South Africa CDC-RFA-JG-25-0057 Final NOFO for Publication..pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 20, 2025

Combination prevention solutions to reach epidemic control among high risk, priority populations in high burden areas in South Africa (SA) under the President's Emergency Plan for AIDS Relief (PEPFAR) Opportunity number: CDC-RFA-JG-25-0057

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 10

Step 2: Get Ready to Apply 32

Get registered 33

Questions 34

Step 3: Prepare Your Application 35

Application contents and format 36

Step 4: Learn About Review and Award 46

Application review 47

Award notices 53

Step 5: Submit Your Application 54

Application submission and deadlines 55

Application checklist 57

Step 6: Learn What Happens After Award 59

Post-award requirements and administration 60

Contacts and Support 67

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on February 20, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 10

Basic information U.S. Centers for Disease Control and Prevention (CDC)

Global Health Center

Division of Global HIV and Tuberculosis

Reducing HIV and TB incidence and mortality in global settings through data-driven programs and strengthened public health systems.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Combination prevention solutions to reach epidemic control among high risk, priority populations in high burden areas in South Africa (SA) under the President’s Emergency Plan for AIDS Relief

(PEPFAR)

Opportunity number:

CDC-RFA-JG-25-0057

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

February 20, 2025

Expected award and start date: September 30, 2025

We will inform you of your application status by the end of August 2025.

See other submissions for other time frames that may apply to this

NOFO.

Summary The goal of this NOFO is to provide targeted combination prevention solutions and approaches to vulnerable, high-risk priority populations, including adolescents and young people, aged between 10-24, in workplaces, schools, and communities.

The NOFO aims to create demand for and support the use of the following prevention and response interventions through direct service delivery, referrals, and technical assistance:

• Evidence-based biomedical interventions such as:

◦ HIV testing services.

◦ Antiretroviral therapy.

◦ Pre-exposure prophylaxis (PrEP).

◦ Post-exposure prophylaxis (PEP).

◦ Condom promotion and distribution.

◦ Sexually transmitted infection (STI) screening and treatment.

◦ Sexual and reproductive health.

◦ Mental health and substance abuse screening.

◦ Psychosocial support.

◦ Minimum package of post-violence care.

• Behavioral interventions such as:

Step 1: Review the Opportunity 5

◦ School and community-based HIV and violence prevention, including health education for all adolescents and youth as well as community leaders, parents, and caregivers.

◦ HIV risk reduction.

• Structural HIV, TB, and violence interventions such as social mobilization.

• Youth empowerment such as:

◦ Economic strengthening.

◦ Gender norm changes.

◦ Gender-based violence (GBV) prevention.

◦ Family strengthening programs.

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $25,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 2 The number of awards is subject to available funds and program priorities.

Exact amounts for each award under this NOFO will be determined upon award.

We plan to award projects for five 12-month budget periods for a five-year period of performance.

Funding strategy

Funding amounts We encourage you to apply for the expected total NOFO funding for Year 1.

You may not request more than this amount.

Funding amounts for years two through five will be set at continuation. We will continue funding based on:

• Availability of funds.

• Evidence of satisfactory progress, as documented in your required reports.

• The determination that continued funding is in the best interest of the federal government.

Step 1: Review the Opportunity 6

Component funding

Overview

We fund all President’s Emergency Plan for AIDS Relief (PEPFAR) cooperative agreements using component funding.

Component funding allows us to provide funding as it becomes available. To do so, we fund sets of activities by quarter and project.

CDC may fund one or more of your components to start the budget period, and then consider other components based on available funding later.

Setting up components

You must set up your components in your application. While preparing your application:

• Review the expectations for year one activities in the strategies and activities section.

• Group your activities under the following anticipated components. Only include the activities planned for year one.

◦ Component 1: COP Q1 Targets and Activities.

◦ Component 2: COP Q2 Targets and Activities.

◦ Component 3: COP Q3 Targets and Activities.

◦ Component 4: COP Q4 Targets and Activities.

◦ Component 5: COP Additional Targets and Activities.

For information on how to incorporate component funding into your application, see the following sections:

• Budget narrative

• Component funding instructions for SF-424A

PEPFAR Local partner funding preference This NOFO includes a funding preference for local partners. Your organization will receive 30 extra points during the selection process if you provide sufficient documentation demonstrating you meet the PEPFAR local partner definition.

