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.

Keepin Ya Mob Healthy: Aboriginal Community Participation and Aboriginal Health Worker Training in Victoria

2001 ◽  
Vol 7 (1) ◽  
pp. 116 ◽  
Author(s):  
Karen Adams ◽  
Merilyn Spratling
Keyword(s):  
Training Program ◽  
Health Worker ◽  
Aboriginal People ◽  
Health Workers ◽  
Aboriginal Health ◽  
Successful Implementation ◽  
Community Consultation ◽  
Worker Training ◽  
Health Worker Training ◽  
Aboriginal Health Worker

This article outlines the development of accredited Aboriginal Health Worker training in Victoria. The processes of community consultation are presented as the primary reason for the successful implementation of the training program in its first year of delivery. The most important community consultation processes involved the active input of Elders and Aboriginal Health Workers. The training was seen as more credible by other Koorie people because of the input of these groups. The supportive role played by both the State and Commonwealth governments as well as industry groups are also explored. The successful implementation of the Aboriginal Health Worker training program demonstrates that Aboriginal people know what is best for them and can effectively initiate, organise and deliver their own culturally appropriate training programs.

Recruiting people with HIV to an online self-management support randomised controlled trial: barriers and facilitators

Sexual Health ◽  
2019 ◽  
Vol 16 (4) ◽  
pp. 340
Author(s):  
Karen M. Klassen ◽  
Tanya Millard ◽  
Julia Stout ◽  
Karalyn McDonald ◽  
Sarity Dodson ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Randomised Trial ◽  
Management Program ◽  
Self Management ◽  
Cluster Randomised Trial ◽  
Management Support ◽  
Factors Associated ◽  
Challenges And Opportunities ◽  
Study Sites ◽  
Randomised Controlled

Background Recruitment of people to randomised trials of online interventions presents particular challenges and opportunities. The aim of this study was to evaluate factors associated with the recruitment of people with HIV (PWHIV) and their doctors to the HealthMap trial, a cluster randomised trial of an online self-management program. Methods: Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. Results: Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (β coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (β coefficient 55.9; 95% CI –2.55, 114.25; P = 0.06). Conclusion: Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.

scholarly journals Saving babies’ lives (SBL) – a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kaajal Patel ◽  
Sopheakneary Say ◽  
Daly Leng ◽  
Manila Prak ◽  
Koung Lo ◽  
...  
Keyword(s):  
Data Collection ◽  
Neonatal Mortality ◽  
Rural Areas ◽  
Health Workers ◽  
Randomised Trial ◽  
Scale Up ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
The Continuum

Abstract Background Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies’ Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. Methods This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies’ Lives programme, which is the intervention. The Saving Babies’ Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies’ Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. Discussion Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. Trial registration ClinicalTrials.gov: NCT04663620. Registered on 11th December 2020, retrospectively registered.

scholarly journals Protocol for a cluster randomised trial in Madhya Pradesh, India: Community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

2020 ◽  
Author(s):  
Arjun Agarwal ◽  
Rukmini Banerji ◽  
Peter Boone ◽  
Diana Elbourne ◽  
Ila Fazzio ◽  
...  
Keyword(s):  
Community Health ◽  
Rural Areas ◽  
Controlled Trial ◽  
Health Centre ◽  
Randomised Trial ◽  
First Grade ◽  
Madhya Pradesh ◽  
Cluster Randomised Trial ◽  
Education Intervention ◽  
Cluster Randomised

Abstract Background Rural areas of India exhibit high neonatal mortality, and low literacy and numeracy. We assess the effect of a complex package of health interventions on neonatal survival, and the effect of out-of-school-hours teaching on children’s literacy and numeracy, in rural Madhya Pradesh. Methods/Design This is a cluster-randomised controlled trial with villages (clusters) receiving either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial villages receiving the health intervention are controls for the education intervention, and vice versa. Clusters 196 villages in Satna district, Madhya Pradesh, India: each at least five kilometres from a Community Health Centre, a population below 2,500, and at least 15 children eligible for the education intervention. Participants CHAMPION2 - resident married women under 50 without a family planning operation, provided they are enumerated pre-randomisation, or marry a man enumerated pre-randomisation. STRIPES2 - resident children born 16June 2010-15June 2013, not in school before the 2018-2019 school year and intending to enrol in first grade in 2018-2019 or 2019-2020.

Tobacco control practices among Aboriginal health professionals in Western Australia

2009 ◽  
Vol 15 (2) ◽  
pp. 152 ◽  
Author(s):  
Albert (Sonny) A. G. Pilkington ◽  
Owen B. J. Carter ◽  
Alexander S. Cameron ◽  
Sandra C. Thompson
Keyword(s):  
Smoking Cessation ◽  
Aboriginal People ◽  
Health Workers ◽  
Aboriginal Health ◽  
Current Smoking ◽  
Attitudes And Practices ◽  
Telephone Interviews ◽  
Knowledge Attitudes And Practices ◽  
Major Impediment ◽  
Do So

Smoking among Aboriginal people is extremely widespread (50 v. 17% of the general population). Aboriginal Health Workers (AHW) are at the vanguard of tackling this problem but many themselves smoke and little is known of their knowledge, attitudes and practices regarding smoking cessation. Structured telephone interviews were conducted with 36 AHW, including 31% current smokers, 31% ex-smokers and 38% non-smokers, to assess their current smoking cessation practices and knowledge of health risks, nicotine dependence, cessation strategies and pharmacotherapies. AHW considered diabetes, alcohol use and heart disease more problematic than smoking among Aboriginal people. Fear of appearing hypocritical stopped many who smoke from discussing smoking cessation with clients but also stopped some non-smoking AHW whose colleagues or family smoked. Cultural concerns about telling others ‘what to do’ was also a major impediment. Knowledge of the health effects of smoking was good, but knowledge of appropriate advice around cessation pharmacotherapies was suboptimal. AHW trained in smoking cessation were more knowledgeable and active in smoking cessation, but most AHW had received no training, despite being keen to do so. Specific smoking cessation training is sought and appears needed by AHW, particularly in the areas of brief interventions, motivational interviewing, dependence assessment and pharmacotherapies.

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.

scholarly journals Ngununggula: The story of a cancer care team for aboriginal people

2022 ◽  
Vol 9 (1) ◽  
pp. 50-51
Author(s):  
Janelle Trees ◽  
Trish Levett ◽  
Kyla Wynn ◽  
Rowena Ivers
Keyword(s):  
Cancer Care ◽  
Medical Service ◽  
Aboriginal People ◽  
Health Workers ◽  
Holistic Approach ◽  
Aboriginal Health ◽  
Care Team ◽  
South Wales ◽  
Care Workers ◽  
Training Modules

In Dharawal Country in regional New South Wales, a small and powerful team provides cancer prevention, screening, support and care for Australian Aboriginal people, their families and communities. In keeping with Aboriginal practices and values, their uniquely holistic approach encompasses everything from food security and finding childcare, to support at diagnosis, surgical, radiation or chemo treatment, through to holding funerals, facilitating yarning groups, and Ceremony for survivors of cancer and their carers. The team created a manual for Aboriginal Health Workers, and other staff of Aboriginal Community Controlled Health Services, together with training webinars, and modules. The program is also designed for Aboriginal Liaison Officers and Palliative Care Workers who work in hospitals. The book and the training modules are called Ngununggula. The name, from the Gundungurra language, means working and walking together. “We’ll make ourselves available to anyone that wants to tread this path because we know all the pitfalls. We’ve learned them. We’ve tripped and had to climb out of them again. Anyone that wants the shortcuts—more learning, less pain—here they are. We want to share and help. I want the message to get out all over the place. I want to share the resources, to support anyone else who wants to run programs or build a team like we do.” Kyla Wynn, Counsellor/Co-ordinator Cancer Care Team, Illawarra Aboriginal Medical Service. Partners include: Aboriginal Health and Medical Research Council, Illawarra Aboriginal Medical Service, University of Sydney, University of Wollongong, Menzies School of Health Research.

scholarly journals Action leveraging evidence to reduce perinatal mortality and morbidity (ALERT): study protocol for a stepped-wedge cluster-randomised trial in Benin, Malawi, Tanzania and Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph Akuze ◽  
Kristi Sidney Annerstedt ◽  
Lenka Benova ◽  
Effie Chipeta ◽  
Jean-Paul Dossou ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Process Evaluation ◽  
Study Protocol ◽  
Health Workers ◽  
Randomised Trial ◽  
User Participation ◽  
Cluster Randomised Trial ◽  
Evidence Based ◽  
Stepped Wedge ◽  
Cluster Randomised

Abstract Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period. Methods This is a cluster randomised stepped-wedge trial with a nested realist process evaluation across 16 hospitals in Benin, Malawi, Tanzania and Uganda. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement supported by data from a clinical perinatal e-registry and iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. The trial’s primary outcome is in-facility perinatal (stillbirths and early neonatal) mortality, in which we expect a 25% reduction. A perinatal e-registry will be implemented to monitor the trial. Our nested realist process evaluation will help to understand what works, for whom, and under which conditions. We will apply a gender lens to explore constraints to the provision of evidence-based care by health workers providing maternity services. An economic evaluation will assess the scalability and cost-effectiveness of ALERT intervention. Discussion There is evidence that each of the ALERT intervention components improves health providers’ practices and has modest to moderate effects. We aim to test if the innovative packaging, including addressing specific health systems constraints in these settings, will have a synergistic effect and produce more considerable perinatal mortality reductions. Trial registration Pan African Clinical Trial Registry (www.pactr.org): PACTR202006793783148. Registered on 17th June 2020.

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