HRSA-21-064.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Global Health (OGH) Office of the Administrator (OA)

Health Resources and Services Administration (HRSA)

Capacity Building for Sustainable HIV Services

Funding Opportunity Number: HRSA-21-064

Funding Opportunity Type(s): New OR Competing Continuation Assistance Listings (CFDA) Number: 93.266

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: May 7, 2021

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

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: February 25, 2021

Jaclyn Perlman Project Officer, OGH/OA Telephone: (301) 945-0836 Email: JPerlman@hrsa.gov

Authority: Public Law 108-25 (the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003) [22 U.S.C. 7601 et seq.], Public Law 110-293 (the Tom Lantos and Henry Hyde United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008), and Public Law 113-56 (PEPFAR Stewardship and Oversight Act of 2013).

https://www.hrsa.gov/office-global-health https://www.hrsa.gov/about/organization/key-staff.html mailto:JPerlman@hrsa.gov

HRSA-21-064 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2021 Capacity Building for Sustainable HIV Services. The purpose of this cooperative agreement, funded under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is to enhance the quality, effectiveness, efficiency, patient-centeredness, safety, accessibility, equity, and sustainability of HIV clinical services and related non-clinical supports in identified countries with PEPFAR programs. HRSA is committed to sustainable control of the HIV/AIDS epidemic, by working with local partners and Ministries of Health to build the capacity of health care workers and health systems to produce a sustained, efficient, and responsive approach to the HIV epidemic in resource-limited countries. The program aims to build the capacity of countries to be agile and current in their response to the needs of program beneficiaries, achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, and sustain these efforts over time.

Funding Opportunity Title: Capacity Building for Sustainable HIV

Services Funding Opportunity Number: HRSA-21-064 Due Date for Applications: May 7, 2021 Anticipated Total Annual Available FY 2021 Funding:

$50,000,000

Estimated Number and Type of Award(s): Up to two cooperative agreement(s) Estimated Award Amount: Up to $50,000,000 per year subject to the availability of appropriated funds and other funding sources.

Cost Sharing/Match Required: No Period of Performance: September 30, 2021 through September

29, 2026 (5 years) Eligible Applicants: Domestic or foreign public or non-profit private entities, including schools of medicine, nursing, public health, management and public administration, and academic health centers, community-based organizations, faith-based organizations, and consortia consisting of such organizations, are eligible to apply.

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

HRSA-21-064 ii

Application Guide

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

Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, March 17, 2021 Time: 10 a.m. – 11:30 a.m. EST Call-In Number: 1-888-730-9136 Participant Code: 5686097 Weblink: https://hrsa.connectsolutions.com/nofo_pre-application/

Playback Number: 1-800-518-0081 Passcode: 3521 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/nofo_pre-application/

HRSA-21-064 iii

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 MANAGEM ENT (SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-21-064 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Capacity Building for Sustainable HIV Services project.The purpose of this cooperative agreement, funded under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is to enhance capacity building in PEPFAR countries. Capacity building encompasses quality, effectiveness, efficiency, patient-centeredness, safety, accessibility, equity, and sustainability of all HIV clinical services and related non-clinical support in identified PEPFAR countries. HRSA is committed to sustainable control of the HIV/AIDS epidemic, by working with local partners in country (such as civil society, faith-based and community-based organizations, key populations groups, etc.) and Ministries of Health to build the capacity of health care workers and health systems to produce a sustained, efficient, and responsive approach to the HIV epidemic in resource-limited countries. The program aims to build the capacity of countries to be agile and current in their response to the needs of program beneficiaries, achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets,1 and sustain these efforts over time.

The goal of this program is to improve health outcomes for people living with HIV/AIDS (PLHIV) along the HIV care continuum by building sustainable health systems, including a global workforce with the right skills, mix, and distribution to respond to HIV and other population health priorities. The program will support countries currently receiving capacity building support (Mozambique, Botswana, India, Jamaica, Trinidad & Tobago, and Ukraine) through HRSA’s International AIDS Education and Training Centers (IAETC) program, as well as extend this work and offer additional programming to new countries.

