title: "I Do Feel Like a Scientist at Times": A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting.
abstract: BACKGROUND
  Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia.
  
  
  METHODS
  In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis.
  
  
  RESULTS
  Most participants displayed positive attitudes, indicating the test was both easy to use and useful in their clinical context. Participants indicated that point-of-care testing had improved management of STIs, resulting in more timely and targeted treatment, earlier commencement of partner notification, and reduced follow up efforts associated with client recall. Staff expressed confidence in point-of-care test results and treating patients on this basis, and reported greater job satisfaction. While point-of-care testing did not negatively impact on client flow, several found the manual documentation processes time consuming, suggesting that improved electronic connectivity and test result transfer between the GeneXpert and patient management systems could overcome this. Managing positive test results in a shorter time frame was challenging for some but most found it satisfying to complete episodes of care more quickly.
  
  
  CONCLUSIONS
  In the context of a RCT, health professionals working in remote primary care in Australia found the GeneXpert highly acceptable. These findings have implications for use in other primary care settings around the world.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.|The Burnet Institute, Melbourne, VIC, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Natoli
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.affiliation: Flinders University International Centre for Point of-Care Testing, Flinders University, Adelaide, SA, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Shephard
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Causer
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Badman
authors.affiliation: Apunipima Cape York Health Council, Cairns, QLD, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Hengel
authors.affiliation: Ngaanyatjarra Health Service, Alice Springs, NT, Australia.
authors.forename: Annie
authors.initials: A
authors.lastname: Tangey
authors.affiliation: South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Coburn
authors.affiliation: The Burnet Institute, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy / Q000635:transmission; D017281:Cost of Illness; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007588:Job Satisfaction; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D011209:Power, Psychological; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D013048:Specimen Handling; D013997:Time Factors; D019564:Unnecessary Procedures