Strengthening the Delivery of Quality HIV/TB Laboratory Services at all Levels Including Quality Management Systems, Equipment, and Laboratory Network Optimization for Efficient Patient Management in the Kingdom of Eswatini under PEPFAR | CDC RFA GH20 2026

Opportunity Information: Apply for CDC RFA GH20 2026

This funding opportunity, titled "Strengthening the Delivery of Quality HIV/TB Laboratory Services at all Levels Including Quality Management Systems, Equipment, and Laboratory Network Optimization for Efficient Patient Management in the Kingdom of Eswatini under PEPFAR," is a U.S. Centers for Disease Control and Prevention (CDC) cooperative agreement (Funding Opportunity Number: CDC RFA GH20 2026; CFDA/Assistance Listing: 93.067) focused on improving national HIV and tuberculosis laboratory systems in Eswatini. It sits within the broader PEPFAR framework and is aligned with the United Nations and PEPFAR 95-95-95 targets, which depend heavily on reliable diagnostic testing, timely results, and strong quality systems across the entire laboratory network. Eligibility is broadly open (unrestricted), and the CDC anticipated making one award under this announcement.

Funding is described in a way that can be confusing at first glance: the "Award Ceiling for Year 1 is 0 (none)," while CDC also anticipated approximately $5,000,000 in total funding for Year 1, contingent on the availability of funds. Practically, that combination often signals that CDC did not set a maximum cap per applicant for the first year in the public notice (or that the ceiling was intentionally left unspecified), while still indicating the approximate amount CDC expected to allocate for the program in that fiscal year. The instrument type being a cooperative agreement also matters because it implies substantial federal involvement in the work, meaning the recipient would be expected to collaborate closely with CDC on planning, implementation, monitoring, and technical direction.

The problem this opportunity is trying to solve is that, despite real progress in Eswatini in reorganizing laboratory services and introducing accreditation-oriented standards, the Eswatini Health Laboratory Service (EHLS) is still struggling to meet the demands created by the HIV and TB epidemics. The NOFO highlights several systemic bottlenecks: missing or unapproved core policies and strategic plans, insufficient laboratory management capacity to provide consistent strategic direction for EHLS, gaps in equipment availability and in how the national laboratory network is optimized, and ongoing challenges with sustainability as donor-supported activities need to be absorbed by the Ministry of Health (MOH). In other words, the country has been moving toward higher quality laboratory services, but the underlying governance, management, infrastructure planning, and long-term financing and staffing arrangements are not yet strong enough to deliver consistent, nationwide performance at the scale required for epidemic control.

The opportunity lays out a set of objectives that collectively aim to strengthen the laboratory system from policy through service delivery and sustainability. First, it seeks to help EHLS develop and formalize policies specifically focused on delivering quality HIV and TB laboratory services. This is about establishing clear national expectations and standards for how testing is performed and managed, which typically includes quality management requirements, testing algorithms, referral and specimen transport expectations, equipment standardization approaches, and the definitions of roles and responsibilities across tiers of the system. Second, it emphasizes enabling EHLS leadership to take an active role in monitoring and evaluation of the national Laboratory Strategic Plan. That focus signals that leadership oversight, routine performance management, and accountability structures are viewed as essential for translating written plans into real operational improvements across the network.

Third, the NOFO calls for technical assistance to expand access and coverage for quality HIV/TB laboratory services. This objective is essentially the service delivery engine of the program: improving the reach, reliability, and turnaround time of testing in ways that better support patient management, including diagnosing infections, initiating treatment quickly, and monitoring response to therapy. Although the announcement text does not list every test area, in PEPFAR-supported HIV/TB laboratory programs this typically intersects with viral load testing systems, early infant diagnosis, TB diagnostics (including rapid molecular testing where available), and the quality assurance practices that ensure test results are trustworthy and clinically actionable. The mention of equipment and network optimization points toward practical work like right-sizing instruments to match demand, reducing downtime through better maintenance and procurement planning, improving sample referral pathways between peripheral sites and higher-tier laboratories, and strengthening supply chain and inventory practices that affect uninterrupted testing.

Fourth, the opportunity explicitly prioritizes health information systems connectivity by strengthening interoperability between the Laboratory Information System (LIS) and the Client Management Information System (CMIS). This is a major patient-management issue because even high-quality testing does not help patients if results are delayed, lost, or not linked to the correct clinical record. Improving LIS-CMIS interoperability generally aims to reduce manual data entry, improve result transmission speed from labs to clinics, enhance data completeness and accuracy, support longitudinal patient monitoring, and enable better program surveillance and reporting. It can also support more effective monitoring of the laboratory network itself by providing near real-time visibility into volumes, turnaround times, error rates, instrument performance, and reagent stock status.

Finally, the NOFO makes sustainability and transition planning a core deliverable by requiring development of a transition plan for MOH absorption of donor-supported human resources and other recurring costs for selected HIV/TB activities. This reflects a common challenge in donor-supported laboratory systems: key staff positions, maintenance contracts, reagents, connectivity costs, and quality assurance activities may be funded externally during scale-up, but long-term resilience depends on integrating these costs into national budgets, staffing structures, and procurement systems. A credible transition plan typically clarifies which positions and costs are prioritized for absorption, timelines, responsible parties, financing strategies, and risk mitigation steps so that service levels do not drop when donor support changes.

In summary, this CDC PEPFAR cooperative agreement is designed to help Eswatini move from improvements that are partially donor-driven and unevenly institutionalized to a more sustainable, policy-grounded, well-managed, and data-connected national laboratory network. The intended end state is a laboratory system that reliably supports HIV and TB diagnosis and monitoring across all levels of care, is guided by approved policies and a functioning strategic plan, uses optimized equipment and network design to deliver results efficiently, and is increasingly financed and staffed through MOH systems to maintain gains over time.

• The Department of Health and Human Services, Centers for Disease Control - CGH in the health sector is offering a public funding opportunity titled "Strengthening the Delivery of Quality HIV/TB Laboratory Services at all Levels Including Quality Management Systems, Equipment, and Laboratory Network Optimization for Efficient Patient Management in the Kingdom of Eswatini under PEPFAR" 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 07, 2020.
• Applicants must submit their applications by Mar 07, 2020 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 1 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.

Apply for CDC RFA GH20 2026

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