title: A randomised trial of point-of-care tests for chlamydia and gonorrhoea infections in remote Aboriginal communities: Test, Treat ANd GO- the "TTANGO" trial protocol.
abstract: BACKGROUND
  High prevalence rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been reported in Aboriginal people in remote and regional areas of Australia for well over two decades, and repeat positivity rates are high. To interrupt disease transmission and reduce the risk of complications, early diagnosis and treatment is important. However in many remote and regional areas there are long delays between testing for these curable sexually transmissible infections and providing treatment, due to both physical distance from laboratories and difficulties when recalling patients for subsequent management once results are available. Point-of-care (POC) tests have the potential to provide more timely diagnosis, to increase treatment and contact tracing, and in turn reduce CT and NG infection rates.
  
  
  METHODS
  TTANGO (Test, Treat, ANd GO) is a cross-over cluster randomised controlled trial in 12 regional or remote Australian health services, which predominantly provide clinical services to Aboriginal people. The overall aim of TTANGO is to measure the clinical effectiveness, cost-effectiveness and cultural and operational acceptability of molecular POC testing for CT and NG infection. The primary outcome is repeat positivity at three months after treatment of an initial CT or NG infection. Participating health services will undertake the clinical management of CT and NG under two different modalities for one year each. In the first year, six health services will be randomly assigned to manage these infections under current diagnostic guidelines. The other six will supplement current diagnostic guidelines with POC testing, whereby diagnosis is made and subsequent treatment for those with positive POC tests is offered at the initial consultation. In the second year, the health services will cross over to the opposite management modality. TTANGO will be conducted over four years; 1.5 years of trial initiation and community consultation, 2 years of trial conditions and evaluation, and 6 months of data analysis and feedback.
  
  
  CONCLUSIONS
  TTANGO is the first cluster randomised trial of POC testing for CT and NG internationally. The results of this trial will provide crucial information to guide sexual health clinical practice in remote Aboriginal communities and other high prevalence settings.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12613000808741.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.forename: Lisa
authors.initials: L
authors.lastname: Natoli
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.forename: Louise
authors.initials: L
authors.lastname: Causer
authors.forename: Belinda
authors.initials: B
authors.lastname: Hengel
authors.forename: David
authors.initials: D
authors.lastname: Whiley
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.forename: Steven B
authors.initials: SB
authors.lastname: Badman
authors.forename: Annie
authors.initials: A
authors.lastname: Tangey
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.forename: Mark
authors.initials: M
authors.lastname: Shephard
authors.forename: David G
authors.initials: DG
authors.lastname: Regan
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000208:ethnology / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D057210:Delayed Diagnosis; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000208:ethnology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D019095:Point-of-Care Systems / Q000191:economics / Q000458:organization & administration*; D015995:Prevalence; D012008:Recurrence