title: Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia: analysis of longitudinal continuous quality improvement data.
abstract: Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in continuous quality improvement (CQI).
  
  
  
  Preventive health audits (n = 16,086) were conducted at 137 Aboriginal PHC centres participating in the Audit and Best Practice for Chronic Disease Program, 2005-2014. STI testing and counselling data were analysed to determine levels of variation in chlamydia, syphilis and gonorrhoea testing and sexual health discussions. Multilevel logistic regression was used to determine factors associated with higher levels of STI-related service delivery and to quantify variation attributable to health centre and client characteristics.
  
  
  
  Significant variation in STI testing and counselling exists among Aboriginal PHC centres with health centre factors accounting for 43% of variation between health centres and jurisdictions. Health centre factors independently associated with higher levels of STI testing and counselling included provision of an adult health check (odds ratio (OR) 3.40; 95% Confidence Interval (CI) 3.07-3.77) and having conducted 1-2 cycles of CQI (OR 1.34; 95% CI 1.16-1.55). Client factors associated with higher levels of STI testing and counselling were being female (OR 1.45; 95% CI 1.33-1.57), Aboriginal (OR 1.46; 95% CI 1.15-1.84) and aged 20-24 years (OR 3.84; 95% CI 3.07-4.80). For females, having a Pap smear test was also associated with STI testing and counselling (OR 4.39; 95% CI 3.84-5.03). There was no clear association between CQI experience beyond two CQI cycles and higher levels of documented delivery of STI testing and counselling services.
  
  
  
  A number of Aboriginal PHC centres are achieving high rates of STI testing and counselling, while a significant number are not. STI-related service delivery could be substantially improved through focussed efforts to support health centres with relatively lower documented evidence of adherence to best practice guidelines.
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street, Geraldton, WA, 6530, Australia. barbara.nattabi@uwa.edu.au.
authors.forename: Barbara
authors.identifier: 0000-0001-5125-2820
authors.initials: B
authors.lastname: Nattabi
authors.affiliation: Menzies School of Health Research, Brisbane, QLD, Australia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Matthews
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia.
authors.forename: Jodie
authors.initials: J
authors.lastname: Bailie
authors.affiliation: The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Rumbold
authors.affiliation: Spinifex Health Service Tjuntjuntjara, Kalgoorlie, WA, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Scrimgeour
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Gill
authors.initials: G
authors.lastname: Schierhout
authors.affiliation: South Australian Health and Medical Research Institute, Adelaide, South Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street, Geraldton, WA, 6530, Australia.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002908:Chronic Disease; D003376:Counseling; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006266:Health Education / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006303:Health Services, Indigenous / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards; D058996:Quality Improvement; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander populations; Clinical audits; Indigenous; Primary health care; Quality improvement; Sexually transmitted infections; Variation in care