hrsa-25-056 FINAL.pdf

Notice of Funding Opportunity

Application due March 11, 2025

HIV/AIDS Bureau Division of Policy and Data

Street Medicine Interventions for People with HIV who are Unsheltered- Demonstration Sites.

Opportunity number: HRSA-25-056

Modified on 1/28/25 Updated TA Webinar information

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Award information 20

Step 2: Get Ready to Apply 22

Get registered 23

Find the application package 23

Application writing help 23

Step 3: Prepare Your Application 25

Application contents and format 26

Step 4: Learn About Review and Award 36

Application review 37

Selection process 42

Award notices 42

Step 5: Submit Your Application 43

Application submission and deadlines 44

Application checklist 45

Step 6: Learn What Happens After Award 47

Post-award requirements and administration 48

Contacts and Support 52

Contents 2

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

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time on March 11, 2025.

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

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

Jump to a step

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

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Award information 20

Basic information Health Resources and Services Administration (HRSA)

HIV/AIDS Bureau

Division of Policy and Data

Street medicine interventions for people with HIV – Demonstration Sites

Have questions?

Go to Contacts and Support.

Key facts Opportunity name:

Street Medicine Interventions for People with HIV who are Unsheltered- Demonstration Sites.

Opportunity number:

HRSA-25-056

Announcement version:

Modification #1

Federal assistance listing:

93.928

Statutory authority:

42 USC § 300ff-101 (§ 2691 of the Public Health Service Act)

Key dates NOFO issue date:

January 8, 2025

Informational webinar:

See Webinar Information

Application deadline:

March 11, 2025

Expected award date is by:

July 2, 2025

Expected start date: August 1, 2025

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

Summary The Health Resources and Services Administration (HRSA) HIV/AIDS (HAB) Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) Program is accepting applications for fiscal year (FY) 2025 to fund 10 organizations under the announcement Street Medicine Interventions for People with HIV who are Unsheltered - Demonstration Sites (HRSA-25-056).

Using an implementation science approach, the 10 demonstration sites will collaborate with each other and the Capacity Building Provider (HRSA-25-055) and Evaluation Provider (HRSA-25-057) within this initiative to adapt, document, evaluate, and disseminate street medicine interventions for people with HIV. For this initiative, street medicine is the provision of health services in unsheltered environments (e.g., on streets, under bridges, other public or open space) to people with HIV who are out of care or not consistently engaged in care and unstably housed and reside in unsheltered.

This field of medicine and public health response holds much promise to improve the health and quality of life of people with HIV. This improvement may be demonstrated through innovative approaches to assess needs to re-engage clients into prior HIV care, link others to HIV care provisions, offer access to antiretroviral therapy, and monitor the response for viral suppression, along with addressing other HIV primary care needs as identified. The initiative will identify the core program components, strategies to scale interventions, implementation within the context of the Ryan White HIV/AIDS Program (RWHAP), and sustainable interventions in communities with variable resources.

Additional priority populations are identified by the National HIV/AIDS Strategy (NHAS) (2022-2025), which are:

• Gay, bisexual, and other men who have sex with men, in particular Black, Latino, and American Indian/Alaska Native men;

• Black women;

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

Step 1: Review the Opportunity 5 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/about-program/legislation-title-xxvi.pdf https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025

• Transgender women;

• Youth aged 13–24 years; and

• People who inject drugs.

The demonstrations sites will work with the Capacity Building Provider (HRSA-25-055) and Evaluation Provider (HRSA-25-057) to implement this initiative. HRSA encourages you to read and familiarize yourself with the program expectations of the companion

NOFO.

The funded Demonstration Sites (HRSA-25-056) will:

• Participate with the Capacity Building Provider and Evaluation Provider to adapt, document, implement, evaluate, and disseminate street medicine interventions that effectively respond to the needs of people with HIV who are unsheltered.

• Make sure the interventions are equitable, inclusive, and client-centered, and incorporate the reduction of stigmatizing attitudes, beliefs, and behaviors.

• Create an interdisciplinary team consisting of medical, mental health, substance use, and social services staff who:

◦ Are skilled and experienced in the needs and barriers experienced by people who are unsheltered,

◦ Can swiftly respond with appropriate services and resources, and

◦ Consider safety and environmental factors of the care delivery area.

• Participate with the Capacity Building Provider and Evaluation Provider in the activities outlined in the initiative’s communications and dissemination plan, including the creation of user-friendly, multimedia materials such as publications and implementation manuals.

• Participate in the initiative’s implementation science multi-site evaluation.

• Participate with the Capacity Building Provider and Evaluation Provider in all activities of the initiative including:

◦ Evaluation,

◦ Data collection,

◦ Strategic planning meetings, and

◦ The initiative’s multi-site meetings.

Review HRSA-25-055 Capacity Building Provider and HRSA-25-057 Evaluation Provider to understand the initiative activities.

HRSA expects that the recipients funded from these funding opportunities will work together to achieve the initiative goals and objectives.

Step 1: Review the Opportunity 6

Funding details Application Types: New

Expected total available funding in FY 25: $3,650,000

Expected number and type of awards: 10 Grants

Funding range per award: $365,000 per Demonstration Site per year

We plan to fund awards in 12-month budget periods for a total four -year period of performance from August 1, 2025 to July 31, 2029.

The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

Step 1: Review the Opportunity 7

Eligibility Who can apply You can apply if you are eligible for funding under Ryan White HIV/AIDS Program Parts A - D of Title XXVI of the Public Health Service (PHS) Act. These entities include:

Types of eligible organizations These types of domestic* organizations may apply:

• Public institutions of higher education

• Private institutions of higher education

• Non-profits with or without a 501(c)(3) IRS status

• State, county, city, township, and special district governments, including the District of Columbia, domestic territories, and freely associated states

• Independent school districts

• Native American tribal governments

• Native American tribal organizations

* “Domestic” means the 50 states, the District of Columbia, 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, and the Republic of Palau.

Individuals are not eligible applicants under this NOFO.

Other eligibility criteria

• Public and nonprofit private entities

• State and local governments

• Academic institutions

• Local health departments

• Nonprofit hospitals and outpatient clinics

• Community health centers receiving support under Section 330 of the PHS Act

• Faith-based and community-based organizations

• Indian Tribes or Tribal organizations with or without federal recognition

Step 1: Review the Opportunity 8

Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition.

We will not consider an application that:

• Is from an organization that does not meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

Application limits You may not submit more than one application. If you submit more than one application, we will only accept the last on-time submission.

Cost sharing This program has no cost-sharing requirement. If you choose to share in the costs of the project, we will not consider it during merit review. We will hold you accountable for any funds you add, including through reporting.

Step 1: Review the Opportunity 9

Program description Purpose The Capacity Building Provider (HRSA-25-055), the Demonstration Sites (HRSA-25-056), and the Evaluation Provider (HRSA-25-057) will collaborate to achieve the initiative’s goal and five objectives:

Goal: Adapt, document, implement, evaluate, and disseminate street medicine interventions that effectively respond to the needs of people with HIV who are unsheltered.

• Objective 1: Build capacity of demonstration sites to effectively respond to the health care needs of people with HIV who are unsheltered.

• Objective 2: Achieve successful uptake and sustainability of adapted and implemented interventions by RWHAP recipient staff and clients.

• Objective 3: Conduct a high-quality, mixed methods, multi-site, implementation science evaluation, and cost analysis across demonstration sites.

• Objective 4: Develop and disseminate user-friendly, multimedia implementation materials that will serve as tools for RWHAP settings to replicate street medicine interventions and provide enhanced care and support for their clients.

• Objective 5: Use the Centers for Medicare and Medicaid (CMS) Place of Service Codes that reflect place where services are rendered.

Street Medicine Overview

As a client-centered service, street medicine is designed to bring the services offered in a clinic into the unsheltered spaces where people live, spend time, and congregate such as the streets and wooded areas. As described by subject matter experts globally, street medicine is conducted where people live and must include a change in traditional health care delivery structure to engage those unstably housed. Street medicine is not a new form of health care delivery. Rather, street medicine programs have existed for decades. These programs have demonstrated the ability to provide health care service in an effective manner, resulting in improved health outcomes.

Street medicine programs may take a different approach to address components of delivering health care services than traditional health care settings. Some components are the safety, local and state regulations, and selection of services to offer people.

