Background and Aim
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable yet costly conditions that cause significant morbidity and mortality among Aboriginal and Torres Strait Islander peoples and Māori and Pasifika peoples. In the Metro South region of Queensland, Māori and Pasifika communities represent a significant proportion of ARF and RHD diagnoses. Evidence suggests that treatment uptake among these patients is insufficient, however the reasons remain unclear.

This study sought to better understand enablers and barriers to treatment adherence among Māori and Pasifika populations. The aims were to: explore knowledge and beliefs regarding ARF and RHD diagnosis and treatment; identify factors that influence treatment uptake, both positively and negatively; and capture perspectives on how services could be improved.

Methods and Analysis
A prospective, exploratory qualitative design was employed using one-on-one semi-structured interviews. Eligible participants were identified through the Notifiable Conditions System (NoCS) with an ARF and/or RHD notification, self-identified as Māori and/or Pasifika, resided in Metro South, and had valid contact details. Randomly sampled participants were interviewed by a Pasifika researcher using the talanoa (conversational) method. Data were analysed thematically using an inductive approach.

Outcomes
Thirty-three interviews were conducted with 30 participants and their families, representing Pacific nations including Samoa, Tonga, Cook Islands, Fiji, Solomon Islands, Papua New Guinea, and Aotearoa New Zealand. Participants ranged in age from 11 to 76 years (median 35); 15 were male and 15 female. Thematic analysis of data is ongoing. Preliminary analysis highlights ongoing disparities in the way some people experience healthcare, limited cultural understanding among providers, low health literacy, a need for greater awareness and education, and inconsistent clinical follow-up, particularly among mobile families.

Conclusion and future actions
Māori and Pasifika communities expressed strong engagement and a desire to co-design strategies to improve awareness, understanding, and clinical care for ARF and RHD in Metro South.

Background and aim
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable conditions caused by group A Streptococcal infection and driven by social determinants of health. Despite this, they continue to disproportionately affect Aboriginal and Torres Strait Islander people, particularly in the Northern Territory (NT), which carries 39% of Australia’s RHD burden. Disease prevalence is likely underestimated, and targeted screening programs are recommended to support early diagnosis and management. The Deadly Heart Trek (DHT) is a community-led initiative designed to improve early detection and prevention of ARF and RHD in high-burden, remote communities.

Methods and analysis
In August 2025, during the 5th Annual DHT, a multidisciplinary team including First Nations cultural guides, visited 12 communities across the Katherine and Big River Region of the NT over two weeks. Echocardiographic screening and skin assessments were conducted in school-aged children, alongside community education. Screening outcomes were analysed to determine RHD prevalence and associated skin infection rates.

Outcomes
A total of 816 children were screened, 92% identifying as Aboriginal. Echocardiography identified 741 (90.8%) normal studies, 27 (3.3%) newly diagnosed RHD cases, and 15 (1.8%) previously known cases. All 42 RHD cases occurred in Aboriginal children, representing an overall prevalence of 5.1% and 5.6% among Aboriginal children—substantially exceeding the World Heart Federation high-burden threshold of 0.2%. A variety of skin infections were present in approximately one third of children assessed.

Conclusions and future outcomes
The high prevalence of undiagnosed RHD and skin infections demonstrates an extremely high endemic burden and supports continued targeted echocardiographic screening in high-risk communities. Community-led, culturally grounded models such as DHT align with current guidelines and are essential for early detection and continuity of care. Sustained investment and strategic action are critical to improving outcomes for individuals, families and communities affected by RHD and ARF.

Background and Aim
Tuberculosis (TB) incidence in Aboriginal and Torres Strait Islander peoples is low by global standards, but higher than in the Australian-born non-Indigenous population. Australia’s Strategic Plan for Control of Tuberculosis in Australia has recognised that an in-depth analysis of TB in Aboriginal and Torres Strait Islander peoples is an important step for TB management.

We aimed to conduct a long-term national analysis to understand the epidemiology of TB among Aboriginal and Torres Strait Islander peoples including disease distribution, drug resistance, and treatment outcomes.

Methods and Analysis
TB is a notifiable disease in Australia. We analysed TB notifications from the National Notifiable Diseases Surveillance System from 2002 to 2024. We conducted descriptive epidemiological analysis, including incidence rate calculations, using RStudio.

Outcomes
From 2002 to 2024, there were 799 notifications of TB among Aboriginal and Torres Strait Islander peoples. Incidence was highest in 2003 at 9.5 per 100,000 and lowest in 2019 at 3.0 per 100,000 with visual evidence of declining incidence. The mean annual incidence was 4.5 per 100,000 (95% CI: 4.0 – 5.3). In 2024, there were 41 notifications of TB (3.7 per 100,000). Among Aboriginal and Torres Strait Islander peoples with TB, 47.7% (381/799) resided in a remote or very remote area. First-line drug resistance was detected in 4.4% (35/799) of notifications, and 1.1% (9/799) were multidrug-resistant. No pre-extensively or extensively drug-resistant TB was detected. Of those with available HIV-1 test results, 1% (6/620) were HIV-1 positive. Most people (72.1%, 576/799) were cured or completed treatment and 4.3% (34/799) died of TB.

Conclusions and Future Actions
Understanding the long-term epidemiology of TB in Aboriginal and Torres Strait Islander peoples is a critical step to inform TB programs and policies. Future actions should include Indigenous-led design of activities aimed at managing TB with input from communities.

Aboriginal Governance Structures
This project was developed in partnership with Aboriginal and Torres Strait Islander people and organisations. The Project Analysis Team includes a Gomeroi woman and epidemiologist. The Project Governance Group, which includes 6 Aboriginal members, provides ongoing guidance on project design, analysis, outputs, and communication of outputs. The National Aboriginal Community Controlled Health Organisation (NACCHO) supported the project proposal and will review final outputs, and the NACCHO medical advisor provides feedback through the Project Governance Group and technical reference subgroup. The Project Governance Group will be invited to be authors on resulting papers. The National Aboriginal and Torres Strait Islander Health Protection sub-committee of the Australian Health Protection Committee has endorsed the project proposal and will review the final project. Research ethics approval includes approval from the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Research Ethics Committee and the South Australia Aboriginal Health Research Ethics Committee.

The National Tuberculosis Advisory Committee (NTAC) is providing oversight of the project, including technical advice from a TB technical reference subgroup who will be invited to be authors on resulting papers. The Australian Centre for Disease Control acts as a data custodian and data steward of tuberculosis notification data reported to the National Notifiable Diseases Surveillance System. Release of NNDSS data for the project was approved (data request 581/2024).

Background and Aim:
Australia’s tuberculosis (TB) incidence is low; however, the burden is disproportionate across different areas and population groups. Aboriginal people in remote regions of the Northern Territory face a higher burden of disease. Geographic isolation, limited diagnostic infrastructure, and historical inequities contribute to ongoing transmission and delayed prevention. We aimed to strengthen TB models of care in remote Aboriginal communities through collaboration, community partnership, lived-experience insights, and improved clinical data systems.

Methods:
A collaboration was formed between the jurisdictional TB program, Aboriginal Health Services and a research institute. Using a mixed-methods, implementation research approach, we developed a model for enhanced TB prevention and care in remote Aboriginal communities. Qualitative lived-experience interviews explored how TB is understood, experienced, and navigated in community. Primary care clinical information systems were adapted to systematically record an individually assigned TB status, using data from multiple electronic and paper systems. Consultation with community and health service stakeholders was undertaken through Yarning and workshops. Findings were used iteratively to redesign service delivery.

Outcomes:
Lived-experience conversations revealed that TB is understood relationally, embedded within family, culture, and broader life contexts. Trust, time, repeated conversations, and the central role of Aboriginal Health Workers (AHWs) were critical. Clinical data demonstrated a substantial burden of untreated TB infection, overlapping risk factors, and low prior screening coverage. Community and health service feedback highlighted the potential of AHWs in enhancing TB care. These findings informed service redesign, which included upskilling AHWs, implementing newer short regimens for TB preventive treatment; rolling out ultra-portable chest X-ray for household outreach; and in-language TB resources.

Conclusion and Future actions:
Relational, community-grounded TB care is feasible and necessary in remote Australia. Priorities include expanding AHW training, in-language resources, and broader community-based screening to support prevention-focused, locally delivered TB care.

Background and aim:
Tuberculosis (TB) remains a significant public health challenge in Australia, disproportionately affecting Aboriginal and/or Torres Strait Islander communities. In 2024, the National Aboriginal and Torres Strait Islander Health Protection Subcommittee (NATSIHP) and the National Tuberculosis Advisory Committee (NTAC) established a partnership to address this inequity. The partnership aims to reorient the national TB response to better reflect Aboriginal and Torres Strait Islander People’s needs with the goal of reducing the burden of TB in Aboriginal and Torres Strait Islander People.

Methods and analysis:
A working group with representatives from NATSIHP and NTAC was established in 2025 to develop the National Guidance for the Prevention and Response to Tuberculosis in Aboriginal and/or Torres Strait Islander Communities (The Guidance). To ensure the Guidance was underpinned by strong Aboriginal and Torres Strait Islander Governance, Aboriginal and Torres Strait Islander health professionals and individuals with lived experience of TB led its development through their roles as members of the working group. Further to this, Aboriginal and Torres Strait Islander health leaders and community members from high TB prevalence regions contributed through surveys and interviews, ensuring the content reflected lived experience and community priorities. Cultural and technical experts provided feedback on drafts.

Outcomes: The Guidance provides advice to health professionals in Australia to enable timely, accessible, culturally safe and community-led approaches to TB prevention and response, with the ultimate goal of reducing the burden of TB in Aboriginal and Torres Strait Islander People. Key recommendations in the Guidance include culturally informed approaches to contact tracing and clearer indications for BCG vaccination in children. Patient-centred management and treatment adherence support is emphasised over Directly Observed Therapy to foster trust and reduce stigma.

Conclusion and future action: Achieving TB health equity for Aboriginal and Torres Strait Islander people requires urgent action and sustained collaboration between health professionals, policy makers and communities. It is essential that Aboriginal and Torres Strait Islander people and community controlled organisations are involved in all TB responses affecting Aboriginal and Torres Strait Islander communities, and wherever possible lead and deliver initiatives.

Background
In 2025 an early childhood education and care (ECEC) worker was diagnosed with smear-positive cavitary pulmonary tuberculosis (TB). They had migrated to Australia several years earlier from a high-burden TB country, with immigration screening chest X-ray clear at that time.

They reported symptoms for three months prior to diagnosis. Due to cavities and smear-positivity, the infectious period was defined as seven months pre-diagnosis. In this period, they worked across all classes of an ECEC centre attended by children aged 10 months to 5 years.

Methods
There were 117 high-risk contacts at the centre (89 children, 28 staff). Eight previously-enrolled children and 7 former staff were followed up separately.

Screening was conducted at on-site clinics, at baseline and ‘break-of-contact' (2 and 10 weeks after last exposure). Screening included symptom assessment and TB infection (TBI) testing, using tuberculin skin test (TST) for children, and TST or IGRA (interferon-gamma release assay) for staff.

All children were offered window prophylaxis with rifampicin or isoniazid, dispensed on site.

Communication with parents was via online information sessions and written materials.

Outcomes
All 117 contacts at the centre completed screening. No TB disease was identified.

At baseline, 1 child had a positive TST with negative IGRA, and was treated for TBI. One staff member had a positive IGRA, and was born in a high-burden TB country.

At break-of-contact screening, 3 baseline-negative staff contacts tested IGRA-positive, indicating recent TBI (11% of 27 screened staff). No child was positive.

Additionally, 6/8 previously-enrolled children and 3/7 former staff completed one-off screening (all negative for TBI).

Window prophylaxis was dispensed to 86/89 (97%) children, with high reported adherence.

Conclusions
On-site TB screening and provision of window prophylaxis achieved high uptake. There was evidence of TB transmission to three staff contacts and possibly one child.

Including ECEC workers in immigration TBI screening may prevent similar exposures.