Flesh, Blood, Sex and Consumption: Applied Epidemiology in Victoria

Abstract

In this thesis I present the key projects and activities that I completed as part of the Australian National University's Master of Philosophy in Applied Epidemiology (MAE) program during 2018-2019. During this time I was based in the Communicable Disease Epidemiology and Surveillance (CDES) unit at the Victorian Department of Health and Human Services (DHHS), and the Surveillance and Evaluation section of the Burnet Institute in Melbourne, Victoria. I completed four major projects across these two organisations, as well as being involved with a range of other infectious disease surveillance and research activities. At DHHS, I investigated a cluster of tuberculosis cases in a cultural community. This three-year investigation was one of the largest tuberculosis cluster investigations ever undertaken by the Department of Health and Human Services and the Victorian Tuberculosis Program. The epidemiological side of the investigation in which I was involved utilised epidemiological, social-location and genomic data to better understand transmission within the cluster. I also conducted an epidemiological study of delays in patient presentation and diagnosis for Buruli ulcer in Victoria. Given the current lack of effective interventions to reduce disease transmission in Victoria, prompt diagnosis and treatment are critical to minimise the impact of the disease. The study aimed to characterise and identify factors influencing presentation and diagnosis delays in patients notified to DHHS between 2011 and 2017 to better inform public health messaging for the public and medical practitioners. The study was published in the Tropical Medicine and Infectious Diseases journal in July 2019. At the Burnet Institute I completed a program evaluation of the ACCESS project, a sentinel surveillance system for STIs and BBVs that was funded by the Australian Government Department of Health to expand nationally during 2016-2019. Based on the outcomes of the evaluation, I made several recommendations to improve the operation of the ACCESS project during the next potential funding period. My data analysis project at the Burnet Institute examined the epidemiology and subtype diversity of HIV-1 in newly-arrived Asian-born and Australian-born men who have sex with men (MSM) populations using routinely-collected surveillance and subtyping data. Understanding and addressing HIV transmission in the newly-arrived Asian-born MSM population is increasingly important in Victoria, with both the population and the proportion of HIV notifications from the population increasing in recent years. The appendices to the thesis include summaries of other program requirements outside these four main projects. I developed public health communications materials for a non-scientific audience in the form of participant information for the NHMRC-funded Beating Buruli in Victoria case-control study. I completed three teaching activities; a lecture on data visualisation, a session on the basics of social network analysis for infectious diseases, and a "lesson from the field" on tuberculosis cluster and outbreak investigations. Finally, I present a short summary of my involvement as a team leader in the SaMELFS Samoa mosquito survey and molecular xenomonitoring study, for which I travelled to Samoa in June 2019. Through the completion of these projects and activities I have clearly demonstrated the core field epidemiology training program competencies and accumulated knowledge and experience that will no doubt serve me well in the future. Show more