Technical assistance for STI control: Time for a re-think?
Neilsen, G., & Young, F. (2012, October). Technical assistance for STI control: Time for a re-think?. Presented at Incorporating the Australasian Sexual Health Conference, Victoria, Australia, 15-17 October, .
Introduction: Technical assistance (TA) for STI control in developing countries is usually donor-funded, provided by expatriate advisors through multi-lateral agencies
or international NGOs, and informed by global or regional clinical guidelines adapted
for use at national level. STI control is a reflection of the status of health systems, and improvements also mirror general health system strengthening efforts.
Issues: STI-specific program funding has declined relative to HIV programming and
also been affected by the global financial crisis. Global development assistance agreements have shifted emphasis to indigenous country ownership. While local capacity has often been improved, higher-level issues, such as governance, thwart improvements elsewhere. Clinical supervision is weak or absent in most settings. Superficial TA by ‘parachute’ advisors fails to address structural barriers to STI programming.
Findings from randomised controlled trials of STI interventions for HIV prevention
reduced donor and government support for STI programming, and other strong
evidence was sidelined.
Recent advances in STI control such as periodic presumptive treatment are often
rejected or unsupported, while syndromic management is inappropriately applied,
and ano-rectal infections are ignored. Targeted STI interventions with priority
populations remain ‘boutique’ models and rarely replicated to scale. Awareness of
emerging threats, such as untreatable gonorrhoea, is low, responses largely absent,
and relevant laboratory capacity declining. Development of rapid point-of-care
diagnostics remains limited.
Program inertia has prevented innovation (e.g., rights-based approaches; voucher
programs; expedited partner treatment; rapid response teams addressing violence
against sex workers, men who have sex with men, and transgenders), and responses to changing community realities (e.g., the need to shift from venue-based outreach to mobile phones and the internet; and increases in gender-based violence).
Conclusions: STI control may decline unless these issues are addressed. Advocacy for policy changes supporting STI control must be strengthened. STI TA needs and
outcomes must be better evaluated with specific indicators.