Decentralised point-of-care testing for acute, chronic and infectious disease: benefits and challenges

The COVID-19 pandemic has reinforced Australia’s need for diagnostic testing frameworks that are well-prepared, well-resourced, responsive, appropriately governed, scalable, interdisciplinary and collaborative [1]. Point-of-care (POC) technologies offer diagnostic solutions capable of delivering individual, community and public health benefits in settings where: a) laboratory testing is not available, b) rapid turn-around time is needed, c) high loss to follow-up occurs in high-risk populations with standard of care cascades and/or d) disease transmission rates exceed laboratory response capacity.

Key translational research derived from collaborative point-of-care testing networks for a) diabetes management (238 remote health services; 3,233 operators; 172,069 HbA1c and 51,379 urine albumin:creatinine ratio tests), b) acute care (106 remote health services; 2,279 operators; 32,950 blood gas, 32,689 cardiac troponin, 46,418 urea/electrolytes, 48,193 international normalised ratio tests), c) hepatitis C virus (HCV) (41 sites; 110 operators; 5,733 HCV tests; 4,978 RNA, 755 antibody), d) syphilis screening (156 sites; 1,412 operators), e) chlamydia, gonorrhea or trichomonas (51 sites; 795 operators; >50,000 tests) or f) COVID-19 (101 remote health services, 733 operators, 72,624 tests) will be used to highlight operational, clinical, public health, and economic benefits of POC testing. Challenges associated with scale-up and accreditation pathways for decentralised POC testing will be discussed.