Projects

Investigators: Dr. Jisoo Amy Kwon, Associate Professor Richard Gray, Professor Louisa Degenhardt, Dr. David Goodman, Professor Matthew Hickman, Professor Jason Grebely, Professor Greg Dore

The project aims to estimate the prevalence and population size of people who inject drugs (PWID) in NSW using a Bayesian Evidence Synthesis approach. Data collection and preparation from multiple sources are currently underway, and the Bayesian model structure has been developed. The next steps will involve integrating the available data into the model and generating prevalence and population size estimates for NSW.

Investigators: Professor Limin Mao, Professor Loren Brener, Dr. Mia Harrison, Dr. Elena Cama, Dr. Theresa Caruana

This project aims to strengthen understanding of how peer workers and peer knowledge shape workplace culture and care across NSW BBV/STI healthcare systems (including harm reduction settings), with particular attention to stigma (experienced by peers and within service delivery) and the long-term impacts of peer workforce participation. Outcome measures will include analysis of research and policy literature and organisational documents to strengthen understanding of the long-term impact of peer support on the healthcare workforce through various delivery and funding models qualitative thematic analysis of cultural narratives and integration experiences, including stigma experiences, impact and how to reduce stigma and empower peers.

Methods will include a literature review, survey, and qualitative interviews in a case study approach focussing on peer work in the AOD and harm reduction sector. Participants will include survey and individual interviews with healthcare workers with lived and living experience (including peer workers in formal and informal capacities) in harm reduction service networks in NSW across, including but not limited to a[TEST], NUAA, SWOP, Hepatitis NSW, Positive Life NSW, Multicultural HIV and Hepatitis Service (MHAHS), and other relevant NSW Health services; round-table guided group discussions will include peer workers, managers and clinicians. Deliverables include the literature review, 1 brief online survey, interviews of up to 20 participants in the AOD and harm reduction sector, 3–5 group interviews (via round-table guided group discussions) with thematic analysis, a project report for NSW Health with actionable recommendations, and community briefings and practical recommendations for community organisations to implement in building peer workforces.

Investigators: Dr. Sarah Warzywoda, Associate Professor Benjamin Bavinton, Dr. Nathanael Wells

This project aims to strengthen understanding of how registered nurses’ (RNs) extended scope of practice is defined, utilised, and constrained within publicly funded sexual health services (PFSHS) across NSW. It will define the maximum theoretical scope of RN practice, assess how closely current practice aligns with this scope, and identify policy, organisational, and individual‑level barriers and facilitators influencing RNs’ ability to work to their full potential. Outcome measures will include the development of a consolidated, evidence‑based statewide framework describing maximum RN scope in PFSHS, descriptive evidence of gaps between policy and practice, and identified factors impacting full‑scope utilisation, alongside evidence‑based recommendations to support workforce optimisation, policy development, and service improvement.

Methods will include a mixed‑methods approach comprising a comprehensive review of NSW Health policies, clinical guidelines, position descriptions, and professional standards; a statewide cross‑sectional anonymous online survey of RNs working in PFSHS assessing tasks performed, autonomy, and decision‑making; and qualitative semi‑structured interviews exploring contextual barriers and facilitators to full‑scope practice. Participants will include RNs working in PFSHS across NSW, with a purposive subsample from urban, rural, and remote settings participating in interviews. Deliverables will include the statewide framework defining maximum RN scope of practice, a report with actionable recommendations for the NSW Ministry of Health, peer‑reviewed journal article(s), and national and international conference presentations.

Investigators: Dr. Kerryn Drysdale, Dr. Mia Harrison, Professor Limin Mao

This project aims to strengthen understanding of how existing partner notification and treatment pathways for syphilis operate for pregnant people, and how these pathways can be adapted or enhanced to better engage partners across diverse relationship contexts. The focus is on mapping current pathways and identifying barriers, enablers, and prospective modifications needed to more comprehensively incorporate partners of pregnant people diagnosed with syphilis into test‑and‑treat cascades of care, in order to prevent syphilis (re)infection and congenital syphilis. Outcome measures will include mapped pathways for testing, treatment, and partner notification; identified system‑, service‑, and individual‑level barriers and enablers; and evidence‑based recommendations to improve screening, contact tracing, partner engagement, monitoring, and review.

