Integration of STI Prevention and Management with Family Planning and Antenatal Care in Sub-Saharan Africa: What More Do We Need to Know?

Abstract

CONTEXT: The high prevalence of sexually transmitted infections (STIs) and their role in HIV transmission have made integrating STI prevention and management into existing family planning and antenatal care programs a goal in most resource-poor countries, especially in Sub-Saharan Africa. However, little is known about how integrated services can best be configured, and what impact they have on prevention of infection and unwanted pregnancy. METHODS: The literature is reviewed to examine what is and is not known about integration and to identify priority areas to be addressed through research. RESULTS: The feasibility and effectiveness of strategies that focus on the addition of either STI prevention services or detection and treatment activities are uncertain. An urgent need for research exists in three areas. The first is the development and testing of strategies that, instead of adding STI-related activities to existing family planning and antenatal care programs, seek to reorient the goals of routine consultations toward protection against the dual risks of unwanted pregnancy and infection and involvement of clients in deciding the outcome of the consultation. Second, strategies that reach male partners and facilitate access by adolescents to sexual and reproductive health services need to be developed and tested. Finally, prospective, preferably randomized studies need to be carried out to test and compare the impact of alternative integration strategies on population-level indicators of behavior and health. CONCLUSIONS: Strategies for integration of services need to be rigorously tested to ensure that they are both feasible and effective before they are implemented. International Family Planning Perspectives, 2002, 28(2):77‐86