Remote Aboriginal Communities In Australia Research Articles

Community-based Aboriginal staff taking the lead in family support: a case study of transforming practices prompted by the COVID-19 pandemic

ABSTRACT The Play to Connect programme is an ongoing action research project investigating implementation of a parenting programme for families and children living in disadvantaged remote Aboriginal communities in Australia’s Northern Territory. The aim of this research was to identify critical skills and supports needed for community staff to deliver family support services in their community. The presented collaborative research project was undertaken by two community-based Aboriginal implementation officers and two visiting practitioners between March 2020 and December 2021. At this time, social service delivery was impacted by COVID-19 lockdown restrictions when visiting staff were temporarily permitted to fly into remote communities. The visiting practitioners interviewed the local Aboriginal community staff after family visits to explore how to build their professional competencies and contribute to the nature of programme delivery. Thematic analysis of the interviews and debriefing notes emphasise three key factors crucial in building professional competencies: experiential and reflective learning; partnership and collaboration; and increased self-efficacy. The promising practices identified have potential for broader application across Aboriginal communities to enhance cross-cultural and multi-disciplinary teamwork for service delivery. These professional development processes can ensure more accessible programmes for Indigenous communities based on cultural relevance and the diverse needs of participating families.

The Kimberley Dental Team: A process evaluation of a volunteer dental programme serving remote Aboriginal communities in Australia.

This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not-for-profit, volunteer organization providing care to remote Aboriginal communities in Western Australia. A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression. A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10-year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school-aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school-aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 (p < .001). The volunteer profile showed significant diversity beyond the conventional dentist-nurse structure and 40% being repeat volunteers. The KDT programme maintained a strong focus on service provision to school-aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity.

Community-Led Data Collection: Enhancing Local-Level Scabies Surveillance in Remote Aboriginal Communities in Australia.

Novel approaches to geohealth data analysis offer major benefits to neglected tropical disease control by identifying how social, economic and environmental elements of place interact to influence disease outcomes. However, a lack of timely and accurate geohealth data poses substantial risks to the accuracy of risk identification and challenges to the development of suitably targeted disease control programs. Scabies is one of many skin-related NTDs that is nominated as a priority for global disease control by the World Health Organization, but for which there remains a lack of baseline geospatial data on disease distribution. In this opinion paper, we consider lessons on impediments to geohealth data availability for other skin-related NTDs before outlining challenges specific to the collection of scabies-related geohealth data. We illustrate the importance of a community-centred approach in this context using a recent initiative to develop a community-led model of scabies surveillance in remote Aboriginal communities in Australia.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial.

The management of early childhood caries (ECC) is challenging. A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

Editors' Foreword

Editors' Foreword Mark G. Brett and Susan E. Hylen This issue of JBL was produced under extraordinary circumstances. The world was in lockdown in response to the COVID-19 pandemic, and each day we woke to news of rising infection rates and death tolls around the globe. There have been significant variations among the international reports, although a relentless unveiling of inequalities has been typical in many different contexts. In the United States and the United Kingdom, the infection statistics are disproportionately high; in Vietnam and Kerala, remarkably low. Remote Aboriginal communities in Australia have so far been spared, in part because their leaders saw the potential dangers very early and exhorted people to retreat to their traditional lands away from the centers of industry. Because Aboriginal people have suffered from imported diseases many times in the past, the communal memory was sensitized to the signs of danger.1 Amid these very pressing global concerns, academic journals have reported a dramatic fall in the number of submissions written by women. But as Gale Yee made clear in her Presidential Address to the Society of Biblical Literature last year, there are many other intersectional factors that need to be considered: race, color, and class would need to be added to our statistics before the dynamics of inequality could be understood in all their layered complexity. And even if some institutions in the United States can celebrate the participation of nonwhite faculty, there are researchers from universities in many other parts of the world who have never contributed to JBL. Most of us will be all too aware that patterns of inequality have steadily increased since the 1980s, and even the dismal science of economics has managed to produce bestsellers on the theme. Most recently, in Capital and Ideology, Thomas Piketty has delivered a one-thousand-page challenge to all of us who worry about [End Page 231] the problems generated by inequality in education.2 That book was written before the coronavirus pandemic, so there is already a new genre of revelation upon us. In the September issue of JBL this year, we are aiming to provide a forum on the topic "Biblical Studies in a Pandemic," and an international group of scholars has been asked to offer their brief reflections. We hope that this will just be one example of a lively debate in years to come. [End Page 232] Footnotes 1. Amy McQuire, "Aboriginal Community Health's Success with Covid-19," The Saturday Paper 298 (2020), https://www.thesaturdaypaper.com.au/news/health/2020/04/25/aboriginal-community-healths-success-with-covid-19/15877368009740. 2. Thomas Piketty, Capital and Ideology, trans. Arthur Goldhammer (Cambridge: Harvard University Press 2020). Copyright © 2020 Society of Biblical Literature

