SOL-176-15-000001.pdf

RFP No.: SOL-176-15-000001 Page: 3

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Contents

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 COST REIMBURSEMENT CONTRACT TYPE

B.3 TOTAL CONTRACT VALUE AND OBLIGATED AMOUNT

B.4 PRICE/COST SCHEDULE

B.5 FIXED FEE (CPFF)

B.6 INDIRECT COSTS (CPFF)

B.7 COST REIMBURSABLE (CPFF)

B.8 CANCELLATION CEILING

SECTION C – DESCRIPTION / SPECIFICATIONS/STATEMENT OF WORK

C.1 PURPOSE

C.2 PROGRAM OBJECTIVES AND RESULTS

C.3 BACKGROUND

C.4 LINK TO THE U.S. STRATEGIC FRAMEWORK FOR FOREIGN ASSISTANCE

C.5 USAID AND OTHER DONOR RELATED ACTIVITIES

C.6 ACTIVITY DESCRIPTION COMPONENTS AND RESULTS

SECTION D – PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 BRANDING AND MARKING POLICY

D.3 BRANDING STRATEGY

D.4 APPROVAL OF BRANDING IMPLEMENTATION PLAN

SECTION E – INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

SECTION F – DELIVERIES OF PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 AUTHORIZED WORK DAY / WEEK

F.5 DELIVERABLES AND REQUIRED REPORTING

F.6 DELIVERABLES, DELIVERY SCHEDULE AND FIXED FEE PAYMENT SCHEDULE

F.7 KEY PERSONNEL

F.8 PERFORMANCE STANDARDS

F.9 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE DOCUMENTS

(SEPTEMBER 2013)

F.10 752.242-70 PERIODIC PROGRESS REPORTS (OCTOBER 2007)

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 CONTRACTING OFFICER'S AUTHORITY

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.4 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998) (CPFF)

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G.5 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

G.6 PAYING OFFICE

G.7 ACCOUNTING AND APPROPRIATION DATA

G.8 CONTRACTOR’S PRIMARY POINT OF CONTACT

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 INSURANCE AND SERVICES

H.2 AUTHORIZED GEOGRAPHIC CODE

H.3 AIDAR 752.225-70 SOURCE AND NATIONALITY REQUIREMENTS (FEB 2012)

H.4 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APR 2014)

H.5 AMMONIUM NITRATE AND CALCIUM AMMONIUM NITRATE RESTRICTION

(SEPTEMBER 2011)

H.6 LANGUAGE REQUIREMENTS

H.7 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION

TECHNOLOGY RESOURCES

H.8 ADS 548 INFORMATION TECHNOLOGY REQUIREMENT

H.9 ADS 547 MANAGEMENT OF INFORMATION TECHNOLOGY RESOURCES

H.10 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES

H.11 REPORTING OF FOREIGN TAXES (JULY 2007)

H.12 NONDISCRIMINATION (JUNE 2012)

H.13 ACCESS TO USAID FACILITIES AND USAID’S INFORMATION SYSTEMS (AUGUST 2013)

H.14 USAID DISABILITY POLICY - ACQUISITION (DECEMBER 2004)

H.15 302.3.5.16(A)(1) CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION) (FEBRUARY 2012)55

H.16 302.3.5.16(A)(3) CONDOMS (ACQUISITION) (SEPTEMBER 2014)

H.17 302.3.5.16(A)(4) PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR

PRACTICE OF PROSTITUTION OR SEX TRAFFICKING (SEPTEMBER 2014)

H.18 USAID-FINANCED THIRD-PARTY WEB SITES (AUGUST 2013)

H.19 CONFERENCE PLANNING AND REQUIRED APPROVALS (AUGUST 2013)

H.20 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION (JULY 2014) .. 58

H.21 302.3.5.22 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA LIBRARY (DDL)

(OCTOBER 2014)

H.22 ELECTRONIC PAYMENTS SYSTEM

H.23 COMPLIANCE WITH SECTION 508 OF THE REHABILITATION ACT OF 1973, AS AMENDED ... 61

H.24 GENDER CONSIDERATION

H.25 ENVIRONMENTAL COMPLIANCE

PART II – CONTRACT CLAUSES

SECTION I – CONTRACT CLAUSES

I.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.3 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

I.4 52.222-50 COMBATING TRAFFICKING IN PERSONS (FEB 2009)

I.5 52.244-2 SUBCONTRACTS ALT I. (JUNE 2007)

I.6 52.222-52 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT ACT TO CONTRACTS

FOR CERTAIN SERVICES – CERTIFICATION (MAY 2014)

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PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHEMENTS

SECTION J - LIST OF ATTACHMENTS

PART IV – REPRESENTATIONS AND INSTRUCTIONS

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.3 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010)

K.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

K.5 FAR 52.209-XX REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX

LIABILITY OR A FELONY CRIMINAL CONVICTION

K.6 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)

K.7 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION (MAY 2012)

K.8 52.230-7 PROPOSAL DISCLOSURE—COST ACCOUNTING PRACTICE CHANGES (APR 2005) 81

K.9 INSURANCE - IMMUNITY FROM TORT LIABILITY

K.10 SIGNATURE

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.2 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.3 52.216-1 TYPE OF CONTRACT (APR 1984)

L.4 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.5 GENERAL INSTRUCTIONS TO OFFERORS

L.6 PROPOSAL SUBMISSION

L.7 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL

L.9 INSTRUCTIONS FOR THE PREPARATION OF BRANDING AND MARKING PLANS

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

M.2 GENERAL AND SOURCE SELECTION INFORMATION

M.3 EVALUATION CRITERIA

M.4 COST PROPOSAL EVALUATION

M.5 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.6 SOURCE SELECTION

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PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to obtain services as described in Section C. Statement of Work.

B.2 COST REIMBURSEMENT CONTRACT TYPE

This is a Cost-Plus-Fixed-Fee (CPFF) completion contract. For the consideration set forth below, the contractor must provide the deliverables or outputs described in Sections C and F in accordance with the performance standards specified in Sections C and F.

B.3 TOTAL CONTRACT VALUE AND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is TBD. The fixed fee, if any, is TBD. The estimated cost plus fixed fee, if any, is TBD.

(b) Within the estimated cost plus fixed fee (if any) specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the contractor (and payment of fee, if any) for performance hereunder is TBD. The contractor cannot exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through TBD.

(d) The breakdown by country of the amount currently obligated is as follows:

115 116 119 120 122

TOTAL

Kazakhstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan

B.4 PRICE/COST SCHEDULE

Kazakhstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan Total

a. Direct Costs

b. Subtotal

c. Indirect Costs

d. Fixed Fee

e. Total Price

Contract Line Item Number

(CLIN)

Description Year 1 Year 2 Year 3 Year 4 Year 5 Total Price

0001 Base Period

Option 1: Additional Funding X

Total with Option

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B.5 FIXED FEE (CPFF)

Pursuant to FAR 16.306(d), the fixed fee payable under this contract will be tied to the completion of the reports and deliverables specified in Section F.6 of this contract and in accordance with the final approved Fee Schedule.

B.6 INDIRECT COSTS (CPFF)

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs will be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases:

Description Rate Base Type Period Indirect Cost X % 1/ 1/ 1/ Indirect Cost Y % 2/ 2/ 2/ Indirect Cost Z % 3/ 3/ 3/

1/Base of Application:

Type of Rate:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

Type of Rate:

Period:

B.7 COST REIMBURSABLE (CPFF)

Allowable costs will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, Allowable Cost and Payment, FAR 52.216-8, Fixed Fee, if applicable, and AIDAR 752.7003, Documentation for Payment.

In addition, the requirement and conditions concerning estimated cost and funding apply as detailed in FAR 52.232-22, Limitation of Funds, incorporated by reference in Section I of this contract.

B.8 CANCELLATION CEILING

CLIN 0001 is considered non-severable, and is therefore a multi-year contract as defined in FAR

17.103. Therefore, this contract is subject to the requirements of FAR 17.106.

Cancellation Dates:

Contract Year 2: Date______ Amount: $___0___ Contract Year 3: Date______ Amount: $___0___ Contract Year 4: Date______ Amount: $___0___ Contract Year 5: Date______ Amount: $___0___

Cancellation Ceiling: This is a CPFF Completion type contract where the contractor is authorized to be reimbursed for all costs which are allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment.” Therefore, the contractor will not incur any costs which would have been amortized over the life of the contract should the contract be cancelled in accordance with FAR 52.217-2. Therefore, the cancellation ceiling for each cancellation date is indicated above.

[END OF SECTION B]

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SECTION C – DESCRIPTION / SPECIFICATIONS/STATEMENT OF WORK

C.1 PURPOSE

The purpose of this HIV Regional Flagship Activity is to increase use of evidence-based government- and NGO-provided HIV prevention, treatment and care services by people living with HIV and key populations: people who inject drugs, prisoners, sex workers and men who have sex with men. By providing targeted technical assistance to the government and NGO sector to reach the populations driving the HIV epidemic, this Activity will ultimately contribute to reducing the number of new HIV infections and reducing HIV-related deaths in Central Asia.

C.2 PROGRAM OBJECTIVES AND RESULTS

The purpose of this contract is to increase use of evidence-based government and NGO-provided HIV prevention, treatment and care services by key populations to reduce the spread of HIV. Under this HIV Regional Flagship Activity, the Sub IRs from RDCS will be referred to as Results. (See Section C.6)

Relationship to the Central Asia Regional Development Cooperation Strategy (RDCS), Kyrgyz Republic Country Development Cooperation Strategy (CDCS), and Other USG Programs

The RDCS covers the four Central Asian Republics of Kazakhstan, Tajikistan, Uzbekistan and Turkmenistan. (See Attachment 1 in link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc). The USAID Mission in the Kyrgyz Republic has its own strategy. However, this regional activity will cover all five Central Asian Republics with the focus on Tajikistan, Kyrgyz Republic and Kazakhstan, with the common purpose described above in C.1.

