Sexually Transmitted Infection (STI)
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.
Control of STI/RTI is an important component of the NACP; during NACP IV, the programme aimed to provide universal, comprehensive and standardized quality STI/RTI services at all health care facilities to all population groups with special emphasis on HRG population and vulnerable groups.
Laboratory support for STI/RTI has been strengthened through 1 Regional STI Laboratory and 2 state reference centres. The function of these centres are to provide validation of Syndromic Case Management (SCM) by doing etiologic testing, antibiotic susceptibility testing for Gonococci, EQAS for syphilis and conduct operations research providing evidence to the programme.
Current Situation
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.
Service Delivery
GSACS through its network of 66 designated STI/RTI Clinics (DSRCs) established in Medical Colleges, district hospitals, some sub-district and trust hospitals is providing free standardized STI/RTI services. These clinics have been branded as “Suraksha Clinics” and provide sexual & reproductive health services. Counsellors cum Coordinators have been appointed in each such clinic to ensure proper counseling of STI patients. Complete and quality STI service delivery includes:
- Treatment of patient & Treatment of partners
- Risk reduction communication
- Patient education and counseling
- Test for syphilis screening and HIV for all clinic attendees and syphilis screening test of all ANC
- Other necessary laboratory test if required
- Condom demonstration and provision
- Follow up & Documentation and Reporting
- Referral to ICTC / higher health centre
- Referral to other services, as necessary
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.
Capacity Building
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 counsellors (quarterly) and STI clinic incharges and faculties of Supportive Supervisory Teams (biannually).
Supportive Supervision
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.
Reporting Status
All the STI clinics and TI NGOs do data entry in web-based software-SIMS for reporting every month regularly.
Regional STI Laboratory and State Reference Centres
Government Medical College and SSG General Hospital, Vadodara has been identified as ‘Regional STID Laboratory’. 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 Urban Health Centres (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.