Step 1: Review the Opportunity 7

Eligibility Statutory authority This program is authorized under:

• The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, Public Law 108-25 (22 U.S.C. 7601, et seq.).

• The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293.

• The PEPFAR Stewardship and Oversight Act of 2013, Public Law 113-56.

• Public Health Service Act (42 U.S.C. 242I).

Eligible applicants This is a fully competitive NOFO, and eligibility is unrestricted. Any and all types of organizations are eligible and encouraged to apply, including but not limited to those listed below.

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Foreign or non-U.S. based entities.

Step 1: Review the Opportunity 8

Other required qualifying factors

Delivery location While any type of organization may apply, you must conduct the project in South Africa.

Responsiveness criteria We will review your application to make sure it meets these requirements.

These are the basic requirements you must meet to move forward in the competition. We won’t consider an application that:

• Is from an organization that doesn’t meet eligibility criteria. See requirements in eligibility.

• Is submitted after the deadline.

• Proposes research activities. See 45 CFR 75.2 for the definition of research.

• Requests more funding than the expected total NOFO funding for Year 1.

• Exceeds the 20-page limit for the project narrative (see the project narrative section for what counts toward the page limit).

• Is not in English.

• Includes a budget or budget narrative that uses a currency other than U.S. dollars.

• Does not respond to and is outside the scope of this NOFO.

See the application checklist to understand your application requirements.

Application limits We do not limit the number of applications an organization may submit.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirement. We will not consider cost-sharing fund contributions during your application review.

However, if you submit voluntary cost-sharing funds and we fund your project, we will require you to report on these funds.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Research)

Program description Background overview and related work HIV and AIDS in SA: current challenges SA has an estimated 7.8 million people living with HIV and AIDS. Among them, 605,866 are between the ages of 10 and 24, with 404,887 being female and 200,979 being male. To control the epidemic, we need to make prevention interventions for adolescents and young people accessible and available, connect those living with HIV to care, and keep them in care.

HIV infection rates among adolescent girls and young women have dramatically decreased. Despite the decline, there are several reasons for concern, including:

• High levels of new infections among young women in certain areas.

• HIV infection rates among adolescent girls and young women remain significantly higher compared with adolescent boys and young men.

Closing the gaps in HIV epidemic control To tackle these challenges, we must continue to work with SA to prioritize and grow combination prevention and Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) programs. These efforts should align with the country’s epidemic context to prevent HIV transmission among adolescent girls and young women.

This NOFO builds on 10 years of DREAMS PEPFAR programming in SA under CDC-RFA-GH16-1643 and CDC-RFA-GH19-1922. These awards have shown the importance of working with multiple stakeholders, gathering input from those who benefited from the program, and securing government buy-in.

Our strategy to accelerate closing the gaps in epidemic control focuses on:

• Addressing gender inequality.

• Preventing and responding to GBV within prevention and clinical care.

• Ensuring health equity for priority populations.

Activities under this NOFO must focus on key programs and geographic regions (as detailed in the Focus population section) to improve the efficiency and effectiveness of technical assistance and, in select programs, direct service delivery.

Step 1: Review the Opportunity 10

Prioritizing HIV prevention among adolescents and young people will boost efforts like condom programming, behavior change, healthy gender norms, voluntary medical male circumcision, and reducing HIV risk behaviors among young women in transactional sex or sex work. These steps have demonstrated the capacity to sharply lower rates of new HIV infections.

Strengthening and expanding proven HIV interventions HIV prevention programs are far stronger when combined with social and structural approaches. This includes social mobilization, empowerment, economic strengthening, gender norm changes, GBV prevention, and family strengthening programs.

This NOFO will support, strengthen, standardize, and streamline sub-district and district-level community and public health system HIV prevention efforts.

These include behavioral, clinical, and social interventions that work closely with:

• AIDS councils.

• Department of Health, including District Health Management Teams.

• Department of Social Development.

• Department of Basic Education at provincial and district levels.

To reach the accelerated targets, you’ll be required to innovate in service delivery. In areas where PEPFAR or the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) implementing partners are present, you should work together to close gaps in service and avoid service overlap. Doing so will maximize the efficient use of resources and complement the national HIV program.

