Public health implications of molecular point-of-care testing for chlamydia and gonorrhoea in remote primary care services in Australia: a qualitative study.
OBJECTIVE
With accurate molecular tests now available for diagnosis of chlamydia and gonorrhoea (Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG)) at the point-of-care (POC), we aimed to explore the public health implications (benefits and barriers) of their integration into remote primary care in Australia.


METHODS
Qualitative interviews were conducted with a purposively selected group of 18 key informants reflecting sexual health, primary care, remote Aboriginal health and laboratory expertise.


RESULTS
Participants believed that POC testing may decrease community prevalence of sexually transmitted infections (STIs), and associated morbidity by reducing the time to treatment and infectious period and expediting partner notification. Also, POC testing could improve acceptability of STI testing, increase testing coverage and result in more targeted prescribing, thereby minimising the risk of antibiotic resistance. Conversely, some felt the immediacy of diagnosis could deter certain young people from being tested. Participants also noted that POC testing may reduce the completeness of communicable disease surveillance data given the current dependence on reporting from pathology laboratories. Others expressed concern about the need to maintain and improve the flow of NG antibiotic sensitivity data, already compromised by the shift to nucleic acid-based testing. This is particularly relevant to remote areas where culture viability is problematic.


CONCLUSIONS
Results indicate a high level of support from clinicians and public health practitioners for wider access to CT/NG POC tests citing potential benefits, including earlier, more accurate treatment decisions and reductions in ongoing transmission. However, the data also highlight the need for new systems to avoid adverse impact on disease surveillance.


BACKGROUND
Australian and New Zealand Clinical Trials Registry: ACTRN12613000808741.
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Burnet Institute, Melbourne, Victoria, Australia.
L
L
Natoli
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
R J
RJ
Guy
Flinders University International Centre for Point of-Care Testing, Flinders University, Adelaide, South Australia, Australia.
M
M
Shephard
Queensland Paediatric Infectious Diseases (QPID) Laboratory, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
D
D
Whiley
Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia.
S N
SN
Tabrizi
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
J
J
Ward
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
D G
DG
Regan
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
S G
SG
Badman
Burnet Institute, Melbourne, Victoria, Australia.
D A
DA
Anderson
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
J
J
Kaldor
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
L
L
Maher
D001291:Attitude of Health Personnel; D001315:Australia; D002689:Chlamydia; D002690:Chlamydia Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D006069:Gonorrhea / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008403:Mass Screening; D025202:Molecular Diagnostic Techniques; D009344:Neisseria gonorrhoeae; D000067716:Point-of-Care Testing; D015995:Prevalence; D011320:Primary Health Care; D011634:Public Health; D036301:Qualitative Research; D019035:Rural Health Services; D012424:Rural Population
INFECTIOUS DISEASES; PUBLIC HEALTH; QUALITATIVE RESEARCH