The quality of care by private practitioners for sexually transmitted diseases in Uganda

One of the limited number of strategies available to reduce the spread of h uman immunodeficiency virus (HIV) infections in sub-Saharan Africa is the e ffective treatment of other, curable, sexually transmitted diseases (STDs). At present, a large proportion of people with STDs either treat themselves at home or seek treatment from private sector practitioners (PSPs) rather than use publicly funded services. A randomized controlled trial of the eff icacy of a behavioural intervention with or without improved STD services i s being carried out in Masaka, a rural area of south-western Uganda. The tr ial involves three groups, each covering six parishes. People living in one group of parishes receive information, education and communication activit ies (IEC) to increase public awareness regarding STDs and HIV/AIDS. The sec ond group receives the same IEC interventions with improved treatment of ST Ds by both public and private service providers. The third group receives c ommunity development activities unrelated to HIV. In order to improve our u nderstanding of how the quality of care provided by PSPs might be ameliorat ed, we interviewed 36 PSPs in the trial area, and made an assessment of the care they were providing. We also carried out six focus group discussions with patients to obtain their opinions on private services. PSPs in the int ervention arm of the trial, who had attended meetings dealing with the synd romic management of STDs, referred to syndromes 82% of the time compared wi th 12% in the control arms, a mean difference of 70% (p < 0.001); stocked l ocally appropriate antibiotics 76% of the time compared with 52%, a mean di fference of 24% (p < 0.001); and are more likely to prescribe appropriate d rugs 82% of the time compared with 27%, a mean difference of 55% (p < 0.001 ). This small study suggests that PSPs can help improve the management of S TDs.