U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention (CDC)

CDC-RFA-PS09-902

Announcement Type: 

Funding Opportunity Number: CDC-RFA-PS09-902

Catalog of Federal Domestic Assistance Number:  93.977

Key Dates:

Letter of Intent Deadline:  NA

Application Deadline:  August 25, 2008

Executive Summary:  NA

 

This announcement contains the following information:

Funding Opportunity Description

Authority:  This program is authorized under Section 318 (a) (b) (c) of the Public Health Service Act [42 U.S.C. Section 247c (a) (b) and (c)] and Section 301 of the Public Health Service Act [42 U.S.C. Section 241], as amended. Regulations governing the implementation of this legislation are covered under 42 CFR Part 51b, Subpart A.

 

 

 

 

 

 

TABLE OF CONTENTS

 

 

 

I.          Funding Opportunity Description and General Guidance

A.     Background ……………………………………….……… …3

B.     Purpose ……………………………………………..….…….5

           C.  Activities….……………………………………………….…11

1.      Comprehensive STD Prevention System.…...11

2.      Infertility Prevention Project………………...26

3.      Syphilis Elimination Effort..………………...31

4.      Gonococcal Isolate Surveillance Project ........39

5.      CDC ………………………………………...40

            D.  Application Content…………………………………………41

1.      Executive Summary…………………………41

2.      Comprehensive STD Prevention System……42

3.      Infertility Prevention Project………………...48

4.      Syphilis Elimination Effort………………….55

5.      Gonococcal Isolate Surveillance Project….…60

6.      Chlamydia Evaluation Initiative……….…….61

 

II.         Award Information  …………………………………………….63

 

III        Eligibility Information……………………………………….…66

 

IV        Application and Submission Information………………………71

                 A.  Content and Form of Submission………….…72

                 B.  Submission Dates and Times…………………77

     C.  Funding Restrictions……………………….…79

     D.  Other Submission Requirements…………..…81          

 

V         Application Review Information………………………………82

A.     Review and Selection Process…………….….87

B.     Anticipated Award Dates…………………….87

 

VI.      Award Administration Information ……………………………87

 

VII.      Agency Contacts………………………………………………90

 

VIII.      Other Information…………………………………………….92

 

 

 

Background:  

Sexually transmitted diseases (STDs) remain among the most challenging public health problems facing the United States.  CDC estimates that approximately 19 million new sexually transmitted infections occur each year and that almost half of them are among young people ages 15 to 24.  Untreated, chlamydia and gonorrhea increase a woman’s risk for pelvic inflammatory disease (PID) and infertility.  Furthermore, most STDs facilitate the sexual transmission of human immunodeficiency virus (HIV).   In addition to the physical and psychological consequences of STDs, these diseases exact a tremendous economic toll; direct medical costs associated with STDs in the United States are estimated to be as much as $14.7 billion annually.  The substantial physical, emotional, and fiscal costs are unnecessary because STDs are preventable, and early detection and treatment through routine screening can forestall costly and severe complications.

 

Although rates of STD infections vary by jurisdiction and region of the country, on a national level, African American, American Indian/Alaska Natives, and Hispanic populations suffer disproportionately from STDs. In addition, there is considerable STD morbidity among Whites and Asian/Pacific Islanders. Race and ethnicity, by themselves, are not risk factors for sexually transmitted infections, however, because of a complex set of historical, structural, environmental, and cultural factors, African Americans, even when compared to others with similar risk behaviors, are at greater risk for STDs. In 2006, compared to whites, African Americans were approximately six times more likely to be infected with syphilis, eight times more likely to be infected with chlamydia, and 18 times more likely to be infected with gonorrhea.  Among African American adolescents, the persistent heavy burden of STDs is even more critical. In 2006, young African American women (15-19 years old) had the highest reported gonorrhea rate of any group (2,898 per 100,000) and young African American men (15-19 years old) had a reported gonorrhea rate (1,503 per 100,000) that is 39 times higher than their white peers. In addition, the rates of chlamydia among American Indian/Alaska Natives in 2006, were more than five times higher than whites, and gonorrhea rates for Hispanics were more than two times higher than whites.

 

Men who have sex with men (MSM) are another population with a heavy burden of STDs.  This increased disease burden includes HIV infection, which compounds the problem and complicates prevention, detection, and medical management of STDs.  In 2006, an estimated two-thirds of primary and secondary (P&S) syphilis cases were among MSM.

 

Addressing these disparities will require significant efforts from health departments, health care providers, and affected communities.  It will also require health departments to collect and assess morbidity, behavioral, and other data to identify significant trends for each STD.  This information should be used to develop plans and implement activities designed to best reduce morbidity and related disparities. Concurrently, health departments, through direct services and clear guidance to medical institutions and other care providers, must strive to ensure the consistent delivery of comprehensive STD prevention services (fully integrated STD, HIV, and hepatitis prevention services), especially to individuals and communities disproportionately affected by STDs.

CDC’s Division of STD Prevention (DSTDP) works to help people be safer and healthier through prevention and control of STDs and their complications.  DSTDP’s priority disease prevention goals and strategies are:  (1) Prevention of STD-related infertility and other complications of PID by screening and treating at-risk persons, primarily women <26 years of age, and by working to reduce racial/ethnic disparities in gonorrhea and chlamydia; (2) Prevention of STD-related outcomes of pregnancy by reducing congenital syphilis, reducing adult male and female syphilis, increasing screening and treatment of syphilis, testing for chlamydia, gonorrhea and syphilis during pregnancy, and reducing neo-natal herpes; (3) Prevention of STD-related cancers by decreasing human papilloma virus (HPV) infection and its sequelae and increasing adult hepatitis B vaccination; and (4) Prevention of STD-related HIV transmission and acquisition and other STD-HIV interactions by decreasing bacterial STDs, increasing HIV screening among those with STD and those with behavioral risks, ensuring routine STD screening among HIV infected persons, and reducing genital herpes.   Achieving these specific disease prevention goals will involve understanding the social determinants of health in the promotion of sexual health and the primary prevention of sexually transmitted infections.

 

Purpose:  

The purpose of this program is to enhance the prevention and control of STD by supporting and improving the ability of public health departments to (1) design, implement, and evaluate Comprehensive STD Prevention Systems (CSPS); (2) implement the Infertility Prevention Project (IPP) and promote interventions that prevent STD-related infertility; (3) implement the Syphilis Elimination Effort (SEE) in designated high morbidity areas (HMAs) to enhance activities to prevent, control and eliminate syphilis; and (4) implement the Gonococcal Isolate Surveillance Project (GISP) in eligible jurisdictions.  Grantees implementing these programs must primarily focus their efforts on the prevention of chlamydia, gonorrhea, and syphilis among disproportionately impacted populations.  Grantees also have the option of applying for additional funds under the Chlamydia Evaluation Initiative (CEI), a project designed to support program evaluation activities to estimate chlamydia screening and partner treatment rates.

 

The ‘Comprehensive STD Prevention Systems (CSPS) provides an overarching framework on which grantees may develop their comprehensive STD prevention program plans, regardless of funding source.  CSPS is comprised of eight essential functions; as outlined in the Program Operations Guidelines (POG), they are:  (1) Community and Individual Behavior Change Services, (2) Medical and Laboratory Services, (3) Partner Services, (4) Leadership and Program Management, (5) Surveillance and Data Management, (6) Training and Professional Development, (7) STD Outbreak Response, and (8) Program Evaluation. (For more information about the essential functions, please access DSTDP’s Program Operations Guidelines, http://www.cdc.gov/std/program/#resources.).   

 

Although CSPS has a firm foundation in the eight essential functions contained in the Program Operations Guidelines, the ordering of these strategies have been realigned in this program announcement in the following format:

  • Surveillance (Surveillance and Data Management, STD Outbreak Response)

 

  • Interventions (Medical and Laboratory Services, Partner Services, Community and Individual Behavior Change Services)

 

  • Evaluation (Program Evaluation)

 

  • Program Support Systems (Leadership and Program Management, Training and Professional Development)

 

The purpose of this reformatting is to emphasize the importance of using key surveillance, program, and other data to effectively focus prevention efforts on the populations currently at greatest risk for STDs.  CDC recognizes that, because funding is limited, grantees will need to prioritize their activities within the CSPS essential functions and tailor them to the at-risk populations identified by local epidemiology.  The data used to develop the epidemiological profile must be of a high quality in order to ensure that significant morbidity trends and service gaps are identified and addressed.  In turn, implementing effective, high quality interventions requires ongoing assessment of program activities.  Program managers must routinely review epidemiological, behavioral, and program data so that programs can be modified and updated in response to changing epidemiology or implementation weaknesses.    

 

STD control programs typically have broad responsibilities within their jurisdictions beyond the scope of this announcement for surveillance, subject matter expertise, medical services, professional and public education, and guidance of other STD prevention activities.  Funds provided by this program announcement are not sufficient to achieve all of the goals of STD prevention. Investments from other sources (e.g., state and local governments and the health care delivery sector) in STD programming are necessary and critical to providing comprehensive STD prevention services to persons and communities in need. Given the need for comprehensive services, to maximize efficient use of limited resources and to provide high quality prevention services to persons in need, grantees should engage in meaningful collaborations with appropriate public and private health care and other non-medical partners, particularly organizations serving at-risk populations. Furthermore, while epidemiologists and program managers need to carefully investigate morbidity and individual interventions for each STD, grantees must also ensure that services are comprehensive, tailored to the needs of the populations they serve,  and fully integrated at the client services level (e.g., STD screening and treatment, HIV testing, hepatitis B vaccination). To enhance such collaborations, grantees should consider the recommendations made by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention’s (NCHHSTP) strategy calling for Program Collaboration and Service Integration (PCSI).  PCSI promotes improved comprehensive services at the client level through enhanced collaboration at the program level, thereby offering opportunities to (1) increase efficiency, reduce redundancy, and eliminate missed opportunities; (2) increase flexibility and better adapt to overlapping epidemics and risk behaviors; and (3) improve operations through the use of shared data. Examples of collaborative activities include: providing opt-out HIV testing in STD clinics; normalizing comprehensive STD/HIV testing in emergency departments, jails, family planning and other medical settings serving populations at increased risk; collaborating on structural interventions to increase adherence to chlamydia screening guidance in clinical settings; offering adult hepatitis B vaccination and STD screening in high prevalence areas or settings where high risk individuals seek services; and promoting HPV immunization in populations for whom the vaccine is recommended. Grantees should collaborate with programs addressing HIV prevention, viral hepatitis prevention, HIV treatment, immunizations, and reproductive health care to routinely offer comprehensive STD services and disseminate holistic prevention messages for populations at-risk for multiple problems.     

 

In addition, significant prevention opportunities exist in certain venues, such as sites where risk behaviors occur or where individuals meet their drug using or sexual partners. These are important places because they offer opportunities to provide at-risk individuals with prevention messages or services.  Often, these risk-associated venues are identified through partner elicitation interviews with infected persons.  Identifying risk-associated venues is an essential first step to enhancing STD prevention messages and services for social and sexual networks of persons at increased risk for STDs, including HIV.  For MSM in particular, sexually focused internet sites are increasingly identified as venues where men meet other men to arrange sexual encounters that are often unsafe. Health departments should ensure that staff have the tools and skills needed to conduct Internet Partner Services and provide prevention messages on-line. Developing and maintaining these new essential capacities will require considerable training, technical assistance, protocol and policy development, and ongoing strong support from health department leadership. 

This program addresses “Healthy People 2010” focus area 25, Sexually Transmitted Diseases (STD), http://www.healthypeople.gov/document/html/volume2/25stds.htm . It also supports the overarching goals of Healthy People 2010:  (1) to increase years and quality of healthy life and (2) eliminate disparities among subgroups of the population.

 

This program also addresses the CDC Health Protection Goals of:  healthy people in every stage of life, and healthy people in healthy places.

 

Measurable outcomes of the program will be in alignment with one (or more) of the following performance goals for the Coordinating Center for Infectious Diseases (CCID), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP):  (1) Reduce the rates of non-HIV sexually transmitted diseases in the United States. Furthermore, this program supports the NCHHSTP programmatic imperatives of program collaboration and service integration, and reduction of health disparities.

 

This announcement is only for non-research activities supported by CDC.  If research is proposed, the application will not be reviewed.  For the definition of research, please see the CDC Web site at the following Internet address:  http://www.cdc.gov/od/science/regs/hrpp/researchDefinition.htm 

 

 

 

 

Activities: 

Award amount may vary in subsequent years commensurate with changes in public health needs, changes in information technology, emerging trends in STDs and related risk behaviors, and future availability of funding.

