Kenya CDC-RFA-JG-25-0088 Final NOFO for Publication.pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 19, 2025

Implementation of integrated, resilient, and sustainable health systems for HIV/TB epidemic control in the Republic of Kenya under the President's Emergency Plan for AIDS Relief (PEPFAR) Opportunity number: CDC-RFA-JG-25-0088

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 33

Get registered 34

Questions 35

Step 3: Prepare Your Application 36

Application contents and format 37

Step 4: Learn About Review and Award 47

Application review 48

Award notices 53

Step 5: Submit Your Application 54

Application submission and deadlines 55

Application checklist 57

Step 6: Learn What Happens After Award 59

Post-award requirements and administration 60

Contacts and Support 67

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 February 19, 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

Basic information U.S. Centers for Disease Control and Prevention (CDC)

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Implementation of integrated, resilient, and sustainable health systems for HIV/TB epidemic control in the Republic of Kenya under the President’s Emergency Plan for AIDS Relief (PEPFAR)

Opportunity number:

CDC-RFA-JG-25-0088

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

February 19, 2025

Expected award and start date: September 30, 2025

We will inform you of your application status by the end of August 2025.

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

NOFO.

Summary The goal of this NOFO is to support Kenya’s health programs by strengthening resilient, integrated, and sustainable health systems. The NOFO builds on the achievements of Kenya’s HIV/TB program and aligns with the country’s vision of universal health coverage (UHC) and meeting and maintaining the UNAIDS 95-95-95 targets.

You will provide support for HIV/TB and associated comorbidities at the national and county levels to enhance:

• Leadership.

• Governance.

• Health financing.

• Human resources for health (HRH).

• Supply chain management systems.

By integrating HIV services into broader healthcare systems, this NOFO will contribute to improving efficiencies through innovative approaches.

Collaboration with program managers and technical experts will ensure universal access to timely, high-quality health services.

Focus populations include:

• The general population.

• People living with HIV/TB, and related health conditions.

• National and county leaders.

• And facility and community-based health workforce.

Step 1: Review the Opportunity 5

By adopting an approach of integrating the HIV program into a strengthened healthcare system, this NOFO aims to create a strong, efficient, and sustainable healthcare infrastructure in Kenya. This approach will enhance the country’s current capacity for comprehensive HIV/TB services while advancing toward UHC.

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $6,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1 to 2 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Step 1: Review the Opportunity 6

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: COP Q1 Targets and Activities.

◦ Component 2: COP Q2 Targets and Activities.

◦ Component 3: COP Q3 Targets and Activities.

◦ Component 4: COP Q4 Targets and Activities.

◦ Component 5: COP Additional Targets and Activities.

◦ Component 6: Emerging Public Health Priorities (buffer component if needed).

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR Local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 30 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in Kenya.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

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

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work In 2010, Kenyan officials divided responsibilities between its national and county governments. The ministry of health (MOH) in Kenya manages healthcare at two levels: service delivery at 47 counties and policy and standards at national level. Sharing responsibilities and resources between the two levels of government creates ongoing challenges in HIV/TB service delivery.

Statistics for the HIV epidemic in Kenya include:

• High HIV burden

◦ About 68,000 children (ages 0 to 14) are living with HIV.

◦ About 1.4 million people are living with HIV.

• Overall HIV prevalence is 3.7% with:

◦ 2.6% among males.

◦ 5.3% among females.

• High mother-to-child transmission rate at 8.6%.

• 50% reduction in HIV incidence in the last four years, but still approximately 22,000 new infections, annually.

◦ 41% of adult new infections occur among individuals aged 15 to 24.

• 18,743 HIV-related deaths annually.

Currently, health systems are kept separate in donor-funded programs such as HIV/TB, malaria, family planning, and nutrition. They are implemented at the national and county levels, including:

• Leadership and governance: Development of policies, regulations, and standards.

• Health financing: Allocating national and county funds and organizing domestic resources.

• HRH: National training institutions, professional organizations, and national and county Public Service Boards (PSBs).

