Global international migration rates continue to increase despite the COVID pandemic. Australia is very culturally diverse, with young people comprising a significant proportion of migrant and refugee women. Migrant and refugee women can encounter challenges in accessing and obtaining contraception and complex factors can influence their choice of contraception. This study aimed to explore young migrant and refugee women’s views and experiences of the contraceptive implant and investigate factors influencing their decision-making.

We interviewed 33 migrant and refugee women, aged 15-24 years, who live in NSW, Australia and speak a language other than English at home.

First generation migrant and refugee women had more knowledge of contraception options compared to women who emigrated to Australia as young adults. Many participants were able to balance the contradictory messaging between their own cultural/religious backgrounds and mainstream Australian ideas concerning contraception and made contraception choices independent of their families despite a reported stigma within their culture/religion regarding contraception and sex. Most participants sought out contraception experiences from close friends and social media platforms to guide their decision-making. Additionally, doctors from a different cultural background to their own, or sexual health clinics, were preferred when accessing contraception services.

In terms of views regarding the implant itself, participants generally regarded the use of the implant as convenient, cost-effective, and confidential. However, the side effect of irregular cycles/bleeding were seen as a barrier for daily activities. However, most participating women viewed this as acceptable if only temporary. Implant insertion was viewed as a less invasive, and therefore preferable, procedure than an intrauterine device insertion. Most participants would recommend the implant to peers.

We anticipate this presentation will encourage primary healthcare providers to challenge their perceptions of migrant and refugee women’s contraception needs and to identify opportunities to support women in making informed contraception choices.

• Better understand the complex needs and experiences of migrant and refugee women regarding contraception choice and access, particularly relating to the contraceptive implant
• Identify strategies to strengthen contraception counselling, resourcing and messaging for young migrant and refugee women to facilitate contraception choice and decision-making.
• Reflect on own experiences and consider opportunities to better support young women seeking contraceptive care

After COVID-19 arrived in New Zealand, a national system was developed to improve contact tracing. The first outbreak was followed by a period of ‘COVID-19 elimination’, until a community outbreak occurred in August 2020. Pacific community primary healthcare providers stepped up to provide outreach services across all phases of the pandemic response.

Methods
We worked with a multiethnic Pacific advisory group of community leaders and providers who provided guidance on context and the services provided by community PHC providers.
We describe the characteristics of cases and their contacts, focused on the results of contact tracing. . Demographic and clinical characteristics of cases, number of contacts, and timeliness of contact tracing were analysed by ethnicity.

Findings
Most of the 179 cases were Pacific peoples (59%) or Māori (25%), living in areas of high socioeconomic deprivation, who had higher rates of comorbidity and accounted for almost all (21/22) hospitalisations, all 8 ICU admissions and all 3 deaths. 6% belonged to the European majority ethnic group.

Of 2,528 registered contacts, 46% were Pacific, 14% Māori and 19% European. Overall, 41% of contacts were reached within 4 days of onset of disease of the case, which was significantly lower for Pacific 31%) than for other ethnic groups.

Our findings confirm the greater health burden that ethnic minorities faced from COVID-19 in NZ. The significant delay in the timeliness of care for Pacific shows that the public health response was inequitable for those at highest risk.

Tailored public health responses and better registration of marginalised groups are necessary to provide better access to services and to improve insights for optimal future outbreak management. Learning from this project about involving Pacific communities in the preparedness phase of Pandemic and Infectious Diseases Planning is important for achieving equity in the New Zealand Health System Reforms.

1. ‘One-size fits all’ outbreak responses does not meet the needs of ethnic minorities, who are known to be more at risk of infectious disease outbreaks and pandemics.
2. Pacific community primary health care providers played an essential role in addressing the needs of communities through out the different stages of the pandemic during testing, supporting outreach, access to welfare support and promotion and delivery of vaccinations
3. Lessons from the Pandemic Response can be applied to health system reforms to address institutional racism that leads to long standing disparities in health outcomes due to infectious diseases.

