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The paper examines a 'circulatory' system of gender inequity in Australian universities where gender bias prevents women from accessing senior decision-making roles and stultifies their capacity to act as gender change agents. It has been mooted that equity quotas for senior roles can derail this circuit of male privilege in academia. Yet a plastic reading of the shape of gender equity policy and practice in Australian universities over the last 40 years reveals an increasing acceptance of individualism, which positions women's liberation as being achievable through self-responsibilisation. If these discourses remain unchallenged, gender quotas for senior roles alone will likely only benefit those entrepreneurial women admitted to senior positions, rendering the causes of gender inequity hidden and exonerated. Using a novel methodology that combines a 'plastic' with a complex systems lens of policy manoeuvres, we suggest gender quotas, accompanied by strategy designed to develop leaders' gender competency and change agency, are required to support more sustainably equitable work structure within the academy.

In the last 15 years the Common European Framework of Reference (CEFR) has become a very influential basis for the design of language curricula and the assessment of language learning outcomes, not only in its home continent but around the world. This article provides a basic introduction to the CEFR and then identifies the issues that have arisen when governments and language educationists have set out to apply the framework in the education systems of Taiwan, Japan and China. There is also some discussion of initiatives to establish national frameworks as alternative to the CEFR in Australia and New Zealand. The conclusion is that it is difficult to achieve a balance between the desirability of setting international standards in language learning and the need to represent the social and educational contexts of particular countries.

This article reports part of an ongoing process that is taking place at one high school. With the vision of an inclusive school in which all students could flourish, the school deliberately set out to develop a culture in which the students would feel welcome, connected and have a sense of belonging. This article focuses on, first, how the school, with a culturally-diverse student population, implemented a whole school intercultural approach aimed at improving students' views of the school climate and, second, the impact that this had on students' perceptions of the school climate and their self-reports of wellbeing, resilience and identity. These results indicated that, at the end of the 18 month period, students' perceptions of the school climate were statistically significantly higher for four of the six school climate scales. Further, students' scored statistically higher in terms of their wellbeing, resilience, self-anchoring and moral identity.

This article examines student responses to a technique for summarizing electronically available information based on word frequency. Students used this technique to create word clouds, using those word clouds to enhance personal and small group study. This is a qualitative study. Small focus groups were used to obtain student feedback. Feedback indicated that students adapted their use of word clouds in ways consistent with their learning style preferences. Kolb's learning styles inventory was used. Student response also indicated that word clouds have potential in the workplace. (Contains 1 table and 2 figures.)

The flipped classroom approach, a form of blended learning, is currently popular in education praxis. Initial reports on the flipped classroom include that it offers opportunities to increase student engagement and build meaningful learning and teaching experiences. In this article, we analyse teacher and student experiences of a trial flipped classroom application in a third year undergraduate human geography course that challenges conventional thinking and practice in resource management, including an explicit focus on the marginalization of Indigenous knowledges in that context. The flipped classroom trial included empirical research with teachers and students to gauge the strengths and weaknesses of this mode of learning. Interviews, focus groups, surveys, reflections and participant-observation activities were conducted before, during and after the course. The research shows that this particular implementation of the flipped classroom approach generated multiple experiences for teachers and students, some constructive, others less so. Overall, space, time and flexibility matters not only to the kinds of pedagogical tools we employed to tailor learning to students' differing needs, but also to the kinds of learning spaces -- online and offline, individually and in groups -- in which learning happens.

Typical individuals make rapid and reliable evaluations of trustworthiness from facial appearances, which can powerfully influence behaviour. However, the same may not be true for children with autism spectrum disorder. Using an economic trust game, the current study revealed that like typical children, children with autism spectrum disorder rationally modulate their trust behaviour based on non-face cues to partner trustworthiness (e.g. reputation information). Critically, however, they are no more likely to place their trust in partners with faces that look trustworthy to them, than those that look untrustworthy. These results cannot be accounted for by any group differences in children's conceptualization of trustworthiness, ability to read trustworthiness from faces or understanding of the experimental paradigm. Instead, they seem to suggest that there may be a selective failure to spontaneously use facial cues to trustworthiness to guide behaviour in an ecologically valid context.

Knowing about dying and death is a typical part of lifelong learning, gained through personal experience with the death of loved ones, popular culture, and formal education. Sudden and unexpected death aside, adults in the general community can use this knowledge to plan for the manner of their dying. Such planning might include will making, advance care planning, enduring guardianship, organ donation, and for some, decisions about the where and how of end-of-life care. People with intellectual disability, however, are often not afforded similar opportunities to learn about or plan for dying. The aim of this paper is to outline current thinking around the need for people with intellectual disability to learn about and understand dying and death.

Student experience surveys have become increasingly popular to probe various aspects of processes and outcomes in higher education, such as measuring student perceptions of the learning environment and identifying aspects that could be improved. This paper reports on a particular survey for evaluating individual experiments that has been developed over some 15 years as part of a large national Australian study pertaining to the area of undergraduate laboratories--Advancing Science by Enhancing Learning in the Laboratory. This paper reports on the development of the survey instrument and the evaluation of the survey using student responses to experiments from different institutions in Australia, New Zealand and the USA. A total of 3153 student responses have been analysed using factor analysis. Three factors, "motivation," "assessment" and "resources," have been identified as contributing to improved student attitudes to laboratory activities. A central focus of the survey is to provide feedback to practitioners to iteratively improve experiments. Implications for practitioners and researchers are also discussed.

Background: Comorbid depression and/or anxiety symptoms occur in 25%of patients attending cardiac rehabilitation (CR) programs and are associated with poorer prognosis. There is a need to evaluate psychological interventions, including meditation, that have potential to improve psychological health in CR programs. Aims: The aim of this study was to determine the feasibility and acceptability of integrating ameditation intervention into an existing Australian CR program for the reduction of depression and anxiety symptoms. Methods: This was a mixed-methods feasibility randomized controlled trial. Thirty-one patientswith CVD and, at aminimum,mild depression and/or anxiety symptoms were randomized to meditation and standard CR or to standard CR alone. A 16-minute guided group meditation was delivered face-to-face once a week for 6 weeks, with daily self-guided meditation practice between sessions. Feasibility outcomes included screening, recruitment, and retention. Semistructured interviews of patients' (n = 10) and health professionals' (n = 18) perspectives of intervention participation and delivery were undertaken to assess acceptability. Between-group differences in depression, anxiety, stress, self-efficacy for mindfulness, and health status at 6 and 12 weeks were also assessed. Results and Conclusion: Meditation was considered feasible, with 83%(12/15) of the intervention group completing an average of 3.13 (SD, 2.56) out of 6 group meditation sessions and 5.28 (SD, 8.50) self-guided sessions. Meditation was considered acceptable by patients, clinicians, and health managers. Between-group differences in the number of CR sessions completed favored the intervention group in per-protocol analyses (intervention group vs control group, 12 vs 9 sessions; P = .014), which suggests thatmeditationmay be useful to improve patients' adherence to exercise-based CR program. [ABSTRACT FROM AUTHOR]

An assessment of the acylation of ferrocene laboratory exercise across three successive years resulted in a significant fluctuation in student perception of the experiment. This perception was measured by collecting student responses to an instrument immediately after the experiment, which includes Likert and open-ended responses from the student. Students in all three years identified technical benefits from the experiment. In Years 1 and 3, students also recognised the benefits of improving their conceptual understanding of organic chemistry. However, in Year 2, where background knowledge became a critical and limiting factor, all perception of conceptual understanding as an experiment objective was lost, and only recognition of technical development remained. Analysis of these data also indicated that students who have enough time to complete the experiment also perceive a measure of responsibility for their own learning, whereas time-poor students have an over-reliance on the laboratory notes and demonstrators. Addressing concepts such as these may be the triggers required for time-poor experiments to garner a positive student experience and maximise both the conceptual and technical benefits of the experiment.

It is important to understand the factors that can contribute to quality of life in retirees. Accessing latent benefits, which are generally associated with paid employment, has been shown to increase quality of life. It is proposed that meaningful leisure may act as a substitute for paid employment in retirees. A sample of 123 male and female participants living in 8 different retirement villages in Queensland, Australia, were assessed using the Latent and Manifest Benefits Scale, the World Health Organisation Quality of Life scale and the Meaningful Leisure Activity Questionnaire to examine the role of meaningful leisure activity on access to latent benefits and perceived quality of life. Results showed that during retirement, access to the five latent benefits of time structure, shared experiences, identity, collective purpose and enforced activity is positively related to quality of life. Results demonstrated that only collective purpose mediated the relationship between meaningful leisure and quality of life. Further, meaningful leisure was positively related to quality of life. The implications of these results are discussed.

Bridging courses designed to support students commencing tertiary education are widespread, and some evidence for the value of semester-length courses has been reported; however, little attention has been paid to short-but-intense bridging courses, and empirical evidence of their effectiveness is particularly sparse. The current study followed the academic performance of a cohort of students enrolled in a first-year chemistry unit of study designed for those with little or no background knowledge of chemistry. The aims of this study are two-fold: first to determine the strength of the linkage between prior knowledge in chemistry and performance on the end of semester exam, and secondly, to explore the reasons for any differences observed. In particular, the value of the week-long intensive-mode bridging course offered by the University of Sydney was analysed. Quantitative and qualitative data were collected. The research has shown that participation in the chemistry bridging course is associated with "bridging the gap" in academic performance between students with No Prior Chemistry background and those with a Strong Background. While the content of the bridging course is a significant contributor to academic success, so too is the confidence in their own learning that the course engenders among participants. (Contains 7 figures.)

This paper describes an educational analysis of a first year university chemistry practical called "Investigating sugar using a home made polarimeter". The analysis follows the formalism of the Advancing Chemistry by Enhancing Learning in the Laboratory (ACELL) project, which includes a statement of education objectives, and an analysis of the student learning experience. The practical requires students to accurately prepare solutions of known concentrations of a common consumer chemical (sucrose), and then investigate the interaction between these solutions and plane-polarised light. The instrument used is a "home built" polarimeter which students assemble, allowing them to recognise that scientific apparatus need not be mysterious in its operation or construction. Student feedback data were conducted using the ACELL Student Learning Experience (ASLE) instrument. Analysis of the data shows that overwhelmingly students rate the experiment as "worthwhile" or better. However, many also rate the experiment as "boring" or "uninteresting". By contrast, staff and student feedback at an ACELL experiential workshop rated the experiment very highly in terms of the "interest" criterion. In this contribution we discuss this alignment of staff and student perceptions of various elements, including "interest" and explore the correlation with the overall laboratory experience. (Contains 3 figures and 3 tables.)

The IMSCI model for teaching writing scaffolds the instruction so that students understand the features of a genre, see the teacher model writing a text in the target genre, participate in the creation of a text in the genre (through shared or collaborative writing), and independently write a text in the genre. This model is based on social learning theory and best practices in the instruction of English-language learners. An extended example of students writing historical fiction is provided, including images that show teacher modeling and student work. (Contains 7 figures.)

As a result of investigations showing that communication problems can be a significant contributing factor to major aviation accidents, the International Civil Aviation Organization (ICAO) has established a set of Language Proficiency Requirements. All pilots and air traffic controllers engaged in international aviation must be certified by their national civil aviation authorities as meeting the requirements by March 2011. This has created a demand for tests designed to assess the speaking and listening skills of aviation personnel, and language testers have become involved as developers and evaluators of the various assessment instruments. The present paper gives an overview of the issues and introduces the themes discussed by the other contributors to this special issue of the journal, covering both the linguistic nature of aviation communication and more practical considerations in test design.

Provides observations from a study of an attempt to introduce Indonesian in an Australian high school. Data collection was done through interviews and classroom observations. Classroom test results were used to compare achievement in subject content and language learning. Findings are discussed. (Author/VWL)

Defining goals and objectives is a critical component of adaptive management of natural resources because they provide the basis on which management strategies can be designed and evaluated. The aims of this study are: (i) to apply and test a collaborative method to elicit goals and objectives for inshore fisheries and biodiversity in the coastal zone of a regional city in Australia; (ii) to understand the relative importance of management objectives for different community members and stakeholders; and (iii) to understand how diverse perceptions about the importance of management objectives can be used to support multiple-use management in Australia’s iconic Great Barrier Reef. Management goals and objectives were elicited and weighted using the following steps: (i) literature review of management objectives, (ii) development of a hierarchy tree of objectives, and (iii) ranking of management objectives using survey methods. The overarching goals identified by the community group were to: (1) protect and restore inshore environmental assets; (2) improve governance systems; and (3) improve regional (socio-economic) well-being. Interestingly, these goals differ slightly from the usual triple-bottom line objectives (environmental, social and economic) often found in the literature. The objectives were ranked using the Analytical Hierarchical Process, where a total of 141 respondents from industry, government agencies, and community from across Queensland State undertook the survey. The environment goal received the highest scores, followed by governance and lastly well-being. The approach to elicit and rank goals and objectives developed in this study can be used to effectively support coastal resource management by providing opportunities for local communities to participate in the setting of regional objectives. [ABSTRACT FROM AUTHOR]

Abstract: In order to manage Marine Protected Areas (MPAs) effectively, cooperative coordination arrangements between MPA and fisheries agencies are essential, but are recognised as very difficult to achieve. Barriers to, and benefits of, developing partnerships between these agencies have been reviewed and a comprehensive list of 46 specific performance indicators to evaluate MPA and fisheries agency partnership effectiveness has been compiled. These indicators have been linked to the USAID Policy and Coordination Program's partnership assessment framework that applies three evaluation domains, namely: strategic values and capacity to implement, operational processes and resultant impact of a partnership. In a case study designed to test the methodology, the IUCN MPA assessment guidelines and these performance indicators were used as the basis for an evaluation of the effectiveness of an Australian MPA and fisheries inter-agency partnership. This provided a rapid, qualitative evaluation methodology, which indicated that the partnership investigated had resulted in positive impacts in respect to MPA management objectives. However, the evaluation process also identified areas that could be improved, particularly in respect to the agencies' shared values and operational processes. For example, community and stakeholder communication and engagement is an important objective in MPA management, which needs mutual support from both agencies, but this activity scored lowly in the evaluation. As a result, it was recommended that MPA and fisheries agencies should develop formal agreements, such as Memorandums of Understanding (MOUs), and that these agreements should include shared objectives and targets, incentives for both agencies, co-ordinated communication processes and a risk management strategy. [Copyright &y& Elsevier]

Objectives Three-drug nonoccupational post-exposure prophylaxis ( NPEP) typically includes co-formulated emtricitabine-tenofovir ( FTC-TDF) and a protease inhibitor. However, protease inhibitors can cause significant toxicities, can interact with prescribed and illicit drugs, and work late in the viral cycle. Agents that act before viral integration into host DNA may have efficacy advantages. Raltegravir ( RAL) is a good candidate for NPEP as it has few side effects or drug interactions and acts prior to HIV integration. The objective of this study was to investigate the use of RAL in 3-drug NPEP in terms of safety, adherence and tolerability. Methods We evaluated 28 days of RAL-FTC-TDF treatment in 86 men and FTC-TDF treatment in 34 men eligible for three- and two-drug NPEP, respectively. We assessed adherence (compared between groups and with nonstudy controls) and clinical and adverse events at weeks 1, 2 and 4, and efficacy at week 12. Analyses were by intention to treat, excluding from the adherence analysis subjects who ceased NPEP because their source was HIV-uninfected. Results No participant became infected with HIV. For RAL-FTC-TDF and FTC-TDF, regimen completion rates were 92% and 91% and medication adherence rates were 89% and 90%, respectively. Eight (9%) RAL recipients developed mild myalgias, with four developing transient grade 4 elevations in creatine kinase (two developed both), all of which improved to grade 2 or less by week 4 without RAL discontinuation. Eight prescribed and 37 potential illicit drug interactions with a protease inhibitor were avoided by use of RAL. Conclusions RAL-FTC-TDF is well tolerated as NPEP, results in high levels of adherence and avoids potential drug−drug interactions. Patients and clinicians should be aware of the potential for acute muscle toxicity when RAL is used as NPEP. [ABSTRACT FROM AUTHOR]

Abstract: Population-based surveys indicate there is broad public support for wind energy, but proposed wind farms are often faced with significant opposition from local residents. The aim of this study was to assess the utility of the theory of planned behaviour (TPB) and other theoretically relevant variables in exploring intentions to oppose wind farm developments in Australia. An online survey asked respondents about their attitudes, intentions and past behaviour regarding wind farms, and their perceptions of wind farm proximity, visual perceptions and sense of place. A hierarchical regression analysis found that of the three TPB components (i.e. attitudes, subjective norms, perceived behavioural control) only social pressure from significant others (i.e. subjective norm) predicted oppositional intentions. Past behaviour was the best predictor of these intentions, and it also moderated (i.e. reduced) the association of attitudes to intentions. Attitudes to proximity, visual perceptions and sense of place did not significantly predict these intentions. The results suggest that behavioural intentions to oppose wind farm developments were most strongly associated with past oppositional behaviour and the potential of certain community members to influence local resident's views. [Copyright &y& Elsevier]

The rate of economic growth and policy development within the waste and recycling sector is not only bringing about rapid evolution in the range of available waste treatment technologies but also adding to the complexity of the waste streams requiring treatment as opposed to disposal. As such, there is a need for a suitably skilled workforce in order to both maintain current services and further develop this critical sector. This paper provides a brief overview of the critical factors currently impacting workforce availability to the waste and recycling sectors within the UK and Queensland, Australia. The paper also discusses the role of industry accreditation of waste management professionals and its role in sourcing a suitable skilled workforce, highlighting the different approaches between the UK and Queensland, including the analysis of the trends in individual professional memberships between the two countries. The paper concludes with discussion around the UK model of the professional recognition of waste managers and if such an approach may be applicable to Queensland in order to increase the attractiveness of the industry to potential employees and provide an appropriately skilled workforce during a time of unprecedented labour demand. [ABSTRACT FROM AUTHOR]

The expectation of participation in cervical screening programs has become a ubiquitous feature of women's lives; but despite the obvious importance of trying to prevent cervical cancer, both the expression and fulfillment of that expectation are far from straightforward. This is because the actors involved are not always consistent in their interpretation of the risks involved and safety sought. The history of cervical screening in Australia illustrates how the implementation of medical surveillance can be shaped by such interpretations. We argue in particular that conflict in Australia over screening frequency requires an explanation of this kind, and more broadly that we have entered an era of preventive medicine that can be described as one of 'contested surveillance'. [ABSTRACT FROM AUTHOR]

The article reviews a five part series of oral history interviews titled "Australian Generations" that were broadcast on ABC National Radio in Australia in 2010.

Monitoring compliance and enforcing laws are integral to ensuring the success of marine protected areas (MPAs), but traditional monitoring techniques are costly and resource demanding. Three SoundTrap 300 recorders were deployed for one month between 1 July and September 12, 2018 to collect acoustic data in two marine parks off southeastern Australia: one recorder in Cod Grounds Marine Park (CGMP) and two in the Solitary Islands Marine Park National Park Zone (SIMP NPZ). Extractive activities such as fishing are not permitted in these zones. Raven Pro 2.0 was used to analyze data for vessel presence. Transmission loss equations for each site were generated using patrol boat GPS tracks and used to predict if acoustically recorded vessels were inside park boundaries based on received sound levels. In CGMP, 41 vessels were predicted within the park during the recording period; 34 vessels were predicted within the SIMP NPZ. Thursdays and Saturdays were identified as peak days for vessel presence in CGMP while Thursdays were the peak day in the SIMP NPZ. Most vessel activity at both locations took place between 06:00 and 17:00 AEST. Peak vessel presence in CGMP occurred at 09:00 AEST while the peak vessel presence in the SIMP NPZ occurred at 16:00 AEST. Approximately 12.7 h of vessel sounds were recorded within CGMP; approximately 3.8 h of vessel noise were recorded within the SIMP NPZ. Passive acoustic monitoring of vessel patterns in Australian Marine Parks has provided valuable insight to redirect compliance decisions on how to focus surveillance efforts. • Monitoring compliance is integral to ensuring the success of marine protected areas. • Passive acoustic monitoring is a tool that can be used to improve domain awareness. • Passive acoustic monitoring provides insight to redirect compliance decisions. [ABSTRACT FROM AUTHOR]

Discusses the author's experience of presenting a workshop on reconciliation to the annual conference of Adult Learning Australia at he Gagudju Crocodile hotel in October 2001. Graphic representation of the extraordinary story "The Allocation of Food by Jesus," collected by anthropologist R. M. Berndt in 1952 on the Daly River; Discussion of the massacre of Aboriginal Australians at Mirki; Impact of the workshop on participants.

Background: The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign.Methods: The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey.Results: Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa).Conclusion: Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression. [ABSTRACT FROM AUTHOR]

Background: Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT).Methods: ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training.Results: Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training.Conclusions: Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision. [ABSTRACT FROM AUTHOR]

Background: The human papillomavirus (HPV) vaccine and regular (i.e., every five years) cervical screening are essential to prevent cervical cancer. Australia has high overall coverage of both interventions but little is known about coverage among people who inject drugs. and known barriers to preventive care among this population may extend to cervical cancer control measures., Methods: Data were obtained from the 2023 Illicit Drug Reporting System interviews, in which people who regularly inject drugs participated. The sample was restricted to people with a cervix, with participants aged 25-74 years eligible for the National Cervical Screening Program and participants born after 1980 eligible for HPV vaccination. Age-standardised prevalence ratios were used to compare coverage among this sample to the Australian general population; other results were summarised descriptively., Findings: Among participants eligible for screening (n = 243), most (96.7 %) reported lifetime uptake, while 70.2 % had been screened during the past five years, which was similar to the general population (prevalence ratio [PR]: 1.14, 95 % confidence interval [CI]: 0.96-1.31). Among those never or overdue for screening (n = 57), one third (31.7 %) were aware that self-sampling is available and barriers to screening varied, with similar numbers reporting personal (e.g., 'I didn't know I needed to'), logistical (e.g., 'I don't have time'), and test-related reasons (e.g., 'the test is uncomfortable/painful'). Among participants eligible for HPV vaccination (n = 99), coverage was 27.2 %, 38 % lower than the general population (PR: 0.62, 95 % CI: 0.39-0.86)., Conclusions: Cervical screening coverage among this sample of people who inject drugs was similar to the Australian population. Health promotion messaging that focuses on the availability of self-sampling and the importance of regular screening may improve coverage among those overdue for screening. HPV vaccination was lower than the general population, warranting targeted efforts to offer the vaccine to eligible people who inject drugs., Competing Interests: Declaration of competing interest AP has received untied educational grant from Seqirus and Mundipharma for study of opioid medications. All other authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. We conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3-14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1-34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33-5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. Our findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions.

Introduction: Stigma has negative consequences for the health of people who inject drugs and people living with hepatitis C virus (HCV). This study evaluated factors associated with stigma related to injecting drug use (IDU) or HCV and those associated with being treated negatively by health workers., Methods: ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire including IDU- and HCV-related stigma, and negative treatment by health workers. Logistic regression was used to identify factors associated with experiencing stigma and negative treatment in a cross-sectional sample., Results: Of 1,211 participants, 31% were women, 64% had injected drugs in the previous month, and 65% had been diagnosed with HCV. IDU-related stigma was reported by 57% of participants and was associated with being a woman, higher than Year 10 education, homelessness, opioid agonist treatment, recent injecting, overdose history, hospitalisation for drug use, and unknown HCV status. HCV-related stigma was reported by 34% of participants diagnosed with HCV and was associated with being a woman, homelessness, receptive needle/syringe sharing, arrest for drug use/possession, and recent HCV testing. Negative treatment from health workers was reported by 45% of participants and was associated with being a woman, receptive needle/syringe sharing, hospitalisation for drug use, and arrest for drug use/possession., Discussion and Conclusions: Results highlight important intersections and disparities in stigmatising experiences among people who inject drugs. Considering these intersections can assist health services provide more inclusive care., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: TB has received speaker fees from Gilead Sciences. JG reports personal fees from Abbott, Abbvie, Cepheid, Gilead Sciences, and Roche and grants from Abbvie, bioLytical, Cepheid, Gilead Sciences, and Hologic, outside the submitted work. GD reports grants from AbbVie and Gilead Sciences. LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior, Mundipharma and Seqirus. HV has received honorarium from Gilead Sciences. All remaining authors have no potential conflicts to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Understanding needle/syringe sharing is crucial for reducing hepatitis C virus (HCV) infection and reinfection. This study aimed to assess the prevalence and factors associated with needle/syringe sharing among people who inject drugs in Australia, including those previously receiving HCV treatment., Methods: The ETHOS Engage study was an observational cohort study which collected self-reported survey data on demographic and drug use information from people who inject drugs attending drug treatment clinics and needle and syringe programs over two waves between May 2018 and June 2021. Logistic regression was used to identify factors associated with needle/syringe sharing., Results: Overall, 1555/2395 people enrolled in ETHOS Engage (65%) injected drugs in the past month. Among these, 432 (28%) reported needle/syringe sharing in the past month and 276 (18%) reported receptive sharing. Factors associated with receptive sharing included younger age (adjusted odds ratio [aOR] 1.72; 95% confidence interval [CI] 1.28-2.30), recent incarceration (aOR 2.04; 95% CI 1.40-2.94), more frequent injecting (≥daily vs. less than weekly; aOR 2.59; 95% CI 1.75-3.84) and unstable housing (aOR 1.78; 95% CI 1.26-2.52). Among 560 participants with prior HCV treatment, 87 (16%) reported receptive sharing with younger age (aOR 2.42; 95% CI 1.45-4.05) and daily or greater injection frequency (aOR 2.51; 95% CI 1.31-4.83) associated with receptive sharing., Discussion and Conclusions: Needle/syringe sharing was common among this population accessing harm reduction services. This study identifies high-risk populations with needle/syringe sharing. Research is needed to optimise HCV treatment to ensure people with ongoing risk behaviours receive adequate harm reduction following treatment to prevent reinfection., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Evaluating gender-specific trends in hepatitis C virus (HCV) treatment uptake among men and women who inject drugs is crucial for ensuring equitable progress towards HCV elimination. This study aimed to quantify differences in testing, treatment, and current HCV infection between men and women who inject drugs., Method: ETHOS Engage is an observational cohort study of people who inject drugs attending drug treatment clinics and needle and syringe programs in Australia recruited from May 2018-September 2019 (wave 1) and November 2019-April 2021 (wave 2). Participants completed a questionnaire including self-reported HCV testing and treatment history and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to compare the factors associated with self-reported HCV testing and treatment and current HCV infection for men and women who inject drugs., Results: Among 2,395 participants enrolled in ETHOS Engage, 66% (n = 1,591) were men, 33% (n = 786) women, and <1% (n = 18) did not identify as a man or woman. HCV testing history and current infection were similar among men and women. Among men or women ever eligible for HCV treatment (ever chronic HCV) (n = 1,242), women were less likely to report a history of HCV treatment compared to men (227/352, 64% vs. 631/890, 71%; p = 0.03). Among women, those aged <45 were less likely to report HCV testing (aOR: 0.57, 95%CI: 0.36, 0.90), treatment (aOR: 0.47, 95%CI: 0.29, 0.77), and more likely to have HCV infection (aOR: 1.48, 95%CI: 1.00, 2.20) CONCLUSION: Among women, those of childbearing age (<45) were less likely to report testing and treatment and were more likely to have current HCV infection. Women <45 years old should be a priority population for HCV care. Services that interface with these women should be optimised to enhance HCV testing and treatment., Competing Interests: Declaration of competing interest HV has received honoraria from Gilead Sciences. JG is a consultant/advisor and has received research grants from Abbvie, Abbott, Biolytical, Camurus, Cepheid, Gilead Sciences, Hologic, Indivior, Merck/MSD, and Roche. GD has received research grants from Gilead, Abbvie, and Merck. LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior, Mundipharma and Seqirus. PR has received research funding from Gilead Sciences. CH has research grants from Indivior. All remaining authors have no potential conflicts to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Abstract: In 2023, an increased number of urogenital and anorectal infections with Neisseria meningitis serogroup Y (MenY) were reported in New South Wales (NSW). Whole genome sequencing (WGS) found a common sequence type (ST-1466), with limited sequence diversity. Confirmed outbreak cases were NSW residents with a N. meningitidis isolate matching the cluster sequence type; probable cases were NSW residents with MenY isolated from a urogenital or anorectal site from 1 July 2023 without WGS testing. Of the 41 cases, most were men (n = 27), of whom six reported recent contact with a female sex worker. Five cases were men who have sex with men and two were female sex workers. Laboratory alerts regarding the outbreak were sent to all Australian jurisdictions through the laboratories in the National Neisseria Network. Two additional states identified urogenital MenY ST-1466 infections detected in late 2023. Genomic analysis showed all MenY ST-1466 sequences were interspersed, suggestive of an Australia-wide outbreak. The incidence of these infections remains unknown, due to varied testing and reporting practices both within and across jurisdictions. Isolates causing invasive meningococcal disease (IMD) in Australia are typed, and there has been no MenY ST-1466 IMD recorded in Australia to end of March 2024. Concerns remain regarding the risk of IMD, given the similarity of these sequences with a MenY ST-1466 IMD strain causing a concurrent outbreak in the United States of America., (© Commonwealth of Australia CC BY-NC-ND.)

Background: Chlamydia remains the most notified bacterial sexually transmissible infection in Australia with guidelines recommending testing for re-infection at 3months post treatment. This paper aimed to determine chlamydia retesting and repeat positivity rates within 2-4months among young women in Australia, and to evaluate what factors increase or decrease the likelihood of retesting., Methods: Chlamydia retesting rates among 16-29-year-old women were analysed from Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of sexually transmissible infection and bloodborne virus (ACCESS) sentinel surveillance data (n =62 sites). Among women with at least one positive test between 1 January 2018 and 31 August 2022, retesting counts and proportions within 2-4months were calculated. Logistic regression was performed to assess factors associated with retesting within 2-4months., Results: Among 8758 women who were positive before 31 August 2022 to allow time for follow up, 1423 (16.2%) were retested within 2-4months, of whom 179 (12.6%) tested positive. The odds of retesting within 2-4months were 25% lower if tested in a coronavirus disease 2019 (COVID-9) pandemic year (2020-2022) (aOR=0.75; 95% CI 0.59-0.95). Among 9140 women with a positive test before 30 November 2022, 397 (4.3%) were retested too early (within 7days to 1month) and 81 (20.4%) of those were positive., Conclusions: Chlamydia retesting rates remain low with around a sixth of women retested within 2-4months in line with guidelines. Re-infection is common with around one in eight retesting positive. An increase in retesting is required to reduce the risk of reproductive complications and onward transmission.

Introduction: Evaluating progress towards hepatitis C virus (HCV) elimination among Aboriginal and Torres Strait Islander peoples is critical given the disproportionate burden of infection. We examined factors associated with current HCV infection and self-reported treatment among Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal peoples) and non-Aboriginal peoples who inject drugs (PWID) in Australia., Methods: ETHOS Engage is an observational cohort study of PWID attending drug treatment and needle and syringe programs in Australia. Participants underwent point-of-care HCV RNA testing (Xpert HCV RNA Viral Load Fingerstick) and completed a questionnaire including self-reported history of HCV treatment., Results: Between May 2018 and June 2021, 2395 participants were enrolled and 555 (23%) identified as Aboriginal (median age 42 years, 58% were men, 63% injected drugs in last month, 76% ever incarcerated). HCV RNA prevalence was 23% among Aboriginal PWID (24% in 2018-2019 and 21% in 2019-2021; p = 0.44), and 21% among non-Aboriginal PWID (24% in 2018-2019 and 16% in 2019-2021; p < 0.001). Self-reported HCV treatment was 65% among Aboriginal PWID (63% in 2018-2019 and 69% in 2019-2021; p = 0.30), and 70% among non-Aboriginal PWID (67% in 2018-2019 and 75% in 2019-2021; p < 0.001). Among Aboriginal PWID, current HCV infection was associated with recently injecting drugs and receiving opioid agonist treatment, and self-reported HCV treatment was negatively associated with younger age, homelessness and recently injecting drugs., Discussion and Conclusions: Equitable access to HCV care and prevention is needed to ensure Australia meets its elimination targets among Aboriginal PWID., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of hepatitis C virus (HCV) infection. This study assessed the effectiveness of direct-acting antiviral (DAA) therapy among Aboriginal peoples in the three years following universal access in Australia. REACH-C, a national multicentre prospective cohort study, evaluated HCV treatment outcomes from sequential DAA initiations across 33 health services between March 2016 and June 2019. DAA effectiveness was assessed by sustained virological response (SVR) in the total (full analysis set) and effectiveness (modified analysis set excluding those lost to follow-up) populations. Overall, 915 (10%) Aboriginal and 8095 (90%) non-Indigenous people commenced DAA therapy, of whom 30% and 16% reported current injecting drug use and 73% and 42% were treated in primary care, respectively. SVR in the total and effectiveness populations was 74% and 94% among Aboriginal people and 82% and 94% among non-Indigenous people, with loss to follow-up contributing to lower SVR in the total population analysis (22% Aboriginal, 13% non-Indigenous). Among Aboriginal people, returning for follow-up was positively associated with older age (aOR 1.20; 95% CI 1.04, 1.39) and SVR was negatively associated with cirrhosis (aOR 0.39; 95% CI 0.19, 0.80) and prior DAA treatment (aOR 0.14; 95% CI 0.04, 0.49). Factors reflecting higher vulnerability or inequity were not associated with returning for testing or SVR. DAA therapy was highly effective among Aboriginal peoples with HCV treated through primary and tertiary services. Tailored community-led interventions are necessary to optimize follow-up and engagement. Sustained DAA uptake and equitable access to care, treatment and prevention are required for HCV elimination., (© 2023 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Objectives: To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health., Design, Setting: Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS)., Participants: First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019., Main Outcome Measures: Positive infectious syphilis test rate; change in annual positive test rate., Results: 180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years., Conclusion: The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis., (© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention-to-treat (ITT) and per-protocol (PP) analyses. Within REACH-C, 10,843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9,174 of 10,843). SVR was 81% (8,750 of 10,843) by ITT and 95% (8,750 of 9,174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43-0.72), cirrhosis (aOR 0.52, 95% CI 0.41-0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46-0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28-0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow-up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44-2.11; IDU + OAT: aOR 1.39, 95% CI 1.11-1.74; OAT only, aOR 1.36; 95% CI 1.13-1.68) and age (aOR 0.97, 95% CI 0.97-0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up., (© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.)

Background: Understanding factors associated with engagement across the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is critical for developing targeted interventions to enhance engagement and further HCV elimination efforts. We describe the CoC among Australian PWID, and identify factors associated with engagement at each stage., Methods: As part of the 2018 and 2019 Illicit Drug Reporting System, Australians who regularly inject drugs reported lifetime HCV antibody and RNA testing, treatment uptake and completion. Multivariable logistic regression identified characteristics associated with outcomes., Results: Of 1499 participants, 87% reported antibody testing. Of those, 70% reported RNA testing, of whom 60% reported being RNA positive. Among those, 76% reported initiating treatment, 78% of whom completed. Incarceration history (adjusted odds ratio 1.90; 95% confidence interval 1.28-2.82), current opioid agonist treatment (OAT) (1.99; 1.14-3.47), and recent alcohol and other drug (AOD) counselling (2.22; 1.27-3.88) were associated with antibody testing. Incarceration history (1.42; 1.07-1.87), and current OAT (2.07; 1.51-2.86) were associated with RNA testing. Current OAT (1.92; 1.22-3.03) and recent AOD counselling (1.91; 1.16-3.13) were associated with treatment uptake. Methamphetamine as drug injected most often in the last month was associated with reduced odds of antibody (0.41; 0.25-0.66) and RNA testing (0.54; 0.40-0.74), compared to heroin., Conclusion: CoC engagement amongst Australian PWID is encouraging, with AOD service engagement associated with testing and treatment. Further efforts to reach those not service engaged, particularly those not receiving OAT or who predominantly inject methamphetamine, are needed to achieve HCV elimination targets., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia., Design: We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018., Methods: Six indicators were measured: (1) state-wide total HIV laboratory tests; (2) number of GBM attending publicly-funded clinics; (3) 12-monthly testing uptake; (4) annual testing frequency; (5) HIV testing with a STI diagnosis; and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas-born., Results: Overall, 43,560 GBM attended participating clinics (22,662 Australian-born, 20,834 overseas-born) from 2010-2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p<0.001 for all) in testing uptake (83.9% to 95.1%); testing with a STI diagnosis (68.7% to 94.0%); annual HIV testing frequency (1.4 to 2.7); and a decreasing trend (p<0.01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian-born and overseas-born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian-born GBM (7.1% to 2.8%), but an increasing trend in overseas-born GBM (15.3% to 16.9%) (p<0.001 for all)., (© 2021 British HIV Association.)

Background: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia., Methods: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid)., Results: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment., Conclusions: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)