SOL-72065618R00008_ECHO__04.03.2018.pdf

Date Issued: April 3, 2018 Closing Date for Submission of Questions: April 17, 2018 @ 03:00 pm (Maputo time)

Closing Date for Submission of Past Performance:

Closing Date for Receipt of Proposals:

April 24, 2018 @ 03:00 pm (Maputo time)

May 21, 2018 @ 03:00 pm (Maputo time)

Subject: Request for Proposals (RFP) No. 72065618R00008 Efficiencies for Clinical HIV/AIDS Outcomes (ECHO) in Mozambique

Dear Sir/Madam

The United States Government, represented by United States Agency for International Development (USAID) Mission in Mozambique is seeking a proposal from qualified organizations interested in providing the services under the Efficiencies for Clinical HIV Outcomes (ECHO) Activity as described in the attached solicitation.

This procurement will be conducted under a full and open competition under which US and other organizations within Geographic Code 935 are eligible to compete and the North American Industry Classification (NAICS) code is 541990. The procedures set forth in Federal Acquisition Regulation (FAR) Part 15 will apply.

USAID/Mozambique anticipates awarding one Cost Plus Fixed Fee (CPFF) completion type contract as a result of the solicitation. The estimated cost range for this procurement is $210 million to $250 Million for the implementation of this activity for a total estimated period of 5 years with no option years, subject to availability of funds. Offerors must propose costs that are realistic and reasonable corresponding with their technical approach.

USAID encourages participation to the maximum extent possible of small business concerns, small disadvantaged business concerns and women-owned small business concerns in this activity as the prime contractor or as subcontractors in accordance with Part 19 of the FAR.

The RFP and any amendments to this solicitation will be issued and posted on the Federal Business Opportunities (FBO) website at https://www.fbo.gov. It is the Offeror’s responsibility to check the website periodically for official updates and amendments to the solicitation. It is the responsibility of https://www.fbo.gov/

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

72065618R00008

4. TYPE OF SOLICITATION 5. DATE ISSUED

REQ-656-18-000012

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7) SAME AS NUMBER 7

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

9. Sealed offers in original and Electronic only_____ copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in

(Hour) (Date) CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All Offers are subject to all terms and conditions contained in this solicitation.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE NUMBER EXT.

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A I

B PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

C J

D PART IV - REPRESENTATIONS AND INSTRUCTIONS

E

F

G L

H M

K STATEMENTS OF OFFERORS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within 270 calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%) (See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated:

CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER 15A. NAME AND

ADDRESS

OF OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT. 15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM G.6 (4 copies unless otherwise specified)

10 U.S.C. 2304(a) ( ) 41 U.S.C. 253(c) ( )

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BY CODE CODE

26. NAME OF CONTRACTING OFFICER (Type or print) 27. UNITED STATES OF AMERICA 28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

(Signature of Contracting Officer)

(REV. 9-97)

10. FOR INFORMATION CALL:

11. TABLE OF CONTENTS

STANDARD FORM 33

SOLICITATION

OFFER (Must be fully completed by offeror)

AWARD (To be completed by Government)

N/A 3 132

X

Faizallet Sultan 258 21 352 2113 fsultan@usaid.gov

X

X

X

X

X

X

X

X

X

X

X

X

X

SOLICITATION/COCONTRACT FORM

SUPPLIES OR SERVICES AND PRICES/COSTS

DESCRIPTION/SPECS./WORK STATEMENT

PACKAGING AND MARKING

INSPECTION AND ACCEPTANCE

DELIVERIES OR PERFORMANCE

CONTRACT ADMINISTRATION DATA

SPECIAL CONTRACT REQUIREMENTS

CONTRACT CLAUSES

LIST OF ATTACHMENTS

INSTR., CONDS., AND NOTICES TO OFFERORS

EVALUATION FACTORS FOR AWARD

REPRESENTATIONS, CERTIFICATIONS AND OTHER

U.S. Agency for International Development/Mozambique Office of Acquisition and Assistance Rua 1231, No., 41 Bairro Central “C”, Maputo, Mozambique

USAID/Mozambique mailto:fsultan@usaid.gov

Table of Contents

PART I – THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE AND SERVICES

B.3 ESTIMATED COST AND FIXED FEE AND OBLIGATED AMOUNT

B.4 APPROVED BUDGET BY CONTRACT LINE ITEMS

B.5 INDIRECT COSTS

B.6 ADVANCE UNDERSTANDINGS OF CEILING INDIRECT COST RATES AND FINAL REIMBURSEMENT

FOR INDIRECT COSTS

B.7 COST REIMBURSABLE

B.8 PAYMENT OF FIXED FEE

B.9 MULTI-YEAR CONTRACT

B.10 LABOR

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 INTRODUCTION

C.2 BACKGROUND

C.3 PURPOSE AND ACTIVITIES

C.4 TECHNICAL APPROACH

C.5 GRANTS UNDER CONTRACTS

C.6 COLLABORATING, LEARNING AND ADPATING (CLA)

C.7 MONITORING AND EVALUATION

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 MARKING

SECTION E - INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

E.3 MONITORING AND EVALUATION

SECTION F – DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 PERFORMANCE STANDARDS

F.5 REPORTS AND DELIVERABLES

F.6 MANANGEMENT APPROACH/KEY PERSONNEL

F.7 TECHNICAL APPROVAL REQUIREMENTS

F.8 AUTHORIZED WORK WEEK

F.9 AIDAR 752.242-70 PERIODIC PROGRESS REPORTS (OCT 2007)

F.10 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE DOCUMENTS

(SEPTEMBER 2013

SOL-720656R00008 Efficiences for Clinical HIV/AIDS Outcomes (ECHO)

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998)

G.2 CONTRACTING OFFICER'S AUTHORITY

G.3 ADMINISTRATIVE CONTRACTING OFFICE

G.4 CONTRACTING OFFICER’S REPRESENTATIVE (COR)

G.5 TECHNICAL DIRECTION/RELATIONSHIP WITH USAID

G.6 PAYMENT METHOD AND INVOICES

G.7 ACCOUNTING AND APPROPRIATION DATA

G.8 CONTRACTOR’S PRIMARY POINT OF CONTACT

G.9 CONTRACTOR’S PAYMENT ADDRESS

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JUL 1997)

H.2 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JAN 2002)

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

H.4 AIDAR 752.228-70 MEDICAL EVACUATION (MEDEVAC) SERVICES (JUL 2007)

H.5 AUTHORIZED GEOGRAPHIC CODE

H.6 LOGISTIC SUPPORT

H.7 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION TECHNOLOGY RESOURCES

H.8 LANGUAGE REQUIREMENTS AND REPORTING

H.9 AIDAR 752.211-70 LANGUAGE AND MEASUREMENT (JUN 1992)

H.10 SUBCONTRACTING PLAN REPORT FOR INDIVIDUAL CONTRACTS AND SUMMARY CONTRACTING

REPORT

H.11 AIDAR 752.204-72 ACCESS TO USAID FACILITIES AND USAID’S INFORMATION SYSTEMS (MAY 2016) (DEVIATION NO. M/OAA-DEV-AIDAR-16-2c)

H.12 CLOUD COMPUTING (MAY 2016)

H.13 AIDAR 752.222-70 USAID DISABILITY POLICY (DEC 2004)

H.14 AIDAR 752.7007 PERSONNEL COMPENSATION (2007)

H.15 ADDITIONAL REQUIREMENTS FOR PERSONNEL COMPENSATION

H.16 AIDAR 752.7031 LEAVE AND HOLIDAYS (OCT 1989)

H.17 WORKER’S COMPENSATION INSURANCE (DEFENSE BASE ACT) (DEC 1991)

H.18 CONSENT TO SUBCONTRACTS

H.19 GOVERNMENT FURNISHED FACILITIES OR PROPERTY

H.20 AIDAR 752.7013 CONTRACTOR-MISSION RELATIONSHIP (OCT 1989)

H.21 EXECUTIVE ORDER ON TERRORISM FINANCING (MAR 2002)

H.22 SUBCONTRACTING PLAN AND THE SF 294 – SUBCONTRACTING REPORT FOR INDIVIDUAL

CONTRACTS AND SF 295 – SUMMARY CONTRACTING REPORTS

H.23 LIMITING CONSTRUCTION ACTIVITIES (AUGUST 2013)

H.24 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA LIBRARY (DDL) (OCTOBER 2014)

H.25 AIDAR 752.7032 INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION REQUIREMENTS (APR 2014)

H.26 BUSINESS TRAVEL

H.27 AIDAR 752.231-71 SALARY SUPPLEMENTS FOR HG EMPLOYEES (MAY 2015)

H.28 ELETRONIC PAYMENT SYSTEM

H.29 ENVIRONMENTAL COMPLIANCE

H.30 FAR 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS REPRESENTATION (JAN 2017)

H.31 USAID-FINANCED THIRD-PARTY WEB SITES (NOVEMBER 2017)

H.32 AIDAR 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUNE 2008) (AAPD-08-01)

H.33 AIDAR 752.245-71 TITLE TO AND CARE OF PROPERTY (APR 1984)

H.34 USE OF POUCH FACILITIES (JUL 1997)

H.35 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION

H.36 CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION) (AAPD 12-04/ FEBRUARY 2012)

H.37 CONDOMS (ACQUISITION) (AAPD 12-04/JUNE 2005)

H.38 PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR PRATICE OF

PROSTITUTION OR SEX TRAFFICKING (ACQUISITION) (AAPD 12-04 APRIL 2010)

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

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

I.2 752.252-2 AIDAR CLAUSES INCORPORATED BY REFERENCE (MAR 2015)

I.3 FAR 52.204-1 APPROVAL OF CONTRACT (DEC 1989)

I.4 AIDAR 752.222-71 NONDISCRIMINATION (JUNE 2012)

I.5 FAR 52.229-8 TAXES – FOREIGN COST-REIMBURSEMENT CONTRACTS (MAR 1990)

I.6 AIDAR 752.229-71 REPORTING OF FOREIGN TAXES (JULY 2007)

I.7 AIDAR 752.231-72 CONFERENCE PLANNING AND REQUIRED APPROVALS (AUG 2013)

I.8 COMBATING TRAFFICKING IN PERSONS (MAR 2015)

I.9 FAR 52.252-4 ALTERATIONS IN CONTRACT (APRIL 1984)

PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS

PART IV – REPRESENTATIONS AND INSTRUCTIONS

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS

K.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

K.2 FAR 52.204-5 WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS) (OCT 2014)

K.3 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (NOV 2017)

K.4 PREDECESSOR OF OFFEROR (JULY 2016)

K.6 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

K.7 FAR 52.209-11 REPRESENTATION BY CORPORATION REGARDING DELINQUENT TAX LIABILITY

OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

K.8 FAR 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)

K.9 FAR 52.222-38 COMPLIANCE WITH VETERANS’ EMPLOYMENT REPORTING REQUIREMENTS (DEC 2016)

K.10 FAR 52.230-1 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION (OCT 2015)

K.11 FAR 52.230.7 DISCLOSURE STATEMENT COST ACCOUNTING PRACTICES AND CERTIFICATION

(APR 2005)

K.12 AGREEMENT ON, OR EXCEPTIONS TO, TERMS AND CONDITIONS

K.13 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER

K.14 SECURITY CLEARANCE CERTIFICATION

K.15 AUTHORIZED NEGOTIATORS

K.16 SIGNATURE

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

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

L.2 FAR 52-216-1 TYPE OC CONTRACT (APR 1984)

L.3 SUBMISSION OF PAST PERFORMANCE INFORMATION

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

L.5 GENERAL INSTRUCTIONS TO OFFERORS

L.6 PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS

L.7 INSTRUCTIONS FOR THE PREPRATIONS OF THE TECHNICAL PROPOSAL

L.8 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL

L.9 STANDARD FORM (SF) 33

L.10 PROPOSED COSTS/PRICES

L.11 FIXED FEE CEILINGS

L.12 REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENT OF OFFERORS

L.13 POLICIES AND PROCEDURES

L.14 EVIDENCE OF RESPONSIBILITY

L.15 LETTERS OF COMMITMENTS (TEAM MEMBERS AND MAJOR SUB-CONTRACTS)

L.16 INFORMATION TO SUPPORT CONSENT TO SUB-CONTRACTS

L.17 INFORMATION CONCERNING WORK-DAY, WORK-WEEK, AND PAID ABSENCE

L.18 INSTRUCTIONS FOR THE PREPARATION OF A BRANDING IMPLEMENTATION AND MARKING

PLAN

SECTION M - EVALUATION FACTORS FOR AWARD

M.1 GENERAL INFORMATION

M.2 TECHNICAL PROPOSAL EVALUATION CRITERIA

M.3 COST PROPOSAL EVALUATION

M.4 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD

M.5 SOURCE SELECTION

M.6 CONTRACTING WITH SMALL BUSINESS CONCERNS AND DISADVANTAGES ENTERPRISES

PART I – THE SCHEDULE

SECTION B - Supplies or Services and Price/Costs

B.1 PURPOSE

The purpose of this Contract is provide services under the Efficiencies for Clinical HIV Outcomes (ECHO) activity specified within the Scope of Work (SOW) to support the Government of Mozambique’s (GRM) achievement of HIV/AIDS epidemic control and establishing a sustainable, government-led HIV response by 2023 in provinces where USAID is the primary clinical support partner.

B.2 CONTRACT TYPE AND SERVICES

This is a Cost-Plus-Fixed-Fee (CPFF) completion type contract in accordance with FAR 16.306. For consideration set forth below, the Contractor must perform the tasks required in Section C (Statement of Work) and the additional requirements described in Section F, H and E in accordance with the performance standards specified herein. The period of performance is 5 years.

B.3 ESTIMATED COST AND FIXED FEE AND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee is ___TBD_____. The estimated fixed fee is ___TBD_____. The estimated cost plus fixed fee 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 must not exceed the aforesaid obligated amount in accordance with the Limitation of funds Clause, FAR 52.232.22.

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

B.4 APPROVED BUDGET BY CONTRACT LINE ITEMS

(a) The contract budget found herein is based on the contractor’s original proposal and/or final proposal revision, which was accepted by USAID through award of this contract.

(b) Without the prior written approval of the Contracting Officer, the Contractor may not exceed the total estimated costs set forth in the budget hereunder or the total obligated amount, whichever is less.

(c) The following itemized budget sets forth the estimates for reimbursement of dollar costs for individual line items of cost, and the fixed fee.

Cost Category Year 1 Year 2 Year 3 Year 4 Year 5 Total

Total Direct Costs

Indirect Costs Grants Under Contracts

(GUC)

$16,805,740.00 $17,646,028.00 $18,528,336.00 $19,454,764 $20,427,496.00 $92,862,364.00

Fixed Fee Total

B.5 INDIRECT COSTS

For the Prime Contractor:

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

Description Rate

Base 1/ 2/

Type 1/ 2/

Period 1/ 2/

1/Base of Application Type of Rate: Provisional Period:

2/Base of Application:

Type of Rate: Provisional Period:

3/Base of Application:

Type of Rate: Provisional

For Each of the Major Subcontractor (s)*

Description Rate

Base 1/ 2/

Type 1/ 2/

Period 1/ 2/

1/Base of Application:

Type of Rate:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

Type of Rate:

Period:

1. *“Major Subcontractors” are those subcontractors whose proposed cost exceeds 10% of the

Offeror’s proposed total cost or perform a key element of the scope of work. USAID may request to review any proposed subcontractors below the 10% threshold. As applicable, any request to review proposed subcontractors below the 10% threshold will be communicated to the Offeror.

Note 1: Contractors may recover applicable indirect costs (i.e., overhead, G&A, etc.) if it is part of the contractor's usual accounting procedures, consistent with FAR Part 31, and Negotiated Indirect Cost Rate Agreement (NICRA).

B.6 ADVANCE UNDERSTANDINGS OF CEILING INDIRECT COST RATES AND

FINAL REIMBURSEMENT FOR INDIRECT COSTS

(a) Reimbursement for indirect costs shall be at the lower of the negotiated final ( or predetermined) rates or the following ceiling rates:

Description Rates Base Period

% 1/ 1/ % 2/ 2/ % 3/ 3/

1/Base of Application:

Period:

2/Base of Application:

Period 3/Base of Application:

Period

(b) The Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect costs rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform to the lower rates.

(c) This understanding shall not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.7 COST REIMBURSABLE

The U.S. dollar costs allowable will be limited to reasonable, allocable and necessary costs determined in accordance with FAR 31 (Contract Cost Principles), 2 CFR 200, FAR 52.216-7, (Allowable Cost and Payment), FAR 52.216-8 (Fixed Fee) if applicable, and AIDAR 752.7003, (Documentation for Payment).

B.8 PAYMENT OF FIXED FEE

Payment of fee shall be in accordance with FAR 52.216-8. The Contractor shall be paid fees based on vouchered costs. The amount of fixed fee paid will be based on a percentage of costs vouchered in the same ratio as total fixed fee is to total direct costs.

B.9 MULTI-YEAR CONTRACT

This is a multi-year contract as defined in FAR 17.103. Therefore, this contract is subject to the requirements of FAR 17.106. In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply: [Amount and dates to be filled in at time of award]

Cancellation Dates:

Contract Year 2: DATE TBD, [Award year + 1 year] Cancellation Ceiling: $2,298,403.03

Contract Year 3: DATE TBD, [Award year + 2 years] Cancellation Ceiling: $1,938,409.55

Contract Year 4: DATE TBD, [Award year + 3 years] Cancellation Ceiling: $1,549,064.10

Contract Year 5: DATE TBD, [Award year + 4 years] Cancellation Ceiling: $1,081,563.00

The cancellation dates and ceiling amounts are estimates and the finals will be established at the time of award. The amounts will be based on the nonrecurring costs to be incurred by the awardee, which would be applicable to, and which normally would be amortized over the life of the contract, and the items or services to be furnished under the multi-year requirement. This is a CPFF type contract, pursuant to which all costs for which the contractor seeks reimbursement must be allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment.”

B.10 LABOR

(a)Compensation of personnel under this contract or any resulting subcontract must be in accordance with AIDAR 752.7007 Personnel Compensation (July 2007), and will be based upon a combination of factors including the Mission’s Local Compensation Plan for the professional category being negotiated and consideration of the individual’s education, work experience and recent relevant salary history. Unless otherwise authorized by the Mission Director or AA having programmatic responsibility, the compensation for CCN and TCN labor must not exceed the Mission’s Local Compensation Plan and must be paid in the currency of the cooperating country. Exceptions to compensation above the Local Compensation Plan will be treated on a case by case basis, in accordance with AIDAR 722-1770 (Employment of Third Country Nationals (TCN’s) and Cooperating Country Nationals (CCN’s). A table of USAID/Mozambique’s Local Compensation Plan is provided as Attachment in Section J of this solicitation.

(b) All local hired national personnel and other non-U.S. expatriates must be paid in accordance with AIDAR 722-170(a). TCNs and CCNs who are working in the United States or are legal residents of the United Stated at the time they are hired for under the contract, must be extended benefits, and the subject restrictions on the same basis as U.S. citizens who work in the United States.

(c ) The work day and work policies and method of accounting of paid absences including holidays for the contractor and major subcontractors is set forth in Section H of this contract.

[END OF SECTION B]

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 INTRODUCTION

The goal of the Efficiencies for Clinical HIV Outcomes (ECHO) activity is to support the Government of Mozambique’s (GRM) achievement of HIV/AIDS epidemic control and establishing a sustainable, government-led HIV response by 2023 in provinces where USAID is the primary clinical support partner. ECHO will focus on 5 objectives.

Objectives

In close partnership with the GRM, MISAU and partner DPS authorities and using PEPFAR’s technical considerations ECHO will:

1) Strengthen the essential public health services necessary for HIV epidemic control at the national, provincial and district level to ensure long-term sustainability of the HIV response.

2) Reach 95% HIV treatment coverage in designated geographic regions in Mozambique by the end of the activity.

3) Reach at least 95% viral suppression among people receiving antiretroviral therapy and maintain this level of suppression during the life of the activity in designated geographic regions in Mozambique;

4) Ensure that Mozambique is utilizing the latest evidence for rapid scale up and maintenance of effective HIV interventions, ECHO will routinely review global experience and annually adjust, adopt, and implement priority interventions; and

5) Generate evidence and provide the GRM with data, measured findings, and recommendations necessary to make key service delivery decisions supporting the achievement of Mozambique’s annual targets for epidemic control.

By achieving the above, ECHO will satisfy the GRM and United States Government (USG) President’s Emergency Plan for AIDS Relief (PEPFAR) objectives to achieve the World Health Organization (WHO) targets for epidemic control in Mozambique within ECHO’s implementation period. ECHO’s key areas of assistance will include: HIV testing services (HTS), the institutionalization of early antiretroviral therapy (ART) for those who test positive, retention on ART, viral load monitoring to ensure viral suppression for all people receiving ART, prevention of mother to child transmission of HIV (PMTCT), and TB and HIV collaborative activities. ECHO will be based in Beira, Sofala province, with a small government engagement and support office in Maputo. The activity will include a mix of technical assistance and direct service delivery approaches and models utilized at facilities and in communities to improve efficiencies in HIV-AIDS service delivery based on the latest evidence and promising practices. ECHO’s priority is ultimately on optimizing HIV/AIDS service delivery utilizing a patient/family-centered approach in close coordination with the GRM’s Ministry of Health (MISAU) and Provincial Health Directors (DPS). USAID requires high quality measurement of outcomes and results which are expected and go hand in hand with rapid, sustained levels of effort in service delivery.

In addition to the implementation of models identified in the PEPFAR Country/Regional Operational Plan (COP/ROP) Guidance 2018, the activity will also include testing, demonstration, and implementation of promising HIV service delivery approaches considered to be innovations. Multi-month dispensing in communities (e.g. through Grupos de Apoio a Adesão Comunitária (GAAC)), self-testing for partners of Persons Living with HIV/AIDS (PLHIV) in GAAC who do not agree to be tested through conventional testing points, and pre-exposure prophylaxis (PrEP) for specific populations are examples of innovations that are currently being tested and measured as potential interventions for additional scale-up. To gain efficiencies and assist in the planning for a sustainable response in service delivery, ECHO will pursue the measurement of costs, other inputs, and outcomes related to promising and innovative approaches for HIV service delivery.

ECHO will support grants under contract (GUC) to government and non-government bodies in Mozambique at the provincial, district and facility levels. The objective of the GUC along with the capacity strengthening elements described in sections below is to help prepare national actors – both governmental and non-government, to effectively manage the government-led HIV response by 2023.

The Contractor must show a measurable, progressive reinforcement of the capacity of local government and non-government organizations (NGOs) and communities to respond to the national HIV epidemic, as well as progress towards the sustainability of the activities.

ECHO will be implementing in two phases which will maximize the impact of PEPFAR’s investment, both throughout and beyond the life of the activity. Phase 1 of ECHO will focus on strengthening the institutional capacity of the Mozambican public health sector, upon which all HIV/AIDS services rely, to respond to immediate needs for achieving epidemic control. Interventions during this phase will include intense support for the delivery of HIV prevention, care, and treatment services to maximize the number of HIV positive + patients on treatment, ensure adherence and retention, and prevent new infections. Such interventions are essential to ensuring that the epidemic in Mozambique passes its tipping point so the number of people who are living with HIV begins to decline. At the same time, these interventions will be implemented through an institutional strengthening approach to ensure that the capacity of health workers to deliver quality services increases and strengthening the institutional systems and policies to support a strong HIV response. ECHO will track results for each district and ensure the institutionalization of interventions, identify problems and challenges, and make course corrections on an ongoing basis.

In line with PEPFAR guidance, ECHO will move away from a “one-size-fits-all” model that was common in previous programs, to a model that provides targeted, cost-efficient, and more effective interventions to achieve the activity’s overall goal and objectives. As treatment coverage increases, the GRM will assume greater responsibility for the delivery of HIV services and the intensity of direct support from ECHO for service delivery will decrease. ECHO will continue to provide technical assistance to ensure the maintenance, quality and the institutionalization of systems to support the long-term sustainability of HIV services. The rolling “graduation” of sites once epidemic control treatment coverage rates are reached (as per PEPFAR sites classification and GRM annually updated epidemiological data) throughout Phase 1 will demonstrate progress towards a sustainable transition of greater responsibility to the GRM. Site “graduation” will then be a benchmark for the type of support to be provided for each of the specific sites supported by ECHO. These shifts will be geographically targeted, with each district’s results tracked individually, and USAID/Mozambique and ECHO will make decisions for transitioning based on district-level data on an annual basis. Such granular shifts in targeting on an annual basis have not been common practice in the past. Instituting this type of adaptive programming will help ECHO maximize the impact and sustainability of limited PEPFAR resources. Declining direct support over the life of ECHO will lead to commensurate shifts in the budget over time.

In addition to capacity building and transition of services to local government, ECHO will allocate the entirety of its community-based care and support program activities (linkages, adherence and retention in care) to local non-governmental organizations (including community – based organizations) through competitive sub-awards. These organizations will benefit also from the ongoing capacity building on management and technical domains for better services provision and long-term sustainability. Approximately 40% of the overall budget of ECHO will flow to local government and NGOs.

During Phase 2 of ECHO and, based on the capacity assessments started in Phase 1 as part of the capacity building support, ECHO will transition elements of the activity to host-country counterparts, and will continue to provide targeted TA to ensure sustainability beyond the life of the activity.

Examples of program functions that can be transitioned, based on the capacity assessments, include:

clinical service delivery, routine supervision of HIV services, training, community/patient services and monitoring & evaluation. By the end of the award-term the Contractor must have trained and transferred capacity to GRM and NGOs to assume all of the program components and activities. Some program functions may be transitioned in early stages of Phase 1 depending on the capacity development assessments that will be conducted throughout activity implementation. Complementary USG-funded activities and other multilateral and bilateral donor supported activities will help to strengthen effective host-country systems, develop sustainable health financing strategies and support the implementation of new laws and policies required to achieve and sustain epidemic-control.

The length of Phases 1 and 2 will depend on the on-going assessments and evaluation of accomplishments towards sustained HIV/AIDS epidemic control. .

C.2 BACKGROUND

Mozambique is a country of approximately 26 million people1 challenged by high levels of poverty, low educational attainment and access to clean water and sanitation, and relatively high rates of infectious and communicable diseases. The total fertility rate is 5.4 and 45% of the population is under 15 years of age.2 Life expectancy at birth is 55 years (57 years for females and 54 years for males).3 Forty-three percent of children under the age of 5 years are stunted.

Ten years of guerilla warfare (1964-1974) led to independence from Portugal in 1975 and were followed by another sixteen years of civil war. The democratic era began in 1994 with the first official elections. The country has witnessed periodic cycles of political conflict, the most recent occurring since 2013. The current ceasefire between the ruling party FRELIMO and the opposition party RENAMO has just been extended and includes ongoing negotiations over political decentralization.

In terms of socioeconomic development, Mozambique remains one of the world’s least developed countries with a ranking of 180 out of 187 countries4 in the United Nations Human Development Index. Mozambique's economy suffered a major blow following the discovery of nearly $2 billion in government-backed hidden debt in 2015 and 2016, which contributed to rapid inflation, a depreciating national currency, and reduced growth rates falling from 6.6% in 2015 to an estimated 4.5% to 3.7% in 2016. Sixty percent of Mozambicans live on less than $1.25/day.5 Seventy percent of Mozambicans are estimated to be multi-dimensionally poor and 37% destitute with substantial variation by region and province.6

INE Moçambique_Projecções_2007_2040 http://www.ine.gov.mz

World Bank Data 2014

World Bank, 2014. Available at: data.worldbank.org/indicator/SP.DYN.LE00.MA.IN?locations=MZ

Human Development Report, 2015, UNDP

World Bank, 2014

Oxford Poverty and Human Development Initiative (2016). “Mozambique Country Briefing”, Multidimensional Poverty Index Data Bank.

OPHI, University of Oxford. Available at: www.ophi.org.uk/multidimensional-poverty-index/mpi-country-briefings/ http://data.worldbank.org/indicator/SP.DYN.TFRT.IN

The leading causes of death in 2015 were HIV/AIDS, malaria, lower respiratory infections, cerebrovascular disease, and diarrheal diseases.7 Several key health indicators show improvement.

Premature mortality due to malaria dropped 61%, premature mortality due to diarrheal diseases dropped 47%, and premature mortality due to lower respiratory infections dropped 41% from 2005 to

2015.8 Antenatal care (ANC) coverage, defined as at least one ANC clinic visit, increased from 91% in 2011 to 93% in 2015, with 70% of women delivering in a health facility.9 Under-five child mortality was 90/1,000 live births in 2012, declining from 103/1,000 live births in 2010.10

C.2.1 Summary of Relevant USG and Donor Activities USAID’s Country Development Cooperation Strategy (CDCS) 2014-2019 guides all USAID programming to support the Mozambican health sector. Development Objective 4 aims to improve the health status of target populations. This objective is supported by three intermediate results (IR):

IR 4.1 Increased coverage of high impact health and nutrition services; IR 4.2 Increased adoption of positive health and nutrition behaviors; IR 4.3 Strengthened systems to deliver health, nutrition, and social services. The ECHO activity supports achievement of all three IRs of Development Objective 4.

ECHO is central to the USAID PEPFAR and Mission portfolio and will be implemented in concert with other activities. In addition to delivering cost-effective, sustainable interventions in partnership with the GRM, the Contractor will coordinate with other U.S. Government initiatives. These include but are not limited to Feed the Future, Ending Preventable Child and Maternal Deaths (EPCMD), Presidential Malaria Initiative (PMI) and Tuberculous programing.

Summary of Relevant USG Activities Activity Summary

USAID MCH

Improved health status for women of childbearing age, particularly pregnant and lactating women and children under five year of age; expand coverage and improve quality of community health activities; supply chain and improved systems strengthening; strengthened quality and safety of priority medicines; improved pharmaco-vigilance and rational use of drugs; training CHWs including immunization, prevention and management of preterm, intrapartum complications and infections.

USAID TB Supply chain management by improving quantification, procurement and timely distribution of TB drugs.

USAID Malaria Supply chain and improved systems strengthening, improved the health status for women of childbearing age, particularly pregnant and lactating women and children under five years of age; improved health behavior.

USAID Family Planning

Increased access to and use of voluntary FP contraceptive methods;

commodities purchased including condoms, essential medicines, and diagnostics; improved maternal and child survival; Improved health behaviors; strengthened quality and safety of priority medicines; improved pharmaco-vigilance and rational use of drugs

USAID Nutrition Increased capacity of MISAU to develop and implement nutrition-oriented policies and programs; improved positive health and nutrition behaviors;

Institute for Health Metrics and Evaluation, Mozambique Country Profile. Available at: www.healthdata.org/mozambique

Institute for Health Metrics and Evaluation, Mozambique Country Profile. Available at: www.healthdata.org/mozambique

IMISIDA, 2015

Mozambique DHS, 2011 & UNICEF, 2012 https://www.feedthefuture.gov/country/mozambique http://www.apromiserenewed.org/countries/mozambique/ https://www.pmi.gov/where-we-work/mozambique support the national malnutrition program. Value chain activities aimed increasing equitable growth in agriculture sector and improving the nutritional status of Mozambicans.

Peace Corps Include, but not limited to: increased capacity of MISAU, NGOs, community organizations, and CHWs to prevent and control HIV

Summary of Relevant Other Donor Activities Clinton Health Access Initiative

(CHAI)

POC: improving diagnosis; diagnostic machines + reagents for CD4, PCR

Finland TA to support implementation of national HRH Plan (seconded position HR office); training for MNCH nurses in Tete

AFD (France) Construction, equipment for two hospitals in Sofala (Central Hospital in Beira & Marromeu District Hospital)

GFTAM HIV, TB & Malaria: see theglobalfund.org for details of Mozambique grants

AICS (Italy) Support to HRH development: improve performance of health services at national level, Sofala and Maputo provinces

JICA (Japan) Construction of Nacala (Nampula) Health Institute; strengthen instructor capacity in training institutes; strengthen HCW capacity to provide humane care in MNCH

AECID (Spain) Strengthen capacity of CISM to conduct research in Malaria, HIV and TB

DFID (UK) Donation of plumpy nut for treatment at health facilities

UNFPA Sexual reproductive health (SRH): 1) improve access to SRH information and services with special focus on girls/women empowerment-Action for Girls Initiative 2) Support to multi-sectoral Geração Biz program 3) improve access to SRH information and services with special focus on community-based family planning for adolescents

UNICEF Point of Care machines, reagents, database

WHO Strengthening civil registration and vital statistics

C.3 PURPOSE AND ACTIVITIES

C.3.1 Purpose The purpose of Efficiencies for HIV/AIDS Clinical Outcomes (ECHO) is achieve epidemic control in Mozambique in designated geographic areas, the point at which new HIV infections have decreased and fall below the number of AIDS-related deaths.

C.3.2 Geographic Focus ECHO’s geographic focus may change over time. The numbers of districts reaching the criteria for sustained and attained will grow over time, reducing the number of “scale-up saturation” and “scale-up aggressive” districts. ECHO will track results for each district and will ensure that priority interventions are institutionalized, problems are identified, and course corrections are made. MISAU and/or PEPFAR may also change geographic designations. As part of a mid-term evaluation, ECHO’s SOW may be revised for the remaining years.

