HRSA-23-126 SNA NOFO-Implementation Sites Final-MOD-6-6-23.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

HIV/AIDS Bureau

Division of Metropolitan HIV/AIDS Programs

A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites

Funding Opportunity Number: HRSA-23-126 Funding Opportunity Type(s): New

Assistance Listings Number: 93.899

Application Due Date: June 12, 2023 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: April 12, 2023

MODIFIED June 6, 2023: The maximum amount you may request in years two and three has increased from $375,000 to $500,000 per award, subject to the availability of appropriated funds.

Chrissy Abrahms Woodland Director, HAB Division of Metropolitan HIV/AIDS Programs Phone: 301-443-1373 Email: CAbrahms@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: Consolidated Appropriations Act, 2023, Pub. L. 117-328, Division H, title II and 42 USC §§ 300ff-16 and 300ff-101 (§§ 2606 and 2691 of the Public Health Service Act).

mailto:CAbrahms@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII. Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites.

The purpose of this program is to develop, implement, and evaluate status neutral strategies within Ryan White HIV/AIDS Program (RWHAP) Part A jurisdictions for racial and ethnic minority subpopulations who need HIV prevention services. This Notice of Funding Opportunity (NOFO) will fund up to four implementation sites to design and implement status neutral strategies for racial and ethnic minorities (i.e., Black women;

Black, Latino, American Indian/Alaska Native gay, bisexual, and other men who have sex with men; transgender people; and people who use substances) in a syndemic approach1, weaving together resources from across infectious disease areas and incorporating social determinants of health to deliver whole-person care, regardless of a person’s HIV status.

This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. You should note that this program may be cancelled before award.

Funding Opportunity Title: A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites

Funding Opportunity Number: HRSA-23-126

Due Date for Applications: June 12, 2023

Anticipated FY 2023 Total Available Funding:

$2,000,000

1 Co-occurring epidemics or conditions that interact with one another to disproportionately impact the morbidity and mortality in marginalized communities and contribute to excess burden of disease to a population.

http://www.hrsa.gov/

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Estimated Number and Type of Awards: Up to four (4) cooperative agreements

Estimated Annual Award Amount:

Up to $500,000 in year one, $500,000 in year two, and $500,000 in year three, per award subject to the availability of appropriated funds

Cost Sharing/Match Required: No

Period of Performance: September 1, 2023 through August 31, 2026 (3 years)

Eligible Applicants: RWHAP Part A funded recipients. Tribes and tribal organizations are not eligible.

See Section III 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 this NOFO and in HRSA’s SF-424 Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

HRSA has scheduled the following webinar:

Thursday, April 27, 2023 2 p.m. – 4 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1605914943?pwd=cytPQkxSSW0vSVZnT2lKWGtvVytjQT09

Meeting ID: 160 591 4943

Passcode: Y7CJg161

Attendees without computer access or computer audio can use the dial-in information below.

Call-In Number: 833 568 8864 Meeting ID: 160 591 4943 Passcode: 08077130 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1605914943?pwd=cytPQkxSSW0vSVZnT2lKWGtvVytjQT09 https://hrsa-gov.zoomgov.com/j/1605914943?pwd=cytPQkxSSW0vSVZnT2lKWGtvVytjQT09

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HRSA will record the webinar. Recording will be available at Target HIV.

https://targethiv.org/

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX: GEOGRAPHIC SERVICE AREAS

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites. This three-year project has two coordinated components: Implementation Sites and an Evaluation and Technical Assistance Provider (ETAP). Funding is available for four RWHAP Part A recipients who are interested in developing and implementing a status neutral framework in their jurisdictions.

The purpose of this project is to develop, implement, and evaluate status neutral strategies within Ryan White HIV/AIDS Program (RWHAP) Part A jurisdictions for racial and ethnic minority subpopulations (i.e., Black women; Black, Latino, American Indian/Alaska Native gay, bisexual, and other men who have sex with men; transgender people; and people who use substances) who need HIV prevention services.

This project will focus on the prevention pathway, utilizing the existing RWHAP non-medical case management model (NMCM) and applying it to people who test negative for HIV and are at substantial risk for HIV, in order to assist in improving access to needed services. NMCM is the provision of a range of client centered activities focused on improving access to and retention in needed core medical and support services.