If awarded, you should provide an integrated approach to comprehensive HIV-prevention services. You can do so by working with and improving the current health system and its service area. This will help create sustainable integrated prevention, care, and treatment services. Activities should fit into the government’s system at the community level and primary health care center level.

It is critical to measure impact while continuing to invest in high-quality prevention, care, and treatment programs. A comprehensive, strategic, and evidence-based approach is necessary to ensure good return on investments.

It is key to collect and provide high-quality data to inform programs and track epidemic control progress among adolescents and young people, pregnant women, and young women in transactional sex or sex work.

Step 1: Review the Opportunity 11

Purpose The purpose of this NOFO is to develop and implement a combination of approaches for preventing new HIV infections among adolescent girls and young women in ways that also reach men and adolescent boys and their families.

The results will be:

• Reduced HIV incidence.

• Decreased teenage pregnancy rates.

• Decreased GBV.

• Increased retention in school.

• Increased economic empowerment opportunities that complement the “She Conquers” and Zikhala Kanjani youth national campaign, including promoting HIV self-testing for adolescents and young people in general.

Approach Program logic model The following logic model includes the expected strategies under this NOFO.

The logic model also includes the program’s expected outcomes. Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

The asterisked ( * ) outcomes are those we expect you to achieve or substantially contribute to during the five-year period of performance. You must report on these outcomes.

Not all outcomes apply to all strategies. You will use these outcomes as a guide for developing performance measures.

Step 1: Review the Opportunity 12

Table: Strategies and outcomes

Strategies Short-Term Outcomes Intermediate Outcomes

Long-Term Outcomes

Strategy 1: Implement and scale-up HIV combination prevention solutions in priority districts for vulnerable, high-risk priority populations (adolescents, young people, male sex partners, and their families) to increase their knowledge, risk perception, and service uptake.

Strategy 2: Provide high-quality, confidential community HIV testing and counseling services to adolescents, young people, and male sex partners to refer and link them to comprehensive prevention and treatment services.

Strategy 3: Collaborate with key stakeholders to design, strengthen, and implement quality youth-responsive HIV services for adolescents and young people, following the national guidelines to improve access to prevention and treatment services.

Increased identification of the most vulnerable and high-risk populations targeted with evidence-based interventions.*

Increased knowledge and skills in HIV risk reduction among adolescents, young people, male sex partners, and their families.*

Increased coverage of HIV testing services among adolescents, young people, and male sex partners.*

Increased successful linkage of adolescents, young people, and male sex partners to prevention and treatment services.*

Increased availability and coverage of quality youth-responsive HIV services at the community level.*

Increased meaningful engagement in co-creation of quality youth-responsive HIV services at the community level.*

Increased adoption of HIV protective behaviors among priority populations.*

Improved provision of quality, evidence-based community HIV combination prevention interventions.*

Increased knowledge of HIV status among those at risk of and living with HIV.*

Increased uptake of HIV prevention and treatment services among adolescents, young people, and male sex partners.*

Increased access to quality HIV services among adolescents, young people, and male sex partners at the community level.*

Reduced new HIV infections among high-risk and vulnerable adolescents and young people.*

Improved health, educational, and social outcomes among adolescents.*

Step 1: Review the Opportunity 13

• By quality youth-responsive HIV services, we mean availability and coverage of comprehensive HIV prevention and treatment services that are responsive to the needs of young people where they are, in the way they want them, and at times that suit them.

◦ Health care providers can create a warm and respectful environment, ensure opportunities for confidential, one-on-one conversations, and encourage youth to involve their parents or caregivers while also respecting their privacy.

◦ Peer mentors can support young people navigate the health system, advocate for the services they need, and empower them to make healthy choices. Youth advisory boards can advise staff and advocate for health systems that are responsive to young people’s needs.

Strategies and activities This section elaborates on the strategies described in the logic model by providing expected activities and details about how you expect to implement your program.

Following are strategies and the required and optional activities under this NOFO. You may also propose additional related strategies and activities to achieve the expected outcomes.

Strategy 1: Implement and scale-up HIV combination prevention solutions in priority districts for vulnerable, high-risk priority populations (adolescents, young people, male sex partners, and their families) to increase their knowledge, risk perception, and service uptake.

Required activities:

• Help SA implement comprehensive and evidence-based combination HIV prevention services, with a focus on key behavioral outcomes, strong linkages to positive health, dignity, and prevention, and PEP services.

• Support SA at community and facility sites to scale up accessibility, availability, and uptake of services in line with a health equity approach.

This includes the consistent promotion and distribution of quality condoms through planning, coordination, and implementation, including communication, demand creation, and supply chain system strengthening.

Optional activities:

• Not applicable for this strategy.

Step 1: Review the Opportunity 14

Strategy 2: Provide high-quality, confidential community HIV testing and counseling services to adolescents, young people, and male sex partners to refer and link them to comprehensive prevention and treatment services.

Required activities:

• Support SA at community and facility sites to implement high-quality, safe, and confidential HIV counseling and testing services by trained staff using different modalities in adherence with national algorithms and policies.

• Ensure accurate reporting and use of program data to improve case finding and connecting clients who tested negative for HIV with prevention services.

• Ensure successful linkages of people living with HIV to care and treatment services.

• Identify and implement strategies to strengthen approaches that treat people the same regardless of their HIV infection status as a part of intensive counseling and ethical testing.

• Integrate and monitor targeted testing modalities, such as self-testing or partner notification, to improve access and testing coverage among adolescent girls and young women, including their male sexual partners.

• Provide continuous training to testers to increase their competence and improve the quality of testing services.

Optional activities:

• Not applicable for this strategy.

Strategy 3: Collaborate with key stakeholders to design, strengthen, and implement quality youth-responsive HIV services for adolescents and young people, following the national guidelines to improve access to prevention and treatment services.

Required activities:

• Identify and implement strategies to enhance communities’ acceptance of programs and the effectiveness of the combination prevention package among local government, community stakeholders, and residents.

Step 1: Review the Opportunity 15

◦ At the community level, you should consult political leadership, including the beneficiaries, traditional leadership, church leaders, and sporting clubs.

• In coordination with SA, identify and co-create HIV clinical, behavioral, and social prevention interventions in 27 PEPFAR priority districts. These interventions include social mobilization, youth empowerment, economic strengthening, gender norm changes, GBV prevention and response, and family strengthening programs.

• Conduct an evaluation following the interventions to assess the outcomes of the layering of DREAMS comprehensive interventions.

• Co-create HIV prevention activities with adolescents and young adults, beneficiaries, and mentors.

◦ The co-creation process should include the development of innovative programming to improve access to HIV prevention, case finding, and treatment outcomes.

• Use DREAMS to provide one-stop youth responsive services in the community, including PEP, STI, HIV self-testing, contraceptives, PrEP, and GBV services. Ensure strong collaboration and two-way communication with district support partners and youth zones.

• Work with maternal child health programs to provide basic sexual and reproductive health services, antenatal care, and additional support for teenage mothers.

• Support the transition of some HIV prevention programming to SA.

Provide technical assistance to strengthen these programs, including comprehensive sexuality education and economic strengthening for adolescent girls and young women.

Optional activities:

• Strengthen SA’s data collection and reporting tools under adolescent and youth-responsive services.

To support the purpose of this NOFO, you are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities.

Step 1: Review the Opportunity 16

Epidemic control activities In coordination with the Global Health Security and Diplomacy (GHSD) Bureau at the U.S. Department of State, and as part of PEPFAR, CDC works with host country governments and other partners. Together, we assess the needs of each country and design a plan for assistance that fits within the host nation’s strategic plan.

We consider a national HIV epidemic to be under control when:

• The number of HIV-related deaths is declining, and

• The number of new infections is less than the number of deaths.

Controlling the epidemic does not mean that HIV will be eliminated. Instead, it means that the number of people with HIV in the population is decreasing. If new infections or death rates increase, this means the epidemic is no longer under control.

Our work doesn’t end when we reach epidemic control; we must sustain the gains. During your award we may ask you to conduct additional activities to reach and maintain epidemic control, consistent with the scope of this NOFO and the related policies below. This may include:

• Improving prevention, testing, and treatment efforts for HIV/AIDS, TB, sexually transmitted infections (STI), and related opportunistic infections, especially among vulnerable, key, and priority populations as defined in PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) Guidance.

• Promoting sustainable, country-led approaches to managing HIV/AIDS and TB and empowering national and local partners to take the lead in designing and conducting high-quality and cost-effective programs. This could involve forming new partnerships with private, public, local, and multisector entities that can complement and expand the reach of existing programs.

• Improving and expanding laboratory, surveillance, and information systems and using the PEPFAR platform for broader disease surveillance and public health programs in ways that align with PEPFAR goals and initiatives.

• Enhancing efforts to prevent, detect, respond to, and treat other diseases affecting people living with or at risk of HIV.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.state.gov/reports-pepfar/

Related policies If awarded, any activities you conduct must follow the directions in:

• Reimagining PEPFAR’s Strategic Direction: Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030.

• PEPFAR’s annual COP/ROP Guidance and approved COPs/ROPs.

• Similar forthcoming strategy, guidance, or planning documents that are consistent with relevant laws.

Geographic focus The geographic focus of this program may change during the period of performance, based on the burden of disease and changing program and PEPFAR priorities.

Outcomes We expect you to achieve or substantially contribute to the outcomes asterisked ( * ) in the logic model by the end of the five-year period of performance. You will be expected to report on these outcomes.

Focus populations The focus populations for this NOFO include:

• Adolescent girls and young women.

• Adolescent boys and young men.

• Male sex partners.

• Parents and caregivers.

• People who are at high risk for HIV infection and transmission.

• People with or at risk of TB.

The NOFO also targets staff from the national, provincial, and district Department of Health and Departments of Education and Social Development, as well as recipients of capacity-building and technical assistance efforts.

There is a particular focus on those living in the jointly identified SA and PEPFAR priority geographic areas (districts) listed below. These priority areas may change over time based on HIV and TB/HIV burden, national priorities, funding, and shifts in policies.

Based on continuous monitoring of the epidemic, we may ask you to expand or contract activities. You may also be asked to expand programs to certain

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf areas outside of the 27 districts based on the epidemiology. This NOFO will help better understand the epidemic among these populations within the country, design effective responses, deliver or implement at scale, overcome barriers, and measure and sustain program impact.

Here is a list of the current 27 priority districts. Note: At the province, district, and implementation level, the activities under this award will be closely coordinated with those of the United States Agency for International Development and other PEPFAR-funded partners to ensure collaboration and avoid duplication.

The same principle will apply to other stakeholders, such as the Global Fund and United Nations agencies. Geographic areas of focus may change based on the annual COP approval process.

Eastern Cape:

• Alfred Nzo District Municipality

• Amathole District Municipality

• Buffalo City Metropolitan Municipality

• Chris Hani District Municipality

• Oliver Tambo District Municipality

Free State:

• Lejweleputswa District Municipality

• Thabo Mofutsanyane District Municipality

Gauteng:

• City of Johannesburg Metropolitan Municipality

• City of Tshwane Metropolitan Municipality

• Ekurhuleni Metropolitan Municipality

• Sedibeng District Municipality

KwaZulu-Natal:

• eThekwini Metropolitan Municipality

• Harry Gwala District Municipality

• Ugu District Municipality

• uMgungundlovu District Municipality

• Uthukela District Municipality

• Uthungulu District Municipality

• Zululand District Municipality

Step 1: Review the Opportunity 19

Limpopo:

• Capricorn District Municipality

• Mopani District Municipality

Mpumalanga:

• Ehlanzeni District Municipality

• Gert Sibande District Municipality

• Nkangala District Municipality

North West:

• Bojanala Platinum District Municipality

• Dr Kenneth Kaunda District Municipality

• Ngaka Modiri Molema District Municipality

Western Cape:

• City of Cape Town Metropolitan Municipality

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of:

• Race.

• Color.

• National origin.

• Disability.

• Age.

• Sex (including gender identity, sexual orientation, and pregnancy).

• Other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to be as healthy as possible. Health disparities are often caused by social determinants of health. Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age.

These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks. They also influence which populations are most affected by health conditions.

Step 1: Review the Opportunity 20

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

We expect all proposed activities to affirm and advance health equity and an equitable, diverse, and inclusive workforce as core principles. In addition to the strategies and activities listed above, during your award, we may ask you to conduct activities consistent with local laws to:

• Address health disparities in access to and use of HIV and TB services.

• Reduce HIV and TB stigma and discrimination.

• Promote civil and human rights to improve health outcomes of people living with or at risk of HIV and TB.

