Leveraging Health Service Equity Approaches for Sustainable HIV Epidemic Control | HRSA 22 160

Opportunity Information: Apply for HRSA 22 160

Leveraging Health Service Equity Approaches for Sustainable HIV Epidemic Control (HRSA-22-160) is a U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) cooperative agreement designed to help PEPFAR-supported countries, with an initial emphasis on Malawi and Zambia, sustain progress toward HIV epidemic control. The core idea is to take proven, real-world lessons and best practices from domestic (U.S.) health service delivery and adapt them into practical, scalable platforms that strengthen HIV treatment programs overseas. Rather than launching entirely new standalone projects, the funding is intended to continue, expand, and scale existing HRSA global HIV activities in ways that measurably improve treatment outcomes and make country programs more resilient over time.

A central theme of the opportunity is health equity: applicants are expected to work with HRSA to identify and address social determinants of health and inequities embedded in the healthcare system that prevent certain groups from accessing, staying in, or benefiting fully from HIV services. The program prioritizes person-centered care that is tailored to the realities of clients and communities, especially those who are consistently underserved or at higher risk of falling out of care. In practice, this means designing service delivery approaches that reduce barriers like stigma, transportation constraints, long waiting times, poor data systems, fragmented maternal and child health services, or clinic workflows that unintentionally exclude adolescents, young women, or other priority populations.

Program activities are expected to align closely with PEPFAR priorities and explicitly contribute to achieving the UNAIDS 95-95-95 targets (95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment are virally suppressed). Importantly, the notice emphasizes that activities must be developed with local stakeholders and include a credible transition plan so that host-country institutions can take ownership, expand successful models, and sustain results. Local ownership is not treated as an add-on; it is positioned as a defining requirement to improve long-term efficiency and durability of PEPFAR investments and to ensure that gains in HIV outcomes do not erode when external support changes.

The funding focuses on several specific service delivery areas that have direct links to treatment continuity and viral suppression. One priority is empowering adolescent girls and young women in targeted geographies and strengthening their linkage to health services, recognizing that social and structural barriers often undermine prevention and treatment access for this group. Another priority is improving facility capacity to link clients to HIV care quickly and keep them engaged over time, including reducing treatment interruption. The program also calls for partnering with high-volume treatment sites to implement differentiated service delivery models, which can include approaches like multi-month dispensing, community-based refills, fast-track pickup, tailored appointment schedules, and other methods that match intensity of services to client needs while protecting clinical quality.

Maternal and infant health is another major focus area. The award supports quality improvement and family-centered strategies to meet the needs of mothers and their HIV-exposed infants from pregnancy through the postpartum and breastfeeding period, extending up to 24 months. This reflects the reality that continuity during and after pregnancy is a vulnerable point in the HIV care cascade, and that strong integration of services can reduce loss to follow-up and improve outcomes for both mothers and children. Alongside these clinical priorities, the opportunity highlights the importance of optimized client care records, reporting, and data use, with the expectation that stronger data systems will improve decision-making and performance across the HIV continuum of care, from linkage and retention to viral load monitoring and suppression.

Beyond implementing improvements in Malawi and Zambia, the broader intent is to generate learning that can be shared across other PEPFAR-supported countries. The project is expected to compile, evaluate, and disseminate best practices for building equitable, person-centered health services that respond to social determinants of health and remain functional under stress, including lessons from global pandemics and other disruptions. The aim is a more resilient service delivery architecture that can absorb shocks, adapt quickly, and still protect outcomes like retention in care and viral suppression.

The notice describes several key objectives that frame what success should look like. These include: developing actionable strategies that advance health equity while countries approach and maintain PEPFAR goals; introducing innovations that reach sub-populations with unmet needs using results-driven implementation models; identifying and spreading best practices that are person-centered and address social determinants; strengthening health system capacity so HIV services can transition smoothly to host-country governments; and monitoring and evaluating the transition process to ensure that performance and health outcomes do not decline as ownership shifts. Achieving these objectives requires close coordination with country and multilateral stakeholders to prioritize solutions that are genuinely country-led rather than externally imposed.

From an administrative standpoint, this is a discretionary funding opportunity using a cooperative agreement mechanism, meaning the recipient should expect substantial federal involvement and collaboration with HRSA during implementation. The opportunity listed an award ceiling of $10,000,000 and anticipated a single award. Eligible applicants were broad and included various levels of government, public and private higher education institutions, nonprofit organizations (including 501(c)(3)s), for-profit entities (including small businesses), and other applicants as further clarified in the full eligibility guidance. The funding opportunity was posted June 7, 2022, with an original closing date of August 5, 2022.

Overall, the grant is best understood as a targeted, high-impact effort to keep HIV programs on track for epidemic control by combining equity-focused service redesign, differentiated and data-driven care models, maternal-infant continuity strategies, and deliberate transition planning to local institutions. The expected end state is not only improved HIV treatment performance in the short term, but also stronger national systems that can sustain high-quality, equitable HIV care with increasing local ownership across PEPFAR-supported settings.

• The Department of Health and Human Services, Health Resources and Services Administration in the health sector is offering a public funding opportunity titled "Leveraging Health Service Equity Approaches for Sustainable HIV Epidemic Control" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.266.
• This funding opportunity was created on Jun 07, 2022.
• Applicants must submit their applications by Aug 05, 2022. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $10,000,000.00 in funding.
• The number of recipients for this funding is limited to 1 candidate(s).
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For profit organizations other than small businesses, Small businesses, Others (see text field entitled Additional Information on Eligibility for clarification).

Apply for HRSA 22 160

[Watch] Creating a grant proposal using the step-by-step wizard inside the applicant portal: