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The Deadly Liver Mob Project (DLM) was an initiative of the Western Sydney Local Health District Harm Reduction team. The project came about as a result of poor attendances at the needle and syringe program by Aboriginal people and very few episodes of care over the immediate preceding years in the adjacent sexual health clinic, despite the area being one of the most populous areas for Aboriginal people in Australia. The DLM incorporates a peer driven intervention [PDI] with incentives provided for each step in participation to encourage people to be educated about BBV and then recruit and educate their peers as well as consider offers of hepatitis C and sexual health screening. Evaluation of the DLM in Western Sydney and the new site in Nepean Blue Mountains Local Health Districts will be undertaken using a non-experimental mixed-method design.
The overall aims of the evaluation are:
This evaluation is supported by BRISE and the two participating health districts
This project aims to investigate the attitudes of gay and bisexual men to new HIV prevention technologies, particularly pre-exposure prophylaxis (PrEP) and treatment as prevention. The main method of data collection is a national, online survey of gay and bisexual men which has been repeated every two years since 2011.
To view the 2015 report, please click here.
The Sydney Gay Community Periodic Survey is a cross-sectional survey of gay and homosexually active men recruited at a range of gay community sites in Sydney. In 2015, online recruitment was included for the first time. Since 1996, the project has been funded by the NSW Ministry of Health and supported by ACON and Positive Life NSW. The major aim of the survey is to provide data on sexual, drug use and testing practices related to the transmission of HIV and other sexually transmissible infections (STIs) among gay men in Sydney. Reports on previous rounds of the survey can be accessed at https://csrh.arts.unsw.edu.au/research/publications/gcps/
The primary focus of this exploratory, qualitative project, funded by BRISE, was to interview a range of professionals employed in health services, health promotion and other relevant roles to document their expert views on the experiences and needs of straight-identified MSM in New South Wales. Other activities included reviewing the literature, analysing existing CSRH data, and appraising the terminology and activities evident in online personal ads posted by straight MSM.
Publications can be accessed at https://csrh.arts.unsw.edu.au/research/projects/straight-msm/
Injecting drug use (IDU), and opioid dependence, are thought to be significant contributors to the burden of disease in Australia and globally. Much of the burden derives from the increased risks of blood-borne virus transmission due to unsafe drug injection, with elevated risks of hepatitis C (HCV) and hepatitis B (HBV) among people who inject drugs (PWID). Updated estimates of the population size of PWID, and the incidence and prevalence of hepatitis C and hepatitis B, are proposed. PWID sampled in surveillance studies are becoming older, fewer people may be initiating to heroin use following the heroin shortage of 2001, and the types of drugs being injected by those who do still inject have shifted. Such shifts may influence the trajectory of blood-borne virus (BBV) epidemics in Australia, so it is crucial that new population size estimates are available to inform such projections and that out-dated estimates and projections are conducted.
NSW Health has provided funding to the Kirby Institute to coordinate and conduct studies to:
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The NSW Needle and Syringe Program Enhanced Data Collection (NNEDC) provides a coordinated state-wide mechanism to collect and analyse data from people who inject drugs (PWID) who attend public sector Needle and Syringe Programs (NSPs). The NNEDC provides key data on priority populations and injection risk behaviour, monitors trends in the NSP population, and contributes to surveillance and performance in meeting the targets outlined in the NSW HIV Strategy 2012-2015 and the NSW Hepatitis B and C Strategies 2014 -2020. The NNEDC was implemented in 2004 and 2008 and for four consecutive years, 2013 to 2016. This BRISE project will conduct the NNEDC for a fifth consecutive year (2017).
Louise Geddes, Jenny Iversen and Lisa Maher. New South Wales Needle and Syringe Program Enhanced Data Collection Report 2017. Sydney: Kirby Institute, University of New South Wales; 2017.
Download 2018 Report
Download 2017 Report
Co-investigator: Dr Monika Wadolowski
BRISE ASP aims to gather evidence of current and past strategies for STI and BBV management within NSW Aboriginal community controlled health services (ACCHS), and assess the strength of these strategies for increasing in STI/BBV testing, management and health outcomes. Strategies considered for BRISE ASP will include prevention programs, health promotion programs, and projects supporting clinical staff to achieve best practice in testing and management. BRISE ASP will also consider strategies led by ACCHS, peak bodies (e.g. AH&MRC), local health districts (LHDs), and other collaborators. The findings from BRISE ASP will help inform future strategies and programs for STI/BBV management in ACCHS settings. BRISE ASP will explore the potential for multiple strategies to be combined, or opportunities to involve partnerships, such as ACCHS and local health districts (LHDs) to maximise the effectiveness and sustainability of future programs.
HBV and HCV notifications (1993-2012), held by the Notifiable Conditions Information Management System, have been linked (by CHeReL) to several datasets, including HIV administrative dataset (from 1985), the Pharmaceutical Drugs of Addiction System administrative database (from 1985), NSW Admitted Patient Data Collection (from 2001), NSW Central Cancer Registry (from 1994), NSW Registry of Births Deaths and Marriages (from 1993), and Cause of Death Unit Record File (from 1993). Future linkages will also include NSW Perinatal Data Collection (from 1994), NSW Bureau of Crime Statistics and Research (from 1994), NSW Emergency Department Data Collection (from 2005), Pharmaceutical Benefits Scheme (PBS) (from 2010), and Medicare Benefits Schedule (MBS) (From 2010). Linkages to PBS and MBS will be carried out by AIHW. This project will also utilize these datasets to improve the reporting of Aboriginal and Torres Strait Islander peoples within the study. The next round of data linkage is expected to occur mid-2017.
The BRISE linkage project has the capacity to provide ongoing evaluation of the impact of new HBV and HCV treatments on population-level liver disease burden, and inform HBV and HCV care cascades, including among Aboriginal and Torres Strait Islander peoples.
Those who sell sex (sex workers) have been identified in a priority population in state and national strategies for the prevention of HIV and other sexually transmissible infections. This project monitors trends in sexual health testing, diagnoses and treatment among sex workers in New South Wales and provides details on characteristics pertaining to the health of sex workers in the state. In 2016, the project used data collected from publicly-funded sexual health clinics to assess the prevalence and incidence of HIV, chlamydia, gonorrhoea, and infectious syphilis among sex workers and produced a report (see below). A more detailed analysis of HIV/STIs in male sex workers determined that involvement in sex work was not an independent risk factor for infections in gay and bisexual men (Callander D, et al. Sexually Transmitted Infections 2017 [in press]).
A molecular epidemiology study that was published in 2016 confirmed that gonorrhoea had recently re-emerged as an endemic STI among heterosexuals in NSW. The role that female sex work – and oral sex, in particular – plays in this re-emergence is currently under investigation with the cooperation of the Ministry of Health, SWOP, and clinical services.
Callander D, Cox C, Schmidt H, Donovan B. Sex Worker Health Surveillance: a Report to the New South Wales Ministry of Health. 2015. Sydney, NSW: Kirby Institute.
Download the report
In New South Wales, strategies for the control of STIs and hepatitis highlight the need for targeted surveillance and monitoring of these infections, particularly among populations most at-risk. Data for this project are routinely collected patient data extracted via the ACCESS Project (Australian Collaboration for Coordinated Enhance Sentinel Surveillance) from sexual health clinics, hospital infectious diseases clinics, general practices and pathology laboratories across the state. The indicators produced from these data are used to monitor testing, diagnosis and management of STIs and hepatitis – including among priority populations – and play an important part in the state’s overall surveillance and monitoring mechanisms.
Co-investigator: Ian Down
The first stage of this work involves mapping the current referral pathways for people newly diagnosed with HIV. Through this we aim to identify where monitoring clinical data needs expansion, and if existing community-based and clinical pathways are sufficient to ensure data collection is efficient and consistent across jurisdictions and between settings. This research will allow improvements to communication, client services, and better clinical and personal outcomes for people diagnosed with HIV.
We will liaise with state health departments, relevant community organisations and select clinical services in each jurisdiction, including in specific non-urban locations where feasible, to map the current follow-up procedures applicable to individuals who have been newly diagnosed with HIV. We will map current clinic based procedures for post-diagnosis counselling and clinical blood work testing, treatment initiation protocols, referrals to community and peer support services, as well as data collection and reporting within and between clinic-based and community-based services. We will map current procedures in community organisations for counselling, community and peer support services, referrals to clinical services, as well as data collection and reporting within and between clinic and community- based services. We will also review the current surveillance mechanisms, in each jurisdiction with the aim of assessing how these mechanisms either dissuade or facilitate the patient trajectory between the clinic and community based services.
The robustness or the degree of external validity of results from the NSW NSP Enhanced Data Collection (NNEDC) is difficult to determine. A key limitation is the lack of information that is collected from NSP clients who decline to participate in the NNEDC, particularly in terms of demographic characteristics and injecting risk behaviour. However, while the NNEDC is designed to remove the need to request data of NSP clients on each occasion of service by replacing this with an annual snapshot data collection, this collection aims to place as few demands as possible on respondents who are not reimbursed for their participation.
The current study aims to assess the robustness of the NNEDC by determining the representativeness of respondents relative to the broader population of NSW NSP clients by comparing basic demographic (age, gender, Indigenous status) and drug use (self-reported drug last injected) characteristics. The 2017 NNEDC will include a mandatory core module to be completed by all presenting NSP clients. Data will be analysed using STATA to model univariate and multivariate associations between demographic and drug use characteristics and completion of the NNEDC survey. Wald X2 tests and related 95% confidence intervals (CIs) will be calculated to assess statistical significance and precision.
A collaboration between Kirby Institute and NUAA is developing educational materials and workshop to train peer workers in hepatitis C. The educational program will cover HCV epidemiology and natural history, HCV prevention, and treatment with direct-acting antiviral regimens. Peer workers, including those involved in Kirby-related research projects, will undertake the program to enhance evidence-based peer education of people who inject drugs.
Periodic survey of sexual health, condom use and testing for STIs among young people Young people are a key priority population for the prevention and management of sexually transmissible infections (STIs). Building on previous CSRH research on sexual health, a new (online) periodic survey among young people has been initiated in 2015. Called ‘It’s Your Love Life’ (IYLL), the survey will take place annually from 2015 with a focus on sexual health, condom use and testing for STIs. The study has four main objectives: 1) to assess the extent of condom use and STI testing among young people aged 15-29 years in NSW and monitor changes over time in young people’s sexual health related behaviours, 2) to understand barriers and facilitators of condom use and STI testing among young people, 3) to assess young people’s engagement and exposure to a range of intervention components that are part of the NSW Sexual Health Promotion framework, and 4) to evaluate the impact of sexual health programs on young people knowledge, attitudes and behaviours regarding condom use and testing for STIs.
Between December 2015 and March 2016, more than 4,000 young people living in NSW (mean age 20 years, range 15-29) have been recruited from targeted online advertisement on Facebook and Instagram and were invited to complete an online questionnaire. Of the 4,000 participants who accessed the survey, 3,500 provided answers to core behavioural questions on their sexual activity, condom use and testing for STIs that were included in a first survey module called the Snapshot. Also, more than 2,000 participants went beyond the first survey module and provided complete answers to detailed questions on individual, social and structural barriers to condom use and STI testing as well as exposure to major sexual health programs and interventions targeting young people in NSW. The survey will deliver novel data on sexual health among young people, on the extent of exposure to sexual health programs among young people, and on sexual health programs ability to change young people’s sexual health-related behaviours. Data and insights generated from the study findings will be used to directly inform the NSW Sexual Health Promotion (SHP) Framework.
To view the 2016 survey, please click here.