Evaluations of sexually transmitted infection (STI) programmes often ignore the series of hurdles that patients have to overcome before they are cured. So they tend to overestimate cure rates. Research by the London School of Hygiene and Tropical Medicine, the Institute of Tropical Medicine, Antwerp, the National Institute for Medical Research and the African Medical and Research Foundation, Tanzania, attempted a more accurate estimate of STI programme success in Mwanza Region, Tanzania.

STI control programmes aim to reduce the spread of infection by encouraging behaviour change, promoting condom use and detecting and treating STIs. The steps that patients have to go through before they are cured include:

• becoming aware of symptoms
• seeking care from health services
• receiving the correct diagnosis
• getting a prescription for effective treatment
• obtaining the drugs
• completing the full course of therapy.

The researchers estimated the cure rate for the most common bacterial STIs (gonorrhoea, chlamydial infection, syphilis and chancroid) at primary health centres in Mwanza before and after an intervention to improve detection and treatment of STIs. This involved training health staff in the syndromic management of STIs, ensuring a regular supply of efficacious antibiotics and supervising health units.

They found that:

• The proportion of patients with STI symptoms who sought care from health centres rose from 39 percent to 51-72 percent after services were improved.
• After the intervention, about 76 to 85 percent of cases were correctly diagnosed and of these 69 to 80 percent received effective treatment. The estimated efficacy of treatments prescribed before the improvements was 28 percent.
• 84 percent of patients completed their full treatment.
• The estimated overall cure rate at health centres offering improved STI services ranged between 23 and 41 percent. The figure was below ten percent before the intervention.

This study shows that cure rates are generally very poor. Relatively low-tech efforts, such as the one tested here, can have a large impact on STI cure rates and on the incidence of HIV infection. When evaluating the performance of health services in STI control, it is important to consider every step of the process from infection to cure. With this model it is possible to identify bottlenecks and plan for interventions that are likely to have the biggest impact.

Source(s):
'How many patients with a sexually transmitted infection are cured by health services? A study from Mwanza region, Tanzania' by A. Buvé et al., Tropical Medicine and International Health 6 (2001)

Funded by: European Commission; UK Department for International Development; Centre for International Migration and Development, Germany; UK Medical Research Council

id21 Research Highlight: 14 March 2002

Further Information:
Anne Buvé
STD/HIV Research and Intervention Unit
Institute of Tropical Medicine
Nationalestraat 155
2000 Antwerp
Belgium

Tel: +32 3 247 6533
Fax: +32 3 247 6532
Contact the contributor: abuve@itg.be

Institute of Tropical Medicine, Antwerp

Richard Hayes
Infectious Disease Epidemiology Unit
London School of Hygiene & Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7927 2243
Fax: +44 (0)20 7637 4314
Contact the contributor: Richard.Hayes@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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