Uganda CDC-RFA-JG-25-0045 Final NOFO for Publication..pdf

Division of Global HIV and Tuberculosis

Notice of Funding Opportunity

Application due February 18, 2025

Strengthening civil society organizations' capacity and coordination to accelerate HIV epidemic control in Uganda by implementing comprehensive HIV/AIDS prevention and treatment for key and priority populations under PEPFAR Opportunity number: CDC-RFA-JG-25-0045

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 18, 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:

Strengthening civil society organizations’ capacity and coordination to accelerate HIV epidemic control in Uganda by implementing comprehensive HIV/AIDS prevention and treatment for key and priority populations under PEPFAR

Opportunity number:

CDC-RFA-JG-25-0045

Announcement type:

New

Assistance listing: 93.067 Global AIDS Program

Key dates

Application deadline:

February 18, 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 A key PEPFAR priority is ensuring human rights and leaving no one behind. To achieve this priority, it’s critical for all sub-populations to attain the UNAIDS 95-95-95 targets to reach epidemic control by 2030.

This NOFO aims to reach populations that are at the highest risk of HIV in Uganda, including:

• Key populations: female sex workers, men who have sex with men, people who inject drugs, and transgender persons.

• Priority populations: fisher folk and truckers.

• Adolescent girls and young women.

However, existing interventions and programs meant to reach key and priority populations are missing the mark. This NOFO supports civil society organizations (CSOs) in providing services that focus on increasing the access of key and priority populations to HIV prevention, care, and treatment.

This NOFO builds on lessons from the Local Capacity Initiative and Key Populations Investment Fund. It aims to:

• Address legal, policy, and structural barriers that limit access to services.

• Improve the capacity of CSOs to work effectively with CDC-funded implementing partners, the Ministry of Health (MoH), and other relevant government ministries to provide comprehensive HIV/AIDS services.

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

Step 1: Review the Opportunity 5 phu5 Sticky Note Please replace application deadline with: February 18, 2025, at 11:59 p.m. ET

Funding details Type: Cooperative agreement

Expected total NOFO funding for Year 1: $10,000,000 This is the expected total Year 1 funding for all awards made under this

NOFO.

Expected number of awards: 1-2 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.

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.

Step 1: Review the Opportunity 6

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.

◦ Component 6: Emerging Public Health Priorities (buffer component if needed).

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 Uganda.

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 Despite national decline, key groups still face high HIV prevalence HIV prevalence in Uganda has declined to 5.1% among adults ages 15 to 49.

However, key populations still bear a high burden, contributing to more than 7% of all new HIV infections.

The prevalence of HIV among this NOFO’s focus populations is as follows:

• 36% among sex workers, with the highest rates recorded in Mbarara city (55%), Masaka city (47%), and Fort Portal city (43%).

• 11% among men who have sex with other men.

• 8.2% among persons who inject drugs.

• 12% among transgender persons.

• Between 15 and 23.3% among fisher folk.

• Between 15 and 20% among truck drivers.

• 3.3% among adolescent girls and young women ages 15 to 24, compared to 0.8% among young men.

Efforts to address the HIV epidemic in these groups remain inadequate, made worse by the harsh legal environment against some members of key populations.

Note: This NOFO will support services for all key populations except persons in prisons and other closed settings.

Past efforts, challenges, and gaps In 2018, PEPFAR Uganda introduced strategies to improve HIV case finding for key populations, including:

• Social network strategy.

• Assisted Partner Notification.

• Routine community health outreaches coupled with data capture through national tools to increase access to care.

Still, some challenges and gaps remain, including concerns about data safety and security, and a need for program adaptations that require:

Step 1: Review the Opportunity 10

• Service integration.

• Use of technology.

• Improved implementation of peer-to-peer approaches.

• Strong community leadership.

Currently, there is limited capacity to implement these service delivery adaptations or to integrate HIV, STI, and viral hepatitis services with broader health services for key and priority populations.

Bridging remaining gaps through community empowerment This NOFO will support collaborations and learnings through a unifying community focus and shared accountability in alignment with the World Health Organization’s definition of community empowerment:

“A collective process that enables key populations to address the structural constraints to health, human rights, and well-being and improve access to health services.”

Increasing the capacity of CSOs to serve key populations This NOFO will draw lessons from previous efforts, such as the Local Capacity Initiative (The PEPFAR Local Capacity Initiative Interventions in Uganda — MEASURE Evaluation) and Key Population Investment Fund to improve CSOs’ capacity to increase demand for and enable the delivery of comprehensive HIV services to key and priority populations.

If awarded, we will expect you to:

• Support community systems.

• Strengthen efforts to accelerate identification, linkage, retention, adherence, and viral load suppression for the focus populations.

• Enhance strategic policy engagements to address structural barriers to service delivery.

