Jane L Goller

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia

Objective: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation. Methods: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<

Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines

400/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation. Results: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94). Conclusion: These research findings support the need to focus on improving local environments to increase physical activity participation.

Risk factors for HIV seroconversion in men who have sex with men in Victoria, Australia: Results from a sentinel surveillance system

Objectives Australian guidelines recommend annual testing for HIV and sexually transmitted infections (STIs) for all men who have sex with men (MSM) and 3–6 monthly testing for those at higher risk as defined by behavioural criteria. We assessed HIV/STI re-testing rates among MSM attending primary care clinics. Methods We conducted a retrospective follow-up of HIV negative MSM tested for HIV or STIs (chlamydia or syphilis) at four primary care clinics in the 9-month period: April to December 2006. Re-testing rates for these infections were calculated over 18 months. Logistic regression was undertaken to identify predictors of guideline adherence. Results Of the MSM requiring annual HIV testing according to the guidelines, the re-testing rates at 1 y were 35% (762/2163). Among the higher risk MSM, 6-monthly HIV re-testing rates were 15% (283/1862). Within the subgroup who reported 11 or more male sexual partners within the past 6 months, HIV re-testing rates within 6 months were 19%. Independent predictors of HIV re-testing within 6 months in higher-risk MSM were reporting 11 or more male sexual partners in the last 6 months (AOR 3.1, 95% CI 1.8 to 4.8); being born overseas (AOR 2.0, 95% CI 1.2 to 3.4); and previous HIV testing more than 12 months earlier (AOR 3.3, 95% CI 1.9 to 5.5). Conclusion There is poor adherence to national guidelines that recommend regular re-testing of MSM for STIs, particularly among those at higher risk who require more frequent testing. Clinical strategies are urgently needed to encourage more frequent HIV/STI testing among MSM, especially in the higher risk subgroup.

Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings

OBJECTIVES HIV diagnosis rates in men who have sex with men (MSM) began increasing in Australia 10 years ago, and there has been a major resurgence of syphilis. We determined predictors of HIV positivity and seroconversion among MSM in Victoria, Australia. METHODS We conducted a retrospective longitudinal analysis of data from MSM who underwent HIV testing between April 2006 and June 2009 at three primary care clinics. Logistic regression was used to determine predictors of HIV positivity and seroconversion. RESULTS During the study period, 7857 MSM tested for HIV. Overall HIV positivity was 1.86% (95% confidence interval (CI): 1.6-2.2). There were 3272 repeat testers followed for 4837 person-years (PY); 60 seroconverted and HIV incidence was 1.24 (95% CI: 0.96-1.60) per 100 PY. Independent predictors of HIV seroconversion were: an infectious syphilis diagnosis within the last 2 years (adjusted hazard ratio (AHR)=2.5, 95% CI: 1.1-5.7), reporting six or more anal sex partners in the past 6 months (AHR=3.3, 95% CI: 1.8-6.3), reporting an HIV-positive current regular partner (AHR=3.4, 95% CI: 1.1-10.6) and reporting inconsistent condom use with casual partners in the past 6 months (AHR=4.4, 95% CI: 1.7-11.5). CONCLUSION Our results call for HIV prevention to target high-risk MSM, including men with a recent syphilis diagnosis or a high numbers of partners, men who have unprotected anal sex with casual partners and men in serodiscordant relationships. The HIV incidence estimate will provide a baseline to enable public health officials to measure the effectiveness of future strategies.

No increase in HIV or sexually transmissible infection testing following a social marketing campaign among men who have sex with men

OBJECTIVE To describe the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria, Australia. METHODS The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites. Target populations included men who have sex with men (MSM), young people and injecting drug users (IDU). Sites collected demographic and risk behaviour information electronically or using paper surveys from patients undergoing routine HIV or STI (syphilis, chlamydia (Chlamydia trachomatis)) or hepatitis C virus (HCV) testing. These data were linked with laboratory results. RESULTS Between April 2006 and June 2008, data were received for 67 466 tests and 52 042 questionnaires. In clinics providing electronic data, >90% of individuals tested for HIV, syphilis and chlamydia had risk behaviour information collected. In other clinics, survey response rates were >85% (HIV), 43.5% (syphilis), 42.7-66.5% (chlamydia) and <20% (HCV). Data completeness was >85% for most core variables. Over time, HIV, syphilis and chlamydia testing increased in MSM, and chlamydia testing declined in females (P = 0.05). The proportion of positive tests among MSM was 1.9% for HIV and 2.1% for syphilis. Among 16-24-year-olds, the proportion positive for chlamydia was 10.7% in males and 6.9% in females. Among IDU, 19.4% of HCV tests were antibody positive. CONCLUSIONS The VPCNSS has collected a large, rich dataset through which testing, risk behaviours and the proportion positive can be monitored in high-risk groups, offering a more comprehensive BBV and STI surveillance system for Victoria. Building system sustainability requires an ongoing focus.

Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network

Background: A social marketing campaign ran in 2004 in the Victoria to increase rates of HIV/sexually transmissible infection (STI) testing among men having sex with men (MSM). Methods: To evaluate the initiative data from HIV sentinel surveillance, laboratory data on testing for HIV/STIs and STI/HIV testing uptake reported in annual surveys were analysed. Results: The sentinel surveillance network showed no increase in the overall extent of HIV testing and no difference in the proportion of MSM reporting regular annual HIV testing during the campaign (43%) and post campaign (41%). The annual behavioural surveys showed that between 2004 and 2006 there was no significant increase in this overall proportion of MSM reporting having an HIV test in the last 12 months (p = 0.96). The behavioural surveys also showed an increasing trend in the proportion reporting specific STI tests over time: anal swab (26% to 39%, p⩽0.01) and urine test (42% to 50%, p⩽0.01) and there was a steady increase in the amount of STI testing at the clinics detected through the laboratory reports: chlamydia (average increment of 6.4 tests per month, p<0.01), gonorrhoea (6.5 tests per month, p⩽0.01) and syphilis (4.0 tests per month, p⩽0.01) but it began at least 2 years before the campaign and was not accelerated during the campaign. Conclusion: Based on a range of indicators there was no evidence that the campaign increased HIV/STI testing. These findings highlight the importance of evaluating public health campaigns to assess their impact to ensure that they are modified if no impact is identified.

Impact evaluation of a youth sexually transmissible infection awareness campaign using routinely collected data sources.

BACKGROUND Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. METHODS We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. RESULTS Chlamydia positivity was 5.6% in 12233 females, 7.7% in 10316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92-2.69), being born overseas (OR 1.50, 95% CI 1.25-1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40-2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65-7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53-0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62-2.17), being born overseas (OR 1.35, 95% CI 1.16-1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40-1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46-2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00-1.51), being HIV-positive (OR 1.80, 95%CI 1.32-2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37-14.5). CONCLUSIONS Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.

The rise of infectious syphilis in Victoria and the impact of enhanced clinical testing

BACKGROUND Young people are at high risk of sexually transmissible infections (STI) and notifications of chlamydia are rising rapidly. In 2007, a Victorian multimedia campaign aimed to increase STI testing and condom use among 18-25-year-olds. We conducted a retrospective impact evaluation using multiple sources of routinely collected data. METHODS Population-level chlamydia testing data from general practice, chlamydia testing data from five government primary care clinics with a high caseload of young people, and behavioural data from an annual youth behavioural survey were analysed. Analyses included time-series regression to assess trends in testing levels, Kruskal-Wallis tests to assess changes in positivity, and χ(2)-tests to assess knowledge and behaviour change. RESULTS There was no significant difference in the slope of monthly chlamydia testing in population-level or clinic-based surveillance during the campaign compared with before or after the campaign, and no changes in chlamydia positivity. Between 2007 and 2008, there was a significant increase in STI knowledge among females (P<0.01) and in the proportion of females reporting always using a condom with casual (P=0.04) and new sexual partners (P<0.01) in the annual behavioural survey. CONCLUSIONS Our findings suggest the campaign had no impact on STI testing but may have contributed to an increase in knowledge and condom use among females; however, this increase could not be directly attributed to the campaign. Future campaigns targeting young people for STI testing should consider alternative messages and approaches, and include robust evaluation mechanisms to measure campaign impact prospectively.

Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007-2011

Objective: Passive surveillance indicates a clear increase in infectious syphilis cases in Victoria, but trends are likely to be influenced by changes in testing. We therefore used testing data from two Melbourne clinics with a high caseload of men who have sex with men to examine infectious syphilis prevalence, time trends and risk factors for infection.

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

Objective: To describe trends in chlamydia positivity from 2007 to 2011 among heterosexual people tested for chlamydia at selected clinics that provide services to people at high risk in Victoria, Australia.