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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Implementation preferences for the management of sexually transmitted infections in the South African health system: a discrete choice experiment
Sexually Transmitted Infections, Article sextrans-2023-055816, Year 2023
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Description
Objectives: Despite strengthening HIV prevention with the introduction of pre-exposure prophylaxis (PrEP), STI services have remained relatively unchanged and the standard of care remains syndromic management. We used a discrete choice experiment to investigate service users' preferences for the diagnosis and treatment of STIs in South Africa. Methods: Between 1 March 2021 and 20 April 2021, a cross-sectional online questionnaire hosted on REDCap was administered through access links sent to WhatsApp support groups for HIV PrEP users and attendees of two primary healthcare clinics and two mobile facilities in the Eastern Cape and Gauteng provinces aged between 18 and 49 years. Participants either self-completed the questionnaire or received support from a research assistant. We used a conditional logit model for the initial analysis and latent class model (LCM) to establish class memberships, with results displayed as ORs and probabilities. Results: We enrolled 496 individuals; the majority were female (69%) and <30 years (74%). The LCM showed two distinct groups. The first group, comprising 68% of the participants, showed a strong preference for self-sampling compared with no sampling (OR 2.16, 95% CI 1.62 to 2.88). A clinic follow-up appointment for treatment was less preferable to same-day treatment (OR 0.78, 95% CI 0.63 to 0.95). Contact slip from index patient (OR 0.86, 95% CI 0.76 to 0.96) and healthcare professional (HCP)-initiated partner notification (OR 0.63, 95% CI 0.55 to 0.73) were both less preferable than expedited partner treatment (EPT). The second group included 32% of participants with a lower preference for self-sampling compared with no sampling (OR 0.65, 95% CI 0.41 to 1.04). There was no treatment option that was significantly different from the others; however, there was a strong preference for HCP-initiated partner notification to EPT (OR 1.53, 95% CI 1.10 to 2.12). Conclusions: Our results suggest that service users preferred STI testing prior to treatment, with the majority preferring self-taken samples and receiving aetiology-based treatment on the same day. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Authors & Co-Authors
Iwuji, Collins C.
United Kingdom, Brighton
Brighton and Sussex Medical School
South Africa, Durban
Africa Health Research Institute
Martin, Catherine E.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Pillay, Diantha
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Shamu, Patience
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Nzenze, Susan A.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Murire, Mercy
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Cox, Laura Ashleigh
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Miners, Alec H.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Llewellyn, Carrie D.
United Kingdom, Brighton
Brighton and Sussex Medical School
Mullick, Saiqa
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Statistics
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1136/sextrans-2023-055816
ISSN:
13684973
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa
Participants Gender
Female