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					 1               U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

 2                      Centers for Disease Control and Prevention (CDC)

 3    Addressing Syndemics Through Program Collaboration and Service Integration (PCSI)

 4

 5   I. AUTHORIZATION AND INTENT

 6   Announcement Type: New – Type 1

 7   Funding Opportunity Number: CDC-PS10-10175

 8   Catalog of Federal Domestic Assistance Number: 93.940 HIV Prevention Activities

 9

10   Key Dates

11   Application Submission Date: June 15, 2010

12   Application Deadline Date: 60 Days after date of publication on Grants.gov, 11:59pm

13   Eastern Standard Time

14   Authority: This program is authorized under Sections 317(k)(2) and 318(b) of the Public

15   Health Service Act [42 U.S.C. Sections 247b(k)(2) and 247c(b)], as amended.

16

17   Background:

18   Despite decades of sustained improvements in the prevention and control of HIV/AIDS,

19   viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) in the United

20   States, these infectious diseases remain among the most commonly reported conditions

21   annually. These remain a major public health concern and highly prevalent in the

22   population, with growing evidence of concentration among minorities, the socio-

23   economically disadvantaged or marginalized, or among those with poor access to quality
24   prevention, treatment and care services. Each year, more than 19 million STDs are

25   estimated to occur in the United States, including just over 56,000 new HIV infections.

26   One in 4 adolescent American women is being infected with one of the four most common

27   STDs. There are more than 5 million people living with chronic viral hepatitis and more

28   than 1 million people living with HIV in the U.S. Although the numbers and rates of some

29   conditions such as hepatitis B and TB have shown consistent declines in the past decade,

30   there is concern that these reductions are now leveling off or becoming more concentrated

31   among certain population subgroups.

32

33   For STDs, the picture is somewhat less encouraging. Gonorrhea rates in the U.S. must be

34   contrasted with the resurgence of infectious syphilis and continued increases in reported

35   chlamydial infection These infections disproportionately affect U.S. minorities with

36   some of the most marked racial health disparities for infectious diseases, especially

37   impacting African Americans. Similar disparities exist for Hispanics/Latinos and Native

38   American/Alaska Native populations. These conditions place a tremendous physical,

39   social and economic burden on individuals, relationships, families, and society. They are

40   associated with substantial stigma and discrimination experienced directly and indirectly

41   by those infected with, and those affected by, them. They are a significant drain on

42   health care resources with the annual costs for management and treatment of common

43   STDs (including HIV) being estimated to be approximately $15 billion annually in the

44   U.S. Prevention programs are at a cross-road; having to choose between maintaining

45   independent and vertical prevention programs versus finding ways to better package,

46   prioritize and target evidence-based and cost-effective prevention interventions that are




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47   comprehensive, holistic and acceptable to individuals. Many national organizations and

48   CDC grantees have called for better integration of services that are provided by related

49   programs, especially of prevention activities related to HIV/AIDS, viral hepatitis, STDs,

50   and TB. Several factors have accelerated the momentum toward collaboration and

51   integration of prevention services related to these diseases in the United States. One

52   factor is a greater understanding of the extent to which these diseases are synergistically

53   interacting epidemics or syndemics. The risk of acquiring any of these diseases is

54   associated with similar behaviors and environmental conditions, and they have reciprocal

55   or interdependent effects. For example:

56          • HIV, viral hepatitis and STDs share common risks and modes of transmission;

57          • STDs increase the risk for HIV infection;

58          • HIV is the greatest risk factor for progression to TB disease;

59          • HIV accelerates liver disease associated with viral hepatitis, making hepatitis the
60            leading cause of death among persons living with HIV/AIDS;
61
62          • TB is an AIDS-defining opportunistic condition; and

63          • Clinical course and outcomes are influenced by concurrent disease (HIV/TB can

64              be deadly, and TB accelerates HIV disease progression).

65   As a result, certain populations are at elevated risk for multiple diseases. Common risks

66   suggest the need for common solutions and enhanced collaboration among related

67   prevention programs. Because these disease conditions share many social, environmental,

68   behavioral, and biological determinants and are often managed by the same or similar

69   organizations, public health efforts to prevent their occurrence require a syndemic

70   approach. This approach provides a way of thinking about public health work that

71   focuses on connections among health-related problems, considers those connections



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72   when developing health policies and aligns public health activities with other avenues of

73   social change to foster conditions in which all people can be healthy.

74

75   Purpose:

76   The purpose of this program is to plan, scale-up, and support the implementation of a

77   syndemic approach to the prevention of HIV/AIDS, viral hepatitis, STD’s and TB

78   through Program Collaboration and Service Integration (PCSI) activities as described in

79   the recently published NCHHSTP’s white paper “Enhancing the Prevention and Control

80   of HIV/AIDS, viral hepatitis, STDs, and TB in the United States”. Details of this

81   strategy and approach can be found at http://www.cdc.gov/nchhstp/programintegration.

82   The program aims to strengthen and provide opportunities for collaboration to support

83   integrated approaches to service delivery. It aims to maximize the health benefits that

84   persons receive from prevention services by increasing service efficiency; maximizing

85   opportunities to screen, test, treat, or vaccinate those in need of these services; improving

86   the health among populations negatively affected by multiple diseases; improving

87   operations through the use of shared data; and enabling service providers to adapt to and

88   keep pace with changes in disease epidemiology and new technologies. The program is

89   also intended to identify strategies for leveraging resources to maximize the yield and

90   sustainability of integrating services.

91   Program Goals

92   The following are specific, national level goals for this program:

93         Goal #1: Maximize prevention opportunities by increasing the delivery of

94          integrated screening for populations at risk for multiple infections.




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 95         Goal #2: Reduce concurrent transmission of HIV, viral hepatitis and sexually

 96          transmitted diseases.

