Amendment RFP_HE176-09-005-01.doc

Accordingly the following changes are made:

1. Section B.4 PRICE SCHEDULE, is revised as following:

Base Period

a. Total Cost

b. Grants

c. Fixed Fee

d. Total Cost + Fixed Fee

2. Section C.1 (f) 1. Regional Strategy with Country Specific Activities Replace fourth paragraph with text below:

Throughout the Statement of Work and in related attachments, countries are listed in alphabetical order, not in order of expected emphasis. The HIP’s greatest inputs will be in Tajikistan (27%), followed by Kyrgyzstan (23%), Uzbekistan (19%), Kazakhstan (16%), Turkmenistan (10%), and Regional (5%).

3. Section C.1 (f) 2. US Government (USG) priorities

Replace original table with table:

Planned funding for HIP by program element and country

4. Section C.2 Statement of Expected Results, Intermediate Result 2: Building Public Health Capacity, IR 2.2 Management Improved Include text below:

Appropriate DR TB case management strategies comprise: (1) a rational method for designing optimal treatment regimens; (2) a patient-centered approach for delivering this regimen with direct observation; and, (3) a plan for monitoring and managing side effects. Presently, only Kazakhstan has approved WHO based multidrug-resistant (MDR) TB case management guidelines and protocols. It is encouraged to use them for adaptation to the other four countries of Central Asia. Case management should include the existence of a standardized recording and reporting system with the following categories: patient registration, culture and DST results, and monitoring of treatment delivery and response over a 24-month period. Cohort analyses include interim indicators and treatment outcomes beyond two years, as well as treatment outcomes by treatment regimen and DST results. Medical practitioners must provide special attention to patients who are HIV-positive — or who are suspected of being HIV-positive — as there are considerations to be taken in medicating patients who are co-infected with TB and HIV.

In Central Asia, there are great concerns regarding “chronic” TB patients, as often they: (1) do not have access to treatment; (2) have not complied with treatment regimens; and/or, (3) have defaulted from treatment. The “chronic” category of patients presents a major public health threat and has become a source for ongoing transmission of DR TB to the general population. Appropriate strategies should be developed for their categorization and management to prevent transmission.

In 2009, the TB Control & Assistance Program (TB CAP) activity being funded by USAID/CAR is working with governments to develop national DR TB management plans, and to provide technical assistance in applying for Green Light Committee approval to access quality, second-line drugs. Both of these activities may require further support.

5. Section C.2 Statement of Expected Results, Intermediate Result 3: Improving the Quality of Health Services, IR 3.2 Continuum of Care Improved Include text below:

DR TB patients are at increased risk of treatment non-adherence for myriad reasons, which include: (1) if the patient is a “chronic” patient, he/she is more likely to have had problems with non-adherence in the past; and, (2) adherence to DR TB therapy is particularly difficult (e.g. the treatment cycle lasts two years, treatment requires more drugs, and treatment can result in adverse side effects. Adherence is an essential element in preventing the generation of pan-resistant strains capable of community-wide spread that leave virtually no possibility of cure for the patient. Main adherence promotion strategies include directly-observed treatment, disease education, and socioeconomic and emotional support. The program should seek to reach out to those DR TB patients, including those who are active or former prisoners, and those who do not have access to treatment or would not adhere to treatment. The provision of outreach and social support should be considered for “chronic” TB patients.

6. Section C.4 Country Scopes of Work Include text below:

Offerers should propose how they will achieve the below outcomes, illustrative activities and illustrative performance measures in each of the five Central Asian countries. To ensure harmonization and avoid duplication, the contractor will be required to closely coordinate drug resistant TB activities with other USAID partners.

Expected outcomes

Intermediate Result 2: Building Public Health Capacity IR 2.2 Management Improved Outcome: National capacity in management of DR TB is strengthened Illustrative Activities:

· Enhance national capacity to detect and manage DR TB cases based on national plans

· Implement pilot projects in select regions to introduce a comprehensive, up-to-date approach to DR TB case management, including diagnosis, DR treatment regimens, directly observed treatment, treatment monitoring, adverse effects management, and patient education

· Provide training to implement international DR TB case management standards

· Provide training in diagnostic and clinical guidelines for management of patients co-infected with DR TB and HIV

· Provide technical assistance to develop guidelines to treat DR TB in special circumstances (e.g. pregnancy, diabetes mellitus, renal insufficiency, liver disorders, and HIV)

· Provide technical assistance to governments in their applications to the Green Light Committee for approval for access to quality, second-line drugs

· Provide technical assistance to governments in developing DR TB management plans Illustrative Performance measures:

· Treatment success rate in USG-assisted DOTS Plus programs to treat MDR TB patients (results in 24 months)

· Percent of the estimated number of new smear-positive pulmonary TB cases that were detected under DOTS (i.e. Case Detection Rate)

· Compliance with internationally recognized DR TB case management standards Intermediate Result 3: Improving the Quality of Health Services IR 3.2 Continuum of Care Improved Outcome: Adherence to DR TB Treatment Regimens Improved Illustrative Activities:

· Train and monitor health center staff to ensure directly observed treatment and patient support measures are in place

· Provide health education to patients, their families, and communities, with a focus on stigma reduction

· System to detect and treat adverse effects, including supply of appropriate medications Illustrative Performance Measures:

· Default rate among new DR TB patients

7. Section L.7 Instructions for the Preparation of the Cost Proposal, Part 2 – Proposed Costs/Prices

Replace text with text below:

The cost estimate for the five year contract is from $71.0 M to $73.0 M including fixed fee if any. Of this total, $850,000 to $1.0 M is expected to be used for grants under the contract. Costs for each country are estimated to be the following for the full five years:

Kazakhstan (apr. 16%)

Kyrgyzstan (apr. 23%)

Tajikistan (apr. 27%)

Turkmenistan (apr. 10%)

Uzbekistan (apr. 19%)

Regional (apr. 5%)

Replace the table with the table below:

Total Direct Labor

Salary and Wages

Fringe Benefits

Consultants

Travel, Transportation, and Per Diem

Equipment and Supplies

Subcontracts*

Allowances

Participant Training

Other Direct Cost

Overhead

G&A

Material Overhead

Grants

Total Estimated Cost

Fixed Fee

Total Est. Cost Plus Fixed Fee

8. ATTACHMENT 20 Questions and Answers, revise answer to question #24:

24. You indicated that Abt Associates is the incumbent for this program, and might serve as a resource for other interested organizations. Can you please elaborate?

Abt is not the incumbent for the HIP, as the HIP is not a follow-on activity. The HIP combines efforts to move forward from many of the excellent USAID programs in Central Asia, including health sector reform work and work to introduce concepts of quality improvement (implemented by Abt), DOTS and maternal and child health work (implemented by Project HOPE), and building local capacity for HIV prevention (implemented by John Snow Incorporated). The HIP incorporates the success from all of these programs, and builds upon them, while focusing more on improving health status outcomes than USAID/CAR has in the past. All of these programs have provided important lessons and compiled best practices that will serve as a resource for future implementers in Central Asia; these resources can be accessed from the project websites listed in the RFP. However, none of these organizations is an incumbent to the HIP and all interested eligible bidders are encouraged to submit proposals.

9. add ATTACHMENT 22 List of participants of the pre-proposal conference on March 9, 2009:

Abt Associates, Inc.

Simon Smith

Marc McEuen, Senior Associate phone 301-347-5669 www.abtassociates.com Aga Khan Foundation USA

Zach Scott, Program Assistant

202 293 2537 www.akdn.org BearingPoint - Management & Technology Consultants

Lizann Prosser, Senior Manager

T + 1 703 747 5453 www.bearingoint.com

Booz Allen Hamilton

Camelia Falcon, Associate

Nathan Kline, Associate

703 377 7525

Chemonics International Inc.

Ronald Parlato, Director, Senior HIV/AIDS Specialist

Nancy Hedin 202 999 3300 www.chemonics.com Comprehensive Health Services, Inc.