Framework within USAID/Central Asia Republics RDCS:

The overall goal of USAID/CAR’s Regional Development Cooperation Strategy (RDCS) is enhanced regional cooperation and prosperity in the Central Asian Republics as seen in the illustration below. The USAID investments in HIV programs will support CA’s RDCS through Development Objective (DO) 3:

More accountable and inclusive governance institutions that serve the public good. The sequential logic underlying this DO is that broad prosperity, equality and stability are not possible without rule of law, strong public service delivery and improved equity in utilization of social and health services. The RDCS also assumes that inclusivity and serving the public good are not a natural, default state for governance institutions. Rather, this condition is dependent upon competent state and local bodies and capable civil society institutions engaging constructively to increase quality, access and utilization of public services. In addition, as service delivery improves, people will be healthier and better educated and can constructively participate in the economy and hold their governments accountable. Additionally, a decrease in the spread of infectious diseases, such as HIV, will also mitigate transnational threats and strengthen the ability of countries to collaborate more closely across borders. Thus, the CA HIV project rationale is closely related to the objectives of Democracy and Governance, as it is focused on improved governance of civil society and public services in the health sector.

The purpose of this activity is to increase use of evidence-based government and NGO-provided HIV prevention, treatment and care services by people living with HIV (PLHIV) and key populations: people who inject drugs (PWID), prisoners, sex workers (SW) and men who have sex with men (MSM). This activity will directly support all Intermediate Results (IRs) under the RDCS DO3 including: IR3.1: More constructive engagement between representative civil society and governments, IR3.2 More accountable and transparent state bodies and IR3.3: Increased use of vital health and education services.

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As funding declines, USAID investments in HIV will be increasingly allocated to capacity building activities focused on the scale up services and health policy reform in order to better promote country ownership and sustained results by CA governments themselves. As PEPFAR and USAID Strategies shift USG investments in HIV programming from direct service delivery to more targeted technical assistance, a more nuanced systems-approach is required to allocate USAID resources to activities that will translate into sustainable results. Consequently, this HIV project design demonstrates increased emphasis on strengthening the collaborative relationship between civil society and government.

Framework within USAID/Kyrgyz Republic’s CDCS:

The overall goal of USAID/Kyrgyz Republic’s CDCS is a democratic, well-governed, and prosperous Kyrgyz Republic. (See Attachment 2 in link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc) These activities will support the Kyrgyz Republic’s CDCS largely through DO 2: Improved service delivery and policy for all citizens. The CDCS calls for project designs under all DOs that consider a set of crosscutting themes and shared operational approaches to doing their work. These are common frames that will be used in all USAID/Kyrgyz Republic project designs under this CDCS: inclusivity (including gender equity and youth), reducing extreme poverty, building resilience to shocks; and science, technology, innovation and partnerships. Inclusivity is especially relevant to HIV activities. The PAD states, “USAID seeks to expand and improve services so that they are equitable and that all citizens have a voice in influencing their government. Activities authorized in the PAD will assist marginalized groups to access improved health and HIV services, and ultimately, achieve better health outcomes. Improved health status also leads persons to achieve better educational outcomes and as well as to increase economic opportunities.” Under DO2, these activities support IR 2.2: Increased utilization of quality public services (health and education) by all citizens. As a result of this new HIV activity, USAID investments will enhance national capacity to deliver and sustain quality prevention, treatment and care of HIV services for key populations.

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Linkages to USAID/CAR’s Feed the Future Initiative (Tajikistan):

Tajikistan is a Feed the Future (FTF) focus country, and FTF work is concentrated in the southwestern part of Tajikistan, the region most dependent on agriculture and least food secure. FTF in Tajikistan will increase agricultural productivity and incomes, and improve nutrition outcomes in its focus area. Nutrition is an integral part of FTF and the initiative leverages nutrition, maternal and child health and family planning funding to increase food security in its defined target area. It is anticipated that there will continue to be linkages between the HIV and nutrition components in FTF sites. For example, outreach workers in Khatlon will be trained in nutrition and then provide this information to key populations or refer key populations in need to healthcare workers trained in FTF.

Linkages to USG/CAR’s Five-Year PEPFAR Strategy

This activity fits within CA’s 5-year PEPFAR strategy, which abides by the Global Health Initiative (GHI) principles and sets out the following objectives for the PEPFAR CA program (See Attachment 3 in link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc):

● Objective 1: Improve access in public and private sectors to quality HIV prevention, care and treatment services to reduce the transmission and impact of the HIV epidemic in Central Asia.

● Objective 2: Strengthen the capacity of the health system to deliver improved, expanded, equitable and sustainable HIV/AIDS services for key populations, PLHIV and their families, and other affected populations.

● Objective 3: Strengthen the capacity of public and private sectors to collect, analyze, manage and utilize data for evidence-based planning and policymaking at all levels.

Other USG programs are currently contributing to efforts to reduce the prevalence of HIV in the Central

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Asia Region. This activity will coordinate closely with the United States Centers for Disease Control (CDC), which collaborates closely with Ministries of Health across the Central Asia Region and provides technical assistance related to HIV prevention and treatment in a number of areas, including laboratory, epidemiology, surveillance, public health evaluation and workforce capacity. This activity will also complement work currently being supported via USAID, including: an initiative to support a local HIV NGO association capacity; an activity focusing on HIV prevention, care, and treatment services for prisoners and ex-prisoners; efforts to support Global Fund to Fight AIDS, TB and Malaria (GF) grant implementation in the region; and an activity conducting economic analyses and producing evidence on maximizing the impact of HIV investments. The activity will also coordinate with Peace Corps PEPFAR activities in the Kyrgyz Republic.