 

Comprehensive STD Prevention Services (CSPS)

 

CSPS Activities

In order to reduce rates of reportable STDs in their jurisdictions, grantees must develop program plans with goals, measurable objectives, and monitoring plans that address the program announcement’s purposes.  In developing program plans within the context of the CSPS framework, grantees must:

  1. Address health disparities in syphilis, gonorrhea, and chlamydia using local surveillance data to identify populations that will be the focus of program plans.
  2. Describe plans to maximize or improve program collaboration and service level integration, e.g., collaboration with HIV/AIDS programs for clinical, prevention, and partner services; and hepatitis programs for HCV screening and hepatitis B vaccinations. These plans and the resulting partnerships should expand the reach of comprehensive STD prevention services in both the public and private sectors.
  3. Direct the majority of CDC funds towards the following strategies/activities:
    1. Increase chlamydia screening among women <26 years of age seen in public and private health care settings.
    2. Improve or expand access to screening, treatment, and partner services for populations disproportionately affected by STDs, including HIV.
    3. Improve and enhance partner services, i.e., assuring partner evaluation and treatment through both traditional and innovative means.
    4. Increase gonorrhea screening in geographic areas with elevated gonorrhea incidence and in public and private settings where populations at increased risk may be reached.

e.   Improve program evaluation, i.e., collecting, analyzing and using data to guide program activities and developing strong monitoring and evaluation plans for surveillance and program interventions. 

 

I.          Surveillance

A.        Surveillance and Data Management

Surveillance is the ongoing and systematic collection, analysis, interpretation, and dissemination of standardized health data for the purpose of public health action. Data management is the conversion of information into usable or storable form. Through surveillance and data management activities, STD programs identify populations affected by syphilis, gonorrhea, and chlamydia, including racial and ethnic minorities, MSM, adolescents, and persons living in areas with high morbidity.  Programs also need to identify co-infection rates with other STDs (i.e., HIV, hepatitis B) as well as rates of repeat STD infections. High quality surveillance and data management are essential to the implementation of effective STD prevention programs and should include the following activities:

1.         Establish and maintain information systems to monitor incidence of reportable STDs by relevant geographic and subpopulation categories including sex, race/ethnicity, provider type, and sexual orientation. Information systems should allow for routine assessment of STD/HIV co-infections and support the monitoring and evaluation of program activities, evidence-based action plans, and Performance Measures.

2.         Promptly investigate reports of STD from all sources to assure appropriate diagnosis, treatment and follow up of infected individuals and their partners.

3.         Assure complete laboratory and provider adherence to STD reporting regulations through written protocols to monitor and evaluate timeliness, completeness, and accuracy of reporting; and to provide regular feedback through periodic written updates, phone, and on-site visitation.

4.         Establish confidentiality and security guidelines for the collection, storage, and use of STD data received by the grantee.

5.         Routinely conduct, analyze, and report on STD prevalence monitoring activities.

6.         Routinely analyze and disseminate STD data by relevant geographic and subpopulation categories for the purposes of informing needs assessment, planning, and policy development, including standards setting and intervention strategy design; identify those populations and locales where prevention efforts should be implemented or enhanced.

7.         Establish and maintain written protocols for informing and updating physicians and other medical care providers on local morbidity trends and requirements for morbidity reporting.

8.         Identify or develop other potential sources of data for behavioral, clinical, laboratory, and/or programmatic information that can be used to guide STD prevention and control activities.

 

B.        Outbreak Response Plan

In order to detect and respond promptly to STD outbreaks, STD programs must create, maintain, and utilize Outbreak Response Plans.  Plans should include (1) standards for surveillance and procedures for analysis of data; (2) a timetable and schedule for review of disease trends; (3) disease thresholds for gonorrhea and syphilis at which the plan is to be initiated; (4) meaningful involvement of the affected community and their medical service providers in the effort; (5) proposed duties and activities for staffing including number, disciplinary mix, and specific responsibilities of members of response teams; (6) notification to CDC; (7) evaluation of the effectiveness of the outbreak response; and (8) schedule for the periodic review of both the outbreak plan and the surveillance system attributes. At a minimum, grantees should review age, race, gender, sexual orientation, provider type, and geographic information to identify populations experiencing increased incidence of gonorrhea and syphilis.

1.         Establish an STD Outbreak Response Plan that reflects the above-mentioned elements.

II.        Interventions

STDs are controlled and prevented through interventions that address detection and treatment of infections and provide services to exposed partners. Additionally, behavioral interventions enhance measures to reduce risk behavior. All STD prevention activities should be part of comprehensive STD prevention services, which includes STD, HIV, and viral hepatitis prevention activities.  Interventions (medical and laboratory, partner services and community and individual behavioral change services) should be focused on at-risk populations, especially those significantly impacted by health disparities (e.g., racial, ethnic, sexual orientation, or residing in areas with elevated morbidity rates), which are identified through  local morbidity, behavioral assessments and other data sources.  

A.        Medical and Laboratory Services:  High quality, accessible medical and laboratory services are essential elements in the prevention of STDs within any community. This intervention provides assurance of access to diagnostic and treatment services and targeted screening based on local and national recommendations in both public and private settings. Assurance of such services should consistently include the following:

1.         Ensure the provision of comprehensive STD diagnostic and treatment services in public STD clinics, i.e., implement high quality standards of care consistent with CDC’s guidelines and recommendations, including HIV opt-out testing. (See budget section for funding restrictions on clinical care) http://www.cdc.gov/std/treatment/2006/toc.htm

2.         Promote and implement the use of STD screening services recommended by CDC and other professional organizations with expert knowledge of STD screening practices, including annual chlamydia screening for sexually active women <26 years of age.

3.         Use local epidemiology to identify populations at greatest risk and locations where at-risk individuals can access STD screening, treatment, and other appropriate prevention services (e.g., promotion of enhanced gonorrhea screening by providers serving young adults in geographical areas with elevated prevalence).

4.         Implement evidence-based, locally-driven screening activities.

5.         Facilitate screening and treatment of partners of STD-infected individuals.

6.         Ensure prompt treatment of persons with STDs through the adoption of protocols for presumptive treatment (e.g., epi-treat STD-associated syndromes) and the consistent availability of on-site, “stat” (immediate) STD laboratory tests (Clinical Laboratory Improvement Amendments [CLIA] adherence required) in laboratories in public STD clinics.

 7.        Enhance access to STD services by developing and disseminating information that addresses health services availability and facilitates health services utilization.

8.         Increase awareness of providers in both public and private sectors of CDC STD screening recommendations and local priority populations. Encourage all providers serving at-risk populations to consistently offer recommended STD screening and treatment services, and to report morbidity promptly and accurately. This can be accomplished through provider visitations, grand rounds, and regular updates. All providers should be strongly encouraged to offer HCV testing, hepatitis B vaccination, and HIV screening, to at-risk persons as part of comprehensive STD prevention services.

 

B.        Partner Services:  Partner Services is the process by which sex partners of an individual diagnosed with an STD are identified, contacted, and notified of their exposure, and promptly offered appropriate clinical services and treatment to reduce their risk of complications of infection or further transmission of the disease; and to identify unnamed partners or persons with symptoms or at-risk for disease.  Partner services are a set of key STD prevention activities designed to rapidly identify infected and exposed persons, ensure their prompt treatment and ultimately reduce the overall burden of disease. Assurance of such services includes the following activities:

1.         Conduct partner elicitation and notification activities for all cases of early syphilis, and assure prompt partner evaluation and treatment.

2.         Conduct partner elicitation and notification activities for gonorrhea and chlamydia, as indicated by local epidemiology and priorities. 

3.         Develop and implement strategies and innovative methods to assure and enhance prompt partner evaluation and treatment for all partners of patients with gonorrhea and chlamydia through approaches such as provider referral, patient referral (self-referral or provider-assisted), expedited partner therapy (EPT) where permitted, and presumptive interviews in a manner which minimizes time and effort required by health department staff and maximizes prompt treatment of exposed partners.

4.         Offer comprehensive STD/HIV partner services to individuals co-infected with HIV and those exposed to multiple diseases. 

5.         Assess effectiveness and productivity of partner services for each disease independently (e.g., HIV, syphilis, gonorrhea, and chlamydia).

6.         Assess the feasibility of offering EPT to partners of infected persons, and where appropriate and permitted by local statutes and regulations, develop and implement protocols.  

7.         Develop and implement protocols for Internet Partner Services (IPS).

8.         Ensure comprehensive STD services for all examined partners.

 

C.        Community and Individual Level Behavioral Change Services:  Behavioral interventions are an important part of STD prevention services. Used in conjunction with biomedical approaches for the treatment and prevention of STDs, behavioral interventions should complement and enhance these efforts.  Behavioral intervention components include health education and community and individual behavior change interventions. Assurance of these activities includes the following:

1.         Provide STD prevention education for at-risk individuals and populations to include:  the role of abstinence, behavioral and other types of risk reduction (reducing multiple concurrent partnerships), correct and consistent condom use, symptom recognition, routine recommended screening, vaccination against HBV and HPV, prompt health-care seeking behavior, and partner services. 

2.         Promote the use of appropriate health education materials for use by public and private health care providers, institutions, schools, community-based organizations, and other STD prevention partners.

3.         Collaborate with other prevention programs (i.e., HIV, viral hepatitis, Reproductive Health, Family Planning, and Immunization) to design and implement comprehensive STD prevention messages and health education materials for individuals and communities with multiple risks.

4.         Integrate STD prevention messages into HIV testing and treatment services, and HIV prevention and other evidence-based behavioral interventions.

5.         Collaborate with experts in the fields of communication, behavioral and social science, social marketing and advertising who are reaching at-risk populations to design and disseminate STD prevention messages.

6.         Refer individuals at-risk for HIV infection to appropriate HIV risk-reduction programs.

 

III.       Evaluation

The purpose of evaluation is to identify and consistently collect data regarding program activities to improve program performance. Program evaluation should be based on monitoring activities implemented to achieve program goals and objectives and should be fully integrated into program activities from their conception.  Evaluation may include activities relevant to STD control but not funded under this FOA (e.g., STD clinical services).  STD prevention program evaluation activities should be guided by the comprehensive program evaluation guidance that can be found at http://www.cdc.gov/std/Program/pupestd.htm or in the Program Operations Guidelines at http://www.cdc.gov/std/program/#resources.

 

Evaluation activities that are required of all grantees include Process Evaluation, Performance Measures, and Program Improvement Plans. Evidence-based action plans are required from syphilis HMAs.

A.        Process Evaluation: Process evaluation determines whether program activities are implemented as intended. Information gathered is used for refining or modifying the activities and related procedures to improve their effectiveness. Steps of Process Evaluation include:

1.         Engage stakeholders and determine which program activities to evaluate.

2.         Develop logic models to link specific program activities with outputs.

3.         Develop questions that evaluation should answer.

4.         Develop and implement a plan to collect and analyze data to answer the evaluation questions developed.

5.         Determine appropriate next steps for program activity based on the assessment of the data analysis.

           

B.        Performance Measures:  As part of program evaluation, grantees are required to report on a set of Performance Measures. The primary purposes of collecting and analyzing data for Performance Measures are to improve STD prevention programs and to provide national data on performance of key program indicators. Performance Measures (or indicators) represent quantifiable information that provides insight into the yield or impact of a particular element of an STD prevention program.  Performance Measures complement local program evaluation activities and are important tools for program management.  They allow programs to monitor progress toward specified outcomes, facilitate the comparison of programmatic efforts over time, and encourage project areas to identify and implement “best practices”.  These Measures are outlined in the CSPS application content section. Performance Measures may be reviewed and revised throughout the project period. Comprehensive guidance on Performance Measures can be accessed through http://www.cdc.gov/std/program/#perform .

 

For each Performance Measure, grantees should:

1.         Ensure that systems are in place to capture complete and accurate data.

2.         Ensure that quality assurance mechanisms for data collection and reporting are in place and utilized.

3.         Use Performance Measure data to inform program planning, implementation, evaluation, and program improvement. 

 

C.        Program Improvement Plans:  Programs should develop approaches for using surveillance and evaluation data to improve program performance at least yearly. Plans should be developed based on analysis of morbidity trends, Performance Measures data, and evaluation findings. Program Improvement Plans should:

1.         Address program gaps and needs identified through the review of epidemiological and surveillance data, program evaluation findings, Performance Measures, input through technical reviews, and site visits.

2.         Identify the steps necessary to build on program strengths and remedy weaknesses identified.

3.         Include key milestones and timelines, key champions for implementation, and indicators for evaluating success.

4.         Include a request for technical assistance from outside sources, as needed.

 

D.        Evidence-Based Action Plans:  An evidence–based action plan guides the collection of information of the target populations, services being provided, resource allocation, and outcomes of programs in order to make decisions about program activities, identify technical assistance and training needs, improve program effectiveness, and inform choices about future program development.  Currently, evidence-based action plans are required as part of the evaluation process for syphilis elimination activities in the HMAs. However, evidence-based action plans may also be used as an effective tool for CSPS and IPP interventions.  For comprehensive guidance on evidence-based action plans, please see the syphilis elimination website at http://www.cdc.gov/stopsyphilis/plan.htm.  Programs should consider:

1.         Developing evidence-based action plans for significant STD prevention interventions.

2.         Regularly reviewing the data collected using the action plan guidance to determine the effectiveness of the intervention and allocation of resources. 

3.         Assessing the findings to improve interventions or reallocate resources.

 

IV.       Program Support Systems

STD program management should ensure that human, material, financial and technological resources are used in the most effective and cost-effective way to reach the program’s goals and objectives.  Program support must be provided through leadership and program management, and training and professional development.

A.        Leadership and Program Management: Leadership provides the vision and context in which management activities are implemented. It includes the initial development and implementation of policies and collaborations through partnerships with other entities in both public and private arenas, (e.g., actively collaborating with community partners to increase chlamydia screening among sexually active women <26 years of age across all segments of the community and seeking opportunities for program collaboration and service integration). Program Management oversees the implementation of elements created by leadership.  Assurance of leadership and program management services includes the following:

1.         Develop plans, based on epidemiologic and prevention activity data, to strengthen and promote comprehensive STD prevention activities; and to provide infrastructure, technical capacity, and public health leadership skills to perform and ensure delivery of STD prevention activities. 

2.         Develop and support STD education and screening services targeted to populations in geographical areas of elevated incidence.

3.         Develop and/or provide technical assistance on STD prevention activities.

4.         Develop strategies to keep key decision and policy makers apprised of local STD/HIV epidemiology and prevention strategies, including health disparities and the value of program collaboration and service integration.

5.         Educate the public about policies, legislation, and resources to assure access to STD prevention and clinical services.

6.         Create and facilitate partnerships between public STD, HIV, and hepatitis prevention programs, laboratories, HIV care providers, community based organizations, health care providers, correctional facilities, and others to enhance program collaboration and service integration.

7.         Identify alternative/additional resources to expand the capacity of the health care system to improve the delivery of comprehensive STD prevention services.

8.         Provide infrastructure and communications structures that support private and public collaborations.

9.         Implement initiatives to increase chlamydia screening in sexually active

 

women <26 years of age in public and private settings.

 

10.              Implement initiatives to reduce health disparities (e.g., enhanced

 

gonorrhea screening of African Americans).

 

11.       Promote the delivery of STD prevention services and opt-out HIV testing

 

in settings serving at-risk populations.

 

12.       Work with communities disproportionately impacted by STD to increase

 

awareness of STD risks, symptoms, risk reduction activities, and

 

availability of services.  

 

B.        Training and Professional Development: Training is a set of activities designed to develop specific skills of workers who perform public health functions. The training process includes assessment of staff proficiency and identification of training needs; delivery of training to address skill and knowledge deficiencies; and evaluation of the effectiveness of the training on performance.  Professional development is a strategy to develop the necessary professional expertise within the targeted workforce. Public health professionals should receive training and professional development designed to ensure their ability to consistently implement and conduct culturally, perhaps linguistically appropriate prevention activities. Training plans should be developed and updated annually based on assessments of staff training needs and program performance on objectives and Performance Measures. Training plans should address the needs of all STD program staff including clinicians, disease intervention specialists (DIS), supervisors, and program managers. Activities include:

1.         Systematically assess the training needs of STD staff and external partners including the ability to implement STD interventions and services.

2.         Provide CDC developed, sponsored or recognized training for public STD and HIV professionals including, but not limited to, DIS, counselors, clinicians, public health nurses, and supervisors through collaboration with the National Network of Prevention Training Centers (NNPTCs) and other entities. Training should include relevant updates on epidemiology and prevention strategies.

3.         Collaborate with professional organizations in support of continuing education for health professionals and others associated with STD/HIV prevention.

4.         Enhance STD prevention capacity of private providers through regular updates of surveillance and STD prevention control strategies.

5.         Provide consultation and assistance to providers and laboratories related to STD diagnostics, treatment, and reporting.

 

 

Infertility Prevention Project (IPP)

Purpose

The purpose of the Infertility Prevention Project (IPP) is to reduce infertility among women through the screening and treatment of chlamydia and gonorrhea.  These STDs are considered major causes of pelvic inflammatory disease (PID), ectopic pregnancy and related infertility among women in the United States.   Funds are intended to support and improve the ability of state and local health departments to design, implement, and evaluate activities specific to the prevention of STD-related infertility.  IPP funded interventions should be based on a thorough scientific understanding of local chlamydia and gonorrhea epidemiology, including geographic and racial/ethnic health disparities, public and private provider screening practices, and national guidelines. 

This program addresses the “Healthy People 2010” focus area(s) of Sexually Transmitted Disease, http://www.healthypeople.gov/document/html/volume2/25stds.htm.

Measurable outcomes of the program will be in alignment with the following performance goal(s) for the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP):  Reduction of Pelvic Inflammatory Disease.

 

Measurable outcomes of the program will be in alignment with one (or more) of the following performance goals for the Coordinating Center for Infectious Diseases (CCID), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP):  (1) Reduce the rates of non-HIV sexually transmitted diseases in the United States. Furthermore, this program supports the NCHHSTP programmatic imperatives of program collaboration and service integration, and reduction of health disparities.

 

IPP Activities

All IPP activities must be designed to reduce morbidity of those STDs which contribute to infertility. These activities are broadly categorized as 1) Clinical and Partner Services, 2) Laboratory Support, 3) Surveillance, Prevalence Monitoring and Data Management, and 4) Program Management and Leadership. The goal of reducing morbidity among STDs which contribute to infertility should be achieved by providing chlamydia screening to sexually active women <26 years of age as well as gonorrhea screening to young women at-risk. Programs should ensure prompt treatment of infected women and their sex partners. Programs should 1) provide chlamydia and gonorrhea test kits and other screening materials to public sector medical providers serving this population and 2) promote routine chlamydia screening of sexually active women <26 years of age seen by other health care providers in the public and private sectors. 

 

Grantees should develop program plans for infertility prevention based on access to at-risk populations, local prevalence of chlamydia and gonorrhea, current recommendations and guidelines, and available resources (federal, state, local, and private). Program plans should be consistent with regional IPP infrastructure plans and developed in collaboration with Family Planning and Laboratory partners. Grantees must:

1.         Conduct surveillance and maintain prevalence monitoring and data management systems to ensure collection of all IPP core data elements.

2.         Ensure clinical and partner services which includes routine chlamydia screening of sexually active women <26 years of age, geographically-targeted gonorrhea screening of young sexually active women residing in high prevalence areas, and prompt treatment of infected women and their sex partners. All persons infected with chlamydia and gonorrhea should promptly be offered partner services. Appropriate chlamydia and gonorrhea partner services should be evidence-based and may include traditional health department provided partner elicitation, notification, and referral; or various types of patient referral, including patient notification and EPT. Grantees interested in developing and implementing EPT protocols should identify potential barriers in their jurisdiction (i.e., prohibitions by state or local laws, public health codes and/or administrative rules and regulations, policy conflicts or ambiguities, and resistance of professional boards) and identify ways to address these barriers before implementing this strategy.

3.         Support laboratory testing by encouraging laboratory partners to adopt test technologies that are cost-effective, sensitive, and specific.

4.         Provide Program Management and Leadership including the development and distribution of materials and training for public and private medical care providers, as well as the general public, on chlamydia and gonorrhea prevalence, screening, treatment, and partner services.

5.         Assess both chlamydia and gonorrhea morbidity at the jurisdictional level. Identify subpopulations of young women with higher prevalence of chlamydia and gonorrhea and develop interventions to reach them, including those affected by health disparities, those residing in high morbidity geographical areas, or seen by providers serving at-risk women.  

6.         Develop program plans to address STD health disparities by using local data to identify the populations and health care providers for targeted services.

7.         Devote the majority of IPP resources toward the following strategies/activities:

a.         Increase adherence to recommendations for chlamydia screening among sexually active women <26 years of age in public and private sectors.

b.         Improve gonorrhea detection through targeted screening of young sexually active women in public and private sectors based on local prevalence, positivity, and/or morbidity.

c.         Educate providers on local chlamydia and gonorrhea morbidity trends, screening and treatment recommendations, and available partner services activities.

d.         Improve access to screening, treatment, and partner services in the public and private sectors for populations disproportionately affected by STDs.

e.         Conduct ongoing program evaluation including the consistent collection of standardized data to use in analyzing and assessing site-specific prevalence trends and the quality of services implemented.  Evaluation results should lead to improved program activities.

 

Grantees are expected to use the most cost-effective approaches available and provide a rationale for the approaches selected.  To improve cost-effectiveness, programs should target screening to sexually active women <26 years of age in settings with a chlamydia prevalence among these women of at least three percent (family planning clinics, STD clinics, adolescent health clinics, Indian Health Service sites, community health centers, school-based health centers, juvenile detention centers, jails, and other sites serving women who live in high morbidity locations).  Screening men is generally not cost-effective unless the prevalence among men is substantially higher than the prevalence among women. Grantees should refer to the male screening consultation meeting report for additional information, http://www.cdc.gov/std/chlamydia/ChlamydiaScreening-males.pdf 

 

The grantee must provide the Regional IPP Coordinator a draft copy of the CSPS Background section, IPP plan, and IPP budget in sufficient time to provide feedback prior to local clearance.  Any comments from the Regional IPP Coordinator received seven days before submission to local clearance should be considered by the project area for incorporation in the application.

 

Syphilis Elimination Effort (SEE)

 

Purpose

 

The purpose of the Syphilis Elimination Effort (SEE) is to promote health and quality of life by preventing, controlling, and eliminating endemic transmission of syphilis from the United States. All SEE funds must be used to support prevention program activities that directly relate to syphilis elimination activities. High Morbidity Areas (HMAs) and post-High Morbidity Areas (post-HMAs) may use funds for infrastructure development to support syphilis elimination activities. Additionally, for HMAs, 15 to 30 percent of funds must be awarded to community organizations that serve affected populations.

 

Measurable outcomes of the program will be in alignment with the following performance goal(s) for the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP):  Elimination of Syphilis.

The National Plan to Eliminate Syphilis from the United States, 2006, has three goals: 1) Investing in public health services; 2) Delivering prioritized, culturally competent interventions; and 3) Increasing accountability of services and interventions. Each goal has three recommended areas of focus (the “3 By 3” approach to syphilis elimination), resulting in a total of nine activities:  Surveillance, Clinical and Partner Services, Community Mobilization, Health Care Provider Mobilization; Tailoring of Interventions; Evidence-based Action Planning, Monitoring and Evaluation; Training and Staff Development; and Research (not covered under this announcement). These strategies are interrelated (e.g., enhancing SEE interventions will require evaluation); however, it is not intended that state and local health departments implement all of the activities described in the plan. Rather, sites should consider these activities as a compendium of effective or promising interventions from which their local syphilis elimination plan can be drawn upon. Further details on the strategies and activities are available at http://www.cdc.gov/stopsyphilis/plan.htm.

 

Project areas should use local epidemiological and behavioral risk surveillance data (e.g.,

case reports, prevalence data, etc.) to identify interventions and set appropriate targets. SEE efforts should be specifically directed towards populations disproportionately affected by syphilis (e.g., MSM, HIV+ MSM, commercial sex workers, African Americans). 

 

Eligibility

 

SEE funds are available to project areas defined as HMAs. A project area is a HMA if it has a minimum of 100 P&S cases or a case rate of 2.2/100,000 with a minimum of 60 P&S cases based on provisional data from the most recent calendar year reported by MMWR week 20 of the following year (e.g., 2009 HMA status is based on 2007 provisional data reported by May 17, 2008). SEE funds will be allocated based on these criteria:

 

High Morbidity Areas

 

  • Project areas that qualify for HMA status receive base funding of $150,000; and

 

  • A proportion of the remaining available funds based on the percent of reported P&S cases for all HMAs for the two prior years for which data is available (i.e., if a project area’s P&S cases are 10 percent of the total P&S cases among the HMAs, that project area would receive 10 percent of the total remaining SEE funds not used to support base funding).

 

Post-High Morbidity Areas

 

  • A project area that no longer meets the criteria for HMA status will be designated

 

post-HMA, and receive base funding for two years after the area no longer

 

meets the HMA criteria.

 

 

SEE Activities

Applicants should adhere to the National Plan to Eliminate Syphilis from the United States when developing program plans. The nine major activities for syphilis elimination are as follows:

1.         Surveillance:  Improve and enhance syphilis surveillance and outbreak response. Strong surveillance capacity must be in place in order to characterize the epidemic, inform or direct programmatic efforts, tailor interventions to populations at-risk, and monitor and evaluate their effects. Grantees should ensure that surveillance data are shared routinely with appropriate providers and community stakeholders and that outbreak identification and response plans are in place to effectively identify, diagnose, manage, and report rapid increases in syphilis.

Required for both HMAs and post-HMAs  

a.         Collect and report gender of sex partners/ sexuality data to CDC.

b.         Promote routine and regular (at least quarterly) analysis of epidemiologic data on syphilis.

c.         Encourage and monitor (quarterly basis) syphilis reporting from public and private providers.

d.         Use reactor grids to prioritize follow up of syphilis cases. These should be evaluated annually or more frequently if the local epidemiology changes.

e.         Develop a Syphilis Outbreak Response Plan. This should be reviewed and updated if necessary, on an annual basis. Additionally, grantees should develop an area-specific criterion that determines when the outbreak response plan is to be implemented.  This should be reviewed and updated, if necessary, on an annual basis

2.         Clinical and Partner Services:  Prompt quality clinical management of persons diagnosed with or exposed to infectious syphilis is a fundamental component for the prevention and control of syphilis. Clinical services for syphilis include early access to care, accurate diagnosis and staging, appropriate treatment, patient counseling, partner management, and follow up. Partner services is a key strategy to the control of syphilis through reducing the proportion of infectious persons in the population.

Required for both HMAs and post-HMAs

a.         Apply optimum interviewing techniques to maximize the number of partners elicited and partners initiated.

b.         Use the geographic and socio-demographic concentration of syphilis to inform DIS of the best locations to screen at-risk persons.

c.         Communicate and collaborate with other parties interested in partner notification for the elimination of syphilis (e.g., community-based organizations, health care providers especially in HIV care settings, and jails).

3.         Laboratory Services:  High quality laboratory services are essential for an enhanced response for syphilis elimination. Serologic testing remains the most frequent method for diagnoses of the disease. STD clinics and other clinical settings serving at-risk individuals should consistently offer rapid testing (e.g., stat RPR) and darkfield microscopy to all persons exposed to or suspected of having early syphilis. DIS should routinely conduct laboratory visits to address reporting requirements, types of test performed, and frequency of reporting.

4.         Community Mobilization: The current U.S. epidemic of infectious syphilis disproportionately affects disadvantaged ethnic minority communities and MSM. Community mobilization is an essential component of community and public health programs. Successful community participation in public health efforts is best achieved when affected community members collaborate in equal partnership with health professionals to determine health goals, implement interventions, and evaluate outcomes.

Required for HMAs only

a.         Ensure ongoing monitoring of surveillance data in order to track the evolution in local epidemics and inform appropriate community partners.

b.         Establish meaningful community participation in local SEE efforts.

c.         Ensure that local data are regularly reviewed with community partners and used to inform community-driven prevention efforts.

5.         Tailored Interventions: Tailored interventions strive for greater program efficiency and impact by identifying and utilizing the characteristics that are distinct to the targeted topic, context, or population. Interventions can be tailored to address a specific issue or a specific population.

Required for HMAs only

a.         Assess health-care seeking behaviors; health care access; partner services; and screening for ethnic minority populations affected by syphilis to inform the development or tailoring of culturally appropriate interventions.

6.         Health Provider Mobilization:  Individuals receive STD prevention and care services not only at public STD clinics, but also from private practice settings, HIV care providers, community health centers, emergency rooms, family planning clinics, correctional settings, jails, and other health care facilities. Mobilization requires the building of relationships and alliances with these and other providers and can include epidemiologic data sharing, DIS provider visitations, grand rounds, treatment recommendations, and prompt response to clinical and prevention provider questions.

Required for HMAs only

a.         Conduct provider visitations, including education and morbidity updates to encourage screening, appropriate treatment, and timely reporting of individuals with STDs.

b.         Create partnerships with local drug treatment centers and programs to facilitate treatment for drug users with STDs.

c.         Create partnerships with corrections facilities to facilitate screening, appropriate treatment, and timely reporting of individuals with STDs.

d.         Create alliances with health care providers to improve information management systems and data sharing capabilities.

Required for both HMAs and post-HMAs

e.         Ensure screening and treatment of all pregnant women for syphilis, using the recommendations contained in the CDC Treatment Guidelines.

f.          Undertake congenital syphilis relevant surveillance, monitoring and evaluation activities, including improving surveillance systems and strengthening monitoring and evaluation systems.

7.         Train and Develop Staff:  Staff training is critical to develop and maintain knowledgeable and credible clinical and prevention staff involved with SEE. The NNPTCs can play a substantial role in ensuring that opportunities are available for training of health department staff, laboratorians, and public and private practitioners.

Required for HMAs only

a.         Identify nationally and locally available training opportunities and resources.

b.         Ensure adequate training of supervisors to support local SEE activities.

8.         Evidence-Based Action Planning: An evidence–based action plan guides the collection of information of the target populations, services being provided, resource allocation, and outcomes of programs in order to make decisions about program activities, identifies technical assistance and training needs, improves program effectiveness, and informs choices about future program development. Monitoring involves assessing and documenting program procedures to assure that activities have been appropriately performed and are contributing to the success of the program. Evaluation is a systematic way to improve and account for actions.

Required for both HMAs and post-HMAs

a.         Develop evidence-based action plans that are supported by surveillance or research evidence.

b.         Prioritize risk groups and interventions for syphilis elimination.

c.         Disseminate findings of evaluation activities to appropriate partners.

9.         Research:  not funded by this program announcement.

 

For a complete listing of the 75 sub-activities that complements the above, please go to the National Plan at www.cdc.gov/stopsyphilis .

 

Gonococcal Isolate Surveillance Project (GISP)

 

The Gonococcal Isolate Project (GISP) was established to monitor trends in antimicrobial susceptibilities of strains of gonorrhea in the United States to establish a rational basis for the selection of gonococcal therapies.  Activities associated with GISP include:

1.         At participating STD clinics, collect urethral isolates of N. Gonorrhoeae

 

(based on a presumptive or confirmed identification) from the first 25 men

 

with urethral gonococcal infection (regardless of symptom status) each

 

month, along with required demographic and clinical data.

 

2.         Collect, handle, ship, and store gonorrhea specimens.

3.         Report demographic and clinical data in a timely manner to CDC and their

 

respective state/local public health authorities.

 

CDC Activities

 In a cooperative agreement, CDC staff is substantially involved in program activities above and beyond routine grant monitoring.

 

CDC activities for this program are as follows:

1.         Provide consultation and technical assistance (TA) to health departments on various aspects of their STD prevention programs (e.g., performance measurement, program evaluation, outbreak response planning).  Program consultants will facilitate the joint development, implementation, and evaluation of grantee-specific Program Improvement Plans.

2.         Work with grantees to assess training needs and provide training to managers, supervisors, and disease intervention staff, or other prevention programs, including hepatitis coordinators, HIV program managers, reproductive health representatives, and family planning partners either directly or through the NNPTCs or other training partners.

3.         Disseminate current information, including national surveillance data, prevention, and management recommendations in all areas of STD prevention, including STD-related infertility prevention and syphilis elimination.

4.         Support and facilitate program collaboration with other CDC programs and HHS offices to enhance and improve integration of services.

5.         Monitor grantee progress toward achieving stated target levels of performance, from objectives and Performance Measures, and work with the grantee to make improvements if target levels are not met through consultation via site visits, email, telephone, and review of progress reports.

6.         Oversee the recruitment, development, and management of all directly assigned STD prevention field staff.

7.         Provide up-to-date national guidance in essential program functions (e.g., Community and Individual Behavioral Change Services, Medical and Laboratory Services, Partner Services, Leadership and Program Management, Surveillance and Data Management, Training and Professional development, STD Outbreak response, and Program Evaluation) to facilitate local program activities as well as local and national public health policy. These can be downloaded from www.cdc.gov/std.

8.         Provide programmatic consultation, technical assistance, and reference/diagnostic services for STDs through reference laboratory activities.

9.         Support and facilitate program collaboration to enhance and improve integration of services.

 

Application Content

 

1.         Executive Summary

 

The executive summary should include a clear and succinct description of the program including, but not limited to, the funding being applied for (CSPS, IPP, SE, and GISP), program mission and purpose, program structure, and overarching goals of the program for which funding is requested.

 

2.         CSPS

 

A.        Background and Need for CSPS

 

This section should describe the grantee’s total STD program (not just the portion that is federally funded), STD prevention needs, and plans for proposed CSPS, IPP, and SE funded activities. The grantee must include the following:

1.         An Epidemiologic profile focusing on syphilis (all stages), gonorrhea, chlamydia and related health disparities.  Data presented should include P&S syphilis, Early Latent syphilis, chlamydia, and gonorrhea morbidity categorized by race and year of report (2003-2007). The profile should also include epidemiologic trends by relevant characteristics including gender, age, race/ethnicity, geography.  Health disparities should be assessed and discussed. Five-year trend data should be presented by number reported and case rate, as well as a comparison of reported case numbers for the time periods January-June in 2008 and January-June 2007.

2.         A description of P&S syphilis, Early Latent syphilis, chlamydia, and gonorrhea categorized by gender (male, female, and total) and age (standard age groups) and year of report (2003-2007).

3.         A description of P&S syphilis cases co-infected with HIV. Data (number of cases, number of cases with partner information, number of cases co-infected with HIV, number of cases known to be HIV negative or of unknown HIV status) should be presented by gender. For male cases include a discussion about the number of MSM cases co-infected with HIV and those MSM cases known to be HIV negative or of unknown status.

4.         Discussion of significant behavioral trends of groups affected by STDs (e.g., sexual risk, substance abuse, and health care seeking); health services delivery trends (e.g., number of dedicated STD clinics, clinic attendance, approximate number of patients turned-away for services due to fees or appointments, health department relationships with private providers); and program management (e.g., organizational structure, funding, federal and local staffing, resource limitations) trends over the past five years.  Include any other relevant information or trends that may be major factors affecting STD morbidity within the project area.

5.         An overview of the STD program to include discussion of surveillance, including an outbreak response plan, interventions (Medical and Laboratory, Partner Services, Community and Individual Behavior Change Services) and program support systems (Leadership and Program Management, Training and Staff Development) as outlined in the CSPS activities section of this guidance. 

6.         Discussion of community and key provider involvement and organizational partnerships in planning, implementing and evaluating program activities, including successes and barriers. Specifically describe the degree to which service level and programmatic integration are being conducted. Describe program collaboration and service integration activities with other governmental and non-governmental entities (e.g., regional infertility prevention projects, reproductive health programs, school-based clinics, correctional centers, HIV Prevention and Care Programs, Hepatitis Programs, HIV Prevention and Ryan White planning groups, correctional health, substance abuse treatment, Indian Health Services, faith-based organizations, private sector providers, NNPTCs, AIDS Education and Training Centers).

7.         Discussion of the activities and the process used to meaningfully involve American Indian tribal governments, Tribal organizations representing those governments, or Alaska Native Villages and Corporations located within your jurisdiction.  Describe how Tribes are involved in the delivery of STD Prevention services and how your health department supports of provides services on behalf of the tribes. 

8.         Report on each of the 2008 objectives and Performance Measures for the period January-June 2008. For each applicable Performance Measure, the grantee should discuss the following:

            a.         Performance level, including numerator and denominator values.

            b.         Data sources used for the numerator and denominator.

            c.         Action plan for improving performance.

            d.         Barriers encountered in collecting data or improving performance.

e.         Technical assistance needs for data collection, data use, or program              performance improvement.

