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Improving Hepatitis B Management in an Urban ACCHO

Improving Hepatitis B Management in an Urban ACCHO

Aboriginal and Torres Strait Islander people are a priority population for hepatitis B (HBV) prevention, testing and treatment with current estimates of the prevalence of active infection between 2-4% in urban settings. The Victorian Aboriginal Health Service (VAHS) has provided universal childhood vaccination from the early 1990s. The aim of this project was to evaluate HBV-related clinical practice within VAHS through examination of clinical data including testing, immune status and follow up of chronic infection, and to implement evidence-based practice as per current guidelines.

This project was part of the REACCH collaboration. HBV testing data of all patients attending VAHS from 2009-2012 aged 15-54 were extracted from the clinical database (Communicare) using GRHANITEĀ® software. All serological markers relating to HBV immunity and infection were examined. A chart audit was undertaken to further examine immune and infection status, and management of chronic HBV infection. Changes were implemented to improve testing protocols, target immunisation of those at high risk of HBV infection, and better manage those with chronic HBV infection.

Of the total 5427 individuals who attended the medical service within VAHS in this period, 815 (15%) were tested for HBV. Of those tested, testing in accordance with current guidelines, increased from 6.4% to 71.8% in the study period. The findings of the chart audit (n=279) were; 53% Immune Vaccinated, 22% Resolved infection, 20% Non-immune, 3% Chronic infection. The changes implemented were (i) a routine testing protocol (HBVsAb and HBVcAb +/- HBVsAg), (ii) addition of HBV immune/infection status as a Clinical Item in Communicare and (iii) development of a Communicare template and recall system to support management of chronic HBV infection.

Clinical audit and implementation of protocols consistent with current guidelines has improved HBV-related practice at VAHS.

Australian Society for HIV 2014

Immune Control of the HIV reservoirs

Prevalence of Sexually Transmitted Infections (STIs) and patient characteristics of older men over 60 years of age attending a public STD clinic in South Australia

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.

Conducting clinical audits to improve sexual health service delivery in primary health care services: Successes, challenges and lessons learnt

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.

High prevalence, incidence and clearance of anal high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

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.

Efficacy and acceptability of a combination intervention for smoking cessation in HIV positive individuals: a pilot study

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.

Is the stage of the menstrual cycle related to chlamydia detection?

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.

Unpacking Chlamydia in Victoria: Retrospective analysis of surveillance data to estimate reinfection

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.