Background:Emerging evidence suggests the 4CMenB vaccine provides moderate protection against gonorrhea, likely due to the close genetic relationship between Neisseria gonorrhoeae and Neisseria meningitidis. 4CMenB has an impact on unencapsulated meningococcal oropharyngeal carriage, where outer membrane proteins are exposed, potentially exerting selective pressure on these strains. We assessed the impact of 4CMenB immunization on gonorrhea disease and oropharyngeal meningococcal carriage among adolescents in the Northern Territory (NT), Australia. Methods:All adolescents aged 14-19 years in the NT were eligible to receive two doses of 4CMenB between 2021 and 2023. Participants had oropharyngeal swabs collected at baseline and 12 months. Vaccine effectiveness (VE) against gonorrhea was assessed using linked notification and immunization data. A Cox proportional hazards model stratified by sex, age, and geography estimated VE. Mixed-effects logistic regression estimated postvaccination odds of meningococcal carriage. Results:A total of 30 650 adolescents were included in the VE analysis, with 9.6% receiving 2 doses of 4CMenB, and 42.4% of the population identifying as Aboriginal or Torres Strait Islanders. Gonococcal notifications were reduced in vaccinated adolescents (VE 38.4%, 95% CI: 18.6-53.4). Overall, meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14-2.48), driven by genogroup B and nongroupable strains. Carriage of disease-associated meningococci remained stable. Conclusions:4CMenB confers modest protection against gonorrhea in a real-world setting with higher adolescent disease prevalence. These findings are important for women, considering infections are often asymptomatic and have the potential for serious complications. The NT has now introduced a 4CMenB infant and adolescent program.

BACKGROUND:Assessing patient perspectives is fundamental to determining whether anti-racism and cultural training programs and services associated with an intervention achieve their intended outcomes, yet reviews frequently focus on health provider perspectives. This systematic review, therefore, aimed to investigate First Nations Peoples' experiences, as patients, of interventions to improve their Cultural Safety and experiences in secondary and tertiary healthcare settings. METHODS:American Psychological Association's PsycInfo (via EBSCOhost), Cumulative Index to Nursing and Allied Health Literature Complete (via EBSCOhost), PubMed, and Scopus (via Elsevier) were all searched from inception to 9 December 2025. Eligible intervention studies needed to report the experiences of First Nations' people as care recipients in secondary and tertiary healthcare settings. Eligible study countries were Australia, Canada, Aotearoa (New Zealand), and the United States of America (USA). General study quality was assessed using the Mixed Methods Appraisal Tool. Study quality was also examined with a modified version of the Aboriginal and Torres Strait Islander Quality Appraisal Tool to provide a First Nations perspective. Qualitative meta-aggregation was conducted to synthesize both qualitative and quantitative data. RESULTS:There were 22 reports (11 qualitative, 7 quantitative, and 4 mixed methods) of 20 eligible studies, including 2092 First Nations care recipients. Interventions and quantitative outcomes were heterogeneous, precluding meta-analysis. Four studies reported on cultural training for health professionals, with the remainder service-level interventions. The qualitative meta-aggregation resulted in six synthesized findings, which reflected the mechanisms by which these programs worked and their outcomes. Four synthesized findings described mechanisms. These included emotional and practical support; acknowledgement, respect, and support for culture; feeling accepted, heard, valued, safe, comfortable, and respected; and navigating treatment and the system. The two synthesized findings related to outcomes concerned perceptions of health services and, relatedly, impacts on health service access. Quality appraisal revealed no discussion of existing and newly created intellectual property considerations. Study limitations included undefined terminology, terms being used interchangeably, and a few studies from the USA and Aotearoa (New Zealand). CONCLUSIONS:Published intervention studies assessing First Nations care recipients' experiences appear to be increasing. Future interventions must clearly define the terminology in the intervention, use mixed-methods approaches, and report intellectual property considerations. TRIAL REGISTRATION:Systematic review: PROSPERO, CRD42024521218 (prospective, available at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024521218).

