Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities on Anangu Pitjantjatjara Lands

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Abstract
Objective To evaluate the impact of a program to improve access to, and delivery of, diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities. Design Analysis of cross‐sectional data from annual age‐based screening. Setting: Six remote Aboriginal communities and three homelands on the Anangu Pitjantjatjara Lands in the far north‐west of South Australia, 1996‐1998. Participants: All Aboriginal people aged 12‐40 years listed on the Nganampa Health Council population register as resident on the Anangu Pitjantjatjara Lands. Main outcome measures: Prevalence of gonorrhoea and chlamydial infection, determined by urine polymerase chain reaction tests. Results The prevalence of gonorrhoea in people aged 12‐40 years almost halved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P<0.001). The fall in prevalence of gonorrhoea was comparable and statistically significant in both men and women. Prevalence of chlamydial infection also fell, from 8.8% in men and 9.1% in women in 1996 to 7.2% in both men and women in 1998, but this decline was not statistically significant (test for trend: P=0.174). Conclusion This study documents a rapid reduction in prevalence of gonorrhoea, probably reflecting reduced duration of infectiousness due to advances in diagnosis, increased testing activity and reduced interval to treatment rather than behaviour change. These results demonstrate that, in remote communities, even with a highly mobile population, it is possible to implement effective control activities for sexually transmitted diseases.