CDC-RFA-PS20-2004.pdf

Centers for Disease Control and Prevention

National Center for HIV-AIDS, Viral Hepatitis, STD, and TB Prevention

National Network of Sexually Transmitted Diseases Clinical Prevention Training Centers

(NNPTC)

CDC-RFA-PS20-2004

Application Due Date: 11/12/2019

National Network of Sexually Transmitted Diseases Clinical Prevention Training Centers

(NNPTC)

CDC-RFA-PS20-2004

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- PS20-2004. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

National Network of Sexually Transmitted Diseases Clinical Prevention Training Centers

(NNPTC)

C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

New -- Type 1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-PS20-2004

E. Assistance Listings (CFDA) Number:

93.978 F. Dates:

1. Due Date for Letter of Intent (LOI): 09/25/2019

2. Due Date for Applications: 11/12/2019, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

Letters of Intent are optional and encouraged, and are due no later than 9/25/19 at 11:59PM U.S. Eastern Standard Time. Applications are due no later than 11/12/2019, at 11:59pm U.S.

Eastern Standard Time.

3. Date for Informational Conference Call:

The informational conference call will be held on 9/10/2019 at 2:00pm U.S. Eastern Standard Time. Please register to attend at: https://cc.readytalk.com/r/m8dquplqfb1d&;eom

G. Executive Summary:

1. Summary Paragraph:

CDC announces the availability of FY2020 funds for a cooperative agreement to strengthen STD clinical services through the development and delivery of training (T) and technical assistance (TA) to promote STD prevention and care at the clinical provider, healthcare organization and system levels. All T/TA will be based on the CDC STD Treatment Guidelines, other CDC recommendations, and emerging clinical science. This NOFO has three https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov https://cc.readytalk.com/r/m8dquplqfb1d&eom components: Component A Regional Centers, Component B National STD Prevention Training Centers Coordination Center (NPTC3), and Component C National STD Curriculum Center (NSTDC). It supports the following strategies under each Component: Component A-assess training needs and service gaps, develop and deliver STD clinical prevention, provide T/TA for providers; Subcomponent (SC) A1 - support providers and clinical settings to integrate HIV preventive services in STD specialty clinics; SC A2 - support the fellow training program; Component B- facilitate coordination and promote the NNPTC, collect data to inform training strategies, manage a clinical consultation line; SC B1 - coordinate support for PTCs participating in SC A1; Component C- develop an online STD curriculum, develop and facilitate national learning communities, work with regional PTCs to scale up ECHO and other distance learning approaches; SC C1 - develop resources, curricula and learning communities to support the increase of HIV preventive services in STD specialty clinics.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 12

Component A (core) and Subcomponent A1 up to 8; Subcomponent A2 up to 6; Component B (core) and Subcomponent B1 – 1; Component C (core) and Subcomponent C1 - 1 .

Applicants may apply for core funding under Component A, Component B, and/or Component C. Only recipients of Component A (Core) will be considered for funding under Subcomponent A1 and A2; The recipient of Component B (Core) will be considered for funding under Subcomponent B1; Only the recipient of Component C (Core) funding will be considered for Subcomponent C1 funding. Applicants must include separate project narratives, work plans and budgets for each component and subcomponent.

d. Total Period of Performance Funding: $50,000,000

e. Average One Year Award Amount: $0 Component A Regional Centers Core funding - $600,000 Subcomponent A1 (Scaling up HIV Prevention Services in STD Specialty Clinics) - $300,000 Subcomponent A2 (STD Clinical Prevention Fellowship) - $150,000

Component B National STD PTC Coordination Center (NPTC3) core funding - $500,000

Subcomponent B1 (Scaling up HIV Prevention Services in STD Specialty Clinics) - $250,000

Component C National STD Curriculum Center (NSTDC) core funding - $750,000 Subcomponent C1 (Scaling up HIV Prevention Services in STD Specialty Clinics) - $500,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 03/01/2020

h. Cost Sharing and / or Matching Requirements: N

Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources including program income to promote sustainability is strongly encouraged. However, cost sharing will not be factored during the review and selection process.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Sexually transmitted diseases (STDs) adversely impact Americans’ health, adding burden to the U.S. economy. [1-3] The 2017 CDC STD Surveillance Report documented steep and sustained increases in gonorrhea (GC), chlamydia (CT) and syphilis, with congenital syphilis rates reaching a 20-year high. [4] While most STDs are asymptomatic, lack of effective and timely treatment is associated with severe consequences, including increased risk of HIV transmission and acquisition, pelvic inflammatory disease (PID), and subsequent infertility, ectopic pregnancy and chronic pelvic pain in women. Untreated syphilis during pregnancy can lead to infection of the fetus in 80% of cases and the direct medical cost of neonatal hospitalizations associated with congenital syphilis alone was estimated to be over $12 million in 2017. [5] Healthcare providers, clinics and health systems remain at the forefront of the battle against STDs, and a National Network of STD Clinical Prevention Training Centers (NNPTC) plays a key role in optimizing the delivery of STD prevention at each level of care.[6-8] STD clinical care in the U.S. remains sub-optimal, despite the availability of accurate diagnostic tests and effective treatment for many STDs . STD-related content in professional schools also remains inadequate, leaving providers with additional training and resource needs to increase knowledge, skill, and capacity to manage STDs. [9,10] Systems approaches are critical in order to implement lasting change in STD prevention practices.[11,12] A dynamic and complex healthcare landscape demands innovative methods to reach providers and health systems. With widespread availability of health insurance, STD care has shifted to primary care (PC) providers in some areas of the country, while STD clinics continue to provide the majority of STD care in others. In addition to serving as a resource of subject matter expertise (SME) and excellence in timely, culturally sensitive STD care for the community, STD specialty clinics provide safety net services for uninsured and under-insured individuals, as well as those who are disproportionately impacted by STDs/HIV. Optimization of services in STD specialty clinics remains a cornerstone of the STD control strategy in the U.S. However, most STDs are diagnosed in PC and other settings necessitating a multi-pronged approach to address a variety of training demands. This NOFO will support The National Network of Sexually Transmitted Diseases Clinical Prevention Training Centers (NNPTC), a network charged with improving the capacity of providers, clinical sites and healthcare systems to employ state-of-the-art knowledge and resources to diagnose, manage, treat and counsel individuals with/at-risk for STDs in order to reduce morbidity and improve sexual health on an individual, local and national level. This new NOFO was informed by lessons learned through the prior NOFO (PS-14-1407) including the importance of: tailoring training to specific regions and providers, employing technology as a scalable method to reach providers in a broad range of settings, using data to drive training strategy, and training future leaders in STD clinical prevention.[6-8, 11-13]

b. Statutory Authorities This program is authorized under section 318 of the Public Health Service Act, 42 U.S.C.

section 247(c), as amended.

c. Healthy People 2030 This NOFO addresses the Healthy People 2020 focus area(s) of Sexually Transmitted Diseases.

It also addresses: Maternal, Infant, and Child Health, HIV infection, Immunizations and Infec tious Diseases, Access to Quality Health Services, Cancer, Public Health Infrastructure.

d. Other National Public Health Priorities and Strategies This NOFO supports CDC priorities including:

Division of STD Prevention's Strategic Plan 2017-2022 CDC Call to Action: Lets Work Together to Stem the Tide of Rising Syphilis in the US National Strategy for Combating Antibiotic-Resistant Bacteria National Public Health Action Plan for the Detection, Prevention, and Management of Infertility National Stakeholder Strategy for Addressing Health Equity Presidents Initiative: Ending the HIV Epidemic: A Plan for America CDCs National Center for HIV, Viral Hepatitis, STD, and TB Prevention’s (NCHHSTP) Strategic Plan Through 2020 National HIV/AIDS Strategy CDC Winnable Battles

e. Relevant Work This NOFO builds upon CDC programs including:

PS14-1407: National Network of STD Clinical Prevention Training Centers PS14-1402: Improving STD Programs through Assessment, Assurance, Policy Devel opment, &; Prevention Strategies

PS19-1901: Strengthening STD Prevention &; Control for Health Departments PS18-1808: National Network to Enhance Capacity of State &; Local STD Prevention

Programs PS17-1707: Community Approaches to Reducing STDs PS14-1408: DIS Training Centers PS19-1904: Capacity Building Assistance (CBA) for High Impact HIV Prevention Progr https://www.healthypeople.gov/ https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://www.healthypeople.gov/2020/topics-objectives/topic/hiv https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services https://www.healthypeople.gov/2020/topics-objectives/topic/cancer https://www.healthypeople.gov/2020/topics-objectives/topic/public-health-infrastructure https://www.cdc.gov/std/dstdp/strategic-summary.html http://www.cdc.gov/std/syphilis/syphiliscalltoactionapril2017.pdf http://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf http://www.cdc.gov/reproductivehealth/infertility/pdf/drh_nap_final_508.pdf https://minorityhealth.hhs.gov/npa/Default.aspx https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview https://www.cdc.gov/nchhstp/strategicpriorities/default.htm https://www.cdc.gov/nchhstp/strategicpriorities/default.htm https://www.hiv.gov/federal-response/national-hiv-aids-strategy/overview https://www.cdc.gov/winnablebattles/index.html https://www.grants.gov/web/grants/view-opportunity.html?oppId=250755 https://www.grants.gov/web/grants/view-opportunity.html?oppId=236374 https://www.grants.gov/web/grants/view-opportunity.html?oppId=236374 https://www.grants.gov/web/grants/view-opportunity.html?oppId=304454 https://www.grants.gov/web/grants/view-opportunity.html?oppId=300322 https://www.grants.gov/web/grants/view-opportunity.html?oppId=300322 https://www.grants.gov/web/grants/view-opportunity.html?oppId=290103 https://www.grants.gov/web/grants/view-opportunity.html?oppId=246313 https://www.grants.gov/web/grants/view-opportunity.html?oppId=298832 am Integration PS18-1802: Integrated HIV Surveillance &; Prevention Programs for Health Department s PS19-1907: STD Surveillance Network (SSuN)

