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BackgroundYoung people living in remote Australian Aboriginal communities experience high rates of sexually transmissible infections (STIs). STRIVE (STIs in Remote communities, ImproVed and Enhanced primary care) was a cluster randomised control trial of a sexual health continuous quality improvement (CQI) program. As part of the trial, qualitative research was conducted to explore staff perceptions of the CQI components, their normalisation and integration into routine practice, and the factors which influenced these processes.MethodsIn-depth semi-structured interviews were conducted with 41 clinical staff at 22 remote community clinics during 2011–2013. Normalisation process theory was used to frame the analysis of interview data and to provide insights into enablers and barriers to the integration and normalisation of the CQI program and its six specific components.ResultsOf the CQI components, participants reported that the clinical data reports had the highest degree of integration and normalisation. Action plan setting, the Systems Assessment Tool, and the STRIVE coordinator role, were perceived as adding value to the program, but were less readily integrated or normalised. The remaining two components (dedicated funding for health promotion and service incentive payments) were seen as least relevant. Our analysis also highlighted factors which enabled greater integration of the CQI components. These included familiarity with CQI tools, increased accountability of health centre staff and the translation of the CQI program into guideline-driven care. The analysis also identified barriers, including high staff turnover, limited time involved in the program and competing clinical demands and programs.ConclusionsAcross all of the CQI components, the clinical data reports had the highest degree of integration and normalisation. The action plans, systems assessment tool and the STRIVE coordinator role all complemented the data reports and allowed these components to be translated directly into clinical activity. To ensure their uptake, CQI programs must acknowledge local clinical guidelines, be compatible with translation into clinical activity and have managerial support. Sexual health CQI needs to align with other CQI activities, engage staff and promote accountability through the provision of clinic specific data and regular face-to-face meetings.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044. Registered 6/05/2010. Prospectively Registered.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3024-y) contains supplementary material, which is available to authorized users.

The objective of the study was to determine if oral beta carotene would improve abnormalities observed in Papanicolaou smears or reduce the amount of HPV DNA in genital samples. A randomized double blind placebo controlled trial was designed for 117 women with abnormal cervical morphology, not undergoing laser ablative therapy, at The Royal Women’s Hospital, Victoria. Thirty milligrams of oral beta carotene were administered daily for 12 months. Post‐intervention cervical cytology and the amount of HPV DNA present on tampon specimens as determined by polymerase chain reaction and Hybrid Capture were the main outcome measures. After 12 months therapy there was no difference between the beta carotene and placebo groups in Papanicolaou smear results (58% and 62% normal) and HPV positivity (42% and 46% positive) (P> 0.86). Women taking beta carotene were not more likely to have improved cervical cytology or a decrease in the amount of HPV DNA (P> 0.2). The median post‐intervention beta carotene level was 0.63 µm ml−1 (range 0.04–1.6) for the beta carotene group and 0.15 µm ml−1 (range 0.02–1.51) for the lecithin group (P < 0.0001). This clinical trial did not identify a beneficial effect of 30 mg of oral beta carotene on cervical cytology, or on the amount of HPV DNA present from tampon specimens.

These findings strongly support screening among MSM and in particular not testing asymptomatic MSM for urethral gonorrhoea or any MSM for pharyngeal chlamydia.

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Predictors of repeat users were measured in a matched case-control study by conditional logistic regression analysis. A case (N¼304) was defined as reporting having ever used IWTK before. A control was a user who reported never using the program earlier. Two controls (N¼608) were systematically sampled for each case by matching date of use of IWTK of the case within 3 months. Results From 2007 to 2010, 17% of 1747 women who used IWTK for STI testing indicated they had used IWTK previously. Of these, 45% used it >2 times. Mean age was 24.765.7 yr; most were African American (69%); single (87%); 57% had 2e4 sexual partners previous yr; 44% had new partners in last 3 months; 32% were currently having sex >1 person; 16% practiced anal sex in the last 3 months; 13% never used condoms; 77% had been treated for an STI; (5 HIV+). In multivariate analysis, repeat IWTK users were more likely to be $20 yr. (OR¼2.10, 95% CI 1.30 to 3.38) and reside in Maryland (OR¼2.03, 95% CI 1.31 to 3.13). They were more likely to have had a pelvic exam in past yr (OR¼2.03, 95% CI 1.36 to 3.05); be treated for an STI (OR¼2.32, 95% CI 1.57 to 3.44); to perceive internet screening as confidential (OR¼1.98, 95% CI 1.32 to 2.97); report results from self-administrated swabs as accurate (OR¼2.49, 95% CI 1.61 to 3.87); be less likely to drink alcohol before sex (OR¼0.63, 95% CI 0.44 to 0.91); and to never use condoms with vaginal sex (OR¼0.43, 95% CI 0.27 to 0.69). Of repeat users, 84.2% reported having a negative prior test and 48/304 (15.8%) reported last test positive; 27 had CT; 24 had TV; 3 had GC; 6 were mixed infections. At present test, 40 (13.2%) were positive: 14 had CT, 2 had GC, 28 had TV; 4 were mixed infections. Previous TV was associated with current TV positivity (p<0.05). Conclusions IWTK attracted many previous participants who practiced high-risk sexual behaviours to use IWTK for repeat STI testing. IWTK may offer an alternate approach for rescreening previously infected women.

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However, significant associations were observed in MSM with anal HPV 16 (with coinfectiondAOR, 10.94, 95% CI, 1.18 to 101.68; withoutdAOR, 4.96, 95% CI, 1.40 to 17.57). Conclusion We found type-specific associations of HPV 6 and 16 seropositivity with prevalent anal HPV infection, but not with prevalent genital HPV infection alone. Anal HPV 6 infection was associated with seropositivity in both MSW and MSM, while anal HPV 16 infection was only associated with seropositivity in MSM. Our data suggest that, in men, anal HPV infection may be more efficient than genital HPV infection in inducing immune responses. This may have relevance for protective immunity or the lack thereof, conferred by natural infection. Background Mycoplasma genitalium (Mg) is an emerging sexually transmitted infection that has been associated with serious upper genital tract infections in women such as cervicitis, pelvic inflammatory disease and endometritis. The burden of disease for Mg in Australia is unknown as there are no current population prevalence or incidence data. Methods Women aged 16e25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in SouthEastern Australia and consented to participate in a 12-month study providing vaginal swabs through the mail. Women were tested at 6-monthly intervals for chlamydia and Mg. Results Overall, 1116 women were recruited from 29 clinics; with 79% of women retained at the conclusion of the study. The prevalence of Mg at recruitment was 2.4% (95% CI 1.5 to 3.3). Increased numbers of sexual partners was strongly associated with Mg (adjusted OR [AOR]¼2.2; 95% CI 1.0 to 4.6), as was being recruited from SHC (AOR¼3.4; 95% CI 1.5 to 5.3). Mg incidence was 1.2 per 100 women years (95% CI 0.7 to 2.1) and was associated with women recruited from SHC (HR¼4.9; 95% CI 1.5 to 16.3) and having increased numbers of new sexual partners (HR¼5.7; 95% CI 1.4 to 23.1). We found a median organism load of 1.43103/5?L, which was 100 times less than that found in chlamydia positive samples. We also found an azithromycin failure rate of 15% (95% CI 3.2 to 37.9). Conclusion Mg is common in young Australian women, and consistent with international studies, Mg was less prevalent than chlamydia. Background Mycoplasma genitalium (MG) is an emerging STI associated with reproductive tract syndromes in men and women, and P1-S1.57 EPIDEMIOLOGY OF