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Goal 1: Begin to address the Regional State of Health Emergency in the US-Affiliated Pacific Islands due to an epidemic in non-communicable diseases in women and their families.

1. Within the USAPI, catalogue culturally appropriate/sensitive promising practices (not yet evaluated) which address Non-Communicable Diseases.

OWH, OMH

1. Complete the catalogue compilation of promising practices within one year.

2. Work with the Pacific Islands Health Officers Association to identify 1-3 priority NCD for each USAPI.

OMH

2. Identify the priority NCDs for each USAPI within one year.

3. Fund at least one promising practice in each USAPI within two years.

Goal 2: Provide enhanced technical assistance to National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded state and programs in the Pacific to increase outreach to underserved Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities and populations.

1. Identify gaps and opportunities to increase outreach and recruitment and deliver trainings via Webinar and/or in-person to assist NBCCEDP grantees in increasing outreach and breast and cervical cancer screening among underserved AANHPI communities.

CDC

1. Fifty percent of funded states with significant AANHPI populations and programs in the Pacific will screen 10% more AANHPI women than the previous 6-month period.

2. As part of NBCCEDP, provide support for underinsured and uninsured AANHPI women to complete annual clinical breast and mammography exams per established clinical guideline to improve the early detection of breast cancer.

CDC

2. Support breast cancer screening programs for underinsured and uninsured AANHPI women.

3. Provide support for patient navigators to support outreach and case management.

CDC

3. Support patient navigator programs to support outreach and case management.

Goal 3: Enhance surveillance and epidemiological response capacity for communicable diseases in U.S. territories and in the Pacific Island Jurisdictions.

Provide technical assistance and training on specific public health concerns to local and territorial public health entities to enhance their surveillance and response capacity.

CDC

Conduct three focused technical assistance and training efforts (for Guam, American Samoa, and the Federated States of Micronesia) as follows:

1. Guam: Assist with assessment and evaluation of risk factors related to mumps outbreak in immigrant Micronesian population.
2. American Samoa: Provide technical assistance for the establishment of an electronic surveillance program utilizing records from the LBJ Tropical Medicine Center and local community health clinics.
3. Federated States of Micronesia: Provide technical assistance for the establishment of an electronic surveillance program utilizing records from local medical facilities and clinics.

Goal 4: Implement policy and environmental change to enhance prevention and control of chronic disease and associated risk factors.

1. Enhance program efforts directed toward support and empowerment of USAPI community action toward policy and environmental change aimed at chronic disease prevention.

CDC

1. Support USAPI community/village-based projects aimed at the prevention of diabetes and chronic disease (including associated risk factors) through the model year.

2. Support policy change at the community/village level that supports development of prevention of chronic disease (based on current evidence strategies for chronic disease prevention through AHRQ and CDC's Winnable Battles campaign).

Goal 5: Support USAPI population health and healthcare system partnerships/networks working to reduce the burden of chronic disease.

Continue support for development and use of computer based Chronic Disease Electronic Management System (CDEMS) among USAPI healthcare systems. CDEMS is a flexible database for tracking any chronic condition and can easily be adapted to the unique needs of the USAPI. CDEMS provides consistent and standardized organization of patient/population data to help monitor and track chronic disease. An additional strategy includes the establishment of a USAPI regional-based CDEMS support network that provides training, technical assistance and trouble-shooting for participating jurisdictions.

CDC

1. At least three U.S.-Affiliated Pacific Islands (USAPI) healthcare systems with CDEMs operational; with at least 75% of known patients with diabetes fully registered within the system.

2. CDEMS support network functional within region as evidenced by technical assistance team documentation and reporting.

3. Completion of at least one demonstration project that provides training and support for data extraction between an electronic medical record system and CDEMS data interfaces (American Samoa and VA system VISTA).

4. Support USAPI directed projects funded to help support prevention or delay of diabetes related amputations (i.e. funding and support for resource needs related to training, prevention related supplies, community outreach). Outcomes include at least a 10% reduction in lower extremity foot ulcers/amputations in people with diabetes from baseline measure (using CDEMs or similar surveillance system).

Goal 6: Support regional USAPI population health surveillance efforts that define the burden of diabetes and TB.

Link with ongoing efforts to reduce the burden of diabetes and TB comorbidity within the USAPI.

CDC

1. Develop the CDEMs TB and diabetes surveillance system interface for at least three of the six USAPI jurisdictions government health care systems.

2. Increase the number of people screened for both diabetes and TB by 10% above baseline in at least three USAPI jurisdictions (measured through the CDEMS and existing DTBE EpiAnywhere tracking system).

3. Improve access to resources, training, and support for TB and diabetes screening as evidenced by Pacific Islanders TB Controllers Association (PITCA) and Pacific Chronic Disease Coalition (PCDC) reports, technical assistance documentation, and training schedules.

Goal 7: Collaborate with Guam Immunization Program which is part of the Guam Department of Public Health and Social Services (DPHSS) to end the ongoing mumps outbreak on Guam.

1. Provide a third dose of MMR vaccine to students in highly affected schools.

CDC, Guam DPHSS

Decline in mumps cases to baseline levels within 1 year after third dose intervention.

2. Ensure that catch-up vaccination campaigns are being done in highly affected areas.

CDC, Guam DPHSS

3. Provide education and training on mumps prevention and control to healthcare providers in clinics and hospitals, school nurses, daycare providers, community leaders, and minority group leaders.

CDC, Guam DPHSS

4. Evaluate the third dose intervention.

CDC, Guam DPHSS

5. Continue with education on prevention measures in the community.

CDC, Guam DPHSS

Goal 8: Improve laboratory capacity and procurement of medications and laboratory materials to assist healthcare professionals in the diagnosis and management of STDs.

Support high quality laboratory test platforms in Guam and Yap. Identify a mechanism for the procurement of STD testing materials and medications directly to US Pacific Island Jurisdictions (USPIJs). CDC and partners will place a laboratory director in Guam who will be responsible for the Guam lab. USPIJs would use the laboratory for processing of STD specimens.

CDC, CMS, FDA

1. Provide training and begin STD testing on laboratory test platforms in Guam and Yap.

2. Support a laboratory director for the Pacific Islands to be based in Guam.

3. Increase number of PI residents screened for STDs through CLIA certified laboratory and improved management of the STD screening and managements systems.

Goal 9: Improve coordination of obesity prevention efforts of the Hawaii Department of Health targeting Native Hawaiian population through an inter-sectoral approach.

Amend RFP process to include collaboration between smaller community-based organizations and the state health department. Complete health impact assessments (HIAs) for all identified medically underserved areas (MUAs) in the state of Hawaii.

CDC, Hawaii Department of Health

Complete HIAs for the 18 designated MUAs in Hawaii within the year. Draft policy recommendations and tool-kits for each area based upon results of findings.

Goal 10: Increase capacity of Hawaii Department of Health to incorporate GIS mapping of chronic disease incidence and prevalence and documentation of food deserts and food insecurity for underserved Asian Americans, Native Hawaiians, and Pacific Islander populations.

Provide support for collaboration and utilization of GIS to shape policy and community advocacy.

CDC, State DOH GIS Workgroup

Support State efforts to create GIS program specifically focused on chronic disease at the state dept. of health.

Goal 11: Expand the Supplemental Nutrition Assistance Program (SNAP) and school lunch program to better serve Hawaii's eligible AANHPI population to increase access to healthy foods and prevent childhood obesity.

Determine ways to expand the reach of SNAP and the school lunch program in Hawaii to expand coverage of SNAP to include eligible AANHPI communities and provide vouchers to be used at farmers' markets and other venues which promote easier access to healthful food. Support a program at the DOH to coordinate this effort.

CDC, USDA, State DOH

Create voucher system to expand program to include eligible underserved AANHPI population.

Goal 12: Continue successful data submission from Pacific Regional Central Cancer Registry (PRCCR). In June, the PRCCR submitted data successfully for the first time with the latest call for data.

CDC to continue to provide technical support for PRCCR.

CDC

Schedule deadlines for regular data submission by PRCCR.

Goal 13: Develop culturally and linguistically appropriate evidence-based initiatives for AANHPIs to promote tobacco use prevention and cessation in racial and ethnic minorities.

Utilize clinic-based counseling, tobacco cessation quit lines, prevention and education programs, and community systems change interventions for AANHPI populations at high risk for morbidity and mortality related to tobacco use.

OMH, CDC

Schedule deadlines for regular data submission by PRCCR.