HRSA-21-066.pdf

HRSA-21-066

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

Global Reach Ι

Funding Opportunity Number: HRSA-21-066 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.266

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: May 10, 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: March 11, 2021

George Tidwell Senior Program Advisor, HRSA OA OGH Telephone: (301) 443-4688 Email: gtidwell@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/about/organization/key-staff.html https://www.hrsa.gov/office-global-health mailto:gtidwell@hrsa.gov

HRSA-21-066 ii

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 for the Global Reach Ι Program. The purpose of this initiative is to collaboratively formulate and deliver high quality solutions across the range of programming required to achieve durable HIV epidemic control under the U.S.

President’s Emergency Plan for AIDS Relief (PEPFAR), emphasizing new and innovative approaches pursued jointly with HRSA and other stakeholders. An additional purpose is to assist with translating new science into programming and to mitigate the impact of forces such as global pandemics on the HIV response. Programs and activities are to span health services, structural interventions, and data use and tracking systems.

Ultimately, most annual PEPFAR appropriations are directed to individual countries, and inter-agency headquarters and country-based teams then allocate funding to individual funding mechanisms consistent with priorities and performance targets. These processes typically occur in the period January through April, and allocations to agencies and mechanisms are made and approved during this period. Priorities, targets and funding amounts vary from year to year.

Accordingly, this notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. This initiative may otherwise be cancelled prior to award.

Funding Opportunity Title: Global Reach Ι Funding Opportunity Number: HRSA-21-066 Due Date for Applications: May 10, 2021 Anticipated Total Annual Available in

FY 2021:

$20,000,000

Estimated Number and Type of Award(s): Up to two (2) cooperative agreement(s) Estimated Award Amount: Up to $100 million over 5 years, subject to the availability of appropriated funds.

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

September 29, 2026 (5 years)

HRSA-21-066 iii

Eligible Applicants: Eligible applicants include domestic and foreign public and private nonprofit entities, including institutions of higher education, faith-based and community-based organizations, Tribes and tribal organizations, and for profit entities.

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

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online 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

Friday, March 26, 2021 Time: 11 a.m. - 12:30 p.m. EST Call-In Number: 1- 888-730-9136 Participant Code: 5686097 Weblink: https://hrsa.connectsolutions.com/nofo_pre-application/ http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/nofo_pre-application/

HRSA-21-066 iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

7. OTHER SUBMISSION REQUIREMENTS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A

APPENDIX B

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Global Reach Ι Program.

The purpose of this initiative is to collaboratively formulate and deliver high quality solutions across the range of programming required to achieve durable HIV epidemic control, emphasizing new and innovative approaches pursued jointly with HRSA and other stakeholders. An additional purpose is to assist with translating new science into programming and to mitigate the impact of forces such as global pandemics in the HIV response. Programs and activities are to span health services, structural interventions, and data use and tracking systems.

Global Reach Ι encompasses four major categories of support:

1. HIV Direct Service Delivery

2. Human Resources for Health

3. Quality Improvement

4. Health System Strengthening

Global Reach Ι will also involve “reaching back” to HRSA’s broader expertise and equities, to be brought to bear on global health needs

2. Background

Statutory Authorities

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).).

Overview

Global Reach Ι is the first in a series of new consolidated HRSA programs. It encompasses aspects of previous HRSA offerings under PEPFAR including:

• Resilient & Responsive Health Systems Initiative (RRHS)

• Resilient & Responsive Health Organizations Initiative (RRHO)

• Medical Education Partnership Initiative (MEPI)

• General Nursing Capacity Building Project (GNCBP) and sub-project Nursing

Education Partnership Initiative (NEPI)

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Global Reach Ι also includes successful elements of other HRSA initiatives supporting HIV treatment and care, and quality improvement.

HRSA’s current PEPFAR portfolio is heavily involved in diverse programming in human resources for health as well as the emerging priority area of quality improvement. HRSA is again administering HIV treatment and care programs and is positioned to expand in this area where opportunities and gaps appear. HRSA also plans to support system strengthening necessary to migrate the leadership of the HIV response from the national level to district or county level to achieve and sustain epidemic control and to enhance local capacity beyond HIV.

HRSA administered PEPFAR care and treatment programs in ten countries or “operating units” (OUs) and successfully transitioned all of these programs to qualified local partners, nearly all of which remain PEPFAR implementing partners (IPs) today. HRSA administered diverse educational and training programs as well as other capacity building activities.

HRSA continues to administer a number of special initiatives on behalf of PEPFAR including programs administered by Historically Black Colleges and Universities.

HRSA now aims to link all of its equities in the PEPFAR response. HRSA’s PEPFAR program sits within the Office of the HRSA Administrator (OA) and Office of Global Health (OGH), and maintains strong links with the HIV/AIDS Bureau.

This structure provides greater visibility of the Program and provides access to other key Bureaus and Offices such as the Bureau of Health Workforce (BHW), Bureau of Primary Health Care (BPHC), Maternal and Child Health Bureau (MCHB), and the Federal Office of Rural Health Policy (FORHP).

Program Description

Mature PEPFAR implementing partners and the agencies working with them continue to march toward sustainable epidemic control. Gaps remain, and many of these gaps are consistent across many PEPFAR countries.

Within each country, the highest burden districts or counties are generally covered, and existing implementing partners tend to fill any newly identified geographic gaps.

Opportunities remain in OUs with continued weak performance across the HIV care continuum, particularly with interventions targeted to low coverage and poor performing modalities in prevention, testing, linkage, treatment including adherence and continuity of treatment, and viral load coverage and viral suppression. Key and priority populations and associated interventions present additional opportunities to optimize coverage and impact.

Countries in which HRSA has a team on the ground may provide particular opportunities to intervene in key areas, even in mature programs.

This is a moment for new innovative solutions, advanced and/or developed as part of the application process, with such discovery and dissemination, in collaboration with HRSA, to continue throughout the duration of this project.

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HRSA will release several companion funding opportunity announcements during the same period as this announcement and with overlap in some program areas, with the intention of creating additional opportunities and partners to support a broader engagement in global health. HRSA 21-064 and HRSA-21-096 are among the companion announcements.

PEPFAR Country Operating Plan (COP) and Regional Operating Plan (ROP) funding will be the primary PEPFAR funding sources for this project, and the associated annual COP Guidance will define the contours of the interventions and expected impact.

This notice of funding opportunity (NOFO) is informed by the PEPFAR COP21 Guidance (FY21) https://www.state.gov/wp-content/uploads/2020/12/PEPFAR-COP21-Guidance- Final.pdf. You should refer to applicable sections and orient your submission accordingly.

During the Emergency Phase of PEPFAR, HRSA supported treatment services in ten countries in Africa and the Caribbean. The United States Agency for International Development (USAID) and the US Centers for Disease Control and Prevention (CDC) have since assumed responsibility for most of these services given their large staff presence in most PEPFAR countries. There are other primarily small countries, which are included in one of several PEPFAR regional programs. Many of these countries do not have the same level of United States Government (USG) field coverage as the large independent PEPFAR countries. One such country is Sierra Leone, which currently has no CDC or USAID staff supported by PEPFAR and small overall staffing. HRSA, on the other hand, is present in Sierra Leone (and Liberia), and is supporting a full range of HIV treatment and other services in support of the HIV care continuum.

There are other countries and opportunities for HRSA to fill such gaps in instances where HRSA feels that it has the capacity, contacts, and contextual understanding to extend such support. This cooperative agreement aims to provide HRSA with the capacity to extend the reach of PEPFAR as well as continue to deliver HRSA’s Agency-wide expertise.

In November 2014 UNAIDS released a Fast Track Strategy for ending AIDS by 2030 https://www.unaids.org/en/resources/campaigns/World-AIDS-Day-Report-2014.

Over 18 years PEPFAR https://www.state.gov/pepfar/ has evolved to a complex and high impact program, with mature stakeholders and partners showing that epidemic control is indeed possible including in large OUs with big outbreaks. The final push to achieve the UNAIDS Fast Track Strategy https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_Fas tTrack_en.pdf goals brings particular challenges that were not so prevailing when coverage was lower. Meanwhile all stakeholders are seeking ways to maintain the remarkable gains and assure that clear counterparts in each OU are able to take up and maintain the response.

