[Federal Register Volume 60, Number 77 (Friday, April 21, 1995)]
[Notices]
[Pages 19943-19948]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9879]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[Announcement 523]
Innovations in Syphilis Prevention in the United States:
Reconsidering the Epidemiology and Involving Communities
Introduction
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1995 funds for cooperative agreements
to conduct research toward substantially reducing syphilis in the
United States, especially in the southeastern United States, the region
with the highest syphilis rates. Syphilis is linked to substantial
mortality and morbidity through congenital syphilis, and through its
ecologic relationship with and cofactor role in HIV transmission.
Therefore, effective, innovative, community-based approaches to
syphilis prevention may have an important multiplier effect on HIV
prevention and adult and infant health in the communities where
syphilis is most prevalent.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
2000, a PHS-led national activity to reduce morbidity and mortality and
improve the quality of life. This announcement is related to the
priority area of Sexually Transmitted Diseases. (To order a copy of
``Healthy People 2000,'' see the section ``Where to Obtain Additional
Information.'')
Authority
These cooperative agreements are authorized under Section 318(b) of
the Public Health Service Act (42 U.S.C. 247c(b)) as amended.
Applicable program regulations are found in part 51 (b), subparts A and
F of title 42, Code of Federal Regulations.
Smoke-Free Workplace
The PHS strongly encourages all grant recipients to provide a
smoke-free workplace and to promote the non-use of all tobacco
products, and Public Law 103-227, the Pro-Children Act of 1994,
prohibits smoking in certain facilities that receive Federal funds in
which education, library, day care, health care, and early childhood
development services are provided to children.
Eligible Applicants
Applications may be submitted by public and private, nonprofit and
for-profit organizations and governments and their agencies.
Universities, colleges, research institutions, hospitals, other public
and private organizations, State and local governments or their bona
fide agents, federally recognized Indian tribal governments, Indian
tribes or Indian tribal organizations, and small, minority- or women-
owned businesses are eligible to apply. Applicants must, however,
document collaboration with each of the following entities:
1. At least one non-profit, public or private research institution
(e.g., university, college, hospital, laboratory);
2. A public health agency in State or local government; and
3. At least one community-based organization (CBO) or other
institution or agency with a track record for working with communities
affected by syphilis in the project area. The CBO does not need to have
a record of working on the problem of sexually transmitted diseases,
only to have [[Page 19944]] worked with the communities that are
affected.
To be eligible, the project area as defined under ``Program
Requirements'' must have an incidence of primary and secondary (P&S)
syphilis in calendar year (CY) 1993 above the PHS year 2000 objective
of 10/100,000 and a total of more than 150 cases of P&S syphilis in CY
1993.
Availability of Funds
Approximately $1 million is available in FY 1995 for a 12-month
budget period; the project period for Phase I (Preparation) is expected
to be for two years. Four to five awards will be funded for Phase I.
The awards are expected to range from $200,000 to $250,000, beginning
in September 1995. Shortly before the completion of Phase I, recipients
will compete for continuation of award in years 3 through 5 (Phase II--
Implementation). Two to three awards are anticipated for expansion into
Phase II research activities for the remaining three years of the
project period. (Further details on Phases I and II is presented below
under the heading ``Purpose and Outline of Program Plan.'') Funding
estimates may vary and are subject to change. Continuation awards
within an approved project period will be based on satisfactory
progress and the availability of funds.
Program Goals
By the end of Phase I (24 months), it is expected that:
1. Strong partnerships among research institutions, health
departments, and at least one community-based organization will have
been established or strengthened.
2. The epidemiology of the transmission of syphilis will have been
analyzed to identify characteristics and target interventions to the
most important mechanisms that sustain syphilis spread and persistence
in the community (Component 1).
3. A programmatic intervention will have been pilot tested and
assessed for its potential for measurably lowering syphilis
transmission in a defined area while being acceptable to members of the
affected communities and to participating organizations or agencies
(Component 2).
4. A sensitive surveillance system for following trends in syphilis
transmission in a population will have been implemented and at least
one full year of baseline data collected.
5. A management information system will have been implemented to
track activities and costs in syphilis prevention activities (Component
3).
At approximately month 18 of the project, applications for a
competitive continuation award for the implementation and evaluation of
a population-level intervention (Phase II) will be due. Fewer, larger,
Phase II awards are foreseen for interventions that show the greatest
potential impact and that are based on well-conducted research from
Phase I. Supplementary guidance for Phase II awards will be provided to
the recipients of Phase I awards.
Purpose and Outline of Program Plan
The purpose of this announcement is to generate new knowledge,
tools, and strategies toward sharply reducing syphilis incidence,
particularly in the southeastern States where incidence is
disproportionately high. Congenital syphilis is closely linked to newly
acquired syphilis infections in women, so an intensified focus on
syphilis transmissions is expected to contribute directly to a
principal, short-term PHS goal of eliminating congenital syphilis.
Phase I and Phase II of the research program. This research program
is separated into two phases of activity and funding (Table 1). The
fundamental goal is best understood in the context of Phase II (years 3
to 5 of the anticipated 5-year project), in which the grantees will
implement and evaluate an innovative, science-based, cost-effective
approach to reducing the transmission of syphilis in a project area.
Table 1
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Grantees
Phase Project years (No.) Focus of activities
------------------------------------------------------------------------
I..... 1 and 2...... 4-5 Preparation for innovative approaches
to syphilis control and prevention.
II.... 3 to 5....... 2-3 Implementation of interventions and
evaluation of impact on population.
------------------------------------------------------------------------
However, CDC is not seeking final proposals for such Phase II
intervention trials at this time because science-based, innovative
approaches to syphilis prevention will require multifaceted preparation
and planning. In particular, communities affected by syphilis should be
represented more substantively than in the past in developing new
approaches to syphilis prevention. This announcement, therefore,
focuses on Phase I subject areas and solicits research proposals that
will yield scientific findings and stimulate the building of multi-
disciplinary research teams needed to guide and implement the Phase II
intervention trial.
Areas of preparatory research in Phase I. During Phase I of this
program, three key research components will be addressed:
1. Innovative uses of epidemiologic and behavioral science methods
and findings about syphilis transmission in communities to direct
prevention strategies.
2. Development of a programmatic intervention and pilot test of
that proposed intervention before large-scale implementation;
development of partnerships with communities affected by syphilis.
3. Development of a sensitive syphilis surveillance activity to be
used in evaluating the efficacy and cost-effectiveness of efforts to
prevent syphilis.
Further explanation of these Phase I activities can be found in the
section ``Program Requirements.''
Program Requirements
This cooperative agreement is foreseen as an important element in a
national reassessment of our approaches to syphilis control and
prevention. To achieve the purpose of this program, the recipient will
be responsible for activities under A. and CDC for activities under B.,
below:
A. Recipient Activities
1. Develop an overall framework to design an effective, innovative
approach to syphilis prevention and to evaluate its impact on a
population.
2. Define a project area. The geographic area defined as the
project area for this program announcement must have reported at least
150 cases of P&S syphilis in 1993. An entire State could be defined as
the project area for this cooperative agreement, or several counties
could be combined to establish the minimum number of syphilis cases.
Applications are especially encouraged from rural areas that meet this
minimum morbidity requirement (150 cases of P&S syphilis).
[[Page 19945]]
3. Undertake the following three research components during Phase I
of this cooperative agreement:
A. Analyze the epidemiology of syphilis transmission within the
project area with the goal of identifying more efficacious and cost-
effective ways to prevent syphilis.
B. Develop an intervention and conduct a pre-implementation of that
evaluation. In collaboration with representatives from affected
communities, consider hypotheses about barriers to or opportunities for
more efficacious and cost-effective innovations in syphilis prevention.
C. Establish surveillance and information systems adequate for
monitoring and evaluating innovative syphilis prevention activities.
Note: Traditional disease surveillance for syphilis demonstrates
substantial year-to-year variability as well as incompletely
understood cyclic oscillations over periods of 5 to 10 years.
During Phase I, you will be expected to implement: (1) A sensitive,
population-level surveillance system for syphilis incidence; and (2) a
management information system (MIS) for estimating the cost of syphilis
prevention, including the costs of collecting and analyzing program
data. Although components 1 and 2 are distinct foci of activity that
involve different types of expertise, they are related in that
interventions that do not focus prevention resources on settings,
social contexts, or individuals who help maintain syphilis transmission
in the community are unlikely to be effective. Likewise, components 1
and 3 are related in that a sensitive surveillance system that truly
reflects incident syphilis cases should have some direct relationship
to syphilis transmission events characterized by the ``epidemiologic
model'' of syphilis for that community.
4. Include affected communities as partners in the research.
Syphilis generally is concentrated in communities with limited
resources. In many communities, syphilis is also a stigmatizing
condition and one for which the most important consequences (congenital
syphilis and facilitation of HIV transmission) often occur
unrecognized. Furthermore, some past control efforts and research
activities may have damaged community rapport with the health
departments and with CDC rather than building trust in a common
purpose. Partnerships with communities affected by syphilis, including
many African American communities where racism may have a continuing
effect, is essential to building trust and to finding solutions.
5. Linkage to other public health programs. Research on syphilis
prevention in the 1990s should occur in the context of other major
public health program areas. These include:
A. Prenatal care (required). The first priority in syphilis
prevention is the elimination of congenital syphilis, which can be
accomplished through prenatal care for women at risk for syphilis and
the appropriate screening for and management of syphilis during
pregnancy. However, it is possible that many pregnant women with
syphilis have a low risk for transmitting syphilis to other adults, and
therefore, are not central to the persistence of syphilis among adults
in the community.
B. HIV Prevention (required). Communities, sub-populations, and
individuals with syphilis are probably at high risk for HIV infection
because of common modes of transmission, the usually higher prevalence
of syphilis and HIV in the same communities, infection, and the role of
genital ulcer diseases as cofactors for sexual transmission of HIV.
Syphilis prevention should be coordinated with and should reinforce
community intervention strategies and other efforts to change sexual
behavior as are associated with HIV prevention. Because syphilis is a
curable communicable disease, screening, health care seeking, and
treatment will likely play prominent roles in syphilis prevention.
Nonetheless, some effort to change behavior must be a component of a
responsible syphilis prevention activity, both to prevent HIV infection
and other STDs in the community from which one is trying to eliminate
syphilis, and to lower the risk of spread if syphilis is reintroduced.
C. Substance abuse (optional). A number of studies have shown that
crack cocaine was closely linked to local epidemics of syphilis in the
late 1980s. People who inject drugs are at high risk for STDs.
Effective, innovative, epidemiologically focused syphilis prevention
activities may be augmented if they are closely linked to substance
abuse treatment. Explain how the proposed syphilis prevention
activities interact with, and possibly reinforce, efforts to prevent
drug abuse.
D. Correctional systems (optional). Because of the association of
syphilis with substance abuse and prostitution, collaboration with the
criminal justice system (e.g., correctional health programs, probation
officers, court referral, juvenile justice) could result in highly
effective approaches to syphilis and HIV prevention. Explain any
interaction between the proposed syphilis prevention activities and
criminal justice programs.
6. Manage, analyze, and interpret data. Data from the three core
activities in part 3 should be secure and confidential. In
collaboration with CDC, analyze, interpret, and publish data promptly
in scientific, programmatic, and policy-making forums. Data should
regularly be communicated to community partners in language that they
can understand.
7. Build a multidisciplinary research team and program
implementation capability. Assemble a multidisciplinary team with the
appropriate expertise (such as in microbiology, medicine, epidemiology,
behavioral sciences, health care services research) to undertake each
of the enumerated steps or activities.
8. Implement a unified core protocol common to all grant recipients
that will be established for component 3 of the required activities
(population-based surveillance for new syphilis transmissions) and
implemented by each recipient. The final core multicenter protocol for
component 3 will likely differ somewhat from the protocol specified by
any individual recipient. Core protocols or common approaches will be
encouraged but will not be required for other components, especially
component 1.
9. Each grantee will participate with other recipients and CDC
representatives in as many as four meetings during the first 24 months,
during which the core protocol for component 3 will be established, and
strategies for and progress toward achieving the goals of the program
announcement will be assessed.
10. The recipient will share reports on progress toward goals with
representatives of communities affected by syphilis and other involved
organizations, agencies, and persons.
11. The recipients will take the lead in data analysis and
publication of data from their own research centers, with participation
and support from CDC.
B. CDC Activities
1. Provide scientific and technical assistance in the general
operation of this syphilis prevention project and in the three key
research components in Phase I.
2. Within 45 days of the notice of grant award, host a meeting of
the successful applicants to develop the core protocol for component 3
and to plan other aspects of the research program. CDC will host as
many as three other meetings of investigators during the first 24
months of the project to [[Page 19946]] promote progress toward core
and national objectives.
3. Assist in monitoring and evaluating scientific and operational
accomplishments of this syphilis elimination project through periodic
site visits for research program reviews, frequent telephone calls, and
review of technical reports and interim data analyses.
4. CDC will assist in data analysis and in the presentation and
publication of data from Phase I and Phase II activities in scientific,
programmatic, and policy-making forums. CDC will actively participate
in evaluating the multicenter core protocol data for component 3
(surveillance and evaluation).
Review Conditions and Evaluation Criteria
To be referred to the independent review group for consideration,
applications must:
1. Document effective partnerships among research institutions,
State or local health departments, and CBOs; and
2. Address the specific requirements in all three research
components.
Applications not meeting these two requirements will be returned to
the applicant without being reviewed. Applications that meet the
preceding requirements will be evaluated according to the following
criteria:
1. Understanding of Goals, Purpose, and Context
Understanding of the objectives of this research and evaluation
program as reflected in statement of research background, program
objectives, and linkage of the specific activities of Phase I to a
well-articulated vision of what is needed to substantially reduce the
prevalence of syphilis in the United States (5 points). Extent the
choice of a project area in which to conduct this research is
appropriate to the research objectives and is explained and justified
in those terms, and extent in the proposed project area the
epidemiology of syphilis, barriers to its reduction or elimination, and
resources available to STD/HIV prevention are well-described (5
points). (Total, 10 points.) (APPLICATION CONTENT items 1 and 2.)
2. Quality and Focus of Proposed Phase I Research
The extent to which excellent research designs address the three
major components of the program announcement while avoiding extraneous
efforts. (APPLICATION CONTENT item 9.)
Component 1: Innovative uses of epidemiologic methods and findings
about syphilis transmission in communities to direct prevention
strategies. The extent to which the proposal is theoretically sound and
reflects detailed knowledge of the meaning of the underlying data, such
as reported syphilis cases of different durations (primary, secondary,
early latent, late latent), reports of sexual contacts among patients,
syphilis seroprevalence from screening data, and other data sources.
The extent to which the planned approaches to analyzing, interpreting,
and using data are innovative and likely to yield new insights into the
transmission of syphilis and the opportunities for prevention and
elimination within the study community (10 points). The extent to which
the findings might be directly translated into public health practice
(e.g., changes in screening criteria or the location for syphilis
serologic testing; changes in PN practices or priorities; relocation or
reorganization of clinical services; development of community-based
interventions), and the clarity with which that potential for
translation is explained in the application (5 points). (Total, 15
points.)
Component 2: Development of a programmatic intervention and pilot
test of that proposed intervention before large-scale implementation;
developing partnerships with communities affected by syphilis. Choice
of an appropriate potential intervention, based on syphilis
epidemiology in the study region plus analysis of community, program,
or other factors that compose an important barrier or opportunity for
more effective, epidemiologic programs (10 points). Scientifically
sound plan for evaluating, during this pre-implementation phase, the
potential impact of the proposed intervention on syphilis transmission
(5 points) and on community perceptions and support for those
prevention activities (5 points). The extent to which the planned
research findings from this component could be directly translated into
public health practice, and the clarity with which that translation is
explained in the application (5 points). (Total, 25 points.)
Component 3: Development of a sensitive syphilis surveillance
activity to serve as a basis for evaluating the efficacy and cost-
effectiveness of syphilis prevention efforts. The extent to which the
proposal is theoretically sound for evaluating the sensitivity and
cost-effectiveness of estimating and following population and sub-
population trends in the transmission of syphilis (5 points). The
extent to which the proposal demonstrates detailed familiarity with
public health disease surveillance and the complexity of trying to
change practices in disease surveillance settings proposed (e.g.,
jails, maternity wards delivery suites) (5 points). Implementation of a
management information system adequate for a cost-effectiveness
analysis of new approaches to prevention programs 5 points). (Total, 15
points.)
3. Capacity, Interdisciplinary Involvement, and Partnerships
Overall ability of a multidisciplinary research team (including
persons in various academic disciplines, public health practitioners,
and community collaborators) to perform the technical aspects of the
project(s) (i.e., qualified and experienced personnel with a record of
excellent scientific achievement) (15 points); appropriate facilities
and plans for the administration of the project(s), and a detailed and
realistic schedule for the specified activities (5 points). (Total, 20
points: APPLICATION CONTENT items 3, 4, 5, and 6.)
4. Inclusion of Affected Communities
The extent to which communities affected by syphilis are involved
in all parts of these research and demonstration activities (5 points).
The extent to which the effective work of one or more CBOs is
documented in attachments to the application and the collaboration and
support of a CBO is thoroughly incorporated into the work of the
multidisciplinary team (5 points). (Total, 10 points: APPLICATION
CONTENT items 3 and 6.)
5. Linkage to Related Prevention Activities
The extent to which the proposed research agenda and the
intervention reflect awareness of other critical prevention services in
the community (pre-natal care, HIV, drug abuse, correctional health)
and are synergistic or at least well-coordinated with those other
preventive health services. (Total, 5 points: APPLICATION CONTENT item
7.)
In addition, consideration will be given to the extent to which the
budget is reasonable, clearly justified, and consistent with the
intended use of the funds. (APPLICATION CONTENT item 8
Funding Priorities
CDC intends to achieve some geographic diversity of project sites
while retaining a principal focus on syphilis in the southeastern
United [[Page 19947]] States. It is the intention to fund at least two
Phase I projects that address syphilis in rural areas in the
southeastern United States, if those applications are fully
competitive.
Interested persons are invited to comment on the proposed funding
priority. All comments received on or before May 19, 1995, will be
considered before the funding priority is established. If the funding
priority should change as a result of any comments received, a revised
Announcement will be published in the Federal Register and revised
applications accepted.
Written comments should be addressed to: Henry S. Cassell III,
Grants Management Officer, Grants Management Branch, Procurement and
Grants Office, Centers for Disease Control and Prevention (CDC), 255
East Paces Ferry Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305.
Executive Order 12372 Review
Applications are subject to Intergovernmental Review of Federal
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets
up a system for State and local government review of proposed Federal
assistance applications. Applicants (other than federally recognized
Indian tribal governments) should contact their State Single Point of
Contact (SPOC) as early as possible to alert them to the prospective
applications and receive any necessary instructions on the State
process. For proposed projects serving more than one State, the
applicant is advised to contact the SPOC for each affected State. A
current list of SPOCs is included in the application kit. If SPOCs have
any State process recommendations on applications submitted to CDC,
they should send them to Henry S. Cassell III, Grants Management
Officer, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305, not later than
60 days after due date for receipt of applications. The Program
Announcement Number and Program Title should be referenced on the
document. CDC does not guarantee to ``accommodate or explain'' State
process recommendations it receives after that date. Indian tribes are
strongly encouraged to request tribal government review of the proposed
application. If tribal governments have any tribal process
recommendations on applications submitted to CDC, they should forward
them to Henry S. Cassell III, Grants Management Officer, Grants
Management Branch, Centers for Disease Control and Prevention (CDC),
255 East Paces Ferry Road, NE., Room 300, Mailstop E-16, Atlanta, GA
30305. This should be done no later than 60 days after the application
deadline date. The granting agency does not guarantee to ``accommodate
or explain'' for tribal process recommendations it receives after that
date.
Public Health System Reporting Requirements
This program is subject to the Public Health System Reporting
Requirements. Under these requirements, all community-based
nongovernmental applicants must prepare and submit the items identified
below to the head of the appropriate State and/or health agency(s) in
the program area(s) that may be impacted by the proposed project no
later than the receipt date of the Federal application. The appropriate
State and/or local health agency is determined by the applicant. The
following information must be provided:
A. A copy of the face page of the application (SF 424).
B. A summary of the project that should be titled ``Public Health
System Impact Statement'' (PHSIS), not exceeding one page, and
including the following:
1. A description of the population to be served;
2. A summary of the services to be provided; and
3. A description of the coordination plans with the appropriate
State and/or local health agencies.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance Number is 93.978,
Preventive Health Services--Sexually Transmitted Diseases Research,
Demonstration, and Public Information and Education Grants.
