Improving the Identification of Priority Populations to Increase Hepatitis B Testing Rates, 2012

BACKGROUND:

It is estimated that over 40 % of the 218,000 people with chronic hepatitis B (CHB) in Australia in 2011 are undiagnosed. A disproportionate number of those with undiagnosed infection were born in the Asia-Pacific region. Undiagnosed CHB can lead to ongoing transmission and late diagnosis limits opportunities to prevent progression to hepatocellular carcinoma (HCC) and cirrhosis. Strategies are needed to increase testing for hepatitis B virus (HBV) (including culturally and linguistically diverse communities, Aboriginal and/or Torres Strait Islander (Indigenous) people and people who inject drugs). General practitioners (GPs) have a vital role in increasing HBV testing and the timely diagnosis CHB. This paper describes the impact of a GP-based screening intervention to improve CHB diagnosis among priority populations in Melbourne, Australia.

METHODS:

A non-randomised, pre-post intervention study was conducted between 2012 and 2013 with three general practices in Melbourne, Australia. Using clinic electronic health records three priority populations known to be at increased CHB risk in Australia (1: Asian-born patients or patients of Asian ethnicity living in Australia; 2: Indigenous people; or 3): people with a history of injecting drugs were identified and their HBV status recorded. A random sample were then invited to attend their GP for HBV testing and/or vaccination. Baseline and follow-up electronic data collection identified patients that subsequently had a consultation and HBV screening test and/or vaccination.

RESULTS:

From a total of 33,297 active patients, 2674 (8 %) were identified as a priority population at baseline; 2275 (85.1 %) of these patients had unknown HBV status from which 338 (14.0 %) were randomly sampled. One-fifth (n = 73, 21.6 %) of sampled patients subsequently had a GP consultation during the study period; only four people (5.5 %) were subsequently tested for HBV (CHB detected in n = 1) and none were vaccinated against HBV.

CONCLUSION:

CHB infection is an important long-term health issue in Australia and strategies to increase appropriate and timely testing are required. The study was effective at identifying whether Asian-born patients and patients of Asian had been tested or vaccinated for HBV; however the intervention was not effective at increasing HBV testing.

Full article at:  http://goo.gl/ADG29j

By:  van Gemert C1,2, Wang J3, Simmons J4, Cowie B5,6, Boyle D7, Stoove M3,8, Enright C4, Hellard M3,8.

• 1Centre for Population Health, Burnet Institute, Melbourne, Australia. carolinevg@burnet.edu.au.
• 2Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. carolinevg@burnet.edu.au.
• 3Centre for Population Health, Burnet Institute, Melbourne, Australia.
• 4Cancer Council Victoria, Melbourne, Australia.
• 5WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia.
• 6Department of Medicine, University of Melbourne, Melbourne, Australia.
• 7GRHANITE™ Health Informatics Unit, Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia.
• 8Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. 
• BMC Public Health. 2016 Feb 1;16(1):95. doi: 10.1186/s12889-016-2716-7.

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Sexually Transmissible Infections in Aboriginal & Torres Strait Islander People

Introduction

Aboriginal and Torres Strait Islander people represent 3% of the Australian population, of which more than two-thirds are less than 34 years of age.¹The Indigenous population is considerably diverse, socially, culturally and geographically, providing a challenging environment to deliver culturally appropriate and accessible healthcare services.²

Despite improvements in health outcomes, disparities between the Indigenous and non-Indigenous populations are evident and occur for a range of health issues, including sexual health.³ Indigenous people continue to be disproportionately represented in the sexually transmissible infections (STI) notification data, particularly in younger age groups residing in remote locations.

Methods

Notification data, for selected STIs, extracted from the Nationally Notifiable Diseases Surveillance System (NNDSS) as at 17 September 2015 were used for the analyses. HIV notification data, collected through the National HIV Registry, were sourced from the 2015 annual surveillance reports from the Kirby Institute.⁴

Case identification

For the purposes of this report, notifications with an Indigenous status field reported as not Indigenous or blank/unknown were considered to be non-Indigenous. In interpreting these data it is important to note that changes in notifications over time may not solely reflect changes in disease prevalence. Changes in screening programs,^{5, 6} the use of less invasive and more sensitive diagnostic tests⁷ and periodic public awareness campaigns⁸ may influence the number of notifications that occur over time. Rates for STIs are particularly susceptible to overall rates of testing.⁹ As a priority and ‘at risk’ population, Indigenous people are commonly targeted for STI screening often resulting in a higher number of reported cases.

Results

In 2014, the notification rates for chlamydia, infectious syphilis and gonococcal infections in the Indigenous population were 3, 4 and 18 times higher respectively than the non-Indigenous population (Table, Figures 1–3).

Below:  Notifications and notification rate (unadjusted) for chlamydia, 2011 to 2014, by year and Indigenous status

Below:  Notifications and notification rate (unadjusted) gonococcal infection, 2011 to 2014, by year and Indigenous status

Below:  Notification rate (unadjusted) for infectious syphilis and number of congenital syphilis cases, by year and Indigenous status, 2011 to 2014

Full article at:   http://goo.gl/cAMUW5

By:  Bright A1.

• 1Office of Health Protection, Australian Government Department of Health, Canberra, Australian Capital Territory.

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Suicide Attempts and Childhood Maltreatment among Street Youth

BACKGROUND:

Although suicide is a known leading cause of death among street youth, few prospective studies have explored childhood experiences as risk factors for future suicide attempt in this population. We examined the risk of attempted suicide in relation to childhood maltreatment among street youth.

METHODS:

From September 2005 to November 2013, data were collected from the At Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Inclusion criteria were age 14 to 26 years, past-month illicit drug use, and street involvement. Participants completed the Childhood Trauma Questionnaire, an instrument measuring self-reported sexual, physical, and emotional abuse and physical and emotional neglect. Suicide attempts were assessed semiannually. Using Cox regression, we examined the association between the 5 types of maltreatment and suicide attempts.

RESULTS:

Of 660 participants, 68.2% were male and 24.6% were Aboriginal. Median age was 21.5 years. The prevalence of moderate to extreme childhood maltreatment ranged from 16.8% (sexual abuse) to 45.2% (emotional abuse). Participants contributed 1841 person-years, with suicide attempts reported by 35 (5.3%) individuals (crude incidence density: 1.9 per 100 person-years; 95% confidence interval [CI]: 1.4-2.6 per 100 person-years). In adjusted analyses, types of maltreatment associated with suicide attempts included physical abuse (adjusted hazard ratio [HR]: 4.47; 95% CI: 2.12-9.42), emotional abuse (adjusted HR: 4.92; 95% CI: 2.11-11.5), and emotional neglect (adjusted HR: 3.08; 95% CI: 1.05-9.03).

CONCLUSIONS:

Childhood maltreatment is associated with subsequent risk of suicidal behavior among street youth. Suicide prevention efforts should be targeted toward this marginalized population and delivered from a trauma-informed perspective.

Below:  Associations of Childhood Maltreatment With Suicide Attempts During Follow-up: ARYS (Vancouver, British Columbia; 2005–2013)

Full article at:   http://goo.gl/roaQzI

By:   Hadland SE1, Wood E2, Dong H3, Marshall BD4, Kerr T2, Montaner JS2, DeBeck K5.

• 1Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
• 2British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;
• 3British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;
• 4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; and.
• 5British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada uhri-kd@cfenet.ubc.ca. 

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“I Do Feel Like a Scientist at Times”: A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting

Background

Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia.

Methods

In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis.

Results

Most participants displayed positive attitudes, indicating the test was both easy to use and useful in their clinical context. Participants indicated that point-of-care testing had improved management of STIs, resulting in more timely and targeted treatment, earlier commencement of partner notification, and reduced follow up efforts associated with client recall. Staff expressed confidence in point-of-care test results and treating patients on this basis, and reported greater job satisfaction. While point-of-care testing did not negatively impact on client flow, several found the manual documentation processes time consuming, suggesting that improved electronic connectivity and test result transfer between the GeneXpert and patient management systems could overcome this. Managing positive test results in a shorter time frame was challenging for some but most found it satisfying to complete episodes of care more quickly.

Conclusions

In the context of a RCT, health professionals working in remote primary care in Australia found the GeneXpert highly acceptable. These findings have implications for use in other primary care settings around the world.

Below:  Influences on acceptability of Xpert CT/NG to operators in remote health services

Full article at:   http://goo.gl/FUoJLa

By:   

Lisa Natoli, Rebecca J. Guy, Louise Causer, Steven G. Badman, John Kaldor, Lisa Maher

The Kirby Institute, UNSW Australia, Sydney, NSW, Australia

Lisa Natoli, David Anderson

The Burnet Institute, Melbourne, VIC, Australia

Mark Shephard

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

Belinda Hengel

Apunipima Cape York Health Council, Cairns, QLD, Australia

Annie Tangey

Ngaanyatjarra Health Service, Alice Springs, NT, Australia

James Ward

South Australian Health and Medical Research Institute, Adelaide, SA, Australia

Tony Coburn

Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia

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Sexual Inactivity & Sexual Satisfaction among Women Living with HIV in Canada in the Context of Growing Social, Legal & Public Health Surveillance

INTRODUCTION:

Women represent nearly one-quarter of the 71,300 people living with HIV in Canada. Within a context of widespread HIV-related stigma and discrimination and on-going risks to HIV disclosure, little is known about the influence of growing social, legal and public health surveillance of HIV on sexual activity and satisfaction of women living with HIV (WLWH).