Clinic-based and street medicine interventions have different approaches for assuring safety of the teams providing and clients receiving care due to the different environments and availability of resources in each setting. Local and state regulations may determine which health care services can be delivered in which setting and when.

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

Step 1: Review the Opportunity 10 https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets

These components are important to understand and include in all street medicine programs.

Health care delivered in traditional settings, such as a clinic or mobile unit, may not address the needs of those who are unsheltered. Barriers such as facility hours of operation and policies related to entry (e.g., no pets, no carts, requirements for shirts and shoes) impact access to and retention in care. Stigma and discrimination may be other factors that prevent those with previous poor experiences in clinic-based settings who are unsheltered from entering traditional settings for health care.

Because people who are rough sleepers or are unsheltered experience a combination of varied social determinants of health challenges, street medicine teams encounter populations with chronic disease co-morbidities, mental health, substance use disorders, and other structural factors requiring innovative, approaches (see also Substance Abuse and Mental Health Services Administration (SAMHSA)’s 2023-2026 Strategic Plan).

Based on the 2022 RWHAP Services Report, 5.2% of clients served were unstably housed with another 6.9% temporarily housed. Clients who were unstably housed had a viral suppression of 72.4% and people who were temporarily housed had a viral suppression of 84.1%, which is a lower viral suppression than those who have stable housing. To end the HIV epidemic in the United States, strategies that tailor services to meet the needs of people who are not engaged in care or virally suppressed where they are located are required. Street medicine, as a form of health care delivery, can be an effective intervention to help RWHAP clients who are not well served by traditional health care delivery systems. Therefore, while street medicine focuses on those people who are unstably housed, it can also serve those who are averse to a traditional clinic building environment.

Key Definitions For this initiative, the following definitions will be used:

• Street medicine: Street medicine is an alternative approach to traditional health care delivery settings. Street Medicine consists of “health and social services” developed specifically to address the unique needs and circumstances of the unsheltered delivered directly to them in their own environment.

• Unstably housed: A type of housing status where the person does not have stable permanent or temporary housing (such as a permanent or temporary placement, apartment, or home). People who have unstable housing live in an emergency shelter or a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for humans; jail, prison, or a juvenile detention facility;

or hotel or motel paid for with emergency shelter voucher.

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

Step 1: Review the Opportunity 11 https://www.samhsa.gov/about-us/strategic-plan https://www.samhsa.gov/about-us/strategic-plan https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2022.pdf

• Unsheltered: A type of housing status where the person sleeps in places not intended for human habitation, a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for humans.

• Out of care or not consistently engaged in care:

◦ Newly diagnosed with HIV within the past 12 months; OR

◦ Previously diagnosed with HIV (more than six months ago) but not engaged in care, as per one or more of the following parameters:

▪ Not have two routine HIV primary care encounters within a 12 month period (according to HRSA annual retention performance measure); OR

▪ Be an existing client at risk of not attending HIV primary care visits (including clients who have missed their last two appointments in the last 12 months, or missed their last appointment in the last six months, or clients who are leaving incarceration or have another high-risk factor);

OR

◦ Persons who are not virally suppressed (defined as having a viral load >=200 copies/mL3) at the time of enrollment into HIV primary care (see HAB performance measure).

• Culturally Responsive Care: Services that are culturally grounded, attuned, and sensitive to the unique needs of each client and their cultural background. See:

Cultural Competence in Health And Human Services.

• Rough Sleeper: A person who sleeps in a public location not meant for human habitation (outside, in a car, in an abandoned building).

• Implementation science is the study of methods to promote or improve the systematic uptake of effective intervention strategies by public health practice, program, and policy. Intervention strategies may occur at the system, community, organization, and individual levels. At HRSA HAB, successful intervention strategies positively impact health and quality of life for people with HIV.

• Intervention strategies: HRSA HAB categorizes interventions into three levels, based on evidence of demonstrated effectiveness. The three levels are collectively known as “intervention strategies” and include:

◦ Evidence-based interventions: Interventions that are demonstrated to effectively improve health and/or quality of life, based on published research.

These interventions meet the CDC criteria for being evidence-based.

◦ Evidence-informed interventions: Interventions that are demonstrated to effectively show promise, based on published research. Evidence-informed interventions may demonstrate impact and strength of evidence without meeting CDC criteria for being evidence-based.

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

Step 1: Review the Opportunity 12 https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio/core-measures/annual-retention-in-care https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio/core-measures/hiv-viral-load-suppression https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio/core-measures/hiv-viral-load-suppression https://npin.cdc.gov/pages/cultural-competence-health-and-human-services https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003128 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003128

◦ Emerging interventions: Innovative practices that have not yet been published or do not have extensive evaluation data but have effectively improved health and/or quality of life.

• Implementation strategies: Methods to enhance the adoption or uptake of interventions in specific settings.

• Culturally responsive care: Services that are culturally grounded, attuned, and sensitive to the unique needs of each client and their cultural background. See:

Cultural Competence in Health and Human Services.

• Flexible service delivery: The ability to quickly adjust services to meet the unique and evolving needs of clients—such as low-barrier care, street medicine, nontraditional clinic hours, and harm reduction.

• Integrated care: Clinicians’ careful coordination of HIV primary care, mental health and substance use disorder care, and supportive services. Clinicians work together systematically and use a multidisciplinary approach to ensure clients receive one consistent message about care and treatment and are included in planning their treatment. See the Substance Abuse and Mental Health Services Administration’s 2023-2026 Strategic Plan.

Background The HRSA Ryan White HIV/AIDS Program has five statutory funding parts that provide a comprehensive system of medical care, support, and medications for low-income people with HIV. The goal is better health results, and lower HIV transmission in priority groups.

The HIV care continuum is key to the program. It shows the journey of someone with HIV from diagnosis to effective treatment, leading to viral suppression. Achieving viral suppression boosts the patient’s quality of life and prevents HIV transmission (also known as Undetectable equals Untransmittable or U=U).

This continuum also helps programs and planners measure progress and use resources effectively. We require you to assess your outcomes and work with your community and public health partners to improve outcomes across the HIV care continuum. To assess your program, review HRSA’s Performance Measure Portfolio.

Strategic frameworks and national objectives To address health challenges faced by low-income people with HIV, using national objectives and strategic frameworks is crucial. These frameworks include:

• Healthy People 2030

• National HIV/AIDS Strategy (NHAS) (2022–2025)

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

Step 1: Review the Opportunity 13 https://npin.cdc.gov/pages/cultural-competence-health-and-human-services https://ryanwhite.hrsa.gov/about/parts-and-initiatives https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum/ https://ryanwhite.hrsa.gov/grants/performance-measure-portfolio https://health.gov/healthypeople

• Sexually Transmitted Infections National Strategic Plan for the United States (2021–2025)

• Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025)

These strategies offer guidance on the main principles, priorities, and steps for our national health response. They serve as a blueprint for collective action and impact.

Expanding the effort There have been significant accomplishments:

• From 2018 to 2022, HIV viral suppression among Ryan White program clients improved from 87.1% to 89.6%. For more, see the 2022 Ryan White Services Report

(RSR).

• Racial, ethnic, age-based, and regional disparities in viral suppression rates have significantly reduced. For more, see the RWHAP Annual Data Report, 2022.

• In 2020, the Ending the HIV Epidemic in the U.S. (EHE) initiative launched to further expand federal efforts to reduce HIV transmission. 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.

Using data effectively HRSA and CDC promote integrated data sharing and use for program planning, quality improvement, and public health action.

We encourage you to:

• Follow the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs.

• Create data-sharing agreements between surveillance and HIV programs.

• Progress towards NHAS goals through integrated data sharing, analysis, and use of HIV data by health departments.

• Complete CD4, viral load, and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems. CDC mandates the reporting of all such data to the National HIV Surveillance System (NHSS).

• Use our interactive RWHAP Compass Dashboard to visualize reach, impact, and outcomes of the Ryan White program and to inform planning and decision making. The dashboard gives you a look at national, state, and metro area data

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

Step 1: Review the Opportunity 14 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-2022.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2022.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/data/rwhap-annual-client-level-data-report-2022.pdf https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ending-epidemic-timeline/ https://www.cdc.gov/program-collaboration-service-integration/php/index.html?CDC_AAref_Val=https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf https://www.cdc.gov/program-collaboration-service-integration/php/index.html?CDC_AAref_Val=https://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf https://data.hrsa.gov/topics/hiv-aids/compass-dashboard and displays client demographics, services, outcomes, and viral suppression. It also includes data about clients in the AIDS Drug Assistance Program (ADAP).

