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A dose of common sense: pharmacists and STI treatment in Ghana
Susannah Mayhew, Khonde Nzambi, Jacques Pepin and
2002-08-15

Research suggests that proper treatment of sexually transmitted infections (STI) could reduce HIV incidence by as much as 40 percent. A study by the UK's Nuffield Institute of Health and London School of Hygiene and Tropical Medicine and the Ghanaian Health Ministry suggests that pharmacists could play a crucial role in effective STI management and represent an under-utilised resource for HIV prevention activities. Interviews with patients and pharmacists the Greater Accra Region revealed that: Each pharmacist sees an average of 30 STI patients a month and more than 60 percent come without a prescription. Pharmacists give first-line treatments for urethral and vaginal discharge but usually refer genital ulcer cases to health facilities. Most also refer patients if they return with symptoms after the first treatment. The most common treatments given are spectinomycin and norfloxacin for urethral discharge and nystatin and metronidazole for vaginal discharge. On the basis of these results, pharmacist training schemes were developed, implemented and evaluated. Following these sessions, bogus patients were sent to each of the pharmacies, pretending to have urethral discharge or a genital ulcer. They found: marked improvements in prescribing patterns for urethral discharge , an increase (up from five to 39 percent) in the proportion of patients given ciprofloxacin as a first-line treatment for urethral discharge, as recommended by the WHO, addition of a second drug, such as doxycycline or tetracycline, in 20 percent of cases, to cover possible Chlamydia trachomatis infections. Pharmacists represent a valuable point of contact for STI patients. To capitalise on this, policymakers should: train pharmacists in the national guidelines for syndromic management of STIs , involve them in promoting condoms and displaying posters and incorporate STI management into pharmacy training curricula (Source: Pharmacists’ role in managing sexually transmitted infections: policy issues and options for Ghana' by S. Mayhew, K. Nzambi, J. Pepin and S. Adjei, Health Policy and Planning 16 (2001)

Research suggests that proper treatment of sexually transmitted infections (STI) could reduce HIV incidence by as much as 40 percent. What is the best way to tackle STI in countries with limited resources? Pharmacists are the most common source of STI treatment in Ghana. Should the government's HIV prevention strategy include training for pharmacists in STI management?

A study by the UK's Nuffield Institute of Health and London School of Hygiene and Tropical Medicine and the Ghanaian Health Ministry suggests that pharmacists could play a crucial role in effective STI management and represent an under-utilised resource for HIV prevention activities.

Interviews with patients and pharmacists in two of the five districts in the Greater Accra Region revealed that: 

-Each pharmacist sees an average of 30 STI patients a month. 

-More than 60 percent come without a prescription. 

The most common STI syndromes reported are painful urination or urethral discharge for men and white vaginal discharge for women. 

Pharmacists give first-line treatments for urethral and vaginal discharge but usually refer genital ulcer cases to health facilities. Most also refer patients if they return with symptoms after the first treatment. The most common treatments given are spectinomycin and norfloxacin for urethral discharge and nystatin and metronidazole for vaginal discharge. 

On the basis of these results, pharmacist training schemes were developed, implemented and evaluated. Following these sessions, bogus patients were sent to each of the pharmacies, pretending to have urethral discharge or a genital ulcer. They found:

-marked improvements in prescribing patterns for urethral discharge 

-an increase (up from five to 39 percent) in the proportion of patients given ciprofloxacin as a first-line treatment for urethral discharge, as recommended by the WHO 

-addition of a second drug, such as doxycycline or tetracycline, in 20 percent of cases, to cover possible Chlamydia trachomatis infections. 

Pharmacists represent a valuable point of contact for STI patients. To capitalise on this, policymakers should:

-ensure that all pharmacists receive training on the national guidelines for syndromic management of STIs 

-encourage pharmacists to assist in preventative activities such as promoting condoms and displaying posters 

-incorporate STI management into pharmacy training curricula 

clearly define pharmacists’ roles in STI treatment including limitations and when to refer 

-share responsibility for controlling pharmacists' activities between pharmacy regulating bodies and the Ministry of Health to avoid possible tensions and controversies. (Source: Pharmacists’ role in managing sexually transmitted infections: policy issues and options for Ghana' by S. Mayhew, K. Nzambi, J. Pepin and S. Adjei, Health Policy and Planning 16 (2001)   

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