[Federal Register Volume 66, Number 138 (Wednesday, July 18, 2001)]
[Notices]
[Pages 37470-37473]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-17910]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 01145]


Expansion of the Prevention of Mother to Child Transmission 
Program, Isoniazid Preventive Therapy Program, and Information, 
Education, and Communication Activities in the Republic of Botswana; 
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 
with the Republic of Botswana Ministry of Health(MOH) for the expansion 
of the prevention of mother to child transmission program (PMTCT), the 
national rollout of the Isoniazid Preventive Therapy (IPT) program, and 
the development and expansion of the Information, Education, and 
Communication (IEC) campaign targeting HIV/AIDS and HIV/AIDS-related 
conditions in Botswana.
    The purpose of this cooperative agreement is to improve and expand 
the Prevention of Mother to Child Transmission program activities in 
Botswana, rollout the National IPT program, and provide technical 
assistance to improve HIV laboratory diagnostic and monitoring 
capability, which will be accomplished through cooperation between CDC 
and the MOH of Botswana.
    These collaborative activities could profoundly impact the scope 
and intensity of the implementation of the National AIDS Policy. 
Cooperative efforts could lead to greater access to counseling and 
testing services in all areas of the country, expansion of the IPT 
program throughout the nation, and significant improvements in HIV/AIDS 
education and promotion activities, and strengthened aspects of the 
public health infrastructure.
    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. Botswana is one of these targeted countries.
    To carry out its activities in these countries, CDC is working in a 
collaborative manner with national governments and other agencies to 
develop programs of assistance to address the HIV/AIDS epidemic. CDC's 
program of technical assistance to Botswana focuses on several areas 
including scaling up promising prevention and care strategies, such as 
PMTCT and IPT, supporting behavior change communication projects, such 
as IEC activities, and other capacity building efforts.
    Botswana is experiencing one of the world's most severe AIDS crises 
that looms as a disaster of unprecedented proportions. The global 
burden of HIV/AIDS in Botswana is the highest in sub-Saharan Africa, 
where 83 percent of the world's AIDS deaths have occurred, and where 
four-fifths of all HIV-positive women live. Despite a relative 
stabilization of infection rates in some countries in West Africa, the 
HIV/AIDS epidemic continues to grow at an alarming rate in Southern 
Africa. Like many countries in this region, Botswana has been 
disproportionately affected by the AIDS pandemic. Over 20 percent of 
the population are believed to be HIV positive and the Botswana 
National Aids Co-ordinating Agency's 2000 Sentinel Surveillance reports 
38.5 percent HIV infection in participating pregnant women. Botswana 
estimates that as many as 25 babies a day are born with HIV. AIDS-
related conditions are responsible for 10 percent of annual deaths, 
with women and adolescents particularly at risk. TB is by far the 
single leading cause of death among adults with AIDS in Botswana. Based 
on Sentinel surveys in 1999, an estimated 19 percent of the total 
population and 29 percent of the economically productive age group (15-
49 years old) are living with HIV infection. The rate of TB infection 
in Botswana (537/100,000 in 1999) is one of the highest in the world.
    Botswana has taken many positive steps to address the AIDS 
epidemic. The President has recognized HIV/AIDS as ``the greatest 
challenge Botswana has faced'' and has warned Botswana that HIV/AIDS 
``threatens the country with annihilation.'' The Botswana government 
pays for up to 80 percent of all HIV/AIDS activities in the country. 
This full-scale national response has

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generated many examples of creative programming and international 
collaborations. The government of Botswana will be among the first 
African countries to launch a TB prevention program using Isoniazid 
Preventive Therapy (IPT) for HIV infected individuals. A Pilot program 
of IPT was implemented in October 2000 and planning for nation-wide 
implementation is underway. In 1999 the MOH launched a pilot project 
for PMTCT in Gaborone and Francistown which has also been approved for 
full scale implementation. Both programs face manpower needs and 
require large scale training efforts for health care workers.
    The Botswana MOH and CDC collaboration was established in 1995 and 
is known as the ``The BOTUSA Project'' and is a successful example of 
MOH and international collaboration. BOTUSA is a strong supporter of 
the IPT program and is providing technical assistance, training for 
health care workers, supplying educational materials, and supporting 
program monitoring and evaluation. BOTUSA's collaboration includes 
support for the national PMTCT program through the provision of 
technical assistance, counseling space, equipment, and materials for 
prenatal clinics throughout the country.
    However, despite the support of the government to fight the 
epidemic and the collaboration with international partners, the 
prevalence of HIV infection appears to have increased substantially in 
Botswana from 1997 to 2000 and the epidemic cannot yet be characterized 
as having stabilized. The capacity of the government to expand their 
pilot projects for prevention and extend the reach of their activities 
to the entire nation will have a substantial impact on the epidemic.

