Incidence and predictors of annual chlamydia testing among 15-29 year olds attending Aboriginal primary health care services in New South Wales, Australia

Simon Graham*, Rebecca J. Guy, James S. Ward, John Kaldor, Basil Donovan, Janet Knox, Debbie McCowen, Patricia Bullen, Julie Booker, Chris O'Brien, Kristine Garrett, Handan C. Wand

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: For the past two decades, chlamydia has been the most commonly notified infectious disease among young people (15-29 year olds) in Australia, the United States of America and the United Kingdom and rates have increased annually in these three countries. In Australia, rates of chlamydia are three times higher in Aboriginal compared with non-Aboriginal people. Australian sexually transmissible infection guidelines recommend annual chlamydia testing for 15-29 year old females and males. This analysis will examine the incidence and predictors of annual chlamydia testing in 15-29 year olds attending four Aboriginal Community Controlled Health Services (ACCHS) in Australia. Methods: From 2009-2011, attendance and chlamydia testing data were extracted from the patient system to calculate the number and proportion of 15-29 year olds that were tested for chlamydia and that tested positive for chlamydia by gender (male, female), age-group (15-19, 20-24, 25-29 years), Aboriginal status (Aboriginal, non-Aboriginal people) and by the four ACCHSs sites (1, 2, 3 and 4). A cohort was created to calculate the incidence rate per 100 person-years (PY) and predictors of an annual chlamydia test (a test within 12-months of a previous test/visit) by the above factors using Cox regression. Unadjusted and adjusted hazard ratios (AHR) and their 95 % confidence intervals (CIs) and p-values were calculated with significance at p ≤ 0.05. Results: From 2009-2011, there were 2896 individuals who attended the four ACCHSs. Overall, 17 % (22 % of females and 10 % of males) were tested for chlamydia and 9 % tested positive (8 % of females and 14 % of males). The median time to an annual chlamydia test was 10.7 months. The cohort included 2318 individuals. Overall the incidence rate of an annual chlamydia test was 9.1 per 100 PY (11.6 in females and 5.8 in males). Predictors of an annual chlamydia test were being female (AHR: 1.7, 95 % CI: 1.2-2.2, p < 0.01), being 15-19 years old (AHR: 1.6, 95 % CI: 1.1-2.3, p < 0.01) and attending ACCHS site 2 (AHR: 3.8, 95 % CI: 1.8-8.0, p < 0.01). Conclusions: This analysis highlights that opportunistic STI testing strategies are needed to increase annual chlamydia testing in young people; especially males.

Original languageEnglish
Article number437
JournalBMC Health Services Research
Volume15
Issue number1
DOIs
Publication statusPublished - 30 Sep 2015
Externally publishedYes

Bibliographical note

Funding Information:
Simon Graham, Julie Booker, Chris O'Brien, Kristine Garrett and James Ward are Aboriginal Australians and acknowledge the contribution Aboriginal and Torres Strait Islander Australians make to this work. We would like to acknowledge all the staff at each ACCHS who provide culturally appropriate medical, allied health and education to improve the health and well-being of Aboriginal people. We would like to acknowledge the investigators of the STRIVE project a large sexual health QIP project implemented in remote Aboriginal communities. The GRHANITE™ data extraction tool was developed by Dr Douglas Boyle at the University of Melbourne. James Ward and Simon Graham were the principal investigators for the SHIMMER project. The SHIMMER project was funded by the New South Wales Ministry of Health. The Kirby Institute is affiliated with the Faculty of Medicine, UNSW Australia. Simon Graham is supported by a McKenzie Post-doctoral fellowship and by the Melbourne Poche Centre for Indigenous Health at the University of Melbourne. Rebecca Guy, John Kaldor and Basil Donovan are supported by National Health and Medical Research Council Fellowships.

Funding Information:
The SHIMMER project received ethical approval from the Aboriginal Health & Medical Research Council of NSW and the University of New South Wales Human Research Ethics Committee. We also received approval from each participating ACCHSs Boards and signed agreements with each ACCHSs detailing issues such as confidentiality, privacy, consent, use of patient data, publications, and roles and responsibilities. The SHIMMER project was funded by the NSW Ministry of Health.

Funding Information:
Simon Graham, Julie Booker, Chris O’Brien, Kristine Garrett and James Ward are Aboriginal Australians and acknowledge the contribution Aboriginal and Torres Strait Islander Australians make to this work. We would like to acknowledge all the staff at each ACCHS who provide culturally appropriate medical, allied health and education to improve the health and well-being of Aboriginal people. We would like to acknowledge the investigators of the STRIVE project a large sexual health QIP project implemented in remote Aboriginal communities. The GRHANITE™ data extraction tool was developed by Dr Douglas Boyle at the University of Melbourne. James Ward and Simon Graham were the principal investigators for the SHIMMER project. The SHIMMER project was funded by the New South Wales Ministry of Health. The Kirby Institute is affiliated with the Faculty of Medicine, UNSW Australia. Simon Graham is supported by a McKenzie Post-doctoral fellowship and by the Melbourne Poche Centre for Indigenous Health at the University of Melbourne. Rebecca Guy, John Kaldor and Basil Donovan are supported by National Health and Medical Research Council Fellowships.

Publisher Copyright:
© 2015 Graham et al.

Keywords

  • Indigenous
  • Quality improvement shimmer
  • STI
  • Sexual health

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