Chlamydia and gonorrhoea testing and positivity within an urban Aboriginal and Torres Strait Islander Community Controlled Health Service 2016–2021

Condy Canuto; Jon Willis; Joseph Debattista; Judith A. Dean; James Ward

doi:10.1071/SH24053

RESEARCH ARTICLE (Open Access)

Next Contents Vol 22(1)

Chlamydia and gonorrhoea testing and positivity within an urban Aboriginal and Torres Strait Islander Community Controlled Health Service 2016–2021

Condy Canuto

^A ^* , Jon Willis ^B , Joseph Debattista ^C , Judith A. Dean

^D and James Ward ^D

+ Author Affiliations

- Author Affiliations

^A School of Public Health, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia.

^B Griffith University, (L03) Room 3.21, Logan, Qld 4131, Australia. Email: john.willis@griffith.edu.au

^C Metro North Public Health Unit, Bryden Street, Windsor, Qld 4030, Australia. Email: Joseph.Debattista@health.qld.gov.au

^D Poche Centre for Indigenous Health, The University of Queensland, Toowong, Qld 4066, Australia. Email: j.dean4@uq.edu.au; james.ward@uq.edu.au

^* Correspondence to: c.canuto@uq.edu.au

Handling Editor: Lei Zhang

Sexual Health 22, SH24053 https://doi.org/10.1071/SH24053

Submitted: 13 March 2024 Accepted: 3 January 2025 Published: 30 January 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

This study describes chlamydia and gonorrhoea testing, positivity, treatment, and retesting among individuals aged ≥15 years attending an urban Aboriginal Community Controlled Health Service during the period 2016–2021.

Method

Utilising routinely collected clinical data from the ATLAS program (a national sentinel surveillance network), a retrospective time series analysis was performed. The study assessed testing rates, positivity, treatment efficacy, retesting and trends over time within an urban Aboriginal Community Controlled Health Service.

Results

Testing rates for chlamydia and gonorrhoea varied between 10 and 30% over the study period, and were higher among clients aged 15–29 years and among females. Positivity rates for both infections varied by age, with clients aged 15–24 years having higher positivity than older clients. Gonorrhoea positivity rates decreased after 2016. Treatment and retesting practices also showed sex disparities, with men having a slightly higher treatment rate within 7 days, whereas females had significantly higher retesting rates within 2–4 months, indicating differences in follow-up care between sexes.

Conclusion

The study emphasises the need for clinical and public health interventions within urban Aboriginal and Torres Strait Islander populations to further reduce chlamydia and gonorrhoea. Prioritising improved access to testing, timely treatment and consistent retesting can significantly contribute to lowering STI prevalence and enhancing sexual health outcomes in these communities.

Keywords: Aboriginal and Torres Strait Islander, Aboriginal Community Controlled Health Service, epidemiology, Indigenous health, sexual health, sexually transmissible infections, STI screening, urban.

References

1 Thng CCM. A review of sexually transmitted infections in Australia – considerations in 2018. Acad Forensic Pathol 2018; 8(4): 938-946.
| Crossref | Google Scholar |

2 King J, McManus H, Kwon J, Gray R, McGregor S. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2023. Sydney: Kirby Institute, UNSW; 2023.

3 Borg SA, Tenneti N, Lee A, Drewett GP, Ivan M, Giles ML. The reemergence of syphilis among females of reproductive age and congenital syphilis in Victoria, Australia, 2010 to 2020: A Public Health Priority. Sex Transm Dis 2023; 50(8): 479-484.
| Crossref | Google Scholar |

4 Thng C, Hughes I, Poulton G, O’Sullivan M. 18 months on: an interrupted time series analysis investigating the effect of COVID-19 on chlamydia and gonorrhoea testing and test positivity at the Gold Coast, Australia. Sex Health 2022; 19(2): 127-131.
| Crossref | Google Scholar | PubMed |

5 Chow EPF, Hocking JS, Ong JJ, Phillips TR, Fairley CK. Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia. Open Forum Infect Dis 2020; 8(1): ofaa536.
| Crossref | Google Scholar |

6 Dalmau M, Ware R, Field E, Sanguineti E, Si D, Lambert S. Effect of COVID-19 pandemic restrictions on chlamydia and gonorrhoea notifications and testing in Queensland, Australia: an interrupted time series analysis. Sex Transm Infect 2023; 99(7): 447-454.
| Crossref | Google Scholar |

7 Silver BJ, Knox J, Smith KS, Ward JS, Boyle J, Guy RJ, et al. Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. Med J Aust 2012; 197(11–12): 647-651.
| Crossref | Google Scholar |

8 Dombrowski JC. Chlamydia and gonorrhea. Ann Intern Med 2021; 174(10): ITC145-ITC160.
| Crossref | Google Scholar |

9 Ong JJ, Bourne C, Dean JA, Ryder N, Cornelisse VJ, Murray S, et al. Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update. Sex Health 2023; 20(1): 1-8.
| Crossref | Google Scholar | PubMed |

10 Chen MY, Donovan B. Genital chlamydia trachomatis infection in Australia: epidemiology and clinical implications. Sex Health 2004; 1(4): 189-196.
| Crossref | Google Scholar | PubMed |

11 Østergaard L, Andersen B, Møller JK, Olesen F. Home sampling versus conventional swab sampling for screening of chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study. Clin Infect Dis 2000; 31(4): 951-957.
| Crossref | Google Scholar | PubMed |

12 Bell S, Ward J, Aggleton P, Murray W, Silver B, Lockyer A, et al. Young Aboriginal people’s sexual health risk reduction strategies: a qualitative study in remote Australia. Sex Health 2020; 17(4): 303-310.
| Crossref | Google Scholar | PubMed |

13 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(6): 559-569.
| Crossref | Google Scholar | PubMed |

14 Graham S, Guy RJ, Wand HC, Kaldor JM, Donovan B, Knox J, et al. A sexual health quality improvement program (SHIMMER) triples chlamydia and gonorrhoea testing rates among young people attending Aboriginal primary health care services in Australia. BMC Infect Dis 2015; 15: 370.
| Crossref | Google Scholar | PubMed |

15 Silver BJ, Guy RJ, Wand H, Ward J, Rumbold AR, Fairley CK, et al. Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal clinical service data. Sex Transm Infect 2015; 91(2): 135-141.
| Google Scholar |

16 Fagan P, McDonell P. Knowledge, attitudes and behaviours in relation to safe sex, sexually transmitted infections (STI) and HIV/AIDS among remote living north Queensland youth. Aust N Z J Publ Health 2010; 34: S52-S56.
| Crossref | Google Scholar | PubMed |

17 Kildea S, Bowden FJ. Reproductive health, infertility and sexually transmitted infections in Indigenous women in a remote community in the Northern Territory. Aust N Z J Publ Health 2000; 24(4): 382-386.
| Crossref | Google Scholar |

18 Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2021. Sydney: Kirby Institute, UNSW; 2022.

19 Lafferty L, Smith K, Causer L, Andrewartha K, Whiley D, Badman SG, et al. Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers’ perceptions of the barriers and facilitators. Implement Sci Commun 2021; 2(1): 127.
| Crossref | Google Scholar |

20 Nattabi B, Matthews V, Bailie J, Rumbold A, Scrimgeour D, Schierhout G, et al. Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia: analysis of longitudinal continuous quality improvement data. BMC Infect Dis 2017; 17(1): 148.
| Crossref | Google Scholar |

21 Hengel B, Guy R, Garton L, Ward J, Rumbold A, Taylor-Thomson D, et al. 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 2014; 12(1): 4-12.
| Crossref | Google Scholar |

22 Russell DJ, Zhao Y, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013–2015. Hum Resour Health 2017; 15(1): 52.
| Crossref | Google Scholar |

23 Keleher H, Hagger V. Health literacy in primary health care. Aust J Primary Health 2007; 13(2): 24-30.
| Crossref | Google Scholar |

24 Australian Bureau of Statistics. Census of population and housing – counts of Aboriginal and Torres Strait Islander Australians. ABS; 2021. Available at https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/census-population-and-housing-counts-aboriginal-and-torres-strait-islander-australians/2021

25 Harrod ME, Couzos S, Ward J, Saunders M, Donovan B, Hammond B, et al. Gonorrhoea testing and positivity in non-remote Aboriginal community controlled health services. Sex Health 2017; 14(4): 320-324.
| Crossref | Google Scholar | PubMed |

