STI services in NACP III - some points for the working group

[Guest guest]

Dear Friends

Let me have the opportunity to convey my greetings and best wishes to all the

members of AIDS India forum for a very happy Durga Puja and Daserra.

This is my response to Dr Sarbajit Chadha’s mail on the subject as mentioned

above.

I had the opportunity to visit several clinics of the NGOs catering services for

STIs in low prevalence states. My observations were as follows:

1) Doctors appointed in the clinics are mostly part time and their involvement

is much less than expected.

2) NACO guideline of Syndromic STD Management has been deviated and doctors

using their own guideline to treat STDs in many instances

3) Referral linkages with higher centers are poorly maintained

4) History of same sex behavior, oral and anal STIs not taken with proper

sensitivity. So may be, a number of things are repeatedly remaining missed out.

5) HMIS is lacking due attention and care specially related to service delivery

and STI management

It is a pity that STI management is the most neglected component in the whole of

the HIV/AIDS intervention business and to make it more clear I request all of

you to have look at the sentinel surveillance data carefully. HIV prevalence in

STD cases has gone up in most of the low prevalence states in 2004. It is a

matter of real concern to me because the implications may be:

1) Behavior changes not reaching the expected level despite ceaseless

efforts(people getting more and more reinfected by STI and subsequently by HIV)

2) The quality of STI services is not up to the mark in general

To bring quality to the service delivery, specially in STI management I suggest

that the working group concerned may brainstorm on developing a medical audit

system for the next five years program of SACS. The system will be a

operationalized through a Quality Control Board and manned by a panel of medical

professionals both from SACS and outside. The members of the board will visit

the clinics, OPDs and other Health Centres on quarterly basis to detect the

deviations from the existing treatment guideline and make recommendations to

SACS time to time on quality control and betterment of services.

I request the group to discuss on another very important issue.

What should be the role of numerous RMPs, unqualified doctors who visit and

treat huge number of STI cases in HIV/AIDS program?

We just can not ignore them at any point of time now. There are basically three

things to brainstorm

Are unqualified doctors like RMPs and quacks eligible to treat STI cases through

the NACO Syndromic Guideline (after necessary training)

Or, their services will be utilized for referral of STI cases to the qualified

doctors, counseling and condom promotion only

And, can non MBBS qualified doctors (BAMS, BHMS) treat STI cases by application

of Syndromic Management guideline in Govt and private set ups?

Why I raise up the issue is I have seen non MBBS doctors working in NGO clinics

and providing treatment for STIs.

With warm regards

Sugata

Dr Sugata Mukhopadhyay

Technical Specialist (HIV/AIDS)

RACHNA Program

CARE India

New Delhi

E-mail: <sugataids@...>