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
Bronwyn Silver A B H , John M. Kaldor B , Alice Rumbold A C , James Ward D , Kirsty Smith B , Amalie Dyda B , Nathan Ryder E F , Teem-Wing Yip E G , Jiunn-Yih Su E and Rebecca J. Guy BA Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia.
B The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia.
C Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
D South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia.
E Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
F School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia.
G Northern Territory Clinical School, Flinders University, PO Box 4066, Alice Springs, NT 0870, Australia.
H Corresponding author. Email: bronwyn.silver@internode.on.net
Sexual Health 13(2) 140-147 https://doi.org/10.1071/SH15077
Submitted: 19 April 2015 Accepted: 15 October 2015 Published: 18 December 2015
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 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.
Additional keywords: Aboriginal Australians, Chlamydia trachomatis, Neisseria gonorrhoeae, screening, STI.
References
[1] World Health Organization. Global strategy for the prevention and control of sexually transmitted infections: 2006–2015: breaking the chain of transmission. Geneva: WHO; 2007.[2] Department of Health and Ageing. Third national sexually transmissible infections strategy 2014–2017. Canberra: Commonwealth of Australia; 2014.
[3] McKay L, Clery H, Carrick-Anderson K, Hollis S, Scott G. Genital Chlamydia trachomatis infection in a subgroup of young men in the UK. Lancet 2003; 361 1792–9.
| Genital Chlamydia trachomatis infection in a subgroup of young men in the UK.Crossref | GoogleScholarGoogle Scholar | 12781541PubMed |
[4] Klouman E, Masenga E, Sam N, Klepp K. Asymptomatic gonorrhoea and chlamydial infection in a population-based and work-site based sample of men in Kilimanjaro, Tanzania. Int J STD AIDS 2000; 11 666–74.
| Asymptomatic gonorrhoea and chlamydial infection in a population-based and work-site based sample of men in Kilimanjaro, Tanzania.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3crgs1aktw%3D%3D&md5=013f3f4ce1581a429f49f8b3fe3ea20bCAS | 11057938PubMed |
[5] Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, Taylor-Robinson D, et al Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340 c1642
| Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial.Crossref | GoogleScholarGoogle Scholar | 20378636PubMed |
[6] Northern Territory Department of Health. Sexual health and blood borne viruses unit surveillance update 2000-2014 [1/3/2015]. Available online at: http://www.health.nt.gov.au/Centre_for_Disease_Control/Publications/Sexual_Health_Surveillance_Updates/index.aspx [verified 1 March 2015].
[7] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2014. Sydney: UNSW; 2014.
[8] Guy R, Ward JW, Smith KS, Su J-Y, Huang R, Tangey A, et al The impact of STI programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 2012; 9 205–12.
| The impact of STI programs in remote Aboriginal communities in Australia: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22697136PubMed |
[9] Hui B, Wilson D, Ward J, Guy R, Kaldor J, Law M, et al The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence. Sex Health 2013; 10 348–56.
| The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence.Crossref | GoogleScholarGoogle Scholar | 23806149PubMed |
[10] Kong F, Guy R, Hocking J, Merritt T, Pirotta M, Heal C, et al Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194 249–52.
| 21381999PubMed |
[11] Hengel B, Jamil M, Mein J, Maher L, Kaldor J, Guy R. Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13 1–9.
[12] Jamil M, Hocking J, Bauer H, Ali H, Wand H, Smith K, et al Home-based chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13 1–11.
[13] Simons B, Jessen C, Rea L, Barnes M, Barnes P, Gaydos C. Providing discrete and reliable STD testing in Alaska via a web-based at-home service. Sex Transm Infect 2013; 89 A70
| Providing discrete and reliable STD testing in Alaska via a web-based at-home service.Crossref | GoogleScholarGoogle Scholar |
[14] Buhrer-Skinner M, Muller R, Buetter P, Gordon R, Debattista J. Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples. Sex Health 2013; 10 32–8.
| 23158104PubMed |
[15] Vass A, Mitchell A, Dhurrkay Y. Health literacy and Australian Indigenous peoples: an analysis of the role of language and worldview. Health Promot J Austr 2011; 22 33–8.
| 21717835PubMed |
[16] Australian Government. Telecommunications in remote Indigenous communities. Canberra: Australian Communications and Media Authority; 2008.