It is in this context that HRSA is renewing its commitment to PEPFAR and specifically seeking to fill gaps as well as to bring targeted and innovative solutions to the remaining barriers to epidemic control around the Globe. Central to this pursuit will be partnerships with Ministries of Health and other governmental institutions, and other stakeholders.

https://www.state.gov/reports-pepfar/ 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 https://www.unaids.org/en/resources/campaigns/World-AIDS-Day-Report-2014 https://www.state.gov/pepfar/ 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

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Category 1: HIV Direct Service Delivery

The Guidance, (page 14/665), states that PEPFAR programs should highlight four key themes in planning and implementation for COP21:

1. Client-Centered Services

2. Community Engagement

3. Resilient and Adaptive Approaches

4. Support for Sustainable Capacity

Note: In the Guidance, “retention” is replaced with “continuity of treatment” and “lost to follow-up” replaced with “interruption in treatment”.

The Guidance states that collective treatment and prevention priorities (page 23/665) for COP21 include:

1. Scaling solutions to address barriers to case finding and treatment continuity, particularly among young and asymptomatic clients, and ensuring all HIV-positive clients are engaged in continuous antiretroviral therapy (ART) and enabled to maintain viral load suppression.

2. Ensuring that PEPFAR prevention activities target the networks with the greatest need so that Voluntary medical male circumcision (VMMC), Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), Pre-Exposure Prophylaxis (PrEP) and access to condoms are saturated in the highest prevalence and highest risk populations as evidenced by high yield, incidence or recency tests.

The Guidance subsequently provides detailed technical considerations for all aspects of prevention, case finding, and treatment, with additional specificity for key and priority populations. You should rely on the Guidance in developing program plans.

In an effort to ensure maximum cost efficiencies and program effectiveness, HRSA expects coordination among partners, and integration of activities that promote PEPFAR principles.

The following activities need to be included in program plans:

• Implementing a woman- and girl-centered approach in OUs where the focus extends beyond KPs or other priority populations.

• Increased impact through strategic coordination and integration;

• Strengthening and leveraging key multilateral organizations, global health partnerships, and private sector engagement;

• Encouraging country ownership and investing in country-led plans;

• Building sustainability through investments in health systems; and

• Promoting innovation.

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HRSA and PEPFAR propose looking to OU specific gaps in prevention, testing, linkage, adherence, and continuity of treatment to promote a new approach. The key features to consider include:

a. Client-friendly

b. Safe

c. Customized

PEPFAR leaders have urged PEPFAR stakeholders to design programs well before scaling them, and this principal may need to be retrofitted to existing programs to make them effective as well as sustainable.

The PEPFAR Site Improvement through Monitoring System (SIMS) https://www.state.gov/pepfar-fy-21-sims-guidance-materials/ provides PEPFAR standards against which facility, community-based services, and above-site activities are assessed.

You can use the SIMS tools to assist with program planning.

PEPFAR is supporting community-led monitoring (CLM) of HIV service delivery through community service organizations (CSOs). Qualified CSOs will implement these activities following agreement with HRSA and/or a separate HRSA recipient on a custom framework or one developed by another organization such as the International Treatment Preparedness Coalition (ITPC). https://itpcglobal.org/?resourcetopic=community-monitoring.

Recipients of this award should capitalize on this feedback, and develop solutions, in collaboration with HRSA, when such monitoring produces gaps or opportunities.

Below each of the four categories of support within this initiative are illustrative outputs and outcomes. These are examples and are not all-inclusive.

