Sexually Transmitted Infection (STI) / Reproductive Tract Infection (RTI) Control Programme
In view of the importance of treatment and control of STIs/RTIs in relation to HIV infection, STD Control Programme has been made an integral component of AIDS control policy for which Government of India has accorded top priority.
In Goa, the STD Control Programme was being implemented as a part of the National STD Control Programme since mid sixties by the Directorate of Health Services. With the arrival and spread of HIV infection and because of its strong relation with STD, the programme was brought under the purview of National AIDS Control Programme in the year 1992 as per the national pattern. With this, the programme has received the much needed boost as follows:
The STI/RTI Prevention & Control Programme, as it is known now is implemented through the following systems in the State of Goa:
• SACS funded Designated STI/RTI Clinics
• All NRHM supported CHCs/PHCs
• TI NGOs for High-Risk Groups
Goa SACS has made budgetary provision for STI/RTI Prevention & Control Programme for trainings, supportive supervision, salaries, consumables, procurement including IEC etc.
Adequate and comprehensive guidelines have been devised for case management including diagnosis, treatment, individual counseling, partner notification, testing, provision of condoms, etc.
STI/RTI management has been further simplified by syndromic management with the availability of STI//RTI colour coded drugs which are uniform across the country.
Orientation trainings, both induction and refresher trainings have been conducted every year for all the medical and paramedical workers engaged in providing STI/RTI services through syndromic approach have been conducted every year. Trainees include Resource faculty, DSRC Medical Officers, Lab. technicians, Counsellors, NRHM health facilities personnel and private practitioners who have been trained in STD syndromic case management i.e. management of STIs/RTIs based on specific symptoms and not dependent on laboratory investigations.
All the four Government Designated STI/RTI Clinics (DSRCs) in Goa have been branded as “Suraksha Clinics” for standardization and greater visibility. These Clinics are located in the Department of Skin and V.D., Goa Medical College; Hospicio Hospital, Margao; District Hospital (Asilo), Mapusa & Chicalim Hospital, Vasco and have been strengthened by providing technical support, equipment, reagents, drugs and manpower in the form of STD Counsellor in each clinic.
SACS has good convergence activities with NRHM as well as TI NGOs so that there is efficient service delivery at all level.
Management of STI/RTI has been incorporated/ integrated into the general health service/peripheral health system; so that patients are able to access treatment at any health centre convenient to them and also unnecessary referrals can be avoided leaving the specialized service free for management of complicated cases.
For High-Risk Groups such as FSWs, MSM, IDUs, Migrant labour, Truckers, etc. the TI NGOs working in coordination with PPPs provide comprehensive STI care with special emphasis on early detection and prompt treatment of STIs/RTIs, regular quarterly medical checkup to screen for asymptomatic infections and presumptive treatment for new HRGs and those who are met after 6 months and biannual screening for HIV and Syphilis. These Preferred Private Providers are those doctors who are preferred by the HRGs and have been trained in STI/RTI syndromic management to ensure standardized quality service delivery. At present, 17 such PPPs have been identified.
Development of appropriate laboratory services for the diagnosis of STI/RTI including the State Reference Centre at Department of Microbiology, GMC, Bambolim.
Early diagnosis and treatment of especially asymptomatic infections through case finding and regular screening has been advocated/ encouraged.
Prevention and transmission of STD/HIV infection through IEC activities to raise awareness and educate the people regarding responsible sexual behavior, safer sex, risk reduction including condom usage and promotion of appropriate health care seeking behaviour.
Regular surveillance of ongoing programmes in order to assess epidemiological situation, monitor and evaluate the programmes through both CMIS and SIMS.
Greater emphasis is placed on strategies to prevent STI/RTI through integration of STD prevention in “IEC for HIV prevention” as well as service related activities.
Sensitization of community about the problems related to STIs/ RTIs through regular IEC activities including TV, Radio and Mass media.
Other activities in the STI Control Programme:
Strengthening of cross referrals/ linkages between TI NGOs, DSRCs, NRHM and ART Centre is important for the success of STD Control Programme as well as HIV Prevention Programme.
There is no data available regarding STI/RTI patients undergoing treatment in Public & Private Sector Undertakings and hence, a MOU has been signed with ONGC, Railways, Professional organization like IADVL, FOGSI and IMA at National level. Accordingly, in the State of Goa, advocacy programmes were conducted in GSL, MPT, Sesa Goa for both the Health Care Providers and their staff and also with professional organization like IMA.
• Better convergence between SACS and NRHM in RCH activities
• Coordination with other agencies like IMA, ESI, MPT (Mormugao Port Trust), FOGSI, Railways, Mining and Industrial Estates, ONGC, defense etc. in the form of training of Doctors, Nurses, Lab. technicians in STI/RTI service delivery programme and monitoring of the programme so as to have standardized treatment and reporting protocols.