Technical Specifications

Form Approved
OMB Control Number: 0920-1282
Expiration Date: 06/30/2026

Public reporting burden of this collection of information is estimated to average 22 hours per response per year,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
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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 this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1282).

CDC RFA PS23-0011: Enhancing STI and Sexual Health Clinic
Infrastructure

Performance Measures Guidance
Version 2.0

CDC/NCHHSTP/DSTDP: Program Development and Evaluation Branch
10-1-2024

Page 1 of 12

Table of Contents
INTRODUCTION AND PURPOSE .................................................................................................................................3
ORGANIZATION OF GUIDANCE..................................................................................................................................4
OVERVIEW OF PERFORMANCE MEASURES ..............................................................................................................5
PERFORMANCE MEASURES: STRATEGY B .................................................................................................................7
PM-6. Summary of QCS assessment, using CDC’s Recommendations for Providing Quality Sexually Transmitted
Diseases Clinical Services (STD QCS) assessment tool. ...........................................................................................7
PM-8. Number of persons provided sexual health services by each clinic stratified by demographics and
priority population. ................................................................................................................................................8
PM-9. Number of persons who received biomedical HIV and STI prevention services: HIV PrEP; HIV nPEP;
Doxy PEP for Bacterial STIs. ....................................................................................................................................9
PM-12. Number of persons tested for HIV and STIs: Syphilis, Gonorrhea, Chlamydia, Mpox............................ 10
PM-13. Number of new (persons testing positive) HIV and STI cases: Gonorrhea, Chlamydia, Mpox. ............. 11
PM-14. Number of new (persons testing positive) for Syphilis, including by disease stage............................... 11

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INTRODUCTION AND PURPOSE
The revised Enhancing STI and Sexual Health Clinical Infrastructure (ESSHCI) Cooperative Agreement
(CoAg) aims to strengthen clinic infrastructure and expand access to comprehensive sexual health
services in high-burden and underserved areas. ESSHCI supports clinics by:
1. Fostering community engagement and strategic partnerships to support the expansion of sexual
health services.
2. Strengthening clinic infrastructure and provision of sexual health services.
3. Conducting short-term activities to expand access to STI prevention and other sexual health services
supporting a syndemic approach.
Project outcomes include increased community involvement in clinic-level planning, increased
engagement with public health partners, increased access to & capacity to provide comprehensive
sexual health services, improved patient clinic experience, increased identification of new STIs, and
increased linkage to prevention and care services for co-occurring conditions.
CDC will use performance measures for PS23-0011 to monitor this project's outcomes. This guidance
ensures recipients understand each measure, its relevance to their work, and the reporting process
throughout the performance period.
Performance measures for years 2 to 5 have been reduced in line with the revised program
requirements, focusing solely on Strategy B. This guidance outlines these measures but may be
updated during the performance period due to shifting priorities or to enhance performance monitoring.
Additional data may be required, and new measures could be developed. The CDC will strive to
minimize any changes or reporting burdens on recipients.
We encourage recipients to review this guidance and share it with relevant staff members in each
jurisdiction who are involved in reporting performance measures.

For questions related to these performance measures, please contact your designated project officer.

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ORGANIZATION OF GUIDANCE
For the performance measures listed, the following components are included in this guidance:
•

Measure: Fully defined title of the performance measures and abbreviated variable name of the
performance measure as listed in the reporting template.

•

Definition/Guidance: Information to help understand the measure, such as definitions for
specific terms, inclusion/exclusion criteria, limitations to the measure, and other applicable
information.

•

Rationale: As applicable, specific measures may include additional context and reasoning for
monitoring the listed performance measure.

•

Data elements: Applicable numerator, denominator, or other variables required to calculate the
measure.

•

Unit of measurement: The unit of measurement or calculation for applicable performance
measures (e.g., number, percentage). Most calculations will auto-populate when the appropriate
numerator and denominator values are entered as ascribed in the pre-populated formula.

•

Key stratification: Levels of interest for assessing performance within selected measures (e.g.,
race/ethnicity, age, gender, gender/sex of sex partners).

•

Applicable recipients: Recipients to whom the performance measures apply.
o All recipients will be required to provide performance measures related to strategies B

•

Reporting mechanism: Specifications on what tool will be used to report data.
Unless otherwise specified, performance measures will be reported through reporting
templates in Excel workbooks provided by the CDC, or through REDCap.

•

Reporting frequency: Guidance on how often the data will be reported:
o Unless otherwise specified, all performance measures will be reported annually, at the
end of the grant year.