• Develop data-sharing strategies with other RWHAP recipients and relevant entities to reduce administrative burden.

• Use electronic data sources to verify client eligibility when you can. See Policy Clarification Notice 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program.

Program resources and innovative models We offer multiple projects and resources to help you. A full list of resources is available on TargetHIV. We urge you to learn about them and use them in your project. For some examples, see Helpful Websites.

Program requirements and expectations The Demonstration Sites, Capacity Building Provider (HRSA-25-055), and Evaluation Provider (HRSA-25-057) are co-collaborators of this initiative. Continuous collaboration and communication among all participants and HRSA are required to achieve the initiative objectives. Based on the funded entity, some activities will be led by one entity, some activities will include participation by each entity, and some activities include a collaborative (co-coordinate) approach by all entities.

The table below provides an overview of the general HAB expectations for the lead and participating roles for initiative activities. These are HAB’s expectations for successful applicants. Multi-site meetings will be virtual or held in the Washington D.C.

metropolitan area.

Responsibilities/Collaborative Role: Lead, Co- Coordinate , Participate

Demonstration Sites

(HRSA-25-056)

Capacity Building Provider

(HRSA-25-055)

Evaluation Provider

(HRSA-25-057)

Within 90 Days of Award

Develop a comprehensive joint work plan.

Co-Coordinate Lead Co-Coordinate

Within 90 days of Award

Host a virtual multi-site meeting. Participate Lead Co-Coordinate

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

Step 1: Review the Opportunity 15 https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-21-02-determining-eligibility-polr.pdf https://targethiv.org/help/ta-directory

Within 6 Months of Award

Develop a communications and dissemination plan.

Participate Co-Coordinate Co-Coordinate

Year 1-4 Implement, refine, document, and evaluate street medicine interventions.

Co-Coordinate Co-Coordinate Co-Coordinate

Year 1 Complete IRB, business associate agreements, and data use agreement.

Participate Participate Lead

Year 1 Evaluate and disseminate street medicine interventions.

Participate Lead Participate

Year 1-2 Recruit and enroll clients in the interventions.

Lead Co-Coordinate Co-Coordinate

Year 1-4 Attend two initiative annual (multi-site) meetings per budget year in the Washington, DC metropolitan area.

Participate Participate Participate

Year 1-4 Develop and implement a multi-site evaluation plan grounded in implementation science.

Participate Participate Lead

Year 1-4 Plan, coordinate, and facilitate all multi-site meetings.

Participate Lead Participate

Year 1 –

Implement, refine, and document interventions.

Lead Participate Participate

Year 1 –

Evaluate interventions. Participate Participate Lead

Year 1 and ongoing

Systematically provide, track, measure, and report implementation technical assistance.

Participate Lead Participate

Year 1 and ongoing

Systematically provide, track, and document evaluation technical assistance.

Participate Participate Lead

Step 1: Review the Opportunity 16

Year 1 and ongoing

Develop a dissemination plan for the creation of user-friendly, multimedia replication materials.

Co-Coordinate Co-Coordinate Co-Coordinate

Year 1 and ongoing

Create and disseminate user-friendly, multimedia replication materials.

Participate Lead Participate

Year 4 Attend the National Ryan White HIV/AIDS Program Conference.

Participate Participate Participate

Details of the Demonstration Site(s) (HRSA-25-056) Specific Requirements In consultation with HRSA, Demonstration Sites, the Capacity Building Provider (HRSA-25-055), and the Evaluation Provider (HRSA-25-057) should collaboratively refine their respective roles and responsibilities within the first 90 days of the award and develop a comprehensive joint work plan. The Capacity Building Provider will lead the planning for a virtual or in-person multi-site meeting within the first 90 days of award to bring together the Demonstration Sites, Capacity Building Provider, and Evaluation Provider to finalize the joint work plan and initiate the communications and dissemination plan.

HAB recommends that within the first six months of award, a virtual or in-person co-coordination meeting is conducted between HRSA and all three entities to develop a communications and dissemination plan. The communication and dissemination plan will include:

• Publication and Dissemination Committee: The Demonstration Site and HRSA staff will participate in the publication and dissemination committee, led by the Capacity Building Provider and Evaluation Provider staff, to generate study questions, topics for presentations and publications, concept sheets and analyses, and other multi-media products.

• Dissemination products and strategies: These will include user-friendly, multi-media materials that incorporate implementation findings from the initiative used to support replication of the intervention. They should include materials aligned with RWHAP service categories for replication purposes. The Demonstration Site, Evaluation Provider, and Capacity Building Provider must work together to ensure the integration of evaluation findings into dissemination products.

• Priority audiences: These include HIV care and treatment providers, as well as supportive service providers. Other audiences may include program administrators, RWHAP program leaders, and policymakers. The Capacity Building

Step 1: Review the Opportunity 17

Provider and Evaluation Provider must ensure products and strategies are culturally responsive and accessible to communities impacted by HIV and unsheltered.

• Dissemination timeline: The timeline will include developing and disseminating materials throughout the initiative, not just at the end. The purpose is to promote real-time learning and dissemination of best practices within the RWHAP. The timeline should incorporate HRSA review and review by subject matter experts, as needed.

• Project websites: The Demonstration Site will collaborate with the Evaluation Provider, Capacity Building Provider, and HRSA to develop and maintain a project-specific page on TargetHIV.org with public access for communication of the project. In addition to the public website, a secure, password-protected shared location (e.g., SharePoint) for implementation sites, Capacity Building Provider, Evaluation Provider, and HRSA staff will be created and maintained during the project to host the initiative’s files.

• Promoting replication: The Demonstration Sites will collaborate with the Capacity Building Provider in spreading the replication materials created through the initiative. When the Demonstration Site independently creates user-friendly, multimedia replication materials, these materials will be posted to TargetHIV.org and the RWHAP Best Practices Compilation to share all products from this initiative with RWHAP recipients.

The Demonstration Sites will lead the following program requirements in consultation with HRSA:

• Implement, adapt, and document street medicine interventions.

• Systematically receive, track, measure, and report implementation technical assistance (TA) from the Evaluation Provider that ensures fidelity to core components of the interventions.

• Recruit and enroll clients in the interventions. Enrollment will begin before the end of year 1.

• Integrate the interventions into your organization’s operations by the end of the initiative.

• Will follow all CMS regulations and use the CMS Code 27 for Street Medicine.

The Demonstration Sites will participate in the following program requirements in consultation with HRSA:

• Complete Institutional Review Board (IRB), Data Use Agreement (DUA), and Business Agreement (BA) within their organization and with the Evaluation Provider.

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

Step 1: Review the Opportunity 18 https://targethiv.org/ https://targethiv.org/bestpractices https://www.streetmedicine.org/index.php?option=com_dailyplanetblog&view=entry&year=2023&month=06&day=27&id=33:new-pos-code-for-street-medicine-from-cms-

• Collect and transfer data to the Evaluation Provider, including information from the Evaluation Provider section about the types of data to be collected.

• Develop user-friendly, multimedia replication material that incorporates implementation findings from the initiative.

All initiative recipients should plan to attend two initiative multi-site meetings per budget year at HRSA headquarters or in the Washington, D.C. metropolitan area. The following three people from each recipient team should plan to attend the annual meetings: Principal investigator, evaluation staff person, and person with lived experience. The meetings will be two days in length.

In addition, all initiative recipients are expected to attend and participate in the National Ryan White Conference on HIV Care and Treatment (NRWC) in 2026 and 2028.

Key Personnel When possible, recipients and subrecipients will consider filling key personnel roles with individuals with lived experience. Lived experience includes persons with HIV and people who have been unstably housed or unsheltered or experienced rough sleeping.

This experience, along with relevant content expertise, is acceptable in lieu of education, as appropriate. The demonstrations sites must include people with lived experience in the adaption, documentation, evaluation, and dissemination of the intervention.

Step 1: Review the Opportunity 19

Award information Funding policies and limitations Policies

• We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and award process.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Your satisfactory progress in meeting the project’s objectives.

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

• If we receive more funding for this program, we may:

◦ Fund more applicants from the rank order list.

◦ Extend the period of performance.

◦ Award supplemental funding.