METHODS:

We analyzed baseline cross-sectional survey data for WLWH (≥16 years, self-identifying as women) enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a multisite, longitudinal, community-based research study in British Columbia (BC), Ontario (ON) and Quebec (QC). Sexual inactivity was defined as no consensual sex (oral or penetrative) in the prior six months, excluding recently postpartum women (≤6 months). Satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women. Multivariable logistic regression analysis examined independent correlates of sexual inactivity.

RESULTS:

Of 1213 participants (26% BC, 50% ON, 24% QC), median age was 43 years (IQR: 35, 50). 23% identified as Aboriginal, 28% as African, Caribbean and Black, 41% as White and 8% as other ethnicities. Heterosexual orientation was reported by 87% of participants and LGBTQ by 13%. In total, 82% were currently taking antiretroviral therapy (ART), and 77% reported an undetectable viral load (VL<40 copies/mL). Overall, 49% were sexually inactive and 64% reported being satisfied with their current sex lives, including 49% of sexually inactive and 79% of sexually active women (p<0.001). Sexually inactive women had significantly higher odds of being older, not being in a marital or committed relationship, having an annual household income below $20,000 CAD, and reporting high (vs. low) HIV-related stigma. No independent association was found with ART use or undetectable VL.

CONCLUSIONS:

Approximately half of WLWH in this study reported being sexually inactive. Associations with sexual dissatisfaction and high HIV-related stigma suggest that WLWH face challenges navigating healthy and satisfying sexual lives, despite good HIV treatment outcomes. As half of sexually inactive women reported being satisfied with their sex lives, additional research is required to determine whether WLWH are deliberately choosing abstinence as a means of resisting surveillance and disclosure expectations associated with sexual activity. Findings underscore a need for interventions to de-stigmatize HIV, support safe disclosure and re-appropriate the sexual rights of WLWH.

Full article at:  http://goo.gl/mpxvqr

By:  Kaida A1, Carter A2,3, de Pokomandy A4,5, Patterson S2,3, Proulx-Boucher K4, Nohpal A3, Sereda P3, Colley G3, O'Brien N4,5, Thomas-Pavanel J6, Beaver K6,Nicholson VJ2, Tharao W7, Fernet M8, Otis J8, Hogg RS2,3, Loutfy M6,9; CHIWOS Research Team.

• 1Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; kangela@sfu.ca.
• 2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
• 4Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.
• 5Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
• 6Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
• 7Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
• 8Département de Sexologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
• 9Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 

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PTSD among Aboriginal & Torres Strait Islander People in Custody in Australia: Prevalence & Correlates

Mental disorder and trauma experiences are highly prevalent among individuals in custody; however, the impact of posttraumatic stress disorder (PTSD) on functioning is rarely considered. Indigenous Australians are incarcerated at 13 times the rate of nonindigenous Australians and report high levels of trauma exposure and psychological distress. 

In analysis of the largest systematic study of mental disorder among indigenous Australians in custody (N = 396), we found that the 12-month prevalence of PTSD was high in both men (12.1%) and women (32.3%). Having PTSD was also associated with high rates of co-occurring mental disorders (anxiety 31.2%, depression 32.8%, psychosis 24.6%, and substance use, 75.4%), lifetime suicidal ideation (50.1%), and suicide attempts (34.4%). Individuals with PTSD, compared to those without, were more likely to experience other mental disorders, OR = 2.42, 95% CI [1.12, 5.80], p = .022; lifetime suicide thoughts, OR= 2.43, 95% CI [1.34, 4.39], p = .001, and attempts, OR = 2.56, 95% CI [1.33, 4.83], p = .002; and high rates of intoxication at the time of arrest. Despite this, most (58.9%) had not accessed any form of mental health care prior to incarceration. These findings highlight the need to identify and manage PTSD in community and custodial populations.

Spanish Abstracts by the Asociacion Chilena de Estres Traumatico

TEPT en Indígenas Australianos en Prisión

Los trastornos mentales y las experiencias de trauma son altamente prevalentes en los individuos en prisión, sin embargo, el impacto del TEPT es considerado raramente. Los indígenas australianos son encarcelados a una tasa que es 13 veces la tasa de australianos no indígenas y reportan altos niveles de exposición a trauma y estrés psicológico. En un análisis más detallado del estudio sistemático más grande sobre los trastornos mentales en los indígenas australianos en prisión (N = 396), encontramos que la prevalencia a los 12 meses del TEPT era alta tanto en hombres (12.1%) como en mujeres (32.3%). Tener TEPT también se asoció con altas tasas de trastornos mentales comórbidos (ansiedad 31.2%, depresión 32.8%, psicosis 24.6% y consumo de sustancias 75.4%), ideación suicida a lo largo de la vida (50.1%) e intentos suicidas (34.4%). Los individuos con TEPT, en comparación con los individuos sin TEPT, tenían más probabilidad de sufrir otro trastorno mental OR = 2.42, 95% IC [1.12, 5.80], p = ,022 y pensamientos suicidas en algún momento de la vida OR = 2.56, 95% IC [1.33, 4.83], p = ,002 y altas tasas de intoxicación al momento del arresto. A pesar de esto, la mayoría (58.9%) no había accedido a ninguna forma de atención en salud mental antes del encarcelamiento. Estos hallazgos destacan la necesidad de identificar y manejar el TEPT en las poblaciones de la comunidad y carcelarias.

Purchase full article at:  http://goo.gl/MbYfWz

By:  

Edward Heffernan^1,*, 

Kimina Andersen²,

Fiona Davidson² and

Stuart A. Kinner^1,3

1. 1 School of Medicine, University of Queensland, Brisbane, Queensland, Australia
2. 2 Metro North Hospital and Health Service, Brisbane, Queensland, Australia
3. 3 Centre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne

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Sexual Health among Female Aboriginal University Students in the Maritime Provinces of Canada: Risk Behaviours & Health Services Use

Young Aboriginal Canadian people are at increased risk of negative sexual health outcomes, including sexually transmissible infections (STIs) and unplanned pregnancy. Associations between Aboriginal ethnicity and sexual risk behaviours and related health services use among sexually active female university students in eastern Canada were examined. 

A secondary analysis of online survey data collected from sexually active female university students under age 30 years from eight post-secondary institutions in the Maritime Provinces of Canada was carried out (N = 5010). Students were asked about their ethnic backgrounds, health services use and sexual health behaviours. Logistic regressions were used to compare Aboriginal students to Caucasian students regarding their sexual health behaviours and services use. 

In adjusted analyses, Aboriginal students were seen to be more likely to not have used a condom or any form of effective contraception at last intercourse. They also were more likely to report any lifetime testing for pregnancy and STIs. Aboriginal students accessed university health services as often as their Caucasian counterparts. 

Aboriginal women attending university in the Maritime Provinces of Canada engage in greater sexual risk taking than Caucasian women and report more related testing. Health services providers working with university students should be aware of these lower rates of barrier protection and use of contraception among Aboriginal women, and use healthcare visits as opportunities to engage these women in reducing their sexual risk taking.

Purchase full article at:  http://goo.gl/kA6uyI

By: Kevin Wilson ^A, Audrey Steenbeek ^A B, Mark Asbridge ^A, Amber Cragg ^A and Donald B. Langille ^A C 

^A Department of Community Health and Epidemiology, Dalhousie University, Clinical Research Centre, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada. 
^B School of Nursing, Dalhousie University, 5869 University Avenue, PO BOX 15000, Halifax, Nova Scotia, B3H 4R2, Canada. 
^C Corresponding author. Email: donald.langille@dal.ca

 

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Beyond Recidivism: Changes In Health & Social Service Involvement Following Exposure to Drug Treatment Court

The majority of Drug Treatment Court (DTC) research has examined the impact of DTCs on criminal recidivism. Comparatively little research has addressed the association between DTC participation and engagement with community-based health and social services. The present study investigated changes in participant involvement with outpatient healthcare and income assistance within a DTC cohort. We hypothesized that involvement with community-based (outpatient) health and social services would increase post-DTC participation, and that service levels would be higher among program graduates and offenders with histories of co-occurring mental and substance use disorders.

Participants were 631 offenders at the DTC in Vancouver, Canada (DTCV). Administrative data representing hospital, outpatient medical care, and income assistance were examined one-year pre/post program to assess differences over time. Generalized estimating equations were used to investigate the association between changes in service use and program involvement. We also examined the relationship between level of service use and offender characteristics.

Members of the cohort were disproportionately Aboriginal (33 %), had been sentenced 2.7 times in the 2 years preceding their index offence, and 50 % had been diagnosed with a non substance-related mental disorder in the five years preceding the index offence. The mean number of outpatient services post DTCV was 51, and the mean amount of social assistance paid was $5,897. Outpatient service use increased following exposure to DTCV (Adjusted Rate Ratio (ARR) = 1.45) and was significantly higher among women (ARR = 1.47), program graduation (ARR = 1.23), and those previously diagnosed with concurrent substance use and mental disorders (ARR = 4.92). Overall, hospital admissions did not increase post-program, although rates were significantly higher among women (ARR = 1.76) and those with concurrent disorders (ARR = 2.71). Income assistance increased significantly post program (ARR = 1.16), and was significantly higher among women (ARR = 1.03), and those diagnosed with substance use disorders (ARR = 1.42) and concurrent disorders (ARR = 1.72).

These findings suggest that the DTCV was a catalyst for increased participant engagement with community health and social supports, and that rates of service use were consistently higher among women and individuals with concurrent disorders. Research is needed to investigate the potential link between health and social support and reductions in recidivism associated with DTCs

Full article at: http://goo.gl/URGCfM

By: Rezansoff SN1, Moniruzzaman A2, Clark E3, Somers JM4.

• 1Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. sra20@sfu.ca.
• 2Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. akm_moniruzzaman@sfu.ca.
• 3British Columbia Corrections, PO Box 9242, STN PROV GOV, Victoria, British Columbia, V8W 9 J2, Canada. elenore.clark@gov.bc.ca.
• 4Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. jsomers@sfu.ca.  

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Exploring the Public Health Impacts of Private Security Guards on People Who Use Drugs: a Qualitative Study

Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. 

This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. 

Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. 

Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.

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By: Markwick N1, McNeil R1,2, Small W1,2, Kerr T3,4.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
• 2Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 4Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.  

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Incidence & Predictors of Annual Chlamydia Testing among 15–29 Year Olds Attending Aboriginal Primary Health Care Services in New South Wales, Australia

For the past two decades, chlamydia has been the most commonly notified infectious disease among young people (15–29 year olds) in Australia, the United States of America and the United Kingdom and rates have increased annually in these three countries. In Australia, rates of chlamydia are three times higher in Aboriginal compared with non-Aboriginal people. Australian sexually transmissible infection guidelines recommend annual chlamydia testing for 15–29 year old females and males. This analysis will examine the incidence and predictors of annual chlamydia testing in 15–29 year olds attending four Aboriginal Community Controlled Health Services (ACCHS) in Australia.

From 2009–2011, attendance and chlamydia testing data were extracted from the patient system to calculate the number and proportion of 15–29 year olds that were tested for chlamydia and that tested positive for chlamydia by gender (male, female), age-group (15–19, 20–24, 25–29 years), Aboriginal status (Aboriginal, non-Aboriginal people) and by the four ACCHSs sites (1, 2, 3 and 4). A cohort was created to calculate the incidence rate per 100 person-years (PY) and predictors of an annual chlamydia test (a test within 12-months of a previous test/visit) by the above factors using Cox regression. Unadjusted and adjusted hazard ratios (AHR) and their 95 % confidence intervals (CIs) and p-values were calculated with significance at p < 0.05.

From 2009–2011, there were 2896 individuals who attended the four ACCHSs. Overall , 17 % (22 % of females and 10 % of males) were tested for chlamydia and 9 % tested positive (8 % of females and 14 % of males). The median time to an annual chlamydia test was 10.7 months. The cohort included 2318 individuals. Overall the incidence rate of an annual chlamydia test was 9.1 per 100 PY (11.6 in females and 5.8 in males). Predictors of an annual chlamydia test were being female, being 15–19 years old and attending ACCHS site 2.

This analysis highlights that opportunistic STI testing strategies are needed to increase annual chlamydia testing in young people; especially males.

Below:  Incidence rate and 95 % confidence intervals of chlamydia testing in females by age-group, 2009-2011

Below:  Incidence rate and 95 % confidence intervals of chlamydia testing in males by age-group, 2009-2011

Full article at:  http://ht.ly/SStqJ 

By: Simon Graham^12*, Rebecca J. Guy¹, James S. Ward³, John Kaldor¹, Basil Donovan¹⁴,Janet Knox¹, Debbie McCowen⁵, Patricia Bullen⁵, Julie Booker⁵, Chris O’Brien⁵, Kristine Garrett⁵ and Handan C. Wand¹ 

^{https://twitter.com/KirbyInstitute}

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