Protocol outlines systematic review of quality improvement interventions for STI detection and management in primary care

Sexually transmitted infections (STIs) represent a significant global public health challenge, contributing to substantial morbidity, mortality, and economic burden. Conditions such as chlamydia, gonorrhea, syphilis, and trichomoniasis, while curable, often lead to severe long-term complications if left undiagnosed and untreated, including infertility, ectopic pregnancy, chronic pelvic pain, and increased susceptibility to HIV acquisition. Primary care settings are crucial for the early detection and effective management of STIs, serving as the first point of contact for many individuals seeking healthcare. However, various barriers impede optimal STI care in these settings, including lack of provider knowledge, insufficient screening practices, limited access to rapid diagnostics, patient reluctance to discuss sexual health, and time constraints during consultations. Current standard-of-care often relies on opportunistic screening and symptom-driven testing, which can miss asymptomatic infections and delay treatment. There is a pressing need for evidence-based quality improvement (QI) interventions to enhance the capacity of primary care providers to identify, treat, and prevent STIs, thereby reducing transmission rates and improving patient outcomes. Understanding which QI strategies are most effective and safe in this context is essential to inform policy and practice, addressing a critical gap in public health efforts.

This document outlines the protocol for a systematic review designed to evaluate the effectiveness and safety of quality improvement (QI) interventions aimed at enhancing the detection and management of curable sexually transmitted infections (STIs) within primary care settings. The review will include randomized controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, and interrupted time series studies. The primary population of interest is individuals attending primary care clinics, and the interventions under scrutiny are diverse QI strategies, such as educational programs for healthcare providers, clinical decision support systems, audit and feedback mechanisms, and patient-focused interventions like reminder systems or enhanced screening protocols. Comparators will include usual care or alternative QI interventions. Key outcomes to be assessed will encompass rates of STI screening, diagnosis, appropriate treatment initiation, treatment completion, and patient safety outcomes related to the interventions. Data extraction will follow a pre-defined template, and risk of bias will be assessed using established tools relevant to each study design. A narrative synthesis will be conducted if meta-analysis is not feasible due to heterogeneity, with subgroup analyses planned where appropriate to explore variations in intervention effects across different settings or patient populations. This rigorous methodological approach aims to provide a comprehensive synthesis of existing evidence to guide future practice.