BACKGROUND:The urban First Nations population in Australia is rapidly increasing. The health policy and research focus on urban First Nations Australians, however, is limited. To contribute to addressing this situation, The University of Queensland Poche Centre for Indigenous Health (UQ Poche Centre), a First Nations-led health research centre, is working closely with urban Aboriginal Community-Controlled Health Services (ACCHS) across Australia. AIM:Our study examined urban ACCHSs stakeholders' perspectives of the health and wellbeing of urban First Nations Australians and identified their priorities for a national Indigenous urban health research agenda. METHODS:Ten stakeholders were recruited for in-depth interviews from ACCHS that were members of the Research Alliance for Urban Community-Controlled Health Services (RAUCCHS), a partnership between the UQ Poche Centre and urban ACCHS focused on achieving equitable health outcomes for urban First Nations Australians. Six stakeholders identified as First Nations Australians. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed using inductive thematic analysis. RESULTS:Stakeholders highlighted a lack of research focused on the health of urban First Nations Australians. Specific priority areas they identified for an urban First Nations health research agenda were: evaluating the effectiveness and adaptability of Indigenous models of care, strengthening care pathways between ACCHS and specialist services, examining the intersection of cultural identity, racism and determinants of health, and greater investment in Indigenous research governance structures and processes. CONCLUSIONS:There is a clear opportunity for researchers to engage with RAUCCHS members to establish a body of urban First Nations health research in Australia that responds to their research priorities.

OBJECTIVE:In remote Australia, where there is a substantial burden of sexually transmitted infections (STIs) among First Nations peoples, testing and timely treatment are key to reducing prevalence. We evaluated the impact of introducing molecular point-of-care (POC) testing for chlamydia/gonorrhoea and later trichomonas on STI testing (including syphilis) and positive tests. METHODS:We conducted a retrospective interrupted time-series analysis of routinely collected data from First Nations peoples aged 15-54 years attending 20 remote/regional clinics participating in the Test, Treat and GO programme (2016-2019). We used segmented regression models to estimate the immediate level change (first month of POC) and after-period trends in monthly tests, positive tests and proportion of concurrent syphilis tests to assess sustainability. Before and after comparisons were estimated using linear regression models. RESULTS:There were 17 437 chlamydia/gonorrhoea and 14 173 trichomonas tests performed, mostly among women (69% and 64%) and individuals aged 15-34 years (72% and 68%). Following the introduction of molecular POC testing, there were immediate level increases in monthly tests: chlamydia/gonorrhoea by 26% (+154, p<0.001) and trichomonas by 21% (+116, p=0.004) and level increases of positive tests: gonorrhoea by 30% (+13, p=0.017) and trichomonas by 29% (+14, p=0.034); chlamydia was unchanged. The proportion of chlamydia/gonorrhoea tests with concurrent syphilis tests remained unchanged (-1.7%; -0.9%; p=0.531), while the proportion increased among positive chlamydia/gonorrhoea tests by 25% (+13%; p=0.013). Increased levels of testing were sustained for gonorrhoea/chlamydia (+2.7, p=0.118) and trichomonas (-3.5, p=0.400) and syphilis among those with positive chlamydia/gonorrhoea tests (-0.2%, p=0.593). CONCLUSION:Molecular POC testing led to immediate and sustained increases in STI testing and an immediate increase in positive tests in remote primary care. The use of POC testing is likely to result in earlier diagnosis and treatment and reduced onward transmission and sequelae, supporting a broader integration of POC testing in high-burden settings.

OBJECTIVES:In remote Australian First Nations communities, the burden of curable sexually transmitted infections (STIs) is highest for young women and men aged 16-29 years and for women is associated with two-fold higher rates of hospitalisations for pelvic inflammatory disease (PID) than for non-First Nations women. Following a randomised trial, decentralised community-led molecular point-of-care (POC) testing for STIs has operated in remote primary care across Australia for more than 7 years, improving uptake and timeliness of treatment for chlamydia, gonorrhoea and trichomonas infections. However, cost-effectiveness remains unknown. METHODS:A decision analytic model was devised to compare costs and outcomes associated with a POC testing programme for chlamydia, gonorrhoea and trichomonas infections in women and men aged 16-29 years seeking care, compared with standard care (laboratory-based testing). The analysis used a government payer perspective and 10-year time horizon. The primary outcome was the cost ($A) per quality-adjusted life year (QALY) gained. Sensitivity analyses examined uncertainty around the results. RESULTS:Based on a combined testing positivity rate of 36% and 29% for chlamydia, gonorrhoea and trichomonas for women and men, respectively, the POC testing programme, compared with laboratory testing, produced an estimated incremental cost per QALY ratio (ICER) of $A19 714 (95% CIs $A19 608 to $A19 821) over 10 years. Among those with an STI, the POC testing programme was predicted to reduce diagnosed PID by 30% and preterm/low birth weight babies by 17%. Sensitivity analyses indicated that the ICER was most sensitive to the probability of infection and receiving treatment within 2 days, based on a willingness-to-pay threshold of $A50 000. CONCLUSION:This health economic evaluation indicates that a scaled molecular POC testing programme for the management of STIs in remote primary care settings is cost-effective compared with standard care. Sustained POC testing in this setting is likely to improve reproductive health outcomes.

Tuberculosis is often perceived as a disease of the past in Australia, yet ongoing transmission persists in some jurisdictions and Aboriginal and Torres Strait Islander peoples continue to experience a disproportionate burden. Drawing on lived experience and community perspectives, we highlight challenges navigating tuberculosis care and opportunities to strengthen prevention and care. Achieving tuberculosis elimination requires more than biomedical tools alone. Earlier diagnosis, culturally responsive and community-led approaches, strengthened Aboriginal health workforces and action on social and structural determinants are needed to ensure tuberculosis is addressed rather than forgotten in Australia.

Globally rates of syphilis have been increasing since 1990 and, historically transmission has predominated among gay, bisexual, and men who have sex with men (GBMSM). In the past decade, transmission has increased among women and men who have sex with women (MSW). This led Australia to declare syphilis a communicable disease of national significance in August 2025. In this commentary, we consider the implications of these developments on conceptions of sexualized drug use (SDU) and research in this field. To date, discourses surrounding SDU have often focused on GBMSM and the culturally specific practice of chemsex. Yet emerging data outlining an association between methamphetamine use and syphilis transmission across populations may warrant a more inclusive SDU research agenda. In reflecting on this topic, we acknowledge that while the association between methamphetamine use and syphilis transmission may stimulate additional research on SDU, there are drawbacks associated with this research focusing on sexually transmitted infections (STIs) alone. We look to the literature on GBMSM and chemsex as a blueprint for a potential research agenda on SDU as practiced by women and MSW. Chemsex research was initially spurred by concerns regarding HIV transmission, however, this body of work has expanded over time to traverse domains of health and wellbeing, service delivery, evaluation and critical theory. We suggest that a similarly diverse body of empirical, applied and critical research on SDU is required to shape culturally appropriate, interdisciplinary services that meet the varied information and support needs of women and MSW who use drugs in sexual contexts.

Congenital syphilis remains a significant public health threat in Australia, warranting national efforts to reduce syphilis incidence overall, focusing on women of reproductive age. To identify priority actions to eliminate congenital syphilis, ASHM convened a national multidisciplinary roundtable with attendance from organisations, colleges, and bodies across the healthcare sector with a focus on Aboriginal and Torres Strait Islander peoples' health, sexual and reproductive health, antenatal health, primary care, pathology, and pharmacy, as well as research institutes and community organisations. This position statement outlines the immediate, short-term and long-term actions identified by roundtable participants to eliminate congenital syphilis in Australia.

Introduction Aboriginal and Torres Strait Islander young people are less likely to utilise health care services, and very little is known about how they engage with and utilise primary health care (PHC) services, particularly in urban areas. Methods Descriptive analysis was used to examine health care encounters among Aboriginal and Torres Strait Islander people aged 15-24 years at urban Aboriginal and Torres Strait Islander community-controlled health organisations (ATSICCHOs) in southeast Queensland (SEQ) between 2018 and 2022. Results Overall, 12,449 individual young people had at least one encounter at an urban ATSICCHO in SEQ. Utilisation among this population increased from 4,187 in 2018 to 5,314 in 2022. Utilisation of health services were highest among the 15-19-year age group (54%) and higher among girls/women (57%) than among boys/men. There were 127,225 encounters among young people during the study period, increasing from 21,020 in 2018 to 27,029 in 2022. Almost two-thirds of encounters were among girls/women (65%). The median number of encounters for all young people between 2018 and 2022 was 3 (IQR: 1-6); for girls/women, 3 (IQR: 1-6) and for boys/men, 2 (IQR: 1-4). Preventive health (30.7%) and health conditions requiring ongoing management (21.9%) were the two main reasons for encounters; the number of encounters increased over time for all reasons. Conclusion Improving utilisation of PHC services remains an ongoing challenge despite increased utilisation and a rise in the number of young people engaging with these services. Models of care within ATSICCHOs, centred on young people, should be funded, trialled, and evaluated to ensure that the health and wellbeing of this population are optimised.

This paper identifies the collective resources and strategies Aboriginal and Torres Strait Islander youth draw upon to build safe and respectful sexual relationships. Interviews and a focus group were conducted with 26 Aboriginal and Torres Strait Islander people aged 16-30 years. Participants described a range of social and relational strategies for managing sexual wellbeing including the careful selection of partners; careful management of privacy and reputation; and, drawing on peer and community networks for information, advice and practical support such as facilitating access to contraception and STI testing. The most innovative interventions for Aboriginal and Torres Strait Islander young people are those that build on these existing collective care practices, working in collaboration with young people themselves to support culturally responsive and effective health promotion. Interventions that adopt a holistic understanding of health and engage with young people's social networks and community contexts can offer effective sexual health protection.

BACKGROUND:Child sexual abuse (CSA) is a major public health concern for modern societies. For Indigenous communities this is compounded by the ongoing impacts of colonisation, including inter-generational trauma, persistent socio-economic disadvantages, and the predominant adoption of mainstream approaches used to prevent and respond to CSA in Indigenous communities. OBJECTIVE:This aim of this study was to conduct a scoping review of Indigenous-specific CSA research literature from Canada, Australia, New Zealand and the United States (CANZUS). METHODS:A structured scoping review of published and unpublished (grey) literature using the Arksey and O'Malley framework. Six databases were searched (PsychInfo, CINAHL, PubMed, Scopus, Informit and Google Scholar) for articles published in English from 2000 to 2023 (inclusive). Identified studies were classified based on their methods (descriptive, reviews, impact/process evaluation, theory and methodology) and primary focus (prevention, disclosure, treatment, multiple foci). RESULTS:Forty-six peer-reviewed academic papers were identified. Most articles were from Australia (44%), followed by the United States (25%), Canada (23%) and New Zealand (8%). Most articles were descriptive (50%). The focus of publications was comparable across prevention (19%), disclosure and reporting (21%) and treatment or support (25%). CONCLUSION:Given Indigenous communities have unique conceptualisations of family, community and relationality, evidence used to develop Indigenous-specific prevention and responses to CSA must reflect their own cultural contexts, building on community agency, resilience, and strength. The relative paucity of both process and outcome evaluations highlights significant knowledge gaps, and a need for more evaluation research across prevention, disclosure and reporting and treatment or support.

