DLSI TA

Context :

Sexually transmitted infections (STIs) represent a major public health challenge worldwide due to their high prevalence, potential complications and impact on reproductive health and social well-being. In response to this situation, international recommendations, issued mainly by the WHO, the Centres for Disease Control and Prevention (CDC) and UNAIDS, advocate an integrated approach based on three pillars: prevention, diagnosis and treatment. In terms of diagnosis and treatment, two complementary approaches are recommended internationally: the syndromic approach and the aetiological approach. Current recommendations emphasise the need to combine these two approaches, adapting their use to the local context in order to optimise clinical relevance, speed of intervention and effectiveness in the fight against STIs.

Historically, health policies and funding in Senegal have largely focused on the fight against HIV/AIDS, in line with international and national priorities. At the same time, STIs are an under-documented and under-funded public health issue, despite their high prevalence and direct impact on sexual and reproductive health (SRH). Epidemiologically, analysis of national trends shows a gradual increase in reported STIs, reflecting both unprotected sexual practices and a lack of awareness, prevention and access to care. Marked geographical disparities persist, with adolescents and young adults, sex workers (SWs) and men who have sex with men (MSM) being the most exposed populations. Furthermore, the evolution of antimicrobial resistance is not taken into account in national treatment recommendations.

Senegal does not have a recent situational analysis, even though several epidemiological, clinical and community indicators point to persistent, underestimated and heterogeneous circulation of STIs across different regions and population groups. The national recommendations on STI management are nearly twenty years old and do not incorporate the latest WHO recommendations in terms of diagnostic approach or adaptation of STI treatments. A situational analysis is therefore essential to consolidate and analyse the information already available, identify gaps in organisation, screening, prevention and management, and formulate recommendations that can be directly implemented within the framework of the GC8 request, taking into account international recommendations, particularly those of the WHO, and the possibility of implementing them in the Senegalese context.

General objective: Conduct a situational analysis on the diagnosis and management of STIs in Senegal in order to improve their consideration in the next Global Fund grant (GC8) and ensure an integrated approach, in line with international recommendations, including the latest WHO guidelines.

Specific objectives:

SO1 Documentary and normative analysis

• Research and analyse available data on the prevalence of different STIs based on a documentary review.
• Conduct a documentary review and analysis of scientific literature on the microbiological profile of STIs in Senegal, including antimicrobial resistance.
• Analyse international recommendations, particularly those of the WHO, and evaluate the national response to STIs in Senegal in light of these recommendations.

SO2 Analysis of the care system

• Assess the level of training of healthcare providers on the management of STIs and describe the current care package offered.
• Document the organisation of care for the diagnosis and management of STIs according to different population groups (key populations, pregnant women, general population) in order to identify specificities, barriers and good practices observed at each level of the health pyramid.
• Assess laboratory capacity and access to aetiological diagnosis of STIs.
• Examine the system for collecting, analysing and transmitting health information related to STIs at the site level.
• Analyse the mechanisms for coordinating the national response to STIs and map the actors involved.
• Assess the availability and accessibility of essential inputs (medicines, condoms, screening tests, etc.).

SO3 Strategic and operational guidelines

• Formulate priority actions and recommendations to be submitted within the framework of GC8.