Graham Simon, Guy Rebecca J, Wand Handan C, Kaldor John M, Donovan Basil, Knox Janet, McCowen Debbie, Bullen Patricia, Booker Julie, O'Brien Chris, Garrett Kristine, Ward James S
Kirby Institute, UNSW Australia, Sydney, Australia.
Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
BMC Infect Dis. 2015 Sep 2;15:370. doi: 10.1186/s12879-015-1107-5.
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.
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.
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.
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.
在澳大利亚，衣原体感染是最常被通报的感染病，在过去十年中，衣原体和淋病的通报率有所上升。与非原住民澳大利亚人相比，原住民衣原体和淋病的通报率最高。定期对年轻人进行衣原体和淋病检测是一项关键的预防策略，以便早期发现无症状感染、提供治疗和安全性行为教育。本研究评估了一项名为SHIMMER的性健康质量改进项目（QIP）是否能增加在澳大利亚新南威尔士州地区四家原住民初级卫生保健服务机构就诊的年轻人的衣原体和淋病检测率。
我们计算了在为期12个月的基线期（2010年3月至2011年2月）与为期12个月的QIP期（2012年3月至2013年2月）中，15 - 29岁人群接受衣原体和淋病检测的比例以及检测呈阳性的比例。采用逻辑回归分析按性别、年龄组、原住民身份和原住民初级卫生保健服务机构评估研究期间衣原体和淋病检测比例的差异。计算比值比（OR）及其95%置信区间（CI），p < 0.05具有统计学意义。
在基线期，1881名个体中有9%接受了衣原体检测，而在QIP期2259名个体中有22%接受了检测（OR：1.43，95% CI：1.22 - 1.67）。从基线期到QIP期，女性检测比例有所增加（从13%增至25%，OR：1.32，95% CI：1.10 - 1.59），男性也有所增加（从3%增至17%，OR：1.85，95% CI：1.36 - 2.52）。QIP期检测率最高的是15 - 19岁女性（从16%增至29%，OR：1.02，95% CI：0.75 - 1.37），但增幅最大的是20 - 24岁男性（从3%增至19%，OR：1.65，95% CI：1.01 - 2.69）。淋病检测也有类似的增加。总体而言，共诊断出70例（11%）衣原体感染，从基线期的24例增至QIP期的46例。总体而言，4例（0.7%）淋病检测呈阳性。
SHIMMER项目中使用的QIP使年轻人的衣原体和淋病检测率几乎增至三倍，并发现衣原体感染病例增加了一倍多。其他初级卫生保健中心可采用该QIP来提高年轻人的检测率。
