Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

640 Abstracts 33238-33241

12th World AIDS Conference

prevention counseling and education along with family planning (FP) and maternal-child health (MCH) services in its Chitwan branch since January 1996.
Prevention of STDs has also been integrated into the works of the clinics' outreach staff and volunteers, who distribute condoms, talk to community members
about STDs, and refer people to the clinic for STD services. Later, service was expanded to two other districts. Previously FPAN did not provide any STD services.
The pilot project utilizes the syndromic management approach in accordance with
Nepal's National STD Case Management Guidelines, a locally appropriate and
cost-efficient approach.
Results: In 15 months, 1,275 clients - both men and women, were treated for
STDs at FPAN clinics and sites in the three districts. More than 87% of those
clients were women. At the FPAN clinic, STD services had a dramatic impact on
the demand for all reproductive health services as evidenced by the rise (65%
from 1995 to 1996) in sterilization services.
Lessons Learned: The lessons learned from the pilot project have encouraged
the policy makers to expand integrated services to Nepal's Eastern and Western
regions in 1998. FPAN - the biggest NGO in reproductive health and FP in the
country is also planning to replicate the model in other parts of the country.
525*/ 33238 STD control for HIV prevention in the US: Is there
likely to be an impact?
William Kassler, K.L. Irwin, M.L. Kamb, H. Weinstock, R.W. Steketee, M. St.
Louis, J. Wasserheit. 1CDC, MS-E44 1600 Clifton Rd, Atlanta, GA 30333, USA
Background: Although enhanced diagnosis and treatment of STD have been
shown to reduce HIV transmission by 40% in Tanzania, the impact of STD control
as an HIV prevention strategy in the US remains uncertain because US populations may experience lower HIV and STD prevalences, less heterosexual HIV
transmission, and better access to quality STD care.
Methods: To assess concurrence of STD and HIV morbidity and quality of STD
care in the US, we reviewed national and local surveys on HIV and STD morbidity
and service delivery from 1990-97.
Results: Prevalences of gonorrhea (4%) and chlamydia (3-9%) in some US
women age 15-24 are similar to those in African women. In many US STD clinics,
HIV incidence exceeds 0.5/100 person-years. US regions with the highest HIV
rates in child-bearing women also have the highest gonorrhea and syphilis rates.
STD services are often lacking in populations at high risk for HIV and STD, e.g.,
<50% of jails routinely screen inmates for STD. Only 50% of local health departments provide on-site STD care and many lack evening or weekend services.
90% of STD clinics in areas with high syphilis morbidity turn away clients due to
limited resources. Private providers (who provide 60% of STD care in the US) are
less likely than public providers to take sexual histories, to screen young, single
women for STDs, and to provide prenatal syphilis screening and treatment.
Conclusion: Given the substantial STD and HIV comorbidity and suboptimal
access to high quality STD services in some areas, enhanced STD diagnosis and
treatment may be effective HIV prevention strategies in the US. Studies to compare the impact and cost-effectiveness of STD control with other HIV prevention
strategies are needed to better allocate prevention resources.
33239 Determinants of STDs among Nigerian youth and
reported STD prevention methods: Targets for
intervention
Paul Coplan1, F. Okonofua2, M. Temin3, E. Renne4, K. Heggenhougen5,
J. Kaufman6. ' Merck Research Labs, PO Box 4, BL2-3, West Point, PA
19486-0004; 4Princeton University, Princeton, NJ; 5Harvard School of Public
Health, Boston, MA, USA; 2 Womens Health & Action Research Centre, Benin
City, Nigeria; 3 World Health Organization Geneva, Switzerland; Ford
Foundation Beijing, China
Objective: To identify determinants of self-reported STDs and self-identified
methods to prevent STDs among Nigerian youth as part of the development of
an intervention to prevent STDs, including HIV.
Methods: 510 randomly selected secondary school students in Benin City,
Nigeria were interviewed (3-4/97) using a structured questionnaire based on
qualitative research. Average age was 18 years (14-29 range). A multivariable
logisitic regression model was used to identify independent determinants of STDs.
Results: Of the 65% of respondents who reported sexual intercourse experience, 40% of girls and 29% of boys reported ever having had a STD. Methods
used to prevent STDs included condoms (43%), abstinence (17%), fewer partners (14%), no protection (12%), and traditional medicine (4%). In practice, no
condom use was reported by 24% of sexually active youth. Sources of STD
treatment were: "chemists" (over the counter drug stores) (22%), no treatment
(19%), private physician (16%), public clinic (8%), self treatment (8%), traditional
healers (3%), and other (8%). Reasons for not using public STD clinics were: cost
(58%), privacy (46%), feeling guilty at clinics (42%), long wait time (14%), and
poor medicinal effectiveness (8%). 29% of youth were unaware that sex while
experiencing a STD symptom could spread the infection, and 25% reported that
adolescents do have sex while experiencing STD symptoms. In a multivariable
logisitic regression model, the determinants of having had a STD were: being

female, more sexual partners, use of hormonal contraceptives vs. no contraceptives, traditional (Odds Ratio {OR} = 3.3, 95% CI = 1.4-7.4) or Catholic (OR
= 2.0, 95% CI = 1.2-3.5) religious affiliation (vs. Pentecostal), unemployed or
retrenched father (OR = 3.5, 95% CI = 1.2-10.4), perceived dislike of condoms
by partner, and lack of knowledge of where to get condoms.

