Abstract
BackgroundDespite two decades of interventions, rates of sexually transmissible infections (STI) in remote Australian Aboriginal communities remain unacceptably high. Routine notifications data from 2011 indicate rates of chlamydia and gonorrhoea among Aboriginal people in remote settings were 8 and 61 times higher respectively than in the non-Indigenous population.Methods/designSTRIVE is a stepped-wedge cluster randomised trial designed to compare a sexual health quality improvement program (SHQIP) to usual STI clinical care delivered in remote primary health care services. The SHQIP is a multifaceted intervention comprising annual assessments of sexual health service delivery, implementation of a sexual health action plan, six-monthly clinical service activity data reports, regular feedback meetings with a regional coordinator, training and financial incentive payments. The trial clusters comprise either a single community or several communities grouped together based on geographic proximity and cultural ties. The primary outcomes are: prevalence of chlamydia, gonorrhoea and trichomonas in Aboriginal residents aged 16–34 years, and performance in clinical management of STIs based on best practice indicators. STRIVE will be conducted over five years comprising one and a half years of trial initiation and community consultation, three years of trial conditions, and a half year of data analysis. The trial was initiated in 68 remote Aboriginal health services in the Northern Territory, Queensland and Western Australia.DiscussionSTRIVE is the first cluster randomised trial in STI care in remote Aboriginal health services. The trial will provide evidence to inform future culturally appropriate STI clinical care and control strategies in communities with high STI rates.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044
Highlights
Despite two decades of interventions, rates of sexually transmissible infections (STI) in remote Australian Aboriginal communities remain unacceptably high
For almost two decades sexually transmissible infection (STI) diagnoses have occurred at hyperendemic rates in many remote Australian Aboriginal and Torres Strait Islander communities [1]
In 2011 the diagnosis rates of Chlamydia trachomatis and Neisseria gonorrhoeae among Aboriginal people resident in remote communities were 8 and 61 times greater than in the nonIndigenous population [1]
Summary
Rates of STIs in remote Aboriginal communities in Australia are unacceptably high and STRIVE will support health services to achieve ‘best practice’ STI care by evaluating the efficacy of a SHQIP in decreasing STI prevalence. STRIVE is the largest randomised controlled trial ever conducted among Aboriginal and/or Torres Strait Islander adults in Australia. The trial outcomes will enhance understanding of STI control and provide evidence of the effectiveness of SHQIPs in endemic communities as program data do not provide sufficient evidence of the effectiveness of programs. Results will provide valuable and much needed information to guide STI clinical practice and programs in remote Aboriginal settings and other vulnerable communities with endemic rates of STIs. Competing interests All authors declare no competing interests. All other authors reviewed the manuscript and contributed to the research protocol.
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