The program shall focus on:

• comprehensive and client-centered service delivery;

• quality improvement to address gaps in performance and inequities;

• transitioning to local partners and integration of HIV services into primary health care;

• strengthening Human Resources for Health (HRH);

• interventions to address other determinants of health, such as behavioral health;

• data management, telemedicine and e-learning, and health informatics/system solutions to identify and track patients, monitor results and progress; and

• improving diagnosis, linkage, treatment, retention and viral suppression rates.

The program also provides direct technical assistance to Ministries of Health and regional and local government entities, and supports institutional capacity building. The

1 https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf

HRSA-21-064 2

overall objective is to achieve and/or maintain HIV epidemic control within the PEPFAR program.

2. Background

This program is authorized by Public Law 108-25 (the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003) [22 U.S.C. 7601 et seq.], Public Law 110-293 (the Tom Lantos and Henry Hyde United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008), and Public Law 113-56 (PEPFAR Stewardship and Oversight Act of 2013).

Since its inception, PEPFAR has invested over $85 billion in the global HIV/AIDS response, saving over 18 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS epidemic.

PEPFAR’s investments continue to strengthen the systems that drive client-centered and sustainable health care. These investments create a lasting health system for partner countries to confront other current and future health challenges, enhance global health security, and protect America’s borders. The HIV/AIDS pandemic constantly evolves in every community and country and PEPFAR continually adapts to address new risk groups, new health challenges, and persistent gaps.

(https://www.state.gov/about-us-pepfar/).

Under the leadership of the Office of the U.S. Global AIDS Coordinator (OGAC), as part of the U.S. Government’s global HIV response, HRSA has been a significant contributor to PEPFAR’s achievements. HRSA’s work builds on the agency’s domestic and international experience and expertise by improving outcomes along the HIV care continuum for PLHIV. Domestically, HRSA’s programming includes integrations with other bureaus in the agency, such as the HIV/AIDS Bureau (HAB) and the Bureau of Primary Health Care (BHPC). HAB provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people living with HIV who are uninsured and underserved. More than half of people living with diagnosed HIV in the United States receive services through the Ryan White HIV/AIDS Program each year. That means more than half a million people received services through the program.2 BHPC oversees the Health Center Program, a national network of health centers that provide comprehensive primary health care services to more than 27 million people nationwide, regardless of a patient’s ability to pay, charging for services on a sliding fee scale. These health centers play an important role in “Ending the HIV Epidemic” by serving as a key point of entry for people undiagnosed with HIV.

Integrating HIV services into primary care delivery is critical for success—both for health centers and for patients living with HIV. They emphasize coordinated and comprehensive care, and have the ability to manage patients with multiple health care needs.3

2 https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program

3 https://bphc.hrsa.gov/qualityimprovement/clinicalquality/hivprimarycare.html https://www.state.gov/about-us-pepfar/ https://www.hrsa.gov/ending-hiv-epidemic https://www.hrsa.gov/ending-hiv-epidemic https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program https://bphc.hrsa.gov/qualityimprovement/clinicalquality/hivprimarycare.html

HRSA-21-064 3

The Capacity Building for Sustainable HIV Services program builds and expands upon the current IAETC program. The IAETC program focuses on pre- and in-service training for human resources, strategies to prevent HIV/TB transmission, continuous quality improvement approaches, systematic research to guide clinical and educational programming, and policy work that addressed structural barriers to health workers’ effectiveness. The new Capacity Building program must include the following:

• Integrating HIV services into primary care delivery

• Support Effective and Efficient Models of HIV Care and Service Delivery

• Enhance Program Sustainability and Transition to Local Partners

• Strengthen HRH

• Reduce Stigma and Discrimination (S&D)

• Strengthen Virtual Platforms and Online Engagement

• Behavioral Health Interventions

• Health Informatics/Systems Solutions

• Community-led Monitoring

• Quality Improvement (QI)

• Promoting Implementation Science and Emerging/Best Practices

HRSA continues to work with host countries and with other key partners to assess the needs of each country and design a customized program of assistance that fits within the host country’s strategic plan. PEPFAR guidance changes regularly; therefore recipients will consistently monitor, adapt, and align their program activities with current PEPFAR guidelines (refer to current COP21 guidance4).

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New OR Competing Continuation

• Competing continuation – A current award recipient whose period of performance ends September 29, 2021 that seeks to continue implementing the program.

4 COP21 Guidelines: https://www.state.gov/wp-content/uploads/2020/12/PEPFAR-COP21-Guidance-Final.pdf https://www.state.gov/wp-content/uploads/2020/12/PEPFAR-COP21-Guidance-Final.pdf

HRSA-21-064 4

• New – An organization that is not the current award recipient that seeks to implement the capacity building program.

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:

• Provide consultation and technical assistance in planning, operating, and evaluating program activities, including working with the recipient to identify criteria that may be used to select in-country partners.

• Facilitate the coordination and collaboration among program partners, such as the office of OGAC, other HHS Agencies, the United States Agency for International Development (USAID), foreign governments, and other key stakeholders.

• Facilitate efforts to provide technical assistance and training to specified individuals and organizations.

• Participate, as appropriate, in planning and producing any conferences, meetings, or workgroups to be conducted during the project period.

• Maintain an ongoing dialogue with the partner concerning program plans, policies, and other issues that have major implications for any activities under the Cooperative Agreement.

• Review and approve documents, curricula, program plans, budgets, contracts revisions of work plans, prior approvals, etc., prior to printing, dissemination, or implementation.

• Organize an orientation meeting with the awardee(s) to brief them on applicable U.S. Government, HHS, and PEPFAR expectations, regulations, and key management requirements as well as report formats and contents. The orientation could include meetings with staff from HHS agencies and the orientation of OGAC.

• Review and approve recipients’ annual work plan and detailed budget, as part of the PEPFAR Country Operational Plan review and approval process, coordinated by OGAC.

• Review and approve recipients’ monitoring and evaluation plan, including for compliance with the strategic information guidance established by OGAC.

• Meet on a quarterly basis with awardee(s) to assess quarterly technical and financial progress reports and modify plans as necessary.

• Meet on an annual basis with awardee(s) to review annual progress report for each U.S. Government Fiscal Year, and to review annual work plans and budgets for subsequent year, as part of the PEPFAR review and approval process for Country Operational Plans, coordinated by OGAC.

• Provide technical assistance, as mutually agreed upon, and revise annually during validation of the first and subsequent annual work plans. This could include expert technical assistance and targeted training activities in specialized areas, such as strategic information, project management, stigma and discrimination, telehealth, community-led monitoring, etc.

HRSA-21-064 5

The cooperative agreement recipient’s responsibilities will include:

• Identify, pilot, evaluate, and scale up new approaches to effective and efficient

HIV service delivery in targeted regions/countries through technical assistance, consultation, and training.

• Identify, refine, and build upon emerging strategies, evidence informed and evidence-based comprehensive prevention approaches, and best practices that address gaps in epidemic control among key populations. Improve diagnosis, linkage, treatment, continuity of treatment, and viral suppression through consultation and technical assistance.

• Collaborate with HRSA, U.S. Government field teams, other U.S. Government agencies, and other key stakeholders as applicable, to achieve program objectives.

• Engage in ongoing consultation with HRSA and field teams as applicable, on program implementation, and inform HRSA in a timely manner on barriers encountered.

• Identify activities to be planned jointly and include HRSA input and approval.

• Consult with HRSA and key stakeholders, and develop and execute a final monitoring and evaluation plan including establishing a final list of indicators, baseline data, and performance targets for each indicator. The monitoring and evaluation plan will be revised as appropriate on an ongoing basis.

