Transcript policies and principles of STI prevention and care

Control & prevention
OF
S.T.I.
ALI ASGHAR FARAZI
MD . MPH .
Global Estimates of curable STDs
New cases

Syphilis
12 M

Gonorrhea
62 M

Chlamydia
92 M

Trichomoniasis
174 M

Sexually Transmitted Infections

Caused by more than 20 micro organisms (some
bacterial other viral)

Most present as:
– Urethral discharge
– Genital ulcers
– Vaginal discharge
– Swollen glands
Sexually Transmitted Infections
a public health concern

Considerable morbidity

High incidence and prevalence

High rate of complications

Bigger problem in women and young people

Facilitate HIV transmission
Failure to control STIs

Low priority by policy-makers and planners
in allocating resources

reasons of perceived discreditable behaviour

failure to appreciate consequences of STIs

failure to recognise the magnitude of the problem
Failure to control STIs (cont’d)

Control efforts mainly on symptomatic patients,
usually men

Service delivery through specialised clinics only,
or predominantly

Treatment strategies focused on definitive diagnosis
rather than on practical decision making
Failure to control STIs (cont’d)

Ineffective low-cost antibiotics continue to be used
for reasons of economy

Little emphasis on educational and other efforts
to prevent infection

Lack of guidance on a rational, practical package
of activities to pursue
Main aims of STI control
1.
To prevent the development of
diseases, complications and sequelae
2.
To interrupt the transmission of
sexually acquired infections
3.
To reduce the risk of HIV infection

Primary prevention: safer sexual behaviors and the use
of condom, improving health seeking behaviors, voluntary
counseling and testing, hotlines, condoms availability and
accessibility.

Secondary prevention: early diagnosis and provision of
care in accessible, effective and acceptable clinics. In low
HIV prevalence situations, STD control is relevant for HIV
control and need to be integrated in primary services.
1. Prevention

Take note of social and cultural determinants

Promote safer sexual behaviour (abstinence,
delayed sexual debut, etc.)

Promote use of condoms
Prevention education and information

STIs are avoidable, treatable and curable

Early treatment is essential

Information about asymptomatic nature of
infection in some cases

Description of recognisable signs and
symptoms
Prevention education and information

Information on where STI services are
provided

Assurance that privacy, confidentiality and
respect are guaranteed

Advice on assessing one’s personal risk of
infection
STI counselling
Identification of issues causing stress or anxiety
Telling
the partner or spouse about the STI
diagnosis
Learning
about, and coming to terms with, worrying
complications, e.g. infertility
Explore
issues of coping with chronic/incurable
infections: (HIV, Herpes, Genital Warts)
STI counselling
Identification of issues causing stress or anxiety
Sense
of guilt or blame: passing on infection to child,
partner etc.
Symptoms
suggestive of HIV infection
Assessment
of individual risk for HIV, and decision to
be screened for HIV
Reinforcement
choices
of patient’s positive decisions and
2. STI care services
Access to STI services

The public sector
–
–
–
–
Primary health care clinics (first-level care)
OPD of hospitals
Reproductive health clinics
Specialised STI clinics
STI care services
Access to STI services

The private sector
–
–
–
–
–
Private physician providing first-level care
Workplace clinics
Pharmacists (differs from country to country)
Private STI clinics
OPD of private hospitals
STI care services
Access to STI services

The informal sector
–
–
–
Traditional healers
Vendors of antibiotics
Others
3. Effective STI care

High quality at first point of contact with
a patient with STI
–
–
–
trained health workers
consistent availability of appropriate drugs
consistent supplies of condoms
3. Effective STI care

Acceptability of STI care
–
–
–
–
–
Convenient opening hours
Non-judgmental staff attitudes
Appropriate staff communication skills
Affordable user fees
Confidentiality and privacy
Partner notification
Approaches to Partner Notification

Patient referral
–
–

patient given responsibility after adequate health education
appropriate community education essential
Provider referral
–
–
health staff contact the partners
considerable human and economic resources required
Partner notification (cont’d)

Treat all sexual partners (c. 3
months)

Treat partners for the same STI
plus any additional ones found
Additional activities
for STI prevention and care

Promote appropriate health care-seeking behaviour

Targeting of services
– sex workers
– young people (10-24 years) in and out of school
– long distance truck drivers
– others
STI transmission dynamics at population level
General population
Bridging population
High frequency
transmitters
Additional activities for
STI prevention and care (cont’d)

Case finding
–

individuals seeking non-STI health care
• Maternal and child heath services
• family planning services
• Antenatal and maternity clinics
Screening
–
testing for STI in individuals not seeking any health
care (due regard to confidentiality and human rights)
Policy to integrate services

In practical terms integration of health services is
defined as:
bringing together common functions within and between
organisations in order to:
–
solve common problems
–
develop a commitment to shared vision & goals
use common technologies and resources to achieve
these goals
–
Integration process

Start from existing primary health care structures

Make the STI package simple and easy to incorporate
into the clinic routine

First integrate the STI prevention and care package,
then the other components

Ensure staff involvement to minimise resistance to
work overload
Strategic areas of action: Summary

Prevention education and information to prevent STI
acquisition

Improve access to STI services at all levels and outlets of
health care delivery

Improve quality STI care

Promote early health care seeking behaviour

Promote effective partner notification and management
Strategic areas of action: Summary

Pursue a policy of integrated services

Explore mechanisms that provide for targeted services
for youth, sex workers and other such population groups

Explore strategies for case finding and screening for STI,
especially in women and adolescent males and females
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