Impact of deploying multiple point-of-care tests with a 'sample first' approach on a sexual health clinical care pathway. A service evaluation.
To assess clinical service value of STI point-of-care test (POCT) use in a 'sample first' clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) forChlamydia trachomatis/Neisseria gonorrhoeae(CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation forTrichomonas vaginalis(TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment.



Service evaluation in a south London sexual health clinic. Symptomatic female and male patients and sexual contacts of CT/NG-positive individuals provided samples for diagnostic testing on clinic arrival, prior to clinical consultation. Tests included routine culture and microscopy; CT/NG (GeneXpert) NAAT; non-NAAT POCTs for TV and BV.



All 70 (35 males, 35 females) patients approached participated. The 'sample first' pathway was acceptable, with >90% reporting they were happy to give samples on arrival and receive results in the same visit. Non-NAAT POCT results were available for all patients prior to leaving clinic; rapid CT/NG results were available for only 21.4% (15/70; 5 males, 10 females) of patients prior to leaving clinic. Known negative CT/NG results led to two females avoiding presumptive treatment, and one male receiving treatment directed at possibleMycoplasma genitaliuminfection causing non-gonococcal urethritis. Non-NAAT POCTs detected more positives than routine microscopy (TV 3 vs 2; BV 24 vs 7), resulting in more patients receiving treatment.



A 'sample first' clinical pathway to enable multiple POCT use was acceptable to patients and feasible in a busy sexual health clinic, but rapid CT/NG processing time was too long to enable POCT use. There is need for further development to improve test processing times to enable POC use of rapid NAATs.
Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.|HIV/STI Department, National Infection Service, Public Health England, London, UK.
Emma M
0000-0002-1432-8109
EM
Harding-Esch
Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.|Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK.
Achyuta V
AV
Nori
Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK.
Aseel
A
Hegazi
Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.
Marcus J
MJ
Pond
Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK.
Olanike
O
Okolo
HIV/STI Department, National Infection Service, Public Health England, London, UK.
Anthony
A
Nardone
HIV/STI Department, National Infection Service, Public Health England, London, UK.
Catherine M
CM
Lowndes
Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.|Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK.
Phillip
P
Hay
Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.|Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK.
S Tariq
ST
Sadiq
D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002690:Chlamydia Infections / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D021141:Nucleic Acid Amplification Techniques; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D019095:Point-of-Care Systems / Q000458:organization & administration; D015397:Program Evaluation; D015203:Reproducibility of Results; D060728:Reproductive Health; D012725:Sexual Behavior; D014247:Trichomonas Vaginitis / Q000175:diagnosis*; D016585:Vaginosis, Bacterial / Q000175:diagnosis*
BACTERIAL INFECTION; CLINICAL STI CARE; DIAGNOSIS; SERVICE DELIVERY; TRICHOMONAS