NOFO 72065625RFA00002 - SUCESSO - Sofala Niassa FINAL.pdf

Issue Date: December 3, 2024 Pre-Application Conference: December 12, 2024 Deadline for Questions: December 23, 2024 Closing Date: February 4, 2024 Closing Time: 05:00 pm (Maputo Time)

Subject: Notice of Funding Opportunity Number (NOFO) 72065624RFA00002 USAID

SUCESSO - Sofala & Niassa

Activity Title: USAID SUstaining Control of the HIV Epidemic through quality Services, resilient Systems, and Community Outreach (SUCESSO) – Sofala & Niassa

Federal Assistance Listing Number: 98.001

Greetings, The United States Agency for International Development (USAID) is seeking applications for a cooperative agreement from qualified entities to implement the USAID SUstaining Control of the HIV Epidemic through quality Services, resilient Systems, and Community Outreach (SUCESSO)– in Sofala & Niassa Activity. Eligibility for this award is restricted to local organizations.

USAID intends to make an award to the applicant(s) who best meets the objectives of this funding opportunity based on the merit review criteria described in this NOFO, subject to a risk assessment. Eligible parties interested in submitting an application are encouraged to read this NOFO thoroughly to understand the type of Activity sought, application submission requirements, and selection process.

To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section B of this NOFO. This funding opportunity is posted on www.grants.gov and may be amended. It is the responsibility of the applicant to regularly check the website to ensure they have the latest information pertaining to this NOFO and to ensure that it has been downloaded from the internet in its entirety. USAID bears no responsibility for data errors resulting from transmission or conversion process. If you have difficulty registering on www.grants.gov or accessing the NOFO, please contact the Grants.gov Support Center at 1- 800-518-4726 or via email at support@grants.gov for technical assistance or if you need assistive technology and are unable to access any material on this site.

Unless an exception in 2 CFR 25.110 applies, applicants must comply with 2 CFR 25 requirements to obtain a Unique Entity Identifier (UEI) and register in the System for Award Management (SAM.gov), as applicable. See Section E, Submission Requirements and Deadlines, for more http://www.grants.gov/ http://www.grants.gov/ mailto:support@grants.gov information. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early.

Please send any questions to the point(s) of contact identified in Section A.4. The deadline for questions is shown above. Responses to questions received prior to the deadline will be furnished to all potential applicants through an amendment to this notice posted to www.grants.gov.

Issuance of this NOFO does not constitute an award commitment on the part of the Government nor does it commit the Government to pay for any costs incurred in preparation or submission of comments/suggestions or an application. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.

Thank you for your interest in USAID programs.

Sincerely, Patrice Lopez Supervisory Agreement Officer

NOFO TABLE OF CONTENTS

NOFO TABLE OF CONTENTS 3

SECTION A: BASIC INFORMATION 4

- END OF SECTION A - 5

SECTION B: ELIGIBILITY 6

SECTION C: PROGRAM DESCRIPTION 7

● Approval of Specified Key Personnel 28

SECTION E: SUBMISSION REQUIREMENTS AND DEADLINES 49

SECTION F: APPLICATION REVIEW INFORMATION 52

SECTION G: AWARD NOTICES 57

SECTION H: POST-AWARD REQUIREMENTS AND ADMINISTRATION 58

SECTION I: OTHER INFORMATION 70

ANNEX 1 - SUMMARY BUDGET TEMPLATE 74

ANNEX 2 - STANDARD PROVISIONS 75

SECTION A: BASIC INFORMATION

A.1 Executive Summary

The USAID SUCESSO – Sofala & Niassa Activity is expected to ensure the continuation of USAID’s support for the national HIV response and ongoing efforts in USAID. The primary goal of SUCESSO – Sofala & Niassa is to support the Government of Mozambique to reach and/or maintain HIV epidemic control by 2031 in selected provinces supported by USAID’s clinical HIV programming, specifically Sofala and Niassa Provinces. The activity will operate in a context where USAID will gradually transition up to 90% of its direct HIV direct services portfolio to Provincial Health Services (SPS) and Provincial Health Directorates (DPS) by the end of the activity. By 2031, USAID SUCESSO – Sofala & Niassa aims to achieve following results:

● Result 1 (R1): Improved facility-based quality of HIV services;

● Result 2 (R2): Fortified provincial health systems to support the HIV response, and,

● Result 3 (R3): Strengthened high quality, comprehensive community-based HIV prevention and treatment services.

SUCESSO – Sofala & Niassa will be restricted to local organizations. The Activity will adopt provincially differentiated implementation approaches and support packages tailored to the demographic profiles, progress towards HIV epidemic control, and locally specific gaps identified in each province. Applicants are expected to form a strong consortium of partners, bringing together organizations with diverse expertise that collectively respond to the needs and expected outcomes of SUCESSO – Sofala & Niassa activity.

A.2 Estimate of Funds Available and Number of Awards Contemplated

USAID intends to award one Cooperative Agreement pursuant to this Notice of Funding Opportunity (NOFO).

