NOFO No. 72066823RFA00001 Tamkeen 51723 (1).pdf

CALL FOR CONCEPT NOTES

Issue Date: May 17, 2023

Virtual Pre-Solicitation Kickoff May 30, 2023, 3:30 PM – 5:00 PM

Deadline for Questions: June 2, 2023, 5 PM

Concept Notes Submission Deadline: June 26, 2023, 5 PM

All times listed above are Central African Time (CAT)/ Juba Local

SUBJECT: Call for Concepts Notes (Notice of Funding Opportunity - NOFO Number 72066823RFA00001

Activity Title: Tamkeen (an Arabic word meaning Empowerment)

Interested Applicants The United States Agency for International Development (USAID) is requesting Concept Notes as part of a five-phase award process. The goal of this activity is to support children, adolescents, and their families living with HIV to improve health outcomes and reduce new HIV infections among adolescent girls and young women (AGYW). Eligibility for this award is not restricted. Local organizations are encouraged to apply.

USAID/South Sudan intends to fund one award under this opportunity. The award will be in accordance with the merit review criteria under this call for Concept Notes. This document describes:

● The type of activities for which Concept Notes will be considered;

● Available funding;

● The process and requirements for submitting Concept Notes;

● The criteria for evaluating Concept Notes; and

● Refers prospective Applicants to relevant documentation and resources.

Based on the submitted Concept Notes, USAID/South Sudan will determine whether to invite respondents to participate in co-creation and subsequently submit a full Application. To be eligible for award, the applicant must provide all information as required in this NOFO and meet eligibility standards in Section C. 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 and or sign up for alerts to ensure they have the latest information pertaining to this NOFO. 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 Helpdesk at 1-800-518- 4726 or via email at support@grants.gov for technical assistance.

USAID may not award to an applicant unless the applicant has complied with all applicable unique entity identifiers and System for Award Management (SAM) requirements. The registration process may take many weeks to complete. Therefore, applicants are encouraged to begin registration early in the process. Please refer to SAM.gov | Entity Registrations for registration information.

USAID will conduct a virtual pre-solicitation conference on May 30, 2023. The pre-solicitation will highlight key aspects of the solicitation. Information from the conference will be posted to grants.gov as an amendment. To register, please send your name and email address to Michael Loro at mloro@usaid.gov copying Awad Bako at abako@usaid.gov no later than Monday May 26, 2023.

Please send any questions to the point(s) of contact identified in Section D. 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 on www.grants.gov.

Issuance of this notice of funding opportunity 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.

Thank you for your interest in USAID programs.

Sincerely, Kevin Sampson, Agreements Officer https://sam.gov/content/entity-registration mailto:mloro@usaid.gov mailto:abako@usaid.gov

TABLE OF CONTENTS

Section A – Program Description Page 4

Section B – Federal Award Information Page 24

Section C – Eligibility Information Page 26

Section D – Application and Submission Information Page 28

Section E – Application Review Information Page 32

Section F – Federal Award Administration Information Page 34

Section G – Federal Awarding Agency Contacts Page 35

Section H – Other Information Page 36

SECTION A: 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 F.

Theory of Change When orphans and vulnerable children (OVC) of parents who died from AIDS related death, or caregivers who are living with HIV, and adolescent girls and young women (AGYW), who are at high risk of getting infected with HIV, are not provided with comprehensive services to enable OVC who are on HIV treatment to adhere to treatment and have viral suppression, supported to be schooled and their families are stable economically; and economic strengthening to AGYW to ensure they are empowered to avoid getting infected with HIV, then the global efforts to eliminate HIV by 2030 will not be realized including for South Sudan.

1. Introduction

USAID/South Sudan, with resources from the President’s Emergency Plan for AIDS Relief (PEPFAR), is seeking assistance for a 5-year activity to support children, adolescents, and their families living with HIV to improve health outcomes and reduce new infections among adolescent girls and young women (AGYW). This planned activity will be in Juba County. The activity is expected to result in mitigation of the impact of HIV, reduction in new HIV infections, and improved HIV clinical outcomes for those on HIV treatment among the target sub-populations.

Subject to availability of funds, USAID intends to provide a total of $15 million for the activity duration. USAID also intends to award this activity to an implementing partner that can build the capacity of local organization(s) and position them to become a direct recipient(s).

