James Ward

A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial (Prepr

Publisher: JMIR Publications Inc.

Date: 28-10-2021

DOI: 10.2196/PREPRINTS.34530

Abstract: here are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the i Strong & Deadly Futures /i well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. his paper presents the protocol to evaluate the effectiveness of i Strong & Deadly Futures /i in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. he target s le will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive i Strong & Deadly Futures /i , a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or i health education as usual /i (control). Control schools will be supported to implement i Strong & Deadly Futures /i following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural ersity, and truancy. he trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. his will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. ustralian New Zealand Clinical Trials Registry ACTRN12620001038987 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038& isReview=true RR1-10.2196/34530

Strong and Deadly Futures: Co-Development of a Web-Based Wellbeing and Substance Use Prevention Program for Aboriginal and Torres Strait Islander and Non-Aboriginal Adolescents

Publisher: MDPI AG

Date: 23-02-2021

DOI: 10.3390/IJERPH18042176

Abstract: School-based programs can effectively prevent substance use however, systematic reviews and consultation with stakeholders identified a need for effective, culturally inclusive programs for Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) youth. This paper describes the development of Strong & Deadly Futures, a six-lesson, curriculum-aligned wellbeing and substance use prevention program that was designed for, and with, the Aboriginal youth. Formative reviews and consultation recommended that the program (i) combine effective components of mainstream prevention with cultural elements, highlighting Aboriginal cultural strengths (ii) avoid stigma and celebrates the cultural ersity by catering to both Aboriginal and non-Aboriginal students and (iii) use digital technology to enhance engagement, implementation and scalability. Guided by an Appreciative Inquiry approach, the program was developed in partnership with an Indigenous Creative Design Agency, and four schools in New South Wales and Queensland, Australia. Aboriginal (n = 41) and non-Aboriginal students (n = 36) described their role models, positive aspects of their community and reasons to avoid substance use these formed the basis of an illustrated story which conveyed the key learning outcomes. Feedback from teachers, students and content experts supported the acceptability of the program, which will be evaluated in a subsequent randomised controlled trial.

Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians

Publisher: AMPCo

Date: 07-2018

DOI: 10.5694/MJA17.01071

HIV incidence in Indigenous and non-Indigenous populations in Australia: a population-level observational study

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1016/S2352-3018(18)30135-8

Setting the record straight: sexually transmissible infections and sexual abuse in Aboriginal and Torres Strait Islander communities

Publisher: AMPCo

Date: 16-02-2020

DOI: 10.5694/MJA2.50492

Reasons for delays in treatment of bacterial sexually transmissible infections in remote Aboriginal communities in Australia: A qualitative study of healthcentre staff

Publisher: CSIRO Publishing

Date: 2015

DOI: 10.1071/SH14240

Abstract: Background Remote Aboriginal communities in Australia experience high rates of bacterial sexually transmissible infections (STIs). To control the transmission and decrease the risk of complications, frequent STI testing combined with timely treatment is required, yet significant delays in treatment have been reported. Perceived barriers to timely treatment for asymptomatic patients in remote communities were explored. Methods: A qualitative study was undertaken as part of the STRIVE (STIs in Remote communities, ImproVed and Enhanced primary health care) project a cluster randomised controlled trial of a sexual health quality improvement program. During 2012, we conducted 36 in-depth interviews with staff in 22 clinics in remote Australia. Results: Participants included registered nurses (72%) and Aboriginal health practitioners (28%). A key barrier to timely treatment was infrequent transportation of specimens to laboratories often hundreds of kilometres away from clinics. Within clinics, there were delays checking and actioning test results, and under-utilisation of systems to recall patients. Participants also described difficulties in physically locating patients due to: (i) high mobility between communities and (ii) low levels of community knowledge created by high staff turnover. Participants also suggested strategies to overcome some barriers such as dedicated clinical time to follow-up recalls and taking treatment out to patients. Conclusions: Participants identified barriers to timely STI treatment in remote Aboriginal communities, and systems to address some of the barriers. Innovative strategies such as point-of-care testing or increased support for actioning results, coupled with incentives to in idual patients to attend for results, may also assist in decreasing the time to treatment.

Correction: Population movement can sustain STI prevalence in remote Australian indigenous communities

Publisher: Springer Science and Business Media LLC

Date: 19-02-2014

DOI: 10.1186/1471-2334-14-86

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.

Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: Results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

Publisher: CSIRO Publishing

Date: 2015

DOI: 10.1071/SH14080

Abstract: Background Remote Australian Aboriginal communities experience high rates of bacterial sexually transmissible infections (STI). A key strategy to reduce STIs is to increase testing in primary health care centres. The current study aimed to explore barriers to offering and conducting STI testing in this setting. Methods: A qualitative study was undertaken as part of the STI in Remote communities, Improved and Enhanced Primary Health Care (STRIVE) project a large cluster randomised controlled trial of a sexual health quality improvement program. We conducted 36 in-depth interviews in 22 participating health centres across four regions in northern and central Australia. Results: Participants identified barriers including Aboriginal cultural norms that require the separation of genders and traditional kinship systems that prevent some staff and patients from interacting, both of which were exacerbated by a lack of male staff. Other common barriers were concerns about client confidentiality (lack of private consulting space and living in small communities), staff capacity to offer testing impacted by the competing demands for staff time, and high staff turnover resulting in poor understanding of clinic systems. Many participants also expressed concerns about managing positive test results. To address some of these barriers, participants revealed informal strategies, such as team work, testing outside the clinic and using adult health checks. Conclusions: Results identify cultural, structural and health system issues as barriers to offering STI testing in remote communities, some of which were overcome through the creativity and enthusiasm of in iduals rather than formal systems. Many of these barriers can be readily addressed through strengthening existing systems of cultural and clinical orientation and educating staff to view STI in a population health framework. However others, particularly issues in relation to culture, kinship ties and living in small communities, may require testing modalities that do not rely on direct contact with health staff or the clinic environment.

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.

Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000-2009

Publisher: AMPCo

Date: 12-2012

DOI: 10.5694/MJA12.10163

Abstract: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000-2009. We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios. Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence. Over the 10-2012 period studied, chlamydia notification rates per 100,000 increased by 80% from 1383 in 2000 to 2494 in 2009 among Indigenous people, and by 335% from 51 in 2000 to 222 in 2009 among non-Indigenous people. The Indigenous versus non-Indigenous summary rate ratio was 23.92 (95% CI, 23.65-24.19 P<0.001). Gonorrhoea notification rates per 100,000 increased by 22% from 1347 in 2000 to 1643 in 2009 among Indigenous people, and by 70% from 10 in 2000 to 17 in 2009 among non-Indigenous people. The gonorrhoea summary notification rate ratio in Indigenous compared with non-Indigenous people was 173.78 (95% CI, 170.81-176.80 P<0.001). In Indigenous people, the highest chlamydia and gonorrhoea notification rates were in women, 15-19-2012-olds, and those living in remote areas. Chlamydia and gonorrhoea notification rates have increased in both populations but were higher among Indigenous people. Our findings highlight the need for targeted prevention programs for young people, especially Indigenous Australians residing in remote areas.

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.

Sexual agency, risk and vulnerability: a scoping review of young Indigenous Australians’ sexual health

Publisher: Informa UK Limited

Date: 18-04-2017

DOI: 10.1080/13676261.2017.1317088

The impact of influenza A(H1N1)pdm09 compared with seasonal influenza on intensive care admissions in New South Wales, Australia, 2007 to 2010: A time series analysis

Publisher: Springer Science and Business Media LLC

Date: 12-10-2012

DOI: 10.1186/1471-2458-12-869

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

DOI: 10.1186/1472-6963-14-285

High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009-2011: Longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening

Publisher: CSIRO Publishing

Date: 2016

DOI: 10.1071/SH16025

Abstract: Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. Methods: Baseline CT and NG laboratory data (2009–2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of in iduals re-tested after an initial CT or NG diagnosis at months (not recommended), 2–4 months (recommended) and 5–12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period 14.9% were re-tested at 2–4 months, 26.9% at 5–12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2–4-month (16.9% v. 11.5%, P 0.01) and 5–12-month (28.9% v. 23.5%, P = 0.01) periods. Women aged 25–29 years had a significantly higher level of re-testing 5–12 months post-diagnosis than females aged 16–19 years (39.8% v. 25.4%, P 0.01). There was a total of 858 people re-tested at 2–12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P 0.01). Conclusions: Just under half the in iduals diagnosed with CT or NG were re-tested at 2–12 months post-diagnosis however, only 15% were re-tested in the recommended time period of 2–4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.

Direct urine polymerase chain reaction for chlamydia and gonorrhoea: A simple means of bringing high-throughput rapid testing to remote settings?

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/SH12108

Abstract: Background Rapid point-of-care tests (POCTs) for chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) have the potential to confer health benefits in certain populations even at moderate sensitivities however, suitable POCTs for these organisms are currently lacking. Methods: In this study, we investigated the use of direct urine polymerase chain reaction (PCR), with the view of implementing a simplified PCR strategy for high-throughput chlamydia and gonorrhoea screening in remote settings. Briefly, a simple dilution of the urine was performed before adding it directly to a real-time PCR reaction. The method was evaluated using 134 stored urine specimens that had been submitted for chlamydia and gonorrhoea testing and had been tested using a commercial C. trachomatis and N. gonorrhoeae PCR method. These included s les that were PCR-positive for chlamydia (n = 87), gonorrhoea (n = 16) or both (n = 2). Direct urine testing was conducted using previously described in-house real-time PCR methods for C. trachomatis and N. gonorrhoeae as well as for recognised N.gonorrhoeae antimicrobial resistance mechanisms. Results: The overall sensitivities and specificities of the direct urine PCR were 78% and 100% for chlamydia, and 83% and 100% for gonorrhoea. N.gonorrhoeae penicillin and quinolone resistance mechanisms were characterised in 14 of the 18 N. gonorrhoeae-positive s les. Conclusions: The results of this study show that the simplified PCR strategy may be a feasible approach for rapid screening and improving chlamydia and gonorrhoea treatment in remote settings.

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.

A national quality assurance survey of Neisseria gonorrhoeae testing

Publisher: Microbiology Society

Date: 2014

DOI: 10.1099/JMM.0.065094-0

Abstract: The aims of this study were to (1) conduct a national survey of Neisseria gonorrhoeae identification by National Neisseria Network (NNN) reference laboratories contributing data to the Australian Gonococcal Surveillance Programme and (2) determine the prevalence in Australia of strains of N. gonorrhoeae lacking gene sequences commonly targeted by in-house PCR assays for confirmation of gonococcal nucleic acid lification tests. Gonococcal clinical isolates referred to NNN laboratories for the first half of 2012 were screened using in-house real-time PCR assays targeting multicopy opa , porA pseudogene and cppB genes. There were 2455 clinical gonococcal isolates received in the study period 98.6 % (2420/2455) of isolates harboured all three gene targets, 0.12 % (3/2455) were porA -negative, 0.04 % (1/2455) opa -negative and 1.14 % (28/2455) cppB -negative by PCR. Notably, no isolates were simultaneously negative for two targets. However, three isolates failed to be lified by all three PCR methods, one isolate of which was shown to be a commensal Neisseria strain by 16S rRNA sequencing. Using PCR as the reference standard the results showed that (1) identification of N. gonorrhoeae isolates by NNN laboratories was highly specific (99.96 %) and (2) strains of N. gonorrhoeae lacking gene sequences commonly targeted by in-house PCR assays are present but not widespread throughout Australia at this point in time.

The end of the Australia antigen? An ecological study of the impact of universal newborn hepatitis B vaccination two decades on

Publisher: Elsevier BV

Date: 11-2012

DOI: 10.1016/J.VACCINE.2012.09.033

Abstract: A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced. A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs. Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04% p<0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43-0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11-0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women. The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.

Risk of Ectopic Pregnancy and Tubal Infertility Following Gonorrhea and Chlamydia Infections

Publisher: Oxford University Press (OUP)

Date: 18-02-2019

DOI: 10.1093/CID/CIZ145

Abstract: Gonorrhea and chlamydia are important causes of pelvic inflammatory disease. Chlamydia also causes long-term sequelae, but the role of gonorrhea is unclear. We followed 300 000 reproductive-aged women for 10 years for ectopic pregnancy and tubal infertility our findings suggest both infections confer similar increases in risk of these outcomes.

So far, so good: Maintenance of prevention is required to stem HIV incidence in aboriginal and torres strait islander communities in Australia

Publisher: Guilford Publications

Date: 06-2014

DOI: 10.1521/AEAP.2014.26.3.267

Abstract: Indigenous people globally remain resilient yet vulnerable to the threats of HIV. Although Australian Aboriginal and Torres Strait Islander peoples experience the worst health status of any identifiable group in Australia, with a standardized morbidity rate three times that of non-Indigenous Australians, the Australian response to HIV has resulted in relatively low and stable rates of HIV infection among Australia's Indigenous peoples. This paper examines the reasons for the success of HIV prevention efforts. These include early recognition by Indigenous peoples of the potential effect that HIV could have on their communities the supply of health hardware (needle and syringe programs and condoms) the development and implementation of culturally-appropriate health promotion messages such as the internationally-recognized Condoman c aign the inclusion of dedicated Aboriginal and Torres Strait Islander Sexual Health Workers in communities and an inclusive policy and partnership approach. Furthermore, the efforts of peak Aboriginal health organizations including NACCHO and its member services and Indigenous programs in peak mainstream organizations like AFAO and its member organizations, have all contributed to prevention success. Efforts need to be maintained however to ensure an escalated epidemic does not occur, particularly among heterosexual people, especially women, and people who inject drugs. New ideas are required as we enter a new era of HIV prevention within the context of the new paradigm of treatment as prevention, and getting to zero new infections.

Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030

Publisher: Wiley

Date: 27-09-2019

DOI: 10.1111/JGH.14457

Abstract: Viral hepatitis affects more than 320 million people globally, leading to significant morbidity and mortality due to liver failure and hepatocellular carcinoma (HCC). More than 248 million people (3.2% globally) are chronically infected with hepatitis B virus (HBV), and an estimated 80 million people (1.1% globally) are chronically infected with hepatitis C virus (HCV). In 2015, more than 700 000 deaths were directly attributable to HBV, and nearly 500 000 deaths were attributable to HCV infection 2-5% of HBV-infected people develop HCC per annum irrespective of the presence of cirrhosis, whereas 1-5% HCV-infected people with advanced fibrosis develop HCC per annum. The rapidly escalating global mortality related to HBV and HCV related viral hepatitis to be the 7th leading cause of death worldwide in 2013, from 10th leading cause in 1990. Australia, New Zealand, and Pacific Island Countries and Territories fall within the World Health Organization Western Pacific Region, which has a high prevalence of viral hepatitis and related morbidity, particularly HBV. Remarkably, in this region, HBV-related mortality is greater than for tuberculosis, HIV infection, and malaria combined. The region provides a unique contrast in viral hepatitis prevalence, health system resources, and approaches taken to achieve World Health Organization global elimination targets for HBV and HCV infection. This review highlights the latest evidence in viral hepatitis epidemiology and explores the health resources available to combat viral hepatitis, focusing on the major challenges and critical needs to achieve elimination in Australia, New Zealand, and Pacific Island Countries and Territories.

Identifying risk and protective factors, including culture and identity, for methamphetamine use in Aboriginal and Torres Strait Islander communities: Relevance of the ‘communities that care’ model

Publisher: Elsevier BV

Date: 12-2020

DOI: 10.1016/J.SOCSCIMED.2020.113451

Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

Publisher: Springer Science and Business Media LLC

Date: 11-07-2022

DOI: 10.1186/S12876-022-02416-5

Abstract: First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU. Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger ( p 0.001), morel likely to reside in most disadvantaged ( p = 0.002) and in regional/remote areas ( p 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8% p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients p = 0.51) and ‘good’ adherence (90.0% vs. 86.9%, respectively p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients ( p 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.

Evaluation of the ResistancePlus GC (beta) assay: a commercial diagnostic test for the direct detection of ciprofloxacin susceptibility or resistance in Neisseria gonorrhoeae

Publisher: Oxford University Press (OUP)

Date: 20-03-2019

DOI: 10.1093/JAC/DKZ108

Abstract: To evaluate the performance of the ResistancePlus GC (beta) assay for the simultaneous detection of Neisseria gonorrhoeae and gyrA S91 markers of resistance (S91F) and susceptibility (WT) to ciprofloxacin, from both clinical specimens and isolates. Performance was assessed on several s le banks, including N. gonorrhoeae isolates (n = 822), non-gonococcal isolates (n = 110), N. gonorrhoeae-positive clinical specimens (n = 402) and N. gonorrhoeae-negative specimens (n = 290). Results were compared with previous testing data, including S91 genotyping and phenotypic resistance profiles. Overall, the assay demonstrated 100% sensitivity for N. gonorrhoeae detection in clinical isolates. For gyrA S91 mutation detection in clinical isolates, the assay showed 100% sensitivity/specificity compared with the genotype, and >99%/>97% sensitivity/specificity when compared with phenotype. For positive clinical specimens, the assay demonstrated >96% sensitivity for N. gonorrhoeae detection and 100% sensitivity/specificity for gyrA S91 mutation detection. The assay demonstrated >99% specificity for N. gonorrhoeae detection against non-gonococcal isolates and 100% specificity for negative clinical specimens. The ResistancePlus GC (beta) assay is suitable for the detection of N. gonorrhoeae and gyrA markers associated with resistance/susceptibility to ciprofloxacin directly in clinical s les. This assay could be implemented for the in idualized treatment of gonorrhoea infections as well as to enhance current antimicrobial resistance surveillance methods.

Efficacy of interventions to increase the uptake of chlamydia screening in primary care: A systematic review

Publisher: Springer Science and Business Media LLC

Date: 05-08-2011

DOI: 10.1186/1471-2334-11-211

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

DOI: 10.3201/EID2309.170427

Public health implications of molecular point-of-care testing for chlamydia and gonorrhoea in remote primary care services in Australia: a qualitative study

Publisher: BMJ

Date: 28-04-2015

DOI: 10.1136/BMJOPEN-2014-006922

Analysis of diagnostic data for sexually transmissible infections in South Australian Aboriginal Community Controlled Health Services (2008–16)

Publisher: CSIRO Publishing

Date: 2019

DOI: 10.1071/SH18189

Abstract: Background Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008–16). Methods: Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. Results: From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27–38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013–16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4 95% confidence interval (CI) 0.2–0.5) and TV positivity (aOR 0.6, 95% CI 0.4–0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9 95% CI 0.5–1.5). Conclusions: Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.

Development of a Risk Algorithm to Better Target STI Testing and Treatment Among Australian Aboriginal and Torres Strait Islander People

Publisher: Springer Science and Business Media LLC

Date: 26-05-2017

DOI: 10.1007/S10508-017-0958-9

Abstract: Identifying and targeting those at greatest risk will likely play a significant role in developing the most efficient and cost-effective sexually transmissible infections (STI) prevention programs. We aimed to develop a risk prediction algorithm to identify those who are at increased risk of STI. A cohort (N = 2320) of young sexually active Aboriginal and Torres Strait Islander people (hereafter referred to as Aboriginal people) were included in this study. The primary outcomes were self-reported high-risk sexual behaviors and past STI diagnosis. In developing a risk algorithm, our study population was randomly assigned to either a development (67%) or an internal validation data set (33%). Logistic regression models were used to create a risk prediction algorithm from the development data set for males and females separately. In the risk prediction models, older age, meth hetamine, ecstasy, and cannabis use, and frequent alcohol intake were all consistently associated with high-risk sexual behaviors as well as with a past STI diagnosis identifying as gay/bisexual was one of the strongest factors among males. Those who had never tested for STIs, 52% (males) and 66% (females), had a risk score >15, and prevalence of undiagnosed STI was estimated between 30 and 40%. Since universal STI screening is not cost-effective, nor practical in many settings, targeted screening strategies remain a crucial and effective approach to managing STIs among young Aboriginal people. Risk prediction tools such as the one developed in this study may help in prioritizing screening for STIs among those most at risk.

First Nations Health Equity Strategy Monitoring and Evaluation Framework: Technical Report

Publisher: The University of Queensland; UQ Poche Centre for Indigenous Health

Date: 10-10-2023

DOI: 10.14264/DB42C9B

Use of health services for sexually transmitted and blood-borne viral infections by young Aboriginal people in New South Wales

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/PY11032

Abstract: The objective of the present study was to describe use of health services for sexually transmitted infections (STI), blood borne viral infections (BBV) and drug and alcohol issues by young Aboriginal people in New South Wales (NSW). A cross-sectional survey was conducted at two Aboriginal sports and cultural events in NSW, in 2007 and 2008, among Aboriginal people aged 16–30 years to ascertain their knowledge of STI, BBV, associated risk behaviours and health service access in NSW. A total of 293 young Aboriginal people completed the survey 58% were female, the mean age was 20 years, and almost 70% were single. Just over one-third (34%) of participants had been tested for an STI in the past 12 months, and over half (58%) reported that they had ever had an STI test (including HIV). Of respondents who had had an STI test in the past 12 months, 54.0% had done so at an Aboriginal Community Controlled Health Service (ACCHS) and 29% by a GP. Just over one-third (36%) of participants had ever had a test for hepatitis C, 45% of whom had received their test at an ACCHS. Participants were also asked about the types of services they had used for advice about STI and BBV. Of the 69% who had sought STI advice, ACCHS was the most common clinical location for doing so (36% for STI and 26% for hepatitis C). This study highlights the important role that ACCHS play in the provision of STI and BBV testing care and management for a cohort of young Aboriginal people in NSW.

Trends in the prevalence of hepatitis B infection among women giving birth in New South Wales

Publisher: AMPCo

Date: 04-2017

DOI: 10.5694/MJA16.00823

Abstract: To evaluate the effect of targeted and catch-up hepatitis B virus (HBV) vaccination programs in New South Wales on HBV prevalence among women giving birth for the first time. Observational study linking data from the NSW Perinatal Data Collection for women giving birth during 2000-2012 with HBV notifications in the NSW Notifiable Conditions Information Management System. HBV prevalence in Indigenous Australian, non-Indigenous Australian-born, and overseas-born women giving birth. Of 482 944 women who gave birth to their first child, 3383 (0.70%) were linked to an HBV notification. HBV prevalence was 1.95% (95% CI, 1.88-2.02%) among overseas-born women, 0.79% (95% CI, 0.63-0.95%) among Indigenous Australian women, and 0.11% (95% CI, 0.09-0.12%) among non-Indigenous Australian-born women. In Indigenous Australian women, prevalence was significantly lower for those who had been eligible for inclusion in the targeted at-risk newborn or universal school-based vaccination programs (maternal year of birth, 1992-1999: 0.15%) than for those who were not (born ≤ 1981: 1.31% for trend, P < 0.001). There was no statistically significant downward trend among non-Indigenous Australian-born or overseas-born women. HBV prevalence was higher among Indigenous women residing in regional and remote areas than those in major cities (adjusted odds ratio [aOR], 2.23 95% CI, 1.40-3.57), but lower for non-Indigenous (aOR, 0.39 95% CI, 0.28-0.55) and overseas-born women (aOR, 0.61 95% CI, 0.49-0.77). Among women giving birth, there was a significant reduction in HBV prevalence in Indigenous women associated with the introduction of the HBV vaccination program in NSW, although prevalence remains higher than among non-Indigenous Australian-born women, and it also varies by region of residence. Continuing evaluation is needed to ensure that the prevalence of HBV infections continues to fall in Australia.

Preventing Substance Use Among Indigenous Adolescents in the USA, Canada, Australia and New Zealand: a Systematic Review of the Literature

Publisher: Springer Science and Business Media LLC

Date: 22-10-2020

DOI: 10.1007/S11121-019-01038-W

Abstract: This systematic review assessed the current evidence base of substance use prevention programs for Indigenous adolescents in the USA, Canada, Australia and New Zealand. The authors investigated (a) the outcomes, type, setting and context of prevention programs (b) the common components of beneficial prevention programs and (c) the methodological quality of evaluations of included prevention programs. The authors searched eight peer-reviewed and 20 grey literature databases for studies published between 1 January 1990 and 31 August 2017. Data extracted included type of program (culturally adapted, culture-based or unadapted), the setting (school, community, family or multi-setting), delivery (computerised or traditional), context (Indigenous-specific or multi-cultural environment) and common components of the programs. Program evaluation methodologies were critically appraised against standardised criteria. This review identified 26 eligible studies. Substance use prevention programs for Indigenous youth led to reductions in substance use frequency and intention to use improvements in substance-related knowledge, attitudes and resistance strategies and delay in substance use initiation. Key elements of beneficial programs included substance use education, skills development, cultural knowledge enhancement and community involvement in program development. Five programs were rated as methodologically strong, seven were moderate and fourteen were weak. Prevention programs have the potential to reduce substance use among Indigenous adolescents, especially when they are developed in partnership with Indigenous people. However, more rigorously conducted evaluation trials are required to strengthen the evidence base.

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.

Increasing access by priority populations to australian sexual health clinics

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2013

DOI: 10.1097/OLQ.0000000000000015

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

DOI: 10.1097/OLQ.0000000000000417

Community and clinic-based screening for curable sexually transmissible infections in a high prevalence setting in Australia: A retrospective longitudinal analysis of clinical service data from 2006 to 2009

Publisher: CSIRO Publishing

Date: 2016

DOI: 10.1071/SH15077

Abstract: Background In response to the high prevalence of sexually transmissible infections (STIs) in many central Australian Aboriginal communities, a community-wide screening program was implemented to supplement routine primary health care (PHC) clinic testing. The uptake and outcomes of these two approaches were compared. Methods: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) community and clinic screening data for Aboriginal people aged 15–34 years, 2006–2009, were used. Regression analyses assessed predictors of the first test occurring in the community screen, positivity and repeat testing. Results: A total of 2792 in iduals had 9402 tests (median: four per person) over 4 years. Approximately half of the in iduals (54%) were tested in the community and clinic approaches combined, 29% (n = 806) in the community screen only and 18% (n = 490) in the clinic only. Having the first test in a community screen was associated with being male and being aged 15–19 years. There was no difference between community and clinic approaches in CT or NG positivity at first test. More than half (55%) of in iduals had a repeat test within 2–15 months and of these, 52% accessed different approaches at each test. The only independent predictor of repeat testing was being 15–19 years. Conclusions: STI screening is an important PHC activity and the findings highlight the need for further support for clinics to reach young people. The community screen approach was shown to be a useful complementary approach however, cost and sustainability need to be considered.

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.

Working with Aboriginal young people in sexual health research: a peer research methodology in remote Australia.

Publisher: SAGE Publications

Date: 03-10-2020

DOI: 10.1177/1049732320961348

Abstract: In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done “on” rather than “with” or “by” them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involving Aboriginal young people as researchers, advisors, and participants in a qualitative sexual health study in one remote setting in the Northern Territory, Australia. We document the methodology, while critically reflecting on its benefits and limitations as a decolonizing method. Findings confirm the importance of enabling Aboriginal young people to play a central role in research with other young people about their own sexual health. Future priorities include developing more enduring forms of coinvestigation with Aboriginal young people beyond data collection during single studies, and support for young researchers to gain formal qualifications to enhance future employability.

Characterization of a Novel Neisseria gonorrhoeae Penicillinase-Producing Plasmid Isolated in Australia in 2012

Publisher: American Society for Microbiology

Date: 08-2014

DOI: 10.1128/AAC.02993-14

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

DOI: 10.1186/S12913-015-1116-5

Population-level diagnosis and care cascade for chlamydia in Australia

Publisher: BMJ

Date: 05-06-2019

DOI: 10.1136/SEXTRANS-2018-053801

Abstract: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections) (2) annual number of chlamydia diagnoses (3) annual number of diagnoses treated (4) annual number of diagnoses followed by a re-test for chlamydia within 42–180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15–29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Among young people in Australia, there were an estimated 248 580 (range, 240 690–256 470) new chlamydia infections in 2016 (96 470 in women 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640–70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660–16 285) diagnoses were followed by a re-test within 42–180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis. The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.

An ecological model of drug and alcohol use and related harms among Aboriginal and Torres Strait Islander Australians: A systematic review of the literature

Publisher: Elsevier BV

Date: 03-2021

DOI: 10.1016/J.PMEDR.2020.101277

Exploring How People Affected by Methamphetamine Exchange Social Support Through Online Interactions on Facebook: Content Analysis (Preprint)

Publisher: JMIR Publications Inc.

Date: 14-03-2019

DOI: 10.2196/PREPRINTS.14011

Abstract: eth hetamine is an illicit and addictive psychostimulant that remains to be a significant cause of economic burden in Australia. Social media is increasingly being used by nongovernment organizations and health services to encourage the growth of social support networks among people with health-related issues. Several studies have investigated the utility of social media in providing social support to groups of people with health-related issues. However, limited research exists that explores how people who have been directly or indirectly affected by meth hetamine use social media for social support. his study aimed to determine the types of social support being sought and provided by people affected by meth hetamine when interacting with others on a Facebook page. total of 14,777 posts were collected from a Facebook page and transferred into an Excel document for content analysis. The posts were manually coded into categories of social support using an adapted version of Cutrona and Suhr’s Social Support Behavior Code. Posts could be coded into more than one category. Saturation was reached at 2000 posts, which were used to draw inferences. motional support was the most offered support type, with 42.05% (841/2000) of posts providing this form of support. This is followed by esteem support, which was provided in 40.40% (808/2000) of posts. Overall, 24.20% (484/2000) of posts offered informational support. Network support and tangible support were the least offered support types, with 2.25% (45/2000) and 1.70% (34/2000) of posts offering these types of support, respectively. his study suggests that online social support groups can be effective in challenging stigma by encouraging people affected by meth hetamine to connect with each other and talk about their struggles. This in turn represents an important step toward successful rehabilitation.

Two distinct gonorrhoea trends and risk factors among women in Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 31-10-2020

DOI: 10.1097/OLQ.0000000000001086

Abstract: In recent years, gonorrhea notifications have increased in women in Australia and other countries. We measured trends over time and risk factors among Australian Aboriginal and Torres Strait Islander (“Aboriginal”) and non-Aboriginal women. We conducted a cross-sectional analysis of data from 41 sexual health clinics. Gonorrhea positivity at each patient's first visit (first-test positivity) during the period 2009 to 2016 was calculated. Univariate and multivariate analyses assessed risk factors for first-test positivity in Aboriginal and non-Aboriginal women. Gonorrhea positivity decreased among Aboriginal women (7.1% in 2009 to 5.2% in 2016, P 0.001) and increased among non-Aboriginal women (0.6%–2.9%, P 0.001). Among Aboriginal women, first-test positivity was independently associated with living in a regional or remote area (adjusted odds ratio [aOR], 4.29 95% confidence interval [CI], 2.52–7.31 P 0.01) and chlamydia infection (aOR, 4.20 95% CI,3.22–5.47 P 0.01). Among non-Aboriginal women, first-test positivity was independently associated with greater socioeconomic disadvantage (second quartile: aOR, 1.68 [95% CI, 1.31–2.16 P 0.01] third quartile: aOR, 1.54 [95% CI, 1.25–1.89 P 0.01]) compared with least disadvantaged quartile: recent sex work (aOR, 1.69 95% CI, 1.37–2.08 P 0.01), recent injecting drug use (aOR, 1.85 95% CI, 1.34–2.57 P 0.01), and chlamydia infection (aOR, 2.35 95% CI, 1.90–2.91 P 0.01). For non-Aboriginal women, being aged 16 to 19 years (aOR, 0.62 95% CI, 0.49–0.80 P 0.01) compared with those ≥30 years was a protective factor. These findings highlight 2 different epidemics and risk factors for Aboriginal and non-Aboriginal women, which can inform appropriate health promotion and clinical strategies.

HIV diagnoses in indigenous peoples: comparison of Australia, Canada and New Zealand

Publisher: Oxford University Press (OUP)

Date: 09-2011

DOI: 10.1016/J.INHE.2011.03.010

Management of chronic hepatitis B in the Torres Strait Islands: an identified need for a comprehensive public health approach to chronic hepatitis B in remote Australian Indigenous communities.

Publisher: CSIRO Publishing

Date: 2014

DOI: 10.1071/PY12130

Abstract: We aimed to document how health service providers in the Torres Strait Island region of northern Australia respond to chronic hepatitis B, and to identify priorities for the effective clinical management of the infection. Semi-structured qualitative interviews with 61 health service providers were conducted in 2011 in the Torres Strait and north Queensland region to explore issues affecting chronic hepatitis B management. Two critical issues were identified affecting the health service response to chronic hepatitis B: (i) the absence of a systems-based approach to clinically managing the infection and (ii) variable knowledge about the infection by the health workforce. Other issues identified were competing and more urgent health priorities, the silent nature of chronic hepatitis B infection at an in idual and systems level, inadequate resources and the transient health workforce. While people living in the Torres Strait region are screened, diagnosed and informed that they are infected with chronic hepatitis B, there is an ad hoc approach to its clinical management. An effective and coordinated public health response to this infection in remote and isolated Australian Indigenous communities needs to be developed and resourced. Critical elements of this response will include the development of clinical guidelines and workforce development.

