ps11-1117 final 3.25.11.doc

Table of Contents

Part 1. Overview Information Part 2. Full Text of the Announcement Section I. Funding Opportunity Description Section II. Award Information Section III. Eligibility Information Section IV. Application and Submission Information Section V. Application Review Information Section VI. Award Administration Information Section VII. Agency Contacts Section VIII. Other Information

PART 1. OVERVIEW INFORMATION

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Agency Name: Federal Centers for Disease Control and Prevention (CDC) Funding Opportunity Title: Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS: Phase II Announcement Type: Competing Continuation Agency Funding Opportunity Number: CDC-RFA-PS11-1117 Catalog of Federal Domestic Assistance Number: 93.523 Key Dates:

Application Deadline Date: May 25, 2011, 5:00 p.m. Eastern Standard Time Measurable outcomes of the program will be in alignment with one (or more) of the following performance goal(s) for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP):

· Decrease the number of persons at high risk for acquiring or transmitting HIV infection.

· Strengthen the capacity nationwide to monitor the epidemic; develop and implement effective HIV prevention interventions; and evaluate prevention programs.

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address:

http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf

PART 2. FULL TEXT

I..FUNDING OPPORTUNITY DESCRIPTION

Statutory Authority

This program is authorized under Sections 317(k)(2) and 318 of the Public Health Service Act (42 U.S.C. Sections 247b(k)(2) and 247c), as amended, and Section 4002 of the Patient Protection and Affordable Care Act (PL 111-148).

Background HIV remains a significant public health threat in the United States, particularly in large urban areas where cases are concentrated. In response to the epidemic, the National HIV/AIDS Strategy has established three primary goals: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related disparities and health inequities.

The program supported by this announcement will help reach the goal of reducing new HIV infections by intensifying HIV prevention efforts in communities where HIV is most heavily concentrated, in particular, by increasing HIV testing; by expanding targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches; and by educating members of these communities about the threat of HIV and how to prevent it. The program supported by this announcement will help achieve the goal of increasing access to care and improving health outcomes for people living with HIV by linking people in heavily affected communities to continuous and coordinated quality care when they learn they are infected with HIV and by linking them to services that can help them meet their basic needs. The program supported by this announcement will help attain the goal of reducing HIV-related disparities and health inequities by furthering the adoption of community-level approaches to reduce HIV infection and improving linkage to and maintenance in care in high-risk communities. In addition, this announcement addresses NHAS goals by increasing the coordination of HIV programs’ implementation and reporting between federal agencies and state and local governments.

In support of the National HIV/AIDS Strategy, the Centers for Disease Control and Prevention (CDC) has identified three targeted strategies that are crucial to reducing new HIV infections: (1) increasing knowledge of HIV status among people living with HIV and their partners; (2) reducing risk of HIV transmission from people living with HIV; and (3) reducing HIV acquisition among persons at high risk for infection. Realizing the benefits of these strategies depends on implementing structural changes, prevention strategies, and interventions that are known to reduce risk of HIV transmission. HIV prevention in the U.S. must be focused, integrated, and coordinated, including an optimal mix of behavioral, biomedical, and structural interventions, adequately funded, and tailored so that levels of services are appropriate to personal and community-level risk of acquiring or transmitting HIV.

At a minimum, all persons should have access to accurate information about HIV transmission and prevention, effective prevention tools, and HIV screening. They should be exposed to social marketing and HIV awareness and prevention communication campaigns. Targeted prevention efforts are needed for populations or communities that experience the highest rates of HIV infection and other sexually transmitted diseases. These populations or communities should be consistent with populations identified in the National HIV/AIDS Strategy. Uninfected persons whose behavior, relationships, or life circumstances put them at high risk of HIV infection, especially those who have partners known to have HIV infection, should be tested for HIV at least once per year; receive intensive evidence-based HIV prevention interventions; and, as needed, be linked to other medical and social services that support reduced HIV acquisition risk. People living with HIV should know their HIV status and be linked to and maintained in high-quality medical care and prevention and social services. Persons named as a partner exposed to HIV or other STD should also receive this range of services.

No single intervention is 100 percent effective, yet in combination, HIV prevention interventions can have a more significant impact on reducing HIV incidence. To harness the full potential of advances in HIV prevention and treatment, jurisdictions with high AIDS prevalence must coordinate the implementation of and capacity building for delivering the strategies and interventions in their Enhanced Comprehensive HIV Prevention Plan (ECHPP) to more effectively target HIV prevention, care, and treatment.

Terminology

For this Funding Opportunity Announcement (FOA), definitions for the following terms apply:

· Metropolitan Statistical Area (MSA): MSA are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. Furthermore, the underlying concept of an MSA is that of a core area containing a large population nucleus, together with adjacent communities having a high degree of economic and social integration with that core. MSA are composed of entire counties or county equivalents. Every MSA has at least one urbanized area with a population of 50,000 or more.

· Metropolitan Division: A metropolitan division (MD) is used to refer to a county or group of counties within a Metropolitan Statistical Area that has a population core of at least 2.5 million. (http://www.whitehouse.gov/omb/assets/bulletins/b10-02.pdf )

· Scalable: Interventions or combinations of interventions that can reach a significant portion of those in need, in a cost efficient manner, and demonstrate population-level impact. (http://nationalaidsstrategy.org/wp-content/uploads/2010/09/NHAS-implementation-recommendations.pdf)

Purpose

Phase I of this program (CDC-RFA-PS10-10181) supported the development and initial implementation of Enhanced Comprehensive HIV Prevention Plans (ECHPPs) for MSAs most affected by the HIV epidemic in order to reduce HIV risk and incidence in those areas. In Phase II, which will be supported under this FOA (CDC-RFA-PS11-1117), all adequately performing jurisdictions funded under Phase I that are responsive to this FOA will be selected to further support coordination and implementation of their ECHPPs over a two-year project period.

The FOA includes two components: Part A – ECHPP Coordination and Evaluation; and Part B – ECHPP Implementation. Part A will support grantees’ efforts to: (1) administer and manage cross-agency coordination efforts, including partnerships and funding streams to better leverage prevention, care, and treatment resources; and (2) administer and manage data coordination which could include activities ranging from the development of common measures to development of integrated data systems to be able to collect relevant data to monitor jurisdictional progress on goals consistent with the National HIV/AIDS Strategy, including data reporting to CDC and other stakeholders. Part B will support additional implementation of “Required” and “Recommended” ECHPP activities (Appendix 1) as described in the previous Funding Opportunity Announcement CDC-RFA-PS10-10181 or other strategies or interventions included in the juridiction’s CDC-approved Enhanced Plan. Applicants may apply for both Part A and Part B or for Part A only. Applicants cannot apply for Part B only.

The ECHPP should serve as a more focused, results-oriented supplement to the jurisdiction's existing Comprehensive HIV Prevention Plan for the purpose of implementing this FOA. The ECHPP should strengthen and refocus the jurisdiction's existing efforts to significantly reduce the number of new HIV infections, increase access to and use of HIV care and treatment, and reduce HIV-related health disparities. The goal is for each jurisdiction to implement an ECHPP that provides for the improved coordinated implementation of HIV prevention, care, and treatment services using the best mix of interventions, intervention targets, and intervention scale to optimize the impact on new HIV infections. To achieve this goal, effective and focused coordination of joint efforts, data systems, program metrics, and multiple funding streams is essential.

The ECHPP developed in Phase I (PS10-10181) should:

1. Align the jurisdiction's distribution of HIV prevention, care, and treatment resources to maximally reduce HIV incidence in the jurisdiction, including:

a. appropriate targeting of current services and combination of services;

b. interventions that are evidence-based and effective in reducing HIV at the population-level; and

c. resource distribution proportional to people’s and communities’ risk of HIV acquisition or transmission.

2. Address gaps in coverage to maximally reduce HIV incidence in the jurisdiction, including coordination of services at different points along the continuum of HIV prevention activities (including substance abuse and mental health treatment) and medical care including antiretroviral treatment.

An ECHPP should include a mixture of interventions and public health strategies selected by the jurisdiction from three categories: (a) required; (b) recommended for consideration; and (c) innovative local activities approved by CDC for inclusion in the enhanced plan. Interventions and strategies in the “required” and “recommended for consideration” categories are described in the Phase I FOA (CDC-RFA-PS10-10181). Because HIV prevention science continues to advance, other behavioral, biomedical, or structural interventions that have strong evidence of efficacy and cost effectiveness may be considered for Phase II when revising or updating the Enhanced Plan. Phase I grantees should prioritize funding for all interventions that are well coordinated, optimally cost effective, focused on high-risk populations and are prioritized in their ECHPP and not adequately funded through other resources. Grantees should be coordinating and collaborating with their appropriate local health departments, local community planning groups, community based organizations (CBOs), federally-funded HIV care providers, other local HIV planning bodies, mental health and substance abuse services, local communities, and other appropriate governmental and non-governmental entities in the implementation of the Phase I FOA activities. Grantees also should have begun implementing activities specified in their ECHHP during Phase I.

Evaluation: All activities should be conducted in a manner that is consistent with current CDC guidelines. For implementation of any new or expanded interventions, public health strategies, or CDC-approved innovative local activities, grantees should collect monitoring and evaluation data, consistent with current CDC data requirements for data reporting related to programmatic activities or as otherwise agreed to during this project. It is expected that grantees will actively monitor local program performance and use this information on a regular basis to evaluate and improve program implementation, outcomes, and impact.

Additional evaluation of grantees’ overall programmatic implementation of the ECHPP will be conducted separately by CDC, and CDC will examine data before and after implementation to assess grantees’ achievement of program implementation, outcome and impact goals. During Phase I, CDC identified specific indicators of program implementation, outcome, and impact that will be used to assess grantee performance in Phase II. These indicators include, but are not limited to:

1. Implementation or process indicators such as number of HIV test events, number of people newly diagnosed with HIV, number of condoms distributed, and number of persons receiving specific prevention services;

2. Outcome measures focused on number of newly diagnosed people linked to clinical care within three months of diagnosis, early HIV diagnosis, integration of HIV prevention into medical care of people living with HIV, exposure to HIV prevention programs and services, and sexual and injection risk behaviors;

3. Impact indicators (from existing CDC surveillance systems) such as HIV incidence, number of previously undiagnosed HIV infections, number of people living with HIV who know their status, and HIV community viral load (particularly among MSM, Blacks, and Latinos);

4. Indicators of changes in organizational practices, regulations, and policies that impact the public health practice of combination HIV prevention, including proven biomedical, behavioral, and structural strategies and interventions.

Program Collaboration and Service Integration (PCSI): This program supports the National Center for HIV, Viral Hepatitis, STD, & TB Prevention (NCHHSTP) program imperative calling for program collaboration and service integration (PCSI). The rationale for PCSI is to maximize the health benefits that persons receive from prevention services by increasing service efficiency; maximizing opportunities to screen, test, treat, or vaccinate those in need of these services; improving the health among populations negatively affected by multiple diseases; improving operations through the use of shared data; and enabling service providers to adapt to, and keep pace with, changes in disease epidemiology and new technologies.

This announcement supports integration of diagnostic and prevention services for the Human Immunodeficiency Virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), sexually transmitted diseases (STD); and tuberculosis (TB) because of CDC's greater understanding of the extent to which:

· STDs increase the risk for HIV infection.

· Control of TB, viral hepatitis, and STDs is needed to protect the health of HIV-infected persons.

· HIV, viral hepatitis and STDs share common risks and modes of transmission.

· Risks for acquiring theses diseases are associated with similar behaviors and environmental conditions and have reciprocal or interdependent effects.

· Clinical course and outcomes of these diseases are influenced by co-infection (for example, HIV/TB can be deadly, and TB accelerates HIV disease progression).

· Populations disproportionately affected by HIV are also disproportionately affected by infections with TB, HCV, HBV, and STDs.

Details of this strategy and approach are outlined in the NCHHSTP White Paper which can be found at http://www.cdc.gov/nchhstp/programintegration.

Reduce Health Disparities and Address Social Determinants of Health: The program supports efforts to improve the health of populations disproportionately affected by HIV/AIDS, viral hepatitis, STDs and TB by maximizing the health impact of public health services, reducing disease prevalence, and promoting health equity consistent with the National HIV/AIDS Strategy available at http://www.whitehouse.gov/administration/eop/onap/nhas. Health disparity is a particular type of health difference that is closely linked with social or economic disadvantage based on racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion.

[HP 2020 - http://healthypeople.gov/hp2020/advisory/PhaseI/glossary.htm]. Health disparities in HIV, viral Hepatitis, STDs, and TB are inextricably linked to a complex blend of social determinants that influence which populations are most severaly affected by these diseases. Social determinants are the economic and social conditions that influence the health of individuals, communities and jurisdictions and include conditions for early childhood development, education, employment, work, food security, health services, housing, income, and social exclusion.

Health equity is a desirable goal that entails special efforts to improve the health of those who have experienced social or economic disadvantage. It requires:

· Continuous efforts focused on eliminnation of health disparities, including disparities in health and in the living and working conditions that influence health; and

· Continuous efforts to maintain a desired state of equity after particular health disparities are eliminated.

In Phase I, programs should have used data, including social determinants data, to identify communities within their jurisdiction that are disporportionately affected by HIV, Viral Hepatitis, STDs and TB and related diseases and conditions, and plan activities to help eliminate HIV-related health disparities. In collaboration with partners and appropriate sectors of the community, programs should have considered social determinants of health in the development, implementation, and evaluation of program specific efforts and selected culturally appropriate interventions that are tailored for the communities for which they are intended.

Healthy People 2020: This program addresses the “Healthy People 2020” focus area(s) of HIV prevention.

