High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009–2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening

Sexual Health ◽  
2016 ◽  
Vol 13 (6) ◽  
pp. 568 ◽  
Author(s):  
Linda Garton ◽  
Amalie Dyda ◽  
Rebecca Guy ◽  
Bronwyn Silver ◽  
Skye McGregor ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Laboratory Data ◽  
Cluster Randomised Trial ◽  
Remote Communities ◽  
Remote Community ◽  
Time Period ◽  
Related Hospitalisation ◽  
Health Quality ◽  
Improvement Programs ◽  
Quality Improvement Programs

Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. Methods: Baseline CT and NG laboratory data (2009–2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2–4 months (recommended) and 5–12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2–4 months, 26.9% at 5–12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2–4-month (16.9% v. 11.5%, P < 0.01) and 5–12-month (28.9% v. 23.5%, P = 0.01) periods. Women aged 25–29 years had a significantly higher level of re-testing 5–12 months post-diagnosis than females aged 16–19 years (39.8% v. 25.4%, P < 0.01). There was a total of 858 people re-tested at 2–12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P < 0.01). Conclusions: Just under half the individuals diagnosed with CT or NG were re-tested at 2–12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2–4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.

Patient, staffing and health centre factors associated with annual testing for sexually transmissible infections in remote primary health centres

Sexual Health ◽  
2017 ◽  
Vol 14 (3) ◽  
pp. 274 ◽  
Author(s):  
Belinda Hengel ◽  
Handan Wand ◽  
James Ward ◽  
Alice Rumbold ◽  
Linda Garton ◽  
...  
Keyword(s):  
Aboriginal People ◽  
Health Workers ◽  
Health Centre ◽  
Randomised Trial ◽  
Laboratory Data ◽  
Aboriginal Health ◽  
Guideline Recommendation ◽  
Cluster Randomised Trial ◽  
Factors Associated ◽  
Sexually Transmissible Infections

Background: In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009–10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of re-testing was determined, along with the associated patient, staffing and health centre factors. Methods: Annual testing was defined as re-testing in 9–15 months (guideline recommendation) and a broader time period of 5–15 months following an initial negative CT/NG test. Random effects logistic regression was used to determine factors associated with re-testing. Results: Of 10 559 individuals aged ≥16 years with an initial negative CT/NG test (median age = 25 years), 20.3% had a re-test in 9–15 months (23.6% females vs 15.4% males, P < 0.001) and 35.2% in 5–15 months (40.9% females vs 26.5% males, P < 0.001). Factors independently associated with re-testing in 9–15 months in both males and females were: younger age (16–19, 20–24 years); and attending a centre that sees predominantly (>90%) Aboriginal people. Additional factors independently associated with re-testing for females were: being aged 25–29 years, attending a centre that used electronic medical records, and for males, attending a health centre that employed Aboriginal health workers and more male staff. Conclusions: Approximately 20% of people were re-tested within 9–15 months. Re-testing was more common in younger individuals. Findings highlight the importance of recall systems, Aboriginal health workers and male staff to facilitate annual re-testing. Further initiatives may be needed to increase re-testing.

Maternal and child health nurses’ experiences of implementing two community-based breastfeeding interventions in Victoria, Australia: A mixed methods process evaluation

2019 ◽  
Vol 16 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Rhian L Cramer ◽  
Helen L McLachlan ◽  
Touran Shafiei ◽  
Lisa H Amir ◽  
Meabh Cullinane ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Breastfeeding Initiation ◽  
Structured Interviews ◽  
Breastfeeding Support ◽  
Community Based ◽  
Significant Drop ◽  
And Child Health

Despite high rates of breastfeeding initiation in Australia, there is a significant drop in breastfeeding rates in the early postpartum period, and Australian government breastfeeding targets are not being met. The Supporting breastfeeding In Local Communities (SILC) trial was a three-arm cluster randomised trial implemented in 10 Victorian local government areas (LGAs). It aimed to determine whether early home-based breastfeeding support by a maternal and child health nurse (MCH nurse) with or without access to a community-based breastfeeding drop-in centre increased the proportion of infants receiving ‘any’ breast milk at four months. Focus groups, a written questionnaire and semi-structured interviews were undertaken to explore the interventions from the perspective of the SILC-MCH nurses (n=13) and coordinators (n=6), who established and implemented the interventions. Inductive thematic analysis was used to identify themes, then findings further examined using Diffusion of Innovations Theory as a framework. SILC-MCH nurses and coordinators reported high levels of satisfaction, valuing the opportunity to improve breastfeeding in our community; and having focused breastfeeding time with women in their own homes. They felt the SILC interventions offered benefits to women, nurses and the MCH service. Implementing new interventions into existing, complex community health services presented unforeseen challenges, which were different in each LGA and were in part due to the complexity of the individual LGAs and not the interventions themselves. These findings will help inform the planning and development of future programs aimed at improving breastfeeding and other interventions in MCH.

scholarly journals Optimizing the Environmental and Economic Sustainability of Remote Community Infrastructure

2020 ◽  
Vol 12 (6) ◽  
pp. 2208 ◽  
Author(s):  
Jamie E. Filer ◽  
Justin D. Delorit ◽  
Andrew J. Hoisington ◽  
Steven J. Schuldt
Keyword(s):  
Environmental Impacts ◽  
Sustainability Assessment ◽  
Model Performance ◽  
Assessment Model ◽  
Remote Communities ◽  
Remote Community ◽  
Rural Villages ◽  
Sustainable Technologies ◽  
Study Results

Remote communities such as rural villages, post-disaster housing camps, and military forward operating bases are often located in remote and hostile areas with limited or no access to established infrastructure grids. Operating these communities with conventional assets requires constant resupply, which yields a significant logistical burden, creates negative environmental impacts, and increases costs. For example, a 2000-member isolated village in northern Canada relying on diesel generators required 8.6 million USD of fuel per year and emitted 8500 tons of carbon dioxide. Remote community planners can mitigate these negative impacts by selecting sustainable technologies that minimize resource consumption and emissions. However, the alternatives often come at a higher procurement cost and mobilization requirement. To assist planners with this challenging task, this paper presents the development of a novel infrastructure sustainability assessment model capable of generating optimal tradeoffs between minimizing environmental impacts and minimizing life-cycle costs over the community’s anticipated lifespan. Model performance was evaluated using a case study of a hypothetical 500-person remote military base with 864 feasible infrastructure portfolios and 48 procedural portfolios. The case study results demonstrated the model’s novel capability to assist planners in identifying optimal combinations of infrastructure alternatives that minimize negative sustainability impacts, leading to remote communities that are more self-sufficient with reduced emissions and costs.

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