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BackgroundSchools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake.MethodsInitiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage.ResultsMedian initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates.ConclusionThis study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.

The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs’ chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn’t and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4–13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6–13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 – 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (−2.5 – 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.

Background Chlamydia reinfection increases the risk of pelvic inflammatory disease. Reinfection is common in Australia and while clinical guidelines recommend retesting 3 months post-treatment, less than 25% are retested. We aimed to examine general practitioner (GP) and patient views on retesting for chlamydia and recall/reminder systems to facilitate retesting. Methods As part of a trial of chlamydia testing in general practice, GPs were provided with resources and support to implement recall/reminder systems to increase retesting. GPs’ attitudes and practices were examined pre- and mid-intervention using semi-structured interviews. Semi-structured interviews were also conducted with patients throughout the trial. Data were analysed thematically. Results 44 GPs undertook a pre-intervention and 24 a mid-intervention interview; 22 patients were interviewed. GPs viewed recalls/reminders as essential to a formal chlamydia control program. There was disparity in whether systems to enable retesting were adopted during the intervention. Barriers to implementing these systems included concerns about costs and time required to ‘chase up’ patients; these barriers persisted during the intervention. Concerns about privacy were raised by most GPs but not patients. Over half of patients were not provided with advice about retesting at the time of their initial chlamydia test. Of the four patients who tested positive, two were retested as per guidelines. Patients were universally supportive of receiving reminders for chlamydia retesting, though retesting when at the clinic for another reason was viewed as ‘more practical’. Patients did not have strong preferences about reminder type (letter, SMS, email). Knowledge gaps were identified by both GPs and patients, and GPs identified a need to improve knowledge of the risks of chlamydia reinfection. Conclusion GPs raised more concerns about retesting and reminders than patients. Increasing GP and patient knowledge of the risks of reinfection is crucial. GPs require additional support to implement strategies to increase re-testing. Disclosure No significant relationships.

OBJECTIVES: To compare the data quality, logistics, and cost of a self-administered sexual behavior questionnaire administered either using a computer-assisted survey instrument (CASI) or by paper and pencil in a primary care clinic. STUDY DESIGN AND SETTING: A self-administered sexual behavior questionnaire was administered to 16-29 year olds attending general practice. Questionnaires were administered by either paper and pencil (paper) or CASI. A personal digital assistant was used to self-administer the CASI. RESULTS: A total of 4,491 people completed the questionnaire, with 46.9% responses via CASI and 53.2% by paper. Completion of questions was greater for CASI than for paper for sexual behavior questions: number of sexual partners [odds ratio (OR), 6.85; 95% confidence interval (CI): 3.32, 14.11] and ever having had sex with a person of the same gender (OR, 2.89; 95% CI: 1.52, 5.49). The median number of questions answered was higher for CASI than for paper (17.6 vs. 17.2; P < 0.01). CASI was cheaper to run at $8.18 per questionnaire compared with $11.83 for paper. CONCLUSION: Electronic devices using CASI are a tool that can increase participants' questionnaire responses and deliver more complete data for a sexual behavior questionnaire in primary care clinics.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Background Chlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN’s views in relation to involvement in chlamydia testing in general practice. Methods Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach. Results The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors’ workloads and expansion of the nurse’s role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the “small town” rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs’ work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing. Conclusion This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.

Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs). Methods: A cross-sectional survey was conducted at baseline and 6–12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups. Results: Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P

