HRSA-24-059_Regional AETC Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

HIV/AIDS Bureau

Office of Program Support

Regional AIDS Education and Training Centers

Funding Opportunity Number: HRSA-24-059

Funding Opportunity Type(s): Competing Continuation and New

Assistance Listings Number: 93.145

Application Due Date: February 5, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: November 7, 2023

Makeva M. Rhoden, PhD, MPH, CHES Deputy Director, Office of Program Support (OPS) HIV/AIDS Bureau Call: (240) 461-6176 Email: AskAETCProgram@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 USC §§ 300ff-111(a) and 300ff-121 (§§ 2692(a) and 2693 of the Public Health Service (PHS) Act). Secretary’s Minority AIDS Initiative and Ending the HIV Epidemic in the U.S. funds are authorized by Consolidated Appropriations Act, 2023, Pub. L. 117-328, Division H, title II. Funds for the Primary Care Prevention Program are authorized under Section 330(e), (g), (h), and/or (i) of the Public Health Service Act (42 U.S.C. § 254b(e), (g), (h), and/or (i)), as appropriate.

mailto:AskAETCProgram@hrsa.gov

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508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Title: Regional AIDS Education and Training Centers Funding Opportunity Number: HRSA-24-059 Assistance Listing Number: 93.145 Due Date for Applications: February 5, 2024

Purpose: The AETC Program consists of a network of HIV experts who, collectively, work to increase and support a workforce capable of and who intend to provide care and treatment to people with or at-risk of HIV.

Program Objective(s): 1) Goal 1: Expand the number of health care team members providing HIV care and prevention services, including providers with different backgrounds or experiences.

2) Goal 2: Expand the ability of health care team members to provide effective HIV care and prevention services.

3) Goal 3: Improve health equity by integrating HIV care and prevention in primary care and other health care settings that provide services to underserved populations.

4) Goal 4: Enhance the capacity of the RWHAP AETC Program to train health care team members to serve people at risk for or with HIV.

Eligible Applicants: Eligible applicants include domestic public and nonprofit private entities, schools and academic health science centers. Community-based organizations are eligible to apply. Tribal organizations and tribal governments are also eligible to apply.

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

Anticipated FY 2024 Total Available Funding:

Up to $19,000,000 Base Funds Up to $9,000,000 Minority AIDS Initiative (MAI) Up to $9,000,000 Ending the HIV Epidemic (EHE)

Award amount includes funds for Regional AETC base, MAI, EHE funds.

HRSA is issuing this notice to ensure that, should funds become available for this purpose, the Agency can process applications and award funds appropriately. HRSA may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

Up to eight (8): competing continuation and new grants will be awarded.

Estimated Annual Award Amount:

Maximum award amounts for Ryan White HIV/AIDS Program (RWHAP) Part F Regional AETC Base, MAI, and EHE: Varies by region (see Appendix A) and are subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: July 1, 2024, through June 30, 2029 (5 years) Agency Contacts: Business, administrative, or fiscal issues:

Nancy Gaines Grants Management Specialist Division of Grants Management Operations, Office of Federal Assistance Management Email: ngaines@hrsa.gov

Program issues or technical assistance:

Makeva Rhoden Deputy Director, Office of Program Support HIV/AIDS Bureau Email: AskAETCProgram@hrsa.gov

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.

mailto:AskAETCProgram@hrsa.gov http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application

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Technical Assistance

HRSA has scheduled the following webinar:

Thursday, November 16, 2023 Time: 1 – 3 p.m. ET

• Weblink: https://hrsa-gov.zoomgov.com/j/1612669089?pwd=bHhaZnZrSEVxWk4xZmtuSnljakJPQT09

• Meeting ID: 161 266 9089

• Passcode: uasmXj2u

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

• Dial by your location:

o +1 669 254 5252 US (San Jose) o +1 646 964 1167 US (US Spanish Line) o +1 646 828 7666 US (New York) o +1 415 449 4000 US (US Spanish Line) o +1 551 285 1373 US (New Jersey) o +1 669 216 1590 US (San Jose) o 833 568 8864 US Toll-free

• Webinar ID: 161 266 9089

• Passcode: 17206479

HRSA will record the webinar. It will be available on the TargetHIV website at https://targethiv.org/library/nofos.

https://hrsa-gov.zoomgov.com/j/1612669089?pwd=bHhaZnZrSEVxWk4xZmtuSnljakJPQT09 https://hrsa-gov.zoomgov.com/j/1612669089?pwd=bHhaZnZrSEVxWk4xZmtuSnljakJPQT09 https://targethiv.org/library/nofos

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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 A: FUNDING TABLE

APPENDIX B: ESTABLISHED BASELINE FOR PRACTICE TRANSFORMATION (PT) SITES

BY REGION

APPENDIX C: AETC PROGRAM GOALS AND OBJECTIVES

APPENDIX D: REGIONAL AETC PROGRAM DATA REPORTING REQUIREMENTS

APPENDIX E: PAGE LIMIT WORKSHEET

HRSA-24-059 AETC 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for the Ryan White HIV/AIDS Program (RWHAP) Part F Regional AIDS Education and Training Centers (AETC) Program. The AETC Program consists of a network of HIV experts who, collectively, work to increase and support a workforce capable of and who intend to provide care and treatment to people with or at-risk of HIV.

The aim of the program during the next five-year period of performance (July 1, 2024 – June 30, 2029) is to build on the previous work and successes of the AETC program and their local partners and implement a modernized and strengthened program framework based on industry standards. The foundational changes include:

1) The establishment of new and clearly defined goals, objectives, and data reporting requirements to promote quality improvement, and increase performance improvement across programs. The goals are (Appendix C):

• Goal 1: Expand the number of health care team members providing HIV care and prevention services, including providers with different backgrounds or experiences.

• Goal 2: Expand the ability of health care team members to provide effective HIV care and prevention services.

• Goal 3: Improve health equity by integrating HIV care and prevention in primary care and other health care settings that provide services to underserved populations.

• Goal 4: Enhance the capacity of the AETC Program to train health care team members to serve people at risk for or with HIV.

2) An increased emphasis on building and maintaining partnerships with RWHAP recipients and health care and health professional organizations.

3) The incorporation of evidenced-based strategies to inform regional programs and target training in areas of high need.

4) The use of structured MAI activities that increase the Regional AETCs ability to support minority-serving providers and organizations, and ensure the HIV workforce includes providers with different backgrounds or experiences.

5) Providing training programs using contemporary methods and modalities, and adult learning techniques to strengthen the HIV workforce.

Each regional AETC will provide training and technical assistance to the health care workforce, health care organizations, faculty responsible for training students enrolled at health professions programs, and instructors in health-related organizations that manage programs for health professions programs.

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This competition is open to current RWHAP Part F Regional AETC Program recipients and new organizations proposing to provide RWHAP Part F Regional AETC funded services. To focus efforts on areas with the greatest prevalence of HIV and with relative shortages of HIV care and treatment professionals, HRSA uses eight (8) geographic regions in alignment with the HHS Regions as listed in Appendix A.

In addition, you must be located in the region you intend to serve and agree to support the HIV training and education needs across the entire region selected. Your organization must be physically located in the region to which you are applying. You must select only one region to support in your application. Proof of physical presence of the applicant organization in the region is required.

The Regional AETC program is responsible for providing evidence-based, innovative HIV training and technical assistance to health care organizations and team members, faculty at health professions institutions, and other health care and health professional organizations that provide training for health professionals and students. There are three components to the RWHAP Part F Regional AETC Program – Base, MAI, and

EHE.

1) Regional Base Program The Regional AETCs are responsible for implementing activities to support the following four components:

o Foundations of HIV (FH) – The purpose of FH is to educate and train health care team members currently not involved in HIV care to increase their ability to prevent new HIV infections, identify people with HIV who are undiagnosed or out of care, and link patients not on antiretrovirals to care.

o Practice Transformation (PT) – The purpose of PT is to implement process improvement, training, and technical assistance to increase the capability of organizations to implement system-level changes and enhance clinical practice to improve the provision of care and treatment to people with HIV and prevention of HIV in priority populations at increased risk.

o Interprofessional Education (IPE) – The purpose of IPE is to assist faculty in health professions programs to create an interactive learning environment designed to increase the number of health professionals able to effectively work in a team-based approach to improve care and treatment of people with

HIV.

o Capability and Expertise Expansion (CEE) – The purpose of CEE is to increase the ability of health care team members currently involved in HIV care to offer quality services based on current national treatment guidelines and standards and to increase the skills to offer comprehensive care to people with HIV.

2) Minority AIDS Initiative (MAI) The AETCs are also required to conduct workforce training and capacity building activities as part of the MAI. The purposes of this multi-year funding are to:

(1) increase the training capacity of minority-serving health care team members, and minority-serving health care facilities and health-related organizations;

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(2) expand the number of minority-serving health care professionals with treatment expertise and knowledge about current standards of HIV-related treatments and prevention techniques; and

(3) increase access to medical care for adults, adolescents, and children with HIV from a variety of racial and ethnic backgrounds, including historically underserved individuals or groups.

Additional information on the MAI funding is provided in Section II: Award Information of this announcement.

3) Ending the HIV Epidemic in the US (EHE) Initiative The AETCs must collaborate with other RWHAP recipients and conduct activities to support the EHE initiative by implementing strategies, interventions, and approaches to address the unique training needs of the health care workforce and organizations in the EHE-funded jurisdictions in the regions listed in Appendix A.

All applicants must demonstrate that they have the organizational capacity to implement each of the program components.

For more details, see Program Requirements and Expectations.

2. Background

The AETC Program is authorized by 42 U.S.C. §§ 300ff-111(a) and 300ff-121 (§§ 2692(a) and 2693 of the Public Health Service (PHS) Act). The Secretary’s Minority AIDS Initiative and Ending the HIV Epidemic in the U.S. funds are authorized by Consolidated Appropriations Act, 2023, Pub. L. 117-328, Division H, title II. Funds for Primary Care HIV Prevention Program are authorized under Section 330(e), (g), (h), and/or (i) of the Public Health Service Act (42 U.S.C. § 254b(e), (g), (h), and/or (i)), as appropriate.

AETC Program Framework

As the workforce development component of the RWHAP, the AETC Program supports and enhances the delivery of comprehensive HIV prevention, care and treatment by providing training and technical assistance to health care organizations and members of the health care team. Since the inception of the program, the Regional AETCs have worked with local partners or organizations with a cadre of HIV and training experts to implement training and technical assistance across the regions.

In addition to the Regional AETCs, the AETC Program includes three components that utilize focused areas of expertise to develop and carry out specific, programmatic responsibilities. Collectively, these components provide a comprehensive approach to develop the HIV workforce and advance the mission of the program. The AETC Program consist of the Regional AETC Program, two (2) National Centers, the National

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HIV Curriculum (NHC) program, and the Integrating the NHC into Health Care Professional Programs.

• National AETC Program Support Center (NASC): The NASC will provide support for the AETC Program by providing technical assistance and program coordination to all AETC recipients to improve program capacity, reach, and impact.

• National Clinician Consultation Center (NCCC): The NCCC offers warmlines and a hotline to provide one-on-one consultation with providers regarding prevention, screening, and the management of HIV, perinatal HIV transmission, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), substance use disorders, and viral hepatitis.

• National HIV Curriculum (NHC): The NHC is an on-demand, online learning platform that provides training on the most current information to increase competency in HIV prevention, screening, diagnosis, and ongoing treatment.

• Integrating the NHC into Health Care Professional Programs: These projects focus on incorporating the NHC into health professions curricula at institutions including medical, nursing and pharmacy programs, and graduate education/residency programs across the country.

For the past three decades, the Regional AETCs focused on providing training, education, consultation, and clinical decision support to diverse health care providers, allied health professionals, and health care support staff through a variety of means, including: Core Training, MAI activities, PT, and IPE. Recipients determined the modalities they would use to design and implement their training programs. This resulted in differences in the scope of education, training and technical assistance delivered even when implementing the same core components. Today there is a need for greater consistency among the Regional AETCs, and the need to incorporate more evidence-based theories and best practices in the implementation of the program components.

THE RYAN WHITE HIV/AIDS PROGRAM

The HRSA Ryan White HIV/AIDS Program (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 respond to emerging needs of RWHAP clients.

An important framework in the RWHAP is the HIV care continuum, which is comprised of the series of stages a person with HIV engages in from initial diagnosis through their https://aidsetc.org/aetc-program/aetc-national-coordinating-resource-center http://www.nccc.ucsf.edu/ https://www.hiv.uw.edu/ https://www.hiv.uw.edu/ https://ryanwhite.hrsa.gov/

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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 required 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 United States

As demonstrated by recent data from the 2021 Ryan White HIV/AIDS Program 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. 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 reach viral suppression.

[1] Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2021. https://ryanwhite.hrsa.gov/data/reports. Published December 2022. Accessed December 13, 2022.

http://ryanwhite.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://health.gov/healthypeople https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025 https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2021.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2021.pdf https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline https://ryanwhite.hrsa.gov/data/reports

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Using Data Effectively: Integrated Data Sharing and Use

HRSA and the Centers for Disease Control and Prevention’s (CDC) 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 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 secure 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 understand transmission patterns, and assess unmet health care needs. Analyses at the national level to monitor progress toward ending the HIV epidemic in the United States 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.

HRSA’s RWHAP Compass Dashboard is an 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).

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. As outlined in Policy Clarification Notice 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf https://data.hrsa.gov/topics/hiv-aids/compass-dashboard https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf

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Program, recipients and subrecipients should use electronic data sources (for example, 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.

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)

• AIDS Education and Training Center Program – National Coordinating Resource Center

All regional HRSA/HAB funded AETC Programs are strongly encouraged to utilize the Special Projects of National Significance (SPNS) Program’s wide array of materials such as implementation manuals, lessons learned, promising practices and other dissemination resources in the provision of training and technical assistance to RWHAP recipients and subrecipients.

https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://targethiv.org/help/ta-directory https://targethiv.org/ace https://targethiv.org/bestpractices https://targethiv.org/CIE https://targethiv.org/cqii https://targethiv.org/deii https://targethiv.org/deii https://targethiv.org/e2i https://targethiv.org/e2i https://targethiv.org/escalate https://targethiv.org/elevate https://targethiv.org/elevate https://targethiv.org/ihip https://targethiv.org/ta-org/aetc-ncrc https://targethiv.org/ta-org/aetc-ncrc

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II. Award Information

1. Type of Application and Award

Application type(s): Competing Continuation and New

HRSA will fund you via a grant.

2. Summary of Funding

Successful recipients are required to implement activities in support of the regional base program, the MAI Initiative, and Ending the HIV Epidemic in the U.S.

Regional AETC Base Program

HRSA estimates up to $19,000,000 will be available each year to fund up to eight (8) recipients to implement the Regional Base Program four core components (FHC, PT, IPE, and CEE) for the RWHAP Part F Regional AETC program. You may apply up to the published ceiling amount in Appendix A annually (reflecting direct and indirect costs). Each regional AETC will cover a designated geographic area. Combined, the regions include all 50 states, the District of Columbia, the U.S. Virgin Islands, Puerto Rico and the six (6) U.S. Pacific Jurisdictions (Guam, American Samoa, the Commonwealth of the Northern Marians Islands, The Republic of Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands).

Minority AIDS Initiative (MAI)

HRSA estimates up to $9,000,000 will be available each year to implement MAI activities as part of your RWHAP Part F Regional AETC Program. You may apply for up to the published ceiling amount in Appendix A for your selected region. The funding amounts for the MAI Initiative ranges from $620,000 – $1,810,000.

Ending the HIV Epidemic in the United States (EHE) Initiative

HRSA estimates that up to $9,000,000 will be available each year to implement EHE activities as part of your RWHAP Part F Regional AETC Program. You may apply for up to the published ceiling amount in Appendix A for your selected region. The funding amounts for the EHE initiative ranges from $179,390 to $1,049,550.

Please review the Program Requirements and Expectations section for additional information.

Applicants must be geographically located in the region in which they are applying for consideration.

The period of performance is July 1, 2024, through June 30, 2029 (5 years).

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RWHAP Part F Regional AETC Program Funding Methodologies

Regional AETC Base Funding

The AETC Program has historically used a data-driven funding methodology to determine the pool of funding available for competition in each region. HRSA determines the amounts awarded to each regional AETC using a methodology based on 10 weighted metrics. This methodology incorporates the following data points:

• New HIV Diagnoses (per 100,000), 2021;

• HIV/AIDS Prevalence (per 100,000), 2021;

• Percent of RW clients virally suppressed, 2021;

• Number of Federally Qualified Health Center delivery sites, 2023;

• Number of RWHAP Outpatient Ambulatory Health Service providers, 2022;

• Number of Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas

(TGAs); and

• Number of States.

Since the last competition, HRSA updated the data and the weights afforded to the components of the methodology to ensure funds are allocated based on the changing landscape of the HIV epidemic in each region. The funding ceiling amounts in Appendix A reflect the implementation of the updated data and updated data-driven methodology.

MAI Funding

The AETC MAI funding is a separately calculated component of the total pool of funding available for competition. The funding is currently awarded to the eight regional AETCs using the same methodology as the base awards which is a methodology based on 10 weighted metrics. The AETC Program received feedback from current recipients that it can be difficult to spend the MAI funds because of the relative lower amount of minority serving providers or populations in their region. HRSA has developed a new MAI funding methodology for this competition. The AETC MAI funding methodology incorporates the following:

• A base award amount that is consistent across each region;

• The Objective Review Committee scores of the recipients; and

• The number of minority HIV/AIDS cases in each region.

The new methodology better aligns MAI funding with need in each region. In addition, it more closely aligns MAI funding with the methodology used for RWHAP Part A and Part B MAI funding and will address concerns about funding amounts.

EHE Funding

As part of the Regional AETC Program application process, all applicants are required to implement training and technical assistance related to EHE-funded services. Funding is determined based on the number of EHE-funded jurisdictions in the regions and a base amount. The amount available is subject to the overall EHE annual appropriation.

The total annual amount available over the five-year project period of performance may

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increase for recipients of awards under this notice to provide additional training in the EHE-funded jurisdictions, as recipients work to achieve the goals of the EHE initiative.

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, HRSA will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation of funds

• Satisfactory progress in meeting the project’s objectives

• A decision that continued funding is in the Federal government’s best interest

45 CFR part 75 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

Limitations on Indirect Cost Rates for Training and Education Grants:

Training awards are budgeted and reimbursed at 8 percent of modified total direct costs (MTDC). To calculate the (MTDC), HRSA excludes from the direct cost base:

• Direct cost amounts for, equipment, tuition, fees and participant support costs

• Subawards and subcontracts exceeding $25,000

State or local governments, and federally recognized Indian tribes, receive reimbursement based on their negotiated rate or state cost allocation plans. State universities or hospitals are not considered governmental agencies.

III. ELIGIBILITY INFORMATION

1. Eligible Applicants

This competition is open to current recipients and new eligible applicants proposing to provide RWHAP Part F Regional AETC services in the geographical regions listed in Appendix A.

You can apply if your organization is in the United States the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau, and is:

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

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• Public or private, nonprofit

• School or academic health science center

• Community-based

• Tribal (government, organizations) To focus efforts on areas with the greatest prevalence of HIV and with relative shortages of HIV care and treatment professionals, for the AETC Regional Program HRSA has divided the United States into eight (8) geographic regions in alignment with the HHS Regions as listed in Appendix A.

