Development of a Risk Algorithm to Better Target STI Testing and Treatment Among Australian Aboriginal and Torres Strait Islander People
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Identifying and targeting those at greatest risk will likely play a significant role in developing the most efficient and cost-effective sexually transmissible infections (STI) prevention programs. We aimed to develop a risk prediction algorithm to identify those who are at increased risk of STI. A cohort (N = 2320) of young sexually active Aboriginal and Torres Strait Islander people (hereafter referred to as Aboriginal people) were included in this study. The primary outcomes were self-reported high-risk sexual behaviors and past STI diagnosis. In developing a risk algorithm, our study population was randomly assigned to either a development (67%) or an internal validation data set (33%). Logistic regression models were used to create a risk prediction algorithm from the development data set for males and females separately. In the risk prediction models, older age, methamphetamine, ecstasy, and cannabis use, and frequent alcohol intake were all consistently associated with high-risk sexual behaviors as well as with a past STI diagnosis; identifying as gay/bisexual was one of the strongest factors among males. Those who had never tested for STIs, 52% (males) and 66% (females), had a risk score >15, and prevalence of undiagnosed STI was estimated between 30 and 40%. Since universal STI screening is not cost-effective, nor practical in many settings, targeted screening strategies remain a crucial and effective approach to managing STIs among young Aboriginal people. Risk prediction tools such as the one developed in this study may help in prioritizing screening for STIs among those most at risk.
KeywordsSexual risk behaviors Sexually transmitted infections Aboriginal and Torres Strait Islander Indigenous Australians Risk prediction
We would like to acknowledge each State and Territory Health Department for the contribution of both in-kind and cash contributions to this project. The project was coordinated by NACCHO and the state and territory-based affiliate organizations who agreed to participate and be a strategic partner in the research. Particular thanks to the survey coordinators based within these organizations who were responsible for the coordination of logistics and data collection in their respective jurisdiction.
This project was funded by the Australian Research Council Linkage Grant # LP0991274.
JW was the principle investigator of the GOANNA study. HW and JW developed the study concept. HW analyzed the data. JW and HW drafted the initial manuscript. JW, JK, HW, JB, MP, and DT were investigators and participated in the design of the study as well as commented on the final draft. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interest.
The project received ethical approval from Aboriginal Human Research Ethics Committees in relevant jurisdictions and the University of New South Wales and La Trobe University Human Research Ethics Committees. Participants were also provided with consent forms with contact details of the relevant research ethics committee(s) should anything in the survey cause distress. Survey collectors verbally confirmed that participants were aged 16–29 years and identified as Aboriginal and/or Torres Strait Islander and ensured that they consented to participation.
- Australian Bureau of Statistics: The Census of Population and Housing. (2011). http://www.abs.gov.au/websitedbs/censushome.nsf/home/CO-56.
- Australian Government Department of Health. (2015). Fourth National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2014–2017. Canberra: ACT Australia.Google Scholar
- Australian Health Ministers’ Advisory Council. (2011). Aboriginal and Torres Strait Islander Health Performance Framework Report 2010. Canberra: Author.Google Scholar
- Australian Institute of Health and Welfare. (2008). National Drug Strategy Household Survey: First results (AIHW Catalogue no. PHE 98). Canberra: Author.Google Scholar
- Australian Institute of Health and Welfare. (2015). Australia’s welfare 2015. Australia’s Welfare Series No. 12. Cat. no. AUS 189. Canberra: Author.Google Scholar
- Centers for Disease Control and Prevention. (2015). Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep 2015; 64(No. RR-3): 1–137.Google Scholar
- Dooley, J. J., Cross, D., Hearn, L., & Treyvaud, R. (2009). Review of existing Australian and international cybersafety research (pp. 175–176). Perth: Child Health Promotion Research Centre, Edith Cowan University.Google Scholar
- Gray, J., & Partington, G. (2003). School attendance and non-attendance. In Q. Beresford & G. Partington (Eds.), Resistance and reform: Aboriginal youth and education (pp. 133–163). Perth: UWA Press.Google Scholar
- Harling, G., Subramanian, S. V., & Bärnighausen, T. (2013). Socioeconomic disparities in sexually transmitted infections among young adults in the United States: Examining the interaction between income and race/ethnicity. Sexually Transmitted Diseases, 40(7), 575–581. doi: 10.1097/OLQ.0b013e31829529cf.CrossRefPubMedPubMedCentralGoogle Scholar
- Krieger, N., Waterman, P. D., Chen, J. T., Soobader, M. J., & Subramanian, S. V. (2003). Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: Geocoding and choice of area-based socioeconomic measures—The Public Health Disparities Geocoding Project (US). Public Health Reports, 118(3), 240–260.CrossRefPubMedPubMedCentralGoogle Scholar
- Larkins, S. L., Page, R. P., Panaretto, K. S., Scott, R., Mitchell, M. R., Alberts, V., et al. (2007). Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: The “U Mob Yarn Up” project. Medical Journal of Australia, 186(10), 513–518.PubMedGoogle Scholar
- Miller, H. G., Cain, V. S., Rogers, S. M., Gribble, J. N., & Turner, C. F. (1999). Correlates of sexually transmitted bacterial infections among US women in 1995. Family Planning Perspectives, 31, 4–9, 23.Google Scholar
- National Health and Medical Research Council (NHMRC). (2001). Australian alcohol guidelines: Health risks and benefits. Canberra: Author. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds9.pdf.
- National Health and Medical Research Council (NHMRC). (2009). Australian guidelines to reduce health risks from drinking alcohol. Canberra: Author. www.nhmrc.gov.au.
- Savage, J. (2009) Aboriginal adolescent sexual and reproductive health programs: A review of their effectiveness and cultural acceptability: An Evidence Check rapid review brokered by the Sax Institute (http://www.saxinstitute.org.au) for the NSW Department of Health.
- Substance Use Among Aboriginal and Torres Strait Islander People. (2015). http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418265. Accessed 26 April 2017.
- The Kirby Institute. (2015). Bloodborne viral and sexually transmitted infections in aboriginal and Torres Strait Islander people: Surveillance and evaluation report. Sydney: University of New South Wales Kirby Institute.Google Scholar
- Wand, H., Guy, R., Donovan, B., & McNulty, A. (2011). Developing and validating a risk scoring tool for chlamydia infection among sexual health clinic attendees in Australia: A simple algorithm to identify those at high risk of chlamydia infection. British Medical Journal, 1(1), e000005. doi: 10.1136/bmjopen-2010-000005.Google Scholar
- Wand, H., Iversen, J., Wilson, D. P., Topp, L. J., & Maher, L. S. (2012). Developing and validating a scoring tool for identifying people who inject drugs at increased risk of hepatitis C virus infection. British Medical Journal, 2(1). doi: 10.1136/bmjopen-2011-000387.
- Ward, J., Wand, H., Bryant, J., Delaney-Thiele, D., Worth, H., Pitts, M., et al. (2016). Prevalence and correlates of a diagnosis of sexually transmitted infection among young Aboriginal and Torres Strait Islander People: A national survey. Sexually Transmitted Diseases, 43(3), 177–184.CrossRefPubMedGoogle Scholar