In light of resurgent STDs, and a public health imperative to respond to related epidemics such as HIV and opioids, this cooperative agreement proposes new approaches to community-based enhanced and sentinel surveillance integrating monitoring of STDs, HIV and behavioral data to identify opportunities
and gaps in prevention and control efforts.
Systematic, ongoing collection of patient-level information to monitor the occurrence of STDs is the foundation upon which STD control programs are based.
Yet routine reporting by clinicians, laboratories and healthcare facilities is inherently limited and does not provide information needed to characterize the intersection of STDs with co-occurring epidemics, to identify populations at risk for adverse health impacts, or to identify opportunities and gaps in the reach of sexual health and disease preventive services.
This NOFO addresses these information needs, and incorporates flexibility to respond to emergent health issues related to STDs by supporting a network of geographically diverse health departments and STD-related clinical partners to implement protocol-based surveillance activities.
These activities complement and enhance existing surveillance strategies and expand the capacity of health departments to collect high-quality, timely data to inform disease prevention and control activities.
Three curable bacterial sexually transmitted diseases (STDs):
chlamydia (CT), gonorrhea (GC), and syphilis are nationally notifiable and have historically been the focus of federally funded STD prevention programs throughout the U. S. In 2017, 2. 3 million cases of these three STDs were reported to CDC, reflecting an increase of 35% since 201 3. However, these cases do not fully reflect the burden of STDs as many infections are asymptomatic and never diagnosed and reported – and this does not include other STDs that are not nationally notifiable.
STDs can have long-term health consequences, such as infertility; in addition to the impact on an individual’s health, STDs are also an economic drain on the U. S. healthcare system costing billions annually.
Moreover, persons with STDs are also at risk for acquisition, or transmission, of HIV and represent a population essential to national efforts to end the HIV epidemic as well as for reducing the spread of STDs.
As the burden of STDs has increased, surveillance systems at the state and local level struggle to ascertain complete information on the characteristics of individual cases and potential co-occurring conditions – essential for understanding differences in health equity and for monitoring adverse health outcomes of STDs.
Integrating enhanced surveillance activities for STD and HIV among individuals being diagnosed with STDs in the community is imperative for monitoring the uptake of prevention interventions to reduce HIV transmission at the population level.
These data are critically needed to inform trends in incidence and prevalence of STDs and HIV among at-risk and vulnerable populations (such as racial, ethnic and sexual minorities) and to steer prevention and control efforts in both the public and private healthcare sectors.
This NOFO supports enhanced case investigations to provide these data across the full spectrum of diagnosing providers.
Monitoring populations seeking STD care, along with documenting the eligibility and receipt of HIV-related preventive interventions, will directly contribute to the development of local, state and national STD/HIV interventions to reduce the burden of disease.
Specialty clinical facilities, such as categorical STD or other sexual health clinics, provide safety net services to populations at risk for acquiring STDs and HIV.
STD clinics are ideal settings to providing opportunities to link HIV-negative patients to preventive services (e.g., Pre and post exposure prophylaxis, PrEP/PEP), and are positioned to re-engage or link HIV-positive persons to treatment; monitoring these services at the patient level can help identify gaps in STD and HIV preventative care.
This NOFO supports sentinel surveillance in STD clinics to provide these data and to create and sustain a robust network of high-quality, specialty STD clinical facilities providing the capacity for collaborators to investigate additional issues of interest to STD diagnostics, treatment, clinical presentation and health consequences of STDs.
This integrated approach to sentinel and enhanced surveillance, supporting core strategies focused on persons at demonstrable risk for STDs and other co-occurring conditions, is the primary public health objective of this NOFO.
These activities are designed to leverage existing resources and enhance capacity for integrated STD and HIV surveillance in pursuit of improved population-level outcomes.
This NOFO builds from, and expands on, a foundation of previous STD Surveillance Network collaborations providing strong evidence of the efficacy and utility of these core, focused and sustainable surveillance strategies.