• Participate in monitoring activities including, but not limited to, Site Improvement Monitoring System (SIMS) and site visits.

2. Summary of Funding

HRSA estimates approximately $50,000,000 to be available annually to fund up to two

(2) recipients. You may apply for a ceiling amount of up to $50,000,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 30, 2021 through September 29, 2026 (5 years).

Funding beyond the first year is subject to the availability of appropriated funds for Capacity Building for Sustainable HIV Services program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce recipient funding levels beyond the first year if the recipient is unable to fully succeed in achieving the goals listed in the application.

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

Grants to foreign organizations and foreign public entities that are performed fully outside of the territorial limits of the U.S. may be paid to support the costs of compliance with federal requirements at a fixed rate of 8 percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and sub-awards in excess of $25,000.

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

HRSA-21-064 6

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic or foreign public or non-profit private entities, including schools of medicine, nursing, public health, management and public administration, and academic health centers, community-based organizations, faith-based organizations, and consortia consisting of such eligible organizations.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

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

HRSA will consider any application that exceeds the page limit referenced Section_IV.2 non-responsive and will not consider it for funding under this notice.

NOTE: Multiple applications from an organization are not allowable.

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

IV. Application and Submission Information

1. Address to Request Application Package

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

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

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

HRSA-21-064 7

2. Content and Form of Application Submission

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

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

Application Page Limit

The total size of all uploaded files included in the page limit may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, 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-21-064, 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. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachments 13 - 15: “Other Relevant Documents”.

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

HRSA-21-064 8

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

Project-Level Activities

Please provide evidence of capacity building experience in the countries currently supported by the program (listed in the Purpose section), in addition to the capability to work in new countries. Provide a detailed approach and activities necessary to achieve the overarching objective and focus areas of the NOFO. During the era of COVID-19, keep in mind innovative approaches and best practices to align with what a country needs during the pandemic.

Focus Areas:

• Integrating HIV Services into Primary Care Delivery – Critical for both PLHIV and for health facilities. Working towards achieving better access to HIV services, through expanding the health workforce and building capacity in primary care facilities. This is a priority for PEPFAR.

• Support Effective and Efficient Models of HIV Care and Service Delivery - This includes providing effective service delivery and integrated services throughout the entire HIV care continuum strengthening clinical mentoring;

providing client-centered services and differentiated service delivery models;

health facility management; training health care workers to provide linkage to prevention, care and treatment, behavioral health services, and essential support services; and to enhance case finding/index testing, continuity of ART, adherence to ART, and viral suppression.

• Enhance Program Sustainability and Transition to Local Partners - To sustain epidemic control, it is critical that HIV services are owned and operated by local institutions, governments, and community-led organizations. There is a need to provide strategic planning and capacity building TA and support to facilitate the process of responsible transition to local partners, while maintaining and monitoring the quality of HIV/AIDS services. Plans should be established and agreed upon in partnership with governments and other local institutions, in order to ensure smooth transition of roles and responsibilities. One programmatic area which may be considered for transitioning over time, is HRH. This is an example of how a country might use the sustainability and transition process to plan for sustaining the health workforce programmatic element.

• Strengthen HRH - Provide TA to country governments to enhance HRH planning, production, and recruitment to deployment and continuity of ART.

Activities should focus on effective and efficient workforce deployment to high burden areas. Provide capacity development and sensitization of providers in order to improve testing services (including index testing/case finding). Address

HRSA-21-064 9

basic and complex HIV treatment issues across the HIV care continuum, in addition to focusing on key populations.

• Reduce Stigma and Discrimination (S&D) - This is a key barrier that impedes the scale-up of effective HIV/AIDS programs along the entire cascade. There is a need to identify and understand complex dynamics driving S&D, in order to implement innovative strategies and community-led approaches, and to strengthen the capacity of civil society and key populations (KP) organizations.