You must select only one region to support in your application and you must agree to support the HIV training and education needs across the entire region selected. In addition, your organization must be physically located in the region you intend to serve.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

We 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

We will only review your last validated application before the Grants.gov due date.

Note: One application from a national organization for multiple regions is not allowable;

multiple applications from a national organization for separate regions are not allowable unless the applicant provides proof of physical presence in each region.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-059 to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that https://www.grants.gov/ https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

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may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 80 pages when we print them. We 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 do not 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 do not count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that is not in the HRSA-24-059 workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-059 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

• When you submit your application, you certify that you and your principals1 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.2

1 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

2 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

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 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 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113

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• If you cannot certify this, you must include an explanation in Attachment 11-15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the Application Guide)

Program Requirements and Expectations

Successful award recipients will address all these elements in their application:

1. There are four (4) core components of the Regional Base Program – FH, PT, IPE, and CEE.

a) FH

FH activities are designed to train health care team members in primary care settings who currently do not provide HIV-related services. Training topics should include HIV prevention, routine HIV screening, and linkage to care for newly diagnosed or untreated people with HIV. Training of non-primary care team members who are likely to provide care for people with or at-risk of HIV must be included in the training plans. These non-primary care team members may include providers working in: Maternal Health, OB/Gyn, Urgent or Emergent Care, Sexually Transmitted Infection Treatment, and Substance Use Disorder Treatment. Minority-serving and health care facilities located in rural settings are included as prioritized areas to target the FH offerings.

Recipients must design FH activities that increase awareness of HIV and knowledge about cultural competency. In addition, FH activities must also increase awareness of the HIV epidemic, and HIV prevention, screening, and linkage to care. Recipients must use didactic and interactive presentations. Recipients can provide additional training to build the skills of the team members to best implement the information presented through more interactive training modalities.

Recipients must:

(1) Offer training in the following topics: HIV epidemiology, HIV prevention, routine HIV screening/HIV testing, linkage to care, initial evaluation of newly diagnosed people with HIV, and management with initial antiretroviral choices.

(2) Offer culturally appropriate training from available RWHAP recipient resources to create a welcoming environment and improve retention in care for people with HIV and priority populations at increased risk of HIV.

Recipients are strongly encouraged to utilize the SPNS Program’s wide array of materials such as implementation manuals, lessons learned, promising practices and other dissemination resources in the provision of training and technical assistance to RWHAP recipients and subrecipients.

(3) Assist faculty of health professions programs to improve their ability to teach about HIV and incorporate HIV-related topics into their curriculum for students and trainees.

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b) PT

It has become widely accepted that primary care practice transformation and delivery are essential to improving patient and provider experience, improving population health, and decreasing cost.3 PT is considered the key to helping practices move from traditional, provider-driven, disease-focused approaches towards health care systems that ensure patients—including their preferences, needs, desires and experiences—are fully integrated into every phase of health care.4 Key elements of transformation include patient-centered approach, expanded access to care, care coordination, continuous quality improvement, and health information technology.5

Through process improvement, training, and technical assistance, the AETCs increase the capability of organizations to implement system-level changes and enhance clinical practice to improve the provision of care and treatment to people with HIV. Several facility types are eligible to participate in PT. These organizations include RWHAP-funded health care delivery sites, Health Centers funded through the PHS Act section 330 authority, and Indian Health Service (IHS) and Tribal health care facilities. HRSA has also prioritized the implementation of PT services at minority-serving facilities that are uniquely positioned to reach, screen, and treat people who are most at risk for HIV.

Recipients must:

(1) Use components of the Patient-Centered Medical Home (PCMH) model6 to conduct process improvement activities in organizations seeking to begin or enhance care and treatment services for people with HIV. Such activities must increase the capability of organizations to implement system-level changes and enhance clinical practice to improve the provision of care and treatment to people with HIV.

(2) Increase the number of health care facilities participating in PT each year of the grant, above the baseline established for each region to meet the performance goals provided in your work plan (See Appendix D – Established Baseline for PT Sites By Region).

