Percent of STI patients appropriately diagnosed and treated

Percent of STI patients appropriately diagnosed and treated

Percent of STI patients appropriately diagnosed and treated

The percent of patients with sexually transmitted infections (STIs) at selected health care facilities who are appropriately diagnosed and treated according to national guidelines, of all STI patients at those centers

Evaluators collect data through observing and interview­ing providers at selected health care facilities offering STI care. Providers are assessed on history taking, ex­amination, and treatment of patients. A provider must score positively on all three items in an interaction with a client for that client to enter the numerator of the indi­cator.

Protocol researchers have tried several alternative data collection methodologies. Instead of, or in some cases in addition to, observation and provider interviews, data have also been collected through exit interviews with clients and interactions with “mystery”  clients œ that is, trained assessors posing as clients.

“Appropriate” diagnosis and treatment is assessed ac­cording to national guidelines governing STI services. In developing countries, these guidelines will most com­monly include protocols for the syndromic management of locally common sexually transmitted pathogens, in­cluding treatment with drugs specified in national drug lists. Some countries recognize both syndromic and etio­logical management as appropriate, according to the diagnostic capacity of the service provider. Where na­tional guidelines are unavailable, WHO guidelines on the syndromic management of STIs may be used to guide assessment of appropriate treatment.

This indicator is calculated as:

(Number of patients with STIs who are appropriately diagnosed and treated / Total number of patients with STIs) x 100

Data Requirement(s):

Assessment of an external expert

WHO/UNAIDS revised guidelines on evaluating STI services; MEASURE Service Provision Assessment (SPA)

STI programs are focusing on syndromic management of STIs as the most practical approach in high preva­lence, low resource situations. The shift to syndromic management has increased the potential coverage of care, since such management poses fewer bottlenecks in diagnosis. Training nurses and other health care pro­viders new to the approach and often to STI care in general has required a huge investment.

This indicator reflects the success of that training, com­bined with efforts to ensure adequate supplies of drugs and other necessary materials to care provision points. It tracks changes in the provision of adequate care to patients seeking care for STIs.

Choosing which STI service delivery points to survey is important. Traditionally, this indicator has applied primarily to public sector STI clinics, because most of the early training in syndromic management was of pub­lic sector employees. However, people with STIs often seek treatment in other sectors œ either at private sector clinics, from pharmacies or from traditional healers. Some countries have begun to include these sectors in training programs for syndromic management, and evaluations using this indicator have successfully been carried out in these sectors. Service delivery points sur­veyed should include representative service providers from any sector that has received training in syndromic management of STIs.

This indicator, measured through observation but in­cluding provider interviews in the process of data col­lection for validation purposes, has been widely used and proven feasible. There has been discussion of the extent to which the direct observation and provider in­terview methodologies bias data. It is thought that ser­vice providers perform better under observation than they normally would, or over-report “correct” diagno­sis and treatment, falsely diminishing the gap between knowledge and practice. However, client exit interviews and mystery patient methodologies, as well as proving feasible, have demonstrated that the biases are smaller than was assumed. The gap between knowledge and practice in the area of treatment often shaped results because service providers do not follow “correct” pro­tocols simply because they know drugs are unavailable or unaffordable. We thus recommend that evaluators present this indicator with indicators of drug availabil­ity.

As with all composite indicators, improvements in some areas may mask deterioration in others. If service in one area is poor, the facility will score poorly on the indica­tor, even if service provision in other areas has pro­gressed significantly. Program managers need scores reported separately by area of knowledge and perfor­mance so that they may identify areas of weakness and may improve program performance.

quality, sexually transmitted infection (STI), cervical cancer

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