Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa
Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa
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 KwaZulu-Natal, 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 antenatal, family planning and child immunisation clinics in rural northern KwaZulu-Natal 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 to 17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (95% CI 17.3 to 33.8%), 47.6% (95% CI 44.5 to 50.8%) or 14.3% (95% CI 9.9 to 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 herpes simplex virus (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 KwaZulu-Natal 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.
528-534
White, R.G.
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Moodley, P.
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McGrath, N.
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Hosegood, V.
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Zaba, B.
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Herbst, K.
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Newell, M.
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Sturm, W.A.
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Hayes, R.J.
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22 July 2008
White, R.G.
d67216d7-2691-4322-9dac-56b96add39e1
Moodley, P.
9cb2dc9c-2dcf-4743-b259-ea6d02a39ff8
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Hosegood, V.
c59a89d5-5edc-42dd-b282-f44458fd2993
Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043
Herbst, K.
2f558167-fbfc-478f-9170-f632d1bcfa9b
Newell, M.
fced7ba6-4d11-463f-8285-99fd50a9d001
Sturm, W.A.
b3b2e793-f6a7-4ae4-8393-e43f0614829b
Hayes, R.J.
cab45e0b-a296-4bf8-b50c-8507e329dac4
White, R.G., Moodley, P., McGrath, N., Hosegood, V., Zaba, B., Herbst, K., Newell, M., Sturm, W.A. and Hayes, R.J.
(2008)
Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa.
Sexually Transmitted Infections, 84 (7), .
(doi:10.1136/sti.2008.032011).
(PMID:18708485)
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 KwaZulu-Natal, 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 antenatal, family planning and child immunisation clinics in rural northern KwaZulu-Natal 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 to 17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (95% CI 17.3 to 33.8%), 47.6% (95% CI 44.5 to 50.8%) or 14.3% (95% CI 9.9 to 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 herpes simplex virus (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 KwaZulu-Natal 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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Published date: 22 July 2008
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Local EPrints ID: 184651
URI: http://eprints.soton.ac.uk/id/eprint/184651
ISSN: 1368-4973
PURE UUID: 4ac06ec0-dab9-48b4-b74f-6c47f8199617
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Date deposited: 06 May 2011 10:12
Last modified: 15 Mar 2024 03:46
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Author:
R.G. White
Author:
P. Moodley
Author:
B. Zaba
Author:
K. Herbst
Author:
M. Newell
Author:
W.A. Sturm
Author:
R.J. Hayes
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