Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 138

5 Clinical and Support Services

STI services/interventions should be designed, organized and implemented at scale. Achieving high
coverage, ensuring quality services and linking or integrating to HIV, sexual and reproductive health
(SRH) and other services requires systematic, standardized approaches. A phased approach to scaling
up services, moving from externally led services to community-led ones, is illustrated in Figure 5.2.

A. Designing STI services
Assess current STI services
When mapping sex worker communities before establishing an intervention (see Chapter 6, Section
6.2.6, part A), data on the quality of STI services, current use of services, their acceptability and
accessibility should also be collected. This information may be used to determine the demand for
STI services and develop a plan to improve existing services or establish new ones.
Define essential STI service package and other services for sex workers
STI services for sex workers should meet basic standards of quantity and quality. The national
programme should lead the development of STI guidelines and operational standards and define the
essential STI and other service package in consultation with technical experts, implementers and sex
workers. These guidelines and standards will be the basis for implementation, training, supervision
and monitoring.
The basic STI service package includes:
• syndromic case management for patients with symptoms
• screening and treatment of asymptomatic STIs:
›› syphilis screening
›› gonorrhoea and chlamydia screening
›› routine STI check-ups
›› referrals to voluntary HTC.
It is important that the STI service package be linked or integrated with HIV, SRH and primary care,
when appropriate and feasible.
Since sex workers have a higher risk of STIs and their risk factors differ from those of the general
populatio