Improving STI counselling services of non-formal providers in Bangladesh: Testing an alternative strategy

Objective: The authors conducted this study to assess the effectiveness of using a public health detailing approach by medical representatives of a private pharmaceutical company to disseminate sexually transmitted infection (STI) counselling information to non-formal providers (NFPs) to improve their STI counselling services. Methods: An intervention was developed that included developing STI counselling guidelines and training medical representatives to disseminate the counselling guidelines to NFPs. To assess the effectiveness of this intervention, the authors conducted 67 mystery client visits to compare the counselling provided by NFPs in intervention areas with counselling provided in areas where the intervention was not implemented. Results: A significantly higher proportion (p<0.05) of mystery clients in the intervention area received advice that was consistent with the national STI counselling guidelines compared with the mystery clients in the control area. No mystery clients in the control area were told to use condoms while the STI lasts compared with 44% (95% CI 28% to 62%) in the intervention area. Likewise, more than twice as many clients in the intervention area were advised not to visit sex workers (53% vs 23%; p=0.014). Conclusion: Public health detailing of medical representatives is a feasible mechanism to improve STI counselling services of NFPs in Bangladesh. Private sector companies provide a potential avenue for reaching the vast number of NFPs with basic information that they can share with their clients. The immediate improvements seen in this study suggest the strong potential of public health detailing as a training tool for NFPs.