Billing Code: 4163-18-P
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Strengthening Safe Hospitals and Clinics in HIV/AIDS Prevention Activities, Services, and Practices in the Republic of Mozambique under the President's Emergency Plan for AIDS Relief (PEPFAR)
Announcement Type: New
Funding Opportunity Number: CDC-RFA-PS08-808
Catalog of Federal Domestic Assistance Number: 93.067
Key Dates:
Application Deadline: March 31, 2008
Authority: This program is authorized under Sections 301(a) and 307 of the Public Health Service Act [42 U.S.C. Sections 241 and 242l], as amended, and under Public Law 108-25 (United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003) [22 U.S.C. 7601].
Background:
President Bush's Emergency Plan for AIDS Relief has called for immediate, comprehensive and evidence based action to turn the tide of global HIV/AIDS. The initiative aims to treat more than two million HIV infected people with effective combination anti-retroviral therapy (ART) by 2008; care for ten million HIV-infected and affected persons, including those orphaned by HIV/AIDS, by 2008; and prevent seven million infections by 2010, with a focus on 15 priority countries, including 12 in sub-Saharan Africa. The Five Year Strategy for the Emergency Plan is available at the following Internet address: http://www.state.gov/s/gac/plan/c11652.htm
Over the same time period, as part of a collective national response, the Emergency Plan goals specific to Mozambique are to treat at least 110,000 HIV-infected individuals; and to care for 550,000 HIV-affected individuals, including orphans, and to prevent new infections.
Purpose:
The purpose of the program is to work with host countries and other key partners to assess the needs of each country and design a customized program of assistance that fits within the host nation's strategic plan.
This program addresses the “Healthy People 2010” focus area(s) of three major program areas in each country. Goals and priorities include the following:
The purpose of this announcement is to further develop activities began under the University Technical Assistance Program cooperative agreement to support a broad expansion of prevention, care, and treatment services and practices in hospitals and clinics in the Republic of Mozambique. This announcement is meant to target groups working in Mozambique who have a proven record of successfully implementing HIV/AIDS programs and practices with other country partners such as CDC, USAID and the Ministry of Health.
Working with the Ministry of Health and other local partners, the agreement is designed to strengthen multiple PEPFAR activity service areas, specifically counseling and testing (CT), infection prevention and control (IPC), male circumcision, cervical cancer prevention, gender issues, human capacity development, malaria, tuberculosis (TB), laboratory biosafety, and anti-retroviral treatment (ART) site infrastructure by primarily. focusing on growing infrastructure and ongoing HIV/AIDS Prevention activities in hospital and clinical settings throughout Mozambique.
There are currently an estimated 1,800,000 HIV infected Mozambicans, with over 500 new infections thought to occur every day. In 2006, approximately 140,000 deaths due to AIDS occurred in Mozambique, and life expectancy was reduced to about 46 years for women and 44 years for men.
Mozambique has an estimated adult HIV prevalence of 16.1 percent. While the HIV burden is not as high as surrounding countries such as South Africa, Swaziland and Zimbabwe, the HIV epidemic in Mozambique is still increasing, unlike in neighboring countries. Data from the 2004 antenatal sentinel survey found that provincial HIV prevalence ranged from 9.2 percent in Nampula Province to 26.5 percent in Sofala Province. It is thought that the high prevalence in the central region is partially due to the return of refugees from neighboring countries after the civil war. HIV prevalence nearing 30 percent among pregnant women has been consistently recorded during bi-annual serosurveys in some antenatal clinics in the Central Region.
Measurable outcomes of the program will be in alignment with the following performance goal(s) for the President’s Emergency Plan for AIDS Relief. At the end of the first year of the funding period, the successful applicant will have achieved the following:
1. Prevention a. Counseling and Testing (CT) (1) 200 healthcare workers trained in clinical CT (2) 100 health facilities or departments/units providing clinical CT (3) 100,000 individuals counseled and tested in clinical settings (4) 50,000 individuals referred to care and treatment as a result of clinical CT (5) 80 NGO staff and volunteers trained in integrated community CT (6) 5 NGOs providing integrated community CT (7) 60,000 individuals counseled and tested at the community level (8) 30,000 individuals referred to care and treatment as a result of integrated community CT services (9) Task analysis for the development of lay counselors conducted b. Infection Prevention and Control (IPC) (1) IPC performance standards for health centers and maternities adapted and field tested (2) Specific budget line for IPC supplies, materials and equipment created/identified at the central, provincial and hospital levels (3) 20 new IPC trainers trained (4) 100 healthcare workers updated in IPC (5) At least five hospitals recognized as high performing sites in IPC (compliance with 80% or more IPC standards) (6) Simple surveillance system developed (e.g. reduction in needlestick injuries, availability of safety equipment) c. Male Circumcision (MC) (1) Three (3) trainers and supervisors trained in MC in each region (south, central, and north in a total of up to 9 trainers nationally) (2) Informed consent, post-operative care and risk reduction counseling materials developed (3) Safe MC services implemented in selected sites in each region (in a total of up to 10 sites) (4) 50 clinical providers trained in MC (5) 500 male circumcisions performed d. Cervical Cancer Prevention among HIV infected Women (1) Training package is available in Portuguese (2) National policy and service delivery guidelines reflect approach to cervical cancer prevention as informed by situational assessment (3) At least 10 new providers (physicians, nurses, midwives) are trained in laboratory and cryotherapy skills (4) Quality cervical cancer prevention services are established in 1-2 sites (5) At least 3,000 women who are living with, or at risk for HIV are screened; treatment provided as necessary e. Gender (1) National policy and service delivery guidelines reflect the appropriate protocol for support and referral of gender based violence clients (2) HIV PEP guidelines for sexually abused victims are approved and implemented in all central and provincial hospitals (3) At least 100 health care providers from up to 6 health care facilities trained in HIV post exposure prophylaxis (PEP) for sexually abused victims and other related gender based violence and sensitivity issues; and are prepared to address the needs of gender based violence clients 2. Care a. Tuberculosis (TB) and HIV (1) Guidelines for HIV/TB management in hospital settings revised and updated (2) Training materials for HIV/TB management in hospital settings developed (3) 20 TB supervisors trained as trainers in HIV/TB management (4) 50 healthcare workers updated in HIV/TB management (5) Performance standards for supervision developed and tested (6) TB respirators selected and purchased for 10 sites (also included in ART infrastructure component) b. Malaria/HIV and Pregnancy (1) Service delivery guidelines for Malaria, HIV/AIDS, and Reproductive Health updated with latest evidence relating to the interaction between HIV and Malaria (2) Clinical performance standards and community performance standards developed (3) 50 supervisors trained in focused antenatal care (FANC) services (4) 100 antenatal care staff trained in FANC with integrated MIP and PMTCT services 3. Treatment a. Biosafety in Laboratories (1) IPC performance standards for HIV/AIDS laboratories adapted, field tested, and introduced to the HIV/AIDS laboratories in up to 20 sites (2) 20 laboratory supervisors trained as trainers in IPC for labs (up to 20 sites) (3) 50 lab technicians updated in IPC measures for labs (up to 20 sites) (4) All HIV/AIDS laboratories with baseline assessments and improvement process initiated (up to 20 sites) b. Infrastructure in ART Sites (1) Central instrument sterilization departments improved in up to three treatment sites (2) Appropriate, sustainable waste management programs provided for up to six treatment sites (3) Plan for isolation units for infectious TB patients developed 4. Other a. Human Capacity Development (HCD) and Training (1) Most cost effective options for nursing education identified (2) Performance standards for pre-service education for health careers developed (3) Inservice training in basic HIV care, stigma and discrimination, infection prevention, and basic bed side care for 200 ancillary workers conducted (4) Web based training information system for inservice training expanded to all provinces (5) Web based training information system for pre-service education developed and tested (6) Workplace safety and health guidelines, including HIV post-exposure prophylaxis, approved by the Ministry of Health (MOH), and gradually implemented in all central and provincial hospitals (7) Improved surveillance of injuries and improved access and uptake to post-exposure prophylaxisThis announcement is primarily intended for non-research activities supported by the Centers for Disease Control and Prevention (CDC) within HHS. If an applicant proposes research activities, HHS will not review the application. For the definition of “research,” please see the HHS/CDC Web site at the following Internet address: http://www.cdc.gov/od/science/regs/hrpp/researchdefinition.htm
Activities:
The recipient of these funds is responsible for activities in multiple program areas designed to target underserved populations in Mozambique. Either the awardee will implement activities directly, or will implement them through its subgrantees and/or subcontractors; the awardee will retain overall financial and programmatic management under the oversight of HHS/CDC and the strategic direction of the Office of the U.S. Global AIDS Coordinator. The awardee must show a measurable progressive reinforcement of the capacity of indigenous organizations and local communities to respond to the national HIV epidemic, as well as progress towards the sustainability of activities.
Applicants should describe activities in detail that reflect the policies and goals outlined in the Five Year Strategy for the President’s Emergency Plan.
The grantee will produce an annual operational plan, which the U.S. Government Emergency Plan team on the ground in Mozambique will review as part of the annual Emergency Plan for AIDS Relief Country Operational Plan review and approval process, managed by the Office of the U.S. Global AIDS Coordinator. The grantee may work on some of the activities listed below in the first year and in subsequent years, and then progressively add others from the list to achieve all of the Emergency Plan performance goals, as cited in the previous section. HHS/CDC, under the guidance of the U.S. Global AIDS Coordinator, will approve funds for activities on an annual basis, based on documented performance toward achieving Emergency Plan goals, as part of the annual Emergency Plan for AIDS Relief Country Operational Plan review and approval process.
Awardee activities for this program are as follows:
During the five year period of this award, the awardee activities for this program are as follows:
1. Prevention a. Counseling and Testing (CT) (1) Increase the number of Mozambicans who know their HIV status (1) Expand clinical CT from TB, inpatient and pediatrics wards to all hospital services, including outpatient departments, nationwide (1) Expand clinical CT from the hospital to the health center and health post levels (1) Expand the integrated community CT program in terms of numbers of implementing NGOs and numbers of clients served (1) Expand the number of counselors available by formalizing and supporting the creation of a cadre of lay counselors b. Infection Prevention and Control (IPC) (1) Strengthen, expand, and institutionalize the IPC initiative in hospitals (1) Create a simple surveillance system to measure the impact of the improved IPC practices (1) Decrease the risk of medical and nosocomial transmission of HIV/AIDS and TB. c. Male Circumcision (MC) (1) Increase the number of skilled providers providing safe MC (1) Strengthen identified health care facilities to provide safe MC services (1) Increase demand for safe MC (1) Increase access to safe MC services d. Cervical Cancer Prevention among HIV infected Women (1) Increase the percentage of HIV infected women in Mozambique who have access to cervical cancer screening and treatment services (1) Increase the percentage of HIV+ women in Mozambique who are screened and treated for cervical cancer in the context of HIV/AIDS services e. Gender: (1) Provide support to the MOH to expand the concept of gender “mainstreaming” into health care service delivery, through integration of gender based violence components into existing HIV programs (1) Increase the percentage of health care providers prepared to appropriately support the needs of gender based violence clients (1) Increase the percentage of gender based violence victims accessing appropriate health care services (1) Expand HIV post-exposure prophylaxis (PEP) services to cover gender based violence victims 2. Care: a. Tuberculosis (TB) and HIV (1) Increase access to HIV Testing for TB patients (1) Improve access to HIV treatment for TB patients (1) Improve management of HIV/TB patients in hospital settings. (1) Minimize nosocomial TB infection among HIV+ patients and healthcare workers b. Malaria/HIV and Pregnancy (1) Increase the percentage of pregnant women (and the subgroup of HIV positive women who are not taking cotrimoxazole prophylaxis) receiving intermittent preventive treatment under direct observation (first dose, second dose, third dose, according to the national guidelines), and sleeping under an insecticide treated bednet (1) Increase the percentage of pregnant women receiving prompt and effective combination treatment for malaria (1) Increase the percentage of HIV+ pregnant women receiving and continuing cotrimoxazole prophylaxis (1) In coordination with ANC efforts, increase the percentage of women of reproductive age receiving and continuing cotrimoxazole prophylaxis (1) Incorporate the use of bed nets and other malaria prevention measures into community based HIV/AIDS interventions 3. Treatment a. Biosafety in Laboratories (1) Expand the existing IPC initiatives to the HIV/AIDS laboratories (1) Strengthen the