In addition to reporting on the Performance Measures in the Background and Need section, grantees must enter January 1-June 30, 2008, Performance Measures data into the PM database (https://webappa.cdc.gov/STD-PM/ ) by September 30, 2008.

 

B.        Proposed 2009 Objectives

Develop measurable and quantitative five-year project period goals and one-year budget period objectives. These goals and objectives should relate to the program priorities identified and justified in the background and need sections of the application. These goals and objectives should relate to the program priorities identified and justified in the background and need sections of the application and CDC STD program priorities. Goals and one to six objectives must be written for each of the program elements: surveillance and data management, medical and laboratory, partner services, behavioral interventions, program evaluation, leadership and program management, and training and professional development. Assure that each objective is specific, measurable, achievable and ambitious, relevant, and time bound (SMART).

 

C.        Program Evaluation

1.         Performance Measures:  Grantees must provide five-year (2013) project period and one-year (2009) budget period goals for the following 2009 DSTD Performance Measures which are related to CDC’s STD performance goals:

CSPS MLS1    a. Proportion of female admittees to large juvenile detention facilities that were tested for chlamydia.

                                          b. Proportion of females tested diagnosed with chlamydia.

 

CSPS MLS2    a. Among clients of IPP family planning clinics, the proportion of women with positive CT tests that are treated within 14 and 30 days of the date of specimen collection.

 

b. Among clients of IPP family planning clinics, the proportion of women with positive GC tests that are treated within 14 and 30 days of the date of specimen collection.

 

CSPS MLS3    a. Among clients of STD clinics, the proportion of women with positive CT tests that are treated within 14 and 30 days of the date of specimen collection.

 

                        b. Among clients of STD clinics, the proportion of women with positive GC tests that are treated within 14 and 30 days of the date of specimen collection.

 

CSPS MLS4    Proportion of P&S syphilis cases treated within 14 and 30 days of the date of specimen collection.

 

CSPS MLS5    a. Proportion of female admittees entering selected adult city and county jails that were tested for syphilis.        

     

b. Proportion of females tested newly diagnosed with syphilis (any stage).

 

                                          c. Proportion of females diagnosed with syphilis treated                                                       within 14 and 30 days of the date of specimen collection.

 

CSPS PS1       Proportion of P&S syphilis cases interviewed within 7, 14, and 30 calendar days from the date of specimen collection, per P&S syphilis case.

                                                                 

CSPS PS2       a. Number of contacts prophylactically treated (Disposition A) within 7, 14 and 30 calendar days from day of interview of index case, per case of P & S syphilis.

     

b. Number of contacts brought to treatment as new syphilis cases (Disposition C) within 7, 14 and 30 calendar days from day of interview of index case, per case of P&S syphilis.

                                         

CSPS PS3       Non-HMAs only: Proportion of ALL gonorrhea cases interviewed within 7, 14, and 30 days from the date of specimen collection.        

     

CSPS SDM1   Proportion of reported cases of gonorrhea, chlamydia, P&S syphilis, EL syphilis, and congenital syphilis sent to CDC via NETSS that have complete data for  age, race, sex, county, and date of specimen    collection.

 

CSPS SDM2   Proportion of reported cases of gonorrhea, chlamydia, P&S syphilis, EL syphilis, and congenital syphilis sent to CDC via NETSS within 30 and 60 days from the date of specimen collection.

     

CSPS SDM3   Proportion of reported cases of P&S syphilis and EL syphilis sent to CDC via NETSS where sex of sex partners is known.

           

Grantees will continue to report the required Performance Measures data in the Performance Measures database (see Reporting Requirements).

Grantees will also be required, at some point during the project period, to report on indicators of service delivery integration and level of program integration when these indicators become available.     

2.                  Program Improvement Plan:  Grantees should develop a Program Improvement Plan based on analysis of morbidity trends, Performance Measures data, and evaluation findings. Grantees should describe a process to review these and other data sources on a regular basis in order to provide an approach to ongoing program improvement. This plan should specify timelines, participants in the process, and how recommendations from the plan will be implemented, monitored, and evaluated.

 

 

 

D.        Outbreak Response Plan

Develop a written outbreak response plan, identifying health department and other public and private partners who will assist in outbreak response efforts.  Provide annual review of the plan. This should be included in the appendix and will not count against the page limit.

 

3.         IPP

A.        Background and Need for IPP

This section should be an extension of the discussion provided under the CSPS section  and should provide greater detail about the grantee’s overall infertility prevention efforts (not just IPP or the portion that is federally funded) and provide a vision and sound platform for proposed IPP-funded activities.  The grantee must include:

1.         An overview and update of chlamydia morbidity trends by relevant characteristics (e.g., gender, age, race/ethnicity, geography). Grantees should provide five-year trend data on morbidity numbers, rates and prevalence as well as a comparison of reported case numbers for the time periods January-June 2008 and January-June 2007.  

2.         An overview and update of gonorrhea morbidity trends by relevant characteristics (e.g., gender, age, race/ethnicity, geography). Grantees should provide five-year trend data on morbidity numbers, rates and prevalence as well as a comparison of reported case numbers for the time periods January-June 2008 and January-June 2007.  Chlamydia and gonorrhea morbidity trends should be assessed independently in order to identify at-risk populations for each disease. 

3.         A discussion of behavioral characteristics (e.g., sexual risk, substance abuse, provider type) associated with chlamydia and gonorrhea case reports.

4.         A description of qualitative changes in health services delivery (e.g., establishment or dissolution of relationships with providers, significant changes in provider networks).

 5.        A discussion of program management (e.g., organizational structures, funding, federal and local staffing, and resource limitations) trends over the past five years. Include any major changes affecting chlamydia and gonorrhea morbidity within the jurisdiction (e.g., legislative or private initiatives).

6.         A description of collaboration with other governmental and non-governmental entities (e.g., regional infertility prevention project, school-based clinics, community health centers, correctional centers, community groups, Indian Health Services, tribes, faith-based organizations, STD/HIV Prevention Training Centers, AIDS Education and Training Centers and other interested professional organizations) including a discussion of partners’ contributions to the design, implementation and evaluation of program activities.

7.         Report the status for each of the 2008 objectives for the period January-

 

June 2008.

 

B.        IPP Activities    

For each IPP activity ([1] Clinical and Partner Services, [2] Laboratory Support, [3] Surveillance, Prevalence Monitoring & Data Management, and [4] Program Management and Leadership), provide a brief description of the status as well as plans to enhance activities and expand services.  Include the following:

1.         Clinical and Partner Services:  Plans should include descriptions of the following:

a.         IPP resource allocation. In order to ensure appropriate allocation of limited screening resources targeting high risk populations, grantees must describe chlamydia tests performed in prevalence monitoring sites during 2007, among women < 26 years of age and among women ≥ 26 years of age. All prevalence monitoring sites should be identified, categorized by site type (Title X FP, non-title X FP, STD, other), and number of tests performed, number positive and positivity should be presented. The grantee must develop plans to either 1) reallocate resources from clinics with chlamydia positivity among women (<26 years old) of three percent (or less) to locations with higher prevalence, or 2) increase positivity in those clinics to above three percent. Prevalence monitoring sites are those clinics and providers submitting chlamydia and gonorrhea testing data to the regional IPP infrastructure. Plans should be specific and time-limited.

b.         Client-level counseling and education strategies used to prevent and control chlamydia and gonorrhea including (a) the importance of partner referral and treatment, (b) the impact of untreated and repeat infections on future fertility and (c) comprehensive STD prevention messages and (d) risk-reduction strategies, such as abstinence, monogamy, i.e., being faithful to a single sexual partner, or using condoms consistently and correctly. 

c.         Screening and treatment assurance activities for at-risk women and their sex partners.

d.         Plans to influence managed care organizations and federally funded community health centers to increase chlamydia screening as supported by screening coverage data (HEDIS and other sources).

e.         Plans for targeted gonorrhea screening of sexually active young women in areas of high gonorrhea prevalence, including a detailed description of the high prevalence population to be targeted. The target population should be determined through a careful review of current prevalence, positivity, and morbidity data and age, race/ethnicity, gender, geographic and other risk factors. Activities should include identifying geographic areas with high gonorrhea morbidity, public and private providers serving these geographic areas, and collaborative plans for increasing gonorrhea screening and treatment among the targeted population and their sex partners.

f.          Provide any plans for male chlamydia or gonorrhea screening activities (see budget section for funding restrictions). To use IPP funds for this purpose, the grantee must provide information on cost-effectiveness and expected impact on female morbidity and infertility prevention. Activities and IPP core data elements must be reported to the regional IPP coordinator.         

2.         Laboratory Support:  Plans should include descriptions of the following:

a.         Tests used for chlamydia and gonorrhea screening.

b.         The rationale for test selection as it relates to cost and performance.

c.         Quality assessment practices to monitor performance of laboratories.

d.         How compliance to regional turnaround time standards is monitored.

e.         Quality assurance procedures to ensure test reproducibility.

f.          Chlamydia and gonorrhea pooling procedures (if applicable).

g.         The rationale for confirmatory testing (if applicable). Include a clear definition of “confirmatory testing” in your area.

3.         Surveillance, Prevalence Monitoring, and Data Management:  Plans should include descriptions of the following:

a.         The surveillance, prevalence monitoring and data management systems used to ensure collection of all CDC core data elements.

b.         How the jurisdiction is using data for program planning.

c.         Adherence to state or local chlamydia and gonorrhea screening criteria. Include definitions, monitoring plans, and evaluation activities.

d.         Quality assurance activities used to monitor completeness and timeliness of submission of chlamydia and gonorrhea prevalence monitoring data to regional coordinators.

e.         Local information systems used to collect core and enhanced regional IPP data elements.

f.          How chlamydia screening coverage in family planning and STD clinics is monitored (i.e., the number of eligible women screened divided by the number of eligible women being seen at a site).

4.         Program Management and Leadership:  Plans should include descriptions of the following:

a.         How regional, state or local protocols and other quality assurance activities are used to improve program efficiency and performance.

b.         How routine chlamydia and targeted gonorrhea screening among private sector providers are promoted. Include collaboration plans, goals, and expected outcomes.

c.         Specify how progress reports and details of significant events, including national IPP activities and updates are shared with the regional IPP committee. Include a description of policies and procedures in place to ensure STD, Family Planning, and Laboratory representative attendance at regional IPP meetings.

d.         How information about the regional project, including disease trends, numbers screened and treated, at-risk populations, and guidelines on screening and treatment are disseminated to providers and communities in the jurisdiction.

e.         Strategies to optimize program resources and increase screening of sexually active young women seen by private providers (e.g., increase non-federal contributions; improve program efficiency by increasing  electronic reporting, reducing treatment delays; negotiating lower costs; expanding third party reimbursement; or other efforts to increase program resources).

 

C.        Proposed 2009 Objectives

List the five-year project period and one-year budget period program objectives for each IPP activity, ensuring they are consistent with the grantee’s program priorities and CDC STD program priorities. Assure each objective is specific, measurable, achievable and ambitious, relevant, and time bound (SMART).  Provide a rationale for the goals and a description of how each relates to Healthy People 2010 Objectives for STD prevention and to CDC STD performance goals. Include specific goals for reducing health disparities and enhancing service level integration (Reference:   http://www.healthypeople.gov/documents/html/volume2/25std.htm  and http://www.cdc.gov/fmo/PDFs/FY09_CD C_Online_Performance_Appendix.pdf)

 

 

D.        Program Evaluation

1.         Performance Measures:  Grantees must provide five-year (2013) project period and one-year (2009) budget period goals for the 2009 DSTD Performance Measures.

2.         Program Improvement Plan:  Program Improvement Plan:  Grantees should develop a Program Improvement Plan based on analysis of morbidity trends, Performance Measures data, and evaluation findings. Grantees should describe a process to review these and other data sources on a regular basis in order to provide an approach to ongoing program improvement. This plan should specify timelines, participants in the process, and how recommendations from the plan will be implemented, monitored, and evaluated.

 

4.         Syphilis Elimination Effort

 

A.        Background and Need for SEE

 

This section should describe the grantee’s syphilis elimination efforts, focusing on the

 

nine SEE activities. This section should complement, but not duplicate, the Background

 

and Need in the CSPS.

 

1.         The grantee should address the status of any of the below listed activities

 

that are conducted within the jurisdiction:

 

a.         Surveillance

 

b.         Clinical and Partner Services

 

c.         Laboratory Services

 

d.         Community Mobilization

e.         Tailored Interventions

 

f.          Health Provider Mobilization

 

g.         Train and Develop Staff

 

h.         Evidence-based action planning

 

i.          Research (not funded under this application)

 

2.         Report the status for each of the 2008 objectives for the period January-

 

June 2008.

 

3.         Provide an update on efforts to conduct syphilis screening at high risk

 

venues and other settings where at-risk individuals can be reached (i.e.,

 

corrections, HIV care facilities).

 

 

B.        Proposed 2009 Objectives

 

List the 2009 budget period (one-year) program objectives for each activity, ensuring they are consistent with the grantee’s program priorities and CDC STD program priorities. Assure that each objective is specific, measurable, achievable and ambitious, relevant, and time bound (SMART). 

 

C.        Program Evaluation

 

1.         Performance Measures:  Grantees must provide five-year (2013) project period and one-year (2009) budget period goals for the 2009 DSTD Performance Measures.

2.         Program Improvement Plan:  Grantees should develop a Program Improvement Plan based on analysis of morbidity trends, Performance Measures data, and evaluation findings. Grantees should describe a process to review these and other data sources on a regular basis in order to provide an approach to ongoing program improvement. This plan should specify timelines, participants in the process, and how recommendations from the plan will be implemented, monitored, and evaluated.

            3.         Evidence-Based Action Plans:  Both HMAs and post-HMAs are required

 

to develop evidence-based actions plans to guide the implementation

 

monitoring of each SE activity. All Evidence-based Action Plans

 

submitted to the CDC must be formatted as described in this

 

announcement.  An action plan is required for each Syphilis Elimination

 

Activity. For ongoing interventions, elements 1–7 of the seven elements

 

described below will be required in grant applications and six month

 

progress reports; only elements 1–6 will be required for a new

 

intervention.

 

a.         Objective:  The program should describe the overall objective and purpose of the intervention and should explicitly state whether the intervention is ongoing or new. 

b.         Target population:  The program should describe the target population for the intervention, and provide justification for why the target population was selected.  Demographic and epidemiologic data should support the choice of the population as a target of the intervention.  For example, an intervention may target white men who have sex with men (MSM) between the ages of 25 and 45 years old because 60 percent of the jurisdiction’s total cases were in this population.

c.         Intervention:  In this section, the program should describe the intervention in detail to include all staff, steps, and activities needed to complete the intervention. The intervention may be traditional, (e.g., screening and treatment, partner services, outreach, or community collaboration) or it may be a novel intervention (e.g., a provider-focused intervention).  Separate monitoring plans may be helpful if the same intervention is used in two different populations (partner notification in the MSM population and partner notification in the heterosexual population) or in two different venues (screening in a mobile van and screening in a jail). 

d.         Implementation plan:  The SEE grantee should list and describe the amount, type, and cost of all of the resources required to implement the intervention.  This list should include the cost of staff hours, travel, vehicle, print materials, screening supplies, laboratory services, and any other resources needed to implement the intervention.

e.         Process evaluation and performance indicators:  The action plan should include performance indicators or measures that will demonstrate how the program will reach the interventions expected outcome.   Examples include, the number of syphilis tests conducted per month; the number of provider visits per month; the number of partners elicited per month; the number of people who recall seeing a poster.

f.          Expected outcomes:  The ideal long-term outcome is the decreased incidence of P&S syphilis; however, it may be difficult to attribute a decrease in syphilis morbidity to a single intervention.  Therefore, this section should also include short-term or intermediate outcomes of the intervention.  For example, a short-term outcome may be increased awareness of a syphilis campaign in the community; an intermediate outcome may be a measured behavior change in the at-risk population or a measured practice change among private healthcare providers.   

g.         Examine and evaluate the data and re-consider the intervention:  All interventions that are defined as ongoing should include this section.  Data collected should be reviewed to determine the effectiveness of an intervention towards achieving objectives stated in the first element. SEE programs are asked to use this data to analyze the success of interventions during the current year and to inform the development of subsequent interventions.  If an intervention is demonstrated not to be effective in achieving the determined short, intermediate, or long term outcome, then in the application or six month progress report the program will provide a description of planned changes in the intervention or reallocation of SEE resources to achieve the stated outcome.  Alternatively, the program may provide justification for continuation of the intervention without change.

For more information about syphilis elimination evidence-based planning and examples of the guidance applied, please refer to Guidance for Syphilis Elimination Effort Evidence-based Action Planning at www.cdc.gov/stopsyphilis .

 

D.        Outbreak Response Plan

 

In addition to developing an STD Outbreak Response Plan that includes syphilis, HMAs and post-HMAs must develop area-specific criteria that determine when the outbreak response plan is to be implemented. This should be reviewed and updated, if necessary, on an annual basis. This should be included in the appendix and will not count against the page limit.

 

5.         GISP

A.        Background and Need for GISP

Provide a narrative that includes the following:

1.                  Describe enrollment strategy.  Specifically describe how the grantee intends to reach a goal of 25 isolates per month.

2.                  Describe procedures for isolate collection, handling, shipping, and storage of duplicate isolates until the regional laboratory confirms that the isolates received are viable.

3.                  Describe patient data the grantee intends to collect and the plan for submitting data to CDC in a timely fashion.

 

6.         Chlamydia Evaluation Initiative (CEI) - Optional

Background and Need for CEI

The Chlamydia Evaluation Initiative (CEI) addresses the continued high burden of chlamydia infection among women over ten years after initial screening recommendations were put into place.  In 2006, over one million cases of chlamydia were reported to CDC, representing the highest annual number of any notifiable disease ever reported. The burden of disease is still considerable among young women attending family planning clinics; the median region-specific positivity rate in 2006 was 6.7 percent.  Given the high burden of infection, CDC continues to recommend that all sexually active women aged <26 years be screened for genital Chlamydia trachomatis infection annually.  However, national estimates suggest that fewer than 50 percent of eligible women seeking care are screened.  National efforts to reduce chlamydia infections are ongoing.  CDC is working to increase chlamydia screening coverage.  To monitor this effort, local chlamydia screening coverage must be better estimated and monitored over time.  No agreed-upon methods or definitive data sources exist to provide, national, state, or community based estimates of chlamydia screening coverage.

 

Activities

The CEI is intended to support program evaluation activities to estimate (1) chlamydia screening and (2) partner treatment rates.  Successful applicants will develop plans to conduct an in-depth, science-based evaluation.  The CEI provides an opportunity for applicants to closely examine either local chlamydia screening coverage rates and/or partner treatment coverage rates.  The geographic area of analysis will be at the community level.  A community is defined as a locale smaller than a state with a defined population and geographic boundaries (e.g., county, metropolitan statistical area, urban area defined by zip codes or census tract).

 

These evaluations will have two primary goals: (1) ascertainment of baseline population-based performance estimate for either chlamydia screening coverage and/or rates of partner treatment and (2) identification of candidate approaches or methodologies for monitoring these parameters over time (while tracking programmatic efforts and achievements to provide the rationale for interpretation).  In the course of addressing the two questions above, grantees will also need to answer the following questions: (1) If estimates are obtained from more than one source or methodology, how do such estimates contribute to the overall assessment of baseline coverage or rates of partner treatment?, (2) How useful are the methodologies or approaches for the purpose of ongoing monitoring?, (3) To what extent are the methodologies identified applicable for broad replication, dissemination, and implementation?, and (4) If estimates obtained from the various sources and methodologies do not appear consistent, what are the explanations for such inconsistency?

 

Grantees will design and conduct a community level evaluation project to identify approaches to the estimation of chlamydia screening coverage rates among sexually active women <26 years and/or rates of treatment among male partners of chlamydia-infected women.  Grantees will use innovative methods to derive local estimates from administrative datasets (available at the state, regional, or national level) and other local data sources appropriate for determination of community-level chlamydia screening coverage.  Similarly, for determination of rates of treatment among male partners of chlamydia-infected individuals, grantees may use any available, appropriate data sources, including, but not limited to, data from DIS partner elicitation interviews.  Any and all available data should be considered for these evaluations (e.g., administrative data, case report data, and local prevalence datasets).

 

II.         Award Information

Type of Award:  Cooperative Agreement.

CDC’s involvement in this program is listed in the Activities Section above.

Award Mechanism:  H25 Venereal Disease Control

Fiscal Year Funds: 2009

Approximate Current Fiscal Year Funding: $104,263,809

Approximate Total Project Period Funding: $521,319,045 (This amount is an estimate and is subject to availability of funds. This figure includes both direct and indirect costs).

Anticipated Award Date: January 1, 2009

Budget Period Length: 12 months

Project Period Length: 5 years

 

 

CSPS

Approximate Number of Awards:                     65

Approximate Average Award:                          $851,968 (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

Floor of Individual Award:                                $28,212

Ceiling of Individual Award:                              None (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

 

IPP

Approximate Number of Awards:                     65

Approximate Average Award:                          $433,733 (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

Floor of Individual Award:                                $15,397

Ceiling of Individual Award:                              None (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

 

 

 

 

SEE

Approximate Number of Awards:                     40

Approximate Average Award:                          $450,000 (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

Floor of Individual Award:                                $150,000

Ceiling of Individual Award:                              None (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

 

GISP

Approximate Number of Awards:                     26

Approximate Average Award:                          $4,500 (This amount is for the first 12-month period, and includes both direct and indirect costs).

Floor of Individual Award:                                None

Ceiling of Individual Award:                              None (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

 

 

 

 

CEI

Approximate Number of Awards:                     6

Approximate Average Award:                          $165,000 (This amount is for the first 12-month period, and includes both direct and indirect costs).

Floor of Individual Award:                                $30,000

Ceiling of Individual Award:                              $200,000 (This amount is for the first 12-month budget period, and includes both direct and indirect costs).

 

Throughout the project period, CDC’s commitment to continuation of awards will be conditioned on the availability of funds, evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the Federal government.

 

III. Eligibility Information

 

III.1. Eligible Applicants

Eligible applicants that can apply for this funding opportunity are listed below:

CSPS – Eligible applicants are the 65 official public health agencies that are current recipients of project grants for Preventive Health Services-Sexually Transmitted Disease Control grants. These applicants have the necessary infrastructure in place to perform the activities required and have the experience needed to successfully complete the required functions.

 

IPP - Eligible applicants are the 65 official public health agencies that are current recipients of project grants for Preventive Health Services-Sexually Transmitted Disease Control grants. These applicants have the necessary infrastructure in place to perform the activities required and have the experience needed to successfully complete the required functions.

 

The following are conditions of IPP funding:

a.         The application must include a letter signed by both STD and designated Title X FP representatives.  The letter must be signed within three months of the application submission deadline.  The letter should briefly describe local FP and STD collaboration and specify the percentage of total IPP funds (minimum 50%) devoted to screening and treatment of women and their sex partners in Title X family planning settings. If this percentage is less than 50 percent, a justification must be provided. In the event of multiple state-level Title X Family Planning grantees, the letter must be signed by all Title X grantees. The letter should reflect the commitment of the STD program manager (or their designee) and Family Planning partners to attend twice-annual regional IPP meetings.  

b.         Grantees must expend a percentage of IPP funds, up to 10 percent of total awarded IPP funds, on targeted gonorrhea screening (women <26 years of age) equivalent to the proportion of gonorrhea among women < 26 years of age when compared to total gonorrhea and chlamydia among women < 26 years of age. Calculations should be based on morbidity data from the most recent calendar year available.  Targeted gonorrhea screening is defined as enhanced gonorrhea/chlamydia screening among women identified by local surveillance as being at increased risk for gonorrhea (e.g., if gonorrhea is seven percent of the sum of gonorrhea and chlamydia among women <26 years of age, then a minimum of seven percent of total IPP testing funds should be devoted to targeted gonorrhea screening [maximum of 10%]).

c.         Up to 15 percent of total IPP funds awarded may be used to support male screening. The collaboration letter from the STD program director and the Title X family planning program representative(s) must indicate how the Title X family planning partner(s) were involved in the decision. The grantee must include a detailed budget that delineates the amount of IPP funds allocated for male screening and treatment activities.

d.         IPP funds can be used to support testing, treatment, and counseling services provided to the partners of individuals with chlamydia. However, support of Disease Intervention Specialists for these partner services is restricted pending the development of CDC guidance regarding such services.

e.         IPP funded services should be provided in settings consistent with Public Health Service Act (PHSA) section 318A, specifically health departments, grantees funded under PHSA sections 329, 330, 340A, 1001, or other health care providers serving a significant number of low-income women. 

 

SEE – Project areas eligible for Syphilis Elimination funding have a minimum of 100 P&S cases or a case rate of 2.2/100,000 with a minimum of 60 P&S cases. Project areas that have achieved post-HMA status are eligible for SE base funding for a post HMA status transition period of two years.

 

The following are conditions of SEE funding:

a.         HMAs may use funds for infrastructure development to support syphilis elimination activities. All SE funds must be used for SE activities.

b.         HMAs must award fifteen to thirty percent of funds to community organizations that serve affected populations.  These organizations have access to, and history and social credibility with, persons and groups affected by syphilis. They are able to provide culturally competent, relevant, and effective interventions. Grantees will have to report on activities of these funded organizations in future project period progress.

 

GISP – Eligible applicants are the following project areas:  Alabama, Arizona, Baltimore, California, Colorado, Florida, Georgia, Hawaii, Illinois, Los Angeles, Louisiana, Michigan, Minnesota, Missouri, Nevada, New Mexico, New York City, North Carolina, Ohio, Oklahoma, Oregon, Philadelphia, San Francisco, Texas, Virginia, and Washington.

 

CEI - Eligible applicants are the 65 official public health agencies that are current recipients of project grants for Preventive Health Services-Sexually Transmitted Disease Control grants. These applicants have the necessary infrastructure in place to perform the activities required and have the experience needed to successfully complete the required functions.

 

III.2. Cost Sharing or Matching

Cost sharing or matching funds are not required for this program.

 

III.3. Other

CDC will accept and review applications with budgets greater than the ceiling of the award range. 

 

 

Special Requirements:

If the application is incomplete or non-responsive to the special requirements listed in this section, it will not be entered into the review process.  The applicant will be notified the application did not meet submission requirements.

  • Late applications will be considered non-responsive.  See section “IV.3.  Submission Dates and Times” for more information on deadlines.
  • Note: Title 2 of the United States Code Section 1611 states that an organization described in Section 501(c)(4) of the Internal Revenue Code that engages in lobbying activities is not eligible to receive Federal funds constituting a grant, loan, or an award.

 

IV. Application and Submission Information

 

IV.1. Address to Request Application Package

To apply for this funding opportunity use the application forms package posted in Grants.gov.

 

Electronic Submission:

CDC strongly encourages the applicant to submit the application electronically by utilizing the forms and instructions posted for this announcement on www.Grants.gov, the official Federal agency wide E-grant Web site.  Only applicants who apply on-line are permitted to forego paper copy submission of all application forms.

Registering an organization through www.Grants.gov is the first step in submitting applications online. Registration information is located in the “Get Registered” screen of www.Grants.gov. While application submission through www.Grants.gov is optional, CDC strongly encourages applicants to use this online tool.

 

Please visit www.Grants.gov at least 30 days prior to filing your application to become familiar with the registration and submission processes. Under “Get Registered,” the one-time registration process will take three to five days to complete; however, as part of the Grants.gov registration process, registering an organization with the Central Contractor Registry (CCR) annually, could take an additional one to two days to complete. CDC suggests submitting electronic applications prior to the closing date so if difficulties are encountered, a hard copy of the application may be submitted prior to the deadline.

 

If access to the Internet is not available, or if there is difficulty accessing the forms on-line, contact the CDC Procurement and Grants Office Technical Information Management Section (PGO-TIMS) staff at 770-488-2700 and the application forms can be mailed.

 

IV.2. Content and Form of Submission

Letter of Intent (LOI):  NA

A letter of intent is not applicable to this funding opportunity announcement.

 

 

Application:

A Project Abstract must be submitted with the application forms.

 

All electronic project abstracts must be uploaded in a PDF file format when submitting via Grants.gov.  The abstract must be submitted in the following format, if submitting a paper application:

  • Maximum of 2-3 paragraphs.
  • Font size: 12 point unreduced, Times New Roman
  • Single spaced
  • Paper size: 8.5 by 11 inches
  • Page margin size: One inch

 

The Project Abstract must contain a summary of the proposed activity suitable for dissemination to the public.  It should be a self-contained description of the project and should contain a statement of objectives and methods to be employed.  It should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically literate lay reader.  This Abstract must not include any proprietary/confidential information. 

 

A project narrative must be submitted with the application forms.  All electronic narratives must be uploaded in a PDF file format when submitting via Grants.gov.  The narrative must be submitted in the following format, if submitting a paper application:

  • Maximum number of pages: 100.  If your narrative exceeds the page limit, only the pages which are within the page limit will be reviewed.
  • Font size: 12 point unreduced, Times New Roman
  • Single spaced
  • Paper size: 8.5 by 11 inches
  • Page margin size: One inch
  • Printed only on one side of page.
  • Number all narrative pages; not to exceed the maximum number of pages.
  • Paper application should be held together only by rubber bands or metal clips; not bound in any other way.
  • Include a complete index with page numbers to all parts of the application and its appendices.

 

The narrative should address activities to be conducted over the entire project period and must include the following items in the order listed:  

A.  Executive Summary

 

B.   CSPS

1.         Background and Need

                              a.   Discussion of Epi-Profile

b.   Description of Populations Disproportionately Impacted by Syphilis, Gonorrhea, and Chlamydia

                  c.         Discussion of Behavioral Trends

                  d.         Program Overview

                              1.         Surveillance & Outbreak Response Plan

2.         Interventions (Medical and Laboratory Services, Partner Services, and Community and Individual Behavior Change Services)

3.         Program Support Systems (Leadership and Program Management, Training and Staff Development)

e.   Discussion of Community and Key Provider Involvement and            Organization Partnerships

1.         Discussion of Program Collaboration and Service Integration

f.   Report of 2008 Objectives

g.  Report on 2008 Performance Measures

2.         Proposed CSPS 2009 Objectives

                        3.         Program Evaluation

                                    a.         Performance Measures

                                    b.         CSPS Program Improvement Plan

                        4.         Outbreak Response Plan

                                           

C.  IPP

                        1.         Background and Need

                                    a.         Overview of Chlamydia Morbidity and Trends

                                    b.         Overview of Gonorrhea Morbidity and Trends

                                    c.         Discussion of Significant Behavior Trends

                                    d.         Discussion of Health Services Delivery Trends

                                    e.         Discussion of Program Management

                                    f.          Description of Collaborative Relationships

                                    g.         Report on 2008 Objectives

                                    h.         IPP Activities and Plans

                                                1.         Description of Clinical and Partner Services

                                                2.         Description of Laboratory Support

3.         Description of Surveillance, Prevalence Monitoring, and Data Management

4.         Description of Program Management and Leadership

2.         Proposed 2009 Objectives

3.         Program Evaluation

a.         IPP Performance Measures

b.         IPP Program Improvement Plan

 

D.  SEE

1.         Background and Need

a.         Status of Activities Conducted

b.         Report on 2008 Program Objectives

c.         Screening at High-Risk Venues

2.         Proposed 2009 Objectives

3.         Program Evaluation

a.         SEE Performance Measures

b.         SEE Program Improvement Plan

c.         SEE Evidence-Based Action Plans

4.         Outbreak Response Plan

 

 

E.   GISP

1.         Background and Need

      2.         Enrollment Strategy

      3.         Procedures for Isolate Collection and Handling

                  Patient Data

 

F.   CEI (optional)

      1.         Background and Need

      2.         Description of Selected Community

      3.         Methodology, Data Sources, and Approach

      4.         Expected Outcomes

      5.         Technical Assistance Needs

      6.         Budget

 

The budget and budget justification will be included as a separate attachment, not to be counted in the narrative page limit. A separate budget with budget justification will be included for each component.

 

Additional information must be included in the application appendices.  The appendices will not be counted toward the narrative page limit.  This additional information includes:

1.      Curriculum Vitae of Project Director

2.      Outbreak Response Plan

3.      IPP letter of support

4.      Table 1. Percentage Direct Assistance/Financial Assistance (DA/FA) Staff Time Attributed to STD and HIV Activities.

5.      Table 2.  State and Local Contribution for STD Prevention by Budget Category.

 

Additional information submitted via Grants.gov should be uploaded in a PDF file format, and should be named (i.e., Curriculum vitae, Letters of Support, Indirect Cost Rate Agreement, etc.)

No more than 50 should be uploaded per application. 

 

The agency or organization is required to have a Dun and Bradstreet Data Universal Numbering System (DUNS) number to apply for a grant or cooperative agreement from the Federal government.  The DUNS number is a nine-digit identification number, which uniquely identifies business entities.  Obtaining a DUNS number is easy and there is no charge.  To obtain a DUNS number, access the Dun and Bradstreet website or call 1-866-705-5711. 

 

Additional requirements that may request submission of additional documentation with the application are listed in section “VI.2.  Administrative and National Policy Requirements.”

 

IV.3. Submission Dates and Times

 

Application Deadline Date:  August 25, 2008

 

Explanation of Deadlines:  Applications must be received in the CDC Procurement and Grants Office by 5:00 p.m. Eastern Time on the deadline date. 

 

Applications must be submitted electronically at www.Grants.gov.  Applications completed on-line through Grants.gov are considered formally submitted when the applicant organization’s Authorizing Organization Representative (AOR) electronically submits the application to www.Grants.gov.  Electronic applications will be considered as having met the deadline if the application has been successfully submitted electronically by the applicant organization’s AOR to Grants.gov on or before the deadline date and time.

 

When submission of the application is done electronically through Grants.gov (http://www.grants.gov), the application will be electronically time/date stamped and a tracking number will be assigned, which will serve as receipt of submission.  The AOR will receive an e-mail notice of receipt when HHS/CDC receives the application.

This announcement is the definitive guide on LOI and application content, submission address, and deadline.  It supersedes information provided in the application instructions.  If the application submission does not meet the deadline above, it will not be eligible for review.  The application face page will be returned by HHS/CDC with a written explanation of the reason for non-acceptance.  The applicant will be notified the application did not meet the submission requirements. 

 

IV.4. Intergovernmental Review of Applications

The application is subject to Intergovernmental Review of Federal Programs, as governed by Executive Order (EO) 12372.  This order sets up a system for state and local governmental review of proposed federal assistance applications.  Contact the state single point of contact (SPOC) as early as possible to alert the SPOC to prospective applications and to receive instructions on the State’s process.  Visit the following Web address to get the current SPOC list:

 http://www.whitehouse.gov/omb/grants/spoc.html

 

IV.5. Funding Restrictions

The Funding Announcement 09-902, supports cooperative grants to several public health agencies that are currently implementing one or more STD control programs. The purpose of this program is to enhance the prevention and control of STD by supporting and improving the ability of public health departments in STD control.

 

The additional activities required under this FOA emphasize the importance of using key surveillance, program, and other data to effectively focus prevention efforts on the populations currently at greatest risk for STDs. Grantees will be collecting, storing, and retrieving identifiable information including the transmission of highly sensitive data to CDC; e.g. gender of sex partners/ sexuality.

 

All information collection activities that will be implemented through the grantee will require approval from OMB for compliance to the Paperwork Reduction Act.

 

Restrictions, which must be taken into account while writing the budget, are as follows:

  • Recipients may not use funds for research.
  • Recipients may not use funds for clinical care, including treatment, except where noted for IPP.
  •  Recipients may only expend funds for reasonable program purposes, including personnel, travel, supplies, and services, such as contractual.
  • Awardees may not generally use HHS/CDC/ATSDR funding for the purchase of furniture or equipment.  Any such proposed spending must be identified in the budget.
  • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party or provider who is ineligible.
  • Reimbursement of pre-award costs is not allowed.
  • When federal funds are used to develop or purchase STD health education materials, they shall contain medically accurate information regarding the lack of effectiveness of condoms in preventing the STD the materials are designed to address.

 

If requesting indirect costs in the budget, a copy of the indirect cost rate agreement is required.  If the indirect cost rate is a provisional rate, the agreement should be less than 12 months of age.  The indirect cost rate agreement should be uploaded as a PDF file with “Other Attachment Forms” when submitting via Grants.gov.

 

The recommended guidance for completing a detailed justified budget can be found on the CDC Web site, at the following Internet address:

http://www.cdc.gov/od/pgo/funding/budgetguide.htm.

 

IV.6. Other Submission Requirements

A letter of intent is not applicable to this funding opportunity announcement.

 

Application Submission Address:

Electronic Submission:

HHS/CDC strongly encourages applicants to submit applications electronically at www.Grants.gov.  The application package can be downloaded from www.Grants.gov.  Applicants are able to complete it off-line, and then upload and submit the application via the Grants.gov Web site.  E-mail submissions will not be accepted.  If the applicant has technical difficulties in Grants.gov, customer service can be reached by E-mail at support@grants.gov or by phone at 1-800-518-4726 (1-800-518-GRANTS).  The Customer Support Center is open from 7:00a.m. to 9:00p.m. Eastern Time, Monday through Friday. 

 

HHS/CDC recommends that submittal of the application to Grants.gov should be prior to the closing date to resolve any unanticipated difficulties prior to the deadline.  Applicants may also submit a back-up paper submission of the application.  Any such paper submission must be received in accordance with the requirements for timely submission detailed in Section IV.3. of the grant announcement. The paper submission must be clearly marked:  “BACK-UP FOR ELECTRONIC SUBMISSION.”  The paper submission must conform to all requirements for non-electronic submissions.  If both electronic and back-up paper submissions are received by the deadline, the electronic version will be considered the official submission.

 

The applicant must submit all application attachments using a PDF file format when submitting via Grants.gov.  Directions for creating PDF files can be found on the Grants.gov Web site.  Use of file formats other than PDF may result in the file being unreadable by staff.

 

V. Application Review Information

 

V.1. Criteria

Applicants are required to provide measures of effectiveness that will demonstrate the accomplishment of the various identified objectives of the cooperative agreement.  Measures of effectiveness must relate to the performance goals stated in the “Purpose” section of this announcement.  Measures must be objective and quantitative and must measure the intended outcome.  The measures of effectiveness must be submitted with the application and will be an element of evaluation.

 

The application will be evaluated against the following criteria:

 

CSPS

(1) Background:  To what extent does the grantee provide an overview and update of (1) syphilis, gonorrhea, and chlamydia, (2) significant behavioral, health service delivery, and (3) programmatic management trends or issues? To what extent does the grantee discuss community involvement, organizational partnerships, and meaningful involvement with American Indian tribal governments? (4) To what extent does the grantee discuss of program collaboration and service integration? (5) To what extent does the grantee adequately identify and justify at-risk populations, particularly those experiencing health disparities? (30 Points)

 

(2) Program Plan:  To what extent does the grantee provide a description of the status of each essential function? To what extent does the narrative address priority populations and strategies/activities? Is relevant information regarding service level integration provided? (30 Points)

 

(3) Objectives:  To what extent do the proposed objectives address morbidity and at-risk population(s) described in the Background? Are the proposed objectives SMART? To what extent will they accomplish program goals? (20 Points)

 

(4) Evaluation:  To what extent does the grantee address process evaluation and the program improvement plan? To what extent has the grantee provided goals for each Performance Measure? If applicable, does the grantee provide a rationale for not responding to one or more of the Performance Measures? (20 Points)

 

 

 

IPP

(1) Background:  To what extent does the grantee provide an overview of all infertility prevention activities? To what extent does the grantee update both chlamydia and gonorrhea morbidity, significant behavioral, health service delivery, and program management trends or issues? To what extent does the grantee discuss collaborative relationships, service level and programmatic integration? (30 points)

 

(2) Program Plan:  To what extent does the grantee provide a description of the status of clinical and partner services, laboratory support, and program leadership? To what extent does the grantee provide a description of surveillance, prevalence monitoring, and data management issues? (30 Points)

 

(3) Objectives:  To what extent do the proposed objectives address morbidity and at-risk population(s) described in the Background? Are the proposed objectives SMART? To what extent will they accomplish program goals? (20 Points)

 

(4) Evaluation:  To what extent does the grantee address process evaluation and the program improvement plan? To what extent has the grantee provided goals for each Performance Measure? If applicable, does the grantee provide a rationale for not responding to one or more of the Performance Measures? (20 Points)

 

 

 

SEE

(1) Background:  To what extent does the grantee provide an overview of all syphilis elimination activities? To what extent does the grantee address the significant behavioral trends and issues? To what extent does the grantee address screening efforts at high-risk venues and other places where at-risk individuals can be reached? (25 Points)

 

(2) Program Plan:  To what extent does the grantee provide a description of the status of the syphilis elimination activities that they are conducting? (25 Points)

 

(3) Objectives:  To what extent do the proposed objectives address morbidity and at-risk population(s) described in the Background? Are the proposed objectives SMART? To what extent will they accomplish program goals? (25 Points)

 

(4) Evaluation:  To what extent does the grantee address process evaluation and the program improvement plan? To what extent has the grantee provided goals for each Performance Measure? If applicable, does the grantee provide a rationale for not responding to one or more of the Performance Measures? To what extent does the grantee provide evidence-based action plans for each intervention, complete with the objective, target population, intervention, implementation, performance indicators, expected outcomes, and evaluation of the intervention (if applicable)? (25 Points)

 

 

 

GISP

(1)  To what extent does the grantee provide an overview and an update to the demonstrated need? (25 Points)

(2)  To what extent does the grantee describe the enrollment strategy? (25 points)

(3)  To what extent does the grantee describe the procedures for isolate collection, handling, and shipping? (25 Points)

(4)  To what extent does the grantee describe the intended data to collect and submit in a timely manner? (25 Points)

 

CEI

 (1) To what extent does the grantee supply supporting background materials? (15 Points)

 (2) To what extent does the grantee provide a description of the selected community and the rationale for the selection? (35 Points)

 (3) To what extent does the grantee provide a description of the methodology, data sources, and approach to generating the community-level estimate(s)? (40 Points)

 (4) To what extent does the grantee provide expected outcomes? (10 Points)

 

Budget (SF 424A) and Budget Narrative will be reviewed, but not scored. 

 

As part of this cooperative agreement, CDC will provide collaborative assistance in the development and implementation of CEI activities. 

 

 

 

V.2. Review and Selection Process

Applications will be reviewed for completeness by the Procurement and Grants Office (PGO) staff, and for responsiveness jointly by NCHHSTP/DSTDP and PGO. Incomplete applications and applications that are non-responsive to the eligibility criteria will not advance through the review process.  Applicants will be notified the application did not meet submission requirements.

 

An objective review panel will evaluate complete and responsive applications according to the criteria listed in the “V.1. Criteria” section above.  The review will be based on the criteria stated above.  The panel will consist of CDC employees with 100% being from outside the funding Office and at least 51% being from outside the funding Center.  [The objective review process will follow the policy requirements as stated in the GPD 2.04 at http://198.102.218.46/doc/gpd204.doc.  Applications will be funded in order by score and rank determined by the review panel. 

 

V.3. Anticipated Announcement Award Dates

January 1, 2009

 

 

VI. Award Administration Information

 

VI.1. Award Notices

Successful applicants will receive a Notice of Award (NoA) from the CDC Procurement and Grants Office.  The NoA shall be the only binding, authorizing document between the recipient and CDC.  The NoA will be signed by an authorized Grants Management Officer and emailed to the program director and a hard copy mailed to the recipient fiscal officer identified in the application.

 

Unsuccessful applicants will receive notification of the results of the application review by mail.

 

VI.2. Administrative and National Policy Requirements

Successful applicants must comply with the administrative requirements outlined in 45 CFR Part 74 and Part 92, as appropriate.  The following additional requirements apply to this project:

  • AR-6               Patient Care
  • AR-7               Executive Order 12372
  • AR-8               Public Health System Reporting Requirements
  • AR-9               Paperwork Reduction Act Requirements
  • AR-10                         Smoke-Free Workplace Requirements
  • AR-11                         Healthy People 2010
  • AR-12                         Lobbying Restrictions
  • AR-14                         Accounting System Requirements
  • AR-23                         States and Faith-Based Organizations
  • AR-24                         Health Insurance Portability and Accountability Act Requirements
  • AR-25             Release and Sharing of Data

Additional information on the requirements can be found on the CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/Addtl_Reqmnts.htm.

CDC Assurances and Certifications can be found on the CDC Web site at the following Internet address: http://www.cdc.gov/od/pgo/funding/grants/foamain.shtm

 

For more information on the Code of Federal Regulations, see the National Archives and Records Administration at the following Internet address: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html

 

VI.3. Reporting Requirements

The applicant must provide CDC with an annual interim progress report via www.grants.gov:

1.      The interim progress report is due no less than 90 days before the end of the budget period.  The progress report will serve as the non-competing continuation application, and must contain the following elements:

a.       Standard Form (“SF”) 424S Form.

b.      SF-424A Budget Information-Non-Construction Programs.

c.       Budget Narrative.

d.      Indirect Cost Rate Agreement.

e.       Project Narrative.

 

In addition to addressing the Performance Measures in the 2009 progress report and annual report, the grantee must enter Performance Measures data in the Performance Measures database (https://webappa.cdc.gov/STD-PM/ ). Data for the period January 1 -June 30, 2009 is due by September 30, 2009, and data for July 1 – December 31, 2009, is due by March 31, 2010.

 

Also, the applicant must provide CDC with an original, plus two hard copies of the following reports:

2.   Financial status report, no more than 90 days after the end of the budget period.           

3.   Final performance and Financial Status reports, no more than 90 days after the end of the project period.

These reports must be submitted to the attention of the Grants Management Specialist listed in the “VII. Agency Contacts” section of this announcement.

 

VII. Agency Contacts

CDC encourages inquiries concerning this announcement.

For general questions, contact:

            Technical Information Management Section

Department of Health and Human Services

            CDC Procurement and Grants Office

            2920 Brandywine Road, MS E-14

            Atlanta, GA 30341

            Telephone: 770-488-2700

 

 

 

For program technical assistance, contact:

            Ron Turski, Project Officer

Department of Health and Human Services

Centers for Disease Control and Prevention

            1600 Clifton Road

            MS-E/27

            Atlanta, GA.  30333

            Telephone:  404-639-8315

            E-mail: rat3@cdc.gov

 

For financial, grants management, or budget assistance, contact:

Cheryl Pressley, Grants Management Specialist

Department of Health and Human Services

            CDC Procurement and Grants Office

            2920 Brandywine Road, MS-E/15

            Atlanta, GA 30341

            Telephone:  404-639-8164

            E-mail:  cam6@cdc.gov

CDC Telecommunications for the hearing impaired or disabled is available at: TTY 770-488-2783.

 

 

 

VIII. Other Information

Other CDC funding opportunity announcements can be found on the CDC Web site, Internet address: http://www.cdc.gov/od/pgo/funding/FOAs.htm.

 

Applicants may access the application process and other awarding documents using the Electronic Research Administration System (eRA Commons).  A one-time registration is required for interested institutions/organizations at http://era.nih.gov/ElectronicReceipt/preparing.htm

Program Directors/Principal Investigators (PD/PIs) should work with their institutions/organizations to make sure they are registered in the eRA Commons.

1.      Organizational/Institutional Registration in the eRA Commons

2.  Project Director/Principal Investigator (PD/PI) Registration in the eRA Commons: Refer to the NIH eRA Commons System (COM) Users Guide.

  • The individual designated as the PD/PI on the application must also be registered in the eRA Commons. It is not necessary for PDs/PIs to register with Grants.gov.
  • The PD/PI must hold a PD/PI account in the eRA Commons and must be affiliated with the applicant organization. This account cannot have any other role attached to it other than the PD/PI.
  • This registration/affiliation must be done by the Authorized Organization Representative/Signing Official (AOR/SO) or their designee who is already registered in the eRA Commons.
  • Both the PD/PI and AOR/SO need separate accounts in the eRA Commons since both hold different roles for authorization and to view the application process.

Note that if a PD/PI is also an HHS peer-reviewer with an Individual DUNS and CCR registration, that particular DUNS number and CCR registration are for the individual reviewer only. These are different than any DUNS number and CCR registration used by an applicant organization. Individual DUNS and CCR registration should be used only for the purposes of personal reimbursement and should not be used on any grant applications submitted to the Federal Government.

Several of the steps of the registration process could take four weeks or more. Therefore, applicants should check with their business official to determine whether their organization/institution is already registered in the eRA Commons.  HHS/CDC strongly encourages applicants to register to utilize these helpful on-line tools when applying for funding opportunities.

 

 

CDC Home Page: http://www.cdc.gov

CDC Funding Web Page: http://www.cdc.gov/od/pgo/funding/FOAs.htm  

CDC Forms Web Page: http://www.cdc.gov/od/pgo/funding/grants/app_and_forms.shtm