• Make the workforce more inclusive.

Organizational capacity You must include a heading in your Project Narrative titled Organizational Capacity, under which you should include a brief description of your organizational capacity to carry out these strategies and activities.

You must also provide supporting documentation in your attachments. See the attachments section for full instructions.

Collaborations If awarded, we will expect you to collaborate closely with CDC SA, especially with the Activity Manager and Project Officer, as well as with other administrative and technical support staff.

Implementing this award will require working very closely with SA, especially national, provincial, and district health, education, and social development authorities and the South African National AIDS Council (SANAC), among other South African institutions. You may support direct service delivery and technical assistance, as the NOFO outlines.

As part of support for program implementation, your activities will closely align with PEPFAR implementing partners who provide and support technical assistance and direct service at facilities and in communities for general, priority, and key populations. This also includes other program implementers at national, provincial, and district levels.

At the national level, you will work with other stakeholders involved in HIV and AIDS prevention, care, and treatment services to develop policies, guidelines, training curricula, and operational tools, as well as to coordinate program implementation.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

Through the PEPFAR program, CDC works with partners to help prevent HIV infection, provide life-saving treatment to people living with HIV, and reduce HIV-related deaths. We encourage our partners to collaborate with local organizations, U.S.-based organizations, and international partners. The goal of this collaboration is to complement efforts to lower costs, make programs more effective, sustain the gains, and accelerate progress towards the three UNAIDS 95-95-95 targets:

• At least 95% of people living with HIV know their HIV status.

• At least 95% of people who know their HIV status are on treatment.

• At least 95% of people on treatment have a suppressed viral load.

If you work with key populations as defined in PEPFAR’s annual COP/ROP Guidance, we will expect you to collaborate with them when designing, delivering, and monitoring HIV services.

Data, monitoring, and evaluation CDC expectations CDC expects you to review, clean, and use routine performance data for program management. As a result, you should hold regular review meetings to discuss performance and use data to inform program quality improvement activities.

In your application budget, you should allocate at least 6.5% of funds for monitoring activities and 5.5% for evaluation activities. We will discuss these percentages and finalize them at or after award. These are estimates for the total funding over the 5-year project.

Required performance measures

Overview This program includes two types of indicators. These include:

• PEPFAR’s Monitoring, Evaluation, and Reporting (MER) indicators common to all awards. You can find additional information regarding MER reporting in the MER Guidance and resource materials, available at DATIM’s MER Indicator Reference Guides.

• Custom indicators that either we or you create. These monitor achievement of outcomes not directly measured by MER indicators.

These include process and outcome measures that directly correlate with the logic model.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides

The indicators shown below may change before award or in future years. For example, any gaps or unmet needs not fulfilled in the first year may affect the targets in later years.

MER indicators Below, are some anticipated MER indicators, targets, and reporting frequencies for the first year. You can propose any additional relevant MER indicators as part of your initial Evaluation and Performance Measurement Plan.

• PP_PREV: Number of priority populations (PP) reached with the standardized, evidence-based intervention(s) required that are designed to promote the adoption of HIV prevention behaviors and service uptake.

[Target: 98,244; Reporting Frequency: Semi-annual]

• HTS_TST: Number of persons who received HIV testing services (HTS) and received their test results. [Target: 76,088; Reporting Frequency:

Quarterly]

• PrEP_NEW: Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. [Target: 37,513; Reporting Frequency: Quarterly]

• GEND_GBV: Number of people receiving post-gender-based violence (GBV) clinical care based on minimum package. [Target: 5,495; Reporting Frequency: Semi-annual]

• AGYW_PREV: Percentage of DREAMS participants that completed at least the DREAMS primary package of evidence-based services/interventions.

[Target: 74%; Reporting Frequency: Semi-annual]

Custom indicators At this time, custom indicators are system-calculated based on routinely collected program data entered into the Community Based Information Management System. You will only be required to report on PEPFAR MER indicators (noted above) and expected to conduct routine monitoring of programs and patients to ensure client health and quality program implementation. This may change in future project years. You may also propose custom indicators.

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, quarterly progress reports, surveillance and survey reports, and other program monitoring tools.

Step 1: Review the Opportunity 23

Evaluation Below, we include examples of evaluation topics that we may expect you to answer through process, outcome, or economic evaluation. In your application, include at least one, but no more than three potential evaluation questions. We will expect you to conduct a mid-term and end-term evaluation.

• Implementation successes and challenges of the DREAMS program:

process evaluation.

• Efficiency of layering the core structural, behavioral, and biomedical prevention services on HIV prevalence among adolescent girls and young women: outcome evaluation.

• The degree to which DREAMS and adolescent boys and young men programming is aligned with the SA government programming in the implementation of HIV prevention and care and treatment services provided through youth-responsive platforms with community outreach services: outcome evaluation.

Evaluation data sources Data sources may include registers, tally sheets, electronic and paper patient records, recipient progress reports, focus groups, in-depth interviews, surveys, and other program monitoring tools.

Dissemination of evaluation results Dissemination channels could include:

• local and international conferences and forum abstract presentations

• conference poster displays

• manuscripts

• bulletins

• reports

• presentations to technical working groups and stakeholder meetings

• other approved products in print and electronic media

The primary intended users of evaluation results and findings will be the wider program stakeholders.

CDC and stakeholders will use overall evaluation findings during the 5-year project period to share and implement key recommendations to strengthen program implementation and effectiveness, sustainability, and continued program improvement after the award ends.

Step 1: Review the Opportunity 24

All evaluation reports will be publicly available on PEPFAR resource sites.

Evaluation and performance measurement plan You must submit an initial draft of your evaluation and performance measurement plan with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

As you develop your evaluation and performance measurement plan, align it with national, PEPFAR, and agency priorities as detailed in the NOFO. If awarded, we will work with you to finalize the plan and ensure it takes into account agreements made during COP/ROP planning.

Include the following elements in your evaluation and performance measurement plan.

Methods Describe how you will:

• Collect the performance measures.

• Respond to the evaluation topics.

• Use evaluation findings for continuous program quality improvement.

• Incorporate evaluation and performance measurement into planning, implementing, and reporting of project activities.

Additionally, explain:

• How findings will contribute to reducing or eliminating health disparities, as relevant.

• How key program partners will participate in the evaluation and performance measurement process.

• How feasible it will be to collect appropriate evaluation and performance data.

• How you will share evaluation findings with communities and populations of interest in a way that meets their needs.

• Other relevant information, such as performance measures you propose.

Evaluation activities You must carry out specific evaluation activities.

At least one evaluation must be carried out for each cooperative agreement during the course of funding. The evaluation can be:

Step 1: Review the Opportunity 25

• Process evaluation: Measures how the intervention was delivered, what worked and did not, the differences between the intended population and the population served, and access to the intervention.

• Outcome evaluation: Determines the effects of the intervention in the focus population, such as change in knowledge, attitudes, behavior, or capacity.

• Economic evaluation: Determines cost, cost drivers, cost effectiveness, efficiency, factors influencing economic behavior and choices, or the economic impact of interventions or activities to justify the investment.

Describe:

• The type of evaluations you will complete (process, outcome, and/or economic).

• Key evaluation questions these evaluations will address.

• Other information, such as measures and data sources.

Data management plan (DMP) For all public health data you plan to collect, a DMP is required. For a definition of “public health data” and other key information, see AR 25: Data Management and Access on our website.

You must submit an initial draft of your DMP with your application. You must submit a more detailed plan within the first six months of the award. See reporting.

Submit your initial DMP with your application and include:

• The data you will collect or generate and their sources.

• Any reasons why you cannot share this data with CDC. These could include legal, regulatory, policy, or technical reasons.

• Who can access the data and how you will protect and secure it.

• Data standards that explain what documentation released data will have.

That documentation should describe collection methods, what the data represent, and data limitations.

• Archival and long-term data preservation plans.

• How you will update the DMP as new information becomes available during the project. You will provide updates to the DMP in annual reports. For more information about CDC’s policy on the DMP, see Data Management and Access Requirement at CDC’s website.

In addition to the other requirements listed, also include:

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html https://www.cdc.gov/grants/additional-requirements/ar-25.html

• Cybersecurity plans.

• How you will protect personally identifiable information (PII) when you collect, store, transfer, and use this data.

• How you will remove information from the data that could reveal participants’ identities (de-identify the data) in intermediate and final data sets.

CDC and PEPFAR will inform you of data you need to share with us and how and when it should be shared.

Work plan You must provide a work plan for your project. The work plan connects your performance outcomes, strategies and activities, and measures. It provides more detail on how you will measure outcomes and processes. A sample work plan is provided below.

You should provide a detailed work plan for the first year and a high-level work plan for later years.

Table: Sample format

Activities you will implement

Progress or process measures

From the data, monitoring, and evaluation section.

Relevant period of performance outcomes

From the logic model.

Responsible position or party

Funding component / completion date

Strategy 1:

1.

2.

3.

Strategy 2:

1.

2.

3.

Step 1: Review the Opportunity 27

Paperwork Reduction Act Any activities involving information collection from 10 or more individuals or organizations may require Paperwork Reduction Act (PRA) approval. The PRA requires review and approval of the information collection by the White House Office of Management and Budget. For further information to determine if a proposed activity requires PRA approval, contact your project officer. Collections include items like surveys and questionnaires. If you have collections requiring PRA approval, CDC is responsible for working with OMB to gain the approval.

For more information about CDC’s requirements under PRA see CDC Paperwork Reduction Act Compliance.

Funding policies and limitations General policies

• Your budget is arranged in eight categories: salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual.

• You may use funds only for reasonable program purposes consistent with the award, its terms and conditions, and federal laws and regulations that apply to the award. If you have questions about this determination, ask the grants management officer.

• Generally, you may not use funds to purchase furniture or equipment.

Clearly identify and justify any such proposed spending in the budget.

• All requests for funds contained in the budget should be stated in U.S.

dollars.

• Cost increases due to changes in exchange rates are allowed if enough funding is available. If an increase in the exchange rate would reduce the scope of the project or cause you to need more federal funding, you must get prior approval for exchange rate fluctuations.

• Support beyond the first budget year will depend on:

◦ Appropriation of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 28 https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.cdc.gov/scientific-integrity/php/public-information-collection/?CDC_AAref_Val=https://www.cdc.gov/os/integrity/reducepublicburden/index.htm https://www.law.cornell.edu/definitions/index.php?width=840&height=800&iframe=true&def_id=13f24ea1f961f5f0d14b87ec1b39b25f&term_occur=999&term_src=Title:45:Chapter:A:Subchapter:A:Part:75:Subpart:E:Subjgrp:39:75.440

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

Unallowable costs You may not use funds for:

• Research.

• Clinical care, except as allowed by law.

• Pre-award costs, unless we give you prior written approval.

• Other than for normal and recognized executive-legislative relationships:

◦ Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body.

◦ The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body.

◦ See Anti-Lobbying Restrictions for CDC Recipients.

• Needle exchange programs.

For guidance on some types of costs that we restrict or do not allow, see 45 CFR part 75, General Provisions for Selected Items of Cost.

Indirect costs Indirect costs have a common or joint purpose across more than one project and cannot be easily separated by project. Learn more at CDC Budget Preparation Guidelines.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Provide a summary of the rate. Enclose a copy of the current approved rate agreement in your attachments.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 http://www.cdc.gov/grants/documents/Anti-Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08 https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf https://www.ecfr.gov/current/title-2/section-200.414 rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Foreign organizations and foreign public entities Indirect costs on awards to foreign organizations and foreign public entities performed fully outside of the U.S. and its territories may be paid to support the costs of complying with federal requirements. This rate is fixed at eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization.

Other indirect cost policies

• As described in 45 CFR 75.403(d), you must consistently charge items as either indirect or direct costs and may not double charge.

• Indirect costs may include the cost of collecting, managing, sharing, and preserving data.

Salary rate limitation As of January 2024, the HHS/CDC salary rate limitation is $221,900. This salary rate limitation does not apply to PEPFAR funds, which are part of an appropriation from the U.S. Department of State; but to the extent that HHS/ CDC funds are added to an award, this limitation applies. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use program income for the purposes and under the conditions of the award. Find more about program income at 45 CFR 75.307.

Program-specific limitations

CDC PEPFAR terms and conditions You can find a list of PEPFAR-specific terms and conditions on our website.

They apply to all PEPFAR awards, so we strongly encourage you to read them and ask questions if you need more information. These terms and conditions will apply if you are selected for an award so you should confirm that you are able to comply with…