Walker D, Muyinda H, Foster S, Kengeya-Kayondo J, Whitworth J
Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Health Policy Plan. 2001 Mar;16(1):35-40. doi: 10.1093/heapol/16.1.35.
One of the limited number of strategies available to reduce the spread of human immunodeficiency virus (HIV) infections in sub-Saharan Africa is the effective treatment of other, curable, sexually transmitted diseases (STDs). At present, a large proportion of people with STDs either treat themselves at home or seek treatment from private sector practitioners (PSPs) rather than use publicly funded services. A randomized controlled trial of the efficacy of a behavioural intervention with or without improved STD services is being carried out in Masaka, a rural area of south-western Uganda. The trial involves three groups, each covering six parishes. People living in one group of parishes receive information, education and communication activities (IEC) to increase public awareness regarding STDs and HIV/AIDS. The second group receives the same IEC interventions with improved treatment of STDs by both public and private service providers. The third group receives community development activities unrelated to HIV. In order to improve our understanding of how the quality of care provided by PSPs might be ameliorated, we interviewed 36 PSPs in the trial area, and made an assessment of the care they were providing. We also carried out six focus group discussions with patients to obtain their opinions on private services. PSPs in the intervention arm of the trial, who had attended meetings dealing with the syndromic management of STDs, referred to syndromes 82% of the time compared with 12% in the control arms, a mean difference of 70% (p < 0.001); stocked locally appropriate antibiotics 76% of the time compared with 52%, a mean difference of 24% (p < 0.001); and are more likely to prescribe appropriate drugs 82% of the time compared with 27%, a mean difference of 55% (p < 0.001). This small study suggests that PSPs can help improve the management of STDs.
在撒哈拉以南非洲地区，可用于减少人类免疫缺陷病毒（HIV）感染传播的策略数量有限，其中之一是有效治疗其他可治愈的性传播疾病（STD）。目前，很大一部分性病患者要么在家自行治疗，要么寻求私营部门从业者（PSP）的治疗，而不是使用公共资助的服务。在乌干达西南部的农村地区马萨卡，正在进行一项关于行为干预与改善性病服务与否的疗效的随机对照试验。该试验涉及三个组，每个组覆盖六个教区。居住在一组教区的人们接受信息、教育和宣传活动（IEC），以提高公众对性病和艾滋病毒/艾滋病的认识。第二组接受相同的IEC干预，同时公共和私营服务提供者改善了性病治疗。第三组接受与艾滋病毒无关的社区发展活动。为了更好地了解如何改善PSP提供的护理质量，我们采访了试验地区的36名PSP，并对他们提供的护理进行了评估。我们还与患者进行了六次焦点小组讨论，以获取他们对私人服务的意见。试验干预组中参加过性病综合征管理会议的PSP，82%的时间提及综合征，而对照组为12%，平均差异为70%（p<0.001）；76%的时间储备当地适用的抗生素，而对照组为52%，平均差异为24%（p<0.001）；82%的时间更有可能开出适当的药物，而对照组为27%，平均差异为55%（p<0.001）。这项小型研究表明，PSP有助于改善性病的管理。