Conclusions: Many youth were unaware that sex while experiencing a STD
symptom could spread the STD. Condom use was the most frequently cited
method for protection against STD, followed by abstinence/fewer sexual partners. Traditional and Catholic religious affiliations were strong determinants of
STD risk, as were perceived barriers to condom use. Interventions are needed
to educate youth on avoiding sex when symptomatic for STDs, to assist youth in
developing STD prevention strategies, and to facilitate condom use.
S33240 Impact of the introduction of a computerized
management information system on medical services at
the AIDS Support Organization, Uganda
Francis Mubiru1, E. Katabira1, S.M. Monicol, E. Marum2, K. Bussels2,
G. Olupot1, L. Muhangi'. 1 Taso PO Box 10443 Kampala; 2Centres for Disease
Control/USAIDS Kampala, Uganda
Background: In January, 1997, The AIDS Support Organization (TASO) in
Uganda introduced a computerized management information system (MIS) which
includes records on all newly registered clients, all counselling sessions, and all
medical visits provided to these clients. Non-computerized records from previous
years suggested that the rate of detection and treatment of other sexually transmitted diseases (STDs) was much lower than would be expected based on the
prevalence of STDs indicated by surveillance and research data in Uganda.
Methods: The rate of detection and treatment of STDs in January, 1997 was
analysed and presented to TASO clinicians at a workshop in February, 1997.
To assess the impact of sharing the findings of the MIS, we compared rates of
genital exams and STD diagnosis between the 1st quarter and the 4th quarter of
1997. Overall in 1997, 16,402 clients received medical care at 7 TASO centres in
the eastern and southern region of the country.
Results: The rates of genital exam and diagnosis of STDs increased significantly over the course of the year. Comparing 1st and 4th quarter data, the
percentage of clients receiving a genital exam increased from 8% to 21% (p <.0001); the percentage diagnosed with an STD increased from 6.3% to 12.7% (p
<.0001) of all clients seen. The odds ratio of detection of STDs after MIS data
were shared with clinicians was 2.2 (95% CI 1.9-2.5). This significant increase
was probably associated with encouraging clinicians to perform more genital
exams, and counsellors integrating discussion of STDs in their sessions.
Conclusions: For an organization such as TASO which provides medical care
to thousands of clients at multiple sites, a computerized MIS is essential to identify services needing improvement. When MIS data documented the low rates
of STD exams and diagnoses, and when these data were shared with clinicians
and counsellors, these rates more than doubled over the course of the year.
Introduction of an MIS can have a significant impact on services provided to AIDS
patients.
33241 Performance of a rapid RPR method for syphilis
screening of antenatal and STD clinic attenders in
Guyana
Hans-Ulrich Wagner1, R. Dyalsingh2, M. Edwards2, E. Godi1, W. Kitson-Piggott',
J. Lewis3, T. Tiwari2. Caribbean Epidemiology Centre (CAREC)/GTZ, 16-18
Jamaica Boulevard Federation Park, Port of Spain, Trinidad; 2Ministry of Health,
Georgetown, Guyana; 3Centre for Disease Control (CDC), Atlanta, USA
Background: Untreated syphilis in pregnant women contributes to considerable
infant mortality in developing countries. In Guyana, syphilis screening is part of
antenatal care, but requires a visit to a laboratory. Only 80% of women are tested,
and less than 40% of those testing positive receive treatment due to loss to
follow-up. Similar problems apply to STD patients. Same day results obtained by
on-site testing could increase treatment coverage.
Methods: The performance of a fingerstick (modified commercial) RPR test
carried out by briefly trained nurses was assessed among 562 patients in Georgetown, Guyana (160 males & 116 females attending an STD Clinic; 286 antenatal
clinic attenders at 3 Health Centres). For comparisons, venous blood samples
were obtained for RPR testing in a reference laboratory (gold standard), and
confirmation by TPHA.
Results: RPR reactivity rate was 10.5% in ANC attenders and 18.0% (female
26.5%; male 11.8%) in STD patients. Including minimally reactive readings by
rapid test as positive results (excluding them), the field method had a sensitivity
of 74.7 (73.7)%, a specificity of 94.6 (98.1)%, and a positive predictive value of
69.4 (86.2)%.

On-site Test
+ve
-ve
Weakly +ve
Total

Lab RPR +ve
56
20
3
79

Lab RPR -ve
9
457
17
483

Total
65
477
20
562

Discussion: The rapid method was less sensitive than reported from other
assessments, possibly because of a very brief training period. However, it seemed
justified to promote its adoption in Guyana since the treatment rate of seropositive women under the existing system was much less than 75%. Overtreatment
of 5.4% (1.9% when excluding weakly +ve results) false positives would seem
acceptable. Efforts need to be made to improve nurses' skills in reading test
results.