The quality of care by private practitioners for sexually transmitted diseases in Uganda

One of the limited number of strategies available to reduce the spread of human immunodeficiency virus (HIV) infections in sub-Saharan Africa is the effective treatment of other, curable, sexually transmitted diseases (STDs). At present, a large proportion of people with STDs either treat themselves at home or seek treatment from private sector practitioners (PSPs) rather than use publicly funded services. A randomized controlled trial of the efficacy of a behavioural intervention with or without improved STD services is being carried out in Masaka, a rural area of south-western Uganda. The trial involves three groups, each covering six parishes. People living in one group of parishes receive information, education and communication activities (IEC) to increase public awareness regarding STDs and HIV/AIDS. The second group receives the same IEC interventions with improved treatment of STDs by both public and private service providers. The third group receives community development activities unrelated to HIV. In order to improve our understanding of how the quality of care provided by PSPs might be ameliorated, we interviewed 36 PSPs in the trial area, and made an assessment of the care they were providing. We also carried out six focus group discussions with patients to obtain their opinions on private services. PSPs in the intervention arm of the trial, who had attended meetings dealing with the syndromic management of STDs, referred to syndromes 82% of the time compared with 12% in the control arms, a mean difference of 70% (p < 0.001); stocked locally appropriate antibiotics 76% of the time compared with 52%, a mean difference of 24% (p < 0.001); and are more likely to prescribe appropriate drugs 82% of the time compared with 27%, a mean difference of 55% (p < 0.001). This small study suggests that PSPs can help improve the management of STDs.