Prepackaged therapy for urethritis: the "MSTOP" experience in Cameroon.

RATIONALE: The social marketing of STD treatment may be a strategy to increase the availability of effective therapy for urethritis in male patients. OBJECTIVE: To evaluate a pilot project of social marketing of urethritis treatment packages. The project, initially designed for over the counter sale in private pharmacies, was finally restricted by national health authorities to primary healthcare settings in Yaoundé and Douala, Cameroon. METHODS: Monthly sales of packages containing antibiotics, condoms, partner referral cards, and written information on STDs were monitored by the social marketing agency. Structured interviews were conducted with a sample of traceable patients who had consulted for urethritis. Structured interviews completed by focus group discussions were conducted among healthcare providers. Interview findings were further validated by a "mystery patient" survey, using surrogate patients. Lastly, 15 key informants among the decision markers involved in the project were interviewed in depth. Local independent consultants carried out the whole evaluation. RESULTS: A total of 1392 treatment packages were sold in 10 months. Patients who had purchased the package reported high compliance with the treatment, with 99% taking the single dose of cefuroxime-axetil and 83% completing the course of doxycycline. 76% notified all or some partners, and 84% of those who had sex during treatment used condoms. In contrast, only 27% of trained healthcare providers prescribed "MSTOP". They questioned the omission of laboratory diagnosis, the selection of antibiotics, and the duration of therapy. Public health authorities were also sceptical about the choice of antibiotics and viewed the initial project as an overt encouragement of self medication. CONCLUSIONS: Although the MSTOP project was not implemented in the way it had initially been designed, it highlighted the patients' interest in the product. Public health authorities in Cameroon should have been made aware of the limitations of the formal sector's response to STD care among men before over the counter sale of prepackaged therapy could have been considered as an alternative approach to inadequate self medication.

Condom issues in AIDS prevention in Africa.

PIP: In vitro studies have demonstrated that an intact latex condom provides an effective barrier against several sexually transmitted pathogens, including herpes simplex virus type 2, hepatitis B virus, cytomegalovirus, HIV, Neisseria gonorrhea, Chlamydia trachomatis, and mycoplasma. This paper discusses some of the major advances and critical issues which should be incorporated in condom program design and implementation. The authors drew extensively from their experience with Family Health International's AIDSTECH Project with 21 targeted HIV prevention programs in 14 African countries. The programs are designed primarily to reach high-risk behavior groups among whom the virus is most prevalent. The authors observe from their work that a number of social, economic, political, and cultural obstacles impede greater condom use in Africa; private sector initiatives which recruit members of target populations to be key personnel in project implementation show promise for reaching high-risk behavior groups; condom logistics systems remain a weak link in condom distribution programs; rising costs and inadequate sources of latex condoms are problematic; and alternatives to the male latex condom could be commercially available by 1992. Sections discuss barriers to condom use, new approaches in condom distribution, condom quality assurance, condom costs and economics, and technological advances in condoms.^ieng