(3) Dedicate 20% of base funds to support PT activities.

(4) Utilize the following site-specific criteria for selecting a PT site for 1.) Health

Centers funded through the PHS Act section 330 authority, 2.) RWHAP Parts

3 Jabbarpour Y. DeMarchis E. Bazemore A. and Grundy, P. The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization. Published July 2017; Prepared by Patient-Centered Primary Care Collaborative.

4 Bokhour BG. Fix GM. Lukas CV et al. How can healthcare organizations implement patient-centered care?

Examining a large-scale cultural transformation BMC Health Serv Res. 2018; 18: 168. doi: 10.1186/s12913-018- 2949-5 5 Maryland Health Care Commission. Practice Transformation.

(https://mhcc.maryland.gov/mhcc/Pages/apc/apc_icd/apc_icd_practice_transformation.aspx) 6 Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/index.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842617/ https://doi.org/10.1186%2Fs12913-018-2949-5 https://doi.org/10.1186%2Fs12913-018-2949-5 https://mhcc.maryland.gov/mhcc/Pages/apc/apc_icd/apc_icd_practice_transformation.aspx https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/index.html https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/index.html

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A, B, C, or D funded health care delivery sites, and 3.) IHS and Tribal facilities:

4a. Health Centers funded through the PHS Act 330 authority (per each

PT site);

Criteria 1: At least one of the following:

• Located in an EHE-funded jurisdiction OR

• Patient population served is at least 25% racial/ethnic minority OR

• Patient population served is at least 10% sexual minority (LGBTQIA+)

OR

• Patient population served is at least 10% active substance users, AND

Criteria 2: At least one of the following Uniform Data System (UDS) performance measures for each PT site for the preceding year’s data was below the recent median result for reporting organizations:

• Measure: Percentage of patients 15 through 65 years of age who were tested for HIV when within age range (Routine HIV Screening) OR

• Measure: Percentage of patients whose first-ever HIV diagnosis was made by health center personnel between December 1 of the prior year and November 30 of the measurement period and who were seen for follow-up treatment within 30 days of that first-ever diagnosis (Linkage to Care)

4b. RWHAP Parts A, B, C, or D funded health care delivery sites;

Criteria 1: At least one of the following:

• Located in an EHE-funded jurisdiction OR

• Patient population served is at least 25% racial/ethnic minority OR

• Patient population served is at least 10% sexual minority (LGBTQIA+)

OR

• Patient population served is at least 10% active substance users, AND

Criteria 2: At least one of the following performance measures reported on the RWHAP Service Report (RSR) was less than the national average result:

• Annual Retention in Care: Percentage of patients, regardless of age, with a diagnosis of HIV who had at least two (2) encounters within the 12-month measurement year (2021 RSR average 78.3%) OR

• HIV Viral Load Suppression: Percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/ml at last viral load test during the measurement year (2021 RSR average 89.7%)

4c. IHS and Tribal Facilities;

• All IHS and Tribal health care facilities offering outpatient, ambulatory medical care services.

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c) IPE

IPE is a teaching approach associated with promoting interdisciplinary collaboration and improving quality of patient care.7 Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. The goal of IPE in the AETC Program is to assist faculty of health profession programs (HPPs) to create an interactive learning process to increase the number of students and trainees who intend to practice as a team member in the field of HIV care. IPE programs are designed to foster an interest in HIV care earlier in the education or training of future health care team members, thus contributing to improved outcomes along the HIV care continuum.

In keeping with the statutory intent to increase the number of minority-serving providers, HRSA has prioritized the implementation of HIV IPE training with an emphasis on Minority-Serving Institutions (MSIs); Historically Black Colleges and Universities (HBCUs), Tribal Colleges and Universities, Hispanic-Serving Institutions, and Asian American Pacific Islander-Serving Institutions.

Recipients must:

(1) Work with the faculty at HPPs to establish and implement HIV IPE programs.

The IPE program must be designed to affect change at the student as well as the institutional/health professional program level.

(2) HIV IPE programs must include both medical and nursing…