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An evaluation of medical practitioner’s diagnosis, treatment and care of STI/HIV patients: analyses using simulated patients approach in highly HIV/AIDS prevalence states of India
Presented by Pradeep Kumar Bhargava, India.
Bhargava P.K.1, Rajaretnam T.1, Satihal D.1
1Population Research Centre, JSS Institute of Economic Research, Dharwad, India
Objectives: (a) To assess the appropriateness of clinical management provided to patients reporting symptoms of STI and HIV/ AIDS; (b) the extent practitioners adopts syndrome case management and advices to STI cases; and (c) to analyze criteria followed for Anti-retroviral Therapy.
Methods: Paper used primary data collected on practice of STI and HIV/AIDS care adopted by medical practitioners during 2003-04 in Karnataka India. 35 villages and urban blocks selected through PPS sampling methods. To assess the quality of care/services provided by the care providers in relation to STI and HIV/AIDS, simulated patient approach was followed. The analysis is based on data from 814 medical practitioners and 462 simulated patients.
Results: 3/4th of the practitioners did receive training on STI/ HIV/AIDS for less than 3 days. Mostly practitioners enquired from patients about duration of symptoms, sexual behavior, marital status and extramarital relationship from patients. In 70% of cases, doctors made physical examination and in 30% cases only oral enquiries. Practitioners rarely examined patients by touching the affected parts. Most of the practitioners conducted or recommended VDRL test, Elisa/HIV test and urine test/analysis. Slightly more than ½ practitioners were aware about syndrome case management and of them 4/5th followed and favors it. Major criteria for referring patients for HIV test are continuous fever, loss of weight and continuous diarrhea (3/4th) followed by TB & STI (1/4th). More than 4/5th practitioners provide pre-test counseling. Only 1/3rd reported to have prescribed ART. CD4 count was as criteria to start ART.
Conclusions: Analyses clearly emphasized the need to train personnel at all the levels such as doctors, nurses in government and private sectors on issues related to STI and HIV/AIDS. Currently, based on the recommendation provided by PRC Dharwad on the project study, follow up action has been taken by ICHAP/KHPT and organized training program for practitioner.
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