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Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa
  1. Richard G White (richard.white{at}lshtm.ac.uk)
  1. London School of Hygiene and Tropical Medicine, United Kingdom
    1. Prashini Moodley (moodleyp{at}ukzn.ac.za)
    1. Department of Medical Microbiology, Nelson R. Mandela School of Medicine, University of KwaZuluNatal, South Africa
      1. Nuala McGrath (nuala.mcgrath{at}lshtm.ac.uk)
      1. Africa Centre for Health and Population Studies, South Africa
        1. Vicky Hosegood (vicky.hosegood{at}lshtm.ac.uk)
        1. Africa Centre for Health and Population Studies, South Africa
          1. Basia Zaba (basia.zaba{at}lshtm.ac.uk)
          1. London School of Hygiene & Tropical Medicine, United Kingdom
            1. Kobus Herbst (kherbst{at}africacentre.ac.za)
            1. Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Afric, South Africa
              1. Marie-Louise Newell (mnewell{at}africacentre.ac.za)
              1. Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Afric, South Africa
                1. A W Sturm (sturm{at}ukzn.ac.za)
                1. Nelson R. Mandela School of Medicine, South Africa
                  1. Richard J Hayes (richard.hayes{at}lshtm.ac.uk)
                  1. LSHTM, United Kingdom

                    Abstract

                    Objectives: Syndromic sexually-transmitted infection (STI) treatment remains a cost-saving HIV prevention intervention in many countries in Africa. We estimate the effectiveness of syndromic treatment for curable STIs in rural KwaZuluNatal, South Africa and the trend in STI prevalences before and after the introduction of syndromic treatment in 1995.

                    Methods: Data were available from various clinical studies, surveys of public and private health providers, the general-population and women attending ante-natal, family planning and child-immunisation clinics in rural northern KwaZuluNatal between 1987 and 2004. Overall effectiveness was defined as the estimated proportion of the annual number of symptomatic curable STI episodes cured by syndromic treatment, based on separate estimates for six curable STI aetiologies by gender.

                    Results: Median overall effectiveness was 13.1% (95%CI 8.9-17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (17.3-33.8%), 47.6% (44.5-50.8%), or 14.3% (9.9-19.4%) if 100% treatment-seeking, 100% correct treatment-provision or 100% cure were assumed, respectively. Time-trends were difficult to assess formally but there was little evidence of decreasing STI prevalences. Including incurable, but treatable HSV-2 ulcers in the effectiveness calculation would halve the proportion of ulcers cured or correctly treated, but this reduction could be entirely countered by including episodic antiviral-treatment in the national guidelines.

                    Conclusion: Overall effectiveness of syndromic treatment for curable STIs in rural KwaZuluNatal remains low, and there is little evidence of reduced curable STI prevalences. As syndromic treatment is likely to be a cost-saving HIV prevention intervention in South Africa, innovative strategies are urgently needed to increase rates of treatment-seeking and correct-treatment provision.

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