[Federal Register: July 2, 2004 (Volume 69, Number 127)]
[Notices]
[Page 40377-40381]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02jy04-58]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Provision of Routine HIV Testing, Counseling, Basic Care and
Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda
Announcement Type: New.
Funding Opportunity Number: 04227.
Catalog of Federal Domestic Assistance Number: 93.941.
DATES: Application Deadline: August 2, 2004.
I. Funding Opportunity Description
Authority: This program is authorized under Sections 301 and 307 of
the Public Health Service Act, [42 U.S.C. 241 and 242l], as amended,
and section 104 of the Foreign Assistance Act of 1961, [22 U.S.C.
2151b].
Purpose: The Centers for Disease Control and Prevention (CDC)
announces the availability of fiscal year (FY) 2004 funds for a
cooperative agreement program for Provision of Routine HIV Testing,
Counseling, Basic Care and Antiretroviral Therapy (ART) in Teaching
Hospitals in the Republic of Uganda.
The overall aim of this program is to develop national models of
routine HIV testing in clinical settings, which also provide for the
full continuum of post-test counseling and care, including ART.
The United States Government seeks to reduce the impact of HIV/AIDS
in specific countries within sub-Saharan Africa, Asia and the Americas.
The President's Emergency Plan for AIDS Relief (PEPFAR) encompasses
HIV/AIDS activities in more than 75 countries, and focuses on 14
countries, including Uganda, to develop comprehensive and integrated
prevention, care, and treatment programs. CDC has initiated its Global
AIDS Program (GAP) to strengthen capacity and expand activities in the
areas of: (1) HIV primary prevention; (2) HIV care, support and
treatment; and (3) capacity and infrastructure development, including
surveillance. Targeted countries represent those with the most severe
epidemics and the highest number of new infections. They also represent
countries where the potential impact is greatest and where the United
States government agencies are already active. Uganda is one of those
countries.
CDC's mission in Uganda is to work with Ugandan and international
partners to develop, evaluate, and support effective implementation of
interventions to prevent HIV and related illnesses, and improve care
and support of persons with HIV/AIDS.
Mulago and Mbarara Hospitals are Uganda's only university teaching
hospitals. The majority of the nation's doctors and nurses are trained
within their facilities. The next tier of clinical provision is the
regional referral hospitals, which also have an in-service training and
supervisory function for the clinicians within their region. Voluntary
counseling and testing (VCT) services are only available at 11 percent
of health facilities (Uganda Health Facilities Survey 2002), and
currently there is no routine counseling and testing (RCT) within
hospitals. Where testing services are available in a hospital setting,
only selected patients (about 28 percent, according to a recent study)
are referred for testing, and pre- and post-test counseling support is
generally poor or absent. In the same study, 55 percent of those not
tested said they would have wanted to be tested. The most recent
Demographic and Health Survey in Uganda indicated that 70 percent of
people living in Uganda would like to receive HIV testing, but only ten
percent reported that they had ever been tested. An estimated 20-70
percent of patients in hospital wards, TB clinics, and sexually
transmitted infection (STI) clinics are HIV infected, but HIV testing
is not currently part of routine care. Improved basic preventative
care, as well as ART, is about to become more widely available in
Uganda as a result of various activities, including this one. ART will
be launched within the public hospital system at those facilities where
staffing, laboratory service, and the potential for training are
maximal.
The purpose of this program are: to provide assistance to Uganda's
two university teaching hospitals, Mulago and Mbarara Hospitals; to
establish and manage routine counseling and testing services for all
patients; to provide comprehensive clinical care for persons with HIV,
including staff; to incorporate cotrimoxazole prophylaxis, other basic
care interventions, and ART; and to deliver training to clinicians and
other staff in these activities.
In addition, the provision at their homes of HIV counseling and
testing to the household members of persons receiving ART, and
subsequent inclusion in the HIV care program as appropriate, would be
encouraged.
The measurable outcomes of the program will be in alignment with
goals of the GAP to reduce HIV transmission and improve care of persons
living with HIV. They also will contribute to the goals of the PEPFAR,
which are: Within five years treat more than two million HIV-infected
persons with effective combination ART; care for seven million HIV-
infected and affected persons, including those orphaned by HIV/AIDS;
and prevent ten million new infections. Some of the specific measurable
outputs from this program will be: The number of clients receiving
counseling and testing; the percentage of hospital patients receiving
counseling and testing; the number of clients receiving basic care
packages; the number of new clients served with ART, and those current
ART clients receiving continuous service for more than 12 months; and
the number of persons trained to provide all the forgoing services.
Activities
Awardee activities for this program are as follows:
a. Establish or expand a project office(s), as required by the
activities.
b. Identify project staffing needs; hire and train staff.
c. Identify furnishings, fittings, equipment, computers, and other
fixed assets procurement needs of the project and implementing
partners, and acquire from normal sources.
d. Establish suitable administrative and financial management
structures.
e. Work with Ministry of Health and other stakeholders to develop
RCT and care operational guidelines.
f. Support the teaching hospitals to implement RCT in all hospital
units, including the outpatient departments.
g. Train hospital staff, residents, and students in provision of
HIV/AIDS basic preventive care package and ART management, with the
expectation of having at least 1,000 patients receiving regular ART by
March 2005.
h. Support the partner hospitals to implement a basic preventive
care and ART program for patients and staff.
i. In collaboration with the Ministry of Health train appropriate
personnel in conducting the ART accreditation process for potential ART
centers.
j. Support the hospitals to develop a simple data collection
system, integrated with the general Health Management Information
System (HMIS), but collecting specific information related to this
program that is not routinely collected by the HMIS.
k. Ensure that the commodities supply and management system is
operational with respect to test kits, cotrimoxazole, anti-retrovirals
(ARVs), TB diagnostic materials and drugs, and other necessary
commodities. Use existing hospital and public sector
[[Page 40378]]
systems as far as possible and project emergency re-supply only as
necessary.
l. Develop a simple quality assurance system for RCT in clinical
settings.
m. Publish reports, guidelines and training manuals relating to RCT
testing in clinical settings.
n. Ensure that the above activities are undertaken in a manner
consistent with the national HIV/AIDS strategy, and ARV policy and
implementation guidelines.
In a cooperative agreement, CDC staff is substantially involved in
the program activities, above and beyond routine grant monitoring.
CDC Activities for this program are as follows:
a. Provide technical assistance, as needed, in the development of
training curricula, materials, and diagnostic therapeutic guidelines.
b. Collaborate with the recipient, as needed, in the development of
an information technology system for medical record keeping,
information access, and in the analysis of data derived from those
records.
c. Assist, as needed, in monitoring and evaluation of the program,
and in development of further appropriate initiatives.
d. Assist, as needed, in appropriate analysis and interpretation of
data collected during training sessions.
e. Provide input, as needed, into the criteria for selection of
staff and training candidates, and the regional hospital to be included
in the RCT program.
f. Provide input into the overall program strategy.
g. Collaborate, as needed, with the recipient in the selection of
key personnel to be involved in the activities to be performed under
this agreement, including approval of the overall manager of the
program.
Technical assistance and training may be provided directly by CDC
staff, or through organizations that have successfully competed for
funding under a separate CDC contract.
II. Award Information
Type of Award: Cooperative Agreement.
CDC involvement in this program is listed in the Activities Section
above.
Fiscal Year Funds: 2004.
Approximate Total Funding: $9,170,000.
(This amount is the approximate total funding amount for the entire
five-year project period.)
Approximate Number of Awards: One.
Approximate Average Award: $1,834,000.
(This amount is for the first 12-month budget period, and includes
direct costs.)
Floor of Award Range: None.
Ceiling of Award Range: $1,834,000.
Anticipated Award Date: September 1, 2004.
Budget Period Length: 12 months.
Project Period Length: Five years.
Throughout the project period, CDC's commitment to continuation of
awards will be conditioned on the availability of funds, evidence of
satisfactory progress by the recipient (as documented in required
reports), and the determination that continued funding is in the best
interest of the Federal Government.
