PKG00253841-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau

Ending the HIV Epidemic: A Plan for America — Ryan White HIV/AIDS Program Parts A and B

Funding Opportunity Number: HRSA-20-078

Funding Opportunity Type(s): New Assistance Listings (CFDA) Number: 93.686

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: October 15, 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: August 13, 2019

Heather Hauck, MSW, LICSW Deputy Associate Administrator Telephone: (301) 443-1993 Email: hhauck@hrsa.gov

Authority: Public Health Service Act, Section 311(c) (42 U.S.C. § 243(c)) and title XXVI (42 U.S.C. §§ 300ff-11 et seq.)

mailto:hhauck@hrsa.gov

HRSA-20-078 ii

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2020 Ending the HIV Epidemic: A Plan for America — Ryan White HIV/AIDS Program Parts A and B. The purpose of this program is to focus resources in 48 counties, Washington, D.C., San Juan, Puerto Rico, and seven states with substantial rural HIV burden (hereafter referred to as “jurisdictions”) to implement strategies, interventions, approaches, and core medical and support services to reduce new HIV infections in the United States. The overarching goal for this initiative is to reduce new HIV infections in the United States to less than 3,000 per year by 2030.

Funding Opportunity Title: Ending the HIV Epidemic: A Plan for

America — Ryan White HIV/AIDS Program Parts A and B

Funding Opportunity Number: HRSA-20-078 Due Date for Applications: October 15, 2019 Anticipated Total Annual Available FY 2020 Funding:

$55,125,000

Estimated Number and Type of Award(s):

47 cooperative agreement(s)

Estimated Award Amount: Up to $9,000,000 per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No Period of Performance: March 1, 2020 through

February 28, 2025 (5 years) Eligible Applicants: Eligible applicants are:

• RWHAP Part A funded Eligible Metropolitan Areas (EMAs) or Transitional Grant Areas (TGAs) whose service area includes one or more of the identified 48 HIV high burden counties; and the EMAs of Washington, D.C. and San Juan, PR.

• RWHAP Part B funded States/Territories identified as having a substantial rural HIV burden–Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina.

• The RWHAP Part B Program of the State of Ohio on behalf of Hamilton County.

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

HRSA-20-078 iii

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: Tuesday, August 27, 2019 Time: 2 p.m. – 4 p.m. ET Call-In Number: 1-888-950-9561 Participant Code: 6408323 Weblink: https://hrsa.connectsolutions.com/ending_the_hiv_epidemic/ Playback: Webinar will be available on the TargetHIV website.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/ending_the_hiv_epidemic/ https://www.targethiv.org/calendar/webinar-and-call-archives

HRSA-20-078 iv

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

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: LIST OF ELIGIBLE APPLICANTS

APPENDIX B: FUNDING RANGES

APPENDIX C: ASSURANCES

HRSA-20-078 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding for the Ending the HIV Epidemic: A Plan for America — Ryan White HIV/AIDS Program (RWHAP) Parts A and B as administered by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) in conjunction with the existing RWHAP Parts A and B funding.

The purpose of this initiative is to focus resources in 48 counties, Washington, D.C., San Juan, Puerto Rico (PR), and seven states (hereafter referred to as “jurisdictions” and listed in Appendix A) to implement effective and innovative strategies, interventions, approaches, and services to reduce new HIV infections in the United States. The overarching goal for this initiative is to reduce new HIV infections in the United States to less than 3,000 per year by 2030.

The Ending the HIV Epidemic: A Plan for America (hereafter referred to as the “initiative”) has four pillars, or key strategies:

• Pillar One: Diagnose all people with HIV as early as possible;

• Pillar Two: Treat people with HIV rapidly and effectively to reach sustained viral suppression;

• Pillar Three: Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs); and

• Pillar Four: Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.

HRSA and the Centers for Disease Control and Prevention (CDC), along with the National Institutes of Health (NIH) Centers for AIDS Research (CFARs), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA) are collaborating on the implementation of each of these Pillars. At the most general level:

• Pillar One is led by CDC and, among many activities, includes working with the HRSA Health Center Program to increase testing among Health Center Program patients;

• Pillar Two is led by HRSA and focuses on providing access to HIV care and treatment through the RWHAP and the Health Center Program, including working with CDC funded organizations and/or CDC staff to link people with HIV, newly diagnosed or re-identified through testing programs, to care;

• Pillar Three is co-led by CDC and HRSA with the HRSA Health Center Program focusing on providing PrEP related outreach, care coordination, medical services and medications supported by CDC efforts to promote PrEP among populations needing PrEP services as well as other prevention activities, such as syringe services programs (SSPs); and

• Pillar Four is led by CDC to rapidly detect HIV clusters and networks with support from the HRSA RWHAP and Health Center Program to provide HIV care and treatment or PrEP services through the Health Center Program, as applicable.

https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis https://bphc.hrsa.gov/

HRSA-20-078 2

This HRSA HAB initiative is authorized under Section 311(c) of the Public Health Service Act, (42 U.S.C. § 243(c)) and title XXVI, (42 U.S.C. § 300ff-11 et seq.), with the funding to be used in conjunction with the RWHAP. As such, there is the opportunity for RWHAP programs funded under this announcement to have a broader approach to addressing HIV in their communities than what exists in services authorized by the RWHAP legislation. For example, for this initiative, the only requirement for determining eligibility for service provision is that the individual has a documented HIV diagnosis;

there is no requirement that individuals meet RWHAP eligibility requirements. In addition, funded recipients are not limited to using the RWHAP service categories for this initiative. Recipients are encouraged to be innovative and creative as they design ways to use these funds to end the HIV epidemic in their jurisdictions. (See Funding Restrictions section on page 21 for more information).

Proposed activities may include, but are not limited to: increasing organizational capacity; information dissemination and public outreach; community engagement;

implementation of emerging practices, evidence-informed and/or evidenced-based interventions, particularly around linkage to care, retention in care, reengagement in care, and adherence counseling; the provision of needed client services; and data infrastructure development and systems linkages.

Applicants must describe how proposed activities will address Pillar Two (Treat), including:

• Expanding access to HIV care and treatment in the focus jurisdictions for people with HIV, both those who are newly diagnosed and those who are not engaged in care, and/or not virally suppressed; and

• Addressing unmet needs and improving client-level health outcomes.

Applicants must also describe how proposed activities support Pillar Four (Respond), to respond quickly to HIV cluster detection efforts for those people with HIV needing HIV care and treatment.

Funded recipients will use these initiative resources in conjunction with the RWHAP Parts A and B systems of HIV care and treatment to develop, implement, and/or enhance innovative approaches to engaging people with HIV who are newly diagnosed, not in care, and/or not virally suppressed. In addition, the recipients will provide rapid access to a comprehensive continuum of high quality care and treatment services. All funded recipients will be required to collaborate with the recipients of HRSA-20-079 Ending the HIV Epidemic: A Plan for America – Technical Assistance Provider (TAP) and HRSA-20-089 Ending the Epidemic: A Plan for America – Systems Coordination Provider (SCP). The purpose of the TAP is to provide technical assistance to you on implementation of work plan activities, innovative approaches, and interventions. The purpose of the SCP is to assist you in coordinating your initiative planning, funding sources, and programs with the existing HIV care delivery systems. In addition, the SCP will assist in the identification of existing and new stakeholders, as well as collate and disseminate best practices, innovative approaches, and interventions identified by the TAP that facilitate the success of the initiative.

HRSA-20-078 3

2. Background

This program is authorized by Public Health Service Act, Section 311(c) (42 USC 243(c)) and title XXVI (42 U.S.C. §§ 300ff-11 et seq.). For more information about RWHAP and the different program parts, please visit the Health Resources and Services Administration (HRSA) website: http://hab.hrsa.gov/.

Ending the HIV Epidemic: A Plan for America In February 2019, the Administration announced a new initiative, Ending the HIV Epidemic: A Plan for America. This 10-year initiative beginning FY 2020 seeks to achieve the important goal of reducing new HIV infections in the United States to less than 3,000 per year by 2030. The first phase of the initiative will focus on 48 counties, Washington, D.C., San Juan, PR, and 7 states that have a substantial rural HIV burden.

