STD/HIV/TB Section. Pre-Exposure Prophylaxis (PrEP) Project Grant. Request for Proposals. April 4, 2016

Transcription

1 STD/HIV/TB Section Pre-Exposure Prophylaxis (PrEP) Project Grant Request for Proposals April 4, 2016 Notice of Intent Due: April 20, 2016 at 4:30 p.m. (Required) Applications Due on Wednesday, May 4, 2016, at MDH by 4:30 p.m.

2 Table of Contents I. Introduction:... 1 At a glance PrEP Request for Proposals (RFP) timeline... 1 Background... 2 Purpose... 2 PrEP Minnesota Context... 2 Project Overview... 3 II. Scope of Work... 3 Pre-Exposure Prophylaxis... 3 Funding Availability... 4 Eligible Applicants... 4 Project Objectives... 5 RFP Tasks... 5 Target Population... 7 III. Proposal Submission Requirements... 8 RFP Timeline... 8 Pre-Proposal Conference call... 8 Notice of Intent... 8 Proposal Due Date... 9 Questions... 9 IV. Program Information Expectations of Applicants What MDH will do for you? Award Notification Disclaimer Conflicts of Interest Proposal Contents Disposition of Responses Sample Grant Contract Terms and Conditions V. Proposals Review and Selection Process Phase I Review Phase II Review Phase III Review Due Diligence Form VI. Proposal Evaluation Criteria and Selection Process Project Narrative Scoring Criteria Project Work Plan Narrative Scoring Criteria i

3 Project Evaluation Plan Scoring Criteria Project Budget Plan/Narrative Scoring Criteria Overall Assessment VII. Response Components of the Proposal Format and Style Requirements Response Content Developing the Proposal Project Description Narrative Project Work Plan Narrative Project Evaluation Budget Plan and Narrative FORMS Form A: Notice of Intent Form B. Application Checklist for Submission Form C: Applicant Information and certification Sheet Form D: Project Narrative Form E: Work Plan Form F: Evaluation Plan Form G: Budget Narrative & Allocations Form H: Due Diligence Form ii

4 PART I: Introduction At A Glance PrEP Request for Proposals Timeline RFP Publication Date on MDH Website April 4, 2016 RFP Issuance Date/ RFP Announcement date): April 4, 2016 Applicant Conference Calls April 19 and 20, 2016 Notice of Intent due April 20, 2016 Proposal Questions Accepted Though April 22, 2016 Submission of Full Proposals Due: May 4, 2016 Applicant Evaluation and Selections May 24, 2016 Announcement of funding Decisions: May 31, 2016 Grant Contract Negotiation begin: June 7, 2016 Grant Agreement Development Ends June 30, 2016 Grant Agreement Period Begins: July 1,

5 Background The human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) continues to be a persistent public health problem in Minnesota as is in the rest of the country. Since the Minnesota Department of Health (MDH) began collecting data on HIV/AIDS, the number of living cases has steadily increased. As of December 31, 2014 there were 7,988 persons believed to be living with HIV/AIDS in Minnesota. Of which 86% are men who have sex with men (MSM). The largest disparity within the males living with HIV/AIDS in Minnesota is African American MSM or MSM/injecting drug users at 74% of all cases. About 1,368 individuals are MSM of color living with HIV in Minnesota that includes Hispanics, American Indian, Asian/Pacific Islanders, African American, African born, and persons of multiple races. Also in the same year, there were 32 transgender persons living with HIV/AIDS in Minnesota. However, MDH epidemiologists believe that is an underestimate as they only recently added the current gender identity to the HIV surveillance adult case report form. Purpose The MDH is soliciting applications under this Request for Proposals (RFP) for the development, implementation, and evaluation of pre-exposure prophylaxis (PrEP) services for communities at the highest risk of HIV infection. The STD/HIV/TB Section within the Infectious Disease Epidemiology Prevention and Control Division of MDH, received grant funds from the Minnesota Department of Human Services (DHS) to expand PrEP programming in the state. PrEP is a highly effective risk reduction strategy for HIV-negative people at high risk for HIV infection. The population at highest risk include, MSM, transgender persons, and other populations with ongoing risk behaviors that puts them at substantial risk of acquiring HIV infection. The overall goal of PrEP is to prevent acquiring HIV infection when a person is exposed to the virus, by taking a pill that contains two HIV medications daily. PrEP in Minnesota Context In Minnesota, PrEP is currently prescribed at private and public clinics as a high impact HIV prevention for HIV negative persons who have medical insurance or can afford to pay. The fullextent to which PrEP is being utilized in Minnesota is unknown. There are three sites funded by MDH to implement PrEP services in the state. One program targets MSM, another focuses on prenatal services, and the other targets a diverse clientele. These programs are currently overwhelmed with clients seeking PrEP, which demonstrates there is potential to greatly increase the number of PrEP providers and consumers, as well as expand PrEP education in the state. The PrEP services are needed to reach individuals willing to use it, especially MSM, high risk heterosexuals, and transgender individuals who experience unique health inequities and other barriers in accessing adequate health care and other services. In addition, transgender individuals have a high prevalence of HIV and STDs and also experience isolation and lack of social services. Also, both MSM and transgender persons of color lack adequate culturally 2

