annually and based on the number of living cases of HIV/AIDS in the EMAs and TGAs. HRSA awards MAI funding that is calculated annually and based on the number of people with HIV and AIDS who are minorities in a jurisdiction. HRSA awards the remaining funds as discretionary supplemental awards based on the demonstration of additional need by the eligible EMAs and TGAs. The normalized score from the objective review of the demonstration of additional need provided in the competitive application during the first year of the three-year period of performance will be utilized to calculate the discretionary supplemental award in the second and third years. Further, if determined eligible for priority funding, HRSA will calculate the additional amount awarded, and that amount will be included in the final award annually.

HRSA HAB has transitioned the RWHAP Part A program from an annual competitive funded program to a multi-year funded program, effective FY 2022. The period of performance is three years (March 1, 2022 through February 28, 2025). A competitive application will be submitted for FY 2022, and Non-Competing Continuation (NCC) Progress Reports will be submitted for FY 2023 and FY 2024. An annual SF-424A and Budget will need to be submitted in each year of the period of performance (i.e., in FY 2022 you will only include an SF-424A and Budget covering the FY 2022 budget period, same for FY 2023, and FY 2024). Furthermore, an annual work plan and assurances will be required with the competitive application and the NCC progress reports.

Additional information on the transition of the RWHAP Part A program from an annual to a multi-year period of performance is located on TargetHIV.

As stated, eligible jurisdictions may apply for an amount up to the funding ceilings listed in Appendix B. If the RWHAP Part A award calculation results in an amount less than the budget submitted with your application, your budget will be proportionally reduced across all budget categories to reflect the actual award amount. If your award calculation results in an amount greater than the budget submitted with the application, you may be required to submit a revised SF-424A, budget narrative, and service category plan table. Establishing realistic ceiling amounts ensures that there will be an approved project budget in place at the beginning of each budget period.

HRSA will send the Notice of Award (NOA) to the CEO or to the delegated administrative agency responsible for dispersing RWHAP Part A funds.

Please note that the HHS Secretary (Secretary) may reduce the amount of grant funds under the RWHAP Part A to an EMA/TGA for a fiscal year (FY) if, with respect to such grants for the second preceding FY, the EMA/TGA fails to prepare audits in accordance with the procedures of Section 7502 of Title 31, United States Code. See Section 2682(a) of the PHS Act.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

https://targethiv.org/library/rwhap-part-multi-year-funding http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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Please see Policy Clarification Notice 15-01 Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D along with the FAQs for information regarding the statutory 10 percent limitation on administrative costs.

III. Eligibility Information

1. Eligible Applicants

RWHAP Part A recipients that are classified as an EMA or as a TGA and continue to meet the status as an eligible area as defined in the statute are eligible to apply for these funds. Eligibility for RWHAP Part A grants is based in part on the number of confirmed AIDS cases within a statutorily specified “metropolitan area.” The Secretary uses the Office of Management and Budget’s (OMB) census-based definitions of a Metropolitan Statistical Area (MSA) in determining the geographic boundaries of a RWHAP metropolitan area. HHS utilizes the OMB geographic boundaries that were in effect when a jurisdiction was initially funded under RWHAP Part A. For all newly eligible areas, the boundaries are based on current OMB MSA boundary definitions.

For an EMA, this is more than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years, and for a TGA, this is at least 1,000, but fewer than 2,000 cases of AIDS reported and confirmed during the most recent five calendar years for which such data are available. In addition, for three consecutive years, recipients must not have fallen below both the required incidence levels already specified, and required prevalence levels (cumulative total of living cases of AIDS reported to and confirmed by the Director of CDC, as of December 31 of the most recent calendar year for which such data are available). For an EMA, the required prevalence is 3,000 living cases of AIDS. For a TGA, the required prevalence is 1,500 or more living cases of AIDS. However, for a TGA with five percent or less of the total amount from grants awarded to the area under Part A unobligated, as of the end of the most recent FY, the required prevalence is at least 1,400 (and fewer than 1,500) living cases of AIDS.

This competition is open to eligible Part A jurisdictions to provide comprehensive primary health care and support services for people with HIV who are low income, uninsured, and underserved in their service areas as listed in Appendix B.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that exceeds the page limit referenced in Section IV non-responsive and will not consider it for funding under this notice.

https://hab.hrsa.gov/sites/default/files/hab/Global/HRSA-HAB-PCN15-01.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/HRSA-HAB-PCN15-01.pdf https://hab.hrsa.gov/sites/default/files/hab/Global/faqpolicyclarificationnotice15-01.pdf

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HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Maintenance of Effort (MOE) The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by Section 2605(a)(1)(B) of the PHS Act. Core medical services and support services are defined in Section 2604(c)(3) and 2604(d) of the legislation. Complete the MOE information and submit as Attachment 12.

NOTE: Multiple applications from an organization are not allowable.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan, and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the Application Guide for the Application Completeness Checklist.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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Application Page Limit The total size of all uploaded files included in the page limit shall not exceed the equivalent of 100 pages when printed by HRSA. The page limit includes the project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form "Project_Abstract Summary.” Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22- 018 it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 100 will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 14: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications.

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the PHS Act provides the Secretary of HHS with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan, and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment. For information content required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide. Your abstract should be limited to one page and include the following information in this order:

• A general overview of the HIV epidemic in the EMA/TGA, including epidemiologic, demographic, and geographic information. You may present this information as a table.

• A description of the comprehensive system of care in the entire EMA/TGA, including the available core medical and support services funded by RWHAP Part A and by other sources, where services are located, and how clients access those services, including services for disproportionately impacted subpopulation(s) supported by MAI funds.

• The overall viral suppression rate for the EMA/TGA. Use HIV surveillance data on TargetHIV.

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

If any request for information is not applicable, state “Not Applicable” and provide justification.

Successful applications will contain the information below. Please use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 (Need)

This section must briefly describe how the EMA/TGA will utilize RWHAP Part A grant funds in support of a comprehensive continuum of high-quality care and treatment for people with HIV in the RWHAP Part A service area, as defined in Appendix B.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 (Need)

The purpose of this section is to demonstrate the severity of the HIV epidemic in the EMA/TGA. Include quantifiable data on HIV epidemiology, the HIV care continuum, unmet need, co-occurring conditions, complexity of providing care, and the early identification of individuals with HIV/AIDS. Also, include the identification of subpopulations of focus.

https://targethiv.org/library/hrsa-22-018

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A. Demonstrated Need The Demonstrated Need section includes Epidemiologic Overview, HIV Care Continuum, Unmet Need, Co-occurring Conditions, and Complexities of Providing Care sub-sections.

RWHAP Part A recipients should conduct a comprehensive needs assessment to determine service needs in the jurisdiction. Based on the comprehensive needs assessment, recipients must set priorities and allocate resources to meet these needs as directed by the planning council (PC) or recommended by the planning body (PB).

HAB will direct supplemental funds to eligible areas where epidemiologic data demonstrate that HIV infection prevalence rates are increasing, where there is documented demonstrated need and service gaps, and where there is a demonstrated disproportionate impact on vulnerable populations.

1) Epidemiologic Overview An epidemiologic overview provides a description of the demonstrated need for HIV care in the population of an area in terms of the socio-demographic characteristics of persons newly diagnosed with HIV, people with HIV, and persons at higher risk for HIV. Understanding the populations affected by HIV provides the basis for setting priorities, identifying appropriate interventions and services, allocating funding to HIV care services, implementing appropriate service standards, and evaluating programs and policies.

