Opportunity Information: Apply for CDC RFA GH15 1603
Apply for CDC RFA GH15 1603
- The Centers for Disease Control and Prevention in the health sector is offering a public funding opportunity titled "Strengthening Clinical and Laboratory Services at the National Referral Level to Improve HIV Prevention, Care, and Treatment in the Republic of Zambia under the Presidents Emergency Plan for AIDS Relief (PEPFAR)" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.067 Global AIDS.
- This funding opportunity was created on Dec 12, 2014 and posted on Dec 12, 2014.
- Applicants must submit their applications by Jan 23, 2015 Electronically submitted applications must be submitted no later than 1159 p.m., ET, on the listed application due date.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- The funding agency has allocated a total of $5,495,000.00 to eligible and selected applicants.
- Each selected applicant is eligible to receive up to $27,475,000.00 in funding.
- The number of recipients for this funding is limited to 1 candidate(s).
- Eligible applicants include: Others (see text field entitled Additional Information on Eligibility for clarification).
- The University Teaching Hospital (UTH)
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Opportunity Summary:
This PEPFAR-funded CDC cooperative agreement (Funding Opportunity Number CDC RFA GH15-1603) focused on strengthening HIV clinical and laboratory services at Zambia's national referral level, with the University Teaching Hospital (UTH) identified as the eligible applicant. The overall intent was to improve HIV prevention, care, and treatment outcomes by upgrading comprehensive case management for people living with HIV, tightening referral linkages between the national referral hospital and primary care facilities, and expanding the use of key laboratory monitoring tools such as viral load testing and HIV drug resistance testing. The award mechanism was a cooperative agreement, meaning CDC would anticipate substantial involvement in guiding and supporting implementation. The opportunity was posted December 12, 2014, with a closing date of January 23, 2015, and an estimated total funding level of about $5.495 million, with an award floor of $5.495 million and an award ceiling of $27.475 million, and a single expected award. No cost sharing or matching was required. The CFDA number associated with the program was 93.067 (Global AIDS).
On the clinical side, the project emphasized comprehensive management of HIV-infected persons at the referral level, including timely initiation of antiretroviral therapy (ART) for all patients who meet national eligibility criteria and stronger management of common co-infections and complications. Core activities included staging HIV disease and starting ART, routine screening and treatment for tuberculosis (TB), sexually transmitted infections (STIs), and opportunistic infections (OIs), and provision of key prophylaxis interventions in line with national guidelines. Specifically, the approach included TB syndromic screening for HIV patients with laboratory confirmation and TB treatment when indicated, provision of isoniazid prophylaxis to patients who screen negative for TB, and cotrimoxazole prophylaxis for eligible HIV-infected clients. The intent was to increase the number of both children and adults started on ART, increase overall ART initiation uptake, and ensure HIV-infected people are appropriately diagnosed and treated for TB, STIs, and OIs as part of routine HIV care. These actions were linked to broader goals of improved viral suppression and stronger retention on ART.
A major operational focus was strengthening referral and continuity-of-care systems between the national referral facility and named primary care sites. The opportunity called for more deliberate referral tracking, including providing quarterly lists of referred patients to receiving facilities and requesting feedback on referral outcomes and ongoing retention in treatment. This reflects a recognition that referral hospitals often see complex patients, but long-term success depends on reliable handoffs back to decentralized ART sites, follow-up on missed visits, and confirmation that patients remain engaged in care.
On the laboratory and treatment monitoring side, the project prioritized routine viral load (VL) testing as the standard method for monitoring ART effectiveness, alongside HIV drug resistance (DR) testing for patients suspected of treatment failure. Key activities included implementing VL testing for all individuals on ART at 6 months and 12 months after initiation and then annually, and using those VL results to guide regimen adjustments consistent with national guidance. For suspected treatment failure, the project required DR testing to inform the selection of appropriate subsequent antiretroviral regimens. Expected outputs included a higher proportion of ART patients with VL results available on schedule, more suspected treatment failure cases with DR results available, and more patients with suspected failure being placed on the most appropriate regimen based on DR findings. The intended effect was to increase the use of effective regimens that lead to viral suppression, which is central to both patient health and population-level HIV transmission reduction.
