[Federal Register Volume 66, Number 136 (Monday, July 16, 2001)]
[Notices]
[Pages 37036-37039]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-17658]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 01153]


Expansion of Prevention, Care and HIV/AIDS Surveillance With the 
Ministry of Public Health, Kingdom of Thailand; Notice of Availability 
of Funds

A. Purpose

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 2001 funds for a cooperative agreement 
program with the Kingdom of Thailand, Ministry of Public Health (MOPH) 
for the improvement and expansion of prevention activities, care and 
surveillance, and targeting HIV/AIDS and HIV/AIDS-related conditions in 
Thailand.
    The purpose of this cooperative agreement is to improve and expand 
in Thailand: (1) HIV transmission prevention capacity (e.g., MTCT, 
heterosexual, homosexual, and blood-borne), (2) care and support 
services for persons living with HIV/AIDS (e.g., psychosocial support, 
enhancing opportunistic infection prevention and treatment, and 
monitoring use of antiretroviral drugs), and (3) surveillance efforts, 
including laboratory-based surveillance activities (e.g., STDs, TB and 
other opportunistic infections, and drug-resistant HIV strains), which 
will be accomplished through cooperation between CDC and the Thai MOPH.
    The U.S. Government seeks to reduce the impact of HIV/AIDS and 
related conditions in specific countries within sub-Saharan Africa, 
Asia, and the Americas through its Leadership and Investment in 
Fighting an Epidemic (LIFE) initiative. Through this program, 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, especially for surveillance. Targeted countries represent 
those with the most severe epidemics and the highest number of new 
infections. They also represent countries where the potential for 
impact is greatest and where U.S. Government agencies are already 
active. Thailand is one of these targeted countries.
    To carry out its activities in these countries, CDC is working in a 
collaborative manner with national

[[Page 37037]]

governments and other agencies to develop programs of assistance to 
address the HIV/AIDS epidemic. CDC's program of technical assistance to 
Thailand focuses on several areas including strengthening surveillance 
and laboratory measures, scaling up promising prevention and care 
strategies, supporting behavior change communication projects, 
promoting technology transfer, and other capacity building efforts.
    Thailand is experiencing one of Asia's most severe AIDS crises. As 
of the end of 1999, it was estimated that approximately 755,000 adults 
and children were living with HIV/AIDS in Thailand. In 1999, nearly 
66,000 adults and children died of AIDS. Since the beginning of the 
epidemic, 75,000 children have been orphaned as a result of AIDS. 
Cumulative reported AIDS cases through 2000 (n = 160,350) demonstrate 
that sexual transmission accounts for the majority of cases (83 
percent). Vertical transmission (mother to child) and transmission 
through injecting drug use each account for about five percent. In 
seven percent of AIDS cases, information about transmission is 
incomplete or unknown. The rising number of symptomatic HIV patients is 
posing an increasing burden for hospitals in Thailand-especially in the 
northern part of the country.
    Internationally, Thailand is considered a model in the developing 
world for the implementation of timely and effective HIV/AIDS policies 
and programs. Thailand's National AIDS Program began in 1987, and was 
strongly endorsed by the Prime Minister, who chaired the National AIDS 
Committee to coordinate Program efforts. Three key accomplishments of 
the Program are noted here: (1) In 1990-91, in response to rising HIV 
prevalence among brothel-based CSWs (from three percent in 1989 to 15 
percent in 1991) and male military conscripts (five-tenths percent in 
1989 to three percent in 1991), the Thai government launched a multi-
sectoral nationwide campaign to reduce HIV transmission. Key elements 
of the plan included expanded sexually transmitted diseases (STD) 
treatment, a mass media information campaign and a program to promote 
universal and consistent condom use in commercial sex ``100 percent 
Condom Programme''. As a result of these efforts, utilization of 
commercial sex declined, condom use in commercial sex increased, STD 
cases dropped, and the prevalence of HIV among army conscripts 
decreased by more than half. The World Bank estimates that since 1993, 
behavior change and condom use have prevented an estimated 200,000 new 
HIV infections in Thailand. (2) Since the early 1990's, voluntary 
counseling and testing (VCT) for all pregnant women has been 
progressively implemented throughout Thailand. To reduce maternal to 
child transmission (MTCT) of HIV, Thailand began in year 2000 a 
national program to provide HIV infected pregnant women a short regimen 
of AZT before and during delivery, AZT syrup for the child, and a one-
year supply of infant formula. Initial results from earlier pilot 
programs demonstrated a reduction in vertical transmission rates from 
30 percent to seven to eight percent. (3) Another major Thai 
accomplishment has been in ensuring the safety of the blood supply. The 
estimated rate of HIV transmission through blood products in Thailand 
is 1 in 80,000 transfusions--one of the lowest rates in any developing 
country. The Ministry of Public Health made HIV screening of all blood 
units mandatory in 1989 and has, through screening, discouraged high 
risk donors from donating.
    However, despite these and others interventions, the World Bank 
estimates that 29,000 people in Thailand were newly infected with HIV 
in the year 2000 (25,000 adults and 4,000 children). Roughly half of 
the new adult infections occurred among women infected by their 
husbands, or sex partners, one-quarter were found among injection drug 
users (IDUs), about twenty percent were among sex workers and their 
clients, and five percent among other groups. Without appropriate 
intervention, it is estimated that the proportion of HIV infections 
related to injection drug use, either directly (e.g., sharing injection 
equipment between IDUs) or indirectly (i.e., sex partner of an IDU), 
will rise to some 40 percent of all new infections by 2005.
    The Thai MOPH has a well-functioning, national HIV sero-
surveillance system. Groups tested include blood donors, antenatal 
clinic attendees, IDUs, male STD clinic patients, and female sex 
workers in brothels ``direct'' sex workers as well as those in massage 
parlors and other places ``indirect'' sex workers. Surveillance needs 
to be strengthened to include behavioral surveillance among special 
populations such as IDUs and indirect sex workers engaging clients in 
new venues, and expanded, especially among youth, to include sexually 
active adolescents who are still attending school, and who are out of 
school. In addition, monitoring and evaluation activities to assess the 
impact of care and support programs for persons living with HIV/AIDS is 
urgently needed. Such activities should include enhanced surveillance 
for tuberculosis (TB) and other opportunistic infections, and 
monitoring the increasing use of antiretroviral drugs and the likely 
emergence of drug resistant HIV strains.
    These collaborative activities could profoundly impact the scope 
and intensity of the implementation the National AIDS Policy. 
Cooperative efforts could lead to significant improvements in the 
collection of critical data to support future action, a better 
understanding of the association between specific behaviors and HIV 
prevalence, improved and more responsive systems of care, and 
strengthened aspects of the public health infrastructure. Since 1990, 
CDC has had a strong collaboration with the Thai MOPH to conduct 
research and related activities on HIV infection and AIDS in Thailand 
in order to improve understanding of the disease and provide a 
scientific basis for the development of public health actions. The 
collaboration seeks to broaden its mission to include the LIFE 
Initiative activities outlined in this program.

B. Eligible Applicants

    Assistance will be provided only to the MOPH, Kingdom of Thailand. 
No other applications are solicited.
    The MOPH is the only appropriate and qualified organization to 
fulfill the requirements set forth in this announcement for the 
following reasons:
    1. The MOPH is directly responsible for the implementation, 
monitoring and evaluation of population-based HIV/AIDS prevention and 
care policies and services.
    2. The MOPH is uniquely positioned-in terms of constitutional 
authority, mandate and ability-to oversee and safeguard public health, 
and to collect and analyze information and disseminate surveillance and 
health system performance reports related to the prevalence and 
incidence of HIV/AIDS, HIV/AIDS-related conditions and other health 
issues.
    3. The MOPH has in place the central, provincial and district-based 
structures required to immediately engage in the activities listed in 
this announcement.

C. Availability of Funds

    Approximately $1,500,000 is available in FY 2001 to fund this 
agreement. It is expected that the awards will begin on or about 
September 30, 2001 and will be made for a 12-month budget period within 
a project period of five years. Annual funding estimates may change.
    Continuation awards within the approved project period will be made 
on the basis of satisfactory progress as

[[Page 37038]]

evidenced by required reports and the availability of funds.
    All requests for funds, including the budget contained in the 
application, shall be stated in U.S. dollars. Once an award is made, 
the Department of Health and Human Services (DHHS) will not compensate 
foreign grantees for currency exchange fluctuations through the 
issuance of supplemental awards.
    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.

Use of Funds

    Funds received from this announcement may not be used for the 
direct purchase of antiretroviral drugs for treatment of established 
HIV infection (with the exception of nevirapin in PMTCT cases and with 
prior written approval), occupational exposures, and non-occupational 
exposures and will not be used for the purchase of machines and 
reagents to conduct the necessary laboratory monitoring for patient 
care.
    Applicants may contract with other organizations under these 
cooperative agreements, however, applicants must perform a substantial 
portion of the activities (including program management and operations) 
and delivery of prevention services for which funds are requested.
    The costs that are generally allowable in grants to domestic 
organizations are likewise allowable to foreign institutions and 
international organizations, with the following exceptions:
    1. Alterations and Renovations: Unallowable.
    2. Customs and Import Duties: Unallowable. This includes consular 
fees, customs surtax, value added taxes, and other related charges.
    3. Indirect Costs: With the exception of the American University, 
Beirut, the Gorgas Memorial Institute, and the World Health 
Organization, indirect costs will not be paid (either directly or 
through a sub-award) to organizations located outside the territorial 
limits of the United States or to international organizations 
regardless of their location.

D. Program Requirements

    In conducting activities to achieve the purpose of this program, 
the recipient will be responsible for the activities under 1. 
(Recipient Activities), and CDC will be responsible for the activities 
listed under 2. (CDC Activities).

1. Recipient Activities

a. Expand HIV/AIDS Prevention Programs
    Support the national program to prevent mother-to-child HIV 
transmission through national monitoring and evaluation of the program 
and training health care workers implementing it; develop and implement 
pilot projects to improve the program by integrating into the program 
enhanced HIV prevention activities during pregnancy and systematic HIV-
related care for HIV-infected pregnant women and their families.
b. Expand HIV/AIDS Care and Support Programs
    (1) Collaborate in the development of national strategies for 
increasing the quality of community and home-based care of persons with 
HIV/AIDS and related conditions, and implement pilot projects in 
increased quality of HIV/AIDS care at district and provincial levels.
    (2) Expand the development of stronger linkages between TB and HIV/
AIDS prevention and care programs.
    (3) Enhance access to TB preventive therapy and other opportunistic 
infection primary and secondary prophylaxis regimens and monitor their 
impact.
    (4) Assist in monitoring and evaluating novel and appropriate uses 
of antiretroviral agents.
c. Strengthen HIV/AIDS and HIV/AIDS-Related Surveillance
    (1) Expand and improve national HIV/AIDS/STD/TB surveillance 
programs with a focus on improved systems for case reporting, 
monitoring and evaluation, and measures to determine incidence, 
prevalence, and behavioral risk factors.
    (2) Produce and disseminate an MOPH annual HIV/AIDS surveillance 
report containing data accruing from the HIV/AIDS-related surveillance 
systems (e.g., surveillance for TB, and other opportunistic 
infections), operational research, and special studies; expand the 
report to include data generated from other sources (e.g., non-MOPH), 
where appropriate; expand presentation and discussion of surveillance 
data, particularly at the local level to improve programs; and increase 
distribution of the report.
    (3) In collaboration with CDC and other partner agencies, present 
project findings to other researchers and policy makers at local and 
international meetings and conferences.
d. Strengthen of Public Health Laboratory Services Supporting 
Surveillance, Prevention and Care Activities
    (1) In collaboration with CDC and other relevant agencies, finalize 
the establishment of a National Microbiology Reference Laboratory 
(NMRL) system supportive of surveillance, training, research, 
reference-level testing services and quality assurance activities.
    (2) Expand introduction of the use of rapid HIV tests through 
development of national guidelines, point of service protocols and 
quality assurance programs appropriate for national, provincial and 
district levels.
    (3) Improve management of public health laboratory functions 
through development of information management systems and improved 
telecommunication infrastructure.
e. Strengthen of the Public Health Infrastructure
    Improve MOPH planning for and infrastructure supporting the 
collection, management, analysis and distribution of health information 
related to HIV/AIDS and related conditions.

2. CDC Activities

    a. Collaborate with MOPH on designing and implementing the 
activities listed above, including but not limited to the provision of 
technical assistance to develop and implement program activities, 
laboratory services, quality assurance, data management, statistical 
analysis, and presentation of program methods and findings.
    b. Collaborate with MOPH and other relevant partners and agencies 
in the development of special laboratory-based surveillance activities.
    c. Monitor project and budget performance.

E. Application Content

    Please use the information in the Program Requirements, Other 
Requirements, and Evaluation Criteria sections of this document to 
develop your application content. Your application will be evaluated on 
the criteria listed, so it is important to follow them in laying out 
your program plan. The narrative should be no more than 25 double-
spaced pages, printed on one side, with one-inch margins, and with 
unreduced font. Pages should be numbered, and a complete index to the 
application and any appendices must be included.

F. Submission and Deadline

    Submit the original and two copies of PHS 5161-1 (OMB Number 0937-
0189).

[[Page 37039]]

Forms are available in the application kit and at the following 
Internet address: www.cdc.gov/od/pgo/forminfo.htm
    On or before August 15, 2001, in both electronic (Microsoft Word 
and Excel format) and hard copy, submit the application to the Grants 
Management Specialist identified in the ``Where to Obtain Additional 
Information'' section of this announcement.

G. Evaluation Criteria

    Your application will be evaluated against the following criteria 
by an independent review group appointed by CDC.

1. Understanding of the Problem (10 Points)

    Extent to which the applicant demonstrates a clear and concise 
understanding of the nature of the problem described in the Purpose 
section of this announcement. This specifically includes description of 
the public health importance of the planned activities to be undertaken 
and realistic presentation of proposed objectives and projects.

2. Technical Approach (30 Points)

    The extent to which the applicant's proposal includes an overall 
design strategy, including measurable time lines, the extent to which 
the proposal addresses regular monitoring and evaluation, and the 
potential effectiveness of the proposed activities in meeting 
objectives.

3. Ability to Carry Out the Project (25 Points)

    The extent to which the applicant documents demonstrated capability 
to achieve the purpose of the project.

4. Personnel (20 Points)

    The extent to which professional personnel involved in this project 
are qualified, including evidence of experience in working with HIV/
AIDS, opportunistic infections, and HIV/STD surveillance.

5. Plans for Administration and Management of Projects (15 Points)

    Adequacy of plans for administering the projects.

6. Budget (Not Scored)

    The extent to which itemized budget for conducting the project, 
along with justification, is reasonable and consistent with stated 
objectives and planned program activities.

7. Protection of Human Subjects (Not Scored)

    The extent to which the application adequately addresses the 
requirements of 45 CFR 46 for the protection of human subjects.

H. Other Requirements

Technical Reporting Requirements

    Provide CDC with original plus two copies of:
    1. Written quarterly progress reports;
    2. Financial status report, no more than 45 days after the end of 
the budget period; and
    3. Final financial and performance reports, no more than 90 days 
after the end of the project period.
    4. 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.
    Send all reports to the program contact and the Grants Management 
Specialist, both identified in the ``Where to Obtain Additional 
Information'' section of this announcement.
    The following additional requirements are applicable to this 
program. For a complete description of each, see Attachment I of the 
announcement. Some of the more complex requirements have some 
additional information provided below.

AR-1--Human Subjects Requirements
AR-6--Patient Care
AR-14--Accounting System Requirements
AR-22--Research Integrity

I. Authority and Catalog of Federal Domestic Assistance Number

    This program is authorized under section 307 of the Public Health 
Service Act, [42 U.S.C. section 242I], as amended. The Catalog of 
Federal Domestic Assistance number is 93.941.

J. Where To Obtain Additional Information

    This and other CDC announcements can be found on the CDC home page 
Internet address--http://www.cdc.gov. Click on ``Funding'' then 
``Grants and Cooperative Agreements.''
    If you have questions after reviewing the contents of all the 
documents, business management technical assistance may be obtained 
from: Dorimar Rosado, Grants Management Specialist, Grants Management 
Branch, Procurement and Grants Office, Centers for Disease Control and 
Prevention, 2920 Brandywine Road, Room 3000, MS-15, Atlanta, GA 30341-
4146, Telephone: (770) 488-2782, Fax: (770) 488-2847, e-mail: 
[email protected].
    For program technical assistance, contact: Jordan W. Tappero, MD, 
MPH, Director, Thailand-CDC Collaboration, Director, The HIV/AIDS 
Program, DMS 6 Building, Ministry of Public Health, Tivanon Road, 
Nonthaburi 11000, THAILAND, Tel: (66 2) 591 8358, Fax: (66 2) 591 5443, 
Mobile: (66 1) 755 9011, e-mail: [email protected].

    Dated: July 10, 2001.
John L. Williams,
Director, Procurement and Grants Office, Centers for Disease Control 
and Prevention.
[FR Doc. 01-17658 Filed 7-13-01; 8:45 am]
BILLING CODE 4163-18-P