SUBJECT
Title
AUTHORIZE ACCEPTANCE OF FUNDING TO ADDRESS SEXUALLY TRANSMITTED INFECTIONS AND APPLY FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
Sexually transmitted infections (STIs) remain among significant public health concerns locally and across California and the United States. STIs can be associated with increased risk of HIV acquisition and transmission and can cause multiple health complications, including infertility, blindness, hearing loss, and death. Surveillance data demonstrate that the incidence of reportable bacterial STIs has been increasing in San Diego County since 2003, with notable increases in the last several years.
The County of San Diego (County) receives funding from the California Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch to support STI intervention activities, prevention, outreach, education, and surveillance. On May 21, 2019 (9), the San Diego County Board of Supervisors (Board) authorized acceptance of CDPH STD Control Branch funding in the amount of $1,045,125 for the period of July 1, 2019, through June 30, 2024. Subsequently, the Board authorized acceptance of additional funds from CDPH STD Control Branch to support local STI intervention activities, with the most recent action on November 15, 2022 (6) for an increase in the amount of $260,264.
On January 24, 2024, CDPH STD Control Branch notified the County of allocations for the period of July 1, 2024, through June 30, 2026, in the amount of $2,164,638. Today’s action requests the Board authorize acceptance of $2,164,638 in funding to support core STI prevention and control activities in San Diego County and authorize applications for additional funding opportunity announcements to support STI testing and prevention resources throughout the region.
Today’s action supports the County 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, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. Given the linkage between STIs and HIV, today’s action also advances the County Getting to Zero initiative by connecting residents who are vulnerable to HIV and STIs to testing and prevention resources, as well as ensuring that residents living with diagnosed HIV and STIs are linked to timely care and treatment services.
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 $2,164,638 from the California Department of Public Health STD Control Branch for the period of July 1, 2024, through June 30, 2026, to support core STI prevention and control activities in San Diego County, and authorize the Agency Director, Health and Human Services Agency, or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments or revisions that do not materially impact or alter the services or funding level.
3. Authorize the Agency Director, Health and Human Services Agency, or designee, to apply for additional funding opportunity announcements, if available, for STI testing and prevention resources.
EQUITY IMPACT STATEMENT
In San Diego County, Sexually Transmitted Infections (STIs) disproportionately impact communities of color (particularly Black/African American residents), youth, and gay, bisexual, and other men who have sex with men. According to the 2022 annual STI data from the County of San Diego (County) Health and Human Services Agency, Public Health Services, HIV, STD, and Hepatitis Branch, in 2022, local STI transmission rates were higher among Black/African Americans and other/mixed-race women and men than among other populations. Specifically, the rate of gonorrhea in Black/African American males was 5.2 times higher than that of white males and 3.7 times that of Hispanic males. In addition, the rate of infection in Black/African American females was 5.4 times higher than that of white females and 3.4 times that of Hispanic females.
Over the past few years, the County has conducted various community engagement activities focused on identifying and addressing disparities among populations most impacted by STIs in San Diego County. 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. Additional funds from the California Department of Public Health Sexually Transmitted Diseases Control Branch will enhance County programs that support persons vulnerable to or diagnosed with STIs and prevent health complications such as congenital syphilis. In addition, these funds will support community organizations to increase awareness of STDs and access to prevention, testing, and treatment services in affected communities.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed actions align with the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to services and resources and Sustainability Goal #4 to protect health and well-being. Funds from the California Department of Public Health Sexually Transmitted Diseases Control Branch will provide resources to support the HIV, STD, and Hepatitis Branch within the County Health and Human Services Agency, Public Health Services, with capacity and services aimed at preventing, detecting, and treating STIs. This will be accomplished by increasing the capacity of services that support testing, identification, and treatment of STIs, improving the overall health of communities, and reducing the demand for associated care services while increasing the effectiveness of care providers.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2024-26 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $1,157,822 and revenue of $1,082,319 in FY 2024-25, and estimated costs of $1,157,822 and revenue of $1,082,319 in FY 2025-26. The funding source for this grant is the California Department of Public Health STD Control Branch. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated at $75,503 in FY 2024-25 and $75,503 in FY 2025-26. The funding source for these costs will be existing Realignment. The public benefit of 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 April 2, 2024.
BACKGROUND
Sexually transmitted infections (STIs) remain among significant public health concerns locally and across California and the United States. STIs can be associated with increased risk of HIV acquisition and transmission and can cause multiple health complications, including infertility, blindness, hearing loss, and death. Like much of California and the United States, San Diego County witnessed a significant decrease in STI transmission in the 1990s, largely due to fear of HIV acquisition and the absence of effective treatment for HIV. However, transmission rates began to rise by the early 2000s. By 2022, STI transmission rates were the highest they have been in over 70 years nationally.
