Aboriginal and Torres Strait Islander Health Program Studies

Aboriginal Surveillance Reports

In 2007 the NCHECR formally approved the development of an Aboriginal and Torres Strait Islander Health Program within the Centre. The program works collaboratively across sectors to bridge the unacceptable gaps in health outcomes in sexual health and blood borne viruses between Aboriginal and Torres Strait Islander peoples and non Indigenous peoples.

The overall objective of the Aboriginal and Torres Strait Islander Health Program is to enhance the capacity of Aboriginal communities in responding to STIs, HIV and viral hepatitis and to develop NCHECR’s ability to work effectively on improving sexual health and BBV health outcomes for Aboriginal and Torres Strait Islander people in Australia through the conduct of rigorous and culturally appropriate research.

Aims: The program has four main domains of activity that aims to enhance Sexual Health and BBV activities within Aboriginal and Torres Strait Islander communities.

3 - Capacity Building - Work with existing health services in enhancing capacity of systems and workforce in the areas of sexual health and BBV service delivery, research and surveillance.

4 - Information dissemination through the development of a comprehensive clearinghouse of Aboriginal and Torres Strait Islander Sexual Health initiatives including surveillance and research
Program Structure

The Aboriginal and Torres Strait Islander Health Program hosts the following studies:
STRIVE: STI in Remote communities: ImproVed & Enhanced primary health care
Funding: National Health and Medical Research Council
Years: 2009-2013
Principal investigators: Kaldor, J., Ward, J., Rumbold, A., Guy, R., Law, M., Donovan B., Maher, L. McDermott, R.

STRIVE is a a randomised community trial to control sexually transmitted infections in remote Aboriginal communities in northern and central Australia.

Objectives of STRIVE

Primary:

(1) To determine whether targeted clinical review and support provided to health services can achieve substantive and sustained improvements in the provision of sexual health clinical services in remote Aboriginal communities.

(2) To determine whether the attainment of best practice levels in clinical activity can reduce the prevalence of STIs in these communities.

Secondary:

(1) To measure the impact of the STRIVE trial on health service staff.

(2) To measure other non-STRIVE activities which may influence sexual health service delivery

Study Design:

A community-based, multi-state, randomised community trial, comparing ‘best practice’ STI care in primary health care Services to standard STI care, over a three-year period. During the first year of the study, 21 communities will be recruited to participate in the trial, and undergo preparatory procedures for the trial. At the start of each of the next three years, seven of the communities will be randomly assigned to receive an intervention of clinical review and support aimed at enhancing service delivery, so that by the start of year four, all 21 communities will be receiving the intervention.

Collaborating institutions on STRIVE

• National Centre in HIV Epidemiology and Clinical Research
• Menzies School of Health Research
• Northern Territory Department of Health and Families
• Aboriginal Medical Services Alliance of the Northern Territory
• University of Adelaide
• Central Australian Aboriginal Congress
• University of Melbourne

Centre for Clinical Research Excellence in Aboriginal Health- with a focus on STIs and BBVS
Funding: National Health and Medical Research Council
Years : 2009-2013
Chief Investigators: Kaldor, J., Ward J., Dore, G., Donovan, B. , Delaney Thiele, D., Couzos, S., Hunt, J., Scrimgeour, D.
Associate Investigators: Mooney Somers, J., Saunders, M., Waples-Crowe, P., Williams, S.
To develop a Centre for Clinical Research Excellence with a focus on sexually transmissible and blood borne viral infections within the Aboriginal Community Controlled Health Sector (ACCHS) in Australia. The CCRE is collaboration between the National Centre in HIV Epidemiology and Clinical Research (NCHECR) and the National Aboriginal Community Controlled Health Organisation (NACCHO). This CCRE is built upon the signing of a MOU signed in April 2008 between the two organisations.

Together, NCHECR and NACCHO will develop and implement a clinical research program through five selected ACCHS in urban and regional areas that with an aim of improving clinical practice and program delivery in this sector.