The project also incorporated supportive care components, notably nutritional counseling and management for people living with HIV and their families. The logic is that better nutrition supports immune function, treatment tolerance, and recovery from infections, and can reduce morbidity linked to nutritional deficiencies. As a result, the project anticipated increases in the number of HIV-infected persons receiving nutritional advice and management, and reductions in morbidity related to nutritional deficiencies over time.
Capacity building and clinical systems strengthening were also highlighted, with assistance to Zambia's Ministry of Health (MOH) to improve clinician skills and develop or refine guidelines for HIV care and treatment. Activities included mentorship of clinicians in other facilities by partner staff and the establishment of Advanced HIV Treatment Centers in additional provinces. These centers were meant to handle complicated HIV cases, such as patients failing second-line therapy who require DR testing to guide regimen selection, or patients with complex co-morbidities (for example advanced cardiac failure or end-stage renal disease). This element reinforces the national referral function by building a network of higher-level expertise and referral capacity beyond the main tertiary hospital, improving access to specialized management and reducing bottlenecks at the central facility.
In terms of outcomes, the opportunity laid out a progression from short-term outputs (within 1 to 2 years) such as increased ART initiation among adults and children, increased appropriate management of TB/STIs/OIs, improved referral feedback loops, and increased availability of VL and DR test results. Intermediate outcomes (3 to 4 years) and long-term outcomes (around 5 years) centered on sustained improvements in virological suppression, increased retention on ART, and stronger overall clinical management of HIV-infected persons, especially those with complicated disease or suspected treatment failure. Taken together, the grant framed national referral-level strengthening as a way to raise the quality of complex HIV care, improve monitoring and regimen optimization, and create more reliable linkages across levels of Zambia's health system to keep patients suppressed and retained in care.
Frequently Asked Questions (FAQs)
What is this funding opportunity?
This is a PEPFAR-funded CDC cooperative agreement (Funding Opportunity Number CDC RFA GH15-1603) focused on strengthening HIV clinical and laboratory services at Zambia's national referral level.
Who was eligible to apply?
The University Teaching Hospital (UTH) was identified as the eligible applicant.
What is the main purpose of the award?
The overall intent was to improve HIV prevention, care, and treatment outcomes by strengthening comprehensive case management for people living with HIV, improving referral linkages between the national referral hospital and primary care facilities, and expanding the use of key laboratory monitoring tools such as viral load testing and HIV drug resistance testing.
What type of funding mechanism was used?
The award mechanism was a cooperative agreement. This means CDC anticipated substantial involvement in guiding and supporting implementation.
What is the Funding Opportunity Number (FON)?
The Funding Opportunity Number was CDC RFA GH15-1603.
What program number (CFDA) is associated with this opportunity?
The CFDA number associated with the program was 93.067 (Global AIDS).
When was the opportunity posted and when did it close?
The opportunity was posted on December 12, 2014, and the closing date was January 23, 2015.
How much funding was expected under this opportunity?
The estimated total funding level was about $5.495 million.
What were the award floor and award ceiling?
The award floor was $5.495 million and the award ceiling was $27.475 million.
How many awards were expected?
A single award was expected.
Was cost sharing or matching required?
No cost sharing or matching was required.
What clinical improvements did the project emphasize at the national referral level?
The project emphasized comprehensive management of HIV-infected persons at the referral level, including timely initiation of antiretroviral therapy (ART) for all patients who meet national eligibility criteria and stronger management of common co-infections and complications.
What were the core clinical activities described in the opportunity?
Core activities included staging HIV disease and starting ART, routine screening and treatment for tuberculosis (TB), sexually transmitted infections (STIs), and opportunistic infections (OIs), and provision of key prophylaxis interventions in line with national guidelines.
How did the opportunity describe TB screening and prevention for people with HIV?
The approach included TB syndromic screening for HIV patients with laboratory confirmation and TB treatment when indicated, plus provision of isoniazid prophylaxis to patients who screen negative for TB.
Was cotrimoxazole prophylaxis included as part of routine HIV care?
Yes. Cotrimoxazole prophylaxis for eligible HIV-infected clients was specifically included.
What ART-related targets or intended effects were described?
The intent was to increase the number of both children and adults started on ART, increase overall ART initiation uptake, and link these improvements to stronger retention on ART and improved viral suppression.
How did the opportunity address management of co-infections and complications?
It called for routine screening and treatment for TB, STIs, and opportunistic infections as part of routine HIV care, alongside timely ART initiation and guideline-based prophylaxis interventions.
Why was referral strengthening a major operational focus?
The opportunity recognized that referral hospitals often see complex patients, but long-term outcomes depend on reliable handoffs back to decentralized ART sites, follow-up on missed visits, and confirmation that patients remain engaged in care.
What specific referral tracking activities were called for?
The opportunity called for deliberate referral tracking, including providing quarterly lists of referred patients to receiving facilities and requesting feedback on referral outcomes and ongoing retention in treatment.
What laboratory monitoring approach was prioritized for ART effectiveness?
Routine viral load (VL) testing was prioritized as the standard method for monitoring ART effectiveness.
What viral load testing schedule was described?
Viral load testing was to be implemented for all individuals on ART at 6 months and 12 months after initiation and then annually.
How were viral load results intended to be used?
Viral load results were intended to guide regimen adjustments consistent with national guidance.
When was HIV drug resistance (DR) testing expected to be used?
Drug resistance testing was required for patients suspected of treatment failure to inform selection of appropriate subsequent antiretroviral regimens.
What outputs were expected from the viral load and drug resistance testing components?
Expected outputs included a higher proportion of ART patients with VL results available on schedule, more suspected treatment failure cases with DR results available, and more patients with suspected failure placed on the most appropriate regimen based on DR findings.
What was the intended impact of expanding VL and DR testing?
The intended effect was increased use of effective regimens that lead to viral suppression, supporting both patient health and population-level HIV transmission reduction.
Did the project include supportive care beyond clinical and laboratory services?
Yes. The project incorporated supportive care components, notably nutritional counseling and management for people living with HIV and their families.
What changes were anticipated from the nutrition component?
The project anticipated increases in the number of HIV-infected persons receiving nutritional advice and management, and reductions in morbidity related to nutritional deficiencies over time.
How did the opportunity address capacity building and clinical systems strengthening?
It highlighted assistance to Zambia's Ministry of Health (MOH) to improve clinician skills and develop or refine guidelines for HIV care and treatment, including mentorship of clinicians in other facilities by partner staff.
What are Advanced HIV Treatment Centers in the context of this opportunity?
Advanced HIV Treatment Centers were described as additional provincial centers intended to handle complicated HIV cases, such as patients failing second-line therapy who require drug resistance testing, or patients with complex co-morbidities (for example advanced cardiac failure or end-stage renal disease).
How do Advanced HIV Treatment Centers relate to the national referral function?
This element was designed to build a network of higher-level expertise and referral capacity beyond the main tertiary hospital, improving access to specialized management and reducing bottlenecks at the central facility.
What short-term outputs were highlighted?
Within 1 to 2 years, the opportunity described outputs such as increased ART initiation among adults and children, increased appropriate management of TB/STIs/OIs, improved referral feedback loops, and increased availability of VL and DR test results.
What intermediate and long-term outcomes were anticipated?
Intermediate outcomes (3 to 4 years) and long-term outcomes (around 5 years) centered on sustained improvements in virological suppression, increased retention on ART, and stronger overall clinical management of HIV-infected persons, especially those with complicated disease or suspected treatment failure.
What is the overall theory of change behind strengthening national referral-level services?
The grant framed national referral-level strengthening as a way to raise the quality of complex HIV care, improve monitoring and regimen optimization, and create more reliable linkages across levels of Zambia's health system to keep patients suppressed and retained in care.
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