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Open Access Highly Accessed Research article

Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services

James Ward1*, Jane Goller3, Hammad Ali2, Anna Bowring3, Sophia Couzos4, Mark Saunders5, Phyllis Yau3, John M Kaldor2, Margaret Hellard3, Rebecca J Guy2, Basil Donovan26 and on behalf of the ACCESS Collaboration

Author Affiliations

1 Baker IDI Heart and Diabetes Institute, Alice Springs 0871 NT, Australia

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

3 The University of Melbourne, Grattan Street, Parkville VIC 3010, Australia

4 James Cook University, James Cook Drive, Townsville QLD 4811, Australia

5 National Aboriginal Community Controlled Health Organisation, Canberra City ACT 2601, Australia

6 Sydney Sexual Health Centre, Sydney Hospital, Sydney 2000 NSW, Australia

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BMC Health Services Research 2014, 14:285  doi:10.1186/1472-6963-14-285

Published: 1 July 2014

Abstract

Background

Chlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.

Methods

We describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander (‘Aboriginal’) status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16–29 years and for chlamydia testing and positivity.

Results

Data were included from 16–29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).

Conclusions

Higher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

Keywords:
Chlamydia; Aboriginal and Torres Strait Islander people; Testing; Positivity; Indigenous; Australia