Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa

Ham, D. Cal; Hariri, Susan; Kamb, Mary L.; Mark, Jennifer; Forhan, Sara E.; Likibi, Mupatal; Lewis, David A.

doi:10.1097/olq.0000000000000383

Cited by 13 publications

(18 citation statements)

References 20 publications

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“…This aligns with our experience in two previous studies from rural South Africa where, despite recruiting women regardless of the presence of symptoms, a relatively large proportion of women reported STI-associated symptoms upon recruitment [9,10]. Various factors may prevent symptomatic individuals from seeking health care: a lack of knowledge and awareness of sexual health and stigmatised ideas about STIs among patients and healthcare workers [11], poor effectiveness of the syndromic approach [12], lack of partner notification and subsequent reinfection [13] and rising resistance rates of N. gonorrhoeae and M. genitalium resulting in disappointment due to ineffectiveness of initial treatment [4,14].…”

Section: Introductionsupporting

confidence: 88%

“…Also, perceptions, beliefs and stigma related to sexual health contribute to the burden of untreated STIs. Community education and disclosure support are needed to (15) raise community awareness, tackle common myths and alter attitudes towards sexual health [11,24]. Sexuality education for healthcare workers should address recognition of STIs, possible (non-sexually transmitted) causes, complications if left untreated and opportunities for treatment including the role of partner notification.…”

Section: Discussionmentioning

confidence: 99%

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Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

Hoffman

Fritz

Matlakala

et al. 2019

Tropical Med Int Health

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objectives To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa.methods Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility.results We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30 days; 49% (87/177) had symptoms >6 months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care.conclusions We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population.keywords unmet need, sexually transmitted infections, community-based strategies, primary health care Tropical Medicine and International Health

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Section: Introductionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

Hoffman

Fritz

Matlakala

et al. 2019

Tropical Med Int Health

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“…Other studies suggest knowledge of correct regimens is a problem. In the 2002 survey, 41% of providers reported knowledge of correct syndromic treatment,11 and in a 2009 study, 40% of public health providers correctly identified the recommended first-line or alternative treatment regimens for MUS and 6% for VDS 16. A more recent study found 31% of providers post training prescribed the correct syndromic regimen to patient actors, however was more conservative in including errors in dose or frequency as well as drug name 25.…”

Section: Discussionmentioning

confidence: 99%

“…Missed opportunities for referral and integration with other HIV services,13 and concerns about provider attitudes towards clients with or at risk for STIs, have been described 11 14. Previous studies of public health facilities and providers in South Africa have demonstrated stockouts, lack of provider knowledge and limited referral processes 11–13 15 16…”

Section: Introductionmentioning

confidence: 99%

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

et al. 2017

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This evaluation of STI services across South Africa found gaps in the availability of medications, adherence to STI guidelines, condom provision and prevention messaging. Limited integration with HIV services for this high-risk population was a missed opportunity. Quality of STI care should continue to be monitored, and interventions to improve quality should be prioritised as part of national strategic HIV and primary healthcare agendas.

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“…2 Many studies have demonstrated the positive impact of SM on the incidence of STIs and HIV in a given population, but the knowledge of the SM guidelines amongst doctors is suboptimal, especially amongst those without formal STI training. 10 There is also evidence that doctors do not always adhere to national treatment guidelines. 11 This study sought to determine the knowledge, attitudes and practices of doctors regarding syndromic STI management guidelines at Jubilee Hospital.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections

Uchenna

Govender

2018

South African Family Practice

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Background: Sexually transmitted infections (STIs) are a public health problem globally, but especially so in sub-Saharan Africa. They contribute significantly to the burden of disease in South Africa and are recognised as major contributors to the human immunodeficiency virus (HIV) epidemic, with other potential complications when not managed properly. First-line doctors play a critical role in the management of persons suffering from STIs, and need to comply with the national guidelines for STI management. Aim: To determine the knowledge, attitudes and practices of doctors working in Jubilee District Hospital, Metsweding region, Tshwane, regarding the STI syndromic management (SM) guidelines. Setting: Jubilee District Hospital in Tshwane North, Gauteng province, South Africa. Methods: A cross-sectional, descriptive study using a self-administered questionnaire was conducted. Results: Forty-three of the 50 doctors employed at the hospital participated in the study. Fourteen (32.6%) of the doctors were in the 36-40-year age group. Most of the doctors (36 or 83.7%) had only the basic bachelor's degree, and only 4 (9.3%) attended additional STI training. Only 2 respondents (4.6%) had correct knowledge concerning management of male urethritis syndrome and 10 (23.3%) regarding management of genital ulcer syndrome. In compliance with the national SM guidelines for STIs, 22 (52.4%) of the doctors said they made a diagnosis of STIs using history and physical examination. Only 7 (16.7%) said they asked their patients during every consultation about the number of sexual partners, 21 (51.7%) said they always counsel/ screen patients with STIs for HIV infection, and only 4 (9.5%) said they always filled in partner notification slips after attending to the index patient with STIs. This study demonstrated a relationship between doctors' knowledge of the SM guidelines for STIs and their age. Conclusion: Overall the knowledge and practices of doctors at Jubilee District Hospital were suboptimal, and training on the SM of STIs should be made available to address this. Management should introduce regular monitoring, evaluation and supportive services for the doctors regarding their management of STIs according to the guidelines.

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Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa

Abstract: Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.

Cited by 13 publications

References 20 publications

Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

Community‐based strategies to identify the unmet need for care of individuals with sexually transmitted infection‐associated symptoms in rural South Africa

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections

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