Sexually transmitted infections/bloodborne viruses in Aboriginal people; understanding the burden of disease and evaluating interventions.

Abstract

Aboriginal and Torres Strait Islander (Aboriginal) Australians are disproportionately affected by sexually transmissible infections (STIs). Notification rates for chlamydia and gonorrhoea are 3-fold and 21-fold greater in Aboriginal compared with non-Aboriginal people. Untreated STIs can cause poor reproductive health outcomes such as pelvic inflammatory disease. As a high proportion of these infections are asymptomatic, STI testing is an important prevention strategy, and guidelines recommend annual testing among 15-29 year olds. Notification rates of hepatitis B are 4-folder greater in Aboriginal than non-Aboriginal people. Hepatitis B can be transmitted through unsafe sex and unsafe injecting practices, and is a major cause of liver cancer in Aboriginal people. Immunisation, and early diagnosis and treatment are key prevention strategies for hepatitis B. This thesis begins with two projects focused on understanding the epidemiology of chlamydia and gonorrhoea and hepatitis B in Aboriginal people. Chapter 2 involves an analysis of national chlamydia and gonorrhoea notification data, and found in the past decade notifications of chlamydia and gonorrhoea have been increasing steadily in Aboriginal Australians and are highest in 15-29 year olds and those residing in remote areas. Chapter 3 is a meta-analysis which found chronic hepatitis B in Aboriginal people remains 4-fold greater than non-Aboriginal, despite universal vaccination being available since 2000. The next three chapters describe baseline and intervention results from a quality improvement program (QIP) implemented with four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia, aiming to improve STI and hepatitis testing and management. Chapter 4 uses baseline data and found that 7% of young people were tested for chlamydia annually and 1% for gonorrhoea each year, however young people had a median of 5 visits where testing could be offered. Chlamydia positivity was 10% in 15-29 year olds. Chapter 5 is a retrospective cohort that showed the incidence of annual chlamydia testing (within 12-months of a previous test/visit) was 9%. Chapter 6 describes the impact of the QIP. In the 12-month QIP period chlamydia and gonorrhoea testing increased from 9% to 22%, and a clinical audit showed that testing was integrated during reproductive health visits, adult health checks and mental health checks. Gonorrhoea positivity was very low at 0.3% across both periods. The QIP almost tripled chlamydia and gonorrhoea testing, suggesting QIP may play an important role in the control of STIs in Aboriginal people in Australia.