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Chapter 5 Demonstrates My Involvement from the Development Stage Onwards

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Chapter 5 Demonstrates My Involvement from the Development Stage Onwards Masters of Philosophy in Applied Epidemiology Australian National University ‘Infectious diseases among marginalised populations’ Dina Raus Saulo November 2014 Field placement The Kirby Institute Field Supervisors Academic Supervisors John Kaldor & Tony Butler Phyll Dance, Emily Fearnley & Stephanie Davis Funded by: Indigenous Offender Health Capacity Building Grant, Justice Health Research Program, Kirby Institute & the Leonard Broome Scholarship i ii Declaration of Work This body of work includes multiple discrete projects that were undertaken collaboratively with multiple stakeholders and the author acknowledges the contribution made by each of the stakeholders involved in the projects. Taken as a whole document, the author certifies that this thesis is an original work. None of the work has been previously submitted by me for the purpose of obtaining a degree or diploma in any university or other tertiary education institution. To the author’s best knowledge, this thesis does not contain material previously published by another person, except where due reference is made in the text. The author acknowledges that copyright of published works contained within this thesis resides with the copyright holder(s) of those works. …………………………………………………………………………. Dina Raus Saulo Dated: 17th December, 2015 iii Abstract From February 2013 to November 2014 I undertook a field placement at the Kirby Institute for Infection and Immunity in Society (the Kirby Institute), as a part of a Master of Philosophy in Applied Epidemiology (MAE). This bound volume is the product of projects undertaken while at the Kirby Institute in the Justice Health Research Program and the Public Health Interventions Research Group. Within are six chapters which demonstrate work undertaken, lessons learnt, knowledge gained and MAE requirements met. Due to my placement predominantly in the justice health research program, three out of four major projects have a focus on blood borne viruses and associated risk factors among offender populations. I evaluated the national prison entrant’s blood borne virus and risk behaviour survey (NPEBBVS), the only multi-jurisdictional prison BBV monitoring mechanism nationally. As a data analysis project I explored hepatitis B core antibody and hepatitis C antibody prevalence and associated risk factors among Indigenous and non-Indigenous prison entrants from the NPEBBVS. Findings from this chapter were presented at a number of conferences and events. As an acute public health problem, I had the opportunity to investigate hepatitis C (HCV) incidence cases in a prison facility. We developed a case series study using mixed methods to collect data on the unusual cluster of HCV cases. I conducted both quantitative and qualitative interviews with participating inmates to gather prisoner’s perspective of HCV incidence, understanding routes of transmission in the prison setting and possible strategies in decreasing exposure and risk. From the start of 2013 I was involved in the ‘vaccine impact in the Indigenous population’ (VIP- I) study with a large group of investigators. The aim of VIP-I was to evaluate the effectiveness of the HPV vaccine among Indigenous women in Australia. My role in the study was as a field coordinator, chapter 5 demonstrates my involvement from the development stage onwards. This chapter is largely methodological, only preliminary results are presented as recruitment is still ongoing. Teaching experience during the MAE included; lessons from the field and a group teaching session with MAE peers. I worked individually on a project management module for the lesson from the field exercise, my fellow MAE cohort completed this module which touched on interdisciplinary collaboration in research. The group teaching experience was created and conducted with two fellow MAE scholars, we built a framework to distinguish real or artificial rate change when interpreting time series data. The projects within this thesis contribute to the Kirby Institutes area of work with marginalised at risk populations. I have been fortunate to be a part of a number of projects that have iv potential to impact public health policy and programs for both Indigenous and offender populations. v Table of Contents Acknowledgments Chapter 1: Introduction Field placement and summary of core activities .......................................................... 1 Chapter 2: Data analysis Blood borne virus prevalence and risk behaviours among Indigenous and Non- Indigenous Prison Entrants in four Australian States .................................................. 12 Advanced draft publication: Hepatitis C and hepatitis B prevalence and associated risk factors among Indigenous and non-Indigenous prison entrants in Australia ....... 39 Chapter 3: Evaluation of a surveillance system Evaluation of the national prison entrant blood borne virus survey ....................... 53 Chapter 4: Outbreak investigation Incident Hepatitis C cases detected through a custodial hepatitis C treatment program .................................................................................................................... 99 Chapter 5: Epidemiological study Impact of Australia's HPV vaccination program on prevalence of HPV genotypes among Aboriginal and Torres Strait Islander women attending for Pap testing .... 156 Chapter 6 Teaching experience ............................................................................................... 222 Lessons from the field ............................................................................................ 224 MAE teaching experience ....................................................................................... 225 vi Acknowledgments The MAE has been an amazing experience; I can’t recommend it enough to people wanting a solid foundation in field epidemiology. I appreciate the ability to have worked on a diverse range of projects and collaborations throughout my placement at the Kirby Institute. Firstly, I would like to thank Rebecca Guy and John Kaldor for suggesting I apply for the MAE in 2012 and Tony Butler for the ability to join the Justice Health Research Program under the Indigenous Offender Health Capacity Building Group. I would like to particularly acknowledge my field supervisors: John Kaldor (Head of Program, Public Heath Interventions Research Group) and Tony Butler (Head of Program, Justice Health Research Program). Thank you both for your time and support during my placement at the Kirby. To my academic supervisors Stephanie Davis, Phyll Dance and Emily Fearnley, thank you for your support, encouragement and guidance throughout the MAE. Additionally thank you to Martyn Kirk and other staff of the MAE program at National Centre for Epidemiology and Public Health. I have acknowledged collaborators and investigators of projects within the bound volume however there are people who I have worked with or had support from along the way who I would like to say a special thank you to; Skye McGregor, Paul Simpson, Michael Levy, Amalie Dyda, Lise Lafferty and Lorraine Yapp. Kerryn, Pip, Anna, Courtney, Tim, Anita, Jason and Tove: It was a pleasure doing the MAE with you all, I look forward to see where the future takes us all. Family and friends have been such support during the MAE: Mum, Dad, Johnny and Benson, love you all. Harp, Kristie and Summer thanks for scheduled study breaks and check-ins. And lastly Liam Ridgeway, I wouldn’t have been able to do this without you, thank you for your constant love and support. vii 1 Introduction Field placement & summary of core activities 1 INFECTIOUS DISEASES AMONG MARGINALISED POPULATIONS Contents 1.1 Abbreviations list .................................................................................................................... 3 1.2 Introduction ........................................................................................................................... 4 1.3 Overview of field placement .................................................................................................. 4 1.3.1 The Kirby Institute .................................................................................................. 4 1.3.2 Justice health research program ............................................................................ 5 1.3.3 Indigenous Offender Health Capacity Building Group ........................................... 6 1.4 Summary of MAE requirements ............................................................................................. 7 1.4.1 Teaching requirements .......................................................................................... 7 1.4.2 Advanced draft peer review publication ............................................................... 7 1.4.3 Communication for a non-scientific audience ....................................................... 7 1.5 Conference presentations ...................................................................................................... 8 1.6 Course Work ........................................................................................................................... 9 2 CHAPTER 1 | INTRODUCTION 1.1 Abbreviations list ANU Australian National University BBV Blood Borne Viruses HBV Hepatitis B HCV Hepatitis C HIV Human Immunodeficiency Virus HPV Human papillomavirus IOH-CBG Indigenous Offender Health - Capacity Building Group JHRP Justice Health Research Program MAE Masters in Applied Epidemiology NCEPH National Centre for Epidemiology and
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