Background In Australia, despite dramatic increases in chlamydia notifications and recommendations that young people be tested annually, testing rates in general practice remain low. ACCEPt is a randomised controlled trial to evaluate the impact of chlamydia testing on prevalence. General practitioners (GPs) in the intervention arm received regular feedback on testing performance, visual reminders and incentive payments to facilitate increased testing. To assess the acceptability of the intervention, participating GPs were interviewed at baseline and midpoint to investigate their chlamydia management practices and their opinions about the intervention. Methods Semi-structured interviews were conducted with purposively sampled GPs prior to randomization (baseline) and after one year in the intervention (midpoint) until saturation was reached. Data were analysed both thematically and using Normalisation Process Theory (NPT), a framework that explains how complex interventions can be successfully implemented, embedded and integrated in institutional settings. Emerging themes from each timepoint were compared and interpreted within the NPT framework. Results A total of 44 GPs at baseline and 24 GPs at midpoint were interviewed. The ACCEPt intervention increased GPs’ comfort and ease in offering a test, and were associated with a shift in attitudes from symptom-based testing to age-based testing. Many GPs highlighted that feedback, a key aspect to embedding the intervention, was a major driver of increased testing. The intervention was gradually implemented over time through increasing awareness and engagement with education and exposure to the project. Logistical issues, such as remembering to offer a test, were overcome with practical facilitators like computer alerts. However, integration was limited as not all GPs utilised the intervention components or other clinic staff to increase testing because of restrictions in clinic structure. Conclusion GPs reported that the ACCEPt intervention and its implementation within the NPT framework have been effective at facilitating chlamydia testing in general practice. Disclosure of interest statement ACCEPt was commissioned and funded by the Australian Government Department of Health and Ageing. Additional funding has been received from the National Health and Medical Research Council, the Victorian Department of Health and NSW Health.

Introduction ACCEPt is a randomised controlled trial of annual chlamydia testing for 16–29 year olds in general practice. Part of the trial examines whether practice nurses (PNs) can play a role in chlamydia testing. PNs previously identified education as an important facilitator to their involvement in testing. We evaluated the impact of education on PNs’ knowledge and attitudes in relation to chlamydia testing. Methods The 2-hour education program was delivered at clinics to PNs by ACCEPt staff. A survey was conducted at baseline and repeated 6–12 months post education; analysis focused on PNs who completed both surveys. The survey used Likert scales, which were analysed as continuous variables (scores). We used t-tests to assess if changes in mean scores between survey rounds were greater in the education group. Results In total 72 PNs completed both surveys (42 of which received education). Changes in mean scores between survey rounds in the education group were significantly different to the non-education group for the statements: most chlamydia infections in men are asymptomatic (p = 0.01); I would offer a chlamydia test to a 23-year old married female having a pap test (p = 0.04); I would like to be more involved in testing (p = 0.04); I would like to be more involved with managing a recall/reminder system (p = 0.05); and time/workload constraints are barriers to testing (p = 0.001). The increases in mean knowledge score (p Conclusion Our evaluation suggests PN participation in the ACCEPt education program improved chlamydia testing knowledge and attitudes among PNs and could be utilised more widely across primary care. The findings also suggest time/workload constraints became a stronger barrier after education, presumably due to greater involvement in testing. Future analyses will determine if the education program combined with other initiatives have increased testing rates. Disclosure of interest statement ACCEPt was commissioned and funded by the Australian Government Department of Health and Ageing. Additional funding has been received from the National Health and Medical Research Council, the Victorian Department of Health and NSW Health.

Background ACCEPt, a large cluster randomised control trial, aims to determine if annual testing for 16 to 29 year olds in general practise can reduce chlamydia prevalence. ACCEPt is also the first trial investigating the potential role of the PN in chlamydia testing. To inform the intervention, GPs’ and PNs’ chlamydia knowledge and practises were explored. Methods GPs and PNs from 143 clinics were recruited from 54 postcodes in 4 Australian States and asked to complete a survey at time of recruitment. Survey responses were compared using conditional logistic regression to account for GPs and PNs from the same clinics participating. Results Of 607 GPs and 126 PNs enrolled in ACCEPt, 86% and 78% completed the questionnaire, respectively. A third of GPs (32%) compared to 23% of PNs (P = 0.076) correctly identified the two age groups with the highest infection rates in women and only 17% vs 16% (P = 0.942) identified the correct age groups in men. Fewer GPs than PNs would offer testing opportunistically to asymptomatic young patients, including women having a Pap smear (55% vs. 84%, P = Conclusion Our survey reveals more gaps in chlamydia knowledge and management among GPs than PNs, which may be contributing to low testing rates in general practise. PNs have a role in increasing chlamydia testing.