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Table 3 Strategies proposed for improving partner notification in male partners of antenatal mothers found syphilis positive in the STOP qualitative study, Kampala, Uganda

From: Perspectives on male partner notification and treatment for syphilis among antenatal women and their partners in Kampala and Wakiso districts, Uganda

  Variables Of Interest Barriers and Facilitators Strategies Proposed
Characteristics of Subject
Age and Gender Male   Target Programs to Specific Age groups and Genders
Female
Socio economic status • High income
• Low Income
• Affords Cost of going to Clinic
• Cannot Afford cost
Barriers
Cannot afford cost of transport to clinic, Cannot afford wait at clinic.*
High income may have even more stigma to attend government clinics
Facilitators
Can Afford cost of attending,
Can afford drugs
Incentivise Return after Notification, Establish Community based clinics
Information to |Reduce Stigma
Expedited Partner treatment **
Participant’s Knowledge about Syphilis Disease • Know about Mode of transmission
• Hereditary
• Sexually Transmitted or Not
• Perception of syphilis and HIV/AIDS
• Knowledge of signs and symptoms of syphilis
• Knowledge of Painful Treatment of Syphilis
Barriers
Perception that transmission is hereditary*
Fear of HIV/AIDs
Diagnosis*
Stigma*
Facilitators
Factual Knowledge of Transmission*
Factual knowledge of signs and symptoms of syphilis**
No Stigma
Provision of Information Brochures on Syphilis and its Transmission
Increase awareness of Curability of Syphilis
Provide Information on STDs and Syphilis Disease
Counseling of STD index partners on Syphilis
Increase Access to Syphilis Information especially using Modern Technologies; Phones, mails, Websites, Social Media
Individual’s Ability to Leave Work to go to clinic • Self Employed
• Employed by Others
• Time off
• Working Hours
Barriers
Employed with long working hours*
No weekdays off Clinic closed on Weekends*
Cannot afford long wait even if self employed*
Support
Works at night
Has time off in week
To provide Expedited Partner Therapy (EPT) where allowed
To prioritize Notification Retuness (Not wait in line)
To provide open STD clinic hours after work
To provide Weekend Open STD Clinics
Incentivise Clinc visits after Notification for Men
Perceptions and Practices of Notified partner towards their Partner • Partner Violence
• Good communication with Partner
• Value partner
• Value Unborn Baby
Barriers
History of partner violence
Fear of partner*
Fear of partner violence*
Facilitators
Perceived benefits of syphilis treatment*
Good Communication skills**
Client Oriented** Counseling
Values unborn baby*
Values partner*
Community based Programs to Reduce GBV and especially in respect to STD disclosure
Provide Client Oriented Counseling to address perceived barriers before notification with index partners
Increase knowledge of benefits of Syphilis treatment to Unborn babies and Infected Mothers**
Increase Knowledge about benefits of Syphilis Treatment to Expectant mothers**
   Desires Baby and Mother to be healthy*
Values Relationship (describes relationship as loving)*
Increase knowledge about benefits of healthy sexual relationships
Increase capacity to communicate effectively in STD infected clients
Increase Clinician Involvement in Partner Notification
Physical
Physical Set up of Life with Partner • Lives with Partner
•Lives separate from partner
•Time with Partner (travel. work etc)
Barriers
Stay separate houses
Facilitators
Good communication skills*
Counseling for partner*
Trained counselors*
Increase Clinician
*Provided Notification for willing clients
Improve Contact tracing programs
Improve STD surveillance programs with appropriate follow up of all persons in sexual network
Provide STD Counseling targeted to separate Living Situations to Clients
Characteristics of the Disease
Type of symptoms • Painful/Non painful
• Recognizable to partner or others
• Disfiguring
• Curable /Not curable
• Rare/Not rare
• Long treatment or Short treatment
• Treatment Painful or Not painful
• Options for treatment available
Barriers
Non painful disease, Unrecognizable by individual or partner, Not curable (fatalism), Stigma, fear of painful treatment
Supports
Short painless treatment. Various treatment options eg pills, injections, syrups
Increase the Provision of Information about Syphilis and symptom free STD/Syphilis infection
Provide counseling for curable and non-curable STD
Increase provision of Painless Syphilis Treatments rather than painful injections of Benzathine Peniccilin**
Reduce costs of less painful treatment and increase access to those medications**
Community Knowledge about Disease • Acceptance/Stigma
• High level of knowledge about disease
Barrier
Stigma, Low knowledge, Fears of community about transmission to other members of the community *
Fear of fatality by community
Facilitators
Knowledge of syphilis*
Increase knowledge about Syphilis in Community especially males**
Increase acceptance and reduce Stigma of syphilis and STD in community**
Increase Capacity of Community clinics to treat syphilis well and efficiently**
Characteristics of the Health Services
Accessible STD services • FA Barriers
Far from community, easily identified as STD clinic, expensive, opens only on weekdays, staff cannot speak language
Facilitators
Nearby clinic, opens at hours that can meet clients needs, opens on weekends or late evening
Increase Multiple community STD care services availability**
Increase opening hours of STD clinics to accommodate men’s working hours*
Capacity of Clinics • Capable Staff Trained and Knowledgeable on STD Management
• STD specific Counseling
• Able to treat STD promptly and appropriately
Separate Clinics for Men and Women
• Availability of STD Medicines
Barriers
Health workers with limited capability, and training, Limited recent updates in training
Laboratory services not adequate, No timely return of laboratory results, poor clinic set-up
Facilitators
Separate clinics for men and women.
Confidentiality STD Medicines available
Improve capacity of health care workers providing STD and syphilis care
Improve Infrastructure for STD Clinics,; Better privacy and set up
Improve laboratory services**
Provision of Home based STD sample collection and testing**
Improve capacity of health workers to provide efficient male -oriented STD care
Improve Surveillance Systems and Contact tracing capacities of clinics and hospitals
Perceptions and Practices of Health Workers • Trained Staff with Perceptions that reflect training in support for Syphilis Testing and Treatment Barriers
Rude staff, Impatient, Poor confidentiality and not attentive*, men treated in antenatal clinic*
Health workers not aware of their role in Partner Notification
Facilitators
Trained staff* separate clinics, confidential clinic premises
Train STD staff in provision of efficient ethical services**
Provide separate treatment clinic space for men even though partners of Antenatal Women**
Increase access to basic STD care and services for all groups men, women and all high risk groups and especially partners of infected persons(both men and women)**
Train STD care professionals in provision of surveillance an notification services as well as in contact tracing especially of men**
Improve capacity of clinics to provide standardized STD/syphilis care to men and women**
Legal Frameworks and Policies on STD Management and Partner Notification • Protocols Developed for Surveillance
• Policies Developed and In Pace for STD Control and Management of Partner Transmission
• Legal Mandate of Medical Personnel to report Notifiable diseases
• Systems response for reported diseases as detailed by medical and legal protocols that are ethically optimized
• Legal consequences of actionable practices
• Maximizing Rights and Health within the policies and frameworks of STD control
Barriers
No or limited legal frameworks supporting mandatory notification of partners as part of control** No notifiable STD disease component in Surveillance protocols** No training on protocols if exist
Supports
Established Surveillance systems. Legal frameworks and policies eg classification of diseases as notifiable, and mandatory notification of partners within established and humane protocols.
Training of personnel on the frameworks and policies. Negative legal consequences for non- notification of known partners
Set up sustainable STD surveillance programs*
Enhance Notification Programs and their linkage to other organs of governance**
Set up frameworks that capitalize on existing laws to protect the rights and health of persons with STD or syphilis to access care and control STD**
Strengthen legal frameworks or their implementation in National and local program for STD prevention and management**
  1. *From Participant data, ** From the literature, From other programs but proposed for the Ugandan context (Based on Kroeger A. Anthropological and socio-medical health care research in developing countries. Social science & medicine 1983;17(3):147-61)