D Nsibande

Publications (2)3.94 Total impact

• Article: Effectiveness and cost effectiveness of syndromic sexually transmitted infection packages in South African primary care: cluster randomised trial.

  M Colvin, M O Bachmann, R K Homan, D Nsibande, N M Nkwanyana, C Connolly, E B Reuben
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  ABSTRACT: To evaluate the effectiveness and cost effectiveness of syndromic sexually transmitted infection (STI) packages on appropriate treatment and preventive management during primary care consultations. Cluster randomised trial of 37 Durban primary care clinics randomised to use syndromic packages (containing antibiotics, condoms, partner notification cards, and written information) or not. We assessed outcomes using simulated patients who reported STI symptoms and recorded how they were managed, before and after implementation (269 and 256 simulated patient consultations). We adjusted for baseline values and intra-clinic correlation of outcomes statistically. We used health department information to estimate the extra resources needed to provide the packages to 20 clinics for 1 year and their costs. Simulated patients in intervention clinics were more likely to receive appropriate syndromic STI management (correct treatment plus condoms offered plus partner notification cards offered; prevalence rate ratio 2.3; 95% confidence intervals (CI) 1.6 to 3.0) and to receive more STI advice and information (odds ratio 1.5; 95% CI 1.01 to 2.1). Women were less likely to receive appropriate syndromic STI management. The intervention increased STI information provision in women more than in men. The extra cost per extra patient appropriately managed was $1.51. Syndromic packages improved syndromic STI management at a reasonable cost and should be used more widely.
  Sexually Transmitted Infections 09/2006; 82(4):290-4. · 2.85 Impact Factor
• Article: Quality of primary care for sexually transmitted diseases in Durban, South Africa: influences of patient, nurse, organizational and socioeconomic characteristics.

  M O Bachmann, M S E Colvin, D Nsibande, C Connolly, B Curtis
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  ABSTRACT: Quality of sexually transmitted disease (STD) primary care in South Africa varies widely but reasons for this are poorly understood. We investigated 37 randomly sampled clinics providing STD care, with simulated patients, and staff interviews and record review. Census data provided local socioeconomic indicators. Multiple regression identified independent predictors of quality. Of 271 simulated patient visits, 79% were correctly treated and 39% were correctly managed. Women received worse care, and care tended to be poorer in mainly African and mainly coloured (mixed race) areas. African and Indian nurses were more likely to provide correct treatment. Previous STD training was marginally associated with correct treatment. Quality assessments using simulated patients were not generally associated with assessments using staff interviews and record review. There were frequent missed opportunities for STD prevention and treatment, and evidence of racial but not socioeconomic inequalities.
  International Journal of STD & AIDS 07/2004; 15(6):388-94. · 1.09 Impact Factor