Q&A for Funding Announcement PS15-1506: Demonstration Projects to Reduce HIV Infections and Improve Engagement in HIV Medical Care among Men Who Have Sex with Men (MSM) and Transgender Persons

PS15-1506, “Health Department Demonstration Projects to Reduce HIV Infections and Improve Engagement in HIV Medical Care among Men Who Have Sex with Men (MSM) and Transgender Persons”

Question 1: New Jersey (Steve Saunders; NJ DOH): If there are counties under our state health department’s jurisdiction which are a part of another health department’s Metropolitan Division, are we eligible to work in those counties? Specifically, there are three counties in NJ that are part of NY MD. NJ should be eligible to apply for funds to work in the three counties that are included.

Answer: The only health departments that are eligible to apply for CDC-RFA-PS15-1506 funding are listed in the eligibility tables in the FOA. However, the eligible health department may work with other health departments (e.g., through MOUs, subcontracts, etc.) that are responsible for areas within the eligible MSA/MD in an attempt to provide services to a larger portion of the MSA/MD. In this case, it is NYCDHMH. NJ is encouraged to work directly with NYCDHMH to determine if an arrangement can be worked out that makes sense to cover the need in the relevant NJ counties.

Question 2: California Department of Health (Kama Brockmann): Please clarify the 25% requirement regarding budget.
Answer: Language on page 17 of the amended FOA states that when proposing activities under both Category 1 and Category 2, no less than 25% of the overall proposed budget should be allocated to either Category.

Question 3: Please list the changes included in the amended FOA.

1. Added the due date for applications (June 1) [cover page, page 1, page 24]
2. Added a dedicated mailbox for questions [page 1, page 24]
3. Added the date/time/contact information for the informational call for applicants (April 22 at 3:30 pm EST) [page 1, page 24]
4. Modified
   page 18 removed: For the purposes of this FOA, definitions for the following terms apply:
   Metropolitan Statistical Area (MSA): MSA are geographic entities defined by the U.S. Office of Management and Budget (OMB) for use by Federal statistical agencies in collecting, tabulating and publishing Federal statistics. Furthermore, the underlying concept of a MSA is that of a core area containing a large population nucleus, together with adjacent communities having a high degree of economic and social integration with that core. MSA are composed of entire counties or county equivalents. Every MSA has at least one urbanized area with a population of 50,000 or more. Metropolitan Division: A metropolitan division (MD) is used to refer to a county or group of counties within a Metropolitan Statistical Area that has a population core of at least 2.5 million. (http ://www.whitehouse.gov /omb /assets/bulletins/b10 -02 .pdf )page 22 added: i) the jurisdiction’s laws/regulations require the reporting of all CD4 and viral load results to the state/city health department; ii) a minimum of 95% of HIV-related test results from laboratories that perform HIV-related testing for each area are being reported to the state/city health department; and iii) the jurisdiction is reporting at least 95% of all CD4 and viral load test results to CDC as of December 31, 2013 (as outlined in the 2012 Monitoring Report, published in November 2014).
5. Added language to clarify funding amounts for applicants applying for 1 component vs. 2 components
   [page 17]
   For those applicants eligible for both Category 1 (PrEP) and Category 2 (Data to Care), it is strongly recommended that the applicants apply for both. When proposing activities under both Category 1 and Category 2, no less than 25% of the overall proposed budget should be allocated to either Category. For applicants that are eligible for Category 1 only and applicants that are eligible for both Categories but applying for only one Category, the available funding will be 75% of the available funding levels for proposals addressing both Categories (approximate average award = $2,175,000; award ceiling = $5,250,000; award floor = $375,000)
6. Added language to clarify that activities are required to be conducted in the MSA/MD listed in the FOA (rather than in the entire state); but if an applicant has more than one MSA/MD listed in the FOA, the applicant can choose how many to conduct activities in
   [page 18] States that have local health departments directly funded by CDC are not eligible to apply for the MSAs/MDs that contain locally funded health departments within the state.State health departments with one eligible MSA/MD are required to work in the specified eligible MSA/MD. States that have more than one eligible MSA/MD may elect to work in all or a reduced number of eligible MSAs or MDs, in order of prevalence.
7. Corrected an inconsistency in the project period (so all references are to 3 years instead of 2) [page 16]
8. Changed the estimated award date to 9/30/2015 [page 2]

Note: There was some discussion on the call regarding terminology. References to African American MSM were changed to Black MSM. This was a very last minute decision that came after the final branch review and we apologize for the confusion.

