title: Quality of Sexually Transmitted Infection Case Management Services in Gauteng Province, South Africa: An Evaluation of Health Providers' Knowledge, Attitudes, and Practices.
abstract: BACKGROUND
  The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden.
  
  
  METHODS
  From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training.
  
  
  RESULTS
  Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management.
  
  
  CONCLUSIONS
  Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.
authors.affiliation: From the Divisions of *HIV/AIDS Prevention and †STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; ‡University of Washington, Seattle, WA; §National Institute for Communicable Diseases of National Health Laboratory Services, Johannesburg, South Africa; ¶CDC, Division of Global HIV/AIDS, Atlanta, GA; ∥Alexandra Community Health Centre, Johannesburg, South Africa; **Centre for HIV and STIs, National Institute for Communicable Diseases (NHLS), Sandringham, South Africa; and ††Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia eases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David Cal
authors.initials: DC
authors.lastname: Ham
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.forename: Mary
authors.initials: M
authors.lastname: Kamb
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mark
authors.forename: Ricky
authors.initials: R
authors.lastname: Ilunga
authors.forename: Sara
authors.initials: S
authors.lastname: Forhan
authors.forename: Mupatal
authors.initials: M
authors.lastname: Likibi
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010820:Physicians; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000517:prevention & control; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult