Strengthen Capacity of South African Government's Department of Health and Implementing Partners to Deliver Quality Differentiated, Advanced Clinical Care (ACC) for Unstable HIV and TB/HIV Patients in the Republic of South Africa (SA) under PEPF | CDC RFA GH21 2122

Opportunity Information: Apply for CDC RFA GH21 2122

This funding opportunity, titled "Strengthen Capacity of South African Government's Department of Health and Implementing Partners to Deliver Quality Differentiated, Advanced Clinical Care (ACC) for Unstable HIV and TB/HIV Patients in the Republic of South Africa (SA) under PEPFAR," is a CDC cooperative agreement aimed at improving the clinical management of complicated HIV and TB/HIV cases in South Africa. It sits under the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), with CFDA number 93.067, and it was posted as a discretionary funding opportunity (Funding Opportunity Number: CDC RFA GH21 2122). Applications were due March 12, 2021, by 11:59 p.m. Eastern Time. Eligibility is listed as unrestricted, meaning a wide range of organizations could apply, subject to any additional eligibility clarifications in the full notice.

The program rationale is tied to persistent treatment challenges in South Africa's HIV response, particularly among patients who are clinically unstable or present with advanced disease. The notice highlights two major pressure points in the treatment cascade: first, an estimated 20 percent of people who newly start antiretroviral therapy (ART) are initiating late, which often corresponds with more advanced illness and higher short-term risk of severe outcomes; second, about 10 to 15 percent of patients on first-line ART are failing treatment. Together, these issues contribute to poorer retention in care, especially during the first 12 months after starting ART, a period when patients are particularly vulnerable to dropping out of treatment or experiencing complications. The opportunity is therefore oriented toward reducing morbidity and mortality while improving retention and viral load suppression, with a specific emphasis on the needs of people living with HIV who are unstable and those co-infected with TB/HIV.

The core strategy in the notice is capacity building for health service providers so that they can better recognize, triage, and manage complicated and unstable HIV and TB/HIV cases using differentiated, advanced clinical care (ACC) approaches. Rather than focusing only on direct service delivery, the NOFO emphasizes strengthening the ability of the South African Department of Health and implementing partners to deliver higher-quality clinical care through targeted skills transfer, mentorship, and systems for ongoing clinical support. The intent is to improve clinical decision-making and patient management for cases that go beyond routine HIV care, including patients with suspected or confirmed treatment failure, advanced disease, or complex co-morbidities such as tuberculosis.

The notice specifies that funded activities must include building in-country capacity through in-person and other innovative capacity-building approaches in ACC. In practice, this means structured training and mentorship models that can reach frontline facility-based staff while also creating sustainable local expertise. A key required element is a Train-the-Trainer approach, which is meant to develop a cadre of local clinical leaders who can continue training and mentoring others after the award period and reduce reliance on external experts over time. In addition, the NOFO calls for using existing virtual platforms and technological tools to provide technical assistance to facility-based staff on the management of complicated HIV and TB/HIV patients. This points to ongoing remote consultation and mentorship models (such as virtual case discussions, tele-mentoring, and digital decision-support approaches) to reinforce best practices, troubleshoot difficult cases, and standardize quality across facilities.

Expected outcomes focus on measurable improvements in clinical competency and service quality, rather than simply counting trainings delivered. The NOFO expects increased competencies among health workers to provide appropriate services for complicated HIV and TB/HIV patients, improved quality of ACC services delivered by providers who have received the training and technical support, and stronger referral practices for genotypic testing among eligible clients experiencing viral load failure. The emphasis on genotypic testing referrals reflects an intent to improve the identification and management of drug resistance and to ensure that patients failing first-line therapy are evaluated appropriately for regimen changes, which is directly connected to better viral suppression and reduced onward transmission risk.

From a funding standpoint, the NOFO notes that the award ceiling for Year 1 is listed as $0 (none), which typically signals that a specific per-award cap is not provided in the summary even though funding is expected. Despite that ceiling notation, CDC anticipated approximately $10,000,000 in total Fiscal Year funding for Year 1, contingent on the availability of funds, and the notice projected up to three awards. As a cooperative agreement, the instrument type also implies substantial CDC involvement during implementation, commonly including collaboration on technical direction, performance monitoring, and alignment with broader PEPFAR and national program priorities.

• The Department of Health and Human Services, Centers for Disease Control - CGH in the health sector is offering a public funding opportunity titled "Strengthen Capacity of South African Government's Department of Health and Implementing Partners to Deliver Quality Differentiated, Advanced Clinical Care (ACC) for Unstable HIV and TB/HIV Patients in the Republic of South Africa (SA) under PEPF" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.067.
• This funding opportunity was created on Jan 11, 2021.
• Applicants must submit their applications by Mar 12, 2021 Electronically submitted applications must be submitted no later than 1159 p.m., ET, on the listed application due date.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• The number of recipients for this funding is limited to 3 candidate(s).
• Eligible applicants include: Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled Additional Information on Eligibility.

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