26 Durey A. Reducing racism in Aboriginal health care in Australia: where does cultural education fit? Aust N Z J Publ Health 2010; 34: S87-S92.
| Crossref | Google Scholar |

27 Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust 2014; 200(11): 649-652.
| Crossref | Google Scholar | PubMed |

28 Pearson O, Schwartzkopff K, Dawson A, Hagger C, Karagi A, Davy C, et al. Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia. BMC Publ Health 2020; 20(1): 1859.
| Crossref | Google Scholar |

29 Bradley C, Hengel B, Crawford K, Elliott S, Donovan B, Mak DB, et al. Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project. BMC Health Serv Res 2020; 20(1): 769.
| Crossref | Google Scholar |

30 Ward J, Goller J, Ali H, Bowring A, Couzos S, Saunders M, et al. Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services. BMC Health Serv Res 2014; 14(1): 285.
| Crossref | Google Scholar |

31 McCormack H, Guy R, Bourne C, Newman CE. Integrating testing for sexually transmissible infections into routine primary care for Aboriginal young people: a strengths-based qualitative analysis. Aust N Z J Publ Health 2022; 46(3): 370-376.
| Crossref | Google Scholar | PubMed |

32 Boyle D, Kong F. A systematic mechanism for the collection and interpretation of display format pathology test results from Australian primary care records. Electron J Health Informat 2011; 6(2): 18.
| Google Scholar |

33 Donovan B, Dimech W, Ali H, Guy R, Hellard M. Increased testing for Neisseria gonorrhoeae with duplex nucleic acid amplification tests in Australia: implications for surveillance. Sex Health 2015; 12(1): 48-50.
| Crossref | Google Scholar | PubMed |

34 Ward J, Wand H, Bryant J, Delaney-Thiele D, Worth H, Pitts M, et al. Prevalence and correlates of a diagnosis of sexually transmitted infection among young Aboriginal and Torres Strait islander people: a national survey. Sex Transm Dis 2016; 43(3): 177-84.
| Crossref | Google Scholar |

35 The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. RACGP: East Melbourne, Vic; 2018.

36 Ward J, Bradley C, Donovan B, Hengel B, Elliott SR. A new national STI and BBV surveillance system for aboriginal community-controlled health services. Int J Popul Data Sci 2020; 5(5): Available at https://ijpds.org/article/view/1481.
| Google Scholar |

37 Foster R, Ali H, Crowley M, Dyer R, Grant K, Lenton J, et al. Does living outside of a major city impact on the timeliness of chlamydia treatment? A multicenter cross-sectional analysis. Sex Transm Dis 2016; 43(8): 506-512.
| Crossref | Google Scholar | PubMed |

38 Ward J, Guy R, Huang R-L, Knox J, Couzos S, Scrimgeour D, et al. 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? Sex Health 2012; 9(2): 109-112.
| Crossref | Google Scholar |

39 D’Costa B, Lobo R, Thomas J, Ward JS. Evaluation of the young deadly free peer education training program: early results, methodological challenges, and learnings for future evaluations. Front Publ Health 2019; 7: 74.
| Crossref | Google Scholar |

40 Guy R, Kaldor J, Causer L, Wand H, Natoli L, Badman S, et al. A cluster trial of molecular point-of-care tests for sexually transmissible infections (STIs): treatment outcomes from TTANGO. 2016 Australasian Sexual Health Conference; 2016.

41 Guy RJ, Natoli L, Ward J, Causer L, Hengel B, Whiley D, et al. A randomised trial of point-of-care tests for chlamydia and gonorrhoea infections in remote Aboriginal communities: test, treat and go- the “TTANGO” trial protocol. BMC Infect Dis 2013; 13(1): 1-9.
| Crossref | Google Scholar |

42 Rose SB, Garrett SM, Hutchings D, Lund K, Kennedy J, Pullon SRH. Clinician education, advice and SMS/text reminders improve test of reinfection rates following diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae: before and after study in primary care. BMJ Sex Reprod Health 2020; 46(1): 32-37.
| Crossref | Google Scholar |

43 Canuto K, Brown A, Wittert G, Harfield S. Understanding the utilization of primary health care services by Indigenous men: a systematic review. BMC Publ Health 2018; 18(1): 1198.
| Crossref | Google Scholar |

44 Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis 2017; 17(8): e235-e279.
| Crossref | Google Scholar | PubMed |

45 Pearson WS, Chan PA, Habel MA, Haderxhanaj LT, Hogben M, Aral SO. A description of telehealth use among sexually transmitted infection providers in the United States, 2021. Sex Transm Dis 2023; 50(8): 518-522.
| Crossref | Google Scholar |

46 Andrea T, Stanzia M, Marvellous M, Albert M, Enock M. STIs and unplanned pregnancies risk perceptions among female students in tertiary institutions in Zimbabwe. Int J HIV AIDS Prev Educ Behav Sci 2021; 7(2): 66-74.
| Google Scholar |

47 Canuto C, Hussaini MY, Quarteroni A, Zang TA. Spectral methods in fluid dynamics. Springer Science & Business Media; 2012.

48 Ward J, Guy RJ, Rumbold AR, McGregor S, Wand H, McManus H, et al. Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial. Lancet Glob Health 2019; 7(11): e1553-e1563.
| Crossref | Google Scholar | PubMed |

49 Causer L, Watchirs-Smith L, Saha A, Wand H, Smith K, Badman S, et al. P171 From trial to program: TTANGO2 scale-up and implementation sustains STI point-of-care testing in regional and remote Australian Aboriginal health services. Sex Transm Infect 2021; 97(Suppl 1): A102-A103.
| Google Scholar |

50 Rose SB, Garrett SM, Hutchings D, Lund K, Kennedy J, Pullon SRH. Addressing gaps in the management of Chlamydia trachomatis and Neisseria gonorrhoeae in primary care: lessons learned in a pilot intervention study. Sex Transm Dis 2019; 46(7): 480-486.
| Crossref | Google Scholar |

51 Lanier Y, Castellanos T, Barrow RY, Jordan WC, Caine V, Sutton MY. Brief sexual histories and routine HIV/STD testing by medical providers. AIDS Patient Care STDS 2014; 28(3): 113-120.
| Crossref | Google Scholar | PubMed |

52 Read PJ, Martin L, McNulty A. Would you self-collect swabs in a unisex toilet? Sex Health 2012; 9(4): 395-396.
| Crossref | Google Scholar | PubMed |

53 Hengel B, Ward J, Wand H, Rumbold A, Kaldor J, Guy R. P5.007 annual Chlamydia trachomatis and Neisseria gonorrhoea testing in an endemic setting: the role of client and health centre characteristics. Sex Transm Infect 2013; 89(Suppl 1): A336-A337.
| Crossref | Google Scholar |

54 Spurling GKP, Hayman NE, Cooney AL. Adult health checks for Indigenous Australians: the first year’s experience from the Inala Indigenous Health Service. Med J Aust 2009; 190(10): 562-564.
| Crossref | Google Scholar | PubMed |

55 Pimenta JM, Catchpole M, Rogers PA, Perkins E, Jackson N, Carlisle C, et al. Opportunistic screening for genital chlamydial infection. I: acceptability of urine testing in primary and secondary healthcare settings. Sex Transm Infect 2003; 79(1): 16-21.
| Crossref | Google Scholar | PubMed |

56 McCormack H, Wand H, Newman CE, Bourne C, Kennedy C, Guy R. Exploring whether the electronic optimization of routine health assessments can increase testing for sexually transmitted infections and provider acceptability at an Aboriginal community controlled health service: mixed methods evaluation. JMIR Med Inform 2023; 11: e51387.
| Crossref | Google Scholar |

57 Pavlin NL, Gunn JM, Parker R, Fairley CK, Hocking J. Implementing chlamydia screening: what do women think? a systematic review of the literature. BMC Publ Health 2006; 6: 221.
| Google Scholar |

58 Panaretto KS, Lee HM, Mitchell MR, Larkins SL, Manessis V, Buettner PG, et al. Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia. Aust N Z J Obstet Gynaecol 2006; 46(3): 217-224.
| Crossref | Google Scholar | PubMed |

59 Miller GC, McDermott R, McCulloch B, Fairley C, Muller R. Predictors of the prevalence of bacterial STI among young disadvantaged indigenous people in north Queensland, Australia. Sex Transm Infect 2003; 79(4): 332-335.
| Crossref | Google Scholar | PubMed |