2. Background

South Sudan has made significant progress in providing services to the sub-populations outlined below. Programming for orphans and vulnerable children (OVC) in Juba County started in 2016 and has evolved to support children and families affected by the HIV epidemic with comprehensive, wrap-around services to support clinical outcomes for priority sub-populations including children and adolescents living with HIV (C/ALHIV), HIV-exposed infants (HEI), children of HIV+ female sex workers (FSW), HIV+ caregivers, and their families. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) initiative started in South Sudan in FY21 to support AGYW to prevent new HIV infections among this disproportionately affected population, and to fast track the country’s efforts to reach epidemic control by 2025. According to the 2021 Global UNAIDS report on HIV, adolescent girls in the ages 15 - 19 years, make up 52 percent of all new HIV infections1 This requires a

1https://reliefweb.int/report/world/2021-unaids-global-aids-update-confronting-inequalities-lessons-pandemic-responses-40 https://reliefweb.int/report/world/2021-unaids-global-aids-update-confronting-inequalities-lessons-pandemic-responses-40 https://reliefweb.int/report/world/2021-unaids-global-aids-update-confronting-inequalities-lessons-pandemic-responses-40 significant, targeted expansion of HIV prevention services (including pre-exposure prophylaxis [PrEP], post-exposure prophylaxis [PEP], and condoms and lubricants), HIV testing services (HTS) and uninterrupted access and adherence to antiretroviral therapy (ART) to this sub-population.

New data from WHO shows that violence against women remains devastatingly pervasive and starts at a young age. Across their lifetime globally 1 in 3 women, around 736 million, are subjected to physical or sexual violence by an intimate partner or sexual violence from a non-partner – a number that has remained largely unchanged over the past decade. This violence starts early: 1 in 4 young women (aged 15-24 years) who have been in a relationship will have already experienced violence by an intimate partner by the time they reach their mid-twenties. Gender-based violence (GBV) and violence against children (VAC) affect both genders, AGYW are particularly vulnerable, with one in three experiencing some form of sexual violence by 18 years of age.2 Economic and social pressures fuel transactional and intergenerational sex, leaving AGYW even more at risk of HIV infection.

South Sudan faces serious challenges in addressing HIV without all the evidence-based approaches to achieve the highest possible control of the epidemic. Estimated HIV prevalence in the general population was 1.9% in 2022 (South Sudan Spectrum estimate). The 2022 Spectrum estimates indicate that more females (3.5 percent) than male (1.9 percent) in the age bracket of 25 - 45 years are infected. More specifically, the Juba County results show that HIV disproportionately affects females (5.0 percent), more than male (3.1 percent) in the same age bracket of 25 - 45 years. In the age bracket of 15 - 24 years, females have a higher HIV prevalence of 1.8 percent compared to 0.8 percent among males of the same age group.

While many people living with HIV (PLHIV) are now able to stay alive and take care of their families as a result of antiretroviral therapy, lingering effects of the epidemic’s past high mortality remain. About

2.6 percent of children aged 0-14 years are orphaned. The impact of HIV disrupted and destabilized families and communal support systems, exacerbated by civil wars, food insecurity, and widespread poverty.

Although the South Sudan government policy of free primary education has boosted primary school enrollment and completion, 2.8 million children are still out of school and there is a significant drop-off at the secondary level. This is especially prevalent in urban areas and among girls, with teenage pregnancy being a key reason for girls’ dropping out of school.3

3. The Revitalized Transitional Government of National Unity (RTGoNU) of South Sudan’s Response to the HIV Epidemic

The RTGoNU of South Sudan has shown some political commitment to addressing HIV. However, there remains extremely limited financial and reliable human resources for this role. As such, most of the response, over 90%, is being supported through the Global Fund (GF), PEPFAR, and other multilateral donors. There are currently no clear government policies and laws that: protect and avail a conducive environment for delivery of high-impact interventions, target the most vulnerable sub-populations such as AGYW, FSW, clients of FSW, priority populations, or men who have sex with men

2https://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globally-experience-violence 3 https://www.unicef.org/southsudan/what-we-do/education http://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globally-experience-violence https://www.unicef.org/southsudan/what-we-do/education

(MSM) to prevent and lower the risk of HIV acquisition. The South Sudan AIDS Commission (SSAC) oversees implementation of the National HIV Prevention Strategy and the National Strategic Plan (NSP) for the overall HIV response, which outline the country’s strategy for achieving epidemic control. SSAC reports directly to the presidency. Within the Ministry of Health (MoH), the Directorate of the National AIDS Program leads the health sector’s HIV response. The Ministry of Gender and Social Services is responsible for providing social services to vulnerable populations, including violence prevention and response. As the delivery of ART and other HIV services is scaled up and decentralized, coordination across sectors and stakeholders has become increasingly important but remains challenging.

