A regional initiative to reduce XXXX amongst aboriginal @entity1 living in remote communities of the Northern Territory, Australia.

@entity1 @entity799 @entity299 @entity1908 @entity315 @entity272 @entity6793
BACKGROUND: Linked to extreme rates of chronic @entity299 , @entity6793 is endemic amongst Aboriginal @entity1 in Australia's Northern Territory (NT). Many of those with @entity6793 will also have @entity1908 . We report the results of a community-based collaboration within the East Arnhem Region, which aimed to reduce the prevalence of both @entity272 in Aboriginal @entity1 . METHODOLOGY/PRINCIPAL FINDINGS: Commencing September 2004, we conducted an ecological study that included active surveillance for @entity272 amongst @entity1 aged <15 years in five remote East Arnhem communities over a three year period. Screening was undertaken by trained local community workers, usually accompanied by another project team member, using a standard data collection form. @entity272 were diagnosed clinically with the aid of a pictorial flip chart developed for the purpose. Topical 5% @entity315 was provided for age-eligible @entity1 and all household contacts whenever @entity1908 was diagnosed, whilst those with @entity6793 were referred to the clinic for treatment in accordance with current guidelines. In addition, annual mass @entity1908 treatment (5% @entity315 cream) was offered to all community residents in accordance with current guidelines but was not directly observed. @entity6793 and @entity1908 prevalence per month was determined from 6038 skin assessments conducted on 2329 @entity1 . @entity6793 prevalence dropped from 46.7% at baseline to a median of 32.4% (IQR 28.9%-41.0%) during the follow-up period - an absolute reduction of 14.7% (IQR 4.7%-16.8%). Compared to the first 18 months of observation, there was an absolute reduction in @entity6793 prevalence of 18 cases per 100 @entity1 (95%CI -21.0, -16.1, p</=0.001) over the last 18 months. Treatment uptake increased over the same period (absolute difference 13.4%, 95%CI 3.3, 23.6). While @entity1908 prevalence was unchanged, the prevalence of infected @entity1908 (that is with superimposed @entity6793 ) decreased from 3.7% (95%CI 2.4, 4.9) to 1.5% (95%CI 0.7, 2.2), a relative reduction of 59%. CONCLUSION: Although @entity6793 prevalence remained unacceptably high, there was a substantial reduction overall with improvements in treatment uptake a critical factor. More acceptable alternatives, such as @entity799 for @entity6793 and ivermectin as a community-wide scabicide, warrant further investigation in these settings. We are encouraged by progress made through this work, where local action was led by local community members and primary health care providers with external training and support. TRIAL REGISTRATION: ClinicalTrials.gov NCT00884728.
