Skip Navigation LinksFlexible-Use-of-Federal-and-State-Grant-Funds-for-Monkeypox-Mpox-Response Flexible Use of Federal and State Grant Funds for Monkeypox (Mpox) Response

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GAVIN NEWSOM
Governor

State of California—Health and Human Services Agency
California Department of Public Health


All Local Health Officers and Public Health Directors
Flexible Use of Federal and State Grant Funds for Monkeypox (Mpox) Response
4/24/2023




​Dear Local Health Officer and Public Health Director: 

The monkeypox (mpox) state of emergency in California ended January 31, 2023, yet local mpox response efforts have continued and may need to ramp up if mpox cases increase. The purpose of this letter is to inform local health jurisdictions (LHJs) that receive federal or state funds from the California Department of Public Health (CDPH) Sexually Transmitted Diseases (STD) Control Branch or CDPH Office of AIDS (OA) about which of these existing resources can be used to support local mpox response efforts. Leveraging availability flexibility in these funding sources will support a syndemic approach to HIV, sexually transmitted infections (STI) and mpox prevention and control, since most mpox transmission in the current outbreak is occurring through sexual transmission in the same populations at risk for HIV and other STIs. 

I. Federal Grants

​According to the U.S. Centers for Disease Control and Prevention (CDC), LHJs and community-based organizations who are subrecipients funded under the following CDC Notice of Funding Opportunities (NOFOs) may use their grant resources, including funds or staff, for mpox activities that are conducted in conjunction with their HIV or STD prevention activities: 

  • PS18-1802, “Integrated Human Immunodeficiency Virus (HIV) Surveillance and Prevention Programs for Health Departments”
  • PS19-1901, “Strengthening STD Prevention and Control for Health Departments”
  • PS20-2010, “Ending the HIV Epidemic”

Additional information on specific federal HIV and STD grants administered by CDPH is provided below. 


a. PS18-1802 - Integrated HIV Surveillance and Prevention Programs for Health Departments

Funds may be used for mpox resources, including funds or staff, for mpox activities that are conducted in conjunction with LHJ HIV or STD prevention activities.

If LHJs are interested in having resources redirected and/or staff reassigned to mpox activities that are not conducted in conjunction with the core work of existing activities, then CDC prior approval of a reassignment or fiscal redirection request is required. 

Note: Assignment of staff paid from STD resources to engage in mpox related activities does not represent a reassignment. 


b. PS19-1901 - Strengthening STD Prevention and Control for Health Departments (PCHD) – Congenital Syphilis

Funds may be used for mpox if alternate resources such as state general funds are fully utilized or no longer available, including funds or staff, for mpox activities that are conducted in conjunction with other activities permitted through this grant. Examples would include, but not be limited to:

  • ​​Conducting patient education, linkages to care, and enhanced case management services for pregnant people with mpox (and infants exposed to mpox at birth)

  • Including mpox in morbidity and mortality reviews to identify missed opportunities for timely prevention and treatment in pregnant services (where relevant)

  • Integrating education on mpox into education for health care providers on identifying signs and symptoms of mpox in people who are pregnant

​Redirection of these funds to support mpox activities can be done without prior approval from CDC if the proposed changes do not represent a significant redirection of funds (i.e., cumulative changes of 25 percent of the last approved award budget period). While flexibility is available, CDPH STD Control Branch is asking LHJs to provide projections to track mpox expenditures. LHJs wishing to utilize their PCHD Congenital Syphilis funding for mpox response must complete an LHJ Mpox Redirection tracking spreadsheet provided by the CDPH STD Control Branch. The purpose of the tracking sheet is to provide detail of the staff redirection and capture costs in response to mpox. This is to account for redirections and response efforts that have already happened and to track future or continued mpox redirections and/or response efforts.  The STD Control Branch will send additional guidance on how to track and report redirection of funds to comply with the 25 percent threshold. ​

Note: The congenital syphilis grant scope of work does not include delivery of direct clinical services (such as mpox vaccination or HIV/STI/mpox testing and treatment) so these funds should not be used for delivery of clinical services. 

c. PS19-1901 – STD PCHD Disease Intervention Specialist (DIS) Workforce Development Supplemental Funding

Funds may be used for mpox resources, including funds or staff, for mpox activities that are conducted in conjunction with other activities permitted through this supplement. Examples would include, but not be limited to:​

  • Expanding and enhancing frontline public health staff

  • Conducting DIS workforce training and skills building

  • Building organizational capacity for outbreak response

  • Evaluating and improving recruitment, training, and outbreak response efforts

  • DIS conducting contact tracing to further develop and strengthen contact tracing skills needed for mpox

  • Conducting community mobilization and education events focused on contact tracing or case investigation for mpox

Redirection of these funds to support mpox activities can be done without prior approval from CDC if the proposed changes do not represent a significant redirection of funds (i.e., cumulative changes of 25 percent of the last approved award Delivery of Integrated Services budget period). While flexibility is available, we are asking LHJs to provide projections to track mpox expenditures. 

LHJs wishing to utilize their DIS Workforce Development funding for mpox response must complete an LHJ mpox redirection tracking spreadsheet provided by the CDPH STD Control Branch. The purpose of the tracking sheet is to provide detail of the staff redirection and capture costs in response to mpox. This is to account for redirections and response efforts that have already happened and to track future or continued mpox redirections and/or response efforts. The STD Control Branch will send additional guidance on how to track and report redirection of funds to comply with the 25 percent threshold.