4. PEPFAR’s Support to the RTGoNU’s Response to the HIV Epidemic

The overarching goal of PEPFAR South Sudan investments is to achieve and sustain epidemic control equitably, provide high-quality client-centered HIV services to PLHIV, and continue to urgently reduce the number of new infections. PEPFAR-supported activities are guided by and aligned to South Sudan’s NSP for HIV Response 2023-2025. Strengthening systems that support data management, supply chain, infection surveillance, and laboratory capacity also remain PEPFAR priorities in the Country Operational Plan for FY244 (COP23).5

5. OVC and DREAMS Priorities for PEPFAR South Sudan

South Sudan currently implements both DREAMS and OVC programing in Juba County only. This is an initiative designed to reduce risk and foster resilience among AGYW. DREAMS consists of a core set of layered, evidence-based interventions to address HIV risk knowledge and behaviors including uptake of clinical sexual and reproductive health (SRH) and HIV services. The DREAMS program in FY22 reached over 2,500 AGYW aged 15-24.

USAID/South Sudan has a well-established OVC program which aims to improve child well-being by mitigating the impacts of HIV, reducing their risk of HIV acquisition, and increasing their resilience to thrive in households affected by HIV. The comprehensive OVC program strengthens family capacity to meet children’s basic needs for shelter, nutrition, health, education and protection. The program targets children with known risks, especially C/ALHIV to ensure they receive family and home-based support to bolster treatment outcomes. This activity will build on the successes of current efforts, leveraging key learning and evidence-based approaches to accelerate progress toward epidemic control at this critical point in South Sudan’s response against HIV.

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The OVC program provides family-based support to over 4,600 highly vulnerable children aged 0-17 and their caregivers. Adolescent girls aged 15-17 in the OVC program will also be referred to DREAMS (if eligible) and will thus receive the most intensive combination of OVC and prevention services.

Additionally, AGYW 15 - 17 years in DREAMS are considered for enrollment into OVC if they are included in a priority sub-population.

Currently, the DREAMS and OVC services are supported through USAID. Priorities for the DREAMS and OVC activities include:

DREAMS Activity:

● Support AGYW ages 15-24 engaging in transactional sex or with high risk factors for HIV, including through referrals from clinical and female sex workers (FSWs) partners.

● Prioritize economic strengthening services for AGYW, including life skills and economic empowerment/entrepreneurship skills through an Empowerment and Livelihood for Adolescents (ELA) curriculum, vocational training, apprenticeships/internships, and linkage to employment.

● Provide referrals to additional services, as needed, to support AGYW, including functional literacy and other health services.

● Improve access to and quality of post-GBV services for AGYW:

○ Ensure AGYW are referred for relevant post-GBV services and are able to complete referrals (transportation stipends, accompaniment, etc.)

○ Collaborate with clinical partners to improve service referral networks and the quality of post-GBV services offered at facilities.

● Conduct community norms change activities with AGYW and their communities, including male partners, around HIV awareness and violence prevention.

● Collaborate with clinical partners to provide referrals to HIV testing services, Pre-exposure prophylaxis (PrEP), and post-GBV services, including Post exposure prophylaxis (PEP), sexually transmitted infections (STIs) screening, HIV testing, and family planning (FP) services.

● Coordinate with the OVC program to ensure bi-directional referrals for eligible AGYW.

OVC activity:

● Provide comprehensive, wrap-around services for children, adolescents, and families, to meet key benchmarks around health, safety, school, and household economic stability. The activity will ensure that the three 95s (95% of people living with HIV know their status, 95% of those who know their status as HIV + are put on treatment with antiretroviral therapy – ART), and this includes:

○ Ensuring access to HIV and health services;

○ Supporting household economic stability through savings groups, income generating activities, and vocational training; and

○ Supporting children, especially girls, to remain and progress in school.

● Improve clinical outcomes for C/ALHIV and HIV+ caregivers across the three 95s:

○ 1st 95: Conduct HIV risk assessment, mobilization, and referrals to HTS. Provide psychosocial support for stigma and discrimination reduction. Provide disclosure support.

○ 2nd 95: Assist referrals to ART, Community Clinic Coordinators (CCCs) monitor appointment attendance, conduct monthly case conferencing with Case Care Workers (CCWs). CCWs do home based ART adherence counseling, conduct household visits to support treatment adherence and drug refill.

○ 3rd 95: Provide caregiver and patient education on the importance of viral load suppression (VLS) and monitoring incorporating the concept of Undetectable = Non- Transmissible (U = U). Monitor and support appointment attendance. Monitor multi-month dispensing (MMD) status and monthly case conferencing with CCCs. Monitor viral load (VL) status and support referrals to VL testing and ensure results are received.

Support those with high VL to complete enhanced adherence counseling at the facility.

● Support primary prevention of HIV and violence for boys and girls ages 10-14.

● Provide basic education support to eligible OVC

6. Activity Description

a. Purpose

The goal of this activity is to support children, adolescents, and families in the epidemic to improve HIV and health outcomes and reduce new HIV infections among AGYW. The period of performance of this Activity is for five (5) years with a Total Estimated Amount (TEC) not to exceed $15,000,000. This Activity supports South Sudan’s national strategic plan (NSP) Framework for reduction of HIV transmission and acquisition and in meeting the 95-95-95 goal.

b. Geographic Focus

The geographic focus is Juba County. However, USAID may require the Recipient of this award to shift or expand the geographic focus outside of Juba during the life of the Activity to better align with PEPFAR geographic priorities, shifts in the epidemiology and/or gaps in coverage and alignment with other donor geographic priorities. This will be based on additional funding availability.

c. Population Focus

Consistent with the broader PEPFAR guidance on programming for OVC and DREAMS, this activity will target vulnerable children and families most affected by the HIV epidemic, and AGYW at highest risk of HIV infection.

Caregivers and communities are a focus for building resilience and providing a safe and secure foundation for positive education and health outcomes for OVC and AGYW and effectively reducing their vulnerability.

This activity will prioritize the following sub-populations for support in order to contribute to PEPFAR’s strategic goal of epidemic control and align with the Reimagining PEPFAR 5x3 Strategy:6

1. Vulnerable children aged 0-17 with known risk factors to be prioritized for comprehensive OVC services and case management, including:

● C/ALHIV

● HEI

● Children and adolescents living with an HIV+ caregiver, especially those who are not virally suppressed, or are at greatest risk of interruption in treatment

● Children who have experienced sexual and other abuse

● Children of HIV+ FSWs

● HIV+ adolescent girls who are pregnant or are mothers

2. Adolescent girls and boys aged 10-14 will be eligible to receive HIV and violence prevention activities using an approved curriculum, per the country's operational plan guidance.

3. AGYW aged 15-24 with risk and vulnerability factors as outlined in the PEPFAR DREAMS guidance will be prioritized for DREAMS services:

d. Anticipated Targets

In FY24, the activity is expected to achieve the following PEPFAR Monitoring Evaluation and Reporting targets:

● At least 5,114 orphans, vulnerable children, and their caregivers are reached with OVC services

(OVC_SERV).

○ Of these, at least 4,965 should receive the comprehensive package of services (OVC_SERV/Comprehensive).

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○ Of these, at least 1,336 adolescent girls aged 15-17 receive an OVC-eligible service through the DREAMS program (OVC_SERV/DREAMS).

● At least 4,031 AGYW are active DREAMS program beneficiaries, of whom at least 2,418 finishes at least the primary DREAMS service packages (AGYW_PREV).

These numbers are an indication of anticipated annual reach for Year 1. Annual PEPFAR targets for future years will be defined through the COP (for PEPFAR funds/results) and work planning process.

Additional information on USAID’s defined custom indicators listed in Section 10.

Additional custom indicators may include but not limited to:

● Access/linkage to and uptake of SRH and HIV prevention services, including HTS, FP, PrEP, and

PEP

● Referrals to post-violence care services

● Clinical outcomes for C/ALHIV and HIV+ caregivers

● Education support for school retention and progression

● Livelihood opportunities for AGYW

● Identification and response to cases of sexual and other GBV in OVC and AGYW

● Engagement of community leaders for promotion of positive community gender norms change, and addressing GBV

7. Intermediate Results and Key Activities

Goal: Improve HIV and health outcomes for children, adolescents, and families in the epidemic and reduce new HIV infections among adolescent girls and young women.

The OVC comprehensive component will use a family-based, case management approach to develop differentiated care plans and approaches for the families and children they serve. It is assumed that children and families in the most insecure situations will be targeted and stabilized, and that some families, such as those who have virally unsuppressed persons or survivors of sexual violence, will require more intensive case management than others.

Interventions for AGYW need to ensure provision of a comprehensive and layered approach to services to address the multidimensional circumstances placing AGYW at increased risk of contracting HIV, in line with DREAMS guidance which can be found at https://www.pepfar.gov/reports/guidance.

https://www.pepfar.gov/reports/guidance

Figure 1: Tamkeen Results Framework

a. Intermediate Results

Intermediate Result 1: Vulnerable children are healthy, safe, stable and schooled

Interventions under IR 1 will be designed to mitigate the socio-economic vulnerability of at-risk children and their caregivers to the impacts of HIV. Interventions for OVC should be family- and community-centered and designed to keep children healthy, safe, stable, and schooled, utilizing case management as a foundation. Case management can be understood as the process of identifying vulnerable children and caregivers, assessing their needs and resources, working with the family and the child to plan actions and accessing services, monitoring both the completion of actions and receipt of services, and progress towards achievement of objectives and graduation benchmarks.

For more information on the activities that qualify under healthy, safe, stable, and schooled, please refer to the PEPFAR MER Indicator Reference Guide Version 2.4 FY20 at https://www.pepfar.gov/reports/guidance. OVC programming should be consistent with the 2012 PEPFAR OVC Guidance.

A robust case management and referral process will support the continuum of care integrating and leveraging other existing programs to ensure that OVC and family members are successfully linked to appropriate services. The activity should provide adequate access, including through assisted referrals to social protection, prevention and care and treatment services provided by locally competent providers, and be based on the changing needs and circumstances of families. Interventions should appropriately address the ages and developmental stages of OVC.

Activities proposed to address this intermediate result should address priority areas as outlined in the sub-intermediate results below.

IR 1.1: Increased capacity of families to support vulnerable children

Vulnerable children aged 0-17 with known HIV risk factors and their families will be provided with comprehensive family based OVC services. The activity will employ evidence-based strategies to build the social and economic capacity of parents/caregivers to meet their children’s health, nutrition, education and protection needs.

Case management will include household vulnerability and needs assessments, care plans, reliable tracking of services and referrals, and measuring progress towards achievement of care plan objectives and of graduation benchmarks against the outcome domains healthy, safe, stable and schooled.

All families in the comprehensive OVC program should receive regular home visits engaging children and caregivers. In addition to providing direct support to families, the activity must ensure that children access needed health, social, education and protection services provided directly by the project, or through referrals to services provided by the government or other institutions.

Healthy: The activity will ensure that the child’s HIV status is known, including risk assessments and referrals for HIV testing for at-risk OVC. For children under 5, the activity will support parents that they meet their developmental milestones. The activity will support adolescents to acquire the knowledge and skills to protect their SRH and reduce their risk of HIV infection. Caregivers will be supported to build their skills in parent-child communication, positive parenting and open communication on SRH and HIV.

Safe: The activity will support caregivers and adolescents to recognize abuse, neglect and exploitation and where and how to seek support. The activity will support children who have experienced violence, especially sexual violence, abuse or neglect to access comprehensive post-violence services including medical, psychological and legal support. Parenting support will instill skills to practice positive discipline instead of harsh corporal punishment. The activity will support families to access birth registration documentation/Identification documentation.

Stable: The activity will support families with household economic strengthening to enable them to meet their children’s needs for health, nutrition, shelter and education. Interventions will be based on vulnerability assessments and be tailored according to vulnerability levels, and might include provision of financial literacy, savings and lending groups or other opportunities for increasing income and assets. Linkage to food security interventions or other social protection services may also be required.

Schooled: The activity will address key barriers to access to education and retention until children have completed prescribed learning cycles. School enrollment, education attainment and progression will be tracked. The applicant must outline strategies for addressing barriers to school enrolment and achievement of learning outcomes.

IR 1.2: Children and adolescents living with HIV receive comprehensive support to be retained on ART and virally suppressed.

The OVC program platform with its family-based approach offers a significant opportunity to improve clinical outcomes among C/ALHIV and HEI (and their caregivers) as well as to support their overall health, well-being, and protection. The activity will enhance pediatric HIV case finding, linkage to treatment and viral suppression.

Since the roll-out of South Sudan’s preventing mother to child transmission program, there has been a reduction in babies born to HIV+ mothers, who are vertically infected by HIV. However, retention in care of mother-baby pairs and re-testing until the infant is tested at 2 months and continued follow-up until 18 months continues to pose challenges. In addition, even HIV negative children born to HIV+ mothers are known to face specific risks and vulnerabilities.

While the pediatric treatment gap is decreasing, there are still older asymptomatic C/ALHIV who have remained undiagnosed. In addition, with C/ALHIV on treatment, viral suppression tends to be lower than in adults. Keeping children on treatment can be challenging, especially as they enter adolescence and become keenly sensitive to real or perceived stigma. Safeguarding children’s futures also entails supporting adult retention and suppression to keep them well and able to care for the children in their household.

Activities will focus on identifying C/ALHIV, support them and their caregivers to link to treatment, and to ensure that C/ALHIV already on treatment receive comprehensive OVC services. These include meeting the psychosocial needs of C/ALHIV, disclosure, and support to a safe SRH during their transition to adulthood.

In collaboration with PEPFAR-supported facilities and implementers, the Activity will apply Memoranda of Understanding (MOUs) between OVC and clinical IPs and use the existing bi-directional referral system with shared confidentiality arrangements in order to increase the enrollment of C/ALHIV and HEI in the OVC comprehensive program and collaborate on case conferencing.

Case management will include routine home visits in order to regularly monitor child well-being;

provide knowledge and skills-building with OVC parents/caregivers in order to support treatment adherence and retention in care among both C/ALHIV and HIV-positive caregivers. The case managers will provide reminders for ART refills and tracking of viral load samples collection; and will deliver differentiated, age-appropriate service packages for enrolled C/ALHIV, HEI, and their families. The intended outcome is to address their unique health, nutrition, education, protection, psychosocial, developmental, and economic strengthening needs.

IR 1.3 Children aged 10-14 have knowledge and skills about preventing HIV and sexual violence

Primary prevention of violence and HIV is critical to reducing HIV incidence and the prevalence of VAC, including sexual violence, which is a driver of the HIV epidemic. In line with PEPFAR guidance, eligible children and adolescents aged 10-14 years will participate in an approved HIV and violence curriculum.

Illustrative Outcomes for IR 1:

● Increased enrollment of C/ALHIV, HEI, and children of HIV-positive caregivers, children of HIV-positive FSWs, in the comprehensive OVC program

● Improved coverage of biological children of HIV+ mothers who are linked to HTS and have a documented HIV test result (i.e., increased OVC program support for index testing)

● Improved rates of viral suppression among C/ALHIV and HIV-positive caregivers

● Improved savings, income, and assets among OVC households

● Adolescents and caregivers have knowledge on preventing violence against children (VAC) and how to access post-violence services

Intermediate Result 2: Increased resilience of AGYW to HIV risks

The national data on AGYW suggests a disturbing convergence of vulnerabilities and risk factors. The combination of pressure to engage in transactional sexual activity, difficulty in accessing advice on and services for family planning (FP), and GBV create an unsafe environment that increases HIV contraction risks for AGYW.

To address these vulnerabilities, the multi-country PEPFAR initiative DREAMS was designed to support AGYW to be empowered to prevent contraction of HIV. DREAMS requires that beneficiaries receive multiple, layered services integrating comprehensive evidence-informed HIV programming.

South Sudan’s DREAMS program focuses on adolescent girls aged 15-19 and young women aged 20-

24. Under this IR, interventions must reach AGYW with the comprehensive DREAMS package of services through both community and facility platforms, comprising economic empowerment, SRH, FP, HIV testing, social assets and support community norms and attitudes change to reduce HIV transmission, vulnerability and risk.

Services will be provided directly but also through r group-based, family-based, and individual activities, or through provision and tracking of referrals to clinical and social services. Activities will need to be tailored and responsive to the needs of older and out-of-school AGYW and address contextual factors such as high mobility and poverty levels.

All DREAMS beneficiaries will be tracked with unique identifier code to monitor services that each beneficiary received and completion of service packages.

IR 2.1: Improved livelihoods and social assets among AGYW

Economic factors and gender inequality in economic potential are recognized as complex drivers of HIV. Economic empowerment interventions are key to the DREAMS package to ensure that AGYW have decreased reliance on transactional sex and to strengthen their self-efficacy and decision-making power in relationships.

Economic strengthening targeting AGYW may include providing gender-specific and age-appropriate financial literacy training; conducting market assessments as a basis for the selection of entrepreneurial training in order to develop marketable skills; providing vocational scholarships for AGYW; providing post-training start up support through seed funding, internships, and business placements; linkage to wage employment, facilitating savings groups for AGYW who may have income streams; facilitating peer support and strengthening social capital/assets; and facilitating access to coaching and mentoring opportunities in collaboration with the private sector and other business networks.

IR 2.2: Increased uptake of adolescent sexual and reproductive health and HIV services

Interventions under this IR will be designed to enhance service seeking behaviors among AGYW and actively link them to AGYW friendly health services including HIV testing and HIV self-testing, PrEP, comprehensive SRH services, STI screening, and FP, and post-GBV services. Demand creation must be responsive to the needs and fears of adolescents and young women and must seek to actively overcome barriers and stigma associated with uptake of SRH and HIV services, especially PrEP.

The successful applicant will be expected to collaborate with health facilities, advocate for youth friendly and stigma free HIV prevention services, provide referrals to post-GBV services, and track and document completion of referrals. This will also include collaboration with clinical services to improve post-GBV referral networks, and the quality of post-GBV services.

Interventions under this IR will build understanding among AGYW on the biological, behavioral and structural factors that put them at risk of HIV acquisition. Activities will promote creative ways for beneficiaries to understand their individual risk, the value of knowing one’s HIV status, and the appropriate strategies with which they can protect themselves and their sexual partners.

Beneficiaries will receive scientifically accurate information on efficacy and advantages and disadvantages of key biomedical prevention measures such as condoms, and PrEP.

Interpersonal platforms such as structured small group sessions utilizing evidence informed curricula will ensure that adolescents feel they can communicate in a ‘safe space’ where confidentiality is assured. Intervention approaches will also be expected to include individualized ongoing support/mentoring to AGYW for reducing their risks.

IR 2.3 Increased capacity of communities to address harmful social and gender norms affecting HIV risk among children and AGYW

South Sudan has structures at community level that govern a substantial part of life both in rural and urban communities. The Activity will raise awareness with community-based leaders (traditional leaders, faith leaders, school leaders and others) on their role as opinion leaders for creating an enabling environment for AGYW around HIV awareness, combating stigma against AGYW seeking prevention services such as PrEP or condoms, harmful gender norms, GBV and VAC, exploitative and transactional sexual relationships and teenage pregnancy.

Strategic and structured community mobilization may also serve to engage men and boys to raise awareness on the drivers of HIV transmission for AGYW and GBV. Interventions must be strategic, targeted and structured. Community engagement activities must be done in collaboration with other PEPFAR supported community level engagement.

Illustrative Outcomes for IR 2

● Increased uptake of comprehensive HIV and SRH services by AGYW (HTS, FP, STI screening, diagnosis, and treatment)

● AGYW have increased individual protective assets such as self-esteem, problem solving abilities, confidence and social networks

● Improved financial literacy and money management skills

● Improved access to vocational and (self-) employment opportunities among AGYW

● Positive community norms change for HIV and violence prevention (including engagement of men and boys)

Intermediate Result 3: Support USAID and PEPFAR localization and national capacity building goals.

IR 3.1: Support the transition to and prime implementation and funding of capable local partners.

Assist local partners (LP) to build the technical and organizational capacity to become successful prime recipients of USAID funds and comply with USG regulations, policies, and PEPFAR performance standards and reporting requirements. This support from the prime implementing partner may include, depending on the LP, but is not limited to:

● Strong technical capacity to implement OVC and DREAMS interventions.

● Improved financial management and internal control systems (e.g. having banking accounts, book keeping system, financial statements, accounting cycle, sources of funding, financial reporting, audit and review of financial statements)

● Demonstrated ability of the LP to manage funding responsibly and efficiently

● Capacity to meet USG programmatic and financial reporting requirements

● Assist with maintenance of Active status on SAM website

● Capability to use PEPFAR data systems for decision-making and course correction as needed

● Ensuring the LP has well-defined indicators of success and a description of how it intends to monitor its own program performance in a cost-effective and efficient manner, including sources of data

● Helping the LP to attain proficiency using PEPFAR reporting and performance management systems and developing a capacity for data analysis and use.

