STD AAPPS Assessment Tool

Attachment C-Instrument: Assessment Tool-Electronic Version
Form Approved
OMB No. 0920-0879
Expiration Date
03/31/2018
Thank you for participating in this assessment. Your responses will help CDC/DSTDP better understand your experiences under STD AAPPS, characterize progress, and plan future funding programs.
For each strategy listed in the STD AAPPS FOA, please answer the following three questions located in each box (green, yellow and red). For each question, please select the box that best describes
your STD program’s status (Q1) and changes (Q2) from your perspective, and your feelings about the inclusion of that strategy in the FOA (Q3). While some activities are only recommended and
not required, please answer all of the questions for both required and recommended strategies. The comment boxes at the end of each section are optional. Please email your completed form to
Tunicia Walker at [email protected]. If you have questions, please contact Aisha Rios at [email protected]. Thank you for your time and assistance.
Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

SURVEILLANCE
1) (Required) Ensure confidentiality and security
guidelines for the collection, storage, and use of
all surveillance data according to NCHHSTP
guidance.
2) (Required) Improve the quality and timeliness of
case-based data collection to routinely obtain
information on gender of sex partners, pregnancy
status, HIV status, treatment given, patient’s
address and provider information
CDC estimates the average public reporting burden for this collection of information as 60 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and
maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless
it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information
Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

3) (Required) Geocode case-based surveillance data
to target interventions to providers serving a high
volume of patients with STDs and to populations
in geographic areas with high numbers of
reported infections.
4) (Required) Conduct automated matching of STD
and HIV cases for identification of syndemics and
for targeting health department partner services
for co-infected individuals to identify new HIV
infections and other HIV infected individuals who
are not in care.
5) (Required) Disseminate surveillance information
to affected populations, communities, providers
and key stakeholders
6) (Recommended) Increase the number of STD
cases and surveillance data received through
electronic laboratory reports and electronic
health records in the surveillance system
7) (Recommended) Expand surveillance systems
beyond case-based reporting to sentinel systems
and population-based approaches.
Comments: (optional)
2

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

MONITORING SCREENING RATES
8) (Required) Measure annual CT screening rates
among young females (15-24 years) enrolled in
Medicaid programs, and seen in Title X and
other family planning clinics, ideally using the CT
HEDIS measure.
9) (Required) Measure annual syphilis and rectal
GC screening rates among MSM seen in high
volume HIV care settings.
10) (Recommended) Measure annual CT screening
rates among young females (15-24 years)
enrolled in large health plans, ideally using the
CT HEDIS measure.
11) (Recommended) Measure syphilis and rectal GC
screening rates among MSM seen in settings
providing health care to MSM.
12) (Recommended) In jurisdictions with congenital
syphilis: measure screening for syphilis among
pregnant females in prenatal care and birthing
facilities.
Comments: (optional)

3

Weakened
some

Weakened
a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

ASSESSING GAPS
13) (Required) Identify the clinical and prevention
service gaps for at-risk individuals who are
receiving care (e.g., missed opportunities by
providers including safety net providers).
14) (Recommended) Determine where uninsured or
underinsured, at-risk clients are receiving safety
net services.
15) (Recommended) Estimate the proportion of
uninsured or underinsured, at-risk individuals in
the jurisdiction.
Comments: (optional)

4

Weakened
some

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

WeakRequired
ened a lot

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
ened
change
somevery weak judge - we ened a lot
some
what
in this
don’t do
weak in
area.
much in
this area.
this area

MONITORING AR GC AND OTHER EMERGING STD THREATS AND CONGENITAL SYPHILIS
16) (Required) Assess the proportion of GC cases
that are treated correctly according to current
CDC STD Treatment Guidelines, stratified by
provider type.
17) (Required) Determine the number of private or
public health laboratories in the jurisdiction that
have the capacity to conduct N. gonorrhoeae
culture and AST. Specify the transport/culture
media used. If AST is done, specify the method
such as disk diffusion (Kirby-Bauer), Etest, or agar
dilution.
18) (Required) Where high number of CS cases:
Assess congenital syphilis cases to determine the
epidemiologic and health care factors associated
with the cases to inform interventions
19) (Recommended) Establish surveillance capacity
to detect emerging STD threats
Comments: (optional)

