Interventions to reduce the interval to treatment in syphilis: Central case management and encrypted email

Syphilis is an endemic sexually transmitted infection in remote Aboriginal communities in central and northern Australia. Declining prevalence rates a nd limited resources have led to the introduction of cost effective strateg ies aimed at reducing the duration of infectiousness. In 1995 Nganampa Heal th Council established a central syphilis register, centralised diagnosis a nd coordinated the monitoring of case management. In February 1997 a freely available, high security cryptographic software was introduced-to transmit syphilis serology results, on a daily basis, as encrypted email from the l aboratory to the health service. Data from the annual age-based screening p rogram (12 to 40 years) for the four years(1995 to 1998) were used to evalu ate the impact of the interventions on the interval to treatment. The numbe r of people screened for syphilis in each of the four years varied from 756 to 1,021, with the prevalence declining from 2.4% in 1995 to 1.2% in 1998. Centralised diagnosis-and improved case management reduced the interval to treatment from 47 days in 1995 to 24 days in 1996. The reduction to 16 day s in 1997 reflects the combined impact of the initial intervention and the introduction of encrypted email transmission of results. The subsequent reb ound to 24 days in 1998 reflects the impact of a high population mobility o n the mean interval to treatment. The significant reduction in interval to treatment due to centralised diagnosis and improved case management provide s a strong argument for diagnosis and case monitoring by a skilled worker u sing a central syphilis register. The transmission of syphilis results usin g encrypted email contributed to a further reduction in the mean interval t o treatment in infectious cases of syphilis. High security encryption techn ology is both feasible and cost effective, and has secured the acceptabilit y of email delivery of confidential STD results in these communities. The h igh mobility of the population in remote communities remains an ongoing cha llenge in implementing this strategy.