Comparison of recording of hepatitis B infection in the NSW Perinatal Data Collection with linked hepatitis B notifications

Publisher: The Sax Institute

Date: 12-2017

DOI: 10.17061/PHRP2751745

Abstract: Results of routine maternal antenatal hepatitis B (HBV) screening have been recorded in the New South Wales (NSW) Perinatal Data Collection (PDC) since January 2011. We evaluated the accuracy of this reporting in 2012, the first year that comprehensive data were available, by linking the PDC to HBV notifications. PDC records of mothers giving birth in 2012 were probabilistically linked to HBV notifications recorded in the NSW Notifiable Conditions Information Management System (NCIMS). Sensitivity and specificity of the PDC record of HBV status were determined using a linked HBV notification from the NCIMS database as the gold standard. Results were also examined according to health service (area health service, hospital level, public or private) and in idual factors (maternal age, country of birth, Aboriginality, parity, timing of first antenatal visit). Among 99 510 records of women giving birth in NSW in 2012, positive HBV status was recorded for 0.69% of the women according to the PDC record and 0.90% from linked NCIMS records. The overall sensitivity of the HBV status variable in the PDC data was 65.5% (95% confidence interval [CI] 62.4, 68.7) and positive predictive value was 85.3% (95% CI 82.6, 87.9). In general, the low prevalence of HBV meant we had limited statistical power to assess differences between health service factors and maternal factors however, sensitivity was significantly lower in PDC data for HBV in Australian-born non-Aboriginal women (37.0% 95% CI 27.5, 46.7) than in overseas-born women (69.9% 95% CI 66.6, 73.1 p < 0.001). PDC records of HBV status for women giving birth in 2012 had high specificity but poor sensitivity. Sensitivity varied across area health services and levels of maternal services, and by various maternal factors. Because the results of maternal HBV screening can be used to monitor HBV prevalence in adults, analysis of the PDC records in subsequent years is necessary to track whether sensitivity improves over time.

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.

Population movement can sustain STI prevalence in remote Australian indigenous communities

Publisher: Springer Science and Business Media LLC

Date: 25-04-2013

DOI: 10.1186/1471-2334-13-188

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.

Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004-2008

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 04-2011

DOI: 10.1097/OLQ.0B013E318202719D

Indigenous Youth Peer-Led Health Promotion in Canada, New Zealand, Australia, and the United States: A Systematic Review of the Approaches, Study Designs, and Effectiveness

Publisher: Frontiers Media SA

Date: 13-02-2018

DOI: 10.3389/FPUBH.2018.00031

‘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

DOI: 10.1093/FAMPRA/CMY011

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.

Substance use prevention programs for indigenous adolescents in the United States of America, Canada, Australia and New Zealand: Protocol for a systematic review

Publisher: JMIR Publications Inc.

Date: 02-2018

DOI: 10.2196/RESPROT.9012

Could point-of-care testing be effective for reducing the prevalence of trichomoniasis in remote Aboriginal communities?

Publisher: CSIRO Publishing

Date: 2014

DOI: 10.1071/SH14035

Abstract: High prevalence of trichomoniasis is reported for many remote Indigenous communities despite intensive screening and treatment programs. Mathematical modelling has previously been used to show that point-of-care (POC) testing for gonorrhoea and chlamydia has the potential to increase the impact of screening in reducing the prevalence of these sexually transmissible infections. The study was extended to estimate the impact of a rapid POC test for trichomoniasis. The results suggest that POC testing in place of conventional testing will also provide additional reductions in trichomoniasis prevalence. However, more emphasis should be placed on testing for trichomoniasis in older women due to the high prevalence observed in this group.

Elevated reporting of unprotected anal intercourse and injecting drug use but no difference in HIV prevalence among Indigenous Australian men who have sex with men compared with their Anglo-Australian peers.

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/SH12097

Abstract: Background Although half of the HIV notifications among Aboriginal and Torres Strait Islander people (‘Indigenous Australians’) are attributed to homosexual transmission, there has been little research examining sexual and drug use risk practices among Indigenous Australian men who have sex with men (MSM). Methods: Respondents were Indigenous Australian (n = 1278) and Anglo-Australian men (n = 24 002) participating in the routine cross-sectional Gay Community Periodic Surveys conducted in Australia from 2007 to 2011. Sociodemographic characteristics, sexual risk practices, drug use, HIV testing and HIV status of Indigenous and Anglo-Australian men were compared and evaluated to discover whether Indigenous status was independently associated with HIV risk practices. Results: Although an equivalent proportion of Indigenous and Anglo-Australian men reported being HIV-positive (9.6%), Indigenous MSM were more likely to report unprotected anal intercourse with casual partners in the previous 6 months (27.9% v. 21.5% Adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.11–1.49). Indigenous men were more likely than Anglo-Australian men to report use of several specific drugs and twice as likely to report injecting drug use in the previous 6 months (8.8% v. 4.5% AOR = 1.43, 95% CI: 1.11–1.86). Conclusions: Despite a higher proportion of Indigenous men reporting sexual and drug use practices that increase the risk of HIV transmission, there were no differences in the HIV status of Indigenous and Anglo-Australian men. However, the elevated rates of risk practices suggest that Indigenous MSM should remain a focus for HIV prevention, care and support.

Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia.

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/SH19204

Abstract: Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives. Methods: In-depth interviews with 35 young Aboriginal women and men aged 16–21 years in two remote Australian settings were conducted inductive thematic analysis examining sexual health risk reduction practices was also conducted. Results: Participants reported in idual and collective STI and pregnancy risk reduction strategies. In idual practices included accessing and carrying condoms having a regular casual sexual partner being in a long-term trusting relationship using long-acting reversible contraception having fewer sexual partners abstaining from sex accessing STI testing. More collective strategies included: refusing sex without a condom accompanied health clinic visits with a trusted in idual encouraging friends to use condoms and go for STI testing providing friends with condoms. Conclusion: Findings broaden understanding of young Aboriginal people’s sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people’s existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people’s sexual health include: peer condom distribution accompanied health service visits peer-led health promotion continued community-based condom distribution enhanced access to a fuller range of available contraception in primary care settings engaging health service-experienced young people as ‘youth health workers’.

Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia

Publisher: Springer Science and Business Media LLC

Date: 15-02-2017

DOI: 10.1186/S12879-017-2241-Z

Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia

Publisher: BMJ

Date: 05-2019

DOI: 10.1136/BMJOPEN-2018-026679

Abstract: To examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia. Qualitative study. Primary health care services serving remote Aboriginal communities in the Northern Territory, Australia. Seven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program. Semi-structured in-depth interviews conducted in person or by telephone data were analysed using an inductive and deductive thematic approach. Despite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems. This study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.

Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial.

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/S2214-109X(19)30411-5

Incomplete recording of Indigenous identification status under-estimates the prevalence of Indigenous population attending Australian general practices: a cross sectional study

Publisher: Springer Science and Business Media LLC

Date: 14-08-2019

DOI: 10.1186/S12913-019-4393-6

Individual and population level impacts of illicit drug use, sexual risk behaviours on sexually transmitted infections among young Aboriginal and Torres Strait Islander people: results from the GOANNA

Publisher: Springer Science and Business Media LLC

Date: 19-07-2016

DOI: 10.1186/S12889-016-3195-6

'Next Generation Youth Well-being Study:' understanding the health and social well-being trajectories of Australian Aboriginal adolescents aged 10-24 years: Study protocol

Publisher: BMJ

Date: 03-2019

DOI: 10.1136/BMJOPEN-2018-028734

Abstract: Australian Aboriginal and/or Torres Strait Islander (hereafter referred to as ‘Aboriginal’) adolescents (10–24 years) experience multiple challenges to their health and well-being. However, limited evidence is available on factors influencing their health trajectories. Given the needs of this group, the young age profile of the Aboriginal population and the long-term implications of issues during adolescence, reliable longitudinal data are needed. The ‘Next Generation: Youth Well-being Study’ is a mixed-methods cohort study aiming to recruit 2250 Aboriginal adolescents aged 10–24 years from rural, remote and urban communities in Central Australia, Western Australia and New South Wales. The study assesses overall health and well-being and consists of two phases. During phase 1, we qualitatively explored the meaning of health and well-being for adolescents and accessibility of health services. During phase 2, participants are being recruited into a longitudinal cohort. Recruitment is occurring mainly through community networks and connections. At baseline, participants complete a comprehensive survey and undertake an extensive age relevant clinical assessment. Survey and clinical data will be linked to various databases including those relating to health services medication immunisation hospitalisations and emergency department presentations death registrations education child protection and corrective services. Participants will receive follow-up surveys approximately 2 years after their baseline visit. The ‘Next Generation’ study will fill important evidence gaps by providing longitudinal data on the health and social well-being of Aboriginal adolescents supplemented with narratives from participants to provide context. Ethics approvals have been sought and granted. Along with peer-reviewed publications and policy briefs, research findings will be disseminated via reports, booklets and other formats that will be most useful and informative to the participants and community organisations.

Inclusivity and equity in human microbiome research

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/S0140-6736(18)33204-5

The epidemiology of gonococcal arthritis in an Indigenous Australian population

Publisher: BMJ

Date: 19-03-2015

DOI: 10.1136/SEXTRANS-2014-051893

Abstract: Disseminated Gonococcal Infection (DGI) is caused by Neisseria gonorrhoeae bacteraemia. Typically the primary source is a sexually acquired mucosal infection. If not recognised and treated promptly DGI can be associated with significant morbidity and, in rare cases, death. Central Australia has one of the highest rates of gonococcal notifications in Australia. Despite this, the nature and prevalence of complications arising from gonococcal infections within this at-risk population is unknown. Enhanced surveillance and audit of patients with DGI discharged from Alice Springs Hospital between 2003 and 2012. Patient demographics and clinical management data were extracted from healthcare records and investigation databases. DGI cases were significantly more likely to present in young (≤29 years) Indigenous women compared with young Indigenous men (χ(2), p=0.020). Overall Indigenous women had nearly twice the risk of DGI compared with men (relative risk 1.92 (95% CI 1.45 to 2.53)). The incidence of DGI per all gonococcal notifications on average was 911/100 000 (95% CI 717 to 1142) gonococcal notifications. DGI represents a severe complication of N. gonorrhoeae infection. In Central Australia DGI is not a rare oddity but rather an important differential when dealing with patients with undefined sepsis and associated joint disease.

