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Iwuji C, Martin CE, Pillay D, Shamu P, Nzenze S, Murire M, Cox LA, Miners A, Llewellyn C, Mullick S. Implementation preferences for the management of sexually transmitted infections in the South African health system: a discrete choice experiment. Sex Transm Infect 2024; 100:10-16. [PMID: 37918916 PMCID: PMC10850665 DOI: 10.1136/sextrans-2023-055816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES Despite strengthening HIV prevention with the introduction of pre-exposure prophylaxis (PrEP), STI services have remained relatively unchanged and the standard of care remains syndromic management. We used a discrete choice experiment to investigate service users' preferences for the diagnosis and treatment of STIs in South Africa. METHODS Between 1 March 2021 and 20 April 2021, a cross-sectional online questionnaire hosted on REDCap was administered through access links sent to WhatsApp support groups for HIV PrEP users and attendees of two primary healthcare clinics and two mobile facilities in the Eastern Cape and Gauteng provinces aged between 18 and 49 years. Participants either self-completed the questionnaire or received support from a research assistant. We used a conditional logit model for the initial analysis and latent class model (LCM) to establish class memberships, with results displayed as ORs and probabilities. RESULTS We enrolled 496 individuals; the majority were female (69%) and <30 years (74%). The LCM showed two distinct groups. The first group, comprising 68% of the participants, showed a strong preference for self-sampling compared with no sampling (OR 2.16, 95% CI 1.62 to 2.88). A clinic follow-up appointment for treatment was less preferable to same-day treatment (OR 0.78, 95% CI 0.63 to 0.95). Contact slip from index patient (OR 0.86, 95% CI 0.76 to 0.96) and healthcare professional (HCP)-initiated partner notification (OR 0.63, 95% CI 0.55 to 0.73) were both less preferable than expedited partner treatment (EPT). The second group included 32% of participants with a lower preference for self-sampling compared with no sampling (OR 0.65, 95% CI 0.41 to 1.04). There was no treatment option that was significantly different from the others; however, there was a strong preference for HCP-initiated partner notification to EPT (OR 1.53, 95% CI 1.10 to 2.12). CONCLUSIONS Our results suggest that service users preferred STI testing prior to treatment, with the majority preferring self-taken samples and receiving aetiology-based treatment on the same day.
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Affiliation(s)
- Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Africa Health Research Institute, Durban, South Africa
| | - Catherine E Martin
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Diantha Pillay
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Patience Shamu
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Susan Nzenze
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Mercy Murire
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Laura Ashleigh Cox
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Alec Miners
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Carrie Llewellyn
- Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Saiqa Mullick
- Department of Implementation Science, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Dorrell P, Pillay Y, Maithufi R, Pinini Z, Chidarikire T, Stamper N, Frank D, Peters RPH. Impact of the first COVID-19 lockdown on male urethritis syndrome services in South Africa. Sex Transm Infect 2022; 99:200-202. [PMID: 35790390 DOI: 10.1136/sextrans-2022-055483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Globally, there have been significant changes in utilisation of STI testing and treatment services during the period of the COVID-19 pandemic. The impact of COVID-19 in countries that use syndromic STI management is not documented. This study used routine STI surveillance data to evaluate the impact of COVID-19 on utilisation of STI syndromic management services during the first wave of the COVID-19 epidemic in South Africa. METHODS We conducted a time-trend analysis of male urethritis syndrome (MUS) cases reported through routine national STI surveillance in South Africa and COVID-19 data available through the national dashboard. We defined three time periods (prelockdown, lockdown and postlockdown) based on COVID-19 response levels. Trends in MUS reporting was compared between these time periods at national and provincial level and with the number of positive COVID-19 tests in a district. RESULTS An overall reduction of 27% in the national number of MUS cases reported (monthly average from 27 117 to 20 107) occurred between the pre-COVID-19 and COVID-19 lockdown periods (p<0.001), with a range of 18%-39% between the nine provinces. Postlockdown, case numbers returned almost to the prelockdown level (26 304; -3.0%). No significant difference was found in number of MUS cases between the prelockdown and postlockdown periods. A weak correlation (R2=0,21) was identified between the change in number of MUS reported and COVID-19 positive tests in a district. CONCLUSIONS A strong reduction in reported MUS cases for syndromic management was observed during the first wave of the COVID-19 epidemic and lockdown across all provinces in South Africa. This is likely the result of various healthcare system and service delivery factors associated with lockdown measures. The observed return of MUS cases reported to prelockdown measures is reassuring.
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Affiliation(s)
- Philip Dorrell
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Pretoria, South Africa.,Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Derusha Frank
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa .,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
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Garrett NJ, McGrath N, Mindel A. Advancing STI care in low/middle-income countries: has STI syndromic management reached its use-by date? Sex Transm Infect 2016; 93:4-5. [PMID: 27084840 DOI: 10.1136/sextrans-2016-052581] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nigel J Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Nuala McGrath
- Faculty of Medicine and Faculty of Human, Social and Mathematical Sciences, University of Southampton, Southampton, UK.,Africa Centre for Population Health, Somkhele, University of KwaZulu-Natal, Durban, South Africa
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Weaver MR, Pillay E, Jed SL, de Kadt J, Galagan S, Gilvydis J, Marumo E, Mawandia S, Naidoo E, Owens T, Prongay V, O'Malley G. Three methods of delivering clinic-based training on syndromic management of sexually transmitted diseases in South Africa: a pilot study. Sex Transm Infect 2015; 92:135-41. [PMID: 26430128 PMCID: PMC4783332 DOI: 10.1136/sextrans-2015-052107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/12/2015] [Indexed: 01/29/2023] Open
Abstract
Introduction The South African National Department of Health sought to improve syndromic management of sexually transmitted infections (STIs). Continuing medical education on STIs was delivered at primary healthcare (PHC) clinics using one of three training methods: (1) lecture, (2) computer and (3) paper-based. Clinics with training were compared with control clinics. Methods Ten PHC clinics were randomly assigned to control and 10 to each training method arm. Clinicians participated in on-site training on six modules; two per week for three weeks. Each clinic was visited by three or four unannounced standardised patient (SP) actors pre-training and post-training. Male SPs reported symptoms of male urethritis syndrome and female SPs reported symptoms of vaginal discharge syndrome. Quality of healthcare was measured by whether or not clinicians completed five tasks: HIV test, genital exam, correct medications, condoms and partner notification. Results An average of 31% of clinicians from each PHC attended each module. Quality of STI care was low. Pre-training (n=128) clinicians completed an average of 1.63 tasks. Post-training (n=114) they completed 1.73. There was no change in the number of STI tasks completed in the control arm and an 11% increase overall in the training arms relative to the control (ratio of relative risk (RRR)=1.11, 95% CI 0.67 to 1.84). Across training arms, there was a 26% increase (RRR=1.26, 95% CI 0.77 to 2.06) associated with lecture, 17% increase (RRR=1.17, 95% CI 0.59 to 2.28) with paper-based and 13% decrease (RRR=0.87, 95% CI 0.40 to 1.90) with computer arm relative to the control. Conclusions Future interventions should address increasing training attendance and computer-based training effectiveness. Trial registration number AEARCTR-0000668.
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Affiliation(s)
- Marcia R Weaver
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
| | | | - Suzanne L Jed
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
| | | | - Sean Galagan
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
| | - Jennifer Gilvydis
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
| | - Eva Marumo
- STI and HIV Prevention Sub-Directorate, National Department of Health, Pretoria, South Africa
| | | | | | - Tamara Owens
- Clinical Skills and Simulation Center, Howard University College of Medicine, Washington DC, USA
| | - Vickery Prongay
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
| | - Gabrielle O'Malley
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA
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Mugo PM, Duncan S, Mwaniki SW, Thiong'o AN, Gichuru E, Okuku HS, van der Elst EM, Smith AD, Graham SM, Sanders EJ. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention. Sex Transm Infect 2013; 89:583-9. [PMID: 23698510 PMCID: PMC3812900 DOI: 10.1136/sextrans-2012-050979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. Methods In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Results Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2–10) at pharmacies, 3 (1–3) at private clinics and 5 (2–17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. Conclusions In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.
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Affiliation(s)
- Peter M Mugo
- HIV Key Populations Studies, Kenya Medical Research Institute, , Kilifi, Kenya
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