Syphilis, gonorrhea, and chlamydia are bacterial STIs of significant focus nationally. Untreated, all have significant negative personal and public health consequences. Of these, syphilis poses the most significant public health concern, as without treatment, an infected individual remains capable of transmitting syphilis to others for up to one year. In 2022, a total of 1,131 cases of infectious syphilis, 7,694 cases of gonorrhea, and 18,144 cases of chlamydia were reported in San Diego County. In addition, a total of 35 probable cases of congenital syphilis were reported in San Diego County. Thus, timely detection and treatment of STIs is important to ensuring the health of individuals and communities.
The County of San Diego (County) Health and Human Services Agency, Public Health Services, HIV, STD, and Hepatitis Branch (HSHB) aims to improve health outcomes in communities disproportionately impacted by HIV, STIs, and viral hepatitis. HSHB is responsible for planning and administering testing, care and treatment, prevention, and STI surveillance. HSHB also provides technical assistance and capacity building for local organizations engaged in HIV, STD, and viral hepatitis activities across the region.
The County receives funding from the California Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch to support STI intervention activities, prevention, outreach, education, and surveillance. On May 21, 2019 (9), the San Diego County Board of Supervisors (Board) authorized acceptance of CDPH STD Control Branch funding in the amount of $1,045,125 for the period of July 1, 2019, through June 30, 2024. Subsequently, the Board authorized acceptance of additional funds from CDPH STD Control Branch to support local STI intervention activities, with the most recent action on November 15, 2022 (6) for an increase in the amount of $260,264.
The CDPH STD Control Branch funding has supported the County to perform essential activities to reduce the risk of transmission, promote health literacy, and provide health education to communities most impacted by HIV, STD, and viral hepatitis. From July 2022 to June 2024, this funding supported the County to provide outreach and education to over 90 obstetricians and gynecologists in partnership with the American Academy of Pediatrics. Trainings included information on best practices for congenital syphilis testing and treatments including screening and treatment recommendations for pregnant women per federal and State guidelines. In addition, this funding supported various outreach activities such as a social media campaign which generated a total of 144,034 impressions from October 2022 to March 2023. The social media campaign focused on promoting awareness of congenital syphilis and the importance of testing for syphilis during pregnancy.
Other activities that will continue to be supported by these funds include the County Don’t Think, Know program, which offers free, in-home chlamydia and gonorrhea testing. Priority populations supported by this program include Black and Hispanic women aged 25 and younger by reducing barriers to testing such as lack of transportation or nearby clinics, as well as concerns about stigma, privacy, and cost. This program provides web access to self-testing kits that can be mailed in for results and facilitates connection to local providers when there are positive cases. Since the program inception in 2013, approximately 10% of females who utilized testing kits have tested positive for chlamydia.
TakeMeHome is another program that will continue to be supported by this funding. This program discreetly delivers free, in-home self-test kits for HIV and STIs such as syphilis, gonorrhea, and hepatitis C virus. Without the need to go into a clinic or testing site, this program aims to maximize access to timely testing among the most impacted populations. TakeMeHome is advertised through gay dating apps and websites with a primary focus on gay, bisexual, and other men who have sex with men who are disproportionately impacted by syphilis and gonorrhea. The County, in partnership with the National Alliance of State and Territorial AIDS Directors, has been implementing this program locally since July 2019. From September 2020 to December 2023, the TakeMeHome program has distributed 1,314 test kits among priority populations. Dating apps were the most impactful form of TakeMeHome information distribution, with a usage percentage of 43% compared to other forms of media platforms.
To continue addressing STIs in San Diego County, HSHB will maintain focus services among populations most impacted by STIs. It is anticipated that funding from CDPH will support activities including:
• Providing additional screening at the emergency departments for persons capable of pregnancy to prevent congenital syphilis;
• Enhancing awareness among providers who serve communities impacted by STIs through additional educational opportunities; and
• Enhancing ongoing activities and expanding County efforts by partnering with community-based organizations to address racial disparities among communities impacted by STIs.
Today’s action will result in costs of $1,157,822 and revenue of $1,082,319 in Fiscal Year (FY) 2024-25, and costs of $1,157,822 and revenue of approximately $1,082,319 in FY 2025-26, for a total of $2,315,643 in costs and $2,164,638 in revenue through FY 2024-26. The revenue agreement will not cover all costs due to limitations imposed by the funder on indirect and administrative expenses. The public benefit of providing these services far outweighs these costs.
Today’s action requests the Board authorize acceptance of CDPH STD Control Branch funds in the amount of $2,164,638 to support core STI prevention and control activities in San Diego County; authorize the Agency Director, Health and Human Services Agency, to execute all required grant documents; and authorize applications for additional funding opportunity announcements to support STI 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 2024-2029 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 Infections, interruption of the spread of STIs, and reduction in the impact of STIs on San Diego County residents, leading to improved physical health and a healthy, safe, and thriving region.
Respectfully submitted,
SARAH E. AGHASSI
Interim Chief Administrative Officer
ATTACHMENT(S)
N/A