Roadmap to recovery: Reporting on a research taskforce supporting Indigenous responses to COVID‐19 in Australia

Publisher: Wiley

Date: 22-09-2020

DOI: 10.1002/AJS4.133

Current issues in the prevalence, diagnosis and management of hepatocellular carcinoma in Australia

Publisher: Wiley

Date: 02-2021

DOI: 10.1111/IMJ.15184

Coinfection with Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis: A crosssectional analysis of positivity and risk factors in remote Australian Aboriginal communities

Publisher: BMJ

Date: 28-10-2015

DOI: 10.1136/SEXTRANS-2014-051535

Abstract: To determine the co-occurrence and epidemiological relationships of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) in a high-prevalence setting in Australia. In the context of a cluster randomised trial in 68 remote Aboriginal communities, we obtained laboratory reports on simultaneous testing for CT, NG and TV by nucleic acid lification tests in in iduals aged ≥16 years and examined relationships between age and sex and the coinfection positivity. ORs were used to determine which infections were more likely to co-occur by demographic category. Of 13 480 patients (median age: 30 years men: 37%) tested for all three infections during the study period, 33.3% of women and 21.3% of men had at least one of them, highest in patients aged 16-19 years (48.9% in women, 33.4% in men). The most frequent combination was CT/NG (2.0% of women, 4.1% of men), and 1.8% of women and 0.5% of men had all three. In all co-combinations, coinfection positivity was highest in patients aged 16-19 years. CT and NG were highly predictive of each other's presence, and TV was associated with each of the other two infections, but much more so with NG than CT, and its associations were much stronger in women than in men. In this remote high-prevalence area, nearly half the patients aged 16-19 years had one or more sexually transmitted infections. CT and NG were more common dual infections. TV was more strongly associated with NG coinfections than with CT. These findings confirm the need for increased simultaneous screening for CT, NG and TV, and enhanced control strategies. Australian and New Zealand Clinical Trials Registry ACTRN12610000358044.

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.

Young Aboriginal people's engagement with STI testing in the Northern Territory, Australia.

Publisher: Springer Science and Business Media LLC

Date: 06-04-2020

DOI: 10.1186/S12889-020-08565-0

Abstract: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15 – 29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people’s engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. In-depth interviews with 35 young Aboriginal men and women aged 16–21 years thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. Findings reveal in idual, social and health service level influences on willingness to undertake clinic-based STI testing. In idual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the in idual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. This is the first socio-ecological analysis of factors influencing young Aboriginal people’s willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people’s lived sexual health experiences and family- and community-based health promotion practices.

Rapid point-of-care tests for HIV and sexually transmissible infection control in remote Australia: Can they improve Aboriginal people's and Torres Strait Islanders' health?

Publisher: CSIRO Publishing

Date: 2012

DOI: 10.1071/SH11051

Developing an ecological framework of factors associated with substance use and related harms among Aboriginal and Torres Strait Islander people: protocol for a systematic review

Publisher: BMJ

Date: 05-2019

DOI: 10.1136/BMJOPEN-2018-024418

Abstract: Aboriginal and Torres Strait Islander people experience high rates of substance use and related harms. Previous prevention programmes and policies have met with limited success, particularly among youth, and this may be a result of inadequately targeting the unique risk and protective factors associated with substance use for Aboriginal and Torres Strait Islander people. The purpose of this systematic review is to therefore synthesise the risk and protective factors associated with substance use and related harms among Aboriginal and Torres Strait Islander people, and critically appraise the methodological quality of the included studies. A total of seven peer-reviewed (Cochrane, Embase, PsychInfo, Medline, ProQuest, Informit, and CINAHL) and two grey literature (Heath InfoNet and Closing the Gap Clearinghouse) databases will be systematically searched using search terms in line with the aims of this review and based on previous relevant reviews. Studies published between 1 January 1990 and 31 April 2018 will be included if they identify risk and/or protective factors for substance use or related harms in a study s le that consists of at least 50% Aboriginal and Torres Strait Islander people. A narrative synthesis will be undertaken where the identified factors will be organised using an ecological approach into in idual, relationship, community, societal and cultural levels. A critical appraisal of study quality will be conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data and the qualitative assessment tool by Godfrey and Long. Formal ethics approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentations and social media. CRD42017073734.

Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians

Publisher: CSIRO Publishing

Date: 2018

DOI: 10.1071/SH17039

Abstract: Background Earlier age at sexual debut is associated with drug and alcohol use, risky sexual behaviours and sexually transmissible infections (STI). Methods: In the present study, 2320 young Indigenous Australians were surveyed. Results: Most study participants had sex for the first time when they were 14 years or younger (79% and 67% for males and females respectively). More than 80% of participants were categorised as being in the high-risk category for the combined sexual risk factors (i.e. not using condoms, drunk or high at last sexual act, or three or more sexual partners in the past year). There was a linear decreasing trend between the proportion of males and females who had less than high school education and age at first sex (Ptrend 0.001). Compared with the highest quintile of age at first sexual debut (≥18 years), those in the bottom quintile ( years) were less likely to have completed high school (63% vs 32% respectively for males 68% vs 26% respectively for females Ptrend 0.001 for both). Conclusions: The findings of the present study suggest that sex education and STI prevention should start early when targeting Indigenous young people, with age-appropriate messages. Sex education should be comprehensive and address in idual risk behaviours, sexual agency and societal vulnerability to not only delay sexual debut, but also to emphasise the importance of STI prevention through condom use, which clearly already works to a certain extent with this group.

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

DOI: 10.1186/S12879-014-0584-2

Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia

Publisher: Wiley

Date: 15-09-2016

DOI: 10.1111/DAR.12320

Abstract: To examine patterns of illicit drug use among Australian Indigenous young people, identify correlates of frequent use separately in urban, regional and remote settings and characterise those who inject. Cross-sectional design at 40 Indigenous events. Self-complete surveys were administered to Indigenous people aged 16-29 years using mobile devices. 2,877 participants completed the survey. One in five reported using cannabis at least weekly in the previous year, but the use of other drugs was less prevalent. Patterns of drug use were largely similar across regions, although more participants in urban and regional areas reported using ecstasy (12% vs 11% vs 5%) and cocaine (6% vs 3% vs 1%) and more reported weekly cannabis use (18% vs 22% vs 14%). Injecting was rare (3%) but those who did inject reported a high incidence of needle sharing (37%). Meth hetamine (37%), heroin (36%) and methadone (26%) were the most commonly injected drugs, and injecting was related to prison experience (AOR 5.3 95% CI 2.8-10.0). Attention is needed in relation to cannabis use, particularly among those Indigenous young people living in regional and urban settings. Also, although injecting is uncommon, it is associated with prison involvement. Priority must be given to reducing the numbers of Indigenous youth entering justice settings, delaying the age at first entry to justice settings, and reducing the risk of BBV acquisition while in custody through, for ex le, prison-based NSP, BBV education, and Indigenous-specific treatment that emphasises connection to country and culture. [Bryant J, Ward J, Wand H, Byron K, Bamblett A, Waples-Crowe P, Betts S, Coburn T, Delaney-Thiele D, Worth H, Kaldor J, Pitts M. Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia. Drug Alcohol Rev 2016 :447-455].

Substance Use Prevention Programs for Indigenous Adolescents in the United States of America, Canada, Australia and New Zealand: Protocol for a Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 20-09-2017

DOI: 10.2196/PREPRINTS.9012

Abstract: ndigenous adolescents are at a higher risk of experiencing harms related to substance use compared with their non-Indigenous counterparts as a consequence of earlier onset and higher rates of substance use. Early onset of substance use has been identified as a risk factor for future substance use problems and other health, social, and family outcomes. Therefore, prevention of substance use among adolescents has been identified as a key area to improve health of Indigenous Peoples. Evidence exists for the effectiveness of prevention approaches for adolescents in mainstream populations and, most recently, for the use of computer- and Internet-delivered interventions to overcome barriers to implementation. However, there is currently no conclusive evidence about the effectiveness of these approaches for Indigenous adolescents. he purpose of this review is to synthesize the international evidence regarding the effectiveness of substance use prevention programs for Indigenous adolescents in the United States, Canada, Australia, and New Zealand. total of 8 peer-reviewed databases and 20 gray literature databases will be searched, using search terms in line with the aims of this review and based on previous relevant reviews of substance use prevention. Studies will be included if they evaluate a substance use prevention program with Indigenous adolescents (aged 10 to 19 years) as the primary participant group and are published between January 1, 1990 and August 31, 2017. narrative synthesis will be provided about the effectiveness of the programs, the type of program (whether culture-based, adapted, or unadapted), delivery of the program (computer- and Internet-delivered or traditional), and the setting in which the programs are delivered (community, school, family, clinical, or a combination). he study will identify core elements of effective substance use prevention programs among Indigenous adolescents and appraise the methodological quality of the studies. This review will provide researchers, policy makers, and program developers with evidence about the potential use of prevention approaches for Indigenous adolescents.

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.

Hepatitis C viral infection and imprisonment among Aboriginal and Torres Strait Islander and non‐Indigenous people who inject drugs

Publisher: Wiley

Date: 15-07-2018

DOI: 10.1111/DAR.12845

Abstract: An understanding of the relationship between hepatitis C viral (HCV) infection and contextual factors such as imprisonment may contribute to the development of targeted treatment and prevention programs. We examine the associations of imprisonment and drug dependence with lifetime exposure to HCV, and whether these associations differ for Aboriginal and Torres Strait Islander and non-Indigenous people who inject drugs. Respondent-driven s ling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community s le of people who injected drugs, which comprised 243 Indigenous and 227 non-Indigenous participants who had ever been tested for HCV. Data are cross-sectional. Two binary Poisson models were developed to examine associations for variables relating to imprisonment, Indigeneity and drug use history. Sharing needles and syringes in prison (adjusted risk ratio 1.25, 95% confidence interval 1.02-1.53) remained significantly associated with HCV infection after adjustment for Indigeneity, injecting drug use history and drug dependence. Opioid dependence and concurrent dependence on opioids and meth hetamine was also independently associated with HCV infection. Sharing needles and syringes in prison is linked with HCV infection, for both Aboriginal and Torres Strait Islander and non-Indigenous people who inject drugs. Further development of treatment and prevention programs in prisons is required, with consideration of the role of opioid and meth hetamine dependence in HCV exposure.

Hepatocellular carcinoma in Indigenous Australians: a call to action

Publisher: AMPCo

Date: 19-02-2021

DOI: 10.5694/MJA2.50961

Contextual and behavioural risk factors for sexually transmissible infections in young Aboriginal people in central Australia: a qualitative study

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/SH19181

Abstract: Rates of sexually transmissible infections (STIs) in remote central Australian Aboriginal communities have been persistently high for over two decades, yet risk factors for STIs in these communities are not well understood. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

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.

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.

Chlamydia prevention indicators for Australia: review of the evidence from New South Wales.

Publisher: CSIRO Publishing

Date: 2012

DOI: 10.1071/SH11183

Abstract: Background: Annual notifications of chlamydia (Chlamydia trachomatis) diagnoses have increased steadily in Australia in the last decade. To guide public health programs, we developed 10 national chlamydia prevention indicators and report on each indicator for New South Wales (NSW). Methods: Using systematic methods, we reviewed the literature to report on the 10 health and behaviour indicators for 15- to 29–year-old heterosexuals in NSW from 2000. We included data with two or more time points. Results: Chlamydia notification rates (Indicator 1) in 15- to 29–year-olds have increased by 299%, from 237 per 100 000 population in 2001 to 946 per 100 000 population in 2010 and the percent of 15- to 34-year-olds with an annual Medicare-rebated chlamydia test (Indicator 2) increased by 326%, from 1.9% in 2001 to 8.1% in 2010. Since 2004, sentinel surveillance showed a 28% increase in chlamydia prevalence (Indicator 3) in 15- to 29-year-old females tested at their first sexual health service visit (from 8.5% in 2004 to 10.9% in 2010) but no significant increase in males. No NSW-specific chlamydia incidence (Indicator 4) was available. Pelvic inflammatory disease hospitalisation separations rate decreased from 0.58 per 1000 in 2001 to 0.44 per 1000 in 2010 in 15- to 29-year-old females (Indicator 5).Secondary school surveys in 2002 and 2008 showed chlamydia knowledge increased in males. The sexual risk-taking behaviour of young people remained unchanged (Indicators 6–10). Conclusions: Although notifications have risen steeply, the modest increase in chlamydia prevalence maybe a more realistic reflection of transmission rates. Strategies are needed to increase testing and to modify sexual risk behaviour. Crucial gaps in epidemiological data were identified.

Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis.

Publisher: Springer Science and Business Media LLC

Date: 31-08-2013

DOI: 10.1186/1471-2334-13-403

Evaluation of the Deadly Liver Mob program: Insights for roll-out and scale-up of a pilot program to engage Aboriginal Australians in hepatitis C and sexual health education, screening, and care

Publisher: Springer Science and Business Media LLC

Date: 02-2018

DOI: 10.1186/S12954-018-0209-Y

A Web-Based Therapeutic Program (We Can Do This) for Reducing Methamphetamine Use and Increasing Help-Seeking Among Aboriginal and Torres Strait Islander People: Protocol for a Randomized Wait-List Co

Publisher: JMIR Publications Inc.

Date: 26-07-2019

DOI: 10.2196/14084

A HIV diagnosis and treatment cascade for Aboriginal and Torres Strait Islander peoples of Australia

Publisher: Informa UK Limited

Date: 16-11-2021

DOI: 10.1080/09540121.2021.2001416

Safer sex and condom use: A convenience sample of Aboriginal young people in New South Wales

Publisher: CSIRO Publishing

Date: 2011

DOI: 10.1071/SH10138

Abstract: Background This paper examines condom use in a s le of Aboriginal young people in New South Wales (NSW) aged 16–30 years. Methods: Cross-sectional data were collected using hand-held computer devices from 293 Aboriginal people attending two Aboriginal events in NSW. Results: Almost two-thirds of respondents reported having had a casual sex partner in the previous 6 months. Of these, 39.2% reported always using a condom with casual partners. Having always used a condom with casual partners varied among respondents, and was more likely among younger respondents (adjusted odds ratio (AOR): 2.7, 95% confidence interval (CI): 1.2–6.1) and less likely among those who used illicit drugs (AOR: 0.2, 95% CI: 0.1–0.7). Conclusions: In comparison to published studies of other Australians, casual sex appears to be more common among this s le of Aboriginal young people however, the proportion who report having always used condoms with casual partners is very similar. This suggests that although casual sex is more common, Aboriginal young people do not engage in risky behaviour any more often than other young Australians. Further work should be conducted with those who do not always use condoms, such as those who are older and who use illicit drugs, particularly with regards to how abstinence from drug use supports protective behaviours such as condom use among this population of Aboriginal young people.

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

DOI: 10.1371/JOURNAL.PONE.0094361

Analytical evaluation of GeneXpert CT/NG, the first genetic point-of-care assay for simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis

Publisher: American Society for Microbiology

Date: 06-2013

DOI: 10.1128/JCM.00806-13

Abstract: GeneXpert CT/NG was evaluated with 372 characterized bacterial strains. Sensitivity of 10 genome copies/reaction was obtained for both agents. Four Neisseria mucosa and two Neisseria subflava isolates were positive for one of two gonococcal targets however, the assay flagged all as negative. The assay was analytically highly sensitive and specific.

Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non‐Indigenous people who inject drugs

Publisher: Wiley

Date: 30-05-2016

DOI: 10.1111/DAR.12392

Abstract: Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs. Respondent-driven s ling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community s le of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, meth hetamine-dependent only, opioid-dependent only, dependent on meth hetamine and opioids). Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both meth hetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only. The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both meth hetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) s le of Indigenous and non-Indigenous people who inject drugs. Drug Alcohol Rev 2016 :611-619].

Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non‐Indigenous people who have recently used methamphetamine: the NIMAC survey

Publisher: Wiley

Date: 22-06-2020

DOI: 10.1111/DAR.13085

Australian First Nations response to the pandemic: A dramatic reversal of the ‘gap’

Publisher: Wiley

Date: 30-09-2021

DOI: 10.1111/JPC.15701

Abstract: Until the recent death in Dubbo of an Aboriginal man, there have been no deaths from Covid 19 in Australia. The extraordinary success of Aboriginal and Torres Strait Islander populations in controlling the effects of this pandemic has been a global role model. Until early 2021, in spite of their high risk status, dispersed population and fear of health services due to racism, Indigenous outcomes were better than those for non‐Indigenous. Aboriginal health leaders at every level brought in worlds best practices and applied them in all urban, rural and remote locations. Instead of the many hundreds of cases, hospitalisation and deaths expected, there were only 150 cases nationwide with15% hospitalised but no one in ICU and no deaths. This result is a complete reversal of the gap and was due to the outstanding Indigenous leadership, that governments at all levels listened to Aboriginal wisdom and that control was handed to those who knew what to do. This result is not only evidence for why a Voice enshrined in the Constitution would work, it heralds a new way of working with Aboriginal people in Australia. This viewpoint makes the case for a different model to engage and empower First Nations to really close the gap ‐ themselves.

Transformation to a patient-centred medical home led and delivered by an urban Aboriginal and Torres Strait Islander community, and association with engagement and quality-of-care: quantitative findin

Publisher: Springer Science and Business Media LLC

Date: 06-09-2023

DOI: 10.1186/S12913-023-09955-X

Young Deadly Free: impact evaluation of a sexual health youth peer education program in remote Australian communities

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/SH20069

Abstract: Background Aboriginal and Torres Strait Islander people in remote and very remote communities in Australia experience high rates of sexually transmissible infections (STIs), 4- to 29-fold the rates reported for non-Aboriginal people living in remote areas. Young people aged 16–29 years are particularly vulnerable to STIs. The Young Deadly Free (YDF) sexual health youth peer education program was implemented in 15 remote or very remote communities in four Australian jurisdictions in an effort to address endemic STI rates in these communities. The present study sought to evaluate the effect of YDF for Aboriginal young people. Methods: Young people (n = 128) participated in youth peer educator training to deliver peer education sessions on sexual health topics to other young people in their communities. Pre and post surveys were used to examine changes in STI knowledge, attitudes and behavioural intentions of the young people attending the peer education sessions. GHRANITE software extracted deidentified STI testing data for young people attending 13 community health services. Results: Young people (n = 426) attended peer education sessions delivered by trained youth peer educators. Pre and post surveys were completed by 174 and 172 young people respectively (median age 20 years). Gains were reported in STI knowledge, intentions to test (χ2 = 10.58, d.f. = 4, n = 142, P & 0.001) and number of STI tests (50.8% increase from baseline). Feelings of shame associated with STI testing remained high (39.5% post survey). Conclusions: Peer education can enhance the sexual health literacy of young Aboriginal people residing in remote communities. The extent to which knowledge gains result in behaviours that prevent STI transmission requires further evaluation. Normalising STI testing among Aboriginal young people would help reduce feelings of shame.

A decentralised point-of-care testing model to address inequities in the COVID-19 response

Publisher: Elsevier BV

Date: 07-2021

DOI: 10.1016/S1473-3099(20)30859-8

Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study

Publisher: BMJ

Date: 04-09-2013

DOI: 10.1136/SEXTRANS-2013-051118

Abstract: To examine the association between prior chlamydia and gonorrhoea infections and adverse obstetric outcomes. Records of women resident in New South Wales, Australia with a singleton first birth during 1999-2008 were linked to chlamydia and gonorrhoea notifications using probabilistic linkage. Obstetric outcomes and potential confounders were ascertained from the birth record. Logistic regression, adjusted for potential confounders was used to estimate the association between a disease notification prior to the birth and adverse birth outcomes: spontaneous preterm birth (SPTB), small for gestational age (SGA) and stillbirth. Among 354 217 women, 1.0% (n=3658) had a prior chlamydia notification 0.06% (n=196) had a prior gonorrhoea notification. The majority of notifications (>80%) occurred before the estimated conception date. 4.1% of women had a SPTB, 12.1% had a SGA baby and 0.6% of women had a stillbirth. Among women with a prior chlamydia notification, the risk of SPTB and stillbirth was increased, aOR 1.17 (95% CI 1.01 to 1.37) and aOR 1.40 (95% CI 1.00 to 1.96) respectively but there was no association with SGA, aOR 0.99 (95% CI 0.89 to 1.09). For women with gonorrhoea the risks for SPTB, stillbirth and SGA were respectively aOR 2.50 (95%CI 1.39 to 4.50), 2.35 (95% CI 0.58 to 9.56) and 0.98 (95% CI 0.58 to 1.68). Among women with a prior chlamydia diagnosis, the risk of SPTB did not differ between women diagnosed >1 year prior to conception, within the year prior to conception or during the pregnancy, (p=0.9). Sexually transmissible infections in pregnancy and the preconception period may be important in predicting pregnancy outcomes.

Chlamydia sentinel surveillance in aboriginal community controlled health services finds higher testing and positivity rates among younger people

Publisher: Elsevier BV

Date: 12-2012

DOI: 10.1111/J.1753-6405.2012.00929.X

Abstract: To measure chlamydia testing and positivity rates among 16-39 year olds attending Aboriginal Community Controlled Health Services (ACCHSs). Retrospective non-identifiable computerised records containing consultation and chlamydia testing data were collected for patients (16-39 years) attending eight ACCHSs during 2008-09 in urban, regional and remote settings for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) system. Annual chlamydia testing and positivity rates were estimated. Over two years, 13,809 patients aged 16-39 years (57.8% female, 82.3% Aboriginal or Torres Strait Islander) attended. The annual overall chlamydia testing rate was 13.0% (2008) and 16.0% (2009). Testing rates were higher among females (p<0.001) and among patients aged 16-29 than 30-39 years (males: p=0.01 females: p<0.001). Chlamydia positivity was 8.5% overall similar in females (8.7%) and males (7.8%) (p=0.46) highest among 16-19 years (females: 17.4% males: 13.0%), declining to 1.5% among females 35-39 years (p<0.001) and 4.8% among males 30-34 years (p<0.001). Chlamydia testing at these ACCHSs approached recommended levels among some patient groups, however, it should increase. High positivity among younger people highlights they should be targeted. Young people should be targeted for sexual health interventions. ACCHSs are well placed to provide enhanced sexual health services if appropriately resourced.

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

DOI: 10.1016/S1473-3099(18)30045-8

Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection

Publisher: American Medical Association (AMA)

Date: 09-04-2019

DOI: 10.1001/JAMA.2019.2947

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.