The activity will support the President’s Emergency Plan for AIDS Relief Blueprint: Creating an AIDS Free Generation. Specifically, this program will address the action step “Increase access to and uptake of HIV services by key populations” in the Roadmap for Smart Investments. The Blueprint states that to be smart about our investments we need to target interventions to populations at greatest risk. The Blueprint posits that evidence-based, high quality HIV/AIDS prevention, care and treatment programs will contribute to reduced morbidity and mortality and improved quality of life and productivity for key populations.

Evidence-based programs refer to programs that have been proven scientifically and demonstrated effectiveness globally.

The activity is also expected to help contribute to the overall Care and Treatment earmark of 50% specified in the PEPFAR Stewardship and Oversight Act of 2013. As a Targeted Technical Assistance program, PEPFAR/CAR was mandated to ensure that 17% of FY14 Country Operating Plan (COP) funding was included in the HIV care and treatment budget codes. While the PEPFAR/CAR attributable percentage may change on an annual basis over the course of the Act depending on guidance from the Office of the Global AIDS Coordinator (OGAC), the overall goal will remain in place. Activities will be designed and funded with the legislative earmark in mind.

Linkages to PEPFAR Regional Gender Strategy:

The goal of the PEPFAR CAR Regional Gender Strategy (2013-2019) is to reduce gender barriers to HIV services, decrease HIV vulnerability, increase healthy behaviors, and enhance the well-being and rights of key populations. The following four strategic opportunities represent a set of linked opportunities to achieve the overall goal of the gender strategy. (See Attachment 4 in link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc)

1. Promote understanding of and attention to gender norms, relational dynamics, and gender inequalities within the policy and program agendas of principal stakeholders.

2. Reduce major gender-related barriers to HIV services for key populations by implementing gender-responsive HIV outreach and service models.

3. Reduce gender-based violence and its role in exacerbating HIV vulnerability and limiting access.

4. Enhance the capacity of key populations to advocate for and lead policy change that advances gender equality in the HIV response.

Linkages to Agency Priorities around Resilience/Extreme Poverty:

As primarily upper-middle income (Kazakhstan, Turkmenistan) and lower-middle income (Kyrgyz Republic, Uzbekistan) economies, the Agencies priorities around resilience and extreme poverty are relevant to those who are most marginalized and at risk of sliding into extreme poverty: prisoners, injecting drug users, sex workers, and men who have sex with men. By focusing efforts around these key populations, this activity helps shore up the countries’ status as middle-income economies, preventing backsliding. In addition, efforts around reintegrating [U1] key populations into society—both from a health support perspective as well as a social support—address both resilience and extreme poverty by providing the support needed to live with HIV and help them contribute productively to society.

Furthermore, preventing the wider spread of HIV and TB can mitigate any concomitant negative impacts on economic growth and stability.

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Linkages to Science, Technology, Innovation, and Partnerships:

The response to the HIV epidemic in Central Asia is one grounded in the scientific evidence around what structural, biological, and behavioral interventions are most likely to reduce HIV prevalence in a country.

Various technologies and innovations are appropriate to use in the HIV response, such as using mobile health services, harmonizing information systems for client enrollment and referral, rapid testing for HIV, and laboratory monitoring at the facility, oblast, and national level. (See link http://www.usaid.gov/GlobalDevLab)

Sustainability and Local Solutions:

All activity components (Results 1 and 2) (See Section C.6 for more information on the components) enhance sustainability, builds local capacity among government and NGOs, and creates partnerships among public, private and donor agencies. This, in turn, leads to (Results 3) a stronger civil society and social partnerships, stronger government commitment and improved ability to provide quality HIV/AIDS services in their countries after donor assistance phases out. (See Section C.6 for more information on the components).

C.3 BACKGROUND

In 2004, the World Bank described the HIV/AIDS situation in Eastern Europe and Central Asia as the fastest growing HIV/AIDS epidemic in the world. Ten years later, national HIV responses are better focused, but Central Asia is one of only two regions in the world where the annual number of people newly infected with HIV is still on the rise.

All CAR countries have concentrated HIV/AIDS epidemics primarily driven by people who inject drugs (PWID) located in urban centers and along drug transportation corridors from Afghanistan through Tajikistan, Turkmenistan, Uzbekistan, the Kyrgyz Republic and Kazakhstan. HIV prevalence among PWID is high and growing throughout the region, ranging from 3.8-18% in Kazakhstan, 14.6% in the Kyrgyz Republic and 16.3% in Tajikistan. HIV remains concentrated within key populations (KP): PWID, sex workers (SW), and men who have sex with men (MSM). There is evidence to suggest that that the incidence of sexual transmission is on the rise. The risk of acquiring HIV among key populations (KP) is increased by unsafe sexual practices: less than 50% of PWID in Tajikistan report using a condom with SW, while in the Kyrgyz Republic, the syphilis prevalence is 32% among SW, 16% among prisoners and 13% among MSM. In 2011, the proportion of registered HIV cases acquired through sexual transmission (50.7%) exceeded, for the first time, the proportion of cases acquired through injection drug use (43.7%) in Kazakhstan. Prisoners also have high prevalence of HIV related to high rates of incarceration of PWID, as well as unsafe injecting and sexual practices during incarceration. Re-entry to society following incarceration is challenging, and those living with HIV are often released with minimal supplies of medication, and without support for reintegration into society or HIV adherence support. Only a small percentage of prisoners who are people living with HIV (PLHIV) are currently receiving treatment and most prisons in Central Asia lack personnel who have sufficient knowledge and experience in administering antiretroviral therapy (ART) and TB treatment and managing side effects. Prisons also have limited/no access to timely laboratory services necessary to administer ART and monitor its results.

Substantial evidence indicates that a combination of structural, biological and behavioral interventions, linked with a supportive social and political environment and with high population coverage, can decrease HIV risk and vulnerability among KP. In Central Asia, the proportion of persons who access and receive these core interventions (the coverage rate), particularly among PWID, is generally very low. In addition, CAR countries have largely vertical, specialized health care systems that lack the coordination or referral mechanisms needed to facilitate access to a continuum of HIV/AIDS prevention, treatment, and care services. Moreover, the prison health system is another vertical health system, which falls outside of the Ministry of Health under the Ministry of Justice or Ministry of Internal Affairs. Policies and practices across the region in many instances fail to address the service needs of key affected populations; constrain access to services and violate their rights; limit implementation and scale-up of evidence-based prevention, treatment, and care services; and generally overlook the potential role of non-state actors, Page: 14 including NGOs and coordinating bodies, communities, and the private sector in the delivery of HIV services. There are high levels of social stigma and institutional discrimination against key populations in the CAR, which affect both the delivery, and the demand for, HIV related services. Moreover, there is inadequate political commitment, leadership, and funds for HIV programs targeting key affected populations. In addition, many organizations and individuals across the region lack the capacities and systems needed to effectively plan, implement, manage, and monitor HIV programs.

There is also a need to facilitate PLHIV access to treatment and care services. The lack of adherence support for ART and low retention rates among PLHIV remain key gaps to be addressed to ensure the delivery of effective services and reduction of high PLHIV mortality rates. Linking sufficient numbers of KP with diagnostic and treatment services is challenging due to the limited availability and accessibility of safe, stigma-free service points. Medication-assisted therapy (MAT) is limited and there are, in some countries, policy and political constraints to implementing or scaling up MAT. Access to rapid HIV tests for KP is limited by regulations preventing non-governmental organizations (NGOs) from providing HIV screening and confirmation tests, resulting in lack of confirmatory results and delays in enrollment in care.

Furthermore, many government sites also do not employ rapid testing.

Regional Context

Although the CARs have only a limited number of development partners providing HIV assistance, national responses are primarily donor dependent. The two main HIV donors are the Global Fund to Fight AIDS, TB and Malaria (GFATM) and USAID. The CARs have been notified of their funding levels under the GFATM’s New Funding Model, which are largely at the same level as previous grants, with the exception of Kazakhstan which is no longer eligible for new GFATM HIV grants. There has been a strong level of synergy between USAID and GFATM funding, with USAID funding complementing GFATM programming, through a greater emphasis on prevention and helping to address TA needs in the country.

There are opportunities for collaboration with the World Bank’s new health systems strengthening program.

If development partners withdraw assistance for HIV/AIDS too quickly without good transition planning, the CARs would have difficulty in sustaining their HIV/AIDS responses. The return on investment of donor HIV programming in Central Asia will be maximized by a strong focus on addressing critical issues of sustainability and planned donor transition. There is an opportunity to build on its existing health and HIV investments in Central Asia by leveraging stronger and better resourced national responses to HIV. By demonstrating evidence informed policy and programming approaches, coupled with a strong replication strategy, donors can work with the governments and civil society to increase the scale, quality, effectiveness and sustainability of national HIV/AIDS responses.

Through this procurement, USAID intends to demonstrate effective and efficient models to increase the supply of and demand for high-quality HIV prevention, care and treatment services; build the capacity of non-governmental organizations to increase their sustainability and technical expertise; and develop or strengthen governments’ mechanisms to address the HIV epidemic collaboratively with NGOs.

Country Context

HIV Statistics by country

Population1 Estimated number of PLHIV (adults and children)2

Estimated number of PWID2

HIV Prevalence among PWID3

% PWID on

ART3

Kazakhstan 17,737,000 19,000 123,640 4% 42%

Kyrgyz Republic 5,548,000 12,000 25,000 14.6% 22%

Tajikistan 7,910,000 11,000 25,000 16.3 No data

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Uzbekistan 28,662,000 28,250 No data 8.4% No data

Turkmenistan 5,113,000 0 (reported by country)

No data No data No data

Total 64,969,000 70,250 173,640

1 U.S. Census Bureau, 2013 2 Global AIDS Report 2012 3 UNGASS Country reports, 2012

Maps in Attachment 5 (See link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc)

Kazakhstan The Government of Kazakhstan (GoK) is the primary funder of its national HIV program, supporting 53% of funding over the last year, with 27% from the Global Fund, 12% from USG, and 8% from other international organizations. GFATM support for HIV will end in 2016 with the end of the current grant for $12.5 million from Round 10 which is focused on PWID and PLHIV in five geographical regions. USG implementing partners comprise of the primary source of TA to Kazakhstan and this support will be even more critical in the next several years. UN agencies’ modest funding supports HIV activities, including interventions to prevent mother to child transmission of HIV, and treatment for HIV infected children.

