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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights STI Training STI Training for Clinicians & Health Promoters in the Dominican Republic (FCO 51453)
Background STI continues to be a growing problem in the Dominican Republic. In light of the growing evidence that STIs facilitate HIV transmission, proper STI diagnosis and treatment is essential to controlling the spread of HIV/AIDS. The Departamento de Enfermedades de Transmision Sexual y SIDA (DETS) and the Instituto Tecnologico de Santo Domingo (INTEC), with the assistance of AIDSCAP, developed and implemented the first national STI Syndromic Management training program under this Letter of Agreement. Objectives The purpose of the training was to provide a simple, cost-effective diagnosis and treatment for STI. The course addressed not only syndromic management techniques, but also counseling for risk assessment, condom use, contact tracing, and compliance with treatment. Human sexuality was an essential part of the course content. The workshop was constructed to be a training for trainers so the information could be replicated in the future by the participants. Accomplishments Thirty seven training and refresher courses took place in the cities of Santo Domingo, Santiago, Puerto Plata, Barahona, y La Romana. Sixteen of the courses targeted clinicians involved in treating people with STIs (i.e. physicians, nurses, and technicians). Another 21 courses addressed participants who were not involved in direct treatment of STDs. This group of "non-clinicians" was comprised of social workers, nurse supervisors and educators. Most came from AIDSCAP/DR supported IAs. Individuals from the Dominican Social Security Institute, Profamilia and the Centro Medico La Romana also participated. A total of 854 clinician and non-clinicians (557 women and 297 men) attended the training courses. Both clinicians and non-clinicians had to attend refresher courses six months after the initial training workshop in each city. The majority of them went through these refreshments. Pre- and post-tests were conducted for all participants. Knowledge regarding the topics covered in the initial training course was measured after each training. The following areas were covered: knowledge of STDs, ability to utilize syndromic management of STDs, and use of flowcharts. In addition to the courses themselves, various educational and training materials emerged from the workshops. A videotape of the workshop was produced for training replication. In addition to the 550 manuals for clinicians and 1,000 for non-clinicians produced, 1500 informational brochures were printed and 1,000 pocket-sized, laminated brochures with treatment algorithms were made for clinicians. AIDSCAP/DR developed an STI referral guide which contains a list of the training program participants as well as other health professionals working in HIV/AIDS to be distributed nationwide and added to the AIDS Hotline computer database as a Referral Section. In all, 3,500 educational materials were distributed to the participants. Constraints The greatest impediment to the project's success was that the Training Manual was not completed at the anticipated date. This brought about unforeseen work and costs. However, since this was a pilot project, revisions to the preliminary materials enriched the final manual. The energy crisis in the country as well as other national situations also hindered the timely production of the manual. Findings and Recommendations DETS/INTEC found that the materials produced for the course greatly facilitated the learning process for the participants. CETS administered a questionnaire of the participants' opinions of the trainers, contents, and materials during the workshops. This training course needs to be replicated throughout the MOH PHC infrastructure and through residency programs such as Gynecology and Obstetrics, Urology, Dermatology, etc.
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