General limitations

• For guidance on some types of costs we do not allow or restrict, see Project

Budget Information in Section 3.1.4 of the Application Guide. You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items of Cost.

• You cannot earn profit from the federal award. See 45 CFR 75.400(g).

• Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2025, the salary rate limitation is $225,700. This limitation may be updated.

Program-specific statutory or regulatory limitations You cannot use funds under this notice for the following:

• Charges that are billable to third party payers (e.g., private health insurance, prepaid health plans, Medicaid, Medicare);

• To directly provide medical or support services (e.g., HIV care, counseling, and testing) that supplant existing services;

• Cash payments to intended recipients of RWHAP services;

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

Step 1: Review the Opportunity 20 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.400

• Purchase or construction of new facilities or capital improvements to existing facilities;

• Purchase or improvement to land;

• Fundraising expenses or lobbying activities and expenses;

• Syringe Services Programs (SSPs) that have not received HRSA’s prior approval or are not in compliance with HHS and HRSA policy. See https://www.aids.gov/ federal-resources/policies/syringe-services-programs/;

• To develop materials designed to directly promote or encourage intravenous drug use or sexual activity;

• PrEP or PEP medications or related medical services. (Please note that RWHAP recipients and sub-recipient providers may provide prevention counseling and information to eligible clients’ partners – see RWHAP and PrEP Program Letter, November 16, 2021); and/or

• International travel.

See Manage Your Grant for other information on costs and financial management.

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects.

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

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

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

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

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

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

Step 1: Review the Opportunity 21 https://www.aids.gov/federal-resources/policies/syringe-services-programs/ https://www.aids.gov/federal-resources/policies/syringe-services-programs/ https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/hiv-care/prep-dcl-november-2021-508.pdf https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/hiv-care/prep-dcl-november-2021-508.pdf https://www.hrsa.gov/grants/manage-your-grant https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 23

Find the application package 23

Application writing help 23

Get registered SAM.gov You must have an active account with SAM.gov to apply. This includes having a Unique Entity Identifier (UEI). SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov. You can see step-by-step instructions at the Grants.gov Quick Start Guide for Applicants.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for opportunity number HRSA-25-056 .

After you select the opportunity, we recommend that you click the Subscribe button to get updates.

Application writing help Visit HHS Tips for Preparing Grant Proposals.

Visit HRSA’s How to Prepare Your Application page for more guidance.

See Apply for a Grant for other help and resources.

FAQs will be posted on our TA webpage after the webinar with a link to the Grants.gov Related Documents tab.

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

Step 2: Get Ready to Apply 23 https://sam.gov/entity-registration https://sam.gov/content/entity-registration https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application/assurances-non-construction-programs https://grants.gov/applicants/applicant-registration http://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/search-grants https://www.hhs.gov/grants-contracts/grants/get-ready-for-grants-management/tips-for-preparing-grant-proposals/index.html https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://www.hrsa.gov/grants/apply-for-a-grant

Join the webinar More information on this NOFO's webinar will be posted at a later date to the related documents tab here.

We recommend you “Subscribe” to the NOFO on Grants.gov to receive updates when documents are posted.

The Webinar will be recorded.

Have questions? Go to Contacts and Support.

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

Step 2: Get Ready to Apply 24 https://grants.gov/search-results-detail/354785

Step 3:

Prepare Your Application

In this step

Application contents and format 26

Application contents and format Applications include 5 main components. This section includes guidance on each.

Application page limit: 60 pages.

Submit your information in English and express whole number budget figures using U.S. dollars.

Make sure you include each of these:

Components Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form.

Attachments Insert each in the Attachments form.

Other required forms Upload using each required form.

Required format You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3.2 of the Application Guide.

Project abstract Complete the information in the Project Abstract Summary form. Include a short description of your proposed project. Include the needs you plan to address, the proposed services, and the population groups you plan to serve. For more information, see Section 3.1.2 of the Application Guide.

Project narrative In this section, you will describe all aspects of your project. Project activities must comply with the non-discrimination requirements.

Use the section headers and the order listed.

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

Step 3: Prepare Your Application 26 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=24 https://www.hrsa.gov/sites/default/files/hrsa/grants/application-guide.pdf#page=13

Introduction See merit review criterion 1: Need

Briefly describe the purpose of your project. Provide a clear and succinct description of your ability to successfully meet and carry out program requirements and expectations.

Briefly describe how you plan to participate in the activities of the Capacity Building Provider (HRSA-25-055) and Evaluation Provider (HRSA-25-057).

Need See merit review criterion 1: Need

• Describe the target population and their unmet health needs.

• Outline the community or organization’s needs you plan to address.

• Discuss any relevant barriers in the service area that you hope to overcome.

• Use and cite demographic data whenever possible.

• Share your understanding of the needs of people with HIV who are unsheltered in your service area and the impact of HIV care engagement and retention for them by including data on the number unsheltered in your jurisdiction. Provide data regarding demographics and co-existing conditions.

• Describe how the client, clinical, social, and structural factors contribute to the need for a street medicine intervention in your service area.

• Describe the need and challenges associated with using an implementation science approach to a street medicine intervention.

• Provide a discussion of the challenges associated with implementation, evaluation, and replication for people with HIV who are unsheltered or rough sleeping and out of care or experiencing barriers to retention in care.

• Use and cite literature and publications whenever possible to help the information provided. You can include surveillance and epidemiology reports, profiles of state and local public health departments, needs assessment surveys, risk behavioral surveys, and other programmatic data.

Approach See merit review criterion 2: Response

• Tell us how you will address the needs you described and meet the program requirements and expectations described in this NOFO.

• If appropriate, include strategies for ongoing staff training, teamwork, and information sharing. Also include strategies for outreach and collaboration to involve patients, families, and communities.

Step 3: Prepare Your Application 27

• If it applies, include a plan to distribute reports, products, or project outputs to target audiences.

• Propose a plan for continuing the project when federal funding ends. We expect you to keep up key strategies or services and actions that have led to improved practices and outcomes for the target population.

• Describe the operations of your street medicine teams.

◦ Describe your proposed strategy to re-engage people with HIV and provide HIV primary care and support services. Describe how you will include HIV testing and linkage to care to people at risk for HIV as a component of your intervention.

◦ Identify the professions that serve on your street medicine team and their responsibilities.

◦ List the specific intervention components, the anticipated number of HIV primary care and support services you will provide, and any identified services your street medicine team cannot offer.

◦ List hours of operation of your street medicine team.

◦ Describe locations where your street medicine team will offer services.

◦ Describe the facilities, partnerships, and systems available to your street medicine team to provide HIV primary care and support services.

◦ Describe the policies, protocols, and regulations that govern your street medicine team.

◦ Describe the implications of local regulations that limit your street medicine team.

◦ List the services and activities provided by your street medicine team that are billed and reimbursed by healthcare coverage.

• Describe how you will work with the Evaluation Provider using implementation science to adapt, document, evaluate, and disseminate your intervention with the goal of replication at other organizations.

• Describe how many people with HIV you currently provide HIV primary care to through street medicine, if applicable, and how many people you could enroll into the street medicine intervention in the first year of the initiative.

• Describe your capacity to enroll enough people by the end of year two to accurately make statements, findings, and results.

• Describe how you will partner with the Evaluation Provider to complete the IRB process and begin enrollment before the end of the first year. State if your organization could sign a reliance agreement for the IRB with the Evaluation Provider or if your organization will need to submit an IRB package independent of the Evaluation Provider’s IRB.

Step 3: Prepare Your Application 28

• Describe how you will involve of people with HIV (specifically people with experience being unsheltered) in the adaptation, documentation, evaluation, and dissemination of the street medicine intervention and how you will support the participation of people with HIV.

• Describe strategies you will use for ongoing staff training, teamwork, and information sharing. Also include strategies for outreach and collaboration efforts to involve people with HIV.

• Describe your plans for sustaining and integrating your intervention into your organization by the end of the initiative.

• Describe how you will collaborate with Capacity Building Provider and Evaluation Provider on specific activities such as developing a joint workplan and communications and dissemination plan.

• Describe how you will collaborate with Capacity Building Provider and Evaluation Provider to create and disseminate user-friendly, multi-media materials that incorporate implementation findings from the initiative.

High-level work plan See merit review criteria 2: Response and 4: Impact

• Describe how you’ll achieve each of the objectives during the period of performance.

• Provide a timeline that includes each activity and identifies who is responsible for each.