Subject to funding availability and at the discretion of the Agency, USAID intends to provide $77,500,000 in total USAID funding over a five (5) year period.

A.3 Start Date and Period of Performance for Federal Awards

The anticipated period of performance is five (5) years. The estimated start date will be the date of signature of the award or other date as determined by the Agreement Officer.

A.4 Agency Point of Contact

Patrice Lopez Supervisory Agreement Officer mission-maputo-oaa@usaid.gov

Nelly Mahanjane mailto:mission-maputo-oaa@usaid.gov

Acquisition & Assistance Specialist mission-maputo-oaa@usaid.gov

A.5 Acquisition and Assistance Ombudsman

The A&A Ombudsman helps ensure equitable treatment of all parties who participate in USAID’s acquisition and assistance process. The A&A Ombudsman serves as a resource for all organizations who are doing or wish to do business with USAID. Please visit this page for additional information: https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman.

The A&A Ombudsman may be contacted via: Ombudsman@usaid.gov

A.6 Authorized Geographic Code

The geographic code for the procurement of commodities and services under this Activity is 935 which includes the United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source. Except as may be specifically approved in advance by the Agreement Officer, all commodities and services that will be reimbursed by USAID under this award must be from the authorized geographic code specified in this NOFO, and must meet the source and nationality requirements set forth in

22 CFR 228.

- END OF SECTION A -

mailto:mission-maputo-oaa@usaid.gov https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman https://www.usaid.gov/work-usaid/acquisition-assistance-ombudsman

SECTION B: ELIGIBILITY

B.1 Eligible Applicants

Eligibility is restricted to Local Mozambican Organizations (local entities) as defined by ADS 303.6.

Local Entity as defined in Section 7077 of Public Law 112-74, the Consolidated Appropriations Act, 2012 (P.L. 112-74), as amended by Section 7028 of the Consolidated Appropriations Act, 2014 (P.L. 113-76), and included by reference in subsequent appropriations acts, local entity means an individual, a corporation, a nonprofit organization, or another body of persons that

(1) is legally organized under the laws of the Republic of Mozambique;

(2) has as its principal place of business or operations in the Republic of Mozambique; and

(3) is

(A) majority owned by individuals who are citizens or lawful permanent residents of the Republic of Mozambique; and

(B) managed by a governing body the majority of who are citizens or lawful permanent residents of the Republic of Mozambique.

For purposes of this definition, “majority-owned’ and “-managed by” include, without limitation, beneficiary interests and the power, either directly or indirectly, whether exercised or exercisable, to control the election, appointment, or tenure of the organization's managers or a majority of the organization's governing body by any means.”.

Faith-based organizations are eligible to apply for federal financial assistance on the same basis as any other organization and are subject to the protections and requirements of Federal law.

Additionally, USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

B.2 Cost Sharing

Cost Sharing is not required for this activity.

- END OF SECTION B -

SECTION C: PROGRAM DESCRIPTION

This funding opportunity is authorized under the Foreign Assistance Act (FAA) of 1961, as amended. The resulting award will be subject to 2 CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, and USAID’s supplement, 2 CFR 700, as well as the additional requirements found in Section H.

Acronyms List

ADS Automated Directives System (https://www.usaid.gov/environmental-procedures/laws-regulations-policies/ads)

AHD Advanced HIV disease

AIDS Acquired immunodeficiency syndrome

AJUDA Analyzing Joint Underperformance and Defining Assistance

ANC Antenatal care

AO Agreement Officer

AOR Agreement officer’s representative

ART Antiretroviral Treatment

C/ALHIV Children and adolescents living with HIV

CBO Community-based organization

CDC Centers for Disease Control and Prevention

CDCS Country Development Cooperation Strategy

CCS Well Baby Consultation (Consulta Criança Sadia)

CCR Child at risk consultation (Consulta Criança em Risco)

CLA Collaborating, Learning and Adapting

CLM Community-led monitoring

COP Country Operational Plan

COVID-19 Coronavirus disease 2019

CRM Climate Risk Management

DDD Decentralized drug distribution

DO Development Objective

DPS Provincial Health Directorate

DQA Data quality assurance and assessments

DREAMS Determined, Resilient Empowered, AIDS-Free, and Safe Programming

DSD Differentiated Service Delivery

ECHO Efficiencies for Clinical HIV Outcomes

EID Early Infant Diagnosis

EMMP Environmental Mitigation and Monitoring Plan

EMMR Environmental Mitigation and Monitoring Report https://www.usaid.gov/environmental-procedures/laws-regulations-policies/ads https://www.usaid.gov/environmental-procedures/laws-regulations-policies/ads https://www.usaid.gov/environmental-procedures/laws-regulations-policies/ads

FP Family Planning

G2G Government to Government Agreement

GBV Gender-Based Violence

GESI Gender and Social Inclusion

GIS Geographic Information Systems

GRM Government of the Republic of Mozambique

HCW Health care worker

HEI HIV-exposed Infant

HIV Human immunodeficiency virus

HIVST HIV Self Testing

HPV Human papillomavirus

HRH Human resources for Health

HSS Health Systems Strengthening

HTS HIV testing services

IEE Initial Environmental Examination

IHO USAID Integrated Health Office

IPV Intimate Pattern Violence

ITT Interruptions in Treatment

IMASIDA Immunization, Malaria and HIV/AIDS Indicators Survey

INSIDA Mozambique Population-Based HIV Impact Assessment

INGO International non-governmental organization

IR Intermediate result

KP Key populations

LOE Level of effort

MCH Maternal Child Health

MEO Mission Environmental Officer

MEL Monitoring, evaluation and learning

MER Monitoring, Evaluation, and Reporting

MH Maternal Health

MNCH Maternal Neonatal and Child Health

NCD Non-Communicable Disease

NGO Non-governmental organization

OVC Orphans and vulnerable children

PEP Post-Exposure Prophylaxis

PEPFAR President's Emergency Plan for AIDS Relief

PHC Primary Health Care

PICT Provider-initiated testing & counseling

PLHIV People living with HIV

PMTCT Prevention of mother to child transmission

PNC Prenatal care

PrEP Pre-exposure prophylaxis

RRF Rapid Response Fund

SAAJ Adolescents and Youth Friendly Services

SBCC Social and behavior change communication

SPS Provincial Health Services

SOP Standard operating procedures

SRH Sexual and reproductive health

STI Sexual Transmitted Infections

TB Tuberculosis

UNICEF United Nations Children's Fund

USAID United States International Agency for Development

USG United States Government

VCT Voluntary Counseling and Testing

VL Viral load

VMMC Voluntary Medical Male Circumcision

WHO World Health Organization

A. INTRODUCTION

The main goal of the USAID Sustaining Control of the HIV Epidemic through quality Services, resilient Systems, and community Outreach (SUCESSO) - Sofala & Niassa Activity is to support the government to reach and/or maintain HIV epidemic control by 2031 in select provinces supported by USAID’s clinical HIV programming, namely Sofala and Niassa Provinces. The activity will operate in a context in which USAID will gradually transition (up to 90% by project’s end) the HIV direct services clinical portfolio to Provincial Health Services (SPS) and Provincial Health Directorates (DPS).

Aligned with PEPFAR's Five-Year Strategy (December 2022), the PEPFAR Sustainability Roadmap, the HIV Response National Strategic Plan (2021 - 2025), and the Second HIV National Acceleration Plan (2024 - 2026), this activity responds to USAID/Mozambique’s Country Development Cooperation Strategy Objective 1: Healthier and Better Educated Mozambicans, especially the young and vulnerable. This activity also aligns with USAID's global strategy on localization, which seeks to enhance the engagement of local partners by aiming to achieve a 50% involvement of local partners by 2030. Accordingly, SUCESSO - Sofala & Niassa will leverage localization lessons learned and experience of USAID/Mozambique's Integrated Health Office (IHO) and is expected to build on the gains and results of enhanced provincial-level capacity building being provided by USAID’s “Efficiencies for Clinical HIV Outcomes” (ECHO) project, implemented by Abt Associates. SUCESSO - Sofala & Niassa will also capitalize on USAID Government-to-Government (G2G) investments across these same provinces.

SUCESSO - Sofala & Niassa will aim at achieving the following results by 2031:

● Result 1 (R1): Improved facility-based quality of HIV services;

● Result 2 (R2): Fortified provincial health systems to support the HIV response; and

● Result 3 (R3): Strengthened high quality, comprehensive community-based HIV prevention and treatment services.

SUCESSO - Sofala & Niassa is expected to support government efforts to ensure that gaps are addressed and that the country is on the right path to achieve and maintain 95-95-95 in the four provinces, using provincially differentiated implementation approaches and support packages that consider epidemiologic and demographic profile, progress towards HIV epidemic control, and identification of locally specific gaps.

B. PROGRAM DESCRIPTION

B.1 Background and Problem Analysis Mozambique is a country of more than 34.5 million people, with a median age of 17.0 years. The total fertility rate is 4.6 and life expectancy at birth is 59 years. The country is challenged by high levels of poverty, with 42.1% of the population without access to drinkable water, 14.7% without access to electricity, and 71.3% without access to sanitation. Mozambique continues to rank low in the United Nations Human Development Index, ranking 185 out of 191 countries.

https://www.state.gov/wp-content/uploads/2022/11/PEPFARs-5-Year-Strategy_WAD2022_FINAL_COMPLIANT_3.0.pdf https://drive.google.com/drive/folders/1wsDxbtlkRYP1TKhwAR82v8vRdgc_vQWl https://www.usaid.gov/mozambique/country-development-cooperation-strategy-cdcs-2020-2025 https://www.usaid.gov/mozambique/country-development-cooperation-strategy-cdcs-2020-2025

Shortly after obtaining independence in 1975, Mozambique entered sixteen years of civil war that highly impacted the country's overall infrastructure. Over the past half-decade, Mozambique has weathered a series of significant challenges, including major health crises (e.g., COVID-19, cholera, and wild polio) and escalating frequency and severity of climate-related disasters. Cyclones Idai (2019), Kenneth (2019), Freddy (2023), and Filipo (2024) not only disrupted livelihoods but also wrought havoc upon infrastructure and exacerbated the displacement of communities. Among the adult population (15 - 59 years old), HIV was the lead cause of death (25%) followed by infections, such as meningitis/encephalitis (22%) . Despite these harrowing statistics, between 2009 to 2019, the country has seen progress in key health indicators, including a 50% drop in mortality due to malaria, and a 28% reduction in mortality due to diarrheal diseases and lower respiratory infections. The most recent Demographic Health Survey also shows that under-five child mortality has declined from 97/1,000 in 2011 to 60/1,000 in 2022/23, and that institutional deliveries have increased from 55% to 65%.

HIV prevalence among adults in Mozambique is 12.5%, with current models estimating 2.4 million adults living with HIV, with prevalence higher among women (15.0%) than men (9.5%).

The country has taken major strides forward in the past several years with 87% of adults (15+ years old) being aware of their status, 93% were on antiretroviral therapy (ART), and 89% were virally suppressed. Individual sub-populations, like pediatrics, adolescents, and young men, lag the general population.

B.2 Overall Geographic Focus SUCESSO – Sofala & Niassa will be implemented in Sofala and Niassa Provinces, with the possibility to expand to other provinces based on emerging needs identified by the USAID Mission, IHO and/or PEPFAR inter-agency team. In 2019, PEPFAR agreed with the Ministry of Health to provide direct service delivery support at a subset of all public health facilities through its implementing partners. These sites, affectionately known as AJUDA sites, serve 85% of all ART clients across the country, although ART client coverage may differ across provinces. While these sites have not shifted much over the past five years, as implementation evolves and new epidemiologic data become available, adjustments may be required, as dictated by USAID.

Synergies and complementarity with sustainability sites, which are supported by provincial authorities with PEPFAR and non-PEPFAR funds, are encouraged to maximize the likelihood of reaching and/or maintaining provincial HIV epidemic control.

B.3. Logic Model and Intended Results By 2031, USAID envisions provincial health directorates with appropriate capacity to maintain high levels of HIV treatment coverage and viral suppression, complemented by prevention interventions to reduce HIV transmission (Result 1 and Result 3), and buttressed by resilient provincial health systems (Result 2). USAID is committed to shifting leadership for priority setting, project design, implementation, and measuring results to local organizations and the host government to drive sustainable change. SUCESSO - Sofala & Niassa will require a nuanced package of support, tailored to the local context, which may vary not only by province but also across different communities within provinces. Having a strong understanding of strengths and challenges in these local communities will allow the awardee to tailor its support and adapt over time. SUCESSO - Sofala & Niassa activities will be predicated on a regular review of provincial and local program data, determination of gaps, engagement of target populations in both program design and implementation, and subsequent programming and assessment of interventions that address those identified gaps.

Result 1: Improved facility-based quality of HIV services.

Strengthening HIV program quality and fostering service quality improvement is core to achieving 95-95-95 goals, improving the health of the Mozambican people, and providing person-centered appropriate prevention interventions to individuals at risk of acquiring HIV and treatment interventions to PLHIV. As provinces get closer to epidemic control, closing the final gaps will likely involve innovative approaches, tailored support to different subsets of PLHIV, and keen awareness of how to provide high quality care in a cost-effective manner. The quality and reach of HIV services in Mozambique has made great strides in recent years, as demonstrated by improvements between clinical cascade coverage of IMASIDA 2015 and INSIDA 2021. Still, there remain gaps and inequities in the response. Population-level viral suppression remains lower in the central and northern parts of the country, when compared to the south, and rates of viral load suppression remain stubbornly low among adolescents and young adults. Improving the quality and patient-friendliness of services will help close these gaps and ensure all populations can reach epidemic control. Streamlining and simplifying services, bringing them closer to clients and reducing the need for multiple facility touchpoints, will further enable PLHIV to remain healthy and engaged in HIV treatment. Targeted integration across disease areas may also allow for de-stigmatization of HIV and greater uptake of HIV prevention services among individuals who might be at risk of HIV acquisition.

IR 1.1: Access and use of combination prevention interventions

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Integrate prevention services (HIV testing, PrEP provision, condoms provision, STI screening and treatment, GBV screening and PEP provision, and referrals to VMMC as appropriate) into primary healthcare services including triage, emergency, within all MCH services entry points, example FP, ANC, SBCC, CCS/EPI, CCR, etc.

● Provide PrEP through differentiated service delivery models (facility and community-based) and through multi-month dispensing. Align DSD models with other prevention and health promotion activities were doing so aligns with client preferences (such as family planning services provided in the community).

● Develop support material for facility and community providers of prevention services, in collaboration with local governments and community stakeholders, that are informed by local data, and which target services towards key gaps and de-prioritize where there is saturation.

