Surveys or reviews of client records from primary health care sites provided by supervisors or evaluators on types of comprehensive STI care services provided.  It is recommended that data are collected using a census-based approach (i.e., from all primary care sites in the target area).  For validation purposes, the data collector may choose to conduct brief follow-up interviews with a subset of clients.  Where the data are available, the indicator can be disaggregated by province and district, urban/rural location, type of facility (public, private, community-based), and client characteristics (sex, age group, most-at-risk populations).

Data Source(s):

Client records, surveys, and interviews from primary care sites, staff, and clients.

Purpose:

This indicator measures the coverage and components of care provided by primary health facilities delivering recommended STI diagnostic testing, treatment, and related services. These facilities can serve as points of entry for persons in need of STI, HIV/AIDS, and other reproductive health care services and trends in STI care delivery can inform planning, commodities and logistics for diagnostic testing, medications, condoms and other preventive supplies, as well as, staffing needs and training. STIs other than HIV are responsible for a large global burden of morbidity and mortality, both directly through their impact on general health and quality of life, reproductive health and child health and through their role in facilitating the transmission of HIV. Improved comprehensive case management of STIs is one of the interventions proven to be a feasible and cost-effective approach to reduce the incidence of HIV in the general population (WHO, 2007).  The U.N. Declaration of Commitment on HIV/AIDS specifies control of STIs as a primary HIV prevention strategy (UNGASS, 2001). Treatment and reduction of STIs are related to achieving Millennium Development goals # 6 to combat HIV/AIDS, #5 to improve maternal health and #4 to reduce infant mortality.

Issue(s):

While the indicator measures coverage of comprehensive STI care, it does not evaluate the quality and outcomes of the care. Lack of accuracy and quality control in record keeping at primary care sites can impact the validity of this indicator. While focusing on primary care facilities provides useful information on a main point of entry to health care, in many settings, people with STIs seek medications directly from pharmacies and the informal private sector, often without diagnosis, follow-up care, or preventive counseling and supplies. In order to promote utilization of primary care facilities, especially by most-at-risk subpopulations, public and private primary care providers need to take into account the health seeking behaviors and preferences of the different subpopulations. Particular attention should be given to gender equity, adolescents, low-income and marginalized groups, in addition to ease of access, scheduling, and privacy (WHO, 2007).

Gender Implications:

Women’s access to and utilization of primary care STI treatment services may be limited by cultural gender norms that affect women’s mobility, exposure to media and STI treatment information, women’s resources for health care services, as well as, the possible stigma associated with STI treatment.  STI services that require partner notification may be putting women’s safety and livelihoods at risk. The UNAIDS (2010) agenda for women, girls, and gender equality calls for national AIDS authorities and ministries of health to incorporate gender equality into policies STIs and HIV for the achievement of universal access to prevention, treatment, care and support for women.

References:

CDC, 2010, Sexually Transmitted Diseases Treatment Guidelines, 2010, MMWR, Dec. 17, 2010/Vol. 59/No. RR-12, Atlanta, GA: CDC. https://www.cdc.gov/mmwr/pdf/rr/rr5912.pdf