Compliance with the primary health care treatment guidelines and the essential medicines list in the management of sexually transmitted infections in correctional centres in South Africa: findings and implications

ABSTRACT

Background: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially in the management of communicable diseases such as sexually transmitted infections (STIs), has the potential of further enhancing AMR rates. Data on the extent of these challenges in Primary Health Care (PHC) facilities in correctional centres in South Africa (SA) is limited. Hence this study was conducted to determine the level of compliance with the 2008 PHC Standard Treatment Guidelines and Essential Medicines List (PHC STGs/EML) in the management of STIs in South Africa, and to identify potential factors contributing to the compliance and non-compliance to guide future strategies.

Method: An investigational descriptive study, including retrospective and prospective data, was conducted over an eight month period.

Results: Male urethritis syndrome, lower abdominal pain and genital ulcer syndrome were the three most common STIs. Doxycycline, ciprofloxacin and metronidazole were prescribed for most of the STIs. Overall compliance with the 2008 PHC STGs/EML was low for all STIs.

Conclusion: The study highlights the need to implement antimicrobial stewardship programmes, including educational activities, to promote the rational use of antimicrobials and monitor their use in PHC facilities in SA.

KEYWORDS:

• Compliance
• Essential Medicines List
• primary health care
• sexually transmitted infections
• Standard Treatment Guidelines
• South Africa

Acknowledgments

The authors are grateful to the Department of Correctional Services for allowing data to be collected at the their correctional centres as well as the medical staff who participated in the interviews. We also thank Prof. HS Schoeman for his contribution towards the analysis of the data.

Declaration of interest

B Godman received a small grant from the Karolinska Institutet as well as VR-Link grant from Swedish Research Council (VR-Link 2013-6710) to help with the write-up of the paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The manuscript was not funded.

Notes on contributors

Tammy B. Matsitse

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.

Elvera Helberg

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.

Johanna C. Meyer

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.

Brian Godman

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.

Amos Massele

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.

Natalie Schellack

TB Matsitse, E Helberg and JC Meyer conceptualized the study and devised the protocol. TB Matsitse collected the data under the supervision of E Helberg and JC Meyer. TB Matsitse and JC Meyer analysed the data in consultation with a statistician. TB Matsitse wrote the first draft of the manuscript. All authors were involved in data interpretation and critiquing the first and subsequent drafts of the manuscript. All authors approved the final submission.