Point-of-care tests for the diagnosis of Neisseria gonorrhoeae infection: A systematic review of operational and performance characteristics

Publisher: BMJ

Date: 23-10-2013

DOI: 10.1136/SEXTRANS-2012-050656

Abstract: Systematic review of the performance and operational characteristics of point-of-care (POC) tests for the diagnosis of Neisseria gonorrhoeae. We searched PubMed and Embase until August 2010 using variations of the terms: 'rapid test', 'Neisseria gonorrhoeae' and 'evaluation'. We identified 100 papers, 14 studies were included nine evaluated leucocyte esterase (LE) dipsticks and three immunochromatographic strips, and two clinical audits of microscopy were identified. Of the field evaluations the gold standard was nucleic acid lification technology in six studies and bacterial culture in the other six. In four studies, 50% or more of the patients were symptomatic. The median sensitivity of LE dipsticks was 71% (range 23-85%), median specificity was 70% (33-99%), median positive predictive value (PPV) was 19% (5-40%) and median negative predictive value (NPV) was 95% (56-99%). One LE study found a sensitivity of 23% overall, increasing to 75% in symptomatic women. LE dipsticks mostly involved three steps and took under 2 min. The median sensitivity of immunochromatographic tests (ICT) was 70% (60-94%), median specificity was 96% (89-97%), median PPV was 56% (55-97%) and median NPV was 93% (92-99%). Immunochromatic strips involved five to seven steps and took 15-30 min. Specificity of microscopy ranged from 38% to 89%. ICT and LE tests had similar sensitivities, but sensitivity results may be overestimated as largely symptomatic patients were included in some studies. ICT had a higher specificity in women than LE tests. The findings highlight the need for improved POC tests for diagnosis of N gonorrhoeae and more standardised evaluations.

Markers of hepatitis B infection and immunity in patients attending Aboriginal community controlled health services

Publisher: Wiley

Date: 09-2014

DOI: 10.5694/MJA14.00121

Abstract: Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. We aimed to increase the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data. A cross-sectional study of de-identified records from electronic patient systems over 5 years (8 January 2009 to 11 July 2013). Four Aboriginal community controlled health services. All patients attending for a clinical visit were included in the study. Hepatitis B testing records were included if at least one serological test for HBV was done. Percentage of clinical patients tested for hepatitis B, compliance with guidelines and serological status. A total of 2959 people aged 15-54 years were screened for HBV, representing 17.2% of all people with a clinical visit in the study period. A total of 865 Aboriginal patients were tested concurrently for hepatitis B surface antigen (HBsAg), hepatitis B core antibody and hepatitis B surface antibody. Of those, 352 (40.7%) were susceptible to HBV infection (95% CI, 37.4%-43.9%) and 34 (3.9%) had either an acute or chronic infection indicated by a positive HBsAg result (95% CI, 2.6%-5.2%). In 329 women with antenatal screening, six (1.8%) returned a positive HBsAg result (95% CI, 0.37%-3.28%). A substantial proportion of patients tested were susceptible to HBV, with a high percentage potentially infectious compared with the general population. High levels of active infection and susceptibility to infection suggest many opportunities for transmission and indicate the potential benefit of routine HBV testing and vaccination in this population.

First Nations peoples leading the way inCOVID‐19 pandemic planning, response and management

Publisher: Wiley

Date: 20-07-2020

DOI: 10.5694/MJA2.50704

Exploring How People Affected by Methamphetamine Exchange Social Support Through Online Interactions on Facebook: Content Analysis

Publisher: JMIR Publications Inc.

Date: 10-2019

DOI: 10.2196/14011

Abstract: Meth hetamine is an illicit and addictive psychostimulant that remains to be a significant cause of economic burden in Australia. Social media is increasingly being used by nongovernment organizations and health services to encourage the growth of social support networks among people with health-related issues. Several studies have investigated the utility of social media in providing social support to groups of people with health-related issues. However, limited research exists that explores how people who have been directly or indirectly affected by meth hetamine use social media for social support. This study aimed to determine the types of social support being sought and provided by people affected by meth hetamine when interacting with others on a Facebook page. A total of 14,777 posts were collected from a Facebook page and transferred into an Excel document for content analysis. The posts were manually coded into categories of social support using an adapted version of Cutrona and Suhr’s Social Support Behavior Code. Posts could be coded into more than one category. Saturation was reached at 2000 posts, which were used to draw inferences. Emotional support was the most offered support type, with 42.05% (841/2000) of posts providing this form of support. This is followed by esteem support, which was provided in 40.40% (808/2000) of posts. Overall, 24.20% (484/2000) of posts offered informational support. Network support and tangible support were the least offered support types, with 2.25% (45/2000) and 1.70% (34/2000) of posts offering these types of support, respectively. This study suggests that online social support groups can be effective in challenging stigma by encouraging people affected by meth hetamine to connect with each other and talk about their struggles. This in turn represents an important step toward successful rehabilitation.

Evaluation of the Young Deadly Free Peer Education Training Program: Early Results, Methodological Challenges, and Learnings for Future Evaluations

Publisher: Frontiers Media SA

Date: 05-04-2019

DOI: 10.3389/FPUBH.2019.00074

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.

Commentary on Milloy et al. (2010): The stark reality of overdose mortality among indigenous peoples--a(nother) plea for action.

Publisher: Wiley

Date: 06-10-2010

DOI: 10.1111/J.1360-0443.2010.03208.X

Higher HCV antibody prevalence among Indigenous clients of Needle and Syringe Programs

Publisher: Elsevier BV

Date: 10-2011

DOI: 10.1111/J.1753-6405.2011.00743.X

Abstract: To compare prevalence of hepatitis C virus (HCV) antibody and associated risk behaviours among Indigenous and non-Indigenous participants in the Australian Needle and Syringe Program Survey. During 1 or 2 weeks each October from 1998 to 2008, clients of participating needle and syringe programs (NSPs) completed a self-administered questionnaire on demographics and risk behaviour and provided a capillary blood s le for HIV and HCV antibody testing. After de-duplication, 16,132 in iduals participated during the 11 years, of whom 1,380 (8.6%) identified as Indigenous. Higher proportions of Indigenous than non-Indigenous participants were HCV antibody positive (57% versus 51%, p<0.001). In an overall multivariable analysis, Indigenous status (OR 1.17 CI 1.03-1.32) and female gender (OR 1.25 CI 1.16-1.35) were independently associated with HCV antibody seropositivity. Indigenous participants also reported higher rates of risk behaviour, including receptive sharing of needle syringes (21% vs 16% p<0.001), receptive sharing of ancillary injecting equipment (38% vs 33% p<0.001), having been injected by others (18% vs 13% p<0.001), and injecting in public (54% vs 49% p<0.001). These results highlight the need for targeted, culturally appropriate programs to minimise risks for bloodborne viral transmission among Indigenous people who inject drugs.

Using social networking sites to recruit participants: methods of an online survey of sexual health, knowledge and behaviour of young South Australians

Publisher: Elsevier BV

Date: 08-2021

DOI: 10.1111/1753-6405.13117

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

DOI: 10.1111/1753-6405.12427

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.

Burden of the Beast

Publisher: Queensland University of Technology

Date: 17-03-2022

DOI: 10.5204/MCJ.2862

The Alice Springs Hospital Readmission Prevention Project (ASHRAPP): a randomised control trial

Publisher: Springer Science and Business Media LLC

Date: 20-02-2017

DOI: 10.1186/S12913-017-2077-7

Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings

Publisher: Public Library of Science (PLoS)

Date: 16-07-2015

DOI: 10.1371/JOURNAL.PONE.0133202

A Neisseria gonorrhoeae strain with a meningococcal mtrR sequence

Publisher: Microbiology Society

Date: 08-2014

DOI: 10.1099/JMM.0.074286-0

Web-based therapeutic interventions for assessing, managing and treating health conditions in Indigenous people: a scoping review protocol

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2017

DOI: 10.11124/JBISRIR-2016-003324

Abstract: The objective of the scoping review is to map the international scientific literature on web-based therapeutic interventions (WBTI) used by Indigenous people for assessing, managing and treating health conditions. The focus of this review is WBTIs for a broad range of health conditions, including but not limited to, communicable and non-communicable diseases, mental health conditions (including the broader concept of social and emotional wellbeing), use of harmful substances and gambling. The questions for the scoping review are: 1. What types of WBTI used for assessing, managing and treating health conditions in Indigenous populations have been reported in the literature? 2. What conclusions and interpretations with regards to the uptake and the effects of WBTI used for assessing, managing and treating health conditions in Indigenous populations have been reported in the literature? 3. What recommendations for practice with regards to the use of WBTI for assessing, managing and treating health conditions in Indigenous populations have been reported in the literature? 4. What explanations have been reported in the literature for the observed uptake of WBTI used for assessing, managing and treating health conditions in Indigenous populations? 5. What types of outcomes have been reported in the literature for the use of WBTI for assessing, managing and treating health conditions in Indigenous populations? 6. What explanations have been reported in the literature for the observed outcomes of WBTI used for assessing, managing and treating health conditions in Indigenous populations?

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.

Exploring factors impacting early childhood health among Aboriginal and Torres Strait Islander families and communities: Protocol for a population-based cohort study using data linkage (the 'Defying the Odds' study)

Publisher: BMJ

Date: 03-2018

DOI: 10.1136/BMJOPEN-2017-021236

Abstract: Empirical evidence on family and community risk and protective factors influencing the comparatively high rates of potentially preventable hospitalisations and deaths among Aboriginal and Torres Strait Islander infants and children is limited. As is evidence on geographical variation in these risks. The ‘Defying the Odds’ study aims to explore the impact of perinatal outcomes, maternal social and health outcomes and level of culturally secure service availability on the health outcomes of Western Australian (WA) Aboriginal infants and children aged 0–5 years. The study combines a retrospective cohort study that uses state-wide linked health and administrative data from 12 data sources for multiple generations within Aboriginal families in WA, with specifically collected survey data from health and social services supporting Aboriginal families in regions of WA. Data sources include perinatal/birth registration, hospital, emergency department, mental health services, drug and alcohol service use, mortality, infectious disease notifications, and child protection and family services. Multilevel regression models will be used to examine the intensity of admissions and presentations, mortality, intensity of long stays and morbidity-free survival (no admissions) for Aboriginal children born in WA in 2000–2013. Relationships between maternal (and grand-maternal) health and social factors and child health outcomes will be quantified. Community-level variation in outcomes for Aboriginal children and factors contributing to this variation will be examined, including the availability of culturally secure services. Online surveys were sent to staff members at relevant services to explore the scope, reach and cultural security of services available to support Aboriginal families across selected regions of WA. Ethics approvals have been granted for the study. Interpretation and dissemination are guided by the study team’s Aboriginal leadership and reference groups. Dissemination will be through direct feedback and reports to health services in the study and via scientific publications and policy recommendations.

Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia

Publisher: Springer Science and Business Media LLC

Date: 20-08-2020

DOI: 10.1186/S12913-020-05388-Y

Abstract: Sexually transmissible infection (STI) and blood-borne virus (BBV) diagnoses data are a core component of the Australian National Notifiable Diseases Surveillance System (NNDSS). However, the NNDSS data alone is not enough to understand STI and BBV burden among priority population groups, like Aboriginal and Torres Strait Islander people, because it lacks testing, treatment and management data. Here, we describe the processes involved in establishing a STI and BBV sentinel surveillance network representative of Aboriginal Community-Controlled Health Services (ACCHS)—known as the ATLAS network—to augment the NNDSS and to help us understand the burden of disease due to STI and BBV among Aboriginal and Torres Strait Islander peoples. Researchers invited participation from ACCHS in urban, regional and remote areas clustered in five clinical hubs across four Australian jurisdictions. Participation agreements were developed for each clinical hub and in idual ACCHS. Deidentified electronic medical record (EMR) data relating to STI and BBV testing, treatment and management are collected passively from each ACCHS via the GRHANITE tm data extraction tool. These data are analysed centrally to inform 12 performance measures which are included in regular surveillance reports generated for each ACCHS and clinical hub. The ATLAS network currently includes 29 ACCHS. Regular reports are provided to ACCHS to assess clinical practice and drive continuous quality improvement initiatives internally. Data is also aggregated at the hub, jurisdictional and national level and will be used to inform clinical guidelines and to guide future research questions. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE. The ATLAS network is an established national surveillance network specific to Aboriginal and Torres Strait Islander peoples. The data collected through the ATLAS network augments the NNDSS and will contribute to improved STI and BBV clinical care, guidelines and policy program-planning.

Quality improvement interventions for improving the detection and management of curable sexually transmitted infections in primary care

Publisher: Wiley

Date: 10-2016

DOI: 10.1002/14651858.CD012374

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.

Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia

Publisher: AMPCo

Date: 12-2012

DOI: 10.5694/MJA11.11450

Abstract: To assess the extent of diagnosed and undiagnosed pelvic inflammatory disease (PID) in Aboriginal women in remote central Australia. Retrospective cross-sectional study in five remote central Australian primary health care centres. Medical records of all resident Aboriginal women aged 14-34 years were examined. Data were from presentations with documented lower abdominal pain, excluding other causes, for 2007-2008. PID investigations undertaken, PID diagnoses made, recommended treatment, and presentations meeting the guideline criteria for diagnosing PID based on pelvic examination, symptom profile or history. Of 655 medical records reviewed, 119 women (18%) presented 224 times with lower abdominal pain. Recommended investigations to diagnose PID were infrequently undertaken: bimanual examination (15 cases [7%]) testing for gonorrhoea and chlamydia (78 [35%]) and history taking for vaginal discharge (59 [26%]), intermenstrual bleeding (27 [12%]) and dyspareunia (17 [8%]). There were 95 presentations (42%) consistent with guidelines to diagnose PID, most (87 [39%]) based on symptom profile and history. Of these, practitioners made 15 diagnoses of PID, and none had the recommended treatment documented. Pelvic inflammatory disease occurred frequently among Aboriginal women in central Australia during the study period but was vastly underdiagnosed and poorly treated. Undiagnosed or inadequately treated PID leads to poorer reproductive health outcomes in the long term. Increased awareness of PID symptoms, diagnosis and treatment and a revision of the guidelines is needed to improve detection and management of PID in this high-risk setting.

Hepatitis B immunization for indigenous adults, Australia

Publisher: WHO Press

Date: 16-09-2016

DOI: 10.2471/BLT.16.169524

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

DOI: 10.1186/S12913-018-3024-Y

The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence

Publisher: CSIRO Publishing

Date: 2013

DOI: 10.1071/SH13026

Abstract: Background Despite the availability of testing and treatment, bacterial sexually transmissible infections (STIs) continue to occur at endemic levels in many remote Indigenous communities in Australia. New generation molecular point-of-care (POC) tests have high sensitivity, comparable with conventional diagnostic tests, and have the potential to increase the impact of STI screening. Methods: We developed mathematical models of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) transmission in remote Indigenous communities in Australia to evaluate screening and treatment strategies that utilise POC tests. Results: The introduction of POC testing with 95% sensitivity could reduce the prevalence of gonorrhoea and chlamydia from 7.1% and 11.9% to 5.7% and 8.9%, respectively, under baseline screening coverage of 44% per year. If screening coverage is increased to 60% per year, prevalence is predicted to be reduced to 3.6% and 6.7%, respectively, under conventional testing, and further reduced to 1.8% and 3.1% with the introduction of POC testing. Increasing screening coverage to 80% per year will result in a reduction in the prevalence of gonorrhoea and chlamydia to 0.6% and 1.5%, respectively, and the virtual elimination of both STIs if POC testing is introduced. Conclusions: Modelling suggests that molecular POC tests of high sensitivity have great promise as a public health strategy for controlling chlamydia and gonorrhoea. However, evaluation of the cost-effectiveness of POC testing needs to be made before widespread implementation of this technology can be considered.

Guarding against an HIV epidemic within an Aboriginal community and cultural framework; lessons from NSW

Publisher: The Sax Institute

Date: 2010

DOI: 10.1071/NB10015

Use and uptake of web-based therapeutic interventions amongst Indigenous populations in Australia, New Zealand, the United States of America and Canada: a scoping review

Publisher: Springer Science and Business Media LLC

Date: 31-05-2020

DOI: 10.1186/S13643-020-01374-X

Abstract: Barriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems. This review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions. Studies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants. Following a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies. Data was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice. A total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use. Culturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities.

An urgent call to collect data related to COVID-19 and Indigenous populations globally

Publisher: BMJ

Date: 03-2021

DOI: 10.1136/BMJGH-2020-004655

A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial

Publisher: JMIR Publications Inc.

Date: 07-01-2022

DOI: 10.2196/34530

Abstract: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. The target s le will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural ersity, and truancy. The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Australian New Zealand Clinical Trials Registry ACTRN12620001038987 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038& isReview=true PRR1-10.2196/34530

Community-based interventions to address alcohol and drug use in Indigenous populations in Australia, New Zealand and Canada

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2018

DOI: 10.11124/JBISRIR-2017-003504

Abstract: What is the effectiveness of community-based interventions designed to reduce harm associated with alcohol and other drug use in Indigenous populations in Australia, New Zealand and Canada?

Lessons learned from the implementation of the Young Deadly Free peer education programme in remote and very remote Australian Aboriginal communities

Publisher: Informa UK Limited

Date: 09-02-2022

DOI: 10.1080/14681811.2021.1879775

STI in remote communities: Improved and enhanced primary health care (STRIVE) study protocol: A cluster randomised controlled trial comparing 'usual practice' STI care to enhanced care in remote primary health care services in Australia

Publisher: Springer Science and Business Media LLC

Date: 09-09-2013

DOI: 10.1186/1471-2334-13-425

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

DOI: 10.1186/S12879-015-1107-5

Baker IDI South Australia

Location: Australia

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South Australian Health And Medical Research Institute

Location: Australia

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University Of New South Wales

Location: Australia

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University Of Queensland

Location: Australia

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Flinders University

Location: Australia

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Use Of Molecular Resistance Assays To Provide Alterative Oral Treatment Strategies For Gonorrhoea In Indigenous And Other High-risk Populations; A Randomised Cluster Trial

Start Date: 2017

End Date: 2020

Funder: National Health and Medical Research Council

Should Australia Introduce A National Chlamydia Testing Program? Evaluation Of A Randomised Controlled Trial

Start Date: 2013

End Date: 2017

Funder: National Health and Medical Research Council

Sexual And Reproductive Health And Behaviours Of Young Offenders (14-18 Years) In NSW & Qld

Start Date: 2013

End Date: 2017

Funder: National Health and Medical Research Council

The Australian Centre For Research Excellence In Offender Health

Start Date: 2013

End Date: 2018

Funder: National Health and Medical Research Council

Sexual Health And Relationships In Young Indigenous People

Start Date: 2009

End Date: 2013

Funder: Australian Research Council

Interventions To Improve Outcomes For Young Aboriginal And Torres Strait Islander People In Sexually Transmissible Infections Blood Borne Viruses And For People Using Methamphetamines

Start Date: 2017

End Date: 2020

Funder: National Health and Medical Research Council

STRIVEplus: Refinement And Translation Of An Intervention Designed To Improve Sexual Health Service Delivery In Remote Communities

Start Date: 2013

End Date: 2018

Funder: National Health and Medical Research Council

Modelling The Interaction Between Sexually Transmitted Infections And HIV Transmission To Inform Public Health Policy

Start Date: 2010

End Date: 2013

Funder: National Health and Medical Research Council

Deadly Liver Mob: Engaging Aboriginal People In Viral Hepatitis, HIV And Sexual Health Services

Start Date: 2016

End Date: 2020

Funder: National Health and Medical Research Council

A Population-based Record Linkage Study Of The Impact Of Chlamydia Infection On Reproductive Health In Women

Start Date: 2012

End Date: 2015

Funder: National Health and Medical Research Council

Centre For Clinical Research Excellence In Aboriginal Health: Sexually Transmitted And Bloodborne Viral Infections

Start Date: 2009

End Date: 2015

Funder: National Health and Medical Research Council

New Strategies To Increase Testing And Treatment For Endemic Sexually Transmitted Infections In Remote Aboriginal Communities

Start Date: 2014

End Date: 2018

Funder: National Health and Medical Research Council

Novel Interventions To Address Methamphetamines In Aboriginal Communities, Including A Randomised Trial Of A Web Based Therapeutic Tool Used To Treat Dependence In Clinical Settings.

Start Date: 2016

End Date: 2020

Funder: National Health and Medical Research Council

Using Mathematical Models To Assess The Impact Of Interventions To Reduce Sexually Transmitted Infections In Australia

Start Date: 2009

End Date: 2011

Funder: National Health and Medical Research Council

Uptake, Sustainability And Impact Of Scaling Up Point-of-care Testing For Sexually Transmissible Infections In Remote And Regional Aboriginal Communities

Start Date: 2014

End Date: 2019

Funder: National Health and Medical Research Council

A Randomised Trial Of Rapid Point-of-care Tests For Chlamydia And Gonorrhoea Infections In Remote Aboriginal Communities

Start Date: 2011

End Date: 2014

Funder: National Health and Medical Research Council

Australian Centre For Research Excellence In Aboriginal Sexual Health And Blood Borne Viruses

Start Date: 2015

End Date: 2020

Funder: National Health and Medical Research Council

The Forgotten Generation: Understanding Health Trajectories In Aboriginal Adolescents And Youth

Start Date: 2015

End Date: 2019

Funder: National Health and Medical Research Council

A Randomised Trial To Control Sexually Transmitted Infections In Remote Aboriginal Communities.

Start Date: 2009

End Date: 2014

Funder: National Health and Medical Research Council

ASH RAPP – Alice Springs Hospital ReAdmission Prevention Project

Start Date: 2014

End Date: 2016

Funder: National Health and Medical Research Council

SCALE-C: Strategies For Hepatitis C Testing And Treatment In Aboriginal Communities That Lead To Elimination

Start Date: 2018

End Date: 2022

Funder: National Health and Medical Research Council

Linkage Projects - Grant ID: LP0991274

Start Date: 06-2010

End Date: 03-2014

Amount: $755,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP180100701

Start Date: 02-2020

End Date: 02-2024

Amount: $1,191,949.00

Funder: Australian Research Council

ARC Centres Of Excellence - Grant ID: CE230100027

Start Date: 12-2023

End Date: 12-2030

Amount: $35,000,000.00

Funder: Australian Research Council