A sexual health quality improvement program (SHIMMER) triples chlamydia and gonorrhoea testing rates among young people attending Aboriginal primary health care services in Australia.
BACKGROUND
In Australia, chlamydia is the most commonly notifiable infection and over the past ten years chlamydia and gonorrhoea notification rates have increased. Aboriginal compared with non-Aboriginal Australians have the highest notifications rates of chlamydia and gonorrhoea. Regular testing of young people for chlamydia and gonorrhoea is a key prevention strategy to identify asymptomatic infections early, provide treatment and safe sex education. This study evaluated if a sexual health quality improvement program (QIP) known as SHIMMER could increase chlamydia and gonorrhoea testing among young people attending four Aboriginal primary health care services in regional areas of New South Wales, Australia.


METHODS
We calculated the proportion of 15-29 year olds tested and tested positivity for chlamydia and gonorrhoea in a 12-month before period (March 2010-February 2011) compared with a 12-month QIP period (March 2012-February 2013). Logistic regression was used to assess the difference in the proportion tested for chlamydia and gonorrhoea between study periods by gender, age group, Aboriginal status and Aboriginal primary health service. Odds ratios (OR) and their 95 % confidence intervals (CIs) were calculated with significance at p < 0.05.


RESULTS
In the before period, 9 % of the 1881 individuals were tested for chlamydia, compared to 22 % of the 2259 individuals in the QIP period (OR): 1.43, 95 % CI: 1.22-1.67). From the before period to the QIP period, increases were observed in females (13 % to 25 %, OR: 1.32, 95 % CI: 1.10-1.59) and males (3 % to 17 %, OR: 1.85, 95 % CI: 1.36-2.52). The highest testing rate in the QIP period was in 15-19 year old females (16 % to 29 %, OR: 1.02, 95 % CI: 0.75-1.37), yet the greatest increase was in 20-24 year olds males (3 % to 19 %, OR: 1.65, 95 % CI: 1.01-2.69). Similar increases were seen in gonorrhoea testing. Overall, there were 70 (11 %) chlamydia diagnoses, increasing from 24 in the before to 46 in the QIP period. Overall, 4 (0.7 %) gonorrhoea tests were positive.


CONCLUSIONS
The QIP used in SHIMMER almost tripled chlamydia and gonorrhoea testing in young people and found more than twice as many chlamydia infections. The QIP could be used by other primary health care centres to increase testing among young people.
Kirby Institute, UNSW Australia, Sydney, Australia. simon.graham@unimelb.edu.au.|Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia. simon.graham@unimelb.edu.au.
Simon
S
Graham
Kirby Institute, UNSW Australia, Sydney, Australia. rguy@kirby.unsw.edu.au.
Rebecca J
RJ
Guy
Kirby Institute, UNSW Australia, Sydney, Australia. hwand@kirby.unsw.edu.au.
Handan C
HC
Wand
Kirby Institute, UNSW Australia, Sydney, Australia. jkaldor@kirby.unsw.edu.au.
John M
JM
Kaldor
Kirby Institute, UNSW Australia, Sydney, Australia. bdonovan@kirby.unsw.edu.au.|Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia. bdonovan@kirby.unsw.edu.au.
Basil
B
Donovan
Kirby Institute, UNSW Australia, Sydney, Australia. Janet.knox@ncahs.health.nsw.gov.au.
Janet
J
Knox
Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia. DMcCowen@armajun.org.au.
Debbie
D
McCowen
Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia. patriciab@wachs.net.au.
Patricia
P
Bullen
Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia. jbooker@illawarraams.com.au.
Julie
J
Booker
Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia. cobrien@illawarraams.com.au.
Chris
C
O'Brien
Aboriginal Community Controlled Health Service, Sydney, New South Wales, Australia. Kristine.Garrett@galambila.org.au.
Kristine
K
Garrett
South Australian Health and Medical Research Institute, Adelaide, Australia. james.ward@sahmri.com.
James S
JS
Ward
D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D055815:Young Adult