STI Control Program among Indigenous Adolescents and Young Adults in Northern Territory - Research Proposal Example

A Proposal: STI Control Program among Indigenous Adolescents and Young Adults in Northern Territory Table of contents: 1.0 Introduction……………………………………………………………………… 2.0 Program Goal……………………………………………………………………. 3.0 Program Objectives……………………………………………………………… 4.0 Strategies…………………………………………………………………………. 5.0 Evaluation………………………………………………………………………… 6.0 Timeline………………………………………………………………………….. 7.0 Capacity Building and Sustainability………………………………………….. 8.0 Conclusion……………………………………………………………………….. 9.0 References………………………………………………………………………. 1.0 Introduction: STI’s are a great concern in Northern Territory (NT) due to the high notification rates that has been reported in the past years compared to other Australian States, and high morbidities resulting from some of the STI’s such as chlamydia (Kirby Institute,2014; ABS, 2012). Common STIs in NT include chlamydia, syphilis, trichomoniasis, gonorrhea and human papillomavirus (Kirby Institute, 2014). Gonorrhea and chlaymdia notification rates are highest in NT with rates been 16 and 3 times respectively, compared to the Australian rates. STI cases are highest among young people aged between 15 to 29 years (DHNT, 2012). The high rates can be attributed to an altered behavioural pattern among young individuals such as early initiation of sex, having several sex partners, inconsistent utilization of condoms, knowledge deficit about the various risk factors that predisposes them to STIs, and inadequate testing and treatment health services (Fairbairn, Tyler, Su & Tilley, 2010; Lea, 2010). Another possible reason for the high rates among this age group is the high prevalence of teenage pregnancy (age 15-20) in NT (ABS, 2011). This implies that they are engaging in unprotected sex that highly predisposes them to STIs. Indigenous NT population substantially present with more STI cases compared to the non-indigenous population (Kirby Institute, 2014; DHNT, 2012). In NT, the districts with highest notification rates over the past years is Katherine (Department of Health Northern Territory [DHNT], 2012). The high prevalence of STI also increases the direct costs such as expenditure on the treatment and management of STIs and their complications, and indirect costs associated with loss of productivity to the population and the local, Territory and national government. The prevalence of these STIs in NT especially the district of Katherine led to this STI control program targeting Adolescents and young adults aged between 15 and 29 years residing in Katherine. A successful implementation of the program will see an increase in accessibility and utilization of condoms among members of the target group population, more target group population reporting easy accessibility to screening and treatment services, and an overall reduction in the reported number and rates of STIs. 2.0 Program Goal: The program's goal is to reduce the number of reported cases of STIs among individuals aged between 15 to 29 years residing in Katherine by 20% 18 months after initiating the program. 3.0 Program Objectives: 1. To enhance condom utilization among the target group in Katherine by at least 20% in the 18 months of running the health promotion program. The sub-objectives under this objective include: 1.1 To increase the availability of condoms by 30% in Katherine after the 18 months of implementation of the program. 1.2 To increase the number of target group members reporting appropriate use of condoms by 10% after 18 months of program initiation. 2. To ensure that the percentage of retested individuals after three months post-treatment is at least 90% within the 18 months after initiation of the program. The sub-objectives include: 2.1 To increase the number of target group members reporting for retesting after three months post-treatment by at least 20%. 2.2 To ensure that health professionals tasked with contacting and reminding previously treated individuals do so to at least 95% of previously treated target group members forgetting reporting for retreatment. 3. Improve accessibility to STI screening, testing and treatment services by at least 30% 18 months after initiation of the program. 3.1 To double the number of STI outreach sessions providing screening and testing services to the target population in 18 months after program initiation. 3.2 Ensure that health professional attending to each member of the target population diagnosed with an STI identify persons who have had sexual contact with the treated individual for screening and treatment so that the health professionals report at least 70% of contact tracing in 18 months of program implementation. 