Routine HIV testing in the context of syndromic management of sexually transmitted infections: outcomes of the first phase of a training programme in Botswana

Abstract

Objective:In 2004, the Ministry of Health adopted revised protocols for the syndromic management of sexually transmitted infections (STI) that included routine HIV testing. A training programme for providers was developed on the revised protocols that featured interactive case studies and training videos. An objective of the first phase of the training programme was to test its effect on four measures of clinical practice: (1) routine HIV testing; (2) performance of physical examination; (3) risk-reduction counselling and (4) patient education.Methods:Clinical practice in a district where providers were trained was compared with a district without training. The measures of clinical practice were reported by 185 patients of providers who had been trained and compared with reports by 124 patients at comparison clinics.Results:Relative to patients at comparison clinics, a higher percentage of patients of trainees reported that the provider: (1) offered an HIV test (87% versus 29%; p<0.001); (2) conducted a physical examination (98% versus 64%; p<0.001); (3) helped them to make a plan to avoid future STI acquisition (95% versus 76%; p<0.001) and (4) provided patient-specific information about HIV risk (65% versus 32%; p<0.001). Among patients offered HIV testing, the percentage who accepted did not differ between groups (38% of 161 patients of trainees versus 50% of 36 comparison patients; p = 0.260). Overall, 33% of patients of trainees and 14% of comparison patients were tested (p<0.001).Conclusion:A multifaceted training programme was associated with higher rates of HIV testing, physical examination, risk-reduction counselling and better HIV risk education.

The impact of provider-initiated (opt-out) HIV testing and counseling of patients with sexually transmitted infection in Cape Town, South Africa: a controlled trial

“…The absolute increase in HIV testing rate of nearly 14% is smaller than the difference of 20% anticipated prior to the study, though it is similar to increases reported in prior studies in South Africa (13% increase for TB patients) [16] and Botswana (19% increase for STI patients) [27]. This study may have underestimated the impact of the PITC intervention as two practice shifts could have narrowed the difference between control and intervention clinic outcomes in the study setting.…”

“…The evidence for PITC with STI patients is limited to a few quasi-experimental studies in the UK and the Netherlands [ 20 , 21 , 25 , 26 ], and one controlled trial in Sub-Saharan Africa [ 27 ]. The European trials report significant increases in HIV testing for STI patients, although a recent UK study with low-risk STI patients showed that there was a significant increase in the offer of testing, not in the proportion of patients who accepted testing [ 28 ].…”

“…The European trials report significant increases in HIV testing for STI patients, although a recent UK study with low-risk STI patients showed that there was a significant increase in the offer of testing, not in the proportion of patients who accepted testing [ 28 ]. The one Sub-Saharan African PITC study with STI patients was a controlled trial in Botswana that showed a significant increase in HIV testing for STI patients (33% in intervention clinics as compared to 14% in control clinics, p < 0.001) [ 27 ]. However, PITC was one of four clinical interventions that made up the training intervention in this study, making it difficult to isolate the impact of PITC alone.…”

Advancing the health of women and newborns: predictors of patient satisfaction among women attending antenatal and maternity care in rural Rwanda

“…Patient satisfaction is increasingly recognized as an essential component of evaluating health systems in developing countries [26]. While a few studies have found significant effects of health interventions in Africa on improving patient satisfaction [27][28][29][30], patient satisfaction is still infrequently measured in assessing the success of health interventions in resource-limited settings. This study demonstrates both the feasibility and utility of measuring patient satisfaction as a critical component of QI initiatives.…”

Three methods of delivering clinic-based training on syndromic management of sexually transmitted diseases in South Africa: a pilot study

“…Several articles have reported on the effectiveness of classroom-based STI syndromic management training, 9 14 15 but less is known about the effectiveness of clinic-based programmes. In general, evidence shows that online learning is as effective as classroom methods.…”