RFI-674-24-SECURE.pdf

RFI NUMBER: RFI-674-24-SECURE

SUBJECT: Request for Information and Comment on a Potential

Opportunity focused on Sustaining Epidemic Control through Unified prevention in Lesotho

ISSUED DATE: October 16, 2023

RESPONSE DUE DATE: November 11, 2023, 12:00 Pretoria time

RESPONSE TO: nboayue@usaid.gov, steffo@usaid.gov, and gponkratova@usaid.gov

To all Interested Respondents/Parties:

The United States Government, represented by the U.S. Agency for International Development Lesotho (USAID/Lesotho), is issuing this Request for Information (RFI) for the purpose of offering industry and stakeholders an opportunity to review and provide responses to inform the draft program description framework (Attachment B of this document) for the USAID/Lesotho Sustaining Epidemic Control through Unified prevention in Lesotho (SECURE Lesotho) Activity.

The purpose of this RFI is to obtain feedback from stakeholders prior to USAID potentially issuing a Notice of Funding Opportunity (NOFO) Announcement.

This is a Request for Information and is not a Request for Proposals (RFP) or Request for Applications (RFA). It is issued solely for information, market research and planning purposes and it should not be construed as a commitment by the U.S. Government or USAID to issue any solicitation or Notice of Funding opportunity, or ultimately award a contract or assistance agreement based on this RFI, or to pay for any information voluntarily submitted as a result of this request. USAID reserves the right to, or not to incorporate any, some, or none of the comments received from this RFI into any subsequent solicitations or design documents.

Furthermore, USAID/Lesotho is not seeking technical or cost proposals at this time and will not accept unsolicited proposals. If a solicitation is issued, it will be announced on www.grants.gov and/or beta.sam.gov in the near future. It is the potential responder's responsibility to monitor the site for the release of any further information. It should be noted that responding to this RFI does not give any advantage to any firm or organization in any subsequent procurement. Any information submitted in response to this notice is voluntary. You will receive an electronic confirmation acknowledging receipt of your response and responses will be held confidential.

Interested parties can download this RFI from www.grants.gov and www.BETA.sam.gov. All responses (feedback, questions, and recommendations) regarding this communique will ONLY be accepted via email to the addresses mentioned on the cover page and must use the subject line “Response to RFI-674-24-SECURE “Organization name”.

mailto:nboayue@usaid.gov mailto:steffo@usaid.gov mailto:gponkratova@usaid.gov http://www.grants.gov/ https://sam.gov/content/home http://www.grants.gov/ http://www.beta.sam.gov/

Please ensure that your responses are concise and specific. Proprietary information should not be sent. USAID is in no way obligated to respond to RFI responses received, utilize submitted information or issue a solicitation because of this RFI. Responses to this RFI will be accepted through the dates noted at the top of this letter. No basis for claims against the U.S. Government shall arise as a result of a response to this request for information or from the U.S. Government’s use of such information. USAID is not responsible for any costs incurred in responding to this RFI.

USAID may, at its sole discretion, decide to host a Pre-Solicitation conference. Such meeting would likely be conducted on November 7, 2023, in Maseru Lesotho. Organizations interested in participating in the Pre-Solicitation conference must send an expression of interest to Steffo@usaid.gov, gponkratova@usaid.gov, and nboayue@usaid.gov no later than October 26, 2023.

Thank you for your interest in USAID/Lesotho projects.

Sincerely, /S/ Nya Kwai Boayue Contracting/Agreement Officer USAID/Southern Africa

ATTACHMENT A – Requested Response ATTACHMENT B – USAID Sustaining Epidemic Control through Unified prevention file://ausnapnaswash01.us.usaid.gov/VDI_appdata/Profile/gponkratova/Downloads/Steffo@usaid.gov file://ausnapnaswash01.us.usaid.gov/VDI_appdata/Profile/gponkratova/Downloads/gponkratova@usaid.gov file://ausnapnaswash01.us.usaid.gov/VDI_appdata/Profile/gponkratova/Downloads/nboayue@usaid.gov%20

Attachment A: Requested Response

If your organization is interested in this activity, we invite you to respond to this request to enhance the design of the activity(ies) described in Section B. Responses from organizations should be no more than 4 pages total in addition to a cover letter that details the name, address of the organizations, organization type (e.g., non-governmental organization, social enterprise, civil society organization). Responses should clearly tie back to whatever question is being addressed, but submissions do not need to address all questions listed. All responses should provide sufficient detail and justification explaining why a certain recommendation is offered.

Question 1: The purpose of this activity as described in Section B is to prevent, detect, and respond to new HIV infections through the provision of evidence-based and person-centered differentiated service delivery interventions. Lesotho has a high HIV prevalence in the general population with specific subpopulations being disproportionately affected by HIV in the country. Lesotho’s HIV epidemic is partially fueled by behavioral and structural drivers, including social and cultural factors. Moreover, stigma and discrimination limit access to prevention and treatment services for some populations. In such a context, what elements should USAID prioritize in the activity design to effectively address cultural and structural barriers that impede effective uptake of HIV prevention services?

Responses should be no more than 1 page.

Question 2: The PEPFAR program is increasingly focused on the sustainability of the HIV response with country ownership as a key element. Effectively engaging political leaders through partnership approaches for joint responsibility and joint accountability to drive a sustained HIV response. This activity is intended to reinforce community systems and district level leadership structures to sustain quality HIV prevention services. In the context of Lesotho, how can USAID position this activity to elevate community participation to institutionalize community-based service delivery models and build capacity for district level management bodies to effectively participate in national priority setting discussions.

Responses should be no more than 1 page.

Lastly, beyond the specific questions listed above, respondents may choose to provide overall feedback (comments, suggestions, and enhancements) on the design of the activity (ies) as described in Section B, if desired. What changes, if any, would you make to the proposed activity to advance the desired goal and objectives.

Responses should be no more than 1 page.

[END OF ATTACHMENT A]

ATTACHMENT B - USAID Sustaining Epidemic Control through Unified prevention

1. Background The Kingdom of Lesotho is a mountainous, landlocked country surrounded by the Republic of South Africa. It covers an area of 30,350 km2 and has a population of 2,140,201. Lesotho has the second highest HIV prevalence in the world, at 23.5% in adults aged 15-59 years, with markedly higher rates among women (27.4%) than among men (17.8%), as per the Lesotho Population Based HIV Impact Assessment (LePHIA 2020). The country has an estimated 280,000 people living with HIV with 90% of PLHIV knowing their status, 97% of those PLHIV who know their status being on ART, and 92% of those on ART having suppressed viral loads (LePHIA 2020). Primary prevention is still needed to reduce HIV incidence beyond what is achievable with ART scale-up alone. While HIV incidence declined from 1.1% in adults aged 15-59 years per the 2016 (LePHIA 2016), the HIV incidence was still high at 0.5% in the same population in 2020.

The Government of Lesotho has committed to the UNAIDS 95-95-95 goals to achieve epidemic control and has laid out key priorities in the National HIV and AIDS Strategic Plan (NHASP) 2023/24 - 27/28. Through collaboration with partners including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Government of Lesotho (GOL) is committed to the reduction of new HIV infections in adults and children, and reduction of AIDS-related deaths.

USAID/Southern Africa Mission in Lesotho implements a comprehensive portfolio of activities under PEPFAR. PEPFAR has been partnering with the GOL since its inception to contribute to the reduction of HIV related morbidity and mortality. The overarching goal of the PEPFAR program in Lesotho is to expand access to quality HIV prevention, treatment and HIV-related services in support of the revised NHASP 2023/24 - 27/28.

USAID/Southern Africa Mission/ Lesotho seeks to support USAID Sustaining Epidemic Control through Unified prevention in Lesotho (USAID SECURE) Activity in furtherance of GOL efforts to revitalize HIV/AIDS prevention at the community level in Lesotho and facilitate a sustained and equitable HIV response for all populations with a specific focus on key populations (KP).

2. Project Goal and Objectives The overall goal of USAID SECURE is to prevent, detect, and respond to new HIV infections through unified approaches to prevention and strengthened community systems, which is intended to advance the Government of Lesotho (GOL) commitment to improve access to combination prevention services for people at risk of acquiring HIV.

USAID SECURE will work strategically with key stakeholders including GOL, Civil Society, Community gatekeepers and recipients of services to reach and maintain prevention saturation as part of a holistic approach to epidemic control. USAID SECURE has three interrelated objectives to strengthen community-based services to ensure they meet the needs of clients, their families, and communities.

The first component is to Improve uptake of combination HIV prevention services according to the needs and life stages of people. To sustainably maintain epidemic control new HIV infections must be prevented through provision of status neutral evidence based biomedical and behavioral interventions. Primary HIV prevention is still needed to reduce HIV incidence beyond what is achievable with ART Scale-Up. Despite global progress on the three 95s (90,92, and 97), Lesotho still has many new infections occurring with approximately 4,821 new HIV infections estimated to have occurred among all the population in 2022. Therefore, there is a need to reach and maintain prevention saturation as part of a holistic approach to epidemic control.

The second objective is to improve coverage of non-discriminatory, client-centered, integrated services across the continuum of care for key populations. This objective is geared towards meeting individuals where they are with what they need through differentiated HIV service delivery modalities to prevent new infections and maintain/improve access, ensure ART continuity and improve health outcomes. Overall, HIV prevalence is high in the general population in Lesotho. However, there are disparities in the HIV disease burden among various subpopulations in the country. Sex workers, men who have sex with men, and adolescent girls and young women are disproportionately affected by HIV and AIDS in Lesotho. In 2020, HIV prevalence among women stood at 26.1% compared to 16% among men for the age group 15- 49 years. The 2019 Integrated Bio-Behavioral Surveillance Survey (IBBS2) Report for Key Populations in Lesotho indicates that female sex workers in Lesotho have an extremely high prevalence for HIV estimated at 47.6%. HIV prevalence among men who have sex with men is estimated at 24%, while the Lesotho Country Progress Report of 2015 notes high prevalence among PiP at 31%. Lesotho’s HIV epidemic is fueled by inter-relationships between behavioral and structural drivers. The primary structural drivers include social and cultural factors affecting women and girls as well as other key populations (e.g., MSM and TG) such as gender inequality, poverty or income disparities, mobility and migration, food insecurity and barriers to access of health care services, which worsened at the peak of the COVID-19 pandemic.

The third objective is to reinforce community systems and DHMT-level structures that can sustain high quality combination HIV prevention services and respond to other global health security threats. See the Figure below for additional details on anticipated intermediate results in each project component area to facilitate the overall USAID SECURE Activity goal.

3. Integrated Program Design A successful program description would have a comprehensive program design that effectively addresses the three program components in an integrated overall project design, while supporting client-friendly services tailored to the needs of each population.

4. Geographic Coverage USAID SECURE is intended to be national in scale, in line with the GOL vision to revitalize primary health care platforms and strengthen existing community structures across all districts in Lesotho. A successful program design should have a nimble, efficient management approach that responds effectively to program needs. This activity should maintain a continuous focus on health equity, by expanding access to high quality health interventions that address gaps in specific sub-national areas and across populations, including those living in hard-to-reach geographical locations.

5. Technical Approach

Key to success will be the meaningful engagement of community stakeholders and recipients of the HIV prevention services in the design, development, implementation, and monitoring of the project. By putting communities and their members at the center of health care delivery, USAID SECURE will build confidence in health systems, community resilience, strengthen community leadership and local governance structures for enhanced community ownership, and provide a foundation for sustained impact of the HIV response and facilitate Lesotho’s goal of universal health coverage.

Guiding principles across the project components to advance the overall USAID SECURE goal should, at a minimum, include the following:

1. Support and facilitate adoption of healthy behaviors that minimize risk for HIV infection and uptake of services and uptake of services through Social and Behavioral Change (SBC). The activity should clearly define the specific behaviors that underpin the HIV outcome; clarify the target populations for these behaviors and segments; collect data or use best available information from secondary sources on barriers and motivators;

design and test SBC interventions (Communication, Human-Centered Design, Behavioral Economics, and Marketing) that address the identified behavioral determinants; ensure adequate funding for SBC interventions; while ensuring effective coordination with clinical programs.

2. Coordination, collaboration and complementarity with other PEPFAR programs and partners: SECURE Lesotho will closely coordinate and implement programs and technical assistance with other new and ongoing PEPFAR-funded programs, the Global Fund, and other bilateral and multilateral programs.

3. Non-discriminatory and human rights-based HIV programming/GENDER: The activity should adopt an approach that places individuals and their inherent human rights at the center of its strategies. It should demonstrate an understanding of and a commitment addressing the unique and diverse identities, social contexts, and practical realities facing members of the key population. Furthermore, it should prioritize sensitivity and inclusivity, ensuring that all individuals, regardless of their gender identity or other personal characteristics, receive equitable access to the program’s services and support.

4. The activity should make CLA (collaborating, learning and adapting) principles systematic and intentional throughout the program cycle to bridge critical knowledge gaps, share findings with stakeholders to improve program implementation.

5. The activity should use evidence-based interventions and a range of data analytic tools to improve programs and clients’ outcomes. Data-driven decision making should include robust feedback loops across all levels of the health system, enhanced community-based oversight and monitoring strategies to inform local decision making and priority setting, and institutionalized use of data to facilitate decision making.

6. Policy adaptation and innovation should be integral parts of this activity to support the introduction and scale up of new biomedical interventions as per the national guidelines, and adapt new innovations and be flexible to withstand the impact of shocks to the health system and emerging threats.

7. This activity should meet clients where they are with what they need through differentiated HIV service delivery to prevent, detect and respond to HIV infections through robust, targeted prevention embedded within the community including scaling up VMMC and PrEP as approved by MOH.

8. This activity should enhance CLM (Community-Led Monitoring) principles to improve the delivery of HIV services and foster active community engagement in HIV service delivery, including the participation of KP partners. This activity should emphasize specific strategies employed to engage and involve key community stakeholders in the CLM process, highlighting their roles and contributions within this framework.

[END OF ATTACHMENT B]