 97         Goal #3: Reduce STD related HIV infections.

 98         Goal #4: Reduce HIV associated TB disease.

 99   This program addresses the “Healthy People 2010” focus area(s) of HIV, Sexually

100   Transmitted Diseases, Immunization and Infectious Diseases, and Respiratory Diseases.

101   Performance Goals

102   Measurable outcomes of the program will be in alignment with one (or more) of the

103   following performance goal(s) for the National Center for HIV/AIDS, viral hepatitis,

104   STDs, and TB:

105         Goal #1: Reduce the rate of new HIV infections in the United States.

106         Goal #2: Reduce the rates of viral hepatitis in the United States.

107         Goal #3: Reduce the rates of non-HIV sexually transmitted diseases (STDs) in the

108          United States.

109         Goal #4: Reduce the rate of tuberculosis (TB) in the United States.

110   Reduction of Health Disparities

111   The program supports efforts to improve the health of populations disproportionately

112   affected by HIV/AIDS, viral hepatitis, STDs, TB, and related diseases and conditions,

113   and to help eliminate health disparities. Disparities in HIV/AIDS, viral hepatitis, STDs,

114   and TB disproportionately affect racial/ethnic, gender minorities and other vulnerable

115   populations. Health disparities in HIV/AIDS, viral hepatitis, STDs, and TB are

116   inextricably linked to a complex blend of social and economic determinants, which

117   determine populations most severely impacted by these diseases.



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118

119   This announcement is only for non-research activities supported by CDC. If research is

120   proposed, the application will not be reviewed. For the definition of research, please see

121   the CDC Web site at the following Internet address:

122   http://www.cdc.gov/od/science/regs/hrpp/researchDefinition.htm

123

124   II. PROGRAM IMPLEMENTATION

125   Recipient (Grantee) Activities:
126
127   General:
128
129   1. Utilize the principles of effective program collaboration and service integration as

130      outlined in the NCHHSTP White Paper when developing a syndemic approach to

131      prevention (please see CDC Website at the following internet address:

132      http://www.cdc.gov/nchhstp/programintegration).

133   2. Maximize the likelihood that successful integrated models will be sustainable (for

134      example by adapting and making minor modifications to existing programs).

135   3. Ensure that all required activities are performed, all deadlines are met, and quality

136      assurance plans, policies, and procedures are upheld.

137   4. Participate in grantee meetings, conference calls, and required conferences.

138   5. Collaborate closely with CDC on the implementation of required activities.

139

140   Program Collaboration: Program collaboration is a mutually beneficial and well-

141   defined relationship entered into by two or more programs, organization, or




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142   organizational units to achieve common goals. Recipient activities for collaboration are

143   as follows:

144   1. Identify a senior organizational leader to be a PCSI champion that will provide

145      leadership support and implementation oversight.

146   2. Identify or hire a PCSI coordinator with prevention program experience, technical

147      expertise, and coordination/facilitation skills. The management and coordination of

148      PCSI activities should account for 100% of effort for the individual identified, and

149      examples of activities may include but are not limited to:

150          (a) Improving communication and coordinate work between:

151                       CDC and locally funded HIV, viral hepatitis, STD and TB prevention,

152                        treatment and care programs, including surveillance and epidemiology,

153                        laboratory, immunization, and other relevant units.

154                       Grantees of other local, tribal, and federal agencies concerned with the

155                        prevention, treatment, and care of HIV, viral hepatitis, STD, and TB

156                        infections, to promote priority clinical preventive services and to target

157                        the social determinants of health including but not limited to substance

158                        abuse, incarceration, poverty, and homelessness.

159          (b) Identifying opportunities for impactful collaboration; maximize opportunities

160                 to screen, test, treat or vaccinate high risk individuals in need of these

161                 services; promote greater health equity and address social determinants of

162                 health; and implement high priority integrated services targeted to those at

163                 greatest need.




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164   3. Identify or hire a data analyst with experience in data collection and reporting in

165      public health programs. Data management for PCSI activities should account for at

166      least 50% of effort for the individual identified and examples of activities may

167      include but are not limited to:

168                     Coordinating and collecting data from integrated settings.

169                     Ensuring data quality and adherence to confidentiality standards.

170                     Reporting data on interim and annual progress reports.

171                     Assisting with evaluation activities.

172   4. Create a PCSI steering committee consisting of key staff across HIV/AIDS, viral

173      hepatitis, STD, and TB programs, and other relevant units such as surveillance and

174      epidemiology, laboratory, and immunization. This committee will be responsible for

175      working across the organization to raise awareness about PCSI, review

176      epidemiological and co-morbidity data, identify PCSI opportunities and barriers to

177      PCSI implementation, obtain input from stakeholders, and articulate priorities for

178      implementation.

179   5. Conduct a PCSI assessment that includes but is not limited to:

180          (a) Assessing local disease epidemiology to determine where there are missed

181              opportunities for preventive services and which populations and settings are

182              likely to benefit most from a syndemic approach to prevention through PCSI.

183          (b) Determining gaps in data to describe syndemics and the feasibility in

184              collecting such data.

185          (c) Assessing existing laws, policies, and procedures to determine barriers to

186              implementing service integration. These include but are not limited to:




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187                          Confidentiality standards for surveillance and program data.

188                          Informed consent laws for HIV testing.

189                          Data collection, sharing agreements, reporting, and data systems.

190                          Laboratory policies and procedures

191                          Local funding opportunities (grants, contracts, etc.)

192            (d) Assessing current practices and the operational barriers for integrated service

193                delivery locally, such as the need for testing supplies and training.

194   6. Develop and implement a locally relevant PCSI plan that includes but is not limited

195      to:

196            (a) A description of how HIV/AIDS, viral hepatitis, STD’s and TB are

197                synergistically interacting epidemics locally.

198            (b) Findings from the PCSI assessment.

199            (c) PCSI goals and objectives for the jurisdiction.

200            (d) PCSI priorities for the jurisdiction.

