Recorded presentation

Carol S. Shepherd, ScD, MS, MS, Lori Bollinger, PhD, Margaret Rowan, MBA, CPA, and Kathy McClure, MPH. The POLICY Project, The Futures Group International, 1050 17th Street, NW, Suite 1000, Washington, DC 20036, 202-775-9680, c.shepherd@tfgi.com

In Jamaica, clients who are suspected of having a sexually transmitted infection (STI) are referred to clinics based on a complaint of discharge or other symptoms that sound like a STI. The clients are diagnosed and treated according to syndromic management. Thus, the client receives treatment immediately, which decreases transmission and complications. However, syndromic management fails to identify and manage appropriately a substantial proportion of women with cervical infections who are asymptomatic and it identifies many women as being infected when they are not. Attempts have been made to improve the performance of syndromic algorithms by incorporating risk assessments and vaginal examinations into the protocols. These experiences have been disappointing.

A study conducted in Kingston on antenatal patients in 1997 found that 3.6% of the sample had serologic evidence of Syphilis (FTA-Abs confirmed), 5.4% tested positive for Gonorrhea, 17.8% tested EIA positive for Chlamydia, 18% tested positive for Trichomonas and 1.3% were confirmed for HIV by Western Blot.

This study was undertaken to better inform the MOH’s decision to continue syndromic management of STIs or adopt a more effective treatment protocol that includes rapid testing for STIs. A cost effectiveness (C/E) analysis of the current guidelines versus alternative protocols was conducted along with a sensitivity analysis to determine the prevalence rate at which it becomes C/E to introduce a rapid test for screening women for STIs. The study identified the most C/E protocol to: increase the number of STIs diagnosed and treated appropriately and the number of STIs averted.

Learning Objectives:

• By the end of this session, participants will be able to;
• 1. Recognize the problems associated with syndromic management of STIs;
• 2. Identify alternatives to STI diagnosis and treatment; and
• 3. Discuss the cost effectiveness of STI diagnosis and treatment alternatives compared to syndromic management in differing prevalence settings within the Jamaican context.

Keywords: STD, Cost-Effectiveness

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation