HHS-2021-IHS-EPI-0001.pdf

Billing Code: 4165-16

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Epidemiology Program for American Indian/Alaska Native Tribes and Urban

Indian Communities

Announcement Type: New and Competing Continuation

Funding Announcement Number: HHS-2021-IHS-EPI-0001

Assistance Listing (Catalog of Federal Domestic Assistance or CFDA) Number: 93.231

Key Dates

Application Deadline Date: September 1, 2021

Earliest Anticipated Start Date: September 30, 2021

I. Funding Opportunity Description

Statutory Authority

The Indian Health Service (IHS) is accepting applications for a cooperative agreement for

Tribal Epidemiology Centers (TECs) serving American Indian/Alaska Native (AI/AN)

Tribes and Urban Indian communities. This program is authorized under: the Snyder

Act, 25 U.S.C. 13; the Transfer Act, 42 U.S.C. 2001(a); and the Indian Health Care

Improvement Act (IHCIA), as amended, 25 U.S.C. 1621m. This program is described in the Assistance Listings located at https://beta.sam.gov (formerly known as Catalog of

Federal Domestic Assistance) under 93.231.

Background

The TEC program was authorized by Congress in 1996 as a way to provide public health support to multiple Tribes and Urban Indian communities in each of the IHS

Administrative Areas. The funding opportunity announcement is open to currently funded TECs.

TECs are uniquely positioned within Tribes, Tribal organizations, and Urban Indian organizations (UIO) to conduct disease surveillance, research, prevention, and control of disease, injury, or disability, and to assess the effectiveness of AI/AN public health programs. Some of the existing TECs have already developed innovative strategies to monitor the health status of Tribes and Urban Indian communities, including development of Tribal health registries and use of sophisticated record linkage computer software to correct existing state data sets for racial misclassification.

TECs provide critical support for activities that promote Tribal Self-Governance and effective management of Tribal and Urban Indian health programs. Data generated locally and analyzed by TECs enable Tribes and Urban Indian communities to effectively plan and make decisions that best meet the needs of their communities. In addition, TECs can immediately provide feedback to local data systems, which will lead to improvements in Indian health data overall.

As more Tribes choose to operate health programs in their communities, TECs ultimately will provide additional public health services such as disease control and prevention programs. Some existing TECs provide assistance to Tribal and Urban Indian communities in such areas as sexually transmitted disease (STD) control and cancer prevention.

They also assist Tribes and Urban Indian communities to establish baseline data for successfully evaluating intervention and prevention activities.

Sexually transmitted infections (STIs) remain a major public health challenge in the

United States (U.S.) with an estimated 20 million new infections occurring each year;

half of them occur among adolescents and young adults ages 15–24. Many STIs, like chlamydia and gonorrhea, can be asymptomatic; however, if left untreated, STIs can lead to infertility and increase the risk of acquiring other STIs. For pregnant women, there are additional risks of ectopic pregnancy, miscarriage, stillbirth, and early infant death.

Although widespread across the U.S. among all populations, the STI epidemic disproportionately affects certain racial and ethnic groups, including AI/AN people.

Such disparities in STI incidence are complex to understand but may be rooted in a number of social factors such as poverty, inadequate access to health care, lack of education, social inequality, and cultural influences. Recent surveillance data demonstrate that STI rates continue to increase in Indian Country. The latest surveillance report showed that AI/AN people have 3.8 times the incidence rate of chlamydia compared with whites and a 4.4 times higher rate of gonorrhea. For more information, please visit https://www.ihs.gov/epi/includes/themes/responsive2017/display_objects/documents/STI

/Indian_Health_Surveillance_Report_STI_2015.pdf. AI/AN people have the second highest rates for both chlamydia and gonorrhea compared to other races/ethnicities.

Gonorrhea rates have continued to increase since 2011. Regional differences in STIs in

Indian Country are observed. Recurrent STIs can increase the likelihood of human immunodeficiency virus (HIV) transmission, and gonorrhea and syphilis often present as co-morbid conditions with HIV diagnosis, particularly among men who have sex with men (MSM).

AI/AN youth and AI/AN women, particularly women of reproductive age, have a disparate and increased STI burden. In addition, recent outbreaks of syphilis have been observed among AI/AN communities, resulting in a dramatic increase in congenital syphilis cases in recent years. Some of these outbreaks are also connected to the use of injection drugs and methamphetamines. Particularly concerning is the dramatic increase in syphilis cases among AI/AN women and the rise in congenital syphilis (CS) cases.

The CDC national STI surveillance report demonstrated that from 2014 to 2018 CS cases, among all races, in the U.S. increased from 462 to 1,306 (183 percent). In 2018, AI/AN mothers had the highest rate of reported CS cases nationally. The rate of increase in reported CS cases among AI/AN mothers is higher than for any other race or ethnicity in the U.S. (from 13.2 cases per 100,000 live births in 2014 to 79.2 in 2018).

Untreated CS can cause miscarriage, stillbirth, prematurity, low birth weight, or death shortly after birth. The impact of CS depends on when a pregnant woman contracts syphilis and whether she has access to treatment for the infection. Up to 40 percent of babies born to pregnant women with untreated syphilis may be stillborn or die from the infection as a newborn. According to CDC data, analysis of CS cases born to AI/AN mothers in 2018 identified gaps in prenatal care and access to timely and appropriate treatment.

The STI National Strategic Plan, released on December 17, 2020, aims to reverse the recent dramatic rise in STIs in the U.S. Please visit https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-2021-2025.pdf for the most recent documents, outlining the following goals and selected objectives:

1. Goal 1: Prevent New STIs

a. Objective 1.1 – Increase awareness of STIs and sexual health.

b. Objective 1.2 – Expand implementation of quality, comprehensive STI primary prevention activities.

c. Objective 1.3 – Increase completion rates of routinely recommended human papillomavirus (HPV) vaccination.

d. Objective 1.4 – Increase the capacity of public health, health care delivery systems, and the health workforce to prevent STIs.

2. Goal 2: Improve the Health of People by Reducing Adverse Outcomes of STIs

a. Objective 2.1 – Expand high-quality affordable STI secondary prevention, including screening, care, and treatment, in communities and populations most impacted by STIs.

b. Objective 2.2 – Work to effectively identify, diagnose, and provide holistic care and treatment for people with STIs by increasing the capacity of public health, health care delivery systems, and the health workforce.

3. Goal 3: Accelerate Progress in STI Research, Technology, and Innovation

a. Objective 3.4 – Identify, evaluate, and scale up best practices in STI prevention and treatment, including through translational, implementation, and communication science research.

4. Goal 4: Reduce STI-Related Health Disparities and Health Inequities

a. Objective 4.1 – Reduce stigma and discrimination associated with STIs.

b. Objective 4.2 – Expand culturally competent and linguistically appropriate

STI prevention, care, and treatment services in communities disproportionately impacted by STIs.

c. Objective 4.3 – Address social determinants of health and co-occurring conditions.

5. Goal 5: Achieve Integrated, Coordinated Efforts that Address the STI Epidemic

a. Objective 5.1 – Integrate programs to address the syndemic of STIs, HIV, viral hepatitis, and substance use disorders.

b. Objective 5.2 – Improve quality, accessibility, timeliness, and use of data related to STIs and social determinants of health.

c. Objective 5.3 – Improve mechanisms to measure, monitor, evaluate, report, and disseminate progress toward achieving national STI goals.

Furthermore, the STI National Strategic Plan identifies the following priority groups:

adolescents and young adults; MSM; and, pregnant women.

The STI National Strategic Plan also puts emphasis on other subgroups including racial and ethnic minorities (including AI/AN people) and geographic focus on regions with high STI burden. This national plan outlines goals, objectives, and indicators that specifically focus on health disparities and particularly addresses disparities in CS among

Tribal communities. Applicants should create their action plans in the context of these goals, objectives, and indicators.

The TEC program will continue to enhance the ability of the Indian health system to collect and manage data more effectively and to better understand and develop the link between public health problems and behavior, socioeconomic conditions, and geography.

The TEC program will also support Tribal and Urban Indian communities by providing technical training in public health practice and prevention-oriented research and by promoting public health career pathways serving AI/AN populations.

Purpose

The purpose of this IHS cooperative agreement is to strengthen public health capacity and to fund Tribes, Tribal organizations, and UIOs, and inter-Tribal consortia in identifying relevant health status indicators and priorities to support Public Health interventions that reduce morbidity and mortality in the population using sound epidemiologic principles. Work plans submitted in response to this announcement must incorporate the applicant’s desired objectives and all of the required activities of the program’s four goal sets, which are combined from the seven TEC core functional areas as outlined in the Indian Health Care Improvement Act (IHCIA) at 25 U.S.C. 1621m(b).

The seven core functions of the TECs are:

(1) Collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian Tribes, Tribal organizations, and

UIOs in the service area;

(2) Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health;

(3) Assist Indian Tribes, Tribal organizations, and UIOs in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data;

(4) Make recommendations for the targeting of services needed by the populations served;

(5) Make recommendations to improve health care delivery systems for Indians and

Urban Indians;

(6) Provide requested technical assistance to Indian Tribes, Tribal organizations, and

UIOs in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; and

(7) Provide disease surveillance and assist Indian Tribes, Tribal organizations, and

Urban Indian communities to promote public health.

The seven core functions, included in the four goal sets are:

Goal Set 1: Public Health Promotion

Collect health status data, provide disease surveillance and assist Tribes, Tribal organizations, and UIOs to promote public health.

Goal Set 2: Evaluation

Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health.

Goal Set 3: Recommendation

Assist Indian Tribes, Tribal organizations, and UIOs in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data. Make recommendations for the targeting of services needed by the populations served. Make recommendations to improve health care delivery systems for

Indians and Urban Indians.

Goal Set 4: Technical Assistance

Provide technical assistance to Indian Tribes, Tribal organizations, and UIOs in the development of local health service priorities and determine incidence and prevalence rates of disease and other illness in the community.

Applicant objectives may include activities beyond the required activities but must address them. Additional activities must still fall within the seven core functions and the four Goal sets.

Required activities under the core funding are: Community Health Profiles (CHP); Data collection and Disease Surveillance; Public Health Preparedness and Response; STD

Activities; technical assistance to Indian Tribes, Tribal organizations, and UIOs; evaluate and support Area-wide interventions that promote severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine uptake; and, evaluate and support Area-wide interventions that promote SARS-CoV-2 outbreak response and recovery.

See Section I: Required, Optional, and Allowable Activities for full details.

It is the intent of IHS to fund sufficient TECs to serve Tribes and Urban Indian communities in all 12 IHS administrative areas.

Each TEC selected for funding will act under a cooperative agreement with the IHS.

During funded activities, the TECs may receive Protected Health Information (PHI) for the purpose of preventing or controlling disease, injury, or disability, including, but not limited to, reporting of disease, injury, vital events, such as birth or death, and the conduct of public health surveillance, public health investigation, and public health interventions for the Tribal and Urban Indian communities that they serve. TECs acting under a cooperative agreement with IHS are public health authorities for which the disclosure of PHI by covered entities is authorized by the Privacy Rule, 45 CFR

164.512(b).

Required, Optional, and Allowable Activities

Goal Set 1: Collect health status data, provide disease surveillance, and assist Tribes, Tribal organizations, and UIOs to promote public health (Core Functions 1 and 7).

Required Activities under Goal Set 1:

1) CHPs

a. Develop culturally appropriate community health assessments encompassing all the Tribal and/or Urban Indian communities served by the TEC.

b. CHPs should include information appropriate to allow Tribal and Urban

Indian leaders to make informed decisions, prioritize health problems, and develop, implement, and evaluate their community health improvement plans.

c. Provide and enact a plan that includes a project overview, specific health indicators, and means of dissemination for both Tribe-specific and regional

CHPs.

d. Participate in local, regional, and national committees that address public health priorities and, as appropriate, with other Federal agencies.

e. Establish and maintain an advisory council that can provide overall program direction and guidance. The advisory council should include some members with technical expertise in epidemiology and public health (e.g., from state health departments or county health departments) and include representation from the Tribal health and Urban Indian health programs within the TECs regional area.

f. Translate available data and/or results of analyses on disease incidence/prevalence and determined risk factors into useful products, messaging, and outreach to effectively guide stakeholders’ interventions addressing public health priorities.

2) Data collection and Disease Surveillance

a. Establish and maintain data sharing agreements and Memorandums of

Understand (MOU) to support data collection and analysis. Agreements may be needed with local organizations, Tribal governments, state authorities, and

Federal agencies.

b. Provide disease surveillance and assist Indian Tribes, Tribal organizations, and UIOs to promote public health.

Optional Activities with Budget Support under Goal Set 1:

1) IHS-funded UIOs Technical Assistance

These activities are eligible for a supplemental budget of up to $100,000 per award.

The grantee will support 41 IHS-funded UIOs located in 22 states through the following activities:

a. providing training and technical assistance on planning, conducting, and implementing community health needs assessment;

b. developing new and updating existing CHPs; and

c. providing ongoing training and tutorials on how to interpret data, such as the

Census and American Community Survey data.

These activities have additional reporting requirements including quarterly progress reports that are due within 30 days after the budget period ends. These reports must include a brief comparison of actual accomplishments to the goals established for the period, a summary of progress to date or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required.

2) Group A HIV/STI Activities

These activities are eligible for a supplemental budget of up to $100,000 per awardee.

Activities under this supplement are organized under the operational strategies of the Ending the HIV Epidemic: A Plan for America initiative (EHE).

TEC sites serving areas that do not include the EHE Phase One priority

Geographic area(s) and Location(s) are eligible to apply for this supplemental funding. For a list of Phase One priority Geographic Areas and Locations, please visit https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one.

Coordination Operational Strategy

a. Grantees will send at least one representative to the annual HIV Coordination meeting, scheduled in September of each year to coincide with the U.S.

Conference on HIV/acquired Immunodeficiency syndrome (AIDS). The budget should include travel and associated costs for participation.

b. Grantees will participate in the IHS National AI/AN STI Prevention workgroup.

Diagnosis Operational Strategy

c. The TECs will provide technical assistance and/or disease surveillance support to Tribal and Urban communities by developing analytical reports to examine the burden of HIV and other relevant comorbidities such as STIs and hepatitis C virus (HCV) in Tribal and Urban communities.

Treatment Operational Strategy

d. The TECs will provide support to Tribal and Urban communities in the development of enhanced activities and expanded capacity to better identify

AI/AN people who are not in care, including those who were never linked to care following an HIV, STI, or HCV diagnosis and those who have fallen out of care.

