New methods to track progress toward elimination of sexually transmissible infections and blood-borne viruses in Australia

ac.person.orcid 0000-0003-1185-0636
ac.person.orcid 0000-0002-2929-4634
ac.person.orcid 0000-0002-8116-4319
ac.person.orcid 0000-0001-8851-4126
ac.person.position HDR Student
ac.person.position Staff
ac.person.position Staff
ac.person.position Staff
dc.contributor.advisor Guy, Rebecca
dc.contributor.advisor McGregor, Skye
dc.contributor.advisor Donovan, Basil Khawar, Laila 2022-03-07T04:56:39Z 2022-03-07T04:56:39Z 2021
dc.description.abstract The scale up of prevention, diagnostic and treatment initiatives across the world have led to substantial decreases in the burden of infectious diseases. The World Health Organization (WHO) sets elimination/eradication goals for infectious diseases that are suitable candidates for such initiatives. My thesis focused on measuring progress towards elimination of selected infectious diseases in Australia. Chapter 2 presents a systematic review of reports that described diseases targeted for elimination/eradication globally, the associated goals, terminology use, and validation processes. The review highlighted 26 infectious conditions that have been targeted for elimination/eradication and proposed a model to categorise different goals that will assist in establishing a more standardized approach to the development and communication of these initiatives. Chapters 3 and 4 focused on defining and tracking elimination of genital warts (GW) in Australia. Although Australia has observed substantial declines in GW due to implementation of the quadrivalent human papillomavirus (qHPV) vaccine in 2007 that protects against GW, there was no agreed upon elimination definition for GW. Chapter 3 reports a modified Delphi method to reach expert consensus on a GW elimination definition in the Australian context. Consensus was met that at ≥80% HPV vaccination coverage, GW will be eliminated as a public health problem by 2060, with a 95% reduction relative to 2006. Chapter 4 involved a cross-sectional analysis of routinely collected data from 34 sexual health clinics between 2004-2018 that focused on examining trends in GW diagnoses in locally- versus overseas-born patients (n=439,957), the first study to have examined this in Australia and internationally. The analysis showed reductions of 72%, 49% and 21% among Australian-, overseas-, and overseas-born patient from without qHPV/nonvalent (nHPV) vaccines, respectively. The reductions in Australian-born people reflects the efficacy of q/nHPV vaccines and the wide-spread vaccination coverage in Australia. However, population-wide elimination of GWs in Australia is dependent on other countries initiating or expanding their HPV vaccination programmes. Chapter 5 measured Australia’s progress towards the WHO goal of eliminating mother-to-child transmission (MTCT) of HIV, through a retrospective analysis of national surveillance data from 1988-2019 (n=887). The analysis showed an increase in the uptake of effective interventions to prevent MTCT. This led to a decline in the MTCT rate to zero, where women were diagnosed antenatally. However, when including women diagnosed postnatally, the MTCT rate was higher than the <2% elimination threshold set by the WHO. The analysis also indicated gaps in data for antenatal HIV screening and >40% of key demographic data were missing for mothers in recent years, suggesting a need for additional enhanced surveillance. My research has highlighted the importance of detailed assessments of progress towards elimination of infectious diseases. The findings will assist policy makers and health workers to identify gaps in the delivery of interventions and to enhance surveillance systems to capture necessary information to determine when Australia has met elimination goals for GW and MTCT-HIV.
dc.language English
dc.language.iso en
dc.publisher UNSW, Sydney
dc.rights CC BY 4.0
dc.subject.other Elimination
dc.subject.other Eradication
dc.subject.other Disease control
dc.subject.other Genital warts
dc.subject.other HIV
dc.subject.other Mother-to-child transmission of HIV
dc.subject.other Surveillance
dc.subject.other Elimination target
dc.subject.other Infectious diseases
dc.subject.other sexually transmissible infections
dc.subject.other blood-borne viruses
dc.title New methods to track progress toward elimination of sexually transmissible infections and blood-borne viruses in Australia
dc.type Thesis
dcterms.accessRights embargoed access
dcterms.rightsHolder Khawar, Laila
dspace.entity.type Publication
unsw.accessRights.uri 2023-03-08
unsw.description.embargoNote Embargoed until 2023-03-08
unsw.relation.faculty Medicine & Health The Kirby Institute The Kirby Institute The Kirby Institute
unsw.subject.fieldofresearchcode 4202 Epidemiology
unsw.thesis.degreetype PhD Doctorate
Resource type