• Supply chain and commodity management: Purchasing, storing, and distributing supplies.

Step 1: Review the Opportunity 10

Kenya’s HIV program continues to experience several challenges:

• The two main organizations that lead Kenya’s HIV management efforts, the National Syndemic Diseases Control Council and the National AIDS/ STI Control Program, often have responsibilities that overlap.

• The National Public Health Institute is not fully functional.

• The Government of Kenya (GOK) spends less than 15% of its budget on health, which is less than the Abuja declaration recommends. Most funding comes from donors.

• The HIV program also relies heavily on PEPFAR-funded health workers.

Program data shows that over 30 counties have over 25% donor dependency.

• There are challenges with supply chain and commodity management experiences both upstream and downstream, with frequent commodity stock-outs reported.

The Kenyan government has made healthcare delivery a priority in its economic plan for 2022-2027. They plan to implement UHC that focuses on primary healthcare (PHC). PHC aims to provide easier access to healthcare and emphasizes prevention, reducing out-of-pocket costs for health care. The approach will improve the quality of healthcare workers and link hospitals with communities, using technology and data to make healthcare more efficient and effective. This NOFO will use PHC and other health regulations to help improve healthcare systems and achieve the goals of the CDC and the Kenyan MOH.

This NOFO will focus on strengthening health systems and is aligned with the PEPFAR 5X3 strategy (Reimagining PEPFAR’s Strategic Direction (state.gov)).

You will build systems to ensure that the gains made so far will be sustained.

Your activities will be guided by the five pillars of the strategy, including:

• Health equity for priority populations.

• Sustaining the response.

• Public health systems and security.

• Transformative partnerships.

• Science-backed decisions.

Using this approach will ensure that the health systems contribute to UHC by providing services to underserved populations. When implemented, this approach will accelerate the response to ending HIV/AIDS as a public health threat by 2030. It will also strengthen sustainable health systems for current and future health threats.

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

Step 1: Review the Opportunity 11 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

You will address sustainability through three elements:

• Political: Leadership and governance.

• Financial: Health financing.

• Organizational: HRH, commodity and supply chain management, health information, and service integration.

Expected outcomes by year five include:

• A high-quality HIV/TB program that is managed by the country—majorly country-financed and led by the country. The program should enable sustained viral suppression and prevent, detect, and respond to new infections and ending HIV as a public health threat.

• Sustained leadership and technical capacity to oversee HIV/TB and other health programs.

• Sustained access to commodities for uninterrupted service delivery.

Purpose The purpose of this NOFO is to make healthcare systems in Kenya stronger, more connected, and better prepared. This will help Kenya control the HIV/TB epidemic, achieve UHC, and respond to new health threats.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1:

Strengthen leadership and governance structures for MOH/ GOK to manage, coordinate, and sustain health systems for HIV/TB and emerging public health threats.

Strategy 2: Provide technical support to GOK to promote sustainable health financing for the implementation of quality, sustainable HIV/TB and related health programs.

Strategy 3: Provide technical support to GOK in managing HRH for implementing quality, efficient, and sustainable HIV/TB and related health programs.

Strategy 4:

Strengthen supply chain systems for counties to improve commodity security for HIV/TB and related health programs.

Increased use of health regulations and policies by MOH leadership team to coordinate health programs and strategic partnerships.*

Increased adoption of integrated service delivery models.*

Increased capacity of MOH/GOK to effectively manage program finances.*

Increased use of digital financial management systems by MOH/GOK.*

Increased use of health program data for effective HRH management by

MOH/GOK.*

Improved coordination of commodity management within supply chain management systems.*

Increased capacity of counties to effectively manage HIV/TB commodities and other domestic resources.*

Improved governance of health program by

GOK.*

Increased efficiency in health program service delivery.*

Increased financial management of health programs by

MOH/GOK.*

Reduced reliance on donor funding to support management and implementation of HIV/TB programs.*

Increased absorption of donor-supported staff by MOH.*

Increased provision of simplified, integrated services due to effective management of HRH.*

Improved distribution and allocation of commodities at the site level.*

Decreased interruption of services due to commodity outages.*

Increased efficiency, transparency, and accountability in financial management.*

Sustained management of quality HIV/TB program by GOK.

Sustained technical capacity of GOK to manage HIV/TB and other health programs.*

Sustained access to commodities needed for service delivery.*

Sustained capacity of health systems for HIV/TB to prevent, detect, and respond to new and emerging public health threats.

Step 1: Review the Opportunity 13

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Increased enrollment of the public, including people living with HIV, into health insurance schemes.*

Reduced fraud, waste, and abuse within MOH programs.*

Additional information on outcomes in the logic model:

• Health regulations and policies include those related to health financing, HRH, health quality, and other aspects of healthcare.

• Coordination of health programs and strategic partnerships includes but is not limited to coordination between national and county health authorities, facilities, and community health workforce.

• Governance of health program by GOK includes but is not limited to country stewardship and oversight of HIV/TB and other health services at national and county levels.

• Health insurance schemes include national, county, or private health insurance.

• By effectively manage, we mean that counties will lead the procurement, govern the use, and manage the supply chain for HIV/TB commodities as well as other domestic resources for HIV/TB and other health programs, and financially manage the program.

• Health program data for HRH management includes, but is not limited to, the use of standard tools and information systems to effectively manage

HRH.

• Simplified, integrated services include, but are not limited to, offering integrated services for HIV/TB and other associated comorbidities as well as for non-communicable diseases.

• Sustained management of quality HIV/TB program by Kenya includes, but is not limited to utilizing local institutions, local finances, and local health information systems to sustain viral suppression, end HIV as a public health threat, maintain the gains already made (such as 95-95-95), and achieve epidemic control by Kenya’s leadership with minimal or no external support.

Step 1: Review the Opportunity 14

• Sustained technical capacity of GOK to manage HIV/TB and other health programs means having continued ability by local staff to offer specialized support to the HIV program in terms of prevention, treatment, health information, and laboratory.

• Sustained access to commodities needed for service delivery means continuous availability of health commodities with minimal/no interruptions that may impede service delivery.

• Sustained capacity of health systems for HIV/TB to prevent, detect, and respond to new and emerging public health threats means the ongoing ability of the health systems to deal with new or emerging infections or health threats.

◦ Health systems here are defined in the broad sense of leadership and governance, health financing, HRH, commodity and supply chains, service delivery, and health information systems.

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

The following are strategies and the required activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Strategy 1: Strengthen leadership and governance structures for MOH/GOK to manage, coordinate, and sustain health systems for HIV/TB and emerging public health threats.

Required activities:

• Provide technical support to government organizations overseeing the coordination of HIV/TB and related health programs at the national and county levels.

• Provide technical support to strengthen governance at the county and national levels to increase accountability and transparency in decision-making to improve delivery and transition management.

• Provide technical support to county leadership and economic blocs for implementing county transition roadmaps.

Step 1: Review the Opportunity 15

• Implement strategic partnerships with key stakeholders to drive the transition and sustainability agenda of HIV/TB and related health programs.

• Collaborate with local organizations to strengthen local and community health systems.

• Participate in joint planning with other health stakeholders and provide technical support for program sustainability

• Implement PHC strategies at the county level in line with GOK’s vision for the HIV/TB program.

• Provide data and information to inform new health regulations, policies, and guidelines at the national and county levels to sustain control of the HIV epidemic.

• Institutionalize training and capacity building in both public and private sectors.

• Add quality standards to existing laws and regulations.

• Support the government in reviewing policies, tax regime, and business costs to aid local manufacturing of HIV-related commodities

• Support collaboration between the government, private sector, and other stakeholders to leverage local capacity and innovation for local manufacturing of HIV-related commodities.

Strategy 2: Provide technical support to GOK to promote sustainable health financing for the implementation of quality, sustainable HIV/TB and related other health programs.

Required activities:

• Participate in government and donor financial planning cycles—for example, the Medium-Term Expenditure Framework to align activities with country operational planning, identify synergy, and avoid duplication.

