Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.
Methods: Clinical audits were conducted in sixteen ACCHS in urban, regional and remote locations across Australia, between 2008 and 2013 as part of various sexual health CQI programs. Technical assistance was provided to ACCHS to extract and collate health service data regarding STI testing and management. Results and recommendations were fed back to health services in the form of written reports and facilitated discussion with staff.
Results: Despite the differences between the participating ACCHS and their locations, the gaps identified and factors that enhanced or created barriers to improving outcomes were similar across services. Increases in STI testing occurred more easily among female than among male clinic attendees due to the integration of STI testing into routine health screening and reproductive health visits among women. Factors within services which facilitated improved outcomes included: the presence of key management and clinical staff to drive changes in response to recommendations; systematic approaches to any health screening already in place; the integration of STI testing into existing health screening among 15 to 29 year olds; effective communication and team work amongst staff; engagement with medical staff; and regular review and feedback. The lack of those factors provided challenges to increasing STI testing among clinic attendees, particularly among men.
Conclusion: Clinical audits in the context of CQI programs can assist services to improve outcomes in STI testing and management. The factors that facilitate or create challenges to addressing gaps identified are fairly consistent across a range of services and should be taken into account when developing and implementing sexual health CQI programs.
Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.
Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.
Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.
HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.
We investigated the association between chlamydia detection and stage in the menstrual cycle to investigate whether chlamydia detection was higher at different stages of the cycle. Electronic medical records for women attending Melbourne Sexual Health Centre March 2011 - 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate OR (95%CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables.
Chlamydia is prevalent among young Australians. The latest national surveillance report (2011) shows a rate of diagnosis of 1400 per 100,000 population aged 15-29 years. In Victoria, the number of notifications in 2011 was 19,238; 81% in 15-29 year olds; however notifications continue to rise in all age groups. International evidence suggests chlamydia reinfection is responsible for a substantial burden of infections. Given the associated health risks, monitoring reinfection in the population is important to understand disease burden and evaluate interventions. We describe the rate of reinfection and time between infections in Victoria, 2004-2011.