[Federal Register Volume 66, Number 141 (Monday, July 23, 2001)]
[Notices]
[Pages 38287-38289]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-18284]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Program Announcement 01155]


Improving the Quality of HIV/AIDS Care in the Republic of 
Zimbabwe; 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 University of Zimbabwe (UZ), School of Medicine, Clinical 
Epidemiology Unit(CEU) for improving the quality of health care 
services for HIV/AIDS and of related clinical preventive services in 
the Republic of Zimbabwe.
    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 Global AIDS Initiative. Through this 
initiative, CDC's Global AIDS Program (GAP) aims 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. Zimbabwe is one of these targeted countries.
    To carry out its activities in these countries, CDC is working in a 
collaborative manner with national governments, non governmental 
organizations (NGOs), other national and international agencies to 
develop programs of assistance to address the HIV/AIDS epidemic. CDC's 
program of technical assistance to Zimbabwe 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.
    Zimbabwe is experiencing one of the world's most severe AIDS crises 
that looms as a disaster of unprecedented proportions. Zimbabwe has one 
of the world's highest HIV prevalence rates among adults, life 
expectancy has declined from 63 years to 38 years in only a decade, and 
the proportion of children orphaned by AIDS is expected to reach 35 
percent by 2010.
    The need for appropriate, quality health care corresponding to the 
generalized epidemic of HIV/AIDS in Zimbabwe is enormous. Approximately 
2 million of the 12 million Zimbabweans are infected with HIV. An 
estimated 60 percent of hospital inpatients in Zimbabwe suffer from 
HIV-related conditions, and more than 2,000 deaths per week result from 
AIDS. A recent burden of disease assessment in Zimbabwe found that 
nearly 45 percent of all lost disability-adjusted life years (DALYs) in 
Zimbabwe can be attributed to HIV/AIDS. Tuberculosis rates have 
increased 10-fold since the mid-1980s, and the World Health 
Organization(WHO) now lists Zimbabwe as having the highest estimated 
incidence rates of tuberculosis in the world at more than 500 new 
cases/100,000 population annually. Despite the tremendous stress on 
hospitals from the high proportion of patients suffering from HIV-
related conditions, the majority of persons diagnosed with or suspected 
as suffering from HIV/AIDS related conditions in Zimbabwe have in fact 
been discharged to either self care or systems of ``community and home-
based care,'' services that may range from quite helpful to being of 
very little help.
    In response to HIV/AIDS, Zimbabwe has taken many positive steps. It 
was one of the first governments in the world to negotiate a large 
World Bank loan for AIDS prevention in 1992. In December 1999, the 
Government of Zimbabwe (GOZ) declared AIDS a national disaster, created 
a new ministerial-level multi-sectoral National AIDS Council (NAC), 
announced a new National AIDS Policy, and instituted an ``AIDS levy'' 
payroll tax to underwrite improved national AIDS prevention and care 
services.
    The national response has also included many examples of creative 
programming and successful grassroots initiatives in the face of 
staggering adversity. Many of these grassroots initiatives were in the 
domain of home-based care and support for persons living with HIV/AIDS 
(PLWA). Several excellent evaluations of home-based care for PLWA have 
been conducted in Zimbabwe at specific points in time. However, no 
consistent focus or organizational entity has been established that is 
dedicated to systematically monitoring, evaluating, and attempting to 
improve the quality of care for HIV/AIDS across all levels of the 
health system and society, from central hospitals to community and 
home-based care programs. The AIDS and TB Unit of the Ministry of 
Health and Child Welfare (MOHCW), which is responsible for public 
sector health care for HIV/AIDS within the Ministry, has only one 
physician, who also oversees all health sector aspects of HIV/AIDS 
prevention and care, as well as all governmental programs for STDs and 
TB. Therefore, the MOHCW critically needs allied organizations that can 
assist in coordinating and implementing a broad range of activities to 
improve quality and coverage of care for HIV/AIDS and related 
conditions.
    The Clinical Epidemiology Unit (CEU) at the University of Zimbabwe 
(UZ) School of Medicine was established in 1989, after training of an 
initial cadre of clinical epidemiologists in the United States and 
Australia. Supported through the International Clinical Epidemiology 
Network (INCLEN) by the Rockefeller Foundation (until 1992) and by 
Australia AID (from 1994 to 2001), the UZ CEU has trained 16 persons in 
clinical epidemiology (including 7 currently in training), 3 in Health 
Social Science, 3 in Biostatistics, 2 in Health Economics, and 3 in 
Pharmaco-epidemiology. This diversity and extent of training in 
clinical epidemiologic disciplines is superimposed on an underlying 
further diversity of clinical

