P5-S6.09 Using syndromic management of STI as an entry point to HIV prevention intervention in a resource poor setting
Authors: Bassey V , Eyo A 
Published: July 2011

Issue

Almost all the patients who presents to the hospital with symptoms and/or signs of sexually transmitted infection have been engaged with unprotected sexual intercourse, thus they are predispose to contacting STI including HIV and complications. STIs can increase the risk of HIV acquisition and transmission by a factor of up to 10. The WHO estimates that more than three million new curable STI infections occur annually among people aged 15–49 worldwide. In 1995, over half of female patients seeking treatment for a sexually transmitted infection (STI) tested in 13 states were HIV positive. Among STI patients in 10 states, in 2000, HIV prevalence increased by age, the lowest rate was ages 10–19, and the highest among those ages 50+. Akwa Ibom State has one of the highest rates among selected states for 2000 with 21% of STI patients tested HIV positive In 2008, Akwa Ibom and Cross River States had the highest rate of HIV infection in the South South Zone at 9.7% and 6% respectively. The health seeking behaviour of the poor at public health facilities is influenced by cost, the fear that services are not going to be confidential and the fear of meeting people they know at the healthcare facility. Thus this sexual risky population often do not always access care, thus contributing to the underserved most at risk population in the community.

Method

ECEWS implemented Condom and Other Prevention using the combination prevention among the probable STI patients in rural health facility and missionary health centres in Akwa Ibom and Cross River state using STI counselling, ABC messages, risk reduction, condom promotion, HTC referral, syndromic diagnosis and treatment of STI. Drugs were provided and dispensed free according to the syndromic management guidelines of WHO/FMOH. Preceding this, communities were mapped as areas of high sexual activity and STI prevalence. The CHEW, nurses and doctors in those facilities were selected and trained as health educators to reach this people with HIV prevention messages and syndromic management of STI.

Result

13 401 probable STI patients were reached with risk reduction counselling for HIV, condom promotion and STI management by 35 ECEWS trained health educators across primary health centres, missionary hospitals and other rural health post across 20 sites in Akwa Ibom and Cross River states. The strengthened referral system enable majority (88%) of the client to access HTC with little or no challenge. A HIV positivity rate of 12% was observed among this population.

Conclusion

Using syndromic management as an entry point, poor and most at risk individual in poor rural settings easily accessed effective of HIV prevention messages, counselling, and treatment of STI and behavioural plan towards sexual prevention of HIV. Therefore, syndromic management of STI provides cure and ample opportunity as entry point to reach this MARP in a resource poor setting where laboratory investigation is not easily accessible in intervention of sexual prevention of HIV/AIDS.