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OVERVIEW OF PERFORMANCE MEASURES
Recipients’ work plans may focus on multiple strategies of A, B, and C. Recipients are not required to
work in all three strategy areas and are expected to report only on the measures that align with strategy
B.
CDC will use performance measures for ESSHCI PS23-0011 to monitor and evaluate the outcomes of
this project. CDC understands there may be some overlap in data from various funding streams. Please
pay attention to the specifics of what is required for ESSHCI PS23-0011 measures and ensure data
related to this cooperative agreement is reported. To support recipients in reporting for the project, CDC
will update performance measures and guidance based on data validation, quality checks, and input
from recipients.
CDC recognizes that there are limitations to using performance measures to evaluate the scope of
work being conducted by recipients, especially considering the varying work plans among recipients
and associated contextual factors. For this reason, CDC will use other methods of collecting information
to assess performance more robustly (e.g., work plan updates, success stories, progress calls, and
focused evaluation projects). CDC will rely on a combination of these sources to assess progress
throughout the period of performance.
The performance measures associated with this cooperative agreement are intended to be used by
CDC and recipients to:
•
•
•
•

Monitor implementation and progress toward achieving intended outcomes.
Demonstrate accountability to interested parties (e.g., funders, public) by showing how funds
are being spent.
Maximize learning opportunities and technical assistance needs associated with the
implementation and
Assess the impact of this cooperative agreement to strengthen clinic infrastructure and expand
access to comprehensive sexual health services.

Strategies and Activities

Outcomes

Measures

Strategy B: Strengthen clinic infrastructure and provision of comprehensive sexual health services
(Required strategy – Years 1-5)

▪ B1. Conduct clinic

infrastructure assessment to
document available
comprehensive sexual
health services and identify
and address gaps.

▪ B2. Implement clinic-level

▪ Increased clinic capacity to

provide quality
comprehensive sexual health
services.



PM-6. Summary of QCS assessment; using QCS
assessment tool.



PM-7. Description of strategies to improve clinic
systems for referrals, lab systems, linkages to care,
treatment, and /or record keeping.



PM-8. Number of patients provided sexual health
services by each clinic stratified by demographics and
priority population.



PM-9. Number of patients who received biomedical
HIV and STI prevention services (e.g., HIV PrEP, HIV

plan to increase access to
sexual health services.

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Strategies and Activities

Outcomes

Measures
PEP, doxy-PEP for bacterial STIs) identified by clinic,
stratified by demographics and priority population.

▪ Increased identification of



PM-12. Number of persons tested for STI (syphilis,
gonorrhea, chlamydia- by anatomic site, mpox, HIV) by
clinic stratified by demographics and priority
population.



PM-13. Number of new (persons testing positive) STI
cases (gonorrhea, chlamydia, mpox, HIV) identified by
clinic, stratified by demographics and priority
population.



PM-14. Number of new (persons testing positive) for
syphilis by disease stage (primary, secondary, EL, LLS,
Neurosyphilis) identified by clinic, stratified by
demographics and priority population.



PM-15. Number of new STI cases (syphilis, gonorrhea,
chlamydia, mpox) treated with recommended CDC
treatment.



PM-16. Number of persons testing positive for HIV
who were initiated on ART.



PM-17. Number of new (persons testing positive)
STI/HIV cases who were referred to or offered partner
services.



PM-18. Description of formal linkage agreements with
community partners.



PM-10. Confirmation of patient satisfaction survey or
assessment plan established. (To include specific Likertscale questions from CDC, assessing patient
satisfaction.)



PM-11. Patient satisfaction level with the clinic services
and STI care. (Results of CDC patient satisfaction
measure(s)).

new STIs by clinic.

▪ B3. Implement additional

evidence-based approaches
to enhance clinic sexual
health services.

▪ B4. Assess and improve

patient clinic experience
and satisfaction.

▪ Increased linkage to public

health partners for prevention
and care services for cooccurring condition.

▪ Improved patient clinic
experience.

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PERFORMANCE MEASURES: STRATEGY B
•

Applicable recipients: All recipients will be required to provide performance measures related
to strategies B.

•

Reporting mechanism: Performance measures for strategy B will be reported through the
evaluation reporting templates provided by the CDC and the STD QCS tool. Both tools are
formatted as Excel workbooks.

Measure

PM-6. Summary of QCS assessment, using CDC’s Recommendations for Providing
Quality Sexually Transmitted Diseases Clinical Services (STD QCS) assessment tool.

Guidance

The STD QCS tool should be used to assess the recipient’s clinic infrastructure for each of the
seven domains of recommended STD clinical services for the stipulated performance period.
Instructions for completion are included on the 1st sheet of the QCS tool.
The assessment summary sheet will auto-populate with data entered in the individual sheets.
CDC will collate data from recipients’ assessment summary sheet, so please ensure those
tables are populated.

