O5-S2.04 Evaluation of sexually transmitted infection clinical services in Gauteng Province, South Africa: knowledge, attitudes, and beliefs among health care providers
Authors: Mark J , Hariri S , Ilunga R , Forhan S , Likibi M , Kamb M L , Lewis D 
Published: July 2011

Background

The STI clinical encounter is an opportunity to identify and prevent new HIV as well as STI infections. We sought to evaluate the STI clinical encounter among public and private clinicians in South Africa to determine opportunities for improved prevention services.

Methods

From November 2008 to March 2009, we studied the knowledge, beliefs, and attitudes of STI health care providers in rural and urban facilities in Gauteng Province. We selected public and private health facilities reporting >100 patients annually, stratifying among 6 municipalities. We interviewed managers from eligible clinics and all eligible staff to participate in self-administered, computer-assisted surveys. We used STATA 9 for univariate, stratified analysis by χ2and Fisher's exact test.

Results

Of 641 eligible clinicians, 613 (96%) completed the survey, including 100% of public and 65% of private providers. Most clinicians were nurses (91%), female (89%), from public clinics (92%), and had formal STI (87%) or HIV (96%) training within 10 years. The median number of STI patients seen daily was 6 and most providers were experienced in STI care (median 9.5 years), although more so in private clinics (11.7 years). Most clinicians recognised most of the common syndromes and correctly identified treatment options, particularly for bacterial genital ulcer syndrome. Most (94%) understood genital herpes recurs, but only 85% agreed herpes could be treated. Nonetheless, misperceptions were common: less than half (48%) agreed with the statement that some STIs cannot be cured with medication,” only 5% disagreed that “herpes is curable,” 34% agreed “untreated STIs develop into AIDS,” and 33% agreed that “HIV medications were more dangerous than having AIDS.” STI or HIV training was either unrelated or inversely related to these misperceptions. While most providers (95%) felt offering HIV testing to STI patients was one of their most important responsibilities, many (27%) believed it permissible to test patients for HIV without consent. Clinicians reporting having STI or HIV training were more likely to agree with HIV testing without consent (30% vs 17%, p=0.001) see Abstract O5-S2.04 table 1.

Abstract O5-S2.04 Table 1

Sexually transmitted infections provider knowledge, beliefs and attitudes in Gauteng, South Africa, 2008–2009

N=611AgreeDisagreeDo Not Know%n%n%nKnowledge Some STIs cannot be cured with medication48.129445.72796.238 Genital herpes often recurs93.15693.8233.119 Genital Herpes often causes urethral discharge in men25.715787.437712.677 Genital herpes is curable42.22584.832453.029 Genital Herpes sores can be treated with medication(s)84.951910.0615.131 Untreated STIs can develop into AIDS33.920760.63705.634 Many patients with STIs already have HIV or AIDS42.425952.23195.433Beliefs I think one of my most important responsibilities is to strongly recommend HIV testing to each of my STI patients93.65725.1311.38 I think traditional herbal medicine is able to cure some STIs16.29981.04952.817 I think traditional herbal medicine is able to cure HIV/AIDS1.5979.748718.8115 In the long run, some HIV medication(s) can be more dangerous than having AIDS31.119065.13983.823Attitudes Under certain circumstances, it is OK to test patients for HIV without telling them26.015971.84392.113

Conclusions

Most clinicians understood STI syndromic treatment, however many misunderstood important aspects of HIV/STI clinical care and their implications for prevention. Brief refresher courses on specific aspects of treatment and prevention may benefit HIV/STI clinical care and prevention in Gauteng.