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

Objective: Tc evaluate the impact of a program to improve access to, and de livery of, diagnosis anal treatment on prevalence of gonorrhoea and chlamyd ial 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 Anang u 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 Pitjantjatjar a Lands. Main outcome measures: Prevalence of gonorrhoea and chlamydial infection, d etermined by urine polymerase chain reaction tests. Results: The prevalence of gonorrhoea in people aged 12-40 years almost hal ved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P <0.001). The fal l 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 =0.1 74). Conclusion: This study documents a rapid reduction in prevalence of gonorrh oea, 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 co mmunities, even with a highly mobile population, it is possible to implemen t effective control activities for sexually transmitted diseases.