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Brennan DJ, Charest M, Turpin A, Griffiths D, Adam BD, Maxwell J, McCrady K, Ahmed R. "It's a win for the clinic, it's a win for the frontline, but, most importantly, it's a win for the client": Task Shifting HIV Prevention Services from Clinicians to Community Health Workers in Ontario, Canada. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:780-792. [PMID: 35505827 PMCID: PMC9049009 DOI: 10.1007/s13178-022-00721-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 05/28/2023]
Abstract
Introduction Despite strong evidence from low- and middle-income countries supporting the use of task shifting to provide quality, cost-effective HIV-related health services, this strategy has been adopted less widely in high-income countries such as Canada. Methods In 2020, we conducted semi-structured interviews with 19 clinicians (e.g., psychologists, nurses, physicians) and 14 community health workers (CHWs) in Ontario to examine their perspectives on the prospect of shifting HIV/STBBI testing services and PrEP in Ontario, Canada. Interviews were transcribed and then analyzed using content analysis. A community consultation with key stakeholders was also performed to assess the validity of the findings. Results There was substantial agreement between clinicians and CHWs with respect to shifting specific tasks related to HIV/STBBI testing and PrEP. In particular, most participants felt that rapid HIV testing could and should be provided by CHWs and that ASOs could be ideal sites for clients to obtain and use self-testing kits for STBBIs. Most respondents agreed that CHWs have the skills and expertise required to perform most non-clinical services related to PrEP (e.g., pre-counselling, follow-up, case management). The co-location of clinicians and CHWs could help support the development of task shifting initiatives. Conclusion Findings indicate that there is enthusiasm among both clinicians and CHWs with respect to shifting HIV prevention services. Creative solutions are required to have a meaningful impact on HIV incidence in this population. Policy Implications With adequate training and supervision, non-regulated CHWs should be allowed to provide certain HIV prevention services such as rapid HIV testing. A provincial, publicly funded program for PrEP is recommended.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | - Maxime Charest
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Aaron Turpin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | | | - Barry D. Adam
- Departments of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON Canada
- Ontario HIV Treatment Network, Toronto, ON Canada
| | | | - Keith McCrady
- 2-Spirited Peoples of the 1st Nations, Toronto, ON Canada
| | - Robbie Ahmed
- Alliance for South Asian AIDS Prevention, Toronto, ON Canada
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2
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Chan C, Patel P, Johnson K, Vaughan M, Price K, McNulty A, Templeton DJ, Read P, Cunningham P, Grulich AE, Bavinton BR. Community-based peer-led HIV/sexually transmitted infection testing services in Sydney for gay and bisexual men captured an eighth of new HIV diagnoses in New South Wales, Australia. AIDS 2021; 35:1878-1880. [PMID: 34397488 DOI: 10.1097/qad.0000000000002982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital
- School of Population Health, UNSW Sydney
| | - David J Templeton
- Kirby Institute, UNSW Sydney
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney
| | - Phillip Read
- Kirby Institute, UNSW Sydney
- Kirketon Road Centre
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia
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3
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Leitinger D, Ryan K, Wilkinson AL, Pedrana A, Hellard M, Stoové M. Implications of HIV Self-Testing for Other Sexually Transmissible Infection Testing and Broader Sexual Health Needs: A Mixed-Methods Study of Gay and Bisexual Men in Australia. Sex Transm Dis 2021; 48:417-423. [PMID: 33122598 DOI: 10.1097/olq.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although HIV self-tests can support frequent HIV testing, their impact on attending clinics for other sexually transmissible infection (STI) testing and sexual health care is largely unknown. We explored intentions to use HIV self-tests and how this might affect patterns of attending sexual health services among gay, bisexual, and other men who have sex with men (GBM) in Victoria, Australia. METHODS Gay, bisexual, and other men who have sex with men self-completed an online survey between March 10 and June 10, 2019. Among GBM reporting lifetime HIV testing and intentions to self-test at least once annually, we used logistic regression to identify correlates of intending to replace clinic-based HIV testing with self-tests. Qualitative interviews with purposively selected survey participants undertaken between May and June 2019 explored the implications of self-testing on clinic-based sexual health care. RESULTS Of the 279 survey participants, 79 (29%) reported they would replace most or all clinic-based HIV tests with self-tests, with longer time since last testing for HIV and younger age associated with reporting this outcome in the multivariate analysis. Qualitative interviews revealed different perceived roles for self-tests and clinic-based testing, and the importance of integrating HIV self-tests within broader sexual health routines. CONCLUSIONS Although GBM see a distinct role for HIV self-testing, its rollout will likely result in missed opportunities for clinic-based STI testing and education for some GBM, particularly among younger and less-recently tested GBM. Convenient, non-clinic-based approaches to STI testing are needed alongside support platforms to maximize the benefits of HIV self-testing within comprehensive sexual health routines.