By focusing on these jurisdictions in the first phase of the initiative, the U.S. Department of Health and Human Services (HHS) plans to reduce new HIV infections by 75 percent within 5 years. Across the United States, the initiative will promote and implement the four Pillars to substantially reduce HIV transmissions – Diagnose, Treat, Prevent, and Respond. This NOFO focuses on implementing activities in Pillar Two (Treat) and Pillar Four (Respond). The initiative is a collaborative effort among key HHS agencies, primarily HRSA, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

National HIV/AIDS Strategy: Updated to 2020 The National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS 2020) is a 5-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 people with HIV;

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 to ensure that people with HIV are linked to and retained in high quality HIV care, and have timely access to HIV treatment and the supports needed (e.g., mental health and substance use disorders services) to achieve HIV viral suppression.

HIV Care Continuum Diagnosing people with HIV, linking people with HIV to HIV primary care, and people with HIV 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 that include: HIV diagnosis, linkage to care, retention in care, antiretroviral use, and viral suppression. The HIV care continuum depicts a series of stages in which people with HIV engage in HIV care: from initial diagnosis through their successful treatment with HIV medication. It also demonstrates the proportion of individuals living http://hab.hrsa.gov/ https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html https://www.hhs.gov/blog/2019/02/05/ending-the-hiv-epidemic-a-plan-for-america.html

HRSA-20-078 4

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.

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.

According to recent data from the 2017 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2010 to 2017, 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 85.9 percent;

additionally, racial/ethnic, age-based, and regional disparities have decreased.1 These improved outcomes mean more people with HIV in the United States will live near normal lifespans and have a reduced risk of transmitting HIV to others.2 Scientific advances have shown antiretroviral therapy (ART) preserves the health of people with HIV and 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 people with HIV into care, retaining them in care, and helping them adhere to their ART.

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 (e.g., Data-to-Care activities, cluster and outbreak investigation). HRSA strongly encourages RWHAP Part A and B 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 other programs that include or provide services to people with HIV 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 improve the initiative by helping to

1 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2017. http://hab.hrsa.gov/data/data-reports. Published December 2018. Accessed April 1, 2019.

2 National Institute of Allergy and Infectious Diseases (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.

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2017.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 http://www.cdc.gov/nchhstp/programintegration/docs/pcsidatasecurityguidelines.pdf http://hab.hrsa.gov/data/data-reports https://clinicaltrials.gov/

HRSA-20-078 5

ensure coordinated efforts to promote engagement in care, respond to HIV clusters, and by providing improved ability to monitor and evaluate interventions.

To fully benefit from integrated data sharing, analysis, and utilization, HRSA strongly encourages complete CD4, viral load (VL) and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems. State and health departments may use CD4, VL, and nucleotide sequence data to identify cases, stage of 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 HIV care, measure viral suppression, monitor prevalence of antiretroviral drug resistance, detect transmission clusters and understand transmission patterns, and assess unmet health care needs. Analyses at the national level to monitor progress toward ending the HIV epidemic can only occur if all HIV-related CD4, VL, and HIV nucleotide sequence test results are reported by all jurisdictions. CDC requires the reporting to the National HIV Surveillance System (NHSS) all HIV-related CD4 results (counts and percentages), all VL results (undetectable and specific values), and HIV nucleotide sequences.

Minority HIV/AIDS Funds from the HHS Secretary’s Office, HAB Technical Assistance, and Special Projects of National Significance (SPNS) Program Through Minority HIV/AIDS Funds from the HHS Secretary’s Office and through HAB Technical Assistance Cooperative Agreements, HRSA HAB has a number of projects that may be useful for initiative-funded jurisdictions to consider. Some select examples are:

• Building Futures: Supporting Youth Living with HIV at https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv

• The Center for Engaging Black MSM Across the Care Continuum (CEBACC) at https://targethiv.org/cebacc

• E2i: Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV at https://targethiv.org/e2i

• Using Community Health Workers to Improve Linkage and Retention in Care at https://targethiv.org/chw

Below are additional examples for specific populations, co-morbidities, and program areas: https://targethiv.org/help/ta-directory.

