PKG00246491-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau Office of Training and Capacity Development, Special Projects of National Significance

Capacity Building in the Ryan White HIV/AIDS Program to Support Innovative Program Model Replication

Funding Opportunity Number: HRSA-19-040

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

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Letter of Intent Requested By: January 14, 2019

Application Due Date: February 25, 2019

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

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: November 26, 2018

Adan Cajina, MS Chief, Demonstration and Evaluation Branch HIV/AIDS Bureau, HRSA Telephone: (301) 443-3180 Email: ACajina@hrsa.gov

Authority: 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).

HRSA-19-040 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019, Capacity Building in the Ryan White HIV/AIDS Program (RWHAP) to Support Innovative Program Model Replication. The purpose of this program is to enhance the capacity of RWHAP recipients and subrecipients to replicate evidence-informed interventions, using program implementation tools, manuals and other resources previously developed by the U.S. Department of Health and Human Services (HHS). Dissemination and implementation of recent innovative tools, interventions, and manuals aims to reduce the impact of the HIV epidemic within metropolitan areas and states recently identified as disproportionately affected. The HIV/AIDS Bureau’s Special Projects of National Significance (SPNS) Program supports the development of innovative models of HIV care to respond to the emerging needs of clients served by the RWHAP. It also evaluates the effectiveness of these models’ design, implementation, utilization, cost, and health related outcomes, while promoting the dissemination and replication of successful models.

Funding Opportunity Title: Capacity Building in the Ryan White

HIV/AIDS Program to Support Innovative Program Model Replication

Funding Opportunity Number: HRSA-19-040 Due Date for Applications: February 25, 2019 Anticipated Total Annual Available FY 2019 Funding:

$1,900,000

Estimated Number and Type of Award(s): One (1) Cooperative Agreement

Estimated Award Amount: Up to $1,900,000 per year Cost Sharing/Match Required: No Period of Performance: August 1, 2019 through July 31, 2022

(3 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 are eligible to apply.

See Section III-1 of this notice of funding opportunity (NOFO) for complete eligibility information.

HRSA-19-040 ii

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.

Technical Assistance

HRSA has scheduled the following technical assistance webinar:

Day and Date: Wednesday, December 5, 2018 Time: 3:00 - 4:30 p.m. ET Call-In Number: 1-877-491-0573 Participant Code: 7059-2277 Weblink: https://hrsa.connectsolutions.com/pre-application_webinar_nofo_hrsa-19-040/

The webinar will be recorded and should be available by December 17, 2018 at https://www.targethiv.org/category/resource-type/training-resources.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/pre-application_webinar_nofo_hrsa-19-040/ https://www.targethiv.org/ https://www.targethiv.org/

HRSA-19-040 iii

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. Proposal Abstract

ii. Proposal 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 INFORMATION

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 .......... ERROR! BOOKMARK NOT DEFINED.

VI. AWARD ADMINISTRATION INFORMATION

1. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

2. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-19-040 1

I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for a new three-year Special Projects of National Significance (SPNS) initiative entitled Capacity Building in the Ryan White HIV/AIDS Program to Support Innovative Program Model Replication.

This Notice of Funding Opportunity (NOFO) responds to recent changes in the HIV epidemic and the need to find effective solutions that improve health outcomes along the HIV care continuum for people living with HIV (PLWH). During recent years, a number of innovative interventions have demonstrated effective responses that contribute to ending the HIV epidemic. Ryan White providers who have developed these evidence-informed interventions have produced replication manuals and other tools to assist organizations and jurisdictions interested in adapting and/or replicating such interventions. This NOFO seeks to build the capacity of Ryan White HIV/AIDS Program (RWHAP) recipients and subrecipients to replicate effective models of care., with a particular focus on RWHAP jurisdictions identified as disproportionately affected by HIV By building capacity and encouraging the implementation or replication of effective models of care, the RWHAP intends that these jurisdictions will bring recent innovations to scale, thus improving systems of care, reducing health disparities, improving outcomes along the HIV care continuum, and ultimately contributing towards meeting the goals and objectives of the National HIV/AIDS Strategy.

HRSA anticipates the following outcomes from this SPNS initiative:

• Greater facility among RWHAP recipients and subrecipients in targeted disproportionately-affected jurisdictions to use and integrate innovative program service models, tools, interventions, and manuals, using the allowable service categories outlined in Policy Clarification Notice (PCN) 16-02, “Eligible Individuals and Allowable Uses of Funds;”1

• Increased awareness and knowledge among targeted RWHAP recipients and subrecipients about the value-added benefits of evidence-informed interventions, the RWHAP repository of innovative interventions, methodologies for adoption and replication, anticipated challenges, and resources available for implementing these innovative interventions;

• Increased system-level capacity for adoption of innovative, evidence-informed interventions that provide comprehensive, high-quality, culturally competent HIV screening, care, and treatment (i.e., medical and support services) for persons living with HIV who are not, or fully, engaged in the health care system;

• Greater capacity within the RWHAP to disseminate innovative interventions; and

• Diminished disparities among PLWH with regard to linking into HIV care, re-engagement and retention in HIV care, access to HIV care, and viral load suppression.

1 HIV/AIDS Bureau, HRSA, 2016, https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf.

https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf

HRSA-19-040 2

This initiative is designed to complement ongoing efforts that HRSA is supporting under HRSA-19-030 Ryan White HIV/AIDS Program (RWHAP) Access, Care, and Engagement Technical Assistance Center (ACE TA Center). The main objectives of HRSA-19-030 are:

1) Building the capacity of RWHAP recipients and their subrecipients through tools, training, and technical assistance (TA) to enroll and engage PLWH in expanded health care coverage; and

2) Ensuring that RWHAP funding remains a payer of last resort. The full NOFO may be read at: https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-19-030.

2. Background

The SPNS Program supports the development of innovative models of HIV care that quickly respond to the emerging needs of clients served by the RWHAP. 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.

The RWHAP supports more than 500,000 individuals living with diagnosed HIV each year, making it the Federal Government's largest program specifically for PLWH. The goal of the RWHAP is to improve the availability and quality of HIV services for low income, uninsured, and underserved individuals and families who do not otherwise have access to HIV care and support services. Services funded under the RWHAP are intended to reduce the use of more costly inpatient care, increase access to care for underserved populations, and improve the quality of life for those affected by the epidemic. The RWHAP works toward these goals by funding direct services, local and State programs that provide core medical services and support services, health care provider training, and technical assistance to help funded programs address implementation and emerging HIV care issues.

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

From 2010 to 2016, HIV viral suppression among RWHAP patients who have had one or more medical visits during the calendar year and at least one viral load with a result of <200 copies/mL reported, has increased from 69.5 percent to 84.9 percent;

additionally, racial/ethnic, age-based, and regional disparities have also decreased.2 These improved outcomes mean more PLWH in the U.S. will live near normal lifespans and have a reduced risk of transmitting HIV to others.3 Scientific advances have shown that antiretroviral therapy (ART) preserves the health of PLWH and prevents sexual HIV

2 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.

3 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/ NCT00074581 NLM Identifier:

NCT00074581.

https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-19-030 https://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-19-030 https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2016.pdf http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

HRSA-19-040 3

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.

The National HIV/AIDS Strategy (NHAS)4 and the HIV care continuum, described below, have bolstered further integration of HIV prevention and care efforts and fostered new approaches to addressing barriers to HIV testing, care, and treatment. Federal agencies, state and local health departments, community-based organizations, health care providers, and PLWH use both for measuring progress toward the goals of preventing HIV, diagnosing people who do not know their HIV status, linking PLWH to care and treatment, retaining PLWH in care and treatment, prescribing antiretroviral treatment, and achieving viral suppression.