Questions 4: Is it a requirement of the community advisory board to establish one community advisory board (CAB) for each category in each MSA/MD? Can we use our existing local planning council for this purpose?
Answer: It is up to applicants to decide how best to create a CAB for this project. Though we do not have a specific requirement that each category in each MSA or metropolitan division have its own CAB, we would like to see grantees organize something that is efficient and receives community input and buy-in regarding the proposed activities. This may include creating new groups as well as engaging existing groups for this purpose. Whichever approach the applicant proposes, it should ensure a mechanism for meaningful input for the proposed activities from the communities they are intended to reach.

Question 5: Michigan (Jennifer Litmeyer): If listed as the Detroit division (MD), may we write for the MSA or specify the Detroit division?
You would specify the Detroit MD which is defined as: Detroit-Dearborn-Livonia, MI Metropolitan Division/Wayne County. If applying, please propose activities for this Division.

Question 6: California Department of Health (Kama Brockmann): Is it ok to work with one jurisdiction in year one and include another in subsequent years? We are thinking about working with the highest burdened area and work with others in the 2nd, 3rd years.
Your approach sounds reasonable with the caveat that a justification should include how this is an appropriate response across the MSA/MD given the local epidemiology.

Question 7: NYC DHMH (Julie Meyers): Is it permissible for NYCDHMH to only work in the 5 boroughs of the city (the jurisdiction of the health department) when the MD is larger than that?
Yes. Additionally, in such a situation, CDC encourages the health department to seek opportunities as appropriate to collaborate with other health departments to extend work into these other areas of the MSA/MD.

Question 8: (Rebecca): What are the stipulations on the workplan and page limit— the FOA indicates the workplan may be included as an attachment. If so, is that included in the page limit?
The workplan may be integrated into the narrative or included as a separate attachment. The workplan does count toward the total page limit whether it is included in the narrative or as a separate attachment. Applicants proposing activities for two categories may include a single workplan or two separate workplans. If applying for only one category, the page limit is 20 pages. If applying for two categories, the page limit is 25.

Question 9: Houston Department of Health and Human Services (Kathy Wiley): Do you want one narrative for both categories? 
Applicants proposing activities for two categories may prepare a narrative however they feel it is most clear. Applicants may choose to write one narrative that covers both categories in each section. They may also choose to write one section of the narrative for one category and then repeat section headings when describing the second category. Applicants may decide on the best approach for their proposed activities. The page limit for narratives applying for two categories is 25 pages.

Question 10: California Department of Health (Kama Brockmann): Do we need to prepare separate budgets for each category, since they are being evaluated?
Awaiting PGO comment.
Budgets are being reviewed but they will not be scored. A completely separate budget is not required when proposing activities for two categories. However, allocations for the activities across categories should be clear enough to determine that they meet the requirement of the 25% minimum for one category.

Question 11: NYC DHMH (Julie Meyers): What are the stipulations around subcontracting? Is it permitted?
Issuing subcontracts as part of the plan to implement proposed activities is ok.

Question 12: What does data to care entail – just using surveillance or something else – what do you have in mind (i.e., working with PLWH)?
In addition to the description found on page 9 of the amended FOA, a recommended reference is the following website:
https://effectiveinterventions.cdc.gov/en/HighImpactPrevention/PublicHealthStrategies/DatatoCare.aspx
Further clarification would point to the many opportunities to improve the use of surveillance and other data sources to improve the identification of people living with HIV who are out of care and activities to support their entry into care. This may include many activities that focus on ways to collaborate to improve the use of the list generated from surveillance data as well as activities that may help to refine and prioritize a list of people not in care for HIV (e.g., using additional local data sources).

Question 13: State of Texas (Donci Bardash): Do we submit one application for 2 geographic areas (if we are submitting for an MSA and MD)?
States who are proposing activities for more than one eligible MSA/MD must still submit one application. Additionally, the page limits mentioned earlier (20 pages for one category and 25 pages for two categories) still apply.

Question 14: Chicago DPH (Nanette Benbow): If applying for 2 categories, do we submit 2 separate budgets? Is there a difference in the page limit?

Question 15: Chicago (Deborah): related to above question – budget is listed separately in the FOA and indicates a review process – is it 1 or 2 budgets based on the FOA?
Awaiting PGO comment. Budgets are being reviewed but they will not be scored. A completely separate budget is not required when proposing activities for two categories. However, allocations for the activities across categories should be clear enough to determine that they meet the requirement of the 25% minimum for one category. If applying for only one category, the page limit is 20 pages. If applying for two categories, the page limit is 25.

Reponses to Previously Received Questions

1. It appears that the Georgia Department of Public Health (GDPH) is ineligible for funding under PS 15-1506 and 15-1509. Both FOAs specifically list Fulton County Department of Health and Wellness. We would like to request that GDPH is allowed to apply for these funds because of our experience and expertise with Georgia’s MSM community which positions us as a viable entity for these funds.
   • The intent of the FOA is that, for an MSA/MD where there is a local health department directly funded by CDC, that department is the eligible entity to apply for funding. The state is not eligible to apply for an MSA or MD that contains a locally funded health department within the state. An amendment to the FOA will be published soon to clarify this point .
2. Has the technical assistance call for this FOA been announced yet? Are we restricted to conducting activities under this grant in only the MSA that qualified us or can we propose statewide services?
   • First, there will be an informational call for applicants, although the details have not been finalized . An amendment to the Funding Opportunity Announcement (FOA) will be published soon with this information. Second, the intent of the FOA is that state health departments with one eligible metropolitan statistical area or metropolitan district (MSA/MD) are required to work in the specified eligible MSA or MD. The amendment to the FOA will further clarify this point.
3. Is there a scheduled date for the 15-1506 technical assistance webinar?
   • There will be an informational call for applicants, although the details have not been finalized yet. An amendment to the FOA will be published soon with this information.
4. What are the logic models for PrEP support projects referenced on page 25 of the FOA? Also on page 15/16, the second bullet of the Three-year Overview refers to “the two-year project period.” Is that a typo and should simply be “the three-year project period”?
   • The logic model for PrEP support projects is the figure on page 5 under “2. CDC Project Description, a. Approach” and applicants may use and refer to it in their proposals.
     You are correct the text in the second bullet should read “the 3-year project period.”
5. Is Hawaii and most moderate /low incidence states not eligible to apply for any of the funds even though our epidemic is 85% MSM?
   • The intent of the FOA is to allocate resources to health departments in MSAs or MDs in which there are greater than 3,000 MSM living with HIV by year end 2010 (2011 MSA report, Table 6b, published October 2013). In order for the activities funded through this FOA to have the greatest impact, resources will be allocated to health departments in the geographic areas of the United States where the largest populations of MSM living with HIV reside.
6. The press release lists 24 health departments that will be eligible to apply for these funds. Do you know whether those 24 have been identified publicly? One of our county health departments may be interested (Allegheny County, which houses the city of Pittsburgh).
   • The eligible health departments were published in each of the FOAs: PS15-1506 (pgs. 19-21) and PS15-1509 (pgs. 23-24). As a result of the established eligibility criteria in the respective FOAs, the Pennsylvania Department of Health does not qualify as an eligible applicant/recipient for funding.
7. Massachusetts is pleased to be listed under eligible jurisdictions for Category 1 of this FOA and plans to submit an application for funding. However, we were puzzled not to be included under eligible jurisdictions for Category 2 based on the eligibility criteria regarding complete reporting of all CD4 cell count and HIV viral load test results reported to CDC as of January 2014 (as outlined in the 2012 Monitoring Report, published in November 2014). We understand the importance of complete laboratory reporting of CD4 values and viral load results in order to perform the surveillance, outreach, and linkage to care duties outlined in Category 2 of the FOA. Given the variance in timeframes of the Monitoring Report’s December 31, 2013 “by” date and the FOA’s January 2014 “as of” date for determining states’ eligibility, and given our duly reported compliance with the 95% standard in January 2014 for the 2 prior years, we would respectfully request reconsideration of our eligibility for Category 2 of this FOA.
   • We certainly appreciate your desire to apply for both sections of PS15-1506 and can see the confusion caused by some of the contradictory language in the FOA.
   • However, Massachusetts is not an eligible health department under the original intent of the FOA, and we are amending the FOA now to make that clear.
   • The intent was for eligibility to be limited to the 18 jurisdictions listed in tables 2a/b-5a/b in the Monitoring Report published in November 2014. The dates in the FOA should have exactly the same dates as in the 2012 Monitoring Report for completeness. This language has been amended in the FOA to change January 2014 to December 31, 2013 to eliminate the confusion about what we mean by completeness of reporting.