Aim:
To encourage the use of safer medications for management of behaviours of concern for people with a developmental disability

Content:
Persons with intellectual and developmental disabilities are frequently have behaviours of concern for which they are prescribed multiple medications. Any medication that is prescribed with the primary purpose of behavioural control can be considered a form of chemical restraint. Victorian legislation and published evidence supports the importance of reviewing and rationalising medications of "chemical restraint". Rationalisation of medications is a frequent reason for referral to the Centre for Developmental Disability Health, which is a government funded clinic for the state of Victoria.

Pharmacological recommendations from CDDH:

1) Anti-psychotic medications and benzodiazepines should not be the predominant medication. Effectiveness is limited and side-effects of weight gain may increase challenges and risks for both the patient and the carer.

2) SSRIs (fluoxetine, sertraline) should be considered. High doses may be required for anxiety and OCD, which are both common in ASD.

3) Mood stabilisers (lamotrigine, valproate) should be considered. Down-regulation of the limbic system gives a calming effect without sedation by reducing emotional dysregulation (melt-downs)

4) Clonidine can be used for almost all patients with behaviours of concern. It reduces catecholamine levels that cause mental inflexibility, and increased stimulus response associated with increased stress. It has a calming sedative effect, improves sleep quality (reduced REM sleep) and has an analgesic effect. Although an "off-licence" use, it is considered extremely safe (monitor for orthostatic hypotension).

Goals:
To consider the importance of medication review for patients with developmental disabilities

To increase confidence in making evidence-based medication changes for patients with developmental disabilities in primary care

In people with intellectual and developmental disabilities:
1. Consider avoiding or reducing anti-psychotic medications and benzodiazepines as a treatment strategy for behavioural issues
2. Consider mood stabiliser medications (lamotrigine, valproate) to treat emotional dysregulation; and SSRIs (fluoxetine, sertraline) to treat anxiety and OCD - these often are the trigger for behaviours of concern
3. Consider commencing clonidine - reduced catecholamine activity; calms and helps sleep; lessens mental inflexibility; safe, effective, well-tolerated

Background: There is currently no agreement on what constitutes high-quality primary health care (PHC) in Australia.The Quality, Equity and Systems Transformation in Primary Health Care (QUEST PHC) project has developed a suite of 79 evidence-based indicators and corresponding 128 measures of high-quality general practice to address this gap. Consultations were conducted to establish the content validity of the indicators and measures in different healthcare settings including the prison health sector.

Aim: To canvas views of PHC clinicians and staff working in Australian prisons on the use of the QUEST PHC suite.

Methods: One focus group and one interview were conducted online with five participants from three states. Participants were asked about their views of the high-quality healthcare measures relevant to justice health, and the possible use of the QUEST PHC suite in justice health. Data were analysed thematically using a mixed inductive-deductive approach.

Key findings: Four themes emerged: (1) ‘current PHC in justice health’ noted the differences in PHC delivery across prisons in different states, constraints of the prison system and the high proportion of Indigenous inmates; (2) ‘measuring quality within justice health’ described the complex prison environment impacting quality measurements, quality of existing indicators and the need to incorporate Indigenous cultural perspectives into quality measurements; (3) ‘QUEST indicators for justice health’ talked about the relevance of the indicators in justice health and missing indicators specific to justice health; (4) ‘recommendations for measuring quality in justice health’ included benchmarking across states, developing efficient coding systems, integrating into existing workflow, and improving staff training.

Discussion: Although quality indicators are important and needed in Australian prisons, there are many challenges to implementing a universal tool in a diverse system. Potential application of QUEST PHC in Australian prisons should include indicators unique to that setting and strategies to overcome barriers to implementation.

1. Understanding of the importance of measuring quality of care in Australian prisons.
2. The potential application of indicators and measures of high-quality care.
3. The potential use of the QUEST PHC indicators and measures in Australian justice health.