CFAs: Closing Inequities in HIV Prevention, Care and Treatment among Key Populations in Togo Activity

Deadline: 13-Sep-2024

The United States Agency for International Development (USAID) is seeking applications for a Cooperative Agreement from qualified entities to implement USAID/West Africa’s Closing inequities in HIV prevention, care and treatment among key populations in Togo Activity (Equity KP Togo).

Goal 

• The overarching goal of Equity KP Burkina Faso and Equity KP Togo is to support the Governments of Togo and Burkina Faso and Civil Society Organizations, to accelerate progress toward achieving sustainable HIV epidemic control among KP by 2030.

Objectives 

• Provide quality, comprehensive HIV services to KP and their sexual partners at community and facility levels.
• Enhance the enabling environment for KP and their sexual partners.
• Strengthen monitoring and evaluation, sustainability, and environmental compliance.

Funding Information

• The estimated budget for each activity totals $5 million per country, with $5 million allocated for the Togo activity and $5 million for the Burkina Faso activity, funded by PEPFAR.
• The period of performance anticipated herein is 60 months (5 years) for each activity. The estimated start date will be upon the signature of the award, on or about January 2025.

Guiding Principles 

• “Do no harm” and “do nothing about them without them” 
  • In accordance with its LGBTQI+ and inclusion policy, USAID is committed to upholding the principles of “Do No Harm” and “Do Nothing About Them Without Them.” “Do No Harm” means ensuring the safety and security of beneficiaries and service providers, with programming designed to avoid any interventions that can increase the risk of harm or raise LGBTQI+ groups’ public profile in a way that could lead to backlash. Additionally, special emphasis must be placed on the safeguarding of beneficiaries’ and their service providers’ personal identification information. “Do nothing about them without them” requires the engagement of all beneficiaries throughout the entire process, from design to implementation and evaluation of the interventions.
• Partnership and leverage 
  • Effective partnership and leverage will be pivotal to the success of the two activities. To achieve the activities’ goal, the prime recipients must harness the assets of former USAID KP programming and explore collaboration opportunities with other national and international stakeholders. This entails fostering robust partnerships with various USAID projects (such as Ending AIDS in West Africa (EAWA), Meeting Targets and Maintaining HIV Epidemic Control (EpiC), Community-led Monitoring Activities, PSM, FTO, PROPEL Health, and Expand PF, KP associations and networks, as well as other main national stakeholders including National AIDS Commission, National AIDS Control Program, UNAIDS, GFATM, law enforcement, religious and community leaders, and civil society organizations (CSOs).
• Best practices sharing and scale-up 
  • The two activities aim to accelerate progress in controlling the HIV epidemic among KP at the national level. This goal cannot be achieved without scaling up best practices nationwide. While the activities will focus on PEPFAR-supported regions, close collaboration with the Ministry of Health and other stakeholders must be developed to scale up best practices nationally to have greater national impact.
• Localization and sustainability 
  • The two activities align with USAID’s commitment to advancing the localization initiative and PEPFAR’s transition to local partners, aiming to enhance the sustainability of the HIV response. Emphasis must be placed on ensuring local ownership of interventions, strengthening the capacity of other local actors, and mobilizing domestic resources and facilitating policy changes for sustainability.
• Resilience 
  • Given the context of increasing homophobia and insecurity, the prime recipient should design differentiated and adaptive approaches based on the security levels in each supported region/district. Implementation strategies must be flexible and adjusted according to the evolving local context to ensure effectiveness.
• Collaborating, Learning, and Adapting (CLA) 
  • The adoption of a dynamic Collaborating, Learning, and Adapting (CLA) approach is critical for the success of the two activities. Implementing a robust CLA framework must enhance local learning and adaptability, contributing to a more sustainable HIV response.

Expected Results and Illustrative Interventions

• Objective 1
  • Intermediate Result (IR) 1.1 – Capacity of healthcare workers including community health care workers, is strengthened. 
    • Healthcare workers, including community healthcare workers, undergo training and receive necessary equipment to deliver high-quality integrated HIV services tailored to the needs of KP.
    • Illustrative activities 
      • Train healthcare workers in providing differentiated services for KP: including, but not limited to index testing, self-testing, EPOA, PrEP, PEP, effective referral system, motivational counseling, individual case management, U-U messaging, viral load management, data use for decision making.
      • Provide supportive supervision, coaching and mentorship support.
      • Strengthen organization of PEPFAR supported sites to provide good quality services.
  • Intermediate Result (IR) 1.2 – Differentiated and integrated HIV prevention, care, and treatment services are provided to KP at community and facility levels.
    • Comprehensive HIV services are available for KP at all supported sites, offering state-of-the-art care that covers the entire clinical cascade while prioritizing the safety and security of both KP and healthcare workers. These services are designed to be flexible and adaptable, accommodating the evolving security status in each supported region or district.
    • Illustrative activities 
      • Engage KP in size estimation, hotspots mapping, and program planning.
        • Establish trusted contact and partnerships with KP leaders. Page 10 of 65
        • Conduct hotspots mapping and venue based programmatic size estimation.
        • Plan the program in close collaboration with KP community members.
      • Offer differentiated peer Outreach. 
        • Recruit peer outreach workers.
        • Train peer outreach workers
        • Implement and manage differentiated and innovative peer outreach including going-online services and enhanced peer outreach.
      • Provide comprehensive clinical Services. 
        • Provide combined HIV, hepatitis and STI prevention services.
          • Promote the use of condoms and lubricants.
          • Provide pre-exposure prophylaxis (PrEP) for HIV
          • Provide post-exposure prophylaxis (PEP) for HIV and STIs
          • Provide prevention of vertical transmission of HIV, syphilis, and HBV
          • Promote hepatitis B vaccination.
        • Provide differentiated HIV testing.
          • Offer differentiated HIV testing at community and health facility level: index testing, self testing, EPOA coupled with HIV testing, risk network testing, Drop-in Center testing, testing coupled with PrEP initiation and continuation.
          • Offer diagnostic testing and treatment of other STI and hepatitis B and C.
        • Care and treatment services.
          • Provide differentiated HIV care and treatment including peer navigation, same day ART initiation, individual case management, community and multi-month ARV dispensing, U=U messaging, treatment literacy, electronic patient tracking for continuity of treatment and viral load testing and suppression.
          • Provide TB screening, prevention and treatment.
          • Provide STI, Hepatitis B and hepatitis C diagnosis and treatment.
  • Intermediate Result (IR) 1.3 – Synergies are developed with other health programs to ensure access for KP (family planning, Tuberculosis, Hepatitis B and C, non-communicable disease) 
    • To ensure access for KP to various health programs, effective referral systems are established, encompassing services for family planning, tuberculosis, hepatitis B and C, and non-communicable diseases. Additionally, where feasible, integrated “one-stop” service points are developed to streamline access to multiple healthcare services.
    • Illustrative activities 
      • Conduct a mapping of existing health programs that can assist to meet all the needs of KP for a comprehensive package of services.
      • Develop partnerships with those programs.
      • Establish an effective referral system with those programs and ensure they provide disaggregated data by sex, age, type of key population, and geographical distribution, facilitating effective referrals and monitoring.
  • Intermediate Result (IR) 1.4– MoH is supported to scale up best practices regarding services for KP. PEPFAR-supported sites implement best practices that are then scaled up nationally by the Ministry of Health (MoH). 
    • Additionally, periodic events are organized to facilitate the sharing of best practices between PEPFAR-supported sites and those not supported by PEPFAR, to include policy development relevant to KP programming.
    • Illustrative activities 
      • Conduct joint quarterly supervision with MoH and GFATM prime recipients.
      • Organize a bi-annual best practices on HIV services for KP.
      • Provide technical assistance in policy development regarding KP programming.
• Objective 2
  • Intermediate Result (IR) 2.1 –KP communities are empowered. 
    • Following the principles of “do nothing about them without them,” key populations (KPs) are empowered and engaged in the design, implementation, monitoring, and evaluation of activities. The USAID-funded CBO Cap activity is utilized to enhance the organizational capacity of KP-led associations.
    • Illustrative activities 
      • Engage KP associations/networks in the design, implementation, monitoring, and evaluation of the activities.
      • Conduct group discussion with KP on self-esteem and gender-based violence prevention and care.
      • Train CSOs including KP-led associations on HIV, Human Rights, sexual and reproductive rights, and stigma & discrimination.
      • Leverage CBO Cap activity to strengthen organizational capacity of KP-led associations.
    • Key population groups should be engaged in the selection process for identifying which groups to empower, ensuring their needs and preferences are considered. Empowerment activities should consider the diversity within key populations, addressing the unique needs and challenges of different subgroups (MSM, FSW, TG, youth etc.).
  • Intermediate Result (IR) 2.2 –Structural barriers that fuel stigma, discrimination, and violence against KP and PLHIV are addressed. 
    • Structural barriers contributing to stigma and discrimination are addressed. Healthcare workers, including community healthcare workers, receive training to provide stigma and discrimination-free services. Religious leaders and law enforcement personnel are sensitized to create an enabling environment. Findings from community-led monitoring are utilized to track cases of stigma and discrimination at healthcare settings and implement corrective actions.
    • Illustrative activities 
      • Identify, design, and implement strategies to prevent and respond to violence against KP and PLHIV.
      • Conduct a gender assessment and develop a comprehensive gender action plan for effective implementation.
      • Implement strategies to reduce stigma in healthcare settings.
      • Support KP associations to improve awareness of community and religious leaders and law enforcement personnel.
      • Leverage CLM activities to monitor stigma and discrimination cases at supported sites and provide corrective actions.
• Objective 3 
  • Intermediate Result (IR) 3.1 – Enhanced KP data quality and data use, and strategic information related to KPs. 
    • Quality of national KP cascade data increased. KP programmatic and strategic data are strengthened and used for decision-making. The Unique Identifier Code (UIC) system should be implemented to ensure anonymity and safety of individuals accessing services. The program data should be disaggregated by sex, age, type of key population, and geographic distribution to identify gaps.
    • Illustrative activities 
      • Coach healthcare workers on e-tracker updates and use for decision making.
      • Implement data quality assurance and improvement activities.
      • Provide technical assistance to MoH during KP Integrated biological and behavioral surveillance survey (IBBSS) and size estimation.
      • Conduct relevant operational research to improve quality of services for key populations.
  • Intermediate Result (IR) 3.2 – Enhanced local ownership and domestic resource mobilization for KP programming. 
    • National ownership of KP programming is strengthened and domestic resources allocated to KP programming increased.
    • Illustrative activities 
      • Support KP-led associations in development of domestic resource mobilization plans, including social enterprise initiatives.
      • Advocate for increased domestic resources for KP programming.
    • Local resources mobilized should be disaggregated by the type of key population supported, ensuring transparency and accountability in resource allocation.
  • Intermediate Result (IR) 3.3 – Enhanced climate change awareness and environmental compliance. 
    • All supported sites also comply with environmental requirements and healthcare workers are sensitized on climate change risk, and mitigation actions are put in place.
    • Illustrative activities 
      • Develop and implement an environmental mitigation and monitoring plan (EMMP).
      • Train healthcare workers on medical waste management and infection prevention and control
      • Train healthcare workers on climate change effect mitigation.

