Our projects

A desire to better explain the longstanding disparity in sexually transmissible infections (STIs) and blood-borne viruses (BBVs) among Aboriginal and Torres Strait Islander peoples led to the development of the ATLAS network.

ATLAS was developed in partnership with the Aboriginal Community-Controlled Health Organisation (ACCHO) sector in five clinical hubs, spanning the Kimberley in Western Australia, Cape York in Queensland, urban Brisbane, New South Wales and South Australia. Currently 32 ACCHOs are partners in the collaboration.

ATLAS was designed to address difficulties readily accessing and analysing patient-level service data, as well as to fill gaps regarding testing, treatment and ongoing management information in the Australian National Notifiable Diseases Surveillance System.

The ATLAS network links deidentified clinical data within and between participating sites and returns service-specific reports describing STI and BBV screening, positivity, treatment completion and outcomes to ACCHOs on a regular basis.

In the current funding period, we aim to double the number of participating ACCHOs, link with other primary care providers and add new regions to the ATLAS network. We also plan to expand the scope of the data infrastructure, to include vaccine-preventable diseases and chronic diseases.

The ATLAS network supports the capacity of ACCHOs to provide high quality, evidence-based, best practice clinical care for improved health outcomes for Indigenous peoples.

Activity to expand ATLAS and develop programs that transform clinical outcomes, while strengthening Indigenous governance and research capacity, will exponentially increase the utility and sustainability of Australia’s only comprehensive Indigenous primary care surveillance network.

Dates: 2021 – 2023
Funding: Australian Government Department of Health; $910,000
Contacts: James Ward, Clare Bradley

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Data Science Traineeships

Internationally, primary health care (PHC) systems experience challenges of delivering quality care to growing populations with complex care needs.

The Institute for Urban Indigenous Health, which is a regional network of Aboriginal Community Controlled Health Services in South East Queensland, has overseen substantial increases in uptake of care in their clients, with demonstrable improvement in health outcomes.

However, evidence is emerging of the inability of the system to effectively respond to rapid population growth, necessitating a redesign of the way care is delivered.

Using a mixed methods approach, this prospective observational cohort study will evaluate a model of patient-centred medical homes, developed by an Alaskan Native-controlled health service and adapted to the local context.

Unique to this model is coordinated care that is delivered by a multidisciplinary team, rather than by individual clinicians. Embedded in Aboriginal governance, this study will examine: the feasibility and acceptability of implementing the model of care; whether compared to pre-implementation, this model of care improves access and relational continuity of care; longer-term health outcomes; and cost-effectiveness.

Research findings will deliver key lessons for: broader PHC system reform; system change management in real-world, PHC settings; Aboriginal led and governed models of research collaboration and distinct policy initiatives such as Health Care Homes.

Dates: 2020-2024
Funding: Medical Research Future Fund (MRFF) (APP1200868); $1,209,747.00
Contacts: James Ward, Carmel Nelson, Lyle Turner, Adrian Carson, Leanne Coombe

Implementing a precision public health approach to move toward elimination of STIs, control of HIV and inform on other BBVs in regional Australia

Over the past 15 years, attempts to control STIs and BBVs using traditional public health approaches have provided some evidence about control approaches and impacts on population prevalence and incidence. However, more is required to shift the burden of disease.

Building on previous work, we now propose to trial a precision public health (PPH) approach which will focus on moving toward STIs elimination in the Cairns and Hinterland region of far north Queensland (FNQ).

The objectives include moving toward elimination of CT, NG, and infectious syphilis among Aboriginal and Torres Strait Islander people, and in parallel, reduce locally acquired cases of HIV in the Cairns region.

Other objectives include synergising data sets to contribute to a more complete picture regarding STI and BBV risk and applying this to designing strategies to be implemented across the region, as well as assessing outcomes, acceptability, and feasibility of a PPH approach in eliminating STIs.

This Indigenous led project will inform health services of activities for other BBVs, within the service catchment. The interventions within this project will focus on elimination of STIs in the region. This will be one of the first PPH approaches offered to control STIs nationally.

Dates: 2020-2025
Funding: NHMRC Ideas grant round, APP1185073, awarded $2,455,034.00
Contacts: James Ward, Clare Bradley, Stephen Harfield, Susan Jacubs

A multidisciplinary multi-phased study aimed at eliminating STIs in remote areas of Australia using a precision public health approach

For well over two decades, STIs have been endemic in many remote and regional communities in Australia - identified as the leading incident morbidity for Aboriginal people aged 10-24 years.

To address this problem, this project will utilise multidisciplinary research (i.e. epidemiology, genomics and qualitative research) and a precision public health approach.

Precision public health is an emerging field that uses multidisciplinary data to address public health issues for specific populations, rather than traditional public health approaches that focus on whole populations.

Data will be collated, synthesised and mapped locally to help inform precise public health interventions.

Working in select remote communities, this multi-phased study aims to eliminate STIs (defined as 50-90% reduction in incidence), eliminate congenital syphilis, improve management of blood borne viruses and enhance the delivery of healthcare services.

Expected impacts from this study include significant reduction in STI incidence and improvement in sexual health services.

Importantly, this study will be undertaken in partnership with a community coalition comprised of approximately 30 local community members. These coalitions will ensure that our research is truly developed, led and evaluated by local Aboriginal and Torres Strait Islander people.  

