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Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa

Record type: Article

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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Citation

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), pp. 528-534. (doi:10.1136/sti.2008.032011). (PMID:18708485).

More information

Published date: 22 July 2008

Identifiers

Local EPrints ID: 184651
URI: http://eprints.soton.ac.uk/id/eprint/184651
ISSN: 1368-4973
PURE UUID: 4ac06ec0-dab9-48b4-b74f-6c47f8199617
ORCID for V. Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

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Date deposited: 06 May 2011 10:12
Last modified: 18 Jul 2017 11:51

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Contributors

Author: R.G. White
Author: P. Moodley
Author: N. McGrath
Author: V. Hosegood ORCID iD
Author: B. Zaba
Author: K. Herbst
Author: M. Newell
Author: W.A. Sturm
Author: R.J. Hayes

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