IMPROVING QUALITY OF SEXUALLY-TRANSMITTED DISEASE CASE-MANAGEMENT IN RURAL SOUTH-AFRICA

Objective: To measure quality of sexually transmitted disease (STD) sy ndromic case management and aspects of health-seeking behaviour at bas eline in an intervention trial. Setting: Ten rural primary care clinic s, Hlabisa district, South Africa. Design: Simulated patients (fieldwo rkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facili ties were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surv eillance was performed in all 10 clinics. Results: A total of 9% of si mulated patients were correctly managed (given correct drugs, plus con doms and partner notification cards), recommended drug treatment was g iven in only 41% of visits, and appropriate counselling was given in 4 8% of visits. Among patients leaving the clinic, although 39% waited o ver an hour to be seen and only 37% were consulted in private, all rep orted staff attitudes as satisfactory or good. Only six clinics had sy ndromic management protocols available, three reported intermittent dr ug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 wee k of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. Conclusions: Qual ity of STD case management was poor despite good staff knowledge and a vailability of most essential resources. An intervention comprising st aff training and STD syndrome packets has been designed to improve qua lity of case management. (C) 1998 Lippincott Williams & Wilkins.