201            (e) PCSI evaluation plan

202   Service Integration: Service integration is a distinct method of service delivery that

203   provides persons with seamless services from multiple programs or areas within

204   programs without repeated registration procedures, waiting period or other administrative

205   barriers. Recipient activities for service integration are as follows:

206   1. Utilizing local epidemiology, the PCSI plan, and recommendations from the PCSI

207      steering committee, select populations at risk for multiple disease and appropriate

208      settings to implement service integration. Settings should be selected to ensure that

209      service integration takes place for HIV, viral hepatitis, STDs (syphilis, gonorrhea,



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210      and/or chlamydia), and TB in areas with the highest burden of disease in the

211      jurisdiction. Each setting should at a minimum target two of the mentioned diseases.

212   2. If settings cannot be identified due to barriers, focus on addressing these barriers prior

213      to implementing service integration.

214   3. Conduct the necessary planning to ensure that the setting identified can deliver and

215      report on integrated services.

216   4. Implement the appropriate service integration activities to populations at risk for

217      multiple diseases in the selected settings by working closely with the appropriate staff

218      in HIV, viral hepatitis, STD and TB to design, develop, and implement integrated

219      services. Examples of integrated services may include, but are not limited to:

220          (a) When implementing HIV screening programs among MSM, integrate

221               voluntary testing for syphilis.

222          (b) When implementing HIV screening programs targeting persons who use

223               drugs, integrate voluntary testing for hepatitis C.

224          (c) Ensuring HIV positive individuals in public medical care settings receive

225               syphilis, gonorrhea, chlamydia, hepatitis C, TB screening and hepatitis A

226               and/or B vaccination, in accordance with current CDC guidelines and

227               recommendations.

228          (d) Ensuring HAV/HBV vaccine and Hepatitis C screening to appropriate

229               populations seeking care for STDs within public clinics.

230          (e) Ensuring that routine HIV testing is done in public TB clinics.

231   5. Ensure that clients receive their test results, especially those who test positive.




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232   6. Ensure that clients who test positive are linked to medical care and receive timely and

233      appropriate evaluation and treatment.

234   7. Ensure that all available mechanisms to obtain reimbursement for HIV, viral

235      hepatitis, STDs, and TB screening are utilized.

236   8. Ensure that every effort to utilize existing programs resources are considered prior to

237      using PCSI FOA funds for service delivery.

238   Evaluation

239   1. Develop a PCSI evaluation plan based on the activities described in the PCSI plan

240      that may include but is not limited to: evaluation questions, evaluation framework,

241      process measures, and local indicators

242   2. Report on requested PCSI outcome monitoring data. Templates and guidance on

243      outcome monitoring data will be provided to funded jurisdictions. Examples of data

244      to be collected may include but are not limited to:

245          (a) Reporting on baseline data prior to service integration activities.

246          (b) Based on the integrated settings selected, the number of tests done for HIV,

247               hepatitis C, gonorrhea, syphilis, chlamydia and/or TB.

248          (c) The yield of screening tests. This includes the number of newly identified cases

249               of HIV/AIDS, hepatitis B or C, gonorrhea, syphilis, chlamydia, or TB and sero-

250               positivity rate resulting from an added screening to a categorical setting.

251          (d) Co-infections found from added screening to a categorical setting.

252          (e) Number of HAV/HBV vaccine administered to at risk adults.

253




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254   In a cooperative agreement, CDC staff are substantially involved in the program

255   activities, above and beyond routine grant monitoring.

256   CDC Activities:

257   1. Collaborate with grantees and provide technical assistance in the development of all

258      plans, policies, procedures, and instruments related to this program.

259   2. Work with grantees to assess and broker training and technical assistance needs.

260   3. Provide technical assistance and consultation on program and administrative issues

261      directly or through partnerships with health departments; capacity building assistance

262      providers; contractors; and other national, regional, and local partners to increase

263      applicant capacity to implement programs funded under this FOA.

264   4. Facilitate peer-to-peer exchange of information and experiences (for example, best

265      practices, lessons learned) through the following activities: meetings, workshops,

266      conferences, newsletter development, the internet, and other avenues of

267      communication.

268   5. Provide guidance and technical assistance on collecting and reporting on PCSI

269      outcome monitoring data.

270   6. Conduct monitoring of the following:

271          (a) Grantees’ implementation of their programs through direct observation during

272               site visits, review of progress reports and budget materials, and phone and e-

273               mail communication.

274          (b) Grantees’ compliance with applicant requirements, including financial

275               management practices and client/data confidentiality requirements.

276          (c) Grantees’ progress toward meeting program objectives.




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277   7. Convene grantee meetings during the course of the project.

278

279   III. AWARD INFORMATION AND REQUIREMENTS

280   Type of Award: Cooperative Agreement. CDC substantial involvement in this program

281   appears in the Activities Section above.

282   Award Mechanism: U38

283   Fiscal Year Funds: 2010

284   Approximate Current Fiscal Year Funding: $ 1,800,000

285   Approximate Total Project Period Funding: $ 5,400,000 (This amount is an estimate,

286   and is subject to availability of funds.) This includes direct and indirect costs.

287   Approximate Number of Awards: 6

288   Approximate Average Award: $ 350,000 (This amount is for the first 12-month budget

289   period, and includes both direct and indirect costs.)

290   Floor of Individual Award Range: $300,000

291   Ceiling of Individual Award Range: $400,000 (This ceiling is for the first 12-month

292   budget period.) This includes direct and indirect costs.

293   Anticipated Award Date: September 30, 2010

294   Budget Period Length: 12 months

295   Project Period Length: 3 years

296   Throughout the project period, CDC’s commitment to continuation of awards will be

297   conditioned on the availability of funds, evidence of satisfactory progress by the recipient

298   (as documented in required reports), and the determination that continued funding is in

299   the best interest of the Federal government.




