Improving Quality of Care for HIV and Sexua¬¬lly Transmitted Infections through integrated choice of prevention and diagnostic methods at the MSF Sitsandziwe Clinic in Matsapha, Eswatini.

Given the high burden of HIV/STI and the limitations faced by health facilities in Eswatini, there is a need to implement safe, acceptable, affordable, primary healthcare-based interventions that hold potential to improve the quality of HIV/STI prevention and care, especially for the most vulnerable sectors of society.  

Currently, evidence from operations research is fragmented as many research projects have put the focus in very specific implementation niches (e.g., on HIV PrEP alone, on Doxy-PEP alone, on voluntary medical male circumcision alone). Evidence is needed on the potential benefits of integrating, in a comprehensive way, engaging different cadres of healthcare providers, approaches of demonstrated efficacy for HIV/STI prevention and diagnosis-based management. Knowledge from real world, field implementation of integrated, comprehensive HIV/STI approaches can provide guidance to other public and private HIV/STI prevention and care providers as well as to grassroots and actors from the civil society that are working towards the control and/or elimination of HIV/STI and of the stigma and discrimination that affects persons living with HIV/STI and the persons they live or share spaces with.   

Our study will provide evidence on the feasibility, acceptability and outcomes of combined HIV/STI prevention and care options in an MSF-run clinical setting where clinic clients can make an informed, autonomous choice on which options they can use, based on their own considerations of risks and needs. The laboratory components of our research project will also serve to contribute with evidence on the possibility of replacing non-affordable, technician-dependant, molecular diagnostics by new rapid, near-the-patient RDT and PCR bacterial and viral STI tests as well as on antimicrobial resistance among persons affected by STI of concern such as NG. This evidence can help inform the implementation of appropriate antimicrobial stewardship programs, antimicrobial resistance surveillance systems, updated STI treatment guidelines and strategies to move from syndromic to diagnosis-based management of STI. 

Overall, this study will contribute to the knowledge base on best guidance to improving the quality of care for individuals with/at risk of HIV/STI. The research findings will be used by MSF to inform healthcare policies and interventions to enhance HIV/STI prevention, diagnosis, and treatment, ultimately reducing the combined burden of HIV/STI and improving overall public health in Eswatini and other similar health resource-constrained settings.

The overall aim is to evaluate the feasibility of an integrated, comprehensive model of HIV/STI care, which integrates innovative approaches for HIV/STI prevention and diagnosis-based case management within the context of the Sitsandziwe Clinic, a routine healthcare setting in a semi-urban area in Matsapha, Eswatini. 

Primary objectives  

P1. To document the demand, uptake, and outcomes of routine HIV/STI prevention and diagnosis-based case management interventions. 

P2. To evaluate the diagnostic performance of seven new STI RDT and PCR tests having molecular technologies (GeneXpert) as gold standard for comparison. 

P3. To describe the uptake, adherence, and outcomes of Doxy-PEP for the prevention of bacterial STI (syphilis, CT, and NG) in populations at high-risk of STI acquisition. 

P4. To explore Clinic clients’ and HIV/STI stakeholders’ views and perceptions on feasibility and acceptability of integrated HIV/STI services in a semi-urban clinic environment targeting populations at risk of HIV/STI acquisition.  ne IST.