Lewis Marshall

University of Notre Dame Australia, Fremantle, Western Australia, Australia

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Publications (11)24.91 Total impact

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    ABSTRACT: Objective: To assess the clinical epidemiology of chlamydia among Aboriginal and Torres Strait Islander (Indigenous) people attending sexual health services around Australia. Design: Retrospective analysis of routine demographic, behavioural and clinical data, between 1 January 2006 and 31 December 2011. Setting: 18 sexual health services in major cities and regional centres in five jurisdictions. Main outcome measures: Attendance, chlamydia testing and positivity rates in patients visiting for the first time, and factors associated with chlamydia positivity. Results: Of 168 729 new patients, 7103 (4.2%) identified as Indigenous, of whom 74.3% were tested for chlamydia. Chlamydia positivity was 17.0% in Indigenous women (23.3% in 15-19-year-olds and 18.9% in 20-24-year-olds) and 17.3% in Indigenous men (20.2% in 15-19-year-olds and 24.2% in 20-24-year-olds). There was an increasing trend in chlamydia positivity in Indigenous women from 2006 to 2011 (P for trend = 0.001), but not in Indigenous men. In Indigenous women, factors independently associated with positivity were: younger age, being heterosexual, living in Queensland and attending the service in 2010. In Indigenous men, independent factors associated with chlamydia positivity were younger age, being heterosexual, having sex only in Australia and living in a regional area. Conclusion: The high and increasing chlamydia positivity rates highlight the need for enhanced prevention and screening programs for Indigenous people.
    The Medical journal of Australia 06/2014; 200(10):595-8. DOI:10.5694/mja13.10875 · 3.79 Impact Factor
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    Sexual Health 08/2013; DOI:10.1071/SH13066 · 1.58 Impact Factor
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    ABSTRACT: To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention called Emergency Contraception Mediated Pharmacy Access to Chlamydia Testing (ECOMPACT). Selective, opportunistic and cross-sectional study targeting asymptomatic women requesting emergency contraception (EC). 20 community pharmacies in the Perth metropolitan region, Australia. ECOMAPCT was developed through literature review and stakeholder consensus. Pharmacists were trained to offer ECOMPACT after the EC consultation. Women with signs and symptoms of sexually transmitted infections (STI) were referred to a physician for a full sexual health check. Asymptomatic women were offered a free ECOMPACT testing kit. The women self-collected a low-vaginal swab and returned their pathological specimen to designated drop-off sites. A pathology service analysed the specimens and sent the results to a sexual health physician. The effectiveness of ECOMPACT was determined by the uptake of the intervention and how well the target population was reached. An effective screening rate was calculated. Qualitative analysis was undertaken to understand acceptability issues from the perspective of the consumer and the pharmacists. Of the 769 EC consultations in a 6-month period, 569 (78%) women were given information on chlamydia screening. All 247 (41%) agreed to participate. 81 (33%) of these women were ineligible. They were either symptomatic (n=33; 41%), or were under 18 years of age (n=48; 59%). Pharmacists successfully requested 166 (67%) pathology tests, of which 46 (28%) were returned to a pathology drop-off site. All tested negative for Chlamydia trachomatis. The effective screening rate was 6%. Consumers and pharmacists considered ECOMPACT to be highly convenient and the time taken to offer a chlamydia test along with an EC consultation as highly appropriate. ECOMPACT was found to be simple, effective and acceptable. Given the opportunity, adequate training and support, community pharmacists in Australia were capable of requesting direct-to-consumer chlamydia tests.
    BMJ Open 08/2013; 3(8):e003338. DOI:10.1136/bmjopen-2013-003338 · 2.06 Impact Factor
  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A239-A239. DOI:10.1136/sextrans-2013-051184.0745 · 3.08 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine trends and correlates of chlamydia positivity among young heterosexuals attending Australian sexual health services and to compare these with population-based notification data. METHODS: Data from 18 sexual health services and the national notification scheme were analysed. A χ(2) test assessed trends in chlamydia positivity among young heterosexuals tested from 2006 to 2010, and logistic regression was used to determine correlates of positivity. Nucleic acid amplification tests were used throughout the study period. RESULTS: During 2006-2010, 64 588 heterosexuals aged 15-29 years attended the sexual health services for the first time and the annual chlamydia testing rate was consistently >80%. Overall, chlamydia positivity increased by 12%, by 8.3% in heterosexual men (from 13.2% in 2006 to 14.3% in 2010; p-trend=0.04) and by 15.9% in women (from 11.3% in 2006 to 13.1% in 2010; p-trend<0.01). Independent correlates of chlamydia positivity in sexual health service patients were being aged 15-24 years, residing in a regional/rural area, being Aboriginal and/or Torres Strait Islander, being a non-Australian resident and attending in 2010 compared with 2006. Over the same period, the population-based notification rate increased by 43% against a background of a >100% increase in testing. CONCLUSIONS: The sexual health service network suggests a moderate increase in chlamydia prevalence in young heterosexuals tested at sexual health services, in contrast to the steep increase shown by notifications. This highlights the caution needed in interpreting chlamydia trends without a corresponding testing denominator.
