PKG00264243-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 C Capacity Development Program

Funding Opportunity Number: HRSA-21-058 Funding Opportunity Type: New

Assistance Listings (CFDA) Number: 93.918

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: February 19, 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 25, 2020

Mindy Golatt, MPH, MA, RN, CPNP CAPT, United States Public Health Service Chief, Midwestern Branch Telephone: (301) 443-3944 Fax: (301) 443-1839 Email: MGolatt@hrsa.gov

Authority: 42 USC § 300ff-54(c)(1)(B) (§ 2654(c)(1)(B) of the Public Health Service Act ).

mailto:MGolatt@hrsa.gov

HRSA-21-059 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Community HIV/AIDS Programs is accepting applications for the fiscal year (FY) 2021 Ryan White HIV/AIDS Program (RWHAP) Part C Capacity Development Program. The purpose of this program is to strengthen organizational infrastructure to respond to the changing health care landscape and to increase capacity to develop, enhance, or expand access to high-quality HIV primary health care services for low-income, uninsured, and underserved people with HIV.

This notice 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. You should note that this program may be cancelled prior to award.

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

Capacity Development Program

Funding Opportunity Number: HRSA-21-058 Due Date for Applications: February 19, 2021 Anticipated Total Annual Available FY 2020 Funding:

$8,000,000

Estimated Number and Type of Award(s): Up to 60 grants

Estimated Award Amount: Up to $150,000 Cost Sharing/Match Required: No Period of Performance: September 1, 2021 through

August 31, 2022 (1 year)

Eligible Applicants: Public and nonprofit private entities, faith-based and community-based organizations and tribes and tribal organizations are eligible to apply for these funds.

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:

Day and Date: Thursday, January 7, 2021 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-c-cdp-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://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-21-058 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) Part C Capacity Development Program. The purpose of this program is to 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.

Funding under this program is intended 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) however, HRSA will not fund the same activity in FY 2021 as HRSA funded previously in FY 2019 or FY 2020. If the proposed project is an expansion of a previously funded activity, you will be required to 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 four (4) activities from which to choose. If applying under this category, select only one of the four activities listed below:

• Community Health Workers

• Integration of HIV Primary Care with Oral Health and/or Behavioral Health

• Rapid Antiretroviral Therapy (ART)

• Transitioning Youth into Adult HIV Care

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 are three (3) activities from which to choose. If applying under this category, select only one of the three activities listed below:

• Dental Equipment for Expanding Dental Service Capacity

• Emergency Preparedness

• Telemedicine

Collectively, activities will allow applicants to better align with priority areas for the U.S. Department of Health and Human Services (HHS) and HRSA, including investing in mental health, addressing the opioid crisis, and promoting collaboration. The selected activity should target populations disproportionately affected by the HIV 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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epidemic and who have poor 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.

According to statute, HRSA shall give preference in making awards for this program to entities that provide primary care services in rural areas or to underserved populations.

You can find more information about these preferences in Section V of this notice of funding opportunity (NOFO).

2. Background

This program is authorized by 42 USC § 300ff-54(c)(1)(B) (§ 2654(c)(1)(B) of the Public Health Service 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.

The Part C Capacity Development Program was first authorized by Congress in 2000.

The purpose of this program is to strengthen organizational capacity to respond to the changing health care landscape and to increase capacity to develop, enhance, or expand access to high-quality HIV primary health care services for low-income, uninsured, and underserved people with HIV. The proposed activity should be of a short-term nature and should be completed by the end of the one-year funding opportunity period of performance.

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.

https://hab.hrsa.gov/

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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:

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. RWHAP also provides TA 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 (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.

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

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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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.

Program Resources and Innovative Models

Through the Minority HIV/AIDS Fund from the HHS Secretary’s Office (MHAF) and HAB 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: 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.

• Replication Resources from the SPNS Systems Linkages and Access to Care (https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care) https://targethiv.org/library/hrsa-hab-building-futures-supporting-youth-living-hiv 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 https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care https://targethiv.org/library/replication-resources-spns-systems-linkages-and-access-care

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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 MHAF 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.

Clinical Quality Management Section 2664(g)(5) of the Public Health Service Act requires RWHAP Part C 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: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $8,000,000 to be available to fund up to 60 recipients.

You may apply for a ceiling amount of up to $150,000 total cost (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 September 1, 2021 through August 31, 2022 (1 year).

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

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propose an expansion of an activity previously supported under FY 2019 or FY 2020 RWHAP Part D Supplemental (HRSA-19-026 or HRSA-20-068) or Part C Capacity Development funding (HRSA-19-031 or HRSA-20-067) for either HIV Care Innovation or Infrastructure Development. Applicants 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-21-059 (RWHAP Part D Supplemental) 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

Public and nonprofit private entities, faith-based and community-based organizations, and Tribes and tribal organizations are eligible to apply. Foreign entities are not eligible for this award.

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.

Maintenance of Effort - Applicants applying for HIV Care Innovation activities must agree to maintain non-federal expenditures for early intervention services (EIS) (i.e., counseling of individuals with respect to HIV, high risk targeted HIV testing, referral and linkage to care, other clinical and diagnostic services related to HIV diagnosis, and the provision of therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from HIV) at a level equal to or greater than your total non-federal expenditures for EIS during the most 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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recently completed fiscal year prior to the competitive application deadline (as authorized by section 2664(d) of the PHS Act). Submit information to ensure compliance with the maintenance of effort requirements as Attachment 6.

NOTE: Multiple applications from an organization are not allowable.

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 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-21-058, it may count against the page https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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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.

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 9: 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 http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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the project title as “FY 2021 RWHAP Part C Capacity Development Program” 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 HIV primary care services for low-income, uninsured, and underserved people with HIV).

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

Identification of the funding preference requested, if applicable

The project abstract must be single-spaced and is limited to one page in length.

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: or non-medical case management. 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 current 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, development of written policies and procedures for CHW services; provision of training and professional development for both CHWs and their immediate supervisors; plans to integrate CHWs into the HIV care team; and defining the CHW’s role in community engagement. Applicants 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 https://www.c3project.org/roles-competencies https://www.c3project.org/roles-competencies

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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.

Integration of HIV Primary Care with Oral Health or Behavioral Health Develop strategies, policies, and procedures to improve care coordination and integration of HIV primary care with oral health care or behavioral health services (e.g., scheduling appointments, communication strategies). Specific activities may include develop policies and procedures to facilitate onsite provision of oral health care or behavioral health services. Organize primary care and oral health or behavioral health teams and train staff to understand workflow and processes. Develop policies and procedures for coordinating and tracking referrals for oral health care or behavioral health services. The activity must address one or more of the stages of the HIV care continuum.

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, these and other clinic and system-wide system changes (e.g., workforce development or changes in workflows/procedures) are likely needed to ensure rapid linkage to care and ART initiation. You must ensure that activities leverage existing staff or enhance current collaborations with external organizations in order to provide Rapid ART services.

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.hiv.gov/federal-response/policies-issues/hiv-aids-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 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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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 and procedures and staff training to assist youth in transitioning from pediatric to adult HIV medical care. Transition planning is a RWHAP Part C 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 to develop a transition process; capacity building to support the transition into the adult HIV medical care setting; and a mechanism for post-transition assessment.

Implementation efforts should be linked to specific evaluative outcome metrics to measure successful transition. The activity must address one or more of the 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).

2) Infrastructure Development

Dental Equipment for Expanding Dental Service Capacity Purchase dental equipment for the purpose of developing, enhancing, or expanding oral health care services for people with HIV (i.e., creating or expanding an HIV dental operatory or clinic).

Emergency Preparedness

The areas of focus for this activity are to address the development of organizational assessments of vulnerability, creation of an emergency preparedness plan, staff training and evaluation through drills and exercises, and identification of and collaboration with the local emergency management planners. The activity should result in the development of an implementation plan/toolkit and/or policies and procedures for effective preparation and response to natural disasters (e.g., hurricanes, tornadoes) and public health emergencies (e.g., disease outbreaks) resulting in minimal interruption to care and treatment for people with HIV. For resources addressing this topic, access the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website; ASPR’s 2017-2022 Health Care Preparedness and Response Capabilities Report, and the ECRI Institute website.

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.

https://www.ncbi.nlm.nih.gov/pubmed/28754584 https://www.phe.gov/about/aspr/Pages/default.aspx https://www.phe.gov/about/aspr/Pages/default.aspx https://www.phe.gov/about/aspr/Pages/default.aspx https://www.ecri.org/components/CCRM/Pages/SafEnv7.aspx

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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 to be employed. Include a concise description 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 your 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:

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 quality 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 Criteria #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 and 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 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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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 activity, 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 populations. Describe the relevant gaps or barriers in your current services delivery model, including unmet needs, these capacity funds will address for newly diagnosed and out-of-care people with HIV.

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 a description of current partnerships 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 populations in care and achieve higher levels of viral suppression.

For Infrastructure Development 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 selected 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.

Regarding Dental Equipment for Expanding Dental Service Capacity, describe any additional information on how your current infrastructure and oral health resources limit your organization’s ability and capacity to satisfy the unmet need or current demand for oral health services to your RWHAP-eligible population.

Regarding Emergency Preparedness, discuss your organization’s current capacity for responding to emergencies including public health emergencies, disaster preparedness, and continuity of operations. Include any recent capacity needs assessed in carrying out or continuing operations during the COVID-19 pandemic. If you have received funding under the FY2020 Coronavirus Aid, Relief and Economic Security (CARES) Act, discuss any impact of those awards on your organization’s ability to maintain operations during emergency or disaster recovery. Discuss any lessons learned or assessments of your organization’s

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ability to operate under such conditions and how these funds will be utilized to improve current capacity.

Regarding Telemedicine, 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 if 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 --…