The epidemiologic overview should focus on the most recent year for which data are available. When presenting trends, HRSA recommends a minimum of three years of data. Please cite data sources. Submit the HIV/AIDS Demographics Table, including socioeconomic data, as Attachment 3.

a) Provide a brief summary of the HIV epidemic in your EMA/TGA geographic area.

b) Describe the socio-demographic characteristics of (1) persons newly diagnosed, (2) people with HIV, and (3) persons at higher risk for HIV in the service area. Include the following, as available in the geographical region of the jurisdiction:

i. Demographic data (e.g., race, age, sex, transmission category, current gender identity) and

ii. Socioeconomic data (e.g., percentage of federal poverty level (FPL), income, education, health insurance status, language barriers).

c) Describe the relative rates of increase in HIV diagnosed cases within new and emerging populations, as applicable.

i. Include information on how you identified emerging populations, any unique challenges, and estimated costs to the RWHAP Part A program, if applicable, and

ii. Describe the increasing need for HIV-related services based on the relative increase of HIV cases.

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2) HIV Care Continuum

The ultimate goal of HIV treatment is to achieve viral suppression. This is important for people with HIV to stay healthy, have improved quality of life, and live longer. People with HIV who maintain viral suppression have effectively no risk of passing HIV to others.

The HIV care continuum is a public health model that outlines the steps or stages that people with HIV go through from diagnosis to achieving and maintaining viral suppression. There are two approaches to monitor the HIV care continuum—the prevalence-based approach and the diagnosis-based approach. The prevalence-based HIV care continuum describes the number of people who are at each step of the continuum as a percentage of the total number of people with HIV (known as HIV prevalence). Prevalence includes both people whose infection has been diagnosed and those who have HIV but do not know it. The diagnosis-based HIV care continuum depicts each step as a percentage of the number of people with diagnosed HIV. For the purposes of this NOFO, a diagnosis-based HIV care continuum will be utilized.

To be able to monitor progress across the HIV care continuum in a meaningful way, it is important to have standardized data elements that are both practical and feasibly implemented in RWHAP Part A recipient jurisdictions. Each step of the diagnosis-based HIV care continuum outlined below includes specific definitions, including descriptions of the numerators and denominators, as described in the CDC HIV Prevention Progress Report, 2019. Each step of the HIV care continuum is listed below:

Diagnosed: Number of persons aged ≥13 years with HIV infection in the jurisdiction at the end of the calendar year.

Receipt of Care: Percentage of persons with diagnosed HIV who had at least one CD4 or viral load test during the calendar year.

• Numerator: Number of persons aged ≥13 years with diagnosed HIV infection who had a care visit during the calendar year, as measured by documented test results for CD4 count or viral load.

• Denominator: Number of persons aged ≥13 years with HIV infection diagnosed by previous year-end and alive at year-end.

Retained in Care: Percentage of persons with documentation of two or more CD4 or viral load tests performed at least three months apart during the calendar year.

• Numerator: Number of persons aged ≥13 years with diagnosed HIV infection who had two care visits that were at least 90 days apart during the calendar year, as measured by documented test results for CD4 count or viral load.

• Denominator: Number of persons aged ≥13 years with HIV infection diagnosed by previous year-end and alive at year-end.

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Viral Suppression: Percentage of persons aged ≥13 years with HIV infection who had a viral load test result of <200 copies/mL at the most recent viral load test during the calendar year.

• Numerator: Number of persons aged ≥13 years with diagnosed HIV infection whose most recent viral load test in the calendar year showed that HIV viral load was suppressed.

• Denominator: Number of persons aged ≥13 years with HIV infection diagnosed by previous year-end and alive at year-end.

Linked to Care: Percentage of persons with newly diagnosed HIV infection who were linked to care within one month after diagnosis as evidenced by a documented CD4 count or viral load.

• Numerator: Number of persons aged ≥13 years with newly diagnosed HIV infection during the calendar year who were linked to care within one month of their diagnosis date as evidenced by a documented test result for a CD4 count or viral load.

• Denominator: Number of persons aged ≥13 years with newly diagnosed HIV infection during the calendar year.

a) Using the CDC…