grant presentation on zika virus, with note section

Running Head: ZIKA VIRUS GRANT 0

Zika Virus Grant

Name

Institution

Background and Needs Assessment 3

Zika virus logic model 9

Narrative: Zika Virus Logic Model 11

Statement of Purpose 12

Work Plan/Implementation Plan 13

PRECEDE: PROCEED Model 13

Zika Virus Program 16

Objectives, Strategies and Assessment Column Chart 18

Evaluation Plan 24

Capacity and Organizational Support 25

Advisory Board 27

Fundamentally, Zika Virus is propagated by the infected Aedes albopictus and the Aedes aegyptispecies of mosquitoes(Center for Disease Contol and Prevention, 2017). In contrast to the malaria-carrying mosquitoes, the Aedes species is mainly active during the day. Therefore, the use of mosquito nets is rendered ineffective in curtailing their spread.In the distant past, Zika virus was mainly reported in the tropical climates with the first cases of human infection reported in the year 1952 in Uganda and Tanzania. Subsequently, additional outbreaks were reported in other parts of Africa, Pacific Islands and parts of South East Asia(Center for Disease Contol and Prevention, 2017). As of March 9, 2017, a situational report by the World Health Organization (WHO) revealed that cases of the vector borne disease had been reported in eighty four countries, territories or sub-national areas (World Health Organization, 2017). In addition to that, the global risk assessment of the virus by the WHO remains high as it is further anticipated that the disease will spread geographically to other areas where competent vectors have been established.

In between January 1, 2015 and April 26, 2017, a total of 5,264 Zika Virus infection cases had been reported in the continental United States of America(Center for Disease Control and Prevention, 2017). This figure can further be broken down as shown:

• 92.4% of the infections were associated with individuals who had travelled to affected areas

• 4.25% of the infections were attributed to local mosquito-borne transmission

• 0.87% of the cases were transmitted through sexual intercourse

• 0.55% of the cases came about as a result of congenital infection

• 0.0019% of the cases arose from laboratory transmission. An additional 0.0019% of the cases were transmitted through an unknown route.

Within the aforementioned duration, a total of 36,575 Zika virus infections were reported in the US territories. In contrast to the data that was garnered from the continental US, the bulk of these cases were related to mosquito-borne transmission as shown below:

• 99.61% of the infections resulted from mosquito bites

• 0.39% of the infections were related to individuals who had travelled to the affected areas.

Florida and Texas are the main affected states within the continental US. Consequently, certain areas within the Miami-Dade County in Florida have been categorized by the Center for Disease Control and Prevention (CDC) as high risk areas (Centre for Disease Control and Prevention, 2016). Similarly, the CDC highlighted Brownsville, Cameron County, in Texas as a high risk area for mosquito borne transmission of Zika Virus(Centre for Disease Control and Prevention, 2016). Focusing on Texas, the Department of State Health and Services (DSHS) on April 28, 2017 reported that a total of 11 new Zika virus infection cases have been reported since the year began (Texas Department of State Health Service, 2017).Furthermore, in between 2015 and 2016 a total of 322 cases had been reported to the DSHS. The table below gives a summary of the Zika Virus cases by county from December 2015 through April 2017 (Texas Department of State Health Service, 2017).

Table 1 Zika virus cases reported by county in Texas from December 2015 through April 2017.

In reference to the data that has been illustrated on Table 1 above, it is clear that some areas in Texas are more prone to incidences of Zika virus than others. For instance, both in 2015 and 2016 Harris County, Tx had the highest number of Zika virus infections. It was closely followed by Dallas, Tarrant, Cameron, Bexar, Travis, Fort Bend, Denton, Bell, Webb, Williamson and Hidlago.

Within these areas, the populace that has been determined by the DSHS to be in the high risk category is pregnant women and their unborn children (Texas Department of State Health Service, 2017). It is expected that with an increase in temperatures, there will be an increase in mosquito activity and thus increased risk of new infections. Therefore, on April 7, 2017 a health alert was issued which encourages pregnant women to get tested for Zika virus at least in their first and second trimesters. In essence, pregnant women and their unborn child are at a higher risk citing the severe birth defects that result from being infected with the disease.

