ORCID Profile
0000-0001-8851-4126
Current Organisations
University of New South Wales
,
University of Sydney
,
Royal Australasian College of Physicians
,
Royal College of Physicians
,
Royal College of Physicians of Ireland
,
Sydney Sexual Health Centre
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Medical Biotechnology | Social and Cultural Anthropology | Public Health and Health Services | Urban Sociology and Community Studies | Sociology not elsewhere classified | Public Health and Health Services not elsewhere classified | Medical Biotechnology Diagnostics (incl. Biosensors) | Pharmacology and Pharmaceutical Sciences not elsewhere classified |
ANZSRC Socio-Economic Objective (SEO)
Cultural Understanding not elsewhere classified | Human Pharmaceutical Treatments (e.g. Antibiotics) | Social Structure and Health | Human Diagnostics | Men's Health | Expanding Knowledge in Technology
Related Links
Publications
A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.CMI.2018.08.001
Abstract: Papua New Guinea has among the highest prevalences of sexually transmissible infections (STIs) globally with no services able to accurately test for anorectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Here we prospectively evaluated the diagnostic performance of a molecular CT/NG assay used at the point-of-care (POC) with the aim of enhancing anorectal STI screening and same-day treatment. Men who have sex with men, transgender women and female sex workers taking part in Papua New Guinea's first large-scale biobehavioural study were enrolled and asked to provide a self-collected anorectal swab for POC GeneXpert CT/NG testing. Same-day treatment was offered if positive. A convenience s le of 396 unique and randomly selected s les were transported to Australia for comparison using the Cobas 4800 CT/NG test (Roche Molecular Diagnostics, Pleasanton, CA, USA). A total of 326 s les provided valid results by Cobas whereas 70 s les provided invalid results suggesting inhibition. The positive, negative and overall percentage agreements of GeneXpert CT/NG for the detection of C. trachomatis were 96.7% (95% CI 92.3%-98.9%), 95.5% (95% CI 91.3%-98.0%) and 96.0% (95% CI 93.3%-97.8%), and for N. gonorrhoeae were 93.0% (95% CI 86.1%-97.1%), 100.0% (95% CI 98.3%-100.0%) and 97.8% (95% CI 95.6%-99.1%), respectively. The overall rate of agreement between the GeneXpert and Cobas CT/NG assays was high with 96.0% for C. trachomatis and 97.8% for N. gonorrhoeae. Results from this study data suggest that the GeneXpert CT/NG assay is suitable for testing self-collected anorectal specimens at the POC and that same-day treatment was feasible.
Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol
Publisher: Springer Science and Business Media LLC
Date: 06-01-2017
Psychological distress among re-education through labour camp detainees in Guangxi Autonomous Region, China
Publisher: Informa UK Limited
Date: 02-01-2017
DOI: 10.1080/09638237.2016.1276529
Abstract: There is currently no information about the prevalence of, and factors contributing to psychological distress experienced by re-education through labour c detainees in China. A cross-sectional face-to-face survey was conducted in three labour c s in Guangxi, China. The questionnaire covered socio-demographic characteristics sexually transmissible infections (STIs) drug use psychological distress (K-10) and health service usage and access inside the labour c s. K-10 scores were categorised as ≤30 (low to moderate distress) and >30 or more (highly distressed). Univariate and multivariate logistic regression models identified factors independently associated with high K-10 scores for men and women separately. In total, 755 detainees, 576 (76%) men and 179 (24%) women, participated in the health survey. The study found 11.6% men versus 11.2% women detainees experienced high psychological distress, but no significant gender differences were observed (p> 0.05). Multivariate logistic regression showed that multiple physical health problems were significantly associated with high psychological distress among men. Drug treatment and forensic mental health services need to be established in detention centres in China to treat more than 10% of detainees with drug use and mental health disorders.
HIV incidence in Indigenous and non-Indigenous populations in Australia: a population-level observational study
Publisher: Elsevier BV
Date: 09-2018
Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: Analysis of longitudinal clinical service data
Publisher: BMJ
Date: 04-11-2015
DOI: 10.1136/SEXTRANS-2014-051617
Abstract: To undertake the first comprehensive analysis of the incidence of three curable sexually transmissible infections (STIs) within remote Australian Aboriginal populations and provide a basis for developing new control initiatives. We obtained all results for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) testing conducted during 2009-2011 in in iduals aged ≥16 years attending 65 primary health services across central and northern Australia. Baseline prevalence and incidence of all three infections was calculated by sex and age group. A total of 17 849 in iduals were tested over 35 months. Baseline prevalence was 11.1%, 9.5% and 17.6% for CT, NG and TV, respectively. During the study period, 7171, 7439 and 4946 initially negative in iduals had a repeat test for CT, NG and TV, respectively these were followed for 6852, 6981 and 6621 person-years and 651 CT, 609 NG and 486 TV incident cases were detected. Incidence of all three STIs was highest in 16-year-olds to 19-year-olds compared with 35+ year olds (incident rate ratio: CT 10.9 NG 11.9 TV 2.5). In the youngest age group there were 23.4 new CT infections per 100 person-years for men and 29.2 for women and 26.1 and 23.4 new NG infections per 100 person-years in men and women, respectively. TV incidence in this age group for women was also high, at 19.8 per 100 person-years but was much lower in men at 3.6 per 100 person-years. This study, the largest ever reported on the age and sex specific incidence of any one of these three curable infections, has identified extremely high rates of new infection in young people. Sexual health is a priority for remote communities, but will clearly need new approaches, at least intensification of existing approaches, if a reduction in rates is to be achieved.
Pathology Laboratory Surveillance in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses: Protocol for a Cohort Study
Publisher: JMIR Publications Inc.
Date: 08-08-2019
DOI: 10.2196/13625
Abstract: Passive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. The aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. ACCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of in iduals tested and retested, test yield, positivity, and incidence. To date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory reporting of indicators will occur in 2019 with publication to follow. The ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. DERR1-10.2196/13625
A real-time PCR assay for direct characterization of theNeisseria gonorrhoeaeGyrA 91 locus associated with ciprofloxacin susceptibility
Publisher: Oxford University Press (OUP)
Date: 03-11-2015
DOI: 10.1093/JAC/DKV366
Abstract: The objective of this study was to develop a real-time PCR method for specific detection of the gonococcal GyrA amino acid 91 locus directly in clinical s les so as to predict Neisseria gonorrhoeae ciprofloxacin susceptibility. The real-time PCR assay, GyrA91-PCR, was designed using two probes, one for detection of the WT S91 sequence and the other for detection of the S91F alteration. The performance of the assay was initially assessed using characterized N. gonorrhoeae isolates (n = 70), a panel of commensal Neisseria and Moraxella species (n = 55 isolates) and clinical s les providing negative results by a commercial N. gonorrhoeae nucleic acid lification test (NAAT) method (n = 171). The GyrA91-PCR was then applied directly to N. gonorrhoeae NAAT-positive clinical s les (n = 210) from the year 2014 for which corresponding N. gonorrhoeae isolates with susceptibility results were also available. The GyrA91-PCR accurately characterized the GyrA 91 locus of all 70 N. gonorrhoeae isolates (sensitivity = 100%, 95% CI = 94.9%-100%), whereas all non-gonococcal isolates and N. gonorrhoeae NAAT-negative clinical s les gave negative results by the GyrA91-PCR (specificity = 100%, 95% CI = 98.4%-100%). When applied to the 210 N. gonorrhoeae NAAT-positive clinical s les, the GyrA91-PCR successfully characterized 195 s les (92.9%, 95% CI = 88.5%-95.9%). When compared with the corresponding bacterial culture results, positivity by the GyrA91-PCR WT probe correctly predicted N. gonorrhoeae susceptibility to ciprofloxacin in 161 of 162 (99.4%, 95% CI = 96.6%-99.9%) s les. The use of a PCR assay for detection of mutation in gyrA applied directly to clinical s les can predict ciprofloxacin susceptibility in N. gonorrhoeae.
Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study
Publisher: Oxford University Press (OUP)
Date: 09-11-2017
DOI: 10.1093/CID/CIX769
Abstract: There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort. A cohort of 315123 Western Australian women, born during 1974-1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID. Over 3199135 person-years, 120748 women had pathology test records for both chlamydia and gonorrhea, 10745 chlamydia only, and 653 gonorrhea only. Among those tested, 16778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66-5.03) in women who were both chlamydia and gonorrhea positive 4.54 (95% CI, 3.87-5.33) in those only gonorrhea positive and 1.77 (95% CI, 1.61-1.94) in those only chlamydia positive. Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.
Is It Time to Rethink Syphilis Control?
Publisher: Oxford University Press (OUP)
Date: 16-10-2015
DOI: 10.1093/CID/CIU813
Changes in the rates ofNeisseria gonorrhoeaeantimicrobial resistance are primarily driven by dynamic fluctuations in common gonococcal genotypes
Publisher: Oxford University Press (OUP)
Date: 20-12-2016
DOI: 10.1093/JAC/DKW452
Abstract: To examine how gonococcal genotypes and associated changes over time influence rates of Neisseria gonorrhoeae antimicrobial resistance. All available N. gonorrhoeae isolates collected in New South Wales, Australia in the first half of both 2012 and 2014 were genotyped using the Agena MassARRAY iPLEX platform. Genotypic data were compared with phenotypic antimicrobial resistance profiles over time. We focused on penicillin and ciprofloxacin as significant increases in resistance to both antibiotics were observed over this time period. Genotyping data were obtained for 760 and 782 isolates in 2012 and 2014, respectively. A total of 162 distinct genotypes were identified in the study, including 36 (22.2%) genotypes present in both years ( persisting genotypes), 54 (33.3%) observed in 2012 only and 72 (44.4%) observed in 2014 only (s ingle-year genotypes). Overall, persisting genotypes comprised 15 of the 20 most common genotypes, 8 of which showed a significant change in proportion from 2012 to 2014. Persisting genotypes also comprised the majority (>70%) of ciprofloxacin- and penicillin-resistant isolates in both years. Significant fluctuations in the most common persisting genotypes accounted for the majority of observed increases in both ciprofloxacin and penicillin resistance. Single-year genotypes contributed to ∼20% of ciprofloxacin and penicillin resistance in each year. The results show that the gonococcal genotypes persisting in the study population fluctuated significantly within a 3 year period, with numerous other genotypes appearing or disappearing. It is the net effect of these changes that determines N. gonorrhoeae antimicrobial resistance levels within the population.
Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors among Female Sex Workers in Australia: A Retrospective Cohort Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services
Publisher: Springer Science and Business Media LLC
Date: 07-2014
Real-time PCR detection ofNeisseria gonorrhoeaesusceptibility to penicillin
Publisher: Oxford University Press (OUP)
Date: 25-07-2016
DOI: 10.1093/JAC/DKW291
Abstract: The objective of this study was to develop a real-time PCR assay targeting the gonococcal porB gene (PorB-PCR) for predicting susceptibility of Neisseria gonorrhoeae to penicillin. This complements a previously described PCR assay for detecting penicillinase-producing N. gonorrhoeae (PPNG) developed by our laboratory (PPNG-PCR). The PorB-PCR assay was designed using six probes to characterize various combinations of amino acids at positions 101 and 102 of the PorB1b class protein, including the WT G101/A102 and mutant G101K/A102D, G101K/A102N and G101K/A102G sequences, as well as the PorB1a sequence. The ability of these sequences to predict penicillin susceptibility was initially assessed using 2307 N. gonorrhoeae isolates from throughout Australia for which phenotypic susceptibility data were available. The assay was then applied to N. gonorrhoeae-positive clinical specimens (n = 70). Specificity was assessed by testing commensal Neisseria strains (n = 75) and N. gonorrhoeae-negative clinical specimens (n = 171). Testing of the 2307 N. gonorrhoeae isolates using PorB-PCR to detect G101/A102 and PorB1a sequences identified a total of 78.4% (61.2% and 17.2%, respectively) of penicillin-susceptible isolates with specificities of 97.4% and 99.3% and positive predictive values of 98.8% and 98.9%, where PPNG strains were simultaneously identified and excluded. Similar performance data were obtained when the PorB-PCR assay was applied to the N. gonorrhoeae-positive clinical specimens. No false-positive results were observed for the N. gonorrhoeae-negative s les and no cross-reactions were observed with the non-gonococcal species. When used in parallel with the previously described PPNG-PCR, the PorB-PCR approach has the potential to facilitate in idualized treatment of gonorrhoea using penicillin.
Increasing hepatitis A immunity in men who have sex with men in Sydney, 1996-2012
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.VACCINE.2015.01.090
Abstract: We examined the hepatitis A virus status of all MSM seen at a large sexual health clinic in inner Sydney between 1996 and 2012. Overall, the proportion of MSM susceptible to hepatitis A decreased from 68.1% in 1996 to 36.2% in 2012 most of this reduction was attributable to vaccination.
‘You’re a woman, a convenience, a cat, a poof, a thing, an idiot’: transgender women negotiating sexual experiences in men’s prisons in Australia
Publisher: SAGE Publications
Date: 22-11-2016
Abstract: We examine the lived experiences of transgender women in Australian men’s and women’s prisons. We draw on Alice Ristroph’s sexual punishments framework to discuss the ersity and ambiguities of sexual experiences reported by participants, and argue for a need to move beyond the dominant narrative of prison rape.
Assessing the Impacts of Integrated Decision Support Software on Sexual Orientation Recording, Comprehensive Sexual Health Testing, and Detection of Infections Among Gay and Bisexual Men Attending General Practice: Observational Study
Publisher: JMIR Publications Inc.
Date: 06-11-2018
DOI: 10.2196/10808
Sexual health and students: The pathways travelled by those with sexual health concerns
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17083
Abstract: The aim of this study was to identify the type of research (Internet, phone lines, friends, family, media or medical journal) undertaken by university students with sexual health concerns, and the effect this research had on their healthcare-seeking behaviour. The Internet was the most common (46%) first point of call for health information, closely followed by doctors (40%). Of those who undertook extra research, the majority subsequently went to a doctor. Health practitioners need to be aware of this tendency for independent research.
Is it time to switch to doxycycline from azithromycin for treating genital chlamydial infections in women? Modelling the impact of autoinoculation from the gastrointestinal tract to the genital tract
Publisher: Springer Science and Business Media LLC
Date: 30-04-2015
Multitarget PCR Assay for Direct Detection of Penicillinase-Producing Neisseria gonorrhoeae for Enhanced Surveillance of Gonococcal Antimicrobial Resistance
Publisher: American Society for Microbiology
Date: 08-2015
DOI: 10.1128/JCM.00540-15
Abstract: A multitarget PCR was developed for the direct detection of penicillinase-producing Neisseria gonorrhoeae (PPNG). The assay was validated by testing 342 PPNG isolates and 415 clinical s les. The method is suitable for routine detection of PPNG strains. Its multitarget approach reduces the potential for false-negative results caused by sequence variations.
Azithromycin-resistant syphilis-causing strains in Sydney, Australia: Prevalence and risk factors
Publisher: American Society for Microbiology
Date: 08-2014
DOI: 10.1128/JCM.00301-14
Abstract: Azithromycin has shown high efficacy in randomized trials when used for treating infectious syphilis in Africa. However, its use in clinical practice has been limited by the development of antimicrobial drug resistance. Resistance has not previously been reported from Australasia. The aim of this study was to determine the prevalence of and risk factors for azithromycin-resistant syphilis-causing strains in Sydney, Australia. We evaluated 409 s les that were PCR positive for Treponema pallidum DNA collected between 2004 and 2011 for the presence of the A2058G mutation, which confers resistance to macrolide antibiotics such as azithromycin. Overall, 84% of s les harbored the mutation. The prevalence of the mutation increased during the study period ( P trend, 0.003). We also collected clinical and demographic data on 220 patients from whom these s les had been collected to determine factors associated with the A2058G mutation 97% were from men who have sex with men. Reporting sex in countries other than Australia was associated with less macrolide resistance (adjusted odds ratio, 0.25 95% confidence interval, 0.09 to 0.66 P = 0.005), with other study factors showing no association (age, HIV status, recent macrolide use, stage of syphilis, or history of prior syphilis). Azithromycin cannot be recommended as an alternative treatment for syphilis in Sydney.
The acceptability and cost of a home-based chlamydia retesting strategy: Findings from the REACT randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 12-2016
The sexual behaviours of adolescents aged between 14 and 17 years involved with the juvenile justice system in Australia: A community-based survey
Publisher: Public Library of Science (PLoS)
Date: 28-12-2020
DOI: 10.1371/JOURNAL.PONE.0243633
Abstract: To overcome key knowledge gaps in relation to justice involved and vulnerable young people and their sexual health and to compare this group with their peers from other youth health surveys in Australia to determine the extent of the issues. Young people, aged between 14 and 17 years, who had ever been or were currently involved with the criminal justice system were purposively s led. The survey was anonymous and delivered using Computer Assisted Telephone Interview (CATI). A total of 465 justice involved MeH-JOSH young people, aged between 14 and 17 years, participated in the study: 44% Aboriginal and/or Torres Strait Islander (Indigenous) and 37% not attending school. Of the total valid responses, 76% (n = 348) reported having ever had sex, with sexual initiation at a median age of 14 years. We compared these data with their peers in other Australian surveys and found that young people in our study had a higher engagement in sex and start having sex at a younger age, reporting more sexual partners at all ages. The sexual behaviours of young people involved in the justice system in this study suggest they may be at a greater risk for sexually transmissible infections than their age-matched peers in the general population. Policymakers should elevate them to a priority population for targeting sexual health services and health promotion.
Estimating the critical immunity threshold for preventing hepatitis A outbreaks in men who have sex with men
Publisher: Cambridge University Press (CUP)
Date: 13-11-2016
DOI: 10.1017/S0950268815002605
Abstract: Several outbreaks of hepatitis A in men who have sex with men (MSM) were reported in the 1980s and 1990s in Australia and other countries. An effective hepatitis A virus (HAV) vaccine has been available in Australia since 1994 and is recommended for high-risk groups including MSM. No outbreaks of hepatitis A in Australian MSM have been reported since 1996. In this study, we aimed to estimate HAV transmissibility in MSM populations in order to inform targets for vaccine coverage in such populations. We used mathematical models of HAV transmission in a MSM population to estimate the basic reproduction number ( R 0 ) and the probability of an HAV epidemic occurring as a function of the immune proportion. We estimated a plausible range for R 0 of 1·71–3·67 for HAV in MSM and that sustained epidemics cannot occur once the proportion immune to HAV is greater than ~70%. To our knowledge this is the first estimate of R 0 and the critical population immunity threshold for HAV transmission in MSM. As HAV is no longer endemic in Australia or in most other developed countries, vaccination is the only means of maintaining population immunity %. Our findings provide impetus to promote HAV vaccination in high-risk groups such as MSM.
The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: What additional disease burden will a nonavalent vaccine prevent?
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 11-10-2018
DOI: 10.2807/1560-7917.ES.2018.23.41.1700737
Abstract: Background: A National human papilloma virus (HPV) Vaccination Programme for the prevention of HPV infection and associated disease using the quadrivalent HPV vaccine (4vHPV) has been funded and implemented in Australia since 2007, initially for girls only and extended to boys in 2013, with uptake rates among the highest observed worldwide. Aim: We report on the impact of this national programme on HPV prevalence and associated disease burden and estimate the potential impact of adopting a nonavalent HPV (9vHPV) vaccine. Methods: We performed a non-systematic literature review of studies measuring the burden of HPV-associated disease and infection in Australia before and after introduction of HPV vaccination. We also included key national reports with estimates of HPV-related disease burden. Results: Substantial declines in high-grade cervical disease and genital warts among vaccine-eligible women have been observed. Reductions in genital warts incidence and HPV prevalence among heterosexual men of similar age were observed before introduction of the male vaccination programme, indicating a substantial herd effect. 9vHPV vaccine is expected to prevent up to 90% of cervical and 96% of anal cancers. Of an estimated 1,544 HPV-associated cancers in 2012, 1,242 would have been preventable by the 4vHPV vaccine and an additional 187 anogenital cancers by the 9vHPV vaccine. Conclusions: Vaccination using 4vHPV vaccine has had a large demonstrable impact on HPV-related disease in Australia. A switch to 9vHPV could further reduce the HPV-associated cancer burden. With continued high coverage among both males and females, elimination of vaccine-type HPV disease seems achievable in Australia.
Low HIV testing rates among people with a sexually transmissible infection diagnosis in remote aboriginal communities
Publisher: AMPCo
Date: 08-2016
DOI: 10.5694/MJA15.01392
Abstract: To determine the rates of HIV testing among people who had received positive test results for chlamydia, gonorrhoea and trichomoniasis, or who had been tested for syphilis. Pathology data for the period January 2010 - December 2014 from 65 remote Aboriginal communities participating in the STRIVE trial of sexually transmissible infection (STI) control were analysed. Rates of HIV testing within 30 and 90 days of an STI test (for chlamydia, gonorrhoea or trichomoniasis), the result of which was positive, and within 30 days of a test for syphilis factors independently associated with concurrent HIV testing. 31.8% of 15 260 positive STI test results were linked with an HIV test within 30 days of the test (including 5.6% not on the same day), and 34.8% within 90 days 44.1% were linked with syphilis testing within 30 days. 53.4% of all those tested for syphilis were also tested for HIV within 30 days. Multivariate analysis found that HIV testing was more likely for men, in geographical regions 3 and 4, in association with positive STI test results during 2012, 2013 or 2014 (v 2010), and in association with positive test results for gonorrhoea or chlamydia. Similar associations with these factors were found for syphilis testing. A significant challenge in Aboriginal health is avoiding an increase in the number of HIV infections. One critical intervention in this regard is timely and appropriate testing. Adhering to screening recommendations is clearly an aspect of the delivery of sexual health services to remote communities that can be improved in striving to achieve this aim.
Molecular Antimicrobial Resistance Surveillance forNeisseria gonorrhoeae, Northern Territory, Australia
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2017
Further evidence to support the individualised treatment of gonorrhoea with ciprofloxacin
Publisher: Elsevier BV
Date: 09-2016
A new approach to estimating trends in chlamydia incidence
Publisher: BMJ
Date: 06-01-2015
DOI: 10.1136/SEXTRANS-2014-051631
Abstract: Directly measuring disease incidence in a population is difficult and not feasible to do routinely. We describe the development and application of a new method for estimating at a population level the number of incident genital chlamydia infections, and the corresponding incidence rates, by age and sex using routine surveillance data. A Bayesian statistical approach was developed to calibrate the parameters of a decision-pathway tree against national data on numbers of notifications and tests conducted (2001-2013). Independent beta probability density functions were adopted for priors on the time-independent parameters the shapes of these beta parameters were chosen to match prior estimates sourced from peer-reviewed literature or expert opinion. To best facilitate the calibration, multivariate Gaussian priors on (the logistic transforms of) the time-dependent parameters were adopted, using the Matérn covariance function to favour small changes over consecutive years and across adjacent age cohorts. The model outcomes were validated by comparing them with other independent empirical epidemiological measures, that is, prevalence and incidence as reported by other studies. Model-based estimates suggest that the total number of people acquiring chlamydia per year in Australia has increased by ∼120% over 12 years. Nationally, an estimated 356 000 people acquired chlamydia in 2013, which is 4.3 times the number of reported diagnoses. This corresponded to a chlamydia annual incidence estimate of 1.54% in 2013, increased from 0.81% in 2001 (∼90% increase). We developed a statistical method which uses routine surveillance (notifications and testing) data to produce estimates of the extent and trends in chlamydia incidence.
Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
Publisher: Public Library of Science (PLoS)
Date: 04-11-2021
DOI: 10.1371/JOURNAL.PCBI.1009385
Abstract: The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An in idual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence.
Privacy-Preserving Record Linkage of Deidentified Records Within a Public Health Surveillance System: Evaluation Study
Publisher: JMIR Publications Inc.
Date: 24-06-2020
DOI: 10.2196/16757
Abstract: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link in idual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures. The aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance. Although ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs. Sensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches. This study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
Was an epidemic of gonorrhoea among heterosexuals attending an Adelaide sexual health services associated with variations in sex work policing policy?
Publisher: BMJ
Date: 13-11-2016
DOI: 10.1136/SEXTRANS-2014-051918
Abstract: A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis. Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken. At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008. A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission.
Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001–2013: a population-based cohort study
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16207
Abstract: Background: This study aimed to examine trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age. Methods: A cohort of 318002 women, born between 1974 and 1995, residing in Western Australia (WA) was determined from birth registrations and the 2014 electoral roll. This cohort was then probabilistically linked to all records of chlamydia and gonorrhoea nucleic acid lification tests conducted by two large WA pathology laboratories between 1 January 2001 and 31 December 2013. Trends in chlamydia and gonorrhoea testing and positivity were investigated over time and stratified by Aboriginality and age group. Results: The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 from 24.5% to 36.6% in Aboriginal and 4.0% to 8.5% in non-Aboriginal women (both P-values .001). Concurrent testing was high ( %) and so patterns of gonorrhoea testing were similar. Chlamydia and gonorrhoea positivity were substantially higher in Aboriginal compared with non-Aboriginal women age-, region- and year-adjusted incidence rate ratios were 1.52 (95% confidence interval (CI) 1.50–1.69, P 0.001) and 11.80 (95% CI 10.77–12.91, P 0.001) respectively. Chlamydia positivity increased significantly in non-Aboriginal women aged 15–19 peaking in 2011 at 13.3% (95% CI 12.5–14.2%) trends were less consistent among 15–19-year-old Aboriginal women but positivity also peaked in 2011 at 18.5% (95% CI 16.9–20.2%). Gonorrhoea positivity was 9.7% (95% CI 9.3–10.1%), 6.7% (95% CI 6.4–7.0%), 4.7% (4.4–5.0%), and 3.1% (2.8–3.4%) among Aboriginal women aged respectively 15–19, 20–24, 25–29 and ≥30 years, compared with % in all age groups in non-Aboriginal women. Over time, gonorrhoea positivity declined in all age groups among Aboriginal and non-Aboriginal women. Conclusion: Between 2001 and 2013 in WA chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities.
A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea.
Publisher: Springer Science and Business Media LLC
Date: 06-06-2016
Hepatitis C incidence among patients attending primary care health services that specialise in the care of people who inject drugs, Victoria, Australia, 2009 to 2020
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.DRUGPO.2022.103655
Abstract: Monitoring trends in hepatitis C virus (HCV) incidence is critical for evaluating strategies aimed at eliminating HCV as a public health threat. We estimate HCV incidence and assess trends in incidence over time among primary care patients. Data were routinely extracted, linked electronic medical records from 12 primary care health services. Patients included were aged ≥16 years, tested HCV antibody negative on their first test recorded and had at least one subsequent HCV antibody or RNA test (January 2009-December 2020). HCV incident infections were defined as a positive HCV antibody or RNA test. A generalised linear model assessed the association between HCV incidence and calendar year. In total, 6711 patients contributed 17,098 HCV test records, 210 incident HCV infections and 19,566 person-years incidence was 1.1 per 100 person-years (95% confidence interval (CI): 0.9 to 1.2). Among 559 (8.2%) patients ever prescribed opioid-related pharmacotherapy (ORP) during the observation period, 135 infections occurred during 2,082 person-years (incidence rate of 6.5 per 100 person-years (95% CI: 5.4 to 7.7)). HCV incidence declined 2009-2020 overall (incidence rate ratio per calendar year 0.8 (95% CI: 0.8 to 0.9) and among patients ever prescribed ORT (incidence rate ratio per calendar year 0.9, 95% CI: 0.75 to 1.0). HCV incidence declined among patients at primary care health services including among patients ever prescribed ORP and during the period following increased access to DAA therapy.
Prevalence and correlates of a diagnosis of sexually transmitted infection among young aboriginal and Torres strait islander people: A national survey
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Reply to Kenyon.
Publisher: Oxford University Press (OUP)
Date: 16-10-2018
DOI: 10.1093/CID/CIX905
Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16046
Abstract: Background Gonorrhoea occurs at high levels in young Aboriginal and Torres Strait Islander people living in remote communities, but there are limited data on urban and regional settings. An analysis was undertaken of gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services participating in a collaborative research network. Methods: This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15–54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year. Results: A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15–29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test. Conclusions: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.
Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial
Publisher: Elsevier BV
Date: 10-2018
Incidence and predictors of annual chlamydia testing among 15-29 year olds attending Aboriginal primary health care services in New South Wales, Australia.
Publisher: Springer Science and Business Media LLC
Date: 06-2015
RATES OF PELVIC INFLAMMATORY DISEASE AND ECTOPIC PREGNANCY ARE NO LONGER DECLINING: AN ECOLOGICAL ANALYSIS OF AUSTRALIAN HOSPITAL ADMISSIONS AND EMERGENCY PRESENTATION DATA, 2009-2014
Publisher: BMJ Publishing Group Ltd
Date: 07-2017
Monitoring the Control of Sexually Transmissible Infections and Blood-Borne Viruses: Protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) (Preprint)
Publisher: JMIR Publications Inc.
Date: 11-05-2018
Abstract: ew biomedical prevention interventions make the control or elimination of some blood-borne viruses (BBVs) and sexually transmissible infections (STIs) increasingly feasible. In response, the World Health Organization and governments around the world have established elimination targets and associated timelines. To monitor progress toward such targets, enhanced systems of data collection are required. This paper describes the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). his study aims to establish a national surveillance network designed to monitor public health outcomes and evaluate the impact of strategies aimed at controlling BBVs and STIs. CCESS is a sentinel surveillance system comprising health services (sexual health clinics, general practice clinics, drug and alcohol services, community-led testing services, and hospital outpatient clinics) and pathology laboratories in each of Australia’s 8 states and territories. Scoping was undertaken in each jurisdiction to identify sites that provide a significant volume of testing or management of BBVs or STIs or to see populations with particular risks for these infections (“priority populations”). Nationally, we identified 115 health services and 24 pathology laboratories as relevant to BBVs or STIs purposive s ling was undertaken. As of March 2018, we had recruited 92.0% (104/113) of health services and 71% (17/24) of laboratories among those identified as relevant to ACCESS. ACCESS is based on the regular and automated extraction of deidentified patient data using specialized software called GRHANITE, which creates an anonymous unique identifier from patient details. This identifier allows anonymous linkage between and within participating sites, creating a national cohort to facilitate epidemiological monitoring and the evaluation of clinical and public health interventions. etween 2009 and 2017, 1,171,658 in idual patients attended a health service participating in ACCESS network comprising 7,992,241 consultations. Regarding those with unique BBV and STI-related health needs, ACCESS captured data on 366,441 young heterosexuals, 96,985 gay and bisexual men, and 21,598 people living with HIV. CCESS is a unique system with the ability to track efforts to control STIs and BBVs—including through the calculation of powerful epidemiological indicators—by identifying response gaps and facilitating the evaluation of programs and interventions. By anonymously linking patients between and within services and over time, ACCESS has exciting potential as a research and evaluation platform. Establishing a national health surveillance system requires close partnerships across the research, government, community, health, and technology sectors. ERR1-10.2196/11028
Reactive arthritis following a Microsporidia infection
Publisher: SAGE Publications
Date: 10-07-2016
Abstract: Reactive arthritis may be caused by both sexually transmissible and enteric organisms, though Microsporidia is not currently recognised as a causative agent. This case report describes the development of reactive arthritis following Microsporidia infection in an immunocompetent man.
Balancing the cost–benefit equation for cervical cancer prevention: a moving target
Publisher: Elsevier BV
Date: 12-2016
Attendance patterns and chlamydia and gonorrhoea testing among young people in Aboriginal primary health centres in New South Wales, Australia.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15007
Abstract: Background To inform a sexual health quality improvement program we examined chlamydia and gonorrhoea testing rates among 15–29 year olds attending Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia, and factors associated with chlamydia and gonorrhoea testing. Methods: From 2009 to 2011, consultation and testing data were extracted from four ACCHS. Over the study period, we calculated the median number of consultations per person and interquartile range (IQR), the proportion attending (overall and annually), the proportion tested for chlamydia and gonorrhoea, and those who tested positive. We examined factors associated with chlamydia and gonorrhoea testing using logistic regression. Results: Overall, 2896 15–29-year-olds attended the ACCHSs, 1223 were male and 1673 were female. The median number of consultations was five (IQR 2–12), four (IQR 1–8) for males and seven (IQR 3–14) for females (P 0.001). Nineteen percent of males and 32% of females attended in each year of the study (P 0.001). Overall, 17% were tested for chlamydia (10% of males and 22% of females, P 0.001), and 7% were tested annually (3% of males and 11% of females, P 0.001). Findings were similar for gonorrhoea testing. In the study period, 10% tested positive for chlamydia (14% of males and 9% of females, P 0.001) and 0.6% for gonorrhoea. Factors independently associated with chlamydia testing were being female (adjusted odds ratio (AOR) 2.64, 95% confidence interval (CI) 2.07–3.36), being 20–24 years old (AOR: 1.58, 95% CI: 1.20–2.08), and having consultations (AOR: 16.97, 95% CI: 10.32–27.92). Conclusions: More frequent attendance was strongly associated with being tested for chlamydia and gonorrhoea. To increase testing, ACCHS could develop testing strategies and encourage young people to attend more frequently.
Understanding the Targeting and Uptake of HIV Testing Among Gay and Bisexual Men Attending Sexual Health Clinics
Publisher: Springer Science and Business Media LLC
Date: 19-12-2018
DOI: 10.1007/S10461-017-2012-2
Abstract: We assessed trends in HIV testing outcomes during a period of clinic-based initiatives introduced to increase HIV testing among gay and bisexual men (GBM) attending sexual health clinics (SHCs) in New South Wales (NSW). A cohort of 25,487 HIV-negative GBM attending 32 SHCs in NSW (2009-2015) was classified into six sub-groups each year based on client-type (new/existing), risk-status (low/high-risk), and any recent HIV testing. Poisson regression methods were used to assess HIV testing outcomes in sub-groups of GBM. HIV testing outcomes and the sub-groups with greatest statistically significant annual increases were: in iduals attending (26% in high-risk existing clients with recent testing) testing uptake (4% in low-risk existing clients with no recent testing) testing frequency (6% in low-risk existing clients with no recent testing and 5% in high-risk existing clients with recent testing) and total tests (31% in high-risk existing clients with recent testing). High-risk existing clients with recent testing had a 13% annual increase in the proportional contribution to total tests. Our findings show improved targeting of testing to high-risk GBM at NSW SHCs. The clinic-based initiatives should be considered for translation to other similar settings.
The Molecular Epidemiology and Antimicrobial Resistance ofNeisseria gonorrhoeaein Australia: A Nationwide Cross-Sectional Study, 2012
Publisher: Oxford University Press (OUP)
Date: 28-09-2016
DOI: 10.1093/CID/CIW648
Abstract: Antimicrobial resistance (AMR) by Neisseria gonorrhoeae is considered a serious global threat. In this nationwide study, we used MassARRAY iPLEX genotyping technology to examine the epidemiology of N. gonorrhoeae and associated AMR in the Australian population. All available N. gonorrhoeae isolates (n = 2452) received from Australian reference laboratories from January to June 2012 were included in the study. Genotypic data were combined with phenotypic AMR information to define strain types. A total of 270 distinct strain types were observed. The 40 most common strain types accounted for over 80% of isolates, and the 10 most common strain types accounted for almost half of all isolates. The high male to female ratios (>94% male) suggested that at least 22 of the top 40 strain types were primarily circulating within networks of men who have sex with men (MSM). Particular strain types were also concentrated among females: two strain types accounted for 37.5% of all isolates from females. Isolates harbouring the mosaic penicillin binding protein 2 (PBP2)-considered a key mechanism for cephalosporin resistance-comprised 8.9% of all N. gonorrhoeae isolates and were primarily observed in males (95%). This large scale epidemiological investigation demonstrated that N. gonorrhoeae infections are dominated by relatively few strain types. The commonest strain types were concentrated in MSM in urban areas and Indigenous heterosexuals in remote areas, and we were able to confirm a resurgent epidemic in heterosexual networks in urban areas. The prevalence of mosaic PBP2 harboring N. gonorrhoeae strains highlight the ability for new N. gonorrhoeae strains to spread and become established across populations.
‘It Opened My Eyes’—examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory
Publisher: Oxford University Press (OUP)
Date: 28-03-2018
Abstract: Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.
Decreased susceptibility to cephalosporins among gonococci?
Publisher: Elsevier BV
Date: 03-2014
GREATER THAN TENFOLD INCREASE IN PHARYNGEAL CHLAMYDIA TRACHOMATIS AMONG GAY AND BISEXUAL MEN ATTENDING AUSTRALIAN SEXUAL HEALTH CLINICS 2010-2016
Publisher: BMJ Publishing Group Ltd
Date: 07-2017
Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 05-2015
Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions
Publisher: Springer Science and Business Media LLC
Date: 31-01-2015
A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
HIV testing in re-education through labour camps in Guangxi Autonomous Region, China (a cross-sectional survey)
Publisher: BMJ
Date: 04-03-2015
Treponema pallidum strain types and association with macrolide resistance in Sydney, Australia: New TP0548 gene types identified
Publisher: American Society for Microbiology
Date: 08-2016
DOI: 10.1128/JCM.00959-16
Abstract: Strain typing of Treponema pallidum , using the three-target enhanced classification scheme, was performed with 191 s les obtained between 2004 and 2011 in Sydney, Australia. The most common strain type was 14d/g (92/191 s les [48%]). Two new TP0548 gene types were detected (m and n). Strain type was associated with macrolide resistance and possible acquisition outside Australia.
High-throughput informative single nucleotide polymorphism-based typing of Neisseria gonorrhoeae using the Sequenom MassARRAY iPLEX platform
Publisher: Oxford University Press (OUP)
Date: 26-01-2014
DOI: 10.1093/JAC/DKT544
Abstract: Neisseria gonorrhoeae antimicrobial resistance (AMR) is a global problem heightened by emerging resistance to ceftriaxone. Appropriate molecular typing methods are important for understanding the emergence and spread of N. gonorrhoeae AMR. We report on the development, validation and testing of a Sequenom MassARRAY iPLEX method for multilocus sequence typing (MLST)-style genotyping of N. gonorrhoeae isolates. An iPLEX MassARRAY method (iPLEX14SNP) was developed targeting 14 informative gonococcal single nucleotide polymorphisms (SNPs) previously shown to predict MLST types. The method was initially validated using 24 N. gonorrhoeae control isolates and was then applied to 397 test isolates collected throughout Queensland, Australia in the first half of 2012. The iPLEX14SNP method provided 100% accuracy for the control isolates, correctly identifying all 14 SNPs for all 24 isolates (336/336). For the 397 test isolates, the iPLEX14SNP assigned results for 5461 of the possible 5558 SNPs (SNP call rate 98.25%), with complete 14 SNP profiles obtained for 364 isolates. Based on the complete SNP profile data, there were 49 different sequence types identified in Queensland, with 11 of the 49 SNP profiles accounting for the majority (n = 280 77%) of isolates. AMR was dominated by several geographically clustered sequence types. Using the iPLEX14SNP method, up to 384 isolates could be tested within 1 working day for less than Aus$10 per isolate. The iPLEX14SNP offers an accurate and high-throughput method for the MLST-style genotyping of N. gonorrhoeae and may prove particularly useful for large-scale studies investigating the emergence and spread of gonococcal AMR.
Challenges facing Asian sex workers in Western Australia: Implications for health promotion and support services
Publisher: Frontiers Media SA
Date: 13-06-2018
Ongoing decline in genital warts among young heterosexuals 7 years after the Australian human papillomavirus (HPV) vaccination programme
Publisher: BMJ
Date: 10-10-2015
DOI: 10.1136/SEXTRANS-2014-051813
Abstract: Australia has provided free quadrivalent human papillomavirus (HPV) vaccines to school girls since mid-2007 and a catch-up programme in the community to women aged up to 26 years in 2007-2009. We describe the temporal trend of genital warts in different populations in Melbourne. We analysed the proportion diagnosed with genital warts for all new patients attending Melbourne Sexual Health Centre from July 2004 to June 2014, stratified by different risk groups and age. Adjusted ORs were calculated to compare the annual trend in the proportion of patients with genital warts in different risk groups in the prevaccination period (before June 2007) and the vaccination period (after July 2007). The proportion with genital warts decreased in women aged <21 years, from 18.4% in 2004/2005 to 1.1% in 2013/2014 (p 32 years, from 4.0% to 8.5% (p=0.037). The odds per year for diagnosis of genital warts adjusted for number of sexual partners in the vaccination period were 0.55 (95% CI 0.47 to 0.65) and 0.63 (95% CI 0.54 to 0.74) in women and heterosexual men aged 32 years. A small annual decline in genital warts was observed in men who have sex with men (aOR=0.92 95% CI 0.88 to 0.97). Genital warts have now become rare in young Australian women and heterosexual men 7 years after the launch of the national HPV vaccination programme but in stark contrast, remain common in men who have sex with men.
Assessing the Impacts of Integrated Decision Support Software on Sexual Orientation Recording, Comprehensive Sexual Health Testing, and Detection of Infections Among Gay and Bisexual Men Attending General Practice: Observational Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-04-2018
Abstract: ay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs), yet opportunities for sexual health testing of this population are often missed or incomplete in general practice settings. Strategies are needed for improving the uptake and completeness of sexual health testing in this setting. he goal of the research was to evaluate the impact of an intervention centered around integrated decision support software and routine data feedback on the collection of sexual orientation data and sexual health testing among gay and bisexual men attending general practice. study using before/after and intervention/comparison methods was undertaken to assess the intervention’s impact in 7 purposively s led Australian general practice clinics located near the urban centers of Sydney and Melbourne. The software was introduced at staggered points between April and August 2012 it used patient records to prompt clinicians to record sexual orientation and accessed pathology testing history to generate prompts when sexual health testing was overdue or incomplete. The software also had a function for querying patient management system databases in order to generate de-identified data extracts, which were used to report regularly to participating clinicians. We calculated summary rate ratios (SRRs) based on quarterly trends and used Poisson regression analyses to assess differences between the 12-month preintervention and 24-month intervention periods as well as between the intervention sites and 4 similar comparison sites that did not receive the intervention. mong 32,276 male patients attending intervention clinics, sexual orientation recording increased 19% (from 3213/6909 [46.50%] to 5136/9110 [56.38%]) during the intervention period (SRR 1.10, 95% CI 1.04-1.11, P .001) while comprehensive sexual health testing increased by 89% (305/1159 [26.32%] to 690/1413 [48.83%] SRR 1.38, 95% CI 1.28-1.46, P .001). Comprehensive testing increased slightly among the 7290 gay and bisexual men attending comparison sites, but the increase was comparatively greater in clinics that received the intervention (SRR 1.12, 95% CI 1.10-1.14, P .001). In clinics that received the intervention, there was also an increase in detection of chlamydia and gonorrhea that was not observed in the comparison sites. ntegrated decision support software and data feedback were associated with modest increases in sexual orientation recording, comprehensive testing among gay and bisexual men, and the detection of STIs. Tests for and detection of chlamydia and gonorrhea were the most dramatically impacted. Decision support software can be used to enhance the delivery of sexual health care in general practice.
PREVALENCE OF TRICHOMONAS VAGINALIS PREDICTED TO INCREASE SUBSTANTIALLY IN AUSTRALIA DUE TO REPLACEMENT OF PAP SMEARS WITH HPV TESTING FOR CERVICAL SCREENING: A MODELLING STUDY
Publisher: BMJ Publishing Group Ltd
Date: 07-2017
The impact of removing financial incentives and/or audit and feedback on chlamydia testing in general practice: A cluster randomised controlled trial (ACCEPt-able)
Publisher: Public Library of Science (PLoS)
Date: 04-01-2022
DOI: 10.1371/JOURNAL.PMED.1003858
Abstract: Financial incentives and audit/feedback are widely used in primary care to influence clinician behaviour and increase quality of care. While observational data suggest a decline in quality when these interventions are stopped, their removal has not been evaluated in a randomised controlled trial (RCT), to our knowledge. This trial aimed to determine whether chlamydia testing in general practice is sustained when financial incentives and/or audit/feedback are removed. We undertook a 2 × 2 factorial cluster RCT in 60 general practices in 4 Australian states targeting 49,525 patients aged 16–29 years for annual chlamydia testing. Clinics were recruited between July 2014 and September 2015 and were followed for up to 2 years or until 31 December 2016. Clinics were eligible if they were in the intervention group of a previous cluster RCT where general practitioners (GPs) received financial incentives (AU$5–AU$8) for each chlamydia test and quarterly audit/feedback reports of their chlamydia testing rates. Clinics were randomised into 1 of 4 groups: incentives removed but audit/feedback retained (group A), audit/feedback removed but incentives retained (group B), both removed (group C), or both retained (group D). The primary outcome was the annual chlamydia testing rate among 16- to 29-year-old patients, where the numerator was the number who had at least 1 chlamydia test within 12 months and the denominator was the number who had at least 1 consultation during the same 12 months. We undertook a factorial analysis in which we investigated the effects of removal versus retention of incentives (groups A + C versus groups B + D) and the effects of removal versus retention of audit/feedback (group B + C versus groups A + D) separately. Of 60 clinics, 59 were randomised and 55 (91.7%) provided data (group A: 15 clinics, 11,196 patients group B: 14, 11,944 group C: 13, 11,566 group D: 13, 14,819). Annual testing decreased from 20.2% to 11.7% (difference −8.8% 95% CI −10.5% to −7.0%) in clinics with incentives removed and decreased from 20.6% to 14.3% (difference −7.1% 95% CI −9.6% to −4.7%) where incentives were retained. The adjusted absolute difference in treatment effect was −0.9% (95% CI −3.5% to 1.7% p = 0.2267). Annual testing decreased from 21.0% to 11.6% (difference −9.5% 95% CI −11.7% to −7.4%) in clinics where audit/feedback was removed and decreased from 19.9% to 14.5% (difference −6.4% 95% CI −8.6% to −4.2%) where audit/feedback was retained. The adjusted absolute difference in treatment effect was −2.6% (95% CI −5.4% to −0.1% p = 0.0336). Study limitations included an unexpected reduction in testing across all groups impacting statistical power, loss of 4 clinics after randomisation, and inclusion of rural clinics only. Audit/feedback is more effective than financial incentives of AU$5–AU$8 per chlamydia test at sustaining GP chlamydia testing practices over time in Australian general practice. Australian New Zealand Clinical Trials Registry ACTRN12614000595617
Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice
Publisher: Springer Science and Business Media LLC
Date: 07-11-2014
A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics
Publisher: BMJ
Date: 02-09-2016
DOI: 10.1136/SEXTRANS-2016-052578
Abstract: Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers. From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis. These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
OPTIMISING EXISTING SEXUAL HEALTH CLINICS INCREASES HIV TESTING AMONG GAY AND BISEXUAL MEN AT HIGHER RISK OF INFECTION
Publisher: BMJ Publishing Group Ltd
Date: 07-2017
Can preventive care activities in general practice be sustained when financial incentives and external audit plus feedback are removed? ACCEPt-able: a cluster randomised controlled trial protocol
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18097
Abstract: Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. Results: The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P& .001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P& .001) and rectum (6.6–14.8/100 PY, P& .001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7–2.2), using injecting drugs (HR=1.7, 95%CI: 1.4–2.0), being HIV positive (HR=1.4, 95%CI: 1.2–1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2–1.6). Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
Pathology Laboratory Surveillance in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses: Protocol for a Cohort Study
Publisher: JMIR Publications Inc.
Date: 18-02-2019
Abstract: assive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. he aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. CCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of in iduals tested and retested, test yield, positivity, and incidence. o date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory reporting of indicators will occur in 2019 with publication to follow. he ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. R1-10.2196/13625
Molecular test for chlamydia and gonorrhoea used at point of care in remote primary healthcare settings: a diagnostic test evaluation
Publisher: BMJ
Date: 10-05-2018
DOI: 10.1136/SEXTRANS-2017-053443
Abstract: A new molecular test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate as conventional nucleic acid lification tests (NAAT), but performance has not been evaluated in routine primary care, performed at the point of care by clinicians. We aimed to examine its diagnostic performance when used by clinicians in remote community health services in Australia with high prevalences of CT and NG infection. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#12613000808741) At 12 health services, training was provided to 99 clinicians in the use of the GeneXpert CT/NG assay who tested specimens from all patients undergoing STI screening. Specimens were also sent in parallel for conventional laboratory-based NAATs and the concordance of results was evaluated. Clinicians conducted 2486 tests: CT concordance was 99.4% (95% CI 99.1 to 99.7) with a positive concordance of 98.6% (95% CI 95.9 to 99.7) and negative concordance of 99.5% (95% CI 99.1 to 99.8) NG concordance was 99.9% (95% CI 99.7 to 100.0) with a positive concordance of 100.0% (95% CI 97.5 to 100.0) and negative concordance of 99.9% (95% CI 99.7 to 100.0). In this first study reporting routine point-of-care use of GeneXpert CT/NG by primary care clinicians, we found excellent concordance with conventional NAATs. The use of the GeneXpert CT/NG at the point of care could potentially transform management and control of these infections in many endemic settings, including low/middle-income countries.
Juvenile-Onset Recurrent Respiratory Papillomatosis: The Benefits of Quadrivalent Human Papillomavirus Vaccination Continue to Accrue
Publisher: Oxford University Press (OUP)
Date: 09-11-2018
Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: A cross-sectional survey
Publisher: AMPCo
Date: 02-2014
DOI: 10.5694/MJA13.10729
Chlamydia screening strategies and outcomes in educational settings: A systematic review
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis
Publisher: Oxford University Press (OUP)
Date: 13-04-2017
DOI: 10.1093/CID/CIX326
Abstract: Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91% Ptrend < .0001) and HIV-positive MSM (42% to 77% Ptrend < .0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend < .0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend < .0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend < .0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend = .030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend < .0001), while secondary infections decreased from 45% to 26% (Ptrend = .0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87 P = .005) or frequency (r = -0.93 P = .001). Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
Does Living Outside of a Major City Impact on the Timeliness of Chlamydia Treatment? A Multicenter Cross-Sectional Analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
Renal impairment associated with tenofovir disoproxil fumarate for antiretroviral therapy and HIV pre-exposure prophylaxis: An observational cohort study
Publisher: Public Library of Science (PLoS)
Date: 24-02-2023
DOI: 10.1371/JOURNAL.PONE.0280339
Abstract: Tenofovir disoproxil fumarate (TDF) is associated with adverse renal outcomes when prescribed for HIV infection. There are few data concerning real-world renal outcomes amongst patients prescribed TDF for pre-exposure prophylaxis (PrEP). Data were extracted from 52 sexual health clinics across Australia from 2009–2019. All patients prescribed TDF-containing antiretroviral therapy and PrEP were included. Rates of renal impairment (a fall in eGFR to ml/min/1·73m 2 ) were calculated for people living with HIV (PLWHIV) prescribed TDF and HIV negative PrEP-users. Risk factors were assessed using Cox-proportional hazards models. Sensitivity analysis of risk using 1:1 propensity-score matching to adjust for potential imbalance in HIV and PrEP cohorts was conducted. 5,973 patients on PrEP and 1,973 PLWHIV were included. There were 39 (0.7%) instances of renal impairment in the PrEP group and 81 (4.1%) in the PLWHIV cohort (hazard ratio [HR]:0.35 95% confidence interval [CI]: 0.22–0.56). Rates of renal impairment were 4.01/1000 person-years (95%CI:2.93–5.48) in the PrEP cohort and 16.18/1000 person-years (95%CI:13.01–20.11) in the PLWHIV cohort (p .001). Predictors of renal impairment were: older age (40–49 years (HR:5.09 95%CI: 2.12–12.17) and 50–82 years (HR:13.69 95%CI: 5.92–31.67) (compared with 30–39 years) and baseline eGFR ml/min (HR:61.19 95%CI: 19.27–194.30). After adjusting for age and baseline eGFR the rate of renal impairment remained lower in the PrEP cohort (aHR:0.62 95%CI: 0.40–0.94, p = 0.023). In propensity-matched analysis using 1,622 patients per cohort the risk of renal impairment remained higher in the PLWHIV cohort (log-rank p = 0.001). Patients prescribed TDF-based PrEP had lower rates of renal impairment than patients prescribed TDF for HIV infection. In propensity analysis, after matching for some risk factors, rates of renal impairment remained higher amongst patients with HIV.
