HQ HIDMSB CDC-RFA-JG-25-0055 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 21, 2025

Advancing country-led sustainable digital health transformation across PEPFAR-supported countries through informatics workforce capacity development to end HIV/ AIDS and TB as a public health threat by 2030 under PEPFAR Opportunity number: CDC-RFA-JG-25-0055

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 32

Get registered 33

Questions 34

Step 3: Prepare Your Application 35

Application contents and format 36

Step 4: Learn About Review and Award 45

Application review 46

Award notices 50

Step 5: Submit Your Application 51

Application submission and deadlines 52

Application checklist 54

Step 6: Learn What Happens After Award 56

Post-award requirements and administration 57

Contacts and Support 64

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 21, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information U.S. Centers for Disease Control and Prevention (CDC)

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Advancing country-led sustainable digital health transformation across PEPFAR-supported countries through informatics workforce capacity development to end HIV/AIDS and TB as a public health threat by 2030 under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0055

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

February 21, 2025

Expected award and start date: September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary We recognize the pivotal role of informatics and digital health in achieving PEPFAR’s goal of ending HIV/AIDS as a public health threat by 2030. The increasing accessibility of digital health technologies offer unprecedented opportunities to improve health outcomes. However, many PEPFAR-supported countries lack the ability to fully leverage digital health solutions.

This NOFO aims to advance country-led, -owned, and -managed sustainable health information systems (HIS) through robust informatics capacity development across PEPFAR-supported countries. The goals of this work include:

• Ensure data-driven decision-making.

• Accelerate HIV/TB epidemic control.

• Promote health system resilience.

• Advance broader health outcomes beyond HIV.

This NOFO aligns with the PEPFAR Five-year Strategy and the PEPFAR-supported UNAIDS Sustainability Approach. The strategies that will guide activities are:

1. Develop and integrate secure, standards-based, and interoperable HIS investments into national and regional systems.

2. Assess informatics capabilities and digital health maturity across health sector.

3. Plan and execute national and subnational health informatics workforce development strategies.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 5 https://pubmed.ncbi.nlm.nih.gov/18019962/ https://www.state.gov/wp-content/uploads/2022/11/PEPFARs-5-Year-Strategy_WAD2022_FINAL_COMPLIANT_3.0.pdf https://www.unaids.org/sites/default/files/media_asset/HIV%20response%20sustainability%20response%20primer_web.pdf https://www.unaids.org/sites/default/files/media_asset/HIV%20response%20sustainability%20response%20primer_web.pdf

4. Develop, implement, and evaluate governance and policy strategies for the health informatics workforce and HIS at all levels.

Other HIS strategies, digital health roadmaps, etc. specific to and defined by the country, CDC, continent, and global organizations should be reviewed and applied.

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $25,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1-4 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

Step 1: Review the Opportunity 6

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: HOP/COP Q1 Targets and Activities

◦ Component 2: HOP/COP Q2 Targets and Activities

◦ Component 3: HOP/COP Q3 Targets and Activities

◦ Component 4: HOP/COP Q4 Targets and Activities

◦ Component 5: HOP/COP Additional Targets and Activities

◦ Component 6: Non-HOP/COP or buffer component (if needed)

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in PEPFAR-supported countries and regions.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work Digital health challenges PEPFAR’s Five-Year Strategy and UNAIDS Sustainability Approach chart the course to the sustainable development goal of ending HIV/AIDS as a public health threat by 2030.

While PEPFAR has made significant progress, several challenges persist:

• Using digital health information systems to reach undiagnosed, untreated, non-virally suppressed individuals.

• Increasing service access for people living with HIV and other at-risk populations.

• Addressing broader public health concerns through PEPFAR platforms.

• Improving government capacity for program and system leadership and management.

• Measuring gains and capabilities in public health systems for responding to HIV and other health threats.

Implementing digital health initiatives in low- and middle-income countries (LMICs) presents the following challenges:

• Technology and systems challenges: Issues such as inadequate hardware, poor connectivity, and poorly designed systems undermine technological infrastructure, while HIS integration and data interoperability problems impede data use.

• Governance challenges: weak data governance affects privacy, security, and ethical usage.

• Human resources challenges:

◦ Many LMICs lack informatics workforce strategies, resulting in a shortage of skilled professionals. Limited capacity for data generation, management, and use can result in incomplete, late, and unreliable data, impacting decision-making.

◦ High staff turnover, low pay, and few career growth opportunities make it hard to attract and keep qualified informatics professionals.