Through its SPNS Program, HRSA HAB funds demonstration project initiatives focused on the development of effective interventions to respond quickly to emerging needs of people with HIV receiving assistance under the RWHAP. Through these demonstration projects, 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 people with HIV. All initiative recipients are encouraged to review and integrate a variety of SPNS evidence-informed tools within their initiative plans and identified needs/activities. SPNS related tools may be found at the following locations:

• Integrating HIV Innovative Practices (IHIP) (https://targethiv.org/ihip) https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv https://targethiv.org/cebacc https://targethiv.org/e2i https://targethiv.org/chw https://targethiv.org/help/ta-directory https://targethiv.org/ihip

HRSA-20-078 6

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://targethiv.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 people with HIV.

• Dissemination of Evidence-Informed Interventions (https://www.targethiv.org/library/dissemination-evidence-informed-interventions) The Dissemination of Evidence-Informed Interventions initiative runs from 2015– 2020 and disseminates four adapted linkage and retention interventions from prior SPNS and the Minority HIV/AIDS Funds from the HHS Secretary’s Office 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 (CATIs) that are replicable, cost-effective, capable of producing optimal HIV care continuum outcomes, and easily adaptable to the changing health care environment.

Manuals are currently available at the link provided and will be updated on an ongoing basis.

II. Award Information

1. Type of Application and Award

Type(s) 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 involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

HRSA program involvement will include:

• Providing the expertise of HAB personnel and other relevant resources to support the efforts of the initiative activities;

• Facilitating partnership and communication with other federal agencies, particularly CDC, to improve coordination efforts;

• Facilitating collaboration with the TAP and SCP to assist in the development, implementation, coordination, and integration of initiative activities;

https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care https://www.targethiv.org/library/dissemination-evidence-informed-interventions https://www.targethiv.org/library/dissemination-evidence-informed-interventions

HRSA-20-078 7

• Participating in the design and direction of the strategies, interventions, tools, and processes to be established and implemented for accomplishing the goals of the cooperative agreement;

• Approving uses of funds outside of existing allowable RWHAP costs and service categories;

• Providing ongoing review of the establishment and implementation of activities and measures for accomplishing the goals of the cooperative agreement;

• Participating, as appropriate, in conference calls and meetings that are conducted during the project period of the cooperative agreement;

• Reviewing and concurring with all information products prior to dissemination;

and

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

The cooperative agreement recipient’s responsibilities will include:

• Completing proposed initiative work plan activities within the five-year project period;

• Collaborating with HRSA on review of activities, procedures, and budget items, including timely communication with project officer;

• Developing and implementing a methodology, including proposed metrics, to measure the impact of proposed activities, as well as reporting on outcomes;

• Ensuring proposed activities are based on documented need, targeted for maximum impact on HIV care continuum outcomes, and designed to reach the identified target population(s);

• Coordinating the initiative activities with their existing RWHAP programs;

• Collaborating with CDC funded organizations, health centers, and other local and state government agencies on implementing initiative activities;

• Collaborating with the TAP and SCP on the development, implementation, coordination, and integration of initiative activities;

• Developing a sustainability plan to support successful activities following conclusion of the cooperative agreement;

• Modifying activities as necessary to ensure relevant outcomes for the project;

and

• Participating in the dissemination of project findings, best practices, and lessons learned, including adherence to HRSA guidelines pertaining to acknowledgment and disclaimer on all products produced by HRSA award funds.

2. Summary of Funding

HRSA expects approximately $55,125,000 to be available in FY2020 to fund 47 recipients. For FY2020, you may apply for an amount within the range published in Appendix B (including both direct and indirect, facilities and administrative costs). The actual amount available will not be determined until enactment of the final FY 2020 federal appropriation. 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. In the event that the FY 2020 appropriation or other statute fails to authorize this activity, no

HRSA-20-078 8

awards will be made. Final award amounts may be less than you requested.

The period of performance is March 1, 2020 through February 28, 2025 (5 years).

Funding is subject to the availability of appropriated funds for the Ending the HIV Epidemic: A Plan for America — Ryan White HIV/AIDS Program Parts A and B.