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specialties represented in the UZ CEU, including internal medicine, 
pediatrics, obstetricians, surgeons, laboratory scientists, health 
social scientists, biostatisticians, pharmacists, and others.
    For the past 7 years, clinical epidemiology training at UZ has been 
supported by the University of Newcastle-Australia through technical 
assistance, distance learning curriculum, and teaching technology. Over 
the past several years, the CEU petitioned for and has received 
approval from the University of Zimbabwe to offer a local Masters 
training program in Clinical Epidemiology, beginning in 2001. The UZ 
CEU has been solicited by the World Health Organization (WHO) to offer 
this degree training program to qualified candidates from other 
countries in the Region, who will be supported by WHO to be trained at 
the UZ CEU. The UZ CEU is the only existing organizational entity in 
Zimbabwe with the overall mission, structure, and multidisciplinary 
capacity to develop the proposed Quality of HIV/AIDS Care Initiative, 
while simultaneously supporting it through a degree-granting training 
program in clinical epidemiology.
    The purpose of this cooperative agreement is to contribute 
systematically and strategically to improving the quality of HIV/AIDS 
care in Zimbabwe, and related clinically-oriented prevention services 
(such as prevention of mother-to-child-transmission (PMTCT) of HIV 
infection), with a focus on care at the district hospital level and 
below. Since the needs for HIV/AIDS care and clinical prevention 
services will intensify over time, a second and related purpose is to 
train more clinical epidemiologists in Zimbabwe and support them to 
systematically address priority issues in HIV/AIDS clinical care that 
will inevitably arise over the coming decade. This will be accomplished 
through cooperation between CDC and the Clinical Epidemiology Unit, 
University of Zimbabwe School of Medicine, in collaboration with 
relevant policy-setting authorities such as the MOHCW and the National 
Drugs and Therapeutics Policy Advisory Committee (NDTPAC). These 
collaborative activities are expected to contribute meaningfully, 
immediately, and over the coming decade to assist Zimbabwe to develop 
tools needed to increase the quality and coverage of HIV/AIDS clinical 
services.

B. Eligible Applicants

    Assistance will be provided only to the University of Zimbabwe, 
School of Medicine, Clinical Epidemiology Unit (CEU). No other 
applications are solicited.
    The UZ/CEU is the only appropriate and qualified organization to 
fulfill the requirements set forth in this announcement because:
    1. As an established inter-departmental unit organized around the 
cross-cutting discipline of clinical epidemiology, the CEU is uniquely 
positioned to bring together faculty of the School of Medicine (and 
other faculty within the University of Zimbabwe) to design and 
implement a systematic program of clinical epidemiologic investigation, 
systematic reviews, support for guidelines development, and related 
activities to support an initiative to improve the quality of HIV/AIDS 
care in Zimbabwe. The development of the CEU with its generalist focus 
on clinical epidemiology as a core discipline has now been successfully 
implemented, and has resulted in a committed, enthusiastic and capable 
faculty.
    2. The UZ/CEU is the only entity in Zimbabwe, and one of the few in 
Africa, that offers training leading to a master degree in clinical 
epidemiology. Since the Quality of HIV/AIDS Care Initiative is a long-
term endeavor that depends critically on building up human capacity in 
Zimbabwe for assessing and improving the quality of clinical care for 
HIV-related conditions, the CEU is the only potential applicant able to 
be responsive to this critical need to generate trained manpower in the 
domain of clinical epidemiology to address continually emerging issues 
in HIV/AIDS care that will confront Zimbabwe over the coming decade.
    3. Candidates for the Master of Clinical Epidemiology degree all 
conduct investigations and write theses on some aspect related to 
quality, cost-effectiveness, or other properties of clinical care in 
Zimbabwe. To the extent that these trainees can be guided by a 
carefully derived, coordinated set of key health services questions 
related to increasing quality and coverage of HIV/AIDS care, and 
supported specifically by resources dedicated to addressing that 
agenda, this pool of Masters trainees, with their CEU mentors, 
constitutes an immediately available reservoir of human resources 
available to quickly begin addressing high priority issues in HIV/AIDS 
care.

C. Availability of Funds

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

Direct Assistance

    Direct provision of equipment and supplies (e.g., vehicles, 
computer hardware/software, specific consumables & supplies) may be 
requested as direct assistance in lieu of a portion of this financial 
assistance.

Use of Funds

    Funds received from this announcement may not be used for the 
purchase of the direct purchase of drugs for the treatment of active TB 
disease. Funds may not be used for new construction, although limited 
renovation of existing space may be acceptable.
    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.
    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:
    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.
    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.

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    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.

D. 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 Room 3000, 2920 Brandywine Road, Atlanta, GA 30341-4146, 
Telephone: (770) 488-2782, E-mail: [email protected]
    For program technical assistance, contact:
    Michael St. Louis, MD, Global AIDS Program (GAP), Zimbabwe Country 
Team, National Center for HIV, STD, and TB Prevention, Centers for 
Disease Control and Prevention (CDC), Zim-CDC AIDS Project Team, 38 
Samora Machel Avenue, 2nd Floor, Harare, Zimbabwe, Tel: 263 4 796040, 
796048, Fax: 263 4 796032 E-mail: [email protected]

    Dated: July 17, 2001.
John L. Williams,
Director, Procurement and Grants Office, Centers for Disease Control 
and Prevention (CDC).
[FR Doc. 01-18284 Filed 7-20-01; 8:45 am]
BILLING CODE 4163-18-P