6 sensitive health and social service providers within their communities. MSM of color are at disproportionate risk for HIV and other STDs. Project Overview Under this RFP, the MDH wants to expand PrEP services in the state as part of a comprehensive strategy to reduce new HIV infections. The program is intended for gay, bisexual, and other MSM including transgender persons and other heterosexual populations with ongoing risk behaviors that may lead to acquiring HIV infection. PrEP is taking a daily pill, a potent new risk reduction strategy for HIV negative persons that has been scientifically proven to work when taken as required. PrEP is recommended by the Center for Disease Control and Prevention (CDC) as part of the high impact prevention strategy that is aimed at reducing new HIV infections among these populations. MDH is seeking providers to design and implement PrEP programs for populations at the highest risk of HIV infection. These programs will include recruiting individuals at high risk, screening them for HIV infection and eligibility for PrEP, linking them to PrEP friendly providers and enrolling and engaging them into comprehensive PrEP Programs. All programmatic activities shall address the unique barriers within these communities and provide education about PrEP to potential clients and the community by having established successful relationships with these communities or partnering with culturally sensitive organizations and/or clinics. Potential applicants shall assure the provision of culturally sensitive and competent PrEP services to individuals who may benefit from PrEP therapy, and educate individuals and communities about PrEP services. PART II: Scope of Work Pre-Exposure Prophylaxis Pre-exposure prophylaxis consists of a pill that contains two antiretroviral medications that is taken daily by HIV-negative individuals in order reduce the risk of acquiring HIV infection. It has been scientifically proven to significantly reduce the risk of acquiring HIV. The medication was first approved by the U.S. Food and Drug Administration (FDA) for use as HIV treatment in 2004 and was later approved for use as PrEP in July Like any medication, adherence is key to efficacy. Risk-reduction counseling is also an important component of an effective PrEP program. When taken as directed, PrEP is greater than 90% effective at preventing HIV. The overall goal of PrEP is to prevent acquiring HIV infection when a person is exposed to the virus. Federal PrEP guidelines were released on May 14, 2014 by the US Public Health Service. These guidelines provides clear criteria for determining a person s HIV risk and indications for PrEP utilization. It requires that individuals receive HIV testing to confirm negative status before starting PrEP. These guidelines also emphasizes the importance of counseling about adherence 3

7 and HIV risk reduction, including encouraging condom use for additional protection. The recommendations also include, regular monitoring of HIV infection status, medication side effects, and adherence to treatment and sexual or injection risk behaviors. It also encourages providers to supplement with additional educational materials and tools for use when prescribing PrEP. The guidelines recommends daily oral PrEP as one prevention option for sexually active adult men who have sex with other men at substantial risk for HIV, adult heterosexually active men and women at substantial risk for HIV, adult injection drug users at substantial risk for HIV and should be discussed with heterosexually active partners of persons living with HIV in relation to conception and pregnancy. Resource links for PrEP: Funding Availability There is an estimated total award amount of four hundred thousand dollars ($400,000) annually for three years for a one-time competitive grant for PrEP programming. The MDH intends to fund between three to five PrEP projects. The average amount to be awarded is estimated to be $80,000 - $100,000 annually per project but actual awards will be determined based on availability of funds at the conclusion of the RFP process. The funding cycle for this program announcement begins on July 1, 2016 and ends on June 30, Eligible Applicants Eligible applicants shall include: clinics, non-profit healthcare facilities, local public health departments clinics, and any public or private non-profit agency that can meet #1 and #2, of the following criteria: 1. Is currently providing or has provided at least one of the following in the past five years: a) HIV testing; b) HIV health education and risk reduction programming; c) services for people living with HIV/AIDS; or, d) PrEP services to one or more of the high risk populations outlined in this RFP; and, 2. Is currently serving or expect to serve at least 75 percent of clients from the high risk populations outlined in this RFP; and, In addition, clinic sites must meet one of the following: 4

8 3. Currently prescribes PrEP and/or provides other HIV/STD prevention screening and testing services; or, 4. Is willing to prescribe PrEP and provide continued assessment of PrEP utilization within their services. Project Objectives The overall goal of PrEP is to prevent as many new HIV infections as possible. Organizations/clinics applying for this RFP should propose to develop an innovative and comprehensive program that will reach high risk populations and communities impacted by HIV infection. There are four primary objectives of the PrEP project: 1. To implement PrEP risk reduction strategies to reduce the number of new HIV infections among MSM, transgender persons, injecting drug users and others at high risk for HIV infection, particularly persons of color; 2. To increase the number of MSM, transgender persons, injecting drug users, and others at high risk for HIV infection, particularly persons of color that are prescribed PrEP therapy; 3. To increase the number of MSM, transgender persons, injecting drug users and others at high risk for HIV infection that are requesting PrEP for HIV prevention by raising awareness of the efficacy and benefits of PrEP; and, 4. To integrate PrEP into all HIV prevention activities within the agency. PrEP Tasks For clinic-based sites providing health care to high risk population for HIV infection. Clinic-based sites are defined as facilities that provide medical services and can prescribe PrEP, monitor persons on PrEP and are serving members of the proposed target population. Clinical sites will promote, recruit, counsel, and monitor clients enrolled in PrEP and may have insurance navigators. The clinic staff will prescribe PrEP medication and conduct the HIV and STD testing that is an integral part of monitoring a client s PrEP adherence. Clinic staff will conduct preliminary (for those that have not tested for HIV) and/or confirmatory HIV tests to assure an individual is not HIV positive. Further risk assessment information will be generated to determine if the person is a good candidate for PrEP. Those that are eligible will be enrolled in the clinic s PrEP program. Some tasks for clinical sites include but are not limited to: Conduct risk assessment to identify persons at risk for HIV infection, particularly those with ongoing substantial HIV risk. Identify potential individuals from clients and educate them about PrEP. Conduct Pre-prescription assessment: Screen for HIV, STD, mental health issues, drug use, domestic violence, trauma, and other risk factors and barriers. Is non-occupational postexposure prophylaxis (npep) indicated by the client? 5

9 Reach interested individuals to be prescribed PrEP, if not insured, assist them in getting medical insurance and finding other cost payment options available. Continued engagement and retention in PrEP services and other support services (e.g., case management, housing, mental health, chemical dependency counseling, peer support groups, health literacy and education, etc.) as needed. Support individuals to achieve and maintain medication adherence. Conduct regular HIV/STI testing as recommended and re-evaluate other risk factors. Monitor and evaluate the implementation and impact of the PrEP project. For Community-based-organizations Community-based-organizations (CBOs) are defined as agencies conducting HIV testing but do not have the capacity to prescribe PrEP and are serving members of the proposed target population, who will be referred to PrEP friendly providers. Staff at CBOs will engage and recruit high risk members of the targeted populations, screen prospective participants, provide rapid HIV testing, assess eligibility for PrEP and refer individuals that test negative to a PrEP program at medical clinic when appropriate. The agency must have memorandum of understanding (MOU) or another documented relationship with the clinics they are referring to so they can follow up to see if the client completed the referral. The CBO PrEP programming may also include a health care insurance navigator to work with uninsured or underinsured clients to obtain adequate health care coverage. Some sample tasks for CBOs will include: Conduct outreach activities at sites where targeted populations are likely to congregate. Conduct risk assessment to identify persons at risk for HIV infection, particularly those with ongoing substantial HIV risk. Refer individuals testing negative for HIV into PrEP services. Provide risk reduction counseling e.g., harm reduction and condom use. Identify/select potential PrEP candidates from individuals who test HIV negative. Link/refer those interested in PrEP to health care providers with whom you have a MOU and are willing to prescribe PrEP and offer other services. Monitor and evaluate the implementation and impact of PrEP. Evaluation tasks All applicants will be required to use at least 10% of MDH grant funds for evaluating their PrEP program. Applicants must propose a PrEP evaluation plan that is expected to include, but is not limited to collecting and analyzing data. Some evaluation tasks may include: Number of individuals assessed for PrEP (including HIV rapid testing and/or confirmatory testing). Number of individuals determined eligible for a PrEP referral. Number of individuals willing to explore PrEP further. 6

10 Number of individuals actively referred to PrEP clinical program. Number of individuals enrolled in clinical PrEP program (Insured vs Uninsured). Number of individuals still engaged in PrEP at three month intervals (3, 6, 9, etc.) indicating if they were uninsured at first visit, do they now have insurance. Number of individuals connected to medical insurance resources (if project has an insurance navigator on site). Target Population PrEP is not for everyone. PrEP is for persons who are HIV negative, are at substantial risk for HIV infection through sexual transmission and/or injecting drugs and who want PrEP. As per CDC, non-hiv infected persons that exhibit the following characteristic of substantial HIV risk may be appropriate: Men who have sex with men (Gay/Bisexual/Transgender) Heterosexual Women and Men Injection Drug Users HIV positive sexual partners Recent bacterial STD High number of sex partners History of inconsistent or no condom use Commercial sex work HIV positive sexual partners Recent bacterial STD High number of sex partners History of inconsistent or no condom use Commercial sex work In high-prevalence area or network HIV positive sexual partners Sharing injection equipment Recent drug treatment (but currently injecting) 7

11 Part III. Proposal Submission Requirements RFP Timeline RFP Released April 4, 2016 Pre-Proposal conference call April 19 20, 2016 Notice of Intent due by 4: 30 p.m. April 20, 2016 Completed Proposals due by 4:30 p.m. May 4, 2016 Anticipated Notice of Award May 31, 2016 Project Implementation begins: July 1, 2016 Pre-Proposal Conference Calls The MDH staff will offer two opportunities for potential applicants to participate in a Conference Call in where they can ask questions related to the RFP, its requirements and processes, and expectations of applicants. You are encouraged to review the RFP document and its requirements before the conference call. Applicants are strongly encouraged to call in during one of these Conference Calls but participation is not mandatory. Please note that staff will not be able to provide feedback on specific project ideas or the likelihood of receiving funding during the Conference Call. The dates for the Conference Calls are scheduled for: Tuesday, April 19, 2016 from 1:00-2:00 p.m. and Wednesday, April 20, 2016 from 10:00 11:00 a.m. Registration is required to participate in the call-in. To register, send an to Ruth Dauffenbach-Kotrba at ruth.dauffenbach-kotrba@state.mn.us no later than Monday April 18, You will receive a confirmation with call-in instructions. Notice of Intent A notice of intent is required for anyone interested in submitting a proposal and will be due on Wednesday, April 20, Submitting a notice of intent does not mean that you have to submit a proposal. However, proposals will not be accepted from applicants who fail to submit a notice of intent. Notices of intent are due by 4:30 p.m. on Wednesday, April 20, Notice of intent should follow the format presented on the notice of intent form (Form A). Agencies submitting a notice of intent will receive confirmation from MDH that the notice of intent was received. 8

12 Notice of intent is accepted electronically only. Complete the notice of intent form (Form A). Include in the subject line, Notice of Intent PrEP Project Grant and attach the notice of Intent form and to Ruth Dauffenbach-Kotrba at with the attachment must be received by 4:30.p.m. A notice of Intent received after this time will be disqualified. A confirmation will be sent to all applicants when the notice of Intent is received by MDH. Proposal Due Date Completed proposals MUST be submitted electronically to MDH on or before: 4:30 p.m., Wednesday, May 4, 2016 in the format described. Late proposals will not be accepted. (Proposals are not accepted by postal mail or facsimile (fax). Send an to: health.hivprevention@state.mn.us with the subject line titled, PrEP RFP 2016 with four PDF attachments as follows: First, PDF attachment which includes: proposal checklist Form B and the project narrative Form D. Titled PDF [agency or clinic name] PrEP Project Narrative. Second, PDF attachment which includes the project work plan narrative Form E and evaluation plan Form F. Include partnership table and any partners MOUs completed. Titled PDF [agency or clinic name] Project Work Plan. Third, PDF attachment which includes the budget plan and narrative (Form G). The budget must be titled, [agency or clinic name] PrEP Project Budget. Fourth, PDF attachment which includes: applicant Information certification sheet Form C and due diligence Form H - (Form H for non-governmental agency only) and accompanying documents. This must be titled, [agency or clinic name] Certification. PLEASE NOTE: Proposals must be submitted to MDH by 4:30 p.m. on Wednesday May 4, All submissions are final. Full and complete proposals not received by 4:30 p.m., Wednesday, May 4, 2016 will NOT be considered. A confirmation will be sent to all applicants whose proposal is received on time. All questions regarding this RFP should be submitted via to health.hivprevention@state.mn.us. Individual MDH staff are not authorized to respond. All submissions deadline are final. Notices of intent and proposals not received by the deadlines outlined in this RFP will not be considered. All expenses incurred in responding to this RFP are solely the responsibility of the applicant. MDH will not be responsible for RFP documents (e.g., Notice of Intent, Proposal) electronically sent to a wrong address. Questions Questions regarding this RFP or the RFP process will be accepted through Wednesday, April 20, All questions need to be submitted via with PrEP RFP Grant in the 9

13 subject line to MDH will respond to the person who sent the question and will post the question and answer on the MDH website. Questions and answers of a substantive nature will be posted on the MDH website at: where other potential applicants can access the same information. Please include your name and phone number in the . Part IV. Program Information Expectations of Applicants The MDH staff anticipate the contract period to begin on July 1, Clinical sites will be expected to recruit, screen, prescribe PrEP and counsel and monitor PrEP enrollees and assist in linking them to health insurance. Clinical site will be expected to follow the published CDC PrEP guide at: 2. Community-based sites will be expected to recruit and engage high risk members of the target populations, screen prospective individuals, and provide active referral to a PrEP program with whom they have a MOU and assist in navigating the health insurance options. 3. All potential providers are strongly encouraged to think outside the box when developing new ideas for engaging high risk persons into PrEP and addressing their sexual health needs. 4. All projects will submit a narrative report on the project s progress quarterly. A form for this report will be provided by the State. Additional contractual obligations are contained in the sample contract document that can be accessed at MDH s website: What MDH will do for you? 1. During the RFP process MDH will: a. Respond to applicant inquiries about the RFP document, its requirements, eligibility criteria and this process. 10

14 b. Provide pre-proposal conference calls for applicants to ask questions and receive clarification about the RFP documents, its requirements, eligibility criteria and this process. c. Communicate a summary of the questions and answers for prospective applicants. 2. During the grant agreement period MDH will: a. Provide or make referrals for technical assistance and training for applicants that will address topics such as planning, implementation, and evaluation of HIV prevention activities. b. Provide technical assistance through administrative and programmatic site visits to improve the quality of delivered services. c. As required by the CDC, any product used within the PrEP project needs to be submitted for review prior to use. MDH provides for the review and approval of all PrEP project materials submitted in a timely manner. Material review includes, but is not limited to, technical accuracy, compliance with the federal guidelines and appropriateness for the target audience. d. Provide data and information about HIV, STDs, hepatitis, PrEP, and recommendations for effective prevention activities and promising project strategies. e. Coordinate the activities of PrEP with other efforts at the local and state levels to avoid duplication of efforts and to promote consistency. f. Assist applicants working with state and local health departments, community planning groups, funding institutions and other potential partners. g. Share information regarding educational opportunities and available funding from foundations and other public and private groups. h. Work with applicants to effectively implement work plans and provide technical assistance and training to support them. i. Work to revise and finalize budgets and work plans and will respond to requests for prior approval of expenditures and activities. j. Verify expenditure documentation at least once during the grant period. i. Assess fiscal responsibility before grants are awarded and before renewals or extensions. ii. Provide guidance regarding the required content of the progress and evaluation reports for all applicants. iii. Maintain frequent contact and at least one on-site visit to monitor PrEP grant activities during the grant period. 11

15 Award Notification The agency will be notified by letter during the week of May 31, 2016 whether or not their proposal was selected for funding. All decisions are final. We reserve the right to negotiate changes to the proposed activities and budgets submitted. Disclaimer The Minnesota Department of Health reserves the right to withhold the distribution of funds in cases where proposals submitted do not meet the necessary criteria. This Request for Proposals does not obligate the state to award a contract or complete the project, and the state reserves the right to cancel the solicitation if it is considered to be in its best interest. Conflicts of Interest Responder must provide a list of all entities with which it has relationships that create, or appear to create, a conflict of interest with the work that is contemplated in this request for proposals. The list should indicate the name of the entity, the relationship and a discussion of the conflict. Proposal Contents By submitting an application, the applicant warrants that the information provided is true, correct, and reliable for purposes of evaluation for potential grant contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the applicant to suspension or debarment proceedings as well as other remedies available by law. Disposition of Responses All materials submitted in response to this RFP will become property of the State and will become public record in accordance with the Minnesota Statutes, section after the evaluation process is completed. Pursuant to that statute, completion of the evaluation process occurs when MDH, as the granting agency, has completed negotiating grant agreements with the selected applicants. If an applicant submits information in response to this RFP that it believes to be trade secret materials, as defined by the Minnesota Government Data Practices Act, Minnesota Statute 13.37, the responder must: (a) Clearly mark all trade secret materials in its application at the time the application is submitted; (b) include a statement with its application justifying the 12

16 trade secret designation for each item; and, (c) defend any action seeking release of the materials it believes to be trade secrets, and indemnify and hold harmless the State of Minnesota, its agents and employees, from any judgments or damages awarded against the state in favor of the party requesting the materials, and any of and all costs connected with that defense. This indemnification survives the award of any grants pursuant to this RFP. In submitting an application to this RFP, the applicant agrees that this indemnification survives as long as the trade secret materials are in possession of MDH. The State will not consider the prices submitted by the responder to be proprietary or trade secret materials. Sample Grant Contract Terms and Conditions Applicants need to be aware of MDH s standard grant contract terms and conditions in preparing the application. A sample MDH grant contract agreement can be downloaded from: Much of the language reflected in the grant agreement is required by statute. If your organization takes exception to any of the terms, conditions or language in the contract, you must indicate those exceptions in your responses to this RFP; certain exceptions may result in your application being disqualified from further review and evaluation. Only those exceptions indicated in your response to this RFP will be available for discussion or negotiation. Part V. Proposal Review and Selection Process Applications received by the deadline will be reviewed in three phases. Phase I Review MDH staff will initially review all applications received for completeness (refer to application submission checklist Form B) and eligibility. Incomplete applications and non-eligible applicants will not advance to Phase II review. These applicants will be informed by an that their applications did not meet eligibility and/or published submission requirements. Phase II Review MDH staff will recruit a diverse group of people as reviewers that consist of the MDH staff, and other experts in the field who will review the proposals for content. Reviewers will score the applications individually using a provided score sheet. These reviewers will evaluate complete, eligible applications in accordance with the detailed descriptions of scoring criteria in the proposal evaluation and selection section of this RFP. 13

17 Phase III Review MDH staff will review the recommendations to make final funding decisions. Staff will balance recommendations by the reviewers with other factors including, but not limited to: reviewers numerical score ranking, geographic diversity, representativeness of target population, and total available funds. Due Diligence Review MDH requires non-governmental organizations to complete a Due Diligence review form. If an organization is using a fiscal agent, the fiscal agent should complete the Due Diligence Review Form H. Submit this form along with the proposal. Part VI. Proposal Evaluation and Selection Process A complete proposal received by the deadline will be reviewed and scored based on the following: Project Description Narrative: (30 points) Project Work Plan Narrative (35 points) Project Evaluation plan (15 points) Project Budget Plan/Narrative (15 points) Overall Proposal Assessment (5 points) Each reviewer will independently score and submit individual scores for each proposal. All reviewers scores will be tabulated and ranked. Then the reviewers will participate in a review meeting where the applications will be discussed. The reviewers will have an opportunity to modify their scores based on the group discussion. At the end of the process, reviewers will make preliminary recommendations to MDH for a final funding decision. Project Narrative Scoring Criteria (30 points) Are the project goals, objectives and activities for this project clearly defined? Is the population that the project is designed to reach clearly described? Are the proposed activities consistent with the cultural characteristics of the population? Does the applicant adequately describe the need for proposed activities? Does the agency or organization have a history of implementing successful HIV prevention programs? Does the agency or organization adequately describe the capacity and the quality of experience it has to implement the proposed project? 14

18 Do activities help integrate PrEP into related STDs and other HIV preventative strategies, e.g., harm reduction, condom use? Does the applicant describe ways to maintain a focus on PrEP? Are skills related to working with persons from diverse backgrounds described? Are there effective strategies to involve the intended populations? Will people from diverse backgrounds related to race, ethnicity, sexual orientation/identification and socioeconomic status be involved in making decisions? Project Work Plan Narrative Scoring Criteria (35 points) Does the applicant clearly describe the activities they intend to provide/implement? Is it clear who will be responsible for implementing activities throughout the project period? Are the timelines for activities reasonable? Are the proposed activities for each goal consistent with the cultural and socioeconomic characteristics of the intended audience(s) and do they demonstrate cultural appropriateness? Overall, is the work plan sufficiently detailed, clear and easy to understand and demonstrate a clear relationship between the identified needs and the goals and activities? Partnership Scoring Criteria (10 points) Are the partnerships formed described? Are there any partnership documented agreements included? Project Evaluation Plan Scoring Criteria (15 points) To what extent do the proposed evaluation criteria effectively measure the project s process toward meeting their outcomes? Project Budget Plan/Narrative Scoring Criteria (15 points) Is the Budget Narrative and Allocations (Form G) form complete? Are the proposed expenses appropriate to the proposed activities? Does applicant describe how achievements from this project might be sustained into the future, once funding ends? Are the proposed ideas feasible? Overall assessment of grant application (5 points) Overall, based on reviewing all parts of this proposal and what you consider as the strengths and weaknesses of this proposal, is this application: 15

19 Excellent: = 5 points Outstanding level of quality; significantly exceeds all aspects of the minimum requirements; high probability of success; no significant weaknesses. Very Good: = 4 points Substantial response; meets in all aspects and in some cases exceeds the minimum requirements; good probability of success; no significant weaknesses. Good = 3 points Generally, meets minimum requirements; probability of success; significant weaknesses but correctable. Marginal = 2 points Lacks essential information; low probability of success; significant weaknesses but correctable. Unsatisfactory = 1 point Fails to meet minimum requirements; little likelihood of success; needs major revision to make it acceptable. Part VII. Response Components of the Proposal Format and Style Requirements Proposals must be typed and all pages should be numbered consecutively. Use Calibri 12-point font, one-inch margins, and single line spacing. Paragraphs should be separated by a blank space. The project narrative must not exceed 8 pages, excluding attachments. The proposal must be signed where noted. Response Content Forms and steps required for all proposals: Applicants are required to complete Form B Proposal Checklist Form as part of the proposal. All of the required Forms B through H must be completed and included in the proposal. All these forms can be accessed at: 16

20 Developing the Proposal Step 1 through 7 A complete proposal consists of Forms B through H. Step 1: Complete and submit Notice of Intent form (Form A) by 4:30 p.m., Wednesday April, 20, This form is required for someone to be able to submit a proposal. It allows the MDH to plan the review process. Step 2: Complete the proposal checklist form (Form B). This form is self-explanatory. Please check each item on this form as it is completed. Step 3: Complete the applicant information and certification form (Form C). This form provides MDH contact information and other information required by the State. A signature of the director of the applicant agency is required on the certification section of Form C. Step 4: Complete Project Narrative form (Form D). The questions that require responses are provided on Form D. Step 5: Complete Form E and F: Instructions for completing the forms are included on each form. The questions that require responses are provided on Form E and F. Form E: Project Work plan Narrative: Answer all (four) questions on Form E including the partnership question and complete the partnership chart. Include any MOUs, if applicable with this form. Form F: Evaluation Plan form Step 6: Complete Form G. Instructions for completing Form G are included. Form G: Project Budget Plan. Answer all the questions on Form G. Complete the budget narrative for each line item. Step 7: Complete the Due Diligence Form H. (For non-governmental organizations or agencies only) 17

21 Complete Proposal: The proposal for the PrEP project consists of the following required core components: Project Description Narrative: (30 points) Project Work Plan Narrative (35 points) Project Evaluation plan (15 points) Project Budget Plan/Narrative (15 points) Overall Proposal Assessment (5 points) Project Description Narrative: (30 points) (Maximum 4 pages) Use Form D: Project description narrative form to answer these questions. 1. Provide a brief overview of the organizational background including mission and major programming. Also, how the organization meets the eligibility criteria for this RFP? (5 points) 2. Describe in detail, what makes your organization well-suited to provide PrEP programming and other related services you are proposing? Also describe how PrEP will be integrated with other HIV/STD prevention messaging. (5 points) 3. Briefly describe the current and/or past experience(s) relevant to working with your proposed target population, particularly communities of color, individuals with disabilities, and individuals with limited English proficiency; include activities offered, number of individuals served, and a summary of evaluations of activities, where applicable. (5 points) 4. Briefly describe the qualities that demonstrate your agency s capacity to implement the proposed PrEP project. List people who will be involved include titles, relevant roles and qualifications. (5 points) 5. Describe what you propose to do in this project, include the project goals and objectives you plan to address, the targeted population(s) you intend to reach and why this/these activities are needed (5 points). 6. Explain how you will engage the population that your program will serve? Describe the activities and roles the target population you plan to serve will be involved in such as design, planning, implementation and decision-making processes. (5 points) 18

22 Project Work Plan Narrative (35 points) (Maximum 3 pages) (Use Form E: Project work narrative form to answer these questions) 1. Describe how your program activities will be delivered in a culturally and linguistically appropriate and competent manner? (5 points) 2. Describe how your proposed activities will contribute to reducing HIV transmission among the target population you will serve? (5 points) 3. List specific PrEP activities that you are proposing (refer to sample tasks in this RFP) to implement. Using the work plan form (Form E) (completed work plan template is not included in page limit), describe in detail: how you propose to accomplish the steps necessary to implement the project proposed. (15 points) Dates by when you will do those activities; Who is responsible for implementing or accomplishing each activity; Estimated number of people to be reached per proposed activity; and, How you will demonstrate the outcome of your project. 4. Partners: Who are the key partners that will help you increase capacity and partner with, if appropriate. Using the Partner/Collaborator table, include names of your current or potential partners and collaborators for this project, both formal and informal, and describe the roles and responsibilities they will have in this PrEP project. Indicate which partners you have already contacted, those you already have existing relationships with (include MOUs), and those you plan to contact if you are funded. (10 points) Project Evaluation (15 points) (Maximum two pages) (Use Form F: Project evaluation plan form to answer these questions) Describe the plan you will use to measure the processes and the impact of those outcomes on the target population(s) your project is designed to reach? For each activity proposed: Identify employees to be involved and their experience leading or implementing an evaluation; (5 points) Briefly describe the type of data to be collected, the frequency of data collection, and instrument to be used; (5 points) Describe how the data will be analyzed, and reports to be generated; and, (3 points) How the results will be disseminated and used. (2 points) Budget Plan and Narrative (15 points) (Maximum one page) (Use Form G: Project budget plan/narrative form to answer these questions) 19

23 1. The proposed budget plan must include in-kind funds. Please provide a brief description of these in-kind funds reflected in the proposed budget plan. (5 points) 2. Please describe how potential outcomes from this project might be sustained once PrEP funding ends and how your agency will continue to provide support and/or resources for those outcomes and future activities. (5 points) 3. Using the format of the Budget Narrative," briefly describe your overall budget plans and delineate specific line items (i.e., salaries and wages, fringe benefits, travel, supplies, contractual, other expenses, administrative costs, etc.) It is helpful to consider: Is the information in the budget narrative complete, correct, and consistent with the proposed activities? Are the costs projected for the proposed activities and staffing levels reasonable? (5 points) 20

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25 Form A: Notice of Intent Notice of Intent All applicants who are interested in submitting an application for the PrEP Project Grant are required to submit a Notice of Intent form by April 20, This form must be submitted electronically to Ruth Dauffenbach-Kotrba at ruth.dauffenbachkotrba@state.mn.us by 4:30 p.m. on or before April 20, Agency Name Address Contact Person s Name Title Phone Fax We intend to apply as: (Select one). Clinic-based agency Communitybased agency

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27 FORM B: Proposal Checklist Proposal Checklist Please include all of the required information in the proposal including all attachments. Please do not submit any materials that are not requested. Use this form to ensure that you have all required materials for submission. A complete proposal must include the following materials (check below when complete): Form A: Notice of Intent Form B: Proposal Checklist Form C: Applicant Information Certification Sheet Form D: Project Description Narrative (4 pages) Form E: Project Work Plan Narrative (3 pages, excludes work plan table pages) Form F: Project Evaluation Plan (2 pages) Form G: Project Budget Plan/Narrative (One page, excludes budget plan/narrative) Form H: Due Diligence Review Copy of Federally Approved Indirect Rate One of the following items is required for non-government agency: Financial statement - (For organizations with less than $25,000 in revenue) IRS Form (For organizations with $25,000 - $750,000 in revenue) Certified Financial Audit - (For organizations with more than$750,000 in revenue)

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29 FORM C: Applicant Information Certification Sheet Applicant Information and Certification Sheet Name of Agency Project Name: Mailing Address: Primary Contact Person: Address Phone: Fax: Agency Type: Non-profit Status? (Yes or No) Federal Tax Identification number: Or Minnesota Tax Identification Number: Total Budget Amount Requested Proposed Target Population: Proposed Target Service/Geographic area: Certification: I certify that the information contained in this proposal is true and accurate to the best of my knowledge, does not include any trade secrets, and that I have the authority to submit this application. X Signature of authorized agency representative Date Print name and Title

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31 FORM D: Project Description Narrative Project Description Narrative (30 points) Instructions Answer all six questions The maximum number of pages cannot exceed four pages Use Calibri 12-point font One-inch margins and single line spacing Paragraphs separated by a blank space Questions 1. Provide a brief overview of the organizational background including mission and major programming. Also, how the organization meets the eligibility criteria for this RFP? (5 points) 2. Describe in detail, what makes your organization well-suited to provide PrEP programming and others related services you are proposing? Also describe how PrEP will be integrated with other HIV/STD prevention messaging. (5 points) 3. Briefly describe the current and/or past experience(s) relevant to working with your proposed target population, particularly communities of color, individuals with disabilities, and individuals with limited English proficiency; include activities offered, number of individuals served, and a summary of evaluations of activities, where applicable. (5 points) 4. Briefly describe the organizational background and qualities that demonstrate your agency s capacity to implement the proposed PrEP project. List people who will be involved include titles, relevant roles and qualifications. (5 points) 5. Describe what you propose to do in this project, include the project goals and objectives you plan to address, the targeted population(s) you intend to reach and why this/these activities are needed (5 points). 6. Explain how you will engage the population that your program will serve? Describe the activities and roles the target population you plan to serve will be involved in, such as design, planning, implementation and decision-making processes. (5 points)

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33 Form E: Project Work Plan Narrative Project Work Plan Narrative (35 points) Instructions Answer all four questions The maximum number of pages cannot exceed three pages Use Calibri 12-point font One-inch margins and single line spacing Paragraphs must be separated by a blank space Questions 1. Describe how your program activities will be delivered in a culturally and linguistically appropriate and competent manner? (5 points) 2. Describe how your proposed activities will contribute to reducing HIV transmission among the target population you will serve? (5 points) 3. Project work plan: Use the work plan Form F (completed work plan template does not account to the page limit). List specific PrEP activities that you are proposing (refer to sample tasks in this RFP) to implement, describe in detail: how you propose to accomplish the steps necessary to implement the project proposed. (15 points) a. dates by when you will do those activities; b. who is responsible for implementing or accomplishing each activity; c. Number of people to be reached per proposed activity; d. how you will demonstrate the outcome of your project; 1 of 3

34 Applicant Name: Project Goal: Targeted Population Service/Geographic area: Activities Date(s) Person Responsible Projected number of clients Measure or Outcome 2 of 3

35 4. Partnership/Collaboration Describe the key partners that will help you increase capacity and will partner with, if appropriate. Using the Partner/Collaborator chart to include names of your current or potential partners and collaborators for this project, both formal and informal, and describe the roles and responsibilities they will have in this PrEP project. Indicate which partners you have already contacted, those you already have existing relationships with (include MOUs), and those you plan to contact if you are funded.(10 points) Complete Partner/Collaborator chart Organization s Name: Contact Person: Telephone Number: Relationship Status (select one): o New/Potential o Current For how long? o Former When? Organization s Role in Project (within the partnership): Organization s Type: o Profit o Non-Profit Any additional Information: Include any MOU(s). 3 of 3

36 FORM F: Project Evaluation Plan Project Evaluation Plan (15 points) Instructions Must answer this evaluation question The maximum number of pages cannot exceed two pages Use Calibri 12-point font One-inch margins and single line spacing Paragraphs must be separated by a blank space Question Describe the plan you will use to evaluate the components and impact of your program. For each PrEP evaluation activity proposed: Identify employees to be involved and their experience leading or implementing an evaluation. (5 points) Briefly describe the type of data to be collected, the frequency of data collection, and instrument to be used (include sample data collection tool). (5 points) How the data will be analyzed, and reports to be generated. (3 points) How the results will be disseminated and used. (2 points)

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38 FORM G: Project Budget Plan/Narrative Budget Plan/Narrative (15 points) Instructions Must answer all three budget questions The maximum number of pages cannot exceed one page Use Calibri 12-point font One-inch margins and single line spacing Paragraphs must be separated by a blank space Questions 1. The proposed budget plan must include in-kind funds. Please, provide a brief description of these in-kind funds that will be reflected on the proposed budget. (5 points) 2. Please describe how potential outcomes from this project might be sustained once PrEP funding ends and how you and/or your agency will continue to provide support and/or resources for those outcomes and future activities. (5 points) 3. Use the format of the Budget Narrative and briefly describe your overall budget plans and delineate specific line items (i.e., salaries and wages, fringe benefits, travel, supplies, contractual, other expenses, indirect costs, etc.). (5 points) Is the information in the budget narrative complete, correct, and consistent with the proposed activities? Are the costs projected for the proposed activities and staffing levels reasonable? 1 of 6