Specialist antenatal services are an integral and effective component of service delivery in many Aboriginal community-controlled health services (ACCHSs). Sexual health screenings in ACCHS-led antenatal programs has not been thoroughly documented. The new Clinical Practice Guidelines – Antenatal Care Module 1 recommend that all pregnant women be screened for syphilis, HIV, hepatitis B infection with screening for chlamydia in women aged under 25. This study examined guideline adherence in antenatal STI screening advance of an evaluation of the effectiveness, culturally appropriateness and accessibility of existing services.
This project was undertaken as a component of the (Research Excellence in Aboriginal Community Controlled Health) REACCH collaboration. Service-wide testing for sexually transmitted and blood borne viral infections in addition to demographic information including pregnancy status was extracted via GRHANITE software. Overall STI and BBV testing and positivity in clients identified as pregnant in the system was examined.
A total of 203 pregnant women with 229 pregnancies attended the service in the time covered in this study. The mean age of pregnant women was 23.7 (SD=5.9) with a range of 15 (the youngest age covered by this data collection) to 40. Of the 203 women, 176 (87%) were Aboriginal or Torres Strait Islander with 19 (9%) non-Indigenous and 8 (4%) not identified. Across the four years of data reported here, the percentage of clients tested for syphilis 69%, HIV 66% and Hepatitis B infection 72% and chlamydia 80%. Across all age group, 63% of clients had all recommended STI tests and 89% had chlamydia testing in accordance with guidelines. The prevalence of chlamydia was 14.4% in women aged under 25 compared to 1.2% of women aged 25 and older.
These results add to the evidence base on specialised antenatal care services within Aboriginal Community Controlled Health Services. Rates of STI testing are generally comparable to other specialist services.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Most Australian guidelines for clinical screening of chlamydia infection advise testing sexually active individuals aged 16-24 years. Recent research shows that age at first sex in Australia is decreasing; a recent Victorian survey showed 29% of respondents reported being sexually active before age 16 years. There is also evidence that younger age at first sex is associated with risk behavior such as unprotected sex and having multiple sex partners.