Understanding the role of patient communication protocols in sexually transmissible infections point-of-care testing among Aboriginal and Torres Strait Islander peoples in remote communities: a qualitative study

Robert Monaghan; Louise Causer; James Ward; Belinda Hengel; Kirsty Smith; Kelly Andrewartha; Christopher Fairley; Lisa Maher; Donna Mak; Caitlyn White; Jessica Leonard; Rebecca Guy; Lise Lafferty

doi:10.1071/SH24214

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 22(2)

Understanding the role of patient communication protocols in sexually transmissible infections point-of-care testing among Aboriginal and Torres Strait Islander peoples in remote communities: a qualitative study

Robert Monaghan ^A ^* , Louise Causer ^A , James Ward ^B , Belinda Hengel

^A , Kirsty Smith ^A , Kelly Andrewartha ^C , Christopher Fairley

^D ^E ^F , Lisa Maher ^A , Donna Mak ^G , Caitlyn White ^H , Jessica Leonard ^I , Rebecca Guy ^A , Lise Lafferty

^A ^J and on behalf of the TTANGO2 Collaboration

+ Author Affiliations

- Author Affiliations

^A Kirby Institute, University of NSW, Sydney, NSW, Australia.

^B Poche Centre, University of Queensland, Brisbane, Qld, Australia.

^C International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, Australia.

^D School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

^E Melbourne Sexual Health Centre, Melbourne, Vic, Australia.

^F Alfred Health, Melbourne, Vic, Australia.

^G Western Australia Department of Health, Perth, WA, Australia.

^H Aboriginal Health Council of Western Australia, Perth, WA, Australia.

^I Aboriginal Health Council of South Australia, Adelaide, SA, Australia.

^J Centre for Social Research in Health, University of NSW, Sydney, NSW, Australia.

^* Correspondence to: rmonaghan@kirby.unsw.edu.au

Handling Editor: Chunyan Li

Sexual Health 22, SH24214 https://doi.org/10.1071/SH24214

Submitted: 5 November 2024 Accepted: 1 February 2025 Published: 27 February 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

Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia’s STI Management Guidelines recommend regular STI testing every 6–12 months for sexually active individuals aged 15–35 years in high-prevalence, remote areas. However, testing uptake remains low among young Aboriginal and Torres Strait Islander peoples. This analysis explores how healthcare providers engage Aboriginal and Torres Strait Islander peoples in STI testing using point-of-care (POC) diagnostics.

Methods

Semi-structured interviews were conducted with trained STI POC testing operators within the Test Treat ANd GO (TTANGO2) project. Seven clinics involved in TTANGO2 were selected for their ‘high’ and ‘low’ implementation of STI POC testing. Purposive sampling was used to recruit similar personnel from each of the selected clinics. Coding was informed by a patient communication protocol lens.

Results

Twenty healthcare personnel, including Aboriginal Health Workers/Practitioners (n = 8), Registered Nurses (n = 7), Coordinators (n = 2), and Clinical/Practice Managers (n = 3) participated. Key themes related to implementing STI POC testing focused on different stages of identified patient communication protocols, such as offering tests, providing follow-up results, and contact tracing. Concerns about shame and confidentiality were significant factors affecting patient communication protocols throughout the process.

Conclusions

Normalising sexual health discussions in healthcare settings helps reduce feelings of shame and stigma, further encouraging patient participation in sexual health services. Ensuring patient safety and offering culturally appropriate explanations of STI POC testing are essential to reduce barriers, such as shame and stigma. Culturally safe practices can increase patient engagement and provide opportunities for health education. Integrating STI POC testing into routine health care can help normalise testing and boost uptake. However, same-day results may still require patient follow-up to maintain confidentiality. Addressing external factors, such as accessibility, confidentiality, stigma reduction, and community engagement, is crucial for improving STI testing services.

Keywords: Aboriginal and Torres Strait Islander peoples, normalising STI testing, offering STI testing, patient communication protocols, point-of-care testing, qualitative research, remote communities, sexually transmissible infections.

References

1 Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol 2017; 216(1): 1-9.
| Crossref | Google Scholar | PubMed |

2 Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2004; 2(1): 33-42.
| Crossref | Google Scholar | PubMed |

3 Kraft JM, Whiteman MK, Carter MW, Snead MC, DiClemente RJ, Murray CC, et al. Identifying psychosocial and social correlates of sexually transmitted diseases among black female teenagers. Sex Transm Dis 2015; 42(4): 192-197.
| Crossref | Google Scholar | PubMed |

4 World Health Organization. Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021.

5 ASHM. Australian STI Management Guidelines for Use in Primary Care: Aboriginal and Torres Strait Islander People. Sydney: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine; 2021. Available at https://sti.guidelines.org.au/populations-and-situations/aboriginal-and-torres-strait-islander-people/

6 Ward J, Elliott S, Bryant J, Donovan B, Pitts M, Wand H, et al. THE GOANNA SURVEY 2. Results of the second Australian survey of knowledge, relationships, behaviour and health service access relating to sexually transmissible infections (STIs) and blood borne viruses (BBVs) among Aboriginal and Torres Strait Islander young people. Adelaide: South Australian Health and Medical Research Institute (SAHMRI); 2020.

