Victorian Aboriginal Health Service

Globally, hepatitis C virus (HCV) elimination is a priority for marginalised communities, including Aboriginal and Torres Strait Islander peoples in Australia. Innovative and equity focused models of care are required to achieve elimination. The aim of this analysis was to evaluate prevalence of, and factors associated with, HCV infection among Aboriginal peoples engaged during implementation of a point-of-care testing and treatment intervention at Aboriginal primary health care services. The SCALE-C prospective cohort study implemented a decentralised, on-site community-based "test and treat" intervention through four regional Aboriginal Community Controlled Health Organisations (primary care services) in New South Wales and South Australia between May 2019 and July 2022. Following a screening questionnaire (history of HCV infection, injecting drug use, incarceration, opioid agonist therapy use), participants underwent fingerstick point-of-care HCV testing (antibody [no risk] and/or RNA [history of HCV, ever at risk]); those at risk or with current HCV infection were also offered point-of-care HIV and HBV testing, education, and longitudinal follow-up. Participants with current HCV infection were offered DAA treatment. The primary endpoint was current HCV infection, with secondary endpoints including DAA uptake and outcome. Factors associated with current HCV infection were assessed using logistic regression analysis. Of 536 individuals enrolled (median age 39 years, 49% women, 37% injecting drug use ever, 32% incarceration ever), 79% identified as Aboriginal and/or Torres Strait Islander. The proportion with current HCV infection was 9%, ranging from 0.5% among people reporting no lifetime risk to 20% among those reporting risk within the past 12 months. Current HCV infection was associated with recent injecting drug use (adjusted OR: 10.43; 95% CI: 1.34-81.01). Among participants with HCV infection, 62% (28/45) received DAA treatment (median time from enrolment to treatment initiation, nine days [range 2, 22]) and 57% (16/28) of those treated had confirmed sustained virological response (SVR); SVR was 100% (16/16) among those retained in follow up. A community-based decentralised on-site "test and treat" intervention integrated within existing Aboriginal community-controlled health organisations was feasible and effective in HCV case detection. While it holds potential for future elimination efforts, health system enhancement will be required (including dedicated staffing and infrastructure) to support broader implementation and improve linkage to care and treatment. This study was registered with clinicaltrials.gov (NCT03776760) on December 12, 2018.

Background: Worldwide, it is recommended long term care facility (LTCF) infection prevention and control (IPC) programs include surveillance activities. The Australian National Infection Surveillance Program for Aged Care (NISPAC) is seeking to develop, implement and evaluate a standardized program. In order to define the scope of the surveillance methods, an appropriate technique for stakeholder engagement was required.

BackgroundInfection surveillance is a vital part of infection prevention and control activities for the aged care sector. In Australia there are two currently available infection and antimicrobial use surveillance programs for residential aged care facilities. These programs are not mandated nor available to all facilities. Development of a new surveillance program will provide standardised surveillance for all facilities in Australia.MethodsThis study aimed to assess barriers and enablers to participation in the two existing infection and antimicrobial use surveillance programs, to improve development and implementation of a new program. A mixed-methods study was performed. Aged Care staff involved in infection surveillance were invited to participate in focus groups and complete an online survey comprising 17 items. Interviews were transcribed and analysed using the COM-B framework.ResultsTwenty-nine staff took part in the focus groups and two hundred took part in the survey. Barriers to participating in aged care infection surveillance programs were the time needed to collect and enter data, competing priority tasks, limited understanding of surveillance from some staff, difficulty engaging clinicians, and staff fatigue after the COVID-19 pandemic. Factors that enabled participation were previous experience with surveillance, and sharing responsibilities, educational materials and using data for benchmarking and to improve practice.ConclusionStreamlined and simple data entry methods will reduce the burden of surveillance on staff. Education materials will be vital for the implementation of a new surveillance program. These materials must be tailored to different aged care workers, specific to the aged care context and provide guidance on how to use surveillance results to improve practice.

IntroductionSmoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples.Methods and analysisAn Aboriginal-led, multisite non-randomised single-group, pre–post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial.Ethics and disseminationEthics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation.Trial registration numberACTRN12622000654752.

ObjectiveUsing a strength‐based framework, we aimed to describe and compare First Nations patients who completed care in an ED to those who took their own leave.MethodsRoutinely collected adult patient data from a metropolitan ED collected over a 5‐year period were analysed.ResultsA total of 6446 presentations of First Nations patients occurred from 2016 to 2020, constituting 3% of ED presentations. Of these, 5589 (87%) patients waited to be seen and 857 (13%) took their own leave. Among patients who took their own leave, 624 (73%) left not seen and 233 (27%) left at own risk after starting treatment. Patients who were assigned a triage category of 4–5 were significantly more likely to take their own leave (adjusted odds ratio [OR] 3.17, 95% confidence interval [CI] 2.67–3.77, P < 0.001). Patients were significantly less likely to take their own leave if they were >60 years (adjusted OR 0.69, 95% CI 1.01–1.36, P = 0.014) and had private health insurance (adjusted OR 0.61, 95% CI 0.45–0.84, P < 0.001). Patients were more likely to leave if they were women (adjusted OR 1.17, 95% CI 1.01–1.36, P = 0.04), had an unknown housing status (adjusted OR 1.76, 95% CI 1.44–2.15, P < 0.001), were homeless (adjusted OR 1.50, 95% CI 1.22–1.93, P < 0.001) or had a safety alert (adjusted OR 1.60, 95% CI 1.35–1.90, P < 0.001).ConclusionA lower triage category is a strong predictor of First Nations patients taking their own leave. It has been documented that First Nations patients are under‐triaged. One proposed intervention in the metropolitan setting is to introduce practices which expediate the care of First Nations patients. Further qualitative studies with First Nations patients should be undertaken to determine successful approaches to create equitable access to emergency healthcare for this population.

Australian government planning promotes evidence-based action as the overarching goal to achieving health equality for Aboriginal and Torres Strait Islander populations. However, an inequitable distribution of power and resources in the conduct of evidence-based practice produces a policy environment counterintuitive to this goal. This context of contemporary evidence-based practice gives legitimacy to ‘expert practitioners’ located in Australian governments and universities to use Western guidelines and tools, embedded in Western methodology, to make ‘evidence’ informed policy and programming decisions about Aboriginal and Torres Strait Islander populations. This method for decision making assumes a positional superiority that can marginalise the important perspectives, experiences and knowledge of Aboriginal Community Controlled Organisations and their processes for decision making. Here we consider the four steps of an evidence review: (1) developing a review question; (2) acquiring studies; (3) appraising the evidence and (4) assessing the evidence, as components of wider evidence-based practice. We discuss some of the limitations across each step that arise from the broader context within which the evidence review is produced. We propose that an ethical and just approach to evidence-based review can be achieved through a well-resourced Aboriginal community controlled sector, where Aboriginal organisations generate their own evidence and evidence is reviewed using methods and tools that privilege Aboriginal and Torres Strait Islander ways of knowing, doing and being.

This study documents evaluation of the Her Tribe and His Tribe Aboriginal-designed empowerment pilot programs. The programs were designed to support Victorian Aboriginal people to strengthen mental health, social and emotional wellbeing, community connection, and to reduce psychological distress. A second aim was to explore participants’ experiences of the programs, including the feasibility and acceptability of the evaluation component. Her Tribe ran for 16 weeks and His Tribe for 12 weeks. In total, 43 women and 26 men completed assessments at pre- and post-program completion, and 17 and 10, respectively, participated in yarning circles at the 6-month follow up. For both programs, there were significant increases in participants’ access to personal strengths and resources, relationship–community–cultural strengths and resources, and decreases in psychological distress. These changes were associated with small to moderate effects that were maintained at the 6-month follow up. There was a significant increase in aerobic fitness for female but not male participants, and no significant changes in weight for either group. Participants described a range of benefits from the programs, including positive elements and areas for improvement. They also viewed the evaluation as feasible and acceptable, and the findings of value. The outcomes from both pilot programs provide evidence that Aboriginal-designed programs, with a focus on physical and cultural activities, can help to strengthen mental health and wellbeing, community connection, and reduce psychological distress in Victorian Aboriginal communities.

Aquatic therapy is one therapy option for people living with Parkinson's disease (PD). However, the optimal prescription, dosage, and delivery remain unclear. i) To generate consensus statements, ii) to establish evidence-based clinical practice aquatic therapy guidelines for PD. Seventy-three international experts were invited to participate in a 3-step modified Delphi study. Gaps in the aquatic therapy evidence, patient preferences, and stakeholder engagement were considered when developing the initial list of 43-statements identified by the research development group. Practice experts rated each statement on an 11-point Likert scale. Consensus for inclusion was set at a priori of ≥70% of respondents scoring an item ≥7. Two rounds of Delphi questionnaires were completed online, and the expert comments were analyzed using content analysis. An online consensus meeting with an expert subgroup (n = 10) then advised on the guideline's acceptability and debated items until consensus for inclusion was reached. Fifty experts participated in the Delphi round one (83% response rate) and 45 in round two (90% response rate), representing 15 countries. In round one, 35 statements met the criteria for consensus. Content analysis informed the revised statements in round two, where 12 of the remaining 16 statements met consensus. The final agreed aquatic therapy guidelines include key information about dosage, content, safety, contraindications, and the optimal aquatic therapy delivery throughout the disease course. Stakeholders, including international practice experts, informed a rigorous evidence-based approach to integrate the best available evidence, patient preferences, and practice expertise to inform these guidelines.