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300   IV. ELIGIBILITY

301   Eligible applicants that can apply for this funding opportunity are listed below:

302               State and local governments or their Bona Fide Agents

303   A Bona Fide Agent is an agency/organization identified by the state as eligible to submit

304   an application under the state eligibility in lieu of a state application. If applying as a

305   bona fide agent of a state or local government, a letter from the state or local government

306   as documentation of the status is required. Attach with “Other Attachment Forms” when

307   submitting via www.grants.gov.

308   Eligible Jurisdictions

309   Eligibility is limited to health departments or their bona fide agents in jurisdictions with

310   at least 630 AIDS cases, 225 TB cases, 900 syphilis cases, 6,760 gonorrhea cases, and/or

311   82 HBV cases. Applications may be submitted by health departments of states or CDC

312   directly funded cities that meet the criterion above. (2007 Surveillance Data)

313

314   This FOA is limited to jurisdictions with at least 630 AIDS cases, 225 TB cases, 900

315   syphilis cases, 6,760 gonorrhea cases, and/or 82 HBV cases, because this will allow it to

316   reach those areas with the greatest need for a syndemic approach to prevention to

317   populations with multiple related risk that are disproportionately affected by multiple

318   infections. The jurisdictions that meet this criterion account for 80% of the disease

319   burden for AIDS, TB, Viral Hepatitis B, Syphilis, and Gonorrhea in the United States in

320   2007.

321   Eligibility is limited to these applicants because this program was conceptualized and

322   designed specifically for implementation by health departments whose populations



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323   represent high burden of disease across multiple diseases. Health departments have the

324   necessary infrastructure in place and the legal authority to perform the required activities

325   outlined in this funding announcement such as changing and implementing health

326   policies, procedures, and systems impacting program collaboration and service

327   integration (PCSI). These jurisdictions have been historically funded to provide

328   categorical prevention programs for HIV, STD, viral hepatitis, and TB prevention

329   services and thus have developed a robust infrastructure (e.g. organization structure,

330   financial management systems, staff capacity, procurement and grant systems, etc.)

331   capable of supporting this cross-cutting initiative. In addition, laws and regulations have

332   been put into place to enable health departments to perform certain activities to the

333   exclusion of other entities in the interest of protecting the public and the public’s health.

334   A final reason is that limited and dwindling resources for core program activities make

335   integration of prevention activities and efficiency in service delivery in these high burden

336   jurisdictions critically important.

337

338   SPECIAL ELIGIBILITY CRITERIA: Licensing/Credential/Permits

339   Cost Sharing or Matching

340   Cost sharing or matching funds are not required for this program.

341

342   Maintenance of Effort

343   Maintenance of Effort is not required for this program.

344   Other




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345   If a funding amount greater than the ceiling of the award range is requested, the

346   application will be considered non-responsive and will not be entered into the review

347   process. The applicant will be notified that the application did not meet the eligibility

348   requirements.

349

350   Special Requirements:

351   Note: Title 2 of the United States Code Section 1611 states that an organization described

352   in Section 501(c)(4) of the Internal Revenue Code that engages in lobbying activities is

353   not eligible to receive Federal funds constituting a grant, loan, or an award.

354

355   Intergovernmental Review of Applications

356   The application is subject to Intergovernmental Review of Federal Programs, as governed

357   by Executive Order (EO) 12372. This order sets up a system for state and local

358   governmental review of proposed federal assistance applications. Contact the state single

359   point of contact (SPOC) as early as possible to alert the SPOC to prospective applications

360   and to receive instructions on the State’s process. Visit the following Web address to get

361   the current SPOC list: http://www.whitehouse.gov/omb/grants/spoc.html.

362

363   V. Application Content

364   Unless specifically indicated, this announcement requires submission of the following

365   information:

366   Project Abstract




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367   A project abstract must be completed in the Grants.gov application forms. The Project

368   Abstract must contain a summary of the proposed activity suitable for dissemination to

369   the public. It should be a self-contained description of the project and should contain a

370   statement of objectives and methods to be employed. It should be informative to other

371   persons working in the same or related fields and insofar as possible understandable to a

372   technically literate lay reader. This abstract must not include any proprietary/confidential

373   information.

374

375   Table of Contents

376   A table of contents listing all application sections and appendices must be included with

377   the application. The table of contents will not count toward the 30-page limit of the

378   project narrative.

379

380   Project Narrative

381   A project narrative must be submitted with the application forms. The project narrative

382   must be uploaded in a PDF file format when submitting via Grants.gov. The narrative

383   must be submitted in the following format:

384         Maximum number of pages: 30. If the narrative exceeds the page limit, only the

385          first pages which are within the page limit will be reviewed.

386         Font size: 12 point unreduced, Times New Roman

387         Double spaced

388         Paper size: 8.5 by 11 inches

389         Page margin size: One inch



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390         Number all narrative pages; not to exceed the maximum number of pages.

391   The narrative should address activities to be conducted over the entire project period and

392   must include the following items in the order listed. The budget and budget justification

393   will be included as a separate attachment, not to be counted in the narrative page limit.

394   Responses to the items in the subsections below are critical to determining the applicant’s

395   qualification for this funding opportunity. Note: If the applicant fails to provide any

396   documents required in these subsections, the applicant’s score may be impacted.

397

398   1. Organizational Capacity and Past Experience- (Maximum length: seven pages or

399      less)

400          (a) Provide the name and title of the PCSI champion for the jurisdiction. Where in

401               the organization does this person sit? What are the roles and responsibilities of

402               this individual within the organization? How does this individual relate to the

403               program areas of HIV, viral hepatitis, STD and TB?

404          (b) Describe how the applicant will identify or hire a PCSI coordinator and the

405               relevant reporting relationships, authorities, and organizational location for

406               this position.

407          (c) Describe how the applicant will identify or hire a data analyst and the relevant

408               reporting relationships, authorities, and organizational location for this

409               position.

410          (d) Describe the current level of collaboration between HIV, viral hepatitis, STD,

411               and TB programs.




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412         (e) Describe the applicant’s current collaboration and coordination of services

413              with grantees of federal partners targeting HIV, viral hepatitis, STD, and TB

414              programs and its impact.

415         (f) Describe any prior efforts to offer integrated services in the jurisdiction

416              related to HIV, viral hepatitis, STD, and TB and the positive yield or

417              unintended effects resulting from these efforts. Please specify the target

418              populations and settings.

419         (g) Describe any known barriers related to laws, policies, or procedures for

420              integrating services in the jurisdiction, and any plans for addressing these

421              barriers.

422   2. Epidemiological Data – (Maximum length: three pages or less)

423         (a) Describe the applicant’s local epidemiology, and where available, describe

424              local syndemics in terms of disease and co-morbidities, populations,

425              behaviors, and service needs.

426   3. Program Collaboration– (Maximum length: five pages or less)

427         (a) Describe which staff will participate on the applicant’s PCSI steering

428              committee, and how the applicant will recruit, retain, and ensure the active

429              participation of staff.

430         (b) Describe how the PCSI steering committee will solicit stakeholder input.

431         (c) Describe how the applicant will conduct a PCSI assessment, particularly how

432              input will be obtained from HIV, viral hepatitis, STD, and TB programs and

433              other relevant units.




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434         (d) Describe how the applicant will develop a comprehensive PCSI plan that is

435              locally relevant and appropriate.

436   4. Service Integration– (Maximum length: Ten pages or less)

437         (a) Describe how the applicant will utilize local epidemiology, the PCSI plan, and

438              recommendations from the PCSI steering committee to select at risk

439              populations and appropriate settings for integrated services.

440         (b) Describe how the applicant will monitor settings offering integrated services.

441         (c) Describe how the applicant will ensure that clients receive their test results,

442              especially those who test positive.

443         (d) Describe how the applicant will ensure that applicable clients are linked to

444              medical care and receive timely and appropriate evaluation and treatment.

445         (e) Describe the type(s) of consent procedure(s) the applicant will use (for

446              example, opt-out, opt-in) for the settings where service integration will take

447              place.

448         (f) Describe how the applicant will ensure that all available mechanisms to obtain

449              reimbursement for HIV, viral hepatitis, syphilis, gonorrhea, and TB screening

450              are utilized.

451         (g) Describe how the applicant will align program resources to support the

452              delivery of integrated services.

453   5. Evaluation– (Maximum length: Four pages or less)

454         (a) Describe how the applicant will collect data on multiple tests provided to

455              individuals receiving integrated services.




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456          (b) Describe how the applicant will ensure data quality from settings offering

457               integrated services.

458          (c) Describe how the applicant will monitor yield to ensure that the appropriate

459               combinations of integrated services are provided to populations at risk for

460               multiple diseases.

461          (d) Describe the applicant’s process for developing a PCSI evaluation plan.

462   6. Training and Technical Assistance – (Maximum length: One page or less)

463          (a) Describe how applicable staff will be appropriately trained for their respective

464               job responsibilities under this program.

465          (b) Describe how the applicant will provide or coordinate technical assistance for

466               staff managing the FOA and at settings selected for service integration.

467   Budget and Justification

468   The budget justification will not be counted in the stated page limit. In accordance with

469   Form CDC 0.1246E (www.cdc.gov/od/pgo/forms/01246.pdf), applicants are required to

470   provide a line item budget and narrative justification for all requested costs that are

471   consistent with the purpose, objectives, and proposed program activities. The budget and

472   budget justification should be placed in the application’s attachments and named as

473   Appendix A: Budget and Budget Justification.

474   Within the budget, include the following:

475   1. A detailed, line-item budget and justification (also known as a “budget narrative”). A

476      line-item breakdown and justification for all personnel (that is, name, position title,

477      actual annual salary, percentage of time and effort, and amount requested). A line-

478      item breakdown and justification for service integration activities.




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479   2. A line-item breakdown and justification for all contracts, if applicable, including:

480    a. Name of contractor and/or consultants.

481    b. Applicant affiliation (if applicable).

482    c. Nature of services to be rendered.

483    d. Relevance of service to the project or justification for use of a consultant.

484    e. Period of performance (dates) or number of days of consultation (basis for fees).

485    f. Method of selection (for example, competitive or sole source).

486    g. Description of activities.

487    h. Target population.

488    i. Itemized budget and expected rate of compensation (for example, travel, per diem,

489          other related expenses); list a subtotal for each consultant in this category.

490      1) If the above information is unknown for any contractor/consultant at the time the

491           application is submitted, the information may be submitted at a later date as a

492           revision to the budget if the applicant is selected for funding.

493   Additional information may be included in the application appendices. The appendices

494   will not be counted toward the narrative page limit. This additional information includes:

495          Organizational Chart for each of the following programs: HIV, viral hepatitis,

496           STD, and TB.

497          Letter of Support for PCSI from the public health commissioner or senior health

498           officer.

499          Letter of Support from the Director of each of the following programs: HIV, viral

500           hepatitis, STD, and TB.




              22
501         Proof of Eligibility: Jurisdiction’s Surveillance Data demonstrating meeting any

502          of the eligibility data criteria: 630 AIDS cases, 225 TB cases, 900 syphilis cases,

503          6,760 gonorrhea cases, and/or 82 HBV cases (2007).

504   Additional information submitted via Grants.gov should be uploaded in a PDF file

505   format, and should be named:

506         Appendix B: Organizational Chart

507         Appendix C: Letter of Support: Administrator

508         Appendix D: Letter of Support: Program Directors

509         Appendix E: Proof of Eligibility

510   No more than 30 attachments should be uploaded per application.

511

512   Additional requirements for additional documentation with the application are listed in

513   Section VII. Award Administration Information subsection entitled “Administrative and

514   National Policy Requirements.”

515

516   APPLICATION SUBMISSION

517   Registering the applicant organization through www.Grants.gov, the official agency-wide

518   E-grant website, is the first step in submitting an application online. Registration

519   information is located on the “Get Registered” screen of www.Grants.gov. Please visit

520   www.Grants.gov at least 30 days prior to submitting an application to become familiar

521   with the registration and submission processes. The “one-time” registration process will

522   take three to five days to complete. However, the Grants.gov registration process also

523   requires that applicants register their organizations with the Central Contractor Registry



             23
524   (CCR) annually. The CCR registration can require an additional one to two days to

525   complete.