Talking skin: attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia.

Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. Nevertheless, there is limited knowledge about community, healthcare practitioner and service provider perspectives on skin infections and treatment preferences. An increased understanding of their respective knowledge, attitudes and practices will contribute to improving healthcare seeking behaviour, improved diagnosis, treatment acceptability and quality of care within remote Aboriginal communities. The aim of this study was to explore Aboriginal parent/carer, healthcare practitioner, and service provider attitudes and practices regarding skin infections in Aboriginal communities in remote communities in the Pilbara, Western Australia. The study documents their perspectives and preferences regarding treatments for skin infections, as well as the perceived barriers and enablers to treatment uptake for scabies and impetigo amongst Aboriginal families in this region. A qualitative study consisting of semi-structured interviews and focus group discussions was conducted with parents/carers, healthcare practitioners and community service providers in four remote communities in Western Australia. All interviews and focus group discussions were voice recorded and data were analysed using NVivo software and thematic analysis. Despite the high burden, skin infections were considered normal in these communities, and their impact on child health was under-recognised. Common themes identified by all participants included the inadequacy of health services, the pain of the benzathine penicillin G injection, uncertainty regarding the use of oral antibiotics and topical creams, and the need for health practitioner training and improved communication and resources. Documenting carer, service provider and healthcare practitioner perspectives on skin infections provides a more informed understanding of the context in which treatment decisions are made. The ongoing need for culturally appropriate targeted, translational health education; improved treatment guidelines and feasible, painless treatments; and potential for the use of bush medicines for skin infections were themes that emerged.

Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia

ObjectivesTo examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.DesignQualitative study.SettingPrimary health care services serving remote Aboriginal...

Treatment of scabies using a tea tree oil-based gel formulation in Australian Aboriginal children: protocol for a randomised controlled trial

IntroductionIn remote Aboriginal communities in Australia, scabies affects 7 out of 10 children before their first birthday. This is more than six times the rate seen in the rest of...

Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia

BackgroundYoung people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes.MethodsIn-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011–2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components.ResultsOf the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs.ConclusionsAcross all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044. Registered 6/05/2010. Prospectively Registered.

Soil-Transmitted Helminths in Children in a Remote Aboriginal Community in the Northern Territory: Hookworm is Rare but Strongyloides stercoralis and Trichuris trichiura Persist.

(1) Background: soil-transmitted helminths are a problem worldwide, largely affecting disadvantaged populations. The little data available indicates high rates of infection in some remote Aboriginal communities in Australia. Studies of helminths were carried out in the same remote community in the Northern Territory in 1994–1996 and 2010–2011; (2) Methods: fecal samples were collected from children aged <10 years and examined for helminths by direct smear microscopy. In the 2010–2011 study, some fecal samples were also analyzed by agar plate culture and PCR for Strongyloides stercoralis DNA. Serological analysis of fingerprick dried blood spots using a S. stercoralis NIE antigen was also conducted; (3) Results and Conclusions: a reduction in fecal samples positive for S. stercoralis, hookworm and Trichuris trichiura was seen between the studies in 1994–1996 and 2010–2011, likely reflecting public health measures undertaken in the region to reduce intestinal helminths. Comparison of methods to detect S. stercoralis showed that PCR of fecal samples and serological testing of dried blood spots was at least as sensitive as direct smear microscopy and agar plate culture. These methods have advantages for use in remote field studies.

