Reducing Sexually Transmitted Infections In India: IntraHealth's Support To The Key Clinic Network

IntraHealth recently concluded its role in a project in India to reduce sexually transmitted infections (STIs) and promote safer sexual practices through a network of private-sector clinics.

IntraHealth supported Population Services International (PSI), the project lead, in improving the quality of care provided by over 800 franchised Key Clinics in the Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. Targeted especially to reach male clients of commercial sex workers, this project was funded by the Bill and Melinda Gates Foundation through the Avahan program, the foundation’s major HIV prevention initiative in India.

“If you have an STI you are much more susceptible to getting HIV,” says Beth Fischer, who directed IntraHealth’s contributions to the project.

IntraHealth worked to improve the performance and skills of Key Clinic physicians in syndromic management of male STIs including diagnosis, treatment and patient counseling. IntraHealth created the Performance Improvement Core Group (PICG), which is responsible for ensuring clinic services meet quality standards based on the essential job tasks required to treat patients with STIs, as well as patient privacy and communications.

To improve the quality of care in these areas the project measured provider performance through innovative use of simulated patient surveys across the entire Key Clinic network.  This research, conducted every six to nine months, enabled the PICG to identify performance gaps. The PICG shared performance data with clinic providers, engaged them in discussions about the root causes for not meeting standards, and elicited their input on interventions to improve performance. These interventions included training and refresher workshops, support visits, newsletters, a website and technical letters and job aids.

The PICG also added a clinical component to physician training to improve physicians’ STI diagnosis abilities. “Just looking at pictures and describing conditions isn’t the same as actually seeing a real patient,” notes Fischer. The project promoted an STI treatment kit that helped improve correct treatment protocols and designed its training curriculum to address the major challenges providers face in treating STI patients, including how to counsel patients about condom use and treatment for their partners.

These interventions led to improved performance among Key Clinic providers on 14 of 19 quality standards, including significant improvements in advising condom use and partner treatment.

IntraHealth and the PICG also worked to build capacity in management and training, with the aim of developing a supervisory system that will help sustain the quality of services at the clinics. Area franchise managers were aided in building effective mentoring and support systems for the teams that provide training sessions and support visits to Key Clinic doctors. By 2006, 90% of training support team members who had received mentoring support twice or more were performing to standard.

Between May 2006 and May 2007 survey results showed that awareness of Key Clinics as good quality STI care centers increased from 47% to 89%. In the same time period the percentage of male clients seeking treatment increased by 21%.