• Provide program data and technical support to GOK in assessing the cost of health services.

• Train GOK finance managers on financial management that aligns with United States government standards to obtain and manage donor funding.

• Provide technical support and engage with finance committees at the national and county levels to enhance health planning, budgeting, and execution.

Step 1: Review the Opportunity 16

• Support MOH to implement financing models that tap into domestic resources such as cost-recovery initiatives to generate self-sustainable funding.

• Support implementation of national and county HIV/TB sustainability roadmaps, including domestic resource mobilization to sustain HIV/TB and related health services.

• Support strengthening of social protection systems for underserved groups (such as people living with HIV/AIDS and orphaned and vulnerable children), to ensure enrollment and retention in Social Health Authority (SHA) and other insurance schemes.

Strategy 3: Provide technical support to GOK in managing HRH for implementing of quality, efficient, and sustainable HIV/TB and related health programs.

Required activities:

• Provide sustainable training and capacity building to healthcare workers through e-learning platforms and other approaches.

• Support implementation of HRH information systems at the national and county levels to provide data for decision-making.

• Provide technical support to PSBs to use workforce evaluations such as Workforce Indicators of Staffing Needs to identify the correct staffing mix for HIV/TB service delivery.

• Provide technical support to program and county leadership, ensuring a smooth transition of HRH from donor-funded programs to MOH.

• Provide technical support to national and county PSBs to manage HRH.

• Engage stakeholders to advance workforce integration and HRH management across program areas and different funding agencies.

• Provide technical support to PSBs and programs for workforce alignment to GOK service structures, such as team naming, scope of work, and payment.

• Transition all training curriculums to sustainable online platforms, such as e-learning and adoption into university curricula.

• Coordinate with GOK to embed capacity-building and training efforts for health leadership programs into government systems such as field epidemiology and global leadership training programs.

Step 1: Review the Opportunity 17

Strategy 4: Strengthen supply chain systems for counties to improve commodity security for HIV/TB and related health programs.

Required activities:

• Support communication between commodity management and supply chain information systems. This should ensure end-to-end visibility for systems involving purchasing, warehousing, and distributing.

• Participate in routine national and county-level forecasting and quantification processes to accurately measure supply needs.

• Provide technical support for operations of national and county-level commodity technical working groups, health products, and technology units.

• Support trainings, mentorship, and other capacity-building activities for supply chain and commodity management.

• Support counties to ensure continued accuracy of stock management, timely ordering, and reliable data reporting through supportive supervision and quality improvement.

• Implement integrated support supervision and mentorship for different program commodities at the county and facility levels—such as HIV/TB, malaria, nutrition, and family planning.

• Train and mentor supply chain managers to use commodity data for decision-making.

• Conduct supply chain audits and spot checks at health facilities to improve accountability.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

Step 1: Review the Opportunity 18

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

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

Step 1: Review the Opportunity 19 https://www.state.gov/reports-pepfar/ https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/reports-pepfar/

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include:

• General population (adults and children).

• People living with HIV, including:

◦ Key populations (i.e., sex workers, men who have sex with men, transgender, people who inject drugs and people in prisons and closed settings).

◦ Priority populations (i.e., fisher folk, military and uniformed forces, mobile populations like truckers and displaced people).

• Orphans and vulnerable children.

• People affected by TB and related health conditions, such as noncommunicable diseases.

• National and county leaders, program heads, and county health management teams.

• Facility-based workforce, including:

◦ Clinicians.

◦ Nurses.

◦ Laboratorians.

• Community-based health workforce, such as community health promoters.

Step 1: Review the Opportunity 20

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

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

Step 1: Review the Opportunity 21 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If funded, we will expect you to collaborate with:

• U.S. Government (USG)-funded entities, including:

◦ CDC Kenya.

◦ USAID.

◦ Department of Defense.

◦ And their implementing partners.

• GOK entities and national and county governments, including:

◦ MOH.

◦ Ministry of Finance and Planning.

◦ Ministry of Labor.

◦ National and county PSBs.

• Government, faith-based, and private health facilities.

• Civil society organizations.

• Multilateral partners, including but not limited to:

◦ UNICEF.

◦ UNAIDS.

◦ Global Fund.

◦ World Bank.

◦ Private sector players.

◦ Academic and training institutions.

Step 1: Review the Opportunity 22

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 4% of funds for monitoring activities and 6% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

These include process and outcome measures that directly correlate with the logic model.

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

Step 1: Review the Opportunity 23 https://www.state.gov/reports-pepfar/ https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators There are currently no MER indicators applicable for this NOFO, but that may change in future project years.

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year. You may also propose custom indicators.

• Proportion of counties with established financial information management systems and using the data for financial decision-making.

[Target: 80%; Reporting Frequency: Annual]

• Number of capacity building plans developed to strengthen the capacity of host governments and regional institutions on the development, collection, analysis, and use of programmatic, financial, and economic data. [Target: 10; Reporting Frequency: Annual]

• Proportion of PEPFAR-funded HRH who are in cadres/employment titles that are in GOK labor schedule and schemes of service. [Target: 80%;

Reporting Frequency: Annual]

• Proportion of PEPFAR-funded HRH whose salary is within GOK pay band.

[Target: 80%; Reporting Frequency: Annual]

• Proportion of county managers trained in HRH governance and accountability. [Target: 60%; Reporting Frequency: Annual]

• Proportion of counties that have fully enacted and implemented health regulations and policies. [Target: 80%; Reporting Frequency: Annual]

• Proportion of counties that have conducted donor mapping, including activities supported and resources allocated. [Target: 80%; Reporting Frequency: Annual]

• Proportion of healthcare administration staff trained on the statutes, regulations, and policies that govern use of USG funds. [Target: 60%;

Reporting Frequency: Annual]

• Proportion of counties with established HRH information management systems and using the data for HRH decision-making. [Target: 80%;

Reporting Frequency: Annual]

• Proportion of counties with fully operational commodities technical working groups and/or health products and technologies units. [Target:

80%; Reporting Frequency: Annual]

Step 1: Review the Opportunity 24

• Proportion of level of congruency between proposed funding in the county transition/sustainability roadmap and the annual work plan budget. [Target: 80%; Reporting Frequency: Annual]

• Proportion of sub-national units able to monitor and improve distribution and allocation of commodities at site level. [Target: 95%; Reporting Frequency: Semi-Annual]

• Proportion of concordance between actual commodity stocks and inventory at sampled facilities during a supply chain audit. [Target: 90%;

Reporting Frequency: Annual]

• Proportion of people living with HIV/AIDS enrolled and retained in SHA and other health insurance. [Target: 80%; Reporting Frequency:

Quarterly]

• Proportion of counties that have enacted and implemented FIF regulations and using funds for facility improvement. [Target: 80%;

Frequency: Semi-Annual]

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress reports, surveillance and survey reports, and other program monitoring tools.

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term and end-term evaluation.

• Extent to which capacity building interventions contributed to decreased service interruptions due to commodity stock-out: outcome evaluation.

• Extent to which provision of technical support to the county contributed to increased county domestic resources: outcome evaluation.

• Key factors that influenced the strengthening of HRH capacity: outcome evaluation.

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Step 1: Review the Opportunity 25

Dissemination of evaluation results Dissemination channels could include:

• Local and international conferences and forum abstract presentations.

• Conference poster displays.

• Manuscripts.

• Bulletins.

• Reports.

• Presentations to technical working groups and stakeholder meetings.

• Other approved products in print and electronic media.

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Include the following elements in your evaluation and performance measurement plan.

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Step 1: Review the Opportunity 26

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

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

Step 1: Review the Opportunity 27 https://www.cdc.gov/grants/additional-requirements/ar-25.html

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

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

Step 1: Review the Opportunity 28

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

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

Step 1: Review the Opportunity 29 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

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

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

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Step 1: Review the Opportunity 30 https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

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.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

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.

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

Step 1: Review the Opportunity 31 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08…