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DATE: |
November 15, 2022 |
06 |
SUBJECT
Title
AUTHORIZATION TO ACCEPT FUNDING TO ADDRESS SEXUALLY TRANSMITTED DISEASES AND TO APPLY FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
Surveillance data demonstrate that incidence of reportable bacterial sexually transmitted diseases (STDs) have been increasing in San Diego County since 2003, with significant increases in the last several years. Between 2000-2019, cases of syphilis, gonorrhea, and chlamydia have increased by 738%, 256%, and 166%, respectively. While STD cases and rates decreased in 2020, most likely due to decreases in the number of STD screenings performed due to the COVID-19 pandemic, STDs continue to be a major public health concern.
On December 10, 2019 (11), the San Diego County Board of Supervisors (Board) authorized acceptance of the California Department of Public Health (CDPH) Sexually Transmitted Diseases Control Branch State Local Assistance funding, for the period of July 1, 2019 through June 30, 2024, in the amount of $1,292,090. This funding supports STD intervention activities, prevention, outreach, education, and surveillance. On May 10, 2022 (6), the Board authorized acceptance of additional funds in the amount of $1,110,240. At the time $370,080 was confirmed for July 1, 2021 through June 30, 2022, with the same amount anticipated for the next two fiscal years through June 30, 2024 subject to revision of the formula used by CDPH STD Control Branch to determine funding allocations to local health jurisdictions. On September 22, 2022, CDPH notified the County of San Diego (County) of an updated funding allocation of $500,212 for Fiscal Year 2022-23 and Fiscal Year 2023-24, which is $260,264 higher than what had been initially communicated. A requirement of this funding is to allocate 50% of the award to one or more community-based organizations.
Additionally, on July 26, 2022, CDPH notified the County of a new funding allocation to support a Syphilis Outbreak Strategy. This funding totals $2,285,746 for the time period of July 1, 2022 through June 30, 2025. Funding is to be used to support innovative and impactful syphilis and congenital syphilis prevention and control activities, with a focus on disproportionately impacted populations.
Today’s action requests the Board authorize acceptance of $2,546,010 in additional funding to support core STD prevention and control activities in San Diego County. Additionally, today’s action requests the Board to authorize the Agency Director, Health, and Human Services Agency, to apply for additional funds for STD testing and prevention resources.
This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind. In addition, because there is significant overlap between HIV and STDs, this item supports the County’s Getting to Zero initiative by linking residents who are vulnerable to HIV and STDs to testing and prevention resources, as well as ensuring that residents living with diagnosed HIV and STDs are linked to care and treatment services. This item also supports our regional Live Well San Diego vision by building better health for our residents through education, prevention, and intervention to interrupt transmission of disease.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2. Authorize the acceptance of an additional $260,264 from the California Department of Public Health STD Control Branch for the period of July 1, 2022 through June 30, 2024, for State Local Assistance Funding, and authorize the Agency Director, Health and Human Services Agency, or designee, to execute all required grant documents, upon receipt, including any annual extension, amendments or revisions that do not materially impact or alter the services or funding level.
3. Authorize the acceptance of $2,285,746 from the California Department of Public Health STD Control Branch for the period of July 1, 2022 through June 30, 2025, for Syphilis Outbreak Strategy Funding, and authorize the Agency Director, Health and Human Services Agency, or designee, to execute all required grant documents, upon receipt, including any annual extension, amendments or revisions that do not materially impact or alter the services or funding level.
4. Authorize the Agency Director, Health and Human Services Agency, to apply for additional funding opportunity announcements, if available, for STD testing and prevention resources.
EQUITY IMPACT STATEMENT
Sexually Transmitted Diseases (STDs) disproportionately impact communities of color (particularly Black/African American residents), youth, and gay, bisexual, and other men who have sex with men. The County of San Diego (County) was a recipient of community engagement funds from the Health Resources and Services Administration from March 1, 2019 through February 28, 2021. These community engagement efforts focused on Black/African American gay and bisexual men who have sex with men, Latino gay and bisexual men who have sex with men, and transgender persons. Members of these communities, providers, and other key stakeholders were interviewed and convened in a community advisory body to develop a three-year action plan to address STDs and HIV in these disproportionately impacted communities. Currently, the County is receiving community engagement funding that is focusing on the STD and HIV needs of women and youth of all ethnicities. A similar two-year process is occurring to fully understand the needs of these populations and to develop an action plan. If approved, today’s action will increase funding available for County programs that support persons vulnerable to or diagnosed with STDs and prevent STD complications such as congenital syphilis. Additionally, it will increase funding for community organizations to increase awareness of STDs and access to prevention, testing, and treatment services in affected communities.
SUSTAINABILITY IMPACT STATEMENT
The proposed action aligns with the County of San Diego’s (County) Sustainability Goals to strive for programs, operations, and contracts that reflect the County’s values and priorities. Specifically, today’s action contributes to providing just and equitable access to services, protecting health and wellbeing, reducing pollution and waste by lowering greenhouse gas emissions, and striving to become a zero-waste region. The STD Local Assistance Funding and the Syphilis Outreach Strategy Funding will provide funding to support the HIV, STD and Hepatitis Branch, within Public Health Services, with capacity and services aimed to prevent, detect, and treat STDs. Testing and identification will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs of facilities, thus reducing greenhouse gas emissions and waste generated within the care sector. Since climate change and air pollution are direct threats to human health, the reduction of pollution, which can negatively impact human health, is also considered a preventative healthcare measure.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2022-24 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated annual costs of $896,329 and revenue of $892,047 starting in FY 2022-23 through FY 2023-24, for a total estimated cost of $2,558,230 and total revenue of approximately $2,546,010 through FY 2024-25. The funding source is the California Department of Public Health Sexually Transmitted Diseases Branch. Funds for this program will use existing appropriations and be incorporated into future Operational Plans as needed. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs which will not be recovered are estimated at an annual cost of $4,282 through FY 2023-24, for a total unrecovered cost of $12,220 through FY 2024-25. The funding source for these costs will be existing Health Realignment allocated for these programs. The public benefit for providing these services far outweighs these costs. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board recommended approval of the recommendations at their meeting on November 1, 2022.
BACKGROUND
The precipitous increase in Sexually Transmitted Diseases (STDs) over the past 20 years demonstrates the need for increased disease intervention, including outreach, education, prevention, and surveillance. In 2019, reported cases and rates of STDs in San Diego County, including syphilis, gonorrhea, and chlamydia, were among the highest observed in the last three decades. Between 2000-2019, cases of syphilis, gonorrhea, and chlamydia have increased by 738%, 256%, and 166%, respectively. A decline in reported cases and rates was observed from 2019 to 2020. This may be attributable to the effects of the COVID-19 pandemic, which resulted in clients seeking fewer STD screenings. Despite this decline, morbidity remains high.
STDs are associated with increased risk of HIV acquisition and transmission and can cause multiple complications, including infertility, blindness, hearing loss, and death. The County of San Diego (County) receives funding from the Sexually Transmitted Diseases Control Branch State Local Assistance to support its STD prevention and control efforts. This funding supports STD intervention activities, prevention, outreach, education, and surveillance. On December 10, 2019 (11), the San Diego County Board of Supervisors (Board) authorized acceptance of the California Department of Public Health (CDPH) Sexually Transmitted Diseases Control Branch State Local Assistance funding, for the period of July 1, 2019 through June 30, 2024, in the amount of $1,292,090 for STD intervention activities, prevention, outreach, education, and surveillance. In May 2022 (6), the Board authorized acceptance of additional funds in the amount of $1,110,240. At the time $370,080 was confirmed for July 1, 2021 through June 30, 2022, with the same amount anticipated for the next two fiscal years through June 30, 2024 subject to revision of the formula used by CDPH STD Control Branch to determine funding allocations to local health jurisdictions. Among other activities conducted by County Communicable Disease Investigators, in Fiscal Year (FY) 2020-21 the County Health and Human Services Agency, Public Health Services utilized the CDPH STDs Control Branch funding to:
• Conduct 2,814 case and contact investigations;
• Conduct 67 infectious syphilis case and contact investigations among pregnant females; and
• Process 18,170 chlamydia cases and 6,060 gonorrhea cases into the surveillance system.
In September 2022, CDPH notified the County of an updated funding allocation of $500,212 for FY 2022-23 and FY 2023-24 which is $260,264 higher than what had been initially communicated. A requirement of this funding is to allocate 50% of the award to one or more community-based organizations.
While syphilis is transmitted during sexual contact, congenital syphilis occurs when there is transmission of syphilis from mother to child in utero or during delivery. Congenital syphilis is associated with multiple birth defects and stillbirth. In San Diego County, five syphilitic stillbirths occurred from 2016 through 2020. In California, the number of infants born with congenital syphilis increased seven years in a row between 2012 and 2019 and accounted for 125 stillbirths or neonatal deaths from 2012 to 2019. The County has proactively worked to address congenital syphilis through a contract to conduct outreach and education to medical providers about congenital syphilis. The HIV, STD and Hepatitis Branch of Public Health Services prioritizes congenital syphilis above all other syphilis disease investigations. On July 26, 2022, CDPH notified the County of a new funding allocation to support a Syphilis Outbreak Strategy. This funding totals $2,285,746 for the time period of July 1, 2022 through June 30, 2025. Funding is to be used to support innovative and impactful syphilis and congenital syphilis prevention and control activities, with a focus on disproportionately impacted populations.
A waiver of Board Policy B-29 is requested because the CDPH STD Services Branch additional grant revenues do not fully offset the costs. Today’s action will result in costs of $896,329 and revenue of $892,047 in FY 2022-23, costs of $896,329 and revenue of $892,047 in FY 2023-24, and costs of $765,572 and revenue of $761,916 in FY 2024-25. These remaining costs which are not covered are $4,282 for FY 2022-23, $4,282 for FY 2023-24 and $3,656 for FY 2024-25, will be covered by Health Realignment. The public benefit for providing these services far outweighs these costs. The precipitous increase in STDs over the past 20 years demonstrates the need for increased disease intervention, including outreach, education, prevention, and surveillance.
Today’s action requests the Board to approve and authorize acceptance of $2,546,010 in additional funding to support core STD prevention and control activities in the region. Additionally, today’s action requests the Board to authorize the Agency Director, Health and Human Services Agency, to apply for additional funds for STD testing and prevention resources.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Equity (Health) and Community (Quality of Life) initiatives in the County of San Diego’s 2022-27 Strategic Plan, as well as our commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This is accomplished through education about Sexually Transmitted Diseases (STDs), interruption of the spread of STDs, and reduction in the impact of STDs on San Diego County residents, leading to improved physical health and a healthy, safe, and thriving region.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
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