oppHRSA-18-053-cfda93.928-cidHRSA-18-053-instructions.pdf

HRSA-18-053 i

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau Office of Training and Capacity Development

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV

Health Outcomes for Black Men who Have Sex with Men – Evaluation and Technical Assistance Provider

Funding Opportunity Number: HRSA-18-053

Funding Opportunity Type(s): New Catalog of Federal Domestic Assistance (CFDA) Number: 93.928

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: February 5, 2018

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

Deadline extensions are not granted for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: December 5, 2017

April Stubbs-Smith, MPH Director, Division of Domestic HIV Programs Telephone: (301) 443-7813 Fax: (301) 594-2511 Email: AStubbs-Smith@hrsa.gov

Authority: Public Health Service Act, Section 2691 (42 USC § 300ff-101), as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87)

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau is accepting applications for fiscal year (FY) 2018 Special Projects of National Significance (SPNS) Program initiative, Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who Have Sex with Men (BMSM) – Evaluation and Technical Assistance Provider (ETAP). The purpose of this cooperative agreement is to support a single organization to lead a multi-site evaluation and provide technical assistance (TA) to a cohort of up to seven (7) demonstration sites funded under a separate announcement (HRSA-18-047). The demonstration sites will adapt and implement evidence-informed interventions and/or models to engage, link and retain particularly vulnerable populations. Specifically, this initiative will engage and retain BMSM in HIV medical care and supportive services by addressing their behavioral health needs. The ETAP will provide TA and capacity building to the demonstration sites; work collaboratively with them to implement a comprehensive multi-site evaluation; and disseminate successful models, findings, best practices and lessons to the Ryan White HIV/AIDS Program (RWHAP) community.

The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, applications can be processed, and funds awarded in a timely manner. Applicants should note that this program may be cancelled prior to award recommendations.

Funding Opportunity Title: Implementation of Evidence-Informed

Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex With Men – Evaluation and Technical Assistance Provider

Funding Opportunity Number: HRSA-18-053 Due Date for Applications: February 5, 2018 Anticipated Total Annual Available FY18 Funding:

$650,000

Estimated Number and Type of Award(s):

1 Cooperative Agreement

Estimated Award Amount: Up to $650,000 per year Cost Sharing/Match Required: No Project Period/Period of Performance:

August 1, 2018 through July 31, 2022 (4 years)

Eligible Applicants: Entities eligible for funding under Parts A – D of Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009, including public health departments and institutions of higher education, state and local governments, nonprofit organizations, faith-based and community-based organizations, tribes and tribal organizations.

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise. A short video explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

Technical Assistance

HRSA strongly encourages all applicants to participate in a TA webinar for this funding opportunity to ensure the successful submission of the application. The purpose of the webinar is to assist potential applicants in preparing applications that address the requirements of the NOFO.

Day and Date: Thursday, December 21, 2017 Time: 2 p.m. – 3 p.m. ET Call-In Number: 1-888-942-9573 Participant Code: 8381871 Weblink: https://hrsa.connectsolutions.com/hrsa18053-ETAP

The webinar will be recorded and should be available for viewing by December 31, 2017 at https://careacttarget.org/library/hrsahab-notice-funding-opportunity-nofo-announcements.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/hrsa18053-ETAP https://careacttarget.org/library/hrsahab-notice-funding-opportunity-nofo-announcements https://careacttarget.org/library/hrsahab-notice-funding-opportunity-nofo-announcements

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

7. OTHER SUBMISSION REQUIREMENTS ................................ ERROR! BOOKMARK NOT DEFINED.

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

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I. Program Funding Opportunity Description

1. Purpose

This announcement solicits applications for Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (BMSM) – Evaluation and Technical Assistance Provider (ETAP).

Funding will be provided in the form of a cooperative agreement to support one (1) organization for up to four (4) years to lead a multi-site evaluation and provide technical assistance (TA) to a cohort of up to seven (7) demonstration sites funded under a separate announcement (HRSA-18-047). Those demonstration sites will adapt and implement evidence-informed interventions and/or models of care to engage, link and retain particularly vulnerable populations. Specifically, this initiative will engage and retain BMSM in HIV medical care and supportive services by addressing their behavioral health needs. The proposed interventions and/or models of care will include strategies to integrate behavioral health services, including substance use disorder treatment, with HIV care to specifically address the needs of BMSM and improve their health outcomes. The ETAP will evaluate programmatic, clinical, and client level outcomes of the implementation. In addition, the ETAP will assess the costs associated with the implementation of the evidence informed interventions/models of care. The ETAP will also coordinate the development of implementation toolkits, trainings, and other dissemination products that will promote the replication of evidence informed interventions that were shown to improve health outcomes in other Ryan White HIV/AIDS Program (RWHAP) and other health care settings.

Because award recipients under both NOFOs (HRSA 18-047 and HRSA-18-053) will need to work closely together to be successful, the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) encourages applicants for this NOFO to read the companion announcement and be familiar with all program expectations within both NOFOs.

Key Definitions:

For the purposes of this initiative, HIV care services is defined as all of the HIV clinical care and treatment services allowable through the RWHAP. For more information regarding RWHAP eligible services, refer to Policy Clarification Notice #16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds.1

The term behavioral health refers to mental/emotional well-being and/or actions that affect wellness. Behavioral health problems include substance use disorders; alcohol and drug addiction; and serious psychological distress, suicide, and mental disorders.

Problems that range from unhealthy stress or subclinical conditions to diagnosable and treatable diseases such as serious mental illnesses and substance use disorders are included. These illnesses and disorders are often chronic in nature but people can and do recover from them with the help of a variety of interventions, including medical and psychosocial treatments, self-help, and mutual aid. The phrase “behavioral health” is

1 PCN# 16-02 can be viewed at https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters

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also used to describe service systems that encompass prevention and promotion of emotional health; prevention of mental and substance use disorders, substance use, and related problems; treatments and services for mental and substance use disorders;

and recovery support. Behavioral health care includes screening and treatment of substance use disorders; alcohol and drug addiction; and serious psychological distress, suicide, and mental disorders.2

For the purposes of this initiative, evidence-informed interventions are strategies, models, or approaches that have been proven effective or have shown promise as a methodology, practice, or means of improving the care and treatment of people living with HIV (PLWH). Evidence-informed should be understood as distinct from evidence-based. Evidence-informed interventions with strong evidence bases may meet evidence-based criteria established by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC). However, evidence-informed interventions may demonstrate impact and strength of evidence without meeting AHRQ, CDC, or other criteria for being evidence-based.

Evaluations and Technical Assistance Providers Functions

During the course of this project period, the ETAP will be responsible for fulfilling the following four important functions for this multi-site initiative:

1) Conduct a rigorous multi-site evaluation to assess programmatic, clinical, and client-level outcomes, as well as costs associated with implementing interventions and/or models of care;

2) Coordinate and provide remote and onsite TA to demonstration sites through TA toolkits, training materials, and other products;

3) Lead and coordinate the dissemination of best practices, lessons learned, and outcome data from the initiative through practical implementation toolkits; and

4) Promote successful replication of effective evidence-informed interventions and/or models of care, trainings, publications, and other dissemination products.

1) Conduct a Rigorous Multi-Site Evaluation

The ETAP will design, develop, and implement a multi-site evaluation plan to assess the outcomes and impact of adapting and implementing evidence-informed interventions and/or models of care implemented by the seven (7) demonstration sites, as well as the effectiveness of the specific implementation strategies that address the integration of HIV clinical care, behavioral health, and supportive service needs of BMSM living with HIV. The ETAP will conduct a multi-site evaluation of the implementation of interventions and/or models of care selected by demonstration sites under the BMSM living with HIV initiative awarded under HRSA announcement HRSA-18-047.

Evaluation results will inform best practices and lessons learned to be included in dissemination efforts to the RWHAP providers. The ETAP will assess the cost of adapting and implementing the interventions and/or models of care, as well as process and outcome measures resulting from the implementation.

2 Substance Abuse and Mental Health Services Administration. National Behavioral Health Quality Framework. Available at: https://www.samhsa.gov/data/national-behavioral-health-quality-framework.

Accessed September 23, 2017 https://www.samhsa.gov/data/national-behavioral-health-quality-framework

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Outcome measures may include but are not limited to client retention, access to antiretroviral therapy, and viral suppression. The evaluation should also capture biomedical and behavioral health indicators, barriers and facilitators to retention in HIV medical care, and other measures proposed by the ETAP. Key performance measures that must be included in the multi-site evaluation are outcomes of PLWH program participants along the HIV care continuum including:

• Retention in HIV Medical Care - Percentage of clients who had at least one HIV medical care visit in each 6-month period of the 24-month measurement period, with a minimum of 60 days between medical visits.

• Antiretroviral Therapy (ART) among Persons in HIV Medical Care - Percentage of clients prescribed ART for the treatment of HIV infection in the 12-month measurement period.

• Viral Suppression among Persons in HIV Medical Care - Percentage of clients with a viral load <200 copies/mL during the last test in the 12-month measurement period.

Additional Core Performance Measures may also be proposed, subject to HRSA concurrence.3

Process analysis will assess implementation of the evidence-informed interventions and/or models of care, including but not limited to facilitators and barriers to implementation. The ETAP, in coordination with the demonstration sites, will develop the final core process methods.

A cost analysis study (or cost effectiveness study, if feasible) will measure the labor and programmatic costs and expenditures incurred by each demonstration site, to inform feasibility for future replication in RWHAP and other health care settings.

Data Portal and Security: The ETAP must demonstrate the capacity of their organizational information technology infrastructure to electronically receive, store, manage and maintain de-identified client-level data to be collected and reported by demonstration sites. The demonstration sites will submit data to the ETAP through a secure data portal to be designed and maintained by the ETAP. The ETAP will coordinate efforts to assure the privacy and confidentiality of data submitted, collected, and stored. The ETAP will be responsible for monitoring data quality and completeness of submissions and interpreting evaluation results.

Website: In addition to a secure data portal, the ETAP will be responsible for developing and maintaining a project specific website with both public access for communication of the initiative and private password-protected access for demonstration sites, ETAP, HRSA staff and federal partners. The website will be expected to support TA resources for the multi-site evaluation; registration information for the national meetings of the initiative; recent findings of interest from outside the initiative; and links to relevant resources.

3 Performance Measures can be viewed at:

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html

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Institutional Review Board (IRB): Data to be collected and used in this initiative are classified as either public health data or client-level data. Public health data, such as HIV surveillance data and the Ryan White HIV/AIDS Program Services Report (RSR) treatment and support services data, are reported without disclosure of protected health information (PHI). The Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) grants exemptions to covered entities that collect and report PHI for the purposes of communicable disease surveillance in public health activities and quality improvement in health care operations.4 IRB review will be required to determine where the Privacy Rule applies.

Human Research Subjects Protection: The ETAP is required to follow human research subjects protection requirements as further described as set forth in Title 45 – Public Welfare, Part 46 – Protection of Human Subjects (45 CFR part 46).5

Focused evaluation studies: In addition to the multi-site evaluation, the ETAP recipient will be responsible for conducting focused evaluation studies including but not limited to case studies or qualitative studies that focus on addressing issues and barriers specific to BMSM living with HIV that facilitate or impede access to, engagement, and retention in HIV clinical care and treatment. The ETAP, in collaboration with the demonstration sites, HRSA staff, and federal partners, will generate the specific topics for these focused studies.

2) Providing Evaluation and Implementation Technical Assistance

The ETAP will provide evaluation and implementation TA and capacity building assistance (CBA) to demonstration sites funded to implement evidence-informed behavioral health interventions and/or models of care to engage, link, and retain BMSM living with HIV in medical care and support services. The ETAP will provide TA/CBA to the demonstration projects in areas of intervention adaptation, implementation, and maintenance. For the purposes of this initiative, demonstration site applicants are to select one (1) organizational intervention and/or model of care from the identified Center for Engaging Black MSM Across the Care Continuum (CEBACC), NIMH and HRSA/SPNS interventions and/or models of care addressing behavioral health conditions. Sites will modify and implement the selected intervention in order to address the structural, provider, and individual level barriers that limit engagement and retention in HIV care and viral suppression for BMSM living with HIV. The cadre of organizational interventions and/or models is available in the companion demonstration site NOFO (HRSA-18-047). The ETAP will also provide training and other resources and tools specifically tailored to the selected evidence-informed interventions and/or models of care.

The ETAP will also assess demonstration site TA/CBA needs and will be responsible for the provision of evaluation-related TA to the demonstration sites. These overall TA/CBA goals will be achieved through regular face-to-face meetings, site visits, 4 See Summary of the HIPAA Privacy Rule at:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html 5 Title 45 Code of Federal Regulations Part 46, Protection of Human Subjects. Available at:

http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html http://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://cebacc.careacttarget.org/ https://cebacc.careacttarget.org/ http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html

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website resources, webinars, and teleconferences with the grantees and designated HRSA program staff over the course of the project.

Intervention Manuals and Materials: The ETAP will coordinate with sites to adapt education tools and resources to provide competent and high-quality care for BMSM living with HIV, including bi-directional patient-provider education to establish better communication between HIV and behavioral health providers. These manuals and materials will be used by AIDS Education and Training Center (AETC) Programs to support replication of the successful models.

Site Visits: The ETAP will conduct, at minimum, one annual site visit with each demonstration site throughout the initiative, in coordination with federal staff, if available.

The ETAP will develop a site visit protocol to guide the content and focus of these visits.

Generally, the site visits will focus on the provision of TA as requested by the demonstration site or based on the ETAP’s assessment. Site visit protocols should address TA needs in the areas of planning and project implementation, as well as data submission and data quality issues.

Grant Recipient Meetings: The ETAP will coordinate the logistics for two meetings with the demonstration sites during each year of the demonstration sites’ 3-year project period. This activity includes but is not limited to meeting venue selection, logistics coordination, participant registration, development of meeting agendas and meeting facilitation. While the ETAP is responsible for overall logistics and meeting costs, each demonstration site is responsible for its own travel costs, ground transportation, per diem and hotel accommodations for these meetings. All activities will be conducted in collaboration with HRSA staff, federal partners, and demonstration project staff. The meetings will take place in the Washington, DC metropolitan area.

3) Leading and Coordinating Dissemination of Findings

Dissemination: The ETAP, in coordination with HRSA staff, will lead the dissemination of findings and lessons learned from evidence-informed interventions and/or models of care adapted to integrate behavioral health services with HIV clinical care and treatment to address the needs of BMSM and improve their health outcomes along the HIV care continuum. The ETAP will be responsible for producing and disseminating TA toolkits, materials, and products to include implementation manuals. Mechanisms of dissemination may include websites, presentations via webcast, conferences, meetings or national forums. The ETAP will disseminate findings and lessons learned from demonstration sites’ emerging and best practices. In addition, the ETAP will publish materials that enable other public health providers to implement similar interventions and/or models of care. The ETAP and demonstration sites will work with the TARGET Center as the web forum to disseminate information, materials, and products. The ETAP shall make all files, including captioning, audio descriptions, videos, tables, graphics/pictures, registration forms, presentations (both audio and video) or other types of proprietary format files – e.g., Adobe Portable Document Format (.pdf), Microsoft Office PowerPoint (.ppt) and Microsoft Excel (.xls), fully accessible to members of the public with disabilities. Technical and functional standards for accessibility are codified at 36 CFR Part 1194 and may be accessed through the Access Board’s Web site at http://www.access-board.gov.

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The ETAP will form a publication and disseminations committee, consisting of HRSA staff and demonstration project representatives, to generate research questions; topics for presentations and publications; concept sheets and analyses; and an overall dissemination plan for the initiative’s products.

4) Promoting Replication of Evidence-informed Interventions and/or Models of

Care

The ETAP will develop implementation toolkits describing how to replicate models proven effective in improving outcomes as well as best practices for implementation.

The ETAP will also collaborate with national and regional AETC programs to optimize the potential for replication of these evidence informed interventions and/or models of care. The network of AETC programs is uniquely positioned to help increase the capacity of HIV service providers to implement evidence informed strategies for improving health outcomes of PLWH. The AETC program provides education, training and capacity building resources to support its mission to offer timely, high quality, state-of-the-science information to health care professionals working with existing and emerging populations affected by HIV. AETC educational resources and events may be found at www.aidsetc.org.

The ETAP will document challenges and opportunities of emerging practices and will share lessons learned with the demonstration sites and the wider HIV communities. All materials will be disseminated to RWHAP and community health center programs. The ETAP must collaborate with the AETC programs to help foster replication.

Overall project timeline for Demonstration sites and ETAP

The ETAP will review the adaptation and implementation plans developed by the demonstration sites. Informed by this review, the ETAP will design a TA/CBA plan tailored to each model. Also in Year 1, the ETAP will design a multi-site evaluation plan to assess the fidelity, effectiveness and costs of these interventions when implemented in Years 2 and 3 of the initiative. In Years 2 and 3, the ETAP will implement its multi-site evaluation, collecting outcome, process and cost data from the demonstration sites.

In year 4, informed by its findings from the multi-site evaluation, the ETAP will produce web-based materials for publication on the TARGET Center website. The ETAP also will engage in publication and dissemination of findings from the initiative, including best practices, lessons learned and cost analyses to foster rapid, efficient replication of these evidence-informed interventions by other RWHAP-funded care and treatment organizations.

Below is a suggested timeline to assist in the preparation of your required project narrative.

http://www.aidsetc.org/

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Project Date Demonstration Sites ETAP Year 1, Months 1 - 6

• Work with the ETAP to finalize adaptation and implementation plans

• Assess TA needs

• Hire intervention/ evaluation staff, as needed

• Assist with intervention and implementation strategy adaptation

• Develop needs assessment tools

• Conduct needs assessment

• Convene initial multi-site meeting Year 1, Months 7 - 9

• Assist ETAP with developing data multi-site evaluation data collection tools

• Submit evaluation data collection instruments to local IRBs for approval

• Develop evaluation plan

• Develop data collection systems and tools

• Submit instruments to IRB for approval

• Develop TA/CBA plans

• Develop TA/CBA tools

Year 1, Months 10 -

• Begin implementation of evidence-informed intervention

• Begin multi-site evaluation data collection and submission to ETAP

• Begin multi-site evaluation

Year 2 • Submit to IRB for renewal Implementation of evidence-informed intervention

• Mid-intervention implementation strategies (if needed)

• Submit to IRB for renewal

• Collect data, conduct interim evaluation

• Conduct annual site visits

• Convene grant recipient meetings

• Continue to provide TA/CBA using tools developed Year 3, Months 1 - 6

• Submit to IRB for renewal

• Implementation of evidence-informed intervention

• Submit to IRB for renewal

• Collect data, conduct outcome evaluation Year 3, Months 6 - 10

• Wrap-up of evidence-informed interventions

• Develop tools for replication of intervention models

• Develop materials for dissemination

• Collect data, conduct outcome evaluation

• Develop materials for dissemination

• Final multi-site meeting

• Work with AETC to help translate these materials into clinical practice

Year 3, Months 11 -

• Dissemination and promotion of materials

• Final data collection activities

Year 4 N/A • Submit to IRB for renewal

• Analyze project data

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• Develop materials for dissemination

• Disseminate findings from project, promote materials and replication

2. Background

The SPNS Program is authorized by Section 2691 of the Public Health Service Act (42 USC 300ff-101), as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87). The SPNS Program supports the development of innovative models of HIV care to respond to the emerging needs of clients served by the RWHAP.6 The SPNS Program also evaluates the effectiveness of these models’ design, implementation, utilization, cost, and health related outcomes, while promoting the dissemination and replication of successful models.7

Despite decreasing overall HIV incidence in the United States, Blacks/African Americans have higher HIV incidence rates when compared to other racial/ethnic groups. According to the CDC, Blacks/African Americans accounted for almost half (44.3 percent) of all new HIV diagnoses in 2015, among whom, 38.4 percent were gay and bisexual men.8 Among all subpopulations with new diagnoses, BMSM were the most affected subpopulation. If current HIV diagnoses rates persist, about 1 in 2 BMSM in the United States will be diagnosed with HIV during their lifetime compared with 1 in 11 white MSM.9 In 2014, over 400,000 Blacks/African Americans were living with diagnosed HIV infection (42.4 percent of all people living with diagnosed HIV); in addition, Blacks/African Americans comprised the highest number (6,888) and rate (17.4 per 100,000 population) of HIV-related deaths among all racial/ethnic groups.

Similar disparities also exist within the RWHAP. In 2015, the RWHAP served 533,036 clients, and among them 47.1 percent were Black/African American.10 Among male clients, Blacks/African Americans comprised the largest racial/ethnic group (41.2 percent) of RWHAP clients. African Americans also comprised one-third of MSM clients, but 60.1 percent among MSM aged 13-24. Although the percentage of Black/African American men who were retained in care (78.6 percent) was close to the national RWHAP average (80.6 percent), the percentage who achieved viral

6 Current SPNS initiatives as well as previously funded projects can be found at:

http://hab.hrsa.gov/abouthab/partfspns.html 7 Publications and products from various SPNS initiatives can be found at:

http://hab.hrsa.gov/abouthab/special/spnsproducts.html AND https://careacttarget.org/library/integrating-hiv-innovative-practices-ihip 8 Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; Volume 27, published November 2016. Accessed 12-1-16 from : https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf 9 Centers for Disease Control and Prevention. Lifetime Risk of HIV Diagnosis. Conference on Retroviruses and Opportunistic Infection. February 2016. Accessed 9-28-2017 from:

https://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html#Graphics2 10 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. HIV/AIDS Bureau, HRSA, December 2016. Accessed 8-14-17 from:

http://hab.hrsa.gov/sites/default/files/hab/data/datareports/2015rwhapdatareport.pdf http://hab.hrsa.gov/abouthab/partfspns.html http://hab.hrsa.gov/abouthab/special/spnsproducts.html https://careacttarget.org/library/integrating-hiv-innovative-practices-ihip https://careacttarget.org/library/integrating-hiv-innovative-practices-ihip https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf https://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html#Graphics2 http://hab.hrsa.gov/sites/default/files/hab/data/datareports/2015rwhapdatareport.pdf

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suppression was slightly lower (78.9 percent) than the national average (83.4 percent).

Among all MSM racial/ethnic groups, viral suppression was lowest for African- Americans (77.7 percent). BMSM aged 13-24 years had noticeably lower levels of viral suppression (66.9 percent) compared to BMSM overall, with the lowest viral suppression among those with unstable housing (58.5 percent).

Studies have shown that BMSM experience more frequent and severe consequences of substance use than do White MSM, leading to health disparities such as poorer health outcomes.11 BMSM living with HIV are at higher risk of having poor health outcomes, and those negative outcomes are further compounded by mental health issues such as depression. Among BMSM living with HIV, the stress that accompanies experiences of discrimination based on their race, sexual orientation, and HIV status adds to their cumulative burden of stress and increases their vulnerability for depression. Traumatic life experiences may enhance vulnerability of young BMSM to HIV and increased risk-taking behaviors. Understanding the relative contributions of different traumatic experiences on HIV risk is important in identifying interventions needed to improve the health of young BMSM.

National Goals to End the HIV Epidemic

The RWHAP promotes robust advances and innovations in HIV health care using national goals to end the epidemic as its framework. Therefore, activities funded by the RWHAP focus on addressing these four goals:

1) Reduce new HIV infections;

2) Increase access to care and optimize health outcomes for PLWH;

3) Reduce HIV-related health disparities and health inequities; and

4) Achieve a more coordinated national response to the HIV epidemic.

To achieve these shared goals and priorities, recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, to ensure that PLWH are linked and retained in care, have timely access to HIV treatment and the supports needed (e.g., mental health and substance abuse services) to achieve HIV viral suppression.

HIV Care Continuum

Diagnosing PLWH, linking PLWH to HIV primary care, and PLWH achieving viral suppression are important public health steps toward ending the HIV epidemic in the United States. The HIV care continuum has five main “steps” or stages including: HIV diagnosis, linkage to care, retention in care, antiretroviral use, and viral suppression.

The HIV care continuum provides a framework that depicts the series of stages a person with HIV engages in from initial diagnosis through their successful treatment with HIV medication. It shows the proportion of individuals living with HIV or individuals diagnosed with HIV who are engaged at each stage. The HIV care continuum allows recipients and planning groups to measure progress and to direct HIV resources most effectively.

11 Buttram ME, Kurtz SP, and Suratt HL. Substance Use and Sexual Risk Mediated by Social Support among Black Men. J Community Health. 2013 Feb; 38(1): 62–69.

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According to recent data from the 2016 Ryan White Services Report (RSR), RWHAP has made tremendous progress toward ending the HIV epidemic in the United States.

From 2010 to 2016, HIV viral suppression among RWHAP patients, defined as a patient who had at least one outpatient ambulatory health services visit and at least one viral load test during the measurement year, with the most recent HIV RNA level <200 copies/mL, increased from 69.5 percent to 84.9 percent, and racial/ethnic, age-based, and regional disparities have decreased.12 These improved outcomes mean more PLWH in the United States will live near normal lifespans and have a reduced risk of transmitting HIV to others.13 In a September 27, 2017, Dear Colleague letter, CDC notes that scientific advances have shown that antiretroviral therapy (ART) preserves the health of PLWH. There is also strong evidence of the prevention effectiveness of ART. When ART results in viral suppression, it prevents sexual HIV transmission. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner. Such findings underscore the importance of supporting effective interventions for linking PLWH into care, retaining them in care, and helping them adhere to their ART.

RWHAP recipients are encouraged to assess the outcomes of their programs along this continuum of care. Recipients should work with their community and public health partners to improve outcomes across the HIV care continuum. HRSA encourages recipients to use the performance measures developed for the RWHAP at their local level to assess the efficacy of their programs and to analyze and improve the gaps along the HIV care continuum.

II. Award Information

1. Type of Application and Award

Type of applications sought: New.

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where substantial programmatic involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

HRSA Program involvement will include:

• Providing the expertise of HRSA personnel and other relevant resources to the project.

• Facilitating collaborative relationships between the ETAP, demonstration sites, and the regional and national AETC programs

12 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2016 http://hab.hrsa.gov/data/data-reports. Published December 2017. Accessed December 1, 2017.

13 National Institute of Allergy and Infectious Disease (NIAID). Preventing Sexual Transmission of HIV with Anti-HIV Drugs. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US).

2000- [cited 2016 Mar 29]. Available from: https://clinicaltrials.gov/ NLM Identifier: NCT00074581.

https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2016.pdf https://docs.wixstatic.com/ugd/de0404_fab89a3aaeeb406bbd7898d0e90d5dac.pdf http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

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• Reviewing, on an on-going basis, activities, procedures, measures, and tools to be established and implemented for accomplishing the goals of the cooperative agreement.

• Participating in the design and implementation of evaluation tools, evaluation plans, and other project material.

• Reviewing all informational products prior to dissemination.

• Facilitating the dissemination of project findings, best practices, evaluation data, and other information developed as part of this project to the broader network of HIV providers.

• Anticipating and adapting the project to the changes taking place in the health care environment.

• Collecting and analyzing data on national health issues, unmet need, marketplace conditions, special populations, and other key health indicators to guide current/future strategic planning, developmental efforts, and work plan activities.

• Coordinating activities to address the evaluation-related training and TA needs of the target audience and assist with new/emerging strategic initiatives.

The cooperative agreement recipient’s responsibilities will include:

• Designing and implementing a rigorous multi-site evaluation that includes outcome, process, and cost measures to assess the effectiveness of demonstration project interventions in improving health outcomes along the HIV care continuum.

• Conducting focused evaluation studies on issues relating to the clinical, administrative financing, or public policy aspects of the initiative.

• Developing and maintaining a secure website, with both public and private password-protected access for the initiative to serve as a data portal for the reporting of multi-site evaluation data by the demonstration projects and a communications nexus for the initiative.

• Coordinating the efforts of demonstration projects to assure the privacy and confidentiality of study participants in their health-seeking efforts.

• Assuring the appropriate review, approval, and renewal of all multi-site evaluation instruments and documents by an identified IRB.

• Providing TA on the adaptation, implementation, and evaluation of evidence-informed interventions to demonstration sites through regular teleconferences, webinars, site visits and in-person meetings for a range of needs over the course of the initiative.

• Coordinating and leading the logistics for two national multi-site meetings in each of the 3 years of the initiative with the demonstration sites in the Washington, DC/Metropolitan area.

• Conducting an annual site visit to each demonstration site for each year of the initiative.

• Leading and coordinating the publication and dissemination activities for the initiative, working in collaboration with the demonstration projects and HRSA staff.

• Assisting HRSA with information dissemination to constituencies upon request.

• Developing a final report highlighting the clinical, programmatic, and cost outcomes of the multi-site evaluation to facilitate future replication of successful

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models.

• Collaborating with assigned HRSA project officer and other HRSA staff as necessary to plan, execute and evaluate the activities.

2. Summary of Funding

HRSA expects to have approximately $650,000 available annually to fund one (1) recipient. You may apply for a ceiling amount of up to $650,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. The FY 2018 President’s Budget does not request funding for this program. The project period is August 1, 2018 through July 31, 2022 (4 years). Funding beyond the first year is dependent on the availability of appropriated funds for this program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR Part 75.

III. Eligibility Information

1. Eligible Applicants

Entities eligible for funding under Parts A – D of Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009, including public health departments and institutions of higher education, state and local governments, nonprofit organizations, faith-based and community-based organizations, tribes and tribal organizations are eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

NOTE: Multiple applications from an organization are not allowable.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov. You must use the SF- 424 application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

Effective December 31, 2017 - You must use the Grants.gov Workspace to complete the workspace forms and submit your workspace application package. After this date, you will no longer be able to use PDF Application Packages.

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing the NOFO (also known as “Instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit your application in the English language and it must be in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the application package do not count in the page limitation. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline to http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/web/grants/applicants/workspace-overview.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. 3321).

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included in Attachment XX: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications.

Program-Specific Instructions In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), please include the following:

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 Application Guide. The summary abstract must include the following:

• Brief description of the proposed ETAP structure

• Overall project goals

• Overall multi-site evaluation questions

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 (Need) This section should briefly describe the purpose of the proposed project. Provide a clear and succinct description of the roles and activities of the ETAP. Specifically, briefly describe how the ETAP will provide leadership in the implementation of the multi-site evaluation and dissemination activities, support replication among the regional and national AETC programs, and assess and provide TA to the demonstration sites. Briefly describe the proposed multi-site evaluation plan and TA services that the ETAP will provide to the demonstration sites. Briefly describe your organization and any collaborating organizations.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 (Need) Provide a summary that demonstrates a comprehensive understanding of issues http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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regarding the improvement of engagement and retention in HIV care for BMSM.

Additionally, provide a summary that demonstrates your understanding of the need to add to the field of implementation science evidence informed strategies that integrate behavioral health services into HV care for BMSM. Discuss the client level, legal, technological, epidemiological, clinical, and systemic challenges that affect wider-scale adoption and/or optimal application of focused interventions that incorporate behavioral health services to improve health outcomes among BMSM living with HIV.

Provide a discussion of the challenges associated with the evaluation, dissemination, and replication of evidence informed strategies integrating behavioral health services into HIV care for BMSM. When appropriate, corroborate your assessment with citations of literature and publications.

METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 (Response) Propose…