While significant efforts have been put in place to inhibit the spread of Zika virus; there is need to encourage the public to undergo extensive testing for Zika virus whenever they develop a rash or any other symptom that is associated with Zika virus. This is because up to 80% of Zika virus infections do not cause illness and therefore most symptomatic individuals might not be diagnosed making them to be transmitters of the disease (Texas Department of State Health Service, 2017).

The Zika virus logic model gives a representation of a series of activities and their corresponding short term, intermediate and long term outcomes that are expected to occur within Texas within a preferred duration of three years. The model has a linear progression in which the chain of activities presented have a high probability of resulting into behavioral change, knowledge and skill development with the final outcome being the reduction in the escalation of Zika virus cases.

A coalition will be formed through the combination of human and physical resources. That said, the following inputs will be used: financial resources, planning resources, materials and partners at the local, regional and state levels. Using the aforementioned inputs, the coalition is then able to spearhead the activities which have been depicted in the logic model. It is anticipated that if these activities are effectively carried out, they would reach various groups and individuals within the community who in turn will effect certain changes (outcomes).

The broad perspectives that this logic model uses in minimizing the spread of Zika virus within the Texan population are:

1. Introducing educational programs which can increase awareness and sensitization levels in the high risk areas.

2. Encouraging the formation of support groups for pregnant women and women of child bearing age and their sex partners.

It is important to note that each of these main categories is further divided into specific perspectives as captured in the logic model. For there to be an effective decline in the number of Zika virus cases that are reported within Texas, the two broad perspectives need to be in constant interaction.

In principle this funding is geared towards addressing the following;

1. Facilitating extensive community outreach activities and maximizing education that would help in dissuading community members from travelling to affected areas.

2. Prevent the transmission of Zika virus by encouraging repetitive voluntary screening to increase the chances of identifying symptomatic individuals who have the disease but have not reported any illness.

3. Creating public avenues through which information regarding Zika virus can be readily available to the adults in Texas thus boosting the audience`s knowledge.

4. Facilitate public healthcare operations and in the process reinforce the ability of health systems in Texas to provide immediate assistance , and possibly continued care to individuals who might have been affected in the community

In order for a health promotion and disease prevention program to work effectively and efficiently, it requires a supporting model. Models are supportive because they provide the guidelines through which people can prevent getting infectious diseases as well as lead healthy lifestyles. These guidelines are formed based on location, availability of resources, culture and financial considerations. In essence, health care models provide the requirements for improving the overall quality of life and health outcomes for individuals. For the Zika Virus program, the main aim is to create awareness on the cause of the virus, treatment procedures and how to prevent infection in the local community. In addition, through this program, health professionals in the area will be trained on health promotion and disease prevention.

Health promotion models represent implicit approaches to health that are focalized on social relations and cognition. Other models however promote health through research and development of medical interventions to prevent, treat and cure diseases. One model that can be applied to the program planning for Zika virus is PRECEDE-PROCEED. This comprehensive model assists in the designing of a health program, implementation and evaluation of the program. Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) and Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED), is a model through which health professionals provide a platform upon which health theories can be evaluated and planned for in order to enable health behavioral change (Phillips, Rolley, & Davidson, 2012). It aims to determine the impact of environmental, behavioral and genetic factors on health. The socio-ecological influences on health can be categorized into five broad categories: individual, interpersonal, organizational, community and society. These factors impact health on a multi-level manner, starting from the individual level to the societal level.

The PRECEDE focuses on the educational aspect of health behavioral change. Through educating the masses, health professionals would be able to develop interventions for health promotion disease intervention. Unlike other models for health program planning, the PRECEDE model is does not focus on implementation programs. The other aspect of the model is PROCEED. This aspect incorporates the aspects of environment and its impact on health aspects and health behaviors. This model acknowledges that our environment affects our lifestyles and our behavioral patterns in terms of health. These environmental factors include industry, politics, social-classes, culture and traditions. It is for this reason that the PROCEED model aims to include ecological aspects to health promotion and disease prevention. This model aims to understand how these factors impact health and addresses them.

The PRECEDE-PROCEED model offers guidance in planning for health program in the following phases:

• Social assessment. In this phase, the program planners analyze the community in which they intend to implement their health program. They do this by conducting data collection and analysis in the area through the use of one-on-one interviews, focus groups and surveys. Through this process, the planners can determine the requirements of the dwellers in the community, the availability and accessibility of resources and their willingness to embrace change.

• Epidemiological assessment. This phase focuses on identifying the possible health problems in the community and the main issues the health program will focus on. Once the problem is identified, the behavioral and social causative agents are identified and prioritized in the program. This enables the program to have a metric for successful implementation and functioning in dealing with the health problems.

• Educational and ecological assessment. It is imperative to put structures in place to ensure the changes are embraced and sustained. These factors may be categorized as predisposing factors which create the foundation upon which a need for change is identified and embraced by the community; reinforcing factors which continue to offer a reward to the planners once they implement behavioral change; and enabling factors are those that ensure the changes implemented are sustained.

• Intervention alignment. In this phase, the components of the health program are aligned with the requirements of the community and the problem to be dealt with. These components take into consideration the community needs, the possible obstacles for program implementation and the program facilitators.

• Implementation. The program is then implemented.

• Process evaluation. Evaluation is carried out using data collected from the community. The process evaluation is done to ensure the program is implemented based on the criteria set up in the beginning.

• Impact and outcome evaluation. The impact of the program is assessed and evaluated so as to identify possible changes that can improve the program. This is done through focus groups, observations, interviews and studies.

The Zika virus health program will be a 3 year program. Its main objectives will be health promotion and disease prevention. As aforementioned, the program is supported by the PRECEDE: PROCEED model. It will be facilitated by health professionals and other stakeholders in the health sector. The program aims to provide the community with information on the disease. This will be done through awareness campaigns, pamphlets and community education. In addition, the program will contain a vector management section. This will function to prevent the spread of the disease by the destroying the vectors that transmit the Zika virus, surveillance of their prevalence rates and controlling their population (Texas Department of State Health Service, 2017).

Another aspect of the program will be health surveillance. This will incorporate assessing the infection rates in the area, the prevalent mode of transmission, number of patients already treated for the virus and those currently undergoing treatment. Through this data, it will be possible to assess the behavioral, ecological and social factors that contribute to the spread of the disease. Lastly, the program will need to have coordination, command and control. This element of the program will be facilitated by health professionals and administrators. They will come up with effective strategies to ensure effective implementation, adoption and running of the Zika virus program. In order to assist with coordination and creation of awareness, support groups will be formed. These support groups will help in ensuring behavioral change. The changes will be implemented in a 12 step process of cognitive behavioral therapy and counseling.

The program will be evaluated in three phases according to PRECEDE: PROCEED model (Milstein & Wetterhall, 2016). Process evaluation will serve to provide information on the measures that determine the control, improvement and amendment of the program. The next phase is the impact evaluation. This will be done to assess the impact the program has had on the community thus far. This is measured by the observable changes in the community such as increased awareness on the Zika virus and reduced infection rates. Lastly is the outcome evaluation. This evaluates the permanent effects the program has had in the community. This may be in terms of behavioral change, environmental protection, vector control and destruction. Evaluation will also be done continuously by the staff in order to identify areas in which the program might need improvement. In addition, it helps in assessing for the effectiveness of the program (W. K. Kellog Foundation, 2004).

Evaluation will be done by an evaluation working group. This group will consist of public health officials, evaluation experts, health professionals, community based researchers and the key stakeholders. They will work under the guidance of CDC researchers. During the evaluation, four key elements of the program will be assessed. They are feasibility, utility, propriety and accuracy of the program. Evaluation will be carried out mainly by observation. This will involve surveys and comparative cases studies on the community.

The Zika Virus programme will be facilitated by a knowledgeable staff. The program will have several employees. These will be health professionals such as nurses, pathologists, counselors and general physicians. They will provide healthcare to the community. In addition, the nurses and counselors aid in providing health education to the members of the community. The health education program will be run by the health care educator. In addition, for management of the program, there will be a financial officer who will oversee the finances of the program. Moreover, there will be administrative assistants such as a secretary who will assist with organization, administration and running of the program. A graduate assistant will be hired from Towson University to offer assistant to the officers in the program. The staff will require equipment to carry out their activities efficiently. These include laptops; efficient networking software that connects all those involved in the program and data management; laboratory equipment for testing and fieldwork equipment such as phones and recorders. Personal protective equipment is also a necessity for health care professionals and those coming in contact with patients exposed to or infected with the Zika virus. Other resources required in the program include consultancy services for project management, research studies and software development.

To achieve the program’s mandate, relationships with other agencies and organizations are vital. The Zika Virus program has partnered with the Center for Disease Control (CDC). This relationship aids in the provision of information on the Zika Virus. In addition, they assist in carrying out research studies in effective infection control. The CDC also provides guidelines and training to health care professionals on how to care for patients exposed to the Zika virus.

The Towson University assists the program by providing graduate assistants who help healthcare professionals to carry out health education, providing primary health care in the community and assist in providing follow up health care to those treated to the virus. The program also collaborates with the public health facilities in the Texan counties to assist in the community outreach programs. These facilities will help sensitize individuals who are pregnant, sexually active or planning to conceive of the symptoms of the Zika virus, how to prevent the infection and spread of the infection. Furthermore, these facilities will provide treatment and post-treatment care to individuals exposed or infected with the Zika virus. To enable this collaboration with public health facilities, the program collaborates with the Texas Department of Health Services. This department will provide recommendations on appropriate individuals to be admitted to the program’s advisory board. In addition, they provide reliable statistical data on Zika virus infection rates in the Texan state (Texas Department of State Health Service, 2017). The state government also provides resources for creating awareness on Zika virus, health promotion and infection prevention. They also provide the capacity for vector control.

An advisory board would help that in overseeing operations within the program. This board establishes regulations and policies that would guide the operations of the program. These policies are determined by the overall goals of the program. In addition, they determine the staff required to run the program effectively. The board comprises of important figures in the community responsible for finances, governance and health care and program directors who are directly involved in the operations and functionality of the program. In essence, the board consists of people who are beneficiaries of the program. The board will be composed of five professionals in the field on health and medical care or business. Three out of five of the professionals will be members of the Texan community. These professionals will be appointed by the state government. A minimum of two members will be licensed physicians. The advisory board members will be appointed for a 3 year term. A public health officer will also assist in the development of operational and health policies.

References

Center for Disease Contol and Prevention. (2017). Zika Virus. Retrieved May 3, 2017, from Center for Disease Control and Prevention: https://www.cdc.gov/zika/transmission/

Center for Disease Control and Prevention. (2017, April 26). Zika Virus . Retrieved May 4, 2017, from Case counts in the US : (https://www.cdc.gov/zika/geo/united-states.html).

Centre for Disease Control and Prevention. (2016, August 1). Zika virus . Retrieved May 3, 2017, from Zika active transmission areas : (https://www.cdc.gov/zika/intheus/florida-update.html)

Milstein, R. L., & Wetterhall, S. F. (2016, September 30). Framework for Program Evaluation in Public Health. Retrieved May 3, 2017, from Center for Disease Control: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm

Phillips, J. L., Rolley, J. X., & Davidson, P. M. (2012). Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies. Nursing Research and Practice .

Texas Department of State Health Service. (2017). Zika in Texas. Retrieved May 3, 2017, from Texas health and Human Services: (http://www.texaszika.org/).

W. K. Kellog Foundation. (2004). W.K. Kellogg Foundation Evaluation Handbook. New York: W. K. Kellog Foundation.

World Health Organization. (2017). Zika virus microcephaly Guillain-barre' syndrome. Situation Report.