IMPROVING SEXUALLY-TRANSMITTED DISEASE MANAGEMENT IN THE PRIVATE-SECTOR - THE JAMAICA EXPERIENCE

Objectives: To improve the quality of sexually transmitted disease (ST D) case management in Jamaica by providing comprehensive continuing me dical education to private practitioners who manage 60% of all STDs on the island. Methods: Six half-day STD seminars were presented at 3-4- month intervals and repealed in three separate geographic locations. A ll Jamaican practitioners received invitations. The subjects were as f ollows: urethritis, genital ulcer disease, HIV infection, vaginal disc harge syndrome, STDs in children and adolescents, and a review seminar . The program effectiveness was evaluated with a written, self-reporte d pre-test and a telephone post-test that measured changes in clinical management. Results: Six hundred and twenty eight practitioners atten ded at least one seminar. Comparing pre- Versus post-test scores, ther e were practitioner improvement trends in all four of the general STD management categories: counseling/education (69.8-73.3%; P> 0.05); dia gnostics/screening (57.2-71.0%; P = 0.042); treatment (68.3-74.5%; P > 0.05); and knowledge (66.4-83.2%; P = 0.002). Obtaining syphilis sero logies during pregnancy rose from 38.3 to 83.8% (P = 0.001), and provi ding effective treatment for gonorrhea rose from 57.8 to 81.1% (P = 0. 002), but correct responses on treatment for mucopurulent cervicitis a t the post-test was a low 32.4%. Conclusion: The introduction of conti nuing medical education for improved STD care targeting private physic ians in Jamaica was successful based on high attendance rates and self -reported STD management practices. However, efforts should continue t o address the weaknesses found in STD management and counseling and to reach the providers who did not participate. In the global effort to reduce HIV transmission by improving STD care services, continuing edu cation programs that target the private sector can be successful and s hould be included as a standard activity to improve care and provide a public/private link to STD/HIV control. (C) 1998 Lippincott Williams & Wilkins.