Management of sexually transmitted infections in private pharmancies in Limpopo Province : practice and knowledge of pharmacies

Abstract

Management of Sexually Transmitted Infections (STIs) in Private Pharmacies in Limpopo Province: Practice and Knowledge of Pharmacists Background: In 2001, the South African Pharmacy Council (SAPC) developed a strategic plan, which recognised the crucial role that pharmacists could play in controlling sexually transmitted infections (STIs) and the spread of HIV infection. In South Africa, patients seek and receive treatment for STIs from pharmacies despite a legal restriction (Ward, Pharm, Butler, Mugao, Klausner, Mcfarland, Chen & Schwarcz, 2003). Current legislation bars people to seek treatment from the pharmacists for certain acute illnesses, thus significantly influencing the spread of some infections with the view that the longer infections remain untreated, the more opportunities for transmissions to occur. The perceived lack of treatment options in private pharmacies may even prevent patients from accessing advice or preventative measures at the pharmacy level (Gupta, Sane, Gurbani, Bollinger, Mehendale & Godbole, 2010). It is against this background that the study was carried out with the aim of assessing the knowledge and practice of private pharmacists in management of sexually transmitted infections (STIs) in the Limpopo Province and ultimately assist in the reduction of the spread of HIV infections. Objectives: The objectives of the study were; to identify areas of weakness in services provided by pharmacists in management of STIs in private pharmacies; to identify possible pharmaceutical care of HIV; to determine the level of use of Department of Health Standard Treatment Guidelines of sexually transmitted infections by private pharmacy; to determine the availability of sexually transmitted infection drugs for treatment of STIs; and to identify the type of information given to clients with STI. Method: A cross-sectional design was used in this study. The study was carried out in the Limpopo Province, South Africa. Out of the population of 130 pharmacies registered with the SAPC in Limpopo, a sample of 23 was selected. The pharmacies were stratified according to where they were located. This study used a questionnaire designed as an instrument of data collection. The data was collected through a face-to-face interview with the responsible pharmacist in each pharmacy outlet. This study used Simulated Client Method to evaluate the practice. In this method, simulated male and female clients visited randomly selected Pharmacies. Two scenarios were developed for a male patient with urethral discharge and a female patient with vaginal discharge. The simulated clients on a standardised reporting form, outside the pharmacy, carefully recorded all observations made during the simulated scenario. Data analysis: The data were analysed using cross-tabulation techniques and chi-square test was used to check existence of association. Compliance with Standard Treatment Guidelines in terms of treating STI syndrome was used as dependent variable. Location (Rural and urban) of private pharmacies, the gender of the client in the simulated client method, treating genital ulcer syndrome (GUS), treating male urethritis syndrome (MUS) and treating female vaginal discharge syndrome were used as independent variables. The existence of association between the dependent and variable was tested using the Chi-square test of independence. Result: The results showed that 27% of private pharmacies in Limpopo treated and managed STIs clients in accordance with Standard Treatment Guidelines. The structured interviews results showed that 78% of private pharmacists in Limpopo knew the linkage between HIV and STIs. Only 39% of the private pharmacists knew about the existence of Standard Treatment Guidelines and used them in daily client consultations. Cross tabulation of data on compliance with Standard Treatment Guidelines in terms of treating STI syndrome (the dependent variable) and the location of private pharmacies (the independent variable) produced a Chi-square value of 1.31. This showed that the dependent variable had no association with location of independent private pharmacies. The study found that the treatment and management of GUS, MUS and female discharge varied according to location of the private pharmacies. The medicines stocked were in line with the Standard Treatment Guidelines in both rural and urban pharmacies in the Limpopo Province. There was very high demand for STI medication without a prescription averaging of 150 clients per week. Private pharmacies in both areas gave the necessary information to their clients focused on use condom with 54%, partner notification with 38% and only 27% of pharmacists advised client to consult the physician. The simulated client visits showed the discrepancy between knowledge and actual practice of the private pharmacists. Conclusion: The majority of private pharmacies operating in the Limpopo Province do not comply with the Standard Treatment Guidelines for treatment and management of STIs due to inadequate knowledge. While there is a need to train some pharmacists in the provision of primary health care for syndromic STI treatment in order to reduce STIs and HIV transmission, the lifting of current legal restriction in South Africa that prevents pharmacists from prescribing STI medication may be necessary. The knowledge and practice of incidence of specific infections in communities served by the specific pharmacy should be part of the pharmaceutical care provision.