7 National Aboriginal Community Controlled Health Organisation. Aboriginal Community Controlled Health Organisations (ACCHOs). Canberra: NACCHO; 2022. Available at https://www.naccho.org.au/acchos/

8 Australian Institute of Health and Welfare. Rural and remote health. Canberra: Australian Institute of Health and Welfare; 2024. Available at https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health

9 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 2015; 12(1): 4-12.
| Crossref | Google Scholar | PubMed |

10 Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, et al. Remote health workforce turnover and retention: what are the policy and practice priorities? Hum Resour Health 2019; 17(1): 99.
| Crossref | Google Scholar | PubMed |

11 Australian College of Rural and Remote Medicine. Accessing Primary Health Care in Rural and Remote Australia: overview, issues and solutions. Brisbane: Australian College of Rural and Remote Medicine; 2020. Available at https://www.acrrm.org.au/docs/default-source/all-files/rural-and-remote-access-to-phc-background-paper-(2020).pdf?sfvrsn=22e70563_8

12 Veginadu P, Russell DJ, Zhao Y, Guthridge S, Ramjan M, Jones MP, et al. Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017–2019. Hum Resour Health 2024; 22(1): 58.
| Crossref | Google Scholar | PubMed |

13 Cassidy C, Bishop A, Steenbeek A, Langille D, Martin-Misener R, Curran J. Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model. BMC Health Serv Res 2018; 18(1): 581.
| Crossref | Google Scholar | PubMed |

14 Bell S, Aggleton P, Ward J, Murray W, Silver B, Lockyer A, et al. Young Aboriginal people’s engagement with STI testing in the Northern Territory, Australia. BMC Publ Health 2020; 20(1): 459.
| Crossref | Google Scholar | PubMed |

15 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 | PubMed |

16 Guy R, Ward J, Smith KS, Su J-Y, Huang R-L, Tangey A, et al. The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 2012; 9(3): 205-12.
| Crossref | Google Scholar | PubMed |

17 World Health Organization. Point-of-care tests for sexually transmitted infections: Target product profiles. Geneva: World Health Organization; 2023.

18 Causer LM, Hengel B, Natoli L, Tangey A, Badman SG, Tabrizi SN, et al. A field evaluation of a new molecular-based point-of-care test for chlamydia and gonorrhoea in remote Aboriginal health services in Australia. Sex Health 2015; 12(1): 27-33.
| Crossref | Google Scholar | PubMed |

19 Guy R, Ward J, Causer LM, Natoli L, Badman SG, Tangey A, et al. Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial. Lancet Infect Dis 2018; 18(10): 1117-26.
| Crossref | Google Scholar | PubMed |

20 Causer LM, Ward J, Smith K, Saha A, Andrewartha K, Wand H, et al. Clinical effectiveness and analytical quality of a national point-of-care testing network for sexually transmitted infections integrated into rural and remote primary care clinics in Australia, 2016–2022: an observational program evaluation. Lancet Reg Health West Pac 2024; 48: 101110.
| Crossref | Google Scholar | PubMed |

21 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: 127.
| Crossref | Google Scholar | PubMed |

22 Ahluwalia SC, Damberg CL, Haas A, Shekelle PG. How are medical groups identified as high-performing? The effect of different approaches to classification of performance. BMC Health Serv Res 2019; 19(1): 500.
| Crossref | Google Scholar | PubMed |

23 Liamputtong P. Qualitative research methods. 5th edn. Melbourne, Australia: Oxford University Press; 2020.

24 Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher. Int J Transgend Health 2023; 24(1): 1-6.
| Crossref | Google Scholar | PubMed |

25 Martin B. Methodology is content: Indigenous approaches to research and knowledge. Educ Philos Theory 2017; 49(14): 1392-400.
| Crossref | Google Scholar |

26 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): 559-69.
| Crossref | Google Scholar | PubMed |

27 Su J-Y, Belton S, Ryder N. Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities? A mixed-methods study. Cult Health Sex 2016; 18(10): 1150-64.
| Crossref | Google Scholar | PubMed |

28 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 NZJ Publ Health 2022; 46(3): 370-6.
| Crossref | Google Scholar | PubMed |

29 Lobo R, Costa BD, Forbes L, Ward J. Young deadly free: impact evaluation of a sexual health youth peer education program in remote Australian communities. Sex Health 2020; 17(5): 397-404.
| Crossref | Google Scholar | PubMed |

30 King A, Hoppe RB. “Best practice” for patient-centered communication: a narrative review. J Grad Med Educ 2013; 5(3): 385-93.
| Crossref | Google Scholar | PubMed |

31 Rönn MM, Menzies NA, Gift TL, Chesson HW, Trikalinos TA, Bellerose M, et al. Potential for point-of-care tests to reduce Chlamydia-associated Burden in the United States: a mathematical modeling analysis. Clin Infect Dis 2020; 70(9): 1816-23.
| Crossref | Google Scholar | PubMed |

32 Graham S, Martin K, Gardner K, Beadman M, Doyle MF, Bolt R, et al. Aboriginal young people’s perspectives and experiences of accessing sexual health services and sex education in Australia: a qualitative study. Glob Publ Health 2023; 18(1): 2196561.
| Crossref | Google Scholar | PubMed |

33 Harfield S, Purcell T, Schioldann E, Ward J, Pearson O, Azzopardi P. Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA. BMC Health Serv Res 2024; 24(1): 553.
| Crossref | Google Scholar | PubMed |

34 Wi TE, Ndowa FJ, Ferreyra C, Kelly-Cirino C, Taylor MM, Toskin I, et al. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J Int AIDS Soc 2019; 22(Suppl 6): e25343.
| Crossref | Google Scholar | PubMed |

35 Ezhova I, Savidge L, Bonnett C, Cassidy J, Okwuokei A, Dickinson T. Barriers to older adults seeking sexual health advice and treatment: a scoping review. Int J Nurs Stud 2020; 107: 103566.
| Crossref | Google Scholar | PubMed |