Topics

Mycobacterium ulcerans causes necrotising infections of the skin and soft tissue (Buruli ulcer), a disease that is endemic in the coastal regions of Victoria and northern Queensland. Most lesions (> 85%) are painless ulcers, but some are non‐ulcerative.1 As the incidence of Buruli ulcer rises in Victoria,2 Australian health practitioners are increasingly required to recognise this disease in people who reside in or have travelled to endemic areas, with early diagnosis vital for good outcomes.3

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1 University Hospital Geelong, Geelong, VIC
2 Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
3 Sorrento Medical Centre, Sorrento, VIC
4 South Coast Medical, Blairgowrie, VIC

Correspondence: DANIELO@BarwonHealth.org.au

Competing interests:

No relevant disclosures.

1. Boyd SC, Athan E, Friedman ND, et al. Epidemiology, clinical features and diagnosis of Mycobacterium ulcerans in an Australian population. Med J Aust 2012; 196: 341–344. https://www.mja.com.au/journal/2012/196/5/epidemiology-clinical-features-and-diagnosis-mycobacterium-ulcerans-australian
2. O'Brien DP, Athan E, Blasdell K, De Barro P. Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response. Med J Aust 2018; 208: 287–289. https://www.mja.com.au/journal/2018/208/7/tackling-worsening-epidemic-buruli-ulcer-australia-information-void-time-urgent
3. O'Brien DP, Friedman ND, McDonald A, et al. Wound healing: natural history and risk factors for delay in Australian patients treated with antibiotics for Mycobacterium ulcerans disease. PLoS Negl Trop Dis 2018; 12: e0006357.
4. Fyfe JA, Lavender CJ, Johnson PD, et al. Development and application of two multiplex real‐time PCR assays for the detection of Mycobacterium ulcerans in clinical and environmental samples. Appl Environ Microbiol 2007; 73: 4733–4740.
5. Department of Human Services (Victoria). Mycobacterium ulcerans infection. Health.vic; 2018. https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/mycobacterium-ulcerans (viewed May 2018).

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Narrative review

Family planning, antenatal and post partum care in multiple sclerosis: a review and update

Anneke Van Der Walt, Ai‐Lan Nguyen and Vilija Jokubaitis

Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50113
Published online: 1 April 2019

Topics

Nervous system diseases

Women's health

Summary

Multiple sclerosis is more prevalent in women of childbearing age than in any other group. As a result, the impact of multiple sclerosis and its treatment on fertility, planned and unplanned pregnancies, post partum care and breastfeeding presents unique challenges that need to be addressed in everyday clinical practice.
Given the increasing number of disease‐modifying agents now available in Australia for the treatment of multiple sclerosis, there is a growing need for clinicians to provide their patients with appropriate counselling on family planning.
Providing better evidence regarding the relative risks and benefits of continuing therapy before, during and after pregnancy is an important research priority. International pregnancy registries are essential in developing better evidence‐based practice guidelines, and neurologists should be encouraged to contribute to these when possible.
The management of women with multiple sclerosis, especially when they are taking disease‐modifying agents, requires careful assessment of fertility and disease characteristics as well as a multidisciplinary approach to ensure positive outcomes in both mothers and their children.

1 Monash University, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Alfred Health, Melbourne, VIC
4 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: Anneke.VanDerWalt@monash.edu

Competing interests:

Anneke Van der Walt has received travel support, speaking honoraria and served on advisory boards for Biogen Australia, Novartis, Merck, Sanofi, Roche and Teva. Ai‐Lan Nguyen has received grant support and travel support from Biogen Australia. Vilija Jokubaitis has received travel support and speaking honoraria from Biogen Australia.

