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Routine HIV testing in the context of syndromic management of sexually transmitted infections: outcomes of the first phase of a training programme in Botswana
  1. M R Weaver1,2,
  2. M Myaya2,
  3. K Disasi3,
  4. M Regoeng4,
  5. H N Matumo4,
  6. M Madisa2,
  7. N Puttkammer1,2,
  8. F Speilberg6,
  9. P H Kilmarx3,5,
  10. J M Marrazzo1
  1. 1
    University of Washington, Seattle, Washington, USA
  2. 2
    International Training and Education Center on HIV (I-TECH), Seattle, Washington, USA
  3. 3
    BOTUSA (United States Centers for Disease Control and Prevention (CDC)/Botswana), Gaborone, Botswana
  4. 4
    Ministry of Health of the Republic of Botswana, Gaborone, Botswana
  5. 5
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
  6. 6
    University of California at San Francisco, San Francisco, California, USA
  1. Dr M R Weaver, Department of Health Services and I-TECH, University of Washington, 901 Boren, Suite 1100, Seattle, WA 98104, USA; mweaver{at}


Objective: In 2004, the Ministry of Health adopted revised protocols for the syndromic management of sexually transmitted infections (STI) that included routine HIV testing. A training programme 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 programme was to test its effect on four measures of clinical practice: (1) routine HIV testing; (2) performance of physical examination; (3) risk-reduction counselling and (4) patient education.

Methods: Clinical practice in a district where providers were trained was compared with 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% versus 29%; p<0.001); (2) conducted a physical examination (98% versus 64%; p<0.001); (3) helped them to make a plan to avoid future STI acquisition (95% versus 76%; p<0.001) and (4) provided patient-specific information about HIV risk (65% versus 32%; p<0.001). Among patients offered HIV testing, the percentage who accepted did not differ between groups (38% of 161 patients of trainees versus 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 multifaceted training programme was associated with higher rates of HIV testing, physical examination, risk-reduction counselling and better HIV risk education.

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  • Funding: The Ministry of Health of Botswana and I-TECH undertook this work with financial and technical assistance from the BOTUSA, which is a partnership between the government of Botswana and the United States Centers for Disease Control and Prevention. I-TECH is funded by the United States Health Resource Services Administration, grant number 5 U69HA00047-04-00.

  • Competing interests: None.

  • Disclaimer: The opinions expressed by the authors contributing to this article do not necessarily reflect the opinions of the United States Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention or the authors’ affiliated institutions. The use of trade names is for identification only and does not imply endorsement by any of the groups named above.

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