Routine HIV Testing in the Context of Syndromic Management of Sexually Transmitted Infections: Outcomes of the First Phase of a Training Program in Botswana

Abstract

Objective: In 2004, the Ministry of Health adopted revised protocols for syndromic management of sexually transmitted infections (STIs) that included routine HIV testing. A training program for providers was developed on the revised protocols that featured interactive case studies and training videos. An objective of the first phase of the training program was to test its effect on four measures of clinical practice: 1) routine HIV testing, 2) performance of physical examination, 3) risk-reduction counseling, and 4) patient education.

Methods: Clinical practice in a district where providers were trained was compared to a district without training. The measures of clinical practice were reported by 185 patients of providers who had been trained and compared with reports by 124 patients at comparison clinics.

Results: Relative to patients at comparison clinics, a higher percentage of patients of trainees reported that the provider (1) offered an HIV test (87% vs. 29%; P<0.001), (2) conducted a physical examination (98% vs. 64%; P<0.001), (3) helped them to make a plan to avoid future STI acquisition (95% vs. 76%; P<0.001), and (4) provided patient-specific information about HIV risk (65% vs. 32%; P<0.001). Among patients offered HIV testing, the percentage that accepted did not differ between groups (38% of 161 patients of trainees vs. 50% of 36 comparison patients; P=0.260). Overall, 33% of patients of trainees and 14% of comparison patients were tested (P<0.001).

Conclusion: A multi-faceted training program was associated with higher rates of HIV testing, physical examination, risk-reduction counseling, and better HIV risk education.