title: Community and clinic-based screening for curable sexually transmissible infections in a high prevalence setting in Australia: a retrospective longitudinal analysis of clinical service data from 2006 to 2009.
abstract: Background In response to the high prevalence of sexually transmissible infections (STIs) in many central Australian Aboriginal communities, a community-wide screening program was implemented to supplement routine primary health care (PHC) clinic testing. The uptake and outcomes of these two approaches were compared.
  
  
  
  Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) community and clinic screening data for Aboriginal people aged 15-34 years, 2006-2009, were used. Regression analyses assessed predictors of the first test occurring in the community screen, positivity and repeat testing.
  
  
  
  A total of 2792 individuals had 9402 tests (median: four per person) over 4 years. Approximately half of the individuals (54%) were tested in the community and clinic approaches combined, 29% (n=806) in the community screen only and 18% (n=490) in the clinic only. Having the first test in a community screen was associated with being male and being aged 15-19 years. There was no difference between community and clinic approaches in CT or NG positivity at first test. More than half (55%) of individuals had a repeat test within 2-15 months and of these, 52% accessed different approaches at each test. The only independent predictor of repeat testing was being 15-19 years.
  
  
  
  STI screening is an important PHC activity and the findings highlight the need for further support for clinics to reach young people. The community screen approach was shown to be a useful complementary approach; however, cost and sustainability need to be considered.
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Silver
authors.affiliation: The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.affiliation: Epidemiology and Health Systems Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096 Casuarina, NT 0811, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Rumbold
authors.affiliation: South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Smith
authors.affiliation: The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia.
authors.forename: Amalie
authors.initials: A
authors.lastname: Dyda
authors.affiliation: Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ryder
authors.affiliation: Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
authors.forename: Teem-Wing
authors.initials: TW
authors.lastname: Yip
authors.affiliation: Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
authors.forename: Jiunn-Yih
authors.initials: JY
authors.lastname: Su
authors.affiliation: The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, NSW 2052, Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002690:Chlamydia Infections / Q000175:diagnosis; D002692:Chlamydia trachomatis; D006069:Gonorrhea / Q000175:diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening; D009344:Neisseria gonorrhoeae; D015995:Prevalence; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult