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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)