● Support development and roll out of SOPs and implementation models for new PrEP modalities that expand choice as allowed under Mozambican guidelines. Support the evaluation, piloting, and adoption of new products as they become available.

● Ensure guidelines on integration of HIV and family planning services are updated to include HIV prevention services and vice versa.

● Strengthen the integration of HIV prevention services into FP, STI, adolescent responsive/AYF services (SAAJ), DREAMS and MNCH platforms and settings reaching key populations.

IR1.2: Robust HIV case identification interventions

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Perform data reviews to examine where HIV testing is being offered and where HIV-positive individuals are either (a) being newly diagnosed, or (b) re-entering care. Use analyses to inform approaches (e.g., if high positivity in specific age-sex bands, increasing coverage); identify low volume-low positivity sites or high volume-low positivity sites for targeted changes or quality improvement activities.

● Strengthen the quality and provision of provider-initiated testing & counseling (PITC), HIV self-testing, voluntary partner notification (index testing), maternal retesting in ANC services for pregnant and breastfeeding women who previously tested negative, voluntary counseling & testing (VCT) and target community testing outreach tailored to the local context based on epidemic gaps.

● Ensure voluntary index and partner testing, including assisted and unassisted partner notification and contact tracing services adhere to WHO rights-based minimum standards of informed consent, confidentiality, counseling, correct test results, and connection to treatment or other services. Provide multiple options for delivering index partner testing for different client preferences, including anonymous methods for PLHIV not ready or willing to disclose.

● Deploy voluntary HIV self-testing interventions to reach key and priority populations at increased risk of HIV infection including young adults, men, key populations and their families and/or clients, index partners, adolescents and young girls, or other under-served at risk populations.

● Offer immediate initiation of ART services (through models appropriate to the local guidelines, potentially including telehealth linkage or linkage through a community health worker) at the time of diagnosis and, if community-based, connection to a client-preferred ART facility. In cases where immediate ART is not possible, provide linkage interventions that result in 95% of positives initiating ART within 14 days by addressing client-specific barriers.

● Support sites to achieve ≥95% coverage of EID testing for HIV-exposed infants by two months of age, 100% coverage by 12 months of age, and ensure immediate, same-day linkage to ART.

IR 1.3: Effective HIV care and treatment continuity activities

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Support high-quality facility-based HIV treatment services that ensure continuity of treatment for all population segments irrespective of duration on ART through innovative people-centered service delivery models and use of digital health technology.

● Assess potential barriers to continued adherence and retention for all clients on a regular schedule, assessing the desire for services through specific differentiated service delivery (DSD) models, and offering integrated mental health/psycho-social support services to clients with high-risk of IIT, defaulters and clients with elevated viral load. Utilize machine-based learning to flag clients most likely to need support to remain engaged in care and tailor adherence support packages to the client’s specific needs.

● Offer ART through decentralized drug distribution (DDD) models where available, including, but not limited to, mobile brigades, community ART groups (GAACs), private sector pharmacies, community ART distribution by APS’ and health providers, adolescent clubs, youth case management support and family-centered models.

● For those who interrupt care, implement a ‘welcome back’ package that embraces individuals who return to care, and provides tailored support to remain on ART. Support advanced HIV disease (AHD) services to all sites and attain optimal coverage of the core essential service package in eligible clients.

● Leverage peer support models (Mentor mothers, Youth mentors, male champions, other PLHIV) to improve outcomes for populations at risk of disengagement from treatment.

● Support the effective integration of HIV treatment services with other important health care services for PLHIV to ensure people-friendly, easy access to all health care needs, and non-stigmatizing services. Services can include:

o non-communicable disease (NCD) screening and treatment;

o voluntary family planning options for women of reproductive age;

o TB screening, prophylaxis, diagnosis, and treatment;

o Sexually Transmitted infection (STI) education, screening and treatment;

o IPV and gender-based violence (GBV) screening and treatment/referral services;

o PMTCT services with antenatal, postnatal and child health services; and o OVC services for C/ALHIV and their families.

Tailor integration approaches based on the context and needs of specific facilities and populations.

IR 1.4: Access to viral load testing and achieving and sustaining VL suppression.

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results) - (in addition to IR1.3 Illustrative Activities):

● Saturate viral load coverage and sustain viral suppression rates through targeted demand creation in all DSD models.

● Routinely document sample collection, relevant client data, and result return times.

Collaborate with partners providing laboratory sample transport to analyze data and improve the timeliness of results returned.

● Leverage digital technology to provide results to clients in near-real time, where feasible, and in alignment with principles of privacy and confidentiality.

● Strengthen management of treatment failure at all levels of care, which includes, but is not limited to, capacity building of service providers on enhanced adherence counseling;

U=U treatment literacy, optimal viral load coverage, and active clinical case management of viremic patients and those confirmed to have treatment failure.

● Routinely assess barriers to adherence, including to specific sub-populations, and offer appropriate adherence support interventions (e.g., DSD models, linkage to nutritional support, etc.) to clients with identified barriers.

● Strengthen coordination with OVC programs to support adherence and viral load suppression among C/ALHIV and HEI. Ensure longitudinal tracking of maternal and infant service uptake and outcomes (including HEI final outcome).

Result 2: Fortified provincial health systems to support HIV response.

As Mozambique reaches and maintains HIV epidemic control, the management of HIV as a chronic condition will require a health system that is well managed and capable of absorbing challenges, shocks and changes while maintaining the provision of essential services, and efficiently resourced (e.g., human resources, equipment, and commodities). The COVID-19 pandemic highlighted the importance of resiliency of local health systems to withstand unanticipated shocks. In addition to COVID-19, Mozambique also suffers from security concerns in areas of the north, and has endured multiple environmental shocks, further highlighting the importance of strengthening the resilience of local health systems to serve people living with HIV. Building this resiliency will encompass several different elements, including the management and oversight of health facilities (and community-based programs); strategic deployment of available resources; use of data to inform planning and make necessary adaptations; and the creativity to pivot programming in the setting of unanticipated shocks.

Alongside the objectives described in Result 1, SUCESSO - Sofala & Niassa will simultaneously work with provincial (and district) governments to improve the use of data for decision-making purposes, strengthen laboratory and pharmacy capacity, and optimize the deployment and skillsets of human resources in the supported provinces. The specific blend of programmatic and systems strengthening work will need to be tailored to the needs of each province.

IR 2.1: Systematic use of data for decision-making purposes

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Promote and facilitate regular data review meetings with provincial leadership and/or health management teams, focused on identifying specific changes to improve the overall quality of service delivery.

● Support data use and management at site level, by supporting the institutionalization of data use and review through, promoting regular data review, including, strengthening the capacity of health care workers to use data at the facility level to drive improvements.

● Create routine and custom visual analytics that support district and provincial management teams to use data regularly to solve problems.

● Improve the quality of services provided at facility level, by implementing the national Quality Improvement Strategy, including data collection and analysis, development, implementation, and monitoring of targeted action plans.

● Work jointly with community-led monitoring (CLM) stakeholders and provincial/district managers to analyze data, design strategies for improvement, and improve the transparency of quality improvement efforts.

● Strengthen capacity to ensure data quality and reliability, through standardizing data quality assessment (DQA) approaches, supporting DQA processes and instituting appropriate changes to improve the accuracy of data collected.

IR 2.2: Appropriate laboratory and pharmacy capacity to address evolving program needs.

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Support the implementation of electronic laboratory and logistics information systems at the facility level, including roll-out, HCW training, and maintenance (where appropriate).

● Develop SOPs in tandem with provincial/district leaders to ensure communication of stock-levels (pharmaceuticals, supplies, and laboratory reagents), redistribution of commodities (as required), ordering and reporting, between facilities and local/regional warehouses.

● Support provincial coordination with central level partners providing services related to samples and results referrals and drugs/commodities distribution.

● Participate in the Provincial Medicines Technical Working Group (GTM Provincial) and ensure the use of nSIMAM (or alternative systems) data for decision making.

● Support the Improvement of Pharmacy business systems at health facility level with focus on people and processes and tools (shared vision, accountability, human resources, performance management, work conditions, continuous quality improvement….)

● Support integrated laboratory diagnostic work (including mapping and optimization exercises) on common platforms across disease states, including health threats (e.g., TB, HPV, HIV/EID, COVID).

IR 2.3: Strategic use of facility-based human resources and implementation of community-sub system

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Provide technical assistance to improve HRH management within provinces, including reducing vacancy rates, optimizing deployment of new HRH, and ensuring clearly outlined communication between facility and community-level HCWs.

● Support SPS/DPS developing provincial level HRH strategies, including staffing plans, developed and approved in line with GRM and provincial guidelines, training plans in line with overall provincial HIV strategies.

● Upskill the PEPFAR-supported health workforce to provide other PHC services (e.g., MNCH, SRH, TB, FP, COVID, NCDs, MH, GBV, and community care and support) for PLHIV as a bridge towards a multidisciplinary health workforce that can provide comprehensive and integrated services.

● Align the PEPFAR-supported health workforce (both facility- and community-based) with the local health workforce structure in collaboration with relevant line ministries (e.g.

finance and planning).

● Conduct landscape analyses of the existing health system in consultation with the government and other stakeholders to determine needs for HIV programs and potential avenues of HIV integration into PHC.

● Support the development and/or formalization of processes for facility and community HCWs to review progress and improve coordination and documentation of services delivered through a combination of facility and community components.

Result 3: Increased use of high quality, comprehensive community-based HIV prevention and treatment services.

SUCESSO - Sofala & Niassa will support community engagement, as it is a critical component of high-quality primary healthcare services provision for people living with HIV and reaching people at risk of HIV acquisition. Provision of basic services for both prevention and treatment through community platforms helps reduce the costs for PLHIV to access ongoing care, opens more flexible and person-centered avenues for HIV prevention, and helps reduce the stigma associated with HIV. Coordination of integrated community-facility programming within existing governance structures ensures comprehensive, locally led health services, which can be delivered as effectively and potentially more efficiently than traditional care. Equally applicable is the need for SUCESSO- Sofala&Niassa to establish effective coordination and partnerships with existing or upcoming Activities and/or Community organizations working with vulnerable and hard to reach sub populations, such as children adolescents girls and key populations, and ensure linkages and support to prevention service and care and treatment cascade. If needed, SUCESSO - Sofala & Niassa can engage in joint efforts to enhance the existing platforms to facilitate better integration of HIV services; this would include defining the package of services to be delivered through community-based actors (community HRH cadres, local organizations, etc.), including MoH efforts regarding the community-based subsystem, establishing guidelines for on-going support and referrals, and ensuring effective referral systems between health facilities and community structures are three important elements that support community-based care and must all be implemented in alignment with the national guidelines for HIV and TB. Engagement with community-led monitoring (CLM) initiatives will ensure that community concerns and challenges regarding quality of services are considered as part of implementation and quality improvement efforts.

IR 3.1: Robust behavioral and biomedical HIV prevention interventions to increase individual risk perception and promote positive community norms.

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Work and train community, community cadres and faith leaders to broaden messaging platforms and de-stigmatize HIV and integrate HIV prevention and violence prevention into broader health education efforts, tailored to specific population needs.

● Through community health cadre, improve HIV prevention and treatment literacy levels, including U=U messaging, among clients and in communities.

● Strengthen community health systems to offer HIV prevention services including HTS, assisted HIVST, virtual counseling and support, potential distribution of PrEP refills and condoms, referrals for social services.

● Use feedback from community leaders and clients and use locally relevant messaging platforms to increase understanding and awareness of PrEP, condoms and VMMC programs.

● Integrate HIV services into the local community structures for general health promotion, prevention, detection, and referrals to care and treatment services.

● Intentionally integrate HIV services with relevant programming platforms for other line ministries outside health such as Gender, Children and Social Action; Education and Human Development; Youth and Sports.

IR 3.2: Extensive community outreach to PLHIV to provide holistic care and support.

Illustrative activities (Illustrative activities are important but not sufficient - applicant expected to identify additional activities needed to achieve each of the results):

● Strengthen community health systems to integrate HIV into existing community health services, support comprehensive behavior change messaging, reduce IIT and support re-engagement into care, including, but not limited to, appointment reminders, active tracking systems, targeted clinical case management, non-judgmental, supportive providers, virtual adherence support, and innovations for re-engaging highly mobile populations in care. Sensitivities to the varied needs of the populations served (e.g., young adults, adolescents, KPs, men, families) should be a focus of mentoring of all providers to address beneficiary reticence in engagement in services.

● Assess the knowledge, skills, and support needs (including commodities) for community-based health workers to provide a comprehensive suite of integrated health services, including for HIV, and develop interventions to address the identified needs.

● Train and support community health workers including PLHIV to provide the core package of health, for health promotion and care and treatment services adherence as appropriate/necessary.

● Integrate HIV services into the local community structures for general health promotion, norms change, and HIV prevention, and detection and intentionally integrate HIV services with relevant programming platforms for other line ministries outside health such as such as Gender, Children and Social Action; Education and Human Development;

Youth and Sports.

● Increase community participation of members of key and priority populations and KP, youth and community-led organizations in health decision-making forums and working groups (i.e. Comites de Saude/community health councils).

● Develop approaches to expand community (including faith-based) models to engage and access clients who may not be attending facilities for care and treatment services.

● Ensure coordination and referrals between clinical and community-based support services for children and families to support adherence, retention, including case conferencing.

● Collaborate with provincial governments to establish a harmonized system and formal remuneration of community health workers, in alignment with national guidelines, to implement integrated HIV with other disease programs and services, determine resource needs and plan accordingly.

B.4. Implementation Approach SUCESSO - Sofala & Niassa represents a pivotal step in supporting USAID’s vision of gradually transitioning up to 90% of clinical cascade service delivery activities to G2G agreements by 2031.

The project’s ability to support provincial capacity for a sustained and efficient national HIV response is fundamental to its success. USAID is seeking a continuation of effective interventions coupled with innovative tactics to reach and serve specific subpopulations lagging. At the same time, USAID is promoting the use of provincially differentiated implementation approaches and support packages that consider the epidemiologic and demographic profile, progress towards HIV epidemic control, and identification of locally specific gaps, including those related to gender issues, sub-populations and key populations.

In April 2026, SPS/DPSs will each be at different stages of capacity to directly manage the HIV service delivery portfolio. As such, the type of support required by the applicant will differ by province. The Activity is expected to assess the provincial context at the time of project initiation to ensure interventions are tailored to the unique context of each province. SUCESSO - Sofala & Niassa has the benefit of capitalizing on both the gains of enhanced provincial-level capacity building efforts currently being provided by the USAID-supported Efficiencies for Clinical HIV

Outcomes (ECHO) project, implemented by Abt Associates, as well as existing USAID investments under G2G agreements in each province. Through a collaborative decision-making process with USAID and SPS/DPSs, annual consensus should be reached on the most suitable and effective approach -- be it direct service delivery, technical assistance, or a combination of both --acknowledging that the model will shift as the Activity ages. USAID, in partnership with stakeholders, will direct the successful Applicant during the work plan annual process, as to when and which interventions to transition, but expects successful implementing partners to demonstrate adaptable staffing and operational systems to respond to changing implementation approaches.

