ESSHCI Performance Measures Report - Revised

CDC-RFA-PS-23-0011: Enhancing STI and Sexual Health Clinic Infrastructure (ESSHCI)
PERFORMANCE MEASURES REPORT
Click a named tab at the bottom of the workbook to jump to the corresponding worksheet.

Instructions:
Please use this template to submit performance measures for ESSHCI Activities.
This template will be completed twice a year, within the coag period.
Please refer to the performance measures guidance document for additional information and definitions for completing the
template.
Definitions for some measures are also included in footnotes, annotated by numbers, at the bottom of the respective tables in this
reporting template.
If you need assistance or have ANY questions about completing this template, please send an email to your DSTDP project officer.

Notes on Data Entry:

All unshaded cells are available for user input.
Drop-down lists included in the worksheets will be identifiable through a downward arrow that appears when you select it.
Gray cells are auto-calculated and do not require data entry.
Blacked-out cells are not required and do not require data entry.
ONLY Recipients funded for strategy C are required to complement the strategy C tab. Data for strategies A and B are required for all
recipients.

Saving and Submitting Your Work:

Please save this file as "[Agency Name]_Performance Measures Report_Date of Submission[mm.dd.yy]"
To submit your report, save and upload a copy of the completed workbook ending in .xls or .xlsx as a Grant Note in GrantSolutions by
xxxx
Please send a courtesy email to your DSTDP project officer to notify them of your submission.

Relevant Links:

To find general information on using Microsoft Excel, click here:

Microsoft Excel Basics

Public reporting burden of this collection of information is estimated to average 16 hours per response per year, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data 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 this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1282).

CoAg Title:

Enhancing STI and Sexual Health Clinic Infrastructure

CoAg Number:
Agency:
Funded for Strategy C?
Reporting Period:
Date completed:

RFA PS23-0011
Select from dropdown

Form Approved
OMB Control No. 0920-1282
Exp. Date: 06/30/2026

Public reporting burden of this collection of information is estimated to average 16 hours per response per year, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data 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 this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1282).

Sexual Health Services- Prevention
Aggregate Data Tables for PM-8 & 9
Black-out cells: Are not required for those measures and do not represent a reporting burden

Table B3 . Persons Served and Receiving Biomedical HIV and STI Prevention Services
Number of Unique Persons
1
Served

Number of Persons Who Received Number of Persons Who Received Number of Persons Who Received
2
3
4
HIV PrEP
HIV nPEP
Doxy PEP for Bacterial STIs

Total
Age Group
<15 Years
15-19 Years
20-29 Years
30-65 Years
≥ 66 Years
5

Unknown

Gender
Male
Female
Transgender , Non-binary, or another
gender
5
Unknown
Sexual Orientation
Gay
Lesbian
Bisexual
Straight
Other
5

Unknown

Race and Ethnicity
Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Multiracial and/or Multiethnic
5

Unknown

Insurance Status
6

Private
Combination
8

Uninsured
Other
5

Unknown

Data Quality
Are there missing/unavailable data for
any performance measures in the
table(s) above?

Please explain the issues with the
missing data, including variable names,
and your plans to enhance the
completeness of your data (if
applicable).

1

This is the number 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.
The number of people who received preventive services should be a subset and cannot be greater than the number of people served.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.

2

This is the number of people who received PrEP for HIV, in the specified reporting period. Count all persons who received one or more prescriptions for PrEP, 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.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.

3

This is the number of people who received nPEP for HIV, in the specified reporting period. Count all persons who received one or more prescriptions for nPEP, 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.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.

4

This is the number of people who received DoxyPEP for bacterial STIs, in the specified reporting period. Count all persons who received one or more prescriptions for DoxyPEP, including those who
received it once and may have discontinued by the end of the reporting period.
For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.

5

Unknown values for which the stratified data is missing or unavailable, e.g., numbers of people for whom their age groups are identified.

6

Private insurance includes plans provided through an employer or union, purchased by an individual, TRICARE, or other military coverage.

7

Public insurance includes plans funded by government at the federal, state, or local level. E.g., Medicaid, Medicare, Indian Health Service.

8

Uninsured includes persons not covered under any health insurance.

STI Testing and Diagnosis
Aggregate Data Tables for PM-12, 13, 14
Black-out cells: Data entry are not required for those measures

Table B4a . STI and HIV Tests and Diagnoses
Syphilis
Number of Tests 1

Chlamydia
Number of
Diagnoses 2

Number of Tests 1

Gonorrhea

Number of
Diagnoses 2

Number of Tests 1

Number of
Diagnoses 2

Mpox
Number of Tests 1

HIV
Number of
Diagnoses 2

Number of Tests 1

Symptom Status
3

Symptomatic (Tested)
Asymptomatic (Screened)
5
Unknown
4

Disease Stage
Primary
Secondary
Early Latent (EL)
Late Latent (LLS)
Neurosyphilis
5

Unknown

Anatomic Site
Pharyngeal
Rectal
Urogenital
5

Unknown

Data Quality
Are there missing/unavailable data for
any performance measures in the
table(s) above?

Please explain the issues with the
missing data, including variable names,
and your plans to enhance the
completeness of your data (if
applicable).

1

This is the number of tests for: Syphilis, Gonorrhea, Chlamydia, Mpox, and HIV in the specified reporting period. These are counts by tests . For multiple tests for the same infection, count the person each time they are tested in the 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.

2

This is the number of 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 multiple diagnosis for the same infection, count the person each time they are tested and diagnosed in the reporting period.
New STI 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 tested. For unavailable or missing values, please enter the applicable
numbers in the ‘unknown’ fields.

3

4

5

Symptom Status : Refers to the number of persons screened, tested, and/or diagnosed 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 test.)
Symptomatic (Tested): Number of persons presenting with symptoms and tested for listed STIs and/or HIV, at time of visit. These are counts by test. For multiple tests for the same infection, count the person each time they are tested in the
reporting period.
Asymptomatic (Screened): Number of persons with no symptoms and thus screened for possible Syphilis, Gonorrhea, Chlamydia, Mpox, and/or HIV, at time of visit. These are counts by test. For multiple tests for the same infection, count the
person each time they are tested/screened 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.

Number of
Diagnoses 2

STI Testing and Diagnosis (Total)
Aggregate Data Tables for PM-12, 13, 14
Black-out cells: Data entry are not required for those measures

Table B4b . Persons Tested and Diagnosed with STIs and HIV
Syphilis

Chlamydia

Gonorrhea

Mpox

HIV

Number of

Number of New

Number of

Number of New

Number of

Number of New

Number of

Number of New

Number of

Persons Tested 1

Diagnosis 2

Persons Tested 1

Diagnosis 2

Persons Tested 1

Diagnosis 2

Persons Tested 1

Diagnosis 2

Persons Tested 1

Total

Data Quality
Are there missing/unavailable data for
any performance measures in the
table(s) above?

Please explain the issues with the
missing data, including variable
names, and your plans to enhance the
completeness of your data (if
applicable).

1

2

This is the number of people who were tested for: Syphilis, Gonorrhea, Chlamydia, Mpox, and HIV in the specified reporting period. For multiple tests for the same infection, count the person ONCE for the 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.
The number of people receiving preventive services should be a subset of, and cannot be greater than, the number of persons served. For unavailable or missing values, please enter the applicable numbers in the ‘unknown’ fields.
This is the number 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 multiple diagnoses for the same infection, count the person ONCE for the reporting period.
New STI 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. For unavailable or missing values, please enter the
applicable numbers in the ‘unknown’ fields.

3

This is the number of persons that are newly diagnosed and were not tested and diagnosed in a previous reporting period.
New 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. For unavailable or missing values, please enter the
applicable numbers in the ‘unknown’ fields.

4

Unknown values for which the stratified data is missing or unavailable, e.g., numbers of people for whom their age groups are identified.

Number of New
Persons Testing
Positive 3