Interventions need to be developed to address cultural stigma at the facility and community levels, and to provide health care workers the skills and tools necessary to ensure patients’ rights, informed consent, confidentiality, treatment and non-discrimination. Refer to the Stigma Index 2.0,5 which measures S&D among PLHIV and charts progress in reducing occurrences.

• Strengthen Virtual Platforms and Online Engagement - Assisting governments, health care facilities and professionals, and other stakeholders with utilizing and maintaining online learning platforms. Offer affordable online clinical and public health courses, telemedicine and tele-mentoring, and other innovative ways to continue professional development and mentoring online.

• Behavioral Health Interventions - Training, mentoring, and consultation for HIV clinicians to diagnose common mental health and substance abuse disorders, prescribe medications, and provide ongoing management to patients. Provide support to effectively screen, diagnose, and refer patients with mental health and substance use disorders.

• Health Informatics/Systems Solutions - Implementation of data quality assurance (DQA) to assure timely, accurate, complete data at all levels of health care system, and support to national and local health officials to operationalize governance of health information systems (HIS) investments. Improving health outcomes through data-driven approaches. Routine surveillance activities. Assist in identifying the optimal approaches to health system solutions such as matching patient records.

• Community Engagement - Build organizational capacity of civil society/community service organizations (CSOs) to achieve epidemic control.

This includes creating and maintaining civil society engagement, community-led monitoring through CSOs, collaboration and best practices to enhance the PEPFAR program, ensuring that civil society and government work together to increase community awareness, transparency, accountability, and monitor quality and accessibility of services and the patient-provider experience.

• Quality Improvement (QI) - Focus on developing innovative strategies to improve the delivery of HIV quality care and treatment for use by facilities that serve the most vulnerable individuals in PEPFAR-supported countries. Using QI methodologies, tools, and techniques, these projects identify gaps in service

5 https://www.stigmaindex.org/ https://www.stigmaindex.org/

HRSA-21-064 10

delivery, and develop culturally and medically appropriate, sustainable interventions targeted to PEPFAR-identified vulnerable and key populations. The program offerings are delivered as quality improvement collaboratives (rapid and standard), through networks, above site trainings, and coordinated clinical mentoring skills sharing.

• Promoting Implementation Science and Emerging/Best Practices - The assessment of and integration of emerging strategies and evidence-informed interventions (best practices) into nimble and responsive clinical and community practice and engagement activities, in regards to PEPFAR priorities, COP guidance, key populations, etc. This may include pediatric approaches, voluntary medical male circumcision (VMMC), adolescent girls and young women (AGYW), HIV and the aging population, PrEP, and Site Improvement Monitoring Systems

(SIMS).

• Addressing Social Determinants of Health - Social determinants of health have a lasting effect on a wide range of health, functioning, and quality-of-life outcomes and risks. Since key populations are highly marginalized due to stigma, discrimination, and violence, HIV programs must consider how to address these factors, by working with various institutions such as Historic Black Colleges and Universities (HBCUs) and others.

i. Project Abstract

See Section 4.1.ix of HRSA’s SF-424 Application Guide.

Please include a summary of the proposed activities; a description of the impact of the proposed activities; and indicate the funding amount requested for the period of performance. The project abstract should not exceed one page.

ii. Project Narrative

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

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

HRSA-21-064 11

• INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 o This section should briefly describe the background, justification for the program, and the proposed areas of geographic focus and populations served. These choices should demonstrate that you understand the unique impact of the HIV/AIDS epidemic in these areas and on the local population, and the concomitant challenges to HIV/AIDS care as well as the priorities of PEPFAR and OGAC.

o Please provide a clear and succinct description of the technical assistance and capacity development activities (pertaining to the focus areas) that will address the needs of health care providers to improve health outcomes for PLHIV along the HIV care continuum and build a sustainable health workforce to achieve epidemic control in resource-constrained environments. This section should demonstrate an understanding of international public health issues, the HIV/AIDS epidemic and global care delivery systems, PEPFAR priorities and guidelines, the evolving HIV treatment options and associated challenges, and their impact on meeting the needs of clinical health care professionals. Support the problems described, at a minimum, by providing a preliminary statement of need, described below. Reflect the statement of need in the program plan, associated work plans and budgets.

• NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 o Clearly provide sufficient evidence to support the need for HIV capacity development in resource-constrained settings to improve health outcomes of PLHIV and those at risk of contracting HIV. Describe knowledge gaps in the current HIV/AIDS workforce among PEPFAR-funded countries. Provide a concise synthesis of relevant literature that demonstrates a comprehensive, up-to-date understanding of the issues related to education and training needs in the proposed areas of geographic focus.

o Describe and document the target populations in PEPFAR funded countries as well as the challenges posed in the provision of HIV care.

Provide a concise summary of the literature demonstrating a comprehensive understanding of health systems strengthening and human resources for health in resource-constrained settings. You must include data to show where gaps exist that hamper health outcomes for PLHIV.

• METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 o Describe in detail the proposed project’s objectives, goals and intended outcomes. Objectives should be specific, measurable, realistic, and achievable within the project period. Clearly relate the project objectives and goals to the program expectations outlined in this NOFO. Include a plan for promoting sustainability through capacity building. Describe how you will work with relevant Ministries and national bodies, District Management and Specialist Teams and other managers in districts, sub-districts, and facilities.

o Describe the key activities proposed for accomplishing project goals and objectives including, but not limited to, any proposed changes to the delivery of clinical resources for HIV/AIDS providers. Describe how the

HRSA-21-064 12

project aligns with the related activities in the Background section under “focus areas” (pages 3).

o Clearly describe the technical approach/methods for implementing the proposed project and meeting the needs described above. Activities should reflect a focus on sustainability considerations from the outset of the project. The section should include:

• How your organization will build and maintain strategic partnerships with relevant Ministerial, civil society, other U.S. Government-funded programs, and other relevant stakeholders to ensure relevancy and timeliness of education, training, and technical assistance. Ensure that your plans are in alignment with current PEPFAR priorities/guidelines and corresponding national strategic plans.

• How the education and training strategies proposed in this program will support, complement, scale-up, or innovate on existing efforts funded by PEPFAR.

• A description of the training and technical assistance modalities that your organization will use to improve the knowledge, skills, and behaviors of HIV health care professionals, which will ultimately impact clinical patient outcomes. Include innovative training techniques to engage clinically isolated health care professionals.

Include virtual platform and online learning as a strategy.

• A plan to disseminate program findings, lessons learned, and promising practices to local communities, national and international conferences and in peer reviewed publications.

o Describe any innovative methods that you will use to address the stated needs.

o You must also propose a plan for project sustainability after the period of federal funding ends. HRSA expects recipients to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population.

• WORK PLAN -- Corresponds to Section V’s Review Criterion #2 Response and Criterion #4_Impact

Describe the activities or steps that you will use to achieve each of the objectives proposed during the entire period of performance in the Methodology section (submit as attachment #1).

The work plan must include the following information:

o Goals, objectives and outcomes that are SMART (specific, measurable, achievable, realistic, and time measurable). Include appropriate milestones (e.g., a significant or important event(s) in the project period) and any products to be developed. The work plan must relate to the needs identified in the needs assessment and to the activities described in the project narrative.