Positive community responses to an arts–health program designed to tackle diabetes and kidney disease in remote Aboriginal communities in Australia: a qualitative study

ObjectiveThe Western Desert Kidney Health Project (WDKHP) is an innovative clinical screening, arts–health and community development program, staffed by Aboriginal health workers. The WDKHP is aimed at prevention and early detection, improving the chance of better management of kidney disease among people in 10 predominantly Aboriginal communities in rural Western Australia. This paper aimed to understand community responses to the WDKHP in three of these communities. MethodsInterviews were undertaken with 26 Aboriginal people living in three remote communities. Community responses were analysed with attention to the social organisation of participants in each community and a focus on the perspectives of key groups, identified here as ‘Community Leaders’, ‘Homelanders’, ‘Refuge Seekers’ and ‘Dislocated’. ResultsParticipants from all groups reported that the WDKHP was highly acceptable, and an effective means of drawing attention to the need for prevention, early detection and management of diabetes and kidney disease. The integration of Aboriginal health workers to explain the project contributed to the high rates of participation in clinical screening. ConclusionsOutreach clinical services can be an appropriate method of engaging people in remote communities in addressing diabetes and kidney disease. ImplicationsThe remote community setting can act as an ‘enabler’ of healthy lifestyle for Aboriginal people, particularly when augmented by well‐designed outreach programs.

Insights into nutritionists’ practices and experiences in remote Australian Aboriginal communities

Objective:To explore and describe methods of communication, education practices, perceived challenges and the potential role of nutritionists working in remote Australian Aboriginal communities in order to inform future public health efforts. Methods:Nutritionists who work or have worked in remote Aboriginal communities in Australia's Northern Territory within the past decade were identified via purposive and snowball sampling, and responded to a semi‐structured survey in 2012. Content and interpretive thematic analysis was used to generate themes. Results:Working approaches of 33 nutritionists are presented, representing 110 years of working experience in the Northern Territory. Emerging themes included: ‘Community consultation is challenging’, ‘Partnering with local people is vital’, ‘Information is not behaviour’, ‘Localisation of nutrition education is important’ and ‘Evaluation is tricky’. Available time, training background and workforce structure were said to constrain practice and those nutritionists with longer experience described a more culturally competent practice. Conclusions:Modifications in structure, training and support of the public health nutrition workforce, facilitation of professional and cultural partnerships, outcome evaluation and localisation and evaluation of health messages may promote more meaningful nutrition communication in remote communities. Implications:Findings can inform further investigation into the structures needed to improve public health skills for nutritionists transitioning from mainstream practice into the challenging cross‐cultural context of Aboriginal health settings.

A systematic review of the evidence that swimming pools improve health and wellbeing in remote Aboriginal communities in Australia

ObjectiveTo provide an overview of the evidence for health and wellbeing benefits associated with swimming pools in remote Aboriginal* communities in Australia. MethodsPeer‐reviewed and grey literature from 1990 to 2014 was searched to identify studies set in remote Australia that evaluated health and wellbeing benefits that have been associated with swimming pools. Studies were categorised using an evidence classification scale. ResultsTwelve studies met our search criteria. All prospective studies that collected data on skin infections found access to swimming pools to be associated with a drop of skin sore prevalence and ‐where measured‐ severity. Studies documenting ear and eye infections showed mixed outcomes. Many wider community and wellbeing benefits were documented in various studies, although many of these were primarily anecdotal in nature. ConclusionsAlthough a case can be made regarding skin infections and the broader wellbeing benefits that swimming pools may bring to remote Aboriginal communities, the benefit to ear and eye health remains unresolved. ImplicationsThe decision to provide swimming pools to remote Aboriginal communities should not hinge on the demonstration of direct health benefits alone. Equity considerations and the potential broader benefits such amenities may entail are equally important.

Reasons for delays in treatment of bacterial sexually transmissible infections in remote Aboriginal communities in Australia: a qualitative study of healthcentre staff.

