SYNDROMIC MANAGEMENT TRAINING FOR NON-FORMAL CARE PROVIDERS IN PAKISTAN IMPROVES QUALITY OF CARE FOR SEXUALLY TRANSMITTED DISEASES STD CARE: A RANDOMIZED CLINICAL TRIAL

Abstract. We conducted a randomized, controlled, three-armed trial to assess whether train-ing in syndromic management, with provision of packets, could improve the quality of STD services provided among non-formal care providers. The quality of STD case management service, observed by “incognito patients ” in both intervention groups, improved substantially compared to the control group (p < 0.05). The training-and-packets group performed better in service delivery, HIV-testing referral, and condom provision when compared to the training-only group (all p < 0.05). The training-and-packets group also retained more knowledge and practiced more skillfully at six months post-intervention when compared to the training-only group (p < 0.05). Exit interviews of clients suggested that 81 % of providers in the intervention groups offered advice on condom use when compared to none of those in the control group (p < 0.001). Syndromic management training and free syndrome packets for non-formal provid-ers had a positive impact on the quality of STD care among the trained providers. Pakistan, STD services are provided by spe-cialists (dermato-venereologists, gynecolo-gists, and urologists) whose services are ac