Advice to STI patients on prevention and referral to HIV testing services
Export Indicator
STI services seek not just to treat STIs but to prevent their recurrence, by promoting condom use and by encouraging the treatment of partners to avoid reinfection. Increasingly, STI care is seen as an entry point for referral for voluntary testing for HIV. This indicator measures the extent to which these aspects of STI service provision are functioning.
Number of patients with STIs who are given advice on all three issues: condom use, partner notificatio and referrals for HIV testing
Number of patients with STIs
WHO/GPA Prevention Indicator 7 (PI7) only included the first two elements of this indicator. A health care provider must score positively on both condom advice and partner notification advice for the client to enter the numerator for this indicator. The current indicator includes a third element: referral for voluntary testing for HIV. However, if it is not a national policy to refer STI patients for HIV counselling and testing, or if VCT services are not available and not being actively promoted by national AIDS and STI programmes, referral for counselling and voluntary HIV testing should be excluded from the indicator. Both PI7 and this indicator are measured in health facility surveys through direct observation of interaction between care providers and clients. The different components of this indicator should be reported separately, for reasons given in Strengths and Limitations.
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If a client is at an STI clinic, previous efforts to promote safe behaviour have failed them. This measure does not contribute to the evaluation of success of prevention initiatives, merely the extent to which service providers are complying with standards. There has been discussion of the extent to which the direct observation methodology biases data. It is thought that service providers perform better under observation than they normally would. Also, it is suggested that exit interviews with clients may be a more costeffective method than observed interactions in compiling this indicator. However, there is a possibility that clients may misreport the actual content of counselling. Further research is needed to determine the reliability of exit interviews in collecting data for this indicator. Condom promotion, advice on partner referral and referral for HIV testing are in fact quite distinct activities. The value of an aggregate indicator in this field is therefore somewhat limited, at least to programme staff. In addition, referral to HIV testing services will depend upon the availability of those services locally. And the addition of this component will disrupt trends over time in those countries where the similar indicator WHO/GPA Prevention Indicator 7 has been calculated in the past. For these reasons, special care must be taken to ensure than the three elements of this indicator are reported separately.