Program Implementation

Recipient (Grantee) Activities:

Part A – ECHPP Coordination and Evaluation

1. General

If any of the following occurs during the project period, grantees should notify CDC and collaboratively determine what changes, if any, need to be made to the ECHPP:

· Epidemiologic data indicate that AIDS prevalence has increased significantly in an area within the grantee’s jurisdiction.

· Epidemiologic data indicate that HIV incidence has increased significantly among a risk population(s) in the target area.

· Process indicators show that ECHPP activities/combination approaches are not achieving their desired outcomes.

· A change in the list of partners, prevention and care resources, or local policies has created a significant gap in ECHPP scope, reach, coordination, or services.

2. Coordination and Allocation of Resources

· Implement planned systems for coordinating and monitoring partnerships and various federal, state and local funding streams, including providing dedicated staff for this activity.

· Manage, coordinate, and ensure good data systems to evaluate program efforts.

· Collect and report routine and required monitoring, HIV diagnoses, and related information (i.e., CD4 count, viral load) to state and local surveillance programs.

· Balance available resources to ensure that all planned activities are implemented in the most effective combination and to appropriate scale.

· Adjust the ECHPP’s allocation of resources during the project period based on changes in the local HIV epidemiological profile, the relative cost effectiveness of interventions and strategies, success in leveraging resources, and maintenance of balance in the combination of interventions and strategies to optimize the impact of HIV prevention, care, and treatment on incidence.

3. Objectives Grantees should monitor progress and process toward achievement of their ECHPP’s evidence-based goals and specific, measureable, achievable, realistic, and time-based (SMART) objectives for each of the selected interventions and strategies as described:

· Update SMART objectives annually in order to ensure meeting NHAS/DHAP 2015 targets outlined in the National Strategic Goals Tool from Phase I.

· Track program performance indicators and other measures of changes in organizational practices, regulations, and policies that will be used to measure progress in achieving SMART objectives.

· Track performance of all who share responsibility for achieving each of the objectives.

· Track progress in establishing and maintaining cross-agency coordination, including partnerships and funding streams, to better leverage resources.

· Compare progress against the ECHPP’s two-year timeline that shows the planned implementation of each of the selected interventions and strategies.

4. Capacity

· Manage, monitor, and maintain collaboration with the diverse group of stakeholders, partners, state and local governmental and non-governmental entities that are or will be implementing activities including in the ECHPP so that partners regularly contribute effort toward shared objectives.

· Establish and maintain coordination of services across different funding streams, including providing dedicated staff for this activity.

· Maintain appropriate and sufficient staffing in relation to staff persons’ respective roles and responsibilities in implementing or supporting the ECHPP. This would include, but not be limited to, program evaluation and planning staff that would: conduct required data collection and submission activities; use program and other data for local program improvement; and submit required data to CDC via CDC-approved data reporting systems and according to a CDC-prescribed reporting schedule. Hire new personnel within three months of funding.

· Ensure that current and new staff has adequate training to implement all interventions and strategies included in the grantee’s ECHPP.

· Have two or three key staff attend quarterly meetings convened by CDC with all grantees. At least two meetings will be in Atlanta; grantees should budget for key staff to attend all meetings.

· Maintain the ability to supply required monitoring and evaluation data. Report the CDC-required budget table information annually, in addition to other data submissions.

5. Evaluation

· Implement a plan for collecting monitoring and evaluation data on ECHPP activities. This plan will measure achievement of the project SMART objectives given CDC’s data requirements for programmatic activities. Staff roles associated with monitoring and evaluation data management should be included in the plan. The plan may include a logic model or flow diagram as a visual schematic of ECHPP activities, inputs, and outputs.

· Assess the reach of HIV prevention interventions and strategies among relevant populations, as well as resources invested in these activities.

· Use the findings from program performance indicators to adjust project activities to increase impact and efficiency.

· Evaluate the interventions selected for their cultural appropriateness, including structural interventions and policies that were tailored for disproportionately affected communities, in collaboration with a diverse group of partners, for their epidemiologic benefit for disproportionately affected communities.

· Assess success in the filling of program gaps, improving infrastructure (systems, data, human), and supporting capacity building and technical assistance activities.

· Assess extent to which structure, regulations, and policies impede implementation of effective prevention strategies and, subject to lobbying restrictions under federal law (see Administrative and National Policy Requirements, AR-12, Lobbying Restrictions, below), opportunities to remove such barriers.

· Assess mechanisms for Program Collaboration Service Integration (PCSI) at different points along the continuum of prevention, care, and treatment.

· Use a data-driven and inclusive (of communities affected and a broad partnership base) process to assess health disparities and social determinants of health related to HIV, Viral Hepatitis, STDs and TB within the jurisdiction.

· Collaborate with the evaluation team identified by CDC and tasked with additional evaluation of grantees’ overall programmatic implementation of ECHPP.

· In collaboration with other grantees and based on grantees’ combined experience with ECHPP, help CDC develop guidance that will assist other areas to:

· create and manage systems for coordinating partnerships and funding streams;

· coordinate and ensure good data systems to assess effort; and

· select scalable, culturally appropriate interventions to enhance their programming.

Part B – ECHPP Implementation

1. Program Plan

· Expand implementation of ECHPP’s portfolio of “Required” and “Recommended” interventions and strategies to address:

· optimal combinations of interventions identified in the ECHPP; and

· social determinants of health to reduce HIV-related health disparities as well as to reduce service redundancies and provision of non-essential services.

· Implement planned strategies and activities to build capacity in the targeted MSAs where capacity building needs were identified.

2. Capacity

· Maintain appropriate and sufficient staffing in relation to staff persons’ respective roles and responsibilities in implementing the ECHPP portfolio of “Required” and “Recommended” interventions and strategies. Hire new personnel (if needed) within three months of funding.

· Ensure that current and new staff has adequate training to implement all interventions and strategies included in the grantee’s ECHPP.

In a cooperative agreement, CDC staff is substantially involved in the program activities, above and beyond routine grant monitoring.

CDC Activities CDC activities for this program are as follows:

1. Provide consultation and technical assistance to grantees on all aspects of the implementation and adjustment of the ECHPP as well as all protocols, procedures, and instruments related to the plan, both directly and through CDC’s network of grantees and partners.

2. Provide each grantee with a team of CDC scientists and program staff who will provide specific Technical Assistance (TA) for implementation, monitoring, and evaluation of the ECHPP.

3. Work with grantees to address training and TA needs that are crucial to the successful execution of the plan, and that are not addressed by other funding sources.

4. Work with HRSA, CMS and other partners to increase access to proven biomedical interventions, including care and treatment for persons diagnosed with HIV, at the national and local levels.

5. Facilitate coordination, collaboration, and where feasible, service integration among other CDC programs, other federal partners, health departments and their programmatic divisions, local planning groups, directly-funded CBOs, national capacity building assistance providers, care providers and other recipients of Ryan White Treatment Extension Act of 2009, and other critical partners working with at risk populations and towards common goals of risk reduction, disease detection, and a continuum of HIV prevention, care, and treatment.

6. Monitor grantee progress in implementing the ECHPP, and work with grantees through consultation via site visits, email, telephone, and review of progress reports to support implementation of the enhanced plan.

7. Monitor grantee progress in conducting monitoring and evaluation. Work with grantees through consultation via site visits, email, telephone, and review of progress reports and other data reports to support progress, program improvement, and reduced HIV transmission.

8. Provide requirements and expectations for standardized and other data reporting and support monitoring and evaluation (M&E) activities with contractual technical assistance, web-based training on M&E, and M&E-related materials, such as data collection tools.

9. Assess the selected interventions and strategies for cost-per-client served (e.g., budget allocation for the intervention divided by the number of different clients receiving the intervention) and, in the case of HIV testing strategies, cost-per-previously undiagnosed infection identified. Compare this information to outcome monitoring and evaluation data from the selected interventions and strategies and share findings with grantee annually.

10. Obtain necessary CDC and other clearances.

11. Convene, plan, and facilitate quarterly joint grantee meetings during the project period.

II. AWARD INFORMATION

Type of Award: Cooperative Agreement. CDC substantial involvement in this program appears in the Activities Section above.

Award Mechanism: U65 HIV Prevention Activities

Fiscal Year Funds: 2011 Part A: ECHPP Coordination and Evaluation Approximate Current Fiscal Year Funding: $5,450,000 Approximate Total Project Period Funding: $10,900,000 (This amount is an estimate, and is subject to availability of funds. This amount includes both direct and indirect costs.)

Approximate Number of Awards: Up to twelve Approximate Average Award: Depends on tier (This amount will be for the twelve-month budget period and includes both direct and indirect costs.)

Floor of Individual Award Range: $400,000 Ceiling of Individual Award Range: $600,000 (This ceiling is for the twelve-month budget period and includes both direct and indirect costs.) CDC will not accept and review applications with budgets greater than the ceiling amount.

Funding Formula: In determining the final funding formula for Part A awards, CDC will provide all grantees with a base funding amount based on the number of people living with AIDS, year-end 2007. All funding is subject to the availability of federal funds.

The table below is the estimated prevalence for persons living with AIDS, year end 2007 by top MSAs and MDs – United States and Puerto Rico (from Table 24. 2008 HIV Surveillance Report) http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/index.htm.

Part B: ECHPP Implementation

Approximate Current Fiscal Year Funding: Up to $26,550,000 (This amount is an estimate and is subject to availability of funds.

Approximate Total Project Period Funding: Up to $53,100,000 (This amount is an estimate and is subject to availability of funds. This amount is includes both direct and indirect costs.)

Approximate Number of Awards: Up to twelve (The number of awards is subject to availability of funds.)

Approximate Average Award: Depends on tier (This amount will be for the twelve- month budget period and includes both direct and indirect costs.)

Floor of Individual Award Range: Depends on tier, number of AIDS cases, and amount of available funding.

Ceiling of Individual Award Range: Depends on tier, number of AIDS cases, and the amount of available funding. Funding ranges are from $350,000 to $8,100,000 (This ceiling is for the twelve-month budget period and includes both direct and indirect costs.). CDC will not accept and review applications with budgets greater than the ceiling amount.

Funding Formula: In determining the final funding formula for Part B awards, CDC will provide a base funding amount in the order of AIDS prevalence starting at highest prevalence. Base funding for Tier one grantees will be $950,000, base funding for Tier two grantees will be $500,000, and base funding for Tier three grantees will be $350,000. If more than $6,150,000 is available, additional funding will be proportional, based on the number of people living with AIDS, year-end 2007 (if all twelve eligible grantees are funded, the proportional amount will range from 3.78% of remaining funds for grantee with fewest number of AIDS cases to 31.97% of remaining funds for grantee with largest number of AIDS cases. If fewer than twelve sites are funded, the percentages will change to reflect the decreased denominator of AIDS cases). All funding is subject to the availability of federal funds.

Both Part A (ECHPP Coordination and Evaluation) and Part B (ECHPP Implementation) Anticipated Award Date: September 30, 2011

Budget Period Length: Twelve Months Project Period Length: Two Years

III. ELIGIBILITY INFORMATION

Eligible Applicants Eligible applicants that can apply for this funding opportunity are listed below:

· State and local governments or their Bona Fide Agents as specified in the Eligible Jurisdictions (below).

A Bona Fide Agent is an agency/organization identified by the state as eligible to submit an application under the state eligibility in lieu of a state application. If applying as a Bona Fide Agent of an eligible state or local government, a Memorandum of Agreement with the eligible state or local government as documentation of the status is required and must be submitted with the application. At a minimum, the Memorandum of Agreement must include the following:

· Roles and responsibilities of the state or local government agency.

· Roles and responsibilities of the Bona Fide Agent.

· Key personnel contacts for the state or local government agency.

· Key personnel contacts for the Bona Fide Agent.

Attach the Memorandum of Agreement with “Other Attachment Forms” when submitting via www.grants.gov .

Eligible Jurisdictions

Applicants eligible to apply for this cooperative agreement are limited to twelve (12) entities in specific Metropolitan Statistical Areas (MSAs) or specified Metropolitan Divisions (MDs) that have the highest estimated AIDS prevalence at the end of 2007. These twelve eligible areas received funding for Phase I of the project under announcement CDC-RFA-PS10-10181.

The entities eligible to apply for funds under this FOA are as follows:

The MSA or MD with the highest AIDS prevalence in the state health department jurisdiction was selected for eligibility, not accounting for MSAs or MDs in directly funded city health department jurisdictions. In Phase I, projects were supported only within the MSA or MD listed and only within the geographic bounds of the funded entity (where MSAs/MDs extend beyond the jurisdiction of the eligible state or city health department) unless CDC granted approval for limitation or extension of the geographic area. Limitation of activities to a geographic area within the MSA or MD with the highest AIDS morbidity was granted in cases where it would be impractical to conduct activities in the entire area. Extension of activities to geographic areas adjacent to the MSA or MD was granted in cases where AIDS morbidity remains high in those areas.

Required Registrations

Registering any organization through www.Grants.gov, the official agency-wide E-grant website, is the first step in submitting an application online. Registration information is located on the “Get Registered” screen of www.Grants.gov. Please visit www.Grants.gov at least 30 days prior to submitting an application to become familiar with the registration and submission processes. The “one-time” registration process will take three to five days to complete. However, the Grants.gov registration process also requires applicants register their organization with the Central Contractor Registry (CCR) annually. The CCR registration can require an additional one to two days to complete.

Organizations are required to maintain a current registration in CCR.

Central Contractor Registration and Universal Identifier Requirements

All applicant organizations must obtain a DUN and Bradstreet (D&B) Data Universal Numbering System (DUNS) number as the Universal Identifier when applying for Federal grants or cooperative agreements. The DUNS number is a nine-digit number assigned by Dun and Bradstreet Information Services. An AOR should be consulted to determine the appropriate number. If the organization does not have a DUNS number, an AOR should complete the US D&B D-U-N-S Number Request Form or contact Dun and Bradstreet by telephone directly at 1-866-705-5711 (toll-free) to obtain one. A DUNS number will be provided immediately by telephone at no charge. Note this is an organizational number. Individual Program Directors/Principal Investigators do not need to register for a DUNS number.

Additionally, all applicant organizations must register in the Central Contractor Registry (CCR) and maintain the registration with current information at all times during which it has an application under consideration for funding by CDC and, if an award is made, until a final financial report is submitted or the final payment is received, whichever is later. CCR is the primary registrant database for the Federal government and is the repository into which an entity must provide information required for the conduct of business as a recipient. Additional information about registration procedures may be found at the CCR internet site at www.ccr.gov.

If an award is granted, the grantee organization must notify potential sub-recipients that no organization may receive a subaward under the grant unless the organization has provided its DUNS number to the grantee organization.

Cost Sharing or Matching Cost sharing or matching funds are not required for this program.

Other If a funding amount greater than the ceiling of the award range is requested, the application will be considered non-responsive and will not be entered into the review process. The applicant will be notified that the application did not meet the eligibility requirements.

Special Requirements If the application is incomplete or non-responsive to the special requirements listed in this section, it will not be entered into the review process. The applicant will be notified the application did not meet submission requirements.

· Late applications will be considered non-responsive. See section “IV.3. Submission Dates and Times” for more information on deadlines.

· Note: Title 2 of the United States Code Section 1611 states that an organization described in Section 501(c)(4) of the Internal Revenue Code that engages in lobbying activities is not eligible to receive Federal funds constituting a grant, loan, or an award.

Maintenance of Effort Maintenance of Effort is not required for this program IV. Application and Submission Information Address to Request Application Package Applicants must download the SF424 (R&R) application package associated with this funding opportunity from Grants.gov. If access to the Internet is not available or if the applicant encounters difficulty in accessing the forms on-line, contact the HHS/CDC Procurement and Grant Office Technical Information Management Section (PGO TIMS) staff at (770) 488-2700 for further instruction. CDC Telecommunications for the hearing impaired or disabled is available at: TTY 1-888-232-6348.

If technical difficulties are encountered with Grants.gov, contact the Grants.gov Customer Service Contact Center. The Grants.gov Contact Center is available 24 hours a day, 7 days a week, with the exception of all Federal holidays. The Contact Center provides customer service to the applicant community. The extended hours will provide applicants support around the clock, ensuring the best possible customer service is received any time it’s needed. The Grants.gov Contact Center can be reached at 1-800-518-4726 or by email at support@grants.gov. Submissions sent by e-mail, fax, CDs or thumb drives of applications will not be accepted.

Content and Form of Application Submission CDC Assurances and Certifications can be found on the CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm Letter of Intent (LOI):

A letter of intent is not applicable to this funding opportunity announcement.

A Project Abstract must be completed in the Grants.gov application forms. All electronic project abstracts must be uploaded in a PDF file format when submitting via Grants.gov. The abstract must be submitted in the following format:

· Maximum of two to three paragraphs;

· Single-spaced

The Project Abstract must contain a summary of the proposed activity suitable for dissemination to the public. Do not copy and paste text into the Project Abstract Form as it may cause electronic submission errors due to unacceptable characters. It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically literate lay reader. This Abstract must not include any proprietary/confidential information.

A Project Narrative must be submitted with the application forms. All electronic narratives must be uploaded in a PDF file format when submitting via Grants.gov. The narrative must be submitted in the following format:

· Maximum number of pages: 20 (14 for Part A and 6 for Part B). If the applicant’s narrative exceeds the page limit, only the first pages which are within the page limit will be reviewed;

· Font size: 12 point, unreduced, Times New Roman;

· Double spaced;

· Paper size: 8.5 by 11 inches (preferred), or generally accepted paper size;

· Page margin size: One inch;

· Number all document pages of the application (excluding the forms provided in the application package) sequentially from page one (Application Face Page) to the end of the application, including charts, figures, tables, and appendices; and

The narrative should address activities to be conducted over the entire project period and must include the following items in the order listed:

Part A – ECHPP Coordination and Evaluation

1. General (two pages)

· Specify the MSA or Metropolitan Divisions within the MSAs that has the highest AIDS prevalence and that is the area targeted by the ECHPP.

· Specify the highest risk populations in the target area. Summarize the epidemiologic data that quantifies these populations as representing the highest proportion of cases in the jurisdiction. Briefly describe the behaviors, social determinants, and contexts that put each of these populations at risk.

· List the stakeholders, partners, CBOs, local health departments, state health departments, service providers, local planning groups, and other governmental and non-governmental entities that helped develop the ECHPP.

2. Coordination and Allocation of Resources (four pages)

· Describe identified gaps in scope, reach, coordination, and services in the target area are addressed by the applicant’s ECHPP.

· Describe the plan to manage and coordinate data systems to ensure assessment of program efforts.

· Describe the systems for coordinating and monitoring partnerships and funding streams.

· Describe how the routine monitoring and reporting of HIV diagnoses and related information (i.e., CD4 count, viral load) to state and local surveillance programs is assured. Do not include copies of reporting forms.

· Describe any adjustments in allocation of existing resources (i.e., funding from CDC, other federal sources, and the state) made by the ECHPP in order to increase impact on HIV incidence. Provide justification for adjustments made and for the maintenance of previous allocation levels in terms of alignment with the local HIV epidemiological profile, relative cost effectiveness of interventions and strategies, success in leveraging resources, and need to achieve optimal balance in the combination of interventions and strategies in terms of intervention types, populations targeted, and proportions devoted to HIV-positives and high risk HIV-negatives.

· Describe the areas where capacity building needs were identified and the strategies and activities that have been selected or implemented to build that needed capacity.

· Include a copy of the final approved ECHPP in the application’s appendices.

3. Objectives (two pages)

· Indicate all who share responsibility for achieving each of the objectives.

· Indicate how cross-agency coordination will be achieved, including partnerships and funding streams, to better leverage resources.

· Present a two-year timeline that shows the implementation of each of the selected interventions and strategies of the ECHPP.

4. Capacity (three pages)

· Describe the process for managing, monitoring, and maintaining meaningful collaboration in which partners regularly contribute effort toward shared objectives. Include an organizational chart of the project that shows how participating entities, not persons within those entities, are connected.

· Demonstrate coordination and monitoring of services across different funding streams, including providing dedicated staff for this activity.

· Demonstrate the ability to supply the required monitoring and evaluation data and to manage and coordinate relevant data systems where possible.

· Present the staffing plan for the project. Describe how the staff persons are appropriate and sufficient in relation to their respective roles and responsibilities in coordinating and evaluating the ECHPP. Include position descriptions and qualifications for any staff to be hired and indicate, if funded, whether the position can be filled within three months.

· List the stakeholders, partners, CBOs, local health departments, state health departments, service providers, local planning groups, and other governmental and non-governmental entities that are or will be implementing the ECHPP. Provide a letter of support from each of them that clearly acknowledges their specific roles, responsibilities, and expectations on the project.

· Describe the adequacy of the staff and partners’ training and experience to implement the selected interventions and strategies.

5. Evaluation (three pages)

· Describe the current stage of the implementation of each selected activity and strategy in the ECHPP (e.g., staff have been hired and trained but the activity has not yet been implemented).

· Describe the plan and timeline for the collection of M&E data on ECHPP activities that will measure progress on and achievement of the project SMART objectives and that are consistent with current CDC data requirements for programmatic activities (i.e., variables and frequency of reporting). Describe data collection resources, data collection methods, and data reporting systems. Describe plans for data processing, analysis, and report writing.

· Describe how program performance indicator information and local epidemiologic data will be used to adjust project activities to increase impact and efficiency.

· Present evidence that selected interventions and strategies are being or will be assessed for their epidemiologic benefit including cultural appropriateness for local target populations, especially for those disproportionately affected.

· Describe plans to collect qualitative data regarding challenges and successes experienced with systems for coordinating partnerships and funding streams, coordinating data systems, and scaling up services. Indicate willingness to help CDC develop guidance to assist other areas based on these lessons learned.

Part B – ECHPP Implementation

1. Program Plan (four pages)

· Describe the portfolio of interventions and strategies selected to optimally address the gaps in scope, reach, coordination, and services in the target area. Indicate which of the interventions and strategies are new to the jurisdiction, which ones have either been expanded or scaled back in the ECHPP, and which are CDC-approved innovative local activities. Provide a description of how funding for additional ECHPP activities will make the most progress towards achieving NHAS/DHAP 2015 targets outlined in the National Strategic Goals Tool from Phase I.

· Describe how the portfolio of selections will address social determinants of health to reduce HIV-related health disparities as well as reduce service redundancies and provision of non-essential services.

· Describe strategies and activities to build capacity in the targeted MSAs where capacity building needs are identified.

2. Capacity (two pages)

· Present the staffing plan for the project. Describe how the staff persons are appropriate and sufficient in relation to their respective roles and responsibilities in implementing and supporting the ECHPP.