NMCM provides coordination, guidance, and assistance in accessing medical, social, community, legal, financial, employment, vocational, and/or other needed services.

NMCM may also include assisting eligible clients to obtain access to other public and private programs for which they may be eligible.

The goal of this project is to develop and implement a status neutral approach that:

• Creates “one door” for both HIV prevention and treatment services.

• Addresses institutionalized HIV stigma by integrating HIV prevention and care rather than supporting separate systems, which can deepen the divide between people with HIV and people who can benefit from HIV prevention services.

• Enables people to know their status by making HIV testing, linkage to medical care, and testing for other medical conditions such as sexually transmitted infections (STIs) and Hepatitis C virus (HCV) more accessible and routine.

Since a status neutral framework encourages a comprehensive, whole-person assessment of a person’s unique situation, it allows for more tailored—and therefore likely more successful—interventions.

In addition to implementing the status neutral strategies in the four RWHAP Part A jurisdictions, the ETAP, funded under a separate announcement number (HRSA-23- 127), will be a single organization funded via a cooperative agreement to provide

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technical assistance (TA), including planning, coordination, mapping services, and infrastructure development/enhancement, to the four implementation sites on the development of a status neutral framework. The ETAP will also evaluate the outcomes of the strategies implemented at the provider organizations within the four implementation sites and develop TA products and resources for dissemination to HRSA and Centers for Disease Control and Prevention (CDC) funded recipients.

For more details, see Program Requirements and Expectations.

2. Background

A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites is authorized by Consolidated Appropriations Act, 2023, Pub. L. 117-328, Division H, title II, and the RWHAP Part F Special Projects of National Significance (SPNS), authorized under 42 USC §§ 300ff-16 and 300ff-101 (§§ 2606 and 2691 of the Public Health Service Act) and supported by the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health’s Minority HIV/AIDS Fund (MHAF).

The status neutral approach reframes how we think about traditional HIV service models. A status neutral approach centers on the person, not their HIV status. A status neutral approach prioritizes individual needs for services and support that are holistic, comprehensive, continuous, and culturally responsive. The status neutral approach aims to increase access to services and health equity by meeting unmet needs in under-served communities.

The status neutral framework is called “status neutral” because the same approach is used to engage and retain people in care, regardless of HIV status. Status neutral HIV health and social services connect community members to the specific resources they need and want. In a status neutral approach, members of the community typically enter the HIV services system through HIV testing services. After HIV testing, people enter one of two pathways. People whose HIV test is non-reactive enter the prevention pathway. They are offered powerful prevention tools, such as pre-exposure prophylaxis (PrEP), condoms, sexual health education, and syringe services, as needed. People whose HIV test is reactive enter the treatment pathway. They are offered effective HIV treatment as well as other tools, such as condoms, sexual health education, and syringe services, as needed. Consistent use of antiretroviral therapy (ART) and maintaining viral suppression improves personal health and well-being. In addition, people with HIV who take HIV medication as prescribed and reach and maintain viral suppression cannot sexually transmit the virus to their partner.

Regardless of their pathway, community members are offered sexual health education, social and health support services, quality care, and the tools they need to stay healthy and stop HIV. Both pathways share a common goal: preventing HIV transmission and achieving better health outcomes. In addition, a status neutral approach is unique because both pathways (i.e., prevention and treatment) promote continual assessment of each person’s needs, including access to support services, for anyone who could

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benefit from them. This continuous, high-quality care supports ongoing engagement by providing people with or at risk for HIV with the tools they need to stay healthy and help stop the spread of HIV. Providing effective treatment to maintain an undetectable viral load and providing PrEP to those at high risk of acquiring HIV are two such tools.

Status neutral services have four key characteristics that underscore the benefits of adopting a status neutral model. First, the services are whole-person-first. A person-centered approach means seeing each member of the community as a multi-faceted person with a wealth of experiences that influence their health and well-being. Status neutral services are also comprehensive, which means they include and extend beyond HIV prevention and treatment in support of overall health. Status neutral services are also continuous. They engage community members in health and social services as needed over time, with no set endpoint. Finally, the comprehensive and continuous services provided are culturally responsive. The status neutral approach requires understanding that people of different backgrounds have different perspectives on health care and wellness, and service provision should be adapted accordingly.

