Assessment of country implementation of the WHO global health sector strategy on sexually transmitted infections (2016-2021)

  • PLoS ONE, Volume 17, No. 5 May, Year 2022

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Study Justification:
The study aimed to assess the implementation of the WHO Global Health Sector Strategy on sexually transmitted infections (STIs) from 2016 to 2021. The strategy provided guidance and benchmarks for countries to achieve by 2020 and set global targets for achievement by 2030. The study aimed to evaluate the progress made by countries in implementing STI policies, surveillance, service delivery, commodity availability, and surveillance based on the targets of the strategy.
Highlights:
– 58% of countries returned completed surveys reflecting their STI activities in 2019.
– The regions with the highest survey completion rates were South-East Asia, Region of the Americas, and Western Pacific Region.
– 64% of reporting countries had a national STI strategy, and 88% performed STI surveillance activities.
– STI services were available within primary health clinics (88%), HIV clinics (92%), and reproductive health services (85%).
– 70% of countries reported having a national strategy to eliminate mother-to-child transmission of HIV and syphilis.
– 64% of reporting countries monitored antimicrobial resistance for gonococcal infection.
– 59% of countries included the HPV vaccine for young women in the national immunization schedule, and 91% reported availability of cervical cancer screening.
– 34% of countries reported stockouts of STI medicines, primarily benzathine penicillin, within the previous four years.
Recommendations:
– Mechanisms to support improvements in STI service delivery through national-level policy, commitment, programming, and surveillance are needed.
– Efforts should be made to increase the number of countries with a national STI strategy and performing STI surveillance activities.
– Access to STI services should be expanded, particularly within primary health clinics and reproductive health services.
– Strategies to eliminate mother-to-child transmission of HIV and syphilis should be strengthened.
– Monitoring of antimicrobial resistance for gonococcal infection should be increased.
– Efforts should be made to include the HPV vaccine in national immunization schedules and improve availability of cervical cancer screening.
– Measures should be taken to prevent stockouts of STI medicines.
Key Role Players:
– WHO Headquarters and regional offices
– National STI, HIV, and reproductive health programme directors or managers
– National sexual and reproductive health officers or directors
– National programme officers for maternal and child health
– National disease surveillance coordinators
– National laboratory surveillance officers or managers
– WHO country programme officers
– UN agency HIV, STI, or sexual and reproductive health officers (UNICEF, UNAIDS, UNFPA)
Cost Items for Planning Recommendations:
– Development and dissemination of guidelines and policies
– Training and capacity building for healthcare providers
– Strengthening surveillance systems
– Procurement and distribution of STI diagnostics and medications
– Support for national immunization programs
– Awareness campaigns and education materials
– Monitoring and evaluation activities

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used a survey instrument developed by experienced technical personnel at WHO Headquarters and WHO regional offices. The survey was distributed to 194 WHO Member States, and a majority of countries (58%) returned completed surveys reflecting current STI activities. The study provides data on the implementation and prioritization of STI policy, surveillance, service delivery, and commodity availability based on the targets of the WHO Global Health Sector Strategy on STIs. The study also reports on the existence of national strategies and programs related to STIs, as well as the availability of STI services and screening. However, the study is limited to self-reported data from countries, which may introduce bias and inaccuracies. To improve the strength of the evidence, future studies could consider incorporating objective measures and independent verification of reported data.

Background In 2016, WHO launched the Global Health Sector Strategy on STIs, 2016–2021 (GHSS) to provide guidance and benchmarks for country achievement by 2020 and four global targets for achievement by 2030. Methods A country survey jointly developed by experienced technical personnel at WHO Headquarters (HQ) and WHO regional offices was reviewed and distributed by WHO regional advisors to 194 WHO Member States in September-March 2020. The survey sought to assess implementation and prioritization of STI policy, surveillance, service delivery, commodity availability, and surveillance based on targets of the GHSS. Results A majority (58%, 112/194) of countries returned a completed survey reflecting current (2019) STI activities. The regions with the highest survey completion rates were South-East Asia Region (91%, 10/11), Region of the Americas (71%, 25/35) and Western Pacific Region (67%, 18/27). Having a national STI strategy was reported by 64% (72/112) and performing STI surveillance activities by 88% (97/110) of reporting countries. Availability of STI services within primary health clinics was reported by 88% of countries (99/112); within HIV clinics by 92% (103/112), and within reproductive health services by 85% (95/112). Existence of a national strategy to eliminate mother-to-child transmission of HIV and syphilis (EMTCT) was reported by 70% of countries (78/112). Antimicrobial resistance (AMR) monitoring for gonococcal infection (gonorrhoea) was reported by 64% (57/89) of reporting countries with this laboratory capacity. Inclusion of HPV vaccine for young women in the national immunization schedule was reported by 59% (65/110) and availability of cervical cancer screening was reported by 91% (95/104). Stockouts of STI medicines, primarily benzathine penicillin, within the prior four years were reported by 34% (37/110) of countries. Conclusions Mechanisms to support improvements to STI service delivery through national-level policy, commitment, programming and surveillance are needed to operationalize, accelerate and monitor progress towards achievement of the 2030 global STI strategy targets.

In August 2019, a survey instrument in the form of a questionnaire for country completion was jointly developed by experienced technical personnel at WHO Headquarters (HQ) and WHO regional offices. The survey was made available in five languages: English, French, Spanish, Russian, and Portuguese. The survey sought to assess progress towards achievement of the following 2020 milestones within the STI Strategy: (1) number of countries with a STI surveillance system in place; (2) number of countries with a national policy for universal screening of pregnant women for syphilis as a first step in signifying countries’ intent to achieve the milestone of at least 95% of pregnant women attending antenatal care being screened for syphilis; (3) percentage of key populations to the HIV epidemics with access to STI and HIV services; (4) number of countries providing STI services or links to such services; (5) number of countries reporting on antimicrobial resistance (AMR) of N. gonorrhoeae; and (6) number of countries including human papillomavirus (HPV) vaccination among girls within national immunization schedules, as a proxy for delivery of this vaccine. The survey also assessed programme service delivery, including use and availability of diagnostics and medications, and captured technical assistance needs in STI programming and surveillance (S1 File). During October 2019 to March 2020, national STI, HIV or reproductive health programme directors or managers, national sexual and reproductive health officers or directors, national programme officers for maternal and child health, national disease surveillance coordinators, national laboratory surveillance officers or managers, WHO country programme officers, or other UN agency HIV, STI or sexual and reproductive health officers (UNICEF, UNAIDS, UNFPA) completed the questionnaires. These staff were encouraged to liaise with programme managers with responsibility for HIV, reproductive health, immunization and commodities to gather the non-STI information needed to complete the survey. Three email reminders were sent to non-responding countries. Regional office participants were made aware in the invitation to participate and on the survey cover page that results would be used to inform WHO and the World Health Assembly on progress towards globally recommended STI programme implementation (S1 File). Participation in the survey was voluntary and the intent to assess national-level efforts in the prevention and control of STI was included on the survey cover page. Written completion of the survey was considered consent to participate in this public health survey. Collection of these data for public health purposes complies with 45 CFR 46 subpart a-46104 and as described under 45 CFR 164.512(b)(i); “public health activities and purposes” as not human subjects’ research. Completed questionnaires were returned through WHO regional offices to WHO HQ. Data were compiled and entered in Open Clinica™ [4] during February-May 2020 and analysed using SPSS (Chicago, IL, USA), SAS (Cary, NC), and Microsoft Excel (Redmond, WA, USA). Descriptive analyses included frequency and percentages calculations for each survey question, using the number of completed responses as the denominator. Analyses were based on the overall responses received from reporting countries. Missing responses were not included in the denominator for percentage calculations. Analyses were reported for the six WHO regions and by World Bank income classifications [5]. Responses received from these reporting countries are considered a proxy for the performance of the 2020 STI Strategy milestones by WHO Member States.

Based on the provided information, it is not clear what specific innovations or recommendations are being sought to improve access to maternal health. The information provided focuses on the assessment of country implementation of the WHO global health sector strategy on sexually transmitted infections (STIs). If you have any specific questions or need assistance with a different topic, please let me know and I’ll be happy to help.
AI Innovations Description
Based on the provided information, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Strengthen National STI Strategies: Encourage countries to develop and implement comprehensive national strategies to address sexually transmitted infections (STIs), including maternal STIs. These strategies should prioritize STI policy, surveillance, service delivery, and commodity availability.

2. Improve STI Surveillance: Support countries in establishing and strengthening STI surveillance systems to monitor the prevalence and incidence of STIs, including maternal STIs. This will help identify areas with high burden and guide targeted interventions.

3. Enhance STI Service Delivery: Promote the integration of STI services within primary health clinics, HIV clinics, and reproductive health services. This will ensure that pregnant women have easy access to STI screening, diagnosis, and treatment during antenatal care visits.

4. Eliminate Mother-to-Child Transmission of HIV and Syphilis: Advocate for the development and implementation of national strategies to eliminate mother-to-child transmission of HIV and syphilis (EMTCT). This includes promoting routine screening and treatment of pregnant women for these infections.

5. Strengthen Laboratory Capacity: Support countries in strengthening their laboratory capacity to monitor antimicrobial resistance (AMR) of STIs, such as gonorrhea. This will help guide appropriate treatment regimens and prevent the spread of drug-resistant strains.

6. Expand HPV Vaccination and Cervical Cancer Screening: Encourage countries to include human papillomavirus (HPV) vaccination for young women in their national immunization schedules. Additionally, promote the availability of cervical cancer screening services to detect and treat precancerous lesions early.

7. Address Stockouts of STI Medicines: Work with countries to address stockouts of essential STI medicines, such as benzathine penicillin. This will ensure a consistent supply of medications for the treatment of STIs, including maternal STIs.

8. Provide Technical Assistance and Support: Offer technical assistance and support to countries in implementing and monitoring their STI programs. This can include capacity building, training, and sharing best practices.

By implementing these recommendations, countries can improve access to maternal health by addressing STIs, reducing mother-to-child transmission of HIV and syphilis, and promoting early detection and treatment of cervical cancer.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Telemedicine: Implement telemedicine services to provide remote access to prenatal care, consultations, and follow-up visits for pregnant women in remote or underserved areas.

2. Mobile clinics: Establish mobile clinics equipped with essential maternal health services, such as prenatal care, vaccinations, and basic obstetric care, to reach women in rural or hard-to-reach areas.

3. Community health workers: Train and deploy community health workers to provide education, counseling, and basic maternal health services in local communities, bridging the gap between healthcare facilities and pregnant women.

4. Maternal health vouchers: Introduce a voucher system that provides financial assistance to pregnant women, enabling them to access quality maternal healthcare services, including antenatal care, skilled birth attendance, and postnatal care.

5. Maternal health information systems: Develop and implement digital platforms or mobile applications that provide pregnant women with accurate and timely information about maternal health, including pregnancy care, nutrition, and warning signs.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current state of maternal health access, including the number of women receiving prenatal care, the distance to healthcare facilities, and the availability of skilled birth attendants.

2. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the number of women accessing prenatal care, the reduction in maternal mortality rates, or the increase in the number of skilled birth attendants in underserved areas.

3. Modeling and simulation: Use modeling techniques, such as mathematical modeling or simulation software, to estimate the potential impact of each recommendation on the defined indicators. This could involve creating scenarios based on different levels of implementation and analyzing the projected outcomes.

4. Data validation: Validate the simulation results by comparing them with real-world data or conducting pilot studies in selected areas to assess the actual impact of implementing the recommendations.

5. Policy and decision-making: Present the simulation results to policymakers and stakeholders, highlighting the potential benefits and challenges of each recommendation. This information can inform decision-making processes and guide the prioritization of interventions to improve access to maternal health.

6. Monitoring and evaluation: Continuously monitor and evaluate the implementation of the recommendations, tracking the progress of the defined indicators over time. This will help assess the effectiveness of the interventions and identify areas for further improvement.

By following this methodology, policymakers and healthcare providers can make informed decisions on implementing innovations to improve access to maternal health and monitor their impact on maternal health outcomes.


Statistics:
Citations: 2
Identifiers:
DOI: 10.1371/journal.pone.0263550
Research Areas:
Cancer, Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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