Should family planning clinics provide clinical services for sexually transmitted infections? A case study from Côte d'Ivoire.
OBJECTIVE
To evaluate the quality and usefulness of integrated sexually transmitted infection (STI) care at non-governmental family planning (FP) clinics in Côte d'Ivoire.


METHODS
Evaluation components included: (1) a survey measuring the prevalence of STI and the predictive value of the Ivorian vaginal discharge treatment algorithm, (2) client exit interviews, (3) direct observations of client-provider contacts, (4) the monitoring of the clinics' workload and available equipment and supplies and (5) interviews of programme managers and FP providers.


RESULTS
Among 368 FP clients surveyed, the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, B. vaginosis and Candida albicans were respectively 1.6, 5.7, 7.1, 44.8 and 5.2%. The positive predictive value of the national algorithm for the detection of cervicitis was only 6.3%, and was 17.9% among a subgroup of young, single women. Of 200 clients interviewed, 96% were satisfied with the services and 95% would return to the FP clinic if they had genital problems. In 215 observed client-provider contacts, 88% of 94 STI cases were correctly managed. Programme managers and providers reported no substantial work overload as a result of the integration of STI services.


CONCLUSIONS
The prevalence of cervical infections is relatively low in this population and the Ivorian algorithm that treats all women with vaginal discharge performs poorly. Over-treatment of cervicitis can be reduced by modifying the algorithm, although improved diagnostic tools are urgently needed to detect cervicitis in this population. Continued STI case management at the FP clinics is nevertheless justified because there exists an easily identifiable group of higher risk women who need STI care; and because of the demand by a large proportion of clients, the high prevalence of vaginal pathogens, and the limited costs to the FP programme.
Lafort
Yves
Y
STD/HIV Research and Intervention Unit, Institute of Tropical Medicine, Antwerp, Belgium. ylafort@swazi.net
Sawadogo
Youssouf
Y
Delvaux
Thérèse
T
Vuylsteke
Bea
B
Laga
Marie
M
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D019090:Case Management / Q000458:organization & administration*; D003191:Comprehensive Health Care; D007560:Cote d'Ivoire / Q000453:epidemiology; D019468:Disease Management; D005193:Family Planning Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D015995:Prevalence; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control