Genital warts and chlamydia in Australian women: Comparison of national population-based surveys in 2001 and 2011
Publisher: BMJ
Date: 25-02-2014
DOI: 10.1136/SEXTRANS-2013-051307
Abstract: Australia introduced a nationwide human papillomavirus (HPV) vaccination programme for women aged 12-26 years in 2007 and has implemented various chlamydia control strategies over the last 10 years. We compared reported diagnoses of warts and chlamydia in two national population-based s les surveyed 10 years apart. An Australia-wide survey of women aged 18-39 years was conducted by random-digit dialling mobile phone numbers in 2011. The proportion of women self-reporting genital warts and chlamydia was compared with that in equivalent-aged women interviewed in another national telephone survey conducted 10 years earlier using logistic regression adjusting for age, and other factors. 2394 women were included in the 2011 survey. 88 (3.7%) reported a genital warts diagnosis, and 127 (5.3%) had at least one chlamydia diagnosis. For women with warts and chlamydia, the majority were seen in general practice (63.3% and 70.0%, respectively). Comparing women surveyed in 2011 to 4874 women surveyed in 2001, among women eligible for free HPV vaccine through the national programme (women aged 18-30 years), there was a 41% decrease in warts (adjusted OR 0.59, 95% CI 0.39 to 0.89) but among ineligible women (31-39 years) there was a 64% increase (aOR 1.64, 95% CI 1.05 to 2.54). Over the same period chlamydia diagnoses increased by 97% (aOR 1.97, 95% CI 1.15 to 3.37) in women aged 18-24 years. Our results add to evidence from clinic-based studies showing a significant reduction in genital warts among HPV vaccine-eligible women in the general community and increases in the proportion of Australian women diagnosed with chlamydia.
Identifying factors that lead to the persistence of importedgonorrhoeaestrains: a modelling study
Publisher: BMJ
Date: 18-10-2016
DOI: 10.1136/SEXTRANS-2016-052738
Abstract: The importation of We developed an in idual-based model to simulate the transmission of NG in a population of urban MSM, and used this model to investigate factors contributing to the probability that an imported NG strain will persist. The probability of the imported NG strain persisting as the result of a single importation event is less than 1%, but the probability increases to 1% if the imported NG strain is resistant to treatment, and further increases to 3.1% if the imported NG strain can also form mixed infections with the local NG strain. The probability of the imported NG strain persisting increases to 4.4% if there are at least three importation events per month within a 1-year period. The imported NG strain is unlikely to persist as a result of a single importation event. However, the probability of persistence increases if the imported NG strain is resistant to treatment, can form mixed infections with the local NG strain or there are frequent importation events. Identification of the factors that determine the likelihood of persistence of an imported NG strain could contribute to our capacity to respond appropriately and in a timely fashion.
Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: Independent estimates from a nationally representative mobile phone survey
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.VACCINE.2013.11.075
Abstract: Accurate estimates of coverage are essential for estimating the population effectiveness of human papillomavirus (HPV) vaccination. Australia has a purpose built National HPV Vaccination Program Register for monitoring coverage, however notification of doses administered to young women in the community during the national catch-up program (2007-2009) was not compulsory. In 2011, we undertook a population-based mobile phone survey of young women to independently estimate HPV vaccination coverage. Randomly generated mobile phone numbers were dialed to recruit women aged 22-30 (age eligible for HPV vaccination) to complete a computer assisted telephone interview. Consent was sought to validate self reported HPV vaccination status against the national register. Coverage rates were calculated based on self report and weighted to the age and state of residence structure of the Australian female population. These were compared with coverage estimates from the register using Australian Bureau of Statistics estimated resident populations as the denominator. Among the 1379 participants, the national estimate for self reported HPV vaccination coverage for doses 1/2/3, respectively, weighted for age and state of residence, was 64/59/53%. This compares with coverage of 55/45/32% and 49/40/28% based on register records, using 2007 and 2011 population data as the denominators respectively. Some significant differences in coverage between the states were identified. 20% (223) of women returned a consent form allowing validation of doses against the register and provider records: among these women 85.6% (538) of self reported doses were confirmed. We confirmed that coverage rates for young women vaccinated in the community (at age 18-26 years) are underestimated by the national register and that under-notification is greater for second and third doses. Using 2011 population estimates, rather than estimates contemporaneous with the program rollout, reduces register-based coverage estimates further because of large population increases due to immigration since the program.
001.5 An australia-wide molecular study ofneisseria gonorrhoeaeidentifies frequent occurrence of a key cephalosporin resistance mechanism
Publisher: BMJ
Date: 09-2015
Chlamydia and gonorrhoea point-of-care testing in Australia: Where should it be used?
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14213
Abstract: Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia. Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise. Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities. Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact.
Increased testing for Neisseria gonorrhoeae with duplex nucleic acid amplification tests in Australia: Implications for surveillance
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14179
Abstract: Background Gonorrhoea notifications have been increasing in Australia’s cities, in both men and women. We investigated if this could be, at least in part, a result of a testing artefact. Methods: We surveyed 28 laboratories that were known to test for both Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) to determine their testing and reporting practices, and when these practices were instituted. Results: By 2012, 23 (82%) of the laboratories were routinely performing duplex nucleic acid lification tests for both CT and NG even if a test for only one organism was requested, up from 9 (32%) laboratories before 2007. Although written reports of negative NG tests were not provided if the test was not requested, positive NG tests were always communicated to the attending clinician. Conclusions: The move towards routine duplex testing for CT and NG has probably resulted in more Australians being tested for NG than ever before. While this change has advantages for case-finding and improved public health outcomes, it also brings an increasing potential for false-positive NG tests. Recent trends in NG notifications should be interpreted with caution.
Syphilis: A fresh look at an old foe
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15025
Abstract: Syphilis remains a pressing public health problem globally across different populations including men who have sex with men and pregnant women. It is timely to review what international surveillance data tell us and the evidence behind public health interventions aimed at controlling syphilis. A reinvigorated response to the re-emergence of syphilis is required.
Direct real-time PCR-based detection ofNeisseria gonorrhoeae23S rRNA mutations associated with azithromycin resistance
Publisher: Oxford University Press (OUP)
Date: 03-09-2015
DOI: 10.1093/JAC/DKV274
Abstract: Surveillance for Neisseria gonorrhoeae azithromycin resistance is of growing importance given increasing use of ceftriaxone and azithromycin dual therapy for gonorrhoea treatment. In this study, we developed two real-time PCR methods for direct detection of two key N. gonorrhoeae 23S rRNA mutations associated with azithromycin resistance. The real-time PCR assays, 2611-PCR and 2059-PCR, targeted the gonococcal 23S rRNA C2611T and A2059G mutations, respectively. A major design challenge was that gonococcal 23S rRNA sequences have high sequence homology with those of commensal Neisseria species. To limit the potential for cross-reaction, 'non-template' bases were utilized in primer sequences. The performance of the methods was initially assessed using a panel of gonococcal (n = 70) and non-gonococcal (n = 28) Neisseria species. Analytical specificity was further assessed by testing N. gonorrhoeae nucleic acid lification test (NAAT)-negative clinical s les (n = 90), before being applied to N. gonorrhoeae NAAT-positive clinical s les (n = 306). Cross-reactions with commensal Neisseria strains remained evident for both assays however, cycle threshold (Ct) values were significantly delayed, indicating reduced sensitivity for non-gonococcal species. For the N. gonorrhoeae NAAT-negative clinical s les, 7/21 pharyngeal s les provided evidence of cross-reaction (Ct values >40 cycles) however, the remaining urogenital and rectal swab s les were negative. In total, the gonococcal 2611 and 2059 23S rRNA nucleotides were both successfully characterized in 266/306 (87%) of the N. gonorrhoeae NAAT-positive clinical specimens. Real-time PCR detection of gonococcal 23S rRNA mutations directly from clinical s les is feasible and may enhance culture- and non-culture-based N. gonorrhoeae resistance surveillance.
Factors Associated With Sexual Coercion in a Representative Sample of Men in Australian Prisons
Publisher: Springer Science and Business Media LLC
Date: 23-11-2015
DOI: 10.1007/S10508-015-0653-7
Abstract: Very little research has focused on men or prisoners as victims of sexual violence. This study provides the first population-based analysis of factors associated with sexual coercion of men in Australian prisons, and the first to use a computer-assisted telephone interview to collect this information in a prison setting. A random s le of men in New South Wales and Queensland prisons were surveyed using computer-assisted telephone interviewing. We asked participants about sexual coercion, defined as being forced or frightened into doing something sexually that was unwanted while in prison. Associations between sexual coercion in prison and sociodemographics, sexual coercion history outside of prison, and prison-related factors were examined. Logistic regression was used to estimate adjusted odds ratios in examining factors associated with sexual coercion in prisons. Of 2626 eligible men, 2000 participated. Participants identifying as non-heterosexual and those with a history of sexual coercion outside prison were found to be most at risk. Those in prison for the first time and those who had spent more than 5 years in prison ever were also more likely to report sexual coercion. Although prison policies and improving prison officer training may help address immediate safety and health concerns of those at risk, given the sensitivity of the issue and likely under-reporting to correctional staff, community-based organizations and prisoner peer-based groups arguably have a role too in providing both preventive and trauma-focused support.
