Immunization Coverage in Young People Experiencing Homelessness and the Impact of a Nurse-led Program.

OBJECTIVES: To identify the proportion of young people experiencing homelessness who are immunized against vaccine-preventable diseases, and to evaluate the impact of a nurse-led immunization program to improve vaccination coverage in this population. METHODS: A retrospective audit of electronic medical records included 400 participants aged 15 to 24 years who had an encounter with the Young People's Health Service, a nurse-led clinic co-located with a specialist youth homelessness service in Melbourne, Australia, between February 2019 and May 2021. RESULTS: Integrating an immunization nurse within a youth specialist homelessness service increased the percentage of young people who were up-to-date with routine vaccinations from 6.0% (n = 24) to 38.8% (n = 155). Intersecting social determinants of health that increased participants' risk of vaccine preventable diseases, and of missing routine vaccines, were common. CONCLUSIONS: Incomplete coverage of routine vaccines is common in young people accessing homelessness services, and this coverage was improved when young people encountered an immunization nurse while accessing support from a specialist youth homelessness service. As a service model, nurse-led community health clinics co-located within homelessness providers can improve vaccination coverage, and therefore health outcomes, of young people experiencing or at risk of homelessness.

Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network.

BACKGROUND: Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. METHODS: We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. RESULTS: Chlamydia positivity was 5.6% in 12233 females, 7.7% in 10316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92-2.69), being born overseas (OR 1.50, 95% CI 1.25-1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40-2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65-7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53-0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62-2.17), being born overseas (OR 1.35, 95% CI 1.16-1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40-1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46-2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00-1.51), being HIV-positive (OR 1.80, 95%CI 1.32-2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37-14.5). CONCLUSIONS: Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.

The experience of providing young people attending general practice with an online risk assessment tool to assess their own sexual health risk.

BACKGROUND: Targeted chlamydia screening has been advocated to reduce chlamydia associated reproductive sequelae. General practitioners are well positioned to play a major role in chlamydia control. The primary aim of this pilot study was to measure the effect of offering an online sexual health assessment tool, Youth Check Your Risk, on chlamydia testing rates among young people attending general practices. The secondary aim was to test the acceptability of the tool among general practitioners and young people. METHODS: General practitioners at three practices in Melbourne, Australia, referred patients aged 16 to 24 years to Youth Check Your Risk http://www.checkyourrisk.org.au for use post-consultation between March to October 2007. The proportion of young people tested for chlamydia before and during the implementation of the tool was compared. Acceptability was assessed through a structured interviewer-administered questionnaire with general practitioners, and anonymous online data provided by Youth Check Your Risk users. RESULTS: The intervention did not result in any significant increases in the proportion of 16 to 24 year old males (2.7% to 3.0%) or females (6.3% to 6.4%) tested for chlamydia. A small increase in the proportion of 16 to 19 year old females tested was seen (4.1% to 7.2%). Of the 2997 patients seen during the intervention phase, 871 (29.1%) were referred to Youth Check Your Risk and 120 used it (13.8%). Major reasons for low referral rates reported by practitioners included lack of time, discomfort with raising the issue of testing, and difficulty in remembering to refer patients. CONCLUSION: Offering an online sexual risk assessment tool in general practice did not significantly increase the proportion of young people tested for chlamydia, with GPs identifying a number of barriers to referring young people to Youth Check Your Risk. Future interventions aimed at increasing chlamydia screening in general practice with the aid of an online risk assessment tool need to identify and overcome barriers to testing.