Background Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. Methods This qualitative longitudinal study involved 2–4 interviews each over 6 to 12 months with marginalised young people aged 12–24 years living in NSW. The analysis used Nvivo software and grounded theory. Results We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes: Technology brings opportunities to understand, connect and engage with services Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. Multiple marginalisation makes health system navigation more challenging The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support Conclusions The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues. Electronic supplementary material The online version of this article (10.1186/s12939-019-0941-2) contains supplementary material, which is available to authorized users.

Background Herpes simplex virus type 1 (HSV-1) is prevalent worldwide and causes mucocutaneous infections of the oral area. We aimed to define the frequency and anatomic distribution of HSV-1 reactivation in the facial area in persons with a history of oral herpes. Methods Eight immunocompetent HSV-1 seropositive adults were evaluated for shedding of HSV-1 from 12 separate oro-facial sites (8 from oral mucosa, 2 from nose, and 2 from conjunctiva) five days a week and from the oral cavity seven days a week for approximately 5 consecutive weeks by a HSV DNA PCR assay. Symptoms and lesions were recorded by participants. Results HSV-1 was detected at least from one site on 77 of 291 (26.5%) days. The most frequent site of shedding was the oral mucosa, with widespread shedding throughout the oral cavity. Lesional shedding rate was 36.4% (4 of 11 days with lesions) and the asymptomatic rate was 27.1% (65 of 240 non-lesional days). In individual participants, the median rate of HSV shedding by HSV PCR was 19.7% of days (range 11%-63%). Conclusions Reactivation of HSV-1 on the oral mucosa is common and usually asymptomatic. However, HSV-1 is rarely found in tears and nasal mucosa. Frequent oral shedding of HSV-1 may increase the risk for transmitting the virus to both oral and genital mucosa of sexual partners.

Objective: To quantify barriers to healthcare for young people (12-24 years) and identify sociodemographic correlates and predictors. Methods:This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. Results:A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%).Conclusions: Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access.Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.

The known The Australian HPV vaccination program has led to significant declines in a number of HPV-related conditions, including diagnoses of genital warts in young women and heterosexual men at sexual health clinics.The new We found marked declines in the proportions of young Indigenous women and men attending sexual health clinics for the first time who were diagnosed with genital warts following introduction of the HPV vaccination program, similar to declines among non-Indigenous young women and men.The implications Sustained high HPV vaccine coverage rates and monitoring are needed to close the gap between Indigenous and non-Indigenous Australians in the rates of cervical and other HPV-related cancers in older women.T he Australian national human papillomavirus (HPV) vaccination program commenced in April 2007. Free vaccination was provided to 12e13-year-old girls in schools; this was supplemented by a 3-year catch-up program for 13e18-year-old girls in schools and for 18e26-year-old women through family doctors in July 2007.1 In 2013, boys were added to the program, providing free HPV vaccination to 12e13-year-old boys in schools and, for 2 years, a catch-up program for 14e15-year-old boys. Australia uses the quadrivalent HPV vaccine (Gardasil), protecting against HPV types 6 and 11, which cause ano-genital warts, and HPV types 16 and 18, which cause cancer. 2,3The Australian HPV vaccination program has had very promising results. High coverage rates among vaccine-eligible girls have been achieved, 73% receiving all three doses in 2010. 4 Significant reductions in the prevalence of HPV-related conditions have been seen; diagnoses of genital warts in young women and heterosexual men at sexual health clinics, 5,6 inpatient treatment of genital warts at private hospitals, 7 hospital admissions for genital warts, 8 the prevalence in young women of HPV types targeted by the quadrivalent vaccine, 9,10 and the incidence of high grade cervical abnormalities 11 have all declined.Measuring the impact of the HPV vaccination program in Aboriginal and/or Torres Strait Islander (Indigenous) people is important because cervical cancer rates among Indigenous women are twice as high as among non-Indigenous women. 12 Similar findings have been reported overseas; a meta-analysis of data from 35 studies found that indigenous women had elevated risks of invasive cervical cancer and related mortality (pooled risk ratios, 1.72 and 3.45 respectively).13 Indigenous Australians experience poorer outcomes than non-Indigenous people for a range of conditions, 14 including some sexually transmissible infections (STIs). [15][16][17] In response to these inequities, the Australian Government initiated the Closing the Gap program in 2008, 18 followed in 2014 by the Fourth NationalAboriginal and Torres Strait Islander Blood-borne Viruses and STI Strategy, 2014e2017, which includes the aim of achieving high rates of HPV vaccination. 19Despite their disproportionately high rates of cervical cancer, there is a lack of information on HPV vacc...

