PKG00264000-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HIV/AIDS Bureau Division of Community HIV/AIDS Programs

Ryan White HIV/AIDS Program Part D -- Women, Infants, Children, and Youth (WICY) Grants Supplemental Funding

Funding Opportunity Number: HRSA-21-059

Funding Opportunity Type: Competing Supplement Assistance Listings (CFDA) Number: 93.153

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: January 12, 2021

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 6, 2020

Monique G. Hitch, MSHA, MA Chief, Central Branch Telephone: (301) 443-3944 Fax: (301) 443-1839 Email: MHitch@hrsa.gov

Authority: 42 USC §§ 300ff-71 and 300ff-121 (§§ 2671 and 2693 of the Public Health Service Act).

mailto:MHitch@hrsa.gov

HRSA-21-059 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Ryan White HIV/AIDS Program (RWHAP) Part D Women, Infants, Children, and Youth (WICY) Grants Supplemental Funding. The purpose of this supplemental funding is to strengthen organizational capacity to respond to the changing health care landscape and increase access to high quality family-centered HIV primary health care services for low income, uninsured, and underserved WICY with HIV.

Funding Opportunity Title: Ryan White HIV/AIDS Program Part D

Women, Infants, Children, and Youth (WICY) Grants Supplemental Funding

Funding Opportunity Number: HRSA-21-059 Due Date for Applications: January 12, 2021

Anticipated Total Annual Available FY 2021 Funding:

$3,000,000.00

Estimated Number and Type of Award(s): Up to 25 grant awards Estimated Award Amount: Up to $150,000 per year Cost Sharing/Match Required: No Period of Performance: August 1, 2021 through July 31, 2022

(1 year) Eligible Applicants: This funding opportunity is limited to currently funded RWHAP Part D WICY recipients.

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

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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 (TA):

Day and Date: Thursday, December 3, 2020 Time: 2 p.m. – 4 p.m. ET Call-In Number: 1-888-810-4794 Participant Code: 5350312 Weblink: https://hrsa.connectsolutions.com/rwhap-part-d-wicy-sf-ta/

The webinar will be recorded and should be available for viewing at least two weeks following the TA webinar at https://targethiv.org/library/nofos.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/rwhap-part-d-wicy-sf-ta/ https://targethiv.org/library/nofos

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Table of Contents I. Program Funding Opportunity Description

1. PURPOSE

2. BACKGROUND

II. Award Information

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. Eligibility Information

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION and Submission Information

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

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

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEM ENT (SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. Application Review Information

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. Award Administration Information

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. Agency Contacts

VIII. Other Information

HRSA-21-059 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Ryan White HIV/AIDS Program (RWHAP) Part D Women, Infants, Children, and Youth (WICY) (RWHAP Part D WICY or RWHAP Part D) Grants Supplemental Funding for fiscal year

(FY) 2021.

The purpose of this supplemental funding is to strengthen organizational capacity to respond to the changing health care landscape and increase access to high quality, family-centered HIV primary health care services for low income, uninsured, and underserved WICY with HIV.

HRSA intends funding under this program to support one short-term activity that can be completed by the end of the one-year period of performance. You may propose an expansion of an activity previously supported under FY2019 or FY2020 RWHAP Part D Supplemental (HRSA-19-026; HRSA-20-068) or Part C Capacity Development funding (HRSA-19-031; HRSA-20-067) for either an HIV Care Innovation or Infrastructure Development activity; however, HRSA will not fund the same activity in FY 2021 as HRSA funded previously in FY2019 or FY2020. If the proposed project is an expansion of a previously funded activity, you must provide a clear rationale for how the proposed activity builds upon and furthers the objectives of the previously funded HIV Care Innovation or Infrastructure Development activity. You may select only one (1) activity under the selected category.

HIV Care Innovation HIV Care Innovation activities support progress along the HIV care continuum to improve the health and increase the life span of people with HIV, and prevent new infections. There are five (5) activities from which to choose. If applying under this category, select only one of the five activities listed below:

• Community Health Workers

• Intimate Partner Violence Screening & Counseling

• Rapid Antiretroviral Therapy (ART)

• Transitioning Youth into Adult HIV Care

• Youth Stable Housing Collaboration

Infrastructure Development Infrastructure Development activities support organizational development and will increase the capacity of organizations to respond to changes in the health care environment. There is only one activity to choose.

Telemedicine

Collectively, activities will allow RWHAP Part D programs to better align with priority areas for the Department of Health and Human Services (HHS) and the Health https://www.hrsa.gov/grants/find-funding/hrsa-19-026 https://www.hrsa.gov/grants/find-funding/hrsa-20-068 https://www.hrsa.gov/grants/find-funding/hrsa-19-031 https://www.hrsa.gov/grants/find-funding/hrsa-20-067

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Resources and Services Administration (HRSA), including investing in addressing the opioid crisis, mental health, and promoting collaboration. The selected activity should target populations that are disproportionately impacted by the HIV epidemic and experience adverse health outcomes. Successful applicants will demonstrate your organization’s intent and ability to sustain proposed HIV Care Innovation activities or proposed Infrastructure Development enhancements without additional federal funds beyond the one-year period of performance. Furthermore, successful applicants will demonstrate that the proposed activity will strengthen organizational capacity to respond to the changing health care landscape and increase access to high-quality HIV primary health care services for low income, uninsured, and underserved people with

HIV.

2. Background

This program is authorized by 42 USC §§ 300ff-71, and 300ff-121, (§§ 2671 and 2693 of the Public Health Service (PHS) Act). For more information about the RWHAP, please visit the HRSA website: https://hab.hrsa.gov/.

The RWHAP funds direct health care and support services for over half a million people diagnosed with HIV in the United States. HRSA awards RWHAP funds to cities, states, and local community-based organizations to deliver efficient and effective HIV care, treatment, and support services for low-income people with HIV. Since the program’s inception in 1990, RWHAP has developed a comprehensive system of safety net providers who deliver high-quality, innovative HIV health care.

The RWHAP has five statutorily defined Parts (Parts A through D and Part F) that provide funding for core medical and support services, technical assistance (TA), clinical training, and the development of innovative models of care to meet the needs of different communities and populations affected by HIV.

HRSA established the RWHAP Part D program as a mechanism to provide care, support, and access to research opportunities for low income, uninsured, and underserved WICY with HIV, including infants exposed to HIV. As advances in the treatment of HIV have been made, most notably, the testing and treatment to prevent mother to child transmission, the needs of women and children with HIV have evolved.

However, HIV infection rates and health disparities remain significant among youth aged 13-24 years.

The Strategic Framework

The RWHAP supports the implementation of the National HIV/AIDS Strategy for the United States: Updated 2020 (NHAS 2020). This strategy is a 5-year plan that details principles, priorities, and actions to guide the national response to the HIV epidemic.

The plan also provides a blueprint for collective action across the federal government and other sectors to help achieve the strategy’s vision.

To ensure that RWHAP aligns with the National HIV/AIDS Strategy, to the extent possible, activities funded by the program focus on addressing the plan’s four goals:

https://hab.hrsa.gov/

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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, within the parameters of the RWHAP statute and program guidance, to ensure that people with HIV are linked to and retained in care, and have timely access to HIV treatment and the support services needed (e.g., mental health and substance use disorders services) to achieve HIV viral suppression. The RWHAP also provides technical assistance and training initiatives and promotes the effective use of data to enhance recipients’ capacity to implement programs that support the strategy’s objectives.

Expanding the Effort: Ending the HIV Epidemic: A Plan for America

In February 2019 the Administration launched the Ending the HIV Epidemic: A Plan for America (EHE) initiative to further expand federal efforts to reduce HIV infections. This 10-year initiative which began in FY 2020 seeks to achieve the important goal of reducing new HIV infections in the United States to fewer than 3,000 per year by 2030.