List of sites and categorization as approved in the Mozambique 2017 COP. The PLHIV estimates are from Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA) 2015.

https://www.theglobalfund.org/en/portfolio/country/list/?loc=MOZ&k=422a9c0c-7b21-48fa-b37c-61a1ada27bd1

Province District COP15 Prioritization

APR16

Achievement

COP16

Prioritization

Expected Achievement By APR17

COP17

Prioritizatio n

COP17

Target:

(APR18

PLHIV

Manica Barue ScaleUp Agg 44% ScaleUp Agg 53% ScaleUp Agg 67% 10,851

Manica Cidade De Chimoio ScaleUp Agg 49% ScaleUp Sat 56% ScaleUp Sat 67% 25,063

Manica Gondola ScaleUp Agg 36% ScaleUp Agg 43% ScaleUp Agg 64% 17,809

Manica Guro Sustained 58% Sustained 71% Sustained 75% 3,899

Manica Machaze ScaleUp Agg 26% ScaleUp Agg 26% ScaleUp Agg 43% 6,365

Manica Macossa Sustained 23% Sustained 26% Sustained 27% 522

Manica Manica ScaleUp Agg 65% ScaleUp Sat 76% ScaleUp Sat 90% 18,057

Manica Mossurize ScaleUp Agg 48% ScaleUp Sat 53% ScaleUp Sat 66% 6,244

Manica Sussundenga ScaleUp Agg 54% ScaleUp Sat 64% ScaleUp Sat 79% 6,498

Manica Tambara Sustained 18% Sustained 22% Sustained 23% 1,154

Niassa Cidade De Lichinga ScaleUp Agg 45% ScaleUp Sat 52% ScaleUp Agg 74% 12,695

Niassa Cuamba ScaleUp Agg 31% ScaleUp Sat 34% ScaleUp Agg 50% 11,588

Niassa Lago Sustained 49% Sustained 56% Sustained 57% 3,448

Niassa Lichinga Sustained 15% Sustained 33% Sustained 43% 1,507

Niassa Majune Sustained 22% Sustained 25% Sustained 28% 897

Niassa Mandimba Sustained 26% Sustained 31% ScaleUp Agg 47% 5,809

Niassa Marrupa Sustained 27% Sustained 32% Sustained 34% 1,962

Niassa Maua Sustained 28% Sustained 32% Sustained 42% 2,047

Niassa Mavago Sustained 8% Sustained 10% Sustained 10% 2,029

Niassa Mecanhelas Sustained 30% Sustained 31% ScaleUp Agg 42% 6,017

Niassa Mecula Sustained 18% Sustained 20% Sustained 22% 803

Niassa Metarica Sustained 13% Sustained 13% Sustained 15% 2,968

Niassa Muembe Sustained 17% Sustained 21% Sustained 25% 1,437

Niassa Ngauma Sustained 20% Sustained 23% Sustained 27% 2,453

Niassa Nipepe Sustained 27% Sustained 34% Sustained 44% 1,792

Niassa Sanga Sustained 28% Sustained 35% Sustained 46% 1,455

Sofala Buzi ScaleUp Agg 49% ScaleUp Agg 62% ScaleUp Agg 72% 13,148

Sofala Caia Sustained 40% Attained 43% ScaleUp Agg 57% 8,141

Sofala Chemba Sustained 48% Sustained 59% Sustained 57% 2,904

Sofala Cheringoma Sustained 37% Sustained 38% Sustained 30% 3,728

Sofala Chibabava ScaleUp Agg 48% ScaleUp Sat 52% ScaleUp Agg 61% 11,281

Sofala Cidade Da Beira ScaleUp Agg 56% ScaleUp Sat 69% ScaleUp Sat 81% 85,782

Sofala Dondo ScaleUp Agg 38% ScaleUp Sat 49% ScaleUp Agg 63% 26,840

Sofala Gorongosa Sustained 89% Attained 100% Attained 104% 3,552

Sofala Machanga Sustained 59% Sustained 65% Sustained 63% 6,477

Sofala Maringue Sustained 29% Sustained 32% Sustained 33% 2,172

Sofala Marromeu ScaleUp Agg 40% ScaleUp Sat 43% ScaleUp Agg 53% 12,159

Sofala Muanza Sustained 55% Sustained 67% Sustained 58% 1,848

Sofala Nhamatanda ScaleUp Agg 53% ScaleUp Sat 67% ScaleUp Agg 64% 17,966

Tete Angonia Sustained 81% Sustained 102% Sustained 116% 4,653

Tete Cahora Bassa Sustained 121% Sustained 147% Attained 154% 5,226

Tete Changara ScaleUp Agg 58% ScaleUp Sat 71% ScaleUp Sat 87% 9,835

Tete Chifunde Sustained 78% Sustained 101% Sustained 104% 1,069

Tete Chiuta Sustained 126% Attained 146% Attained 158% 944

Tete Cidade De ScaleUp Agg 81% ScaleUp Sat 93% ScaleUp Sat 103% 16,920

Tete

Tete Macanga Sustained 84% Sustained 105% Sustained 102% 1,068

Tete Magoe Sustained 83% Sustained 107% Sustained 118% 3,921

Tete Maravia Sustained 42% Sustained 52% Sustained 53% 1,473

Tete Moatize ScaleUp Agg 61% ScaleUp Sat 74% ScaleUp Sat 79% 11,442

Tete Mutarara ScaleUp Agg 51% ScaleUp Agg 62% ScaleUp Sat 79% 6,879

Tete Tsangano Sustained 45% Sustained 68% Sustained 76% 3,200

Tete Zumbu Sustained 44% Sustained 58% Sustained 64% 2,015

Zambézia Chinde & Luabo ScaleUp Agg 20% ScaleUp Agg 25% ScaleUp Agg 43% 10,369

Zambézia Mopeia ScaleUp Agg 22% ScaleUp Agg 27% ScaleUp Agg 46% 10,972

Zambézia Morrumbala & Derre ScaleUp Agg 17% ScaleUp Agg 20% ScaleUp Agg 40% 30,403

C.3.3 Objectives, Activities and Targets

Objective One: ECHO strengthens the essential public health services necessary for HIV epidemic control at the national, provincial and district level to ensure long-term sustainability of the HIV response.