RWHAP is a proven model for the provision of services that support engagement in care. RWHAP-funded facilities use a medical home model, offering comprehensive, patient-centered care for people with HIV. The medical home model is a multi-disciplinary approach that integrates care, case management, and support services and emphasizes patient-provider relationships. More than half of people with diagnosed HIV in the United States receive services through the RWHAP each year. Approximately 75 percent of RWHAP-funded facilities provide on-site case management for wrap-around services like assistance for food, housing, and transportation. RWHAP patients are also more likely to have access to on-site mental health and substance use disorder services, thus achieving better health outcomes, with a viral suppression rate of 89.4%.

Since the RWHAP legislation requires grant funds to be used for the care and treatment of people with HIV, thus prohibiting the use of RWHAP funds for medical and social support services for people without HIV who are at substantial risk for HIV, people who do not have HIV but have need for HIV prevention services do not always have access to the same medical, behavioral and social services to support engagement in care.

The RWHAP provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people with HIV. The program funds grants to states, cities, counties, and local community-based organizations to provide care and treatment services to people with HIV to improve health outcomes and reduce HIV transmission among priority populations.

The RWHAP has five statutorily defined Parts (Parts A, B, C, D, and F) that provide funding for core medical, support services, and medications; technical assistance (TA);

clinical training; and the development of innovative interventions and strategies for HIV care and treatment to quickly respond to emerging needs of RWHAP clients.

An important framework in the RWHAP is the HIV care continuum, which depicts the series of stages a person with HIV engages in from initial diagnosis through their

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successful treatment with HIV medication to achieve viral suppression. Supporting people with HIV to reach viral suppression not only increases their own quality of life and lifespan, it also prevents sexual transmission to an HIV-negative partner.

The HIV care continuum framework allows recipients and planning groups to measure progress and to direct HIV resources most effectively. RWHAP recipients are encouraged to assess the outcomes of their programs and should work with their community and public health partners to improve outcomes across the HIV care continuum. HRSA encourages recipients to use the performance measures developed for the RWHAP at their local level to assess the efficacy of their programs and to analyze and improve the gaps along the HIV care continuum.

Strategic Frameworks and National Objectives

National objectives and strategic frameworks like Healthy People 2030, the National HIV/AIDS Strategy (NHAS) (2022–2025); the Sexually Transmitted Infections National Strategic Plan for the United States (2021 – 2025); and the Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025) are crucial to addressing key public health challenges facing low-income people with HIV. These strategies detail the principles, priorities, and actions to guide the national public health response and provide a blueprint for collective action across the Federal Government and other sectors. The RWHAP supports the implementation of these strategies and recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, with these strategies to the extent possible.

Expanding the Effort: Ending the HIV Epidemic in the U.S.

According to recent data from the 2021 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2017 to 2021, HIV viral suppression among RWHAP patients who have had one or more medical visits during the calendar year and at least one viral load with a result of <200 copies/mL reported, has increased from 85.9 percent to 89.7 percent.

Additionally, racial and ethnic, age-based, and regional disparities reflected in viral suppression rates have significantly decreased.[1]

In February 2019, the Ending the HIV Epidemic in the U.S (EHE) initiative was launched to further expand federal efforts to reduce HIV infections. This initiative seeks to achieve the important goal of reducing new HIV infections in the United States to fewer than 3,000 per year by 2030. For the RWHAP, the EHE initiative expands the program’s ability to meet the needs of clients, specifically focusing on linking people with HIV who are either newly diagnosed, diagnosed but currently not in care, or are diagnosed and in care but not yet virally suppressed, to the essential HIV care, treatment, and support services needed to help them achieve viral suppression.

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Using Data Effectively: Integrated Data Sharing and Use

HRSA and CDC’s Division of HIV Prevention support integrated data sharing, analysis, and utilization for the purposes of program planning, conducting needs assessments, determining unmet need estimates, reporting, quality improvement, enhancing the HIV care continuum, and public health action. HRSA strongly encourages RWHAP recipients to:

Follow the principles and standards in the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs:

Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action.

Establish data sharing agreements between surveillance and HIV programs to ensure clarity about the process and purpose of the data sharing and utilization.

Integrated data sharing, analysis, and utilization of HIV data by state and territorial health departments can help further progress toward reaching the NHAS goals and improve outcomes on the HIV care continuum.