This CCRE will also enhance clinical research capacity at individual ACCHS participating in the program; as well developing a new clinical research network within ACCHS that may have the ability to expand the scope of activities beyond the life of this grant.

The following Aboriginal Community Controlled Health Services are clinical sites within the CCRE
Nunkawarrin Yunti, Adelaide, South Australia
Goondir Aboriginal Health Service, Dalby, Queensland
Durri Aboriginal Medical and Dental Service, Kempsey NSW
Victorian Aboriginal Health Service Melbourne, VIC
Western Sydney Aboriginal Medical Service, Sydney, NSW

National Survey of young Aboriginal People regarding risk behaviours, knowledge and health service access
Funding: Australian Research Council
Years: 2009-2013 conduct the first ever national survey of young Aboriginal people
Chief Investigators: Ward, J., Worth, H., Smith, A., Pitts, M., Kaldor, J., Bryant, J.
It is well documented that Aboriginal people of Australia experience poorer health at disproportionate levels compared with their non Indigenous counterparts, including much greater levels of bacterial STIs and viral hepatitis. As a result, young Aboriginal people are deemed a priority population in the strategies for these infections both nationally, and in almost every jurisdiction. Young Aboriginal people are arguably the most marginalised of any identifiable group in Australian society. They are recognised as being difficult to engage through health services and, anecdotally, appear to have much higher levels of risk behaviour than non-Aboriginal young people. Despite the public health importance of this issue, little is known about the knowledge, attitudes and risk behaviours of young Aboriginal people in relation to sexual health and blood borne viruses, nor of the types of health services they choose to utilise. Mainstream surveys tend not to collect enough statistical information relating to Aboriginal people, particular those in regional and remote settings. In order to support programs and policy development, it is timely to develop practical mechanisms for collecting systematic information of this kind.

Previous Research In May 2006, the NSW Health Department awarded the Aboriginal Health and Medical Research Council of NSW and the National Centre in HIV Social Research funding to conduct a pilot project of behavioural research among young Aboriginal people. The pilot survey aimed to

• Assess levels of knowledge, risk practice and access to health services in relation to sexually transmissible infections (STIs) and blood borne viruses (BBVs) among Aboriginal people aged 16 to 30 in New South Wales;
• Examine associations between demographic and contextual variables, knowledge, risk practices, and access to health services;
• Pilot the proposed survey methodology, then seek funding to replicate the survey every two years;
• Build research capacity within Aboriginal communities.

Proposed Methodology

We plan to conduct surveys in all jurisdictions. Specific details would be negotiated at the jurisdictional level, while ensuring that there was a common core of information collection at all sites. Data will be collected using PDAs. This technology allows for communities with English as a second language to be active participants as the survey can be spoken in language and downloaded to the handheld computers then survey participants can complete the survey by listening to survey in privacy through head phones.

In each jurisdiction, between 300 and 600 young Aboriginal people aged between 16-30 will be surveyed over a two year period at a mixture of locations and events giving a total sample size of between 2000-4000. Each of the NACCHO Affiliates will be funded to identify appropriate events for data collection, and to organise a data collection mechanism. Engagement and employment of young Aboriginal people within the research process will be a prominent feature of this project with capacity building provided by each of the National Research Centres (2-3 jurisdictions per centre) in partnership with NACCHO. The design and conduct of the survey will be overseen by a national committee. The total period of the project will be for four years with an initial one year consultative and methodological development stage, two years of data collection a year for evaluation, analysis and community reporting.

The objective of this linkage grant will be to work collaboratively to bring about change in Aboriginal and Torres Strait Islander communities. From the successful pilot study we believe we have the right team and methodology to be able to complete this research in Aboriginal communities.

Expected outcomes

• A cost-effective initiative
• Local information to assist in the development of policies and programs relevant to young Aboriginal people in each jurisdiction populations
• Information that can be used of epidemiological modelling as a tool for planning future health services.

NSW Aboriginal Health Research Program
Funding: NSW Health Department
Years: 2008-2011
Chief Investigators: Ward, J., Kaldor J.
For the development of an Aboriginal Health Research Program within NSW Aboriginal Communities. This grant includes a trial aimed at enhancing clinical practice to reduce STIS in urban and regional Aboriginal primary health care settings in NSW, a general practice survey and a study of HCV treatment outcomes with Aboriginal patients.

In addition the program collaborates on the following projects

Evaluation and monitoring of 6 Commonwealth funded STI Youth Demonstration Projects
Funding: AIHW
Years: 2008-2010
The Aboriginal and Torres Strait Islander health program is currently working the Australian Institute for Health and Welfare to develop an evaluation framework for 6 demonstration youth STI projects nationally (2 NT, 3 NSW, 1 VIC).

Design Modelling and Evaluation of a Chlamydia Testing Pilot Program in General Practice
Funding: Department of Health and Ageing

The Aboriginal and Torres Strait Islander Health Program has a supporting in this project that aims to assess the feasibility, acceptability and cost-effectives of an organised program for chlamydia testing in general practice. The secondary aim this project is to increase testing and awareness of Chlamydia in the Australian population.

STI Modelling Grant
Funding NHMRC Project Grants
Chief Investigator: Hocking, J., Regan, D., Wilson, D., Philp, D., Smith, A., Grulich, A., Ward, J.
Years: 2009-2011
This project will use mathematical models to assess the impact of interventions to reduce sexually transmitted infections in Australia. The aims of this project will be to develop dynamic mathematical models to describe the transmission of chlamydia, gonorrhoea and syphilis in Australian populations and further our understanding of their epidemiology. These will then be used to assess the impact of interventions and the cost effectiveness on the incidence and prevalence of chlamydia, gonorrhoea and syphilis in Australian populations.

Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS).
Funding: Department of Health and Ageing
Years: 2008-2011
Along with the Burnet Institute and NACCHO I am a collaborator on this project particularly in establishing a surveillance network with Aboriginal Community Controlled Health Services. The ACCESS program aims to establish a national chlamydia sentinel surveillance system that will help evaluate the impact of interventions designed to control chlamydia in Australia.

Increasing completeness of ‘Aboriginality’ in infectious diseases data through record linkage – a feasibility study
Source: NSW Health
Year: 2008-2009
Chief Investigators: Corner, H., Bartlett, M., McAnulty, J., Ward, J.
The aim of this project is therefore to improve availability and validity of epidemiological data on notifiable diseases in Aboriginal people in NSW so that incidence and prevalence of these diseases can be more accurately estimated. The objective of this project is to link records from the Notifiable Diseases Database (NDD) with other routinely collected population health databases to prepare a de-identified ‘snapshot’ dataset, with improved completeness of ‘Aboriginality’.

Development and trial of Key Performance Indicators For Sexually Transmitted Infection Control In Clinical Settings with High Bacterial Prevalence
Chief Investigators: Silver, B., Rumbold, A., Ward, J., Kaldor, J., Skov, S.
Year: 2008-2009
A review of the literature has revealed a lack of performance indicators relevant to settings with a high prevalence of bacterial STI, such as in the Northern Territory (NT). This project aims to identify, develop, trial and endorse a core set of key performance indicators (KPI) relevant to STI control in the NT. This will improve monitoring of STI control programs allowing comparison between regions and services.

Pelvic Inflammatory Disease in the Primary Health Care Setting: An Investigation Of Clinical Management.
Chief Investigators: Silver, B., Rumbold, A., Smith, K., Knox, J., Ward, J., Kaldor, J., Boyle, J.
Years: 2008-2009
A case note audit will be undertaken to review current clinical practice in relation to the management of women of reproductive age who present to remote community clinics in Central Australia with signs and symptoms of pelvic inflammatory disease and/or urinary tract infection. Secondly, a staff questionnaire will investigate the perceived barriers and facilitators to implementing recommended guidelines for the management of PID. This two fold approach will provide health services with quality data that can inform what improvements are required in the care that women are currently receiving when presenting with signs and symptoms of PID.

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