HRSA-21-064 13

o Plans must demonstrate the ability to reach stated program objectives within the required time of performance (including a plan for rapid launch of project activities) through the inclusion of illustrative timelines for the effective implementation of the program description.

o Describe the activities or steps that will be used to achieve each of the activities proposed in the Methodology section. Use a timeline that includes each activity and identifies responsible staff, meaningful support and collaboration with key stakeholders in planning, designing and implementing all activities. Include the development of stakeholder engagement and, further, the extent to which these contributors reflect the cultural, linguistic and geographic diversity of the populations and communities served. Include any memorandum of agreement/understanding or letter of support that describes commitments to participate in your proposed project. The work plan must cover goals, objectives, and action steps for the entire five-year project period. The work plan should include as much detail as possible with the understanding that a final plan will be developed after the cooperative agreement is awarded, the initial assessment is complete, and HRSA provides our input. It should describe the number of trainees anticipated to be trained, by level of training, training site, and discipline.

o Describe your organization’s quality management plan, which should include quality management infrastructure; and the performance measures used to assess implementation, efficiency, and impact. Describe how the plan will:

• Identify staff responsible for the quality management activities.

• Monitor, measure, and track program goals, objectives, and activities, especially those outlined in the approved work plan; and deliver technical assistance to U.S. Government and international partners as needed.

• Ensure the education and training activities reflect the needs of the population to be trained; are delivered in an effective manner; are reflective of the current knowledge base; are acceptable at the trainee level; and incorporate adult learning principles.

Logic Model

Submit a logic model for designing and managing the project (submit as attachment #1). A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements. While there are many versions of logic models, for the purposes of this notice, the logic model should summarize the connections between the:

o Goals of the project (e.g., reasons for proposing the intervention, if applicable);

o Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience.);

o Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

HRSA-21-064 14

o Target population (e.g., the individuals to be served);

o Activities (e.g., approach, listing key intervention, if applicable);

o Outputs (i.e., the direct products of program activities); and Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. You can find additional information on developing logic models at the following website:

https://www.cdc.gov/eval/logicmodels/index.htm

• RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

Demonstrate a familiarity with the following:

o Challenges inherent in working in low-resource settings o Challenges inherent in working in multiple countries at once o Context-specific characteristics (e.g., culture, health literacy, language) and how they impact HIV care in this/these settings o Current gaps or shortcoming of the current health systems with respect to

HIV/AIDS control. Specifically, the knowledge and ability of health care professionals to counsel, diagnose, treat, and medically manage people with HIV disease, and to help prevent high-risk behaviors that lead to HIV transmission

• EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 and Criterion_#4_Impact

Describe the plan for the program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation should monitor ongoing processes and the progress towards the goals and objectives of the project. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities.

Describe the systems and processes that will support your organization's performance management requirements through effective tracking of performance outcomes, including a description of how the organization will collect and manage data (e.g., assigned skilled staff, data management software) in a way that allows for accurate and timely reporting of performance outcomes.

Describe current experience, skills, and knowledge, including individuals on staff, https://www.cdc.gov/eval/logicmodels/index.htm

HRSA-21-064 15

materials published, and previous work of a similar nature. As appropriate, describe the data collection strategy to collect, analyze, and track data to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery. Describe any potential obstacles for implementing the program performance evaluation and your plan to address those obstacles.

o Describe processes for developing appropriate evaluation tools and strategies to electronically receive, store, manage and maintain data to be collected at performance sites, which may include sensitive/identifiable information. Indicate how these will include data requested specific to the PEPFAR program (e.g., MER indicators and Annual Progress Reports).

o Describe how evaluation and performance measurement will demonstrate the value of the investment (e.g., effect on improving public health outcomes, effectiveness of the program activities, cost-effectiveness or cost-benefit).

o Include expected outcomes of health systems strengthening, human resources for health, organizational capacity building, and technical assistance approaches.

o Plan for tracking not only inputs and activities, but outputs, outcomes, and impact of the activities.

Include any developed evaluation tools as Attachment 11 (optional).

• ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review

Criterion #5

Succinctly describe your organization’s current mission, structure, and scope of current activities, and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations.

Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs to avoid audit findings. Describe how you will routinely assess and improve the unique needs of target populations of the communities served.