526

527   Submit the application electronically by using the forms and instructions posted for this

528   funding opportunity on www.Grants.gov. If access to the Internet is not available or if

529   the applicant encounters difficulty in accessing the forms on-line, contact the HHS/CDC

530   Procurement and Grant Office Technical Information Management Section (PGO-TIMS)

531   staff at (770) 488-2700 for further instruction.

532   Note: Application submission is not concluded until successful completion of the
533   validation process.
534
535   After submission of an application package, applicants will receive a “submission
536   receipt” email generated by Grants.gov. Grants.gov will then generate a second e-mail
537   message to applicants which will either validate or reject their submitted application
538   package. This validation process may take as long as two (2) business days. Applicants
539   are strongly encouraged check the status of their application to ensure submission of
540   their application package is complete and no submission errors exists. To guarantee
541   compliance with the application deadline published in the Funding Opportunity
542   Announcement, applicants are strongly encouraged to allocate additional days prior to
543   the published deadline to file their application. Non-validated applications will not be
544   accepted after the published application deadline date.
545
546   In the event that an applicant does not receive a “validation” email within two (2)
547   business days of application submission, the applicant should contact Grants.gov.
548   Refer to the email message generated at the time of application submission for
549   instructions on how to track the application or the Application User Guide, Version 3.0
550   page 57.
551

552   Organizations that encounter technical difficulties in using www.Grants.gov to submit
553   their application must attempt to overcome those difficulties by contacting the
554   Grants.gov Support Center (1-800-518-4726, support@grants.gov). After consulting
555   with the Grants.gov Support Center, if the technical difficulties remain unresolved and
556   electronic submission is not possible to meet the established deadline, organizations
557   may submit a request prior to the application deadline by email to the PGO TIMS for
558   permission to submit a paper application. An organization's request for permission
559   must: (a) include the Grants.gov case number assigned to the inquiry, (b) describe the
560   difficulties that prevent electronic submission and the efforts taken with the Grants.gov



             24
561   Support Center (c) be submitted to PGO TIMSs at least 3 calendar days prior to the
562   application deadline. Paper applications submitted without prior approval will not be
563   considered.
564
565   If a paper application is authorized, the applicant will receive instructions from TIMS
566   to submit the original and two hard copies of the application by mail or express
567   delivery service.
568

569   Other Submission Requirements

570   Letter of Intent (LOI):

571   A letter of intent is not applicable to this funding opportunity announcement.

572

573   Dun and Bradstreet Universal Number (DUNS)

574   The applicant is required to have a Dun and Bradstreet Data Universal Numbering

575   System (DUNS) identifier to apply for grants or cooperative agreements from the Federal

576   government. The DUNS is a nine-digit number which uniquely identifies business

577   entities. There is no charge associated with obtaining a DUNS number. Applicants may

578   obtain a DUNS number by accessing the Dun and Bradstreet website or by calling 1-866-

579   705-5711.

580

581   Electronic Submission of Application:

582   Applications must be submitted electronically at www.Grants.gov. Electronic applications

583   will be considered as having met the deadline if the application has been successfully

584   submitted electronically by the applicant organization’s Authorized Organizational

585   representative (AOR) to Grants.gov on or before the deadline date and time.

586




             25
587   The application package can be downloaded from www.Grants.gov. Applicants can

588   complete the application package off-line, and then upload and submit the application via

589   the Grants.gov Web site. The applicant must submit all application attachments using a

590   PDF file format when submitting via Grants.gov. Directions for creating PDF files can

591   be found on the Grants.gov Web site. Use of file formats other than PDF may result in

592   the file being unreadable by staff.

593

594   Applications submitted through Grants.gov (http://www.grants.gov), are electronically

595   time/date stamped and assigned a tracking number. The AOR will receive an e-mail

596   notice of receipt when HHS/CDC receives the application. The tracking number serves as

597   a receipt of submission.

598

599   If the applicant encounters technical difficulties with Grants.gov, the applicant should

600   contact Grants.gov Customer Service. The Grants.gov Contact Center is available 24

601   hours a day, 7 days a week. The Contact Center provides customer service to the

602   applicant community. The extended hours will provide applicants support around the

603   clock, ensuring the best possible customer service is received any time it’s needed. The

604   Grants.gov Support Center can be reached at 1-800-518-4726 or by email at

605   support@grants.gov. Submissions sent by e-mail, fax, CD’s or thumb drives of

606   applications will not be accepted.




             26
607

608   Submission Dates and Times

609   This announcement is the definitive guide on LOI and application content, submission,

610   and deadline. It supersedes information provided in the application instructions. If the

611   application submission does not meet the deadline published herein, it will not be eligible

612   for review and the applicant will be notified the application did not meet the submission

613   requirements. The application face page will be returned by HHS/CDC with a written

614   explanation of the reason for non-acceptance.

615
616   Application Submission Date: June 15, 2010, 11:59 p.m. Eastern Standard Time.