4. To lobby for at least 20% fortification in finances allocated to screening, prevention and treatment of STI in the district of Katherine in the first year of program implementation. 4.1 Redirect a fraction of existing local and Territory government health fund to STI prevention and treatment services such that the annual funds available for the program are increased by at least 10%. 4.2 To increase financial allocation to health and specifically for the control and management of STIs in Katherine through the Territory’s department of health 5. To ensure that at least 80% of target group individuals exhibit awareness of STI one year after initiation of the program. 5.1. To double the number of outreach services providing health promotional services regarding the STIs 12 months after program initiation 5.2. To increase the number of ‘safe sex better health’ messages displayed in places and routes frequently accessed by the target population in Katherine by 80% by the 18th month of implementing the program. 4.0 Strategies: The strategies to be employed in this program are based on the highlighted objectives. The strategies are discussed in the table 1 below. Table 1: Objectives, sub-objectives and program strategies targeting STI control in target population. Objective Sub-objectives Strategies 1. To increase utilization of condoms 1.1 To increase the availability of condoms. 1.2 Increase TG members reporting appropriate condom use. Condom use is a significant practice in enhancing protected sex. It has been demonstrated to prevent the risk of a partner acquiring an STI from an individual who has the STI (Infectious and Immunological Health Networks [IIHN], 2008;World Health Organization [WHO], 2006; Rollins, 2013). For the condoms to be used by the target group members, they must be readily available to the target group (TG). This shall be enhanced through liaising with local public health officers to facilitate acquisition of more condoms and working in conjunction with community health workers (CHW) to aid in distribution of condoms to areas highly accessed by the TG such as toilets, urinary, public transport systems, health services centres and in recreational areas (Leach, 2009). Condom availability will enhance condom utilization among TG individuals in the action stage of change as per the Transtheoretical Model (TTM) (Grossman et al., 2008). CHW, and other health professionals in primary, secondary and even tertiary care settings shall be required to demonstrate using models the safe utilization of condoms to the TG. This would increase the confidence, or self-efficacy, in using condoms and promote the acquisition and maintenance of the behaviour as informed by “protection motivation theory [PMT]” and “self-efficacy theory [SET]” of sociocognitive behaviours (Sutton, 2002). 2. To increase retesting of previously treated TG members. 2.1 Increase TG members reporting for retesting. 2.2 Increase reminding rates for TG individuals forgetting reporting for retesting. Treatment failure may occur during management of some STI without necessarily presenting with symptoms, and this may predispose unsuspecting TG members to infections (Euerie, 2014; Geisler & Hook, 2003; Ginnochio et al., 2012). TG shall be educated on the need for retesting after three months post-treatment to enhance reporting for retesting. This is based on health belief model (HBM) that postulates the significance of understanding the perceived benefits of a health behaviour to embracing advised actions and Theory of Reasoned Action that informs why intentions to report for retesting are enhanced if the TG evaluate the need for retesting positively (Sutton, 2002; Montano et al., 2008). ‘ TG members forgetting reporting for retreatment would be reminded to do so by health professionals tasked with contact tracing or report to any convenient screening and testing outreach programs (Strobel & Ward, 2012). 3. Improve accessibility to STI testing and treatment services 3.1 To double the number of screening and treatment sessions. 3.2 Increase contact tracing by health professionals. Outreach sessions bring STI-related services close to the group overcoming the barriers perceived to be hindering seeking of such services by the TG as postulated in the HBM (Sutton, 2002 & Fairbairn et al., 2010). Convenient service provision centers and provision of the STI-related services have been demonstrated to influence individuals towards positive sex behavior along the TTM (Grossman et al., 2008). Utilize outreach clinics, “Aboriginal Community Controlled health services [ACCHS]”, community health centers and group testing to facilitate TG STI education, contact tracing, screening, and treatment (IIHN, 2007). This strategy also included increasing the number health professionals performing contact tracing (Fairbairn et al., 2010; WHO, 2013). 4. To facilitate a 20% increase in budgetary allocation to STI prevention and treatment. 4.1 Redirection of existing health funding to STI prevention and treatment. 4.2 Increase Territory’s financial allocation to STI management. Shall contact the local Governing Council with the rationale for the need for redirection of funds to facilitate creation of dedicated STI clinics in remote area of Katherine and support screening and prevention activities (Southern Australia Department of Health and Ageing [SADHA], 2012). Present a proposal outlining and justifying the need for more financial resources to the Governing Councils in Katherine through which the Minister of Health shall be informed of the financial need, and facilitate the increase in allocation (WHO, 2006). 5. To increase awareness of STI among the TG individuals 5.1 To increase the number and distribution of outreach services offering STI education. 5.2 To increase the number of displayed ‘safe sex better health’ messages Through increased financial allocation, more STI clinics, outreach services and ACCHS offering STI prevention and treatment education shall be available to convey the message to more TG individuals and increase their awareness. Awareness of STI including its risk factors and avoidance of these factors will enhance the TG self-efficacy towards protecting themselves from the risk factors as the individuals will understand their vulnerability or susceptibility to the STI as per the PMT and HBM respectively, and enable them move along the various stages of TTM and make informed decisions regarding their sexual health (Sutton, 2002). Design and print more health messages to social market the adoption of safe sexual behaviors. These messages such as the ‘safe sex better health' and ‘protect your sexual health' captionin' an ABC figure implying abstinence, been faithful or condom use as safe STI prevention measures will be conveyed via stubby coolers or drinks coasters, displayed on toilet doors’ backs, in 24-hour eateries, on buses, in taxis, and in taxi ranks (Sahasrabuddhe & Vermund, 2007; Leach, 2009). 5.0 Evaluation: Process evaluation shall be employed, through use of interviews to ascertain whether the TG individuals are been reached through the program and whether the various program strategies and activities are under implementation a month after initiating the program. A pre-implementation evaluation shall also be carried out to ascertain the levels of STI awareness, condom use and perceived convenience of accessing health services among the TG using semi-structured interviews, and it shall form a basis of impact evaluation a month after initiating the program when the first post-implementation impact evaluation shall be carried out to ascertain changes as a result of the program (Green & South, 2006). The main outcome evaluation shall be obtained from reported monthly and annual cases of STIs in the district. 6.0 Timeline: Table 2: Timeline of program activities Program Activity Time Program Planning and pre-evaluation July 1st 2015 to Sep 1st 2015 1st Planning meeting and consequent discussions July 1st, 2015- Aug 1st 2015 Pre-implementation evaluation Aug 10th 2015 to Sep 1st 2015 Program Initiation and Running Sep 10th 2015 to April 30th 2017 STI education, screening and treatment. Sep 10th 2015- March 10th 2017 1st process evaluation and 1st Post-implementation impact evaluation Oct 10th 2015- Oct 15th, 2015 Availing sufficient condoms in convenient locations Oct 16th 2015 – Oct 30th 2015 Redirection of existing health funds to STI prevention and treatment Sept 1st 2015 to July 1st 2016 Increasing outreach sessions and contact tracing Oct 16th 2015 to Dec 10th 2016 Creation of new and more STI specific clinics July 2016- Dec 10th 2016 2nd process and impact evaluation Jan 10th 2016– Jan 15th 2016 3rd process and impact evaluation July 10th 2016 to July 20th 2016 Outcome evaluation April 1st, 2017 to April 30th, 2017 Program closure May 10th 2017. 7.0 Capacity Building and Sustainability: Substantial components of the program are expected to be running even after completion of the program. Therefore, the gains that would be made during the implementation of the project should not be eroded. To sustain the gains that would have been achieved, the various health professional performing the role of STI education and enhancing awareness are an important human resource that should be empowered to exercise their roles efficiently. These professionals that form the workforce in capacity building should possess appropriate skills, knowledge to implement, evaluate and sustain the project. This entails use of both clinical skills in assessment, screening, treatment and prevention of STIs among the TG and leadership skills such as congruent leadership where the leaders perform and lead as they expect of those been led (Johnstone, Hays, Center & Daley, 2004). With the existing NT Department of Health’s policies and frameworks of health promotion such as outreach services and contact tracing roles played by health professionals, the implementation and sustainability of the program through such interventions is assured (DHNT, 2012). The recently established Governing Councils in NT replacing the hospital boards will also be an important source of support for the program activities and facilitation of provision of health professionals and community support (Department of Health NT, 2015a). In addition, the Council will be a link between the program and the Ministry of Health and can ensure sustainability of screening, testing and treatment of STIS among target groups such as through Katherine’s Clinic 34, and various health settings even after completion of the program (Department of Health NT, 2015b). Through the yearly budgetary allocation to health by the NT government, financial resources support to the various program activities shall be manageable and so shall be sustainable in the long run. 8.0 Conclusion The high prevalence and reported cases of STIs in NT and particularly Katherine district among adolescents and young adults informed the need for this program. The program is aimed at reducing the reported cases of STI among the TG in the district through various means such as increasing condom utilization, enhancing STI awareness, and improving the TG’s accessibility to services related to STI. All the stakeholders including the Territory’s department of health, hospital’s Governing Council and the relevant health professionals would be incorporated in the implementation of the 18-month program. At the conclusion of the program, it is expected that the set goals shall have been achieved, the awareness level and condom utilization among the TG shall have increased, accessibility to STI services shall have improved and the reported monthly and annual cases of STI shall have reduced. 9.0 References: Australian Bureau of Statistics. (2011). 3301.0-Births, Australia, 2011. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3301.02011?OpenDocument Australian Bureau of Statistics. (2012). Australian social trends, June 2012. 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Retrieved from http://www.medscape.com/viewarticle/458822_2 Ginocchio, C.C., Chapin, K., Smith, J.S., Aslanzadeh, J., Hill, C.S. & Gaydos, C.A. (2012). Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoea in the United States as determined by the Optima Trichomonas vaginalis nucleic acid amplification assay. Journal of Clinical Microbiology, 50(8), 2601-2608. Green, J. & South, J. (2006). Evaluation. Berkshire: Open University Press. Grossman, C., Hadley, W., Brown, L.K., Houck, C.D., Peters, A. & Tolou-Shams, M. (2008). Adolescent sexual risk: Factors predicting condom use across the stages of change. AIDS and Behavior, 12(6), 913-922. Infectious and Immunological Health Networks. (2008). Sexually transmitted infections model of care. Perth: Department of Health, State of Western Australia. Johnsone, K., Hays, C., Center, H. & Daley, C. (2004). Building capacity and sustainability prevention innovations: a sustainability planning model. Evaluation and Program Planning, 27, 135-149. Kirby Institute. (2014). HIV,viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2014. Sydney, NSW: The Kirby Institute, UNSW. Lea, T. (2010). Chlamydia and young people. Retrived from https://csrh.arts.unsw.edu.au/media/CSRHFile/SRB17_Chlamydia_and_young_people.pdf Leach, T. (2009). Safe sex no regrets. Final report on the Northern Territory Department of health and families' safe sex no regrets campaign. Retrieved from http://www.safesexnoregrets.nt.gov.au/docs/Safe_Sex_No_Regrets.pdf Montano, D., Kasprzyk, D., Glanz, K., Rimer, B.K & Viswanath, K. (2008). Theory of reasoned action, theory of planned behavior, and the integrated behavioural model. In B. R. K Glanz (Ed.), Health behavior and health education (pp. 67-92). San Francisco: John Wiley & Sons, Inc. Rollins, A. (2013). 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