Peter d'Abbs

Guidance for Contained Field Trials of Vector Mosquitoes Engineered to Contain a Gene Drive System: Recommendations of a Scientific Working Group

THE FOLLOWING RECOMMENDATIONS represent the response of a group of involved scientists to the need for guidance to aid researchers, government authorities, and community leaders as they consider the design and implementation of field trials to assess the safety and efficacy of genetic strategies for reducing the transmission of diseases by mosquito vectors. Guidance is provided for contained (caged) field trials of genetically-engineered (GE) vector mosquitoes that are fertile and contain novel genetic constructs designed to spread through natural mosquito populations (“gene drive systems”). An effort is made to raise the practical issues that must be considered in advance of such testing, provide generalized recommendations based on currently available information, and identify “points to consider” regarding additional information that may be required in order to make informed decisions on a case-by-case basis. This guidance is intended to clarify the pathway for further assessment of the potential utility of such GE mosquitoes as a tool for the improvement of public health in disease-endemic regions. 2. FOCUS

Liquor licensing and community action in regional and remote Australia: a review of recent initiatives

Objective : To review the effectiveness of community‐based initiatives involving restrictions on alcohol availability in remote and regional locations in Australia, and to assess their implications for other communities or towns contemplating similar measures.

A study of the use of free nicotine patches by indigenous people

Objective: To assess use of free nicotine patches by Indigenous people when offered a brief intervention for smoking cessation, and to assess changes in smoking behaviour at six months.

Evaluation of a multi‐component community tobacco intervention in three remote Australian Aboriginal communities

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities.

Measuring Exposure to Cannabis use and other Substance use in Remote Aboriginal Populations in Northern Australia: Evaluation of A ‘Community Epidemiology’ Approach using Proxy Respondents

We evaluate a method to describe changing substance use patterns in northern Australias remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 101 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-κ statistic) among health workers for a history of substance use and current use, varied from κ = 0.207 for petrol sniffing (P = 0.006) up to κ = 0.749 for cannabis use (P<0.001), all better than would be expected by chance. In communities A and B, agreement between health workers’ consensus and self-reported substance use was weaker (0.103<κ<0.482) probably because of under-reporting in interviews. In community C, where interviews were conducted in a confidential clinic setting, agreement between health workers’ concensus and self-report varied from κ = 0.273 for petrol sniffing (P<0.001) up to 0.819 for tobacco use (P<0.001). Aboriginal health worker consensus classification clarified equivocal self-report data.

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

BackgroundInterventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia.MethodsThe intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management.ResultsLevels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period.ConclusionsImprovements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity.

Out of sight, out of mind? Licensed clubs in remote Aboriginal communities

Most Aboriginal communities in the Northern Territory have used provisions under the NT Liquor Act to impose total or partial bans on alcohol and only eight (as of 30 June 1995) had established licensed clubs. This article examines (a) patterns of alcohol consumption in communities with clubs, and (b) economic, social and political aspects of the place of clubs in these communities. Alcohol consumption was estimated on the basis of ‘purchase into store’ figures for 1994–95 provided by the NT Liquor Commission. Among male drinkers, consumption of absolute alcohol in 1994–95 was estimated at 42.5 litres a head, 76% higher than the figure for the NT as a whole, which in turn was 42% above the national level. Similar differences were found for female drinkers. Combined retail turnover of the seven clubs that traded throughout the year was estimated at

Aboriginal participation in health service delivery : coordinated care trials in the Northern Territory of Australia

8.1 million. It is argued that many clubs are able to use their monopolistic control of a valued resource to become powerful political institutions in communities, sometimes leaving non‐drinkers effectively disenfranchised. It is also argued that the health consequences of these high consumption levels have received far less attention than the effects of Aboriginal public drunkenness in urban areas. It is concluded that, while the rights of Aboriginal communities to establish community‐controlled clubs should be respected, the notion that they are under some sort of obligation to do so should be exposed as a measure likely to add to the health burdens of people already inadequately served by health, education and other services.

Alignment of the policy planets: behind the implementation of the Northern Territory (Australia) Living With Alcohol programme

Australian Aborigines have much higher rates of illness and life expectancy, up to 20 years lower than the Australian population as a whole. Community based primary healthcare to Aborigines in the Northern Territory of Australia has, historically, been under-resourced, in part due to distinctive characteristics of the Australian healthcare funding system which has disadvantaged rural and remote regions. From 1998, the Northern Territory was the site of two Coordinated Care Trials (CCTs) which sought to achieve three main objectives: to significantly increase funding available to health services; to implement a system of clinical best practice; and to improve Aboriginal participation in health service delivery through the establishment of Aboriginal community health boards to act as funds managers and providers of health services to the trial populations. The paper outlines general CCT outcomes according to the findings of the commissioned evaluation studies and examines the possibilities and constraints encountered in improving Aboriginal participation in complex health service developments.

Problematizing alcohol through the eyes of the other: Alcohol policy and Aboriginal drinking in the Northern Territory, Australia

The Northern Territory Living With Alcohol Programme (LWAP), implemented in Australia from 1991 to 2000, has been hailed as a successful example of a comprehensive public health alcohol policy, especially in its first 4 years--1991/92 to 1995/96. This paper draws upon a policy analysis of the LWAP currently in progress to identify and describe the factors that made implementation possible at this time. I argue that programme implementation was shaped by a remarkable alignment of agencies and actors in the political, fiscal, administrative and industrial domains. This alignment of forces, however, owed as much to contingency as to planning and did not endure. Although the policy itself remained unchanged and continued to generate significant achievements, the alignment of forces sustaining it began to fragment from late 1995 onwards. The paper concludes by exploring the implications of the analysis for alcohol policy in other domains, and for the relationship between evidence regarding effectiveness and other components of the policy process.