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Walia AM, Fairley CK, Bradshaw CS, Chen MY, Chow EPF. Disparities in characteristics in accessing public Australian sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men. Aust N Z J Public Health 2020; 44:363-368. [PMID: 32865864 DOI: 10.1111/1753-6405.13029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men (MSM) in Melbourne, Australia. METHODS We conducted a retrospective, cross-sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare-eligible and Medicare-ineligible MSM. RESULTS We included 5,085 Medicare-eligible and 2,786 Medicare-ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare-eligible compared to Medicare-ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare-eligible and Medicare-ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare-ineligible MSM were more likely to have anorectal chlamydia compared to Medicare-eligible MSM (10.6% vs. 8.5%; p=0.004). CONCLUSIONS Medicare-ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high-risk behaviour. Implications for public health: Scaling up access to HIV and STI testings for Medicare-ineligible MSM is essential.
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Affiliation(s)
- Anysha M Walia
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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5
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Veronese V, Ryan KE, Hughes C, Lim MS, Pedrana A, Stoové M. Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e14230. [PMID: 32720902 PMCID: PMC7420634 DOI: 10.2196/14230] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 02/20/2020] [Accepted: 04/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND HIV continues to disproportionately affect men who have sex with men (MSM) and transgender women (TW). Undiagnosed HIV is a major driver of HIV transmission rates, and increasing the uptake of regular HIV testing and facilitating timely initiation of HIV treatment is a global HIV prevention priority. However, MSM and TW experience a range of barriers that limit their access to testing and other prevention services. Given their growing ubiquity, digital communication technologies are increasingly being used to support HIV prevention efforts, and a growing number of studies have trialed the use of digital technology to promote HIV testing among MSM and TW. OBJECTIVE We undertook a systematic review and meta-analysis to assess the impact of digital communication technology on HIV testing uptake among MSM and TW. Subanalyses aimed to identify the features and characteristics of digital interventions associated with greater impact. METHODS A systematic literature review was undertaken using select databases and conference repositories. Studies describing the use of a digital technology-internet-enabled devices, including phones, tablets, and computers-to increase HIV testing uptake among MSM or TW using either randomized or observational cohort design with measurement of HIV testing rates measured pre- and postintervention, and published in English between 2010 and 2018 were included. Pooled effect estimates were calculated using a random effects meta-analysis. Subanalyses calculated effect estimates grouped by selected features of digital interventions. RESULTS A total of 13 randomized or observational studies were included in the final review. Digital interventions most commonly used mainstream, existing social media platforms (n=7) or promotion through online peer educators (n=5). Most interventions (n=8) were categorized as interactive and allowed user engagement and most directly facilitated testing (n=7) either by providing self-testing kits or referral to testing services. A total of 1930 participants were included across the 13 studies. HIV testing uptake among MSM and TW exposed to digital interventions was 1.5 times higher than that of unexposed MSM and TW (risk ratio [RR] 1.5; 95% CI 1.3-1.7). Subanalyses suggested an increased impact on HIV testing uptake among interventions that were delivered through mainstream social media-based platforms (RR 1.7; 95% CI 1.3-2.1), included direct facilitation of HIV testing (RR 1.6; 95% CI 1.4-1.9), were interactive (RR 1.6; 95% CI 1.4-1.8), and involved end users in the design process (RR 1.6; 95% CI 1.3-2.0). CONCLUSIONS These findings provide broad support for the integration of technology with existing approaches to promote and facilitate HIV testing among MSM and TW. Our findings identified key features that may be associated with greater impact on HIV testing uptake and can be used to inform future development efforts given the growing interest and application of digital technologies in HIV prevention. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42017070055; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017070055.