Funding availability in subsequent fiscal years will be determined by satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government. The amount available, in addition to the ceiling amounts stated, is based on current projections. It is anticipated that the total annual amount available over the five year period of performance could increase from $55 million to an amount that achieves the initiative’s 5-year goal of a 75 percent reduction in new HIV infections and provides sufficient resources to address social determinants of health such as housing and behavioral health for the newly diagnosed, not virally suppressed, or not yet engaged in HIV care. Applicants should submit the Years 2 – 5 work plans and proposed budgets accordingly. Future year ceiling and award amounts may be adjusted to reflect any changes. Also, the Notice of Award (NOA) will list funding amounts as they become available. HRSA requires the recipient to submit a revised budget and work plan to appropriately reflect the actual funding amounts provided in the NOA. Recipients that successfully increase the number of people with HIV who are newly diagnosed, reengaged in care, and/or virally suppressed may receive an additional performance-based bonus.

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

Eligible applicants are:

• RWHAP Part A funded Eligible Metropolitan Areas (EMAs) or Transitional Grant

Areas (TGAs) whose service area includes one or more of the identified 48 HIV high burden counties; and the EMAs of Washington, D.C. and San Juan, PR.

• RWHAP Part B funded States/Territories identified as having a substantial rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina.

• The RWHAP Part B Program of the State of Ohio on behalf of Hamilton County.

See Appendix A for a complete list of eligible applicants.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

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

HRSA-20-078 9

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, 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. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including clarifications, modifications and/or republications of 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 the 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

HRSA-20-078 10

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 40 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 workspace application package do not count in the page limit. 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 be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You, on behalf of the applicant organization, certify, by submission of your proposal, that neither you nor your principals are 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 you are 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. Project Abstract See Section 4.1.ix of HRSA’s SF-424 Application Guide.

In addition to the requirements listed in the SF-424 Application Guide, please indicate the project title as “Ending the HIV Epidemic: A Plan for America — Ryan White HIV/AIDS Program Parts A and B” and include the following information:

• A summary of the proposed activities which may include: increasing organizational capacity; information dissemination and public outreach;

community engagement; implementation of emerging practices, evidence-informed and/or evidenced-based interventions particularly around rapid linkage to care, retention in care, reengagement in care, and adherence counseling; the provision of RWHAP core medical and/or support services; and data infrastructure development and systems linkages.

• A description of the intended impact (e.g. how the activities will engage people with HIV who are not in care and/or not virally suppressed and provide rapid http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

HRSA-20-078 11

access to a comprehensive continuum of high quality care and treatment services for people with HIV who are newly diagnosed and re-engaged in care).

• The funding amount requested for the five-year period of performance. The request should project, over the period of performance, how much funding will be needed to identify and bring into and retain in care a substantial number of new or re-engaged clients. These projections should include sufficient resources to address social determinants of health such as housing and behavioral health for the newly diagnosed, not virally suppressed, or not yet engaged in HIV care.

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, 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

Briefly describe the proposed project and the target populations of people with HIV who reside in the focus jurisdictions. Include a description of how the proposed activities will address the goal of the initiative by significantly reducing new HIV infections in the focus jurisdictions by 75 percent within the five-year period of performance. Also, briefly describe how you will use initiative resources in conjunction with RWHAP Parts A and B system of HIV care and treatment to achieve this goal.

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

The purpose of this section is to demonstrate the target population(s) of people with HIV who reside in the focus jurisdictions to be served, existing gaps and unmet needs in services, collaborations needed to engage in care and to achieve viral suppression in target populations, and barriers to track progress toward meeting the goals of the initiative.

• Identify and briefly describe the specific target population(s) for this initiative, providing the source of and brief highlights/summary of the data used to determine each population.

• Within the context of your current health care landscape (inclusive of Integrated Plans and existing ending the HIV epidemic plans), identify and briefly discuss any service gaps, barriers, and unmet needs with regard to rapidly engaging and retaining, treating HIV infection, and achieving sustained viral suppression for the target populations (including services to address social determinants of health, as relevant). Also identify and briefly discuss any additional infrastructure and capacity issues that negatively affect your ability to track and/or serve these target populations.

• Describe existing need for, and any current or potential challenges to, collaborating with other relevant partners/providers/agencies to identify, link, engage, retain, and achieve viral suppression for the target populations.

HRSA-20-078 12

METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 Response Provide detailed information regarding the proposed methods that you will use to address the stated needs described in the needs assessment section. Also, include a description of the specific methods you will use to implement the proposed activities in the work plan. Proposed methods must address Pillar Two (Treat) of the initiative, including expanding access to HIV care and treatment for people with HIV in the jurisdiction who are newly diagnosed, not engaged in care, and/or not virally suppressed, addressing barriers and unmet needs, and improving client-level health outcomes. Recipients must also describe how proposed methods support Pillar Four (Respond), to respond quickly to HIV cluster detection efforts for those people with HIV needing HIV care and treatment.

As was noted in the Purpose section, the initiative is authorized under Section 311(c) of the Public Health Service Act, (42 USC 243(c)) and title XXVI, (42 U.S.C.

§ 300ff-11 et seq.). As such, there is the opportunity for funded recipients to have a broader approach to addressing HIV in their communities than exists in services authorized by the RWHAP legislation. You are encouraged to propose methods that are innovative and creative; the methods are not limited to the current RWHAP service categories or eligibility requirements (except for an HIV diagnosis), and there is no requirement to spend at least 75 percent of the award on core medical services.

You should ensure that methods build upon existing strategic plans such as the Ending the HIV Epidemic Plan (based on the guidance that will be provided by the CDC), the Integrated HIV Prevention and Care Plan, and community needs assessments. Overall, you are asked to ensure that methods are consistent with other plans that you will submit for all aspects of your Ending the HIV Epidemic involvement. In addition, provide information regarding collaboration and coordination efforts, including people with HIV involvement, and sustainability plans as follows:

• Collaboration and Coordination: Describe how you will collaborate and/or coordinate with organizations to address the barriers identified in the needs assessment section. Describe how you will build, expand and/or maintain effective strategic partnerships with new and existing key providers within your community, including key points of entry, other RWHAP funded programs including the AIDS Drug Assistance Program (ADAP), Community Health Centers (CHCs), CDC-funded entities, State Medicaid Programs, Housing Opportunities for Persons With AIDS (HOPWA)-funded entities, IHS-funded entities, SAMHSA-funded entities and other mental health and addiction providers, correctional facilities, and other providers and stakeholders outside of your current network that serve and support the target populations, to carry out the proposed activities. Identify the tasks each partner proposes to perform and the amount of funding, if any, you expect to allocate to the partner. Describe how people with HIV who represent the target populations and/or organizations that represent them will be engaged in the implementation of this project, including decision-making activities. Include letters of support and/or letters of commitment

HRSA-20-078 13

from each partner and/or collaborating entity stating their concurrence with the proposed project as Attachment 4.

• Sustainability: Describe how you will continue efforts to end the HIV epidemic in your focus jurisdictions after the period of federal funding ends.

Include a description of how you will balance efforts to have immediate impact with efforts to establish longer-term and more sustainable interventions. In addition, describe how you intend to share or disseminate strategies or services and interventions that have been effective and that have led to improved outcomes in the target population.

WORK PLAN -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact A work plan is a concise easy-to-read overview of your goals, strategies, objectives, activities, timeline, and staff responsible for implementing the project.

You must submit the detailed work plan for the five-year period of performance of March 1, 2020 – February 28, 2025. Your work plan activities should directly relate to Pillars Two and Four of the initiative as outlined in the Ending the HIV Epidemic Plan. The CDC will provide you additional guidance about the Ending the HIV Epidemic plans. Activities should also correspond to your proposed budget for each year of the five-year period of performance. Recipients should consider the relative costs of seeking out the hardest to reach populations, and the likely effect on the budget in later years.

Describe each activity’s goal, specify the objectives, and identify the key action steps that you will use to achieve the proposed activity. Use a timeline that includes each step of the proposed activity, target date for completion, and identifies staff (or partner) responsible for the activities. Identify the measures you will use to evaluate success, including measures that align with initiative data/indicators. Include meaningful support and collaboration with key partners as indicated in the Methodology section. As noted earlier, the amount available, in addition to the ceiling amounts stated, are based on current projections. In the event that additional funding is made available in the future, future year ceiling and award amounts may be adjusted to reflect any changes. Please reflect the increasing activity resulting from these increased funds in Years 2 through 5 of the work plan. Please provide the above information in a table format. Submit the work plan as Attachment 1.

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 the proposed methods described in the methodology section. Identify and describe the approaches that you will use to resolve such challenges. Identify any potential need for technical assistance from the TAP and SCP as described in HRSA-20-079 and HRSA-20-089. Also, describe any proposed resolutions to the barriers described in the Needs Assessment section.

HRSA-20-078 14

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria #3 Evaluative Measures and #5 Resources/Capabilities The purpose of this section is to describe current experience, skills, and knowledge, including individuals on staff, and current and previous work implemented to address the HIV epidemic.

1) Program Infrastructure

• Describe the current or proposed information system capabilities and the methods that will collect, manage, and analyze data (e.g., assigned skilled staff, data management software).

• Describe the systems and processes that will support your organization’s monitoring of the proposed initiative activities, including performance outcomes.

• Describe your capacity to measure and report on a timely and regular basis the following data associated with the initiative Pillars Two and Four:

o Pillar Two (Treat): Describe how you will identify the people with HIV who are newly diagnosed, not engaged in care, and/or not virally suppressed.

o Pillar Four (Respond): Describe how you will coordinate with HIV cluster detection efforts to:

1) Provide data needed for cluster detection, e.g., notable increase in new diagnoses, and

2) Provide data on referrals, retention, and health outcomes for people with HIV identified through cluster detection efforts.

2) Data Collection and Management

• Describe how you will coordinate data collection and exchange with multiple partner sites and with the HIV surveillance system.

• Describe how you will routinely assess data quality and coordinate data quality remediation activities with partner sites.

• Describe the data collection, data review, and data submission processes that will be in place to collect data elements as outlined in the initiative Pillars Two and Four, and meet the reporting requirements as outlined in this NOFO.

Applicants should discuss any anticipated challenges, capacity building needs, and technical assistance needed to meet data collection requirements.

3) Project Evaluation:

• Describe the evaluation plan you will use to monitor the development, implementation, and outcomes of the project activities. Include a description of the proposed metrics you will use to assess the effectiveness of initiative project activities.

HRSA-20-078 15

• Describe the process you will use to measure impact of the program.

Include a description of data use agreements necessary to share data to successfully achieve the goals of the initiative.

• Describe your plans to monitor progress towards completion of stated goals and objectives of the initiative. Explain how you will use data to inform the project and/or infrastructure development, identify new and/or out of care clients, improve service delivery and viral suppression rates, and track and report infrastructure/system development and overall health outcomes.

• Describe any potential obstacles for implementing the program performance evaluation and plans to address those obstacles.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 Resources/Capabilities In this section, provide three major elements: 1) an organizational description and chart,

2) management and staffing expertise, and 3) key partnerships.

• Organizational Description and Chart: Provide an organizational profile and project organizational chart, as Attachment 5. The organizational profile should include significant collaborative partners, key personnel, budget, and other resources. The organizational chart should be a one-page figure that depicts the primary organizational structure of the initiative (not the entire organization) and identified subrecipients/significant collaborators for this initiative.

• Management and Staffing Expertise: Highlight key staff, partners and collaborators with relevant expertise and experience with similar work. This may include short-term dedicated staff time to plan for, lead, coordinate, initiate, and sustain the initiative activities related to efforts aimed at identifying individuals with a new HIV diagnosis and reengaging people with HIV who are not virally suppressed. This information should align with the staffing plan provided in Attachment 2 and the biographical sketches of key personnel provided in Attachment 3. Include any potential obstacles for hiring additional staff for initiative activities and solutions for overcoming such barriers.

• Key Partnerships: Describe the expertise of partners and collaborators discussed in the Methodology section, including their experience providing HIV care and treatment, and conducting outreach to engage target populations for this initiative. Specifically address how their knowledge will assist you in addressing the proposed activities for Pillar Two (Treat) and/or Pillar Four (Respond). As stated in the Needs Assessment section, describe your plan to address current or potential challenges for building new partnerships or connecting with existing programs who can implement initiative activities.

Discuss how your organization will follow the approved work plan, as outlined in the application.