Abigail Harrison|Salim S. Abdool Karim|Katherine Floyd|Carl Lombard|Mark N. Lurie|Nelly Ntuli|David Wilkinson
Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial
South African Medical Research Council|Liverpool School of Tropical Medicine|South African Medical Research Council
sexually transmitted diseases std important cofactors hiv transmission studied impact health worker training std syndrome packets containing recommended drugs condoms partner notification cards information leaflets quality std case management primary care clinics rural south africaa randomized controlled trial five matched pairs clinics compared intervention routine syndromic management outcomes measured simulated patients using standardized scripts included proportion given recommended drugs correctly case managed given recommended drugs plus condoms partner cards adequately counselled reporting good staff attitude consulted privacyat baseline quality std case management similarly poor groups 36 46 simulated patients visiting intervention control clinics respectively given recommended drugs intervention intervention clinics provided better case management controls 88 versus 50 p 001 received recommended drugs 83 versus 12 p 0005 correctly case managed 68 versus 46 p 006 adequately counselled 84 versus 58 experienced good staff attitude p 007 92 versus 86 p 04 consulted privately syndrome packet cost us150 incremental cost us680 total intervention cost equalled 03 annual district health expenditurea simple affordable health service intervention achieved substantial improvements std case management although critical component std control reduce hiv transmission communitylevel interventions influence healthseeking behaviour also needed