STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing ‘usual practice’ STI care to enhanced care in remote primary health care services in Australia

Abstract

BackgroundDespite two decades of interventions, rates of sexually transmissible infections (STI) in remote Australian Aboriginal communities remain unacceptably high. Routine notifications data from 2011 indicate rates of chlamydia and gonorrhoea among Aboriginal people in remote settings were 8 and 61 times higher respectively than in the non-Indigenous population.Methods/designSTRIVE is a stepped-wedge cluster randomised trial designed to compare a sexual health quality improvement program (SHQIP) to usual STI clinical care delivered in remote primary health care services. The SHQIP is a multifaceted intervention comprising annual assessments of sexual health service delivery, implementation of a sexual health action plan, six-monthly clinical service activity data reports, regular feedback meetings with a regional coordinator, training and financial incentive payments. The trial clusters comprise either a single community or several communities grouped together based on geographic proximity and cultural ties. The primary outcomes are: prevalence of chlamydia, gonorrhoea and trichomonas in Aboriginal residents aged 16–34 years, and performance in clinical management of STIs based on best practice indicators. STRIVE will be conducted over five years comprising one and a half years of trial initiation and community consultation, three years of trial conditions, and a half year of data analysis. The trial was initiated in 68 remote Aboriginal health services in the Northern Territory, Queensland and Western Australia.DiscussionSTRIVE is the first cluster randomised trial in STI care in remote Aboriginal health services. The trial will provide evidence to inform future culturally appropriate STI clinical care and control strategies in communities with high STI rates.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044

Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal clinical service data

“…We conducted a retrospective cohort analysis, making use of baseline data collected in the context of STRIVE15 (STIs in remote communities: Improved and enhanced primary health care). The STRIVE trial aimed to evaluate quality improvement strategies in the clinical management of STIs.…”

“…In 2010, a cluster randomised trial15 of health service strategies for improving the control of curable STIs was initiated in 68 remote Aboriginal communities in central and northern Australia. In the context of this trial, it became possible for the first time to obtain records of repeat screening for STIs in these communities, and therefore estimate the rate at which new infections were occurring.…”

Aboriginal community controlled health services: leading the way in primary care

“…The medical literature has many reports of well implemented research programs, often integrated with everyday care in ACCHSs, showing improved health outcomes. Sexual health, 17 maternal and child health, 18 smoking cessation 19 and cardiovascular programs 20 , 21 have been successfully run and monitored in ACCHSs. Recently ACCHSs have been building their capacity to collect and use health service data, enabling review of service delivery, performance tracking and monitoring of the health status of their patient cohorts.…”

Coinfection withChlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis: a cross-sectional analysis of positivity and risk factors in remote Australian Aboriginal communities

“…In 2011, the STIs in Remote communities: ImproVed and Enhanced primary health care (STRIVE) trial commenced,12 which aimed to assess whether a sexual health quality improvement programme could increase STI testing and in turn reduce the prevalence of STIs. The study involved 68 remote communities with predominantly Aboriginal populations in central and northern Australia and is being evaluated with a stepped wedge randomised cluster design.…”