Illustrative Activities

Short Term Outcomes Intermediate Outcomes

Long Term Outcomes

Systems and processes for HIV prevention and treatment created (or adapted) and tested to assure they are effective and reliable prior to scaling.

o Community engaged, and data from existing community-led monitoring activities utilized.

o Early linkages with Global Fund to assure reliable commodities.

o SIMS tools relied upon for applicable standards.

o Designed informed by unique key population needs, relying on applicable o Effective monitoring and prompt action when problems arise in system performance.

o Deliberate actions, in consultation with HRSA and others, to seek, introduce and document innovative solutions and enhancements.

o Continuous reliance of data for decision-making and in preparation of possible program expansion.

o Achieve targets and any milestones o Effective efforts to support a positive therapeutic alliance between the recipient of care, the health care provider, and the health care system.

o OU showing strong progress toward achieving (and maintaining) epidemic control.

o Integration of HIV service delivery in primary care o Differentiated service delivery for HIV services, with possible influence on management of other https://www.state.gov/pepfar-fy-21-sims-guidance-materials/ https://itpcglobal.org/?resourcetopic=community-monitoring https://itpcglobal.org/?resourcetopic=community-monitoring

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Illustrative Activities

Short Term Outcomes Intermediate Outcomes

Long Term Outcomes community stakeholders.

o Index testing consistently performed in accordance with

PEPFAR

requirements for safe and ethical application.

o Counterparts identified to be the recipients of new knowledge and capacity, with further mentoring and supportive supervision to support sustaining this capacity.

o Progress seen in typically challenging areas of pediatric treatment, continuity of treatment, interruption in treatment.

o Strong progress in reducing KP transmission including through stigma reduction chronic diseases

Consistent with underlying authorities, PEPFAR seeks to ensure that children and youth obtaining services through PEPFAR programming are protected from abuse, exploitation, and neglect in PEPFAR-supported programs.

To that end, because activities to be funded under this award may involve children or personnel coming into contact with children, recipients of PEPFAR funds through HRSA must agree to ensure compliance with host country and local child welfare and protection legislation or international standards, whichever gives greater protection, and with U.S. law, where applicable.

Recipients are encouraged to pursue the following supporting actions:

• Establish policies and procedures that prohibit recipient personnel from engaging in child abuse, exploitation, or neglect;

• Consider child safeguarding in project planning and implementation to determine potential risks to children that are associated with project activities and operations;

• Apply measures to reduce the risk of child abuse, exploitation, or neglect, including, but not limited to, limiting unsupervised interactions with children;

prohibiting exposure to pornography; and complying with applicable laws, regulations, or customs regarding the photographing, filming, or other image-generating activities of children;

• Promote child-safe screening procedures for personnel, particularly personnel whose work brings them in direct contact with children; and

• Have a process for ensuring that personnel and others recognize child abuse, HRSA-21-066 7 exploitation, or neglect, report allegations, investigate and manage allegations, and take appropriate action in response to such allegations. You are strongly encouraged to include the above provisions in any applicable code of conduct for its personnel implementing PEPFAR-funded activities.

Category 2: Human Resources for Health (HRH)

Many of the PEPFAR HRH activities administered by HRSA were supported through the PEPFAR Headquarters Operating Plan (HOP) and have comprised special initiatives such as the Medical Education Partnership Initiative, Nursing Education Partnership Initiative, Resilient and Responsive Health Systems Initiative, Resilient and Responsive Health Organizations Initiative, and the Strengthening Inter-Professional Education on HIV Care across Africa (STRIPE) project. New HRH activities may arise through this funding stream and be implemented through this project, though this funding stream continues to diminish within PEPFAR.

The Guidance describes expectations for “Optimizing HRH Staffing for Maximal Impact” in Section 6.6.8 beginning on page 457, with further information in Section 6.6.10 pertaining to “Planning for sustainable epidemic control” beginning on page 476. PEPFAR is focused on ensuring health care workers are utilized in the most efficient and effective manner possible.

The Guidance states that “In planning for COP21, countries should prioritize: 1) ensuring the safety and well-being of the workforce; 2) further optimizing the health and social welfare workforce to efficiently and effectively achieve epidemic control; and 3) advancing the sustainability of the health and social welfare workforce for maintaining epidemic control under local leadership”.

The Guidance contains changes in the HRH section. You should refer to applicable sections and orient your submission accordingly.

Pre-service HRH interventions are increasingly uncommon within PEPFAR, as are opportunities for developing professional boards and councils because, as mentioned earlier, PEPFAR is focused on health care workers’ ability to provide lifesaving HIV care and treatment at high priority service delivery sites. If such opportunities arise within PEPFAR, you will be expected to administer these activities under this initiative.

Broadly, activities might comprise innovative and cost effective approaches to increasing the production, capacity, employment, deployment, and retention of nurses, midwives, clinical officers, pharmacists, community health workers and others who provide primary care and community health services to people living with HIV, tuberculosis (TB), other infectious and chronic diseases.

PEPFAR supports targeted in-service training to improve service delivery and system performance. Developing non-clinical workforce responsible for systems, including district health teams and management of HRH data (e.g., HRIS and PEPFAR HRH inventories), represents an additional likely area of support.

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PEPFAR is requiring transition of programs to local partners, and opportunities may arise to assist with developing the capacity of eligible local partners. Sustainability remains a primary objective of PEPFAR, and a central focus of capacity building efforts is to identify local counterparts supported to receive, apply, and disseminate new knowledge.

Use of telehealth and tele-mentoring platforms to support sites and practitioners lacking the tools to succeed has emerged as an effective intervention. Capability to rapidly spread new advances in treatment and other modalities creates an important advantage when such opportunities arise.

Finally, support for policy and other efforts to create an enabling environment, including to drive improvement across PEPFAR Minimum Program Requirements (MPRs), is expected of treatment partners as well as partners involved with broader system strengthening interventions. The MPRs as described in the Guidance appear below within Category 4:

Health System Strengthening.

Activities

Short Term Outcomes

Intermediate Outcomes

Long Term Outcomes

Health workers trained appropriately to provide equitable and competent care.

The right skill mix of workers exists at the right locations.

Multidisciplinary team-based approaches for case management are defined and optimized to support client-specific needs.

o Health workforce datasets established and utilized, and strong human resource management systems, in collaboration with stakeholders.

o Sustainability counterparts identified for all capacity building activities.

o Workforce monitored and realigned to meet programmatic objectives.

o Identify opportunities for cadres not formally recognized by the government to be formally integrated into national systems.

o Institutionalize Efficient Models.

o Processes created to attribute service outcomes to the facility and community-based HRH responsible for delivering the services and regularly used for HRH management and decision-making.

o Provide leadership in defining and establishing a health workforce that meets workload requirements for HIV services and that host country governments are willing and able to sustain.

Category 3: Quality Improvement

The Guidance suggests that PEPFAR country programs must incorporate explicit quality management practices, including both QA and QI activities, into service delivery and partner management.

Section 3.1 of the Guidance (page 107) describes “PEPFAR’s Focus on Quality and Patient- Centered Services”, perhaps better articulated than in any previous COP Guidance. The role of “quality” in the final stretch to epidemic control has become central, though independent funding for quality is far less common than in previous years, replaced by an expectation that implementing partners imbed such practices in their plans. As stated in the

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Guidance, “diligent and sustained attention to quality is required to reaching sustained epidemic control.”

You must demonstrate the capacity to draw from QI tools and methods and formulate targeted, cost effective and timely QI interventions.

HRSA will continue to support cost-effective rapid quality improvement collaboratives, supported through a number of HRSA global mechanisms. Supporting implementation of existing “change packages” will also be a central strategy. You must pursue QI capacity at the site and district level, particularly in the context of transition and sustainability.

Illustrative Activities

Short Term Outcomes Intermediate Outcomes Long Term Outcomes

Optimal health outcomes met on a daily and routine basis.

A culture of quality comprised of energy, professional investment and teamwork.

Client at the center of all service delivery.

o Use of SIMS to improve quality.

o Use of existing “change packages” as efficient solution to existing and multi-site challenges.

o Improved score for Minimum Program Requirements associated with

QA/QI.

o Quality Management policies in place and practiced, covering key areas such as enabling and engaging provider teams to use data and their first-hand understanding of operations to identify the root causes of barriers to program quality, implementing a client-centered approach and achievement of results.

o Sustained and active approach to implementing CQI at the site level.

o Context specific durable solutions.

o Use of existing indicators (MER, SIMS, SID, above site benchmarks) and establishing new indicators to track key client-centered quality measures (e.g., wait times) and to monitor the progress of quality improvement processes.

o Full compliance with Minimum Program Requirements associated with QA/QI.

Category 4: Health System Strengthening (HSS)

This initiative will support diverse HSS needs as presented in the various categories below.

One of HRSA’s fundamental principles is that for all HSS support as well as other areas of support through this initiative, you must identify host country national counterparts, individuals, groups, or organizational units, who will become the ultimate host of this transitioned and sustainable capacity.

Component 1: Minimum Program Requirements

The Guidance describes 15 minimum requirements for continued PEPFAR support, beginning on page 48 in Section 2.1.1.

As stated in the Guidance, “Evidence demonstrates that lack of any one of these policies/practices significantly undermines progress to reaching epidemic control and results in inefficient and ineffective programs.”

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The status of these requirements in each OU is reported and PEPFAR tracks the progress.

Below is a partial illustration for West Africa (reporting COP20 MPRs).

You must demonstrate the capacity to support improvements in key policy requirements, particularly those directly associated with project interventions such as a unique patient identifier, an important aspect to achieving epidemic control.

Component 2: Transitioning HIV Services to Local Partners

The PEPFAR requirement associated with transitioning HIV Services to Local Partners states: “the intent of the transitioning to local partners is to increase the delivery of direct HIV services, along with non-direct services provided at the site, and establish sufficient capacity, capability, and durability of these local partners to ensure successful, long-term, local partner engagement and impact. This action is a priority for all PEPFAR countries, Regional Programs, and Country Pairs”.

In collaboration with HRSA and other stakeholders, the recipient will identify and strengthen local partners, and will transition some activities and funding to these local partners. HRSA will establish goals in this area, consistent with PEPFAR expectations.

Component 3: Strengthening Capacity for Sub-National Leadership of the National HIV Response

Another area supported by this project is strengthening local leadership in support of sustained and effective leadership of the local HIV response. For countries in which this “devolution” is desired or required, you will be expected to collaborate with HRSA and other

HRSA-21-066 11

stakeholders, including possibly other USG PEPFAR implementing agencies, to successively assess the capacity of district or county health management teams (DHMTs) or comparable sub-national units, and support capacity development on a timeline agreed upon by stakeholders.

This process may also involve partial transition of responsibilities to CHMTs as capacity is achieved and confirmed.

You will be required to identify counterparts and outcomes, in collaboration with HRSA and other stakeholders.

You will be required to develop the domains and elements in consultation with stakeholders, led by HRSA, possibly in collaboration with one or more HRSA implementing partners (IPs).

Illustrative Institutional Strengthening Plan Activities

1. Develop a tailored District Health Management Strengthening Plan, using a competency-based approach and maturity model to enhance performance in each domain identified as in need of improvement.

Illustrative approaches might include:

a. Hands-on training and skills transfer.

b. Development of an online ‘toolkit’ including case studies, didactic materials, and customized tools and job aides.

c. Webinars and videoconferencing to enhance peer-to-peer exchange.

d. Ongoing supportive supervision.

e. If needed, placing a technical advisor or advisors for a period of time to complement, coordinate and collaborate with District Health Management Teams and staff who currently provide site-level capacity development, mentorship, and supportive supervision.

f. Enhancement of critical thinking and crisis response skills using scenario planning.

Illustrative activities might include:

a. Develop county award management capacity especially on key requirements for program and grant management including submission of applications.

b. Support counties to map donor requirements to existing county governance structures to facilitate smooth programming including matching existing positions/roles in the county to required roles and responsibilities for award management.

c. Facilitate skills transfer through twining with the sub-national service-delivery mechanisms to build the capacity of county health care workers and managers to implement interventions and collect and use data for planning and program improvement.

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Component 4: Other Health Systems Strengthening (HSS)

Increasingly PEPFAR limits HSS investments to activities attributable to improvements in treatment and prevention coverage and outcomes.

One clear area where HRSA expects needs to arise is to strengthen Global Fund programs, specifically HIV and related programs, particularly in OUs where the leadership and performance remain sub-optimal. HRSA may seek to catalyze funding from Global Fund for some of the necessary systems strengthening activities, and HRSA, recipients, and other stakeholders, will collaborate on priority impediments to PEPFAR success. Opportunities may arise in monitoring and evaluation, program performance and quality improvement, leadership, governance, and policy.

Illustrative Activities

Short Term Outcomes

Intermediate Outcomes

Long Term Outcomes

Identify several top priority

PEPFAR

minimum program requirements

(MPR)

Identify organizational and individual counterparts to assume aspects of the initiative over time.

Support temporary placement of locally employed individuals to sub-national health management team to support increased responsibility for local HIV response.

Support improved performance of local Global Fund structures in poor performing o Determine barriers and engage with government and other stakeholders to develop a work plan o Review PEPFAR transition requirements, in collaboration with HRSA, and develop plans to conform.

o Agreement from National Gov’t to transition leadership of local HIV response to sub-national level in several high burden sub-national locations.

o Assess priority needs and consult with stakeholders, in collaboration with HRSA, on a plan to address priority gaps.

o MPR score changed from red to yellow with plan for getting to green o Strengthening of counterparts with start of partial transition.

o Local HMTs effectively managing aspects of the local response.

o Evidence of improved performance in key areas such as supply chain, resolution of Global Fund areas of concern, budget execution.

o MPR scored as green o Counterpart organizations and individuals successfully administering aspects of the initiative.

o Local HMTs using data for effective decision-making and demonstrating increasing capacity to managing the local response well, including with community involvement.

o Local Global Fund structures showing significant improved performance including across Global Fund performance framework.

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Activities

Short Term Outcomes

Intermediate Outcomes

Long Term Outcomes

OUs.

Determine and disseminate best practices o Evaluate effective and efficient new service delivery models for HIV, TB and other chronic disease care integrated into primary care at facility and community levels.

o Determine best practices for sustainable health systems with quality delivery of HIV care.

o Evaluate best practices for sustainable and interdisciplinary health care workforce roles.

o Determine best practices for civil society engagement toward sustainable HIV, TB, and chronic disease health care.

o Data available for utilization on best service delivery models and methods for integrating or adapting HIV and related chronic disease management into existing local health systems.

o Data available and utilized to make evidence-based HRH and HSS decisions o Best practices and tools made available on knowledge sharing platform o Improved capacity and planning for sustainable chronic disease and continuum of care management.

o Sustainable HRH for continuation of HIV services by local government o Chronic disease management integrated into existing local health systems o Maintain 90-90- 90 goals for one year (i.e., viral load suppression >90%) o Staffing needs met for one (1) year

II. Award Information

1. Type of Application and Award

Type of applications sought: New

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

HRSA program involvement will include:

• Collaborate in planning, implementing, and evaluating program activities, and facilitate any required technical assistance. Review and possibly contribute to documents, curricula, contracts, personnel (including consultants and contractors), evaluation, implementation science studies and protocols, M&E Plan, etc., prior to printing, HRSA-21-066 14 dissemination or implementation.

• Collaborate on development of work plans and carry over plans ahead of submission by recipient.

• Facilitate coordination and collaboration among program partners including the Office of the Global AIDS Coordinator at the Department of State (S/GAC), other HHS Agencies, the USAID, host governments, and international and other key stakeholders.

• Participate, as appropriate, in the planning and conduct of any meetings or workgroups.

• Facilitate access to the expertise of HRSA and other USG personnel and other relevant resources applicable to the project.

• Collect and analyze data relative to unmet need, special populations, other key health indicators, and emerging priorities or policy shifts to guide current/future strategic planning, developmental efforts, and program activities.

• Participate in the dissemination of program findings, best practices, and lessons learned.

• Provide SIMS tools and HRSA site visit tools. These tools articulate required standards and can be used for program design and self-assessment.

• Catalyze innovation.

The cooperative agreement recipient’s responsibilities will include:

• Adhere to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds, per Section 2.2 of the Application Guide (Acknowledgement of Federal Funding).

• Collaborate with HRSA, the USG field teams, other USG agencies, host governments and other key stakeholders to achieve program objectives.

• Strengthen host country capacity in all aspects of the program with deliberate plans.

• Consult with HRSA and relevant USG Country Teams on program implementation, challenges, and opportunities.

• Develop and execute a final M&E plan, in consultation with HRSA and key stakeholders, including establishing a final list of indicators, baseline data, and performance targets for each indicator.

• Participate in monitoring activities including but not limited to SIMS and HRSA site visits.

2. Summary of Funding

HRSA estimates approximately $20,000,000 to be available annually to fund up to two recipients, with a smaller amount likely in Year 1. Annual amounts are determined through the PEPFAR Country/Regional Operating Plan (COP/ROP).

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 PEPFAR in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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HRSA may shift funding to other recipients and other mechanisms beyond the first year if recipient(s) is unable to achieve the goals set forth in their application.

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

Indirect costs on grants awarded to foreign organizations and performed outside of the territorial limits of U.S. may be paid to support the costs of compliance with federal requirements at a fixed rate of 8 percent of modified total direct costs (MTDC), exclusive of tuition and related fees, direct expenditures for equipment, and sub-awards and contracts under the grant in excess of $25,000.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic and foreign public or private, nonprofit entities, including institutions of higher education, and for-profit entities. Faith-based and community-based organizations, Indian Tribes, and tribal organizations are eligible to apply.

If you are an applicant from a U.S. domestic organization, HRSA encourages you to form a consortium of partners to include foreign institutions with the relevant expertise, with the long-term goal of strengthening networks, ensuring sustainability, and providing in-country personnel.

If you are a foreign applicant, you may include collaboration with U.S. and other foreign institutions with particular expertise in the proposed priority areas as sub-recipient consortium partners.

The applicant institution must meet the eligibility requirements and assumes all legal, programmatic, and financial responsibilities under the award. Consortium participants are sub-recipients under the award. Sub-recipients are subject to all programmatic terms and conditions of the award. Depending on the type of engagement and scope of work, consortium agreements may be in the form of memorandums of understanding (MOUs), sub-awards, or contracts.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider your application non-responsive if it fails to address the programmatic goals and requirements outlined in this NOFO, and will not consider it for review. In addition, HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

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

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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.

NOTE: Multiple applications from an organization are not allowed.

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.

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- 21-066, 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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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 8-15: Other Relevant Documents.

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

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

i. Project Abstract

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

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide.pdf

Please limit project abstract to one page in length, single-spaced, and please place the following at the top of the abstract: Project Title Applicant Organization Name Address Project Director Name Contact Phone Numbers Email Address Website Address, if applicable List all grant program funds requested in the application

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.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-app-guide.pdf

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Please minimize background information and emphasize systems, processes, capabilities and results.

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

• INTRODUCTION -- Corresponds to Section V’s Review Criterion 1 Criterion_1_Need

Provide a concise description of the proposed strategy and approaches you will take for each of the five categories of support.

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

Criterion_1_Need

In relation to Categories 1-4, outline your understanding of the needs of diverse low and middle-income (LMIC) countries. Select three PEPFAR-supported LMICs and discuss the context and specific needs of each. Consider including OUs at various stages of epidemic control (low coverage, improving coverage, approaching epidemic control) to differentiate the unique needs and opportunities of each. Sierra Leone and Liberia are proposed for inclusion under Methodology below and one or both can be included here if desired.

• METHODOLOGY -- Corresponds to Section V’s Review Criterion 2

Criterion_2_Response

For Category 1, please use Sierra Leone and Liberia as potential OUs requiring such support, and orient your responses to the needs, challenges and solutions in each OU.

PEPFAR supports community-led monitoring by community service organizations. Please consult the COP Guidance and describe how you will capitalize on such feedback. Please label your response as M-1.

For Category 2, please summarize existing gaps, design, and rationale of supporting the development of health care workers in low and middle-income countries with high HIV, TB other…