STI Care Services under NACP in Gujarat
Sexually transmitted infections (STIs) rank among the top five conditions for which sexually active adults seek health care in the developing countries. As per the STI prevalence study (2003), over 6% of the adult population in India suffer from one or the other STI/RTI. There is enough evidence to suggest that early diagnosis, treatment and management of STIs including inducing behavior change through education amongst the target groups will reduce transmission of STIs and HIV (Lancet 1995; 346:530-536). Failure to diagnose and treat STIs at an early stage in women of reproductive age group may result in serious complications and squeals, including infertility, fetal wastage, ectopic pregnancy, ano-genital cancer and premature death, as well as neonatal and infant infections. Effective control of STIs is a strong and most cost effective strategy for reducing/preventing transmission of HIV. This is because both STIs and HIV have same routes of transmission and occur in individuals practicing similar type of high risk behavior i.e. unsafe sexual intercourse (with or without substance abuse, alcohol use). Also the presence of a STI in the sexual partner increases the risk of acquisition of HIV from an infected partner many times during unsafe sexual act. The presence of HIV affects the clinical presentation, course, diagnosis as well as management of STIs and presence of STIs increases the risk of acquiring HIV.
Gujarat state estimated an annual incidence of 1.8 million STI/RTI episodes in the state (population of 6 million with 50 % of it as adult & with a rate of 6 % of STI episodes per year among adult population).
Aim and Objectives
To reduce the prevalence of STI by Syndromic case management, involvement of private doctors under public private partnership scheme and treatment facility for RTI/STI will be extended up to PHC level.
There are a total 63 functional STI clinics established in Medical Colleges, district hospitals, some sub-district and trust hospitals. Counsellors cum Coordinators have been appointed in each such clinic to ensure proper counseling of STI patients. Complete and quality STI service delivery includes:
Finance and Consumable Support
There is provision of one time grant for new STI clinics for infrastructure strengthening and recurring grant every year for all centres for procurement of consumables, training and TA/DA of STI clinic staff, supportive supervision of STI clinics and salary of STI counsellors. Computers and clinic signage boards to all the centres have been allotted. Colour coded STD drug kits and RPR test kits are distributed to all STI clinics supplied by NACO.
Each STI clinic has designated STI clinic incharge and recruitment of STI counsellor cum coordinator at each STI clinic. Training of STI clinic staff (doctors, STI counsellors, staff nurses and laboratory technicians) has been arranged by GSACS as per NACO modules regularly. There is regular review meeting of STI counsellor (quarterly) and STI clinic incharges and faculties of Supportive Supervisory Teams (biannually).
Faculties of medical colleges have been trained as members of Supportive Supervisory Teams (SSTs) from dept. of Skin, Obs. & Gynec, PSM and Microbiology. There is much more improvements in availability of basic facilities for STI clinics and quality service delivery as these visits are done in manner of supportive supervision and hands on training of STI clinic staff on various aspects at place.
STI Episodes Treated
About 1.26 lakh persons had attended STI clinic at 63 centres, about 0.33 lakh were treated (episodes + presumptive treatment) by TI through panel doctors (Source: CMIS data base, GSACS) and more than 1.82 lakh were treated by NRHM at sub-district facilities like Taluka hospitals, CHCs and PHCs (Source: HMIS, NRHM data base, Gujarat) in year 2013-14.
All the STI clinics and TI NGOs send STI CMIS regularly and also do data entry in web-based software-SIMS.
Regional STI Centre
Government Medical College and SSG General Hospital, Vadodara has been identified as ‘Regional STD Centre’. It has to provide evidence based input to STI control programme by conducting high quality etiologic testing for STIs, operation research, training and other research based evidence for improving the quality of STI/RTI service delivery. It has to act as the nodal agency for providing etiologic diagnosis for the difficult and treatment failure cases in the region. It works in close coordination of the departments of microbiology, Skin & V.D., Obs. & Gynecology and PSM (Public Health). It receives samples/ patients from the linked State Reference Centers (SRC). B. J. Medical College, Ahmedabad and Government Medical College, Surat have been identified as State Reference Centers.
Linkage with STD Care Project of Surat
Surat Municipal Corporation (SMC) is treating STD patients since the year of 2000 though 40 urban health centre (UHCs) under STD Care project and send reports regularly to the GSACS in regular format of reporting from April, 2008. GSACS gives them technical support in form of training, review meeting and colour coded STD drug kits and RPR test kits. They have expanded their services by upgrading their centres as ICTCs from Oct-08. In this form, this is the best example of the Public Private Partnership (PPP) model.