Illustrative Outcomes for IR 3:

● LP(s) attain proficiency using PEPFAR reporting and performance management systems, and capacity for analysis and use

● LP(s) build their technical and organizational capacity and management structures to be eligible for direct USG funding

● At least one LP is identified to receive a transition award

8. Guiding Principles

The following are programmatic principles which should be clearly incorporated into the interventions and approaches under this Activity:

Alignment with South Sudan AIDS Commission and the Ministry of Health priorities – PEPFAR South Sudan recognizes the SSAC as the center of decision-making, leadership and management of the national HIV Prevention response. It also recognizes the leadership of the MoH in regard to the health sector response and the treatment of HIV clients in the country. All USG partners must support the priorities articulated in the NSP document. The Activity will work closely with relevant SSAC and MoH departments, to ensure high program coverage and layering of services in targeted areas and to strengthen links with government services to ensure a robust continuum of response.

Sustainability - The Activity will contribute to South Sudan’s self-reliance by strengthening the ability of local organizations and community structures to reach and support vulnerable and at-risk populations (OVC and AGYW) and increase the use of services that mitigate the impact of HIV, prevent new HIV infections, and improve HIV clinical outcomes for C/ALHIV. To achieve this the Activity will foster community-led behavioral interventions and encourage sustainable changes in traditional practices and community structures that impact OVC and AGYW. The Activity will also work closely with the MoH, Ministry of Gender and Social Welfare structures to refer and connect target populations with social and health services. Use of systematic methods to identify the most vulnerable AGYW - The Activity will have to describe effective strategies for identifying the most vulnerable AGYW. Criteria and tools for identification need to be developed or adapted from existing evidence-based interventions. Identification strategies will be a vital step for tailored appropriate programming for different subgroups, age bands and geography. This entails accurate assessment of beneficiary needs and matching beneficiaries with messages and interventions as well as social protection and other services provided by government and other implementers.

Family/Household-Centered Approach – Client focused and family-centered approaches that strengthen the parents and caregivers at the household level are considered fundamental to a quality OVC Activity. Households are composed of people who are in some way affiliated, i.e., individuals who share common space for living, cooking, and caring for children. Supporting vulnerable households and by definition, caregivers, can assure continuity of care and support for vulnerable children.

Caregivers should be respected as full participants in any activities that support the care of their children. Interventions designed to strengthen the capacity of families to achieve child wellbeing outcomes will ensure that families and caregivers have access to basic support and are able to access resources to meet important family needs (e.g., education, health costs, food).

Child Safeguarding - Vulnerable children need to be protected from further abuse, violence, neglect and exploitation which sometimes comes from the people that are supposed to protect them.

Families, communities, civil society organizations, faith-based organizations and governments need to work together towards safe-guarding children. Child Safeguarding policies are a first step towards this goal. Activity staff must be trained on such policies and systems should be in place to ensure employment of people without a history of abusing, neglecting, exploiting or violating children.

Existing community child protection structures must be recognized and engaged as appropriate.

(http://www.usaid.gov/sites/default/files/documents/1864/200mbt.pdf)

Gender Equality7 – To promote gender equality and mitigate structural and other gender inequalities, it is critical that this Activity articulates gender integration into all planned activities. The cross-cutting gender strategic areas to be considered include increasing gender equality in HIV/AIDS activities and services, including reproductive health; preventing and responding to GBV; engaging men and boys to address norms and behaviors; increasing understanding of women’s and girls’ legal rights and protection; increasing understanding of women’s and girls’ access to income and productive resources, including education; and increasing men’s involvement in the care of their children. These needs and capacities are dynamic and evolving so require ongoing attention and evaluation.

Approaches are informed by evidence, epidemic realities, and contribute to epidemic control Programming to mitigate the effects of HIV/AIDS and other adversities on OVC, AGYW and PLHIV should prioritize interventions that have been proven effective through outcome evaluation and/or research and should comply with relevant PEPFAR guidance. In some cases, PEPFAR may require review and approval of a curriculum before it can be implemented.

Coordination and collaboration with other sectoral programs and providers - Leveraging existing and on-going efforts from other sectors, especially government counterparts (i.e., Ministries of gender, youth, education), other USG, United Nations…