HRSA’s RWHAP Compass Dashboard is a user-friendly, interactive data tool to allow users to visualize the reach, impact, and outcomes of the RWHAP and supports data utilization to understand outcomes and inform planning and decision making. The dashboard provides a look at national-, state-, and metro area-level data and allows users to explore RWHAP client characteristics and outcomes, including age, housing status, transmission category, and viral suppression. The RWHAP Compass Dashboard also visualizes information about RWHAP services received and the characteristics of those clients accessing the AIDS Drug Assistance Program (ADAP).

As outlined in Policy Clarification Notice 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program, recipients and subrecipients should use electronic data sources (e.g., Medicaid enrollment, state tax filings, enrollment and eligibility information collected from health care marketplaces) to collect and verify client eligibility information, such as income and health care coverage (that includes income limitations), when possible. RWHAP recipients and subrecipients should first use available data sources to confirm client eligibility before requesting additional information from the client.

In addition, RWHAP recipients and subrecipients are encouraged to develop data sharing strategies with other RWHAP recipients and relevant entities to reduce administrative burden across programs. HRSA strongly encourages complete CD4, viral load (VL), and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems to benefit fully from integrated data sharing, analysis, and utilization. State health departments may use CD4, VL, and nucleotide sequence data to identify cases, stage of HIV disease at diagnosis, and monitor disease progression. These data can also be used to evaluate HIV testing and prevention efforts, determine entry into and retention in HIV care, measure viral suppression, monitor prevalence of antiretroviral drug resistance, detect transmission clusters and

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understand transmission patterns, and assess unmet health care needs. Analyses at the national level to monitor progress toward ending the HIV epidemic in the U.S. can only occur if all HIV-related CD4, VL, and HIV nucleotide sequence test results are reported by all jurisdictions. CDC requires the reporting to the National HIV Surveillance System (NHSS) all HIV-related CD4 results (counts and percentages), all VL results (undetectable and specific values), and HIV nucleotide sequences.

Program Resources and Innovative Models

HRSA has several projects and resources that may assist RWHAP recipients with program implementation. These include a variety of HRSA HIV/AIDS Bureau (HAB) projects focused on specific TA, evaluation, demonstration, and intervention activities. A full list is available on TargetHIV. Recipients should be familiar with these resources and are encouraged to use them as needed to support their program implementation.

Examples of these resources include:

• Access, Care, and Engagement Technical Assistance Center (ACE TA)

• Best Practices Compilation

• Center for Innovation and Engagement (CIE)

• Center for Quality Improvement and Innovation (CQII)

• Dissemination of Evidence-Informed Interventions (DEII)

• Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV (E2i)

• Ending Stigma through Collaboration and Lifting All to Empowerment

(ESCALATE)

• Engage Leadership through Employment, Validation, and Advancing Transformation and Equity for persons with HIV (ELEVATE)

• Integrating HIV Innovative Practices (IHIP)

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.

https://targethiv.org/ https://targethiv.org/ace https://targethiv.org/blog/rwhap-best-practices-compilation-discover-and-share-innovations https://targethiv.org/CIE https://targethiv.org/cqii https://targethiv.org/deii https://targethiv.org/e2i https://targethiv.org/e2i https://targethiv.org/escalate https://targethiv.org/escalate https://targethiv.org/elevate https://targethiv.org/elevate https://targethiv.org/ihip

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In addition to the usual monitoring and technical assistance (TA) provided directly to award recipients, HRSA program involvement will include:

• Providing the expertise of HAB personnel and other relevant resources to support the efforts of status neutral activities;

• Facilitating partnership and communication with other federal agencies, particularly CDC and Bureau of Primary Health Care (BPHC), to improve coordination efforts;

• Facilitating collaboration with the ETAP to assist in the development, implementation, coordination, integration, and evaluation of status neutral activities;

• Participating in the design and direction of the strategies, interventions, tools, and processes to be established and implemented for accomplishing the goals of the cooperative agreement;

• Reviewing and concurring with all information products prior to dissemination;

and

• Facilitating the dissemination of project findings, best practices, evaluation data, and other information developed as part of this project to the broader network of RWHAP and CDC HIV funded recipients.

