14th International AIDS Conference Barcelona, Spain - July 7-12, 2002

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no.. TuOrD1154)

Nkatha C, Akach E, Vallely A, Mackay B
Steadman Research, Nairobi, Kenya

BACKGROUND: Many people with STDs seek private treatment. In a DFID-funded project managed by Futures Group, AMREF has trained 600 qualified private providers in syndromic management. Steadman Research was hired to answer questions on what STD patients actually did.

METHODS: A household survey established levels of STDs; a street-and-markets survey found similar levels, but the researchers then went to visit the private providers named by respondents who reported seeking STD care, to establish whether they were trained or untrained. A mystery-shopper survey sent young men and women into medicine shops, half of them saying they had STD symptoms, half with prescriptions.

RESULTS: About 15% of adults report having an STD in the previous 12 months. Of these, 25% did nothing; 10% went directly to a medicine shop; and 65% sought treatment. Of those who sought treatment, 44% went to a government clinic; 39% to an untrained private provider, and only 17% to a trained private provider. Convensience and cost were the main decision factors. Of the 'mystery shoppers' without prescriptions, 1 of 18 males presenting syphilis was given the correct drug; 5 of 27 males presenting gonorrhoea were given the correct drugs. 1 of 11 females presenting syphilis was given the correct drugs. Only 1 out of 20 females presenting gonorrhoea was given the correct drugs. 63% of all prescriptions presented to larger medicine shops were filled (48% in small shops). 21% of mystery clients with a prescription were turned away because the drugs were unavailable. 21% of 107 prescriptions were altered, mainly because the drugs prescribed were unavailable.

CONCLUSIONS: 1. Training 600 private providers was a good start, but to improve coverage either these trained providers must be more actively marketed to STD patients, or training must be extended to unqualified providers. 2. Medicine shop staff are really bad at diagnosing STDs. They should be trained to refer.

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TuOrD1154

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