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The afternoon symposium dedicated to Indigenous Health started with Associate Professor James Ward's summary of the STRIVE study.
The STRIVE study commenced in 2009 and was a randomised community trial with an intervention of a sexual health quality improvement program in 65 remote communities in northern and central Australia.
The primary aims of the STRIVE study were:
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.
The results of the primary aims were discussed in today's presentation. The specifics of the quality improvement program were not discussed.
Results of aim 1: Improvements in the provision of sexual health clinical services
The study showed an improvement of testing rates and retesting after a positive result. The increased uptake of testing in men was more significant than testing in women. Some clinics were "high performer clinics" with 2.5x testing rates in men compared to the control group. The study took place over 3 years. Unfortunately, the increased testing rates were not sustained after the 1st year. The results also showed that only 30% of people with a positive STI result where offered/had a HIV test. Given the recent increase in HIV notifications in the Aboriginal and Torres Strait Islanders in the far north, this is alarming.
Results of aim 2: Prevalence of STIs in the community
The STRIVE study did complete prevalence data of chlamydia, gonorrhoea and trichomonas in the remote communities involved in the study. Unfortunately, I do not have that data to present here. Associate Professor Ward was obviously disappointed with the results that showed no change in prevalence over the length of the study. The next step in data analysis of the study is to see if the high performer clinics had a change in prevalence and try to determine factors which made these clinics high performing. Factors which seem to be associated with better results include: community-controlled clinics, availability of gender-based staff and more stable staffing.
The relative rolling door of staff in remote communities is one possible reason why the increased testing rates were not sustained over time. In fact, the lack of sustained results over the term of an intervention was mentioned in the next presentation by Barbara Nattabi.
Summary of the Indigenous Session
The session started with Assoc Prof James Ward presenting the notification rates of STIs in Aboriginal and Torres Strait Islanders in comparison to non-Indigenous people in Australia, rightly describing the difference in notifications as a human rights disaster. Unfortunately, there was no magic answer given for how to improve this during the afternoon. The afternoon finished with Professor Gracelyn Smallwood giving the history of her journey in sexual health and the growth and fame of Condoman. It was nice to end with a positive story and a reminder that a "bottom up approach" can be both cost effective and productive.