The epidemiology of sexually transmitted infections and neglected tropical diseases in Oceania

Abstract

From February 2017-February 2019 I undertook a field placement at the Kirby Institute, University of New South Wales (UNSW), as part of my Master of Philosophy in Applied Epidemiology (MAE). An MAE graduate is required to be competent in four skills that are essential for an applied epidemiologist. These competencies are demonstrated through four chapters within this MAE: 1) Design and conduct an epidemiological study, 2) Analyse a public health dataset, 3) Investigate an acute public health problem, and 4) Conduct a surveillance evaluation. An additional chapter detailing teaching experience follows the main competency chapters. To meet the epidemiological study component, I conducted the first prevalence study of scabies and impetigo in a primary school in Gizo, the main town on a small island in The Solomon Islands. The prevalence of scabies and impetigo were found to be 56.7% and 43.9% respectively - a significant burden. I also set up two other international epidemiological studies in Fiji and the Solomon Islands, however the implementation of these studies proved to be beyond the timeframe of the 2-year MAE program. For the data analysis component, I investigated the association between the prevalence of clean faces and the prevalence of trachoma in Australian communities endemic for trachoma between 2007-2017 using a binomial logistic regression model. A significant association was found, however a number of caveats need to be considered in the interpretation of this association. My investigation of the increase in gonorrhea notifications in New South Wales (NSW) women in 2018 demonstrated the third competency: investigation of an acute public health problem. Through a case series study, I found that the outbreak appeared to be related to local, heterosexual, condomless sex. As this study was of a sensitive nature, careful methodologies were required. Their success meant that these study methods can serve as a template for future sexually transmitted disease outbreak investigations in Australian women. For the evaluation of a surveillance system competency, I conducted a systematic review of the access and utility of testing (or denominator) data for chlamydia and influenza in Australia. This study found that the most common source of denominator data for these diseases was sentinel surveillance data; and the most common uses were to describe testing practices (chlamydia) and to estimate disease burden (influenza). The final chapter in my bound volume demonstrates my completion of the teaching requirements for the MAE: a Lesson from the Field (LFF) and a group teaching session with MAE peers. My LFF summarized key issues I encountered when setting up the Fiji epidemiology project, and was titled "Ethical, Cultural and Practical Study Design Challenges in the Pacific". My group teaching session was titled "Communicating as a Field Epidemiologist during Public Health Emergencies" and flagged a number of considerations for communicating in the field for first year MAEs. The projects within this bound volume reflect the Kirby Institute's area of work within marginalized and at-risk populations, and demonstrate my completion of the MAE competencies. The diseases in focus include the sexually transmitted infections (STIs): chlamydia and gonorrhea; and the neglected tropical diseases (NTDs): scabies and trachoma. The research I completed was based in three countries: Australia, Fiji and the Solomon Islands; all within Oceania region. Findings from these projects will contribute to the ever-growing body of public health knowledge on sexually transmitted infections and neglected tropical diseases in Oceania, and thus provide important information to guide public health policy and stimulate future research, both within and beyond the region.