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Strategies and Activities

Short-term outcomes Intermediate outcomes Long-term Outcomes

Component A Regional Centers

Core Assess training needs and service gaps Develop and deliver STD clinical preventive services, training/technical assistance (T/TA) consistent with CDC guidelines and recommendations Establish and grow learning communities of key providers including emerging leaders in the STD field Collaborate with the National STD PTC Coordination Center (NPTC3) and the National STD Curriculum Center

(NSTDC)

Improved access to and reach of T/TA for priority providers Increased partnerships between STD PTCs and stakeholders Increased learning communities Increased provider knowledge and skill to provide STD clinical preventive services to persons at risk for STDs Increased participation in the STD Clinical Consultation Network

(CCN)

Increased provider use of externally facing NNPTC newsletter

Increased capacity of STD specialty clinics and other clinical settings serving key populations in priority areas to provide culturally informed STD preventive clinical services Increased provision of STD clinical preventive services by STD specialty clinics and other priority clinical settings Increased receipt of timely STD preventive services for persons at-risk for STDs Increased STD clinical SMEs in academia and state health department STD programs

Subcomponent A1.

Scaling up regional HIV preventive services in STD specialty clinics Assess provision of HIV preventive services in STD specialty clinics to identify

Improved ability of STD specialty clinics to identify those who could benefit from PrEP/ nPEP Increased identification of new HIV infections

Increased capacity of STD specialty clinics to provide culturally sensitive HIV preventive clinical services and linkage to care Increased people with new

Increased availability and accessibility of a trained, skilled and competent clinical workforce to prevent and control STDs in the U.S.

Increased fellows who remain in

STD

academic and/or public health careers Decreased transmission of STDs in the U.S.

including https://www.grants.gov/web/grants/view-opportunity.html?oppId=298832 https://www.grants.gov/web/grants/view-opportunity.html?oppId=291220 https://www.grants.gov/web/grants/view-opportunity.html?oppId=291220 https://www.grants.gov/web/grants/view-opportunity.html?oppId=313105 gaps and needs.

Develop and deliver HIV preventive services, T/TA to STD specialty clinics Establish and grow HIV preventive services learning communities for STD specialty clinic providers in STD specialty clinics Increased identification of virally unsuppressed people in STD specialty clinics Increased PrEP/nPEP – eligible individuals in STD specialty clinics who are offered HIV PrEP/nPEP

HIV infections identified in STD specialty clinics linked to HIV care Increased identification of virally unsuppressed people in STD specialty clinics engaged with HIV care Increased STD specialty clinics who are PrEP providers

Subcomponent A2. STD clinical prevention fellowship Train STD Clinical Prevention Fellows

Increased STD fellows in board-certified training programs Increased presentations at national and regional meetings by fellows

Increased peer-reviewed publications by fellows Increase in STD Clinical Prevention workforce

Component B National STD PTC Coordination Center (NPTC3):

Core Coordinate National Network of STD Clinical Prevention Training Centers (NNPTC) activities Perform a national assessment of needs and service gaps Promote NNPTC expertise and training activities/resources nationally Support participant registration data collection and submission to CDC Develop, support and promote the STD CCN for the NNPTC nationally

Subcomponent B1.

Scaling up regional HIV preventive services in

Increased external users of NNPTC web materials and services Increased satisfaction with NNPTC website by users Increased PTC speakers at national medical/nursing association conferences Increased resource sharing with reduced duplication of resource development within the

NNPTC

Increased external users of NNPTC HIV preventive services web materials and services

Improved national access to and reach of T/TA for priority providers Increased priority provider knowledge and skill to provide STD clinical preventive services to individuals with/at-risk for STDs Increased recognition of the NNPTC as an STD clinical care training and SME resource Increased STD specialty clinic provider knowledge to provide HIV preventive clinical services Increased integration of HIV preventive services in STD specialty clinics

Increased recognition of congenital syphilis and

HIV

Decreased incidence of antibiotic-resistant GC

Decreased morbidity and mortality from STDs, including congenital syphilis, infertility and neuro/ocular syphilis

STD specialty clinics Coordinate resources developed by the NNPTC as part of the scale up of regional HIV prevention services in STD specialty clinics Support the collection of participant data and other evaluation data as part of the scale up of regional HIV prevention services in STD specialty the NNPTC as an HIV preventive services training and SME resource

Component C National STD Curriculum Center (NSTDC):

Core Develop high quality, national STD clinical online curriculum, training and resources Develop national learning communities of key medical directors and decision makers in collaboration with CDC Support regional PTCs to scale up ECHO and other distance learning technologic training approaches

Subcomponent C1.

Scaling up regional HIV preventive services in STD specialty clinics Develop national online HIV preventive services courses, training and resources

Improved national online access to and reach of T/TA, and resources for priority providers Increased use of the national STD online curriculum by priority providers and organizations Increased implementation of national STD online curriculum into the school curriculum by medical or nursing schools Increased STD specialty clinic medical director/priority provider knowledge to offer quality STD clinical preventive services Improved national online access to and reach of HIV preventive services-

Increased capacity of STD PTCs to deliver ECHO and other technology-based training Increased capacity of STD specialty clinics to provide culturally informed STD preventive clinical services Increased provision of specialty STD clinical preventive services by STD specialty clinics Increased receipt of timely STD screening, diagnosis, and treatment by persons at-risk for STDs Increased capacity of STD specialty clinics to provide culturally informed HIV preventive services Increased provision of HIV preventive services by STD specialty clinics focused T/TA and resources for priority providers Increased use of the HIV preventive services online curriculum by priority providers and organizations Increased STD specialty clinic medical director knowledge to offer quality HIV clinical preventive services

i. Purpose This NOFO will support the development and dissemination of training through a multi-modal approach. The goals of this approach are improving the capacity of providers, clinical sites, and healthcare systems to diagnose, manage, treat and counsel individuals with and at-risk for STDs, in order to reduce STD morbidity and improve sexual health on an individual, local and national level. Training will be based on CDC recommendations and emerging clinical science with strategy informed by data from a variety of sources to ultimately decrease morbidity and mortality from STDs.

ii. Outcomes The recipient is expected to demonstrate measurable progress towards accomplishing the short and intermediate-term outcomes that appear in bold in the NOFO logic model. Proposed indicators for these outcomes are described in the section entitled, “CDC Evaluation and Performance Measurement Strategy”. That section also describes outputs that will be measured as part of the performance monitoring strategy. Expected outcomes include:

Component A Regional Centers:

Core

Improved access to and reach of T/TA for priority providers Increased partnerships between STD PTCs and key stakeholders Increased learning communities Increased provider knowledge and skill to provide STD clinical preventive services to persons at-risk for STDs Increased participation in the STD Clinical Consultation Network (CCN) Increased provider use of the externally facing NNPTC newsletter Increased capacity of STD specialty clinics and other clinical settings serving key populations in priority areas to provide culturally informed STD preventive clinical services

Increased provision of STD clinical preventive services by STD specialty clinics and other priority clinical settings

Subcomponent A1. Scaling up regional HIV preventive services in STD specialty clinics

Improved ability of STD specialty clinics to identify those who could benefit from PrEP/ nPEP

Increased identification of new HIV infections in STD specialty clinics Increased identification of virally unsuppressed people in STD specialty clinics Increased PrEP/nPEP – eligible individuals in STD specialty clinics who are offered

HIV PrEP/nPEP Increased capacity of STD specialty clinics to provide culturally sensitive HIV preventive clinical services and linkage to care Increased STD specialty clinics who are PrEP providers

Subcomponent A2. STD clinical prevention fellowship

Increased STD fellows in board-certified training program Increased presentations at national and regional meetings by fellow Increased peer-reviewed publications by fellows Increase in STD clinical prevention work force

Component B National STD PTC Coordination Center (NPTC3)

Core

Increased external users of NNPTC web materials and other services Increased satisfaction with NNPTC website by users Increased PTC speakers at national medical/nursing association conferences Increased recognition of the NNPTC as an STD clinical care training and SME resource

Subcomponent B1. Scaling up regional HIV preventive services in STD specialty clinics

Increased external users of NNPTC HIV preventive web materials and other services Increased recognition of the NNPTC as an STD clinical care training and SME resource

Component C NSTDC Core

Improved national online access to and reach of T/TA and resources for priority providers

Increased use of the national STD online curriculum by priority providers and organizations

Increased implementation of national STD online curriculum into the school curriculum by medical or nursing schools

Increased STD specialty clinic medical director/priority provider knowledge to offer quality STD clinical preventive services

Increased capacity of STD PTCs to deliver ECHO and other technology-based training

Subcomponent C1. Scaling up regional HIV preventive services in STD specialty clinics:

Improved national online access to and reach of HIV preventive services-focused T/TA and resources for priority providers

Increased use of the HIV preventive services online curriculum by priority providers and organizations

Increased STD specialty clinic medical director knowledge to offer quality HIV clinical preventive services

iii. Strategies and Activities Overview Component A Regional Training Centers:

Component A recipients will serve as regionally assigned STD Clinical Prevention Training Centers (STD PTCs) to help arm providers and health care settings to prevent and control STDs in the United States. STD PTC required strategies are to provide T/TA, resources and medical consultation activities to health care facilities, professional clinical organizations, academic medical and nursing institutions and clinical providers who care for populations at risk for STDs in order to promote effective STD clinical preventive services in healthcare settings.