Joan Bisson, DoD Business Development tel: 321 783 2720 x 30607 www.chsmedical.com

CUBRC Center for International Science and Technology Advancement

Dr. Cheryl Wojciechowski, Senior Research Scientist Ms. Nargiz Jumanova, Program Administrative Coordinator Office: 202-222-0413 www.cubrc.org/cista

Emerging Markets Group

Susan Otchere, Senior Manager

Katie Qutub

703 373 7724 www.emergingmarketsgroup.com

EPOS Health Consultants

Dianna Derhak, JD, MBA

Director of Business Development

240 645 1053 www.epos-usa.com

Futures Group International

Edward Abbel 202-775-9680 www.futuresgroup.com

Gryphon Scientific

Travis J Taylor, PhD, Scientist

301-270-0643 www.gryphonscientific.com Health Net Federal Services

Robert McCashin

Phone: (571) 227 – 6558 www.healthfederalservices.com International Medical Corps.

Malika Mirkhanova

Ben Hemingway

202-828-5155 www.imcworldwide.org International HIV/AIDS Alliance

Leigh Ann Evanson, Senior Development Advisor

202 327 5015 www.aidsalliance.org

JSI

Ms. Asta-Maria Kenney

Dr. David Pyle, Senior Associate Tel: 617.482.9485 www.jsi.com Mission Essential Personnel

Matthew McLean

Director, Emerging Markets

571 521 7261

MHN, A Health Net Company

Stuart Murphy

917 228 2234 www.mhn.com Overseas Strategic Consulting, Ltd.

Christopher Wild, Director, Programs Global Health Initiatives

+1 215 735 0500 x3026 www.oscltd.com

Pact

Shari Bush, Sr. Program Development Officer

Tel: 202-684-3621 or 202-466-5666 www.pactworld.org

PATH

Technical Officer TB and HIV Program Gregoria Lyssikatos;

Mayra S. Arias

Tel. 202-454-5009 www.path.org

Project HOPE

Kayt Erdahl, Program Officer, Infectious Diseases Specialist

Tel.: (540) 837-2100

Raytheon Technical Services Company LLC

Jeff Farnquist

Office: 703.295.2313

Save the Children

Amy Agarwal, Associate Director, Program Development, International Programs

Salim Sadruddin, MBBS, MPH, PhD tel.: 202.640.6756 www.savethechildren.org

Synergy International Systems

Adam Watson,Business Development Associate

Tom Slavin

703-883-1119

The QED Group LLC

Alexis Greenan

Project Analyst, Health Practice

Tel: 202-521-1925 www.qedgroupllc.com

The Pragma Corporation

J. Michael Biddison, Vice President

Lyubov A. Gonchar, Project Manager

Tel: (703) 237-9303 www.pragmacorp.com

Technology Management Company’s

Stephen E. Ockenden, Ph.D., Deputy General Manager

Donald D. Englehardt, Project analyst

Phone (703) 961-8651 X1132 www.tmcservices.com

University Research Co., LLC

Stacy Kancijanic, MA

Tel: (301) 941-8420 www.urc-chs.com

URS Corporation

Andrew Panov, Business Development Manager

Melissa Ann Jones, Senior Scientist

703 236 2763

10. Add ATTACHMENT 23 - MDR TB: Country-Specific Background Information MDR TB: Country-Specific Background Information

Kazakhstan

There are 7,000 to 8,000 new MDR TB cases reported in Kazakhstan each year. The National TB Center’s MDR TB unit ward and the Almaty city TB dispensary are the only two facilities in Kazakhstan currently providing MDR TB management services (DOTS-Plus). In the second of these two facilities, from 2003 to 2008, USAID funded the Gorgas TB Initiative to pilot an MDR TB case management activity. The project resulted in the drafting of a number of clinical MDR TB management protocols, and the creation of an MDR TB case management model that includes integrated and comprehensive approaches to detecting MDR TB infection and providing treatment. The treatment success rate of the 2005 cohort at the Almaty city TB dispensary was 73.4 percent.

National clinical guidelines on MDR TB management are based on WHO recommendations and utilize the MDR TB management protocols developed by the Gorgas TB Initiative. With USAID funding, the TB Control & Assistance Program (TB CAP; led by the KNCV TB Foundation in Kazakhstan) is now scaling up the model developed by the Gorgas TB Initiative to Eastern Kazakhstan Oblast — with an added focus on the penitentiary system, and is improving the National TB Center’s capacity to provide MDR TB training to medical practitioners (January 2009–September 2010). During 2009, TB CAP is also developing a “summary of best practices” exhibited by MDR TB pilot sites throughout the region (Kazakhstan, Kyrgyzstan, and Uzbekistan).

There is a need to strengthen the capacity of oblast (province) laboratories to conduct cultures and perform drug susceptibility testing (DST) for second-line drugs. Currently, only the National Reference Laboratory and the Almaty city laboratory have the capacity to provide DST for second-line drugs. There are shortages of rapid diagnostics equipment, supplies, and reagents, and medical practitioners require technical assistance on rapid diagnosis of MDR TB.

Submitted in September 2006 and approved in January 2007, Kazakhstan’s first application to the Green Light Committee (GLC) provided second-line drugs to 380 MDR TB patients enrolled in the Gorgas TB Initiative pilot project. Second-line drugs for an additional 350 patients will be purchased through the Global Drug Facility. The Government of Kazakhstan has provided funding for only enough second-line drugs to treat 2,000 patients, or 25% of the estimated 8,000 newly-diagnosed MDR TB patients each year. The country also has a national technical working group that focuses on MDR TB management that meets on a quarterly basis.

TB in prisons is also a severe issue. In 2007, the case notification rate in prisons was 750 cases per 100,000 persons — about five times the national level. In January 2010 and with Global Fund to Fight AIDS, TB & Malaria (GFATM) support, the Ministry of Justice Penitentiary Committee will be launching a new pilot project to address MDR TB in Karaganda and Pavlodar prisons. The Government of Kazakhstan’s application for GFATM Round 8 funding has been approved ($63 million); this funding will be used to build the capacity of the National TB Program to address MDR TB nationwide.

Uzbekistan

The prevalence of MDR TB in Uzbekistan is approximately 7,000, with an estimated 500 MDR TB cases in each of the country’s 14 oblasts. The Ministry of Health has recently approved MDR TB treatment standards, based on WHO guidelines. Médecins Sans Frontières and Project HOPE have successfully tested one of the WHO-recommended treatment regimens being used in the pilot sites. Factors that have contributed to the rising prevalence of MDR TB include the following: (1) despite the fact that DOTS treatment standards are approved by the Government, there is a parallel practice of “non-DOTS treatment” for chronic cases; (2) the highest rates of defaulters-from-treatment are in urban areas; (3) second-line drugs are extremely expensive for chronic TB patients for free (patients must pay); and, (4) chronic patients receive social welfare from the Government, which creates an incentive to remain ill.

Currently, Uzbekistan has regional MDR TB units for diagnostics and treatment: in Karakalpakstan Oblast (with Médecins Sans Frontières’ support), and in Tashkent city (in the National TB Hospital and in a prison, both with GFATM support), though the Government plans to expand its pilot program to three additional sites (one will be in Samarkand). The approximate treatment success rate for MDR TB patients is 60 percent (2005 cohort), but there are plenty who are not treated because second-line drugs are currently only available for the two existing pilot sites. Uzbekistan has two reference laboratories that can conduct culture and drug susceptibility testing: one in Karakalpakstan and the other in Tashkent. Both reference laboratories use the basic “Lowenstein Jensen test”; however, only the Karakalpakstan laboratory has the capacity to conduct second-line drug susceptibility tests. Médecins Sans Frontières’ assistance has also enabled the Karakalpakstan laboratory to utilize the MGIT rapid test method. Some cases of extensively-drug resistant (XDR) TB have been identified in Karakalpakstan, but none are managed. An application for GFATM Round 8 funding in the amount of $53.4 million has been approved for treatment of 7,000 MDR TB patients.

Tajikistan According to data from a small, sample drug resistance survey (DRS), primary resistance among new cases is 12.9 percent and resistance among previously-treated patients is 59 percent. Programmatic management of drug-resistant TB has not been developed in Tajikistan. It is currently at the initial stage of introducing culture testing (and only in two pilot rayons) and drug-susceptibility testing in the civil and penitentiary systems. With GFATM Round 6 funding, and with German Development Bank (KfW) support, Tajikistan is planning to reconstruct an MDR TB ward with 50 beds in Macheton Hospital, and begin treatment (GLC approval was granted for 50 patients in 2009). Of the five Central Asian republics, Tajikistan has perhaps the most diverse presence of international organizations working in the TB arena: Caritas/Luxembourg works in prisons, Project HOPE focuses on strengthening DOTS, World Food Program provides food support/packages for TB patients and their families, and WHO provides general technical assistance.