III. Eligibility Information
Eligible Applicants
Applications may be submitted by public nonprofit organizations,
private nonprofit organizations, universities, colleges, research
institutions, hospitals, and faith-based organizations that meet the
following criteria:
1. Have at least two years of documented HIV/AIDS related clinical
training experience in Uganda.
2. Have existing activities with Mulago Hospital because it is
critical that this activity commences quickly and that the applicant is
not delayed by procedures required to obtain acceptance from the Mulago
Hospital authorities.
Note: Title 2 of the United States Code section 1611 states that
an organization described in section 501(c)(4) of the Internal
Revenue Code that engages in lobbying activities is not eligible to
receive Federal funds constituting an award, grant or loan.
III.2. Cost Sharing or Matching
Matching funds are not required for this program.
III.3. Other
If you request a funding amount greater than the ceiling of the
award range, your application will be considered non-responsive and
will not be entered into the review process. You will be notified that
your application did not meet the submission requirements.
If your application is incomplete or non-responsive to the
requirements listed below, it will not be entered into the review
process. You will be notified that your application did not meet the
submission requirements.
IV. Application and Submission Information
IV.1. Address to Request Application Package
To apply for this funding opportunity use application form CDC
5161. Application forms and instructions are available on the CDC Web
site, at the following Internet address: http://www.cdc.gov/od/pgo/forminfo.htm
.
If you do not have access to the Internet, or if you have
difficulty accessing the forms on-line, you may contact the CDC
Procurement and Grants Office Technical Information Management Section
(PGO-TIM) staff at: 770-488-2700. Application forms can be mailed to
you.
IV.2. Content and Form of Submission
Application: You must submit a project narrative with your
application forms. Your narrative must be submitted in the following
format:
Maximum number of pages: 25. If your narrative exceeds the
page limit, only the first pages which are within the page limit will
be reviewed.
Font size: 12 point unreduced.
Double spaced.
Paper size: 8.5 by 11 inches.
Page margin size: One inch.
Printed only on one side of page.
Held together only by rubber bands or metal clips; not
bound in any other way.
Must be submitted in English.
Your narrative should address activities to be conducted over the
entire project period, and should consist of, as a minimum, a plan;
objectives; activities; methods; an evaluation framework; a budget
highlighting any supplies mentioned in the Program Requirements, and
any proposed capital expenditure.
The budget justification will not be counted in the page limit
stated above. Guidance for completing your budget can be found on the
United States government Web site at the following address: http://www.cdc.gov/od/pgo/funding/budgetguide.htm
.
Additional information is optional and may be included in the
application appendices. The appendices will not be counted toward the
narrative page limit. This additional information could include but is
not limited to: organizational charts, curriculum vitae, letters of
support, etc.
You are required to have a Dun and Bradstreet Data Universal
Numbering System (DUNS) number to apply for a grant or cooperative
agreement from the Federal government. The DUNS number is a nine-digit
identification number, which uniquely identifies business
[[Page 40379]]
entities. Obtaining a DUNS number is easy and there is no charge. To
obtain a DUNS number, access http://www.dunandbradstreet.com or call 1-866-
705-5711.
For more information, see the CDC Web site at: http://www.cdc.gov/od/pgo/funding/pubcommt.htm.
If your application form does not have a
DUNS number field, please write your DUNS number at the top of the
first page of your application, and/or include your DUNS number in your
application cover letter.
Additional requirements that may require you to submit additional
documentation with your application are listed in section ``VI.2
Administrative and National Policy Requirements.''
IV.3. Submission Dates and Times
Application Deadline Date: August 2, 2004.
Explanation of Deadlines: Applications must be received in the CDC
Procurement and Grants Office by 4 p.m. Eastern Time on the deadline
date. If you send your application by the United States Postal Service
or commercial delivery service, you must ensure that the carrier will
be able to guarantee delivery of the application by the closing date
and time. If CDC receives your application after closing due to: (1)
Carrier error, when the carrier accepted the package with a guarantee
for delivery by the closing date and time, or (2) significant weather
delays or natural disasters, you will be given the opportunity to
submit documentation of the carriers guarantee. If the documentation
verifies a carrier problem, CDC will consider the application as having
been received by the deadline.