1. Niedziela N, Adamczyk‐Sowa M, Pierzchała K. Epidemiology and clinical record of multiple sclerosis in selected countries: a systematic review. Int J Neurosci 2014; 124: 322–330.
2. Hauser S, Oksenberg J. The neurobiology of multiple sclerosis: genes, inflammation, and neurodegeneration. Neuron 2006; 52: 61–76.
3. Australian Bureau of Statistics. Multiple sclerosis (Cat. No. 4429.0). Canberra: Commonwealth of Australia, 2012. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4429.0main+features100182009 (viewed Dec 2017).
4. Amato MP, Portaccio E. Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease‐modifying drugs. CNS Drugs 2015; 29: 207–220.
5. Broadley SA, Barnett MH, Boggild M, et al. A new era in the treatment of multiple sclerosis. Med J Aust 2015; 203: 139–141. https://www.mja.com.au/journal/2015/203/3/new-era-treatment-multiple-sclerosis
6. Confavreux C, Hutchinson M, Hours MM, et al. Rate of pregnancy‐related relapse in multiple sclerosis. N Engl J Med 1998; 339: 285–291.
7. Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the “treatment era”. Nat Rev Neurol 2015; 11: 280–289.
8. Lu E, Wang BW, Alwan S, et al. A review of safety‐related pregnancy data surrounding the oral disease‐modifying drugs for multiple sclerosis. CNS Drugs 2014; 28: 89–94.
9. Friend S, Richman S, Bloomgren G, et al. Evaluation of pregnancy outcomes from the Tysabri^® (natalizumab) Pregnancy Exposure Registry: a global, observational, follow‐up study. BMC Neurol 2016; 16: 150.
10. Therapeutics and Goods Administration. TGA eBusiness Services. Australian Government Department of Health and Ageing. https://www.tga.gov.au/prescribing-medicines-pregnancy-database (viewed Dec 2017).
11. National Clinical Guideline Centre (UK). Multiple sclerosis: management of multiple sclerosis in primary and secondary care (NICE clinical guidelines no. 186). London: National Institute for Health and Care Excellence (UK), 2014. https://www.ncbi.nlm.nih.gov/books/NBK248064 (viewed Dec 2017).
12. Cavalla P, Rovei V, Masera S, et al. Fertility in patients with multiple sclerosis: current knowledge and future perspectives. Neurol Sci 2006; 27: 231–239.
13. Roux T, Courtillot C, Debs R, et al. Fecundity in women with multiple sclerosis: an observational mono‐centric study. J Neurol 2015; 262: 957–960.
14. Borisow N, Döring A, Pfueller CF, et al. Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy. EPMA J 2012; 3: 9.
15. Cordeau D, Courtois F. Sexual disorders in women with MS: assessment and management. Ann Phys Rehabil Med 2014; 57: 337–347.
16. Schairer LC, Foley FW, Zemon V, et al. The impact of sexual dysfunction on health‐related quality of life in people with multiple sclerosis. Mult Scler 2014; 20: 610–616.
17. Multiple Sclerosis International Foundation. Intimacy and sexuality. MS in focus 2005; 6. https://www.msif.org/wp-content/uploads/2014/09/MS-in-focus-6-Intimacy-and-sexuality-English.pdf (viewed Dec 2017).
18. Hellwig K, Correale J. Artificial reproductive techniques in multiple sclerosis. Clin Immunol 2013; 149: 219–224.
19. Laplaud DA, Leray E, Barrière P, et al. Increase in multiple sclerosis relapse rate following in vitro fertilization. Neurology 2006; 66: 1280–1281.
20. Hellwig K, Schimrigk S, Beste C, et al. Increase in relapse rate during assisted reproduction technique in patients with multiple sclerosis. Eur Neurol 2009; 61: 65–68.
21. Hellwig K, Beste C, Brune N, et al. Increased MS relapse rate during assisted reproduction technique. J Neurol 2008; 255: 592–593.
22. Michel L, Foucher Y, Vukusic S, et al. Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatr 2012; 83: 796–802.
23. Correale J, Farez MF, Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Ann Neurol 2012; 72: 682–694.
24. Hughes SE, Spelman T, Gray OM, et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 2014; 20: 739–746.
25. Coyle PK. Switching therapies in multiple sclerosis. CNS Drugs 2013; 27: 239–247.
26. Australian categorisation system for prescribing medicines in pregnancy. Therapeutic Goods Administration, 2011. www.tga.gov.au/australian-categorisation-system-prescribing-medicines-pregnancy (viewed Dec 2017).
27. Gur C, Diav‐Citrin O, Shechtman S, et al. Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod Toxicol 2004; 18: 93–101.
28. Coyle PK. Multiple sclerosis and pregnancy prescriptions. Expert Opin Drug Saf 2014; 13: 1565–1568.
29. Achiron A, Chambers C, Fox EJ, et al. Pregnancy outcomes in patients with active RRMS who received alemtuzumab in the clinical development program [abstract]. Mult Scler J 2015; 21: 581–582.