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Affiliation(s)
- Vanessa Veronese
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | | | - Chad Hughes
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Megan Sc Lim
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
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6
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Lee E, Mao L, Bavinton B, Prestage G, Holt M. Which Gay and Bisexual Men Attend Community-Based HIV Testing Services in Australia? An Analysis of Cross-Sectional National Behavioural Surveillance Data. AIDS Behav 2020; 24:387-394. [PMID: 30863977 DOI: 10.1007/s10461-019-02435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ben Bavinton
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
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7
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van Gemert C, Guy R, Stoove M, Dimech W, El-Hayek C, Asselin J, Moreira C, Nguyen L, Callander D, Boyle D, Donovan B, Hellard M. Pathology Laboratory Surveillance in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses: Protocol for a Cohort Study. JMIR Res Protoc 2019; 8:e13625. [PMID: 33932276 PMCID: PMC6786847 DOI: 10.2196/13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background Passive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. Objective The aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. Methods ACCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of individuals tested and retested, test yield, positivity, and incidence. Results To date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory; reporting of indicators will occur in 2019 with publication to follow. Conclusions The ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. International Registered Report Identifier (IRRID) DERR1-10.2196/13625
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Affiliation(s)
- Caroline van Gemert
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | | | | | - Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Parkville, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.,Doherty Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
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8
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Ryan KE, Wilkinson AL, Asselin J, Leitinger DP, Locke P, Pedrana A, Hellard M, Stoové M. Assessment of service refinement and its impact on repeat HIV testing by client's access to Australia's universal healthcare system: a retrospective cohort study. J Int AIDS Soc 2019; 22:e25353. [PMID: 31379067 PMCID: PMC6680090 DOI: 10.1002/jia2.25353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Achieving the virtual elimination of HIV requires equitable access to HIV prevention tools for all priority populations. Restricted access to healthcare means migrants face particular barriers to HIV prevention services. In February 2016, a peer-led rapid HIV testing service for gay, bisexual and other men who have sex with men (gay and bisexual men, GBM) in Melbourne, Australia, introduced free sexually transmissible infection (STI) testing funded through Medicare (Australia's universal healthcare system). Medicare ineligible migrant clients were required to pay up to $158AUD for STI tests. We determined the uptake of STI testing and assessed the impact on repeat HIV testing among Medicare eligible and ineligible clients. METHODS All HIV tests conducted between August 2014 and March 2018 were included. We describe client characteristics, STI testing uptake and HIV/STI positivity among Medicare eligible and ineligible clients. Repeat HIV testing, assessed as the percentage of HIV tests with a return test within six months, was compared pre-integration (August 2014-June 2016) and post-integration(July 2016-March 2018) of STI testing using segmented linear regression of monthly aggregate data for Medicare eligible and ineligible clients. RESULTS Analyses included 9134 HIV tests among 4753 individuals. Medicare ineligible clients were younger (p < 0.01), and fewer reported previously testing for HIV (p < 0.01) and high HIV risk sexual behaviours. There was no difference in HIV positivity between the two groups (p = 0.09). STI testing uptake was significantly lower among Medicare ineligible clients (7.6%, 85.3%; p < 0.01). Following STI testing introduction there was an immediate increase in six-month return HIV testing (6.4%; p = 0.02) and a significantly increasing rate of return HIV testing between July 2016 and March 2018 (0.5% per month; p < 0.01) among Medicare eligible clients but no immediate change in return testing (-0.9%; p = 0.7) or the rate of change in return testing between July 2016 and March 2018 (0.1% per month; p = 0.3) among Medicare ineligible clients. In March 2018, six-month return HIV testing was 52.3% and 13.2% among Medicare eligible and ineligible clients respectively. DISCUSSION Improvements in return HIV testing observed among Medicare eligible clients did not extend to Medicare ineligible clients highlighting the impact of inequitable access to comprehensive sexual healthcare on test-and-treat approaches to HIV prevention.
