Honduras

Honduras began its efforts to improve STD case management with the introduction of syndromic management in 1995. Within the political framework, a close relationship was developed between AIDSCAP and the Ministry of Health through its Department for the Prevention and Control of STD/AIDS (DETSS), which allowed the project to respond to the needs of the National STD Control Program. An inter-institutional Committee was formed by the Resident Advisor of AIDSCAP/Honduras, the Chief of DETSS and a USAID representative, allowing for effective coordination among these institutions.

The strategy for syndromic management was implemented at the level of the four national regions that report the greatest number of AIDS cases in the country. This strategy was initiated with the identification of four Unidades de Manejo Integral de ETS (UMIETS), one in each health region. These were key existing centers for care and referral of STD cases. In order to initiate the project, AIDSCAP supported the remodeling and equipping of the facilities and training of its staff.

DETSS, with the technical assistance of AIDSCAP, prepared the Manual Nacional de Manejo Sindro de ETS (National Manual of STD Syndromic Management). This manual presents the syndromic approach with the goal of improving the quality of care and increasing access to treatment. The guidelines were developed through a participatory process. Consensus was reached amongst regional coordinators, a 10-member STD expert committee, and medical staff working in "CESAMO" (health facilities with physicians).

Once the Manual Nacional de Manejo Sindro de ETS was distributed, the pilot phase of the training of UMIETS staff was conducted. This included the development of training manuals for three groups: one manual for clinical staff; one manual, focused on educational issues, for educators, psychologists, and social workers; and a technical manual for laboratory staff. These manuals focused on training methodology and tools, and on specific issues related to each of the three groups, with the Manual Nacional de Manejo Sindro de ETS as common reference. The training of clinical and lab staff on the integrated management of STDs based on the syndromic model reached health workers across the network of health services. As a result, 306 staff members from the MOH were trained, among them physicians, registered nurses, and health auxiliaries, and 241 medical and nursing staff members from the IHSS. This training resulted in more timely and better quality services as well as better access to them.

The management of STDs among CSWs is a top priority in Honduras because of their role as a core transmitter group. As in other Latin American countries, CSWs in Honduras must undergo regular STD control visits. One of the objectives of the project was to improve the quality of care and increase the coverage of STD syndromic management in this group in the UMIETS. However, this presented a particular problem in Honduras, as it has in other areas of the world, since no standard recommendations exist for STD management in CSWs. The reason for this is because if a standard risk assessment is used, all these women would be treated for gonorrhea and chlamydia which would, for all purposes, really be a program of universal treatment.

In order to resolve this issue, AIDSCAP, the Ministry of Health, STD specialists, and clinical staff from the four regions collaborated on developing a manual for STD syndromic management in CSWs. Presently, this manual is in the final stage of revisions.

Finally, a special investigation was undertaken to determine the degree of gonococci resistance in the project area. Among the most important results was the confirmation of the existence of the Betalactamas strain which is resistant to penicillin (60 percent), and the identification for the first time in the country of strains resistant to tetracycline (89 percent). Based on these findings, the treatment schemes were modified in the Manual Nacional de Manejo Sindro de ETS.