Include the following elements:

o Organizational Description and Chart Provide a one page project organizational chart, as Attachment #5. The organizational chart should be a figure that depicts the organizational structure of the Capacity Building program (not the entire organization), and it should include contractors (if applicable) and other significant collaborators.

o Management and Staffing Expertise

Describe your organizational knowledge, capability, and experience in managing programs that provide training, technical assistance and capacity development activities in HIV/AIDS programs. Include any experience in the provision of training, technical assistance, and capacity development within the scope of PEPFAR. Discuss any examples of

HRSA-21-064 16

previous projects that reflect the expertise of proposed personnel in working collaboratively with PEPFAR, ministries of health and/or education, and other international and/or multinational HIV/AIDS organizations. Include Provide Attachment #2 for Staffing Plan and Job Descriptions for key personnel.

o Global Health Federal Grants and/or Cooperative Agreements

Provide a table that lists the qualifying global health grants, cooperative agreements, and/or contracts, source of funding; name of project director/principal investigator; institution holding the award; grant, cooperative agreement, or contract number; total amount of award; and end date. The table may include all collaborating institutions listed in this application to meet the requirement. Provide this information in attachment #9.

o Past Performance References

You must provide up to three past performance references (required).

Consortium partners may provide up to three past performance references from the last three years for contracts, grants and/or cooperative agreements of similar size, scope, and complexity (optional). Provide this information in attachment #10.

If you intend to utilize sub-recipient awards, indicate the extent intended, the method of identifying sub-recipients, and the tasks/functions they will be performing. Outline which organization/sub-recipient will carry out the various tasks specified in the technical approach; a matrix or table may be helpful to organize this section. The prime partner will be responsible for all technical activities regardless of the activities implemented by the sub-recipients or other member of the team. Specify the composition and organizational structure of the entire team (including sub-recipients and/or country offices) and specify the nature of organizational linkages (includes their relationships between each other, lines of authority and accountability, and patterns for utilizing and sharing resources).

Provide information on your organization’s resources and capabilities to provide culturally and linguistically competent training and capacity development services.

Cultural competence means having a set of congruent behaviors, attitudes, and policies that come together in a system or organization or among professionals that enables effective work in cross-cultural situations. It includes an understanding of integrated patterns of human behavior, including language, beliefs, norms, and values, as well as socioeconomic and political factors that may have significant impact on psychological well-being, and incorporating those variables into assessment and treatment. Include the project’s cultural and linguistic competence factors. See U.S. Government National Standards for Culturally and Linguistically Appropriate Services at:

https://thinkculturalhealth.hhs.gov/clas#:~:text=The%20National%20CLAS%20Sta ndards%20are,culturally%20and%20linguistically%20appropriate%20services https://thinkculturalhealth.hhs.gov/clas#:%7E:text=The%20National%20CLAS%20Standards%20are,culturally%20and%20linguistically%20appropriate%20services https://thinkculturalhealth.hhs.gov/clas#:%7E:text=The%20National%20CLAS%20Standards%20are,culturally%20and%20linguistically%20appropriate%20services

HRSA-21-064 17

Clearly describe how you will manage the cooperative agreement, including approaches to addressing potential problems.

o Administrative and Budgetary Expertise

Describe your organization’s capacity to administratively manage a federally-funded training program and past experience managing awards and contracts.

Describe your organization’s proposed processes you will use for oversight of and technical assistance for sub-recipients’ services.

o Key Collaborations and Partners

Describe how your organization will work collaboratively and partner with key stakeholders. Propose how they will liaise and coordinate with the host government(s) as well as with other district and local government partners, PEPFAR partners, and other stakeholders working across PEPFAR program areas. If you plan to team up with other organizations or government agencies for the implementation of the proposed activities, outline the services to be provided by each such agency or organization.

State whether or not you have any existing relationships with the proposed partner(s) and, if so, include the Memoranda of Understanding (MOUs) in Attachment #4.

NARRATIVE GUIDANCE

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