SUCESSO - Sofala & Niassa will focus on strengthening the capacity of the Mozambican public health sector, upon which all HIV services rely, to achieve and maintain epidemic control.

Despite significant progress in closing HIV clinical cascade gaps, an initial direct service delivery approach is anticipated. This includes intensive support at the facility and community-levels for the delivery of HIV prevention, care, and treatment services to maximize the number of HIV-positive clients on treatment, ensure adherence and retention, and prevent new infections. In addition, support for facility-based human resources and community-based support staff are anticipated. The expectation is these interventions will be implemented through an institutional strengthening approach, resulting in less direct service delivery and more technical assistance over the years.

The Applicant will work closely and regularly with USAID and SPS/DPS to assess and agree on readiness of activities for transition. Joint annual reviews between SUCESSO - Sofala & Niassa, SPS/DPS, and USAID are expected to make consensus-oriented decisions, and the PEPFAR Country Operational Plan (COP) annual exercise will also be a crucial moment to inform which activities and how and when to transition interventions, deciding which activities will be implemented under the G2Gs and which by the implementing partner/s. To meet transition objectives, USAID capacity strengthening approaches and mechanisms will play a key role in complementing SUCESSO - Sofala & Niassa technical implementation. These efforts will contribute to addressing SPS/DPS institutional capacity gaps that may hinder transition efforts.

Applicants should demonstrate how they can adapt to changing implementation directives.

While the goal is to transition 90% of the HIV service delivery portfolio directly to G2G agreements by 2031, USAID acknowledges that the path may not be direct. The Applicant plays an essential role in anticipating and addressing potential setbacks and challenges throughout the process. The Applicant is expected to be prepared to mitigate any backsliding and intervene promptly, ensuring uninterrupted service delivery and safeguarding of provincial clinical cascade achievements.

Whether implementing directly, providing technical assistance, or some combination of the two, SUCESSO - Sofala & Niassa is encouraged to consider:

● Application of costing and cost-outcome analyses, or cost-effectiveness analyses for questions that indicate the benefit of certain interventions;

● Rapid adoption and utilization of approaches, models, or best practices that are “quick-wins”;

● Strong synergies with community entities and partners to share in the delivery of services and in the achievement of results; and

● Readiness for and early uptake of promising policy reforms and strategies, and early adoption of state-of-the-art practices.

The Activity will also work to ensure consistent utilization of the latest evidence and data for decision-making and rapid scale up of effective HIV interventions. Furthermore, SUCESSO - Sofala & Niassa is expected to propose and utilize evidence-based models, approaches, and methods of service delivery based on gaps identified through: ongoing analyses of results achieved to date and HIV epidemiological context, epidemic drivers and challenges by province/region and population (i.e. children, youth, men and pregnant women) Government of Mozambique and PEPFAR priorities, PEPFAR Technical Considerations from the most recent annual country operational plan (COP), and any emerging new evidence.

SUCESSO - Sofala & Niassa Program Description has been developed based on the following assumptions:

● USAID/Mozambique’s Integrated Health Office views Government-to-Government agreements (G2Gs) as the long-term strategy to support a sustained HIV response in the country;

● USAID/Mozambique’s Integrated Health Office G2G mechanisms are consistently funded in a timely fashion to ensure no interruption in service provision;

● Provincial government capacity continues to positively evolve, with demonstrated capacity to assume greater service delivery responsibilities; and

● USAID/Mozambique’s Integrated Health Office will have institutional capacity building mechanisms to support both provincial G2G mechanisms and civil society organizations, complementing the technical support being provided through SUCESSO - Sofala & Niassa.

Should any of these assumptions change or not be met, adjustments to SUCESSO’s - Sofala & Niassa implementation model will likely be required. USAID will take the lead in signaling if it foresees any alterations required based on annual planning discussions, budget allocation, or any other strategic discussions. The Applicant is also required to highlight concerns or necessary adjustments in a timely fashion, offering proposed solutions that will most efficiently support quality, patient-centered services while maintaining a vision toward increasing SPS/DPS responsibility.

B.5. Management Approach The applicant is expected to develop a comprehensive program management plan that enables achievement of all intermediate results under the activity. The professional staff proposed should possess complementary experience that reflects a combination of strong management skills as well as specific technical expertise and competencies. SUCESSO - Sofala & Niassa aims to establish a robust management and staffing framework that prioritizes a strong technical footprint at the provincial level, supplemented by a subset of advisors at the central level.

Central level advisors will cover various technical domains, ensuring comprehensive engagement with the Ministry of Health (MoH), including participation in…