Abstract
BackgroundSexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization’s current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes.MethodsTo engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach.ResultsTwenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners.ConclusionsWe recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.
Highlights
Transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of Human immunodeficiency virus (HIV)
A recent study from Tshwane District, South Africa, reported that 47.8% of pregnant women living with HIV attending their first antenatal care (ANC) visit for their current pregnancy tested positive for an Sexually transmitted infections (STI), of which nearly 60% were asymptomatic [2]
In the larger study pregnant women living with HIV were offered diagnostic testing via GeneXpert® (Sunnyvale, California, U.S.A.) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV); in South Africa, syndromic management is standard care [31]
Summary
Transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. A recent study from Tshwane District, South Africa, reported that 47.8% of pregnant women living with HIV attending their first ANC visit for their current pregnancy tested positive for an STI, of which nearly 60% were asymptomatic [2]. These results continue to suggest that syndromic management for STIs, especially during pregnancy, is insufficient to optimally detect and treatment these infections. Implementing a comprehensive package of services (i.e., diagnostic testing, medication adherence counselling, STI status disclosure support and partner treatment uptake) will certainly improve sexual, reproductive and maternal-child health outcomes [3, 9]. Women living with HIV and diagnosed with an STI report lower rates of disclosure to their sexual partners [18, 19]
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