In addition to adhering to all applicable federal regulations and public policy requirements, the cooperative agreement recipient’s responsibilities will include:

• Completing proposed initiative work plan activities within the three-year project period;

• Collaborating with HRSA on review of activities, procedures, and budget items, including timely communication with project officer;

• Collaborating with the ETAP, as necessary, to develop and implement a methodology, including proposed metrics, to measure the impact of proposed activities, as well as reporting on outcomes;

• Collaborating with the ETAP, as necessary, to ensuring proposed activities are based on documented need, a status neutral framework, and designed to reach the identified target population(s);

• Coordinating the status neutral activities with its existing RWHAP programs;

• Collaborating with CDC and BPHC funded organizations, health centers, and other local and state government agencies on implementing status neutral activities;

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• Collaborating with the ETAP on the planning, coordination, mapping of services, infrastructure development/enhancement, and evaluation for the development of a status neutral framework;

• As applicable, hiring or assigning people with lived experience, who reflect the subpopulations of focus, to provide NMCM;

• Developing a sustainability plan to support successful activities following conclusion of the cooperative agreement;

• Modifying activities as necessary to ensure relevant outcomes for the project;

and

• Participating in the dissemination of project findings, best practices, and lessons learned, including adherence to HRSA guidelines pertaining to acknowledgment and disclaimer on all products produced by HRSA award funds.

2. Summary of Funding

HRSA estimates approximately up to $2,000,000 to be available annually to fund four

(4) recipients.

You may apply for a ceiling amount up to the amounts listed below (reflecting direct and indirect costs) for each year in the three-year period of performance.

• $500,000 in FY 2023,

• $500,000 in FY 2024, and

• $500,000 in FY 2025.

The period of performance is September 1, 2023 through August 31, 2026 (3 years).

Funding beyond the first year is subject to the availability of appropriated funds for A Status Neutral Approach to Improve HIV Prevention and Health Outcomes for Racial and Ethnic Minorities – Implementation Sites in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

III. Eligibility Information

1. Eligible Applicants

RWHAP Part A recipients that continue to meet the status as an eligible area as defined in the statute are eligible to apply for these funds. Eligibility for RWHAP Part A grants is based in part on the number of confirmed AIDS cases within a statutorily specified metropolitan area. The Secretary uses the Office of Management and Budget’s (OMB) census-based definitions of a Metropolitan Statistical Area (MSA) in determining the geographic boundaries of a RWHAP metropolitan area. HHS utilizes the OMB

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geographic boundaries that were in effect when a jurisdiction was initially funded under RWHAP Part A. For all newly eligible areas, the boundaries are based on current OMB MSA boundary definitions as listed in the Appendix: Geographic Service Areas.

An Eligible Metropolitan Area (EMA) must have more than AIDS 2,000 cases reported to and confirmed by the CDC during the most recent five calendar years; a Transitional Grant Area (TGA) must have at least 1,000 but fewer than 2,000 AIDS cases reported to and confirmed by the CDC during the most recent five calendar years for which such data are available. In addition, for three consecutive years, recipients must not have fallen below both the required incidence levels already specified and required prevalence levels (cumulative total of living AIDS cases reported to and confirmed by the CDC, as of December 31 of the most recent calendar year for which such data are available). For an EMA, the required prevalence is 3,000 living AIDS cases. For a TGA, the required prevalence is 1,500 or more living AIDS cases. However, for a TGA with five percent or less of the total amount from grants awarded to the area under Part A unobligated, as of the end of the most recent FY, the required prevalence is at least 1,400 and fewer than 1,500 living AIDS cases.

This competition is open to eligible Part A jurisdictions as listed in the Appendix:

Geographic Service Areas.

Tribes and tribal organizations are not eligible.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Multiple Applications

Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date.

IV. Application and Submission Information

1. Address to Request Application Package

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

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APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov:

APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-126 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

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

See Section 8.5 of the HRSA SF-424 Application Guide for the Application Completeness Checklist to assist you in completing your application.

Application Page Limit The total number of attachment pages that count toward the page limit shall be no more than 50 pages when we print them. HRSA will not review any pages that exceed the page limit. Using the pages within the page limit, HRSA will determine eligibility using Section III. Eligibility Information of the NOFO.

