A promise made more than 25 years ago has culminated in CQUniversity research that could help transform Australia's response to one of its most neglected tropical diseases.

After the death of a respected Aboriginal health worker and community leader from disseminated strongyloidiasis in 1999, her grieving sister urged Dr Wendy Page Mastin to "let not her death be in vain" - words that would fuel decades of advocacy, clinical practice and research aimed at reducing the burden of the disease in remote Indigenous communities.

Now, that commitment has culminated in a PhD for the CQUniversity researcher and medical practitioner.

The 2021 Northern Territory Australian of the Year has completed her doctoral research at CQUniversity, addressing misconceptions and producing evidence that strongyloidiasis, a preventable and treatable chronic infectious disease, can be significantly reduced through a sustainable primary healthcare approach.

Her thesis, Towards a National Strongyloidiasis Control Program: Closing the Gap on Strongyloidiasis in Endemic Indigenous Communities in Australia, found that integrating strongyloidiasis testing into routine Indigenous adult preventative health assessments reduced prevalence from 44 per cent to less than 10 per cent across four Aboriginal community-controlled health services in north-east Arnhem Land. Testing coverage reached 84 per cent of the resident adult population.

Strongyloidiasis is caused by the microscopic parasite Strongyloides stercoralis. Despite being preventable and treatable if diagnosed early, it remains endemic in many remote Indigenous communities in northern Australia and can lead to life-threatening complications.

Unlike other intestinal worms, Strongyloides stercoralis has a unique autoinfective life cycle. The parthenogenetic parasitic female does not need a male, and her embryonated eggs hatch quickly into rhabditiform (baby) larvae, which have an internal or external pathway. The internal pathway involves the autoinfective filariform (teenage) larvae re-entering the host, thereby enabling a lifelong infection. This ongoing autoinfective lifecycle can be accelerated decades after the initial infection, a condition referred to as hyperinfection or disseminated strongyloidiasis, and can be precipitated by immunosuppressants such as corticosteroids, with a high fatality rate if undiagnosed.

"People don't necessarily die with a diagnosis of strongyloidiasis," Dr Page Mastin said.

"They may die from septicaemia, haemoptysis, meningitis or multiple organ failure. If clinicians aren't thinking about strongyloides, they may never identify the underlying cause. If you don't look, you won't find."

For Dr Page Mastin, the research was driven not only by the science, but also by the people and communities affected.

"In 1999, a senior Aboriginal health worker who was my age became unwell and later died from disseminated strongyloidiasis in Adelaide", she said.

"For me, that was the evidence that strongyloides really does kill. It was a huge loss for community, for me personally and for those of us at Miwatj Health Aboriginal Corporation."

The following year, while attending a public health course, Dr Page Mastin sat beside the woman's sister and explained the efforts underway to improve testing and treatment.

"She said to me, 'Let her death not be in vain'. Those words sit on my shoulders and have been a driving force behind my research and advocacy."

CQUniversity supervisor Professor Jenni Judd said the research demonstrated the power of community-driven, practice-based evidence.

"Dr Wendy Page Mastin's work is an outstanding example of research translating directly into improved health outcomes for communities," Professor Judd said.

"What makes this research particularly significant is that it demonstrates a practical, sustainable solution that can be embedded within existing primary healthcare systems.

"Wendy has combined decades of clinical experience, community partnership and academic rigour to produce evidence that strongyloidiasis control is both achievable and sustainable. Her findings provide an important roadmap for reducing the burden of this neglected disease and closing the gap for Indigenous Australians."

The research also supports calls for strongyloidiasis to be included on Australia's National Notifiable Disease List.

"We would like to see strongyloidiasis made notifiable so we can identify hotspots and where One Health strategies are needed," Dr Page Mastin said.

"If we can make a difference in those hotspots, we're not only making a difference for Strongyloides but for a range of other health conditions as well."

Strongyloidiasis currently affects an estimated 614 million people globally and has been recognised by the World Health Organization as a neglected tropical disease targeted for elimination by 2030.

Dr Page Mastin said she would continue her advocacy through Strongyloides Australasia.

"My passion is still very much our commitment to closing the gap on strongyloidiasis as soon as we can," she said.

"By 2030, we can do it and end the neglect."

Dr Page received her doctorate at CQUniversity's Brisbane graduation ceremony on Friday,14 August.