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FY 2008 – 2009 AGREEMENT ADDENDA 536 and 541 CHANGES

FY 2008 – 2009 AGREEMENT ADDENDA 536 and 541 CHANGES. BACKGROUND. North Carolina ranks high in the nation for certain reportable STDs: Chlamydia (33,615 cases)– 8 states reported more cases in 2006 Gonorrhea (17,312 cases) – 6 states reported more cases in 2006

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FY 2008 – 2009 AGREEMENT ADDENDA 536 and 541 CHANGES

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  1. FY 2008 – 2009 AGREEMENT ADDENDA 536 and 541 CHANGES

  2. BACKGROUND • North Carolina ranks high in the nation for certain reportable STDs: • Chlamydia (33,615 cases)– 8 states reported more cases in 2006 • Gonorrhea (17,312 cases) – 6 states reported more cases in 2006 • P/S Syphilis (309 cases) – 8 states reported more cases in 2006 • HIV Disease (2147 cases) – no national comparison due to reporting variability among states.

  3. Gonorrhea — Rates by state: United States and outlying areas, 2006 Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 119.4 per 100,000 population. The Healthy People 2010 target is 19.0 cases per 100,000 population.

  4. Chlamydia — Rates by state: United States and outlying areas, 2006 Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 345.0 per 100,000 population.

  5. Primary and secondary syphilis — Rates by state: United States andoutlying areas, 2006 Note: The total rate of P&S syphilis for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 3.3 per 100,000 population. The Healthy People 2010 target is 0.2 case per 100,000 population.

  6. BACKGROUND • North Carolina Cases Reported in 2007: • Gonorrhea – 30,612 cases • Chlamydia - 16,665 cases • P/S Syphilis – 324 cases • HIV Disease– 1943 cases

  7. BACKGROUND • Determinants of STD Morbidity • Client Risks • Access to care • Availability of services • Clinical practices • STD Programming must address these factors to assure early identification and intervention to stem the tide of disease transmission. • Assurance through the Agreement Addenda process.

  8. HIV/STD Agreement Addenda2008 - 2009 Changes: • Scope of Work replaces non-negotiable objectives • Based on: • CD rules: NCAC 0101, .0202, .0204 • STD protocols • Branch Policy • Two reporting requirements for activity 536 and three for activity 541

  9. Scope of Work Changes • Added third trimester HIV test in pregnancy • Deleted requirement to do darkfields (may be revisited for 2009/2010) • HIV positive reports to Regional STD Office within 24 hours from 7 days.

  10. Scope of Work Changes • Exceptions to STD Billing • Asymptomatic clients who request screening for non-reportable STDs (e.g. herpes serology, Hep C) • Clients who receive follow-up treatment of warts after the diagnosis is established • Clients who request testing not offered by the state *These clients may be billed for testing and screening according to local billing policy.

  11. HIV/STD Agreement Addenda2008 - 2009 Changes: • Reporting mechanisms • Access/availability work sheet • STD/ERRN Skill Maintenance Log • Quarterly narrative (only for 541)

  12. Reportable Performance Measures • Performance Measure #1 • Availability of clinic hours and accessibility of appropriately trained staff are adequate to meet the needs of the number of clients requesting STD services.

  13. HIV/STD PREVENTION AND CARE BRANCH STD SERVICES ACCESS/AVAILABILITY DATA COUNTY: FISCAL YEAR:

  14. Reportable Performance Measures • Performance Measure #2 • All LHD RNs providing clinical assessment and management of clients with STD concerns, must complete STD Enhanced Role RN training. • Once the STD ERRN training is completed… nurses must complete 100 hours of clinical practice per year and 20 hours of continuing education every two years. • If practice hour requirements cannot be met, one STD intensive course must be completed annually instead.

  15. HIV/STD PREVENTION AND CARE STD Enhanced Role Nurse (ERRN) Skill Maintenance Log County: ____________________ Fiscal Year ____________ • Continuing Education hours must equal at least 20 hours every 2 years • Clinical Practice hours must be at least 100 hours every year • One contact hour = 60 minutes or one clock hour of instruction or participation • One academic semester hour = 15 contact hour • Supervisor’s signature: ______________________ Date__________

  16. Reportable Performance Measures • Performance Measure #3 (Only for activity 541) • At least 90% of persons seeking STD/HIV services will receive or be offered on-site diagnosis, HIV testing and treatment services from appropriately trained staff within one workday of request. • Local health departments must submit a narrative describing structure and policy for assuring timely access to STD services and indicate barriers to achieving this. Documentation of this will be reported annually with the Agreement Addenda.

  17. FOLLOW-UP • Review by QATD Unit • Site Visits by QATD Team • Evaluate Training Needs and Resources • Provide Support and Resources

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