USAID Sustaining Epidemic Control through Unified Prevention (SECURE) Activity – Lesotho

Deadline: 15-Mar-2024

The United States Agency for International Development Mission to Southern Africa seeks applications from qualified entities to implement a five-year activity entitled USAID Sustaining Epidemic Control through Unified Prevention (SECURE) Activity.

The purpose of the USAID Sustaining Epidemic Control through Unified prevention (SECURE) Activity is to reach the general population and key populations (KP) with person-centered, evidence-based biomedical HIV prevention, testing, and treatment services. Building upon USAID’s investments in HIV prevention through the Khanya Project for scale-up of voluntary medical male circumcision (VMMC) and Pre-Exposure Prophylaxis (PrEP) Services in Lesotho and the Meeting Targets and Maintaining Epidemic Control (EpiC) Project, SECURE will address targeted HIV prevention, case finding, and treatment gaps and facilitate a sustained, equitable national HIV response for all populations, including key populations

Program Goals, Objectives, and Intermediate Results

• The overall goal of USAID SECURE is to prevent, detect, and respond to new HIV infections through unified approaches to prevention and strengthened community systems to advance the GOL’s commitment to improve access to combination prevention services for people at risk of acquiring HIV.
• USAID SECURE has three interrelated objectives to strengthen community-based services to ensure they meet the needs of clients, their families, and communities.
  • Objective 1: Improve uptake of combination HIV prevention services according to the needs and life stages of people.
  • Objective 2: Improve effective coverage of non-discriminatory, person-centered, integrated services across the continuum of care.
  • Objective 3: Bolster resilient community systems that sustain quality HIV prevention services.
• Intermediate Result 1: Improve uptake of combination HIV prevention services according to the needs and life stages of people (Creating demand for HIV prevention services)
  • Activities under this intermediate result should intensify and take to scale proven interventions that increase uptake of combination HIV prevention services. Interventions should address individual level, community level, and facility level factors (self-efficacy, personal beliefs and attitudes, peer and community relationships, and client-provider interaction) through promising and proven social and behavior change (SBC) approaches.
    • Sub-Intermediate Result 1.1: Increased health seeking behaviors through customized, contextualized peer[1]led approaches to identify and address barriers to uptake of services using SBC approaches.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Carry out formative research to identify emotional drivers, cultural and social barriers to uptake of services, and identify successful approaches to scale-up.
        • Improve prevention and treatment literacy levels, including Undetectable equals Untransimisable (U=U) messaging, particularly in the youth and young adults who, as a population, have lower HIV literacy.
    • Sub-Intermediate Result 1.2: Enabling environment built to address harmful social norms and relevant structural barriers.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Engage with civil society organizations (CSO) at the community level to promote the provision of services in safe, non-discriminatory spaces.
        • Prevent and respond to gender-based violence, including through KP community-based violence mechanisms and delivery of transformative social and behavior change.
    • Sub-Intermediate Result 1.3: Increased access to expanded choices for high impact, person-centered interventions.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Conduct voluntary medical male circumcision as per the World Health Organization (WHO), MOH and PEPFAR standards.
        • Ensure accessibility of ARV-based prevention options, including new prevention products (e.g., dapivirine vaginal ring, long-acting cabotegravir, etc.) as they become available.
    • Outcome indicators for IR 1 may include:
      • Number of individuals who were newly enrolled on pre-exposure prophylaxis (PrEP) to prevent HIV infection in the reporting period.
      • Number of individuals, excluding those newly enrolled, that return for a follow-up visit or re-initiation visit to receive pre-exposure prophylaxis (PrEP) to prevent HIV during the reporting period.
• Intermediate Result 2: Improve effective coverage of non-discriminatory, client-centered, integrated services across the continuum of care (Supply of HIV prevention interventions)
  • The activities within this intermediate result should seek to broaden the reach of inclusive and client-centered HIV services, including among key populations. Activities under this intermediate result include provision of biomedical prevention services, standardizing community-based care, and enhancing quality of services while addressing stigma and discrimination.
    • Sub-Intermediate Result 2.1: Target populations reached with combination evidence-based HIV biomedical prevention services (e.g. VMMC, PrEP, HTS, PEP, ART for KP, etc.)
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Target case-finding approaches to quickly identify new HIV cases among key populations and facilitate rapid linkage to care.
        • Operationalize and improve functional one-stop-shop models (i.e., men’s corners + drop-in centers for key populations).
    • Sub-Intermediate Result 2.2: Community-based, combination HIV prevention reinforced as the standard of care in existing primary health care structures.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Use community-based approaches to provide person-centered differentiated service delivery (DSD) models to meet needs of populations where they are.
        • Standardize and institutionalize DSD, MMD, and community based-service delivery models, including integrated digital systems for well-coordinated care.
    • Sub-Intermediate Result 2.3: Quality of care and client experience improved by addressing stigma and discrimination.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Conduct integrated prevention quality improvement activities and assessments.
        • Ensure systems for KP to provide feedback on quality and perception of the full range of services to assure that provider interactions and facility systems are not barriers to continuity of treatment, and link to existing community-led monitoring (CLM) efforts.
    • Outcome indicators for IR 2 may include:
      • Number of individuals reached with Demand creation interventions.
      • Percent of KPLHIV aware of their HIV sero-status
• Intermediate Result 3: Bolster resilient community systems that sustain quality HIV prevention services
  • The activities within this intermediate result seek to reinforce community systems and District Health Management Team (DHMT)-level structures that can sustain high quality combination HIV prevention services and respond to other global health security threats.
    • Sub-Intermediate Result 3.1: Advanced local data use and decision-making to drive precision prevention interventions.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Build capacity with local decision-makers in coordinating how activities are integrated and targeted for impact.
        • Leverage existing health information systems to develop prevention dashboards for visualizing subnational prevention coverage and gaps.
    • Sub-Intermediate Result 3.2: A culture of accountability established for enhanced health outcomes at all levels.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Bolster strategic oversight and stewardship within community systems and DHMT-level structures for HIV prevention and key population programming.
        • Increase community participation and leadership in health decision-making forums and working groups (at all levels) to ensure client perspectives on quality of health services are effectively incorporated in planning and priority setting discussions.
    • Sub-Intermediate Result 3.3: Approaches to peer-led models harmonized within existing community structures.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Strengthen micro-planning activities for improved hot spot mapping and increased reach of KP.
        • Work through existing structures and institutions to take successful approaches to scale.
    • Sub-Intermediate Result 3.4: Adaptable models established to maintain essential health services in the face of shocks and stressors to the health system.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Integrate sustainable, low-cost technology solutions to support and connect prevention services and clients (e.g. telemedicine).
        • Leverage digital platforms and mobile technology solutions to deliver HIV prevention messages and services, especially to reach populations in hard-to-reach areas. Selected technologies should be interoperable with existing MOH digital platforms such as DHIS2 and e-register and should be in line with the Government’s vision for digital community health systems that are inter-operable and integrated.
    • Sub-intermediate Result 3.5: Support the MoH to provide strategic oversight and stewardship of HIV prevention and KP services.
      • Expected Activities may include the following: (these are not exhaustive, and the applicant is expected to define additional outcomes)
        • Support national and district level continuous quality improvement activities focused on the HIV prevention and KP program.
        • Provide technical assistance to support MOH’s ability to meaningfully engage KP communities, monitor KP performance data, and coordinate KP programming nationally.
    • Outcome indicators for IR 3 may include:
      • Percent improvement over baseline in the accuracy and completeness of individual-level data in the HIV prevention and KP registers and national DHIS2 database.
      • Percent increase over baseline in the electronic tracking and monitoring of client-level HIV care and treatment outcomes among key populations.

Funding Information

• USAID intends to provide $35 million in total funding over a five-year period.

Guiding Principles and Cross Cutting Approaches

• Social and Behavioral Change (SBC)
  • The SECURE Activity is expected to integrate customized, contextualized SBC approaches across the project objective areas. Interventions are expected to address attitudes, norms, and beliefs held at the individual, community level, and facility level that impact client[1]provider interactions. SBC approaches must clearly define the specific behaviors that underpin the health outcome; clarify the target populations for these behaviors and segments; collect data or use best available information from secondary sources on barriers and motivators; design and test SBC interventions (Communication, Human-Centered Design, Behavioral Economics, and Marketing) that address the identified behavioral determinants.
• Coordination, collaboration, and complementarity with existing institutions and activities
  • A successful activity will closely coordinate implementation of activities and technical assistance at all levels with other PEPFAR-funded programs, the Global Fund, and other bilateral and multilateral programs, including current initiatives as well as those that are anticipated to start during the life of project. In line with USAID’s localization agenda, the SECURE Activity is expected to advance local priorities by making sure that local voices are engaged, supported, and empowered.
• Non-discriminatory, human rights-based focus
  • The SECURE Activity should adopt an approach that places individuals and their inherent human rights at the center of its strategies. SECURE shall commit to providing gender responsive health and social services by addressing the unique and diverse identities, social contexts, and practical realities facing members of the key population and others.
• Collaborating, Learning, and Adapting (CLA)
  • The SECURE Activity should make CLA principles systematic and intentional throughout the program cycle to ensure continuous learning and enable programmatic adjustments in response to evolving circumstances.
• Gender Integration
  • The SECURE Activity should implement a gender-transformative approach8 by undertaking a multi-pronged strategy to address various levels of the socio-ecological model to tackle gender inequities. Male engagement as well as community involvement of relevant leaders including traditional and faith leaders should be an integral part of the gender strategy.

Geographic Focus

• The geographic scope of the activity is the Kingdom of Lesotho.
• A successful application should cover the following districts in their programming:
  • VMMC implementation in all ten (10) districts in Lesotho.
  • Community-based PrEP implementation in Maseru, Berea, Mafeteng, Mohale’s Hoek, and Mokhotlong districts (around Polihali dam construction area).
  • KP services implementation in Maseru and Leribe districts.

Eligibility Criteria

• Eligibility for this NOFO is not restricted.
• Qualified applicants may be U.S. private voluntary organizations (U.S. PVOs) and/or U.S. or other non-U.S. non-governmental organizations (NGOs) or private, non-profit organizations (or for-profit companies willing to forego profits), including universities, research organizations, professional associations, and relevant special interest associations. Public International Organizations (PIOs) and faith-based and community organizations are also eligible for the award. In support of the Agency’s interest in fostering a larger assistance base and expanding the number and sustainability of development partners, USAID welcomes applications from organizations that have not previously received financial assistance from USAID. Organizations may submit applications individually or in partnership with other international or local organizations.
• Each applicant is limited to one application submission under this NOFO as the prime applicant. There is no limitation on being included as a potential sub-awardee in multiple applications submitted by other prime applicants. The use of exclusive teaming arrangements is discouraged. Applications from individuals will not be accepted.
• Applicants are strongly encouraged to promote involvement of “underutilized” partners and local organizations

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