[Federal Register Volume 60, Number 6 (Tuesday, January 10, 1995)]
[Notices]
[Pages 2606-2609]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-570]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Ryan White Title IV; Grants for Coordinated HIV Services and 
Access to Research for Children, Youth, Women, and Families

AGENCY: Health Resources and Services Administration (HRSA), PHS.

ACTION: Notice of availability of funds.

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SUMMARY: The Maternal and Child Health Bureau (MCHB), HRSA, announces 
that fiscal year (FY) 1995 funds are available for grants for projects 
that develop and support the provision of coordinated comprehensive 
services and enhance access to clinical research trials and other 
research activities for children, youth, women and families infected/
affected by the Human Immunodeficiency Virus (HIV). Projects will be 
funded to implement innovative models of family-centered, community-
based coordinated care and research for children, youth, women, and 
families infected/affected by HIV, or those at risk for developing 
infection. Funds were appropriated for this purpose under Section 2671 
of the Public Health Service Act [as enacted by Title IV of the Ryan 
White Comprehensive AIDS Resource Emergency (CARE) Act of 1990, Public 
Law 101-381 (42 U.S.C. 300ff-11 et seq.)].
    The PHS is committed to achieving the health promotion and disease 
prevention objectives of Healthy People 2000, a PHS national activity 
for setting priority areas. Title IV directly addresses the Healthy 
People 2000 objectives related to the priority area of HIV infection. 
Potential applicants may obtain a copy of Healthy People 2000 (Full 
Report; Stock Number 017-001-00474-0) or Healthy People 2000 (Summary 
Report: Stock No. 017-001-00473-1) through the Superintendent of 
Documents, Government Printing Office, Washington, D.C. 20402-9325 
(telephone 202 783-3238).
    The PHS strongly encourages all grant recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products. 
This is consistent with the PHS mission to protect and advance the 
physical and mental health of the American people.

ADDRESSES: Grant applications for the HIV Program for Children, Youth, 
Women, and Families (PHS form #5161-1, approved under OMB #0937-0189) 
must be obtained from and submitted to: Chief, Grants Management 
Branch, Office of Program Support, Maternal and Child Health Bureau, 
Health Resources and Services Administration, Room 18-12, Parklawn 
Building, 5600 Fishers Lane, Rockville, Maryland 20857, (301) 443-1440.

DATES: The application deadline date is April 7, 1995. Competing 
applications will be considered to be on time if they are:
    (1) Received on or before the deadline date, or
    (2) Postmarked on or before the deadline date and received in time 
for orderly processing.
    As proof of timely mailing, applicants should obtain a legibly 
dated receipt from the commercial carrier or the U.S. Postal Service; 
private metered postmarks will not be accepted as proof of timely 
mailing.
    Late applications not accepted for processing or those sent to an 
address other than specified in the ADDRESSES section will be returned 
to the applicant.
    Applicants will be notified of grant awards in July 1995. The 
starting dates for projects will be specified in the program guidance.

FOR FURTHER INFORMATION CONTACT: Additional information regarding 
technical and program issues may be obtained from: Beth D. Roy, 
Division of Services for Children with Special Health Needs, Maternal 
and Child Health Bureau, Health Resources and Services Administration, 
Room 18A-19, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 
20857, telephone (301) 443-9051. Requests for information concerning 
business management issues should be directed to: Dorothy Kelley, 
Acting Grants Management Officer (GMO), Maternal and Child Health 
Bureau, at the address specified in the ADDRESSES section.

SUPPLEMENTARY INFORMATION

Program Background and Objectives

    The Pediatric AIDS Program was initiated in 1988. The program grew 
from 13 projects funded at $4.4 million to a total of 48 projects 
funded at $22 million in 1994. Since 1988, the program has evolved from 
a primary focus on the coordination of services for the management and 
care of infected children and their families to also address the 
broader prevention and care needs of youth and women infected/affected 
by HIV. In FY 1994, Congress funded the Pediatric AIDS Program under 
section 2671 of the Public Health Service Act (Title IV of the Ryan 
White Comprehensive AIDS Resource Emergency (CARE) Act of 1990, Public 
Law 101-381). As a result of authorization under Title IV, the focus of 
the program was expanded to include the development of innovative 
models linking systems of comprehensive primary/community-based medical 
and social services with the National Institutes of Health (NIH) and 
other clinical research trials. Funds authorized under Title IV may be 
used to develop and support the provision of coordinated comprehensive 
services and enhance access to clinical research trials and other 
research activities, for children, youth, women, and families infected/
affected by HIV.
    Last year, published results from a NIH clinical trial (ACTG 076) 
demonstrated the potential for reducing perinatal transmission by two-
thirds when pregnant HIV-infected women were given AZT during pregnancy 
and at delivery, and the infants received AZT in the first weeks of 
life. In FY [[Page 2607]] 1995 in response to these findings, the 
program will further emphasize prevention and early intervention for 
women and the integration of HIV prevention and treatment into broader 
systems of primary care, including care systems supported under the 
Maternal and Child Health (MCH) Services Block Grant.

Purpose

    The purpose of Title IV funding is to improve and expand the 
coordination of a system of comprehensive care for children, youth, 
women, and families who are infected/affected by HIV and to link 
comprehensive care systems with clinical research and other research 
activities. Funds will be used to demonstrate potentially replicable 
models that: (1) cross established systems of care to coordinate 
service delivery, HIV prevention efforts, and clinical research and 
other research activities; and (2) address the barriers to 
comprehensive care experienced by children, youth, women, and families 
infected/affected by HIV.
    While children, youth, and women represent the most recently 
impacted and rapidly growing population groups affected by HIV, they 
also represent the groups facing the greatest barriers in accessing 
care and research. These groups are disproportionately members of 
communities of color with limited economic resources. Given these 
realities, children, youth, and women affected by HIV are confronted 
with a complex array of economic and social issues that increase their 
need for comprehensive services and increase the cost and intensity of 
care. Existing systems of care are often not prepared to respond to 
these needs and require targeted resources and interventions in order 
to develop infrastructures and provider capacities that would allow 
them to provide quality care to these populations.
    Given these unmet needs, activities under these grants should 
address the following goals:

--Foster the development and support of comprehensive care 
infrastructures, including primary care, that increase access to 
culturally competent, family-centered, community-based, coordinated 
care.
--Emphasize prevention within the comprehensive care system in order to 
reduce the spread of the HIV infection to vulnerable populations.
--Link comprehensive systems of care with HIV/AIDS clinical research 
trials and other research activities, resulting in increased access for 
children, youth, women, and their families.

Funding Category

    Applications which do not fall within this category will not be 
considered for funding.
    The HIV Program for Children, Youth, Women, and Families develops 
and supports innovative models that coordinate systems of comprehensive 
HIV care and that foster collaboration between clinical research 
institutions and family-centered primary/community-based medical and 
social service programs for children, youth, women and their families. 
Projects will focus on local capacity-building, making maximum use of 
all available public and private resources for reaching and providing 
health care and supportive services to the target population. Projects 
should strengthen existing comprehensive care infrastructures by: (1) 
broadening the coalition of agencies, providers, community 
organizations and families which participate in the identification of 
needs, services planning, the coordination and delivery of services, 
and the financing of services for HIV affected populations; and (2) 
identifying and addressing systemic issues that affect provider 
collaboration and impact the provision of coordinated high quality 
comprehensive care.
    Preference for funding in this category will be given to projects 
which demonstrate an established model of a comprehensive and 
coordinated system of care that is culturally competent, family-
centered, and community-based. This means that these projects will be 
funded ahead of new groups of applications in this category.

Availability of Funds

    Approximately $4.8 million will be available for competitive 
grants. It is anticipated that a total of 13 grants will be awarded. 
Award amounts may range from $225,000 to $1 million, depending on need 
and scope of the project. Project periods for these grants will be 
three years.

Special Concerns

    The HIV Program for Children, Youth, Women, and Families grantees 
supported by HRSA should coordinate their projects with other Federal, 
State, and local programs concerned with HIV and/or serving the target 
population of children, youth, women and families affected by or at 
risk for HIV, particularly: Title V Maternal and Child Health programs; 
Ryan White Titles I, II and III programs; providers funded by the 
Substance Abuse and Mental Health Services Administration; the Health 
Resources and Services Administration, the Centers for Disease Control 
prevention efforts; and clinical trials funded by NIH or other sources.
    Recognizing the growing impact of HIV on women and communities of 
color, MCHB places special emphasis on improving service delivery to 
women, children and youth from communities with limited access to 
comprehensive care. Furthermore, in order to assure access and cultural 
competence, it is expected that projects will involve individuals from 
the populations to be served in the planning and implementation of the 
project. The Bureau's intent is to ensure that project interventions 
are responsive to the cultural and linguistic needs of special 
populations, that services are accessible to consumers, and that the 
broadest possible representation of culturally distinct and 
historically underrepresented groups is supported through programs and 
projects sponsored by the MCHB.
    Applications will be reviewed with particular attention to 
inclusion of women and persons from culturally distinct populations. 
Funding will be provided to those which, in the Department's view, best 
meet the statutory purposes of the HIV Program for Children, Youth, 
Women, and Families and address achievement of the Healthy People 2000 
objectives related to HIV infection.

Review Criteria

    Applications for grants will be reviewed and rated by objective 
review panels according to the following criteria:

--Adequacy of needs assessment documenting:

    (1) The impact of HIV on children, youth, women, and families in 
the service area;
    (2) Key socio-demographic factors of the Title IV targeted 
populations;
    (3) Barriers to care experienced by the targeted populations;
    (4) Strengths and weaknesses of the existing care systems (MCH, 
primary care, and HIV care), and the impact of these weaknesses on the 
provision of comprehensive HIV care;
    (5) The capacity of local HIV programs to provide comprehensive 
care to the targeted populations; and
    (6) Collaboration with existing local, State, or Federal efforts to 
document the HIV needs of the service area.

--Adequacy of efforts to incorporate within governing bodies, policy, 
and program committees the substantive involvement of persons receiving 
services; adequacy of efforts to obtain input and involve consumers in 
program needs assessments, and the definition of program policy. 
[[Page 2608]] 
--Ability to demonstrate the capacity to coordinate and support a 
comprehensive system of family-centered, community-based, coordinated 
care by documenting:

    (1) service linkages to agencies/organizations providing primary 
care, HIV care, MCH programs, and tertiary care;
    (2) the ability to establish linkages with planning bodies and 
community coalitions involved in the provision of HIV services and 
women's health care services within the proposed catchment area (e.g., 
State Title V agencies, other Ryan White Programs, and Healthy Start 
agencies);
    (3) expertise in providing family centered, coordinated care and 
the ability to support other providers in the provision of such care; 
and
    (4) the organizational structure and staffing necessary to 
implement proposed goals and objectives.

--Adequacy of efforts to identify and address the needs unique to the 
racial/ethnic minority populations infected/affected with HIV within 
the proposed project area, by documenting:

    (1) the social and cultural issues unique to the racial/ethnic 
minority populations infected/affected with HIV within the proposed 
project area, that impact outreach, prevention, and the receipt of 
care;
    (2) the existing provider capacity for conducting outreach and 
prevention activities, and to provide services in a manner that 
acknowledges the social and cultural issues that impact the provision 
and receipt of care to these populations;
    (3) a plan to conduct outreach and prevention and provide HIV 
services that: enhances racial/ethnic minority access to care; 
acknowledges the social and cultural issues that impact the provision 
of care; and supports the receipt of ongoing care.

--Adequacy of efforts to develop linkages which facilitate access to 
clinical trials and other research activities.
--Consistency of the plan with the goals of the Title IV program and 
the extent to which the plan addresses issues identified in the needs 
assessment; clearly defined, time framed goals and objectives for the 
grant period.
--Adequacy of the strategy and proposed steps to utilize and report 
data and evaluation for program planning and management, as well as for 
measuring the efficacy and effectiveness of the program.
--Adequacy of the proposed budget; budget justification based on 
project methodology and required resources.
--The extent to which the application is responsive to the special 
concerns and program priorities specified in this notice.
--Demonstration of an organized, comprehensive system of care, and for 
competing renewal applicants, progress in meeting the goals of the 
current project period will be assessed.

Eligible Applicants

    Grants may be awarded to public or nonprofit private entities that 
provide or arrange for primary health care. Eligible entities may 
include, but are not limited to, State or local health departments, 
university medical centers, public or nonprofit private hospitals, 
community health centers (as defined in section 330(a) of the Act), 
hemophilia treatment centers, drug abuse treatment agencies, tribal 
health programs, school based clinics and institutions of higher 
education.

Allowable Costs

    The MCHB may support reasonable and necessary costs of HIV Project 
grants within the scope of approved projects. Allowable costs may 
include salaries, equipment and supplies, travel, contractual, 
consultants, and others, as well as indirect costs. The MCHB adheres to 
administrative standards reflected in the Code of Federal Regulation 45 
CFR Part 92 and 45 CFR Part 74. All other sources of funding to support 
this project must be accurately reflected in the applicant's budget.

Reporting Requirements

    A successful applicant under this notice will submit reports in 
accordance with the provisions of the general regulations which apply 
under 45 CFR Part 74, Subpart J, Monitoring and Reporting of Program 
Performance, with the exception of State and local governments to which 
45 CFR Part 92, Subpart C reporting requirements will apply. Financial 
reporting will be required in accordance with 45 CFR Part 74, Subpart 
H, with the exception of State and local governments, to which 45 CFR 
Part 92.20 will apply.

Public Health System Reporting Requirements

    This program is subject to the Public Health System Reporting 
Requirements (approved under OMB No. 0937-0195). Under these 
requirements, the community-based nongovernmental applicant must 
prepare and submit a Public Health System Impact Statement (PHSIS). The 
PHSIS is intended to provide information to State and local health 
officials to keep them apprised of proposed health services grant 
applications submitted by community-based nongovernmental organizations 
within their jurisdictions.
    Community-based nongovernmental applicants are required to submit 
the following information to the head of the appropriate State and 
local health agencies in the area(s) to be impacted no later than the 
Federal application receipt due date:
    (a) A copy of the face page of the application (SF 5161).
    (b) A summary of the project (PHSIS), not to exceed one page, which 
provides:
    (1) A description of the population to be served.
    (2) A summary of the services to be provided.
    (3) A description of the coordination planned with the appropriate 
State and local health agencies.

Executive Order 12372

    The HIV Program for Children, Youth, Women, and Families has been 
determined to be a program which is subject to the provisions of 
Executive Order 12372 concerning intergovernmental review of Federal 
programs by appropriate health planning agencies, as implemented by 45 
CFR part 100. Executive Order 12372 allows States the option of setting 
up a system for reviewing applications from within their States for 
assistance under certain Federal programs. The application packages to 
be made available under this notice (Form PHS 5161-1 with revised face 
sheet HHS Form 424 and with Program Narrative and Checklist approved 
under OMB 0937-0189) will contain a listing of States which have chosen 
to set up such a review system and will provide a single point of 
contact (SPOC) in the States for review. Applicants (other than 
federally-recognized Indian tribal governments) should contact their 
State SPOCs as early as possible to alert them to the prospective 
applications and receive any necessary instructions on the State 
process. For proposed projects serving more than one State, the 
applicant is advised to contact the SPOC of each affected State. The 
due date for State process recommendations is 60 days after the 
application deadline for new and competing awards. The granting agency 
does not guarantee to ``accommodate or explain'' State process 
recommendations it receives after that date. (See Part 148, 
Intergovernmental Review of PHS Programs under Executive Order 12372 
and 45 CFR Part [[Page 2609]] 100 for a description of the review 
process and requirements.)

(The OMB Catalog of Federal Domestic Assistance number for the HIV 
Program for Children, Youth, Women, and Families is 93.153.)

    Dated: January 5, 1995.
Ciro V. Sumaya,
Administrator.
[FR Doc. 95-570 Filed 1-9-95; 8:45 am]
BILLING CODE 4160-15-P