Implementation of all strategies and activities described below is required by all applicants using resources awarded through this component. Applicants are encouraged to implement additional innovative activities and to conduct additional evaluation, if resources are available.

Applicants are required to work with state and local public health departments in assigned regions to identify priority healthcare settings and clinical providers for T/TA as each STD prevention program has specific STD public health priorities based on epidemiological and program data due to geography, specific local populations and subpopulations, local healthcare systems capacity, and other challenges. Recipients funded through this NOFO are expected to respond to and support the specific STD prevention program priorities in the project areas they are assigned.

Each recipient will be responsible for a region comprised of between four and fifteen states and territories that align with the PS19-1901 “Strengthening STD Prevention and Control for Health Departments (STD PCHD)” project areas (for a list see:

https://www.cdc.gov/std/funding/pchd/guidance.htm#funding-tables). For the purposes of the application, each Component A regional applicant should describe their experience providing training for STD PCHD project areas that they have worked with in the past. Each applicant should demonstrate established relationships with state and local health departments and training organizations, and a strong working knowledge of the region’s STD morbidity and mortality rates, service gaps, and clinical T/TA needs. Assignment of specific areas comprising regional coverage will be determined by CDC’s DSTDP during the technical review phase of the application process. Decisions will be based on several factors including but not limited to number of funded recipients, objective review rankings, and geographic coverage of state/local/territorial STD morbidity and priority populations at risk.

Assessment methods should be employed to obtain and analyze data to ensure that T/TA and other resources meet the needs of the regional coverage area and that T/TA delivery reaches high priority providers providing care for key populations defined as adolescents and young adults, pregnant women, men-who-have-sex-with-men (MSM) and transgender women in high morbidity settings.

Training content should be tailored to ensure relevance for priority provider populations, informed by local epidemiology, practice gaps, provider audience, input from stakeholders and NNPTC data and should incorporate Quality Improvement (QI) approaches to the extent possible. Training delivery methods may include but are not limited to didactic, experiential, and distance learning including webinars, telehealth or Extension for Community Healthcare Outcomes (ECHO modelsTM) models (https://echo.unm.edu/).

T/TA should focus on the provision of specialized STD clinical preventive services in STD specialty clinics and basic STD clinical preventive services in a variety of locally prioritized clinical settings serving populations with and at-risk for STDs, including but not limited to, community health centers (CHC) or federally qualified health centers (FQHC), rural health clinics, family planning/reproductive health clinics, HIV care settings, other health department clinics, hospital-based clinics including OB/GYN, labor and delivery, correctional settings, tribal health centers, urgent care or emergency departments. Health systems may include hospitals, health maintenance organizations, Accountable Care Organizations (ACOs) or health insurance plans that are serving geographic areas and key populations in prioritized high morbidity areas. TA approaches are not limited to direct on-site methods and may include dissemination of existing toolkits and resources, online and distance-based learning, telemedicine, sharing of best practices, and development of resources to facilitate implementation of STD clinical preventive services and increase clinic efficiency. [14] To ensure that T/TA efforts are prioritized for greatest impact, investment of key partners is vital. Key partners in the region include but are not limited to: CDC-funded state and local STD prevention programs (STD PCHD recipients), other national training centers, academic institutions including medical and nursing schools, professional medical and nursing associations, Continuing Medical Education (CME)/Continuing Nursing Education (CNE)/Continuing Education (CE) and Maintenance of Certification (MOC)-granting organizations. Training collaboration with partners is encouraged to increase reach to key provider populations, leverage resources and reduce redundancy.

Due to the great need for STD clinical preventive services training, training content and delivery methods should be scalable. Experiential training (preceptorships, i.e. low volume in-clinic experiential training) should focus on STD specialty providers and criteria should be developed to assist with prioritizing providers for this type of training. Utilization of train the trainer (TOT) models is one approach to scale up training. Learning communities should be established with key local clinical providers, the composition of which should be based on local epidemiology, needs and priorities. Mentorship of individuals already in leadership positions in public health STD programs/clinics as well as investment in the career development of emerging leaders in the STD healthcare, public health and academic fields remains critical to progress in the fight against STDs.

STD PTCs will work also with CDC and other partners to conduct assessments of HIV preventive services, including barriers and costs of providing these services, in STD specialty clinics. The assessments will inform T/TA to work with sites to integrate quality HIV preventive services, including extra-genital NAAT testing for gonorrhea and chlamydia, on-site nPEP and PrEP services (rather than referring to care elsewhere), viral load testing, reengagement of previously identified individuals living with HIV into care, and linkage of newly identified HIV-positive individuals to care.

Additionally, the STD clinical prevention fellowship will be used to emphasize clinical aspects, epidemiology, behavioral science, health services research and prevention of STDs and will include practical training in the design and implementation of health department based STD clinical prevention services and programs. The fellowship has three major components: 1) Research training that emphasizes STD epidemiology, behavioral sciences, prevention and/or service delivery; 2) clinical experience in STD specialty clinics, and 3) experience in the design, implementation and evaluation of public health programs for the prevention and control of STDs.

Specific required activities for Component A and associated sub-components listed in the logic model must include:

Assess training needs and service gaps.

1. Identify service gaps and training needs in high morbidity areas of the region in collaboration with CDC-funded state and local STD prevention programs, the National STD PTC Coordination Center and the National STD Curriculum Center.

Collect, analyze, and interpret data collected through local/regional training needs assessments and other available pertinent data including data from the National Centers.

Obtain input from stakeholders and other partners related to training needs and local priorities.

Collaborate with state and local STD prevention programs to utilize surveillance data to identify local areas with high morbidity serving key populations and the providers and healthcare settings serving those populations.

2. In collaboration with CDC, assess provision of specialty STD clinical preventive services and maintain a list of STD specialty clinics in the regional coverage area.

In collaboration with CDC, provide input into a tool to assess provision of quality, specialized STD clinical preventive services in an STD specialty clinic.

Conduct assessments for provision of quality specialized STD clinical preventive services in STD specialty clinics.

Assist with the maintenance of a current list of STD specialty clinics in collaboration with CDC and other partners.

The frequency of subsequent training need and service gap assessments will be yearly or less often as determined by CDC in collaboration with the STD PTCs.

Develop and deliver STD clinical preventive services, T/TA consistent with CDC guidelines and recommendations.

3. Apply knowledge of regional coverage area, local epidemiology, key partner feedback and the needs of the priority provider and clinical setting to develop and deliver T/TA and disseminate resources.

Tailor training material content and methods to meet the needs of local providers and clinical settings.

4. Develop training methods that are scalable including TOT models, distance-learning products, telehealth and other methods that employ novel approaches and collaboration with key partners.

Collaborate with stakeholders and partners to determine training methods to effectively reach the greatest number of high priority providers and healthcare settings based on regional needs and priorities.

Utilize local/regional data to inform TA approaches and development of job aids and other tools in coordination with the National STD PTC Coordination Center, the National STD Curriculum Center and CDC.

Implement adult learning theory and QI methods such as rapid cycle/ PDSA activities, testing change, implementing change, dissemination and spread/scale-up of change methods, as appropriate.

Recruit academic faculty in the region and health department medical directors or medical consultants supporting state STD prevention and control programs as TOT trainers.

Provide at least two TOT trainings annually.

Establish and grow learning communities of key providers including emerging leaders in the STD field.

5. Support the development and maintenance of clinical STD expertise at state and local health departments and at academic medical/nursing institutions in the regional coverage area.

Work with state and local STD prevention programs and local/regional medical professional organizations to develop an approach for establishing learning communities.

Determine, develop and deliver content for at least 2 sessions annually using adult learning methods such as ECHO models, if feasible.

Identify and mentor three health department staff and/or academic faculty in the region annually in content areas relevant to STD clinical preventive services.

Collaborate with the National STD PTC Coordination Center (NPTC3) and the National STD Curriculum Center (NSTDC).

6. Work with the NPTC3 to optimize participant data content and collection methods, collect participant data for the priority courses delivered and submit to the NPTC3 for evaluation and performance measurement processes.

Collaborate with STD PTCs and the NPTC3 to develop new approaches to participant data collection.

At least one member of each PTC should provide input into national activities related to updating the network-wide participant data form and strategizing about novel data collection methods.

7. Participate in the STD Clinical Consultation Network (CCN) and the NNPTC national external newsletter.

Ensure that at least two clinical STD SME faculty are available to contribute at a minimum to one newsletter a year.

Ensure that at least two clinical STD SME faculty are available, trained, kept up to date on procedures and clinical trends related to CCN consults, and provide feedback on consultation processes.

Newsletter production frequency and STD PTC assignments will be determined by CDC and the NNPTC within 6 months of funding cycle initiation.

8. Provide input into NSTDC distance learning products.

Each PTC should contribute timely reviews and input into online curriculum development, updates and the process of defining national training objectives.