BACKGROUND:Aboriginal and Torres Strait Islander young people aged 15-24 years of age often encounter challenges accessing and utilising primary health care (PHC). Providing health care responsive to the needs of Aboriginal and Torres Strait Islander young people requires the active involvement of healthcare providers (HCPs), who play a central role in healthcare delivery. This study explored perspectives of HCPs working in urban Aboriginal and Torres Strait Islander Community-Controlled Health Organisations (ATSICCHOs) on the factors that facilitate Aboriginal and Torres Strait young people accessing and utilising PHC services. METHODS:Thirteen research yarns were conducted with HCPs in urban southeast Queensland (SEQ), Australia. Inductive thematic analysis was used to identify factors facilitating health care access and utilisation and were mapped to a social-ecological framework model. RESULTS:Three overarching strength-based themes that facilitate access to health care were common across research yarns: (1) The ATSICCHO model of care addresses the needs of Aboriginal and Torres Strait Islander young people; (2) Family and community play a key role in facilitating Aboriginal and Torres Strait Islander young people's access to healthcare services; and (3) The characteristics of Aboriginal and Torres Strait Islander young people that support health-seeking behaviour. Specific factors identified included targeted programs and initiatives specifically for Aboriginal and Torres Strait Islander young people; equitable access to holistic, comprehensive and culturally safe PHC; characteristics and skills of the ATSICCHO workforce that support young people's engagement and access; and young people's motivation to be healthy and to seek care. Barriers contrasting these themes were also identified. CONCLUSION:HCPs from urban ATSICCHOs provide a unique perspective on the healthcare experience of Aboriginal and Torres Strait Islander young people and the factors that facilitate and/or challenge their access to PHC services. Improving PHC access among Aboriginal and Torres Strait Islander young people should focus on multilevel strategies across all three levels of the social-ecological model, with a particular focus on increasing opportunities for equitable access to PHC services for young people, enhancing target programs and initiatives for young people, and supporting the knowledge, skills and capacity of HCPs to delivery appropriate, culturally safe and holistic care.

Background: Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. "We Can Do This" is a web-based app that was designed with input from cultural Objective: This study aimed to evaluate the effectiveness of the "We Can Do This" web-based app as a psychosocial treatment Methods: The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was help-seeking behavior, and days spent out of role due to methamphetamine use. Results: Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI-1.5 to 2 months (mean difference 0.6 days, 95% CI-1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI-0.3 to 3.3 follow-up. There were no significant group differencesin K10 scores, SDS scores, days out of role, or help-seeking at any 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based as the most common reasons for nonadherence. Conclusions: We found poor engagement with this web-based app. The web-based app had no significant effects methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088 International Registered Report Identifier (IRRID): RR2-10.2196/14084

BACKGROUND:Bacterial sexually transmitted infections (STIs) cause a substantial disease burden worldwide and disproportionately impact young people. In Australia, Aboriginal and Torres Strait Islander people are a priority population in STI testing guidelines. METHODS:The More Options for STI Testing trial evaluated whether providing an incentive impacted STI testing rates in select Central Australian communities. Aboriginal and Torres Strait Islander people aged 16 to 29 years were eligible for a A$30 phone voucher if they had an STI test at a participating Aboriginal community-controlled primary health care clinic. An interrupted time series analysis examined monthly STI test counts for chlamydia, gonorrhea, or syphilis from 2015 to 2020, to determine whether testing increased during the incentives phase (2018-2020). RESULTS:There were a total of 10,457 visits to the clinic in which an STI test was conducted, 5110 of which were during the incentives period. A total of 1526 incentives were provided to eligible clients. The baseline and incentives periods were each divided into 2 phases to account for new clinic openings and the COVID-19 pandemic. Among men, average monthly visits for an STI test were 32.6 (baseline phase 1), 44.1 (baseline phase 2), 50.8 (incentives phase), and 35.4 (incentives/COVID-19 phase). Women had 93.5, 111.3, 118.8, and 113.4 visits, respectively. No significant change in STI testing was observed during the incentives phase. The proportion of visits for an STI test where an incentive was paid (coverage) varied by month, from 36% to 76% of consultations. CONCLUSIONS:The limited impact of incentives could be explained by low coverage or that the incentive was not motivating enough to overcome STI testing barriers. Future studies should investigate alternative methods of increasing STI testing in remote Central Australia, including through primary care clinics.