This announcement is the definitive guide on application submission
address and deadline. It supersedes information provided in the
application instructions. If your application does not meet the
deadline above, it will not be eligible for review, and will be
discarded. You will be notified that your application did not meet the
submission requirements.
CDC will not notify you upon receipt of your application. If you
have a question about the receipt of your application, first contact
your courier. If you still have a question, contact the PGO-TIM staff
at: 770-488-2700. Before calling, please wait two to three days after
the application deadline. This will allow time for applications to be
processed and logged.
IV.4. Intergovernmental Review of Applications:
Executive Order 12372 does not apply to this program.
IV.5. Funding Restrictions
Funds may be used for:
1. RCT at the facilities targeted by the project including required
training, test kit purchase, and staffing.
2. Covering the costs of and procuring elements of the basic
preventive care package, including but not necessarily limited to daily
cotrimoxazole prophylaxis, TB screening, diagnosis and treatment, as
well as possible INH prophylaxis, prevention with positives education,
household water treatment and bednets.
3. ART at the facilities targeted by the project, including
required ARV purchase, training, additional staffing, laboratory
rehabilitation and equipment, and office and information technology
equipment to facilitate enhancement of the hospitals' data management
systems to include ART and necessary program indicators.
4. Evaluation and management of the activities.
Restrictions, which must be taken into account while writing your
budget, are as follows:
Funds may not be used for any new construction.
Antiretroviral Drugs--The purchase of ARVs, reagents, and
laboratory equipment for antiretroviral treatment projects require pre-
approval from HHS/CDC officials.
Needle Exchange--No funds appropriated under this Act
shall be used to carry out any program of distributing sterile needles
or syringes for the hypodermic injection of any illegal drug.
Funds may be spent for reasonable program purposes,
including personnel, training, travel, supplies and services. Equipment
may be purchased and renovations completed if deemed necessary to
accomplish program objectives; however, prior approval by CDC officials
must be requested in writing.
All requests for funds contained in the budget shall be
stated in U.S. dollars. Once an award is made, CDC will not compensate
foreign grantees for currency exchange fluctuations through the
issuance of supplemental awards.
The costs that are generally allowable in grants to
domestic organizations are allowable to foreign institutions and
international organizations, with the following exception: With the
exception of the American University, Beirut, and the World Health
Organization, indirect costs will not be paid (either directly or
through sub-award) to organizations located outside the territorial
limits of the United States or to international organization regardless
of their location.
The applicant may contract with other organizations under
this program, however, the applicant must perform a substantial portion
of the activities, including program management and operations, and
delivery of prevention and care services for which funds are requested.
You must obtain an annual audit of these CDC funds
(program-specific audit) by a U.S.-based audit firm with international
branches and current licensure/authority in-country, and in accordance
with International Accounting Standards or equivalent standard(s)
approved in writing by CDC.
A fiscal Recipient Capability Assessment may be required,
prior to or post award, in order to review the applicant's business
management and fiscal capabilities regarding the handling of U.S.
Federal funds.
Prostitution and Related Activities
The U.S. Government is opposed to prostitution and related
activities, which are inherently harmful and dehumanizing, and
contribute to the phenomenon of trafficking in persons.
Any entity that receives, directly or indirectly, U.S. Government
funds in connection with this document (``recipient'') cannot use such
U.S. Government funds to promote or advocate the legalization or
practice of prostitution or sex trafficking. Nothing in the preceding
sentence shall be construed to preclude the provision to individuals of
palliative care, treatment, or post-exposure pharmaceutical
prophylaxis, and necessary pharmaceuticals and commodities, including
test kits, condoms, and, when proven effective, microbicides. A
recipient that is otherwise eligible to receive funds in connection
with this document to prevent, treat, or monitor HIV/AIDS shall not be
required to endorse or utilize a multisectoral approach to combating
HIV/AIDS, or to endorse, utilize, or participate in a prevention method
or treatment program to which the recipient has a religious or moral
objection. Any information provided by recipients about the use of
condoms as part of projects or activities that are funded in connection
with this document shall be medically accurate and shall include the
public health benefits and failure rates of such use.
