Evaluating STI - Health Systems Trust

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– 15 – 5. TREATMENT OF STI CLIENTS This is a key section of the DISCA Did every clinic fill in 10 clients? If not, is it because they diagnose so few? Were the recorded treatments correct in every respect? The column for each clinic is divided in two so that the total number of clients treated can be recorded on the left side and the number correctly treated on the right in the columns headed X. The total number of clients correctly treated will be the sum of the figures in the right hand columns. Look at the numbers of clients with each syndrome. Is this what you would expect? Discharges are usually the most common syndrome. PID means that this woman did not get effective treatment at the stage when she had cervicitis which may have been asymptomatic, but might have caused a discharge that she did not consider abnormal. This is one of the reasons why it is important to look out for the possibility of STIs amongst all clients who may be at risk – i.e. sexually active and not consistently using condoms if the relationship is not mutually monogamous. On the basis of the information below, are there any issues that need investigating? What action needs to be taken? X X X X X X Number of treated clients recorded Enter number from chart 24 10 10 10 10 Number of clients with urethral discharge Enter number from chart 24 3 3 3 3 4 4 4 4 Number of clients with vaginal discharge Enter number from chart 24 3 2 3 0 3 2 4 4 Number of clients with PID Enter number from chart 24 2 1 3 0 0 0 Number of clients with genital ulcers Enter number from chart 24 1 1 1 0 3 3 1 0 Number of clients with warts Enter number from chart 24 1 1 0 0 0 Number of clients with other STI Enter number from chart 24 0 0 0 1 1 Number of clients (all STIs) correctly treated Enter number from chart 24 Percentage clients correctly treated Number correct X 100 Number recorded There is more than one combination of drugs that can be used effectively to treat STIs syndromically. Many provinces follow the protocol recommended by the National STI Directorate, but some provinces have chosen to use protocols that differ in certain respects. Clinicians should follow the treatment recommended for that province. Where different clinicians follow different protocols within the same area, this can lead to confusion resulting in some clinicians not providing correct treatment. If the treatment recorded would be effective
– 16 – in treating that syndrome, it could be counted as correct treatment, even if it differs slightly from the local protocol. However, if it differs from the recommended protocol and there is any uncertainty about whether it is effective, it should be considered incorrect. If clinicians are consistently using a protocol that differs from the one recommended for their province, this should be addressed. Sometimes there are a number of clients recorded as 6 (other STI). The treatment might give an indication what this ‘other’ STI is. Some clinicians enter a diagnosis of BOM and provide the treatment for urethral discharge. This is an appropriate treatment for a man complaining of burning on micturition who is at risk of STIs and where differential diagnoses have been excluded. This should be entered as urethral discharge. Some clients have several STIs simultaneously and may be treated for both discharge and ulcers. The simplest way to enter this is probably as 6 (other STI). In deciding whether the client was treated correctly, the treatment should be effective for both syndromes. If only one syndrome is effectively treated, this should be counted as an incorrect treatment. Where there are incorrect treatments, do they mostly relate to the same syndrome? What aspects of diagnosis and drug management need to be corrected? Are the errors common to several clinics? Are the incorrect treatments due to the correct drugs not being available at the clinic? 6. KNOWLEDGE OF CORRECT TREATMENTS This section looks at whether clinicians know the correct treatments without consulting the protocol. Does this information correspond with the treatments recorded in the client record section of the DISCA? Is their knowledge correct on all scores – drug, dosage and duration? Correct urethral discharge treatment Enter from 25a (i) Yes Yes Yes Yes Correct vaginal discharge treatment Enter from 25a (ii) Yes Yes Yes Yes Correct genital ulcer treatment Enter from 25a (iii) Yes Yes Yes No Correct treatment in pregnancy Enter from 25b Yes No No Yes Correct alternative to Doxycycline Enter from 25c No Yes No Yes In some provinces pregnant women are treated for vaginitis (Metronidazole if it is after the first trimester) and asked to return if the discharge has not cleared within a week. They are then treated for cervicitis at the return visit (spectinomycin or ceftriaxone and Erythromycin). Spectinomycin or ceftriaxone may not be available at all clinics.
Page 2: Evaluating Quality of STI Managemen
Page 6 and 7: Purpose of this booklet This bookle
Page 8 and 9: DISCA analysis at a district level
Page 10 and 11: - 5 - SUMMARY OF DISCA RESULTS Clin
Page 12 and 13: - 7 - Why does one clinic not have
Page 14 and 15: - 9 - To what extent are speculum e
Page 16 and 17: - 11 - 3. STAFF WORKLOAD AND TRAINI
Page 18 and 19: - 13 - This page is taken from a co
Page 22 and 23: - 17 - Although most protocols do n
Page 24 and 25: - 19 - both these cases less cards
Page 26 and 27: - 21 - ◆ Three of the clinics wer
Page 28 and 29: - 23 - Key Step number 13 - Feedbac

Evaluating STI - Health Systems Trust

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