Other Requirements
Paperwork Reduction Act
Projects that involve the collection of information from 10 or more
individuals and funded by the cooperative agreement will be subject to
review by the Office of Management and Budget (OMB) under the Paperwork
Reduction Act.
Confidentiality
Applicants must have in place systems to ensure the confidentiality
of patient records.
HIV/AIDS Requirements
Recipients must comply with the document entitled Content of AIDS-
Related Written Materials, Pictorials, Audiovisuals, Questionnaires,
Survey Instruments, and Educational Sessions (June 1992) (a copy is in
the application kit). To meet the requirements for a program review
panel, recipients are encouraged to use an existing program review
panel, such as the one created by the State health department's HIV/
AIDS Prevention Program. If the recipient forms its own program review
panel, at least one member must also be an employee (or a designated
representative) of a State or local health department. The names of the
review panel members must be listed on the Assurance of Compliance form
CDC 0.1113, which is also included in the application kit. The
recipient must submit the program review panel's report that indicates
all materials have been reviewed and approved.
Before funds can be used to develop HIV/AIDS-related materials,
determine whether suitable materials are already available at the CDC
National AIDS Clearinghouse.
Human Subjects
If your project involves research on human subjects, you must
comply with the Department of Health and Human Services Regulations, 45
CFR Part 46, regarding the protection of human subjects. Provide
assurance that the project will be subject to initial and continuing
review by an appropriate institutional review committee. You must
provide assurance in accordance with the guidelines and form provided
in the application kit.
In addition to other applicable committees, Indian Health Service
(IHS) institutional review committees also must review the project if
any component of IHS will be involved or will support the research. If
any American Indian community is involved, its tribal government must
also approve that portion of the project applicable to it.
Letters of Intent
Letters of intent are required. On or before May 15, 1995, submit
the original and two copies of a letter of intent to submit an
application to: Henry S. Cassell III, Grants Management Officer, Grants
Management Branch, Procurement and Grants Office, Centers for Disease
Control and Prevention (CDC), 255 East Paces Ferry Road, NE., Room 300,
Mailstop E-16, Atlanta, GA 30305. [[Page 19948]]
Application Submission and Deadline
On or before July 3, 1995, submit the original and two copies of
the application (Form PHS 5161-1--OMB Number 0937-0189) and one
electronic copy on disk to: Henry S. Cassell III, Grants Management
Officer, Procurement and Grants Office, Grants Management Branch,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305.
1. Deadline: Applications shall be considered as meeting the
deadline if they are:
A. Received on or before the deadline or
B. Sent on or before the deadline date and received in time for
submission to the independent review committee. (Applicants must
request a legibly dated U.S. Postal Service postmark or obtain a
legibly dated receipt from a commercial carrier or U.S. Postal Service.
Private metered postmarks will not be acceptable proof of timely
mailing.)
2. Late Applications: Applications that do not meet the criteria in
1.A. or 1.B. are considered late applications and will not be
considered in the current competition and will be returned to the
applicant.
Where to Obtain Additional Information
A complete program description, information on application
procedures, an application package, and business management technical
assistance may be obtained from: Manuel Lambrinos, Grants Management
Specialist, Grants Management Branch, Procurement and Grants Office,
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry
Road, NE., Room 300, Mailstop E-16, Atlanta, GA 30305, telephone (404)
842-6777. Programmatic technical assistance may be obtained from: Sevgi
Aral, Ph.D., Division of STD/HIV Prevention, National Center for
Prevention Services, Centers for Disease Control and Prevention (CDC),
1600 Clifton Road, NE., Mailstop E-02, Atlanta, GA 30333, telephone
(404) 639-8259.
Please refer to Announcement 523 when requesting information and
submitting an application.
Potential applicants may obtain a copy of ``Healthy People 2000''
(Full Report, Stock No. 017-001-00474-0) or ``Healthy People 2000''
(Summary Report, Stock No. 017-001-00473-1) referenced in the
``Introduction'' through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325, telephone (202) 512-1800.
Dated: April 14, 1995.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
[FR Doc. 95-9879 Filed 4-20-95; 8:45 am]
BILLING CODE 4163-18-P
