The Burnet Institute is an Australian medical institute that combines medical research in the laboratory and the field, with public health action to address major health issues affecting disadvantaged communities in Australia, and internationally.As of 2011, the institute was home to more than 450 medical researchers, working across six main themes: infectious diseases; maternal and child health; sexual and reproductive health; alcohol and other drugs harm reduction; immunity, vaccines and immunisation; and the health of young people. With a head office located in Commercial Road, Prahran, Victoria, the institute delivers public health programs across four continents including Africa, Oceania, and Asia and is led by its Director and Chief Executive Officer, Professor Brendan Crabb AC, an immunologist..
BACKGROUND:Bacterial sexually transmitted infections (STIs) are common among people in prison, a population identified by WHO as a key group to addressing the burden of sexually transmitted and blood-borne infections worldwide. To inform elimination efforts, we aimed to estimate the global prevalence of bacterial STIs (chlamydia, gonorrhoea, and syphilis) in prisons and other closed settings. METHODS:We conducted a systematic review and meta-analysis by searching online databases (MEDLINE, Embase, Global Health, PsycInfo, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Global Index Medicus, the Conference Proceedings Citation Index-Science, and the Conference Proceedings Citation Index-Social Sciences & Humanities) and reference lists for studies published from Jan 1, 2000, to Aug 5, 2025. We included peer-reviewed publications (scientific articles, conference abstracts, and technical reports) that reported on the prevalence of current chlamydia, current gonorrhoea, or current or previous syphilis infections, confirmed by validated diagnostic assays, among incarcerated populations (adolescents aged 10-19 years and/or adults aged >19 years). Two reviewers (GB and BH) independently assessed studies, extracted data, and evaluated the quality of studies using an adapted version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Pooled prevalence estimates for each bacterial STI were derived with use of generalised linear mixed-effects models, stratified by age group and, within each age group, by sex. Heterogeneity was quantified based on the I2 statistic and χ2 test. This systematic review and meta-analysis was registered with PROSPERO, CRD42023443370. FINDINGS:The search generated 5237 records, of which 212, corresponding to 206 unique studies, met the eligibility criteria and were included. Of the 206 studies, 137 included adults only (n=425 215), 53 included adolescents only (n=342 762), and 16 included both (n=675 119). 190 (92·2%) studies were conducted in high-income or upper-middle-income countries. Across the 206 studies, data were available for 1 443 096 individuals (483 438 [33·5%] females, 901 188 [62·4%] males, and 58 470 [4·1%] sex not reported). The mean age was 33·6 years (SD 9·7) for adults and 15·6 years (1·1) for adolescents. Among female adults, the pooled prevalence of current chlamydia was 6·5% (95% CI 5·1-8·3; I2=97·0%, p<0·0001; 15 582 crude infections in 166 767 females; 38 studies), the pooled prevalence of current gonorrhoea was 1·5% (0·8-2·7; I2=97·2%, p<0·0001; 4424 crude infections in 167 953 females; 32 studies), and the pooled prevalence of current or previous syphilis was 5·9% (4·1-8·3; I2=98·6%, p<0·0001; 5143 crude infections in 103 641 females; 59 studies). Among male adults, the corresponding estimates were 4·7% (3·7-6·0; I2=94·4%, p<0·0001; 7101 crude infections in 128 380 males; 33 studies), 0·4% (0·2-1·1; I2=98·4%, p<0·0001; 591 crude infections in 330 418 males; 23 studies), and 3·7% (2·8-5·0; I2=99·4%, p<0·0001; 10 404 crude infections in 522 133 males; 61 studies), respectively. Among female adolescents, the pooled prevalence of current chlamydia was 16·8% (14·0-20·0; I2=96·7%, p<0·0001; 31 206 crude infections in 221 350 females; 38 studies), the pooled prevalence of current gonorrhoea was 6·0% (4·5-7·9; I2=89·3%, p<0·0001; 2053 crude infections in 39 949 females; 22 studies), and the pooled prevalence of current or previous syphilis was 1·9% (0·1-26·4; I2=76·0%, p=0·0058; nine crude infections in 449 females; four studies). Among male adolescents, the corresponding estimates were 7·4% (6·3-8·8; I2=97·0%, p<0·0001; 15 122 crude infections in 231 606 males; 29 studies), 2·0% (1·4-2·7; I2=94·5%, p<0·0001; 1393 crude infections in 75 697 males; 17 studies), and 1·9% (0·5-6·5; I2=24·7%, p=0·26; 11 crude infections in 596 males; three studies), respectively. The overall quality of studies was moderate (118 [57·3%] of 206 studies) or high (88 [42·7%] studies). INTERPRETATION:The high prevalence of bacterial STIs in incarcerated populations, particularly among adolescents and females, highlights substantial public health gaps in bacterial STI prevention and treatment. Offering opt-out bacterial STI testing to all people in prison should be considered to accelerate elimination efforts. FUNDING:None.
Early in an infectious disease outbreak, key policy questions include whether and how the outbreak can be brought under control. In the epidemiological modelling literature, analyses of outbreak controllability have often focused on metrics such as reproduction numbers (which quantify the number of infections generated by each infected individual). However, whether an outbreak can be controlled is a complex question, depending on both the precise definition of 'under control' used and numerous factors affecting decision-makers' ability to implement transmission-reducing measures. Here, based on discussions at the Isaac Newton Institute's 'Modelling and inference for pandemic preparedness' programme (5-30 August 2024), we describe a wide range of factors affecting outbreak controllability in practice. Programme participants came from institutions in ten countries, enabling discussions to reflect experiences of using models to inform policy in different settings. We divide the factors according to whether they relate predominantly to characteristics of the pathogen, host population or available interventions, and describe policy considerations when assessing whether an outbreak is controllable.
Postpartum haemorrhage (PPH) is common, affecting an estimated 13% of women having vaginal birth and 31% of women having caesarean birth. Successful management of PPH requires early and accurate diagnosis and effective treatment. A systematic review found that subjective visual estimation of blood loss misses 52% of PPH diagnoses at vaginal birth (pooled sensitivity 48%, 95% CI 44-53), and probably more at caesarean birth. The WHO-International Federation of Gynecology and Obstetrics-International Confederation of Midwives consolidated guidelines on PPH therefore recommend objective quantification of blood loss with products such as a calibrated blood collection drape. When supported by a robust implementation strategy and a first-response treatment bundle, objective measurement of blood loss and monitoring of vital signs has been shown to diagnose PPH accurately and early, and improve clinical outcomes. Refractory PPH can progress to life-threatening PPH, which should be managed by a multidisciplinary team providing aggressive resuscitation and targeted treatment. Saving the life of a woman with excessive postpartum bleeding is a race against time. The six delays to avoid are: (1) in the diagnosis (by use of objective cumulative blood loss measurement and early trigger criteria), (2) in the first-response treatment (by authorising midwives to administer all components of a standardised bundle of interventions), (3) in the escalation (by use of explicit escalation criteria and red flags), (4) in the use of temporising measures (eg, non-pneumatic anti-shock garment), (5) in the identification and targeted management of any specific causes of bleeding, and (6) in the provision of blood and blood products. Quick actions to avoid these delays can mean the difference between life and death for a woman with PPH.
BACKGROUND:People prescribed opioid agonist therapy (OAT) are a key population for hepatitis C virus (HCV) elimination. Health service engagement associated with OAT provision may facilitate hepatitis C testing and treatment. We aimed to quantify the HCV care cascade among people receiving OAT in Australia. METHODS:We extracted linked data from individuals attending any of 58 clinics participating in the ACCESS national sentinel surveillance network of primary care and sexual health clinics from 1 January 2016 to 31 December 2023. Outcomes included evidence of any HCV test (antibody or RNA) or direct-acting antiviral (DAA) prescription at an ACCESS clinic after their first OAT prescription. RNA positive individuals were inferred antibody positive; individuals with a DAA prescription were inferred RNA and antibody positive. We determined the number of individuals at each stage of the following cascade by the end of the study period: (1) positive antibody, (2) positive RNA, and (3) DAA prescription. RESULTS:Among 15 382 individuals prescribed OAT, 44% (6817) had an HCV antibody or RNA test after their first OAT prescription. Of these, 64% (4368/6817) were antibody positive by the end of the study period. Of these, 67% (2911/4368) were RNA positive, and of those, 69% (2007/2911) were prescribed DAAs. CONCLUSIONS:A high proportion of people prescribed OAT were not engaged in care by their OAT provider or across ACCESS network clinics, but when diagnosed, rates of treatment were high. Given high HCV antibody and RNA prevalence, integrating HCV care into regular OAT care should be a priority for HCV elimination in Australia.
Domestic, family, and sexual violence (DFSV) is a widespread public health and human rights issue that disproportionately affects structurally marginalised communities. Mainstream justice responses—focused on policing, criminalisation, and incarceration—frequently do not meet the needs of victim-survivors. Transformative justice (TJ) offers community-led, non-carceral responses that promote harm reduction by seeking to reduce the harms of criminalisation, prevent further violence, promote healing and accountability, and transform the structural conditions that lead to violence. This scoping review maps the characteristics and applications of TJ in the context of DFSV. Led by victim-survivors of DFSV, this review followed Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR checklist. Peer-reviewed and grey literature published between 2005 and 2025 was sourced from eight databases and Google. Sources were included if they described the characteristics of TJ in non-carceral contexts. Sixty-one sources met the inclusion criteria. Data were extracted using a customised tool and synthesised thematically. Most included sources originated in the United States and were situated outside academic publishing, reflecting TJ’s community-based origins. TJ was consistently defined as an abolitionist approach rooted in community accountability, survivor autonomy, and structural transformation. Core principles included anticarceral and feminist commitments, trauma-informed care, and relational accountability. Goals focused on building safety within communities, creating justice processes not reliant on punitive measures, and transforming systemic conditions. Practices included pod mapping, transformative education, and knowledge-building activities such as storytelling and creative expression. The literature highlighted tensions around scalability, consistency, and engagement with state systems. TJ is an evolving field that remains resistant to formal institutionalisation and centres the leadership of those most affected by violence and criminalisation. Its relevance to harm reduction lies in its focus on preventing violence and criminalisation while building community prevention capacities. Research, policy, and practice should prioritise investment in grassroots infrastructures and the leadership of victim-survivors and marginalised communities. The reviewed literature argues that applications of TJ resist being reduced to static models or assimilated into carceral frameworks. Rather, their potential is founded on collective support and sustained political organising, and the long-term work of community transformation. This review followed a pre-specified protocol developed by the research team in accordance with JBI methodology (Peters M et al. in E. Aromataris (eds) Joanna Briggs Institute: South Australia, 2015) and PRISMA-ScR guidelines (Tricco AC et al. in Ann Intern Med 169:467-673, 2018). The protocol is registered on the Open Science Framework (2025) doi: https://doi.org/10.17605/OSF.IO/FTSR4.