Methods will include a qualitative, multi‑stage approach comprising a desktop review of existing antenatal and partner notification pathways, semi‑structured key informant interviews, and iterative pathway mapping and refinement with expert feedback. Participants will include clinicians and professionals involved in antenatal, sexual health, and public health services across metropolitan, regional, and rural NSW, with approximately 25–30 key informant interviews and a small number of follow‑up interviews to validate findings. Deliverables will include a comprehensive visual pathway map, a report with actionable recommendations to enhance partner notification and engagement, and a potential peer‑reviewed publication to strengthen the evidence base for congenital syphilis prevention.

Investigators: Dr. Theresa Caruana & Dr. Bradley Mathers, Rob Monaghan, Associate Professor Lise Lafferty, Rodney Hinton, Rebecca Riseley, Professor Loren Brener, Professor Lisa Maher

This project aims to strengthen harm‑reduction outcomes for Aboriginal and Torres Strait Islander people who inject drugs (PWID) in New South Wales by identifying strategies that increase access to Needle and Syringe Programs (NSPs) and related healthcare services, and by providing recommendations for the culturally safe, acceptable and effective implementation of these strategies in partnership with Aboriginal communities, Aboriginal PWID, Aboriginal Community Controlled Health Organisations and NSW harm‑reduction services. Outcome measures will include data mapping of existing harm‑reduction services and patterns of NSP access by Aboriginal people who inject drugs, identification of structural, cultural and service‑level factors influencing access (including strengths and enablers), and the development of co‑designed recommendations to improve NSP access and harm‑reduction outcomes in NSW.

Methods will include service and data mapping through secondary analysis of existing quantitative datasets (NSP NMDC, ANSPS, NNEDC and local service data) and document review, alongside qualitative interviews with Aboriginal people who inject drugs and service providers from Aboriginal Community Controlled and mainstream health services. An Aboriginal‑led Co‑Design Working Group will guide research priorities, methods, site selection, recruitment strategies and culturally safe consent processes, and will be involved in interpretation of findings and development of recommendations. Qualitative data collection will occur in up to four locations (inner metropolitan, outer metropolitan, regional and rural), with sample size determined through co‑design and purposive sampling. Deliverables will include co-design strategies that aim to increase access to NSP and recommendations to inform the culturally safe implementation of such strategies.
 

Investigators: Dr Elena Cama, Associate Professor Lise Lafferty, Professor Loren Brener, Associate Professor Thomas Tu

This project is an extension of an existing project and aims to strengthen understanding of engagement in hepatitis B screening and care, and the lived experiences of hepatitis B‑related stigma and discrimination among Chinese and Vietnamese communities in NSW. The study will explore how people living with hepatitis B understand and experience engagement in care, the nature and impacts of stigma and discrimination (particularly within healthcare settings), and how stigma affects access to and continuity of care. Outcome measures will include new, community‑specific evidence on barriers and facilitators to engagement in screening and care, lived experiences of stigma and discrimination, and insights to inform the NSW Hepatitis B Strategy 2023–2026 and the 2025 BRISE research priorities.

Methods will include a three‑phase mixed‑methods design drawing on existing quantitative data and new qualitative interview data. The phase 1 study completed in March 2026. This request, for funding support for Phase 2, will involve qualitative interviews with 30 Chinese and Vietnamese people living with hepatitis B, conducted in English, Cantonese, Mandarin, or Vietnamese. Participants will be Chinese or Vietnamese adults living with hepatitis B in Australia, recruited through NSW Health services and high‑caseload prescribers. Deliverables will include a Phase 2 project report, a snapshot report for stakeholders, peer‑reviewed journal articles, and conference presentations to strengthen the evidence base on hepatitis B engagement in care and stigma reduction.

Investigators: Professor Jason Grebely, Professor Natalie Taylor, Dr. Andrea Torres Robles, Dr. Alison Marshall, Associate Professor Lise Lafferty, Scientia Professor Gregory Dore, Associate Professor Marianne Martinello, Dr. Guillaume Fontaine

This project aims to identify and map programmatic‑, provider‑, and patient‑level barriers and enablers across HCV treatment initiation pathways, and to identify priority targets for implementation support and design tailored implementation strategies to enhance linkage to, and initiation of, HCV treatment. Outcome measures focus on understanding what works for enhancing HCV treatment initiation and why, generating evidence to inform changes to health service delivery, revisions to clinical guidelines, and the NSW Health Hepatitis C strategy to guide resource allocation and government action. 

Methods will include assessing implementation barriers and facilitators and using process mapping of existing and proposed HCV treatment practices in community clinics, alongside patient interviews incorporating patient journey mapping to examine barriers and enablers across the treatment pathway. Acceptability, feasibility, and impact of proposed implementation strategies will be explored through interviews and focus groups with patients, healthcare providers, and policymakers, with all data coded against implementation science frameworks to design evidence‑based strategies. Participants will include healthcare providers (including gastroenterologists, hepatologists, infectious disease specialists, nurse practitioners, nurses, and pharmacists), HCV patients from community settings, and policymakers. Data collection will include nine focus groups, in‑depth interviews with 20 healthcare providers and 20 HCV patients across nine existing sites. Deliverables will include a brief project report highlighting key findings, peer‑reviewed journal articles on process mapping and provider and patient barriers and enablers, and outputs designed for immediate uptake through co‑design with patients, providers, and policymakers.

Investigators: Dr. Kerryn Drysdale, Dr. Mia Harrison

This is an exploratory study exploring the intentional use of drugs in combination with sex among cisgender women and heterosexual men in NSW. This includes the use of any recreational or non-prescribed drug, including illicit drugs, before or during sex, for example, to have better sex, to have longer sex, to assist sex or to have a different sexual experience. The purpose of this research is to understand how women and heterosexual men think about, prepare for, engage in and protect themselves during sex on drugs. It will also identify opportunities for improving sexual and reproductive health promotion and care delivery so that they better align with the needs of this group.

RQs are from the funding app:

• To explore perceptions and experiences of harm reduction and sexual health in relation to the use of drugs in combination with sex among cisgender women and heterosexual men, especially approaches to STI and BBV testing (e.g., frequency of testing, locating and accessing testing services).
• To investigate how STI and BBV infection, testing, and prevention is understood by women and heterosexual men who use drugs in combination with sex as part of their overall sexual and reproductive health risks and care needs.
• To explore how women and heterosexual men who use drugs in combination with sex understand their practices of drug use (e.g., as social and/or sexual practices) and what they look for in health services, including testing and general healthcare services.
• To generate insights into the potential role of sociality and sexual networks in notifiable STI prevention and intervention strategies among women and heterosexual men who use drugs in combination with sex (e.g., acceptability of partner notification).

Investigators: Dr. Philippe Adam, Professor John de Wit

The National Debrief Survey is a long-running national survey monitoring sexual health among young adults aged 18–29 years in Australia. Debrief provides information on young people's STI-related knowledge, attitudes and behaviours, including sexual activity, condom use and STI testing, and helps identify emerging sexual health promotion and service needs.

Debrief NSW uses data from NSW participants in the 2025 National Debrief Survey, together with data from previous surveys conducted since 2018, to monitor sexual health among young adults at the jurisdiction level. It describes current sexual health behaviours and needs and examines changes over time in sexual behaviours and norms, condom use, STI testing and other key indicators. A particular focus is on the longer-term impact of the COVID-19 pandemic on sexual behaviours and STI testing, and the extent to which these have returned towards pre-pandemic levels by 2025.

As the only Australian survey routinely monitoring STI-related knowledge, attitudes and behaviours among young adults, Debrief provides an important evidence base for sexual health policy and practice. Findings from Debrief NSW will help inform sexual health promotion, STI prevention, and the planning and delivery of appropriate sexual health services for young people in NSW.

Chief Investigator: Associate Professor Limin Mao

International students have limited sexual and reproductive health literacy, including knowledge about HIVSTI transmission and how to access sexual health services. In close collaboration with and supported by the NSW Play Safe Program’s International Student Consortium and its working group, a self-directed online learning module (OLM) is developed to improve international students’ sexual and reproductive health literacy in NSW. This preliminary evaluation will provide recommendations on changes to the OLM and develop an ongoing evaluation plan.

Investigators: Prof. Gregory Dore, Prof. Gail Matthews, Prof. Jason Grebely, Prof. Marianne Martinello, Prof. Behzad Hajarizadeh, Dr Heather Valerio, Dr Shane Tillakeratne, Ms Marion Barault

This project focuses on developing and validating indicators of engagement in clinical care for people living with chronic hepatitis B, using MBS-based service use data linked to a population-level hepatitis B (HBV) notifications cohort (as described above). The work defines measurable markers of ongoing care engagement (such as regularity of monitoring and specialist review) and applies these indicators to characterise patterns of care over time, including identification of individuals at risk of disengagement. The project also will investigate demographic, clinical, and health system factors associated with variation in care engagement, generating findings intended to inform targeted strategies for improving retention in care and reducing downstream risk of liver disease progression and hepatocellular carcinoma among people with chronic HBV.