Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda

Abstract

Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment-seeking in low-resource settings is scarce. This study aims to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a population-based survey and STI testing among all consenting adults aged 18–49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment-seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment-seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both men and women, having multiple STI related symptoms was positively associated with clinic treatment seeking (men=PRR: 1.73, 95%CI: 1.36-2.21; women=PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of men and women who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.

Burden and Trends of Symptomatic Sexually Transmitted Infections in Malawi From 2000 to 2021: Comparative Analysis of Survey and Case Report Data

“…This was consistent with previous research that men in SSA prefer private facilities for perceived increased quality of care and privacy, despite higher costs. [18][19][20] Individuals with genital ulcer reported using other means of treatment, such as traditional healers, more often than those with other symptoms. Although the traditional health sector is widely used in Malawi, 21 differences in traditional care seeking by STI symptom have not been previously documented.…”