Community-based strategies to identify the unmet need for care of individuals with sexually transmitted infection-associated symptoms in rural South Africa
Community-based strategies to identify the unmet need for care of individuals with sexually transmitted infection-associated symptoms in rural South Africa
复制标题
DOI：
10.1111/tmi.13274
复制
发表时间：
2019-08-01
影响因子：
3.3
通讯作者：
Peters, Remco P. H.
中科院分区：
文献类型：
--
作者：
Hoffman, Charlotte M.;Fritz, Lise;Peters, Remco P. H.
目标 确定南非农村地区六个初级卫生保健 (PHC) 机构未满足的护理需求以及咨询性传播感染 (STI) 服务的障碍。方法 采用三种基于社区的策略进行横断面研究，动员患有性传播感染相关症状的成年人获得护理。培训后，通过诊所海报以及社区卫生保健工作者 (CHW) 和传统领导人的推荐来动员参与者。当专家组访问该机构时，动员患有男性尿道炎综合症的男性和患有白带综合症的女性在指定的两天参观参与的初级卫生保健机构。完成了问卷调查并提供了艾滋病毒快速检测。具有性传播感染相关症状的个体未满足的最低护理需求是通过将病例数除以每个初级卫生保健机构的成人服务人口来计算的。结果 我们成功动员了 177 名有症状的个体：134 名女性 (76%) 和 43 名男性 (24%)。该地区性传播感染护理未满足的最低需求估计为 1:364 (95% CI 1:350-1:380) 人；乡村的这一比率高于乡镇设施，而且女性的比率也更高。通过诊所海报 (57%) 和社区卫生工作者 (23%) 进行的动员最为成功。四分之三 (132/177) 的人报告症状已持续超过 30 天； 49% (87/177) 的症状超过 6 个月。此外，我们还发现了 14 名未经治疗的 HIV 感染者，HIV 检测率达到 7%。不咨询医疗保健的最常见原因是缺乏对症状的认识（34%），以及由于先前治疗后症状持续存在（23%）或反复出现（15%）而对护理感到失望，或出于任何原因对上次就诊期间的总体医疗服务感到失望（10%）。结论 我们发现，南非农村地区患有性传播感染相关症状的个人的护理需求尚未得到满足，需要紧急关注。需要采取多学科方法，通过社区意识和医护人员提供信息来创造服务需求，并结合加强性传播感染服务的质量，以改善生殖健康并预防该人群中未经治疗的性传播感染的并发症。
Objectives To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa. Methods Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility. Results We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30 days; 49% (87/177) had symptoms >6 months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care. Conclusions We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population.