1.Development of clinical managements on diagnostics, treatment and preventive maintenance sexually transmitted disease in municipal hospita a primary part
2.Creation of the program of a training course for doctors of a primary part on diagnostics, treatment and preventive maintenance sexually transmitted disease
3.Distribution of materials on preventive maintenance sexually transmitted disease to try to organize debatable group with participation of the women involved in employment by prostitution, for discussion of strategy of preventive maintenance sexually transmitted disease
The project will include several steps: first step will be development of clinical guidelines on diagnosis, treatment and prevention of STD in PHC setting. To develop those guidelines it would be necessary to conduct assessment of the sexual behavior in several groups, which could present themselves to the PHC specialists and/or which are at increased risk of getting STD: commercial female sex workers, intravenous drug users, young adults (students of graduate colleges) and teenagers. This should be anonymous survey of about 70-100 representatives of each group and the questions addressed will be number of life-time and last month partners, rate and consistence of condom use, types of sexual practice, barriers to condom use, type of birth control measures used, history of previous STD/ symptoms of STD, knowledge of STD symptoms, transmission and prevention, etc. This information will help providers to understand better target audience for STD prevention. It should be noted here, that search of the Russian-language scientific medical literature for 1995-1999 (Russian Medicine bibliographical database) showed virtual absence of publications dedicated to the condom use/failure/behavioral approaches to the encouraging its use (with exception of couple translated Western articles). This is very disturbing as the number of projects dedicated to the prevention of STD in recent years was very high (it seems that all of them are based solely on Western experience and/or anecdotal data generated by each group). After completion of the survey data will be analyzed and blended with already existing clinical recommendations. The existing recommendation will be actively screened for in Internet, translated and presented to the expert group which will survey its applicability in Russian situation. Special attention would be paid to the scientific validity of recommendation, its evidence basis and cultural appropriateness. To ensure cultural appropriateness and lack of ?moral? bias several experts and physicians of different age group will be surveyed regarding recommendations, without indicating opinion of other group members (modified Delphi method). Also focus groups could be employed as deemed necessary to ensure social appropriateness. Created guidelines will be reviewed by several PHC specialists for their technical clarity and implementability.
Second part of the project will be to create curriculum for education PHC physicians in diagnosis, treatment and prevention of STD. This curriculum should be based on guidelines developed at the first step. From the other side, in developing curriculum, project team will first survey PHC specialists on their knowledge of STD diagnosis, treatment and prevention (MCQ tests), also experts will be surveyed as for important additional information that should be included into curriculum (above and beyond guidelines). Developed curriculum will include components of community-oriented prevention as well as risk group prevention approach. This curriculum will be basis for training participants of the third and fourth steps (outreach programs for CFSW and teenagers). Developed curriculum will be accredited through College of Medicine at MAPS and then will be implemented in a short course (seminar). During this seminar participants will be trained in general questions of STD transmission, peculiarities of modern STD and their diagnosis and treatment. Changing paradigm of STD prevention will be presented (transition from contact-treatment to primary prevention), as well as behavioral approaches to promoting healthier sexual behavior. Also programs of risk reduction will be presented to the seminar participants and necessity and drawbacks of the outreach programs will be presented. During this seminar general plan for the participation in the outreach programs for CFSW and teenagers will be outlined.
Next step in the program will be outreach program for prevention among CFSW. The plan for it will be based upon assessment of prevalence of harmful sexual behavior among CSW in St.Petersburg (unprotected receptive intercourse, especially anal; prevalence of condom failure; concomitant use of illicit drugs; prevalence of STD and willingness to seek medical attention, etc.). Team will try to contact some opinion leaders among CSW, collaboration with vice-squad of the local police could be necessary. The program itself will include distribution of materials on STD prevention, attempts to organize discussion groups among CSW on strategies for prevention of STD and proposal to use STD clinic free of charge for diagnosis and treatment of STDs.
In parallel to the CFSW education program, an outreach program for teenagers will be organized. It will also seek opinion leaders and discussion with them STD prevention, distribution of educational materials and free service at STD clinic. Also team will seek contacts with teenager-oriented mass-media to prepare there series of programs on STD prevention. The programs will follow by advertising campaign.
In parallel to the outreach programs an educational book ? ?Sex without venereal diseases? will be published and distributed among organizers of the preventive programs. Excerpts from the book will also be published on the Web and its address will be marketed in several search engines and erotic/sexual Web-sites.