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

2. BACKGROUND North Carolina ranks high in the nation for certain reportable STDs: North Carolina ranks high in the nation for certain reportable STDs: Chlamydia (33,615 cases)– 8 states reported more cases in 2006 Chlamydia (33,615 cases)– 8 states reported more cases in 2006 Gonorrhea (17,312 cases) – 6 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 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. 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 and outlying 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.

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

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

9. HIV/STD Agreement Addenda 2008 - 2009 Changes: Scope of Work replaces non-negotiable objectives Scope of Work replaces non-negotiable objectives Based on: Based on: CD rules: NCAC 0101,.0202,.0204 CD rules: NCAC 0101,.0202,.0204 STD protocols STD protocols Branch Policy Branch Policy Two reporting requirements for activity 536 and three for activity 541 Two reporting requirements for activity 536 and three for activity 541

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

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

12. HIV/STD Agreement Addenda 2008 - 2009 Changes: Reporting mechanisms Reporting mechanisms Access/availability work sheet Access/availability work sheet STD/ERRN Skill Maintenance Log STD/ERRN Skill Maintenance Log Quarterly narrative (only for 541) Quarterly narrative (only for 541)

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

14. HIV/STD PREVENTION AND CARE BRANCH STD SERVICES ACCESS/AVAILABILITY DATA COUNTY: FISCAL YEAR: Designated Providers for STD physical exams (List by name and title) Hours/week available for STD Service Provision List STD Service Provider Vacancies: 1.2.3. Total number of STD visits: Number of these visits that were female clients: Number of these visits that were male clients: Hours/week STD services are offered: Number of HIV tests done: Number of those tests done as part of a clinic visit, if known: Number of those tests done as an HIV test only visit, if known:

15. Reportable Performance Measures Performance Measure #2 Performance Measure #2 All LHD RNs providing clinical assessment and management of clients with STD concerns, must complete STD Enhanced Role RN training. 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. 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. If practice hour requirements cannot be met, one STD intensive course must be completed annually instead.

16. HIV/STD PREVENTION AND CARE STD Enhanced Role Nurse (ERRN) Skill Maintenance Log County: ____________________Fiscal Year ____________ Name Date Completed ERRN course Name of Continuing Education Program Contact Hours STD Clinical Hours Dates Attended STD Intensive (if applicable) Total  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__________

17. Reportable Performance Measures Performance Measure #3 (Only for activity 541) 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. 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. 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.

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