Ryan White HIV/AIDS Part C Capacity Development Program (HRSA-15-024) ORC Reviewer Training May 18, 2015 Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau, Division of Community HIV/AIDS Programs Director: Polly E. Ross, M.D.

Funding Opportunity Announcement (FOA) HRSA-15-024 This FOA solicits applications from existing Part C grantees under the Ryan White HIV/AIDS Program (RWHAP) Part C Capacity Development Program Awards will support activities that address and impact gaps in the HIV Care Continuum which have been identified in the grantee’s service area.

Two Application Components: Capacity Development FOA (HRSA-15-024) Provides program specific instructions 2) SF 424 Application Guide (“Application Guide”) Provides general HRSA application instructions Links are found throughout the FOA Use the January 2015 version An explanatory video of the Application Guide can be found at http://www.hrsa.gov/grants/apply/applicationguide/

Part C Capacity Development: Purpose Capacity Development funds are to be used to assist current Part C grantees in their efforts to strengthen their organizational infrastructure and to increase their capacity to develop, enhance, or expand access to high quality HIV primary health care services for people living with HIV. Please refer to page 1 of the FOA

FY2014 Capacity Development Awards Applicants may propose one (1) activity to address the gaps and need for a comprehensive continuum of outpatient HIV primary care services for a one (1) year Project Period. Applicants may request funding amounts of up to $100,000 for the Project Period. Only specific short term activities will be funded under this grant. Please refer to pages 3-4 of the FOA

HIV Care Continuum                                                                                                                                                                                                                                                                                                                                         www.AIDS.gov 6

Addressing the HIV Care Continuum (CoC) Applicants must provide baseline data (calendar years 2013 and 2014) for each stage of the HIV CoC. The proposed activity must be linked directly to a specific stage with a target level of improvement. (Example: increasing viral load suppression from baseline 50% to 60%) The use of HHS core/HAB HIV indicators is strongly encouraged.

There are two funding categories There are two funding categories. Applicants can only apply under one category for one activity. 1) HIV Care Innovation Disease Case Finding Motivational Interviewing Patient-Based Treatment Adherence Patient Self-Managed Chronic Disease Management 2) Infrastructure Development Electronic Health Records Financial Management Systems Management Information Systems

Category 1: HIV Care Innovation

Disease Case Finding Train designated staff in disease case finding techniques through local health departments and/or CDC funded training centers and apply these skills in the clinical setting to link persons into care after HIV testing Recommended stages of the HIV CoC (choose one): (1) HIV Testing and Linkage to Care (2) Engagement and Retention in Care

Motivational Interviewing Train staff in Motivational Interviewing through the local AIDS Education  and Training Center (AETC) or other resources to engage patients in HIV care and work with both staff and patients on retention and apply the training in the clinical setting Recommended HIV CoC stages (choose one): (1) HIV Testing and Linkage to Care (2) Retention in care (3) Appropriate prescription of of Antiretroviral Therapy (ART)

Patient-Based Treatment Adherence Implement an innovative, patient-based treatment adherence program to provide long term adherence support for chronically non-adherent patients and apply the program Recommended HIV CoC stages (choose one): (1) Appropriate prescription of Antiretroviral Therapy (ART) (2) HIV viral load suppression

Patient Self-Managed Chronic Disease Management Institute a clinic-wide Chronic Disease Management Program for HIV/AIDS based on the Stanford program or other resources for patient self-management to engage patients in long term disease control and apply the program Recommended HIV CoC stages (choose one): Retention in Care (2) HIV viral load suppression 1

Category 2: Infrastructure Development

Electronic Health Records (EHR) Purchasing and implementing EHRs to improve the quality, safety, and efficiency of patient health care. Describe the plan to implement the EHR and the specific linkages to the HIV Care Continuum Recommended HIV CoC Stages (choose 1): (1) Linkage to HIV medical care, or (2) Retention in HIV medical care (3) Appropriate prescription of (ART) or (4) Achieving a high HIV viral load suppression rate

Financial Management Systems Purchasing and implementing a financial accounting system or software capable of managing multiple sources of funding for HIV primary care services, as well as actual expenses by grant line item and enhancing the billing process for third party reimbursement. Recommended HIV CoC Stages (choose 1): (1) Linkage to HIV medical care, (2) Retention in HIV medical care or (3) Achieving a high HIV viral load suppression rate.

Management Information Systems (MIS) Identifying/establishing/strengthening administrative, managerial, and MIS structures to offer, enhance, or expand comprehensive HIV primary healthcare especially in the context of the Affordable Care Act. Another activity can be the purchase of software to interface CAREWare with existing EHRs to improve data collection, reporting, quality improvement activities and/or improvement in the gaps in the HIV CoC. Recommended HIV CoC Stages (choose 1): (1) Linkage to HIV medical care, (2) Retention in HIV medical care, (3) Appropriate prescription of ART, or (4) Achieving a high HIV viral load suppression rate.

Application Structure FOA SECTIONS: Project Abstract Project Narrative Introduction Needs Assessment Methodology Work Plan Resolution of Challenges Evaluation and Technical Support Capacity Organizational Information Budget Budget Justification Narrative Attachments

HRSA-15-024 Review Criteria Criterion 1: Need 20 points Criterion 2: Response 25 points Criterion 3: Evaluative Measures 10 points Criterion 4: Impact 15 points Criterion 5: Resources/Capabilities Criterion 6: Support Requested TOTAL 100 points

Criterion1: NEED How well does the applicant describe the gaps in the local HIV Care Continuum, including the barriers to HIV care? How strong is the baseline data provided? Is it current (CY 2013/2014) and based upon clear and appropriate definitions that align with the HHS/HAB core HIV indicators? How well does the applicant describe the local HIV service delivery system and barriers? How strong is the applicant’s justification for the need for Capacity Development funding? (Corresponds to FOA subsections: Introduction and Needs Assessment )

Needs Assessment 3 required components: HIV Care Continuum Data – applicant’s own program data for each stage of the Care Continuum for calendar years 2013/2014 (must provide definitions for denominators/numerators) (2) Description of service area gaps (3) Barriers that impact access to care and the CoC

Sample Table for Baseline Data   2013 2014 HIV Care Continuum Stage Numerator/Denominator and (%) Numerator/Denominator and (%) Linkage to Care Retention in Care Number of PLWH prescribed ART Viral Load less than 200 cop/mL

Sample Table Including Specific Target Populations   2013 2014 HIV Care Continuum Stage Numerator/Denominator and (%) Linkage to Care (Total) Linkage to Care (MSM) Retention in Care (Total) Retention in Care (MSM) Number on ARVs (Total) Number on ARVs (MSM) Viral Load less than 200 cop/mL (Total) Viral Load less than 200 cop/mL (MSM) Cypriana: Applicants may propose interventions to address Care Continuum gaps for specific patient populations, such as MSM, African Americans, or women. In these situations, baseline data should be provided in the application for the grantee’s HIV program as a whole and for each target population. Applicants may provide community data for the specific stages, if available, as a comparison.

Sample HIV Service Delivery Table Organizations HIV CoC Stages (1000 PLWH in service area) # of HIV tests (# positive tests) # of PLWH enrolled in HIV care # or % prescribed Antiretroviral Therapy # or % w/ Viral Load Suppression Good Life ASO (MSMs, youth) (RW Parts A, B, D) 250 (5) 100 60 (60%) 50 (50%) FQHC Central (RW Parts A, C) 2,000 (5) 200 120 (60%) 90 (45%) Dr. Doolittle (women) (RW Part D) 100 (1) 80 (80%) General Hospital (RW Parts A, B, C) 500 (4) 500 350 (70%) 300 (60%)

Criterion 2: RESPONSE How well does the applicant describe the targeted HIV CoC stage to be addressed with the proposed activity and how well does it align with the gaps The completeness of the proposed sustainability plan described for the post-project period Assessment of the quality of the proposed interventions and the linkage to the specific stage(s) of the local HIV CoC? If a network model is proposed, how well will the funded activity be implemented and evaluated across the entire group of participating entities? (Corresponds to FOA subsections: Methodology/Workplan /Resolution of Challenges )

Methodology Propose methods that will be used to address the selected activity, collaboration and coordination efforts and strategies, and how the organization proposes to sustain the activity at the end of the project period. The selected activity must be under one of the two categories for funding under this FOA: 1. HIV Care Innovation, or 2. Infrastructure Development

Sample Work Plan Problem Statement: Only 65% of PLWH were on antiretroviral therapy with Viral Load suppression of 60% in 2013 was 60%. Goal: Improve % of PLWH on ART to viral load suppression rates to 65% and 75% in the calendar year 2014 and 2015 respectively. Objective Key Steps Completion Date Evaluation Method Performance Level Designated clinic staff to complete treatment adherence training RN, Pharmacists, MCMs will undergo adherence training. Month 6 Track # of persons who complete the adherence training quarterly 95% of designated staff will be trained by month 6 Revise the clinic schedule and room assignments Month 3 Track # of appointment slots for treatment adherence Track # of PLWH attending treatment adherence appointments. Increase # of treatment adherence slots by 50% Increase # of kept adherence appointments by 25% % on ART indicator HAB Viral Load suppression indicator Increase to 70% in 2014 Increase VL suppression to 65%; in 2014

Criterion 3: EVALUATIVE MEASURES Evaluation Quality Management Information Systems

Criterion 3: EVALUATIVE MEASURES How strong is the applicant’s ability to collect, verify, and report data information about changes in the local HIV Care Continuum in a timely manner? How well does the applicant fully describes the mechanisms used to monitor the impact of the proposed activity on the HIV Care Continuum How clear is the description of the CQM program and other resources that will be devoted to the evaluation component of the project including the performance measures, timeline and expected outcomes? (Corresponds to FOA subsections: Evaluation and Technical Support Capacity)

Evaluation and Technical Support Capacity The 2 required components are: Data Collection and Management Describe data collection system and infrastructure for monitoring the proposed activity and the impact of the activity on the stage of the HIV Care Continuum Project Evaluation Describe the CQM program and evaluation activities for the project Discuss the performance measures selected (HHS core/ HAB HIV indicators are recommended.)

Criterion 4: IMPACT How well does the applicant describe the maintenance of this project’s intervention at the conclusion of the grant? How well do the letters of commitment from each agency support the methodology narrative?

Criterion 4: IMPACT (cont.) How clear are the roles, responsibilities, and commitment of collaborating or partnering entities in the implementation of the proposed project? Assess the impact of the proposed Capacity Development activity on the gaps in the local HIV CoC if the project were successfully implemented. (Corresponds to FOA subsections: Methodology and Work Plan)

Criterion 5: Resources/ Capabilities Qualified Personnel Organizational Mission Fiscal & Management Information Systems . (Corresponds to FOA subsections: Evaluation and Technical Support Capacity and Organizational Information Systems)

Criterion 5: Resources & Capabilities How well does the applicant demonstrate that its personnel have the capacity, both by expertise and time/effort allocated to implement the proposed Capacity Development project? Analysis of the staffing plan should reflect appropriate Description of roles/ job titles Education, experience, and expertise Percentage of time spent Partnerships. Barbara: Under this criterion, reviewers should assess the degree to which applicants provided adequate descriptions that project personnel are qualified by training and/or experience to implement the Capacity Development project. Analysis of the staffing plan (which should include the full range of information requested, combining the elements of job descriptions and biographical sketches) should be useful for this review.

Sample Staffing Plan Name Education Title Capacity Dev. Role Experience Ms. Doe MPH Program Coordinator Oversight of grant award and project implementation 5 years as program coordinator, previously was Data/CQM Manager for same entity. Dr. A. Jones MD Medical Director Oversight of clinic staff , SOPs, & CQI projects 15 years providing HIV primary care Ms. Kona Assoc Degree CQM Coordinator, Retention Specialist DIS training, oversight of CQM activities 4 years working in HIV clinic scheduling appts, making referrals, medical data entry Mr. Lewis MSW Medical Case Mgr treatment adherence training 3 years providing HIV medical case management Ms. Johnson RN Contracted Registered Dietician DIS & treatment adherence training 20 years working as a HIV nurse and patient educator Barbara: This slide shows a sample Staffing Plan that should be reviewed under this criteria. It was provided to applicants as a preferred format. Note that the Staffing Plan should include Key Personnel that will oversee the HIV CoC project and staff to be involved w/ the Cap Dev activity.

Criterion 5: Resources & Capabilities How well does the applicant demonstrate the capacity to measure the impact of the proposed Capacity Development activity? How strong is the applicant’s description of consumer involvement in the implementation and evaluation of the proposed activity?

Criterion 6: Support Requested 4 Components Budget Information for Non-Construction Programs SF 424A Capacity Development -specific line item budget Budget justification narrative Staffing Plan

Criterion 6: Support Requested Are the costs, as outlined in the budget and required resources sections, reasonable given the scope of work? How well does the budget justification narrative fully and clearly describe all proposed allocations? How well have key personnel been budgeted for sufficient time devoted to the project to achieve project objectives? (Corresponds to FOA subsections: Budget and Budget Narrative)

Capacity Development Funds May Not Support: Funding Restrictions Capacity Development Funds May Not Support: ongoing service delivery, primary medical care, research or prevention the purchase of land, or construction/ renovation of any building or other facility to make payments for the provision of early intervention services or any such service to the extent that payment has been made or is expected to made by another source of funding. pre-award costs long-term activities

Funding Preference Applicants may request a funding preference if the capacity development activity will be implemented in either or both of the following areas: Rural communities Underserved communities with respect to HIV related health services. The Funding Preference request should be Attachment 6. More information may be found in the FOA page 19.

HIV Care Continuum                                                                                                                                                                                                                                                                                                                                         www.AIDS.gov

Key Summary Analysis Questions for HRSA-15-024 How strongly is the applicant’s justification for Capacity Development funding supported by the baseline data, proposed interventions, and appropriate performance measures? How well does the applicant’s proposal demonstrate the capacity to implement and evaluate the project within the 12 month project period? How well does the application demonstrate the likelihood of improving the local HIV Care Continuum during the funded period and afterwards?

On behalf of the HIV/AIDS Bureau: Thank you for the time and efforts extended for this important work for care of those living with HIV/AIDS!

Your questions are welcome! Thank You! Program Contact Grants Contact Dr. Marinna Banks-Shields Mr. Potie Pettway mbanks-shields@hrsa.gov ppettway@hrsa.gov 301-443-0938 301-443-1014 HAB TARGET Website http://careacttarget.org