supportive supervision system for the HIV/AIDS laboratories b. Infrastructure in ART Sites (1) Implement instrument processing and sterilization systems in treatment sites (1) Implement waste management through provision of incinerators in treatment sites (1) Improve isolation measures to minimize nosocomial TB infection among HIV+ patients and healthcare workers 4. Other a. Human Capacity Development (HCD ) and Training: (1) Provide support to the MOH to improve the quality of pre-service education, particularly for nursing (1) Provide inservice training in basic health care, including HIV, for selected cadres of health workers, including ancillary workers (1) Develop and support the implementation of a nation-wide training information system (1) Support the implementation of workplace safety and health activities including HIV post-exposure prophylaxis (PEP)
The winner of this funding competition must comply with all HHS management requirements for meeting participation and progress and financial reporting for this cooperative agreement (See HHS Activities and Reporting sections below for details), and comply with all policy directives established by the Office of the U.S. Global AIDS Coordinator.
In a cooperative agreement, HHS staff are substantially involved in the program activities, above and beyond routine grant monitoring. HHS Activities for this program are as follows:
1. Organize an orientation meeting with the grantee to brief then on applicable U.S. Government, HHS, and Emergency Plan expectations, regulations and key management requirements, as well as report formats and contents. The orientation could include meetings with staff from HHS agencies and the Office of the U.S. Global AIDS Coordinator.2. Review and approve the process used by the grantee to select key personnel and/or post-award subcontractors and/or subgrantees to be involved in the activities performed under this agreement, as part of the Emergency Plan for AIDS Relief Country Operational Plan review and approval process, managed by the Office of the U.S. Global AIDS Coordinator.
3. Review and approve the grantee’s annual work plan and detailed budget, as part of the Emergency Plan for AIDS Relief Country Operational Plan review and approval process, managed by the Office of the U.S. Global AIDS Coordinator.
4. Review and approve the grantee’s monitoring and evaluation plan, including for compliance with the strategic information guidance established by the Office of the U.S. Global AIDS Coordinator.
5. Meet on a monthly basis with the grantee to assess monthly expenditures in relation to approved work plan and modify plans, as necessary.
6. Meet on a quarterly basis with the grantee to assess quarterly technical and financial progress reports and modify plans as necessary.
7. Meet on an annual basis with the grantee to review the annual progress report for each U.S. Government Fiscal Year, and to review annual work plans and budgets for the subsequent year, as part of the Emergency Plan for AIDS Relief review and approval process for Country Operational Plans, managed by the Office of the U.S. Global AIDS Coordinator.
8. Provide technical assistance, as mutually agreed upon, and revise annually during validation of the first and subsequent annual work plans. This could include expert technical assistance and targeted training activities in specialized areas, such as strategic information, project management, confidential counseling and testing, palliative care, treatment literacy, and adult learning techniques.
9. Provide in-country administrative support to help grantee meet U.S. Government financial and reporting requirements approved by the Office of Management and Budget (OMB) under 0920-0428 (Public Health Service Form 5161).
10. Collaborate with the awardee on designing and implementing the activities listed above, including, but not limited to the provision of technical assistance to develop program activities, data management and analysis, quality assurance, the presentation and possibly publication of program results and findings, and the management and tracking of finances.
11. Provide consultation and scientific and technical assistance based on appropriate, HHS/CDC and Office of the U.S. Global AIDS Coordinator documents to promote the use of best practices known at the time.
12.