(P317) Gaps and opportunities in STIs management among clinicians in resource-limited settings

Background

In Burundi, 132,047 cases of STIs were notified in 2015. Only 16% of women and 16% of men aged 15 to 49 who have had 2 partners sexual intercourse or more in the past 12 months used a condom during course of last sex(Demographic health survey-III, 2016-2017). In poor resource-settings, tailored STI diagnosis and management using cost-effective method is crucial. We reviewed the implementation of syndromic case management national protocol in resource limited areas of Western Burundi.

Methods

We collected the primary data in 3 rural public health centers(Buganda, Rugazi and Gihanga) from direct observations in clinical consultation services in out patient units. These primary data were compared to secondary data which we collected from the curative consultation records in the STIs management registers. Records sampled one year baseline from January to December 2022. The national syndromic case management protocol reiterates the use of simple and cost-effective drugs and sexual partners management.

Results

In sampled rural areas, A total of 35 nurses were serving the 3 sampled health centers during our study period. Of them, only 5/35(14,3%) received initial training on the new national syndromic case management protocol while the rest did not. STIs cases were primarily managed by the trained nurses but the bottle neck of the care continuum was observed when the trained nurse were absent. In the absence of the trained nurse, delegated untrained nurse gave the treatment in 101/503(20%) of the total diagnosed cases from January to December 2022. A big gap was observed when the treatment was given by the trained nurse vs untrained. In 503 diagnosed cases, only 62,3 received the correct and timely treatment compared to the protocol due to the out stock of the appropriate drugs and supplies.

Conclusion

There’s a gap of the implementation of the national syndromic case management protocol compared to what it recommends in resource-constrained areas. More training of health care providers in these areas could increase the quality of care provided to STIs cases. Regular supply of drugs and relevant supplies are important to support the uptake of the syndromic management approach.