Topics

Summary

Pregnancy is known to be a time of increased susceptibility to acquiring to human immunodeficiency virus (HIV) infection and this increased maternal risk places the unborn child at risk of vertical transmission.
Pre‐exposure prophylaxis (PrEP) involves the provision of antiretroviral therapy to an HIV‐negative individual with ongoing risk of HIV exposure to limit the likelihood of HIV transmission.
The inclusion of PrEP as part of a comprehensive strategy is recognised as an effective and safe means of reducing HIV infection in serodiscordant couples, thereby reducing the risk of vertical transmission of HIV.
Current data suggest that PrEP is safe to continue during pregnancy and breastfeeding in HIV‐negative women who remain vulnerable to acquiring HIV.
The recent Pharmaceutical Benefits Scheme subsidisation of PrEP has reduced the financial and practical obstacles of PrEP provision, and a subsequent increase in patient awareness and acceptance of PrEP is expected.
The framework for appropriately identifying and managing at‐risk pregnant and lactating women requiring PrEP is poorly defined and warrants further clarification to better support clinicians and this patient group.
This review discusses the current recommendations highlighting the gaps in the guidelines and makes some recommendations for future guideline development.

1 Perth Children's Hospital, Perth, WA
2 University of Western Australia, Perth, WA
3 Princess Margaret Hospital for Children, Perth, WA
4 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
5 Royal Perth Hospital, Perth, WA
6 PathWest Laboratory Medicine WA, Perth, WA

Correspondence: lisa.horgan@health.wa.gov.au

Competing interests:

No relevant disclosures.

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Perspectives

The Guttmacher–Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

Deborah J Bateson, Kirsten I Black and Shailendra Sawleshwarkar

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50058
Published online: 1 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Sexual health

Women's health

Social determinants of health

There have been many advances in sexual and reproductive health and rights in Australia but we must also recognise the gaps that affect our most vulnerable populations

Australia is a signatory to the United Nations Sustainable Development Goals, which see sexual and reproductive health and rights as central to achieving progress in health and gender equity by 2030.1 Historically, sexual health and reproductive health have been separate entities but the necessity of integrating them is now recognised. In May 2018, the Guttmacher Institute partnered with The Lancet to create a commission on sexual and reproductive health and rights,2 which proposes a bold vision in which everyone is able to exercise their rights and responsibilities regarding sexual behaviour and reproduction freely and with dignity. And while sexual and reproductive health and rights are universal, some populations have distinct needs (Box 1).

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1 Family Planning NSW, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW
4 Westmead Clinical School, University of Sydney, Sydney, NSW
5 Western Sydney Sexual Health Centre, Westmead Hospital, Sydney, NSW

Correspondence: deborahb@fpnsw.org.au

Competing interests:

No relevant disclosures.

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15. Guy RJ, Ward J, Causer LM, et al. Molecular point‐of‐care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster‐randomised, controlled, crossover trial. Lancet Infect Dis 2018; 18: 1117–1126.
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29. Shankar M, Black KI, Goldstone P, et al. Access, equity and costs of induced abortion services in Australia: a cross‐sectional study. Aust N Z J Public Health 2017; 41: 309–314.
30. Dawson AJ, Nicolls R, Bateson D, et al. Medical termination of pregnancy in general practice in Australia: a descriptive‐interpretive qualitative study. Reprod Health 2017; 14: 39.
31. Santaularia J, Johnson M, Hart L, et al. Relationships between sexual violence and chronic disease: a cross‐sectional study. BMC Public Health 2014; 14: 1286.
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Perspectives

Medical abortion: it is time to lift restrictions

Caroline M de Costa, Kirsten I Black and Darren B Russell

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50060
Published online: 1 April 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Lifting the special drug status applied to medical abortion medications will enable equitable access

In 2016, the Committee on Economic, Social and Cultural Rights (a collection of human rights experts tasked with interpreting these rights), in its groundbreaking interpretation of the right to sexual and reproductive health, asserted that abortion services are an integral part of the right to health.1

1 James Cook University, Cairns, QLD
2 University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW
4 Cairns Sexual Health Service, Cairns, QLD

Correspondence: Caroline.DeCosta@jcu.edu.au

Acknowledgements:

We thank Philip Goldstone for his assistance in the preparation of this article.

Competing interests:

No relevant disclosures.

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10. Dickinson JE, Jennings BG, Doherty DA. Mifepristone and oral, vaginal, or sublingual misoprostol for second‐trimester abortion: a randomized controlled trial. Obstet Gynecol 2014; 123: 1162–1168.
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12. Mulligan E, Messenger H. Mifepristone in South Australia — the first 1343 tablets. Aust Fam Physician 2011; 40: 342–345; quiz 351–352.
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14. Hyland P, Raymond EG, Chong E. A direct‐to‐patient telemedicine abortion service in Australia: retrospective analysis of the first 18 months. Aust N Z J Obstet Gynaecol 2018; 58: 335–340.
15. Downing S, McNamee H, Penney D, et al. Three years on: a review of medical terminations of pregnancy performed in a sexual health service. Sex Health 2010; 7: 212–215.
16. Goldstone P, Walker C, Hawtin K. Efficacy and safety of mifepristone‐buccal misoprostol for early medical abortion in an Australian clinical setting. Aust N Z J Obstet Gynaecol 2017; 57: 366–371.
17. Dickinson JE, Brownell P, McGinnis K, et al. Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: worth the effort. Aust N Z J Obstet Gynaecol 2010; 50: 60–64.
18. Shankar M, Black K, Goldstone P, et al. Access, equity and costs of induced abortion services in Australia: a cross‐sectional study. Aust N Z J Public Health 2017; 41: 309–314.

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Narrative reviews

Updates in the management of inflammatory bowel disease during pregnancy

Sally J Bell and Emma K Flanagan

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50062
Published online: 25 March 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Women's health

Summary

The best pregnancy outcomes for women with inflammatory bowel disease (IBD) occur when their disease is in remission at conception and remains in remission throughout pregnancy.
Active IBD can lead to adverse pregnancy outcomes, including spontaneous abortion, pre‐term birth and low birthweight.
The majority of women with IBD who are taking maintenance medication will require medication throughout the pregnancy to prevent disease relapse.
Most IBD medications are considered safe in pregnancy and breastfeeding, except for methotrexate.
Pre‐conception counselling should be arranged with the patient's IBD specialist and should include discussions regarding the importance of optimising disease control before and during pregnancy as well as the medication management plan for pregnancy.
Patients with IBD should be reassured that their fertility is normal when the disease is quiescent, with the exception of women who have had pelvic surgery.
IBD activity should be carefully monitored during pregnancy using non‐invasive techniques, and disease flares during pregnancy should be treated promptly with escalation of therapy in consultation with the patient's IBD specialist.
Mode of delivery should be determined by obstetric need; however, caesarean delivery is preferred for women with a history of ileal pouch anal anastomosis surgery or active perianal Crohn's disease.

St Vincent's Hospital, Melbourne, VIC

Correspondence: Sally.Bell@svhm.org.au

Competing interests:

No relevant disclosures.

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53. Deepak P, Sandborn WJ. Ustekinumab and anti‐interleukin‐23 agents in Crohn's disease. Gastroenterol Clin North Am 2017; 46: 603–626.
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Research

Evaluating the benefits of a rapid access chest pain clinic in Australia

James Andrew Black, Kevin Cheng, Jo‐Anne Flood, Garry Hamilton, Serena Parker, Anees Enayati, Faisal S Khan and Tom Marwick

Med J Aust 2019; 210 (7): . || doi: 10.5694/mja2.50021
Published online: 25 March 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

General medicine

Diagnostic techniques and procedures

Abstract

Objectives: To compare the outcomes and safety of a rapid access chest pain clinic (RACPC) in Australia with those of a general cardiology clinic.

Design: Prospective comparison of the outcomes for patients attending an RACPC and those of historical controls.

Setting: Royal Hobart Hospital cardiology outpatient department.

Participants: 1914 patients referred for outpatient evaluation of new onset chest pain (1479 patients seen in the RACPC, 435 patients previously seen in the general cardiology clinic).

Main outcome measures: Service outcomes (review times, number of clinic reviews); adverse events (unplanned emergency department re‐attendances at 30 days and 12 months; major adverse cardiovascular events at 12 months, including unplanned revascularisation, acute coronary syndrome, stroke, cardiac death).

