SYNDROMIC MANAGEMENT

Effectiveness and cost effectiveness of syndromic sexually transmitted infection packages in South African primary care: cluster randomised trial

M Colvin¹, M O Bachmann², R K Homan³, D Nsibande⁴, N M Nkwanyana⁴, C Connolly⁴ and E B Reuben³

¹ Centre for AIDS Development, Research and Evaluation, Durban, South Africa
² School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
³ Family Health International, Durham, NC, USA
⁴ South African Medical Research Council, Durban, South Africa

Correspondence to:
Correspondence to:
M O Bachmann
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR47TJ, UK; m.bachmann{at}uea.ac.uk

Objectives: To evaluate the effectiveness and cost effectiveness of syndromic sexually transmitted infection (STI) packages on appropriate treatment and preventive management during primary care consultations.

Methods: Cluster randomised trial of 37 Durban primary care clinics randomised to use syndromic packages (containing antibiotics, condoms, partner notification cards, and written information) or not. We assessed outcomes using simulated patients who reported STI symptoms and recorded how they were managed, before and after implementation (269 and 256 simulated patient consultations). We adjusted for baseline values and intra-clinic correlation of outcomes statistically. We used health department information to estimate the extra resources needed to provide the packages to 20 clinics for 1 year and their costs.

Results: Simulated patients in intervention clinics were more likely to receive appropriate syndromic STI management (correct treatment plus condoms offered plus partner notification cards offered; prevalence rate ratio 2.3; 95% confidence intervals (CI) 1.6 to 3.0) and to receive more STI advice and information (odds ratio 1.5; 95% CI 1.01 to 2.1). Women were less likely to receive appropriate syndromic STI management. The intervention increased STI information provision in women more than in men. The extra cost per extra patient appropriately managed was $1.51.

Conclusions: Syndromic packages improved syndromic STI management at a reasonable cost and should be used more widely.

Keywords: sexually transmitted infections; syndromic management; primary care; South Africa

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