BACKGROUND:Globally, hepatitis C virus (HCV) elimination is a priority for marginalised communities, including Aboriginal and Torres Strait Islander peoples in Australia. Innovative and equity focused models of care are required to achieve elimination. The aim of this analysis was to evaluate prevalence of, and factors associated with, HCV infection among Aboriginal peoples engaged during implementation of a point-of-care testing and treatment intervention at Aboriginal primary health care services. METHODS:The SCALE-C prospective cohort study implemented a decentralised, on-site community-based "test and treat" intervention through four regional Aboriginal Community Controlled Health Organisations (primary care services) in New South Wales and South Australia between May 2019 and July 2022. Following a screening questionnaire (history of HCV infection, injecting drug use, incarceration, opioid agonist therapy use), participants underwent fingerstick point-of-care HCV testing (antibody [no risk] and/or RNA [history of HCV, ever at risk]); those at risk or with current HCV infection were also offered point-of-care HIV and HBV testing, education, and longitudinal follow-up. Participants with current HCV infection were offered DAA treatment. The primary endpoint was current HCV infection, with secondary endpoints including DAA uptake and outcome. Factors associated with current HCV infection were assessed using logistic regression analysis. RESULTS:Of 536 individuals enrolled (median age 39 years, 49% women, 37% injecting drug use ever, 32% incarceration ever), 79% identified as Aboriginal and/or Torres Strait Islander. The proportion with current HCV infection was 9%, ranging from 0.5% among people reporting no lifetime risk to 20% among those reporting risk within the past 12 months. Current HCV infection was associated with recent injecting drug use (adjusted OR: 10.43; 95% CI: 1.34-81.01). Among participants with HCV infection, 62% (28/45) received DAA treatment (median time from enrolment to treatment initiation, nine days [range 2, 22]) and 57% (16/28) of those treated had confirmed sustained virological response (SVR); SVR was 100% (16/16) among those retained in follow up. CONCLUSION:A community-based decentralised on-site "test and treat" intervention integrated within existing Aboriginal community-controlled health organisations was feasible and effective in HCV case detection. While it holds potential for future elimination efforts, health system enhancement will be required (including dedicated staffing and infrastructure) to support broader implementation and improve linkage to care and treatment. CLINICAL TRIAL:This study was registered with clinicaltrials.gov (NCT03776760) on December 12, 2018.

Background Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia's STI Management Guidelines recommend regular STI testing every 6-12months for sexually active individuals aged 15-35 years in high-prevalence, remote areas. However, testing uptake remains low among young Aboriginal and Torres Strait Islander peoples. This analysis explores how healthcare providers engage Aboriginal and Torres Strait Islander peoples in STI testing using point-of-care (POC) diagnostics. Methods Semi-structured interviews were conducted with trained STI POC testing operators within the Test Treat ANd GO (TTANGO2) project. Seven clinics involved in TTANGO2 were selected for their 'high' and 'low' implementation of STI POC testing. Purposive sampling was used to recruit similar personnel from each of the selected clinics. Coding was informed by a patient communication protocol lens. Results Twenty healthcare personnel, including Aboriginal Health Workers/Practitioners (n =8), Registered Nurses (n =7), Coordinators (n =2), and Clinical/Practice Managers (n =3) participated. Key themes related to implementing STI POC testing focused on different stages of identified patient communication protocols, such as offering tests, providing follow-up results, and contact tracing. Concerns about shame and confidentiality were significant factors affecting patient communication protocols throughout the process. Conclusions Normalising sexual health discussions in healthcare settings helps reduce feelings of shame and stigma, further encouraging patient participation in sexual health services. Ensuring patient safety and offering culturally appropriate explanations of STI POC testing are essential to reduce barriers, such as shame and stigma. Culturally safe practices can increase patient engagement and provide opportunities for health education. Integrating STI POC testing into routine health care can help normalise testing and boost uptake. However, same-day results may still require patient follow-up to maintain confidentiality. Addressing external factors, such as accessibility, confidentiality, stigma reduction, and community engagement, is crucial for improving STI testing services.