B. Eligible Applicants

    Assistance will be provided only to the MOH of Botswana. No other 
applications are solicited.
    The MOH is the only appropriate and qualified organization to 
fulfill the requirements set forth in this announcement because:

1. The MOH 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.

2. The MOH has in place the central, district, and community-based 
structures required to immediately engage in the activities listed in 
this announcement.

3. The MOH is directly responsible for the implementation, monitoring 
and evaluation of population-based HIV/AIDS prevention and care 
policies and services.

C. Availability of Funds

    Approximately $500,000 is available in FY 2001, to fund this 
agreement. It is expected that the awards will begin on or about 
September 1, 2001 and will be made for a 12-month budget period within 
a project period of 5 years. Annual funding estimates may change.
    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.
    Continuation awards within the approved project period will be made 
on the basis of satisfactory progress as evidenced by required reports 
and the availability of funds.

Use of Funds

    Funds received from this announcement will not be used for the 
purchase of antiretroviral drugs for treatment of established HIV 
infection (with the exception nevirapine 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.
    Funds received will not be used for the direct purchase of drugs to 
treat active TB disease. No funds appropriated under this announcement 
shall be used to carry out any program of distributing sterile needles 
or syringes for the hypodermic injection of any illegal drug.
    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 exception:
    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. Strengthen and support the PMTCT program in-country.
    (1) Increase coverage and improve impact of promotion and education 
activities required to implement the PMTCT program in all health 
districts by the end of 2001 through the provision of an additional IEC 
Officer to be assigned to the PMTCT Programme.
    (2) Upgrade capacity for monitoring and evaluation of the program 
and assure that uptake and awareness of the program is increasing 
through the provision of additional monitoring and evaluation staff to 
the PMTCT Programme
    b. Funding to be administered by the Ministry of Health includes 
the provision of short term contracts for technical and support staff 
needed to enhance current pilot programs in IPT and PMTCT to a nation 
wide level and provide technical support to set up high quality 
laboratory monitoring and testing for HIV diagnosis and treatment. (For 
example, recipient may wish to engage time-limited contractors or 
consultants who would not become permanent staff unless positions were 
created and filled by the official Government of Botswana Department of 
Manpower.
    c. Expand the IPT pilot program for HIV positive individuals to 
provide nationwide access.
    d. Provide training to all relevant health workers nationwide on 
the technical aspects of program implementation. This will be

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accomplished by the engaging of a National Training Coordinator and 
additional trainers to be placed in the Botswana National Tuberculosis 
Programme (BNTP) in the Epidemiology Unit.
    e. Provide technical and support staff needed to expand current 
pilot programs in IPT and PMTCT to a nation wide level and provide 
technical support to set up high quality laboratory monitoring and 
testing for HIV diagnosis and treatment. For example, recipients may 
wish to engage contractors to conduct these activities.
    f. Improve the laboratory capacity to provide monitoring and 
diagnostic testing for HIV positive individuals on anti-retroviral 
treatment and improve ability to determine eligibility and most 
effective timing of treatment and care options. The cooperative 
agreement may be accomplished through the limited renovation (within 
CDC policy guidelines and prior written approval) of buildings and 
property which will be provided by the Ministry of Health in 
Francistown, Serowe, and Maun which are the three largest population 
centers outside of Gaborone, the capital.

2. CDC Activities

    a. Collaborate with MOH on designing and implementing the 
activities listed above, including but not limited to the provision of 
technical assistance to develop and implement program activities, 
quality assurance, data management, statistical analysis, and 
presentation of program methods and findings.
    b. Provide guidance in the renovation of laboratory space in 
Francistown, Serowe, and Maun, technical assistance in the design and 
layout of the laboratory space, and provision of portable buildings 
through a support agreement to increase laboratory space in rural areas 
as needed.
    c. Provide technical assistance in setting up and running a 
virology laboratory for diagnostic and monitoring purposes, type of 
equipment and laboratory tests for best quality of service, and quality 
assurance.
    d. Collaborate with MOH and other relevant partners and agencies in 
the development activities; directly assist with voluntary counseling 
and testing services.
    e. 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). 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, 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 (20 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 (25 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 (20 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.
    A fiscal Recipient Capability Assessment may be required, pre or 
post award, with the potential awardee in order to review their 
business management and fiscal capabilities regarding the handling of 
U.S. Federal funds.
    Send all reports to the program contact and the Grants Management 
Specialist, 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.

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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, Atlanta, GA 30341-4146, 
Telephone number: (770) 488-2782 e-mail: [email protected].
    For program technical assistance, contact: Ethleen S. Lloyd, Global 
AIDS Program (GAP), C/o U.S. Embassy Gaborone, 2170 Gaborone Place, 
Washington D.C. 20521, Telephone: 267-301-696, Fax: 267-373-117.

    Dated: July 12, 2001.
John L. Williams,
Director, Procurement and Grants Office, Centers for Disease Control 
and Prevention.
[FR Doc. 01-17910 Filed 7-17-01; 8:45 am]
BILLING CODE 4163-18-P