The first phase of the initiative is focused 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 five years. The initiative promotes and implements four strategies to substantially reduce HIV transmissions – Diagnose, Treat, Prevent, and 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).

HIV Care Continuum

Diagnosing and linking people with HIV to primary care, and ensuring people with HIV achieve viral suppression are important public health steps toward ending the HIV epidemic in the United States. The HIV care continuum has five main stages that include: HIV diagnosis, linkage to care, retention in care, antiretroviral use, and viral suppression. The HIV care continuum provides a framework that depicts the series of stages a person with HIV engages in from initial diagnosis through their successful treatment with HIV medication. It also demonstrates the proportion of individuals 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.

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

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According to recent data from the 2018 Ryan White Services Report (RSR), the RWHAP has made tremendous progress toward ending the HIV epidemic in the United States. From 2014 to 2018, 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 81.4 percent to 87.1 percent.

Additionally, racial/ethnic, age-based, and regional disparities reflected in viral suppression rates 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 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.

Using Data Effectively: 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, conducting needs assessments, determining unmet need estimates, reporting, quality improvement, enhancing the HIV care continuum, and public health action. HRSA strongly encourages RWHAP Part D 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 data sharing, analysis, and utilization of HIV data by state and territorial health departments can help further progress toward reaching the NHAS 2020 goals and improve outcomes on the HIV care continuum.

HRSA strongly encourages complete CD4, viral load (VL) and HIV nucleotide sequence reporting to the state and territorial health departments’ HIV surveillance systems to benefit fully from integrated data sharing, analysis, and utilization. State 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

1 Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2018. http://hab.hrsa.gov/data/data-reports. Published December 2019. Accessed December 2, 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.

https://hab.hrsa.gov/sites/default/files/hab/data/datareports/RWHAP-annual-client-level-data-report-2018.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/

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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.

Program Resources and Innovative Models

Through the Minority HIV/AIDS Fund from the HHS Secretary’s Office (MHAF) and HAB technical assistance (TA) cooperative agreements, HRSA has a number of projects that may be useful for RWHAP recipients to assist with program implementation. 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

Through HAB’s Special Projects of National Significance (SPNS) Program, HRSA funds demonstration projects focused on the development of effective interventions to respond quickly to emerging needs of people with HIV that receive assistance under the RWHAP. Through these demonstration projects, SPNS evaluates the design, implementation, utilization, cost, and health related outcomes of innovative treatment models. Evaluating these models enables HRSA to identify successful interventions that can be replicated and disseminated nationally. SPNS findings have demonstrated promising new approaches for linking and retaining into care underserved and marginalized people with HIV. As resources permit RWHAP recipients are encouraged to review and integrate 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. SPNS related tools may be found at the following locations:

• Integrating HIV Innovative Practices (IHIP) (https://targethiv.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 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.

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://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://targethiv.org/ihip

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• 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://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 (MHAF) 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 healthcare environment. Manuals are currently available at the link provided and will be updated on an ongoing basis.

Clinical Quality Management Section 2671(f)(2) of the Public Health Service Act requires RWHAP Part D recipients to implement a Clinical Quality Management (CQM) program to: (1) assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent HHS Guidelines for the treatment of HIV/AIDS and related opportunistic infections, and (2) as applicable, to develop strategies for ensuring that such services are consistent with the HHS guidelines for improvement in the access to and quality of HIV health services. Please see Policy Clarification Notice 15-02 Clinical Quality Management for information on CQM program requirements.

II. Award Information

1. Type of Application and Award

Type of applications sought: Competing Supplement.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $3,000,000 to be available to fund up to 25 recipients.

You may apply for a ceiling amount of up to $150,000 total costs (includes both direct and indirect, facilities and administrative costs). The actual amount available will not be determined until enactment of the final FY 2021 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. The period of performance is August 1, 2021, through July 31, 2022 (1 year).

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://targethiv.org/library/dissemination-evidence-informed-interventions https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters

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HRSA will only fund one activity per recipient. HRSA will not fund the same activity in FY 2021 that HRSA funded previously in FY 2019 or FY 2020. However, applicants may propose an expansion of an activity previously supported under FY2019 or FY2020 RWHAP Part D Supplemental funding (HRSA-19-026; HRSA-20-068) or Part C Capacity Development funding (HRSA-19-031; HRSA-20-067) for either an HIV Care Innovation or Infrastructure Development activity. You must present a clear rationale for how the proposed activity builds upon and furthers the objectives of the previously funded activity.

If you apply for funding under this NOFO, and should you also apply and are awarded funding under HRSA-21-058 (RWHAP Part C Capacity Development Program), you must be able to demonstrate the ability to administer multiple federal awards (if successful) and ensure adequate quality controls, staffing, and impartiality when prioritizing the needs of the programs. HRSA does not allow duplication of funded activities.

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

Eligibility is limited to current RWHAP Part D WICY funded recipients.

2. Cost Sharing/Matching

Cost sharing is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount of $150,000 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.

If an application fails to address the programmatic goals and requirements outlined in this NOFO (meet scope), HRSA will not consider it for review or funding under this opportunity.

NOTE: Multiple applications from an organization are not allowable.

https://www.hrsa.gov/grants/find-funding/hrsa-19-026 https://www.hrsa.gov/grants/find-funding/hrsa-20-068 https://www.hrsa.gov/grants/find-funding/hrsa-19-031 https://www.hrsa.gov/grants/find-funding/hrsa-20-067 http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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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 select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

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.

Application Page Limit

The total size of all uploaded files included in the page limit may not exceed the equivalent of 30 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.

Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-059, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit.

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

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Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, 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 7: Other Relevant Documents.

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

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS Programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

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 “FY 2021 RWHAP Part D WICY Supplemental Funding” and include the following information:

Identification of the category (HIV Care innovation or Infrastructure Development) and the selected activity.

A summary of the proposed activity and its intended impact (i.e., how the activity will develop, enhance, or expand access to high quality, family-centered HIV primary http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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care services for low income, uninsured, and underserved WICY with HIV).

The funding amount requested for the one-year period of performance.

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.

See below for a description of the activities that you may select for this funding. You may submit a proposal for only one of the following two categories. You may select only one (1) activity under the selected category.

1) HIV Care Innovation Community Health Workers

Community health workers (CHW) have been successfully deployed to support people with HIV to enhance patient access to care and maintain long-term treatment adherence and retention in care. Historically, the job functions of a CHW in HIV care position titles could include the following: peer navigator; peer, client, or patient advocate; outreach worker; linkage to care worker; psychosocial support worker; or non-medical case management staff. Certification, licensing, and workforce development for CHWs continue to evolve, but a number of state and local CHW accrediting bodies, networks, and associations have adopted the roles and competencies noted by the CHW Core Consensus Project (C3).

If you select this activity, you will expand your organizational capacity to implement, enhance, or expand CHW services to serve the eligible populations identified in your needs assessment. Planned activities should address either the implementation of CHW services into your organization’s RWHAP or an enhancement to your organization’s existing CHW program. Proposed activities should include, but are not limited to, written policies and procedures for CHW services; training and professional development for both CHWs and their immediate supervisors; integration of CHWs into the HIV care team; and CHW’s role in community engagement. You are required to address sustainability beyond the one-year period of performance for any personnel supported by this award. The CHW activities carried out by your program must address one or more of the stages of the HIV care continuum. For resources addressing this topic, including resources for the development of a CHW program in HIV care, access the C3 link above and visit HAB’s TargetHIV site on Using Community Health Workers to Improve Linkage and Retention in Care.

