HAB HRSA-22-027 (U90) Aging-CBP final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau Division of Policy and Data

Emerging Strategies to Improve Health Outcomes for People Aging with HIV:

Capacity-Building Provider

Funding Opportunity Number: HRSA-22-027 Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.928

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: January 25, 2022

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 may take up to 1 month to complete.

Issuance Date: October 26, 2021

Marlene Matosky Chief, Clinical and Quality Branch Telephone: (301) 443-0798 Email: mmatosky@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 USC § 300ff-101 (§ 2691 of the Public Health Service Act)

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508 Compliance Disclaimer

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) Program initiative, Emerging Strategies to Improve Health Outcomes for People Aging with HIV.

This initiative will fund three components: a capacity-building provider (HRSA-22-027), demonstration sites (HRSA-22-028), and an evaluation provider (HRSA-22-029). All three components of the initiative will work together using the HRSA HIV/AIDS Bureau (HAB) implementation science framework to conduct the following activities simultaneously:

• Implement emerging strategies that comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV;

• Assess the uptake and integration of emerging strategies;

• Understand implementation processes including assessing specific implementation strategies;

• Understand and document broader contextual factors affecting implementation;

• Evaluate the impact of the emerging strategies; and

• Document and disseminate the emerging strategies.

HRSA defines emerging strategies as innovative strategies that address disparities and improve health outcomes for people with HIV. Real world validity and effectiveness have been demonstrated, but emerging strategies do not yet have sufficient published research evidence1 or evaluation to document their effectiveness. The initiative will strengthen the evidence base for clinical and psychosocial services that improve the lives and health outcomes of people with HIV who are aging.

This NOFO, HRSA-22-027 Emerging Strategies to Improve Health Outcomes for People Aging with HIV: Capacity-Building Provider, will provide technical assistance and capacity development to up to 10 demonstration sites to identify, implement, refine, and evaluate emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV, within the context of the RWHAP; and communicate and dissemination information regarding the initiative. The capacity-building provider will coordinate and implement all activities and products to align with the HAB implementation science framework.

https://pubmed.ncbi.nlm.nih.gov/33156852/

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The technical assistance and capacity development activities will consist of learning collaboratives, one-on-one technical consultation, and peer-to-peer exchanges related to identifying, implementing, and refining emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV. The technical assistance and capacity development activities should facilitate the implementation and refinement of the emerging strategies with the existing resources and infrastructure of organizations funded through the RWHAP. The capacity-building provider will communicate information about the implementation and progress of the initiative throughout its duration and disseminate the evaluation findings and replication tools.

This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. You should note that this program may be cancelled before award.

Funding Opportunity Title: Emerging Strategies to Improve Health

Outcomes for People Aging with HIV:

Capacity-Building Provider

Funding Opportunity Number: HRSA-22-027 Due Date for Applications: January 25, 2022 Anticipated Total Annual Available FY 2022 Funding:

$750,000

Estimated Number and Type of Award: One (1) cooperative agreement Estimated Annual Award Amount: Up to $750,000 per year (subject to the availability of appropriated funds) Cost Sharing/Match Required: No Period of Performance: August 1, 2022 through July 31, 2025

(3 years) Eligible Applicants: Eligible applicants include entities eligible for funding under RWHAP Parts A - D of Title XXVI of the Public Health Service (PHS) Act, including public and nonprofit private entities; state and local governments; academic institutions; local health departments; nonprofit hospitals and outpatient clinics; community health centers receiving support under Section 330 of the PHS Act; faith-based and community-based organizations; and Indian Tribes or Tribal organizations with or without federal recognition.

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

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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

HRSA has scheduled the following technical assistance Webinar:

Day and Date: Monday, November 15, 2021 Time: 2:00 – 3:30 p.m. ET Call-In Number:

Dial by your location +1 (669) 254-5252 US (San Jose) +1 (646) 828-7666 US (New York) +1 (669) 216-1590 US (San Jose)

+1 (551) 285-1373 US

(833) 568-8864 US Toll-free

Meeting ID: 160 194 2123 Passcode: 04657297

Weblink: Join ZoomGov Meeting https://hrsa-gov.zoomgov.com/j/1601942123?pwd=K3FXQVFVZFFSOE5Md0U0RzE2S0Mrdz09

Meeting ID: 160 194 2123 Passcode: HCzT7aWM

Playback: The webinar will be recorded and should be available within 10 business days on the TargetHIV website. Answers to questions posed before and during the webinar will also be posted there.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa-gov.zoomgov.com/j/1601942123?pwd=K3FXQVFVZFFSOE5Md0U0RzE2S0Mrdz09 https://hrsa-gov.zoomgov.com/j/1601942123?pwd=K3FXQVFVZFFSOE5Md0U0RzE2S0Mrdz09 https://targethiv.org/library/nofos

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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: 1

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I. Program Funding Opportunity Description

1. Purpose

This notice (HRSA-22-027), announces the opportunity to apply for FY22 Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program (RWHAP) Part F: Special Projects of National Significance (SPNS) funding for the Emerging Strategies to Improve Health Outcomes for People Aging with HIV:

Capacity-Building Provider.

This initiative will fund three components: a capacity-building provider (HRSA-22-027), demonstration sites (HRSA-22-028), and an evaluation provider (HRSA-22-029). All three components of the initiative will work together using the HRSA HIV/AIDS Bureau (HAB) implementation science framework to conduct the following activities simultaneously:

• Implement emerging strategies that comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV;

• Assess the uptake and integration of emerging strategies;

• Understand implementation processes including assessing specific implementation strategies;

• Understand and document broader contextual factors affecting implementation;

• Evaluate the impact of the emerging strategies; and

• Document and disseminate the emerging strategies.

HRSA defines emerging strategies as innovative strategies that address disparities and improve health outcomes for people with HIV. Real world validity and effectiveness have been demonstrated, but emerging strategies do not yet have sufficient published research evidence1 or evaluation to document their effectiveness. The initiative will strengthen the evidence base for clinical and psychosocial services that improve the lives and health outcomes of people with HIV who are aging.

The purpose of this funding opportunity (HRSA-22-027) is to support one capacity-building provider to provide technical assistance and capacity development to up to 10 demonstration sites to identify, implement, and refine and evaluate emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV, within the context of the RWHAP and develop a communication plan to create, replicate, and disseminate products. The capacity-building provider will implement all activities and products to align with the HAB implementation science approach (HAB IS). HRSA defines emerging strategies as innovative strategies that address disparities and improve health outcomes for people with HIV. Real world validity and effectiveness have been demonstrated, but emerging strategies do not yet have sufficient published research evidence1 or evaluation to document their effectiveness. The initiative will strengthen the evidence base for clinical and psychosocial services that improve the lives and health outcomes of people with HIV who are aging.

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The technical assistance and capacity development activities will consist of learning collaboratives, one-on-one technical consultation, and peer-to-peer exchanges related to identifying, implementing, and refining emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV. The technical assistance and capacity development activities should facilitate the implementation and refinement of the emerging strategies given the resources and infrastructure of organizations funded through the RWHAP. The capacity-building provider will communicate information about the implementation and progress of the initiative throughout its duration and disseminate the evaluation findings evaluation and replication tools.

This funding opportunity will support an organization that has the capacity, infrastructure, and experience to 1) provide technical assistance and capacity development to the demonstration sites (HRSA-22-028) that provide clinical and support services; and 2) communicate and disseminate information about the initiative. You must have capacity, infrastructure, and experience to perform the following activities:

1. Assist the demonstration sites in identifying, documenting, and refining the emerging strategies through the use of clinical workflows, roles and responsibilities of personnel, process maps, and swim lane flowcharts;

2. Assess individual organizations’ technical needs; manage and provide peer-to-peer technical assistance, coaching, and capacity development to implement, refine, and document their emerging strategies;

3. Develop and implement the Institute for Healthcare Improvement (IHI) Learning Collaborative Model for Achieving Breakthrough Improvement with learning sessions, action periods, and performance measurement to refine the emerging strategies;

4. Create forums to facilitate and foster exchange of information between organizations to improve processes and outcomes;

5. Develop and communicate information to RWHAP recipients, subrecipients, and community throughout the duration of the project such as project status, lessons learned, and tools developed and used; and

6. Develop and disseminate information about the initiative evaluation and products

The demonstration sites (HRSA-22-028) will:

1. Implement: Identify, implement, and refine emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial concerns of people 50 years and older with HIV within the context of the RWHAP;

2. Evaluate: Collaborate in the development of and participate in the evaluation of the emerging strategies to screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial concerns of people 50 years and older with HIV http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx

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within the context of the RWHAP. Demonstration sites will participate in the evaluation of their own emerging strategies and a multi-site evaluation; and

3. Partner: Work closely with the other demonstration sites, capacity-building provider (HRSA 22-027) and evaluation provider (HRSA-22-029) for this initiative to refine, evaluate, and disseminate the emerging strategies.

The evaluation provider (HRSA-22-029) will establish and implement an evaluation design that includes the evaluation of the uptake, implementation, and associated client outcomes of the emerging strategies at the demonstration sites; and cost of emerging strategies.

Awardees under all three funding announcements (HRSA-22-027, HRSA-22-028, and HRSA-22-029) will work together to achieve the overall goals of this initiative. The demonstration sites, capacity-building provider, and evaluation provider will use the HAB IS approach when proposing activities and products. The capacity-building provider will engage the demonstration sites (HRSA-22-028) and evaluation provider (HRSA-22-029) in planning and implementation of all activities and should budget accordingly. Please review the demonstration sites (HRSA-22-028) and evaluation provider (HRSA-22-029) NOFOs for more information about these activities.

2. Background

The SPNS Program is authorized by 42 USC § 300ff-101 (§ 2691 of the Public Health Service Act). The SPNS Program supports the development of innovative models of HIV care to quickly respond to the emerging needs of clients served by the Ryan White HIV/AIDS Program. The SPNS Program evaluates the effectiveness of these models’ design, implementation, utilization, cost, and health-related outcomes while promoting the communication, dissemination and replication of successful models.

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 services, 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. 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

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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 in the United States

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.2 For example, the disparities in viral suppression rates between Black/African Americans and White clients have decreased since 2010.3 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.4

In February 2019, the Ending the HIV Epidemic in the United States (EHE) initiative was launched to further expand federal efforts to reduce HIV infections. This 10-year 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 Department of Health and Human Services (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 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.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline

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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 HIV 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 in the United States 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.

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.

In addition, many RWHAP Special Projects of National Significance (SPNS) projects have demonstrated promising new approaches for linking and retaining priority 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 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 https://targethiv.org/help/ta-directory

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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 Policy Clarification Notice (PCN) 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals & 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.

• 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 healthcare environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

HRSA also recognizes the importance of addressing emerging issues, as well as supporting the needs of diverse populations. To help recipients in responding to these critical issues, HRSA 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 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 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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HIV and Aging:

According to the CDC, there are 1.1 million people with diagnosed HIV in the United States and six (6) dependent areas at the end of 2019. The RWHAP provides services to half of the people with diagnosed HIV. Half of the people receiving services through the RWHAP are 50 years and older. People with HIV have a life expectancy near that of the general population due to the availability and use of HIV antiretroviral therapy and high rates of viral suppression among people 50 years and older5-7 Even with their HIV disease well managed, people aged 50 and older with HIV are at increased risk for and experience a vast host of comorbidities (e.g. cardiovascular disease, diabetes, osteoporosis), geriatric conditions (frailty, falls, neurocognitive impairment), and psychosocial needs (e.g. isolation, loneliness, lack of caregivers, and behavioral health).8-10 People aging with HIV experience the same health concerns as the general aging population except that they experience the health concerns earlier11 in life, more severely, and at a greater disproportion for comorbidities.12 Turrini, et al. found older people with HIV have a higher overall hazard of mortality as well as higher odds of having depression, chronic kidney disease, COPD, osteoporosis, colorectal cancer, lung cancer, hypertension, ischemic heart disease, diabetes, chronic hepatitis, and end-stage liver disease compared to those without HIV, even after adjusting for demographic characteristics.13 As summarized in a September 2020 Medscape article,14 “they are also at higher risk for depression, frailty, polypharmacy, and other age-related conditions. Women may be especially vulnerable.”

HIV medical care has evolved to focus not only on helping clients achieve and sustain viral suppression, but to screen for and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs.15 The HIV Medicine Association of the Infectious Diseases Society of America published an update to its primary care guidelines for people with HIV16 in November 2020, which includes recommendations for people 50 years and older. The body of evidence for models and strategies to effectively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial needs of people 50 years and older with HIV is growing. The emerging strategies include multidisciplinary care teams, focusing on the “M’s” of geriatric care (mind, mobility, medications, multi-complexity, matters most, and modifiable), utilizing a comprehensive geriatric assessment, imbedding a geriatrician in the HIV clinic, and incorporating geriatric consultants.17-22

HHS implements many programs for people aging throughout the U.S. The Centers for Medicare & Medicaid Services (CMS) has a number of programs including the Medicare program and Programs of All-Inclusive Care for the Elderly (also known as PACE) focusing on older people in the U.S. The Administration for Community Living implements the Older Americans Act, which supports the Area Agencies on Aging, and the National Family Caregiver Support Program, among many others. HRSA funds the Geriatric Workforce Enhancement Program and Geriatric Academic Career Award Program. Even though the RWHAP funds over 30 core and support services, there are services that the RWHAP cannot provide or are not available in every service area in the U.S. It is essential that RWHAP recipients and subrecipients engage with all https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2019.pdf https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241833 https://www.medscape.com/viewarticle/937506 https://www.medscape.com/viewarticle/937506 https://hab.hrsa.gov/sites/default/files/hab/clinical-quality-management/aging-guide-new-elements.pdf https://hab.hrsa.gov/sites/default/files/hab/clinical-quality-management/aging-guide-new-elements.pdf https://www.idsociety.org/practice-guideline/primary-care-management-of-people-with-hiv/ https://www.idsociety.org/practice-guideline/primary-care-management-of-people-with-hiv/ https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/pace https://acl.gov/programs/aging-and-disability-networks/area-agencies-aging https://acl.gov/programs/aging-and-disability-networks/area-agencies-aging https://acl.gov/programs/support-caregivers https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf

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available aging resources for their clients in order to maximize clients’ health outcomes, quality of life, and client experience and not duplicate services.

HRSA HAB Implementation Science Approach:

This initiative will use the HAB IS to identify and demonstrate emerging strategies that could be effective for improving outcomes among people 50 years and older with HIV served by the RWHAP, thereby reducing disparities and moving toward ending the HIV epidemic in the U.S. HAB IS was developed to support the translation of insights from the implementation science literature to real-world settings.

HAB IS includes effectiveness criteria for three (3) categories of intervention strategies for the RWHAP: evidence-based interventions, evidence-informed interventions, and emerging strategies. HRSA developed these criteria in collaboration with the CDC and the NIH (see Fig 1 in Psihopaidas et al. (2020) for detailed descriptions). This initiative will focus on evidence-informed interventions and emerging strategies (hereafter referred to collectively as “intervention strategies”). By focusing on these two categories, HRSA seeks to identify highly innovative intervention strategies that are most responsive to the current HIV epidemic.

HAB IS involves two core components. The first component is rapid implementation, which, for this initiative, includes (1) identifying existing emerging strategies with demonstrated effectiveness at improving outcomes for people 50 years and older with HIV, (2) pilot testing those emerging strategies for success specifically within the RWHAP, and (3) creating accessible dissemination products to promote the replication and scale-up of the intervention strategy. The second component is an implementation science evaluation plan.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Providing the expertise of HRSA personnel and other relevant resources to the initiative.

• Facilitating relationships between the demonstration sites, capacity-building provider, evaluation provider, and other relevant stakeholders.

• Reviewing and providing feedback on the activities, documentation, procedures, measures, and tools established and implemented for accomplishing the goals of the cooperative agreement throughout the duration of the initiative.

• Reviewing, providing feedback, and concurring with activities, procedures, tools, measures, products, and written materials prior to external communication and dissemination on an ongoing basis.

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• Facilitating, communicating, and disseminating status updates, lessons, results, best practices, evaluation data, and other information developed as part of this initiative to the broader network of RWHAP recipients and subrecipients, and the HIV care and treatment community.

• Collaborating with recipient to update existing work plans and, as needed, identifying and relaying new priorities during the funding period.

• Conducting regular monitoring calls with recipient.

The cooperative agreement recipient’s responsibilities will include:

• Assisting the demonstration sites in identifying and refining the emerging strategies.

• Assessing individual demonstration sites’ needs and addressing them through coaching and capacity development to implement, refine, and document their emerging strategies.

• Adapting and implementing the IHI Learning Collaborative Model for Achieving Breakthrough Improvement.

• Creating forums to facilitate and foster exchange of information between organizations with the goal of improving processes and outcomes.

• Developing and implementing a communications and dissemination plan to share information about the initiative, and to disseminate materials to support rapid replication of emerging strategies, including initiative findings, implementation toolkits, manuscripts, and professional conference presentations.

• Supporting the evaluation center in carrying out its multi-site evaluation.

• Collaborating with the evaluation center to assess the implemented emerging strategies to inform dissemination plans.

• Anticipating and responding to the changes taking place in the health care environment that may affect the initiative and demonstration sites.

• Collecting and analyzing data relative to national health issues, unmet needs, marketplace conditions, special populations, and other key health indicators to guide current/future strategic planning, developmental efforts, and work plan activities.

• Collaborating with HRSA to update existing work plans and, as needed, integrating new priorities during the funding period.

• Participating in regular monitoring calls with HRSA.

2. Summary of Funding

HRSA estimates approximately $750,000 to be available annually to fund one recipient.

The actual amount available will not be determined until enactment of the final FY 2022 federal appropriation. You may apply for a ceiling amount of up to $750,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. 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 appropriately. The period of performance is August 1, 2022 through July 31, 2025 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for Emerging Strategies to Improve Health Outcomes for People Aging with HIV: Capacity-Building Provider in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx

HRSA-22-027 10

HRSA may reduce recipient funding levels beyond the first year if recipients are unable to fully succeed in achieving the goals listed in application.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include entities eligible for funding under RWHAP Parts A - D of Title XXVI of the Public Health Service (PHS) Act, including public and nonprofit private entities; state and local governments; academic institutions; local health departments;

nonprofit hospitals and outpatient clinics; and community health centers receiving support under Section 330 of the PHS Act. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will may not consider an application for funding if it contains any of the non-responsive criterion criteria below:

• Exceeds the ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

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.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

HRSA-22-027 11

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-027 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

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 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 HRSA SF-424 Application Guide for the Application Completeness Checklist.

Application Page Limitation The total size of all uploaded files included in the page limitation may not exceed the equivalent of 60 pages when printed by HRSA. The page limitation includes the project and budget narratives, attachments, and letters of commitment and support required in the HRSA SF-424 Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-027, it may count against the page limitation.

Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limitation. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limitation. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limitation.

Applications must be complete, within the specified page limitation, 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).

https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 8-15: Other Relevant Documents.

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

Program Requirements and Expectations

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 or it will count toward the page limitation. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Any attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-22-027 13

To assist in preparing your work plan and budget, please see the anticipated overall timeframe and phases for this initiative. Plan to participate in National Ryan White Conferences that occur during the initiative by preparing and presenting on the initiative. If possible, learning sessions and annual initiative meetings will be held at HRSA headquarters in Rockville, Maryland. At least two members from each demonstration site, capacity-building provider, and evaluation provider will attend the learning sessions and annual initiative meetings.

At least annually, the successful applicant should plan to collaborate with HRSA to update existing work plans and, as needed, integrate new priorities during the funding period. The recipient should plan for regular monitoring calls with HRSA (every other week).

Below are the overall phases for the Emerging Strategies to Improve Health Outcomes for People Aging with HIV demonstration sites (HRSA-22-028), the capacity-building provider (HRSA-22-027), and the evaluation provider (HRSA-22- 029). This notice outlines anticipated phases that successful applicants should aim to address across the lifespan of this initiative. This notice also clarifies below the interrelationship between the HRSA-22-027, HRSA-22-28, and HRSA-22-029 recipients as well as with HRSA, on specific initiative activities.

Table 1. Phases and timeline

Phase Demonstration Sites

(HRSA-22-028)

Capacity-Building

Provider

(HRSA-22-027)

Evaluation Provider

(HRSA-22-029)

Year 1, Quarter

• Participate in a meeting with HRSA, capacity-building provider, and evaluation provider to develop joint work plan, timeline, and internal communication strategy

• Finalize and document emerging strategies to be implemented at demonstration site

• Prepare institutional review board submission (if applicable) in coordination with evaluation provider

• Prepare business associate

• Convene a meeting with HRSA, demonstration sites, and evaluation provider to develop joint work plan, timeline, and internal communication strategy

• Support demonstration sites in finalizing and documenting emerging strategies

• Finalize learning collaborative structure, activities, and timeline

• Finalize technical assistance plan including process for tracking

• Participate in a meeting with HRSA, capacity-building provider, and demonstration sites to develop joint work plan, timeline, and internal communication strategy

• Support demonstration sites in finalizing and documenting emerging strategies

• Finalize evaluation design including approach, typology, evaluation questions, and goals

HRSA-22-027 14

(HRSA-22-028)

Capacity-Building Provider

(HRSA-22-027)

Evaluation Provider

(HRSA-22-029)

agreement (if needed) with evaluation provider

• Participate in learning collaborative and corresponding activities (ongoing) technical assistance provided and outcome

• Develop a communication and dissemination plan

• Develop data collection systems and tools

• Assist in the development of the communication and dissemination plan

• Assist demonstration sites with preparation of business associate agreement and institutional review board package

Year 1, Quarter

• Implement and refine emerging strategies

• Participate in the evaluation activities (ongoing)

• Receive institutional review board determination or approval (if needed)

• Establish business associate agreement with evaluation provider (if needed)

• Participate in an assessment of technical assistance needs

• Finalize documentation of emerging strategies

• Support demonstration sites to finalize and document emerging strategies

• Implement learning collaborative’s first learning session

• Assess demonstration sites’ technical assistance needs

• Develop site visit plan for demonstration sites in coordination with

HRSA,

demonstration sites and evaluation provider

• Finalize and implement the communication and dissemination plan

• Plan and participate in annual initiative meeting

• Finalize data collection system and tools

• Receive…