ASD - PAKISTAN

Sexually transmitted disease case management guidelines in Pakistan

It is estimated that of the 340 million new cases of curable sexually transmitted infections (STI) that occur globally each year, 150 million occur in South Asia and South East Asia alone. STI incidence is unacceptably high as a result of ineffective treatment and limited prevention and care activities. Enhanced risk of HIV transmission associated with STIs, and the emergence of a multi-drug resistance as a public health issue, have led to an even more urgent reappraisal of current STI control. In Pakistan, STIs constitute one of the major public health problems. Several studies found that vaginal discharge (63%) and lower abdominal pain/backache (70%), pelvic (29%) and cervical motion tenderness (18%) are common. Twenty-three percent of injecting drug users are HIV carriers and prevalence of syphilis is common in all groups. Studies also showed high prevalence of other STIs and highlighted poor condom usage. Laboratory analysis shows prevalence of individual infections as Chlamidia trachomatis (7.7%), Gardenella vaginalis (2.02%), syphilis (0.38%) and Trichomonas vaginalis (0.38%).

 

Effective control of STIs is a priority component of the National AIDS Control Programme (NCAP). Currently, private - for profit sector providers are the most common source of treatment for STIs. There has been an increased realisation that the primary health care services are not adequately addressing the problem of STIs in general population. Addressing this issue of delivering quality STI care through public sector facilities is included in the programme priorities at national and provincial levels. In light of national experiences and international recommendations, the programme has recently updated STI/RTI case management technical guidelines, through a nationwide consultative exercise. In past, Nuffield and ASD have worked with the NACP for developing and piloting a set of operational guidelines, training and communication materials, as well as package for managing partners. To operationalise STI/RTI care delivery through public facilities, there is an urgent need to: update the case management operations/guidelines; organise the existing training materials into a participatory learning module; and develop guidelines for implementation planning as well as recording/reporting and monitoring tools and modalities. The study assesses the feasibility and effectiveness of providing syndrome-based STI/RTI care through a network of public sector health facilities. It aims to update the STI/RTI case management desk-guide and communication tools, in light of NACP and WHO technical guidelines. The study will implement and evaluate the guidelines and materials in two districts of Punjab, and disseminate experiences and products to other parts of the country.

 

This prospective study would evaluate the early implementation experiences of updated case management guidelines and training materials for delivery of care. Through a working group approach, the guidelines and training/communication materials would be updated/developed, in light of the National Programme and the WHO Guidelines. In the two study districts trainers from AIDS Control Programme would be involved in training about 70 doctors and 70 paramedics, on updated guidelines and training materials. The training events for doctors and paramedics would be arranged through project resources. In these two districts, medicines, condoms, print materials and other supplies would be managed through combined efforts of the programme and research resources.

 

A mix of qualitative and quantitative methods would be used to evaluate the training events, and assess the feasibility, effectiveness and acceptability if the guidelines and tools for STI/RTI implementation planning, case management and monitoring.