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Ubrihien A, Gwynne K, Lewis DA. Barriers and enablers for young Aboriginal people in accessing public sexual health services: A mixed method systematic review. Int J STD AIDS 2022; 33:559-569. [PMID: 35333101 DOI: 10.1177/09564624221080365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A mixed method systematic review was undertaken to address the research question, Do young Australian Aboriginal people barriers in accessing public sexual health services? Aboriginal people are disproportionally affected by significantly higher incidence rates of sexually transmissible infections (STIs), compared to the rest of the Australian population. This problem is particularly acute for young people under 30 years of age who suffer from the consequences of STIs due to the number of sexual partners and challenges faced in accessing healthcare. METHODS The study inclusion criteria were: papers published between January 1999 and September 2019 inclusive; published in any language, discussed healthcare barriers and facilitators; included people under 30 years of age; contained research with one or more of the following terms; Aboriginal, Health, Access, Barriers and Sexual Health; was published or discussed Australia research. Articles were extracted from MEDLINE, Embase, PsychINFO, Proquest Social Sciences, Open Grey and NLM Bookshelf. An initial search identified 770 articles; 23 duplicate articles were removed. 642 were excluded for not meeting inclusion criteria following a title and abstract review of articles. 60 articles underwent full text review by two reviewers and 15 articles were included in analysis. RESULTS This review found that novel approaches to service delivery such as incorporating STI testing into other targeted initiatives, providing self-testing kits and achieving high levels of cultural competency were key facilitators to access. Whereas location of services, inconsistent service provision, shame and differing levels of knowledge about the effects of STIs were key barriers. CONCLUSIONS This systematic review identified barriers and facilitators of access to sexual health services for Aboriginal young people. System level changes are needed to improve physical environments, service integration and consistent provision of culturally competent services. This review highlights the need for further research focussed on assessing the real-world pressures of young Aboriginal people and how healthcare providers can better offer a person-centred service.
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Affiliation(s)
- Ashley Ubrihien
- Faculty of Medicine and Health Sciences, 7788Macquarie University, Sydney, NSW, Australia
| | - Kylie Gwynne
- Faculty of Medicine and Health Sciences, 7788Macquarie University, Sydney, NSW, Australia
- Centre for Global Indigenous Futures, Macquarie University, Sydney, NSW, Australia
| | - David A Lewis
- 576481Western Sydney Sexual Health Centre, Sydney, NSW, Australia
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Pearce E, Jolly K, Harris IM, Adriano A, Moore D, Price M, Ross J. What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review. Sex Transm Infect 2021; 98:62-69. [PMID: 34446545 PMCID: PMC8785066 DOI: 10.1136/sextrans-2021-055142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people. METHODS We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions. MAIN RESULTS From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I2=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I2=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options. CONCLUSIONS Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.
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Affiliation(s)
- Emma Pearce
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ada Adriano
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Ross
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
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Ubrihien A, Gwynne K, Lewis DA. Enabling culturally safe sexual health services in western Sydney: a protocol to improve STI treatment outcomes for Aboriginal young people. Pilot Feasibility Stud 2021; 7:106. [PMID: 33985588 PMCID: PMC8117628 DOI: 10.1186/s40814-021-00847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background Aboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services. Methods This qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed. Discussion This study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations. Trial registration The study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16).
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Affiliation(s)
- Ashley Ubrihien
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
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Groos A, Peardon-Freeman S, McFarlane K, Braithwaite S, Gajjar D, Murch P, Spucches C. Free online chlamydia and gonorrhoea urine test request in Queensland, Australia: convenience of home sample collection versus pathology collection centre attendance for faster results. Sex Health 2021; 18:254-259. [PMID: 34148563 DOI: 10.1071/sh21029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022]
Abstract
Background A free online chlamydia and gonorrhoea urine testing service (Webtest) is available for people living in Queensland, Australia. There are two options to provide a urine sample: at a pathology collection centre or by using a home mailing kit. The study aimed to trial these two testing options designed for young people and describe which is the preferred testing choice. METHODS Data for online requests made from 3 August 2017 to 31 December 2019 provides information for age, gender, location of clients, results received, treatment and partner notification reported by people with positive results. RESULTS For 29 months, there were 4642 Webtest requests and 2906 valid results received. For young people (16-29 years), chlamydia positivity was 8.2% (172/2105; 95% CI, 7.1-9.4) versus 3.2% (26/801; 95% CI, 2.2-4.7) for people aged ≥30 years, and 6.8% (198/2906; 95% CI, 6.0-7.8) for all ages. Home mailing kits were the most popular testing choice, with 68.0% (1977/2906) of results received from urine submitted by post and 32.0% (929/2906) via pathology collection centre. CONCLUSIONS The free online test request service engaged young people at risk of sexually transmissible infections and found home sample collection was most popular.
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Affiliation(s)
- Anita Groos
- Communicable Diseases Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia; and Corresponding author.
| | | | - Kim McFarlane
- Health Contact Centre, Health Support Queensland, GPO Box 48, Brisbane, Qld 4001, Australia
| | - Simone Braithwaite
- Preventive Health Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Deepa Gajjar
- Health Service Strategy and Planning, Metro North Hospital and Health Services, Level 14, Block 7, Royal Brisbane and Women's Hospital, Royal Brisbane Hospital, Qld 4029, Australia
| | - Pamela Murch
- Communicable Diseases Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Catherine Spucches
- Communicable Diseases Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia
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Mycoplasma genitalium Detection in Urogenital Specimens from Symptomatic and Asymptomatic Men and Women by Use of the cobas TV/MG Test. J Clin Microbiol 2020; 58:JCM.02124-19. [PMID: 32213558 PMCID: PMC7269414 DOI: 10.1128/jcm.02124-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 01/18/2023] Open
Abstract
Mycoplasma genitalium (MG) infections are a growing concern within the field of sexually transmitted infections. However, diagnostic assays for M. genitalium have been limited in the United States. As most infections are asymptomatic, individuals can unknowingly pass the infection on, and the prevalence is likely to be underestimated. Diagnosis of M. genitalium infection is recommended using a nucleic acid test. This multicenter study assessed the performance of the cobas Trichomonas vaginalis (TV)/MG assay (cobas) for the detection of M. genitalium, using 22,150 urogenital specimens from both symptomatic and asymptomatic men and women collected at geographically diverse sites across the United States. Mycoplasma genitalium (MG) infections are a growing concern within the field of sexually transmitted infections. However, diagnostic assays for M. genitalium have been limited in the United States. As most infections are asymptomatic, individuals can unknowingly pass the infection on, and the prevalence is likely to be underestimated. Diagnosis of M. genitalium infection is recommended using a nucleic acid test. This multicenter study assessed the performance of the cobas Trichomonas vaginalis (TV)/MG assay (cobas) for the detection of M. genitalium, using 22,150 urogenital specimens from both symptomatic and asymptomatic men and women collected at geographically diverse sites across the United States. The performance was compared to a reference standard of three laboratory-developed tests (LDTs). The specificity of the cobas assay for M. genitalium ranged from 96.0% to 99.8% across symptomatic and asymptomatic men and women. The sensitivities in female vaginal swabs and urine samples were 96.6% (95% confidence interval [CI], 88.5 to 99.1%) and 86.4% (95% CI, 75.5 to 93.0%), respectively. The sensitivities in male urine and meatal swab samples were 100% (95% CI, 94.0 to 100%) and 85.0% (95% CI, 73.9 to 91.9%), respectively. This study demonstrated that the cobas assay was highly sensitive and specific in all relevant clinical samples for the detection of M. genitalium.
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Groos A, Peardon-Freeman S, McFarlane K, Braithwaite S, Gajjar D, Murch P. Free online chlamydia and gonorrhoea urine test request in Queensland: sexually transmissible infections testing can be hard for young people even if the process is easy. Sex Health 2020; 17:543-546. [PMID: 33334415 DOI: 10.1071/sh20118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
Online options to request sexually transmissible infections testing are increasingly popular and a free online chlamydia and gonorrhoea urine testing service is available for people living in Queensland, Australia. Data from 3 August 2017 to 31 August 2019 provide information for 1316 reminder calls to young people (aged 16-29 years) to encourage sample submission. The reminder calls generated few additional samples for testing, suggesting young people may have changed their mind about using the service, sought testing elsewhere or were reluctant to talk further about their original decision to request a test online.
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Affiliation(s)
- Anita Groos
- Blood Borne Viruses and Sexually Transmissible Infections Unit, Communicable Diseases Branch, Queensland Health, 15 Butterfield Street, Herston, Qld 4006, Australia; and Corresponding author.
| | | | - Kim McFarlane
- Health Contact Centre, Health Support Queensland, GPO Box 48, Brisbane, Qld 4001, Australia
| | - Simone Braithwaite
- Preventive Health Branch, Queensland Health, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Deepa Gajjar
- Health Service Strategy & Planning, Metro North Hospital and Health Services, Block 7, Royal Brisbane & Women's Hospital, Royal Brisbane Hospital, Qld 4029, Australia
| | - Pamela Murch
- Blood Borne Viruses and Sexually Transmissible Infections Unit, Communicable Diseases Branch, Queensland Health, 15 Butterfield Street, Herston, Qld 4006, Australia
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Silver B, Kaldor JM, Rumbold A, Ward J, Smith K, Dyda A, Ryder N, Yip TW, Su JY, Guy RJ. 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. Sex Health 2018; 13:140-7. [PMID: 26678863 DOI: 10.1071/sh15077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED 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 individuals had 9402 tests (median: four per person) over 4 years. Approximately half of the individuals (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 individuals 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.
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Affiliation(s)
- Bronwyn Silver
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Alice Rumbold
- Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | - Kirsty Smith
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Amalie Dyda
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
| | - Nathan Ryder
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Teem-Wing Yip
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Jiunn-Yih Su
- Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia
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Graham S, Smith LW, Fairley CK, Hocking J. Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis. Sex Health 2018; 13:99-113. [PMID: 26775118 DOI: 10.1071/sh15171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.
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Affiliation(s)
- Simon Graham
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre and Central Clinical School, Monash University, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
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Dirks JAMC, Wolffs PFG, Dukers-Muijrers NHTM, Brink AATP, Speksnijder AGCL, Hoebe CJPA. Chlamydia trachomatis load in population-based screening and STI-clinics: implications for screening policy. PLoS One 2015; 10:e0121433. [PMID: 25826298 PMCID: PMC4380475 DOI: 10.1371/journal.pone.0121433] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 02/13/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives If the Chlamydia trachomatis (CT) bacterial load is higher in high-risk populations than in the general population, this negatively affects the efficacy of CT screening incentives. In the largest retrospective study to date, we investigated the CT load in specimens collected from 2 cohorts: (1) attendants of a sexually transmitted infection (STI)-clinic and (2) participants of the Dutch population-based screening (PBS). Methods CT load was determined using quantitative PCR in CT-positive male urine and female cervicovaginal swabs. CT loads were converted into tertiles. Using multinominal logistic regression, independent association of cohort, symptoms, risk behaviour and human cell count on load were assessed. Results CT loads were determined in 889 CT-positives from PBS (n = 529; 71.8% female) and STI-clinics (n = 360; 61.7% female). In men, STI-clinic-cohort, human cell count and urethral discharge were positively associated with CT load. In women, PBS-cohort and cell count were positively associated with CT load. Both cohorts had the same range in CT load. Conclusions The general population has a similar range of bacterial CT load as a high-risk population, but a different distribution for cohort and gender, highlighting the relevance of population-based CT-screening. When CT loads are similar, possibly the chances of transmission and sequelae are too.
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Affiliation(s)
- Jeanne A. M. C. Dirks
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Petra F. G. Wolffs
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
- * E-mail:
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Antoinette A. T. P. Brink
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
| | | | - Christian J. P. A. Hoebe
- Department of Medical Microbiology, Maastricht University Medical Center, School of Public Health and Primary Care, Maastricht, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
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Hengel B, Guy R, Garton L, Ward J, Rumbold A, Taylor-Thomson D, Silver B, McGregor S, Dyda A, Knox J, Kaldor J, Maher L. 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. Sex Health 2015; 12:4-12. [PMID: 25426563 DOI: 10.1071/sh14080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED 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 individuals 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.
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Affiliation(s)
- Belinda Hengel
- Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Linda Garton
- NT Department of Health, Sexual Health and Blood Borne Virus Unit, Darwin, NT 0810, Australia
| | - James Ward
- Baker IDI, PO Box 1294, Alice Springs, NT, 0871, Australia
| | - Alice Rumbold
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Debbie Taylor-Thomson
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Bronwyn Silver
- Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia
| | - Skye McGregor
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Amalie Dyda
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Janet Knox
- Lismore Sexual Health Service, NSW Health, Sydney, NSW 2480, Australia
| | - John Kaldor
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
| | - Lisa Maher
- Kirby Institute, UNSW, Australia, Sydney, NSW 2052, Australia
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