2016 NNPTC Annual Meeting

December 5-6, 2016

Wigwam Resort, Phoenix, AZ

Table of Contents

Introduction / 3
Meeting Purpose / 3
Annual Meeting Goals / 3
2015 Meeting Materials / 3
December 5, 2016 Day One:
NNPTC Day One Meeting Agenda / 4
Plenary: NNPTC Meeting Welcome / 5
Plenary: A Walk Through the Annual Evaluation Report / 5
Plenary: Using Data to Determine Future Directions / 6
Breakout Session: Medical Directors / Fellows / 6-8
Breakout Session: National PTC Staff / 8
Breakout Session: Regional PTC Staff / 9-10
December 6, 2016 Day Two:
NNPTC Day One Meeting Agenda / 11
Plenary: DSTDP Priorities & Future Directions / 11-15
Plenary: National PTC Presentations / 15
Breakout Session: STD Treatment Guidelines & Grey Areas / 21-22
Breakout Session: Collaborations with an Impact / 29-31
Plenary: Regional PTC Presentations / 22
Breakout Session: STDCCN Case Review / 23-24
Breakout Session: NNPTC Technology Showcase / 25-26
Plenary: National Partner Collaboration / 26-28
Appendix A: 2016 NNPTC Annual Meeting Survey / 29-38

Introduction:

The National Network of STD Clinical Prevention Training Centers (NNPTC) is an established, national infrastructure with expertise in STD prevention; clinical care and STD program management. Trainingand related services are targeted to providers in clinical, community-based, and public healthsettings. The NNPTC is supported by the Division of STD Prevention(DSTDP) at the Centers of Disease Control and Prevention (CDC) and is committed to supportingtheir goals and initiatives through the development and implementation of training curricula.The NNPTC has established relationships with other national partners including the National Coalition of STD Directors (NCSD), American Sexual Health Association (ASHA),American Sexually Transmitted Disease Association (ASTDA), National Association of Community Health Centers (NACHC), and the Federal Training Center Collaborative (FTCC) partners.

Meeting Purpose:

The purpose of the 2016 NNPTC annual meeting is to develop a plan ofaction that facilitates the translation of current STD prevention science into practice inclinical settings through training and technical assistance. The meetingwill be conducted to identify emerging issues in the field and in the strategic plans of DSTDPwhich may impact training and education, showcase national and regional center accomplishments in the second grant year of this program period, and highlight methods to collaborate.

2016 NNPTC Meeting Goals:

1)Discuss new program priorities and initiatives with CDC and the NNPTC.

2)Share and discuss innovative strategies to achieve program outcomes.

3)Identify collaborative opportunities with key partner organizations to advance STD care.

2016 Meeting Materials:

All presentations from the 2016 NNPTC Meeting can be found on the NNPTC.org website, under the resources tab. You can access the presentations with the passcode 2016NNPTC. Please contact the National Coordination Center at or Destiny Kelley ith any questions or further requests. This meeting report contains highlights via minutes from the meeting sessions

NNPTC Meeting Agenda
Day One: Monday, December 5, 2016
12:00-1:00pm / Kiva/Sahuaro / Registration
1:00-1:15pm / Kiva/Sahuaro / Plenary: NNPTC Meeting Welcome and Introductions
Alice Gandelman, California PTC; Laura Bachmann, AL/NC PTC; and David Harvey, National Coalition of STD Directors
1:15-1:45pm / Kiva/Sahuaro / Introduction Activity: Lindsey Clopp, National Quality Improvement Center
1:45-1:55pm / Kiva/Sahuaro / BREAK
1:55-2:55 m / Kiva/Sahuaro / Plenary: A Walk Through the Annual Evaluation Report
Sharon Devine and Christopher Voegeli, National Evaluation Center, Denver PTC
2:55-3:45pm / Kiva/Sahuaro / Plenary: Using Data to Determine Future Directions
Jami Risley, DSTDP, CDC
3:45-4:00pm / Kiva/Sahuaro / BREAK
4:00-5:15pm / Kiva/Sahuaro / Breakout: Medical Director / Fellows
Bradley Stoner, St. Louis PTC
Kiva/Sahuaro / Breakout: Regional PTC Staff
Barbara Wilgus, PTC at Johns Hopkins
Kiva/Sahuaro / Breakout: National PTC Staff
Lindsey Clopp, National QI Center
5:15-5:30pm / Kiva/Sahuaro / Plenary: Report Back, Wrap Up and Adjourn
Bradley Stoner, St. Louis PTC; Barbara Wilgus, PTC at Johns Hopkins; Lindsey Clopp, National QI Center

Plenary Session: NNPTC Meeting Welcome

Speaker: Alice Gandelman, California PTC; Laura Bachmann, AL/NC PTC; and David Harvey, National Coalition of STD Directors

December 5, 20161:00 – 1:15 PM

Topic / Discussion
Welcome
David Harvey /
  • Long track record with NCSD thinking strategically and how to collaborate more. In this new administration we may have to be more creative in working together in ways that we may have not yet dreamed up.

New Political Environment /
  • Washington DC was shaken to its core after the election. NCSD represents the interest of our members. We are trying to figure out trends and policy that may be forthcoming.

Non-traditional communications /
  • Our President Elect uses non-traditional forms of communication, like Twitter. This may be good way to keep a pulse on what is to come

Nominees /
  • Pay close attention to the nominees of departments that may affect our funding. NIH, HHS and CDC
  • Immerse yourself into the news of who is being nominated for which positions

Federal vs. State /
  • The power of the Feds vs. States’ rights paying attention to what is happening in states from a policy approach. Can this be our loophole?

Affordable Care Act /
  • Budget Reconciliation process to replace ACA /appeal the Affordable Care Act

NCSD / New Staff /
  • Consultants: New Policy Consultant to assist with new political environment.

Plenary Session: A Walk Through the Annual Evaluation Report

Facilitator: Sharon Devine and Christopher Voegeli, National Evaluation Center, Denver PTC

Day One: December 5, 2016 1:55 PM to 2:55 PM

This National Evaluation Center presentation from the 2016 NNPTC Meeting can be found on the NNPTC website, under the Resources tab. You can access the presentations with the password 2016NNPTC. Please contact the National Coordination Center at or Destiny Kelley at with any questions or further requests.

Plenary Session: Using Data to Determine Future Directions

Facilitator: Jami Risley, DSTDP, CDC

Day One: December 5, 2016 2:55 PM to 3:45 PM

This presentationinvolved the CDC presenting additional questions for the Medical Directors / Fellows, Regional PTC Staff, and National PTC Staff to answer in the follow breakout sessions.

Breakout Session: Medical Director / Fellows

Facilitator: Dr. Bradley Stoner, St. Louis PTC

December 5, 20164:00 PM to 5:15 PM

Topic / Discussion
How do we reach PCPs and STD experts in high morbidity areas? /
  • Laura Bachman 60% target audience, but they don't fill out registrations and evaluations
  • Kathy Hsu: three day course, paper evaluation. If short course don't require registrations.
  • Ina: Is it useful to have evaluation data in absence of registration data?
  • Survey monkey, provide website for survey at end of lecture
  • Get registration data on survey monkey
  • Short and sweet
  • American College of Health Association (4 days) - staff passed out evals in back of room.
  • What about data entry piece?
  • Kees - use app, tailor to presentation Kathy - website on iphone and 90 day eval by email
  • Export data to spreadsheet
  • Would have to track device number
  • Low morbidity areas also have training needs. They have pockets of high morbidity areas?
  • Not fair to low morbidity states to be excluded.
  • Accessibility to new information based on up-to-date guidelines
  • How to prioritize areas when low on time and funding?

PrEP, HIV, Syphilis Prevention /
  • Integrative process, same day start program in the works
  • PrEP is important for STD experts to know about
  • PrEP increases likelihood STD detection
  • ALL INTEGRATED
  • By providing PrEP other protective behavior may go down
  • Bring STD clinics back: very high risk patients, complicated syphilis cases
  • PCPs interested in PrEP, foot in the door for syphilis, EG GC-CT, etc.
  • Collaboration STD and HIV speakers
  • Train PCPs how to do a sexual hx
  • Bring PCPs on to panel. Ask what barriers to administering PrEP are, etc.
  • Who are the PCPs who are taking care of high risk patients/MSM/Family planning? How to identify them. (They identify themselves?)
  • Within state surveillance databases - who is reporting? Largest amount were seen in ER and Urgent care!!!
  • Detection CT: Peds>PCP>Obgyn - data from aps partners
  • Depends what states have time to provide data.
  • How to operationalize? May have to pay an epidemiologist to do needs assessment, STD fellow.
  • How to get into ER audience? ER comes to us. Obgyn comes to us for congenital syphilis - requested grand rounds.
  • Target high morbidity providers: health department to invite them. Works well, but health department has to be engaged and have time.
  • Leverage existing resources and engage in evolving relationship

How can we provide more impactful training? /
  • Invest in preceptors who play key roles in their regions, prescription-writers.
  • Teach sexual history taking
  • Implement ap with EMRs...clinical decision support within ap
  • PCPs don't have time. Provide technical assistance.
  • When you see this risk behavior, this is the appropriate screening...
  • Risk reduction messages, where to refer: substance abuse, mental health, etc
  • More STD experts than STD faculty. Unfunded for STD fellow -> what is next step, job... (clinical educator role)
  • Shouldn't be forced to have a fellow...if nobody is interested. Grab those who are interested and provide 100% funding.
  • STD fellow for CCN/HIV, pager or fully-funded individual to handle this
  • Questions to CDC, handled through NNPTC
  • Collaborations
  • CBA: include STD message in CBA presentations (CCN and NNPTC)
  • Get into ED group: National Association of Community Health Centers
  • Kiosks - HIV testing (Dean street model)
  • In ED, find an ED doc interested in STDs and educate her
  • Ran data, how many STDs dx in ER - forefront of STD care
  • NPs in Connecticut don't need physician to sign off because of volume - critical partnership National NP Organization

Are there any other regions with syphilis issues -> create collaborative project? /
  • CDC would like us to develop webinar
  • Make syphilis a priority
  • Urban STD issues vs rural
  • Regional TA expertise (ie EPT barriers, how to access gent: here are the vendors, etc)
  • Billing codes

Final thoughts and suggestions? /
  • Funding, continued need for intensive courses and preceptor time in clinic, develop expertise and bring people in to share knowledge. Infrastructure is decaying. Wet prep, gram stain, etc fading.
  • Put focus on future? NAAT? ..not there yet.

Breakout Session: National PTC Staff

Facilitator: Lindsey Clopp, National QI Center

December 5, 20164:00 PM to 5:15 PM

Topic / Discussion
How National PTC’s can help support the Regional PTCs? /
  • Eval Center - Providing Data that can help Regional PTCs to focus their program and efforts. Continuous QI. Help PTCs develop the capacity and tools to better use the eval data.
  • QI Center - Helping Regional PTC’s increase capacity to provide QI to their regional providers and their sites.
  • Mobile App - Marketing Regional PTCs and their courses. Increasing use of the Treatment Guidelines. Connecting providers with experts via STDCCN when connected to App. Mobile App to work with CDC to increase national marketing similar to STDCCN.
  • Curriculum Center - Connecting online users with their regional PTCs. Help regional PTCs use ECHO model in their own regions. Curriculum Center to look at sharing info of online users (with consent) to market Regional PTC trainings and other NNPTC products.
  • APEX NTIC - Bringing school-based health centers to the table with connections with national school-based health center connection. Example, webinar with CA PTC (Ina Park) SBHCs. JUST HEALTH tool incorporated to EHRs to improve sexual history taking.

What are emerging opportunities for the National Centers to collaborate with each other and with the Regional PTCs? /
  • Increasing marketing materials and marketing tools for national products and regional training. “Higher-level” packaging. Hard to do without additional staff time. Update standardized slides to attach to the end of every NNPTC presentation.
  • Better utilization of existing marketing channels like the CDC twitter.
  • Update standardized slides.
  • Creating more space for collaboration among National Centers and less time in Report Back.

Breakout Session: Regional PTC Staff

Facilitator: Barbara Wilgus, PTC at Johns Hopkins

December 5, 20164:00 PM to 5:15 PM

Topic / Discussion
Are there any interesting themes from the data? /
  • High number of others reported, what does this mean, providers don’t fit into categories on HPAT. Have we looked at what categories may be mission to better define others.
  • Clarification around the audience type
  • Chris Vogeli to re-send reports to UW, St. Louis, NYC

What STD trends are emerging in your region? /
  • A few requests for ocular syphilis, congenital syphilis, and Zika.
  • Do these topics provide a hold to get to new audiences? Conversely the relationships are what are needed to get in the door not the topic or emerging issue.
  • For example AL/NC PTC (Dr. Bachmann) did short rounds 15 min at ERs in NC about syphilis, success was achieved with those systems with established relationships.

Innovative Training Models that have been successful? /
  • The “What’s New Update” format (PTC at JH) and modality tend to attract the most primary care providers. Collaborate with other FTCC partners to put this on throughout this region. 1-day face-to-face training. Many of these have different themes trans health, opioid addiction, rural health.
  • NYC -has done a lot with the state chapter of the AAP. Had 100 people, marketed through the state chapter, and planning a second training.
  • Ratelle: case-based talks, top 10 updates that are audience driven.
  • Denver: 1.5 day regional leadership meeting, bring champions together (not a course) where clinics showcase current initiatives and develop a strategic plans (long-term and short-term). PTC follows-up with them and helps clinics achieve their plans for topics to improve service (e.g. NAAT testing, PrEP, express visits, billing) delivery. Invite goes to nurse managers/medical directors at high volume flagship STD clinics.
This could also be done on Zoom or remotely.
  • St. Louis:Dr. Reno started a program 3 years ago STIR (STI regional response), getting key people from ER, public health, city/county, CBOs, to build partnerships and increase STI treatment and prevention knowledge in St. Louis metro area. Attendance around 50. Now taking this model to Chicago. Have meeting 4 times a year.
  • UWPTC: TCG groups. Is this a model that can be used by other PTCs? This technology could be used to bring together AAPPS grantee’s together.

Collaborations /
  • POC training with Charlotte Gaydos, trying to take training to other locations by the end of June.

How can we increase reach and provide more impactful training to physicians? /
  • Many care settings it is not always the physician providing STI services. Are physicians the best target audience, more often many of our STD clinics are NP run. For individual change NPs are most important, for system level change MD buy-in and audience is needed.
  • Trying to build on existing professional medical associations and approach them to utilize their faculty and make it their agenda (NYC PTC, Ratelle PTC, AL/NC PTC). Utilize existing meetings.
  • Try to approach an FQHC system and do something well with one clinic and then spread to others in the same system to increase impact and create system level change (NYC PTC).
  • AL/NC PTC used a free intern called 163 people, talked to 82 people, and sent a 6-question survey with 21 responses. And out of those only 14 could get numbers to attend grand rounds that was worth the resources.
  • Work with state-based primary care associations (Denver PTC) and look for opportunities for STD messages. Show up where they gather.
  • Non-Medicaid expanded states, public health and emergency rooms continues to diagnose the bulk of STDs.

Recommend the best mix of type and intensity of courses. /
  • One offs, even without data, are a great entry way and often captures primary care audiences. Is there a cascade approach that is universal?
  • Seems regional and state specific.
  • NC has to view a serious of 10 webcasts and then spend time in Guilford clinic to become certified as STD specialist.
  • Should there be means to be certified STD specialist?
  • CA: doing more webinars (reach 500) and 1-day updates.
  • More coordination with AETCs is taking place for the STD/HIV updates. Data sharing still a problem. Could we use ARS systems to collect data in the moment with participants to collect evaluation questions?

How can we reduce overlap or duplication for more impact? /
  • Identify areas of overlap? Is this overlap?
  • If there is overlap who’s role is it to identify?

How should we better promote the NNPTC for improved changes in knowledge and practice? /
  • Market NNPTC resources (app, consultation line, website) at every presentation
  • St. Louis been invited by AACME to provide a short message on our services. If Dodie gets asked again she will see if someone else in the network can assist.
  • Ratelle still doing exhibit booths, showing up has been successful.

How should we include STD directors and AAPPS in improving outcomes? /
  • Models previously discussed, coming to NCSD.
  • A lot of AAPPS grantees don’t have clinical expertise.

NNPTC Meeting Agenda At-A-Glance
Day Two: Tuesday, December 6, 2016
8:00-9:30am / Kiva/Sahuaro / Plenary: DSTDP Priorities and Question and Answer
Dr. Gail Bolan, DSTDP, CDC
9:30-9:40am / Kiva/Sahuaro / Break
9:40-10:50am / Kiva/Sahuaro / Plenary: National PTC Presentations
National Curriculum Center, National Technological Innovation Centers (Apex, Denver, UW), National Evaluation Center, National Quality Improvement Center, National Coordination Center
10:50-10:55am / Transition into Breakout Sessions
11:00-12:15am / Kiva/Sahuaro / Breakout: STD Treatment Guidelines Grey Areas
Ina Park, California PTC
Kiva/Sahuaro / Breakout: Collaborations With An Impact
Gowri Nagendra, NYC PTC and Janine Dyer, Ratelle PTC
12:15-1:00pm / Lunch (Boxed Lunches for Purchase)
12:45-2:00pm / Kiva/Sahuaro / Plenary: Regional PTCs
AL/NC PTC, California PTC, Denver PTC, NYC PTC, PTC at Johns Hopkins, Ratelle PTC, St. Louis PTC, UW PTC
2:00-2:10pm / Break
2:10-3:30pm / Kiva/Sahuaro / Breakout: STDCCN Case Review
Allison Finkenbinder and Helen Burnside, Denver PTC
2:10-3:30pm / Kiva/Sahuaro / Breakout: NNPTC Technology Showcase
Carlos Romero, APEX; Bruce Maeder, UW PTC; and John Fitch, Denver PTC
3:30-4:45pm / Kiva/Sahuaro / Plenary: National Partner Collaboration
Sherilyn Crooks, HRSA HAB and Helen Burnside, Denver PTC
4:45-5:30pm / Kiva/Sahuaro / Closing Plenary: Future Directions for Year 4
Alice Gandelman, California PTC and Laura Bachmann, AL/NC PTC

Plenary Session: DSTDP Priorities & Future Directions