Lewis Marshall

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

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Publications (9)19.82 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.
    Full-text · Article · Jun 2014 · The Medical journal of Australia
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    ABSTRACT: Introduction: M Clinic, managed by the Western Australian AIDS Council (WAAC), opened in Perth in 2010. A novel community/peer-worker based clinical service targeting gay, bisexual and other men who have sex with men (MSM), it complements traditional hospital-based sexual health clinics (HSHCs) operating in Perth and Fremantle. We assessed MSM client HIV and sexually transmissible infection (STI) testing and result delivery preferences at these services. Methods: From March to July 2012, MSM attending M Clinic, Sauna Clinic, Fremantle SHC and Royal Perth SHC were invited to complete anonymous client questionnaires assessing HIV/STI testing and result delivery preferences. Chi-square tests were used to assess differences between clients at WAAC clinics and HSHCs. Results: Of 373 participants, 257 (68.9%) were recruited at M Clinic. Ever testing for HIV (88.4%) and STIs (89.7%) did not differ by clinic type; though compared with HSHC MSM, WAAC clinic clients were less likely to have tested for STIs in the last year (p=0.042). Overall, 71.4% of participants preferred alternative delivery of HIV negative results by telephone, email or text message. Compared with HSHC MSM, WAAC clinic clients were more likely to prefer receiving positive HIV (p=0.001) and STI (p=0.006) results via alternative methods rather than in person. No recent check-up was more common among WAAC clinic clients as a reason for testing (p<0.001). WAAC clinic clients were more likely to worry about confidentiality (p=0.025) and HSHC MSM more likely to report not having had sex recently (p=0.013) as reasons for not testing. Self-collection of anal swabs was more common at WAAC clinics (p<0.001), consistent with their clients’ preference for self-collection (p<0.001). Conclusion: Compared with HSHC MSM, M Clinic clients were more likely to prefer non-traditional methods for HIV/STI testing and result delivery. These findings may inform planning for community/peer-worker based services targeting MSM in other jurisdictions. Disclosure of Interest Statement: The Kirby Institute and National Centre in HIV Social Research receive funding from the Australian Government Department of Health and Ageing and the New South Wales Ministry of Health. The Western Australian AIDS Council, M Clinic, Fremantle Sexual Health Service and Royal Perth Sexual Health Clinic receive funding from the Western Australia Department of Health. The WASHS project was supported by a National Health & Medical Research Council Program Grant. DPC was supported by a scholarship from Australian Rotary Health/Sydney CBD Rotary Club and The Kirby Institute.
    Full-text · Conference Paper · Oct 2013
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    ABSTRACT: To answer a key question ('Are Australian sexual health clinics attracting priority populations?'), we used data from 44 Australian sexual health clinics between 2004 and 2011. We assessed the proportion of patients that were from priority populations (deemed to be at risk of sexually transmissible infections) and compared this to their proportions in the general population using data from Australian Bureau of Statistics and the Australian Study of Health and Relationships. A χ(2)-test was used. A total of 278154 new patients attended during 2004-2011. The proportions from each priority population were significantly higher (P<0.01 for all) than for the general population: young people aged 15-29 years (58.1% v. 20.1%), men who have sex with men (26.0% v. 6.0%), female sex workers (10.8% v. 0.5%), and Aboriginal and Torres Strait Islander people (4.2% v. 2.3%). This study confirms that Australian sexual health clinics attract higher proportions of priority populations and are thus meeting their mandate as defined in the 2010-2013 National Sexually Transmissible Infections Strategy.
    Full-text · Article · Aug 2013 · Sexual Health
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    ABSTRACT: Introduction Australia has a widely dispersed network of public sexual health services that see large numbers of people at risk of genital Chlamydia trachomatis infection. ACCESS was established to monitor chlamydia testing and positivity rates nationally and to assist the interpretation of chlamydia diagnoses reported through passive surveillance. We report on chlamydia testing and positivity in Aboriginal and Torres Strait Islander (hereafter Aboriginal) people attending 18 sexual health services participating in ACCESS between 2006 and 2011. Methods Using line-listed data, we analysed Aboriginal status reporting, testing rates based on first visits and chlamydia positivity in those tested. Outcomes were stratified by age group, sex, and year of attendance and were compared with non-Indigenous clients using a chi-square test and multivariate logistic regression (p < 0.05). Results From 2006 to 2011, 7,103 (4.2%) Aboriginal people and 161,626 (95.8%) non-Indigenous people attended participating sexual health services for an initial visit. Of the Aboriginal people 5,280 (74%) were tested for chlamydia. The positivity rates in Aboriginal people were 17.0% in women (23.3% in 15–19 year olds and 18.9% in 20–24 year olds) and 17.3% in men (20.2% in 15–19 year olds and 24.3% in 20–24 year olds). There were increasing trends seen in chlamydia positivity in Aboriginal and Torres Strait Islander females and non-Indigenous males and females between 2006 and 2011 (p-trend < 0.01). On multivariate analysis, positivity was associated with younger age, being heterosexual and living in Queensland in both Aboriginal men and women. In addition, in Aboriginal men, positivity was associated with not living in a remote area, and not having sex overseas; and in Aboriginal women, it was associated with attending in 2010 or 2011. Conclusion The high Chlamydia positivity rates and increases over time highlight the need for enhanced prevention and screening programmes in Aboriginal people in Australia.
    Full-text · Article · Jul 2013 · Sexually Transmitted Infections
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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 χ2 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.
    Full-text · Article · May 2012 · Sexually transmitted infections
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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.
    Full-text · Article · Jun 2011 · Sexual Health
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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.
    No preview · Article · Apr 2011 · Sexually transmitted diseases
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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.
    No preview · Article · Dec 2010 · Sexual Health
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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.
    No preview · Article · Oct 2010 · Australian and New Zealand Journal of Public Health