Responses to the Syphilis Outbreak

Responses to the syphilis outbreak have recognised the need for a multi-faceted approach and to focus not just on syphilis but more broadly, to address the high rates of other STIs and blood-borne viruses (BBVs) among populations affected. Responses have included the establishment of new, and strengthening of existing, strategies.

Examples of jurisdictional responses are provided in more detail at the end of this page.

Enhanced response, action plan (including priority areas) and governance

A National Strategic Approach and accompanying Action Plan were developed by the AHPPC Syphilis Enhanced Response Governance Group and endorsed by the Australian Health Ministers’ Advisory Council (AHMAC) in December 2017.

The Action Plan has short and longer term goals which is aligned with the Fifth National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmitted Infections Strategy 2018-2022.

The following four priority areas are identified in the Action Plan:
Testing and treatment	Increase the: number of people tested for syphilis, frequency of testing, subsequent treatment of those infected and contact tracing of known sexual contacts.
Surveillance and reporting	Enhancing the: · quality of reporting and · improving access to laboratory testing data and · development of key reporting indicators for outbreak monitoring.
Education and awareness	Access to consistent and appropriate resources for at-risk communities with a particular emphasis on: · young people · pregnant females and women of childbearing age · the health workforce servicing these areas
Antenatal care	Ensuring consistent recommendations for: · repeat testing during pregnancy among females at high risk of infection and · improving the management of perinatal syphilis.

In addition to the four priority areas, the Action Plan recognises the importance of monitoring the progress of key actions by the Governance Group as well as ongoing monitoring and evaluation through the five National BBV and STI strategies. Monitoring and evaluation plans for the new 2018 to 2022 strategies will be developed in consultation with the state and territory governments and partners.

Note: The Sixth National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmitted Infections Strategy for 2023-2030 are currently in consultation and will be released in 2023.

National and Jurisdictional Syphilis Guidelines

Jurisdictional guidelines for syphilis testing and clinical management protocols
Jurisdiction	Title of Guideline (including website link)
National	Syphilis Series of National Guidelines (SoNG), Developed by CDNA and updated in August 2018, provides nationally consistent guidelines for public health units in responding to syphilis.
	Pregnancy care guidelines within SoNG: Syphilis Chapter of the Pregnancy Care Guidelines In addition, the updated in 2019, includes strengthened recommendations for testing females during pregnancy.
	Australian STI Management Guidelines for Primary Care.
	STI/HIV Testing Guidelines for MSM
Western Australia	The Silver Book
Northern Territory	CARPA Standard Treatment Manual Women's Business Manual NT Guidelines for the Management of Sexually Transmitted Infections in the Primary Health Care setting
Queensland	Communicable Diseases Control Guidance and Information : A-Z Primary Clinical Care Manual (PCCM) Syphilis in Pregnancy (SiP) Guidelines
South Australia	South Australian STI Guidelines Aboriginal Health Council of South Australia STI BBV handbook

Examples of jurisdictional responses

The syphilis outbreak began in the Kimberley in 2014 and the Pilbara in 2018. In 2018, the WA Communicable Disease Control Directorate (CDCD) established the WA Syphilis Outbreak Response Group in partnership with AHCWA to align with the national enhanced response to addressing syphilis and other STIs and BBVs in Aboriginal populations. The group includes representation from Aboriginal Health Council of Western Australia (AHCWA), CDCD, WA Country Health Service (WACHS), relevant Aboriginal Community Controlled Health Organisations (ACCHOs), the WA Primary Health Alliance (WAPHA) and Rural Health West (RHW).

Responsibilities include:

a. Share information and data between participating regions

b. Plan, set targets, direct and monitor key performance indicators (KPIs) of the state-wide and regional coordinated public health response

c. Implement standardised indicators and reporting in affected regions

d. Identify, implement and monitor strategies to improve testing, case detection and management of syphilis among antenatal females

e. Strengthen partnerships with government and non-government services to develop and implement strategies

f. Establish and/or monitor state-wide and regional Syphilis Outbreak Response Groups (SORGs) for targeted interventions identified in an agreed WA syphilis action plan

g. Develop a communication plan for stakeholders, including strategies to engage affected communities in the regions.

A WA Syphilis Outbreak Response Action Plan was developed based on input from a stakeholder workshop conducted in November 2018 that involved a range of staff from government and non-government organisations. The affected regions have developed and implemented targeted approaches to controlling the outbreak in their regions, including prevention, education, testing, treatment, contact tracing and workforce development. Regions have established Syphilis Outbreak Response Groups (SORGs) and developed comprehensive action plans to provide direction and co-ordination that align with the WA Syphilis Outbreak Action Plan.

Positive outcomes as a result of state-wide activities and the WA SORG include:
Facilitation of a coordinated public health response that aligns with national action plans
Coordinated communication amongst the regions
Engagement and development of the regional workforce
Opportunities for partnerships

Evaluation of the aims and progress of the action plans includes reporting against KPIs outlined by the Multijurisdictional Syphilis Outbreak Working Group (note: the MJSO has since been disbanded), while data maintained by the CDCD is used to monitor notifications and the status of the outbreak. Stakeholders have acknowledged the urgency of the issue and the need for an effective and coordinated response and the establishment of relevant networks and committees has provided a channel for effective collaboration.

The Australian Government funded the South Australian Health and Medical Research Institute (SAHMRI) to deliver a multi-strategy Aboriginal and Torres Strait Islander community awareness, education and testing campaign for syphilis and other STIs.

You can view the videos in relation to the Syphilis outbreak here, be sure to scroll down for the clinical videos

The SAHMRI campaign is assisting in:

Targeting Aboriginal and Torres Strait Islander people aged 15–29 years living in regional and remote Aboriginal communities of Queensland, Northern Territory, Western Australia, and South Australia; and
Promotion, through television and radio advertising, engaging with local community groups, social media and the Young Deadly Free website

The ‘Young Deadly Free’ website offers a range of resources for young people in remote Aboriginal communities, as well as resources for Elders, parents, youth workers and other community leaders – with tips on how the whole community can work with young people to encourage STI and BBV testing, and knockout STIs and BBVs. The For doctors, nurses, health workers section of the website provides resources to enhance clinical practice in remote Aboriginal and Torres Strait Islander communities, including the STI and BBV control in remote communities: Clinical practice and resource manual.