DEPARTMENT: Health
DEPARTMENT HEAD: Vincent R. Nathan, PhD, MPH
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
Ordinance authorizing the San Antonio Metropolitan Health District (Metro Health) to apply for a Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Disease grant aimed to Increase HPV Vaccination Coverage by Strengthening Adolescent Assessment Feedback Incentive and eXchange (AFIX) Activities in Bexar and surrounding counties and the acceptance of funds upon award to continue to provide immunization services for underserved children and adolescents in Bexar County in order to prevent diseases. The two (2) year CDC grant term will provide support to conduct evidence-based adolescent AFIX visits focusing on low adolescent coverage rates in the San Antonio area.
SUMMARY:
This ordinance allows San Antonio Metropolitan Health District (Metro Health) to apply for a Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Disease grant aimed to Increase HPV Vaccination Coverage by Strengthening Adolescent Assessment Feedback Incentive and eXchange (AFIX) Activities in Bexar and surrounding counties. The two (2) year CDC grant term will provide support to conduct evidence-based adolescent AFIX visits focusing on low adolescent coverage rates in the San Antonio area.
In addition, this ordinance authorizes the Director of Metro Health to initiate, negotiate, and execute any and all necessary documents including a cooperative agreement to effectuate the application and acceptance of the referenced funds and to execute contract amendments pertaining to this contract, to include:
a.) line item budget revisions authorized by the funding agency; b) carry-over funds,
when ascertained and approved by the funding agency through a revised notice of award; c) modifications to the performance measures authorized by the funding agency and listed in the contracts as long as the terms of the amendments stay within the general parameters of the intent of the grant; d) no cost extensions; e) amendments which will provide supplemental grant funds to the grant by the funding agency in an amount of up to 20% of the total amount initially awarded; f) amendments funding one time equipment purchases or defined program services; and changes in regulation mandated by the funding agency.
BACKGROUND INFORMATION:
In collaboration with the CDC, Metro Health administers an Immunization Project that works to reduce illness by maximizing the number of children and adolescents immunized against vaccine preventable diseases such as human papillomavirus (HPV). The project has two components, the Vaccines for Children Program, (VFC Program) and the 317 Childhood Immunization Program (Section 317 Program).
San Antonio is a distinctive metropolitan area which ranks as the seventh largest city in the country, with 1.8 million metropolitan residents, many of whom can be described as young, working poor with low levels of education, and often uninsured. The VFC Program provides vaccines recommended by the CDC and the Advisory Committee on Immunization Practices (ACIP) to over 170 VFC-enrolled healthcare providers in Bexar and surrounding counties. This program targets children who are eligible for Medicaid and those who are either uninsured or underinsured (i.e. child’s insurance does not cover immunizations). The Section 317 Program provides supplemental vaccines targeted to children seen in VFC provider and Metro Health clinic settings who are not eligible for VFC vaccines.
AFIX (Assessment, Feedback, Incentives, and eXchange) is a continuous quality improvement process informed by research and used for improving immunization rates and practices at the immunization provider level under the VFC umbrella. A key component of AFIX is a face-to-face interaction between AFIX staff and the provider staff who are involved in immunization activities. The interaction is important and unique in that it offers an opportunity for education and outreach toward achieving improved immunization service delivery using quality improvement (QI) methods. The AFIX process, once understood and implemented by providers, can assist practices in meeting immunization coverage goals for a variety of standards including Healthy People 2020 objectives and Healthcare Effectiveness Data and Information Set (HEDIS) measures.
Every year in the United States, more than 12,000 women are diagnosed with cervical cancer and more than 4,000 women die of cervical cancer. Up to 93% of cervical cancers could be prevented by HPV vaccination and cervical cancer screening. HPV vaccination helps prevent infection with the HPV types that cause most cervical cancers. HPV vaccination coverage among adolescents remains low, and adolescent-focused AFIX is underutilized. The proposed grant funding targets programs that address the shared risk factors by increasing the number of AFIX visits while also improving the quality of intervention as well. Metro Health is currently implementing the AFIX process in provider offices through the VFC program. The new CDC HPV vaccination coverage grant would allow Metro Health to expand and strengthen its current program to increase the number of adolescent AFIX visits implemented and completed while also prioritizing visits to providers with the greatest potential of positively impacting adolescent vaccination coverage (i.e., providers visiting with a large population with low coverage).
Three vaccinations are routinely recommended for boys and girls aged 11-12 years: HPV, Tdap, and meningococcal vaccinations. Nationally, HPV vaccination coverage lags behind other adolescent vaccination coverage estimates, and remains far below Healthy People 2020 targets of 80% coverage by 2020. The 2014 National Immunization Survey-Teen (NIS-Teen) shows Bexar County HPV series completion rates at 30.8% for females and 15.0% for males aged 13-17 years of age. National HPV completion rates are slightly higher at 39.7% for females and 21.6% for males aged 13-17 years. Metro Health plans to monitor trends in adolescent vaccination coverage and progress toward Healthy People 2020 targets through NIS-Teen, the San Antonio Immunization Registry, and local on-site provider assessment visits.
ISSUE:
Metro Health is requesting City Council authorization to apply for a CDC grant to strengthen adolescent AFIX activities in an effort to increase HPV vaccination coverage rates. The immunization of adolescents to prevent illness like human papillomavirus continues to be an important health strategy. This ordinance will allow Metro Health to strengthen its current AFIX program to increase immunization coverage rates which remain low among adolescents. This is an opportunity not only to improve the number of AFIX visits but also improve the quality of intervention as well. Preliminary results from Prevention and Public Health Funds (PPHF)-funded vaccination awardees, in addition to other recent AFIX activities, suggest that AFIX can be used to increase HPV vaccination coverage rates.
ALTERNATIVES:
The funding provided by this grant supports vital immunization services protecting adolescents from cancer. Should City Council choose not to approve this submission, funds will be distributed to other awardees, limiting opportunities to implement public health approaches to increase HPV vaccination coverage which would leave San Antonio residents, particularly adolescents susceptible to cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers.
FISCAL IMPACT:
The Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Disease grant aimed to Increase HPV Vaccination Coverage by Strengthening Adolescent Assessment Feedback Incentive and eXchange (AFIX) Activities in Bexar and surrounding counties grant is a 2 year project with an estimated amount up to $500,000 for a two (2) year term beginning October 1, 2016 through September 30, 2018. The grant will fund (4) positions. There is no impact on the General Fund.
RECOMMENDATION:
Staff recommends approval of an Ordinance authorizing Metro Health to apply for a Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Disease grant aimed to Increase HPV Vaccination Coverage by Strengthening Adolescent Assessment Feedback Incentive and eXchange (AFIX) Activities in Bexar and surrounding counties grant on increasing HPV vaccination coverage and the acceptance of funds upon award to continue to provide immunization services for underserved children and adolescents in Bexar County in order to prevent diseases.