AIDSCAP seeks a private sector solution to the STD self-treatment dilemma.

Many people in developing countries faced with long waits at health clinics, expensive prescriptions and laboratory tests, stigma associated with sexually transmitted disease (STD) clinic attendance, and the disdain of some health providers opt to buy over-the-counter drugs against their STDs at pharmacies and in markets, and treat themselves. Such self-treatment may lead to partially treated infections and serious complications, not to mention the associated increased risk of contracting or transmitting HIV from having sexual intercourse while still infected with a STD. Population Services International in collaboration with Family Health International's AIDSTECH Project developed a standard prepackaged therapy for male urethritis to be tested in a pilot program in Cameroon. The package was named MSTOP, with MST being the French acronym for STD, and consisted of a pouch containing antibiotics to treat gonorrhea and chlamydia, the two most common causes of urethritis in Cameroon, an educational brochure, detailed instructions on how to take the medication, two cards for referring sexual partners for diagnosis and treatment, and eight Prudence condoms. Medication included two tablets of cefuroxime axetil to be taken in a single oral dose and 20 tablets of doxycycline to be taken orally twice daily for ten days. The kit retailed for US$17, at the low end of what people were willing to pay for urethritis treatment on the market, with Glaxo and Ciba-Geigy supplying the drugs at a preferential price. By the completion of all necessary preliminary studies and consultations, however, new Ministry of Health (MOH) officials had come to power who opposed the original plan of selling MSTOP without prescriptions in pharmacies and health care centers. MSTOP was therefore approved for sale March 1993 only by prescription in 21 health care facilities which served mainly university students and the military and in three private pharmacies near the university campus. More than 86% of the patients who bought the kit reported being satisfied with it, 82% reported treatment compliance, more than 50% notified sex partners, and 84% of those who had sex during treatment used some or all of the condoms in the kit. Subsequent to the ten-month pilot ending March 1994, the MOH failed to support expanding MSTOP sales to more pharmacies to increase its accessibility. Plans for a second phase of the pilot project in Cameroon were abandoned. Change in MOH leadership, resistance from physicians and pharmacy associations, the country's drug registration laws, which precluded use of the cheapest and most effective drug, and lack of acceptance of the syndromic approach to STD management thwarted the potential success of this pilot and its future widespread programmatic expansion. Health officials in six other countries have expressed their interest in working with AIDSCAP to test prepackaged STD therapy.