title: Three methods of delivering clinic-based training on syndromic management of sexually transmitted diseases in South Africa: a pilot study.
abstract: BACKGROUND
  The South African National Department of Health sought to improve syndromic management of sexually transmitted infections (STIs). Continuing medical education on STIs was delivered at primary healthcare (PHC) clinics using one of three training methods: (1) lecture, (2) computer and (3) paper-based. Clinics with training were compared with control clinics.
  
  
  METHODS
  Ten PHC clinics were randomly assigned to control and 10 to each training method arm. Clinicians participated in on-site training on six modules; two per week for three weeks. Each clinic was visited by three or four unannounced standardised patient (SP) actors pre-training and post-training. Male SPs reported symptoms of male urethritis syndrome and female SPs reported symptoms of vaginal discharge syndrome. Quality of healthcare was measured by whether or not clinicians completed five tasks: HIV test, genital exam, correct medications, condoms and partner notification.
  
  
  RESULTS
  An average of 31% of clinicians from each PHC attended each module. Quality of STI care was low. Pre-training (n=128) clinicians completed an average of 1.63 tasks. Post-training (n=114) they completed 1.73. There was no change in the number of STI tasks completed in the control arm and an 11% increase overall in the training arms relative to the control (ratio of relative risk (RRR)=1.11, 95% CI 0.67 to 1.84). Across training arms, there was a 26% increase (RRR=1.26, 95% CI 0.77 to 2.06) associated with lecture, 17% increase (RRR=1.17, 95% CI 0.59 to 2.28) with paper-based and 13% decrease (RRR=0.87, 95% CI 0.40 to 1.90) with computer arm relative to the control.
  
  
  CONCLUSIONS
  Future interventions should address increasing training attendance and computer-based training effectiveness.
  
  
  BACKGROUND
  AEARCTR-0000668.
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.affiliation: I-TECH South Africa, Pretoria, South Africa.
authors.forename: Erushka
authors.initials: E
authors.lastname: Pillay
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Jed
authors.affiliation: I-TECH South Africa, Pretoria, South Africa.
authors.forename: Julia
authors.initials: J
authors.lastname: de Kadt
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Galagan
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gilvydis
authors.affiliation: STI and HIV Prevention Sub-Directorate, National Department of Health, Pretoria, South Africa.
authors.forename: Eva
authors.initials: E
authors.lastname: Marumo
authors.affiliation: I-TECH, India, New Delhi, India.
authors.forename: Shreshth
authors.initials: S
authors.lastname: Mawandia
authors.affiliation: I-TECH South Africa, Pretoria, South Africa.
authors.forename: Evasen
authors.initials: E
authors.lastname: Naidoo
authors.affiliation: Clinical Skills and Simulation Center, Howard University College of Medicine, Washington DC, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Owens
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Vickery
authors.initials: V
authors.lastname: Prongay
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Malley
mesh_terms: D000554:Ambulatory Care Facilities; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D017280:Condoms; D016358:Contact Tracing; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005835:Genitalia; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008297:Male; D016017:Odds Ratio; D016544:Patient Simulation; D010808:Physical Examination; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D013019:South Africa / Q000453:epidemiology; D013577:Syndrome
chemical_list: D000890:Anti-Infective Agents
keywords: AFRICA; EDUCATION; HIV TESTING; SYNDROMIC MANAGEMENT