Over-reliance on donor funding and insufficient long-term funding add to the challenge of hiring and keeping qualified staff.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10 https://www.state.gov/wp-content/uploads/2022/11/PEPFARs-5-Year-Strategy_WAD2022_FINAL_COMPLIANT_3.0.pdf https://www.unaids.org/sites/default/files/media_asset/HIV%20response%20sustainability%20response%20primer_web.pdf

Digital Health Strategies With data and information becoming increasingly digitized, digital health strategies have been adopted by many, including:

• World Health Organization.

• United States Agency for International Development.

• Africa Centres for Disease Control and Prevention (Africa CDC).

• U.S. CDC.

• More than 120 countries.

To support its digital health mission, PEPFAR focuses on:

• Building country capacities to define, develop, maintain, and assess high-quality, secure, and sustainable HIS. These systems are vital for the care, treatment, and prevention of HIV/AIDS, TB, and related conditions.

• Promoting standards for interoperability and data security, enabling the integration of disparate systems and tracking progress toward the UNAIDS 95-95-95 goals.

Developing informatics-savvy health organizations To ensure the sustainability of digital health investments, PEPFAR supports the development of individuals who can create, lead, and manage informatics-savvy health organizations (ISHOs).

An ISHO obtains, uses, and exchanges information to improve public health outcomes and decision-making. PEPFAR uses the ISHO framework to address challenges, allocate resources, and manage progress toward optimal use of public health data.

This NOFO will assist targeted organizations, including ministries of health, national public health institutes, district health offices, or health facilities, in becoming informatics-savvy.

Organizations aiming to develop into ISHOs need three core capabilities:

1. Vision, policy, and governance.

2. Skilled workforce capable of using information and technology tools.

3. Well-designed and effectively used information systems.

Step 1: Review the Opportunity 11

A framework for achieving digital health maturity The CDC developed the TripleIG implementation framework, offering a complete, cyclical, and scalable pathway for countries to achieve ISHO status and digital health maturity. This framework focuses on four interconnected components:

• Informatics for Leaders (I4L): equips leaders with the ability to use information and communications technology to inform decision-making and improve health outcomes.

• ISHO Assessment: a diagnostic tool to evaluate a country’s informatics policy, governance, workforce, and systems.

• Inter-Governmental Learning Exchange to Advance Data-driven Decision-Making (I-LEAD): a platform for knowledge exchange and collaboration to develop vision, strategies, and action plans.

• Growing Expertise in E-health Knowledge and Skills (GEEKS): provides project-based training, modeled after the Field Epidemiology Training Program (FETP), to implement action plans and build local informatics expertise.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://pmc.ncbi.nlm.nih.gov/articles/PMC6740320/pdf/nihms-1033729.pdf https://pmc.ncbi.nlm.nih.gov/articles/PMC6740320/pdf/nihms-1033729.pdf

By investing in governance, workforce, and HIS through the ISHO strategy and the TripleIG framework, PEPFAR-supported countries can establish sustainable digital health systems that:

• Enhance health outcomes.

• Strengthen health systems.

• Contribute to ending HIV/AIDS as a public health threat.

• Address broader health challenges.

These efforts are increasingly coordinated with other US government agencies, in partnership with Africa CDC and various CDC Global Health Center Divisions and supported programs, such as FETP.

Purpose The purpose of this NOFO is to enhance health informatics capacity by focusing on workforce development activities. This will improve the availability and use of high-quality data for HIV/AIDS prevention, treatment, epidemic control, and reporting through country-owned HIS that securely exchange unique patient-level data.

By advancing policies and governance, strengthening local health informatics leadership and technical capacity, and optimizing HIS, this NOFO aims to support effective HIV/AIDS management and reporting.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 13

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1:

Strengthen regional and host country workforce capacity to develop and integrate secure, standards-based, interoperable HIS investments into national and regional architectures.

Strategy 2:

Strengthen host country workforce capacity to assess informatics capabilities and digital health maturity across health sector levels and organizations.

Strategy 3:

Strengthen host country workforce capacity to formulate and execute national and subnational health informatics workforce development plans and strategies.

Strategy 4:

Strengthen host country workforce capacity to develop, implement, and evaluate governance and policy strategies for health informatics workforce and HIS across all levels.

Increased partnerships to advance workforce development.*

Improved availability of detailed information on informatics gaps and priorities across three ISHO pillars.*

Increased knowledge and skills of workforce through TripleIG activities.*

Increased adoption of national and local policies supporting sustainable workforce development approaches and solutions.*

Increased tracking of workforce development programs and credentialing for informatics professionals.*

Increased adoption, harmonization, and optimization of monitoring and evaluation (M&E) reporting tools and procedures by countries.*

Increased capacity to integrate HIS investments for HIV/ TB into national architectures.*

Improved capacity to establish processes for information exchange across all data systems for HIV/

TB.*

Improved capability to analyze and use HIS data on HIV/TB at all levels.*

Increased PEPFAR reporting from country-owned HIS.*

Increased workforce capacity to establish data governance mechanisms that facilitate health information exchange for HIV/TB.*

Improved implementation of data security and privacy policies.*

Increased use of workforce data for strategic development and program planning.*

Improved informatics program priorities, implementation, and

Reduced HIV-related morbidity, mortality, and disease outbreaks.

Improved integration of HIV care data with quality management systems.*

Increased institutionalization of workforce development strategies, approaches, and partnerships within countries.*

Increased digital health maturity.*

Improved health decision-making, outcomes, and resource allocation through use of integrated data.

Enhanced integration of digital health solutions to address broader public health priorities.*

Step 1: Review the Opportunity 14

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Increased integration of health informatics curricula in academic and applied programs supporting HIV/TB.* resource allocations through application of M&E findings.*

Additional information on outcomes in the logic model:

• Partnerships include those among US government, CDC, Africa CDC, and host countries. They may include both public and private partnerships.

• Academic and applied programs include but are not limited to FETP.

• Enhanced sustainability can be achieved through, but is not limited to, strengthened government capabilities and program management of programs via collaborations and partnerships.

• Digital health maturity is measured using institutionalized maturity assessment tools to enhance the health system measurably and sustainably for digital health.

• Improved health decision-making, outcomes, and resource allocation can be achieved through use of integrated data, including better monitoring of linked clinical cascades, National Data Repositories, and surveillance data.

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

Following are strategies and the required activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Step 1: Review the Opportunity 15

Strategy 1: Strengthen regional and host country workforce capacity to develop and integrate secure, standards-based, interoperable HIS investments into national and regional architectures.

Required activities

• Strengthen the national capability of the health informatics workforce to develop an enterprise architecture.

• Improve the capacity of the health informatics workforce to develop and roll out an interoperability architecture across HIS.

• Advance health informatics workforce’s use of standards for data exchange and system interoperability.

• Strengthen the capacity of the health informatics workforce to develop and adapt interoperability standards and tools.

• Advance the ability of the health informatics workforce to optimize individual HIS (such as Electronic Medical Record) to support interoperability and reporting.

• Help countries collaborate with technology organizations on HIS optimization and leverage available resources.

• Advance the capacity of the health informatics workforce to assess HIS, data exchange, and data security and to address identified gaps.

• Improve the ability of the health informatics workforce to develop and implement key components required for health information exchange, such as interoperability layer and client registry.

• Help the health informatics workforce use gap analysis to optimize national digital health strategy.

• Advance the capacity of the health informatics workforce to develop strategies and technology that ensure the unique identification of patients across HIS.

Step 1: Review the Opportunity 16

Strategy 2: Strengthen host country workforce capacity to assess informatics capabilities and digital health maturity across health sector levels and organizations.

Required activities

• Help the health informatics workforce strategically plan for, implement, and use results from an ISHO maturity assessment.

• Improve ISHO strategy and assessment tool and training resources.

• Advance the capacity of the health informatics workforce to develop M&E plans, protocols, and assessment tools. This activity evaluates the implementation of HIS and interoperability solutions, including security assessments for individual systems and data exchanges.

• Strengthen the health informatics workforce’s capacity to assess the implementation of national and subnational informatics policies and to develop strategic plans for addressing gaps.

• Advance health informatics workforce capacity to use evaluation models in country strategic plans.

• Help the health informatics workforce develop strategic roadmaps based on assessments and M&E results.

Strategy 3: Strengthen host country workforce capacity to formulate and execute national and subnational health informatics workforce development plans and strategies.

Required activities

• Support the workforce in developing innovative internal and external partnerships (such as public and private partnerships) to increase the availability of competency-based health informatics training for local staff.

• Help the workforce increase local or regional competency-based pre-service and in-service health informatics training.

• Provide workshops and activities to support countries in national workforce planning, strategy development, and execution, including developing high-priority health informatics workforce programs, credentialing, career development, and training accreditation.

• Advance the capacity of the health informatics workforce to set up information systems (such as Human Resource Information System) to track upskilling, credentialing, and workforce placement and use data for strategic workforce planning across levels.

Step 1: Review the Opportunity 17

• Provide workshops and other activities to build institutional capacity to evaluate outcomes and impact of workforce development initiatives and identify needed governance and policies to address workforce gaps.

• Provide workforce development workshops and other activities to strengthen local communities of practice and health informatics professional associations.

• Enhance the TripleIG framework (I4L, ISHO, I-LEAD, and GEEKS) approach and implementation tools.

• Support developing and delivering I4L training programs for health leaders to drive data-driven policies and strategies.

• Support developing and delivering I-LEAD workshops to foster country teams’ learning and collaborations to develop vision, strategy, and an action plan.

• Support developing and implementing project-based applied GEEKS programs to build a skilled health informatics workforce.

• Support developing and implementing applied health informatics fellowship programs for Africa CDC and national public health institutes.

• Support developing and implementing HIS capacity development programs for FETP.

• Support developing and implementing health informatics capacity-building programs for laboratory training.

Strategy 4: Strengthen host country workforce capacity to develop, implement, and evaluate governance and policy strategies for health informatics workforce and HIS across all levels.

Required activities

• Advance national capability for enterprise architecture planning (for example, outputs and outcomes from national enterprise architecture workshop).

• Advance national capability to bring together diverse country stakeholders to develop HIS workforce governance and policy strategies and roadmaps.

• Advance institutional capacity across levels to assess the impact of governance and policy on the sustainability of HIS workforce development and activities.

Step 1: Review the Opportunity 18

• Advance host country workforce capacity for developing and implementing privacy and security policies.

• Advance integration of HIV care data with quality management systems.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 19 https://www.state.gov/reports-pepfar/ and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include:

• Healthcare workers.

• Ministries of health staff.

• National Public Health Institutes, Africa CDC, and other related organizations supporting digital health development.

• People living with HIV and other at-risk populations (men who have sex with men, transgender individuals, sex workers, people who inject drugs, people in prisons and other closed settings).

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If funded, we will expect you to collaborate with:

Other CDC programs and organizations awarded through CDC:

• Health Informatics Data Management and Statistics Branch.

• Growing Resilience in Outcome-based Workforce Development for Health Informatics Team.

• CDC country offices and teams.

• Government organizations, including ministries of health.

• National public health institutes and Africa CDC.

• Local organizations within supported countries.

Organizations not funded by CDC:

• Other PEPFAR-funded U.S. Government agencies and programs.

• Non-government organizations.

• Regional partners such as Health Informatics in Africa.

• Local government agencies.

• Multilaterals across the country and specific to CDC country offices counterparts that fall within these categories.

• Public/private partnerships.

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

Step 1: Review the Opportunity 22

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 2.5% of funds for monitoring activities and 2.5% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

These include process and outcome measures that directly correlate with the logic model.

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 23 https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year. You may also propose custom indicators.

• Number and quality of informatics capability and gap analysis reports developed across the three ISHO pillars to inform decision-making and roadmap development. [Target: 5; Reporting Frequency: Annual]

• Number of partnerships established to support competent informatics workforce development. [Target: 5; Reporting Frequency: Annual]

• Percentage of staff trained in informatics knowledge and skills out of the total need through I4L, ISHO, I-LEAD, and GEEKS. [Target: 20%; Reporting Frequency: Annual]

• Number of countries that initiated accreditation processes for the training/career development programs. [Target: 1/country; Reporting Frequency: Annual]

• Number of informatics competencies-based curricula and courses.

[Target: 5; Reporting Frequency: Annual]

• Number of existing or new communities of practice to support countries’ use of global goods (What are Global Goods - Digital Square) to advance sustainability. [Target: 2/country; Reporting Frequency: Annual]

• Number of informatics workforce positions proposed. (Target: 1/country;

Reporting Frequency: Annual)

• Number of informatics career pathways proposed. (Target: 1/country;

Reporting Frequency: Annual)

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

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term and end-term evaluation.

• Extent to which the ISHO has been successfully integrated into the institutional policies, procedures, and practice of targeted organizations,

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 24 https://wiki.digitalsquare.io/index.php/What_are_Global_Goods and how its use contributes to measurable improvements in digital health maturity: process evaluation.

• Facilitators and barriers influencing the sustainability of digital health maturity initiatives, partnerships, and strategies that can be implemented to ensure continued progress: process evaluation.

• Effectiveness of national and local policies in supporting the development of a skilled digital health workforce: outcome evaluation.

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If

Step 1: Review the Opportunity 25 awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Include the following elements in your evaluation and performance measurement plan.

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Step 1: Review the Opportunity 26

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 27 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

Step 1: Review the Opportunity 28

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 30 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

Other indirect cost policies

•…