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Performed the experiments: GF ID. The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Given that this study involving human participants and it involves participant privacy, the current ethics does not allow us to provide individual participant data to the public.

Relevant data are available upon request to the corresponding author. The frequency of testing sex workers for sexually transmitted infections STIs in Victoria, Australia, was changed from monthly to quarterly on 6 October The of STIs diagnosed in the clinic increased from to from the monthly to quarterly period, respectively [ Overall the change in frequency is likely to have had a beneficial effect on STI control in Victoria.

Laws governing the sex industry in Australia are determined by the State and Territory Governments and vary across the country. Prior to 6 Octobermonthly STI screening for Chlamydia trachomatisNeisseria gonorrhoeaand Trichomonas vaginalis and quarterly serological tests for HIV and syphilis was recommended for Victorian sex workers.

From Octoberthe recommended frequency of STI screening for sex workers changed from monthly to every three months quarterly. At the time of screening, sex workers are issued with a certificate of attendance for STI screening which they can present to the brothel manager. In some brothels, they are not permitted to work without an in-date certificate of screening. Sex workers in Victoria have an extremely low STI prevalence.

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It is hypothesized that reducing the frequency of STI screening of sex workers would result in more consultation time available for higher-risk individuals, such as men who have sex with men MSMand an overall improvement in population health as a result [9]. Due to the low STI incidence rate, the high rate of condom use in female sex workers FSW and the potential waste of limited public health resources; the Victorian Minister for Health published in the gazette an order to change to STI screening frequency in relation to sex workers from monthly to quarterly.

To evaluate the impact the change in the screening regimen of sex workers has had in Victoria, we compared the of STI diagnoses, nature and duration of clinical consultations seen at the MHSC in the year before and after the change. The aim of this study was to determine if the change in screening frequency of sex workers would lead to more high risk clients being seen, and more STIs being diagnosed at the main public sexual health clinic in Victoria. We conducted a retrospective study investigating all individuals attending the MSHC between 7 October and 7 October The clinic provides about 35, consultations annually.

MSHC provides a walk-in service and all clients are triaged-in by a registered nurse. Clients who are at higher risk of infections or who have noticeable symptoms are prioritised to the service [10]. No referrals are required and all services are free-of-charge. The demographic characteristics, epidemiological and sexual behavioural data, and clinical diagnoses of each client were recorded in the electronic medical system, the Clinic Practice Management System CPMSat each clinic visit.

Clients were categorised into different risk groups according to their self-reported behaviours. A heterosexual male was considered as a man who has not had sex with a man since their first attendance at MSHC and has never attending for a sex work certificate; while a heterosexual female was defined as non-sex-working woman who has had male partners.

Men who have sex with men MSM Girls looking for sex Australia il defined as men who had sex with other men in the last 12 months or in the 12 months before any visit to MSHC. Men who have attended MSHC for a sex worker certificate or ever sold sex were defined as male sex workers.

In addition, MSM who occasionally receive money for sex were also considered as male sex workers [11]. However, clients without any symptoms were seen by doctors or nurses and this depends on the availability of the staff at the clinic. Specific parameters in each risk group, including the of clinical consultations, the time spent in clinical consultations, and the of diagnoses of specific STI chlamydia, gonorrhoea, Mycoplasma genitaliumsyphilis, trichomonas, and HIVwere compared between the monthly and quarterly testing periods.

The time spent in consultations for each client was measured from the start to the end of the each consultation and was collected automatically in CPMS. The rates of STI detection per clinical consultations, and per hours of consultation time in each risk group were calculated.

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The total costs of FSW consultations and the laboratory tests were compared during the period. The costs of pathology services and clinical consultations were extracted from the Australian Medicare Health System [13]. Costs for each clinical consultation depend on the length of consultation. Consultations less than 20 mins were classified as level B and consultations more than 20 mins were level C consultations. No consent was given to the participants. The project involves ly collected clinical information and it is impracticable to obtain consent and the purpose of this project is to monitor and evaluate the health service.

The original data is the client electronic epidemiological data and clinical record was collected during the clinical consultation and was collected for the clients' clinical care. Contacting more than 70, clients after they presented to ask their consent to review their clinical record would be impractical and may cause the client considerable concern or risk breaching their confidentiality.

The data were analysed and reported anonymously. The proportion of clinics consultations that were symptomatic MSM from 7. A total of and STIs defined in the Method section were detected in the monthly and quarterly testing period, respectively Table 3. There was a ificant increase in prevalence of chlamydia from 5. The overall proportion of HIV from 0.

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A two-fold increase in chlamydia from 4. An increase in gonorrhoea cases as proportion of those tested was seen in MSM from 6. There was an increase in trichomonas as the proportion of those tested in FSW from 0. No ificant changes in the other STI cases were observed in both heterosexual females and males during the period. There was a ificant increase in STIs detected per h of consultation time among all clients from This large cost savings was mainly due to a reduction in clinical consultations and the of laboratory tests ordered for FSW.