Dates: January 2021-December 2026
Funding: NHMRC Synergy Grant (APP1185377), worth $5m
Contacts: James Ward, Clare Bradley, Steve Bell, Salenna Elliott

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Aboriginal and Torres Strait Islander people are identified as a key population for COVID-19 prevention and response.

However, there are concerns that messaging and preventative actions concerning COVID-19 are waning and will continue to decline, and community members will be become desensitised to new information.

Given there will be a need to have communication strategies for years to come, and Aboriginal and Torres Strait Islander people use social media readily to access health related information, the challenge remains how to develop consistent, enduring, meaningful and reinforced messaging about risk and response processes for Aboriginal and Torres Strait Islander communities to address both complacency and mistrust.

Using survey research methods to reach 600-1000 Aboriginal and Torres Strait Islander people, this study will investigate how COVID-19 messages (including vaccines) are received by communities, and meaningful ways to ensure communication is enduring and impactful over a longer period. 

Research findings will provide insight into the effectiveness of health messages and mediums used to communicate such messages to Aboriginal and Torres Strait Islander people during a pandemic or similar health crisis.

Dates: Oct 2020 - Dec 2021
Funding: Paul Ramsay Foundation, through the APPRISE CRE Collaboration, $79,000
Contacts: Shea Spierings, James Ward, Scott Trindall

Systems thinking focuses on the dynamic interaction, synchronisation and integration of people, processes and technology to understand an issue. Its process is iterative, holistic and enables multiple stakeholder groups to come together to better understand strengths and gaps in a system-wide response. This study uses systems thinking to explore urban Indigenous communities’ preparedness for COVID-19 in south-east Queensland.

Through workshops, this project will use participatory system dynamics (Community Based System Dynamics) and system thinking’s causal mapping tools to map the causal linkages and feedbacks showing urban indigenous communities engage with the social systems supporting their health and wellbeing.

This study aims to: Understand the interactions of urban indigenous individuals and communities with social systems, including housing, health, education and Indigenous cultural events; Examine how these systems and interactions mitigate or protect the population during COVID-19 and other pandemics; and Identify where linkages and causal pathways exist within systems and interactions that can become leverage points for interventions meant to strengthen the system.

We will use the causal understandings and identified leverage points to synergise interventions and design better policy to address the vulnerabilities and protect the health of urban indigenous communities. Study findings will be reported widely to ensure other urban Indigenous communities’ benefit.

Dates: Oct 2020- December 2021
Funding: Paul Ramsay Foundation, through the APPRISE CRE Collaboration, $107,000
Contacts: Bronwyn Fredericks, James Ward, Shea Spierings, Troy Combo

Harnessing the evidence from an urban First Nations health ecosystem to inform ongoing response, recovery and health system adaptation

Bringing together skilled First Nations researchers with policy, planning and service delivery expertise, this study will investigate and capture critical learnings gained during the COVID-19 pandemic.

Specifically, learnings will be drawn from a large urban community-controlled health “ecosystem” - the Institute for Urban Indigenous Health. 

Focused on First Nations-led responses to COVID-19 in an urban context, this study will use primarily qualitative research methods to explore the following research aims:

• To identify how an Indigenous-led approach compares and contrasts with mainstream and international First Nation responses and outcomes
• To prepare a strategy for, and undertake if circumstances determine, the documentation of the first few cases should an outbreak occur in SEQ among urban Indigenous peoples;
• Use case studies to investigate key aspects of service planning, response and reorientation, and community activation achieved during the current pandemic
• Identify strengths and gaps of the overall pandemic response within a large, urban regional CCHS network, using systems thinking methods.

This study will deliver an in-depth understanding of the critical success factors, any exigent challenges and key learnings from a large urban Indigenous health ecosystem pandemic response. It will have relevance for this and future pandemics as well as more broadly, for health system (both Indigenous-specific and mainstream) understanding, development and improvement;

The study will also provide practical tools and resources for dissemination, adaptation and adoption, as well as advancing individual and collective First Nations research knowledge, skills and career development.

Dates: Oct 2020- Dec 2021
Funding: Paul Ramsay Foundation through the APPRISE CRE Collaboration, $169,000
Contacts: James Ward, Adrian Carson, Carmel Nelson, Lyle Turner

The Eliminate hepatitis C Australia Partnership (EC Australia) was created in 2018 to bring together researchers, implementation scientists, government, health services and community organisations to ensure the whole of Australia sustains high numbers of people accessing hepatitis C treatment.

It is a three-year partnership project, funded by the Paul Ramsay Foundation and coordinated by Burnet Institute.

EC Australia’s goals are to:

• Ensure that 15,000 Australians with chronic hepatitis C are treated and cured of their infection annually
• Ensure that people identified with cirrhosis related to hepatitis C infection are treated and cured, and regularly reviewed to monitor for liver cancer
• Establish a national collaborative framework to facilitate a coordinated response to the elimination of hepatitis C as a public health threat from Australia by 2030.

In the first two years of operating, EC Australia has:

• Conducted a national state-by-state consultation to work with key organisations and state-run viral hepatitis committees to understand the current gaps in funding and workforce capacity across all jurisdictions
• Distributed funding for 18 workforce development projects to increase resourcing for the hepatitis C elimination effort
• Published Australia’s first national report on progress towards the elimination of hepatitis C virus in Australia, in partnership with the Kirby Institute. This report will be published annually to track Australia’s progress towards hepatitis C elimination targets.

Dates: 2018 – 2022
Funding: Paul Ramsay Foundation
Contact: Troy Combo