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Provision of Syndromic Treatment of Sexually Transmitted Infections by Community Pharmacists: A Potentially Underutilized HIV Prevention Strategy

Ward, Kim M Pharm*; Butler, Nadine PhD*; Mugabo, Pierre PhD*; Klausner, Jeffrey MD, MPH; McFarland, Willi MD, PhD; Chen, Sanny MHS; Schwarcz, Sandra MD, MPH

Sexually Transmitted Diseases: August 2003 - Volume 30 - Issue 8 - p 609-613
doi: 10.1097/01.OLQ.0000079521.04451.10

Background Sexually transmitted infections (STIs) are known risk factors for HIV infection.

Goal The goal of this study was to assess the current and potential future role that community pharmacists in Western Cape, South Africa play in the treatment of STIs.

Study Design A cross-sectional survey of community pharmacists in the Western Cape region of South Africa. A face-to-face interview that ascertained experience with requests from patients for STI treatment, current STI treatment practices, and willingness to provide syndromic STI treatment was administered to head pharmacists.

Results Ninety pharmacies were selected and 85 (94%) of the head pharmacists participated; 55 from an urban area and 30 from a rural area. Pharmacists reported a median of 40 urban clients and 25 rural clients who sought STI treatment from community pharmacists. When provided with a hypothetical clinical situation, 13% of urban and 17% of rural pharmacists identified the correct medication for male urethral discharge, 8% of urban pharmacists and none of the rural pharmacists identified correct treatment for genital ulcers, and none of the pharmacists identified the correct medication for vaginal discharge. Fifty-three percent of pharmacists in urban regions and 47% of pharmacists in rural regions expressed willingness to provide syndromic STI treatment. Independent predictors of willingness to provide syndromic treatment were knowledge of the link between HIV transmission and STIs (adjusted odds ratio [OR]: 13.78; 95% CI: 2.69, 70.66), past experience prescribing syndromic STI treatment (OR: 11.1; 95% CI: 1.14, 108.6), and male gender (OR: 4.38; 95% CI: 1.15, 16.7).

Conclusions Pharmacists are frequently called upon to provide STI treatment but have limited knowledge of correct treatment recommendations. Training pharmacists to provide syndromic STI treatment may be one strategy to reduce STI morbidity and HIV transmission.

This study assessed the willingness of community pharmacists in Western Cape, South Africa to provide syndromic treatment of sexually transmitted infections as an additional method of control in a high-morbidity area.

From the *School of Pharmacy, University of the Western Cape, Cape Town, South Africa; and San Francisco Department of Public Health and the University of California San Francisco, San Francisco, California

Reprint requests: Kim Ward, 5 Attlee Road, Southfield, Cape Town 7780, South Africa. E-mail:

Received October 17, 2002,

revised February 19, 2003, and accepted February 20, 2003.

© Copyright 2003 American Sexually Transmitted Diseases Association