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.v Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-126 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Applications must be complete and validated by Grants.gov under HRSA-23-126 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 7-15: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e), which sunsets / terminates on September 30, 2023. Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

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 Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

In addition to the requirements listed in the SF-424 Application Guide, please indicate the project title as “A Status Neutral Approach to Improve HIV Prevention and Health https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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Outcomes for Racial and Ethnic Minorities – Implementation Sites” and include the following information:

• A summary of the proposed project, which may include: the use of existing RWHAP NMCM models to assist eligible clients to access other public and private programs for which they may be eligible; hiring people with lived experience (i.e., people at risk for HIV and/or people with HIV) to provide patient navigator, peer navigator, or community health worker assistance; and partnering with BPHC organizations funded to provide PrEP and other clinical services.

• A description of the intended impact (e.g., how the activities will engage non- RWHAP eligible clients who are disproportionately affected by HIV to assist in improving access to needed medical and social services).

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

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 (Need) https://bphc.hrsa.gov/funding/funding-opportunities/primary-care-hiv-prevention/fy-2022-awards

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Provide an overview of the planned status neutral activities to be implemented. Include information on which racial and ethnic minority groups were identified and how the activities will improve health outcomes for each. Provide a description of your, and any partnering organizations’, capacity to implement and provide services to clients within the first year of the award.

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

The purpose of this section is to demonstrate the need for status neutral care activities for racial and ethnic minorities living in your jurisdiction. Identify and describe the demographics of the groups to be served. Include quantifiable data on the rates of HIV infection and HIV risk in those groups, as well as any issues specific to the service area that are pertinent, such as co-occurring conditions, complexity of providing care, etc.

Utilize relevant local and national data, data and information provided in the FY 2022 competitive RWHAP Part A application, and published research to discuss the existing need that the proposed status neutral activities can address.

Identify the geographic area to be served. Describe the existing HIV care infrastructure including clinical, social, behavioral, community, or faith-based programs currently available to meet the needs of the identified client population, and any relevant gaps or barriers in the service area that the project plans to address.

If staffing is needed to support this program, describe how hiring or assigning people with lived experience (i.e., people at risk for HIV and/or people with HIV) will be prioritized for the role of NMCM or navigator services. In your description, discuss how hiring practices support people with lived experience being compensated at a living wage based on the jurisdiction’s local cost of living standard.

METHODOLOGY -- Corresponds to Section V’s Review Criteria 2 (Response) and 4 (Impact)

Describe the methods and approaches you will use to address the stated purpose and goals in Section I.1. and meet each of the recipient responsibilities listed in Section II.1.

of this NOFO. Please include the following in your description:

1. Provide a description of the proposed status neutral activities to be implemented. Include innovative strategies, procedures, and activities (including involvement of people with lived experience or at risk for HIV for design, implementation, and evaluation of interventions) for meaningful collaboration with HRSA HAB and other local, state, and federal agencies (i.e., CDC and HRSA BPHC) to ensure program design supports new and innovative ways of delivering HIV prevention and care services to meet national HIV prevention goals and advance health equity.

2. Identify why proposed status neutral activities are appropriate for this project, how they align with the overview provided in the Needs Assessment section, HRSA-23-126 15 and how they will contribute to the success of the project over the entire period of performance.

3. Describe how your organization will identify and select subrecipients, including factors that contribute to that decision, and how you will ensure a diverse representation among the subrecipients (geographic, facility type, urban/rural, provider type, model of care, population(s) served, etc.). Include any specific positions to be filled and their duties, the racial and ethnic groups of focus, and specify how these activities will address any gaps in care.

4. Describe how your jurisdiction will coordinate with the ETAP through all stages of the project, including planning, coordination, mapping services, infrastructure development/enhancement, and evaluation on the development of a status neutral framework.

5. Propose a plan for project sustainability after the end of the period of performance. HRSA expects recipients to sustain key elements of their projects (e.g., strategies, services, and interventions) that have been effective in improving practices and have led to improved outcomes for the target population.

WORK PLAN -- Corresponds to Section V’s Review Criteria 2 (Response) and 4 (Impact)

Develop a work plan that delineates steps for implementing and assessing the status neutral activities proposed in the Methodology section and include as Attachment 1.

The work plan should include:

1. Goals for the entire proposed period of performance;

2. Objectives that are specific, time-framed, and measurable;

3. Activities or action steps to achieve the stated objectives with anticipated start and completion dates; and

4. Staff responsible for each action step.

Include all aspects of planning, implementation, and evaluation, along with identifying meaningful support and collaboration with key stakeholders and partners in planning, designing, and implementing all activities, including the extent to which these contributors reflect the cultural, racial, linguistic, and geographic diversities of the populations and communities served.