Respond Operational Strategy

e. Respond rapidly to detect and characterize growing HIV, STI, or HCV clusters and prevent new infections. TECs will provide technical assistance and/or direct support to Tribal and Urban communities on the following activities:

i. Develop or accelerate the refinement of HIV, STI, and HCV community plans that are customized for AI/AN communities. Extensive community engagement in this process will help ensure that community-specific social norms and unique epidemic attributes are addressed.

ii. Develop collaborative partnerships among Tribal, state, and local health departments, the clinical community, and community-based organizations to expand and routinize HIV diagnosis, treatment, prevention, and response.

3) Group B HIV/STI Activities

These activities are eligible for a supplemental budget of up to $250,000 per awardee.

Applicants may either request Group A or Group B activities based on their geographic service area. Applicants should not apply for both Group A and

Group B activities.

Activities under this supplement are organized under the operational strategies of the EHE.

TEC sites serving areas that do include the EHE Phase One priority Geographic area(s) and Location(s) are eligible to apply for this supplemental funding.

For a list of Phase One priority Geographic Areas and Locations, please visit https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one.

Applications for Group B HIV Activities must include the following activities.

Coordination Operational Strategy

a. Grantees will send at least one representative to the annual HIV Coordination meeting scheduled in September of each year to coincide with the U.S.

Conference on AIDS. The budget should include travel and associated costs for participation.

b. Grantees will participate in the IHS National AI/AN STI Prevention workgroup.

Diagnosis Operational Strategy

c. The TECs will provide technical assistance and/or disease surveillance support to communities by developing analytical reports to examine the burden of HIV and other relevant comorbidities such as STIs and HCV in

Tribal communities.

Treatment Operational Strategy

d. The TECs will provide support to communities in the development of enhanced activities and expanded capacity to better identify people who are not in care, including those who were never linked to care following an HIV, STI, or HCV diagnosis and those who have fallen out of care.

Respond Operational Strategy

e. Respond rapidly to detect and characterize growing HIV, STI, or HCV clusters and prevent new infections. TECs will provide technical assistance and/or direct support to communities on the following activities:

i. Develop or accelerate the development and/or refinement of community plans that are customized for AI/AN communities. Extensive community engagement in this process will help ensure that community-specific social norms and unique epidemic attributes are addressed.

ii. Develop collaborative partnerships among Tribal, state, and local health departments, the clinical community, and community-based organizations to expand and routinize HIV diagnosis, treatment, prevention, and response.

Further Activities under this Supplement

Applications are required to address the above activities, and must propose activities addressing at least two of the additional operational strategies below.

Diagnosis Operational Strategy

a. Diagnose all people with HIV, STIs, and HCV as early as possible after infection and connect them to immediate treatment. The TECs will provide technical assistance and/or direct support to AI/AN communities on the following activities:

i. Implementing HIV testing recommendations through the rapid replication of proven or innovative HIV screening models;

ii. Developing and implementing innovative testing and health care engagement strategies focused on meeting the needs of groups at higher risk, including MSM, transgender individuals, high-risk heterosexuals, and persons who inject drugs.

Protection Operational Strategy

b. Protect people at risk for HIV using potent and proven prevention interventions, including Pre-Exposure Prophylaxis (PrEP), a medication that can prevent new HIV infections. The TECs will provide technical assistance and/or direct support to communities on the following activities:

i. Support efforts to increase the awareness of, access to, and utilization of

PrEP among identified populations;

ii. Support efforts to incentivize providers and community-based health care organizations to integrate HIV testing, linkage, and referral to care, and linkage or referral to medical prevention (i.e., PrEP) services into primary care services, particularly for their higher-risk patients;

iii. Raise awareness about the prevention benefits of “Treatment as

Prevention” (TasP) and “Undetectable = Untransmittable” (U=U) among providers, people living with and at risk for HIV, and the general population;

iv. As an entry point to recovery services and overdose and infection prevention, support the development, expansion, implementation, and evaluation of harm-reduction services for people who inject drugs.

v. Evaluate the local acceptability and opportunities for establishing or increasing syringe services programs (SSPs) including: linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases.

vi. Promote early identification of individuals with recurrent STI events with focus on chlamydia, gonorrhea, and syphilis through analysis of clinical or other locally available data.

vii. Promote linkage to care including PrEP or other appropriate services to aid the prevention of HIV and other infectious disease transmission, especially for those diagnosed with STIs.

viii. Promote and support Expedited Partner Therapy (EPT) for individuals diagnosed with chlamydia and gonorrhea to control transmission.

ix. Promote enhanced STI screening among youth and MSM and engage providers in adopting best practices, such as obtaining a thorough sexual history and promoting an adolescent-friendly clinic environment.