Results: Median time to review was shorter for RACPC than for usual care patients (12 days [IQR, 8–15 days] v 45 days [IQR, 27–89 days]). All patients seen in the RACPC received a diagnosis at the first clinic visit, but only 139 patients in the usual care group (32.0%). There were fewer unplanned emergency department re‐attendances for patients in the RACPC group at 30 days (1.6% v 4.4%) and 12 months (5.7% v 12.9%) than in the control group. Major adverse cardiovascular events were less frequent among patients evaluated in the RACPC (0.2% v 1.4%).

Conclusions: Patients were evaluated more efficiently in the RACPC than in a traditional cardiology clinic, and their subsequent rates of emergency department re‐attendances and adverse cardiovascular events were lower.

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1 Royal Hobart Hospital, Hobart, TAS
2 Austin Health, Melbourne, VIC
3 Baker IDI Heart and Diabetes Institute, Melbourne, VIC

Correspondence: andrew.black@ths.tas.gov.au

Acknowledgements:

We gratefully acknowledge grants from the Tasmanian Community Fund and the virtual Tasmanian Academic Health Sciences Precinct. We thank the staff and patients of the Royal Hobart Hospital who attended or worked in the RACPC, as well as the National Heart Foundation for their ongoing support. We are grateful to James Sharman for his assistance with the statistical analyses.

Competing interests:

No relevant disclosures.

1. Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data 2007; 386: 1–32.
2. Cullen L, Greenslade J, Merollini K, et al. Cost and outcomes of assessing patients with chest pain in an Australian emergency department. Med J Aust 2015; 202: 427–432. https://www.mja.com.au/journal/2015/202/8/cost-and-outcomes-assessing-patients-chest-pain-australian-emergency-department
3. Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes. Med J Aust 2006; 184 (8 Suppl): S1–S29. https://www.mja.com.au/journal/2006/184/8/guidelines-management-acute-coronary-syndromes-2006
4. Dougan JP, Mathew TP, Riddell JW, et al. Suspected angina pectoris: a rapid‐access chest pain clinic. Q J Med 2001; 94: 679–686.
5. Byrne J, Murdoch D, Morrison C, et al. An audit of activity and outcome from a daily and a weekly “one stop” rapid assessment chest pain clinic. Postgrad Med J 2002; 78: 43–46.
6. Tenkorang JN, Fox KF, Collier TJ, et al. A rapid access cardiology service for chest pain, heart failure and arrhythmias accurately diagnoses cardiac disease and identifies patients at high risk: a prospective cohort study. Heart 2006; 92: 1084–1090.
7. Davie AP, Caesar D, Caruana L, et al. Outcome from a rapid‐assessment chest pain clinic. Q J Med 1998; 91: 339–343.
8. Debney MT, Fox KF. Rapid access cardiology — a nine year review. Q J Med 2012; 105: 231–234.
9. Fox KF, Tenkorang J, Rogers A, et al. Are rapid access cardiology clinics a valued part of a district cardiology service? Int J Cardiol 2009; 137: 42–46.
10. Klimis H, Thiagalingam A, Altman M, et al. Rapid‐access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services? Int Med J 2017; 47: 986–991.
11. Yu C, Sheriff MJ, Ng ACC, et al. A rapid access chest pain clinic (RACPC): initial Australian experience. Heart Lung Circ 2017; 27: 1376–1380.
12. Klimis H, Khan ME, Thiagalingam A, et al. Rapid access cardiology (RAC) services within a large tertiary referral centre. First year in review. Heart Lung Circ 2018; 27: 1381–1387.
13. Department of Health and Social Care (UK). National service framework for coronary heart disease. Mar 2000. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/198931/National_Service_Framework_for_Coronary_Heart_Disease.pdf (viewed May 2018).
14. Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart Lung Circ 2016; 25: 895–951.
15. Sandoval Y, Smith SW, Shah AS, et al. Rapid rule‐out of acute myocardial injury using a single high‐sensitivity cardiac troponin I measurement. Clin Chem 2017; 63: 369–376.
16. Ashrafi R, Raga S, Abdool A, et al. NICE recommendations for the assessment of stable chest pain: assessing the early economic and service impact in the rapid‐access chest pain service. Postgrad Med J 2013; 89: 251–257.
17. Elford A, Black A, Flood J. Review of the rapid access chest pain assessment clinic at the Royal Hobart Hospital [abstract]. Heart Lung Circ 2016; 25 (Suppl 2): S63.

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Research

Cultural respect in general practice: a cluster randomised controlled trial

Siaw‐Teng Liaw, Vicki Wade, John S Furler, Iqbal Hasan, Phyllis Lau, Margaret Kelaher, Wei Xuan and Mark F Harris

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50031
Published online: 25 March 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Indigenous health

Global health

General medicine

Abstract

Objective: To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff.

Design: Mixed methods, cluster randomised controlled trial with a participatory action research approach.

Setting, participants: Fifty‐six general practices in Sydney and Melbourne, 2014–2017.

Intervention: WoTWoD encompasses a toolkit (ten scenarios illustrating cross‐cultural behaviour in clinical practice), one half‐day workshop, cultural mentor support for practices, and a local care partnership between participating Medicare locals/primary health networks and local Aboriginal Community Controlled Health Services for guiding the program and facilitating community engagement. The intervention lasted 12 months at each practice.

Major outcomes: Rates of claims for MBS item 715 (health assessment for Aboriginal and Torres Strait Islander People) and recording of chronic disease risk factors; changes in cultural quotient (CQ) scores of practice staff.

Results: Complete results were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). 12‐Month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes.

Conclusion: The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation.

Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12614000797673.

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1 UNSW Sydney, Sydney, NSW
2 Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW
3 Menzies School of Health Research, Darwin, NT
4 University of Melbourne, Melbourne, VIC
5 Centre for Health Policy, University of Melbourne, Melbourne, VIC
6 Ingham Institute of Applied Medical Research, Sydney, NSW

Correspondence: siaw@unsw.edu.au

Acknowledgements:

We acknowledge the contributions of Lisa Jackson‐Pulver and the cultural mentors Phillip Orcher, Faye Daniels, Rhonda McPherson, Aunty Diane Kerr, and Nina Fitzgerald that ensured the cultural appropriateness of the design, implementation and interpretation of our study. The trial was funded by the National Health and Medical Research Council (APP1065491).

Competing interests:

No relevant disclosures.

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2. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework report 2008: detailed analyses. Canberra: AIHW, 2009.
3. Department of the Prime Minister and Cabinet (Australia). Closing the Gap: Prime Minister's report 2018. https://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2018.pdf (viewed Dec 2018).
4. KPMG. National monitoring and evaluation of the Indigenous Chronic Disease Package: first monitoring report 2010–11. Canberra: Department of Health (Australia), 2013. http://www.health.gov.au/internet/main/publishing.nsf/Content/icdp-baseline-report (viewed Dec 2018).
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6. Department of Health (Australia). Aboriginal and Torres Strait Islander people. Information on health assessments and follow‐up allied health services. Updated Apr 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_ATSI_mbsha_resource_kit (viewed Dec 2018).
7. Australian Institute of Health and Welfare. Indigenous health check (MBS 715) data tool (Cat. No. WEB 63). Updated 6 Dec 2017. https://www.aihw.gov.au/getmedia/b25f8967-8aa8-4382-9507-d28b9fc4a090/aihw-indigenous-healthcheck-tool-data-tables-2017.xls.aspx (viewed Dec 2018).
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16. Australian Health Ministers’ Advisory Council Standing Committee on Aboriginal and Torres Strait Islander Health Working Party. AHMAC cultural respect framework for Aboriginal and Torres Strait Islander health, 2004–2009. Adelaide: Department of Health, South Australia, 2004. http://iaha.com.au/wp-content/uploads/2013/03/000211_culturalrespectframework.pdf (viewed Dec 2018).
17. Carson B, Dunbar T, Chenhall R, Bailie R. Social determinants of Indigenous health. Sydney: Allen and Unwin, 2007.
18. Couzos S, Thiele D. The International Covenant on Economic, Social and Cultural Rights and the right to health: is Australia meeting its obligations to Aboriginal peoples? Med J Aust 2007; 186: 522–524. https://www.mja.com.au/journal/2007/186/10/international-covenant-economic-social-and-cultural-rights-and-right-health
19. Australian Government. Statistics, boundary and concordance files. Oct 2013. Archived: https://web.archive.org/web/20140226184705/http://www.medicarelocals.gov.au/internet/medicarelocals/publishing.nsf/Content/digital-boundaries (viewed Dec 2018).
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21. Horner S, Rew L, Torres R. Enhancing intervention fidelity: a means of strengthening study impact. J Spec Pediatr Nurs 2006; 11: 80–89.
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23. Liaw ST, Wade V, Lau P, et al. Safe and effective cultural mentorship in general practice. Aust Fam Physician 2016; 45: 431–436.
24. National Health and Medical Research Council. Cultural competency in health: a guide for policy, partnerships and participation. Canberra: NHMRC, 2005. https://nhmrc.gov.au/about-us/publications/cultural-competency-health#block-views-block-file-attachments-content-block-1 (viewed Dec 2018).
25. Bailie R, Si D, Dowden M, et al. Improving organisational systems for diabetes care in Australian Indigenous communities. BMC Health Serv Res 2007; 7: 67.

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Research

Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015

Hamish McManus, Denton Callander, Basil Donovan, Darren B Russell, Catherine C O'Connor, Stephen C Davies, David A Lewis, Margaret E Hellard, Marcus Y Chen, Kathy Petoumenos, Rick Varma, Aaron Cogle, Mark Alastair Boyd, Andrew Grulich, James Pollard, Nick Medland, Christopher K Fairley and Rebecca J Guy

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50006
Published online: 25 March 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Immune system diseases

Abstract

Objectives: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia.

Design, setting: Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program.

Participants: Patients diagnosed with HIV infections, January 2004 – June 2015.

Main outcome measures: Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment); demographic, clinical, and risk group characteristics of patients associated with early treatment; trends in early treatment, by CD4⁺ cell count at diagnosis.

Results: 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27–43 years), and 841 (92%) were men; the median CD4⁺ cell count at diagnosis was 510 cells/μL (IQR, 350–674 cells/μL). The proportion of patients who received early treatment increased from 17% (15 patients) in 2004–06 to 20% (34 patients) in 2007–09, 34% (95 patients) in 2010–12, and 53% (197 patients) in 2013–15 (trend, P < 0.001). The probability of early treatment, which increased with time, was higher for patients with lower CD4⁺ cell counts and higher viral loads at diagnosis.

Conclusions: The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004–2015, reflecting changes in the CD4⁺ cell count threshold in treatment guidelines. Nevertheless, further strategies are needed to maximise the benefits of treatment to prevent viral transmission and morbidity.

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1 The Kirby Institute, University of New South Wales, Sydney, NSW
2 Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW
3 Sexual Health Service Cairns, Cairns, QLD
4 Northern Sydney Sexual Health Service, Royal North Shore Hospital, Sydney, NSW
5 Western Sydney Sexual Health Centre, University of Sydney, Sydney
6 Centre for Population Health, Burnet Institute, Melbourne, VIC
7 Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC
8 Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW
9 National Association of People with HIV Australia, Melbourne, NSW
10 University of Adelaide, Adelaide, SA
11 Lyell McEwin Hospital, Adelaide, SA
12 University Hospital, Geelong, VIC
13 Melbourne Sexual Health Centre, Monash University Central Clinical School, Melbourne, VIC

Correspondence: hmcmanus@kirby.unsw.edu.au

Competing interests:

No relevant disclosures.

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19. Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 58: 1–10.
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21. Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11: 217–229.
22. Cuzick J. A Wilcoxon‐type test for trend. Stat Med 1985; 4: 87–90.
23. Australasian Society for HIV Medicine. When to start antiretroviral therapy in people with HIV. Aug 2015; updated Oct 2017. http://arv.ashm.org.au/clinical-guidance (viewed June 2018).
24. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV‐1‐infected adults and adolescents. Jan 2016. Washington (DC): Department of Health and Human Services, 2016. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl003412.pdf (viewed June 2017).
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27. Grierson J, Koelmeyer RL, Smith A, Pitts M. Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV‐positive Australians. HIV Med 2011; 12: 562–569.
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Perspectives

Monitoring the missing half: why reporting adolescent births is insufficient

Jennifer L Marino and Susan M Sawyer

Med J Aust 2019; 210 (5): . || doi: 10.5694/mja2.50047
Published online: 18 March 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Pediatric medicine