5

Weakened
some

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

WeakRequired
ened a lot

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

ASSURING SCREENING AND TREATMENT RATES
20) (Required) Increase CT screening rates among
young females (15-24 years) enrolled in Medicaid
programs, and seen in Title X and other family
planning clinics, as ideally measured by the CT
HEDIS measure.
21) (Required) Increase syphilis and rectal GC
screening rates among MSM seen in high volume
HIV care settings.
22) (Required) Increase the proportion of patients
with GC that are correctly treated according to
current CDC guidelines in areas of high GC
morbidity
23) (Recommended) Increase annual CT screening
rates among young females seen in large health
plans, ideally using the CT HEDIS measure.
24) (Recommended) Increase syphilis and rectal GC
screening rates among MSM seen in settings
providing health care to MSM.

6

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

25) (Recommended) In jurisdictions with congenital
syphilis: increase screening for syphilis among
pregnant females in prenatal care and birthing
facilities
Comments: (optional)

PARTNER SERVICES/OUTREACH SERVICES AND LINKAGE TO CARE
26) (Required) Increase targeted and effective PS for:
Primary and secondary syphilis cases.
27) (Required) Increase targeted and effective PS
for: HIV co-infected GC and syphilis cases.
28) (Required) Increase targeted and effective PS
for: GC cases with possible GC treatment failure
or suspected or probable cephalosporin-resistant
N. gonorrhoeae isolate using the criteria in the
Cephalosporin-Resistant N. gonorrhoeae Public
Health Response Plan.
29) (Required) Link partners contacted who have
not been diagnosed previously with HIV who test
positive for HIV to care.

7

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

30) (Recommended) Within state law, increase the
provision of expedited partner therapy (EPT) for
CT and GC according to current CDC treatment
guidelines.
31) (Recommended) Increase the provision of
effective partner services provided through social
media websites and other digital or
communication technologies (e.g. internet
partner services).
32) (Recommended) Link newly identified HIVinfected individuals in STD clinics to HIV care.
33) (Recommended) Link uninsured or underinsured
partners to safety net services.
Comments: (optional)

8

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

HEALTH PROMOTION AND PREVENTION EDUCATION
34) (Required) Maintain a website where
surveillance information and basic information
about STDs is available to the public, health care
providers, health planners and policy makers.
35) (Required) Collaborate with other organizations
to implement STD health promotion and
prevention education activities for safety net or
other clinical providers who see at-risk patients.
36) (Recommended) Collaborate with other
organizations to implement STD health
promotion and prevention education activities
for at-risk populations or communities.
37) (Recommended) Provide and promote the use of
high intensity behavioral counseling (HIBC) in
clinical settings serving at-risk patients.
Comments: (optional)

9

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?
Required RecomDropped
mended

Q1: How strong or weak is your STD program in
implementing the following strategies?

STD AAPPS’ Strategies

We are
very
strong in
this area.

We are
somewhat
strong in
this area.

Q2: How much has your STD program strengthened or
weakened in the last 3 years for the following strategies?

We are
We are
Can’t
Strength- Strength- No/ little
somevery weak judge - we ened a lot
ened
change
what
in this
don’t do
some
weak in
area.
much in
this area.
this area

POLICY
38) (Required) Monitor and evaluate impact of
relevant policies.
39) (Required) Educate public, providers and key
stakeholders on the positive potential or proven
impacts of policies on reducing sexually
transmitted infections.
40) (Required) Work with external partners and
other agencies within the executive branch of
state or local governments to improve access and
quality of STD prevention services through
enhanced collaboration with primary care.
Comments: (optional)

OTHER/CROSS-CUTTING REQUIREMENTS AND ISSUES
41) (Required) Submit and use program outcome
measures (POM)
42) (Required) Develop and implement targeted
evaluation plans (TEP)
Comments: (optional)
10

Weakened
some

Weakened a lot

Q3: Do you wish the following
strategies were required,
recommended, or dropped
from the FOA?

Required

Recommended

Dropped