We will also expect you to ensure CSOs collaborate with the MoH, other stakeholders, and CDC implementing partners to carry out comprehensive, integrated, and quality interventions to promote sustainable service delivery models for the focus populations.

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

Step 1: Review the Opportunity 11 https://www.measureevaluation.org/resources/publications/fs-19-362.html https://www.measureevaluation.org/resources/publications/fs-19-362.html

By strengthening their governance, leadership, strategic planning, and financial and human resource systems, CSOs will be set to successfully deliver HIV/TB programming and ensure long-term community ownership.

Purpose The purpose of this NOFO is to strengthen the capacity, coordination, and partnerships of CSOs to accelerate HIV epidemic control in Uganda by:

• Supporting equitable, person-centered, and comprehensive HIV prevention, care, and treatment services to key and priority populations.

• Collaborating with the MoH, other government ministries, and stakeholders to address the legal, policy, and structural barriers that limit the access of key and priority populations to quality, integrated HIV services.

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.

Table: Strategies and outcomes

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1: Enhance sustainable technical and financial capacity of CSOs to effectively manage HIV/AIDS prevention, care and treatment services.

Improved technical and financial capacity of CSOs to apply to and manage grants.*

Increased capacity of CSOs to oversee and monitor quality of

Improved timeliness of programmatic and financial reporting.*

Improved adherence, retention, and viral load suppression in focus populations.*

Sustained financial resource generation by CSOs.

Sustained equitable provision and use of HIV, TB, and health services.*

Step 1: Review the Opportunity 12

Strategies Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 2: Support provision of quality, integrated, equitable, and client-centered community-based HIV prevention, care, and treatment services.

Strategy 3: Support efforts to overcome structural barriers to HIV service delivery.

Strategy 4:

Strengthen coordination of CSOs as a sustainable self-coordinating entity for HIV/AIDS response.

Strategy 5:

Strengthen CSO capacity for data management and health information systems to collect, analyze, report, and use data to improve quality of services and HIV/TB program.

HIV/AIDS service provision.*

Improved skills of CSO providers on ethical, person-centered HIV/ AIDS services.*

Increased case identification and linkage to antiretroviral therapy (ART) in focus populations.*

Increased provision and uptake of quality and integrated HIV services in focus populations.*

Enhanced understanding of stakeholders on legal and structural barriers to quality HIV services provision.*

Reduced duplication of service provision among CSOs working in the same area.*

Improved competencies of CSOs to review, analyze, and use HIV program data for program improvement.*

Increased capacity of CSOs to promote an inclusive and responsive legal/ policy environment.*

Improved data quality and use for program improvement.*

Increased uptake of prevention services among focus populations.*

Reduced stigma and discrimination at health facility and community levels.*

Reduced new HIV infections among key and priority populations, men, and youth.

Decreased HIV-related morbidity and mortality.

Step 1: Review the Opportunity 13

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.

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

Strategy 1: Enhance sustainable technical and financial capacity of CSOs to effectively manage HIV/AIDS prevention, care and treatment services.

Required activities:

• Build sustainable capacity of CSOs, including youth-led CSOs, on principles of good governance, leadership, and financial management to enable them to access grants and implement activities that accelerate HIV epidemic control.

• Build the capacity of CSOs to mobilize resources and develop HIV/AIDS response partnerships that support service delivery, resource mobilization, and sustainability.

• Use training and peer leadership to improve CSO personnel and health workers’ interpersonal communication skills and ability to design and implement information and education strategies.

• Train CSO service providers on equitable, person-centered, and comprehensive HIV/AIDS prevention, care, and treatment approaches, including human rights, sexual and gender-based violence, gender and sexual diversity, and competent services.

• Strengthen the capacity of CSOs to engage in all stages of PEPFAR and Global Fund programs by informing the development of service delivery models and actively participating in planning, delivering, and monitoring services.

Step 1: Review the Opportunity 14

Strategy 2: Support provision of quality, integrated, equitable, and client-centered community-based HIV prevention, care and treatment services.

Required activities:

• Conduct activities to create demand for and increase use of comprehensive HIV prevention interventions, including HIV testing, medication-assisted treatment, and pre-exposure prophylaxis (PrEP) among key and priority populations.

• Implement innovative approaches for HIV case finding and linkages to treatment for key and priority populations.

• Implement innovative, differentiated service delivery approaches to improve adherence to and retention on PrEP and medication-assisted treatment.

• Implement innovative, differentiated service delivery approaches to improve adherence, retention, and viral suppression.

• Provide technical and organizational support to improve the function of drop-in centers, including safety and security, as part of improving access to client-centered services.

• Actively apply and disseminate data and evidence from routine program monitoring, surveys and surveillance, implementation science, and behavioral science. This data and evidence should be used to identify gaps in equity of access or use of services among focus populations, understand root causes, and disseminate evidence-based practices.

• Develop and disseminate HIV educational materials to support client literacy, such as the grassroots implementation of Undetectable=Untransmittable (U=U). This activity should include using social media to maximize reach for key populations, priority populations, youth, and men.

• Implement continuous quality improvement initiatives across all levels of community care.

Step 1: Review the Opportunity 15

Strategy 3: Support efforts to overcome structural barriers to HIV service delivery.

Required activities:

• Design and implement strategic, innovative, and multi-layered interventions to address HIV-related stigma and discrimination at the health facility and community levels.

• Collaborate with the MoH, government ministries, other CSOs, and PEPFAR implementing partners to enable addressing discriminatory policies, gender-based violence, and other inequities that block progress toward sustainable epidemic control.

• Implement recommendations from the Legal Environment Assessment in collaboration with relevant partners and stakeholders.

• Conduct periodic evaluation, documentation, and effective response to incidents of stigma, discrimination, and violence.

Strategy 4: Strengthen coordination of CSOs as a sustainable self-coordinating entity for HIV/AIDS response.

Required activities:

• Conduct periodic mapping and identification of community-based CSOs engaged or to be engaged in providing comprehensive HIV/AIDS services to key and priority populations, youth, and men.

• Enhance collaborative working relationships, networking, and alliances among CSOs by exchanging learning and knowledge, including identifying and replicating good practices.

• Coordinate quarterly reporting and accountability forums for CSOs involved in HIV/AIDS response.

• Contribute to community performance monitoring and accountability activities, including:

◦ Working with community-led monitoring partners.

◦ Providing real-time feedback and proposing actions on crosscutting CSO issues to CDC, MoH, Global Fund, and PEPFAR coordination office.

Step 1: Review the Opportunity 16

Strategy 5: Strengthen CSO capacity for data management and health information systems to collect, analyze, report, and use data to improve quality of services and HIV/TB program.

Required activities:

• Build capacity of CSOs and drop-in-center personnel on community tools and Key Population Combination Prevention tracker to enable improved data capture, accuracy, timeliness, reporting, and use of HIV/TB program data.

• Implement community quality improvement initiatives aimed at improving access, availability, and use of HIV prevention, care, and support interventions, as well as experience of care by clients.

• Document and periodically share best practices related to CSO work in newsletters, social media posts, abstracts, success stories, and manuscripts.

• Ensure privacy, confidentiality, and overall safety and security of data and records, and the timely report on incidents of breaches and mitigation measures.

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.

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.

Step 1: Review the Opportunity 17

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.

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.

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

Step 1: Review the Opportunity 18 https://www.state.gov/reports-pepfar/ 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 https://www.state.gov/reports-pepfar/

Focus populations The focus populations for this NOFO include:

• Key populations:

◦ Female sex workers.

◦ Men who have sex with men.

◦ People who inject drugs.

◦ Transgender persons.

• Priority populations, including fisher folk and long-distance truck drivers, among others.

• Adolescent boys and young men.

• Adolescent girls and young women.

• Youth.

• Persons with disabilities.

• Persons living with HIV/AIDS.

• Community health workers, peer leaders, and peer outreach workers.

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 19

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 funded, we will expect you to collaborate with the following to achieve NOFO objectives:

• MoH including active participation in national-level key population coordination meetings.

• Other host government ministries and agencies, including the Ministry of Gender, Labour, and Social Development, law enforcement entities, and others.

• The Uganda AIDS Commission.

• District health offices.

• Designated CDC monitoring and evaluation partner to enhance capacity and reporting of drop-in-center outputs.

• CDC-funded regional comprehensive partners and their sub-partners in the regions where you will work to advance NOFO objectives.

• Other local CSOs that have a role in achieving the NOFO goals and objectives.

• Other U.S. government agencies implementing PEPFAR, like USAID, Peace Corps, and Department of Defense.

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

Step 1: Review the Opportunity 20 https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html?CDC_AAref_Val=https://www.cdc.gov/about/sdoh/index.html

• Other external organizations, including the Global Fund, the World Health Organization, and other bilateral organizations working on HIV-related programs.

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 10% of funds for monitoring activities and 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.

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

Step 1: Review the Opportunity 21 https://www.state.gov/reports-pepfar/ https://www.state.gov/reports-pepfar/ https://help.datim.org/hc/en-us/articles/360000084446-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.

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, we show 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.

Testing:

• HTS_TST: Number of individuals who received HIV Testing Services and received their test results. [Target: 30,000; Reporting Frequency:

Quarterly]

• HTS_RECENT: Number of newly diagnosed persons living with HIV who received testing for recent infection with a documented result during the reporting period. [Target: 500; Reporting Frequency: Quarterly]

• HTS_INDEX: Number of individuals who were identified and tested using Index testing services and received their results. [Target: 2,500; Reporting Frequency: Quarterly]

• HTS_SELF: Number of individual HIV self-test kits distributed. [Target:

30,000; Reporting Frequency: Quarterly]

Prevention:

• KP_PREV: Number of key populations reached with individual and/or small group-level HIV prevention interventions designed for the target population. [Target: 28,000; Reporting Frequency: Semi-Annual]

• 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: 22,000; Reporting Frequency: Semi-Annual]

• PrEP_NEW: Number of individuals who have been newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period. [Target: 6,500; Reporting Frequency: Quarterly]

• PrEP_CT: Number of individuals, excluding those newly enrolled, that return for a follow-up visit or re-initiation visit to receive pre-exposure

Step 1: Review the Opportunity 22 prophylaxis (PrEP) to prevent HIV during the reporting period. [Target:

8,000; Reporting Frequency: Quarterly]

Treatment:

• TX_CURR: Number of adults and children currently receiving antiretroviral therapy (ART). [Target: 4,500; Reporting Frequency:

Quarterly]

• TX_ML: Number of ART patients (who were on ART at the beginning of the quarterly reporting period or initiated treatment during the reporting period) and then had no clinical contact since their last expected contact.

[Target: Not Assigned; Reporting Frequency: Quarterly]

• TX_NEW: Number of adults and children newly enrolled on antiretroviral therapy (ART). [Target: 500; Reporting Frequency: Quarterly]

• TX_TB: Proportion of ART patients screened for TB in the semiannual reporting period who start TB treatment. [Target: 100%; Reporting Frequency: Semi-Annual]

Viral Suppression:

• TX_PVLS: Percentage of ART patients with a suppressed viral load (VL) result (<1000 copies/ml) documented in the medical or laboratory records/laboratory information systems (LIS) within the past 12 months.

[Target: 95%; Reporting Frequency: Quarterly]

Custom indicators Below we show some anticipated custom indicators, targets, and reporting frequencies for the first year.

You should also propose custom indicators to monitor the achievement of outcomes. Custom indicators should include process and outcome measures directly correlated with the logic model. We anticipate that, to the greatest possible extent, the reported data should be disaggregated by client population type. Below are examples of additional process and outcome measures for the strategies/activities and outcomes previously discussed in the logic model and associated narrative sections.

• Percentage of CSOs successfully trained in financial/grants management and resource mobilization during the reporting period. [Target: 100%;

Reporting Frequency: Quarterly]

• Percentage of CSOs who were awarded or acquired competitive research and program grants. [Target: 50%; Reporting Frequency: Quarterly]

• Percentage of CSOs trained in data analytics and data use. [Target: 100%;

Reporting Frequency: Quarterly]

Step 1: Review the Opportunity 23

• Percentage of key populations who self-report receiving competent and integrated services at the drop-in-centers. [Target: 60%; Reporting Frequency: Quarterly]

• Percentage of CSOs/drop-in centers submitting high-quality (timely, reliable, accurate, etc.) financial and program reports. [Target: 100%;

Reporting Frequency: Quarterly]

• Number of joint implementing partner/CSO/CDC quarterly meetings conducted to share best practices. [Target: 1; Reporting Frequency:

Quarterly]

• Percentage of CSOs that use program data for evidence-based decision-making. [Target: 90%; Reporting Frequency: Semi-Annual]

• Percentage of ART patients with no clinical contact or antiretroviral pick-up for greater than 28 days since their last expected contact (defined as lost clients) who restarted ARVs within the reporting period. [Target:

100%; Reporting Frequency: Quarterly]

Data sources for MER and custom indicators Data sources may include registers, tally sheets, electronic and paper patient records, surveillance and survey reports, National DHIS2, PEPFAR information reporting systems, key/priority population tracker, community meeting notes, the community health information system and quarterly progress reports and other program monitoring tools.

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.

• Assess if CSO capacity was improved to effectively acquire and manage grants for comprehensive HIV/AIDS service delivery: outcome evaluation.

• Assess if CSO coordination improved availability, accessibility, and use of integrated HIV/AIDS services by focus populations: outcome evaluation.

• Extent of changes in stigma and discrimination indices: outcome evaluation.

Step 1: Review the Opportunity 24

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.

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.

Step 1: Review the Opportunity 25

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:

• 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).

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• 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:

• 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.

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

Step 1: Review the Opportunity 27 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

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.

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.

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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.

◦ Extending the period of performance.

◦ Awarding supplemental funding.

See also program-specific limitations.

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

Step 1: Review the Opportunity 29 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

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 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.

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

Step 1: Review the Opportunity 30 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 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC))

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.