Subcomponent A1. Scaling up regional HIV preventive services in STD specialty clinics Assess provision of HIV preventive services in STD specialty clinics to identify gaps and needs

1. Identify priority STD Specialty Clinics that serve key populations disproportionately impacted by the HIV epidemic, located in areas of high HIV morbidity and serving a high proportion of ethnic/racial minority patients.

2. Conduct an assessment of the clinic to document STD and HIV preventive services that are currently provided, identify gaps to expand capacity and scale up services, and assess the quality of services provided to inform T/TA for these settings.

Develop and deliver HIV preventive services T/TA for STD specialty clinics.

3. Work with clinic leadership and staff to identify priority areas for implementation and provide T/TA to address issues.

4. Work with partner clinics to identify and strengthen existing delivery approaches including express visits to scale-up PrEP/nPEP and processes to link individuals living with HIV to care.

5. Assess T/TA program effectiveness using clear and established performance metrics and standard outcome measures.

6. Develop tools and resources to facilitate efficient integration of HIV preventive services in STD specialty clinics.

Establish and grow HIV preventive services learning communities of STD specialty clinic providers.

7. Recruit medical directors and key regional providers working in STD clinics to participate in a learning community focused on enhancing HIV preventive services in the STD specialty clinic setting.

8. Develop and deliver content for the learning community including best practices.

Subcomponent A2: STD clinical prevention fellowship Train STD Clinical Prevention Fellows

1. Describe proposed fellowship activities.

Develop a description of the clinical training program including specific venues for clinical training and plans for clinical supervision.

Describe the proposed research training program including plans for STD research supervision. Research should emphasize STD epidemiology, behavioral science, prevention, and/or service delivery. Fellows should pursue one or more research projects directly relevant to careers in public health, STD epidemiology, and prevention or academic positions with strong relationships with STD health department programs.

Describe plans to provide training in STD prevention program design, implementation, and evaluation, including the public health preceptor assigned to the fellow and the nature of the required local health department rotation (i.e., proposed timing, assignments, activities, projects, and supervision).

Describe the proposed mentor for the fellowship. The proposed mentor for this fellowship should be an established member of the school of medicine that will house the proposed fellow. The mentor should have research expertise in the field of STD prevention as demonstrated by STD relevant publications in the peer-reviewed literature and presentations at national conferences. The mentor must also have active linkages to local STD public health programs.

2. Describe the process for identification and recruitment of a fellow applicant.

Applicants must be postdoctoral with an M.D. or D.O.

Component B National STD PTC Coordination Center (NPTC3)

The NPTC3 plays a critical role in coordinating the NNPTC by facilitating communication across the network. Coordination within the NNPTC should enhance efficiency of training efforts, maximize synergies of the network and decrease duplication. Promotion of the NNPTC is necessary to fully realize the goal of improving the capacity of providers, clinical sites and healthcare systems to provide quality STD clinical preventive services for individuals with and at-risk for STDs. The NPTC3 will lead the promotion of NNPTC expertise, training activities and resources on a national level. The collection of participant registration data for NNPTC trainings provides a mechanism to evaluate effectiveness of targeted training efforts. The NPTC3 will spearhead efforts to develop a participant registration form in collaboration with CDC and the PTCs, and develop and maintain an online database to collect participant data for T/TA activities conducted by each regional training center.

The STD Clinical Consultation network (CCN) provides a mechanism for healthcare providers to submit clinical questions and obtain input from network-affiliated STD clinical experts. The development and subsequent effective and efficient coordination of this consultation network is a key function of the NPTC3 and will involve instituting plans and processes to triage clinical consults, ensure that response timelines are met and quality control continuously evaluated.

Specific required activities for Component B and associated sub-components listed in the logic model must include:

Coordinate National Network of STD Clinical Prevention Training Centers (NNPTC) activities.

1. Facilitate internal and external communications.

2. Develop and maintain a training material resource library for the NNPTC in an easily accessible online format to facilitate sharing and reduce duplication of effort.

Survey the NNPTC to determine the status of current resources.

Determine current resources to be incorporated into the library.

Track new resources as they are developed by the NNPTC.

Perform a national assessment of needs and service gaps.

3. Collaborate with CDC, other CDC partners and the PTCs to develop and conduct an national assessment of training needs for STD specialty clinics and other providers as needed.

Oversee national assessments of providers of STD clinic prevention services in STD specialty clinics.

4. Collaborate with the NNPTC and CDC to assess the overall impact of the NNPTC.

Promote NNPTC expertise and training activities/resources nationally.

5. Collaborate with the network to promote and disseminate NNPTC trainings, materials and resources, develop, update, and manage the NNPTC website, and develop and produce an externally facing national NNPTC newsletter for broad distribution to healthcare providers.

Work with CDC and the STD PTCs to develop a distribution list for the newsletter.

Coordinate the newsletter content development efforts and the assignments delegated to individual PTCs.

Support NNPTC T/TA participant registration data collection and submission of data to

CDC.

6. Develop and maintain a centralized national registration database for NNPTC T/TA.

Convene a work group composed of PTC faculty and staff to review core elements of participant registration data needed to inform the development of the brief participant information form in collaboration with CDC.

The database should capture, at a minimum, the title and type of course, length of training, audience characteristics, training location and date. Specific data elements to be captured will be determined by CDC in collaboration with the NNPTCs within the first three months of budget year one.

The database should allow for online training registration by participants across the U.S.

Quality assurance procedures should be developed and implemented for database use and maintenance.

Collect, clean and submit participant data for T/ TA conducted by the NNPTC to CDC on at least a biannual basis.

Due to the need to use data to inform future training and resource allocation, the frequency of data submission to CDC will be at least every 6 months. The final data submission schedule will be determined within the first three months of budget year one.

Develop, support and promote the STD CCN for the NNPTC nationally.

7. Develop an online system for providers to enter clinical questions and TA requests and use data obtained to inform training material development and delivery.

The STD CCN should capture, at a minimum, information from the consulting provider including demographics and contact information, practice setting including type and location, and clinical question/TA request. A workgroup composed of STD PTC faculty and staff will be convened within the first three months of budget year one to determine additional data elements to be added to the system.

An STD CCN management protocol and training manual for STD PTC staff should be submitted to CDC within the first 6 months of budget year one.

Facilitate the development of a plan, in collaboration with the network, to utilize STD CCN data to inform training material development and delivery.

Report the STD CCN data to CDC on at least a biannual basis.

The frequency of data submission to CDC will be determined within the first six months of budget year one.

Subcomponent B1. Scaling up regional HIV preventive services in STD specialty clinics.

Coordinate resources developed by the NNPTC as part of the scale up of regional HIV prevention services in STD specialty clinics.

1. Develop a resource library.

Track and disseminate resources developed through this activity.

Support the collection of participant data and evaluation data as part of the scale up of regional HIV prevention services in STD specialty clinics.

2. Work with other PTCs receiving A1 Focused Activity funding to develop core evaluation measures to be collected to assess focused activity outcomes.

The frequency of data submission to CDC will be determined within the first six months of budget year one.

Component C National STD Curriculum Center (NSTDC) The NSTDC will work with the STD PTCs to develop, continuously update and improve the online curriculum, including the determination of new topics and development of new, virtual training modalities utilizing the most recent technology. In order to improve the consistency of high priority objectives to be addressed throughout the network, the NSTDC will work with the STD PTCs and CDC to specify several objectives around which to focus training content and evaluation efforts. Standardized slide sets will be developed to address the specified learning objectives with the expectation that they can be adapted for local use. STD specialty clinics provide safety net services to populations disproportionately affected by STDs and should serve as models of quality STD clinical service delivery for other healthcare settings. As a critical component of the STD control infrastructure for the U.S., focused efforts to mentor and build the knowledge base of frontline medical directors and other leaders in STD specialty and other key clinics, as well as provide TA to build and maintain state-of-the-art services at these locations is an important mission for the NSTDC. The learning collaborative will utilize technology that may include but not be limited to ECHO models, for exchange of information.

Specific required activities for Component C and associated sub-components listed in the logic model must include:

Develop high quality national STD clinical online curriculum, training and resources.

1. Institute a plan to develop, update and oversee an online STD curriculum. Assure fidelity to accurate curriculum content based on the most recent CDC STD Treatment Guidelines and other CDC recommendations.

Work with the STD PTCs and CDC to get input on online curriculum content.

Determine key components and desired characteristics of an online STD curriculum and form a plan to update the modules, question banks and mechanisms to track curriculum users over time.

Provide a mechanism for curriculum users to obtain CME/CNE and/or CE credit.

2. In collaboration with CDC and the STD PTCs, lead the development of a set of high-priority standard learning objectives for the network to focus training content and evaluation efforts around.

The standard objectives should be defined within the first six months of budget year one.

Develop standard slide sets containing content to address, at a minimum, the specified high priority learning objectives.

3. Submit NSTDC evaluation data, including measures of reach, increased knowledge and other impact, to the CDC at least every 6 months.

NSTDC evaluation data should contain participant information consistent with the form developed by the NNPTC for other trainings in addition to information specific to curriculum use metrics.

The frequency of data submission to CDC will be determined within the first six months of budget year one.

Develop national learning communities of key medical directors and decision makers in collaboration with CDC.

4. In collaboration with the regional PTCs, develop a set of criteria to guide the strategy to invite medical directors or other frontline decision-makers to the learning community.

5. Recruit medical directors/decision-makers for the learning collaborative.

6. Implement the learning collaborative sessions.

7. Perform evaluation to assess learning…