Respond Operational Strategy

c. Respond rapidly to detect and characterize growing HIV, STI, or Viral hepatitis clusters and prevent new infections. The TECs will provide technical assistance and/or public health surveillance support to communities on the following activities:

i. Establish and support boots-on-the-ground public health workforce capacity that is culturally competent and committed to ensuring implementation of community-based HIV, STI, and/or Viral hepatitis control plans, including facilitating and troubleshooting collaborative community-wide disease control efforts;

ii. Develop or expand the capacity to detect and respond to all established or emerging HIV, STI, and/or Viral hepatitis clusters to reduce disease transmission.

Allowable Activities Under Goal Set 1:

1) Enhance or develop disease surveillance systems. Surveillance systems can address infectious and chronic diseases, record linkage studies to improve existing surveillance systems, suicide data tracking, regional health registries, influenza surveillance, among others.

2) Carry out at least one new disease surveillance activity per cycle, complete with evaluation and the use of measurable outcomes.

Goal Set 2: Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health (Core Function 2).

Required Activities under Goal Set 2:

None required.

Optional Activities with Budget Support under Goal Set 2:

1) Annual Cancer Survivorship Leadership Training

This activity is eligible for a supplemental budget of up to $85,000 per awardee.

One award is anticipated.

This activity supports the CDC National Center for Chronic Disease Prevention and Health Promotion activity Annual Cancer Survivorship Leadership Training.

Grantee will organize and implement at least two, three-day cancer support leadership trainings for 15-25 AI/AN participants, nationally. The training will be designed to give participants a unique opportunity to work together in a safe, supportive environment to learn and practice skills to help people affected by cancer in their communities. The training will be based on the model, A

Gathering of Cancer Support, using the Gathering of Native Americans (GONA) teaching methods.

Outcome:

Participants will show change in knowledge/understanding of the below elements:

Wellness from a Native American Perspective

a. Using a group discussion method such as Rez Café, identify two AI/AN core values that support wellness and healing.

b. Using a group discussion method such as Rez Café, identify two AI/AN core values to draw from to help facilitate a support group.

Cancer 101

c. Describe two ways to take personal action to reduce cancer risk

Exploring Emotional Peer Support Skills and How to Start Up Cancer Support in Your Community.

d. Determine best role for self in setting up cancer support.

e. Identify at least two steps for starting up cancer support in your community.

2) Tribal Public Health Departments

This activity is eligible for a supplemental budget of up to $150,000 per awardee.

Six awards are anticipated.

a. Conduct Ecological Assessments on Tribal public health programs and services in your Area.

b. Develop plans with specific Tribes on strengthening Tribal public health programs and services.

c. Support the establishment and/or expansion of one or more Tribal public health department(s) in your Area.

Allowable Activities Under Goal Set 2:

1) Evaluate sufficiency of IHS electronic health record data to determine AI/AN health status, to create seamless data linkages, and to meet the health information needs for Tribes and Tribal programs. This should include an assessment of the ability for the health information systems to meet those needs, create seamless data linkages, and meet data access needs for Tribes and Tribal organizations.

Goal Set 3: Assist Indian Tribes, Tribal organizations, and UIOs in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data.

Make recommendations for the targeting of services needed by the populations served.

Make recommendations to improve health care delivery systems for Indians and Urban

Indians (Core Functions 3, 4, and 5).

Required Activities Under Goal Set 3:

1) Public Health Preparedness and Response

a. Strengthen Tribally-focused surveillance systems and data.

b. Conduct outbreak investigations and response.

c. Lead community assessments for disaster preparedness, response, and recovery.

d. Develop response plans for major public health emergencies.

e. Lead, coordinate, or participate in Federal, Tribal, state, or local emergency response exercises and activities.

f. Promote and facilitate planning and response activities among Tribes.

g. Build partnerships among government agencies, Tribes, and other organizations to advance emergency preparedness in Indian country.

2) STD Activities

The grantees will conduct activities in this announcement to support the above

STI National Strategic Plan goals and indicators pertaining to chlamydia, gonorrhea, Primary and Secondary Syphilis and congenital syphilis. While the

STI National Strategic Plan includes HPV as an additional focus, applicants should not emphasize HPV in their application. However, HPV-related activities can be incorporated into project plans as a secondary focus if desired, as appropriate and if relevant or complementary to primary work.

a. Community Profiles

In year 1 of award, the grantees will develop an assessment of the overall burden of the following STIs: chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis within the communities they serve.

To support the profile, the grantees will analyze current, existing data or generate their own data related to STI burden with particular emphasis on priority groups listed above and any other priority groups identified during the assessment phase. When analyzing existing data, grantees will ensure analyses are novel and not duplicative of analytic approaches or products available from other sources. Data may include publically available data, surveillance data, clinical data, qualitative data, or other relevant health data source. Applicants should prioritize data that describe STI burden in Tribal communities within their jurisdiction, such as through partnerships with public health authorities at the Tribal, local or state level. Although historic data may be reviewed, analysis must incorporate data on the burden of STIs generated within the last 5 years. The applicants are encouraged to create assessments that examine STI burden at different Tribal communities and report those results accordingly; regional or IHS Area level results or national level results can be used for comparison purposes.

