Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services

BMC Health Services Research

Basil Donovan⁴  Rebecca J Guy⁵  Margaret Hellard²  John M Kaldor⁵  Phyllis Yau²  Mark Saunders³  Sophia Couzos¹  Anna Bowring²  Hammad Ali⁵  Jane Goller²  James Ward⁶ 

[1] James Cook University, James Cook Drive, Townsville QLD 4811, Australia;The University of Melbourne, Grattan Street, Parkville VIC 3010, Australia;National Aboriginal Community Controlled Health Organisation, Canberra City ACT 2601, Australia;Sydney Sexual Health Centre, Sydney Hospital, Sydney 2000 NSW, Australia;The Kirby Institute, The University of New South Wales, Sydney 2052 NSW, Australia;Baker IDI Heart and Diabetes Institute, Alice Springs 0871 NT, Australia

关键词: Australia;    Indigenous;    Positivity;    Testing;    Aboriginal and Torres Strait Islander people;    Chlamydia;   

Others  :  1130648
DOI  :  10.1186/1472-6963-14-285

 received in 2013-11-21, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.

Methods

We describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander (‘Aboriginal’) status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16–29 years and for chlamydia testing and positivity.

Results

Data were included from 16–29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).

Conclusions

Higher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

【 授权许可】

   
2014 Ward et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Peipert JF: Genital chlamydial infections. N Engl J Med 2003, 349(25):2424-2430.
• [2]Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, Taylor-Robinson D, Simms I, Hay P: Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010, 340(apr08 1):c1642.
• [3]Haggerty C, Gottlieb S, Taylor B, Low N, Xu F, Ness R: Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010, 201(S2):134-155.
• [4]Gray-Swain MR, Peipert JF: Pelvic inflammatory disease in adolescents. Curr Op Obstet Gynecol 2006, 18(5):503-510.
• [5]The Kirby Institute: HIV, viral hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2013. Sydney: Kirby Institute, UNSW; 2013.
• [6]Graham S, Guy RJ, Donovan B, McManus H, Su JY, El-Hayek C, Kwan KS, Dyda A, Wand HC, Ward JS: Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000–2009. Med J Aust 2012, 197(11):642-646.
• [7]Latif A, Smith K: Sexually transmitted infections in Central Australia–time for concerted action. Public Health Bull South Aust 2006, 4:32-34.
• [8]Huang RL, Torzillo PJ, Hammond VA, Coulter ST, Kirby AC: Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program. Med J Aust 2008, 189(8):442-445.
• [9]The Kirby Institute: Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2012. 2013 edition. Sydney: The Kirby Institute, UNSW; 2013.
• [10]Hocking J, Willis J, Tabrizi S, Fairley C, Garland S, Hellard M: A chlamydia prevalence survey of young women living in Melbourne. Victoria Sex Health 2006, 3(4):235-240.
• [11]Ali H, Guy RJ, Fairley CK, Wand H, Chen MY, Dickson B, O’Connor CC, Marshall L, Grulich AE, Kaldor JM, Hellard ME, Donovan B: Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia. Sex Transm Infect 2012, 88(7):552-557.
• [12]Council of Australian Governments: Closing the gap in Indigenous disadvantage. http://www.coag.gov.au/closing_the_gap_in_indigenous_disadvantage webcite
• [13]Guy RJ, Kong F, Goller J, Franklin N, Bergeri I, Dimech W, Reilly N, Sullivan E, Ward J, Kaldor JM, Hellard M, Donovan B: A new national chlamydia sentinel surveillance system in Australia: evaluation of the first stage of implementation. Comm Dis Intell 2010, 34(1):319.
• [14]Boyle DIR, Kong FA: Systematic mechanism for the ethical collection and interpretation of display format pathology test results from Australian Primary Care records. In Proceedings of the 17th annual HISA Health Informatics Conference. Canberra; 2009.
• [15]Britt H, Miller GC, Henderson J, Bayram C, Valenti L, Harrison C, Charles J, Pan Y, Zhang C, Pollack AJ, O’Halloran J: General practice activity in Australia 2012–13 General practice series no.33. Sydney: Sydney University Press; 2013.
• [16]AIHW: Healthy for Life. ACCHSs Report Card. Canberra; 2013. Cat No AIHW 97
• [17]Australian Bureau of Statistics: Estimates of Aboriginal and Torres Strait Islander Australians. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001 webcite
• [18]AIHW: National Advisory Group on Aboriginal and Torres Strait Islander Health Information Strategic Plan 2011–2015. Canberra: AIHW; 2011.
• [19]Australian Government Department of Health and Ageing: Closing the gap: tackling chronic disease. overview of the Commonwealth Indigenous Chronic disease package. http://www.healthyactive.gov.au/internet/main/publishing.nsf/Content/health-oatsih-ctg-package webcite
• [20]Ward J, Bryant J, Worth H, Hull P, Solar S, Bailey S: Use of health services for sexually transmitted and blood-borne viral infections by young Aboriginal people in New South Wales. Aust J Prim: Health; 2012.
• [21]Mooney-Somers J, Erick W, Scott R, Akee A, Kaldor J, Maher L: Enhancing Aboriginal and Torres Strait Islander young people’s resilience to blood-borne and sexually transmitted infections: findings from a community-based participatory research project. Health Promot J Austr 2009, 20(3):195-201.
• [22]Royal Australian College of General Practitioners: Guidelines for preventive activities in general practice (“The Red Book”). Melbourne: Royal Australian College of General Practitioners; 2012.
• [23]National Aboriginal Community Controlled Health Organization, Royal Australian College of General Practitioners: National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. South Melbourne: The RACGP; 2012.
• [24]McNulty CA, Freeman E, Bowen J, Shefras J, Fenton KA: Barriers to opportunistic chlamydia testing in primary care. Br J Gen Pract 2004, 54(504):508.
• [25]Ma R, Clark A: Chlamydia screening in general practice: views of professionals on the key elements of a successful programme. J Fam Plan Rep Health Care 2005, 31(4):302-306.
• [26]Temple-Smith M, Kneebone J, Bilardi J, Pirotta M: Chlamydia screening: barriers to a complex intervention in the general practice setting. [Abstract]. In General Practice and Primary Health Care Conference. Melbourne; 2009.
• [27]Merritt TD, Durrheim DN, Hope K, Byron P: General practice intervention to increase opportunistic screening for chlamydia. Sex Health 2007, 4(4):249-251.
• [28]Shafer MAB, Tebb KP, Pantell RH, Wibbelsman CJ, Neuhaus JM, Tipton AC, Kunin SB, Ko TH, Schweppe DM, Bergman DA: Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls. JAMA 2002, 288(22):2846-2852.
• [29]Guy RJ, Ali H, Liu B, Poznanski S, Ward J, Donovan B, Kaldor J, Hocking JS: Efficacy of interventions to increase the uptake of chlamydia screening in primary care: a systematic review. BMC Infect Dis 2011, 11(1):211.
• [30]Council of Australian Governments National Indigenous Reform Agreement: Closing the Gap. http://www.federalfinancialrelations.gov.au/content/npa/health_indigenous/indigenous-reform/national-agreement_sept_12.pdf webcite
• [31]Regan DG, Wilson DP, Hocking JS: Coverage is the key for effective screening of Chlamydia trachomatis in Australia. J Infect Dis 2008, 198(3):349.
• [32]Council of Australian Governments: Closing the gap: National Urban and Regional Service Delivery Strategy for Indigenous Australians. http://www.coag.gov.au/node/67 webcite