Annie Tangey - Academia.edu (original) (raw)

Papers by Annie Tangey

Research paper thumbnail of Point-of-care testing for sexually transmissible infections: translating a trial into routine practice

Research paper thumbnail of Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice

PloS one, 2014

Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the d... more Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for ...

Research paper thumbnail of P5.036 The First Cluster Randomised Trial of a Molecular Chlamydia and Gonorrhoea Point-Of-Care Assay

Sexually Transmitted Infections, 2013

Poster presentations engage in compensated sex (10% MU vs. 4% FC, p < 0.05), not use condoms duri... more Poster presentations engage in compensated sex (10% MU vs. 4% FC, p < 0.05), not use condoms during their last sexual encounter (64% MU vs. 45% FC, p < 0.05), and be a first-time HIV tester (50% MU vs. 41% FC, p < 0.05; see Table 1). MU HIV prevalence was 5% (vs. 17% FC, p < 0.05). Among firsttime testers, HIV prevalence in both MSM and TW was not significantly different between MU and FC attendees (MSM: 13% MU vs. 19% FC p = 0.14; TW: 41% MU vs. 50% FC p = 0.71). Conclusion MU testing reached large numbers of high-risk (TW/ MSM) and potentially bridging (MSMW) populations engaged in unsafe sexual behaviours. MU HIV prevalence for MSM/TW firsttime testers was similar to that of the FC, making MU outreach a worthy complement to FC testing. Further investigation into whether MU attendees would not otherwise access HIV testing is warranted to determine the impact of MU testing.

Research paper thumbnail of P171 From trial to program: TTANGO2 scale-up and implementation sustains STI point-of-care testing in regional and remote Australian Aboriginal health services

Poster presentations, 2021

Background Young people living in remote Aboriginal communities experience some of the highest ra... more Background Young people living in remote Aboriginal communities experience some of the highest rates of chlamydia (CT) and gonorrhoea (NG) infection globally. A cluster-randomised controlled trial (TTANGO) in 11 remote primary health services demonstrated point-of-care (POC) testing for CT/NG was acceptable, accurate, improved the uptake and timeliness of treatment, and was cost-saving. Subsequently, POC testing was scaled-up and implemented in a further 20 remote health services (TTANGO2 program) across four jurisdictions (31 in total). We determine whether the uptake of POC testing observed in the trial was also achieved and sustained during the long-term program. Methods We conducted descriptive, interrupted time series and trajectory analyses to compare POC testing patterns over two time periods (trial: 2013–15 and program: 2016–19). For the trajectory analysis, we applied a Poisson model to identify and fit health services to testing groups. Results Among the 11 services who pa...

Research paper thumbnail of I Do Feel Like a Scientist at Times": A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting

PloS one, 2015

Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeline... more Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia. In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis. Most participants displayed positive attitudes, indicating t...

Research paper thumbnail of CARPA Standard Treatment Manual: a clinic manual for primary health care practitioners in remote and Indigenous health services in Central and Northern Australia

Research paper thumbnail of Additional file 1 of Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers' perceptions of the barriers and facilitators

Research paper thumbnail of Ttango: Operational Performance of a Molecular Based Chlamydia and Gonorrhoea Point-of-Care Testing in Remote Australian Aboriginal Communities

Research paper thumbnail of A cluster trial of molecular point-of-care tests for sexually transmissible infections (STIS): treatment outcomes from TTANGO

1 The Kirby Institute, UNSW Australia, Sydney, Australia 2 The Burnet Institute, Melbourne, Austr... more 1 The Kirby Institute, UNSW Australia, Sydney, Australia 2 The Burnet Institute, Melbourne, Australia 3 Apunipima Cape York Health Council, Cairns, Australia 4. Ngaanyatjarra Health Service, Alice Springs, Australia. 5. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia 6 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia 7. Queensland Paediatric Infectious Diseases (QPID) Laboratory, Brisbane, Australia 8. The Royal Women’s Hospital and Murdoch Childrens Research Institute, Parkville, Vic, Australia 8. Flinders University, Adelaide, Australia. 10. South Australian Health and Medical Research Institute, Adelaide, Australia

Research paper thumbnail of Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers’ perceptions of the barriers and facilitators

Implementation Science Communications

Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly... more Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia. Methods A total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health...

Research paper thumbnail of Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol

BMJ Open

IntroductionAccess to high-quality primary healthcare is limited for remote residents in Australi... more IntroductionAccess to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.Methods and analysisThis paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will b...

Research paper thumbnail of Association of placenta/birth weight ratio and other birth size measures with childhood blood pressure for an Australian Aboriginal cohort: exploring the Barker hypothesis

Research paper thumbnail of 002.2 Operational performance of a new molecular-based point-of-care test for diagnosis ofchlamydia trachomatisandneisseria gonorrhoeaeinfection: concordance with conventional laboratory testing

Sexually Transmitted Infections

Research paper thumbnail of A decentralised point-of-care testing model to address inequities in the COVID-19 response

The Lancet Infectious Diseases

Research paper thumbnail of A reliable and easy to transport quality control method for chlamydia and gonorrhoea molecular point of care testing

Research paper thumbnail of Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial

The Lancet. Infectious diseases, 2018

Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and on... more Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16-29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory...

Research paper thumbnail of Molecular test for chlamydia and gonorrhoea used at point of care in remote primary healthcare settings: a diagnostic test evaluation

Sexually transmitted infections, Aug 10, 2018

A new molecular test for (CT) and (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate ... more A new molecular test for (CT) and (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate as conventional nucleic acid amplification tests (NAAT), but performance has not been evaluated in routine primary care, performed at the point of care by clinicians. We aimed to examine its diagnostic performance when used by clinicians in remote community health services in Australia with high prevalences of CT and NG infection. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#12613000808741) METHODS: At 12 health services, training was provided to 99 clinicians in the use of the GeneXpert CT/NG assay who tested specimens from all patients undergoing STI screening. Specimens were also sent in parallel for conventional laboratory-based NAATs and the concordance of results was evaluated. Clinicians conducted 2486 tests: CT concordance was 99.4% (95% CI 99.1 to 99.7) with a positive concordance of 98.6% (95% CI 95.9 to 99.7) and negative concordance ...

Research paper thumbnail of A field evaluation of a new molecular-based point-of-care test for chlamydia and gonorrhoea in remote Aboriginal health services in Australia

Sexual health, Jan 27, 2014

Background Point-of-care (POC) tests could be important public health tools in settings with trea... more Background Point-of-care (POC) tests could be important public health tools in settings with treatment delays and high rates of sexually transmissible infections (STIs). Use is limited due to suboptimal performance. The performance and ease-of-use of a new molecular-based POC test for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was assessed, alongside two single-organism immunochromatographic tests (ICT). Methods: The evaluation occurred between May 2012 and March 2013 during community STI screens in two remote Aboriginal health services. Urine was tested with the GeneXpert®CT/NG and if sufficient volume, also with Diaquick CT and Gonorrhoea Card. The gold standard comparison was laboratory nucleic acid amplification testing (NAAT). Operational characteristics were also assessed. Results: Among 198 samples, GeneXpert CT sensitivity and specificity was 100% [95% confidence intervals (CI): 75.9-100] and 99.5% (95% CI: 96.5-100), and NG was 100% ...

Research paper thumbnail of The role of support person for Ngaanyatjarra women during pregnancy and birth

Women and Birth, 2012

This study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaany... more This study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaanyatjarra women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cultural practices have been subject to erosion during the past 70 years. Women are now expected to birth hundreds of kilometres from home and, due to financial barriers, without family support. Older women lament their lack of input into, and control of, contemporary birthing services. In order to provide culturally appropriate maternity services we asked: What issues would the Ngaanyatjarra women of the community like to see resolved in the area of antenatal and birthing services? Eligible participants were any Ngaanyatjarra women of the study community who had birthed at least once. We utilised a participatory research methodology. 36 women were interviewed. This paper discusses one finding related to support for child-bearing women. The role is important in many ways. Ngaanyatjarra women did not traditionally have their support persons with them during labour and birth, nor do they necessarily expect them to be present in current times. Most women do, however, wish to have a support person with them during antenatal checkups and when they travel to town to await birth. Aboriginal women from remote communities should be able to have a support person with them when they access regional birthing services, but the nature of this role must not be assumed. A culturally appropriate service has input from the community, provides options and respects choices.

Research paper thumbnail of The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review

Sexual Health, 2012

Objective To systematically review evaluations of the impact of sexually transmissible infection ... more Objective To systematically review evaluations of the impact of sexually transmissible infection (STI) programs delivered by primary health care services in remote Aboriginal communities. Methods: PubMed, Google Scholar, InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings and bulletins were searched to April 2011 using variations of the terms ‘Aboriginal’, ‘programs’ and ‘STI’. The primary outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary health care service, STI programs and other clinical service outcomes were also described. Results: Twelve reports described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a redu...

Research paper thumbnail of Point-of-care testing for sexually transmissible infections: translating a trial into routine practice

Research paper thumbnail of Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice

PloS one, 2014

Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the d... more Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for ...

Research paper thumbnail of P5.036 The First Cluster Randomised Trial of a Molecular Chlamydia and Gonorrhoea Point-Of-Care Assay

Sexually Transmitted Infections, 2013

Poster presentations engage in compensated sex (10% MU vs. 4% FC, p < 0.05), not use condoms duri... more Poster presentations engage in compensated sex (10% MU vs. 4% FC, p < 0.05), not use condoms during their last sexual encounter (64% MU vs. 45% FC, p < 0.05), and be a first-time HIV tester (50% MU vs. 41% FC, p < 0.05; see Table 1). MU HIV prevalence was 5% (vs. 17% FC, p < 0.05). Among firsttime testers, HIV prevalence in both MSM and TW was not significantly different between MU and FC attendees (MSM: 13% MU vs. 19% FC p = 0.14; TW: 41% MU vs. 50% FC p = 0.71). Conclusion MU testing reached large numbers of high-risk (TW/ MSM) and potentially bridging (MSMW) populations engaged in unsafe sexual behaviours. MU HIV prevalence for MSM/TW firsttime testers was similar to that of the FC, making MU outreach a worthy complement to FC testing. Further investigation into whether MU attendees would not otherwise access HIV testing is warranted to determine the impact of MU testing.

Research paper thumbnail of P171 From trial to program: TTANGO2 scale-up and implementation sustains STI point-of-care testing in regional and remote Australian Aboriginal health services

Poster presentations, 2021

Background Young people living in remote Aboriginal communities experience some of the highest ra... more Background Young people living in remote Aboriginal communities experience some of the highest rates of chlamydia (CT) and gonorrhoea (NG) infection globally. A cluster-randomised controlled trial (TTANGO) in 11 remote primary health services demonstrated point-of-care (POC) testing for CT/NG was acceptable, accurate, improved the uptake and timeliness of treatment, and was cost-saving. Subsequently, POC testing was scaled-up and implemented in a further 20 remote health services (TTANGO2 program) across four jurisdictions (31 in total). We determine whether the uptake of POC testing observed in the trial was also achieved and sustained during the long-term program. Methods We conducted descriptive, interrupted time series and trajectory analyses to compare POC testing patterns over two time periods (trial: 2013–15 and program: 2016–19). For the trajectory analysis, we applied a Poisson model to identify and fit health services to testing groups. Results Among the 11 services who pa...

Research paper thumbnail of I Do Feel Like a Scientist at Times": A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting

PloS one, 2015

Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeline... more Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia. In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis. Most participants displayed positive attitudes, indicating t...

Research paper thumbnail of CARPA Standard Treatment Manual: a clinic manual for primary health care practitioners in remote and Indigenous health services in Central and Northern Australia

Research paper thumbnail of Additional file 1 of Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers' perceptions of the barriers and facilitators

Research paper thumbnail of Ttango: Operational Performance of a Molecular Based Chlamydia and Gonorrhoea Point-of-Care Testing in Remote Australian Aboriginal Communities

Research paper thumbnail of A cluster trial of molecular point-of-care tests for sexually transmissible infections (STIS): treatment outcomes from TTANGO

1 The Kirby Institute, UNSW Australia, Sydney, Australia 2 The Burnet Institute, Melbourne, Austr... more 1 The Kirby Institute, UNSW Australia, Sydney, Australia 2 The Burnet Institute, Melbourne, Australia 3 Apunipima Cape York Health Council, Cairns, Australia 4. Ngaanyatjarra Health Service, Alice Springs, Australia. 5. Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia 6 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia 7. Queensland Paediatric Infectious Diseases (QPID) Laboratory, Brisbane, Australia 8. The Royal Women’s Hospital and Murdoch Childrens Research Institute, Parkville, Vic, Australia 8. Flinders University, Adelaide, Australia. 10. South Australian Health and Medical Research Institute, Adelaide, Australia

Research paper thumbnail of Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers’ perceptions of the barriers and facilitators

Implementation Science Communications

Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly... more Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia. Methods A total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health...

Research paper thumbnail of Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol

BMJ Open

IntroductionAccess to high-quality primary healthcare is limited for remote residents in Australi... more IntroductionAccess to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.Methods and analysisThis paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will b...

Research paper thumbnail of Association of placenta/birth weight ratio and other birth size measures with childhood blood pressure for an Australian Aboriginal cohort: exploring the Barker hypothesis

Research paper thumbnail of 002.2 Operational performance of a new molecular-based point-of-care test for diagnosis ofchlamydia trachomatisandneisseria gonorrhoeaeinfection: concordance with conventional laboratory testing

Sexually Transmitted Infections

Research paper thumbnail of A decentralised point-of-care testing model to address inequities in the COVID-19 response

The Lancet Infectious Diseases

Research paper thumbnail of A reliable and easy to transport quality control method for chlamydia and gonorrhoea molecular point of care testing

Research paper thumbnail of Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial

The Lancet. Infectious diseases, 2018

Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and on... more Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16-29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory...

Research paper thumbnail of Molecular test for chlamydia and gonorrhoea used at point of care in remote primary healthcare settings: a diagnostic test evaluation

Sexually transmitted infections, Aug 10, 2018

A new molecular test for (CT) and (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate ... more A new molecular test for (CT) and (NG) (GeneXpert CT/NG) has been demonstrated to be as accurate as conventional nucleic acid amplification tests (NAAT), but performance has not been evaluated in routine primary care, performed at the point of care by clinicians. We aimed to examine its diagnostic performance when used by clinicians in remote community health services in Australia with high prevalences of CT and NG infection. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#12613000808741) METHODS: At 12 health services, training was provided to 99 clinicians in the use of the GeneXpert CT/NG assay who tested specimens from all patients undergoing STI screening. Specimens were also sent in parallel for conventional laboratory-based NAATs and the concordance of results was evaluated. Clinicians conducted 2486 tests: CT concordance was 99.4% (95% CI 99.1 to 99.7) with a positive concordance of 98.6% (95% CI 95.9 to 99.7) and negative concordance ...

Research paper thumbnail of A field evaluation of a new molecular-based point-of-care test for chlamydia and gonorrhoea in remote Aboriginal health services in Australia

Sexual health, Jan 27, 2014

Background Point-of-care (POC) tests could be important public health tools in settings with trea... more Background Point-of-care (POC) tests could be important public health tools in settings with treatment delays and high rates of sexually transmissible infections (STIs). Use is limited due to suboptimal performance. The performance and ease-of-use of a new molecular-based POC test for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was assessed, alongside two single-organism immunochromatographic tests (ICT). Methods: The evaluation occurred between May 2012 and March 2013 during community STI screens in two remote Aboriginal health services. Urine was tested with the GeneXpert®CT/NG and if sufficient volume, also with Diaquick CT and Gonorrhoea Card. The gold standard comparison was laboratory nucleic acid amplification testing (NAAT). Operational characteristics were also assessed. Results: Among 198 samples, GeneXpert CT sensitivity and specificity was 100% [95% confidence intervals (CI): 75.9-100] and 99.5% (95% CI: 96.5-100), and NG was 100% ...

Research paper thumbnail of The role of support person for Ngaanyatjarra women during pregnancy and birth

Women and Birth, 2012

This study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaany... more This study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaanyatjarra women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cultural practices have been subject to erosion during the past 70 years. Women are now expected to birth hundreds of kilometres from home and, due to financial barriers, without family support. Older women lament their lack of input into, and control of, contemporary birthing services. In order to provide culturally appropriate maternity services we asked: What issues would the Ngaanyatjarra women of the community like to see resolved in the area of antenatal and birthing services? Eligible participants were any Ngaanyatjarra women of the study community who had birthed at least once. We utilised a participatory research methodology. 36 women were interviewed. This paper discusses one finding related to support for child-bearing women. The role is important in many ways. Ngaanyatjarra women did not traditionally have their support persons with them during labour and birth, nor do they necessarily expect them to be present in current times. Most women do, however, wish to have a support person with them during antenatal checkups and when they travel to town to await birth. Aboriginal women from remote communities should be able to have a support person with them when they access regional birthing services, but the nature of this role must not be assumed. A culturally appropriate service has input from the community, provides options and respects choices.

Research paper thumbnail of The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review

Sexual Health, 2012

Objective To systematically review evaluations of the impact of sexually transmissible infection ... more Objective To systematically review evaluations of the impact of sexually transmissible infection (STI) programs delivered by primary health care services in remote Aboriginal communities. Methods: PubMed, Google Scholar, InfoNet, Cochrane Controlled Trials Register, Australian New Zealand Clinical Trial Registry, conference proceedings and bulletins were searched to April 2011 using variations of the terms ‘Aboriginal’, ‘programs’ and ‘STI’. The primary outcome of interest in the review was the change in bacterial STI infection prevalence in the target age group assessed through cross-sectional screening studies over a 5-year period or more. The characteristics of the primary health care service, STI programs and other clinical service outcomes were also described. Results: Twelve reports described four distinct STI programs in remote communities and their impact on STI prevalence. In the Anangu Pitjantjatjara Yankunytjatjara (APY) lands of northern South Australia, there was a redu...