Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services.

Jane Goller,Mark Saunders,John M Kaldor,James Ward,Hammad Ali,Rebecca J Guy,Phyllis Yau,Margaret Hellard,Basil Donovan,Anna Bowring,Sophia Couzos

doi:10.1186/1472-6963-14-285

Abstract

BackgroundChlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.MethodsWe describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander (‘Aboriginal’) status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16–29 years and for chlamydia testing and positivity.ResultsData were included from 16–29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).ConclusionsHigher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

Highlights

Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people
Health services Of the six ACCHS one was located in a metropolitan area and the remaining were in regional/remote areas, whereas the majority of the General Practice (GP) clinics (14 of 25; 56%) and Sexual Health Services (SHSs) (13 of 22; 59%) were located in metropolitan areas
Of all patients attending GP clinics, 1.3% were recorded as being Aboriginal, 31.2% as non-Indigenous, and for 67.5% of patients Aboriginal status was not recorded

Summary

Introduction

Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The burden of chlamydia is highest among young Aboriginal and/or Torres Strait Islander people (hereafter ‘Aboriginal’) [6,7,8]. The focus of the Council of Australian Government’s commitment to Closing the Gap in health difference and life expectancy between non-Indigenous and Aboriginal peoples is principally directed towards mortality reduction from chronic disease and improvements to child and maternal health [12], with little focus on sexually transmissible infections (STIs) despite these causing substantial ill health among Aboriginal people. Included within the Closing the Gap initiative are measures to improve surveillance systems that lead to increased understanding of disease among Aboriginal people and communities

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Discussion

Conclusion