title: A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa.
abstract: Quality concerns in STI service delivery and missed opportunities for integration with HIV testing and prevention services in South Africa have been well documented. This national evaluation aimed to evaluate current utilisation and adherence to national STI guidelines, including partner notification and integration with HIV services, for diagnosis and management of STIs.
  
  
  
  Facility surveys assessed infrastructure and resource availability, and standardised patient (SP) assessments evaluated quality of STI care in 50 public clinics in nine provinces in South Africa. The primary outcome was the proportion of SPs receiving essential STI care, defined as: offered an HIV test, condoms, partner notification counselling and correct syndromic treatment. Weighted proportions were generated, and SP findings were compared by gender using χ2tests with Rao-Scott correction.
  
  
  
  More than 80% of facilities reported medications in stock, with the exceptions of oral cefixime (48.3%), oral erythromycin (75.1%) and paediatric syrups. Among 195 SP encounters, 18.7% (95% CI 10.7% to 30.5%) received all hypothesised essential STI services: offered HIV test (67.1%), offered condoms (31.4%), partner notification counselling (70.2%) and recommended syndromic treatment (60.7%). Men were more likely than women to be offered all services (25.1% vs 12.3%, p=0.023), recommended treatment (70.7% vs 50.9%, p=0.013) and partner notification counselling (79.9% vs 60.6%, p=0.020). Only 6.3% of providers discussed male circumcision with male SPs, and 26.3% discussed family planning with female SPs.
  
  
  
  This evaluation of STI services across South Africa found gaps in the availability of medications, adherence to STI guidelines, condom provision and prevention messaging. Limited integration with HIV services for this high-risk population was a missed opportunity. Quality of STI care should continue to be monitored, and interventions to improve quality should be prioritised as part of national strategic HIV and primary healthcare agendas.
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.|International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Kohler
authors.affiliation: National Department of Health, Pretoria South Africa Civitas Building, Pretoria, South Africa.
authors.forename: Eva
authors.initials: E
authors.lastname: Marumo
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Jed
authors.affiliation: International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Gladys
authors.initials: G
authors.lastname: Mema
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Sean
authors.initials: S
authors.lastname: Galagan
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.affiliation: International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Erushka
authors.initials: E
authors.lastname: Pillay
authors.affiliation: International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Julia
authors.initials: J
authors.lastname: DeKadt
authors.affiliation: International Training and Education Center for Health, University of Washington, Pretoria South Africa.
authors.forename: Evasen
authors.initials: E
authors.lastname: Naidoo
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|Department of Medicine, University of Washington, Seattle, Washington, USA.|Department of Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D000554:Ambulatory Care Facilities / Q000600:supply & distribution; D002985:Clinical Protocols / Q000592:standards; D017280:Condoms / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011320:Primary Health Care / Q000592:standards*; D017150:Public Sector; D011787:Quality of Health Care / Q000592:standards*; D018571:Sentinel Surveillance; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D013019:South Africa
keywords: AFRICA; HEALTH SERV RESEARCH; IMPLEMENTATION SCIENCE; PUBLIC HEALTH; SERVICE DELIVERY