HAB HRSA-22-030_Telehealth_final.pdf

U.S. Department of Health and Human Services

HIV/AIDS Bureau

Division of Policy and Data

Telehealth Strategies to Maximize HIV Care

Funding Opportunity Number: HRSA-22-030

Funding Opportunity Type: New

Assistance Listings (AL/CFDA) Number: 93.928

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: April 8, 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: January 11, 2022

LaQuanta P. Smalley, MPH, BSN, RN, CPN Senior Public Health Analyst, Clinical and Quality Branch Telephone: (301) 443-0995 Email: lsmalley@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Section 2691 of the Public Health Service Act (42 U.S.C. § 300ff-101).

mailto:lsmalley@hrsa.gov

HRSA-22-030 i

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 Telehealth Strategies to Maximize HIV Care project. The purpose of this project is to identify and maximize the use of telehealth strategies that are most effective in improving linkage to care, retention in care, and health outcomes, including viral suppression, for people with HIV who receive services through the Ryan White HIV/AIDS Program (RWHAP).

For the purposes of this notice of funding opportunity, the terms modalities1 and strategies2 are used. Strategies chosen for this project will meet the criteria of an emerging intervention.3

There is limited information available regarding which telehealth strategies are most effective in improving linkage to care, retention in care, primary care health outcomes, and viral suppression for people with HIV within the RWHAP. To address this gap in information, HRSA will fund the Telehealth Strategies to Maximize HIV Care project with the following objectives:

• Identify telehealth strategies that are best suited for different RWHAP populations.

• Increase utilization of effective telehealth modalities and/or strategies within the

RWHAP.

• Increase dissemination of telehealth strategies and tools for uptake in the

RWHAP.

1 Modalities are the technologies that are commonly associated with the term “telehealth.” These could include video conferencing, the internet, store-and-forward imaging, streaming media, and land line and wireless communications.

2 The HIV/AIDS Bureau Implementation Science Framework identifies two types of strategies: (1) intervention strategies, which are activities or practices to improve outcomes for people with HIV via telehealth; and (2) implementation strategies, which include methods or techniques that support optimal integration and uptake of these interventions in RWHAP settings.

3 An emerging intervention is one of three categories of strategies defined in the HIV/AIDS Bureau Implementation Science Framework that addresses emerging priorities for improving the care and treatment of people with HIV. Emerging interventions have demonstrated real world validity and effectiveness but do not yet have sufficient published research, evidence, or evaluation to document their effectiveness.

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• Increase the capacity of RWHAP recipients and subrecipients to identify and implement effective telehealth strategies.

• Increase equity in HIV care for people we have not yet successfully maintained in care or populations that historically experience poor health outcomes.

Specifically, the Telehealth Strategies to Maximize HIV Care award recipient will (1) research and select telehealth strategies that can be used to maximize HIV care in the RWHAP; (2) fund, coordinate, provide technical and capacity-building assistance, monitor, and evaluate implementation of telehealth strategies for a minimum of five programs currently funded by the RWHAP as either recipients or subrecipients; (3) create an inventory of project strategies and tools; (4) disseminate the project’s products through various outlets, ultimately for uptake and replication by RWHAP recipients and subrecipients; and (5) evaluate the project using an implementation science framework.

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 project may be cancelled before award.

Funding Opportunity Title: Telehealth Strategies to Maximize HIV Care

Funding Opportunity Number: HRSA-22-030

Due Date for Applications: April 8, 2022

Anticipated Total Annual Available FY 2022 Funding:

$1,750,000.00

Estimated Number and Type of Award:

One cooperative agreement.

Estimated Annual Award Amount: Up to $1,750,000.00 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 non-profit private entities, state and local governments, academic institutions, local health departments, non-profit hospitals and outpatient clinics, community health centers receiving support

HRSA-2-030 iii under Section 330 of the PHS Act, faith-based and community-based organizations, and Indian Tribes or tribal organizations with our without federal recognition.

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

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, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Friday, January 21, 2022 Time: 1:00 – 2:30 p.m. ET Call-In Number:

Dial a number based on your current location +1 (669) 254-5252 US (San Jose) +1 (646) 828-7666 US (New York)

+1 (669) 216-1590 US

+1 (551) 285-1373 US

(833) 568-8864 (Toll Free)

Webinar ID: 161 248 7465 Web link: https://hrsa-gov.zoomgov.com/j/1612487465

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/1612487465

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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

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) Special Projects of National Significance (SPNS) funding for the Telehealth Strategies to Maximize HIV Care (HRSA-22-030) project. HRSA will fund one cooperative agreement for up to three years to identify and maximize the use of telehealth4 strategies that are most effective in improving linkage to care, retention in care, and health outcomes, including viral suppression, for people with HIV who receive services through the Ryan White HIV/AIDS Program (RWHAP).This project builds upon existing programs, and HAB will coordinate with similar activities in HRSA, the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC).

For the purposes of this notice of funding opportunity (NOFO), the following terms are used:

• Modalities are the technologies that are commonly associated with the term “telehealth.” These could include video conferencing, the internet, store-and-forward imaging, streaming media, and land line and wireless communications.

• Strategies include activities or practices (intervention strategies) to improve outcomes for people with HIV via telehealth, as well as the methods or techniques (implementation strategies) that support optimal integration and uptake of these interventions in RWHAP settings.5

• Strategies chosen for this project will meet the criteria of an emerging intervention, as defined by Psihopaidas et al. (2020).6 These types of strategies address emerging priorities for improving the care and treatment of people with HIV. Emerging interventions have demonstrated real world validity and effectiveness but do not yet have sufficient published research evidence or evaluation to document their effectiveness.

The objectives of the Telehealth Strategies to Maximize HIV Care project are:

• Identify telehealth strategies that are best suited for different RWHAP populations.

4 HRSA defines telehealth as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.

5 Psihopaidas, D., Cohen, S.M., West, T., Avery, L., Dempsey, A., Brown, K., & Cheever, L.W. (2020).

Implementation science and the Health Resources and Services Administration’s Ryan White HIV AIDS Program’s work towards ending the HIV epidemic in the United States. PLoS Med, 17(11):e1003128. Doi:

https://doi.org/10.1371/journal.pmed.1003128.

6 Emerging intervention is one of three categories of strategies defined in the HAB Implementation Science Framework. The other categories are (1) evidence-based interventions and (2) evidence-informed interventions. Psihopaidas, D. et al. (2020) uses the term “emerging strategies.” In an effort to clarify and align the naming of the three categories, HAB has since updated this terminology to refer to emerging strategies as emerging interventions.

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• Increase utilization of effective telehealth modalities and/or strategies within the

RWHAP.

• Increase dissemination of telehealth strategies and tools for uptake in the

RWHAP.

• Increase the capacity of RWHAP recipients and subrecipients to identify and implement effective telehealth strategies.

• Increase equity in HIV care for people we have not yet successfully maintained in care or populations that historically experience poor health outcomes.

The award recipient will (1) research and select telehealth strategies that can be used to maximize HIV care in the RWHAP; (2) fund, coordinate, provide technical and capacity-building assistance, monitor, and evaluate implementation of telehealth strategies for a minimum of five RWHAP recipients and subrecipients (further referred to as subawardees); (3) create an inventory of project strategies and tools; (4) disseminate the project’s products through various outlets, ultimately for uptake and replication by RWHAP recipients and subrecipients; and (5) evaluate the project using an implementation science framework.

2. Background

The 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 people we have not yet successfully maintained in care.

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 (TA); 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 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.

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html

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Strategic Frameworks and National Objectives

National objectives and strategic frameworks like Healthy People 2030, the National HIV/AIDS Strategy (2022-2025) (NHAS); 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 provide 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 the extent possible.

Expanding the Effort: Ending the HIV Epidemic in the United States

According to recent data from the 2020 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States.

From 2016 to 2020, HIV viral suppression among RWHAP clients who have had one or more medical visits during the calendar year and at least one viral load (VL) with a result of <200 copies/mL reported, has increased from 84.9 percent to 89.4 percent.

Additionally, racial/ethnic, age-based, and regional disparities reflected in viral suppression rates have significantly decreased.7 For example, the disparities in viral suppression rates between Black/African Americans and White clients have decreased since 2010.8 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.9

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 HHS agencies, primarily HRSA, CDC, NIH, the Indian Health Service, and the Substance Abuse and Mental Health Services Administration.

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 and in care but not yet virally

7 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2020. http://hab.hrsa.gov/data/data-reports. Published December 2021. Accessed December 28, 2021.

8 Black/African American clients went from 81.3 percent viral suppression in 2016 to 86.7 percent in 2020, while 89.4 percent of White clients were virally suppressed in 2016 and 92.5 percent in 2020.

9 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.

https://health.gov/healthypeople https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 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-2020.pdf https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

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suppressed, to the essential HIV care, 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 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 advance the goals of the 2020-2025 Federal Health IT Strategic Plan10 and further progress toward reaching the NHAS goals and improve outcomes on the HIV care continuum.

HRSA strongly encourages complete CD4, 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 TA, evaluation, and intervention activities. A list of these resources is available on TargetHIV. Recipients should be

10 See 2020-2025 Federal Health IT Strategic Plan: https://www.healthit.gov/topic/2020-2025-federal-health-it-strategic-plan 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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familiar with these resources and are encouraged to use them as needed to support their program implementation.

In addition, many RWHAP 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 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 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 TA and resources for recipients.

Examples of projects include:

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

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• 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

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

Telehealth and the RWHAP

According to data from the RWHAP COVID-19 Data Report, in calendar year 2020, as many as 82 percent of RWHAP recipients reported having basic capacity to offer telehealth in some form. In addition, qualitative data from interviews conducted by an internal HRSA Telehealth Workgroup suggested that, when using telehealth modalities to provide services during the COVID-19 pandemic, RWHAP recipients saw fewer missed patient appointments (i.e., fewer “no-shows”) and noted a higher level of patient engagement.

Recent studies show positive uptake and utilization of services when providers use telehealth modalities and strategies to engage people with HIV in their care.11,12,13 However, there is limited information available regarding which strategies are most effective in improving linkage to care, retention in care, primary care health outcomes, and viral suppression for people with HIV within the RWHAP.

You are encouraged to visit the HHS Telehealth website to find resources and best practices for providers. In addition, you may visit the HRSA Training and Technical Assistance Hub website, which houses all HRSA training and TA resources, to extend their reach and further the impact of HRSA award recipients and stakeholders.

Resources are organized by topic and some resources may be listed under multiple topics. Further, HRSA HAB works cooperatively with the HRSA Office for the Advancement of Telehealth (OAT). Visit the HRSA OAT website for additional resources.

11 Dandachi, D. (2019). Integration of telehealth services in the healthcare system: With emphasis on the experience of patients living with HIV. Journal of Investigative Medicine, 67(5), 815-820. Doi:

http://dx.doi.org/10.1136/jim-2018-000872.

12 Ohl, M.E., et al. (2019). Impact of availability of telehealth programs on documented HIV viral suppression: A cluster-randomized program evaluation in the Veterans Health Administration. Open Forum Infections Diseases, 6(6), 1-9. Doi: https://doi.org/10.1093/ofid/ofz206.

13 Purnomo, J., et al. (2018). Using eHealth to engage and retain priority populations in the HIV treatment and care cascade in the Asia-Pacific region: A systematic review of literature. BMC Infectious Diseases, 18(82), 1-16. Doi: https://doi.org/10.1186/s12879-018-2972-5.

https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/cebacc https://targethiv.org/chw https://hab.hrsa.gov/about-ryan-white-hivaids-program/part-f-special-projects-national-significance-spns-program https://hab.hrsa.gov/sites/default/files/hab/data/datareports/cdr-annual-report-2020.pdf https://www.telehealth.hhs.gov/ https://www.hrsa.gov/library/index.html https://www.hrsa.gov/library/index.html https://www.hrsa.gov/rural-health/telehealth http://dx.doi.org/10.1136/jim-2018-000872 https://doi.org/10.1093/ofid/ofz206 https://doi.org/10.1186/s12879-018-2972-5

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The HRSA HAB Implementation Science Approach

HRSA HAB developed the HAB implementation science (HAB IS) framework to support the translation of research into practice, specifically for interventions that could be effective for improving outcomes among people with HIV served by the RWHAP, thereby reducing disparities and moving toward ending the HIV epidemic in the U.S.14

The HAB IS framework includes effectiveness criteria for three categories of interventions for the RWHAP, which include (1) evidence-based interventions, (2) evidence-informed interventions, and (3) emerging interventions. HRSA HAB developed these criteria in collaboration with the CDC and the NIH (see Figure 1 in Psihopaidas et

al. (2020) for detailed descriptions). The telehealth strategy(-ies) chosen for this project will meet the criteria of emerging interventions that are most responsive to the current HIV epidemic.

HAB IS framework also involves two core components: The first component is rapid implementation, which includes (1) identifying existing interventions with demonstrated effectiveness at improving outcomes for people with HIV; (2) pilot testing those for success specifically within the RWHAP; and (3) creating accessible dissemination products to promote the replication and scale-up of the interventions. The second component is implementation science evaluation which focuses on (1) assessing uptake and integration of interventions, (2) understanding implementation processes, (3) understanding factors that affect implementation, and (4) assessing the impact of interventions on client outcomes.

The Telehealth Strategies to Maximize HIV Care cooperative agreement includes an evaluation plan that assesses the implementation of the project. The award recipient will use an implementation science framework to guide the project performance evaluation activities.

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:

• Reviewing, providing recommendations, and concurring with final work plans and project budgets.

14 Psihopaidas, D. et al. (2020).

https://pubmed.ncbi.nlm.nih.gov/33156852/ https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003128 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003128 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003128

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• 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 project.

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

• Facilitating, communicating, and disseminating status updates, lessons learned, 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 in the development of guides and tools and the design, operation, direction, and evaluation of activities, including TA, meetings, training activities, workshops, and selection of subawardees.

• Providing assistance and collaboration in the management and technical performance of activities.

• Assisting with the coordination of the TA efforts in planning, developing, and implementing the various phases of the project.

• Anticipating and providing guidance on the changes taking place in the health care environment that will affect the planning process.

• Coordinating with other HAB programs to address training and TA needs as they may relate to new/emerging strategic initiatives.

• Providing the expertise of HRSA personnel and other relevant resources to support the efforts of the project activities.

• Facilitating relationships between the recipient, subawardees, and other relevant stakeholders.

• Facilitating partnership and communication with other federal agencies (i.e., HRSA OAT, NIH, CDC, and AHRQ), HRSA recipients, and community stakeholders to improve coordination efforts.

The cooperative agreement recipient’s responsibilities will include:

• Researching and identifying telehealth strategies that can be used to maximize HIV care in the RWHAP.

• Soliciting and selecting RWHAP recipients and subrecipients to fund as subawardees to implement the telehealth strategy(-ies) identified by the recipient.

• Coordinating and delivering training and providing support to promote cross-site collaboration among subawardees.

• Providing technical and capacity-building assistance to support subawardees in tailoring, adapting, and sustaining telehealth strategies.

• Monitoring subawardees, collecting data, and evaluating the chosen telehealth strategy(-ies).

• Using an implementation science framework to guide the project’s development, implementation, and performance evaluation.

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• Developing and compiling project strategies and tools into replicable products (e.g., workflows, protocols, funding mechanisms, manuscripts) for dissemination and uptake by RWHAP recipients and subrecipients.

• Disseminating the project’s products through social media, various regional and national outlets and HRSA-supported websites, including but not limited to the Health Center Resource Clearinghouse, TargetHIV.org and the RWHAP Best Practices Compilation.

• Collaborating with HRSA and other stakeholders as necessary to plan, execute, and evaluate the project activities.

• Modifying activities as necessary in keeping with the changing trends and needs of people with HIV and RWHAP recipients and subrecipients.

• Ensuring training and TA delivered to RWHAP recipients and subrecipients is cleared and coordinated with other HRSA training and TA resources.

• Negotiating with HRSA to update existing work plans at least annually.

• Integrating new priorities during the funding period (i.e., through monitoring calls or other communication), as needed.

• Responding timely to requests made by HRSA for data and information related to project activities.

2. Summary of Funding

HRSA estimates approximately $1,750,000 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 $1,750,000 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 Telehealth Strategies to Maximize HIV Care in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce or take other enforcement actions regarding funding levels beyond the first year if the recipient is unable to fully succeed in achieving the goals listed in the approved 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 non-profit private https://www.healthcenterinfo.org/ http://www.targethiv.org/ https://targethiv.org/bestpractices https://targethiv.org/bestpractices 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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entities, state and local governments, academic institutions, local health departments, non-profit 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.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will not consider an application for funding if it contains any of the non-responsive 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, before 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 Grants.gov: HOW TO

APPLY FOR GRANTS.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-030 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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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 limit may not exceed the equivalent of 60 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. 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-22-030, 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.

Applications must be complete, within the 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. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 10-15: Other Relevant Documents.

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

Program-Specific Instructions If awarded, you must ensure people we have not yet successfully maintained in care or populations that historically experience poor health outcomes are not further marginalized by the proposed project. Your application must clearly identify at least one priority population that subawardees will focus the chosen telehealth strategy(-ies) on.

Your priority population(s) may include, but are not limited to, people with HIV who:

• Are from racial and ethnic minority communities

• Experience unstable housing http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371

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• Are aging

• Live in rural areas and/or rely on rural health connectivity and access to virtual networks

• Have limited English proficiency

• Have physical or intellectual disabilities, who may have trouble accessing virtual services

• Are post-partum

• Are home-bound

• Have behavioral health needs

Allowable activities for the Telehealth Strategies to Maximize HIV Care project include, but are not limited to, the following telehealth strategies:

• Provision of virtual clinical services such as screenings and assessments;

• Analysis of telehealth utilization data to identify potential access gaps;

• Leveraging community partnerships to address social determinants of health

(SDOH);15

• Patient and staff education and training;

• Patient engagement and outreach;

• Patient social risk assessments and follow up workflows;

• Community needs assessments and resource mapping;

• Integration and/or enhancement of currently available digital platforms and tools

(e.g., patient portals, remote monitoring, self-care applications, culturally and linguistically appropriate digital tools);

• Virtual reality interventions;

• Patient-centered care coordination;

• Referral tracking and follow up; and

• Creation of administrative and governance practices.

Funds should not be used to develop new, novel telehealth modalities that do not exist.

If you choose to integrate or enhance a new modality, the cost must be reasonable. If awarded, HRSA will work with you to determine whether the chosen modality(-ies) is allowable. Modalities and strategies adopted in the project should also work to balance in-person care and telehealth and advance health information technology interoperability, consistent with the standards identified through the Interoperability Standards Advisory process.16

If you use broadband or telecommunications services for the provision of health care, you may seek discounts through the Federal Communication Commission’s Universal Service Program. For information about such discounts, see https://www.usac.org/rural-

15 SDOH include factors like socioeconomic status, neighborhood and physical environment, social support networks, community violence, and intimate partner violence (IPV). SDOH affect a wide range of health, functioning, and quality-of-life outcomes and risks. Addressing SDOH, such as IPV, is a HRSA objective to improve health and well-being of individuals and the communities in which they reside.

16 See Office of the National Coordinator for Health Information Technology’s Interoperability Standards Advisory at https://www.healthit.gov/isa/.

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health-care/. Patients may also be eligible for free or low cost mobile or broadband services through the Universal Service Lifeline program at https://www.lifelinesupport.org/.

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. Please use the guidance below. It is most current and differs slightly from that in Section 4.1.ix of HRSA’s SF-424 Application Guide.

Provide a summary of the application in the Project Abstract box of the Project Abstract Summary Form using 4,000 characters or less.

Address Project Director Name Contact Phone Numbers (Voice, Fax) Email Address Website Address, if applicable List all grant program funds requested in the application, if applicable

Because the abstract is often distributed to provide information to the public and Congress, prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed project including the needs to be addressed, the proposed services, and the population group(s) to be served. If the application is funded, your project abstract information (as submitted) will be made available to public websites and/or databases including USAspending.gov.

ii. Project Narrative

NARRATIVE GUIDANCE

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

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

Narrative Section Review Criteria

Introduction (1) Need and (2) Response

Needs Assessment (1) Need

Methodology (2) Response, (3) Evaluative Measures,

(4) Impact, and (5) Resources/Capabilities

Work Plan (2) Response, (4) Impact, and (6) Support Requested http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.usaspending.gov/

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Narrative Section Review Criteria

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures, (4) Impact, and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities and (6) Support Requested

Budget Narrative (6) Support Requested

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.

Use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criteria #1 Need and #2 Response

Briefly describe the purpose of your proposed project. This section should describe how the proposed project addresses the goal of identifying and maximizing the use of telehealth strategies that are most effective in improving linkage to care, retention in care, and health outcomes, including viral suppression, for people with HIV who receive services through the RWHAP, and the objectives listed in the “Purpose” section of this NOFO. Describe the overall plan to conduct the project activities to (1) research and select telehealth strategies that can be used to maximize HIV care in the RWHAP; (2) fund, coordinate, provide technical and capacity-building assistance, monitor, and evaluate implementation of the telehealth strategies for a minimum of five subawardees; (3) create an inventory of project strategies and tools; (4) disseminate the project’s products through various outlets, ultimately for uptake and replication by RWHAP recipients and subrecipients; and (5) evaluate the project using an implementation science framework. Clearly state the priority population(s) for your project. Briefly describe the implementation science framework chosen to guide the development, implementation, and evaluation of the project.

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

This section should demonstrate your understanding of the need to enhance the utilization of telehealth for people with HIV who receive services through the RWHAP. Provide a summary of the literature that demonstrates a comprehensive understanding of issues, needs, or gaps in the existing evidence base regarding the role of telehealth strategies in reducing HIV-related health disparities and improving linkage to care, increasing retention in care, and improving health outcomes, including viral suppression. Describe how your proposed project may

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contribute to or add to the existing evidence base and the effectiveness of telehealth in the RWHAP.

Describe the need for telehealth for your priority population(s) including disparities and/or inequities in accessing care. Describe the barriers to care and related SDOH.