In addition, any foreign recipient must have a policy explicitly
opposing, in its activities outside the United
[[Page 40380]]
States, prostitution and sex trafficking, except that this requirement
shall not apply to the Global Fund to Fight AIDS, Tuberculosis and
Malaria, the World Health Organization, the International AIDS Vaccine
Initiative or to any United Nations agency, if such entity is a
recipient of U.S. Government funds in connection with this document.
The following definitions apply for purposes of this clause:
Sex trafficking means the recruitment, harboring,
transportation, provision, or obtaining of a person for the purpose of
a commercial sex act. 22 U.S.C. 7102(9).
A foreign recipient includes an entity that is not
organized under the laws of any State of the United States, the
District of Columbia or the Commonwealth of Puerto Rico. Restoration of
the Mexico City Policy, 66 FR 17303 (March 28, 2001).
All recipients must insert provisions implementing the applicable
parts of this section, `Prostitution and Related Activities,' in all
subagreements under this award. These provisions must be express terms
and conditions of the subagreement, acknowledge that each certification
to compliance with this section, ``Prostitution and Related
Activities,'' are a prerequisite to receipt of U.S. Government funds in
connection with this document, and must acknowledge that any violation
of the provisions shall be grounds for unilateral termination of the
agreement prior to the end of its term. In addition, all recipients
must ensure, through contract, certification, audit, and/or any other
necessary means, all the applicable requirements in this section,
``Prostitution and Related Activities,'' are met by any other entities
receiving U.S. Government funds from the recipient in connection with
this document, including without limitation, the recipients' sub-
grantees, sub-contractors, parents, subsidiaries, and affiliates.
Recipients must agree that HHS may, at any reasonable time, inspect the
documents and materials maintained or prepared by the recipient in the
usual course of its operations that relate to the organization's
compliance with this section, ``Prostitution and Related Activities.''
All primary grantees receiving U.S. Government funds in connection
with this document must certify compliance prior to actual receipt of
such funds in a written statement referencing this document (e.g.,
``[Recipient's name] certifies compliance with the section,
`Prostitution and Related Activities.''') addressed to the agency's
grants officer. Such certifications are prerequisites to the payment of
any U.S. Government funds in connection with this document.
Recipients' compliance with this section, ``Prostitution and
Related Activities,'' is an express term and condition of receiving
U.S. government funds in connection with this document, and any
violation of it shall be grounds for unilateral termination by HHS of
the agreement with HHS in connection with this document prior to the
end of its term. The recipient shall refund to HHS the entire amount
furnished in connection with this document in the event it is
determined by HHS that the recipient has not complied with this
section, ``Prostitution and Related Activities.''
Awards will not allow reimbursement of pre-award costs. Guidance
for completing your budget can be found on the CDC Web site, at the
following Internet address: http://www.cdc.gov/od/pgo/funding/budgetguide.htm
.
IV.6. Other Submission Requirements
Application Submission Address: Submit the original and two hard
copies of your application by mail or express delivery service to:
Technical Information Management Section--PA 04227, CDC
Procurement and Grants Office, 2920 Brandywine Road, Atlanta, GA 30341.
Applications may not be submitted electronically at this time.
V. Application Review Information
V.1. Criteria
You are required to provide measures of effectiveness that will
demonstrate the accomplishment of the various identified objectives of
the cooperative agreement. Measures of effectiveness must relate to the
performance goals stated in the ``Purpose'' section of this
announcement. Measures must be objective and quantitative, and must
measure the intended outcome. These measures of effectiveness must be
submitted with the application and will be an element of evaluation.
Your application will be evaluated against the following criteria:
1. Understanding the issues, principles and systems requirements
involved in delivering RCT, basic preventive care, and ART in a
clinical context in Uganda (25 points)
Does the applicant demonstrate an understanding of the clinical,
social, managerial, ethical and other practical issues involved in
delivering RCT, basic preventive care, and ART effectively in the
setting of Mulago and Mbarara hospitals?