617   Organizations that encounter technical difficulties in using www.Grants.gov to submit
618   their application must attempt to overcome those difficulties by contacting the
619   Grants.gov Support Center (1-800-518-4726, support@grants.gov). After consulting
620   with the Grants.gov Support Center, if the technical difficulties remain unresolved and
621   electronic submission is not possible to meet the established deadline, organizations
622   may submit a request prior to the application deadline by email to the PGO TIMS for
623   permission to submit a paper application. An organization's request for permission
624   must: (a) include the Grants.gov case number assigned to the inquiry, (b) describe the
625   difficulties that prevent electronic submission and the efforts taken with the Grants.gov
626   Support Center (c) be submitted to PGO TIMSs at least 3 calendar days prior to the
627   application deadline. Paper applications submitted without prior approval will not be
628   considered.
629
630   If a paper application is authorized, the applicant will receive instructions from TIMS
631   to submit the original and two hard copies of the application by mail or express
632   delivery service.
633

634   VI. Application Review Information

635   Eligible applicants are required to provide measures of effectiveness that will

636   demonstrate the accomplishment of the various identified objectives of the Funding

637   Opportunity Announcement PS10-10175. Measures of effectiveness must relate to the

638   performance goals stated in the “Purpose” section of this announcement. Measures of


             27
639   effectiveness must be objective, quantitative and measure the intended outcome of the

640   proposed program. The measures of effectiveness must be included in the application

641   and will be an element of the evaluation of the submitted application.

642

643   Evaluation Criteria

644   Eligible applications will be evaluated against the following criteria:

645   1. Organizational Capacity and Past Experience- (Section Total: 20 points)

646          (a) The extent of the involvement and the level of authority for the PCSI

647               champion.

648          (b) The appropriateness of the roles and responsibilities of the PCSI coordinator.

649          (c) The appropriateness of the roles and responsibilities of the data analyst.

650          (d) Quality of the collaboration between HIV, viral hepatitis, STD, and TB

651               programs.

652          (e) The extent of the impact due to current collaboration and coordination of

653               services with grantees of federal partners targeting HIV, viral hepatitis, STD,

654               and TB programs.

655          (f) The extent of prior efforts to offer integrated services in the jurisdiction

656               related to HIV, viral hepatitis, STD, and TB and the positive yield or

657               unintended effects resulting from these efforts.

658          (g) The extent to which barriers are addressed, if identified.

659   2. Epidemiological Data – (Section Total: 10 points)

660          (a) The extent of local epidemiology and syndemic data provided.

661   3. Program Collaboration– (Section Total: 20 points)



             28
662          (a) Quality and appropriateness of the applicant’s proposal relating to the PCSI

663               steering committee.

664          (b) The extent to which the PCSI steering committee will solicit stakeholder

665               input.

666          (c) Quality and appropriateness of the applicant’s proposal describing the process

667               for conducting a PCSI assessment.

668          (d) Quality and appropriateness of the applicant’s proposal for developing a

669               comprehensive PCSI plan that is locally relevant and appropriate?

670   4. Service Integration– (Section Total: 20 points)

671          (a) Quality and appropriateness of how the applicant proposes to utilize local

672               epidemiology, the PCSI plan, and recommendations from the PCSI steering

673               committee to select at risk populations and appropriate settings for integrated

674               services.

675          (b) Quality and appropriateness of how the applicant proposes to monitor settings

676               offering integrated services.

677          (c) The extent of effort described to ensure clients receive their test results,

678               especially those who test positive.

679          (d) The extent of effort described to ensure clients are linked to medical care and

680               receive timely and appropriate evaluation and treatment.

681          (e) Extent to which opt-out testing will be utilized for the settings where service

682               integration will take place.




             29
683          (f) Quality and appropriateness of the applicant’s proposal to ensure that all

684               available mechanisms to obtain reimbursement for HIV, viral hepatitis,

685               syphilis, gonorrhea, and TB screening are utilized.

686          (g) Quality and appropriateness of the applicant’s proposal to align program

687               resources to support the delivery of integrated services.

688   5. Evaluation– (Section Total: 20 points)

689          (a) Quality and appropriateness of the applicant’s proposal to

690               collect data on multiple tests provided to individuals receiving integrated

691               services.

692          (b) Quality and appropriateness of the applicant’s proposal to ensure data quality

693               from settings offering integrated services.

694          (c) Quality and appropriateness of the applicant’s proposal to monitor yield to

695               ensure that the appropriate combinations of integrated services are provided to

696               populations at risk for multiple diseases.

697          (d) Extent to which applicant describes the process for developing a PCSI

698               evaluation plan.

699   6. Training and Technical Assistance (Section Total: 10 points)

700          (a) Extent to which staff will be appropriately trained for their respective job

701               responsibilities under this program.

702          (b) Quality and appropriateness of the applicant’s proposal to coordinate technical

703               assistance for staff managing the FOA and at settings selected for service

704               integration.

705   7. Budget (SF 424A) and Budget Narrative (Reviewed, but not scored)




             30
706      Although the budget is not scored applicants should consider the following in

707      development of their budget. Is the itemized budget for conducting the project, and

708      justification reasonable and consistent with stated objectives and planned program

709      activities?

710

711   If the applicants requests indirect costs in the budget, a copy of the indirect cost rate

712   agreement is required. If the indirect cost rate is a provisional rate, the agreement should

713   be less than 12 months of age. The indirect cost rate agreement should be uploaded as a

714   PDF file with “Other Attachment Forms” when submitting via Grants.gov.

715

716   Funding Restrictions

717   Restrictions, which must be taken into account while writing the budget, are as follows:

718         Recipients may not use funds for research.

719         Use all available mechanisms to obtain reimbursement for HIV, viral hepatitis,

720          syphilis, gonorrhea, and TB screening and ensure that every effort to utilize

721          existing programs resources are considered prior to using PCSI FOA funds for

722          service delivery.

723          Funding may not be utilized for hepatitis A or B vaccination or for

724          medications/treatment related to HIV/AIDS, gonorrhea, syphilis, or viral hepatitis.

725         Recipients may only expend funds for reasonable program purposes, including

726          personnel, travel, supplies, and services, such as contractual.




             31
727         Awardees may not generally use HHS/CDC/ATSDR funding for the purchase of

728          furniture or equipment. Any such proposed spending must be identified in the

729          budget.

