Journal Article

Evaluating the effectiveness and sustainability of a primary healthcare strategy to reduce the prevalence of strongyloidiasis in endemically infected Indigenous communities in Northern Australia

Dempsey, Karen, Judd, Jenni A., Page, Wendy A., Blair, David, Biggs, Beverley-Ann

2025

Overview

Strongyloidiasis is endemic in many remote Indigenous communities in Australia. Early diagnosis, treatment, and follow-up of chronic strongyloidiasis can prevent life-threatening clinical complications and decrease transmission in these endemic communities. The aim of this paper is to evaluate the effectiveness and sustainability of a primary healthcare strategy designed to measure and reduce the prevalence of strongyloidiasis in four remote communities in northeast Arnhem Land. The primary healthcare strategy was a prospective, longitudinal, health-systems intervention designed to integrate serological testing for chronic strongyloidiasis into the Indigenous preventive adult health assessment utilising the electronic health-record systems in four Aboriginal health services. Positive cases were recalled for treatment, and opportunistic follow-up serology after six months. Results were tracked using Strongyloides reports generated by the electronic health-record system. This paper describes the changes in prevalence, effectiveness of treatment, and reinfection during the implementation phase, 2012-2016. An improved Strongyloides electronic report was developed to evaluate the effectiveness and sustainability of the intervention to the end of 2020. During the entire period 2012-2020, 84% (2390/2843) of the resident adults in the four communities were tested for strongyloidiasis at least once. Prevalence was reduced from 44% (1056/2390) ever-positive to 10% (232/2390) positive on their last test. Of positive, treated cases with a follow-up serology test, the last test was negative in 85% (824/967) of individuals. Point prevalence continued to decrease in each community four years after the end of the implementation phase. The results provided practice-based evidence of a significant decrease in the prevalence of strongyloidiasis attributable to the strategy which could be replicated in other health services utilising electronic health-record systems. The final evaluation demonstrated the sustainability and ongoing benefits for endemically infected communities, and the key role that health services can play in strongyloidiasis prevention and control programs.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Animals / Australia - epidemiology / Biology and Life Sciences / Care and treatment / Chronic illnesses / Control programs / Data collection / Disease prevention / Effectiveness / Electronic health records / Endemic Diseases - prevention & control / Ethics / Evaluation / Female / Health aspects / Health care / Health services / Humans / Indigenous peoples / Intervention / Longitudinal Studies / Male / Medical research / Medicine and Health Sciences / Medicine, Experimental / Methods / Middle Aged / Mortality / Native peoples / Patient outcomes / People and Places / Physiological aspects / Prevalence / Primary care / Primary Health Care / Prospective Studies / Serology / Social Sciences / Statistics / Strongyloides / Strongyloidiasis / Strongyloidiasis - diagnosis / Strongyloidiasis - drug therapy / Strongyloidiasis - epidemiology / Strongyloidiasis - prevention & control / Sustainability / Tropical diseases / Young Adult