Impact of replacing cytology with human papillomavirus testing for cervical cancer screening on the prevalence of Trichomonas vaginalis: a modelling study
Publisher: BMJ
Date: 11-01-2018
DOI: 10.1136/SEXTRANS-2017-053294
Abstract: Trichomonas vaginalis (TV) is the most common curable STI worldwide and is associated with increased risk of HIV acquisition and serious reproductive morbidities. The prevalence of TV infection is very low in Australian cities, and this is thought to be at least partly due to incidental detection and treatment of TV in women participating in the cervical cytology screening programme. In 2017, the national cervical screening programme will transition to a new model based on testing for high-risk (HR) human papillomavirus (HPV), with a reduced frequency and commencement at an older age. We model the potential impact of this transition on TV prevalence in Australia. A mathematical model was developed to describe the transmission of TV in the general population and used to evaluate scenarios that capture the switch from cytology-based screening to HR HPV testing. Under these scenarios, in iduals with asymptomatic TV who test negative for HR HPV will remain undiagnosed and untreated. We estimate the change in TV prevalence expected to occur due to the switch from cytology to HR HPV testing and changes to the frequency and age at commencement of screening. Our results suggest that with the transition to HR HPV testing, TV prevalence may increase from the current ~0.4% to 2.8% within 20 years if TV testing coverage is not increased and HR HPV prevalence does not decline further. If HR HPV prevalence continues to decline at its current rate with ongoing vaccination, TV prevalence is predicted to increase to 3.0% within this time frame. Our modelling suggests that in a setting like Australia, where TV can be detected incidentally through cytology-based cervical screening, a transition to HPV testing is likely to result in increasing TV prevalence over time unless additional measures are implemented to increase TV testing and treatment.
Hospitalisations for Pelvic Inflammatory Disease Temporally Related to a Diagnosis of Chlamydia or Gonorrhoea: A Retrospective Cohort Study
Publisher: Public Library of Science (PLoS)
Date: 17-04-2014
Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008-2010
Publisher: Springer Science and Business Media LLC
Date: 12-06-2014
Reply to San Giorgi and Dikkers
Publisher: Oxford University Press (OUP)
Date: 14-02-2018
People Born in Non-Main English Speaking Countries Are Less Likely to Start HIV Treatment Early in Australia: A National Cohort Analysis, 2014-15.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013-2017: A cross-sectional study
Publisher: Public Library of Science (PLoS)
Date: 10-03-2020
Monitoring the Control of Sexually Transmissible Infections and Blood-Borne Viruses: Protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS)
Publisher: JMIR Publications Inc.
Date: 20-11-2018
DOI: 10.2196/11028
Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: a population-based cohort study
Publisher: Elsevier BV
Date: 04-2018
High chlamydia positivity rates in indigenous people attending Australian sexual health services
Publisher: AMPCo
Date: 06-2014
DOI: 10.5694/MJA13.10875
Abstract: To assess the clinical epidemiology of chlamydia among Aboriginal and Torres Strait Islander (Indigenous) people attending sexual health services around Australia. Retrospective analysis of routine demographic, behavioural and clinical data, between 1 January 2006 and 31 December 2011. 18 sexual health services in major cities and regional centres in five jurisdictions. Attendance, chlamydia testing and positivity rates in patients visiting for the first time, and factors associated with chlamydia positivity. Of 168 729 new patients, 7103 (4.2%) identified as Indigenous, of whom 74.3% were tested for chlamydia. Chlamydia positivity was 17.0% in Indigenous women (23.3% in 15-19-year-olds and 18.9% in 20-24-year-olds) and 17.3% in Indigenous men (20.2% in 15-19-year-olds and 24.2% in 20-24-year-olds). There was an increasing trend in chlamydia positivity in Indigenous women from 2006 to 2011 (P for trend = 0.001), but not in Indigenous men. In Indigenous women, factors independently associated with positivity were: younger age, being heterosexual, living in Queensland and attending the service in 2010. In Indigenous men, independent factors associated with chlamydia positivity were younger age, being heterosexual, having sex only in Australia and living in a regional area. The high and increasing chlamydia positivity rates highlight the need for enhanced prevention and screening programs for Indigenous people.
Socio-demographic and structural barriers to being tested for chlamydia in general practice
Publisher: AMPCo
Date: 02-2016
DOI: 10.5694/MJA15.00933
Abstract: To investigate socio-demographic and structural factors associated with not providing a specimen for chlamydia testing following a request by a general practitioner. Cross-sectional analysis of chlamydia testing data for men and women aged 16-29 years attending general practice clinics participating in a cluster randomised controlled trial evaluating the effectiveness of a chlamydia testing intervention. The study period was the 2013 calendar year. The proportion of chlamydia test requests for which the patient did not provide a specimen for testing. During the study period, there were 13 225 chlamydia test requests, for which a chlamydia test was not performed in 2545 instances (19.2% 95% CI, 16.5-22.3%). Multivariate analysis indicated that the odds for not undertaking a requested test were higher for men (adjusted odds ratio [aOR], 1.4 95% CI, 1.3-1.6), those aged 16-19 years (aOR, 1.3 95% CI, 1.1-1.4), those living in areas of greater socio-economic disadvantage (aOR, 1.2 95% CI, 1.1-1.4 for each additional quintile of Index of Relative Socio-economic Disadvantage), and those attending clinics without on-site pathology collection (aOR, 1.4 95% CI, 1.0-1.9). One in five young people did not submit a specimen for chlamydia testing despite their GP requesting it. This highlights the need for clinics to establish systems which ensure that men and those aged 16-19 years undertake chlamydia tests requested by a GP.
Seasonal variation in gonorrhoea incidence among men who have sex with men
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16122
Abstract: Background After reviewing urethral gonorrhoea cases among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) in Adelaide, Australia, we noticed peaks of gonorrhoea among MSM occurred predominantly in the first quarter of the year (January–March). The aim of this study was to formally test this hypothesis against data from a similar period at three sexual health services, one each in Adelaide, Melbourne and Sydney. Methods: This study was a retrospective analysis of computerised records at the three Australian sexual health services. Potential risk factors for urethral gonorrhoea among MSM were also reviewed at the SASSH. Results: More peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. Factors independently associated with urethral gonorrhoea at the SASSH were being a young MSM, especially those aged 25–29 (odds ratio (OR) 2.66, 95% confidence interval (CI): 2.00–3.54), having more than one sexual partner (OR 1.71, 95% CI: 1.43–2.04), having had sex interstate and overseas (OR 1.52, 95% CI: 1.06–2.17), and presenting in the first quarter (OR 1.30, 95% CI: 1.10–1.55). Conclusion: Our data suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities.
Patient, staffing and health centre factors associated with annual testing for sexually transmissible infections in remote primary health centres
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16123
Abstract: Background: In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009–10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of re-testing was determined, along with the associated patient, staffing and health centre factors. Methods: Annual testing was defined as re-testing in 9–15 months (guideline recommendation) and a broader time period of 5–15 months following an initial negative CT/NG test. Random effects logistic regression was used to determine factors associated with re-testing. Results: Of 10 559 in iduals aged ≥16 years with an initial negative CT/NG test (median age = 25 years), 20.3% had a re-test in 9–15 months (23.6% females vs 15.4% males, P 0.001) and 35.2% in 5–15 months (40.9% females vs 26.5% males, P 0.001). Factors independently associated with re-testing in 9–15 months in both males and females were: younger age (16–19, 20–24 years) and attending a centre that sees predominantly ( %) Aboriginal people. Additional factors independently associated with re-testing for females were: being aged 25–29 years, attending a centre that used electronic medical records, and for males, attending a health centre that employed Aboriginal health workers and more male staff. Conclusions: Approximately 20% of people were re-tested within 9–15 months. Re-testing was more common in younger in iduals. Findings highlight the importance of recall systems, Aboriginal health workers and male staff to facilitate annual re-testing. Further initiatives may be needed to increase re-testing.
Biological and behavioral factors associated with positive chlamydia retests
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Decriminalization of Sex Work Is Not Associated with More Men Paying for Sex: Results from the Second Australian Study of Health and Relationships
Publisher: Springer Science and Business Media LLC
Date: 24-02-2017
Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses
Publisher: Elsevier BV
Date: 04-2016
Abstract: To describe the methods and basic demographics of participants in a national survey of Aboriginal and Torres Strait Islander (Aboriginal) people specific to sexually transmissible infections and bloodborne viruses. A national cross-sectional survey of Aboriginal people aged 16-29 years in all Australian jurisdictions between 2011 and 2013 conducted at Aboriginal community events. Questions comprised demographic information, knowledge, risk behaviours and health service utilisation. Questionnaires were completed on personal digital assistants (PDAs). A total of 2,877 people at 21 unique community events completed the questionnaire. A total of 59% of participants were female, median age was 21 years and more than 60% were single at the time of the survey. Just over half the participants were resident in an urban area (53%) and 38% were from a regional area. Aboriginal health organisations played an important role in implementing the research. PDAs were found to be an acceptable method for collecting health information. This survey has recruited a large representative s le of Aboriginal people aged 16-29 years using a methodology that is feasible, acceptable and repeatable. The methodology provides a model for ongoing monitoring of this population as programs and policies are implemented to address young Aboriginal people's STI and BBV risks.
Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings
Publisher: Public Library of Science (PLoS)
Date: 16-07-2015
A longitudinal cohort study of HIV ‘treatment as prevention’ in gay, bisexual and other men who have sex with men: the Treatment with Antiretrovirals and their Impact on Positive And Negative men (TAI
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Surveillance systems to monitor antimicrobial resistance in Neisseria gonorrhoeae: a global, systematic review, 1 January 2012 to 27 September 2020
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 05-05-2022
DOI: 10.2807/1560-7917.ES.2022.27.18.2100917
Abstract: Effective surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is required for the early detection of resistant strains and to ensure that treatment guidelines are appropriate for the setting in which they are implemented. AMR in N. gonorrhoeae has been identified as a global health threat. We performed a systematic review to identify and describe surveillance systems targeting AMR in N. gonorrhoeae . We searched Medline, PubMed, Global Health, EMBASE, CINAHL, Web of Science and ProQuest databases and grey literature between 1 January 2012 and 27 September 2020. Surveillance systems were defined as the continuous, systematic collection, analysis and interpretation of N. gonorrhoeae resistance data. The key components of surveillance systems were extracted, categorised, described and summarised. We found 40 publications reporting on N. gonorrhoeae AMR surveillance systems in 27 countries and 10 multi-country or global surveillance reports. The proportion of countries with surveillance systems in each of the WHO's six regions ranged from one of 22 countries in the Eastern Mediterranean and five of 54 in Africa, to three of 11 countries in South East Asia. Only four countries report systems which are both comprehensive and national. We found no evidence of a current surveillance system in at least 148 countries. Coverage, representativeness, volume, clinical specimen source, type and epidemiological information vary substantially and limit interpretability and comparability of surveillance data for public health action. Globally, surveillance for N. gonorrhoeae AMR is inadequate and leaves large populations vulnerable to a major public health threat.
Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data
Publisher: BMJ
Date: 02-05-2018
DOI: 10.1136/SEXTRANS-2017-053423
Abstract: To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014. We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15–44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related ( Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models. For PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher. PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.
Hepatitis C testing and re-testing among people attending sexual health services in Australia, and hepatitis C incidence among people with human immunodeficiency virus: analysis of national sentinel s
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Reactive arthritis at the Sydney Sexual Health Centre 1992–2012: declining despite increasing chlamydia diagnoses
Publisher: SAGE Publications
Date: 11-07-2016
Abstract: Summary Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992–2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992–2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992–1996 to one in 2007–2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992–1996 to 2257 in 2007–2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27 95% confidence interval [CI] 1.04–10.32 p = 0.043) or born overseas (aOR 2.69 95% CI 1.27–5.70 p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21 95% CI 0.10–0.45 p 0.001). Reactive arthritis was not associated with current or recent chlamydia infection ( p = 0.184) but was marginally associated with past non-gonococcal urethritis ( p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.
Privacy-Preserving Record Linkage of Deidentified Records Within a Public Health Surveillance System: Evaluation Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 21-10-2019
Abstract: he Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link in idual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures. he aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance. lthough ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs. ensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches. his study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
Long-term impact of childhood hepatitis B vaccination programs on prevalence among Aboriginal and non-Aboriginal women giving birth in Western Australia
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.VACCINE.2018.04.057
Abstract: To evaluate the long-term effect of infant and childhood hepatitis B (HBV) vaccination programs among birthing women in Western Australia. A cohort of Western Australian women born from 1974 to 1995 was created using Birth Registrations and Electoral Roll records. They were linked to a perinatal register and notifiable diseases register to identify women having respectively their first births between 2000 and 2012 and diagnoses of HBV infections. HBV prevalence was estimated in Aboriginal and non-Aboriginal women, and according to maternal birth year cohorts. Of 66,073 women, 155 (0.23%) had a linked non-acute HBV notification. HBV prevalence was five times higher in Aboriginal women compared to their non-Aboriginal counterparts (0.92%, 95%CI 0.65-1.18 versus 0.18%, 0.15-0.21). Among Aboriginal women, after adjusting for year of giving birth and region of residence, those born in the targeted infant and school-based vaccination era (maternal year of birth 1988-1995) had an 89% lower risk (adjusted odds ratio [aOR] 0.11, 0.04-0.33) of HBV than those born in the pre-vaccination era (1974-1981). Prevalence also differed between Aboriginal women residing in rural/remote areas compared to those in major cities (aOR 3.06, 1.36-6.88). Among non-Aboriginal women, no significant difference in HBV prevalence was observed by maternal birth cohort (p = 0.20) nor by residence (p = 0.23), but there were significant differences by ethnicity with a 36-fold higher prevalence (aOR 36.08, 22.66-57.46) in non-Caucasian versus Caucasian women. A significant decline in HBV prevalence in Aboriginal birthing mothers was observed following the introduction of HBV vaccination programs in Western Australia. There were also considerable disparities in prevalence between women by area of residence and ethnicity. Our findings reflect those observed in women in other Australian jurisdictions. Continued surveillance of HBV prevalence in birthing mothers will provide ongoing estimates of HBV vaccination program impact across Australia and the populations most at risk of chronic HBV.
Treatment and outcomes of polymerase chain reaction-confirmed early syphilis
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15043
Abstract: Background Syphilis is resurgent among gay and bisexual men (GBM) despite effective treatment and widely available diagnostic serology. The polymerase chain reaction assay for Treponema pallidum (TP-PCR) is available, but little is known about the clinical features and outcomes for patients testing positive by TP-PCR. Methods: Clinical data were collected from four medical practices for patients recording a positive TP-PCR result between 2004 and 2011. Demographic, serological, treatment and reinfection details were obtained. Results were stratified by HIV status and whether treatment conformed to international guidelines. Results: 220 patients were positive for TP-PCR, of whom 92% were GBM. Seventeen (8.1%) were positive by TP-PCR before seroconversion. Almost one-third (32.1%) received treatment beyond that recommended in guidelines, and this was associated with HIV status (40.3% HIV positive vs 22.4% HIV negative, P 0.01). All but one patient with adequate follow up achieved serological cure. There was no significant difference in time to serological cure between the groups receiving standard therapy or enhanced therapy (95 vs 108 days P = 0.67) or between HIV positive and negative patients (93 vs 104 days, P = 0.06). Nineteen patients were reinfected during follow up. Conclusion: TP-PCR aids early diagnosis of syphilis and may be reactive before conventional serological tests. Treatment outcomes for TP-PCR-positive early infection were excellent, but a significant proportion of patients received non-standard therapy. Expanded use of syphilis PCR testing in at-risk populations is recommended since early identification and treatment is likely to be important in controlling the current epidemic in GBM.
Molecular approaches to enhance surveillance of gonococcal antimicrobial resistance
Publisher: Springer Science and Business Media LLC
Date: 10-02-2014
DOI: 10.1038/NRMICRO3217
Abstract: The best available data indicate that the world is heading towards a pandemic of extensively drug-resistant Neisseria gonorrhoeae. At the same time, clinical microbiology laboratories have moved away from using culture-based methods to diagnose gonorrhoea, thus undermining our ability to detect antimicrobial resistance (AMR) using current technologies. In this Opinion article, we discuss the problem of N. gonorrhoeae AMR, particularly emerging resistance to the cephalosporin ceftriaxone, outline current concerns about the surveillance of N. gonorrhoeae AMR and propose the use of molecular methods on a large scale to systematically enhance surveillance.
Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: A qualitative study in remote aboriginal communities in Australia
Publisher: Springer Science and Business Media LLC
Date: 02-04-1000
Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.AMEPRE.2015.01.014
Abstract: Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone. In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status. Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services. Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab heterosexual men, Copan UriSwab men who have sex with men, UriSwab and rectal swab). The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014. The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001) heterosexual men (56% [57/101] vs 34% [34/99], p=0.002) men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010) and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006). The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
Human papillomavirus vaccination and genital warts in young Indigenous Australians: national sentinel surveillance data.
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.00597
Abstract: To examine the impact of the national human papillomavirus (HPV) vaccination program (available to girls and women [12-26 years] since 2007 and to boys [12-15 years] since 2013) on the number of diagnoses of genital warts in Australian Aboriginal and Torres Strait Islander (Indigenous) people. Analysis of routinely collected data from patients attending 39 sexual health clinics (SHCs) in the Genital Warts Surveillance Network for the first time.Major outcome: The average annual proportion of Indigenous and non-Indigenous SHC patients diagnosed with genital warts during the pre-vaccination (2004-2007) and vaccination periods (2008-2014), stratified by age group and sex. 7.3% of the 215 599 Australian-born patients with known Indigenous status and seen for the first time at participating SHCs during 2004-2014 were Indigenous Australians. The average proportion of female Indigenous patients diagnosed with warts was lower during the vaccination period than during the pre-vaccination period (in those under 21, summary rate ratio [SRR], 0.12 95% CI, 0.07-0.21 P < 0.001) in 21-30-year olds: SRR, 0.41 95% CI, 0.27-0.61 P < 0.001) there was no significant difference for women over 30 (SRR, 0.84 95% CI, 0.51-1.36 P = 0.47). The proportion of male Indigenous heterosexual SHC patients under 21 diagnosed with warts was also lower during the vaccination period (SRR, 0.25 95% CI, 0.12-0.49 P < 0.001), with no significant changes among older Indigenous men over 30. There were marked declines in the proportions of diagnoses of genital warts in young Indigenous women and men attending SHCs after the introduction of the HPV vaccination program. If high levels of HPV vaccine coverage are sustained, HPV-related cancer rates should also decline.
A preliminary evaluation of a new GeneXpert (Gx) molecular point-of-care test for the detection ofTrichomonas vaginalis: Table 1
Publisher: BMJ
Date: 23-12-2015
DOI: 10.1136/SEXTRANS-2015-052384
Abstract: Global concerns regarding the prevalence, asymptomatic nature and burden of disease associated with Trichomonas vaginalis (TV) continue. The lack of a portable molecular point-of-care assay to detect this infectious disease has meant that many remote or low-resource settings still need to rely on delayed results from central laboratories and/or syndromic management as treatment strategies. We evaluated the new GeneXpert (Gx) TV nucleic acid lification test (NAAT) compared with an in-house laboratory NAAT to determine whether it would be suitable for use at the point of care. In a state-based laboratory and using their in-house NAAT, we selected the first 60 urine s les that were positive and the first 60 that were negative (n=120) in the study period for Gx TV testing in order to reduce collection delays and avoid the freezing of s les. Positive percentage agreement between the Gx TV and NAAT was 95.0% (95% CI 86.1% to 99.0%), negative percentage agreement was 100.0% (95% CI 93.5% to 100.0%) and overall percentage agreement was 97.4% (95% CI 92.5% to 99.5%). Three discordant results were detected with each being close to the cycle threshold of detection using the in-house NAAT assay. Findings suggest the Gx TV assay is easy to use and has suitable overall agreement for sexually transmissible infection (STI) testing at the point of care. It may be used in combination with the Gx CT/NG assay to test for all three STIs simultaneously using this portable and modular-based NAAT platform.
A sexual health quality improvement program (SHIMMER) triples chlamydia and gonorrhoea testing rates among young people attending Aboriginal primary health care services in Australia.
Publisher: Springer Science and Business Media LLC
Date: 02-09-2015
Related Organisations
Worshipful Society Of Apothecaries
Location: United Kingdom of Great Britain and Northern Ireland
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