UNICEF provides assistance for the development of testing protocols for pregnant women. UNESCO supports youth education and prevention programs to address STI (sexually transmitted infections) and HIV and general education campaigns to reduce stigma and discrimination against PLHIV. UNODC provides TA to the MOH and the Republican AIDS Center (RAC) to expand the MAT programs for KP with manuals for staff on social and medical problems in prisons. UN Women plays an advisory role to all UN organizations to ensure that their country and regional programs incorporate women and girl issues.

UNFPA is focusing on maternal health and the prevention of adolescent pregnancies, and on efforts to ensure SW access to reproductive health (RH) services.

Kyrgyz Republic The Kyrgyz Republic is one of the seven countries with the highest rates of HIV infection in Asia (WHO/UNAIDS). The number of officially registered HIV cases in the past nine years has risen from 826 cases in 2005 to 5,115 in 2014 (Republican AIDS Center). The Kyrgyz Republic has created a supportive policy environment for HIV resulting in more openness of government to work with civil society organizations and engage with donors. The Republican AIDS Center and the National TB Program collaborate with the USG and other donors on training and systems building to support the MOH in order to deliver an effective, evidence-based TB/HIV response. This also includes collaboration between the World Health Organization (WHO), United Nations Development Program (UNDP), GFATM, International Committee of the Red Cross (ICRC), Medecins Sans Frontieres (MSF), and AIDS Foundation East West (AFEW). GFATM funding in the Kyrgyz Republic has amounted to a total of US $30,733,897 since July 1, 2011 to December 31, 2013. These stakeholders have developed a joint strategic plan of activities on prevention and control of HIV/TB co-infection in the Kyrgyz Republic for 2013. Although the GOK approved a national AIDS Program Strategy for 2012-2016, lack of government financing for HIV/AIDS services, widespread stigma and discrimination, and harmful police practices remain formidable challenges. In addition, the Kyrgyz Republic has a health sector program with the World Bank-Sector wide approach (SWAP), which includes HIV as one of its four priority goals.

Tajikistan Although the government has formulated a National Program on HIV/AIDS and established the National Coordination Committee, there is limited public funding for HIV/AIDS projects. This financing gap has largely been filled by the GF. Estimates prepared by the GF indicate that national and international AIDS-related spending in Tajikistan amounted to about USD 15.4 million in 2010/2011, representing a national budget share of 14.9%. International donors account for 84.4% and private funds account for 0.7%. The GF has been the major donor for Tajikistan’s HIV programs. Tajikistan has received GF funding since

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2003, through four rounds of funding for HIV for a total signed amount to-date worth US $64,452, 538.

Since March 2014, the country has been preparing its application to the GF for funding through the New Funding Model (NFM). The GF finances ARV drugs and other treatment-related commodities. HIV services in Tajikistan are primarily offered through a network of specialized programs (provincial and city AIDS Centers); with the National AIDS Center serving as the national body that coordinates HIV surveillance, prevention, care, and treatment activities. Additionally, there are 47 Trust Points (TP) and 25 Friendly Cabinets (FC) that provide free outpatient HIV-related services to PWID and SWs, respectively.

There are 31 TPs are located at the AIDS Centers and 16 are NGO based. There are a limited number of NGOs that provide HIV prevention services to MSM.

Uzbekistan In September 2013, the Government of Uzbekistan (GoU) approved a new law on HIV which established responsibilities and powers of governmental and non-governmental bodies on a national response. The new law lifts all restrictions on entry, stay and residence for people living with HIV in Uzbekistan. Also, in 2013, the GoU committed $1 million annually for ART. These important reforms create a window of opportunity for USAID to support the Government of Uzbekistan in its fight to avert HIV infection and take advantage of the recently signed Memorandum of Understand with the MOH. The GF has provided significant HIV funding to Uzbekistan since 2004. GF assistance emphasizes scaling up HIV prevention among those populations most affected by HIV. In March 2013, MSF began implementing a treatment program covering up to 1,000 people with ART, worth approximately $1.6 million per year (funding is uncertain beyond 2014). In June 2013, Russia announced that it was committing $1.8 million over 3 years to fund UNAIDS to work with the MOH, WHO, UNICEF, and UNFPA to reduce mother-to-child infections and surveillance. UNODC has a long-standing presence in the Central Asia region and supports a number of activities related to the prevention of drug use and HIV/AIDS, policy reform addressing the HIV epidemic, and training programs to prevent drug use, HIV, and delinquency among young people.

Turkmenistan Turkmenistan, a country with a population of 6.2 million, does not track and publish data on its HIV/AIDS epidemic. The National HIV/AIDS strategy for 2011-2015 was developed as a guide to donors and HIV service providers, but it under-funded by the Government of Turkmenistan (GoT) and has not attracted much support from donors. Its strategy acknowledges only the possibility of HIV infections in the country and the need to harmonize laws and policies with international practices. The GoT's HIV strategy emphasizes HIV prevention and includes mention of drugs for treatment. The strategy encourages HIV testing among high-risk groups, including PWID, SW and TB patients, information campaigns for the general population, and that patients testing positive for HIV have the right to free treatment. Currently, the WHO and USAID are the only two bilateral/multilateral organizations assisting the GoT in implementing its response to HIV through the provision of limited technical support.

C.4 LINK TO THE U.S. STRATEGIC FRAMEWORK FOR FOREIGN ASSISTANCE

Under the Foreign Assistance Framework, this contract will support:

Program Objective: Investing in People Program Area: 3.1: Health Program Element: 3.1.1: HIV

Program Sub-elements: 3.1.1.5: Sexual Prevention - Other Sexual Prevention; 3.1.1.6: Adult Care and Support; 3.1.1.9: Counseling and Testing; 3.1.1.13: Health System Strengthening; 3.1.1.14: Strategic Information; 3.1.1.18: Biomedical Prevention – Prevention Among Injecting and Non-Injecting Drug Users.

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C.5 USAID AND OTHER DONOR RELATED ACTIVITIES

The USAID Dialogue on HIV and TB Project and the Quality Health Care Project are currently contributing to the achievement of USG/CAR PEPFAR goals and objectives, but will end in March and September 2015, respectively. Please see PEPFAR site maps by country for information about activities and their geographic location in Attachment 5 (See link https://drive.google.com/a/usaid.gov/?tab=mo#folders/0BwgSyyfookmlWmZZQ0I1R0t3Nmc).

Select, promising interventions from these activities below will be continued or more widely implemented under the award. Current USAID HIV activities include:

● Dialogue on HIV and TB currently works in all five CAR countries to improve equitable access to HIV and TB services through outreach to key populations, especially people who inject drugs, MSM, SW, prisoners and people living with HIV/AIDS through strengthened HIV and TB services. The activity also supports multi-disciplinary teams for PLHIV care and support, and has introduced a referral system and unique identifier code for KPs to receive a range of free, anonymous services. In Kazakhstan, the Kyrgyz Republic, Tajikistan and Uzbekistan, this activity continues through March 2015. This new activity will build on these successful interventions. Please see http://www.dialogueproject.org/ for more information.

● Quality Health Care Project supports activities in the area of TB, HIV and mother and child health in five CAR countries. In the area of HIV, this activity assists countries to strengthen health systems and services to more effectively meet the needs of key populations with the aim of increasing utilization of health services and improving health outcomes. In Kazakhstan, the project supported activities to improve social contracting mechanisms for NGOs to receive funding from the Government. The activity has developed community advisory boards at MAT and AIDS centers, and in select localities has established coordination councils including primary health care centers, AIDS centers and other facilities to address service quality and access for KPs. Training for health care workers has resulted in reduced stigma and discrimination against KPs. In Kazakhstan, the Kyrgyz Republic Tajikistan and Uzbekistan, this activity continues through September 2015. This new activity will build on these successful interventions. Please see http://www.qhcp.net/ for more information.

● HIV React works through the AIDS Foundation East-West in Kazakhstan, the Kyrgyz Republic and Tajikistan on HIV prevention activities in prisons, primarily with incarcerated PWID, and connects released prisoners with HIV-related services in the civil sector to ensure their retention in prevention, care or treatment services. HIV React began in June 2014 and will continue through mid-2016. This new activity will collaborate with HIV React in the area of NGO organizational capacity building and advocacy for evidence-based interventions. Please see http://www.afew.org/

● LEADER for PLHIV seeks to build the capacity of the Central Asian Association of PLHIV to serve as an umbrella organization for national Associations of PLHIV in Central Asia, as well as its advocacy capacity for improved access to and quality of HIV-related health services.

The LEADER project began in April 2014 and continues through mid-2017. This new activity will collaborate with the LEADER project in the area of advocacy and policy development across the region related to improved access to services for PLHIV. (See Attachment 6 Briefer on Leader Project

● Investment Framework: USAID will fund the Joint United Nations Program on AIDS (UNAIDS) to help countries evaluate the state of the disease, shift programming towards the interventions with the highest impact, address inefficiencies in programs and understand total cost and impact through a series of Investment Cases (ICs). The ICs will be used to assist MOH to advocate for increased budget and planning to initiate or continue the financial, legal and programmatic changes necessary to realign HIV spending with the ICs. (See Attachment 7 Briefer on UNAIDS Investment Framework

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● Youth Centers Project in Turkmenistan begun with joint USAID and Chevron funding and starting 2014 the project is fully funded by Chevron. The activity was implemented in two youth centers in Ashgabat and Mary and one Drop-in Center in Ashgabat to prevent HIV and TB among at-risk youth until December 2013. In 2014, the Project changed the scope of work and the title to “Together for Health”. The Project also shifted the focus to key populations for HIV and TB through several Drop-in Centers and is continuing to work with general youth through local health NGOs. The Project also supports the Resource Centre for government representatives who are interested in expanding Youth Center model. (See Attachment 8 Briefer on Turkmenistan Together for Health Project

Current USAID TB activities include:

● Regional TB Program in Central Asia will focus on Tajikistan and Uzbekistan to ensure more effective and more acceptable TB diagnostic and treatment for all, including vulnerable populations, to reduce the burden of TB and the development of drug resistant TB in Central Asia. This activity started in the Fall of 2014 and continues through mid-2019. (See Attachment 9 Brief on Regional TB Program in Central Asia

The USAID/CAR Democracy and Governance (DG) Office funds a number of initiatives designed to support Central Asian civil society organizations' (NGOs) ability to represent constituencies, advocate for reforms, and deliver social services. Many of the NGO beneficiaries under these programs are concentrated in the health sector, including those working on HIV/AIDS issue in a range of roles, from health service delivery to public information campaigns to advocating for the rights of people living with HIV. (See link http://www.usaid.gov/kazakhstan/democracy-human-rights-and-governance)

Relationship to Partner Country, Local Stakeholders and Other Donor Programs

National HIV programs:

Countries across the region do not consistently have in place national HIV/AIDS programs with the resources and approaches needed to effectively contain the growth of the epidemic. Kazakhstan, for example, does not have a National HIV/AIDS Program, although HIV/AIDS is incorporated into its national health program. The Kyrgyz Republic and Tajikistan have National HIV/AIDS Programs that recognize the concentrated nature of the epidemic and support scale up of prevention, treatment and care services. However, these programs do not provide or promote investments in targeted interventions with key populations that will have maximum impact on the epidemic. In December 2012, the Government of the Kyrgyz Republic approved a National AIDS Program for 2012-2016 which increases the government’s share of the financing for anti-HIV activities. At present, the Kyrgyz Republic is totally dependent on the Global Fund and other donor resources for procurement of ART, laboratory supplies, and other commodities. In 2010, the Government of Tajikistan approved its fourth National AIDS Program (NAP) for 2011-2015, financed largely by international donors. The GF finances all ART, test kits and equipment, but GF support is currently limited to transitional funding and, according to the 2012 UNGASS report, the budget deficit for the National AIDS Program is more than $98 million. The new National Strategic Program on HIV/AIDs in Uzbekistan for 2013-2017, among other objectives, aims at preventing HIV among key populations. The Global Fund is providing a significant level of funding to the HIV response in Uzbekistan. In Turkmenistan, the National HIV/AIDS program covers all diagnostics equipment and test kits, AIDS centers staff salaries and premises.

Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM):

The number of other donors supporting HIV/AIDS programming in CAR is limited. GFATM is the major donor in CAR, providing HIV/AIDS grants to Kazakhstan, the Kyrgyz Republic, Tajikistan, and Uzbekistan totaling over $125 million. As the largest HIV donor in the region, GFATM has been the primary source of funding for condoms and lubricants, anti-retroviral drugs and other supplies, as well as a major supporter

Page: 19 of NGOs working with (and often led by) KP. USAID’s 2014 HIV Evaluation found that GFATM award recipients would benefit from USAID targeted technical assistance, especially for NGO organization development, technical and quality assurance training on ARV and TB treatment, as well as on developing evidence-based communication tools. Estimates under the GFATM’s New Funding Model have been shared, though ultimate funding decisions will depend on the successful application of individual countries. Current projections indicate that the level of funding for most (if not all) CAR countries is on the decline (and ceasing altogether in Kazakhstan). This makes GFATM and USG collaboration even more important.

UN and Other Agencies:

The UN system (particularly UNAIDS, UNDP, UNODC and WHO) provides technical guidance to national HIV/AIDS programs, but does not provide major funding support. In the past several years, UNDP has taken on a key implementation role as the Principal Recipient (PR) for GF HIV/AIDS grants in Tajikistan, the Kyrgyz Republic and Uzbekistan, with the intent of transferring this role to the Ministry of Health (MOH) or other national entities at a later date. The USG partners with and funds both UNODC, to support capacity building for work with prison populations, and UNAIDS, to support countries to rationalize and strengthen national investments for addressing HIV.

Other multilateral and bilateral partners include GIZ, the Eurasian Harm Reduction Network (EHRN) and, since 2013, RusAID. USG collaborates closely with the EHRN, particularly on health policy issues, work with PWID, and joint support of the Central Asian Association of PLHIV. RusAID is committing $16.5 million over three years; most of the funding will go to UNAIDS to work with ministries of health and other UN organizations in Armenia, the Kyrgyz Republic, Tajikistan and Uzbekistan, with a primary focus on surveillance and reducing mother-to-child infections. Kazakhstan has adopted legislation establishing its own international aid agency; however it is not yet operational. As Kazakhstan’s aid agency begins work, it will be an important to coordinate and identify opportunities for collaboration in HIV in the region.

Private sector engagement and public private partnership opportunities Although key populations in Central Asia are relatively small in number and generally economically as well as socially marginalized, they generally lack the purchasing power to make programs targeted at them ideal candidates for public private partnerships (PPP). However, there may be opportunities related to aspects of work planned under Sub-IRs 3.3.1 and 3.3.2., focused on access to and quality of services, respectively. USAID may be able to partner with pharmaceutical companies developing Hepatitis C treatment, or with extractive industries interested in corporate social responsibility. In Turkmenistan, multinational firms such as Chevron have partnered successfully with USAID in the past and are interested in more such partnerships. USAID seeks PPP opportunities that have the potential to increase the effectiveness of its projects and contribute to achieving project objectives; under its current Mission and HIV strategies, USAID/CAR does not consider PPPs to be objectives in their own right.

C.6 ACTIVITY DESCRIPTION COMPONENTS AND RESULTS

This procurement will support a base range of activities which support accomplishment of each sub-IR.

Under the base budget scenario, activities will take place in Kazakhstan, the Kyrgyz Republic and Tajikistan. In the event that additional funding becomes available, base activities could begin in Uzbekistan and Turkmenistan, and activities within the contract’s base Scope of Work may be scaled up or intensified to support achievement of the contract objectives. Under each objective, activities falling under the base set of objectives are referred to as base activities, while additional activities that may be purchased to increase impact are referred to as expanded activities.

The geographical focus of the contract under the base scenario is:

● Kazakhstan

●…