Open Access Study protocol

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

James Ward12*, Skye McGregor2, Rebecca J Guy2, Alice R Rumbold34, Linda Garton25, Bronwyn J Silver4, Debbie Taylor-Thomson4, Belinda Hengel6, Janet Knox2, Amalie Dyda2, Matthew G Law2, Handan Wand2, Basil Donovan2, Christopher K Fairley78, Steven Skov12, Donna Ah Chee9, John Boffa9, David Glance10, Robyn McDermott11, Lisa Maher2 and John M Kaldor2

Author Affiliations

1 Baker IDI, Alice Springs, Northern Territory 0870, Australia

2 The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia

3 Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5005, Australia

4 Epidemiology and Health Systems Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia

5 Northern Territory Department of Health, 55 North Stuart Highway, Alice Springs 0870, Australia

6 Apunipima Cape York Health Council, Bungalow, Queensland 4870, Australia

7 Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia

8 School of Population Health, University of Melbourne, Parkville, Victoria, Australia

9 Central Australian Aboriginal Congress, Alice Springs, Northern Territory 0870, Australia

10 University of Western Australia, Perth, Western Australia 6009, Australia

11 Sansom Institute of Health Service, School of Health Sciences, University of South Australia City East Campus North Terrace, Adelaide, SA 5000, Australia

12 Centre for Disease Control, Northern Territory Department of Health, Rocklands Drive, Tiwi 0811, Australia

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BMC Infectious Diseases 2013, 13:425  doi:10.1186/1471-2334-13-425

Published: 9 September 2013



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.


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.


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.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12610000358044

Aboriginal; Indigenous; Sexually transmitted infections; Chlamydia; Gonorrhoea; Trichomonas; Continuous quality improvement; Protocol; Prevalence; Remote