    Sexually transmitted infections 05/2012; 88(7). DOI:10.1136/sextrans-2011-050423 · 3.08 Impact Factor
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    ABSTRACT: To describe the frequency of the 3-month test for re-infection among sexual health service patients in Australia. We assessed the re-testing rates at 30-120 days after chlamydia infection in men who have sex with men (MSM), heterosexual males and females attending sexual health services across Australia between 2004 and 2008. A χ(2)-test was used to determine significant differences in re-testing rates according to demographic characteristics and trends over time. In the 5-year period, 10207 MSM, 28530 heterosexual males and 31190 heterosexual females were tested for chlamydia. Of those tested, 9057 (13.0%) were positive. The proportion of patients with chlamydia infection who were re-tested in 30-120 days was 8.6% in MSM, 11.9% in heterosexual males and 17.8% in heterosexual females. Among MSM, chlamydia re-testing rates were lower in men aged <30 years (8.4%) than ≥30 years (12.5%) (P=0.04) and lower in travellers and migrants (2.9%) than non-travellers (9.9%) (P=0.002). In heterosexual males, chlamydia re-testing rates were lower in men in regional and rural areas (10.5%) than metropolitan areas (13.5%) (P=0.017). There was no increasing trend in re-testing rates between 2004 and 2008 (P=0.787). Of the patients re-tested, 44.1% of MSM were positive, 21.0% of heterosexual males and 16.1% of females. The high chlamydia positivity at 30-120 days support recommendations that call for a 3-month test for re-infection following a positive test. The low re-testing rates highlight the need for innovative strategies to increase re-testing.
    Sexual Health 06/2011; 8(2):242-7. DOI:10.1071/SH10086 · 1.58 Impact Factor
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    ABSTRACT: In most Australian settings, chlamydia notifications do not contain information on the gender of sexual partners. We assessed trends and predictors of chlamydia testing and positivity among men who have sex with men (MSM), attending sexual health services in Australia. The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) program was established in 2008 to collate demographic and chlamydia testing information from 25 sexual health services. We calculated the proportion tested and chlamydia positivity among MSM and assessed trends from 2004 to 2008 using a χ2 test and predictors using logistic regression. In the 5-year period, 11,777 MSM attended as new patients (first visit ever to the service) and the proportion tested for chlamydia increased significantly from 71% in 2004 to 79% in 2008 (P < 0.01). Independent predictors of chlamydia testing were younger age, residing in a metropolitan area (adjusted prevalence ratio [APR] = 1.23; 95% confidence interval [CI]: 1.19, 1.27), being Australian-born (APR = 1.03; 95% CI: 1.01, 1.06), being a traveler or migrant (APR = 1.09; 95% CI: 1.06, 1.12), and sex overseas in the past year (APR = 1.05; 95% CI: 1.03, 1.07). Overall chlamydia positivity was 8.6% (95% CI: 8.0%-9.2%). There was no significant trend in chlamydia positivity between 2004 and 2008. Independent predictors of chlamydia positivity were younger age, being a traveler or migrant (APR = 1.52; 95% CI: 1.26-1.84), and exclusive same-sex contact (APR = 1.28; 95% CI: 1.05-1.55). This new national surveillance program demonstrates that the majority of MSM attending sexual health services was offered chlamydia testing and testing has increased over time. The MSM at highest risk of chlamydia were more likely to be tested. Chlamydia transmission was frequent but stable among MSM accessing clinical services.
    Sexually transmitted diseases 04/2011; 38(4):339-46. DOI:10.1097/OLQ.0b013e318202719d · 2.75 Impact Factor
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    ABSTRACT: Australia has a widely dispersed network of public sexual health services that test large numbers of people from high prevalence populations for genital Chlamydia trachomatis infection. These populations include young sexually active heterosexuals, men who have sex with men, sex workers and Aboriginal and Torres Strait Islander people. The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project was established to monitor chlamydia testing rates and positivity rates at a national level, which in turn will help interpret trends in chlamydia diagnoses reported through passive surveillance. The ACCESS Project is the first time that chlamydia-related data including priority population and testing denominators has been collated at a national level. The present paper reports on chlamydia testing and positivity rates in a sexual health service in the inner west of Sydney between 2004 and 2008 and compares these to published national data from the ACCESS Project in sexual health services. Chlamydia positivity and testing rates at an inner western Sydney sexual health service were compared with aggregate data from the ACCESS Project obtained from 14 sexual health services across Australia. Using a standardised extraction program, retrospective de-identified line-listed demographic and chlamydia testing data on all patients were extracted from patient management systems. Over the 5-year period, 5145 new patients attended the inner-west sexual health service. Almost 66% had a chlamydia test at first visit and there was no significant difference in this testing rate when compared with the ACCESS Project national rate for sexual health services (67.0%; odds ratio [OR] 0.94, 95% confidence intervals 0.88-1.00). The testing rate increased over time from 61% in 2004 to 70% in 2008. There were 281 chlamydia diagnoses at this service, giving an overall chlamydia positivity rate of 9.3%, significantly higher than the ACCESS Project national rate of 8.2% (OR 1.16, 95% confidence intervals 1.02-1.32). Testing rates were similar and positivity rates for Chlamydia trachomatis were higher in this sexual health service in Sydney than national trends.
    Sexual Health 12/2010; 7(4):478-83. DOI:10.1071/SH09125 · 1.58 Impact Factor
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    ABSTRACT: In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, we compared health promotion programs in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalized if licensed, unlicensed brothels criminalized), Perth (criminalization of all forms of sex work) and Sydney (sex work largely decriminalized, without licensing). We interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Despite the different laws, each city had a thriving and diverse sex industry and a government-funded sex worker health promotion program with shopfront, phone, online and outreach facilities. The Sydney program was the only one run by a community-based organisation and the only program employing multi-lingual staff with evening outreach to all brothels. The Melbourne program did not service the unlicensed sector, while the Perth program accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; p<0.001). Sex workers in Melbourne's licensed brothels were the most likely to have access to free condoms (Melbourne 88%, Sydney 39%, Perth 12%; p<0.001). The legal context appeared to affect the conduct of health promotion programs targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer-education and support.
    Australian and New Zealand Journal of Public Health 10/2010; 34(5):482-6. DOI:10.1111/j.1753-6405.2010.00594.x · 1.90 Impact Factor
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    ABSTRACT: Young males have a key role in shaping contraceptive use in a sexual relationship, yet often remain the invisible partner in safe sex promotion. This article describes a conceptual model of STI risk and condom use based on the perceptions and experiences of condom use in a group of young Australian males. An explorative descriptive design was used to conceptualize participants' condom use histories into an organized description of behavior. Forty-two semi-structured interviews were conducted with a purposive sample of males aged 15 to 25 years over an 18 month period. A sequential analytical process of data immersion, coding, and category generation was used to identify personal meanings, motivations, and contextual factors associated with condom use and non-use. Three primary discourses associated with young males' perceptions of STI risk and responding approach to condom use constructed personal commitment to sexual safety as dynamic, context-dependent, and outcome-driven (pregnancy versus STIs as the primary motivator of condom use). A regretful discourse associated with experiences of, or suspected unwanted outcomes, also emerged through changes in risk appraisals and safe sex intentions and behavior. Interventions to increase condom use should go beyond the traditional focus on risky behavior and disease prevention frameworks by addressing the contextual influences on personal risk appraisals and deliver innovative messages to reduce negative social meanings associated with condom use.
    Archives of Sexual Behavior 09/2010; 41(2):487-95. DOI:10.1007/s10508-010-9664-6 · 3.53 Impact Factor
  • Kim L Taylor, Rhonda M Clifford, Lewis Marshall
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    ABSTRACT: Background Chlamydia trachomatis notification rates continue to rise in high-risk groups such as women presenting for emergency contraception. Screening reduces the incidence and complications of chlamydia infections. Community pharmacies would be suitable for the provision of Chlamydia screening.AimTo determine the acceptability to pharmacists and women, of a community pharmacy-based Chlamydia screening program.Method2 questionnaires were designed for pharmacists and women (aged 18-29 years). Participants were asked to complete the questionnaire on Chlamydia screening. This information was then collated and analysed.ResultsOf the 25 pharmacists surveyed, 84% supported a pharmacy-based Chlamydia screening program. Pharmacists indicated that they would be comfortable providing the kit (92%), counselling results (88%) and providing antibiotics (80%). Of the 50 women surveyed, 76% would accept and return a sample while 53% indicated a preference for testing by doctors. Privacy and confidentiality were major concerns identified by the women.ConclusionA well-structured Chlamydia screening program in community pharmacies would be strongly supported by pharmacists and women. The screening program should involve pharmacists supplying a kit to women who request it or as part of an emergency contraception consultation, receiving the urine sample, explaining the results and supplying antibiotics. This program is likely to be successful in pharmacies that provide anonymity, privacy and a friendly environment with approachable female staff.
    Journal of Pharmacy Practice and Research 12/2007; 37(4):287-291. DOI:10.1002/j.2055-2335.2007.tb00767.x

Publication Stats

56 Citations
24.91 Total Impact Points


  • 2014
    • University of Notre Dame Australia
      Fremantle, Western Australia, Australia
  • 2010–2013
    • University of Western Australia
      • School of Medicine and Pharmacology
      Perth City, Western Australia, Australia
  • 2010–2012
    • Fremantle Hospital and Health Service
      Fremantle, Western Australia, Australia