730         The direct and primary recipient in a cooperative agreement program must

731          perform a substantial role in carrying out project objectives and not merely serve

732          as a conduit for an award to another party or provider who is ineligible.

733         Reimbursement of pre-award costs is not allowed.

734   The applicant can obtain guidance for completing a detailed justified budget on the CDC

735   website, at the following Internet address:

736   http://www.cdc.gov/od/pgo/funding/budgetguide.htm.

737

738   Application Review Process

739   All eligible applications will be initially reviewed for completeness by the Procurement

740   and Grants Office (PGO) staff. In addition, eligible applications will be jointly reviewed

741   for responsiveness by the National Center for HIV, Viral Hepatitis, STD, and TB

742   Prevention (NCHHSTP) and PGO. Incomplete applications and applications that are non-

743   responsive to the eligibility criteria will not advance through the review process.

744   Applicants will be notified the application did not meet eligibility and/or published

745   submission requirements.

746

747   An objective review panel will evaluate complete and responsive applications according

748   to the criteria listed in Section VI. Application Review Information, subsection entitled




             32
749   “Evaluation Criteria”. The objective review process will follow the policy requirements

750   as stated in the GPD 2.04 at http://198.102.218.46/doc/gpd204.doc.

751

752   Applications Selection Process

753   Applications will be funded in order by score and rank determined by the review panel.

754   In addition, the following factors may affect the funding decision: maintaining

755   geographic diversity.

756

757   CDC will provide justification for any decision to fund out of rank order.

758

759   VII. Award Administration Information

760   Award Notices

761   Successful applicants will receive a Notice of Award (NoA) from the CDC Procurement

762   and Grants Office. The NoA shall be the only binding, authorizing document between

763   the recipient and CDC. The NoA will be signed by an authorized Grants Management

764   Officer and e-mailed to the program director. A hard copy of the NoA will be mailed to

765   the recipient fiscal officer identified in the application.

766

767   Unsuccessful applicants will receive notification of the results of the application review

768   by mail.

769

770   Administrative and National Policy Requirements




              33
771   Successful applicants must comply with the administrative requirements outlined in 45

772   Code of Federal Regulations (CFR) Part 74 or Part 92, as appropriate. The following

773   additional requirements apply to this project:

774         AR-4            HIV/AIDS Confidentiality Provisions

775         AR-5            HIV Program Review Panel Requirements

776         AR-7            Executive Order 12372

777         AR-8            Public Health System Reporting Requirements

778         AR-9            Paperwork Reduction Act Requirements

779         AR-10           Smoke-Free Workplace Requirements

780         AR-11           Healthy People 2010

781         AR-12           Lobbying Restrictions

782         AR-14           Accounting System Requirements

783         AR-24           Health Insurance Portability and Accountability Act Requirements

784         AR-27           Conference Disclaimer and Use Of Logos

785

786   Additional information on the requirements can be found on the CDC Web site at the

787   following Internet address: http://www.cdc.gov/od/pgo/funding/Addtl_Reqmnts.htm.

788

789   For more information on the Code of Federal Regulations, see the National Archives and

790   Records Administration at the following Internet address:

791   http://www.access.gpo.gov/nara/cfr/cfr-table-search.html

792




             34
793   CDC Assurances and Certifications can be found on the CDC Web site at the following

794   Internet address: http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm

795

796   TERMS AND CONDITIONS

797   Reporting Requirements

798   Each funded applicant must provide CDC with an annual Interim Progress Report

799   submitted via www.grants.gov:

800      1. The interim progress report is due no less than 90 days before the end of the

801          budget period. The Interim Progress Report will serve as the non-competing

802          continuation application, and must contain the following elements:

803               a. Standard Form (“SF”) 424S Form.

804               b. SF-424A Budget Information-Non-Construction Programs.

805               c. Budget Narrative.

806               d. Indirect Cost Rate Agreement.

807               e. Project Narrative.

808   Additionally, funded applicants must provide CDC with an original, plus two hard copies

809   of the following reports:

810      2. Annual progress report, due 90 days after the end of the budget period.

811          Additional guidance on what to include in this report may be provided by CDC

812          well in advance of the due date.

813      3. Financial Status Report (SF 269) no more than 90 days after the end of the budget

814          period.




             35
815      4. Final performance and Financial Status Reports, no more than 90 days after the

816          end of the project period.

817   These reports must be submitted to the attention of the Grants Management Specialist

818   listed in the Section VIII below entitled “Agency Contacts.”

819

820   VIII. Agency Contacts

821   CDC encourages inquiries concerning this announcement.

822

823   For programmatic technical assistance, contact:

824          Susan Arrowsmith, Project Officer

825          Department of Health and Human Services

826          Centers for Disease Control and Prevention

827          1600 Clifton Road, MS E-27, Atlanta, GA 30333

828          Telephone: 404.639.8495

829          E-mail: sla2@cdc.gov

830   For financial, grants management, or budget assistance, contact:

831          Arthur C. Lusby, Grants Management Specialist

832          Department of Health and Human Services

833          CDC Procurement and Grants Office

834          2920 Brandywine Road, MS E-15

835          Atlanta, GA 30341

836          Telephone: 770.488.2865

837          E-mail: CMX3@cdc.gov



             36
838   For general questions, contact:

839          Technical Information Management Section

840          Department of Health and Human Services

841          CDC Procurement and Grants Office

842          2920 Brandywine Road, MS E-14

843          Atlanta, GA 30341

844          Telephone: 770-488-2700

845          Email: pgotim@cdc.gov

846   CDC Telecommunications for the hearing impaired or disabled is available at:

847   TTY 770-488-2783.

848

849   Other Information

850   Additional information about PCSI can be found at the following Internet address:

851   http://www.cdc.gov/nchhstp/programintegration/Default.htm.

852   A tele-briefing will be held May 17, 2003 at 3 p.m. to provide information on the funding

853   announcement and answer questions. More details about the call-in information will be

854   distributed widely.




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