The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic reviewRebecca Guy A G , James S. Ward A , Kirsty S. Smith A , Jiunn-Yih Su B , Rae-Lin Huang C , Annie Tangey D , Steven Skov B , Alice Rumbold E F , Bronwyn Silver F , Basil Donovan A and John M. Kaldor A
A Kirby Institute, University of New South Wales, Sydney 2010, NSW, Australia.
B Centre for Disease Control, Department of Health, Northern Territory Government, Darwin 0810, NT, Australia.
C Nganampa Health Council, Alice Springs 0871, NT, Australia.
D Ngaanyatjarra Health Service, Alice Springs 0871, NT, Australia.
E University of Adelaide, Adelaide 5005, SA, Australia.
F Menzies School of Health Research, Darwin 0810, NT, Australia.
G Corresponding author. Email: Rguy@kirby.unsw.edu.au
Sexual Health 9(3) 205-212 http://dx.doi.org/10.1071/SH11074
Submitted: 16 May 2011 Accepted: 19 August 2011 Published: 25 November 2011
Objective: To systematically review evaluations of the impact of sexually transmissible infection (STI) programs delivered by primary health care services in remote Aboriginal communities. Methods: 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. Results: 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). Conclusion: 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.
Additional keywords: chlamydia, gonorrhoea, prevalence, program evaluation.
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