title: STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing 'usual practice' STI care to enhanced care in remote primary health care services in Australia.
abstract: BACKGROUND
  Despite 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
  STRIVE 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.
  
  
  CONCLUSIONS
  STRIVE 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.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12610000358044.
authors.affiliation: Baker IDI, Alice Springs, Northern Territory 0870, Australia. jward@bakeridi.edu.au.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.forename: Skye
authors.initials: S
authors.lastname: McGregor
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.forename: Alice R
authors.initials: AR
authors.lastname: Rumbold
authors.forename: Linda
authors.initials: L
authors.lastname: Garton
authors.forename: Bronwyn J
authors.initials: BJ
authors.lastname: Silver
authors.forename: Debbie
authors.initials: D
authors.lastname: Taylor-Thomson
authors.forename: Belinda
authors.initials: B
authors.lastname: Hengel
authors.forename: Janet
authors.initials: J
authors.lastname: Knox
authors.forename: Amalie
authors.initials: A
authors.lastname: Dyda
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.forename: Steven
authors.initials: S
authors.lastname: Skov
authors.forename: Donna
authors.initials: D
authors.lastname: Ah Chee
authors.forename: John
authors.initials: J
authors.lastname: Boffa
authors.forename: David
authors.initials: D
authors.lastname: Glance
authors.forename: Robyn
authors.initials: R
authors.lastname: McDermott
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D012107:Research Design; D012423:Rural Health / Q000592:standards*; D012749:Sexually Transmitted Diseases / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
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