30. Haghikia A, Langer‐Gould A, Rellensmann G, et al. Natalizumab use during the third trimester of pregnancy. JAMA Neurol 2014; 71: 891–895.
31. Vukusic S, Kappos L, Wray S, et al. An update on pregnancy outcomes following ocrelizumab treatment in patients with multiple sclerosis and other autoimmune diseases [abstract]. Mult Scler J 2017; 23: 85–426.
32. Glazaka A, Nolting A, Cook S, et al. Pregnancy outcomes during the clinical development programme of cladribine in multiple sclerosis (MS): an integrated analysis of safety for all exposed patients [abstract]. Mult Scler J 2017; 23: 976–1023.
33. Kieseier BC, Benamor M. Pregnancy outcomes following maternal and paternal exposure to teriflunomide during treatment for relapsing‐remitting multiple sclerosis. Neurol Ther 2014; 3: 133–138.
34. Finkelsztejn A, Brooks J, Paschoal FM, Fragoso YD. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta‐analysis of the literature. BJOG 2011; 118: 790–797.
35. Harirchian MH, Fatehi F, Sarraf P, et al. Worldwide prevalence of familial multiple sclerosis: a systematic review and meta‐analysis. Mult Scler Relat Disord 2018; 20: 43–47.
36. Compston A, Coles A. Multiple sclerosis. Lancet 2008; 372: 1502–1517.
37. Fragoso YD, Boggild M, Macias‐Islas MA, et al. The effects of long‐term exposure to disease‐modifying drugs during pregnancy in multiple sclerosis. Clin Neurol Neurosurg 2013; 115: 154–159.
38. Houtchens MK, Kolb CM. Multiple sclerosis and pregnancy: therapeutic considerations. J Neurol 2013; 260: 1202–1214.
39. Polifka JE, Friedman JM. Medical genetics: 1. Clinical teratology in the age of genomics. CMAJ 2002; 167: 265–273.
40. Alwan S, Yee IM, Dybalski M, Guimond C, Dwosh E, Greenwood TM, et al. Reproductive decision making after the diagnosis of multiple sclerosis (MS). Mult Scler 2013; 19: 351–358.
41. Ferrero S, Pretta S, Ragni N. Multiple sclerosis: management issues during pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 115: 3–9.
42. Iorio R, Frisullo G, Nociti V, et al. T‐bet, pSTAT1 and pSTAT3 expression in peripheral blood mononuclear cells during pregnancy correlates with post‐partum activation of multiple sclerosis. Clin Immunol 2009; 131: 70–83.
43. Broadley SA, Barnett MH, Boggild M, et al. Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3, treatment practicalities and recommendations. J Clin Neurosci 2014; 21: 1857–1865.
44. Daclizumab withdrawn from the market worldwide [erratum for Daclizumab for MS]. Drug Ther Bull 2018; 56: 38–21.
45. Broadley SA, Barnett MH, Boggild M, et al. Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 1, historical and established therapies. J Clin Neurosci 2014; 21: 1835–1846.
46. Hellwig K, Haghikia A, Gold R. Pregnancy and natalizumab: results of an observational study in 35 accidental pregnancies during natalizumab treatment. Mult Scler 2011; 17: 958–963.
47. Glazer CH, Tøttenborg SS, Giwercman A, et al. Male factor infertility and risk of multiple sclerosis: a register‐based cohort study. Mult Scler 2017; 46: 1–8.
48. Strijbos E, Coenradie S, Touw DJ, Aerden L. High‐dose methylprednisolone for multiple sclerosis during lactation: concentrations in breast milk. Mult Scler 2015; 21: 797–798.
49. Hellwig K, Haghikia A, Gold R. Parenthood and immunomodulation in patients with multiple sclerosis. J Neurol 2010; 257: 580–583.
50. Vukusic S, Durand‐Dubief F, Benoit A, et al. Natalizumab for the prevention of post‐partum relapses in women with multiple sclerosis. Mult Scler 2015; 21: 953–955.
51. Hellwig K, Rockhoff M, Herbstritt S, et al. Exclusive breastfeeding and the effect on postpartum multiple sclerosis relapses. JAMA Neurol 2015; 72: 1132–1138.
52. Conradi S, Malzahn U, Paul F, et al. Breastfeeding is associated with lower risk for multiple sclerosis. Mult Scler 2013; 19: 553–558.
53. Pakpoor J, Disanto G, Lacey MV, et al. Breastfeeding and multiple sclerosis relapses: a meta‐analysis. J Neurol 2012; 259: 2246–2248.
54. Anderson PO. Monoclonal antibodies. Breastfeed Med 2016; 11: 100–101.
55. McConnell RA, Mahadevan U. Pregnancy and the patient with inflammatory bowel disease: fertility, treatment, delivery, and complications. Gastroenterol Clin North Am 2016; 45: 285–301.
56. Levy RA, de Jesús GR, de Jesús NR, Klumb EM. Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation. Autoimmun Rev 2016; 15: 955–963.
57. Baker TE, Cooper SD, Kessler L, Hale TW. Transfer of natalizumab into breast milk in a mother with multiple sclerosis. J Hum Lact 2015; 31: 233–236.

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Narrative reviews

Pre‐exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children

Lisa Horgan, Christopher C Blyth, Asha C Bowen, David A Nolan and Andrew P McLean‐Tooke

Med J Aust 2019; 210 (6): . || doi: 10.5694/mja2.50052
Published online: 1 April 2019

Topics

Women's health

Infectious diseases

Pharmaceutical preparations

Immune system diseases

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.

1. Mugo NR, Heffron R, Donnell D, et al. Increased risk of HIV‐1 transmission in pregnancy: a prospective study among African HIV‐1 serodiscordant couples. AIDS 2011; 25: 1887–1895.
2. Thomson K. Increased risk of female HIV‐1 acquisition throughout pregnancy and postpartum: a prospective per‐coital act analysis among women with HIV‐1 infected partners. J Infect Dis 2018; 18: 16–25.
3. Drake Al, Wagner A, Richardson B. Incident HIV during pregnancy and postpartum and risk of mother‐to‐child transmission: a systematic review and meta‐analysis. PLoS Med 2014; 11: e1001608.
4. Wira CR, Fahey JV, Rodriguez‐Garcia M, Shen Z, Patel MV. Regulation of mucosal immunity in the female reproductive tract: the role of sex hormones in immune protection against sexually transmitted pathogens. Am J Reprod Immunol 2014; 72: 236–238.
5. Sheffield JS, Wendel GD Jr, McIntire DD, Norgard MV. The effect of progesterone levels and pregnancy on HIV‐1 coreceptor expression. Reprod Sci 2009; 16: 20–31.
6. Morrison C, Fichorova RN, Mauck C, et al. Cervical inflammation and immunity associated with hormonal contraception, pregnancy, and HIV‐1 seroconversion. J Acquir Immune Defic Syndr 2014; 66: 109–117.
7. World Health Organization. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non‐partner sexual violence. Geneva: WHO, 2013. http://apps.who.int/iris/bitstream/handle/10665/85239/9789241564625_eng.pdf?sequence=1 (viewed Jan 2018).
8. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2017. Sydney: Kirby Institute, UNSW, 2017. https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-and-stis-australia-2017 (viewed Feb 2018).
9. Birkhead GS, Pulver WP, Warren BL, et al. Acquiring human immunodeficiency virus during pregnancy and mother‐to‐child transmission in New York: 2002‐2006. Obstet Gynecol 2010; 115: 1247–1255.
10. Nesheim S, Harris LF, Lampe M. Elimination of perinatal HIV infection in the USA and other high‐income countries: achievements and challenges. Curr Opin HIV AIDS 2013; 8: 447–456.
11. Nduati R, John G, Mbori‐Ngacha D, et al. Effect of breastfeeding and formula feeding on transmission of HIV‐1: a randomised clinical trial. JAMA 2000; 283: 1167–1174.
12. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. Women and HIV. Anteretroviral guidelines: US DHHS guidelines with Australian commentary. Sydney: ASHM, 2016. http://arv.ashm.org.au/arv-guidelines/special-patient-populations/hiv-infected-women (viewed Feb 2019).
13. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV‐1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet 2010; 375: 2092–2098.
14. McDonald AM, Zurynski YA, Wand HC, et al. Perinatal exposure to HIV among children born in Australia, 1982‐2006. Med J Aust 2009; 190: 416–420. https://www.mja.com.au/journal/2009/190/8/perinatal-exposure-hiv-among-children-born-australia-1982-2006
15. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Routine antenatal assessment in the absence of pregnancy complications. Melbourne: RANZCOG, 2016. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Routine-Antenatal-Assessment-(C-Obs-3(b))-Review-July-2016.pdf?ext=.pdf (viewed June 2018).
16. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann 2014; 45: 301–314.
17. Baeten JM, Donnell D, Ndase P. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367: 399–410.
18. Donnell D, Baeten JM, Bumpus NN, et al. HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J Acquir Immune Defic Syndr 2014; 66: 340–348.
19. Callahan R, Nanda K, Kapiga S, et al; FEM‐PrEP Study Group. Pregnancy and contraceptive use among women participating in the FEM‐PrEP trial. J Acquir Immune Defic Syndr 2015; 68: 196–203.
20. Marrazzo J, Ramjee G, Richardson B. Tenofovir‐based preexposure prophylaxis for HIV infection among African women. N Engl J Med 2015; 372: 509–518.
21. World Health Organization. WHO technical brief: preventing HIV during pregnancy and breastfeeding in the context of PrEP. Geneva: WHO, 2017. http://www.who.int/hiv/pub/toolkits/prep-preventing-hiv-during-pregnancy/en/ (viewed Jan 2018).
22. Mugo NR, Hong T, Celum C, et al. Pregnancy incidence and outcomes among women receiving pre‐exposure prophylaxis for HIV prevention: a randomised clinical trial. JAMA 2014; 312: 362–371.
23. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: WHO, 2016. http://www.who.int/hiv/pub/arv/arv-2016/en/ (viewed Jan 2018).
24. Mofenson LM, Baggaley RC, Mameletzis I. Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding: systematic review. AIDS 2017; 31: 213–232.
25. Benaboud S, Pruvost A, Coffie PA, et al. Concentrations of tenofovir and emtricitabine in breast milk of HIV‐1‐infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA study, step 2. Antimicrob Agents Chemother 2011; 55: 1315–1317.
26. Ehrhardt S, Xie C, Guo N, et al. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis 2015; 60: 275–278.
27. Siberry GK, Jacobson DL, Kalkwarf HJ, et al. Lower newborn bone mineral content associated with maternal use of tenofovir disoproxil fumarate during pregnancy. Clin Infect Dis 2015; 61: 996–1003.
28. Siberry GK, Tierney C, Stranix‐Chibanda L, et al. Impact of maternal tenofovir use on HIV‐exposed newborn bone mineral. Conference on Retroviruses and Opportunistic Infections; 2016 Feb 22‐25; Boston, MA. http://www.croiconference.org/sessions/impact-maternal-tenofovir-use-hiv-exposed-newborn-bone-mineral (viewed Jan 2018).
29. Centers for Disease Control and Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep 2012; 61: 586–589.
30. World Health Organization. Guideline on when to start antiretroviral therapy and on pre‐exposure prophylaxis for HIV. Geneva: WHO, 2015. http://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf?sequence=1 (viewed Jan 2018).
31. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2017 update: a clinical practice guideline. Atlanta, GA: CDC, 2018. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf (viewed May 2018).
32. Wright E, Grulich A, Roy K, et al. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre‐exposure prophylaxis: clinical guidelines. J Virus Eradication 2017; 3: 168–184.
33. Smith DK, Pals SL, Herbst JH, et al. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr 2012; 60: 421–427.
34. Balkus J, Brown E, Palanee T. An empiric HIV risk scoring tool to predict HIV‐1 acquisition in African women. J Acquir Immune Defic Syndr 2016; 72: 333–343.

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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

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.

1. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. https://sustainabledevelopment.un.org/post2015/transformingourworld (viewed Feb 2019).
2. Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress‐sexual and reproductive health and rights for all: report of the Guttmacher‐Lancet Commission. Lancet 2018; 391: 2642–2692.
3. Medland NA, Chow EPF, Read THR, et al. Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013‐2017) but not in the newly‐arrived Asian‐born. BMC Infect Dis 2018; 18: 410.
4. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: Kirby Institute, UNSW, 2018. https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Annual-Surveillance-Report-2018_0.pdf (viewed Feb 2019).
5. McManus H, Callander D, Donovan B, et al. Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015. Med J Aust 2019; 210: In Press.
6. Kirby Institute. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report 2018. Sydney: Kirby Institute, UNSW, 2018. https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Aboriginal-Surveillance-Report-2018.pdf (viewed Feb 2018).
7. Traeger MW, Schroeder SE, Wright EJ, et al. Effects of pre‐exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta‐analysis. Clin Infect Dis 2018; 67: 676–686.
8. Horgan L, Blyth CC, Bower AS, et al. Pre‐exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children. Med J Aust 2019; 210: xxx–xxx.
9. Australian Institute of Health and Welfare. Cervical screening in Australia 2014–2015 (Cat. No. CAN 104; Cancer Series No. 105). Canberra: AIHW, 2017. https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/summary (viewed Feb 2019).
10. Moazenchi M, Totonchi M, Salman Yazdi R, et al. The impact of Chlamydia trachomatis infection on sperm parameters and male fertility: a comprehensive study. Int J STD AIDS 2018; 29: 466–73.
11. Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility: a cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19: 185–192.
12. Callander D, Guy R, Fairley CK, et al. Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics. Sex Health 2018; https://doi.org/10.1071/sh18097 [Epub ahead of print].
13. Lahra MM, Martin I, Demczuk W, et al. Cooperative recognition of internationally disseminated ceftriaxone‐resistant Neisseria gonorrhoeae strain. Emerg Infect Dis 2018; 24: 735–740.
14. Reekie J, Donovan B, Guy R, et al. Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: a population‐based cohort study. Clin Infect Dis 2018; 66: 437–443.
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.
16. Australian Government Department of Health. Infectious syphillis outbreak. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-infectious-syphilis-outbreak.htm (viewed Feb 2019).
17. Taft AJ, Shankar M, Black KI, et al. Unintended and unwanted pregnancy in Australia: a cross‐sectional, national random telephone survey of prevalence and outcomes. Med J Aust 2018; 209: 407–408. https://www.mja.com.au/journal/2018/209/9/unintended-and-unwanted-pregnancy-australia-cross-sectional-national-random
18. 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.
19. Australian Institute of Health and Welfare. Teenage mothers in Australia 2015. Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/mothers-babies/teenage-mothers-in-australia-2015/contents/table-of-contents (viewed Feb 2019).
20. Richters J, Fitzadam S, Yeung A, et al. Contraceptive practices among women: the second Australian study of health and relationships. Contraception 2016; 94: 548–555.
21. NHS. NHS contraceptive services, England ‐ 2013‐14, community contraceptive clinics. London: NHS, 2014. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-contraceptive-services/nhs-contraceptive-services-england-2013-14-community-contraceptive-clinics (viewed Feb 2019).
22. Stewart M, Digiusto E, Bateson D, et al. Outcomes of intrauterine device insertion training for doctors working in primary care. Aust Fam Physician 2016; 45: 837–841.
23. Garrett CC, Keogh LA, Kavanagh A, et al. Understanding the low uptake of long‐acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health 2015; 15: 72.
24. Pregnancy Outcome Unit. Pregnancy outcome in South Australia 2016. Adelaide: SA Health, 2016. 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).
25. Chan A, Sage LC. Estimating Australia's abortion rates 1985–2003. Med J Aust 2005; 182: 447–452. https://www.mja.com.au/journal/2005/182/9/estimating-australias-abortion-rates-1985-2003
26. Department of Health, Western Australia. Induced abortions in Western Australia 2013–2015. Fifth Report of the Western Australian Abortion Notification System. Perth: Government of Western Australia, 2018. https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Data%20collection/PDF/Induced-Abortion-Report-2013-15.pdf (viewed Feb 2019).
27. Douglas H, Black K, de Costa C. Manufacturing mental illness (and lawful abortion): doctors’ attitudes to abortion law and practice in new South Wales and Queensland. J Law Med 2013; 20: 560–576.
28. Black KI, Douglas H, de Costa C. Women's access to abortion after 20 weeks’ gestation for fetal chromosomal abnormalities: views and experiences of doctors in New South Wales and Queensland. Aust N Z J Obstet Gynaecol 2015; 55: 144–148.
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.
32. Australian Institute of Health and Welfare. Family, domestic and sexual violence in Australia, 2018 (Cat. No. FDV 2). Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-in-australia-2018/contents/table-of-contents (viewed Feb 2019).
33. Millsteed M, C. M. Attrition of sexual offence incidents across the Victorian criminal justice system. Melbourne: Crimes Statistics Agency, 2017.
34. Department of Social Services. National Plan to Reduce Violence Against Women and their Children 2010–2022. Canberra: Australian Government, 2018. https://www.dss.gov.au/women/programs-services/reducing-violence/the-national-plan-to-reduce-violence-against-women-and-their-children-2010-2022 (viewed Feb 2019).
35. Australian Human Rights Commission. University sexual assault and sexual harassment project. Sydney: AHRC, 2018. https://www.humanrights.gov.au/our-work/sex-discrimination/projects/university-sexual-assault-and-sexual-harassment-project (viewed Feb 2019).

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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

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.

1. ESCR‐Net, International Network for Economic Social and Cultural Rights. General Comment No. 22 (2016) on the right to sexual and reproductive health (article 12 of the International Covenant on Economic, Social and Cultural Rights). ESCR‐Net, 2016. https://www.escr-net.org/resources/general-comment-no-22-2016-right-sexual-and-reproductive-health (viewed Feb 2019).
2. MSHealth. Product information‐MS‐2 Step. Melbourne: MS Health, 2014. http://www.mshealth.com.au/products (viewed Feb 2019).
3. Grossman D, Goldstone P. Mifepristone by prescription: a dream in the United States but reality in Australia. Contraception 2015; 92: 186–189.
4. Chen MJ, Creinin MD. Mifepristone with buccal misoprostol for medical abortion: a systematic review. Obstet Gynecol 2015; 126: 12–21.
5. Gatter M, Cleland K, Nucatola DL. Efficacy and safety of medical abortion using mifepristone and buccal misoprostol through 63 days. Contraception 2015; 91: 269–273.
6. World Health Organization. Safe abortion: technical and policy guidelines for health systems. 2nd ed. WHO; 2012. https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en (viewed Feb 2019).
7. Summers A. Abortion and federal policy: here are the facts. ABC, The Drum 2013; 12 June. https://www.abc.net.au/news/2013-06-12/summers-abortion/4748872 (viewed Oct 2018).
8. de Costa CM. Medical abortion for Australian women: it's time. Med J Aust 2005; 183: 378–380. https://www.mja.com.au/journal/2005/183/7/medical-abortion-australian-women-its-time
9. de Costa CM, Russell DB, de Costa NR, et al. Introducing early medical abortion in Australia: there is a need to update abortion laws. Sex Health 2007; 4: 223–226.
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.
11. Goldstone P, Michelson J, Williamson E. Early medical abortion using low‐dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197: 282–286. https://www.mja.com.au/journal/2012/197/5/early-medical-abortion-using-low-dose-mifepristone-followed-buccal-misoprostol
12. Mulligan E, Messenger H. Mifepristone in South Australia — the first 1343 tablets. Aust Fam Physician 2011; 40: 342–345; quiz 351–352.
13. Lee RY, Moles R, Chaar B. Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges. Contraception 2015; 91: 25–30.
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

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.

1. Mahadevan U, McConnell RA, Chambers CD. Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel disease. Gastroenterology 2017; 152: 451–462.
2. Nielsen MJ, Nørgaard M, Holland‐Fisher P, Christensen LA. Self‐reported antenatal adherence to medical treatment among pregnant women with Crohn's disease. Alimentary Pharmacol Ther 2010; 32: 49–58.
3. Julsgaard M, Nørgaard M, Hvas CL, et al. Self‐reported adherence to medical treatment before and during pregnancy among women with ulcerative colitis. Inflamm Bowel Dis 2011; 17: 1573–1580.
4. Selinger C, Eaden J, Selby W, et al. Patients’ knowledge of pregnancy‐related issues in inflammatory bowel disease and validation of a novel assessment tool (“CCPKnow”). Aliment Pharmacol Ther 2012; 36: 57–63.
5. Kashkooli SB, Andrews JM, Roberts MB, et al. Inflammatory bowel disease‐specific pregnancy knowledge of gastroenterologists against general practitioners and obstetricians. United European Gastroenterol J 2015; 3: 462–470.
6. Wright EK, Ding NS, Niewiadomski O. Management of inflammatory bowel disease. Med J Aust 2018; 209: 318–323. https://www.mja.com.au/journal/2018/209/7/management-inflammatory-bowel-disease
7. Nguyen GC, Seow CH, Maxwell C, et al. The Toronto consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology 2016; 150: 734–757.
8. van der Woude CJ, Ardizzone S, Bengtson MB, et al. The second European evidenced‐based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9: 107–124.
9. Selinger CP, Eaden J, Selby W, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis 2013; 7: e206–e213.
10. Mountifield R, Bampton P, Prosser R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis 2008; 15: 720–725.
11. Hudson M, Flett G, Sinclair T, et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet 1997; 58: 229–237.
12. Olsen KØ, Juul S, Berndtsson I, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15–19.
13. Tavernier N, Fumery M, Peyrin‐Biroulet L, et al. Systematic review: fertility in non‐surgically treated inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 847–853.
14. Levi A, Fisher A, Hughes L, Hendry W. Male infertility due to sulphasalazine. Lancet 1979; 314: 276–278.
15. Sussman A, Leonard JM. Psoriasis, methotrexate, and oligospermia. Arch Dermatol 1980; 116: 215–217.
16. Waljee A, Waljee J, Morris A, Higgins PD. Threefold increased risk of infertility: a meta‐analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut 2006; 55: 1575–1580.
17. Oresland T, Palmblad S, Ellstrom M, et al. Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorect Dis 1994; 9: 77–81.
18. Bartels SA, D'Hoore A, Cuesta MA, et al. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross‐sectional study. Ann Surg 2012; 256: 1045–1048.
19. Beyer‐Berjot L, Maggiori L, Birnbaum D, et al. A total laparoscopic approach reduces the infertility rate after ileal pouch‐anal anastomosis: a 2‐center study. Ann Surg 2013; 258: 275–282.
20. Pabby V, Oza SS, Dodge LE, et al. In vitro fertilization is successful in women with ulcerative colitis and ileal pouch anal anastomosis. Am J Gastroenterol 2015; 110: 792.
21. Cornish J, Tan E, Teare J, et al. A meta‐analysis on the influence of inflammatory bowel disease on pregnancy. Gut 2007; 56: 830–837.
22. Mahadevan U, Sandborn WJ, Li DK, et al. Pregnancy outcomes in women with inflammatory bowel disease: a large community‐based study from Northern California. Gastroenterology 2007; 133: 1106–1112.
23. Stephansson O, Larsson H, Pedersen L, et al. Congenital abnormalities and other birth outcomes in children born to women with ulcerative colitis in Denmark and Sweden. Inflamm Bowel Dis 2010; 17: 795–801.
24. Bröms G, Granath F, Linder M, et al. Birth outcomes in women with inflammatory bowel disease: effects of disease activity and drug exposure. Inflamm Bowel Dis 2014; 20: 1091–1098.
25. Abhyankar A, Ham M, Moss AC. Meta‐analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 460–466.
26. Pedersen N, Bortoli A, Duricova D, et al. The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO‐EpiCom Study of 209 pregnant women. Aliment Pharmacol Ther 2013; 38: 501–512.
27. de Lima A, Zelinkova Z, Mulders AG, van der Woude CJ. Preconception care reduces relapse of inflammatory bowel disease during pregnancy. Clin Gastroenterol Hepatol 2016; 14: 1285–1292.e1.
28. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Vitamin and mineral supplementation and pregnancy. RANZCOG, 2015. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Vitamin-and-mineral-supplementation-in-pregnancy-(C-Obs-25)-Review-Nov-2014,-Amended-May-2015.pdf?ext=.pdf (viewed July 2018).
29. Orholm M, Fonager K, Sørensen HT. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease. Am J Gastroenterol 1999; 94: 3236.
30. Laharie D, Debeugny S, Peeters M, et al. Inflammatory bowel disease in spouses and their offspring. Gastroenterology 2001; 120: 816–819.
31. Bennett RA, Rubin PH, Present DH. Frequency of inflammatory bowel disease in offspring of couples both presenting with inflammatory bowel disease. Gastroenterology 1991; 100: 1638–1643.
32. Klajnbard A, Szecsi PB, Colov NP, et al. Laboratory reference intervals during pregnancy, delivery and the early postpartum period. Clin Chem Lab Med 2010; 48: 237–248.
33. Julsgaard M, Hvas CL, Gearry RB, et al. Fecal calprotectin is not affected by pregnancy. Inflamm Bowel Dis 2017; 23: 1240–1246.
34. Tremblay E, Thérasse E, Thomassin‐Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012; 32: 897–911.
35. de Lima A, Zelinkova Z, van der Woude CJ. A prospective study of the safety of lower gastrointestinal endoscopy during pregnancy in patients with inflammatory bowel disease. J Crohns Colitis 2015; 9: 519–524.
36. Magro F, Gionchetti P, Eliakim R, et al. Third European evidence‐based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra‐intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo‐anal pouch disorders. J Crohns Colitis 2017; 11: 649–670.
37. Gomollon F, Dignass A, Annese V, et al. 3rd European evidence‐based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis 2017; 11: 3–25.
38. Abeywardana S, Sullivan EA. Congenital anomalies in Australia 2002–2003 (AIHW Cat. No. PER 41, Birth Anomalies Series No. 3). Sydney: Australian Institute of Health and Welfare, 2008. https://www.aihw.gov.au/getmedia/fe8e4da8-3983-4d1c-8af5-e0d9a3bef956/Congenital%20anomalies%20in%20Australia%202002-2003.pdf.aspx?inline=true (viewed July 2018).
39. Rahimi R, Nikfar S, Rezaie A, Abdollahi M. Pregnancy outcome in women with inflammatory bowel disease following exposure to 5‐aminosalicylic acid drugs: a meta‐analysis. Reprod Toxicol 2008; 25: 271–275.
40. Park‐Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta‐analysis of epidemiological studies. Teratology 2000; 62: 385–392.
41. Hviid A, Mølgaard‐Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. Can Med Ass J 2011; 183: 796–804.
42. Lin K, Martin CF, Dassopoulos T, et al. Pregnancy outcomes among mothers with inflammatory bowel disease exposed to systemic corticosteroids: results of the PIANO Registry (abstract). Gastroenterology 2014; 146: S–1.
43. Hutson J, Matlow J, Moretti M, Koren G. The fetal safety of thiopurines for the treatment of inflammatory bowel disease in pregnancy. J Obstet Gynaecol 2013; 33: 1–8.
44. Casanova M, Chaparro M, Domenech E, et al. Safety of thiopurines and anti‐TNF‐α drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol 2013; 108: 433.
45. Mahadevan U, Martin CF, Sandler RS, et al. 865 PIANO: a 1000 patient prospective registry of pregnancy outcomes in women with IBD exposed to immunomodulators and biologic therapy (abstract). Gastroenterology 2012; 142: S–149.
46. Kanis SL, de Lima‐Karagiannis A, de Boer NK, van der Woude CJ. Use of thiopurines during conception and pregnancy is not associated with adverse pregnancy outcomes or health of infants at one year in a prospective study. Clin Gastroenterol Hepatol 2017; 15: 1232–1241.
47. Narula N, Al‐Dabbagh R, Dhillon A, et al. Anti‐TNFalpha therapies are safe during pregnancy in women with inflammatory bowel disease: a systematic review and meta‐analysis. Inflamm Bowel Dis 2014; 20: 1862–1869.
48. Shihab Z, Yeomans ND, De Cruz P. Anti‐tumour necrosis factor alpha therapies and inflammatory bowel disease pregnancy outcomes: a meta‐analysis. J Crohns Colitis 2016; 10: 979–988.
49. Mahadevan U, Wolf DC, Dubinsky M, et al. Placental transfer of anti‐tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11: 286–292.
50. Julsgaard M, Christensen LA, Gibson PR, et al. Concentrations of adalimumab and infliximab in mothers and newborns, and effects on infection. Gastroenterology 2016; 151: 110–119.
51. Nielsen OH, Loftus EV, Jess T. Safety of TNF‐alpha inhibitors during IBD pregnancy: a systematic review. BMC Med 2013; 11: 174.
52. Mahadevan U, Vermeire S, Lasch K, et al. Vedolizumab exposure in pregnancy: outcomes from clinical studies in inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45: 941–950.
53. Deepak P, Sandborn WJ. Ustekinumab and anti‐interleukin‐23 agents in Crohn's disease. Gastroenterol Clin North Am 2017; 46: 603–626.
54. Foulon A, Dupas JL, Sabbagh C, et al. Defining the most appropriate delivery mode in women with inflammatory bowel disease: a systematic review. Inflamm Bowel Dis 2017; 23: 712–720.

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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

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

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.

1. Australian Bureau of Statistics. 4727.0.55.001. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012–13. Nov 2013. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4727.0.55.001Main+Features12012-13?OpenDocument (viewed Dec 2018).
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).
5. Menzies School of Health Research. Sentinel sites evaluation: final report, February 2013. http://www.health.gov.au/internet/main/publishing.nsf/Content/icdp-sentinel-sites-project (viewed Dec 2018).
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).
8. Australian Institute of Health and Welfare. Healthy futures — Aboriginal Community Controlled Health Services: report card 2016 (Cat No. IHW 171). Canberra: AIHW, 2016.
9. Australian Bureau of Statistics. Australian demographic statistics, June quarter 2016. 15 Dec 2016. http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&31010_jun%202016.pdf&3101.0&Publication&6DAF7F7C4A59465DCA25808900122564&&Jun%202016&15.12.2016&Latest.pdf (viewed Dec 2018).
10. Kendall E, Marshall CA. Factors that prevent equitable access to rehabilitation for Aboriginal Australians with disabilities: the need for culturally safe rehabilitation. Rehabilitation Psychology 2004; 49: 5–13.
11. McGrath P, Holewa H, Kail‐Buckley S. “They should come out here”: research findings on lack of local palliative care services for Australian Aboriginal people. Am J Hosp Palliat Care 2007; 24: 105–113.
12. Kelaher MA, Ferdinand AS, Paradies Y. Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Med J Aust 2014; 201: 44–47. https://www.mja.com.au/journal/2014/201/1/experiencing-racism-health-care-mental-health-impacts-victorian-aboriginal
13. Liaw S, Lau P, Pyett P, et al. Successful chronic disease care for Aboriginal Australians requires cultural competence. Aust N Z J Public Health 2011; 35: 238–248.
14. Downing R, Kowal E. A postcolonial analysis of Indigenous cultural awareness training for health workers. Health Soc Rev 2012; 20: 5–15.
15. Liaw S, Hasan I, Wade V, et al. Improving cultural respect to improve Aboriginal health in general practice: a multi‐methods and multi‐perspective pragmatic study. Aust Fam Physician 2015; 44: 387–392.
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).
20. Department of Health (Australia). PHN background. Updated 19 July 2018. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Background (viewed Dec 2018).
21. Horner S, Rew L, Torres R. Enhancing intervention fidelity: a means of strengthening study impact. J Spec Pediatr Nurs 2006; 11: 80–89.
22. Ang S, Van Dyne L. Handbook of cultural intelligence: theory, measurement and applications. New York (NY): ME Sharpe, 2008.
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

