Academic journal article Bulletin of the World Health Organization

Monetary Incentives for Provision of Syphilis Screening, Yunnan, China/Mesures Incitatives Pecuniaires Pour Permettre le Depistage De la Syphilis Dans le Yunnan, En Chine/Incentivos Monetarios Para la Provision De Pruebas De Deteccion De la Sifilis, Yunnan, China

Academic journal article Bulletin of the World Health Organization

Monetary Incentives for Provision of Syphilis Screening, Yunnan, China/Mesures Incitatives Pecuniaires Pour Permettre le Depistage De la Syphilis Dans le Yunnan, En Chine/Incentivos Monetarios Para la Provision De Pruebas De Deteccion De la Sifilis, Yunnan, China

Article excerpt

Introduction

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum. Approximately 3 million people aged 15-49 years were infected with syphilis in China in 2011, (1) accounting for a large proportion of the estimated 17 721 000 cases globally in 2012. (2) Despite continuous efforts to promote condom use, (3) syphilis transmission has not been prevented effectively, resulting in an increase of reported cases in the country since 2000. (4) To control the epidemic, in 2010 the health ministry in China launched its National Programme for Prevention and Control of Syphilis (2010-2020). (5,6)

Based on evidence from pilot studies, syphilis control efforts in China include early detection of infection through enhanced screening efforts followed by treatment of infected cases. The core intervention strategy has been described as the three-by-one approach, meaning that there are three entry points to screening linked to one standardized mode of care. (5,7) The three settings are: (i) sexually transmitted disease clinics; (ii) human immunodeficiency virus (HIV) testing clinics (usually voluntary counselling and testing centres, and methadone maintenance treatment centres); and (iii) out-of-clinic settings where outreach services are delivered to sex workers and men who have sex with men. Standardized care provided to infected people consists of treatment with benzathine benzylpenicillin, behavioural interventions and partner notification. (5) Screening also started in antenatal clinics after 2011 when syphilis was integrated into a separate programme for prevention of mother-to-child transmission of HIV and hepatitis B virus. (8) We describe the approaches used to scale-up the syphilis screening and treatment interventions in Yunnan province.

Local setting

Yunnan province, with a population of 47 million in 2015, is located in the south-west of the country and is the region hardest hit by HIV infection in China. By the end of 2010, the cumulative reported number of people with HIV infection and acquired immune deficiency syndrome (AIDS) in Yunnan was 83 925; accounting for 21.0% of the total national figure of 399 643. (9) The province is also disproportionately burdened with syphilis cases. Approximately 7000 people with different stages of syphilis infection were reported in 2011 among 45 966 362 residents, an incidence of 15 per 100 000 people. (10) To respond effectively to the increasing epidemic of HIV, a province-wide campaign to prevent and control HIV/AIDS was initiated in Yunnan in 2005. For the initiative, the Yunnan government established a functional network of HIV testing services in health facilities, which provided opportunities for integrating interventions targeted at other sexually transmitted diseases. In addition, introduction of point-of-care tests for syphilis in China allowed an--expansion of syphilis testing in clinics and out-of-clinic settings, such as outreach services or sometimes pharmacies, in the province. (11) Moreover, the central government issued a specific policy to ensure the availability of benzathine benzylpenicillin in health facilities for syphilis treatment. Supplies were ensured through advocacy efforts together with site supervision and monitoring.

Approach

After the three-by-one approach was proposed as the core technical strategy, the next step was to implement the strategy in the field. To do this, the Yunnan Provincial Department of Health allocated public health funds for syphilis testing and treatment services.

Through a situation analysis, the local health facilities were mapped, evaluated for capacity and then categorized as sites for syphilis testing, diagnosis and treatment or sites for syphilis testing only. These were primary-care centres or community and township hospitals. A total of 363 sites across Yunnan province, including all the 130 antenatal clinics, were officially designated as testing, diagnosis and treatment sites by the provincial authority to ensure that each of 129 districts or counties had at least one such site. …

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