Reporting
mechanism

CDC will provide recipients with a copy of the toolkit prior to each reporting period. The
assessment tool can also be downloaded from NACCHO’s website here: STD QCS Tool
Information and additional resources can be found here: STD QCS Resources

Rationale

In alignment with the aim of the ESSHCI cooperative agreement, CDC will use this measure to
assess changes in clinic infrastructure over time within the cooperative agreement period.
Recipients are also encouraged to integrate the STD QCS tool to conduct interval assessments
of their clinic’s infrastructure beyond the cooperative agreement period.

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Measure

PM-8. Number of persons provided sexual health services by each clinic stratified by
demographics and priority population.

Guidance

Please enter the total and disaggregated number (for each level of stratification) of UNIQUE
people who received ANY sexual health services at your clinic in the specified reporting period.
The number of people provided sexual health services should include people tested, screened,
diagnosed, and/or treated or linked to care.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.
You are not required to enter values for fields not listed in the table. Values for fields which are
known to your clinic but not included in the reporting tool should be counted in the total value.

Key
Stratification

•

Age group: Persons of ages <15 years, 15-19 years, 20-29 years, 30-65 years, ≥ 66
Years, *unknown.

•

Gender: Persons identifying as Female, Male, Transgender, non-binary, or another
gender, *unknown.
o Transgender includes all persons whose gender identity or expression is
different from their sex assigned at birth. Transgender persons may selfidentify as transgender male to female or transgender female to male.

•

Sexual Orientation: Persons identifying their sexual attraction and/or behavior as:
o Gay
o Lesbian
o Bisexual
o Straight
o Other: Includes sexual orientation not defined within any of the listed
categories.

•

Race and Ethnicity: Race and ethnicity are to be collected at the local level in
accordance with OMB standards. Current OMB definitions and categories are as
follows:
o American Indian or Alaska Native. Individuals with origins in any of the
original peoples of North, Central, and South America, including, for example,
Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana,
Native Village of Barrow Inupiat Traditional Government, Nome Eskimo
Community, Aztec, and Maya.
o Asian. Individuals with origins in any of the original peoples of Central or East
Asia, Southeast Asia, or South Asia, including, for example, Chinese, Asian
Indian, Filipino, Vietnamese, Korean, and Japanese.
o Black or African American. Individuals with origins in any of the Black racial
groups of Africa, including, for example, African American, Jamaican, Haitian,
Nigerian, Ethiopian, and Somali.
o Hispanic or Latino. Includes individuals of Mexican, Puerto Rican,
Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South
American or Spanish culture or origin.
o Middle Eastern or North African. Individuals with origins in any of the original
peoples of the Middle East or North Africa, including, for example, Lebanese,
Iranian, Egyptian, Syrian, Iraqi, and Israeli.
o Native Hawaiian or Pacific Islander. Individuals with origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including,
for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and
Marshallese.

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o

•

White. Individuals with origins in any of the original peoples of Europe,
including, for example, English, German, Irish, Italian, Polish, and Scottish.

Insurance status: Please enter the number of persons covered under health insurance
as followso Private insurance includes plans provided through an employer or union,
purchased by an individual, TRICARE, or other military coverage.
o Public insurance includes plans funded by government at the federal, state, or
local level. E.g., Medicaid, Medicare, and Indian Health Service.
o Combination includes persons with a combination of both private AND public
insurance coverage.
o Uninsured includes persons not covered under any health insurance.
o Other includes persons who have insurance coverage not covered under any
of the defined categories.

*Unknown: values for which the stratified data is missing or unavailable, e.g., numbers of
people for whom their age groups are identified. You are not required to enter values for fields
not listed in the table. Values for fields which are known to your clinic but not included in the
reporting tool should be counted in the total value.

Measure

PM-9. Number of persons who received biomedical HIV and STI prevention services:
HIV PrEP; HIV nPEP; Doxy PEP for Bacterial STIs.

Guidance

Please enter the total numbers of people who received biomedical prevention services for HIV
and Bacterial STIs in the specified reporting period.
Count all persons who received one or more prescriptions for PrEP, nPEP, and/or DoxyPEP,
including those who received it once and may have discontinued by the end of the reporting
period.
The number of people who received preventive services should be a subset and cannot be
greater than the number of people served (PM-8).
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.
You are not required to enter values for fields not listed in the table. Values for fields which are
known to your clinic but not included in the reporting tool should be counted in the total value.

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Measure
Guidance

PM-12. Number of persons tested for HIV and STIs: Syphilis, Gonorrhea, Chlamydia,
Mpox.
Please enter the total and disaggregated number (for each level of stratification) of people who
were tested for: Syphilis, Gonorrhea, Chlamydia, Mpox, and HIV in the specified reporting
period.
For HIV, please include persons previously known or reported to be HIV positive, e.g., persons
tested for confirmation prior to initiating treatment, in each reporting period.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.
You are not required to enter values for fields not listed in the table. Values for fields which are
known to your clinic but not included in the reporting tool should be counted in the total value.

Key
Stratification

Stratfication by symptom status and anatomic sites refers to the number of tests. For
multiple tests and diagnoses for the same infection, count the person each time they are tested
and diagnosed in the same reporting period.
•

Symptom Status: Refers to the number of persons tested for STI due to the presence
or absence of symptoms at the time of patient visit. (For example, a patient presenting
with no throat or rectal symptoms but with urethral discharge, testing negative after
urethral testing and positive for pharyngeal gonorrhea, after a 3-site
gonorrhea/chlamydia screening, should be counted as symptomatic with reference to
the gonorrhea diagnosis.)
If *unknown and/or the stratified data was not collected, please enter the number of
persons in the unknown field.
o Symptomatic (Tested): Number of persons presenting with symptoms who
were tested and positive for listed STIs and/or HIV.
o Asymptomatic (Screened): Number of persons with no symptoms and thus
screened for listed STIs and/or HIV.

•

Anatomic Site: Persons tested for Gonorrhea and/or Chlamydia at the pharyngeal,
rectal, urogenital sites. If *unknown and/or the stratified data was not collected, please
enter the number of persons in the unknown field.

-----------------------------------------------------------------------------------------------------------------------------Persons Tested and Diagnosed for STIs and HIV (Table B4b) refers to the number of
unique persons tested in the same reporting period. For multiple diagnosis for the same
infection, count the person once in the reporting period.
*Unknown: values for which the stratified data is missing or unavailable, e.g., numbers of
people for whom their age groups are identified. You are not required to enter values for fields
not listed in the table. Values for fields which are known to your clinic but not included in the
reporting tool should be counted in the total value.

Page 10 of 12

Measure

Guidance

PM-13. Number of new (persons testing positive) HIV and STI cases: Gonorrhea,
Chlamydia, Mpox.
PM-14. Number of new (persons testing positive) for Syphilis, including by disease
stage
Please enter the total and disaggregated number (for each level of stratification) of new STI
cases identified: Syphilis, Gonorrhea, Chlamydia, and Mpox, in the specified reporting
period. This may include cases diagnosed in any previous reporting period and reinfected, then
diagnosed in this reporting period. Please count only persons who had a positive test AND
confirmed clinical diagnosis.
For HIV, please count only persons that are newly diagnosed and were not tested and
diagnosed in a previous reporting period.
New STI and HIV cases are the numbers of people who, at minimum, test positive after being
tested in the specified reporting period, and should not be greater than the number of people
tested (PM-12).
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.
You are not required to enter values for fields not listed in the table. Values for fields which are
known to your clinic but not included in the reporting tool should be counted in the total value.

Key
Stratification

Stratfication by symptom status, disease stage, and anatomic sites refers to the number
of tests. For multiple tests and diagnoses for the same infection, count the person each time
they are tested and diagnosed in the same reporting period.
•

Symptom Status: Refers to the number of positive tests for STI due to the presence or
absence of symptoms at the time of patient visit. (For example, a patient presenting with
no throat or rectal symptoms but with urethral discharge, testing negative after urethral
testing and positive for pharyngeal gonorrhea, after a 3-site gonorrhea/chlamydia
screening, should be counted as symptomatic with reference to the gonorrhea
diagnosis.)
If *unknown and/or the stratified data was not collected, please enter the number of
persons in the unknown field.
o Symptomatic (Tested): Number of persons presenting with symptoms who
were tested and positive for listed STIs and/or HIV.
o Asymptomatic (Screened): Number of persons with no symptoms and thus
were screened and subsequently positive for listed STIs and/or HIV.

•

Disease Stage: This stratification only applies to positive tests for Syphilis at stages
confirmed by laboratory testing and/or clinical signs and symptoms at the primary,
secondary, early latent, late/tertiary latent, and neurosyphilis stages of syphilis. If
*unknown and/or the stratified data was not collected, please enter the number of
persons in the unknown field.

•

Anatomic Site: Persons tested and positive for Gonorrhea and/or Chlamydia at the
pharyngeal, rectal, urogenital sites. If *unknown and/or the stratified data was not
collected, please enter the number of persons in the unknown field.

-----------------------------------------------------------------------------------------------------------------------------Persons Tested and Diagnosed for STIs and HIV (Table B4b) refers to the number of
unique persons tested in the same reporting period. For multiple diagnosis for the same
infection, count the person once in the reporting period.

Page 11 of 12

*Unknown: values for which the stratified data is missing or unavailable, e.g., numbers of
people for whom their age groups are identified. You are not required to enter values for fields
not listed in the table. Values for fields which are known to your clinic but not included in the
reporting tool should be counted in the total value.

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