Objectives: To evaluate the effect of targeted and catch‐up hepatitis B virus (HBV) vaccination programs in New South Wales on HBV prevalence among women giving birth for the first time. Design: Observational study linking data from the NSW Perinatal Data Collection for women giving birth during 2000–2012 with HBV notifications in the NSW Notifiable Conditions Information Management System. Main outcome measures: HBV prevalence in Indigenous Australian, non‐Indigenous Australian‐born, and overseas‐born women giving birth. Results: Of 482 944 women who gave birth to their first child, 3383 (0.70%) were linked to an HBV notification. HBV prevalence was 1.95% (95% CI, 1.88–2.02%) among overseas‐born women, 0.79% (95% CI, 0.63–0.95%) among Indigenous Australian women, and 0.11% (95% CI, 0.09–0.12%) among non‐Indigenous Australian‐born women. In Indigenous Australian women, prevalence was significantly lower for those who had been eligible for inclusion in the targeted at‐risk newborn or universal school‐based vaccination programs (maternal year of birth, 1992–1999: 0.15%) than for those who were not (born ≤ 1981: 1.31%; for trend, P < 0.001). There was no statistically significant downward trend among non‐Indigenous Australian‐born or overseas‐born women. HBV prevalence was higher among Indigenous women residing in regional and remote areas than those in major cities (adjusted odds ratio [aOR], 2.23; 95% CI, 1.40–3.57), but lower for non‐Indigenous (aOR, 0.39; 95% CI, 0.28–0.55) and overseas‐born women (aOR, 0.61; 95% CI, 0.49–0.77). Conclusion: Among women giving birth, there was a significant reduction in HBV prevalence in Indigenous women associated with the introduction of the HBV vaccination program in NSW, although prevalence remains higher than among non‐Indigenous Australian‐born women, and it also varies by region of residence. Continuing evaluation is needed to ensure that the prevalence of HBV infections continues to fall in Australia.

BackgroundThe integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data.Methods and analysisThis mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12–24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum.Ethics and disseminationEthics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations.

Background: There is limited information on vaccination coverage and characteristics associated with vaccine uptake in Aboriginal and/or Torres Strait Islander adults. We aimed to provide more current estimates of influenza vaccination coverage in Aboriginal adults. Methods: Self-reported vaccination status (n=559 Aboriginal and/or Torres Strait Islander participants, n=80,655 non-Indigenous participants) from the 45 and Up Study, a large cohort of adults aged 45 years or older, was used to compare influenza vaccination coverage in Aboriginal and/or Torres Strait Islander adults with coverage in non-Indigenous adults. Results: Of Aboriginal and non-Indigenous respondents aged 49 to <65 years, age-standardised influenza coverage was respectively 45.2% (95% CI 39.5–50.9%) and 38.5%, (37.9–39.0%), p-value for heterogeneity=0.02. Coverage for Aboriginal and non-Indigenous respondents aged ≥65 years was respectively 67.3% (59.9–74.7%) and 72.6% (72.2–73.0%), p-heterogeneity=0.16. Among Aboriginal adults, coverage was higher in obese than in healthy weight participants (adjusted odds ratio (aOR)=2.38, 95%CI 1.44–3.94); in those aged <65 years with a medical risk factor than in those without medical risk factors (aOR=2.13, 1.37–3.30); and in those who rated their health as fair/poor compared to those who rated it excellent (aOR=2.57, 1.26–5.20). Similar associations were found among non-Indigenous adults. Conclusions: In this sample of adults ≥65 years, self-reported influenza vaccine coverage was not significantly different between Aboriginal and non-Indigenous adults whereas in those <65 years, coverage was higher among Aboriginal adults. Overall, coverage in the whole cohort was suboptimal. If these findings are replicated in other samples and in the Australian Immunisation Register, it suggests that measures to improve uptake, such as communication about the importance of influenza vaccine and more effective reminder systems, are needed among adults.

Background Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients’ Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. Methods A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. Results Indigenous status was complete in 56% (median 60%, IQR 7–81%) of general practice records for 109,970 patients aged 16–29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16–29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. Conclusions Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened. Trial registration ACTRN12610000297022 . Registered 13th April 2010.