title: Effect of a knowledge-based and skills-based programme for physicians on risk of sexually transmitted reinfections among high-risk patients in China: a cluster randomised trial.
abstract: BACKGROUND
  China is experiencing growing epidemics of HIV and sexually transmitted infections (STIs). Programmes to train physicians in China on HIV and STI knowledge, diagnosis, treatment, and risk reduction counselling can potentially reduce HIV and STI risk among high-risk patients. We aimed to assess a knowledge-based and skills-based programme for physicians in China to reduce patients' STI risk.
  
  
  METHODS
  In this cluster randomised trial, we block randomised counties in two provinces in eastern China to intervention or control groups. In the intervention group, physicians from county general hospitals participated in a structured HIV and STI training programme and received opportunities to enhance their clinical and counselling skills, whereas in the control group, physicians from county hospitals received the training after the intervention group completed final assessments. We recruited STI patients from physicians in both groups, treated baseline gonorrhoea and chlamydia infections, and assessed 9-month gonorrhoea and chlamydia reinfection as the primary outcome. Statistical comparisons between intervention and delayed-control patients used multilevel analyses to account for cluster effects at county and physician levels. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, NCT00644150.
  
  
  RESULTS
  Between April 1, 2007, and Sept 1, 2008, 51 counties were randomly assigned; 27 to receive immediate intervention and 24 to receive delayed intervention. 249 physicians from the 51 county-level hospitals were enrolled, 121 physicians in the intervention group and 128 in the control group. From these physicians, we enrolled 633 and 491 patients, respectively, of whom 508 (80%) and 402 (82%) were available for reassessment at 9 months. Intervention patients at follow-up had significantly lower odds of combined gonorrhoea or chlamydia reinfection than did control patients (58/508 [11%] vs 123/402 [31%]; adjusted odds ratio 0·62 [95% CI 0·46-0·84]).
  
  
  CONCLUSIONS
  Integrating HIV and STI training into medical education in China could be an effective strategy to reduce the country's growing HIV risk and STI epidemics.
  
  
  BACKGROUND
  US National Institutes of Health.
authors.affiliation: School of Public Health, Brown University, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Operario
authors.affiliation: School of Health Service Management, Anhui Medical University, China.
authors.forename: Debin
authors.initials: D
authors.lastname: Wang
authors.affiliation: Fay Boozman College of Public Health, University of Arkansas, Fayetteville, AR, USA.
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.affiliation: School of Public Health, Brown University, USA.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Yang
authors.affiliation: School of Public Health, Brown University, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blaney
authors.affiliation: School of Health Service Management, Anhui Medical University, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.affiliation: School of Health Service Management, Anhui Medical University, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Hong
authors.affiliation: School of Public Health, Anhui Medical University, China.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: School of Health Service Management, Anhui Medical University, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chai
authors.affiliation: Center for World Health, University of California Los Angeles, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Szekeres
authors.affiliation: Center for World Health, University of California Los Angeles, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Galea
authors.affiliation: Center for World Health, University of California Los Angeles, USA. Electronic address: TCoates@mednet.ucla.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Coates
mesh_terms: D000328:Adult; D002681:China; D003376:Counseling / Q000193:education; D004502:Education, Medical, Continuing / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy