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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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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