Target Populations 

• In continuation of USAID’s prior efforts aimed at improving access to HIV services for MSM and FSW and considering the constraints of limited funding and the HIV epidemic context in Togo and Burkina Faso, the current activities will primarily prioritize MSM, FSW, transgender people, and their sexual partners. Major gaps remain in these KP. Other KP will continue to be covered by the GFATM, and the Governments of Burkina Faso and Togo programs.
• The two activities will secondarily target healthcare workers including community healthcare workers, as well as KP associations and networks, local community leaders, religious leaders, law enforcement officials, and policymakers.

Geographic Coverage 

• The two activities are PEPFAR funded and will be implemented at PEPFAR-supported regions. Currently, in Togo, PEPFAR supported regions encompass Grand Lomé, Maritime, Plateaux, and Centrale, while in Burkina Faso, they include Centre, Centre Ouest, Hauts Bassins, Boucle du Mouhoun, and Centre Nord. These targeted regions may undergo modifications during the implementation, influenced by the evolving local context and requests from the Governments of Togo and Burkina Faso.

Eligibility Criteria

• Eligibility for this NOFO is restricted to local entities in Togo, subject to the terms and conditions mentioned in the NOFO. Local entities are defined in ADS 303.6(b) as follows: For the purposes of this section, local entity means an individual, a corporation, a nonprofit organization, or another body of persons that—
  • is legally organized under the laws of,
  • has as its principal place of business or operations in,
  • is majority owned by individuals who are citizens or lawful permanent
  • residents of, and
  • managed by a governing body the majority of who are citizens or lawful
  • permanent residents of a country receiving assistance from funds appropriated under
  • title III of this Act.
• Only Togo Non-US organizations may participate under this NOFO, subject to terms and conditions mentioned in the NOFO.
• For-profit applicants must note that USAID policy prohibits the payment of fee/profit for recipients under assistance instruments. Forgone profit does not qualify as cost-share or leverage.
• USAID welcomes applications from organizations that have not previously received financial assistance from USAID.

For more information, visit Grants.gov.