ECHO will use a mix of approaches to assist the Government of Mozambique to institutionalize efficient practices for reaching and maintaining high quality standards of HIV service delivery. Where a lower level of effort is required to maintain targets, technical assistance, with a spread of intensity from less to more frequent visits to sites (facility or community), will be employed. The type of experience required for that TA, will also vary based on need. Where targets are more difficult to reach or maintain, ECHO will provide activity funded direct service delivery and/or augmented human resources at the district/facility level, also utilizing a spread of intensity depending on need. In all cases, where direct service delivery will be provided, counterparts (even if they are not well matched, recognizing the overall shortage of healthcare staff) will be identified and mentored.

The following are illustrative activities the Contractor will complete during year one of Phase One:

● Gap identification to determine the mix of models needed to reach and maintain targets (based on results, data analyses, and heuristic applications),

● Technical Assistance based on facility, district, provincial and community needs,

● Placement and shared supervision of staff at the facility, district, provincial and community levels,

● Placement of up to four senior level staff members to be embedded at MISAU (specific positions to be agreed upon with MISAU),

● Gap identification and rapid completion of electronic patient tracking systems, last mile drug and commodity delivery systems, viral load monitoring systems, and bi-directional facility and community patient tracking systems.

The Contractor will provide the baseline based on the assessments that will be completed in Phase I for Objective One.

Objective One result:

● Transition of all management of HIV response to MISAU and/or local NGO’s by activity completion.

Objective Two: ECHO will reach 95% HIV treatment coverage in designated geographic regions in Mozambique by the end of the activity.

ECHO will focus on the delivery of high quality, high-impact interventions to ensure that HIV treatment coverage is reached and maintained for over 95% of PLHIV for the life of the activity.

Nearly one million PLHIV are currently on ART (MISAU preliminary data report of 990,085) with an estimated coverage rate of about 45%. Meeting PEPFAR targets in 2018 will increase coverage to approximately 65%. If 80% coverage has not been achieved by the initiation of ECHO, this activity will reach 80% coverage within the first year of operation. ECHO will increase this level of coverage to 85% or higher during Phase 1. The activity will routinely utilize national, PEPFAR, UNAIDS and other available data, as well as findings from relevant research to improve and adjust interventions and outcome measures.

Linkage and retention, especially for men, pregnant women, younger adults and children, are critical areas of focus for ECHO given relatively low percentages of treatment coverage in Mozambique as compared to other countries in the region. ECHO will test and scale-up approaches for increasing testing yields, achieving early diagnosis or reaching undiagnosed PLIHV, linking those who test positive to treatment, and improving retention in these populations.

Monitoring and reporting requirements may not remain constant over the life of the activity and ECHO will comply with all current and updated PEPFAR reporting requirements (see Section F.5 Reports and Deliverables). In addition to this compliance, ECHO will utilize its annual work plan updates (see objective 3) to add or refine indicators and methods of measurement to improve program and patient outcomes. In addition to PEPFAR reporting requirements and ECHO’s additions for annual reporting improvements stemming from Objective Four, USAID and MISAU may request additional information during annual work plan reviews.

USAID will provide the Contractor with the necessary baseline (upon award) and annual targets during the work plan stage for Objectives Two and Three.

Objective Two results:

• 95% of PLHIV living in designated geographic regions in Mozambique know their status

• At least 95% HIV treatment coverage reached and maintained in designated geographic regions in Mozambique.

Objective Three: ECHO will reach at least 95% viral suppression among people receiving antiretroviral therapy and maintain this level of suppression during the life of the activity in designated geographic regions in Mozambique.

HIV virologic suppression is essential to not only reducing HIV-related morbidity and mortality in those already infected but also preventing the continued transmission of HIV infections. Results from the recent Population-Based HIV Impact Assessment (PHIA) in Malawi, Zimbabwe and Zambia show that of those self-reporting ART, the proportion of virologic suppression was 91% in Malawi, 89% in Zambia, and 87% in Zimbabwe, with an average of 65% community viral load suppression among HIV-positive adults, nearing the 73% UNAIDS target. Support for viral load monitoring through

ECHO is expected to achieve community viral load suppression of 73% in all ECHO designated districts.

To reach and maintain virologic suppression for at least 95% of people receiving antiretroviral therapy, ECHO will continuously monitor patient level viral loads. During Phase One, ECHO will be responsible for viral load monitoring in all specified facilities in its assigned geographic districts that are designated for viral load monitoring scale up and maintenance. This includes all aspects of viral load monitoring from the patient in the facility or in the community to the door of the VL laboratory and back to the patient (including strategies to strengthen the efficiency and quality of services).

USAID will provide the Contractor with the necessary baseline (upon award) and annual targets during the work plan stage for Objectives Two and Three.

Objective Three result:

● At least 95% viral suppression among people receiving antiretroviral therapy reached and maintained in designated geographic regions in Mozambique

Objective Four: To ensure that Mozambique is utilizing the latest evidence in rapid scale up and maintenance of effective HIV interventions, ECHO will continuously review global experience and annually adjust, adopt, and implement priority interventions.

ECHO will bring up-to-date and efficient models of service delivery to the HIV program in designated districts at both the facility and community levels. The International AIDS Society (IAS) and PEPFAR partners have suggestions for differentiated models of care that take into account the population served, the location of service, the frequency of service, and the intensity of that service. The PEPFAR Country Operational Plan Guidance for 2018 outlines numerous best practices and priority interventions.

From the onset, ECHO will employ established best practices and recently adopted innovations as the norm for service delivery. Each year when annual work plans are due to USAID for approval, ECHO will update practices based on latest evidence.