Abstract
This study used a quasi-experimental pre-post design to test whether short training can improve medicine sellers' (MSs) practices and skills for prevention and control of sexually transmitted infections (STIs) in Bangladesh. The training included lectures, printed materials, and identification of referral sites. Difference-in-differences estimation was used to determine the effects of intervention on key primary and secondary outcomes. Advice given by the MSs in intervention group for partner treatment and condoms use increased significantly by 11% and 9%, respectively, after adjusting for baseline differences in education, religion, age, duration of training, and study site. Referral of clients to qualified service providers increased by 5% in the intervention group compared to the comparison group, but this change was not found to be statistically significant. Significantly higher proportion of MSs in the intervention group recognized the recommended medications as per the national syndromic management guidelines in Bangladesh for treatment of urethral discharge and genital ulcer symptoms. Short training intervention was found to be effective in improving MSs' practice of promoting condom use and partner treatment to the clients. We anticipate the need for broad based training programs of MSs to improve their skills for the prevention and control of STI/HIV in Bangladesh.
Highlights
Private-for-profit pharmacies areimportant sources of medicine, advice, and referrals for many people in lowand middle-income countries
A total of 269 medicine sellers (MSs) participated in the baseline survey, 118 in the comparison group (CG) and 151 in the intervention group (IG); this represents 89% of the 133 MSs originally identified in the census in the CG from 46 pharmacies and 91% of the 166 identified in the IG from 55 pharmacies
In the end line survey, 116 MSs participated in the CG and 138 in the IG, representing 87% and 83% of those identified in the CG and IG, respectively
Summary
Private-for-profit pharmacies areimportant sources of medicine, advice, and referrals for many people in lowand middle-income countries. People with symptoms of sexually transmitted infections (STIs) and other illnesses often seek health care in these pharmacies because they are affordable and accessible [1,2,3] Most of these medicine shops do not have qualified pharmacists, and rather employ a cadre of “medicine sellers (MSs)” with or without professional training [4]. Some countries have adopted the training of MSs on syndromic management of STIs for the sake of providing quality services [5, 6] These efforts have demonstrated positive impacts on the selection of proper drugs, counselling to use condoms, and referrals to qualified physicians [5, 7]. The World Health Organization (WHO) consultative group highlighted that the role of pharmacists has been changing over the past two decades with the increase of self-treatment worldwide [8]
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