Background Remote Aboriginal communities in Australia experience high rates of bacterial sexually transmissible infections (STIs). To control the transmission and decrease the risk of complications, frequent STI testing combined with timely treatment is required, yet significant delays in treatment have been reported. Perceived barriers to timely treatment for asymptomatic patients in remote communities were explored. A qualitative study was undertaken as part of the STRIVE (STIs in Remote communities, ImproVed and Enhanced primary health care) project; a cluster randomised controlled trial of a sexual health quality improvement program. During 2012, we conducted 36 in-depth interviews with staff in 22 clinics in remote Australia. Participants included registered nurses (72%) and Aboriginal health practitioners (28%). A key barrier to timely treatment was infrequent transportation of specimens to laboratories often hundreds of kilometres away from clinics. Within clinics, there were delays checking and actioning test results, and under-utilisation of systems to recall patients. Participants also described difficulties in physically locating patients due to: (i) high mobility between communities; and (ii) low levels of community knowledge created by high staff turnover. Participants also suggested strategies to overcome some barriers such as dedicated clinical time to follow-up recalls and taking treatment out to patients. Participants identified barriers to timely STI treatment in remote Aboriginal communities, and systems to address some of the barriers. Innovative strategies such as point-of-care testing or increased support for actioning results, coupled with incentives to individual patients to attend for results, may also assist in decreasing the time to treatment.

P6.007 Addressing Endemic Rates of STI in Remote Aboriginal Communities in Australia Using Quality Improvement as a Key Strategy: The STRIVE Study

BackgroundRemote Aboriginal communities in Australia have substantially higher rates of chlamydia (CT), gonorrhoea (NG) and trichomoniasis (TV) diagnosis compared with non-Indigenous people, despite many years of programme and policy aimed...

P5.036 The First Cluster Randomised Trial of a Molecular Chlamydia and Gonorrhoea Point-Of-Care Assay

IntroductionIn many settings, control of sexually transmissible infections (STIs) is compromised by lack of laboratory infrastructure, physical distance from laboratories and loss to follow up of patients. Point-of-care (POC) tests...

Transposing reform pedagogy into new contexts: complex instruction in remote Australia

This article draws on the outcomes of a 4-year project where complex instruction was used as the basis for a reform in mathematics teaching in remote Aboriginal communities in Australia. The article describes the overall project in terms of the goals and aspirations for learning mathematics among remote Indigenous Australians. Knowing that the approach had been successful in a diverse setting in California, the project team sought to implement and evaluate the possibilities of such reform in a context in which the need for a culturally responsive pedagogy was critical. Elements of complex instruction offered considerable possibilities in aligning with the cultures of the remote communities, but with recognition of the possibility that some elements may not be workable in these contexts. Complex instruction also valued deep knowledge of mathematics rather than a tokenistic, impoverished mathematics. The strategies within complex instruction allowed for mathematical and cultural scaffolding to promote deep learning in mathematics. Such an approach was in line with current reforms in Indigenous education in Australia where there are high expectations of learners in order to break away from the deficit thinking that has permeated much education in remote Australia. The overall intent is to demonstrate what pedagogies are possible within the constraints of the remote context.

Prevalences of overweight and obesity among children in remote Aboriginal communities in central Australia

The chronic diseases associated with overweight and obesity are major contributors to the excess disease burden of Aboriginal Australians. Surveillance of overweight and obesity is required to monitor these conditions, and to develop and evaluate interventions to improve health and wellbeing. Remote Aboriginal communities in Australia's Northern Territory (NT) are where approximately two-thirds of the NT Aboriginal people live, a proportion which has been stable over many years. However the remote communities suffer significant socioeconomic disadvantage including limited education and employment opportunities, and poor quality and overcrowded housing. Approximately one-third of Aboriginal people in NT live in central Australia, which consists of the Alice Springs and Barkly districts. The Healthy School-Aged Kids Program includes health promotion and child health screening, and is run in remote Aboriginal communities of NT. This report provides estimates of prevalences of overweight and obesity among children in central Australia who participated in health checks as part of Healthy School-Aged Kids Program in 2010. All children in remote central Australian Aboriginal communities were invited to participate in health checks. Children who attended were weighed and measured. Date of birth, sex, height and weight for each child were used to determine prevalence of overweight (≥+1 standard deviation [SD] BMI-for-age) and obesity (≥+2 SD BMI-for-age) according to WHO Growth standards. Differences in proportions of overweight and obesity by age group and sex, and their statistical significance were calculated. Weight, height, sex and age data were available for 996 children from a population of 1764. It was found that 22.1% of girls and 20.7% of boys were overweight; and 5.1% of girls and 5.8% of boys were obese as defined by BMI-for-age. Prevalence of overweight but not obesity increased with age (for overweight z=3.28, p=0.0011; for obesity z=0.68; p=0.50). The prevalences of overweight and obesity as estimated by BMI-for-age among children in remote central Australian Aboriginal communities were compared with those in other Australian surveys. They appear unlikely to reflect future relative risk of the chronic diseases with which overweight and obesity are associated. Routine collection of data on BMI-for-age may not provide adequate estimation of future risk of chronic disease burden attributable to overweight and obesity among these children. Alternative measures for surveillance for overweight such as waist circumference may prove more useful. Appropriate interventions to reduce risk of chronic disease are required, including interventions to reduce prevalences of overweight and obesity.

Haemoparasites of free-roaming dogs associated with several remote Aboriginal communities in Australia

BackgroundTick-borne haemoparasites Babesia vogeli and Anaplasma platys are common among the free-roaming canine populations associated with Aboriginal communities in Australia, whilst the prevalence of haemoplasmas, which are also suspected to be tick-borne, remained unexplored. The aim of this study was to determine the prevalence of haemoplasma infection in these populations, and to identify any correlation with other haemoparasites. Blood was collected from 39 dogs associated with four Aboriginal communities and screened for infection using PCR and serology. DNA was purified and PCR analyses for piroplasms, Anaplasmataceae family bacteria and haemoplasmas performed. Serum was analysed using a commercial haemoparasite ELISA. Prevalence of infection was compared between communities.ResultsSeventeen dogs (44%) were infected (PCR positive) with Mycoplasma haemocanis, eight (21%) with ‘Candidatus Mycoplasma haematoparvum’, 20 (51%) with A. platys, and 17 (44%) with B. vogeli. Two dogs were infected with a novel haemoplasma as determined by DNA amplification and sequencing. Two dogs (5%) were serologically positive for Dirofilaria immitis antigens, one (3%) was positive for Ehrlichia canis antibodies and nine (24nbsp;%) were positive for A. platys antibodies. Co-infections were frequent. Haemoplasma prevalence was highest (73%, 16/22) in Central Australia and lowest (22%, 2/9) in Western Australia (p = 0.017). In contrast, B. vogeli prevalence was low in Central Australia (18%, 4/22) but higher (78%, 7/9) in Western Australia (p = 0.003).ConclusionsThis is the first time haemoplasma infections, including a novel species, have been molecularly documented in Australian dogs. The wide regional variation in prevalence of some of the haemoparasite infections detected in this study warrants further investigation.

The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review

To systematically review evaluations of the impact of sexually transmissible infection (STI) programs delivered by primary health care services in remote Aboriginal communities. PubMed, Google Scholar, InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings and bulletins were searched to April 2011 using variations of the terms 'Aboriginal', 'programs' and 'STI'. The primary outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary health care service, STI programs and other clinical service outcomes were also described. Twelve reports described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a reduction in the age-adjusted chlamydia and gonorrhoea prevalence by 58% and 67%, respectively (1996-2003). In the Tiwi Islands of Northern Territory (NT), chlamydia and gonorrhoea positivity decreased by 94% and 34%, respectively (2002-2005). In the Ngaanyatjarra Lands of Western Australia, crude chlamydia and gonorrhoea prevalence decreased by 36% and 48%, respectively (2001-2005), and in the central Australian region of NT, there was no sustained decline in crude prevalence (2001-2005). In three of the four programs, there was some evidence that clinical best practice and well coordinated sexual health programs can reduce STI prevalence in remote Aboriginal communities.