Primary Outcomes (end points)
Effectiveness of delivery methods were compared using unannounced standardized patient (SP) encounters. SPs are widely used in medical and nursing education in the United States and unannounced SPs are considered the gold standard for measuring quality of care. Unannounced SPs have been used to measure outcomes of interventions for syndromic management of Sexually Transmitted Infection (STIs) in pharmacies and clinics.
We measured whether or not clinicians completed five STI management tasks during an unannounced SP encounter and the primary outcome was total number completed. Professional actors who were fluent in Setswana attended a three-day SP training and one-day pilot in September 2013. Actors were trained on a standard script for vaginal discharge syndrome for women and male urethritis syndrome for men. All scripts were adapted to the actor’s age, and other personal characteristics. To prevent potential bias due to acting quality, the SPs encounters were balanced meaning that each SP visited a similar number of clinics in each arm during each time period.
After the encounters, SPs provided information about five STI tasks: correct medication, HIV test, provide condoms, partner notification slip, and genital exam. To avoid ingesting or removing drugs from the clinic, SPs disclosed at the end of the encounter. The clinicians recorded the drug name, dose, mode of administration, frequency, and duration on a Medication Slip, and all five elements had to be correct.
STI knowledge was a secondary outcome measured by tests with five, case-based, multiple choice questions per module. Module 4 was the exception, with one question withdrawn. Case-based questions began with a description of a case that the participants might encounter, and then poses questions about managing that case.