An application for GFATM Round 8 funding in the amount of $26.4 million has been approved and will address MDR TB management, focus on TB in prisons, and improve DOTS implementation nationwide.

Turkmenistan Turkmenistan is in the initial stages of setting up an infrastructure to manage MDR TB. According to a small-scale drug-resistance study conducted by “Médecins Sans Frontières”, there was 3.8 percent of new cases exhibited drug resistance, and 18 percent among retreated cases. WHO upgraded the national TB reference laboratory by providing it with modern equipment for MDR TB molecular diagnostics, and in February 2009, the national TB reference laboratory was certified by the Netherlands-based supranational reference lab. Turkmenistan commenced the provision of MDR TB treatment in January 2009, and a department specializing on the treatment of MDR TB patients is planned to open in 2010. The penitentiary administration began implementing DOTS in prisons in June 2008.

There is a great need to introduce infection control measures to TB hospitals: (1) most TB hospitals were not designed with proper ventilation; (2) medical providers are unaware of methods to protect themselves from contracting TB at the workplace; and, (3) patients frequently interact with each other in both DOTS and non-DOTS departments.

In 2008 in Ashgabat, the Government of Turkmenistan purchased second-line drugs and commenced provision of MDR TB treatment with its own funds. Turkmenistan’s application for GFATM Round 8 funds was rejected, and no drug-resistance survey has been conducted to date.

Kyrgyzstan According to a small-sample drug-resistance survey conducted in Bishkek in 2007, the prevalence of MDR TB was 16 percent among new cases and 53.7 percent among previously-treated cases. Kyrgyzstan has an estimated 1,368 MDR TB cases nationwide, of which 444 are receiving treatment (315 in civilian health facilities, and 129 in penitentiary ones). At all levels of the vertical TB system, Kyrgyzstan has exhibited: a lack of support in supervising and monitoring laboratory staff and procedures, gaps in infection control — including for healthcare workers, and difficulties in providing transport for specimens in a timely manner.

USAID supported both Project HOPE and the U.S. Centers for Disease Control & Prevention to provide assistance to the National TB Control Program. The laboratory at the National TB Center performs culture and smear microscopy testing for all National TB Center patients, and drug-susceptibility tests for all first-line drugs (except pyrazinamid) for Bishkek city and Chui oblast. Kyrgyzstan does not have the capacity to provide drug-susceptibility testing for second-line drugs nationwide. Further complicating matters is the dearth of medical staff at both the oblast and rayon (district) levels, which has been attributed to low wages and “brain-drain.”

Kyrgyzstan was awarded GFATM Round 3 and 6 grants, both of which were implemented over five years and had three components: (1) the development and dispersion of informational, educational, and communicational materials for the general population and health workers; (2) laboratory service support for culture; and, (3) a DOTS-Plus pilot to provide treatment for MDR TB patients.

In 2007 and with GLC approval, the International Committee of the Red Cross (ICRC) began implementing an MDR TB treatment program for 164 patients in the penitentiary system. The ICRC also established a new MDR TB department at the National TB Center and continues to provide MDR TB training to TB staff. The ICRC works in Colony 27 and Colony 3, where most patients are previously-treated cases. ICRC engineers renovated Colony 27’s water and sewage systems to accommodate 800 detainees ($120,000).

[End of Amendment]

5. PROJECT NO.

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NO.

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NO.

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NO.

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR AC-

KNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 10-83)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

BY

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

STANDARD FORM 30

(Type or print)

(Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(No., street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(If applicable)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

(X)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign)

(Signature of Contracting Officer)

03/27/2009

USAID/CAR/AA

7030 Almaty place

Department of State

Washington DC 20521-7030

To all Offerors/Bidders

HE176-09-005

03-19-2009

X

The purposes of this amendment are to:

revise the SOW to include the Drug-Resistant Tuberculosis activities and adjust the planned breakdown of activities by geographic area and program element;

post the list of participants of the pre-proposal conference;

post Questions & Answers regarding this RFP.

[continued on page 2]

John Griffin

Contracting Officer

03-27-2009