Intimate Partner Violence Screening & Counseling

There has been an increased risk of intimate partner violence (IPV) and other forms of trauma during the COVID-19 pandemic due to factors such as increased stress, sudden shifts in daily routines, and a rapid decrease in available resources. If you select this activity, you should implement IPV screening and counseling in the clinical setting and establish referral networks to community-based social service organizations taking into consideration the impact of https://www.c3project.org/roles-competencies https://hab.hrsa.gov/about-ryan-white-hivaids-program/hiv-care-continuum https://targethiv.org/library/using-community-health-workers-improve-linkage-and-retention-care https://targethiv.org/library/using-community-health-workers-improve-linkage-and-retention-care

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COVID-19 in your communities. The activity must address one or more of the stages of the HIV care continuum. For resources addressing this topic, access the IPV Toolkit (Intimate Partner Violence Health Partners Toolkit) located on the HRSA Office of Women's Health website.

Rapid ART

Effective Rapid ART models include programs that have linked individuals newly diagnosed with HIV to HIV treatment and care, sometimes within the same or next day.3 These pilot projects demonstrated that as a result of Rapid ART initiation, more participants were able to achieve viral suppression in a shorter time period compared with standard-of-care groups. Two other large, randomized controlled trials also demonstrated the optimal time to initiate ART, with a 50 percent reduction in morbidity and mortality among individuals with HIV who were randomized to receive ART immediately versus delaying initiation of ART.

Through the administration of Rapid ART, along with other effective innovative models of care for rapid linkage to and retention in care, HRSA anticipates timely improvements in health outcomes along the HIV care continuum.

If you select this activity you will enhance your organizational capacity to implement or expand Rapid ART services, defined as the provision of antiretroviral medication to eligible people with HIV within seven to ten days of identification (for out-of-care individuals) or diagnosis. Since Rapid ART initiation may be resource-intensive, requiring a multi-disciplinary team to coordinate the multiple steps of a positive test result, counseling, patient transportation, clinical evaluation, intake, accelerated insurance coverage, and ART and other clinic and system-wide system changes (i.e., workforce development or changes in workflows/procedures) are likely needed to assure rapid linkage to care and ART initiation. You must ensure activities leverage existing staff or enhance current collaborations with external organizations in order to provide Rapid ART services.

Transitioning Youth into Adult HIV Care

If you select this activity, you must implement transition planning activities that include, but are not limited to, written policies, procedures, and staff training to assist youth in transitioning from pediatric to adult HIV medical care. Transition planning is an RWHAP Part D Program requirement; therefore, this activity should focus on innovative approaches that build organizational capacity to effectively implement and manage the transition for the youth population (ages 13-24) to adult care and minimize negative impacts of this transition.

Recommended activities should focus on collaborations with pediatric/adolescent programs, including RWHAP Part C Early Intervention Services recipients, to develop a transition process, capacity building to support transition into the adult HIV medical care setting, and a mechanism for post-transition assessment. You should link Implementation efforts to specific evaluative outcome metrics to measure successful transition. The activity must address one or more of the

3 The RAPID ART Program Initiative for HIV Diagnoses (RAPID) in San Francisco. Beacon et al.

Conference on Retroviruses and Opportunistic Infections. Abstract 93. Boston, Massachusetts, March 4- 7, 2018 http://www.croiconference.org/sessions/rapid-art-program-initiative-hiv-diagnoses-rapid-san-francisco https://www.hrsa.gov/about/organization/bureaus/owh/intimate-partner-violence-human-trafficking-community-level https://www.hrsa.gov/office-womens-health http://www.croiconference.org/sessions/rapid-art-program-initiative-hiv-diagnoses-rapid-san-francisco http://www.croiconference.org/sessions/rapid-art-program-initiative-hiv-diagnoses-rapid-san-francisco

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stages of the HIV care continuum. For resources addressing this topic access US National Library of Medicine National Institutes of Health (https://www.ncbi.nlm.nih.gov/pubmed/28754584).

