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


CONCLUSIONS
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.
Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Rebecca
R
Guy
James S
JS
Ward
Kirsty S
KS
Smith
Jiunn-Yih
JY
Su
Rae-Lin
RL
Huang
Annie
A
Tangey
Steven
S
Skov
Alice
A
Rumbold
Bronwyn
B
Silver
Basil
B
Donovan
John M
JM
Kaldor
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008507:Medically Underserved Area; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data; D013021:South Australia / Q000453:epidemiology; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult