Decentralised COVID-19 molecular point-of-care testing: lessons from implementing a primary care-based network in remote Australian communities

The First Nations COVID-19 molecular Point of Care (POC) Testing Program was initiated as part of the Australian pandemic response, aiming to ensure equitable access to testing, minimise delays in molecular-based diagnosis, inform rapid patient clinical management and public health responses for remote communities. The Program was scaled up quickly and implemented at 105 rural and remote primary care services nationally, becoming the largest decentralised molecular POC testing network in the world.
•This Program was globally unique in its reach, implementation approach, and clinical and public health outcomes. This narrative draws directly on our experiences and evidence generated to provide key recommendations for future infectious disease pandemic preparedness and responses.
•Recommendations include: (i) governance led by First Nations People, (ii) extensive stakeholder and community consultation, (iii) well-supported POC testing workforce with flexible training options, access to a helpdesk and hotline to validate, interpret and act on test results and maintain quality and integration of POC testing in primary care, (iv) guidelines for clinicians to prioritise molecular POC testing in the context of constrained resources, (v) adaptation of quality management and risk mitigation strategies to respond to changing epidemiology, (vi) complementing existing and evolving laboratory infrastructure to maximise testing coverage and reach, (vii) enabling comprehensive real-time connectivity to meet stakeholder needs, and finally (viii) ensuring a strong interface with clinicians and public health systems for test results to initiate rapid responses and for the program to adapt to changing pandemic landscape.