Youth Stable Housing Collaboration (Housing Opportunities for Persons with AIDS (HOPWA), State-Based Programs and other Community Partners) Individuals with HIV who lack stable housing are more likely to delay HIV care, have poorer access to regular care, are less likely to receive optimal antiretroviral therapy, and are less likely to adhere to therapy. A disproportionate number of youth experience homelessness each year in the United States. If you select this activity, you must identify staff to coordinate services/referrals, and draft and implement a Youth Stable Housing Care Plan. You must include other partner organizations to help with this collaborative initiative and create a network of housing and HIV service programs that will employ strategies to reach, engage, support, and house homeless youth. For resources addressing this topic, access the Housing Opportunities for Persons With AIDS (HOPWA) page located on the Department of Housing and Urban Development (HUD) Exchange website.

2) Infrastructure Development Telemedicine

Telehealth technologies can help improve access to quality health care. They have been critical during the COVID-19 pandemic, especially in remote areas, settings that lack sufficient health care services, and in the provision of specialty behavioral health care. HRSA’s Federal Office of Rural Health Policy’s Definition of Telemedicine is “the use of electronic communication and information technologies to provide or support clinical care at a distance.” Included in this definition are patient counseling and case management. The term “telemedicine” also includes clinical activities such as mHealth, telehomecare, remote monitoring, e-health, and tele-ICUs.

If you select this activity, you must develop and acquire, through lease or purchase, computer hardware and software, audio and video equipment, computer network equipment, interactive equipment, data terminal equipment, and other equipment that furthers the objectives of the proposed telemedicine activity. You must describe technology requirements and each type of equipment employed. Include a concise prescription of the relevance to the project, cost-effectiveness, timeliness, accuracy of care, and ease of use. Discuss the telemedicine reimbursement environment and whether Medicare, Medicaid, and/or private insurance in the applicant state(s) cover telemedicine services. For resources addressing this topic, access HRSA’s National Consortium of Telehealth Resource Centers or HRSA Telehealth Programs.

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

https://www.ncbi.nlm.nih.gov/pubmed/28754584 https://www.hudexchange.info/programs/hopwa/ https://www.telehealthresourcecenter.org/%20%20or%20https:/www.hrsa.gov/rural-%20health/telehealth/index.html https://www.telehealthresourcecenter.org/%20%20or%20https:/www.hrsa.gov/rural-%20health/telehealth/index.html https://www.hrsa.gov/rural-health/telehealth

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INTRODUCTION -- Corresponds to Section V’s Review Criteria #1 Need and #2

Response Clearly indicate the activity proposed under either HIV Care Innovation or Infrastructure Development. Briefly describe the purpose of the proposed activity. Clearly indicate the category under which the proposed activity falls: 1) HIV Care Innovation or 2) Infrastructure Development. Discuss why your local community and/or organization is in need of capacity development funds and how the proposed activity will develop, enhance, or expand access to high quality, family-centered HIV primary care services for low income, uninsured, and underserved people with HIV. If the proposed activity is an expansion of a previously funded activity, clearly describe how the proposed activity builds upon and furthers the objectives of the previously funded activity in maximizing impact.

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

Outline the needs of the community and/or organization relative to the selected activity.

For HIV Care Innovation activities, clearly describe and document the target population(s) and their unmet health care needs. More specifically, describe how this targeted population(s) is disproportionately affected by the HIV epidemic and has poor health outcomes. Additionally, describe the service needs based on your evaluation of the gaps in the HIV care continuum for your target population(s) with HIV your organization serves. Provide data on the five stages of the HIV care continuum for your target population(s) with HIV using the most recent three calendar years of available data. You must clearly define the numerator and the denominator for each stage. Use the same numerators and denominators as outlined for the HHS Common HIV Core Indicators.

Regarding Community Health Workers, discuss your organization’s current use of peer navigators, peer outreach, linkage to care, community health workers, or other peer or community-involved service models to increase client linkage, re-engagement, and retention in HIV primary care. If you currently have CHWs, peer navigators, health advocates (etc.) working in your organization, discuss how this activity will enhance your existing CHW program, clinical services, organizational structure, and workflow. If you are planning to add CHWs to your current organizational structure, discuss the planning and integration of this program into the operations and workflow of your current structure. Discuss any professional development and training needs.

Regarding Rapid ART, discuss your organization’s need for capacity development funds to either implement or expand the provision of Rapid ART.

Include a description of your organization’s readiness and ability to implement Rapid ART as a component within your current model of HIV care and treatment services; or, to increase the service capacity of an existing Rapid ART program.

Describe the existing HIV medical and support services currently available to meet the needs of the identified client population. Describe the relevant gaps or barriers in your current service delivery model, including unmet needs, these capacity funds will address for newly diagnosed and out-of-care people with HIV.

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Discuss your organization’s current workflows, including eligibility and intake processes, and how these processes will be revised or adapted to incorporate Rapid ART with the support of these capacity funds.

Include current partnership or community collaborations, such as sources of newly-identified/newly-diagnosed or out-of-care people with HIV, which will be an integral component in successfully implementing Rapid ART immediately upon referral. In addition, identify new partnerships your program may need to establish in order to strengthen capacity to engage hard-to-reach WICY in care and achieve higher levels of viral suppression for these populations.

For the Infrastructure Development telemedicine activity, clearly describe the gaps in organizational capacity that exist due to current limitations in system infrastructure. Include alterations you have made to the current service delivery system and how lessons learned will be applied to this activity. Provide information specific to the telemedicine activity and describe how these gaps or limitations are affecting the optimal provision of quality HIV primary care services and/or affecting your organization’s ability to optimize your response to the changing health care landscape. Describe technology requirements and each type of equipment employed along with its relevance to the project, how it contributes to cost-effective, timely, and accurate care, and ease of use. Discuss the telemedicine reimbursement environment and whether Medicare, Medicaid, and/or private insurance in your state(s) cover telemedicine services. Describe the proposed equipment (through lease or purchase), computer hardware and software, audio and video equipment, computer network equipment, interactive equipment, data terminal equipment, and other equipment that furthers the objectives of the proposed telemedicine activity.

METHODOLOGY -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact Provide detailed information regarding the proposed methods that you will use to address the stated needs described in the needs assessment section. In addition, provide information regarding involvement of people with HIV in the activity, collaboration and coordination efforts, and sustainability plans as follows:

• Involvement of People with HIV: People with HIV who receive services at an RWHAP-funded organization should be actively involved in the development, implementation, and evaluation of program and CQM activities.

Describe how you will engage people with HIV and/or organizations that represent them in the implementation of this activity, including decision-making.

• Collaboration and Coordination: In describing the methods by which you will implement the activity, outline the partners and/or collaborating entities needed for this proposed activity, if applicable. Identify the tasks each partner proposes to perform and the amount of funding, if any, you expect to allocate to the partner. Include letters of support and/or letters of commitment from each partner and/or collaborating entity as Attachment 6.

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• Sustainability: Describe how you will maintain the efforts set forth in this activity after the period of federal funding ends. For example, describe how you will support the maintenance of systems, the continuation of personnel time and effort on proposed activities, continued training of new staff, updates to workflows, policies, and procedures, etc. In addition, describe how you intend to share or disseminate relevant information and/or products developed through the funded activity and lessons learned with other providers in the community and/or collaborators to this project.

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 program.

You must submit the detailed work plan for the 12-month period of performance of August 1, 2021 – July 31, 2022. Describe the activity’s goal, specify the objectives, and identify the key action steps that you will use to achieve the proposed goal. Use a timeline that includes each step of the proposed activity and target date for each step’s completion, and identifies staff responsible for the activities. As relevant, identify the measures you will use to evaluate success. As appropriate, identify meaningful support and collaboration with key partners in planning, designing, and implementing all activities. Please provide the above information in a table format. Submit the work plan as Attachment 5.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2 Response Discuss challenges you are likely to encounter in the planning and implementation of your proposed HIV Care…