National HIV/AIDS Strategy: Updated to 2020

The National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS 2020) is a five-year plan that details principles, priorities, and actions to guide the national response to the HIV epidemic. The RWHAP promotes robust advances and innovations in HIV health care using the National HIV/AIDS Strategy to end the epidemic as its framework. Therefore, to the extent possible, activities funded by RWHAP focus on addressing these four goals:

1) Reduce new HIV infections;

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

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

4) Achieve a more coordinated national response.

To achieve these shared goals, recipients should align their organization’s efforts, within the parameters of the RWHAP statute and program guidance, to ensure that PLWH are linked to and retained in care, and have timely access to HIV treatment and the supports needed (e.g., mental health and substance use disorder 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 U.S. The HIV care continuum, a conceptual framework, has five main “steps” or stages:

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 living with HIV engage 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.

4 U.S. Department of Health and Human Services, 2017, National HIV/AIDS Strategy Progress Report, https://files.hiv.gov/s3fs-public/NHAS_Progress_Report_2017.pdf.

https://files.hiv.gov/s3fs-public/NHAS_Progress_Report_2017.pdf

HRSA-19-040 4

RWHAP funding recipients are encouraged to assess the outcomes of their activities 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.5

Recent HIV Data Trends

According to the latest estimates from the Centers for Disease Control and Prevention (CDC), more than 1.1 million people in the U.S. are living with HIV today, of which about 14 percent do not know their current HIV status. An estimated 39,782 people became newly infected with HIV in the United States in 2016. Encouragingly, the estimated number of annual HIV infections in the U.S. declined 18 percent between 2008-2015.

Reductions have been seen in most risk groups and in all states where data have been available.6

Similarly, the public and private health care system in the U.S. has made gains in engagement and retention in care for persons living with HIV, and for viral suppression.

Overall, the percentage of persons living with diagnosed HIV who were virally suppressed increased from 46.0 percent in 2010 to 59.8 percent in 2015.7

Yet, there are significant disparities in the impact of HIV disease with regard to certain socio-demographic and health status variables, and in certain geographic areas of the U.S. The disease still disproportionately affects people living in poverty, racial and ethnic minority populations, and others underserved by health care and health promotion systems. Being younger than age 30, unstably housed, an African-American or Latino male who is sexually active with other men, and/or a person living with a substance use and/or mental health disorder, are all factors still strongly associated with higher rates of HIV infection, being less engaged and retained in HIV care, having less adherence to treatment regimens, and with not achieving viral suppression.8

Within the U.S., certain geographic areas experience significant disparities with regard to health and social impacts of the HIV epidemic. Historically, large urban areas across the country have experienced the heaviest burden of HIV disease, resulting in the use of targeted federal and state resources. However, this has changed more recently; after many years of sustained effort, a number of the large urban areas have seen significant declines in HIV impact. Small and medium sized cities, most frequently in the Southeastern U.S., now experience larger rates of newly diagnosed cases.9 These areas often have a less developed public and community-based health infrastructure in

5 HIV/AIDS Bureau, HRSA, “Performance Measure Portfolio”, https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio 6 CDC, HIV Surveillance Report, 2016, https://www.cdc.gov/hiv/statistics/overview/index.html 7 CDC, “Understanding the HIV Care Continuum” 2018, https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf 8 U.S. Statistics”, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics, July 2, 2018, and National HIV/AIDS Strategy Progress Report, 2017.

9 CDC and AIDSvu, Inc., a collaboration involving the Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc., https://map.aidsvu.org/map.

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio https://www.cdc.gov/hiv/statistics/overview/index.html https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics https://map.aidsvu.org/map

HRSA-19-040 5

place to react, with fewer resources. HRSA and other agencies within HHS have begun to respond to this by increasing efforts in these areas; this initiative is a part of that effort in that it seeks to build capacity to adopt and integrate innovative models of care in these recently disproportionately affected areas.

Integrated Data Sharing and Use

HRSA and CDC’s Division of HIV/AIDS Prevention support integrated data sharing, analysis, and utilization for the purposes of program planning, needs assessments, unmet need estimates, reporting, quality improvement, the development of your HIV care continuum, and public health action. HRSA strongly encourages RWHAP Part F recipients to:

• Follow the principles and standards in the Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action.

• Establish data sharing agreements between surveillance and HIV programs to ensure clarity about the process and purpose of the data sharing and utilization.

Integrated HIV data sharing, analysis, and utilization approaches by state and territorial health departments can help further progress toward reaching the NHAS 2020 goals and improve outcomes on the HIV care continuum.

To fully benefit from integrated data sharing, analysis, and utilization, HRSA strongly encourages complete CD4/viral load (VL) reporting to the state and territorial health departments’ HIV surveillance systems. CD4 and VL data can be used to identify cases, stage HIV disease at diagnosis, and monitor disease progression. These data can also be used to evaluate HIV testing and prevention efforts, determine entry into and retention in care, measure viral suppression, and assess unmet health care needs.

Analyses at the national level to monitor progress against HIV can only occur if all HIV-related CD4 and VL test results are reported by all jurisdictions. CDC requires that all CD4 results (counts and percentages) and all VL results (undetectable and specific values) be reported to the National HIV Surveillance System (NHSS). Where laws, regulations, or policies are not aligned with these recommendations, states/territories should consider strategies to best implement these recommendations within current parameters or consider steps to resolve conflicts with these recommendations. In addition, NHSS also requires reporting HIV-1 nucleotide sequences from genotypic resistance testing to monitor prevalence of all antiretroviral drug resistance and HIV genetic diversity subtypes and transmission patterns.

The Special Projects of National Significance (SPNS) Program

Through its SPNS Program, HRSA’s HAB funds demonstration initiatives focused on the development of effective interventions to quickly respond to emerging needs of PLWH receiving assistance under the RWHAP. SPNS evaluates the design, implementation, utilization, cost, and health related outcomes of innovative treatment models, while promoting dissemination, replication and uptake of successful interventions. SPNS findings have demonstrated promising new approaches to linking and retaining into care underserved and marginalized populations living with HIV. All http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf

HRSA-19-040 6

RWHAP recipients are encouraged to review and integrate a variety of SPNS evidence-informed tools within their HIV system of care in accordance with the allowable service categories defined in PCN 16-02 Ryan White HIV/AIDS Program Services: Eligible Individuals and Allowable Uses of Funds as resources permit. SPNS related interventions can be found at the following locations:

• Integrating HIV Innovative Practices (IHIP) (https://careacttarget.org/ihip)

Resources on the IHIP website include easy-to-use training manuals, curricula, case studies, pocket guides, monographs, and handbooks, as well as informational handouts and infographics about SPNS generally. IHIP also hosts technical assistance (TA) training webinars designed to provide a more interactive experience with experts, and a TA help desk exists for you to submit additional questions and share your own lessons learned.

• Replication Resources from the SPNS Systems Linkages and Access to Care

(https://careacttarget.org/library/replication-resources-spns-systems-linkages-and-access-care) There are intervention manuals for patient navigation, care coordination, state bridge counselors, data to care, and other interventions developed for use at the state and regional levels to address specific HIV care continuum outcomes among hard-to-reach populations living with HIV.

• Dissemination of Evidence Informed Interventions

(https://nextlevel.careacttarget.org/) The Dissemination of Evidence-Informed Interventions initiative runs from 2015-2020 and disseminates four adapted linkage and retention interventions from prior SPNS and the Secretary’s Minority AIDS Initiative Fund (SMAIF) initiatives to improve health outcomes along the HIV care continuum. The end goal of the initiative is to produce four evidence-informed care and treatment interventions that are replicable, cost-effective, capable of producing optimal HIV care continuum outcomes, and easily adaptable to the changing healthcare environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

Examples of innovative RWHAP evidence-informed initiatives that have been recently completed, or will be completed during the period of this Cooperative Agreement, include, but is not limited to the following:

• Building Futures: Supporting Youth Living with HIV

• Center for Engaging Black MSM Across the Care Continuum (CEBACC)

• Ryan White HIV/AIDS Program (RWHAP) Building Care and Prevention Capacity:

Addressing the HIV Care Continuum in Southern Metropolitan Area

• Improving Access to HIV Care using Community Health Workers (CHWs)

• SPNS Initiative: Building a Medical Home for Multiply Diagnosed HIV positive

Homeless Populations

• SPNS Initiative: Culturally Appropriate Interventions of Outreach, Access, and

Retention among Latino/a Populations

• SPNS Initiative: Health Information Technology Capacity Building for Monitoring and

Improving Health Outcomes along the HIV Care Continuum

• SPNS Initiative: System-level Workforce Capacity Building for Integrating HIV

Primary Care into Community Health Care Settings https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf https://careacttarget.org/ihip https://careacttarget.org/library/replication-resources-spns-systems-linkages-and-access-care https://careacttarget.org/library/replication-resources-spns-systems-linkages-and-access-care https://nextlevel.careacttarget.org/ https://targethiv.org/news/building-futures https://www.nastad.org/domestic/hiv-prevention-health-equity/center-engaging-black-msm-across-care-continuum-cebacc https://researchfunding.duke.edu/ryan-white-hivaids-program-building-care-and-prevention-capacity-addressing-hiv-care-continuum https://researchfunding.duke.edu/ryan-white-hivaids-program-building-care-and-prevention-capacity-addressing-hiv-care-continuum http://cahpp.org/project/chw https://targethiv.org/library/spns-initiative-building-medical-homes-multiply-diagnosed-hiv-positive-homeless-populations https://targethiv.org/library/spns-initiative-building-medical-homes-multiply-diagnosed-hiv-positive-homeless-populations https://targethiv.org/library/spns-initiative-culturally-appropriate-interventions-outreach-access-and-retention-among https://targethiv.org/library/spns-initiative-culturally-appropriate-interventions-outreach-access-and-retention-among https://hab.hrsa.gov/about-ryan-white-hivaids-program/spns-health-information-technology https://hab.hrsa.gov/about-ryan-white-hivaids-program/spns-health-information-technology https://targethiv.org/library/spns-initiative-system-level-workforce-capacity-building-integrating-hiv-primary-care https://targethiv.org/library/spns-initiative-system-level-workforce-capacity-building-integrating-hiv-primary-care

HRSA-19-040 7

• SPNS Initiative: Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum

• Using Evidence Informed Interventions to Improve Health Outcomes among PLWH

Key Definitions:

• Evidence-informed – Models and practices that incorporate the best available research evidence, theory, practitioner wisdom, and client needs, values, and preferences into services planning and decision-making process.10

• Jurisdictions – Recipients of RWHAP Part A and B funds (eligible metropolitan areas, transitional grant areas, states, and authorized territories).

• Disproportionately-Affected Jurisdictions – Jurisdictions that have experienced the highest impact of new HIV diagnoses during the past three calendar years, as recorded by the U.S. Centers for Disease Control and Prevention and reported on the AIDSVu website, https://map.aidsvu.org/map.

• Learning Collaborative – A dedicated group of relevant stakeholders, usually of a limited duration, that focuses on the adoption and integration of innovations, best practices, and techniques within a system of care, leading to improvements in cost-effective patient-centered care, health outcomes, and community health.11

II. Award Information

1. Type of Application and Award

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 quickly respond to the emerging needs of clients served by the

RWHAP.

Type of applications sought: New

HRSA will provide funding in the form of a Cooperative Agreement. A Cooperative Agreement, as opposed to a grant, is a financial assistance mechanism where substantial interaction occurs between HRSA and the funded recipient during performance of the initiative. Proposed activities must support the mutual goals and objectives of the RWHAP and the applicant. Certain activities must be planned jointly, and include HRSA’s input and approval. HRSA must be aware of all recipient activities in sufficient time to provide input and/or assistance.

HRSA Program involvement will include:

In addition to the usual monitoring and technical assistance provided under the

10 Modeled on S.J. Dodge and A. Savage, 2016, “Evidence-Informed Social Work Practice,” Encyclopedia of Social Work, retrieved from http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore- 9780199975839-e-915.

11 Modeled on Oregon Department of Health, “Core Contract (2012), retrieved from https://definedterm.com/learning_collaborative, and Institute for Healthcare Improvement, “IHI’s Collaborative Model from Improvement”, retrieved from http://www.ihi.org/resources/pages/ihiwhitepapers/thebreakthroughseriesihiscollaborativemodelforachievingbreakth roughimprovement.aspx.

https://hab.hrsa.gov/about-ryan-white-hivaids-program/spns-social-media https://hab.hrsa.gov/about-ryan-white-hivaids-program/spns-social-media https://targethiv.org/org/spns-initiative-dissemination-evidence-informed-interventions-improve-health-outcomes-along-0 https://map.aidsvu.org/map http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-915 http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-915 https://definedterm.com/learning_collaborative http://www.ihi.org/resources/pages/ihiwhitepapers/thebreakthroughseriesihiscollaborativemodelforachievingbreakthroughimprovement.aspx http://www.ihi.org/resources/pages/ihiwhitepapers/thebreakthroughseriesihiscollaborativemodelforachievingbreakthroughimprovement.aspx

HRSA-19-040 8

cooperative agreement, HRSA’s responsibilities will include:

• Participating in the final selection of innovative models, replication tools, and resources that will be used in the capacity building efforts;

• Participating in the final selection of targeted jurisdictions and review of any subrecipients, using any disproportionately-affected jurisdictions identified in the application as a starting point;

• Supporting the formation of partnerships with RWHAP recipients in targeted jurisdictions;

• Reviewing, editing and approving written documents and reports, including capacity building curricula, publications, webcast content, and other resources;

• Providing assistance in the management and technical performance of activities;

• Participating in the design, direction and evaluation of activities; and

• Ensuring integration of results into HAB programmatic and data reporting efforts.

The cooperative agreement recipient’s responsibilities will include:

• Collaborating with HRSA in selecting three - five RWHAP jurisdictions to be targeted for the dissemination of innovative service models;

• Assessing the CDC-HRSA Integrated HIV Prevention and Care Plans Including

Statewide Coordinated Statement of Need12 and other secondary sources of data of targeted jurisdictions to identify specific disparities and target populations that could be the focus for replicating service models to improve HIV care continuum outcomes;

• Reviewing findings, implementation manuals, and other tools from among the identified HHS and/or HRSA initiatives of interest and propose 5-10 evidence-informed initiatives for replication, and include a rationale for the recommendations;

• Establishing partnerships with targeted jurisdictions, and developing any collaboration agreements and/or Memoranda of Understanding, to support implementation of the project goals and objectives; and

• Developing capacity building tools and other materials to facilitate the adoption of evidence-informed interventions, to include guidelines on how to build capacity, adopt and adapt effective interventions, conduct formative evaluation, and track costs;

• Establishing at least one Innovation Learning Collaborative within each targeted jurisdiction during the first year of the initiative and maintaining them throughout the initiative;

• Establishing peer-to-peer provider partnerships focused on dissemination of innovative interventions into areas of high HIV incidence, disparities, and unmet need;

• Providing individualized consultation to recipients and subrecipients in targeted jurisdictions on how to improve their capacity to replicate and integrate innovative models of care, as needed;

• Creating tools and materials that facilitate replication and integration of innovations during resource and program planning, subrecipient awarding, request for proposal

12 HIV/AIDS Bureau, HRSA, 2015, Integrated HIV Prevention and Care Plan Guidance, including the Statewide Coordinated Statement of Need, CY 2017- 2021, https://hab.hrsa.gov/sites/default/files/hab/Global/hivpreventionplan062015.pdf.

https://hab.hrsa.gov/sites/default/files/hab/Global/hivpreventionplan062015.pdf

HRSA-19-040 9

writing, and monitoring and service delivery, to be added to the RWHAP’s current compendia;

• Evaluating processes undertaken with targeted jurisdictions to implement the objectives under this initiative;

• Conducting an outcome evaluation that examines reduction in gaps along the HIV care continuum, diminished disparities in health outcomes along the HIV care continuum related to certain socio-demographic and co-morbid health conditions, and changed capacity of entities in disproportionately-affected jurisdictions to replicate innovations;

• Adding to the RWHAP’s repository of evidence-informed interventions, as relevant, along with the necessary descriptions of resources and solutions to challenges encountered; and

• Ongoing consultation and collaboration with RWHAP staff with regard to all of the above.

2. Summary of Funding

HRSA expects approximately $1,900,000 to be available annually to fund one recipient.

You may apply for a ceiling amount of up to $1,900,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is August 1, 2019 through July 31, 2022 (three years). Funding beyond the first year is dependent on the availability of appropriated funds for SPNS during subsequent fiscal years, satisfactory recipient performance, and a decision by HHS that continued funding is in the best interest of the Federal Government. HRSA may reduce or eliminate funding beyond the first year if the recipient is unable to show satisfactory performance in achieving goals and objectives listed in its application.

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

III. Eligibility Information

1. Eligible Applicants

Entities eligible for funding under RWHAP 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 are eligible for this program. Eligible entities include public health departments and institutions of higher education, state and local governments, nonprofit organizations, faith-based and community-based organizations, tribes, and tribal organizations.

Proof of applicant status is required as Attachment 6. This may consist of a Letter of Recognition from the U.S. Internal Revenue Service regarding non-profit status, or other document of a tribe’s and tribal organization’s’ status.

2. Cost Sharing/Matching

Cost sharing/matching is not requirement of this program.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-19-040 10

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 due date 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 before the application due date, HRSA will only accept and review your last validated electronic submission, under the correct funding opportunity number, before the Grants.gov application due date.

IV. Application and Submission Information

1. Address to Request Application Package

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

If you are reading this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) and reviewing or preparing the workspace application package, you will automatically be notified in the event HRSA changes and/or republishes the NOFO 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 For Applicants 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 this NOFO to do otherwise. You must submit the application in the English language and 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, proposal and budget narratives, attachments, and letters of commitment and support required in the Application Guide https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

HRSA-19-040 11

and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Indirect Cost Rate Agreement and proof of organization 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 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 9: 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), include the following:

i. Proposal Abstract See Section 4.1.ix of HRSA’s SF-424 Application Guide. In addition, include the following:

• Summary of proposed Capacity Building Plan

• Overall goals and objectives

• Any disproportionately affected jurisdictions you propose to target in this Initiative

(recommended, but not required)

ii. Proposal Narrative

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

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) http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-19-040 12

Briefly describe the purpose of your proposal as it responds to the purpose set forth in this NOFO.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 (Need)

Provide a detailed review of the needs of RWHAP recipients and subrecipients in disproportionately affected jurisdictions (see definition on p.7) that are the focus of this NOFO. This may include proposed jurisdictions to be targeted and a description of their needs and assets, intended target population(s), specific disparities, barriers, and outcomes of interest along the HIV care continuum.

Please note that while you may propose jurisdictions in the application phase, final determination of specific jurisdictions to be targeted will be made in consultation with HRSA staff during the first three months of the award. Use and cite demographic data whenever possible to support the information provided. This section will help reviewers understand the areas that you wish to serve.

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

Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations (stated on pp. 8-

9) in this NOFO. As appropriate, include development of effective tools and strategies for capacity building, collaborations, clear communication, and information sharing and dissemination, and use of available RWHAP-funded capacity building assistance materials (previously described in section I.2., “Background”). HRSA will also consider replication of additional innovative service models, tools, interventions, manuals, or other resources linked to improvements in the HIV care continuum developed by other HRSA units (e.g., the Bureau of Primary Health Care) and HHS Operating Divisions (e.g., CDC, National Institutes of Health, Substance Abuse and Mental Health Services Administration, etc.). In such cases, the additional service model(s), tools, interventions, manuals, and evidence of effectiveness should be clearly described and related to the previously described RWHAP initiatives of interest. Include how you will work with RWHAP recipients to ensure that planned capacity building activities align with targeted jurisdictions’ Integrated Prevention and Care Plans. Describe efforts to involve HIV service providers, consumers, families, and communities. Include in this section a plan to disseminate reports, products, and other related materials so that other key target audiences receive information related to the initiative.

Include a description of any innovative methods you will use to address the stated needs, and how you intend to collaborate with RWHAP staff in conducting this initiative. Ensure that the activities you propose are national in scope. Describe in Attachment 2 the staffing plan for your work and job descriptions for key positions.

Finally, describe a process to promote the integration and sustainability of evidence-informed interventions after the period of federal funding ends. Under this NOFO, HRSA expects you to work with three to five targeted RWHAP jurisdictions and relevant subrecipients to integrate key elements of one or more models that have been effective in improving delivery of care and have led to improved outcomes for the affected populations. This would include how best to

HRSA-19-040 13

utilize existing service categories under PCN 16-02 and considerations for prioritizing those interventions. HRSA also expects you to recommend actions for continuing capacity building with similar jurisdictions (not specifically engaged in this initiative) after this initiative ends.

WORK PLAN -- Corresponds to Section V’s Review Criteria #2 (Response) and #4

(Impact)

Describe the activities or steps that you will use to achieve each of the objectives proposed during the entire period of performance discussed in the Methodology section. Be sure the work plan focuses on the three to five targeted, diverse jurisdictions, and that it is national in scope and demonstrates collaboration with RWHAP recipients and related HRSA staff. Use a timeline that includes each activity and identifies responsible staff positions. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities.

The work plan should be used as a tool to manage the initiative by measuring progress, identifying necessary changes, and quantifying initiative accomplishments. The work plan should directly relate to your methodology and the program requirements of this announcement. The work plan should include clearly written (1) goals; (2) objectives that are specific, time-framed, and measurable; (3) action steps; (4) staff responsible for each action step (including consultants); and (5) anticipated dates of completion. Goals should be included in the work plan for the entire proposed 3-year period; objectives and action steps are required in the work plan only in relation to goals set for year one.

You must submit with your work plan a logic model for designing and managing the initiative. A logic model is a one-page diagram that presents the high-level conceptual framework for proposed work and explains the links among program elements. While there are many versions of logic models, for the purposes of this NOFO, the logic model should summarize the connections between the:

• Goals of the your work (e.g., objectives, reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience.);

• Inputs (e.g., organizational profile, collaborative partners, key staff, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Include the Work Plan and Logic Model as Attachment 1.

https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf

HRSA-19-040 14

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (Response)

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria #3 (Evaluative Measures) and #5 (Resources and Capabilities)

You must describe the plan for the initiative’s evaluation that will contribute to quality improvement, assessment of outputs and outcomes, dissemination of findings, and program integration. The program evaluation should monitor ongoing processes and the progress towards the goals and objectives of this initiative. Describe your plan to evaluate the inputs (e.g., organizational profile, collaborative partners, key staff, budget, and other resources), key processes, and expected outcomes of the initiative.

You must describe the systems and processes that will support your organization's evaluation requirements, including a description of data you plan to collect, and how you will collect and manage data (e.g., assigned skilled staff, data management software) in a way that provides accurate and timely reporting of results.