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Working Together in JordanA Collaborative Effort Among Government, NGOs, Universities and Health Personnel Leads to Increased Understanding of Sexually Transmitted and Reproductive Tract Infections (STI/RTI)
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Background Comprehensive treatment of sexually transmitted and reproductive tract infections (STI/RTI) is critical to reducing HIV transmission. Expanding access to this treatment in Jordan has not been an easy task. Collection of STI data is sparse, and data that are available are often contradictory and confusing. Data from monthly reports and studies are difficult to analyze, due in part to varying STI laboratory diagnostic capabilities throughout the country. To begin addressing the need for a comprehensive approach to STI management in Jordan, Jordan's National AIDS Program (NAP) and the Ministry of Health (MOH) produced STI case management guidelines based on suggestions from the World Health Organization (WHO). The guidelines include STI patient education, counseling, partner tracing and condom promotion. Current Situation The step-by-step procedures outlined by the NAP and MOH have been difficult to adapt to the local situation. Many physicians complain of a lack of updated medical information and have expressed the need for continued medical education on STI. In addition, providers do not appear to be following the guidelines. Many providers treat STI without even mentioning to patients that the infections are sexually transmitted. Often, no condoms are available or supplied by providers, not even STI specialists. While both public and private physicians provide STI treatment, most STI patients seek treatment in private settings where confidentiality is more ensured. Male clients with STIs often avoid clinics by obtaining unreliable drugs directly from pharmacies. The government requires private clinics to report STIs in Jordan, but many clinics do not comply. In 2003, to gauge the effectiveness of the guidelines and to gather more valuable data, the Implementing AIDS Prevention and Care (IMPACT) Project—funded by the U.S. Agency for International Development (USAID) and implemented by Family Health International (FHI)—collaborated with the MOH to design and implement an STI prevalence study. Family Health Group, a local not-for-profit organization affiliated with the University of Jordan, assisted FHI in conducting this study. The study produced invaluable information on the behaviors that put Jordanians at risk for STI and HIV. The information will help Jordan develop appropriate and effective STI management protocols, improve the national STI/RTI case management guidelines and enhance the quality of STI/RTI services. A technical advisory committee, consisting of people from many health care disciplines and implementing agencies, finalized the study plan. Twelve thousand women participated in the study, which sampled two groups of women attending OB/GYN clinics at Al-Zarqa Hospital, Al-Basheer Hospital and Prince Faysal Hospital. One group was symptomatic, complaining of vaginal discharge, and the other did not have symptoms. The group without symptoms was tested to determine the prevalence of asymptomatic RTI in the population. Both groups were interviewed to assess current STI case management. Results In December 2003, IMPACT and project partners disseminated study results at a workshop, where participants discussed recommendations and application of the findings. Preliminary results show low prevalence of gonococcal and chlamydia cervical infections (GC/CT) in women experiencing vaginal discharge, and even lower prevalence of GC/CT in women without symptoms. No occurrences of syphilis were found in this study population. Vaginal infections were found to be 14 times more common than cervical infections. The STI/RTI project has had great success in achieving its goals. It has generated high-quality STI data, which will inform further programming. The project has conducted two training workshops for health care personnel, including doctors participating in the study, to improve their knowledge and skills. Patients and partners have received free treatment. In addition, the project has helped build the capacity of clinics, laboratories and staff of the different institutions. These goals could not have been achieved without excellent collaboration among many sectors, including the government, NGOs, universities, the private sector and donors. Dr. Ellias Khnoff, an MOH staff member who participated in the study at the Zarqa site, remarked, "This was a great project and a successful study because all of the parties involved benefited. Health care personnel gained experience and knowledge in the training on STI. The patients benefited with proper management, including diagnosis based on state-of-the-art laboratory testing. They also received free treatment, condoms and counseling. Institutions increased capacity. Policy makers in Jordan will have better data and will now have a better understanding of STI." Study Recommendations:
For more information please contact: Basma Khraisat, Country Director March 2004
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