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De La Cruz-Ramirez YM, Olaza-Maguiña AF, Cortez-Orellana SA. Limitations for the management of sexually transmitted infections in Peruvian indigenous pregnant women: Perspectives of midwives. Int J Gynaecol Obstet 2024. [PMID: 38800884 DOI: 10.1002/ijgo.15712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/16/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
SynopsisThere are cultural and institutional limitations for the management of sexually transmitted infections in Peruvian indigenous pregnant women, highlighting the myths and lack of biomedical tools.
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Lafferty L, Beadman M, Ward J, Flynn E, Hosseini-Hooshyar S, Martinello M, Treloar C. Patient and healthcare provider perceptions of acceptability of fingerstick point-of-care hepatitis C testing at Aboriginal Community Controlled Health Services in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 125:104335. [PMID: 38342050 DOI: 10.1016/j.drugpo.2024.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/13/2023] [Accepted: 01/21/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Hepatitis C (HCV) is highly prevalent in First Nations communities globally. Barriers in the uptake of testing and treatment create challenges to realise elimination of HCV in these communities. In efforts to reduce barriers to testing and treatment, the SCALE-C study implemented an HCV test-and-treat intervention integrating point-of-care HCV testing and FibroScan®. SCALE-C was carried out at four Aboriginal Community Controlled Health Services (ACCHS; renowned for providing culturally safe care) in four regional towns in Australia. This qualitative analysis sought to understand healthcare provider and patient perceptions of acceptability of a community-based HCV test-and-treat intervention within ACCHS. METHODS Semi-structured interviews were undertaken with 23 patient participants and 14 healthcare personnel (including Aboriginal Health Workers/Practitioners, nurses, general practitioners, and practice managers) from across the four ACCHS involved in SCALE-C. A coding framework was developed among study authors and informed by Sekhon's Theoretical Framework of Acceptability. RESULTS The SCALE-C intervention enabled opportunities for healthcare providers to listen to patients, and for patients to feel heard (affective attitude). HCV testing was opportunistic and often occurred outside of the allocated SCALE-C clinical hours (burden). For patients, HCV testing within SCALE-C was viewed as a moral responsibility and ensured protection of self and others (ethicality). For personnel, SCALE-C (including following up visits) was regarded as an opportunity to engage with patients especially those with complex health needs which may be unrelated to HCV risk factors (ethicality). Patients and personnel widely regarded the SCALE-C intervention to be effective, and the test-and-treat model was preferable for both patients and personnel. CONCLUSION The SCALE-C intervention was broadly perceived to be acceptable among both healthcare providers and patients within ACCHS. Whilst the prioritisation of HCV was viewed as increasing patient engagement, it was also regarded as an opportunity for addressing other healthcare needs within Aboriginal communities. HCV test-and-treat models of care delivered by ACCHS simplify the HCV care pathway and ensure all HCV care is provided in a culturally safe setting (e.g., patients did not need to attend external services such as pathology).
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia.
| | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - Erin Flynn
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia; Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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Shephard M, Matthews S, Andrewartha K, Dimech W, Cabuang L, Barbara C, Chen XS, Cordioli M, Hançali A, Jiang TT, Kularatne R, Meli S, Muller E, Oumzil H, Padovese V, Sandri A, Vargas S, Zahra G, Unemo M, Blondeel K, Toskin I. Quality control and external quality assessment for the independent clinic-based evaluation of point-of-care testing to detect Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in eight countries. BMC Infect Dis 2024; 24:203. [PMID: 38418947 PMCID: PMC10902926 DOI: 10.1186/s12879-024-09057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Sexually transmitted infections caused by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) remain significant global health problems. The World Health Organization (WHO) has recently conducted a multi-faceted, multi-country validation study (ProSPeRo), which included an evaluation of the Xpert CT/NG and Xpert TV assays on the GeneXpert system (Cepheid, Sunnyvale, Ca., USA) in clinic-based settings across eight countries. To support the study, a training and quality management system was implemented and evaluated. METHODS A comprehensive training program for the study was developed. Quality control (QC) and external quality assessment (EQA) samples were provided by an accredited quality assurance provider. QC testing was conducted at 14 point-of-care testing (POCT) clinics, while EQA samples were tested by the POCT sites and a reference laboratory supporting each clinic. RESULTS For QC testing, concordance with the expected results for CT and NG was > 99% and rates of unsuccessful tests were < 4%. For TV testing, concordance was similar (97%), but rates of unsuccessful tests were high (18%), particularly in the 'TV negative' sample. For EQA testing initially conducted in 2018, concordance was 100% for CT and NG, and 90% for TV for the reference laboratory group (which used non-GeneXpert systems). Concordance for the POCT group was also high (> 94%) for all analytes, but this cohort (which used GeneXpert systems) exhibited a high rate of unsuccessful TV tests. All but one of these unsuccessful tests was subcategorised as 'invalid'. CONCLUSIONS The high level of concordance for QC and EQA testing confirm that the trained operators at the POC clinical sites were competent to conduct POC testing and that the training and quality systems implemented for the ProSPeRo study were effective. The quality materials used were satisfactory for CT and NG but exhibited poor performance for TV testing on the GeneXpert system. The WHO should continue to work with industry and EQA providers to provide improved materials that are reliable, stable and cost effective for quality management, as it seeks to rollout molecular-based STI POCT in non-laboratory-based settings. TRIAL REGISTRATION Ethics approval to conduct the ProSPeRo study was granted by the WHO Ethics Review Committee.
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Affiliation(s)
- Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia.
| | - Susan Matthews
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Kelly Andrewartha
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, South Australia, Australia
| | - Wayne Dimech
- National Serology Reference Laboratory, Australia, Fitzroy, Victoria, Australia
| | - Liza Cabuang
- National Serology Reference Laboratory, Australia, Fitzroy, Victoria, Australia
| | | | - Xiang-Sheng Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, National Center for STD Control, Nanjing, China
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Amina Hançali
- STIs Laboratory, Department of Bacteriology, Institut National d'Hygiene, Ministry of Health- Morocco, Rabat, Morocco
| | - Ting-Ting Jiang
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, National Center for STD Control, Nanjing, China
| | - Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Stephanie Meli
- Point-of-Care Testing Committee, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Etienne Muller
- Centre for HIV & STI, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Hicham Oumzil
- Pedagogy and Research Unit of Microbiology, Faculty of Medicine and Pharmacy, Mohammed V University -Rabat, Virology Department, Institut National d'Hygiène MoH, Rabat, Morocco
| | - Valeska Padovese
- Genito-Urinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - Angela Sandri
- Department of Diagnosis and Public Health, Section of Microbiology, University of Verona, Verona, Italy
| | - Silver Vargas
- Centro de Investigación Interdisciplinaria en Sexualidad SIDA y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Graziella Zahra
- Molecular Diagnostics Infectious Diseases, Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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de Vos L, Daniels J, Gebengu A, Mazzola L, Gleeson B, Blümel B, Piton J, Mdingi M, Gigi RMS, Ferreyra C, Klausner JD, Peters RPH. Implementation considerations for a point-of-care Neisseria gonorrhoeae rapid diagnostic test at primary healthcare level in South Africa: a qualitative study. BMC Health Serv Res 2024; 24:43. [PMID: 38195446 PMCID: PMC10777514 DOI: 10.1186/s12913-023-10478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. METHODS A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. RESULTS Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. CONCLUSIONS The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening.
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Affiliation(s)
- Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States of America.
| | - Avuyonke Gebengu
- Research Unit, Foundation for Professional Development, East London, South Africa
| | | | | | | | | | - Mandisa Mdingi
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Ranjana M S Gigi
- Research Unit, Foundation for Professional Development, East London, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
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Cama E, Beadman K, Beadman M, Walker M, Treloar C. Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework. Harm Reduct J 2023; 20:154. [PMID: 37864220 PMCID: PMC10588043 DOI: 10.1186/s12954-023-00889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance. METHODS Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program. RESULTS Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available. CONCLUSIONS The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
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Cama E, Beadman K, Beadman M, Smith KA, Christian J, Jackson AC, Tyson B, Anderson C, Smyth L, Heslop J, Gahan G, Tawil V, Sheaves F, Maher L, Page J, Tilley D, Ryan A, Grant K, Donovan B, Stevens A, Slattery T, Pearce K, John-Leader F, Walden A, Lenton J, Crowley M, Treloar C. Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program's 'cascade of care' across nine sites in New South Wales, Australia. Harm Reduct J 2023; 20:125. [PMID: 37670361 PMCID: PMC10478220 DOI: 10.1186/s12954-023-00850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the 'cascade of care' progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers. METHODS Routinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care. RESULTS Between 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients 'fall off' the cascade, underscoring the need to address any remaining barriers to care. CONCLUSIONS The DLM program shows promise in acting as a 'one stop shop' in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kerri-Anne Smith
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Mount Druitt, NSW, 2770, Australia
| | - Jade Christian
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Aunty Clair Jackson
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Beverley Tyson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Clayton Anderson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Larissa Smyth
- Byron Central Hospital, Mid North Coast and Northern NSW Local Health District, Byron Bay, NSW, 2481, Australia
| | - Jennifer Heslop
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Gary Gahan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, 1340, Australia
| | - Victor Tawil
- Centre for Population Health, Ministry of Health, Sydney, NSW, 2065, Australia
| | - Felicity Sheaves
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Louise Maher
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Julie Page
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Donna Tilley
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, NSW, 2150, Australia
| | - Ann Ryan
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kim Grant
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Annabelle Stevens
- Centre for Population Health, Ministry of Health, Sydney, NSW, 2065, Australia
| | - Trevor Slattery
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kate Pearce
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Mount Druitt, NSW, 2770, Australia
| | - Franklin John-Leader
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Andrew Walden
- Needle and Syringe Program, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Jo Lenton
- Broken Hill Community Centre, Far West Local Health District, Broken Hill, NSW, 2880, Australia
| | - Margaret Crowley
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Saha A, Andrewartha K, Badman SG, Tangey A, Smith KS, Sandler S, Ramsay S, Braund W, Manoj-Margison S, Matthews S, Shephard MDS, Guy R, Causer L. Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study. J Med Internet Res 2023; 25:e46701. [PMID: 37656506 PMCID: PMC10504621 DOI: 10.2196/46701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. OBJECTIVE The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. METHODS We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. RESULTS From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. CONCLUSIONS This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future.
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Affiliation(s)
- Amit Saha
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia
| | - Steven G Badman
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Annie Tangey
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Ngaanyatjarra Health Service, Western Australia, Australia
| | - Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sergio Sandler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stuart Ramsay
- Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia
| | - Wilton Braund
- Clinical Universe, Adelaide, Australia
- Flinders Medical Centre, Adelaide, Australia
| | | | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia
| | - Mark D S Shephard
- Flinders University International Centre for Point-of-Care Testing, Adelaide, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Louise Causer
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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