For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.

ObjectiveTo estimate the rate of combination antiretroviral treatment change and factors associated with combination antiretroviral treatment change among patients recruited in the Australian HIV Observational Database (AHOD). MethodsAnalyses were based on patients in the AHOD who had commenced combination antiretroviral treatment after 1 January 1997. Combination antiretroviral treatment change was de®ned as the addition or change of at least one antiretroviral drug. A random-effect Poisson regression model was used to assess factors associated with increased rates of combination antiretroviral treatment change. ResultsA total of 596 patients in the AHOD were included in the analysis, with a median follow-up of 2.3 years. The overall rate of antiretroviral treatment change in this group was 0.45 combinations per year. In a multivariate analysis, a low CD4 count (, 200 cells/mL) at baseline was associated with an increased rate of treatment change [rate ratio (RR) 1.43; 95% con®dence interval (CI), 1.13, 1.80; P 0.003)]. Combinations including a nonnucleoside reverse transcriptase inhibitor were also associated with slower rates of change than treatment combinations including a protease inhibitor (RR 0.64, 95% CI, 0.51, 0.80, P , 0.001). ConclusionInitiating combination antiretroviral at a CD4 cell count , 200 cells/mL may be associated with poorer patient outcomes. However, the possibility that clinician or patient concerns about low immunological status led to faster rates of treatment change in this group cannot be discounted.

The sexual health service network suggests a moderate increase in chlamydia prevalence in young heterosexuals tested at sexual health services, in contrast to the steep increase shown by notifications. This highlights the caution needed in interpreting chlamydia trends without a corresponding testing denominator.

Testing rates were similar and positivity rates for Chlamydia trachomatis were higher in this sexual health service in Sydney than national trends.

The high and increasing chlamydia positivity rates highlight the need for enhanced prevention and screening programs for Indigenous people.