Plan for AIDS Relief (PEPFAR) program. FY21 PEPFAR priorities recognize quality health services as essential in order to ensure that optimal health outcomes are met on a daily and routine basis. Therefore, all PEPFAR country programs must incorporate explicit quality management (QM) practices, including both quality assurance (QA) and quality improvement (QI) activities into service delivery and partner management. Focused on building the capacity of countries to sustain and spread QI methodologies, improve documentation of efforts, and continuously enhance staff knowledge, QISSEC strives to impact the delivery of quality HIV services, improve health outcomes, and support HIV/AIDS epidemic control. This Notice of Funding Opportunity (NOFO) will fund two cooperative agreements in support of the PEPFAR focus on the management of evidence-informed interventions for scale-up and spread. The successful applicants will facilitate solutions for long-term change management approaches and sustainability of QA and QI activity. The QISSEC shall focus on developing innovative strategies to improve the delivery of HIV quality care and treatment for use by facilities that serve the most vulnerable individuals in PEPFAR-supported LMICs. Using quality improvement methodologies, tools, and techniques, the project will identify gaps in service delivery, and develop culturally and medically appropriate, sustainable interventions targeted to PEPFAR- identified vulnerable and key populations. Over 18 years PEPFAR https://www.state.gov/pepfar/ has evolved to a complex and high impact program, with mature stakeholders and partners showing that epidemic control is indeed possible. It is in this context that HRSA is renewing its commitment to PEPFAR and specifically seeking to fill gaps as well as to bring targeted and innovative solutions to the remaining barriers to epidemic control around the globe. The PEPFAR 2021 Country Operational Plan Guidance for all PEPFAR Countries (https://www.state.gov/wp-content/uploads/2020/12/PEPFAR-COP21-Guidance-Final.pdf) suggests all PEPFAR country programs must incorporate explicit quality management practices, including both QA and QI activities, into service delivery and partner management.