The Interaction Between Sexually Transmissible Infections And Human Immunodeficiency Virus Infection In Homosexual Men
Funder
National Health and Medical Research Council
Funding Amount
$635,931.00
Summary
This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increase ....This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increased in homosexual men. Currently, HIV rates are increasing in Australia and in many developed countries. We are in need of new and effective methods of HIV prevention. Data in heterosexuals suggest that where STIs are common, the early detection and treatment of these infections may help reduce HIV incidence. There are few data on this relationship in homosexual men. We propose to utilise an existing Sydney cohort of homosexual men to collect data on biologic tests for STIs, history of recent diagnosis of STIs, and symptoms, to allow a comprehensive description of the epidemiology of STIs and their overlap with HIV. The quality of data on the interaction between HIV and STIs in this cohort will be superior to any previously collected in homosexual men, as it will include data on self-reported doctor diagnosed illness, state of the art biologic testing, and symptom data, for the full spectrum of important STIs. The results of this study will be helpful in determining strategies for HIV and STI screening, education and control in the population which comprises the great majority of cases of HIV infection in Australia, and one of the largest risk groups for HIV infection in the developed world. Screening coupled with treatment of asymptomatic STIs may be an effective new approach to HIV prevention in this population.Read moreRead less
Screening For Chlamydia Trachomatis With Routine Pap Smears In General Practice: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$350,500.00
Summary
Genital chlamydia infection is the most commonly reported infectious disease in Australia. Notifications have increased three fold since 1995; five-fold in the ACT and surveillance data underestimate the true incidence of the disease in the community. Chlamydia is associated with immediate morbidity in men and women including urethritis, epididymo-orchitis, cervicitis, and pelvic pain and long-term complications including pelvic inflammatory disease, ectopic pregnancy and tubal factor infertilit ....Genital chlamydia infection is the most commonly reported infectious disease in Australia. Notifications have increased three fold since 1995; five-fold in the ACT and surveillance data underestimate the true incidence of the disease in the community. Chlamydia is associated with immediate morbidity in men and women including urethritis, epididymo-orchitis, cervicitis, and pelvic pain and long-term complications including pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility. The economic costs of Chlamydial infection in Australia have been estimated to be as high as $160 million each year. In the ACT 73.8% of chlamydial infections occur in the 20-40 year old group. Between 60 and 70% of women in this age range participate in Pap screening every two years. While targeted screening for Chlamydia in women is effective in the US, there are few studies that investigate its value in an Australian setting. In this randomised controlled clinical trial we aim to test the novel hypothesis that the routine offer of chlamydia testing to women between 20 and 40 years who undergo Pap screening significantly increases the detection of Chlamydia in that population. This is the first randomised-controlled trial of its type and is an extension of a current non-randomised pilot study of linked Chlamydia-Pap screening in the primary care setting. The aim is to determine if the program can be incorporated more widely in the ACT. The study will: Measure the impact of linked chlamydia-Pap screening on chlamydia screening participation rates More accurately determine the epidemiology of genital chlamydial infection in this age group and social setting; Undertake an economic evaluation of this approach; Determine if promoting the Pap smear as an opportunity for chlamydial screening increases the uptake of Pap screening in younger women Aid in the development of a National Chlamydia Screening strategyRead moreRead less
False Positives In The Diagnosis Of Sexually Transmitted Chlamydia Trachomatis Infection In Children
Funder
National Health and Medical Research Council
Funding Amount
$724,313.00
Summary
Chlamydia trachomatis causes sexually transmitted infections, and also the eye disease trachoma. The detection of Chlamydia in urine sample from a child can be seen as evidence for sexual abuse. We will assess the potential impacts of three mechanisms that could conceivably lead to urogenital Chlamydia diagnosis in a child in the absence of sexual abuse: contamination of the urogenital site with ocula Chlamydia, contamination of urine samples after collection, and diagnostic test malfunction.
A Longitudinal Study Of Bacterial Vaginosis And Mycoplasma Genitalium In Young Australian Women.
Funder
National Health and Medical Research Council
Funding Amount
$102,270.00
Summary
The aim of this research project is to measure how many Australian women are infected with either bacterial vaginosis or Mycoplasma genitalium. These infections can be associated with significant reproductive complications for women. Very little is know about how common these infections are or how often they can occur. This study will follow 1400 women over 12 months, asking them to provide vaginal swabs through the post for testing for these infections.
Role Of HtrA And RseP, Stress Response Proteases, In Development And Persistence Of Chlamydia Trachomatis Infections
Funder
National Health and Medical Research Council
Funding Amount
$389,984.00
Summary
This project will research the most commonly reported bacterial sexually transmitted infection Chlamydia trachomatis. Bacterial proteins which could play a role in chronic infections of humans will be investigated. Proteins will be biologically examined to determine their role during disease. This may identify proteins which could be used for diagnostic and therapeutic tools to prevent chronic Chlamydia infection (which can result in infertility and other serious conditions).
Regulatory Networks Controlling Virulence In Neisseria Gonorrhoeae And Neisseria Meningitidis.
Funder
National Health and Medical Research Council
Funding Amount
$300,773.00
Summary
Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made in particular conditions - their expression is regulated. To target efforts in the development of new vaccines and treatments, it is important to identi ....Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made in particular conditions - their expression is regulated. To target efforts in the development of new vaccines and treatments, it is important to identify all the virulence determinants produced by a particular bacterial species, but also to know which are regulated, and the environmental signals that determine their expression. It can be just as important to know whether a virulence determinant is constantly expressed, and therefore represents an invariant target. Neisseria gonorrhoeae and Neisseria meningitidis are two important disease-causing bacteria that exclusively infect humans and cause gonorrhoea, and meningitis. The complete DNA sequence of both of these bacteria is currently being determined. From computer analysis of these data, it appears that these bacteria have few of the specific regulatory systems that are present in other bacteria. The availability of DNA sequencing data enables an alternative and much more systematic approach to the identification and study of the regulation of virulence determinants. Because of the limited repertoire of regulatory systems still present in N. gonorrhoeae and N. meningitidis, it is feasible to mutate each and determine which are involved in regulation of virulence determinants. We will also be able to identify genes regulated by each system, determine how regulation is achieved, and use this information to identify any presently unknown virulence genes controlled by the same system. Such an analysis has never been previously achieved for any bacterial species, because of the number and complexity of the regulatory systems usually present.Read moreRead less
Adolescent Males' Beliefs And Feelings About The Consequences Of A Partner's Pregnancy: A Survey And Intervention Study
Funder
National Health and Medical Research Council
Funding Amount
$170,095.00
Summary
Each year, in Australia, approximately 28,000 adolescents become pregnant. The psychological, social and financial cost of adolescent pregnancy in Australia is substantial, in both the long and short term. An unexpected finding in North American studies is that a substantial number of adolescent pregnancies occur by design. Prevention programs in Australia and elsewhere assume adolescents do not wish to become pregnant and focus on educating adolescents about causes rather than consequences. Res ....Each year, in Australia, approximately 28,000 adolescents become pregnant. The psychological, social and financial cost of adolescent pregnancy in Australia is substantial, in both the long and short term. An unexpected finding in North American studies is that a substantial number of adolescent pregnancies occur by design. Prevention programs in Australia and elsewhere assume adolescents do not wish to become pregnant and focus on educating adolescents about causes rather than consequences. Research conducted by one of us (JAQ) found that over 75% of pregnant teenagers said they had deliberately become pregnant. Another of us (JTC) studied 1,500 Australian adolescents attitudes and beliefs about pregnancy and parenthood. The findings showed high levels of idealisation, especially in males. Males have been largely neglected in adolescent pregnancy research. The first component of this study is a survey of 500 adolescents to investigate their attitudes and beliefs about pregnancy occurring in a sexual partner, and the consequences of that event for them both. The assessment tool is a computer role-play simulation with its starting point the announcement of a pregnancy. The intervention study involves 300 adolescents and comprises viewing and discussing a video in which 4 adolescent males talk about their experiences of the consequences of pregnancy in a sexual partner. The use of 4 groups with different sequences of assessment and intervention will enable us to ascertain the effectiveness of the intervention. Of particular interest is whether the video or the role-play makes any impact on idealised attitudes and beliefs. This research is the first undertaken on adolescent male attitudes and beliefs using a computer role-play. It will provide essential information for the development of effective, male-oriented prevention programs which focus on consequences as well as causes of adolescent pregnancy.Read moreRead less