Note:
The DIS Workforce grant scope of work does not include delivery of direct clinical services (such as mpox vaccination or HIV/STI/mpox testing and treatment) so DIS Workforce funds should not be used for this purpose. 


d. PS20-2010 - Ending the HIV Epidemic

Funds may be used for mpox resources, including funds or staff, for mpox activities that are conducted in conjunction with LHJ HIV or STD prevention activities.

If you are interested in having resources redirected and/or staff reassigned to mpox activities that are not conducted in conjunction with the core work of existing activities, then CDC prior approval of a reassignment or fiscal redirection request is required. 

Note:
Assignment of staff paid from STD resources to engage in mpox related activities does not represent a reassignment.

II. State Grants

​a. STD Core and STD Prevention and Collaboration (P&C) Grants

Funds may be used to integrate mpox services into local STI response efforts (and vice versa) for people at highest risk for HIV, syphilis, and/or mpox via sexual contact, including, but not limited to, gay and bisexual men and other men who have sex with men (MSM), trans persons, and other priority populations, including to promote racial equity in mpox prevention and control. (STD funds should not be used, for example, to support the mpox response in settings that do not serve people at high risk for HIV or STIs, such as daycare centers or long-term care facilities.)

Proposed activities should be consistent with the purpose of the STD Core and STD P&C grant. Examples of integrated HIV, STI, mpox (and HCV) activities could include, but are not limited to:​

  • Disease investigation, partner services, and partner notification for people exposed to mpox through sexual contact
  • Outreach, education, and vaccination for gay and bisexual men, other MSM, and trans persons such as through outreach at lesbian, gay, bisexual, trans, and queer/questioning (LGBTQ+) focused events, venues, and social media platforms, including with an emphasis on reaching Black, Indigenous, and other People of Color to promote racial equity
  • Mpox testing, vaccination and treatment in priority venues serving people at risk for sexual mpox exposure, such as STI/sexual health and HIV clinics, sex clubs and LGBTQ+ Pride events and, if indicated by mpox epidemiology, other priority settings for delivery of integrated HIV, STD, and HCV services, such as drug treatment programs, emergency departments, homeless encampments, jails, and mobile street outreach settings
  • Disease investigation, partner services, and partner notification for people exposed to mpox through sexual contact
  • Testing, vaccination, and/or treatment as indicated of sexual contacts of probable or confirmed mpox cases
  • Offering mpox vaccination to people prescribed doxycycline post-exposure prophylaxis (doxy-PEP) and HIV preexposure and postexposure prophylaxis
  • Temporary shelter / isolation for unhoused people with mpox exposed through sexual contact
  • Promote integration of mpox education, testing, vaccination, and treatment among local providers and into existing sexual health services
  • Surveillance and other data collection for monitoring and responding to mpox reports

b. Syphilis and Congenital Syphilis Outbreak Strategy (SOS) Grants

Funds may be used to integrate mpox services into local syphilis response efforts (and vice versa) for people at highest risk for syphilis, including, but not limited to, gay and bisexual men and other men who have sex with men (MSM), trans persons, and other priority populations, including to promote racial equity in mpox prevention and control.(STD funds should not be used, for example, to support the mpox response in settings that do not serve people at high risk for HIV or STIs, such as daycare centers or long-term care facilities.)

Proposed activities should be consistent with the purpose of the SOS grant. Examples of integrated syphilis and mpox activities could include, but are not limited to:

  • Integration of mpox outreach, education, and vaccination into syphilis testing and prevention events for gay and bisexual men, other MSM, and trans persons such as through outreach at LBGTQ+ focused events, venues, and social media platforms, including with an emphasis on reaching Black, Indigenous, and other People of Color to promote racial equity

  • Providing mpox testing, vaccination, and treatment as well as syphilis testing in priority venues serving people at risk for sexual mpox exposure, such as

  • STI/sexual health and HIV clinics, sex clubs and LGBTQ+ Pride events and, if indicated by mpox epidemiology, other priority settings for delivery of syphilis prevention services, such as drug treatment programs, emergency departments, homeless encampments, jails, and mobile street outreach settings 

  • Offering mpox vaccination for people diagnosed with syphilis and their sexual contacts during disease investigation, partner services, and partner notification

  • Testing people with mpox and their sexual contacts for syphilis (and other STIs)

  • Offering mpox vaccination to people prescribed doxy-PEP for the prevention of syphilis

  • Promote integration of mpox education, testing, and vaccination among local providers and into existing sexual health services for people at risk for syphilis

​Redirection Process 

All requests to redirect existing federal and state funding, must be submitted to LHJs’ respective Contract Manager at CDPH for each federal and state grant. LHJs’ request must include a budget revision as well as a justification for the redirection of funding. 

Please be advised that this information is fluid and CDPH will release additional information around funding flexibilities for mpox response as it becomes available. 

Sincerely, 

Kathleen Jacobson, M.D.  
Chief, STD Control Branch  California Department of Public Health 

Marisa Ramos, Ph.D. 
Division Chief, Office of AIDS California Department of Public Health 


CDPH STD Control Branch, MS 7320   ●  P.O. Box 997377  ●  Sacramento, CA 95899-7377
(916) 445-9860  ●  Internet Address: www.std.ca.gov