Special focus should be on indicators and priority areas outlined in the STI

National Strategic Plan.

The assessment will serve as a living document and will be updated minimally on year 3 and year 5 of the award.

During years, 2-5 of the award the grantees should: 1) work to obtain information from community members and Tribal leaders on defining gaps and opportunities to further improve STI prevention and care and 2) conduct relevant interventions to improve STI prevention and care services. The grantees will create a report describing the findings from their community engagement and outlining any relevant feasibility, gaps, and opportunities identified in the interventions conducted. Interventions can be expanded to more communities depending on results, feasibility, and acceptability.

b. Communication of findings

At the end of year one grantees will create a report outlining analytic findings of the community profile assessments and also create and include a strategic plan and road map on how to address STI burden within the supported AI/AN communities. Applicants are encouraged to align their strategic approach with the vision and goals of the National STI Strategic Plan and implementing the objectives and strategies most relevant to their role and communities. In addition, applicants should use available data to identify where their resources will have the most impact and to determine indicators and targets best suited to measure their progress towards selected goals. The applicant strategic plan is meant to serve as a living document and be updated based on inputs from supported communities and lessons learned as the work progresses. Please visit https://www.hhs.gov/sites/default/files/STI-National-Strategic-Plan-

2021-2025.pdf for further background.

The grantees will create or adapt communication materials for appropriate audiences (community members, Tribal leaders, health care providers) and convene meetings to share findings with community members and other stakeholders such as Tribal leadership, medical providers, public health partners, etc.

The grantees will work with selected communities to create detailed strategic plans on how to improve STI prevention with specific focus on aligning to any STI National Strategic plan goals, objectives, and indicators and convene a coalition with diverse partners (community members, public health professionals, trainers, health care providers and others). Communities can self-identify or be selected in collaboration with the applicant based on available epidemiologic evidence. Each grantee will work with at least two communities.

c. Meetings

Grantees will meet with IHS Division of Epidemiology and Disease

Prevention (DEDP) staff quarterly to discuss activity progress and garner technical assistance.

Grantees will regularly participate in IHS National STI program workgroup meetings. Each grantee is requested to present once a year on their activities relating to this announcement at these meetings.

Grantees are encouraged to share knowledge gained by presenting findings at

Tribal meetings, regional meetings and/or publishing in peer-reviewed journals.

Grantees will attend one national STI-focused meeting such as the National

Coalition of STD Directors annual meeting or the National STD conference and are strongly encouraged to submit abstracts for presentations. When such meetings are held in person, applicant’s budget should include travel costs for up to three staff to attend.

d. Outcomes

The applicant will provide evidence of direct dissemination of assessment results to Tribal communities including Tribal leadership.

Dissemination could include meetings, online reports (and number of views), media releases, and newsletters.

Optional Activities with Budget Support under Goal Set 3:

1) Targeted STD Activities

This activity is eligible for a supplemental budget of up to $150,000 per awardee.

Six awards are anticipated.

To qualify for targeted STD activities, the applicant must demonstrate an increased incidence of congenital syphilis or syphilis among women of reproductive age within their jurisdiction.

The STI National Strategic Plan specifically outlines a focus on congenital syphilis (CS) in Tribal communities and includes a disparity indicator to reduce

CS rate among AI/AN people/communities.

In order to achieve a reduction in CS rates among AI/AN people, a comprehensive approach to reduce syphilis rates among women of reproductive age is necessary. Grantees will conduct activities in one or more of the following domains with the goal to address the STI Disparity Indicator focusing on the reduction of CS cases among AI/AN people. Applicants can propose additional relevant work to address CS among their communities. Activities are intended to complement and expand from required STD activities and develop a logic model specific to this activity apart from the program-wide logic model.

a. Linkage to prenatal care

Applicants will address gaps in prenatal care that contribute to late maternal syphilis screening and treatment. Applicants should prioritize hard to reach populations, including, but not limited to, persons experiencing homelessness and Persons Who Inject Drugs (PWID), and design interventions to link these populations to care. Applicants will determine whether third trimester screening is occurring within their jurisdictions and evaluate its ability to a) avert cases before birth; and b) detect and treat additional CS cases.

Applicants may partner with health care providers to test different scalable interventions; for example, the feasibility and impact of Electronic Health

Record reminders and/or screening at delivery.

b. Surveillance

Applicants will design activities to address surveillance gaps to capture and accurately report syphilis cases among AI/AN women (particularly women of reproductive age) and understand risk factors associated with transmission.

c. Outbreak response plans and trainings

Applicants will assess gaps in current practices to respond to syphilis outbreaks within their jurisdiction. Applicants will develop comprehensive syphilis outbreak response plans that incorporate and enhance health education and training for providers and disease investigators serving the community. Feasibility of response plans will be assessed with Tribes and

Tribal leadership within their jurisdiction. Applicants can include other STIs in outbreak response plans. Applicants will assess training needs and identify providers/Disease Intervention Specialists in need of training and arrange or develop resources. Applicants will connect with existing resources like the

STD Prevention Training Centers to create trainings for providers in their community that are tailored to local needs and that are culturally appropriate.

Applicants may find more information on the STD Prevention Training

Centers at https://www.nnptc.org/.

d. Screening in alternative locations

Applicants will create an inventory of any screening currently conducted in alternative locations within their jurisdiction and pilot novel screening programs for syphilis (but also including other STIs) that may reach heterosexual populations. Applicants will evaluate the effectiveness of such interventions at case-finding and treatment. This could include jails, inpatient or Emergency Department settings, and substance abuse treatment centers.

e. Communication of findings

The grantee will create a report outlining findings and develop a local strategic plan and road map on how to address CS and syphilis burden within the supported AI/AN communities. This plan will differentiate from the work conducted under Part A activities.

The grantees will create or adapt communication materials for appropriate audiences (community members, Tribal leaders, health care providers) and convene meetings to share findings with community members and other stakeholders such as Tribal leadership, medical providers, public health partners, etc.

Grantee will convene a coalition with diverse partners (community members, public health professionals, trainers, health care providers and others) to create concrete action steps to target CS in their jurisdiction and to inform further adaptation of the local strategic plan.

f. Meetings and Reporting

Grantees will meet with IHS DEDP staff quarterly to discuss activity progress and garner technical assistance.

Grantees will provide reports two times a year summarizing progress towards outcomes in Logic Model.

Grantees will participate in any IHS National STI program workgroup meetings focusing on CS and share their activities with other participants.

Grantees will present on their CS activities minimally once per year.

Grantees are encouraged to share knowledge gained by presenting findings at

Tribal, regional, or national meetings and/or publishing in peer-reviewed journals.

g. Outcomes

Demonstrated improvement in capturing of syphilis cases among women of reproductive age and ascertainment of CS cases. Demonstrated improvement of linkage to care and screening for syphilis with particular emphasis on hard to reach populations, including, but not limited to, persons experiencing homelessness and PWID.

The grantees will provide evidence of direct dissemination of findings to

Tribal communities including Tribal leadership. Dissemination could include meetings, online reports (and number of views), media releases, and newsletters.

Allowable Activities Under Goal Set 3:

1) Public Health Response

Grantees may conduct further activities not addressed above including:

a. Infectious Disease control.

b. Outbreak Response.

c. Assess and support Environmental Health emerging needs of local communities.

Goal Set 4: Provide technical assistance to Indian Tribes, Tribal organizations, and UIOs in the development of local health service priorities and to determine incidence and prevalence rates of disease and other illness in the community (Core Function 6).

Required Activities Under Goal Set 4:

1) Provide culturally appropriate training and technical support based on the needs of Indian Tribes, Tribal organizations, and UIOs served. Topics may include but are not limited to program evaluation, data analysis, data quality, survey design and administration, program planning, community health assessment, and outbreak response.

a. Implement and evaluate at least one public health intervention (conducted by grantee or by supported community) to promote health or address disparities in AI/AN communities.

2) Evaluate and support Area-wide interventions that promote SARS-CoV-2 vaccine uptake. Assess community attitudes/knowledge/beliefs around vaccine availability, vaccine coverage, and uptake among AI/AN populations and the

IHS/Tribal/Urban health care workforce. Address sufficiency and/or gaps regarding vaccine messaging and public communication campaigns and develop implementation strategies to maximize vaccine coverage among AI/AN communities.

This requirement will have a separate budget of $250,000 per TEC.

a. Explain how the TEC will develop, maintain and strengthen relationships with other public health authorities (e.g., Tribal, county, state) in order to facilitate

Public Health assessment, response, communications and dissemination relevant to vaccine implementation to enhance uptake and overall coverage.

b. The TEC will develop a comprehensive needs assessment relevant to the ongoing SARS-CoV-2 vaccine implementation efforts within their relevant

IHS Area.

i. Assessment should include implementation gaps and opportunities for improvement in local vaccination activities.

ii. Based on needs assessment findings, develop and implement intervention strategies to address gaps and enhance opportunities related to improving local vaccine implementation, uptake, and communications.

iii. Perform ongoing evaluation of activities to determine effectiveness and impacts and to inform future efforts.

c. Perform an assessment of existing vaccination capacity, implementation, and uptake for years 1-3 of this funding cycle. Plans for years 4-5 should use this assessment to continue, adapt, and evaluate changes in local conditions and respond to ongoing vaccination needs and goals.

3) Evaluate and support Area-wide interventions that promote coronavirus disease

2019 (COVID-19) pandemic response, mitigation, and recovery.