The additional clinical capacity that this change created was filled with more symptomatic individuals, who were more likely to have STI diagnosed. The less frequent screening did not result in ificantly higher rates of STI per consultations or hours in FSWs, and remained two to four fold lower than all clients seen in the clinic. Up to a quarter of a million dollars annually was diverted away from screening towards higher risk clients.

There was a substantial benefit to the Victorian community with an additional cases of STIs diagnosed with no additional resources.

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The overall benefit to Victoria of this change in frequency has been substantial and provides further evidence to inform effective public health policy for sex workers. Several limitations in this study should be noted. First, our findings are based on one sexual health clinic and it is possible that the changes we observed did not occur in other clinical settings.

Second, our findings are relevant to sex workers working under a licensing regime with low prevalence Girls looking for sex Australia il STI, it may not be appropriate to other settings with high STI rates and low condom use rate among FSW. Third, our study can only analyse FSW who were tested and we cannot infer our observed changes were seen among all FSW working in Melbourne. Fourth, we believe the savings on FSW is an underestimate of all costs because they do not for the time of the individual sex workers to attend consultations.

Fifth, this is a retrospective study and the data obtained ly might not fit in the framework of this study. Incomplete data may occur in the use of secondary data. Sixth, our costs have been estimated assuming that all sex workers were seen by doctors only because this is the case everywhere other than MSHC and even at MSHC doctors see a large proportion of clients.

We acknowledge that we may have overestimated the specific cost savings at MSHC because of this reason, but they allow generalisation of costs to Victoria as a whole. There was another change at MSHC that may have influenced these.

In Januarywe changed our policy to allow MSM to obtain their HIV test by phone rather than by face-to-face consultation. It is also possible that the reduction in this denominator contributed to the higher proportion of MSM who were symptomatic or the rise in STI diagnoses per consultations or hours. Our findings not only reflect a ificant impact at MSHC, but also over the entire state of Victoria.

There is no data set that identifies sex workers who attend general practitioners so it is not possible to undertake the same analysis that we did at MSHC. Unfortunately, there is also no record of the of sex workers working in Victoria although the local sex worker organisation estimates that about half of sex works may attend Girls looking for sex Australia il for screening Skelsey G, personal communication, If all Victorian FSWs are assumed to be tested quarterly, the total health care costs saved will be about half a million dollars in addition to the benefit of making other clinical services more accessible.

In addition, there is no noticeable change in STI detection rate in FSW when the screening interval is reduced from monthly to quarterly. Indeed research has shown that non-paying private partners, with whom they do not use condoms, are the usual source of STIs in FSWs [5]. More important than the cost saving achieved by reducing the screening interval that provides no discernible benefit, is the public health benefit associated with improving the clinical services for those at high risk of STI.

Accessible health services have been shown to be a critical component of effective STI control [14]. The reduction in STI screening in sex workers allowed more higher-risk individuals, such as MSM and the general community to access the sexual health services without additional staff costs.

The data confirmed this and showed more time and consultations were spent on individuals with symptomatic conditions. We did not evaluate the impact on male sex workers because there are relatively few male sex workers in Victoria and the majority One potential benefit of the reduction in sex worker screening is that it may encourage sex workers who work in illegal brothels to move back into the legal system now that the onerous monthly screening program has been removed.

Our centre saw a greater of sex workers supporting this possibility. If this is so, it is an additional advantage of the change because it is believed that women working in the illegal industry have higher rates of STIs and use condoms less [18].

Occupational Health and Safety is also much greater for women working within the legal system. To our knowledge, this is the first study to investigate the impact of the change in STI screening frequency for sex workers on a sexual health service. The findings may have important implications for other countries seeking to create the optimal legislation for sex workers in their countries. We have shown that quarterly STI screening of sex workers is cheaper and more effective than the monthly screening at a community level which is of considerable relevance to public health policy and legislatory reform for those working in the field.

The authors would like to acknowledge A Afrizal for his assistance with data extraction. The funders had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology InformationU. PLoS One. Published online Jul Eric P. Chen12 Catriona S. Brhaw12 Ian Denham1 Matthew G. Law3 and Christopher K. Fairley 12.

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Marcus Y. Catriona S. Matthew G. Christopher K. Marcia Edilaine Lopes Consolaro, Editor. Author information Article notes Copyright and information Disclaimer. Competing Interests: The authors have declared that no competing interests exist. Received Mar 26; Accepted Jun This is an open-access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

This article has been cited by other articles in PMC. Associated Data Data Availability Statement The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Abstract Background The frequency of testing sex workers for sexually transmitted infections STIs in Victoria, Australia, was changed from monthly to quarterly on 6 October

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