Faculty Bibliography

This review compares the effects of various sexually transmitted disease (STD) partner-notification strategies. Using review methods endorsed by the Cochrane Collaboration, it updates previous reviews, and addresses some of their methodological limitations. It includes 11 randomized controlled trials (RCTs) comparing two or more strategies, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV-positive patients. The review found moderately strong evidence that: (1) provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; (2) contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; (3) verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of interventions combining provider training and patient education, for evaluations conducted in developing countries, and for the measurement of potential harmful effects.

This study assessed the feasibility and potential effectiveness of using audiovisual presentations in the waiting rooms of busy South African primary health care clinics, to educate patients about STD prevention and treatment. A 24-minute episode of South Africa's popular soap opera. Soul City was played continuously during three consecutive days in the clinic waiting areas. The storyline of the episode chosen was intended to convey key health messages regarding the prevention and treatment of STDs. The research was conducted at four primary health care clinics serving large, poor peri-urban townships in South Africa. Observations of patient behaviour were made, and a random selection of patients were interviewed on exit. A focus-group discussion was held with all of the clinic staff at each clinic site, to assess staff attitudes towards the use of such audiovisual presentations as part of their future routine duties. The mean proportion of patients who were observed watching the video at any one time varied from 34 to 64 per cent at all four clinics. Based on exit interviews, the presentation was seen by 88.2 per cent of patients attending all four clinics, and its STD content was recognised by 91.5 per cent of those who had seen it. Over 90 per cent of patients found the presentation helpful and interesting. Clinic staff described the use of video-mediated education as a solution to the problem of inadequate health education, and there was unanimous support for it. In future, it will be important to evaluate whether such audiovisual presentations can be effective in improving patients' knowledge and attitudes, and changing their behaviour, without compromising important interactions between clinicians and patients.