HIV Key Populations Studies, Kenya Medical Research Institute, , Kilifi, Kenya.
Sex Transm Infect. 2013 Nov;89(7):583-9. doi: 10.1136/sextrans-2012-050979. Epub 2013 May 22.
While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya.
In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines.
Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2-10) at pharmacies, 3 (1-3) at private clinics and 5 (2-17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews.
In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.
虽然细菌性性传播感染（STI）是 HIV 传播的重要因素，但近年来 STI 控制几乎没有得到关注。本研究旨在评估肯尼亚卫生保健提供者的 STI 治疗和 HIV 检测转介实践。
2011 年，我们使用药房模拟就诊和药房及卫生保健机构访谈，评估了肯尼亚沿海地区药房、私人诊所和政府卫生保健机构男性尿道炎病例管理质量。质量使用卫生部指南进行评估。
参与研究的 26 家药房中有 20 家（77%）、22 家私人诊所中有 20 家（91%）和 4 家政府卫生保健机构全部参与。药房每周成人尿道炎病例中位数（IQR）为 5 例（2-10 例），私人诊所为 3 例（1-3 例），政府卫生保健机构为 5 例（2-17 例）。在模拟就诊中，10%的药房按照推荐剂量和疗程开具了推荐的抗生素，在访谈中，28%的药房和 27%的卫生保健机构按照推荐剂量和疗程开具了推荐的抗生素。大多数方案为喹诺酮类。在 10%的模拟就诊、20%的药房访谈和 25%的卫生保健机构访谈中建议进行 HIV 检测。
在 STI 负担较高的地区，大多数尿道炎男性在药房和私人诊所就诊。大多数提供者不遵守国家指南，很少建议进行 HIV 检测。为了减少 STI 负担和减轻 HIV 传播，迫切需要创新传播最新指南，并将所有卫生保健提供者纳入 HIV/STI 规划。