Follow-up Study Of Indigenous Adults In North Queensland: Chronic Diseases And Sexual Health
Funder
National Health and Medical Research Council
Funding Amount
$1,493,700.00
Summary
This study aims to follow up a cohort of Indigenous adults in rural and remote north Queensland communities who participated in the Well Persons Health Check (funded by OATSIH) during 1998-2000. Out of the 2,862 Indigenous participants, 2,503 (87.5%) agreed to have another Check in a few years time. A follow-up study is proposed for the consenting WPHC participants (any any other adults who wish to participate). This study will have 5 main objectives: 1. Estimate the incidence rate of chronic di ....This study aims to follow up a cohort of Indigenous adults in rural and remote north Queensland communities who participated in the Well Persons Health Check (funded by OATSIH) during 1998-2000. Out of the 2,862 Indigenous participants, 2,503 (87.5%) agreed to have another Check in a few years time. A follow-up study is proposed for the consenting WPHC participants (any any other adults who wish to participate). This study will have 5 main objectives: 1. Estimate the incidence rate of chronic disease conditions (diabetes, renal disease, CVD) and the main determinants of these in the north Queensland cohort (It is expected that Torres Strait Islanders will have different patterns to Aborigines), 2. Estimate the change over a 5 year period in risk factors and complications (including hospitalisations) of those with existing chronic conditions 3. At a community level, evaluate the effectiveness of local interventions aimed at health improvement (e.g. one community has drastically changed rules about alcohol availability, other communities have significantly improved the supply of fresh fruit and vegetables, still others have commenced family savings programs which improve the availability of money over the week and enable savings to buy fridges etc). 4. Estimate whether the early detection of chlamydia and gonorrhoea (using routine urine PCR testing) has lowered the community prevalence of bacterial STIs, and 5. Evaluate the effectiveness of local health promotion programs (e.g. tobacco control initiatives, healthy weight programs). The study will be undertaken in collaboration with Apunipima Cape York Health Council, the Torres Strait Health Council and relevant local community organisations. It will involve skills development for local Indigenous researchers and practitioners. Results will be given back to communities and individuals, with opportunities for further planning.Read moreRead less
A Computer Alert To Increase Chlamydia Testing Of High Risk Women In General Practice: A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$182,575.00
Summary
Chlamydia trachomatis infection is the most common notifiable sexually transmissible infection (STI) in Australia, with over 30,000 infections notified in 2003, rising by 20% each year. Infection with chlamydia can have considerable complications, particularly for women - it is a leading cause of pelvic inflammatory disease and tubal infertility. Unfortunately, as many as 85% of people with infection do not have any symptoms, so are unaware they have chlamydia; yet chlamydia is easy to diagnose ....Chlamydia trachomatis infection is the most common notifiable sexually transmissible infection (STI) in Australia, with over 30,000 infections notified in 2003, rising by 20% each year. Infection with chlamydia can have considerable complications, particularly for women - it is a leading cause of pelvic inflammatory disease and tubal infertility. Unfortunately, as many as 85% of people with infection do not have any symptoms, so are unaware they have chlamydia; yet chlamydia is easy to diagnose with urine tests and easy to treat with single dose antibiotics. Over 65% of infections diagnosed in women are among those aged 16 to 24 years. Internationally, screening programs for chlamydia have reduced the number of people with the infection and have also reduced the rate of complications arising from infection. However, Australia does not have a screening program and only tests about 4% of 16 to 24 year old women, the largest group at risk of infection, each year. We propose to conduct a study which tests the effect of using a computer based alert. This alert is designed to prompt doctors to discuss chlamydia testing with sexually active women aged 16 to 24 years. A group of general practices will be selected. We will randomly allocate some practices to have the alert installed on their computers and the remaining practices will receive no intervention. We will observe both groups of general practices over 12 months and compare their chlamydia testing rates among women aged 16 to 24 years. We estimate that the alert will increase testing rates from the 4% currently tested to 10%. By testing and treating more women with the infection, we can reduce the number of people in the community with the infection. We will also be collecting information about the dollar cost of chlamydia infection to the community. This study will produce valuable information which can be used by government to inform the design of future chlamydia screening and control programs.Read moreRead less