Community-based sexual health care works: A review of the ACT outreach program
Masters of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, ANU College of Medicine and Health Science, The Australian National University, Canberra, ACT 2600, Australia. Sexual Health
(Impact Factor: 1.37).
10/2007; 4(3):201-4. DOI: 10.1071/SH07003
Men who have sex with men, sex workers, youth and university students are at increased risk for sexually transmissible infections (STI) and blood-borne viruses (BBV) and are therefore targets for sexual health services. In recognition of this, a collaborative project offering sexual health care in various outreach settings frequented by these groups was developed.
Data collected by clinicians during consultations in five outreach venues (a sex-on-premises venue, a community AIDS organisation, a university campus, brothels and a youth centre) between 2002 and 2005 were analysed.
During 119 clinics (~547 clinician hours), 313 individuals (205 males and 108 females) received education and/or testing. Of those screened, 6.0% (15/249) were positive for chlamydia and 12.7% (9/71) tested positive for hepatitis C (HCV) antibodies. No new cases of hepatitis B (HBV) or HIV were identified and 37.2% (71/191) of patients reported never having been previously tested for HIV. Seroprevalence of hepatitis A and HBV antibodies were 53.8% (91/169) and 52.1% (135/259), respectively. More than half of all four groups reported inconsistent use of condoms and 8.6% reported intravenous drug use.
Collaborations between agencies to provide outreach services facilitate community-based sexual health education and screening for groups at higher risk of STI and BBV. The database audit showed that through these outreach services cases of chlamydia and HCV that may have remained undetected were identified. The results also highlight the need for continuing hepatitis vaccination, testing, health promotion and education in these populations.
Available from: Elena Jeffreys
- "The 2001-2009 annual national surveillance report demonstrates that prevalence of HIV among sex workers has remained consistently low—less than 1% . In the Australian Capital Territory (ACT), a Canberra Sexual Health Centre study demonstrates that positive diagnosis of Chlamydia among sex workers between 2002 and 2005 was 1.6% and positive diagnosis of syphilis was 0.0% . Such low rates of STIs among sex workers are unique, particularly when one reviews these statistics in the context of wider studies on STIs rates among the general community. "
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ABSTRACT: Australia is an apt landscape upon which to measure the success of mandatory testing of HIV and sexually transmissible infections (STIs) among sex workers. Mandatory testing is implemented in some Australian jurisdictions and not others, allowing for a comprehensive comparison of the outcomes. It is apparent that mandatory testing of HIV and STIs among sex workers in Australia has proven to be a barrier to otherwise successful HIV and STI peer education, preven-tion and free and anonymous testing and treatment. The outcomes of mandatory testing are counterproductive to reduc-ing HIV and STI rates, do not reach the intended target group, are costly and inefficient, and mandatory testing has proven to be a very difficult policy to repeal once in place. Scarlet Alliance, the Australian Sex Workers Association, as well as numerous academics and policy leaders in Australia recommend against mandatory testing of HIV and STIs among sex workers.
Available from: Jacques Ducos
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ABSTRACT: We investigated the performance of dried blood spots (DBS) in hepatitis C virus (HCV) diagnosis using modified commercial tests. Paired DBS and serum samples were collected from 200 patients: 100 patients with anti-HCV antibodies (anti-HCV), including 62 patients with detectable serum HCV RNA, and 100 patients without anti-HCV. The DBS sample consisted of three drops of approximately 50 microL of whole blood applied to a paper card, which was then stored at -20 degrees C within 48 hours of collection. Using the Ortho HCV 3.0 enzyme-linked immunosorbent assay kit on DBS, we observed both a specificity and sensitivity of 99% in detecting anti-HCV. HCV RNA was detected on DBS in 60/62 (97%) patients with detectable serum HCV RNA, which was then successfully quantified in 55 samples (89%) using the Cobas TaqMan HCV test. A good correlation was observed between the DBS HCV RNA concentration and the serum level (r(2) = 0.95; P < 0.001). HCV genotyping was successfully performed on DBS samples, with a full concordance between the 14 paired DBS and serum samples (genotypes 1-4). Conclusion: This study presents DBS as a reliable alternative to serum specimens for detecting anti-HCV, quantifying HCV RNA and genotyping HCV. DBS may increase the opportunities for HCV testing and treatment follow-up in hard-to-reach individuals.
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ABSTRACT: A prospective study was undertaken to develop an evidence-based outreach chlamydia screening program and to assess the viability and efficiency of this complementary approach to chlamydia testing within the routine operations of a primary healthcare service.
A primary healthcare service based in Townsville, Queensland, Australia, identified high-prevalence groups for chlamydia in the community. Subsequently, a series of outreach clinics were established and conducted between August 2004 and November 2005 at a defence force unit, a university, high school leavers' festivities, a high school catering for Indigenous students, youth service programs, and backpacker accommodations.
All target groups were easily accessible and yielded high participation. Chlamydia prevalence ranged between 5 and 15% for five of the six groups; high school leavers had no chlamydia. All participants were notified of their results and all positive cases were treated (median treatment interval 7 days). Five of the six assessed groups were identified as viable for screening and form the basis for the ongoing outreach chlamydia screening program.
The present study developed an evidence-based outreach chlamydia screening program and demonstrated its viability as a complementary approach to chlamydia testing within the routine operations of the primary healthcare service, i.e. without the need for additional funding. It contributes to the evidence base necessary for a viable and efficient chlamydia management program. Although the presented particulars may not be directly transferable to other communities or health systems, the general two-step approach of identifying local high-risk populations and then collaborating with community groups to access these populations is.
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