   • For your reference, please see the Technical Notes of the 2012 Monitoring Report. The amendment also provides information about a webinar for this FOA on April 22, 2015 as well as more detailed information about how to develop budgets based on whether a jurisdiction is eligible for one or two parts of the FOA.
8. We have several questions. If we are interested in applying for both Category 1 and 2, is the 20 page limit per Category (total of 40 pages) or is it a 10 page limit per Category 1 and 2 (for a total of 20 pages)? Can the work plan be integrated into the project narrative or does it need to be a separate document as described in the FOA- same question for the logic model? For the budget, do we need to provide for Year 1 only? Will there be a webinar for PS15-1506? Should programmatic questions be emailed directly to you?
   • Applicants may use the page limit however they think is best for their proposed activities. Applicants do not have 20 pages per Category. If applying for two categories, the applicant may use a total of 25 pages (as per the FOA: “for a multi-component FOA, the maximum page limit is 25.”).
   • You may use the narrative section in the best way you think for proposed activities. The workplan may be integrated into the narrative or included as an attachment. The workplan does count toward the total page limit whether it is included in the narrative or as an attachment. Applicants proposing activities for two categories may include a single workplan or two separate workplans. If applying for only one category, the page limit is 20 pages. If applying for two categories, the page limit is 25. Also, logic models may be included as an attachment in pdf format labeled as “Logic Model.”
   • A proposed budget should be provided for the entire 3-year project with more detail for the first year. A conference call has been scheduled for April 22, 2015 at 3:30 pm EST . We will be publishing an amendment to the FOA soon with the conference call information. CDC has now established a dedicated mailbox for questions: 1506foamailbox@cdc.gov. This information will be included in the FOA amendment.
9. We have concerns about the eligibility criteria used for Category 1 and we do not believe that the rationale for limiting eligibility for Category 2 satisfies federal requirements that permit “Less than Maximum Competition.” For category 1, we understand and agree that it makes sense to target PrEP support projects to areas with the highest concentration of HIV positive MSM, however most state and local health departments do not deliver HIV programming based on MSAs or MDs. Regarding Category 2, limiting competition to the health departments in the geographic areas of the United States where the largest populations of MSM living with HIV reside will ensure that the project can have the most impact on the HIV epidemic, however we do not agree that the eligibility criterion for Category 2 achieves this objective.
   • With regard to your inquiry of eligibility for Category 1, the intent of the FOA is that, for a MSA or MD where a local health department is directly funded by CDC, that department is the eligible entity to apply for funding. The state is not eligible to apply for an MSA or MD that contains a locally funded health department within the state.
   • With regard to your inquiry of eligibility and rationale for Category 2, the FOA intent is to support activities in the MSA or MD in the United States where the largest populations of MSM living with HIV reside. This will ensure that the project can have the most effect on reducing and identifying HIV infections. These eligible MSAs/MDs are listed in the FOA. Again, the intent of the FOA is that, for an MSA/MD where there is a local health department directly funded by CDC, that locally funded health department is the eligible entity to apply for funding.

Reponses to Subsequently Received Questions

1. If a grantee is applying for both categories of the FOA (PrEP Support and Data to Care), does the applicant have to prepare a separate budget for each category, or can they prepare one budget that includes both? The FOA is not completely clear on this point.
   • A completely separate budget is not required when proposing activities for two categories as long as single budget adequately reflects each category.
2. Are Co-Program Directors allowed?
   • Co-Program Directors are allowable – provided the budget justification distinguishes the duties.
3. Is it possible to use the funds to pay for food for meetings, such as meetings of the community advisory board or other community stakeholders who are providing consultation for the project activities (as an incentive to thank them for their assistance)?
   • No funds may be requested for meals or coffee breaks for intramural meetings of an organization or any of its components. However, for external meetings, the organization can provide light refreshments. If a meal is to be served, it must be a working meal, with an agenda where information is to be disseminated, discussed or some form of business is conducted.
4. Is it possible to use the funds for incentives?
   • Yes, participant incentives are an allowable cost if they serve to move the program towards reaching the desired health outcomes. It is a good idea for the organization to develop internal policies related to Incentive Payments.