Abstract
Background To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care(POC) testing for chlamydia(CT), gonorrhoea(NG) and trichomonas(TV) was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality of POC testing delivered through this national program.
Methods We evaluated (i)implementation by measuring trends in mean monthly POC testing; ii)clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii)analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests.
Findings Between 2016-2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years(p<0·0001). A greater proportion of CT/NG positives were treated in intervention compared with historical control periods (< 2days:0·37 vs 0·22 [RR 1·68; 95%CI 1·12, 2·53]; <7days:0·48 vs 0·30 [RR 1·6; 95%CI 1·10, 2·33]; <120 days:0·79 vs 0·54 [RR 1·46; 95%CI 1·10, 1·95]);
similarly for TV positives and by test type. POC testing for CT/NG and TV averted 10,680 and 7,075 infectious days, respectively. Results concordance was high [99·0%(CT), 99·3%(NG) and 98·9%(TV)]; unsuccessful POC test proportion was 1·8% for CT/NG and 2·1% for TV.
Interpretation Molecular POC testing was successfully integrated into primary care settings as part of a routinely implemented program achieving significant clinical benefits with high analytical quality. In addition to the individual health benefits of earlier treatment, fewer infective days could contribute to reduced transmissions in First Nations communities.
Methods We evaluated (i)implementation by measuring trends in mean monthly POC testing; ii)clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii)analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests.
Findings Between 2016-2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years(p<0·0001). A greater proportion of CT/NG positives were treated in intervention compared with historical control periods (< 2days:0·37 vs 0·22 [RR 1·68; 95%CI 1·12, 2·53]; <7days:0·48 vs 0·30 [RR 1·6; 95%CI 1·10, 2·33]; <120 days:0·79 vs 0·54 [RR 1·46; 95%CI 1·10, 1·95]);
similarly for TV positives and by test type. POC testing for CT/NG and TV averted 10,680 and 7,075 infectious days, respectively. Results concordance was high [99·0%(CT), 99·3%(NG) and 98·9%(TV)]; unsuccessful POC test proportion was 1·8% for CT/NG and 2·1% for TV.
Interpretation Molecular POC testing was successfully integrated into primary care settings as part of a routinely implemented program achieving significant clinical benefits with high analytical quality. In addition to the individual health benefits of earlier treatment, fewer infective days could contribute to reduced transmissions in First Nations communities.
| Original language | English |
|---|---|
| Publisher | SSRN |
| Number of pages | 18 |
| DOIs | |
| Publication status | Submitted - 22 Dec 2023 |
Publication series
| Name | The Lancet Regional Health - Western Pacific |
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| Publisher | Elsevier Ltd. |
Keywords
- sexually transmitted infections
- clinical effectiveness
- remote primary care
- chlamydia
- gonorrhoea
- trichomoniasis
- POC testing
- scaling up