Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis

BackgroundIn the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16-29 years in Aboriginal Community Controlled Health Services between 2018 and 2020.MethodsUsing routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test.ResultsOf the13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20-24 years (OR 1.2, 95% CI 1.1-1.4) and 25-29 years (OR 1.1, 95% CI 1.0-1.2) compared to 16-19 years and patients residing in very remote (OR 4.2, 95% CI 3.7-4.8), remote (OR 2.4, 95% CI 2.1-2.8), and regional areas (OR 2.5, 95% CI 2.2-2.8) compared to metropolitan areas. There was no association with patient sex.ConclusionsIntegration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women. In the context of an expanding syphilis epidemic, we assessed the integration of STI testing into Medicare Benefits Schedule Item 715, which is a comprehensive annual health assessment offered to Aboriginal and Torres Strait Islander people in Australian primary care. Guidelines recommend inclusion of STI testing for young people, but the extent to which health services nationally have integrated STI screening into health assessments is unknown. Our national, multi-centre study examined factors associated with integration of STI testing into health assessments for the first time and makes an important contribution to the evidence base supporting national guidelines.