STD AAPPS FOA Frequently Asked Questions
1. What does CDC consider a high number of congenital syphilis cases for a project area?
Applicants should treat any number of cases greater than zero as a high number of congenital syphilis cases.
Congenital syphilis is a serious but rare disease, with fewer than 500 cases reported nationwide for each of the last 10 years (range of 339 – 460 cases).
In 2011, only 23 states reported any cases of congenital syphilis. (July 9, 2013)
2. What is the CDC definition of high gonorrhea morbidity?
Applicants should treat counties and independent cities with more than 1,000 reported cases of gonorrhea in the previous calendar year as high gonorrhea morbidity jurisdictions.
Applicants can consider counties and independent cities to be jurisdictions.
Jurisdictions with more than 1,000 reported cases of gonorrhea have accounted for approximately half of all cases reported nationwide for the last five years. (July 9, 2013)
3. The minimum required activities for monitoring screening rates are very similar to SSuN grant activities for facility-based sentinel surveillance. Unlike SSuN, there are no minimum facilities mentioned in the STD AAPPS FOA. Does that mean applicants have to assess chlamydia, syphilis and rectal gonorrhea screening rates throughout our entire jurisdiction?
Programs must describe how they will monitor chlamydia screening rates:
- among young females enrolled in Medicaid (preferably using the HEDIS measure); and
- those seen in Title X and other family planning clinics.
Programs must also describe how they will monitor annual syphilis and rectal gonorrhea screening among men who have sex with men seen in high volume HIV care settings. (July 9, 2013)
4. What is the definition of “health disparities?” Is there a specific case rate or number of cases that will determine which project areas are required to perform these activities?
Health disparities may be defined as differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes.
Disparities must be measured from a reference point.
What constitutes an important disparity that deserves attention and programmatic action may be influenced by the size of the differences involved and the populations impacted by the disparity. (July 9, 2013)
5. Which HIV data need to be integrated with STD data?
STD cases reported through notifiable disease surveillance should be matched with reported cases of HIV.
Demographic, mode of transmission, and risk factor information should be included in the match. (July 9, 2013)
6. If the applicant’s jurisdiction is not considered high morbidity for gonorrhea, what activities are required?
Document that the jurisdiction is not a high morbidity area in the application.
Applicants must follow CDC’s Cephalosporin-Resistant Neisseria Gonorrhoeae Public Health Response Plan before allocating resources to other activities. (July 9, 2013)
7. For Part B GISP applications, could you clarify if it is permissible to have more than one STD clinic contribute to the 25 monthly isolates from men with urethritis?
More than one STD clinic can be used to contribute to the 25 monthly isolates.
The isolates should be submitted together to the reference laboratory for susceptibility testing each month, and accompanying demographic and epidemiological data should be aggregated and submitted to CDC as one data submission. (July 9, 2013)
8. What constitutes a ‘high volume HIV care settings?’
High volume HIV care settings are places where a significant number of HIV-infected patients receive care for HIV and other medical issues, and where STD screening can be provided. The denominator is the total number of reported HIV-infected individuals in the targeted or selected geographic area. This could be determined by local HIV surveillance data or Ryan White data.
HIV surveillance data could rank providers in a geographic area by number of HIV patients.
Depending on resources, the applicant will have to use their discretion to determine a limit for what is considered a high volume HIV care setting. (July 9, 2013)
9. Can a jurisdiction propose the same activities in its STD AAPPS application and its SSuN application?
- SSuN is a fully competitive cooperative agreement with a completely separate scope of work and should be considered distinct and separate from STD AAPPS.
- STD AAPPS supports core STD prevention infrastructure.
- Applicants for STD AAPPS should make no assumptions about SSuN funding. Applicants must include all necessary activities and human resources for STD AAPPS in the AAPPS application and budget. Thus, some of the same activities and staff can be proposed for both SSuN and AAPPS.
(July 22, 2013)
10. The FOA states awardees are to “…measure annual chlamydia screening rates among young females (15-24 years) enrolled in Medicaid programs, and seen in Title X and other family planning clinics, ideally using the chlamydia HEDIS measure.” Does this mean awardees are to measure chlamydia screening rates among young females seen in family planning clinics that are also on Medicaid or does it expand this measurement to non-family planning sites?
- Programs must describe how they will monitor chlamydia screening rates preferably using the HEDIS measure: among young females enrolled in Medicaid, and those seen in Title X and other family planning clinics.
- Measurement should be at the systems level using available administrative data rather than collecting data at the provider level.
- For # 1, the measurement is chlamydia screening rates among the young females enrolled in the state Medicaid program overall in the jurisdiction. Further stratification of rates by geographic units and providers will allow programs to target chlamydia screening assurance activities.
- For # 2, the measurement is chlamydia screening among the young females seen in family planning clinics.
- Further stratification of rates by geographic units and clinic will allow programs to target chlamydia screening assurance activities.
- Some young females enrolled in Medicaid will be included in both measurements.
(July 22, 2013)
11. Under Assessment, item #2, the FOA states ‘Improve the quality and timeliness of case-based data collection to routinely obtain information on gender of sex partners, pregnancy status, HIV status, treatment given, patient’s address and provider information.’ Is this expected for all reported conditions (namely, sex of sex partners, pregnancy status and HIV status)?
- Initially, this is expected for all cases of primary and secondary syphilis.
- Over the project period, these data should be collected on a representative sample of gonorrhea and chlamydia cases as surveillance systems are strengthened.
- This information should be collected from provider report or EMR, not patient interviews.
(July 22, 2013)
12. Under the ‘Assessment/Conduct Surveillance’ section of the FOA, it states that a required surveillance activity is to ‘ensure confidentiality and security guidelines for the collection, storage, and use of all surveillance data according to NCHHSTP guidelines.’ Are jurisdictions expected to have completed implementation of the PCSI Data Security and Confidentiality Guidelines by the time of grant submission, or simply to certify that any elements not yet implemented and standards not yet met are being addressed?
If guidelines or standards have not yet been met, awardees should include in their applications how these standards are being addressed and a timeline for implementation within the first year. (July 22, 2013)
13. The “Assessment/Conduct Surveillance” section of the FOA discusses required surveillance activities and the automated HIV match – applicants are under the impression that CDC strictly regulates HIV case data release, and we believe that using the Enhanced HIV/AIDS Reporting System (e-HARS) for this purpose would violate DHAP provisions. Can you please clarify? If our state HIV surveillance program wants something in writing from CDC’s Division of HIV/AIDS Prevention (DHAP), will this be forthcoming?
- The NCHHSTP Data Security and Confidentiality Guidelines state that sharing of confidential or identifiable information should be limited to those with a justifiable public health need but any data sharing restrictions should not compromise or impede public health programs or disease surveillance activities.
- As long as the standards of these guidelines are adhered to by both HIV and STD programs and the ORP approves data access, routine matching of case registries is permitted.
- Any older DHAP provisions to the contrary are superseded by these latest guidelines, and this is stated in the guidelines themselves. Nothing else is needed in writing as these guidelines come from all divisions, including DHAP, within NCHHSTP.
(July 22, 2013)
14. Do GISP-funded states provide funding to sentinel sites or do all the funds go to the state lab?
States may the apportion GISP funds however they are best needed to accomplish the required tasks as stated in the STD AAPPS FOA.(July 30, 2013)
15. The Target Populations/Part A- STD AAPPS section of the FOA states that “project areas should describe a minimum prevalence threshold by which chlamydia and gonorrhea screening activities for young females will be assessed and assured.” Please clarify.
Does this apply only to those screening activities that are financially supported with federal dollars such as safety net clinical services? Can only screening programs be supported if the morbidity is at least the minimum threshold?
This requirement should apply to all screening activities in your jurisdiction. Assessing prevalence and assuring minimum thresholds for only those activities supported by federal dollars will not provide enough information or data to accurately access community prevalence, nor guide project area-wide STD prevention activities. Assessing private sector prevalence is expected and essential to program success. (August 7, 2013)
16. In the required and suggested activities under Assessment and Assurance sections of the FOA, there is little mention of monitoring and improving upon the quality of PID and/or chlamydia and gonorrhea re-testing. Can applicants include these activities in our proposal?
Yes, these are activities that CDC anticipates grantees would be likely to include in their proposal. (August 7, 2013)
17. Under the Assessment/Conduct Surveillance section of the FOA, a required activity is “improve the quality and timeliness of case-based data collection to routinely obtain information on gender of sex partners, pregnancy status, HIV status, treatment given, patient’s address and provider information.” Does this include all STDs (e.g. chlamydia, gonorrhea, and syphilis)?
This information should be gathered for all early syphilis cases, as well as all gonorrhea cases . This information should be gathered for chlamydia only if resources allow. (August 14, 2013)
18. Under the Assessment/Conduct Surveillance section of the FOA, a required activity is “conduct automated matching of STD and HIV cases for identification of syndemics and for targeting health department partner services for co-infected individuals to identify new HIV infections and other HIV infected individuals who are not in care.” Please clarify. Are these HIV cases those that have been reported to HIV Surveillance and housed in the eHARS data system or are these persons newly diagnosed with HIV who have accepted partner services? Which data/variables need to be integrated? And should data be integrated from HIV surveillance or HIV prevention?
We are encouraging matching of STD and HIV cases that have been reported to STD and HIV surveillance, respectively. We would hope that basic demographic and risk behavior variables could be integrated where possible in the respective surveillance systems. (August 14, 2013)