This requirement should have a budget of at least $1,000,000 per site.

a) Explain how the TEC will develop, maintain, and strengthen relationships with other public health authorities (e.g., Tribal, county, state) in order to facilitate collaborative pandemic outbreak response activities at the local and regional level.

b) These COVID funds are to meet immediate needs in the response, mitigation, and recovery from the COVID-19 pandemic. Plans for activities should be explicitly tied to measurable pandemic response, mitigation, and recovery outcomes.

Optional Activities with Budget Support under Goal Set 4

1) SASP/DVP/FHC Technical Assistance

This activity is eligible for a supplemental budget of up to $265,000 per awardee.

Twelve awards are anticipated.

Objective: To provide Technical Assistance (TA) to the Substance Abuse and

Suicide Prevention (SASP), Domestic Violence Prevention (DVP), and Forensic

Health Care (FHC) projects funded within their regional area. Technical

Assistance (TA) should apply to Tribes, Tribal organizations, UIOs, and Federal facilities that receive grants from IHS Behavioral Health. TA should assist projects in meeting required reporting activities.

a. Cross-Site/Group TA

i. Representatives from TECs participate in monthly calls with IHS Division of Behavioral Health (DBH) program staff.

ii. The TECs will facilitate or participate in scheduled Area Project Officer

(APO) monthly conference calls/webinars to include all grantees within their respective IHS Area.

iii. Organize and facilitate quarterly webinars related to the expectations and required activities of the SASP, DVP and FHC grant programs.

iv. Provide at least one opportunity per year for individual grantees to meet with local TEC annually at regional or national meeting forum (for example, regional behavioral health conferences).

v. Coordinate in-person, virtual, or teleconference peer-to-peer support opportunities for grantees.

b. Individualized Training and Technical Assistance (TTA)

i. Engage in regular communication with grantee project directors and/or project coordinators, providing individualized TTA to SASP/DVP/FHC grantees based on the needs of individual grant community to meet the expectations and required activities of the grant program.

ii. Provide monthly, individual virtual site visits.

iii. Document individual one-on-one meetings that occurred at regional or national meetings, such as regional behavioral health conferences.

iv. Develop an individualized data collection tracker to assist grantees with local data collection.

v. TECs will work with grantees to establish baseline data related to the

SASP/DVP/FHC funded projects, DBH Alcohol and Substance Abuse

(ASA) Government Performance and Results Act (GPRA) measures and other IHS Strategic Plan Goals.

vi. Technical assistance provided by TECs in this cooperative agreement are limited to efforts that support grantee submission of the required DBH annual progress report (APR) and grantee-specific interventions outlined in the applicant project narrative.

vii. TECs should outline available resources and technology, including software technology for project data analysis and management. TECs may use resources available to them to enhance TA support including software, maintenance, and storage capabilities. However, it is recommended that these activities include an established agreement between the TEC and the grantee.

c. Development of Resources

i. Support grantee development of publications and/or presentation for use in their program.

ii. Provide subject matter expertise, tools, and resources to enhance grantee development of culturally competent, community-based methods for local evaluation and data collection plans.

iii. Create individualized training plans for use with grantees.

iv. Support development of MOUs related to project needs (e.g., provide templates for establishing data collection plans and data sharing agreements, partnerships, and/or services).

v. Develop TTA material including public health messages, and aid in public health messaging practice guides to assist grantees in developing documents identified as grant required activities.

2) Zero Alcohol and Substance Abuse (ASA) Suicide Initiative Technical Assistance

This activity is eligible for a supplemental budget of up to $125,000 per awardee.

One award is anticipated.

Objective: To provide technical assistance that supports the data collection and data analysis requirements of local projects funded under the two IHS Alcohol and Substance Abuse Pilot Project Initiatives; the Community Opioid Intervention

Pilot Project (COIPP) and the Youth Regional Treatment Center (YRTC)

Aftercare Pilot Project. Technical assistance should apply to Tribes, Tribal organizations, UIOs and Federal facilities that receive grants from IHS Behavioral

Health.

a. Data Collection, Analysis, and Reporting

i. Support local grantee efforts to develop data plans that will support grant objectives, project activities and evaluation efforts. Each grantee was highly recommended to develop a logic/model or theory of change as part of their project description.

1. Technical assistance provided by TECs in this cooperative agreement shall support data collection, analysis, and reporting. Data shall be coordinated and submitted with local grantee evaluation efforts and required annual progress reports.

2. Work with grantees to establish baseline data related to pilot project.

3. Work with grantees to establish a local data collection plan, including project data collection tracker related to proposed activities and evaluation efforts. Data will include a compilation of quantitative and qualitative data that addresses the project impact including outcomes such as performance measures related to evaluation outcomes and intended results.

4. TECs will assist grantees to include and prioritize the collection and reporting of DBH ASA GPRA measures and other IHS Strategic Plan

Goals.

ii. Technical assistance provided by TECs in this cooperative agreement shall support grantee submission of the required DBH APR.

iii. TECs should outline available resources and technology, including software technology for project data analysis and management. TECs may use resources available to them to enhance TA support including software, maintenance, and storage capabilities.