Background:As cancer incidence increases globally, so does the prevalence of cancer among Indigenous peoples. Indigenous peoples face significant barriers to healthcare, including access to and uptake of surgery. To date, the synthesis of access to and uptake of surgery for Indigenous peoples living with cancer has not yet been reported. Methods:We conducted a systematic literature review and meta-analysis of access to and uptake of surgery for Indigenous peoples in Canada, Australia, New Zealand, and the United States. Five databases were searched to identify studies of Indigenous adults with cancer and those who received surgery. The Joanna Briggs Institute critical appraisal tools were used to assess the quality and inclusion of articles. Random effect meta-analyses were conducted to estimate the pooled prevalence of surgery in Indigenous people with cancer. Findings:Of the 52 studies in the systematic review, 38 were included in the meta-analysis. The pooled prevalence of surgery in Indigenous people with cancer was 56.2% (95% confidence interval (CI): 45.4-66.7%), including 42.8% (95% CI: 36.3-49.5%) in the Native Hawaiian population, 44.5% (95% CI: 38.7-50.3%) in the Inuit and 51.5% (95%CI: 36.8-65.9%) in Aboriginal and Torres Strait Islander people. Overall, Indigenous people received marginally less cancer surgery than non-Indigenous people (3%, 95% CI: 0-6%). Indigenous people were 15% (95% CI: 6-23%) less likely to receive surgery than non-Indigenous people for respiratory cancers. Remoteness, travel distance, financial barriers, and long waiting times to receive surgery were factors cited as contributing to lower access to surgery for Indigenous people compared to non-Indigenous people. Interpretation:Efforts to improve access and use of cancer services and surgery for Indigenous peoples should be multilevel to address individual factors, health services and systems, and structural barriers. These determinants need to be addressed to expedite optimal care for Indigenous peoples, especially those living in outer metropolitan areas. Funding:The Research Alliance for Urban Goori Health (RAUGH) funded this project. GG was funded by an NHMRC Investigator Grant (#1176651).

Background: Preventing and treating methamphetamine-related harm in Aboriginal and Torres Strait Islander populations is a significant challenge for health care services. Digital health care may offer opportunities to support individuals and families in ways that complement existing methamphetamine treatment options. This study responds to a community-identified priority as Aboriginal Community Controlled Health Services identified methamphetamine use as a key concern and sought support to respond to the needs of people who use methamphetamine and their families. Objective: This paper reports on a process evaluation of the web application's acceptability and feasibility when used by clients and clinicians in residential rehabilitation services and primary care. This study is part of a larger project entitled "Novel Interventions to address Methamphetamine use in Aboriginal and Torres Strait Islander Communities" (NIMAC), which seeks to develop culturally appropriate and strengths-based prevention and treatment interventions to reduce methamphetamine related harm. "We Can Do This" was a web application developed for Aboriginal and Torres Strait Islander people who are seeking to reduce or stop methamphetamine use. Methods: Clinicians and clients who had used the web application were recruited through Aboriginal Community Controlled Health Services and Aboriginal residential rehabilitation services in urban and regional Victoria and South Australia. Unidentified usage data was collected from all participants. After using the web application, those who indicated a willingness to be interviewed were contacted and interviewed by phone or in person and asked about the feasibility and acceptability of the web application. The framework method of analysis was used to structure and summarise the resulting qualitative data. Results: Interviews with 24 clients and 11 clinicians explored the acceptability and feasibility of the web application. Acceptability incorporated the following domains: affective attitude, burden, ethicality, cultural appropriateness, coherence, opportunity cost, perceived effectiveness, and self-efficacy. The evaluation of feasibility assessed barriers and facilitators to the implementation of the program, with a focus on demand, practicality, fidelity, and integration. Results indicated that both clients and clinicians found the web application content coherent, relatable, empowering, and culturally safe. Barriers to using the web application for clients included a lack of internet connectivity and personal issues such as scheduling. Conclusions: Process evaluation is often under-valued. However, as "We Can Do This" was new, innovative and targeted a hard-to-reach population, understanding its feasibility and acceptability as a clinical tool was essential to understanding its potential. "We Can Do This" is unique as the only evidence-based, culturally appropriate internet-based therapeutic program specifically designed for Aboriginal and Torres Strait Islander people who use methamphetamine. Findings suggest it was both acceptable and feasible as a low-cost adjunct to usual care in residential rehabilitation and primary care settings.