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Affiliation(s)
- Kathleen E Ryan
- Burnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
- Department of Infectious DiseasesAlfred HealthMelbourneVic.Australia
| | | | | | | | - Peter Locke
- PRONTO!Thorne Harbour HealthMelbourneVic.Australia
| | - Alisa Pedrana
- Burnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
| | - Margaret Hellard
- Burnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
- Department of Infectious DiseasesMonash University and Alfred HealthMelbourneVic.Australia
| | - Mark Stoové
- Burnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
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Ryan KE, Wilkinson AL, Chow E, Read T, Chen M, Locke P, Leitinger D, Bradshaw C, Pedrana A, Hellard M, Fairley CK, Stoové M. A comparative, retrospective analysis of HIV testing among gay, bisexual and other men who have sex with men in Melbourne, Australia. Aust N Z J Public Health 2019; 43:419-423. [PMID: 31141274 DOI: 10.1111/1753-6405.12903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE PRONTO!, a peer-led rapid HIV-testing service in Melbourne, Australia, opened to improve HIV testing among gay and bisexual men (GBM). We compared client characteristics and return testing among GBM testing at PRONTO! with GBM testing at Melbourne Sexual Health Centre (MSHC). METHODS All GBM attending PRONTO! and MSHC for HIV testing between August 2013 and April 2016 were included. We describe the number of tests, percentage of clients who returned during follow-up, the mean number of tests and median time between tests at the two services. RESULTS At PRONTO!, 33% of 3,102 GBM and at MSHC 50% of 9,836 GBM returned for a further HIV test at least once. The mean number of tests per client was 1.7 and 2.5 at PRONTO! and MSHC (p<0.01), respectively. A majority of clients at both services reported behaviours that would recommend up to quarterly testing, however, the median time between tests was 20.0 and 17.0 weeks at PRONTO! and MSHC (p<0.01), respectively. CONCLUSIONS A greater proportion of clients returned and returned frequently at MSHC compared to PRONTO!, however, at both services HIV testing frequency was suboptimal. Implications for public health: Novel HIV testing services should provide convenient and comprehensive sexual health services.
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Affiliation(s)
- Kathleen E Ryan
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | | | - Eric Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Tim Read
- Melbourne Sexual Health Centre, Melbourne, Victoria
| | - Marcus Chen
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Peter Locke
- PRONTO!, Victorian AIDS Council, Melbourne, Victoria
| | | | | | - Alisa Pedrana
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Margaret Hellard
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Mark Stoové
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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10
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Mullens AB, Duyker J, Brownlow C, Lemoire J, Daken K, Gow J. Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community 'beat' locations. BMC Health Serv Res 2019; 19:93. [PMID: 30711001 PMCID: PMC6359847 DOI: 10.1186/s12913-019-3899-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Innovative health promotion strategies are needed to improve access to HIV testing among regional people in Australia, particularly for men who have sex with men (MSM). This project aimed to establish proof of concept for point-of-care-testing (POCT) via a mobile van clinic at community 'beat' locations. Surveys evaluated client satisfaction, characteristics and testing preferences among 'early adopters'. Sequential mixed-methods approach was used which included secondary qualitative analysis of field notes written by peer-testers (i.e., trained lay providers from the key population being targeted; to extend the contextualise the pilot evaluation), documenting barriers/facilitators and innovations, per action research and to guide recommendations for future health promotion initiatives. METHODS A POCT 'proof of concept' project (2, 3-hourly sessions/week; 20 weeks) was delivered in a regional town by peer-testers using a mobile clinic van, recruited by geosocial 'apps' targeting MSM. Clients completed surveys regarding demographics, and testing satisfaction, frequency and preferences. Peer-testers completed detailed field notes for each session including client characteristics and impressions, salient events, concerns and recommendations. RESULTS The program resulted in 34 online health promotion conversations with MSM and 34 POCT tests (19 HIV, 15 Syphilis; 18 unique client visits; 17 identified as MSM, with 1 heterosexual female. Rates of satisfaction among early adopters of POCT was high. Analysis of field notes revealed three major themes: 1) Practical challenges; 2) Barriers to engagement; and 3) Recruitment method/project promotion. CONCLUSIONS Amongst early adopters satisfaction was high, with 47% of clients reported infrequent testing (over 12 months ago) or having 'never tested'. No tests were reactive. Challenges associated with this health promotion initiative and recommendations for future HIV testing promotion and programs were outlined.
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Affiliation(s)
- Amy B Mullens
- School of Psychology & Counselling, Institute for Resilient Regions, University of Southern Queensland, 11 Salisbury Rd, Ipswich, QLD, 4305, Australia. .,School of Psychology & Counselling, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
| | - Josh Duyker
- Queensland Positive People, 21 Manilla St, East Brisbane, QLD, 4169, Australia
| | - Charlotte Brownlow
- School of Psychology & Counselling, Institute for Resilient Regions, University of Southern Queensland, Main St, Toowoomba, QLD, 4350, Australia
| | - Jime Lemoire
- Queensland Positive People, 21 Manilla St, East Brisbane, QLD, 4169, Australia
| | - Kirstie Daken
- School of Psychology & Counselling, Institute for Resilient Regions, University of Southern Queensland, 11 Salisbury Rd, Ipswich, QLD, 4305, Australia
| | - Jeff Gow
- School of Commerce, Institute for Resilient Regions, University of Southern Queensland, Main St, Toowoomba, QLD, 4350, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
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11
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Brown G, Reeders D, Cogle A, Madden A, Kim J, O'Donnell D. A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project. Front Public Health 2018; 6:231. [PMID: 30234083 PMCID: PMC6127267 DOI: 10.3389/fpubh.2018.00231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
The central role of community and peer-led programs has been a key characteristic of the Australian partnership response to HIV and hepatitis C since the beginning of the epidemics. Despite this, peer-led programs continue to have limited capacity to demonstrate their role and value as part of a multi-sectoral response. What makes one peer-led program a better investment than another? What role does the rest of the sector have in ensuring we gain the most value from these investments? To investigate this, we facilitated interactive systems thinking methods with 10 programs working within communities of people who inject drugs, gay men, sex workers and people living with HIV across Australia. This included articulating program theories in diagram and textual form to help us understand the role of peer-based programs promoting peer leadership within the Australian HIV and hepatitis C responses. Our aim was to develop a framework for monitoring and evaluation that could be applied to peer led programs at different levels and in different contexts. We found that for peer-led programs to fulfill their role, and to navigate the rapid changes occurring in the both epidemics, they need to: demonstrate the credibility of their peer and community insights; continually adapt to changing contexts and policy priorities in tandem with their communities; and maintain influence in both community and policy systems. We developed a framework of four key functions (Engagement, Alignment, Adaptation, and Influence) which peer-based programs need to demonstrate, which form the basis for identifying quality indicators. This article presents a new way of framing and monitoring investments in peer-led programs and peer eadership actions by these programs. If health policy is committed to strengthening the leadership shown by affected communities, then we need to understand, enhance, monitor and value the role of peer-led programs and peer leadership within the overall prevention system. We believe the W3 framework, drawing on systems thinking and modeling, can support funders, policy-makers and programs to achieve this.
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Affiliation(s)
- Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Daniel Reeders
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Aaron Cogle
- National Association of People Living With HIV Australia, Sydney, NSW, Australia
| | - Annie Madden
- The Australian Injecting and Illicit Drug Users League, Canberra, ACT, Australia
| | - Jules Kim
- Scarlet Alliance, Australian Sex Worker Association, Sydney, NSW, Australia
| | - Darryl O'Donnell
- Australian Federation of AIDS Organisations, Sydney, NSW, Australia
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Acceptability of Peer-Delivered HIV Testing and Counselling Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Myanmar. AIDS Behav 2018; 22:2426-2434. [PMID: 29427231 DOI: 10.1007/s10461-017-2022-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men who have sex with men (MSM) and transgender women (TW) are a priority population for HIV prevention in Myanmar but report sub-optimal HIV testing frequency. Previous studies have shown that peer involvement in HIV testing can normalize stigmatized sexualities and reduce barriers to testing. We explored the acceptability of peer-delivered HIV testing among 425 undiagnosed MSM and TW in Yangon and Mandalay. An overwhelming majority of participants (86%) reported being 'comfortable/very comfortable' with peer-delivered HIV testing. Logistic regression identified reporting sexual identity as Apone [adjusted odds ratio (aOR) 3.8; 95% CI 1.2-11.7], recent HIV testing (aOR 3.1; 95% CI 1.4-6.5), reporting a high likelihood of HIV acquisition (aOR 3.6; 95% CI 1.7-7.6), and reporting ≥ 5 casual partners in the past 3 months (aOR 0.2; 95% CI 0.1-0.6) as associated with peer-delivered HIV testing acceptability. Given ongoing HIV vulnerability among MSM and TW in Myanmar, peer-delivered testing may offer prevention benefits by increasing testing rates and identifying undiagnosed infection earlier.
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Acceptability and HIV Prevention Benefits of a Peer-Based Model of Rapid Point of Care HIV Testing for Australian Gay, Bisexual and Other Men Who Have Sex with Men. AIDS Behav 2018; 22:178-189. [PMID: 28849434 PMCID: PMC5758652 DOI: 10.1007/s10461-017-1888-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Frequent HIV testing among gay, bisexual and other men who have sex with men (GBM) is a strategic priority for HIV prevention in Australia. To overcome barriers to testing in conventional clinical services, Australia recently introduced peer HIV rapid point of care (RPOC) testing services for GBM. This mixed methods evaluation describes client acceptability and HIV prevention benefits of a peer HIV testing model. Most aspects of the service model were overwhelmingly acceptable to clients. Two-thirds of survey participants reported preferring testing with peers rather than doctors or nurses and over half reported learning something new about reducing HIV risk. Focus group findings suggested peer-delivered HIV RPOC testing reduced stigma-related barriers to frequent testing and provided novel opportunities for GBM to openly discuss HIV prevention and sexual practices, enhancing their HIV risk-reduction knowledge. Analysis of survey data suggested knowledge transfer occurred particularly among younger and less gay community-attached GBM.
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Ryan KE, Pedrana A, Leitinger D, Wilkinson AL, Locke P, Hellard ME, Stoové M. Trial and error: evaluating and refining a community model of HIV testing in Australia. BMC Health Serv Res 2017; 17:692. [PMID: 29017561 PMCID: PMC5635501 DOI: 10.1186/s12913-017-2635-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The 2012 regulatory approval of HIV rapid point of care (RPOC) tests in Australia and a national strategic focus on HIV testing provided a catalyst for implementation of non-clinical HIV testing service models. PRONTO! opened in 2013 as a two-year trial delivering peer-led community-based HIV RPOC tests targeting gay, bisexual and other men who have sex with men (GBM), with the aim of increasing HIV testing frequency. Initial data suggested this aim was not achieved and, as part of a broader service evaluation, we sought to explore client acceptability and barriers to testing at PRONTO! to refine the service model. METHODS We present descriptive and thematic analyses of data from two in-depth evaluation surveys and four focus groups with PRONTO! clients focused on service acceptability, client testing history, intentions to test and barriers to testing for HIV and other sexually transmitted infections (STIs). RESULTS The three novel aspects of the PRONTO! model, testing environment, rapid-testing, peer-staff, were reported to be highly acceptable among survey and focus group participants. Focus group discussions revealed that the PRONTO! model reduced anxiety associated with HIV testing and created a comfortable environment conducive to discussing sexual risk and health. However, an absence of STI testing at PRONTO!, driven by restrictions on medical subsidies for STI testing and limited funds available at the service level created a barrier to HIV testing. An overwhelming majority of PRONTO! clients reported usually testing for STIs alongside HIV and most reported plans to seek STI testing after testing for HIV at PRONTO!. When deciding where, when and what to test for, clients reported balancing convenience and relative risk and consequences for each infection as guiding their decision-making. CONCLUSIONS A community-based and peer-led HIV testing model reduced previously reported barriers to HIV testing, while introducing new barriers. The absence of STI testing at PRONTO! and the need to access multiple services for comprehensive sexual health screening, created a significant service engagement barrier for some clients. Understanding client motivations to access testing and ensuring novel service models meet client needs is crucial for developing acceptable sexual health services for high-risk populations.
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Affiliation(s)
- Kathleen E Ryan
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia. .,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Huntington Avenue, Cambridge, MA, 02115, USA
| | - David Leitinger
- PRONTO!, Victorian AIDS Council, Rose St, Fitzroy, VIC, 3065, Australia
| | - Anna L Wilkinson
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Peter Locke
- PRONTO!, Victorian AIDS Council, Rose St, Fitzroy, VIC, 3065, Australia
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia.,Infectious Disease Department, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Commercial Road, Melbourne, VIC, 3004, Australia.,School of public health and preventive medicine, Monash University, Commercial Road, Melbourne, VIC, 3004, Australia
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15
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Stoové M, Asselin J, Pedrana A, Lea T, Hellard M, Wilson D, Prestage G, de Wit J, Holt M. Declining prevalence of undiagnosed HIV in Melbourne: results from community-based bio-behavioural studies of gay and bisexual men. Aust N Z J Public Health 2017; 42:57-61. [PMID: 28749540 DOI: 10.1111/1753-6405.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To measure changes in undiagnosed HIV among gay and bisexual men (GBM) in Melbourne. METHODS Undiagnosed HIV was compared between GBM recruited anonymously in 2008 in gay venues only and GBM anonymously or confidentially (results delivery) recruited in 2014 at gay venues and a community festival. Surveys were completed and oral fluid specimens collected for HIV testing; positive tests among GBM reporting being HIV-negative or unknown/untested were classified as undiagnosed. Tests of proportions compared serological prevalence, undiagnosed prevalence and participant characteristics. RESULTS HIV prevalence was 9.5% and 7.1% among 639 and 993 GBM recruited in 2008 and 2014, respectively; undiagnosed prevalence declined significantly from 31.1% to 7.1% (p<0.001). Sexual risk and undiagnosed HIV was highest among venue-recruited participants in 2014 (17.6%). Fewer diagnosed GBM participated confidentially in 2014, but this did not meaningfully influence comparative undiagnosed HIV prevalence. CONCLUSION We provide the first estimates of changes in undiagnosed HIV in Australia, demonstrating a marked decline in undiagnosed HIV among GBM. Implications for public health: Our findings are consistent with reports of increases in HIV testing among GBM. Given sustained high HIV diagnosis rates, new testing models that encourage high frequency testing are needed to control the local HIV epidemic.
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Affiliation(s)
- Mark Stoové
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Jason Asselin
- Centre for Population Health, Burnet Institute, Victoria
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Toby Lea
- Centre for Social Research in Health, UNSW, New South Wales
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - David Wilson
- Centre for Population Health, Burnet Institute, Victoria.,Kirby Institute, UNSW, New South Wales
| | | | - John de Wit
- Centre for Social Research in Health, UNSW, New South Wales
| | - Martin Holt
- Centre for Social Research in Health, UNSW, New South Wales
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Mutch AJ, Lui CW, Dean J, Mao L, Lemoire J, Debattista J, Howard C, Whittaker A, Fitzgerald L. Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia. BMC Health Serv Res 2017; 17:310. [PMID: 28454592 PMCID: PMC5410036 DOI: 10.1186/s12913-017-2249-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/19/2017] [Indexed: 01/18/2023] Open
Abstract
Background The success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing. Methods Service data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed. Results In 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme. Conclusions RAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2249-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allyson J Mutch
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Chi-Wai Lui
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Dean
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Limin Mao
- Centre for Social Research in Health (CSRH), University of New South Wales, NSW, Australia
| | - Jime Lemoire
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Queensland Health, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Andrea Whittaker
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa Fitzgerald
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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