2. Ability to carry out the proposal (25 points)
Does the applicant demonstrate the capability to achieve the
purpose of this proposal?
3. Work Plan (20 points)
Does the applicant describe activities which are realistic,
achievable, time-framed and appropriate to complete this program?
4. Personnel (15 points)
Are the personnel, based on qualifications, training, availability,
and experience, adequate to carry out the proposed activities?
5. Administrative and Accounting Plan (15 points)
Is there a plan to account for, prepare reports on, monitor, and
audit expenditures under this agreement; manage the resources of the
program; and produce, collect, and analyze performance data?
6. Budget (not scored)
Is the budget itemized and well justified for conducting the
activities; and is it consistent with stated activities and planned
program activities?
V.2. Review and Selection Process
Applications will be reviewed for completeness by the Procurement
and Grants Office (PGO) staff, and for responsiveness by the National
Center for HIV, STD, and TB Prevention (NCHSTP)/GAP. Incomplete
applications and applications that are non-responsive to the
eligibility criteria will not advance through the review process.
Applicants will be notified that their application did not meet
submission requirements.
An objective review panel will evaluate complete and responsive
applications according to the criteria listed in the ``V.1. Criteria''
section above.
V.3. Anticipated Announcement and Award Dates
September 1, 2004.
VI. Award Administration Information
VI.1. Award Notices
Successful applicants will receive a Notice of Grant Award (NGA)
from the CDC Procurement and Grants Office. The NGA shall be the only
binding, authorizing document between the recipient and CDC. The NGA
will be signed by an authorized Grants Management Officer, and mailed
to the recipient fiscal officer identified in the application.
Unsuccessful applicants will receive notification of the results of
the application review by mail.
VI.2. Administrative and National Policy Requirements
45 CFR Part 74 and Part 92
[[Page 40381]]
For more information on the Code of Federal Regulations, see the
National Archives and Records Administration at the following Internet
address: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html. The
following additional requirements apply to this project:
AR-10 Smoke-Free Workplace Requirements Additional
information on these requirements can be found on the CDC Web site at
the following Internet address: http://www.cdc.gov/od/pgo/funding/ARs.htm
.
VI.3. Reporting Requirements
You must provide CDC with an original, plus two hard copies, of the
following reports:
1. Interim progress report, no less than 90 days before the end of
the budget period. The progress report will serve as your non-competing
continuation application, and must contain the following elements:
a. Current Budget Period Activities Objectives.
b. Current Budget Period Financial Progress.
c. New Budget Period Program Proposed Activity Objectives.
d. Detailed Line-Item Budget and Justification.
e. Additional Requested Information.
f. Measures of Effectiveness.
2. Financial status report, no more than 90 days after the end of
the budget period.
3. Final financial and performance reports, no more than 90 days
after the end of the project period.
4. Semi annual progress reports, 30 days after the end of the
project period.
These reports must be mailed to the Grants Management or Contract
Specialist listed in the ``Agency Contacts'' section of this
announcement.
VII. Agency Contacts
For general questions about this announcement, contact: Technical
Information Management Section, CDC Procurement and Grants Office, 2920
Brandywine Road, Atlanta, GA 30341, Telephone: 770-488-2700.
For program technical assistance, contact: Jonathan Mermin, MD,
MPH, Global Aids Program [GAP], Uganda Country Team, National Center
for HIV, STD and TB Prevention, Centers for Disease Control and
Prevention [CDC], PO Box 49, Entebbe, Uganda, Telephone: +256-41320776,
E-mail: jhm@cdc.gov.
For financial, grants management, or budget assistance, contact:
Shirley Wynn, Contract Specialist, CDC Procurement and Grants Office,
2920 Brandywine Road, Atlanta, GA 30341-4146, Telephone: 770-488-1515,
E-mail address: zbx6@cdc.gov.
Dated: June 28, 2004.
Alan Kotch,
Acting Director, Procurement and Grants Office, Centers for Disease
Control and Prevention.
[FR Doc. 04-15065 Filed 7-1-04; 8:45 am]
BILLING CODE 4163-18-P