What works? Improving the uptake of STI testing and management among young people in remote Aboriginal and Torres Strait Islander communities in Australia

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Copyright: Hengel, Belinda
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Abstract
Aboriginal people living in remote communities experience a high burden of sexually transmissible infections (STIs). To interrupt the transmission of STIs and prevent complications, regular testing and timely treatment are required. The aim of this thesis is to provide new knowledge about the extent of regular testing, and barriers and facilitators to offering testing and timely treatment from the perspective of health staff working in these areas. Four studies were undertaken. The first, a longitudinal analysis, showed that among individuals attending 68 remote Aboriginal health services, 20.3% of those who had an initial chlamydia/gonorrhoea test were re-tested at 12 (+/-3) months, with rates higher in young people and females. Among both males and females, re-testing was more likely for those who attended a health service which saw predominantly Aboriginal clients. For females, re-testing was also more likely if they attended services which used electronic medical records, and for males, re-testing was more likely if they attended a service which employed Aboriginal health workers and more male staff. Studies 2 and 3, involved qualitative interviews with 36 staff working at 22 remote Aboriginal health services. Barriers for staff offering STI tests included; cultural norms requiring the separation of genders, competing clinical demands, concerns about client confidentiality and limited staff capacity. For timely treatment, barriers included; the large distances between the health centre and laboratories, delays in checking and actioning test results, under-utilisation of recall systems and difficulties in locating clients following receipt of a positive result. The fourth study systematically reviewed the international literature to assess the reach, uptake and outcomes of outreach as a strategy to increase testing coverage. The review revealed that despite the number of people tested being relatively small, the yield of infections was high. The proportion of the target population tested was higher in venues (community centres) but lower in street/public areas. In conclusion, the research in this thesis has identified client, cultural, health centre and systematic factors which impact on regular testing and timely treatment. Many of the barriers identified are modifiable, while others may require innovative strategies to overcome; such as outreach programs, point-of-care testing, and testing modalities outside the clinic.
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Author(s)
Hengel, Belinda
Supervisor(s)
Guy, Rebecca
Kaldor, John
Maher, Lisa
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Publication Year
2015
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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