The role of pharmacists in HIV/STD prevention: evaluation of an STD syndromic management intervention in Nepal.
OBJECTIVE
To evaluate the effects of a pilot sexually transmitted disease (STD) syndromic case management training for pharmacists in Nepal on STD drug dispensing behavior, HIV/STD prevention communication, and condom promotion and sales.


METHODS
Pre- and post-intervention interviews with samples of 160 pharmacists were conducted utilizing the simulated client method to collect data on pharmacists' response to men reporting urethral discharge. In order to assess the long-term effects, a sub-sample of 38 pharmacists trained 7-9 months before the follow-up survey was analysed separately.


RESULTS
There were no significant differences in the percentages of pharmacists who suggested taking medications, dispensed medications, or referred clients to a physician. The proportion of pharmacists who recommended an injection declined from 27% to 14%. Prior to the intervention, only one pharmacist (0.8%) dispensed the correct drugs and regimen for the syndromic treatment of urethritis. This increased to 45% immediately following the training. In a sub-sample of pharmacists who were interviewed 7-9 months after the training, the correct drugs and regimen were dispensed by 26%. The proportion of pharmacists who recommended to clients to have their sex partners treated increased from 5% to 21%. Although the proportion of pharmacists who suggested condom use increased from 14% to 24%, the proportion of pharmacists actually selling a condom or giving advice on HIV testing remained low and unchanged pre- and post-intervention. Over one-third of pharmacists mentioned HIV or AIDS in their interactions with clients, compared to 9% prior to the intervention.


CONCLUSIONS
The findings suggest that STD services provided by pharmacists can be significantly improved through a short-term training intervention, although the improvements are modest and probably time-limited. Interventions must be more intensive and combined with regular follow-ups if they are to meet their desired goals of improving STD treatment in a pharmacy setting.
Tuladhar
S M
SM
New ERA, Kathmandu, Nepal.
Mills
S
S
Acharya
S
S
Pradhan
M
M
Pollock
J
J
Dallabetta
G
G
D000890:Anti-Infective Agents / Q000627:therapeutic use; D019090:Case Management; D017280:Condoms / Q000600:supply & distribution; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D009390:Nepal; D010595:Pharmacists; D010865:Pilot Projects; D011369:Professional-Patient Relations; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000517:prevention & control
D000890:Anti-Infective Agents