First-year objectives should describe key action steps or activities that you will undertake to implement the status neutral activities. Objectives may include but are not limited to hiring appropriate staff, developing and implementing assessment tools, outreach activities to the identified populations, formalizing partnerships to meet medical and social service needs of the people reached, and finalizing data sharing agreements to address project outcome objectives. Clearly indicate the anticipated

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start date of the intervention, and provide numbers for targeted outcomes where applicable, not just percentages. Be sure that the work plan clearly indicates how you will ensure service delivery for the identified racial and ethnic groups.

In your workplan, include action steps to track progress on the following:

1. Time from assessment to screening for sexual health services (PrEP, condom use, pregnancy test, STI, HIV, Hep C, etc.): Number of days from initial presentation at agency to the first scheduled screening with a provider

2. Time from assessment to linkage to other medical and support services:

Number of days from linkage to appointment

3. Time from linkage to service provision: Number of days from linkage or referral to service completion

If awarded, the work plan is used as a tool to actively manage the project by measuring progress, identifying necessary changes, and quantifying accomplishments. The work plan should directly relate to the program components described in the Methodology section as well as the program requirements and expectations detailed in this NOFO.

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

2 (Response) In this section, describe any 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. Additionally, discuss how technical assistance from the ETAP can support the resolution of challenges identified. At a minimum, discuss the challenges listed below:

• Describe any challenges in utilizing the existing NMCM model in your jurisdiction and applying it to non-RWHAP eligible clients (i.e., people at risk for HIV) who are disproportionately affected by HIV risk to assist in improving access to needed services. Be sure to discuss strategies the project will employ to identify and address barriers clients may experience.

• Describe challenges with initiating, managing, and sustaining communication, including data collection and reporting across HRSA HAB, other local, state, and federal agencies (i.e., CDC and HRSA BPHC), to ensure program design supports new and innovative ways of delivering HIV prevention and care services.

• Describe any challenges in hiring people with lived experience within recipient or subrecipient organizations, and the strategies that will be used address those barriers.

• Describe any current or potential data and/or staffing infrastructure issues and strategies to resolve these challenges

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EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion 3 The program performance evaluation should monitor ongoing processes and the progress towards implementing effective status neutral strategies to reduce HIV stigma, prioritize health equity, and improve access to comprehensive care for all people, regardless of HIV status.

Discuss how key personnel (i.e., non-medical case management sub-recipient staff) have and maintain the necessary knowledge, experience, training, and skills to achieve the goals and objectives of the project. Include how collaborative partners and the ETAP can support key personnel in achieving the goals and objectives of the project.

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 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 in a way that allows for accurate and timely reporting of performance outcomes.

Describe your experience conducting process and outcome evaluations with racial/ethnic minorities.

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

5 and 6 Provide a staffing plan and job descriptions for key personnel, submit as Attachment 2. In the staffing plan, describe how the grant funds will be administered in the jurisdiction with reference to the staff positions, including program and fiscal staff, described in the budget narrative and the program organizational chart. The narrative should describe the local agency responsible for the cooperative agreement and identify the entity responsible for administering it, including the department, unit, staffing levels (full-time equivalent staff [FTE], including any vacancies), fiscal agents, and in-kind support staff. As Attachment 3, include biographical sketches for persons occupying the key positions not to exceed two pages in length per person. If a biographical sketch is included for an identified individual not yet hired, include a letter of commitment from that person with the biographical sketch.

Include a project organizational chart as Attachment 4. The chart should be a one-page figure that depicts the project structure, not the entire organization. It should include sub-recipients, contractors and other significant collaborators, if applicable.

Include signed letters of agreement, memoranda of understanding, and descriptions of proposed and/or existing contracts related to the proposed project as Attachment 5.

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iii. Budget The directions offered in the SF-424 Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application Guide and the additional budget instructions provided below. A budget that follows the Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Submit the SF-424A Budget Information – Non-Construction Programs per the instructions in Section 4.1.iv of HRSA’s SF-424 Application Guide.

Note: All status neutral approach project requirements and program expectations that apply to the recipients also apply to subrecipients of their award. Your organization is accountable for your subrecipients’ performance of the project, program, activity, and appropriate expenditure of funds under the award. As such, recipients are required to monitor all subrecipients progress towards identified project goals.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project…