Women's health

Statistics, epidemiology and research design

Sexual health

Environment and public health

Social determinants of health

Lack of national abortion data impedes development of sexual and reproductive health care policies and programs for young Australians

Recent data show a steady decrease in adolescent births to a historic low of 10 births per 1000 15–19‐year‐olds.1 Notwithstanding that some adolescent pregnancies are planned or wanted, these data are surely positive, as pregnant adolescents are vulnerable to numerous adversities and delaying pregnancy is healthier for mothers and children.2 However, birth rates reflect access to comprehensive sexuality education, reliable contraception and safe abortion. Specifically, as lower birth rates may reflect higher abortion rates, a complete national picture is required. More broadly, pregnancy and its outcomes reflect various inequities that continue to affect adolescents and their offspring across their lives. Greater understanding of adolescent pregnancy outcomes, including abortion, would help shape a suite of interventions for vulnerable adolescents, including interventions that facilitate access to quality schooling and alleviate poverty.

1 Royal Women's Hospital, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Murdoch Children's Research Institute, Melbourne, VIC

Correspondence: jennifer.marino@unimelb.edu.au

Acknowledgements:

Jennifer Marino is supported by National Health and Medical Research Council Centre of Research Excellence in Adolescent Health grant 1134894 and project grant 1161145. We thank Dr Deborah Bateson (Family Planning Victoria), Ms Sarah Gafforini and Dr Philip Goldstone (Marie Stopes Australia), Dr Cedric Manen (Family Planning Tasmania) and Prof Rachel Skinner (University of Sydney and Children's Hospital Westmead) for enlightening conversations about this topic and comments on the manuscript.

Competing interests:

No relevant disclosures.

1. Australian Bureau of Statistics. 3301.0 – Births, Australia, 2017. Canberra: ABS, 2018. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3301.0 (viewed Feb 2019).
2. Marino JL, Lewis LN, Bateson D, et al. Teenage mothers. Aust Fam Phys 2016; 45: 712–717.
3. Sedgh G, Finer LB, Bankole A, et al. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolescent Health 2015; 56: 223–230.
4. Singh S, Remez L, Sedgh G, et al. Abortion worldwide 2017: uneven progress and unequal access. New York: Guttmacher Institute, 2018. https://www.guttmacher.org/sites/default/files/report_pdf/abortion-worldwide-2017.pdf (viewed Sept 2018).
5. Centers for Disease Control and Prevention. CDCs abortion surveillance system FAQs. Atlanta, GA: CDC, 2017. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm (viewed Sept 2018).
6. Sanci LA, Sawyer SM, Kang MS, et al. Confidential health care for adolescents: reconciling clinical evidence with family values. Med J Aust 2005; 183: 410–414. https://www.mja.com.au/journal/2005/183/8/confidential-health-care-adolescents-reconciling-clinical-evidence-family-values
7. Pregnancy Outcome Unit. Pregnancy outcome in South Australia 2016. Adelaide: SA Health, Government of South Australia, 2018. https://www.sahealth.sa.gov.au/wps/wcm/connect/4ccbba85-14c6-4b39-a19e-4e8cd54e9ea1/Pregnancy+Outcome+in+South+Australia+2016.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-4ccbba85-14c6-4b39-a19e-4e8cd54e9ea1-mxUFP3N (viewed Feb 2019).
8. Hutchinson M, Ballestas T. Induced abortions in Western Australia 2013‐2015: fifth report of the Western Australian Abortion Notification System. Perth: Department of Health, Western Australia, 2018. https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Data%20collection/PDF/Induced-Abortion-Report-2013-15.pdf (viewed Sept 2018).
9. Part K, Moreau C, Donati S, et al. Teenage pregnancies in the European Union in the context of legislation and youth sexual and reproductive health services. Acta Obstet Gynecol Scand 2013; 92: 1395–1406.
10. Wellings K, Palmer MJ, Geary RS, et al. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000‐12: an observational study. Lancet 2016; 388: 586–595.
11. Hadley A, Ingham R, Chandra‐Mouli V. Implementing the United Kingdom's ten‐year teenage pregnancy strategy for England (1999‐2010): how was this done and what did it achieve? Reprod Health 2016; 13: 139.

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Pagination