May 2002

Estimating the Cost and Effectiveness of Different STI Management Strategies for
Sex Workers in Madagascar

Application of Findings

In May 2001, the research team presented its findings at a participatory planning workshop in Antananarivo, Madagascar, with Ministry of Health officials, service providers, and sex workers. The ability to look at the tradeoffs between alternatives engaged the participants and helped the group reach consensus as to which policy would be pursued.

At the end of the meeting, the Ministry of Health developed an affordable management protocol for sex workers with STIs. The protocol calls for a clinician to employ a combination of diagnostic techniques for management of STIs in sex workers: laboratory test for syphilis; presumptive treatment for gonorrhea, chlamydia, and trichomoniasis on initial visit; and use of a combination of syndromic management and risk assessment for treatment of gonorrhea, chlamydia, and trichomoniasis on follow-up visits, and for chancroid and bacterial vaginosis for all visits. The participants also made the decision to change the country’s policy to have sex workers return every 90 days for follow-up rather than every 30 days, as originally stipulated.

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03 Jan 2009