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.

1. UNAIDS. 2016 United Nations political declaration on ending AIDS sets world on the fast‐track to end of the epidemic by 2030 [media release]. 8 June 2016. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/june/20160608_PS_HLM_PoliticalDeclaration (viewed June 2017).
2. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV‐1 infection with early antiretroviral therapy. N Engl J Med 2011; 365: 493–505.
3. Bavinton BR, Jin F, Prestage G, et al. The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods. BMC Public Health 2014; 14: 917.
4. Das M, Chu PL, Santos GM, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One 2010; 5: e11068.
5. INSIGHT START Study Group; Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 373: 795–807.
6. Australasian Society for HIV Medicine. HIV management in Australasia: a guide for clinical care. 2016. http://hivmanagement.ashm.org.au (viewed June 2017).
7. NSW Ministry of Health. NSW HIV strategy 2016–2020: quarter 4 and annual 2016 data report (NSW HIV Surveillance Data Reports). 2017. https://www.health.nsw.gov.au/endinghiv/Publications/q4-2016-annual-hiv-data-report.pdf (viewed June 2017).
8. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV‐1‐infected adults and adolescents. Oct 2006. Washington (DC): Department of Health and Human Services, 2006. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl000629.pdf (viewed June 2017).
9. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV‐1‐infected adults and adolescents. Dec 2007. Washington (DC): Department of Health and Human Services, 2007. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL000721.pdf (viewed June 2017).
10. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV‐1‐infected adults and adolescents. Dec 2009. Washington (DC): Department of Health and Human Services, 2009. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl001561.pdf (viewed June 2017).
11. Medland NA, McMahon JH, Chow EP, et al. The HIV care cascade: a systematic review of data sources, methodology and comparability. J Int AIDS Soc 2015; 18: 20634.
12. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2016. Sydney: The Kirby Institute; UNSW Sydney, 2016. https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016 (viewed June 2017).
13. Medland NA, Chow EPF, McMahon JH, et al. Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: dramatic fall from 2011 to 2015. PLoS One 2017; 12: e0177634.
14. Grulich AE, de Visser RO, Badcock PB, et al. Knowledge about and experience of sexually transmissible infections in a representative sample of adults: the Second Australian Study of Health and Relationships. Sex Health 2014; 11: 481–494.
15. Mao L, Holt M, Newman C, Treloar C. Annual report of trends in behaviour 2017: HIV and STIs in Australia. Sydney: Centre for Social Research in Health; UNSW Sydney, 2017. https://doi.org/10.4225/53/59faa5c891779 (viewed June 2018).
16. Callander D, Watchers‐Smith L, Moriera C, et al. The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses. NSW HIV report 2007–2014. Sydney: UNSW Australia. https://kirby.unsw.edu.au/report/access-nsw-hiv-report-2007-2014 (viewed June 2017).
17. Callander D, Moreira C, El‐Hayek C, et al. Monitoring the control of sexually transmissible infections and blood‐borne viruses: protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). JMIR Res Protoc 2018; 7: e11028.
18. Australasian Chapter of Sexual Health Medicine; Royal Australasian College of Physicians. Register of public sexual health clinics in Australia and New Zealand. Sydney: RACP, 2016. https://www.racp.edu.au/docs/default-source/default-document-library/register-of-public-sexual-health-clinics.pdf?sfvrsn=e64a2d1a_10 (viewed June 2018).
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.
20. Australian Bureau of Statistics. 1270.0.55.006. Australian Statistical Geography Standard (ASGS): correspondences, July 2011: postcode 2012 to remoteness area 2011. June 2012. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.006July%202011?OpenDocument (viewed June 2017).
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).
25. Petoumenos K, Watson J, Whittaker B, et al. Subsidized optimal ART for HIV‐positive temporary residents of Australia improves virological outcomes: results from the Australian HIV Observational Database Temporary Residents Access Study. J Int AIDS Soc 2015; 18: 19392.
26. Mocroft A, Lundgren JD, Sabin ML, et al. Risk factors and outcomes for late presentation for HIV‐positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med 2013; 10: e1001510.
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.
28. McMahon JH, Moore R, Eu B, et al. Clinic network collaboration and patient tracing to maximize retention in HIV care. PLoS One 2015; 10: e0127726.

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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

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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Monitoring the missing half: why reporting adolescent births is insufficient

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Diagnosis of Mycobacterium ulcerans disease: be alert to the possibility of negative initial PCR results

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Pre‐exposure prophylaxis for HIV prevention during pregnancy and lactation: forget not the women and children

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Medical abortion: it is time to lift restrictions

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Updates in the management of inflammatory bowel disease during pregnancy

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Cultural respect in general practice: a cluster randomised controlled trial

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

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Monitoring the missing half: why reporting adolescent births is insufficient

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