[17] Tangentyere Council and Central Land Council. Ingerrekenhe Antirrkweme mobile phone use among low income Aboriginal people: a central Australian snapshot. Alice Springs: Tangentyere Council and Central Land Council; 2007.
[18] Central Australian Remote Practitioners Association. CARPA standard treatment manual: a clinic manual for primary health care practitioners in remote and Indigenous health services in central and northern Australia, 6th edn. Alice Springs: Centre for Remote Health; 2014.
[19] Broadfoot J, Su JY. A background report about the cessation of the 2010 Central Australian annual sexual health screen. NT Dis Control Bull 2010; 17 9–14.
[20] National Aboriginal Community Controlled Health Organisation/Royal Australian College of General Practitioners. National guide to preventative health assessment for Aboriginal and Torres Strait Islander people, 2nd edn. South Melbourne: The RACGP; 2012.
[21] STATA Corporation. Statistics/Data analysis, 12.0 edn. College Station: STATA Corporation; 2012.
[22] Silver B, Guy R, Wand H, Ward J, Rumbold A, Fairley C, et al Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal service data. Sex Transm Infect 2015; 91 135–41.
| Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal service data.Crossref | GoogleScholarGoogle Scholar | 25371420PubMed |
[23] Huang R, Torzillo P, Hammond VA, Coulter S, Kirby AC. Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program. Med J Aust 2008; 189 442–5.
| 18928437PubMed |
[24] Hengel B, Mein J, Fagan P, Ward J, Kaldor J, Guy R. Health service utilisation patterns in FNQ remote communities: implications for STI testing. Australasian Sexual Health Conference; 28 September 2011; Canberra. Canberra: Australasian Chapter of Sexual Health Medicine, The Royal College of Physicians; 2011. p.52.
[25] Graham S, Sheather J, Guy R, Wand H, Knox J, Kaldor J, et al., A sexual health intervention increases chlamydia and gonorrhoea testing in regional Aboriginal community controlled health services in New South Wales. Australasian Sexual Health Conference; 24th October; Darwin. Darwin: Australasian Chapter of Sexual Health Medicine, The Royal College of Physicians; 2013.p. 134.
[26] Heijne J, Tao G, Kent C, Low N. Uptake of regular chlamydia testing by U.S. women. A longitudinal study. Am J Prev Med 2010; 39 243–50.
| Uptake of regular chlamydia testing by U.S. women. A longitudinal study.Crossref | GoogleScholarGoogle Scholar | 20709256PubMed |
[27] Ward J, McGregor S, Guy RJ, Rumbold AR, Garton L, Silver BJ, et al 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. BMC Infect Dis 2013; 13 1–9.
[28] Hengel B, Ward J, Wand H, Silver B, Garton L, Taylor-Thomson D, et al Annual repeat Chlamydia trachomatis and Neisseria gonorrhoea testing in an endemic setting: the role of client and health centre characteristics. Sex Transm Infect 2013; 89 A336–7.
| Annual repeat Chlamydia trachomatis and Neisseria gonorrhoea testing in an endemic setting: the role of client and health centre characteristics.Crossref | GoogleScholarGoogle Scholar |
[29] Dockery A, Colquhorn S. Mobility of Aboriginal and Torres Strait Islander people: a literature review. Alice Springs: Ninti One Limited; 2012.
[30] Long S, Memmott P. Aboriginal mobility and the sustainability of communities: case studies from north-west Queensland and eastern Northern Territory. Alice Springs: Desert Knowledge CRC; 2007.
[31] Garton L, Kaldor J, Dyda A, Guy R, Rumbold A, Hengel B, et al. Increases in STI testing following the introduction of a sexual health quality improvement program: findings from the STRIVE trial. Australasian Sexual Health Conference; 23rd October; Darwin. Darwin; Australasian Chapter of Sexual Health Medicine, The Royal College of Physicians; 2013. p.128.
[32] Fagan P, Cannon F, Crouch A. The young person check: screening for sexually transmitted infections and chronic disease risk in remote Aboriginal and Torres Strait Islander youth. Aust N Z J Public Health 2013; 37 316–21.
| The young person check: screening for sexually transmitted infections and chronic disease risk in remote Aboriginal and Torres Strait Islander youth.Crossref | GoogleScholarGoogle Scholar | 23895473PubMed |
