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Causer LM, Ward J, Smith K, Saha A, Andrewartha K, Wand H, Hengel B, Badman SG, Tangey A, Matthews S, Mak D, Gunathilake M, Moore E, Speers D, Persing D, Anderson D, Whiley D, Maher L, Regan D, Donovan B, Fairley C, Kaldor J, Shephard M, Guy R. Clinical effectiveness and analytical quality of a national point-of-care testing network for sexually transmitted infections integrated into rural and remote primary care clinics in Australia, 2016-2022: an observational program evaluation. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101110. [PMID: 38952441 PMCID: PMC11215331 DOI: 10.1016/j.lanwpc.2024.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 05/23/2024] [Indexed: 07/03/2024]
Abstract
Background To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care (POC) testing for chlamydia, gonorrhoea and trichomonas was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality of POC testing delivered through this national program. Methods We evaluated (i) implementation by measuring trends in mean monthly POC testing; ii) clinical effectiveness by comparing proportions of positive patients treated by historical control/intervention period and by test type, and calculated infectious days averted; (iii) analytical quality by calculating result concordance by test type, and proportion of unsuccessful POC tests. Findings Between 2016 and 2022, 46,153 POC tests were performed; an increasing mean monthly testing trend was observed in the first four years (p < 0.0001). A greater proportion of chlamydia/gonorrhoea positives were treated in intervention compared with historical control periods (≤2 days: 37% vs 22% [RR 1.68; 95% CI 1.12, 2.53]; ≤7 days: 48% vs 30% [RR 1.6; 95% CI 1.10, 2.33]; ≤120 days: 79% vs 54% [RR 1.46; 95% CI 1.10, 1.95]); similarly for trichomonas positives and by test type. POC testing for chlamydia, gonorrhoea and trichomonas averted 4930, 5620 and 7075 infectious days, respectively. Results concordance was high [99.0% (chlamydia), 99.3% (gonorrhoea) and 98.9% (trichomonas)]; unsuccessful POC test proportion was 1.8% for chlamydia/gonorrhoea and 2.1% for trichomonas. Interpretation Molecular POC testing was successfully integrated into primary care settings as part of a routinely implemented program achieving significant clinical benefits with high analytical quality. In addition to the individual health benefits of earlier treatment, fewer infective days could contribute to reduced transmissions in First Nations communities. Funding This work was supported by an Australian National Health and Medical Research Council Partnership Grant (APP1092503), the Australian Government Department of Health, Western Australia and Queensland Departments of Health.
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Affiliation(s)
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Queensland, Australia
| | - Kirsty Smith
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Amit Saha
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Belinda Hengel
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Steven G. Badman
- Kirby Institute, UNSW Sydney, New South Wales, Australia
- Cepheid, California, USA
| | - Annie Tangey
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Donna Mak
- WA Health, Western Australia, Australia
| | | | - Elizabeth Moore
- Aboriginal Medical Services Alliance of Northern Territory, Darwin, Northern Territory, Australia
| | | | | | | | - David Whiley
- Centre for Clinical Research, University of Queensland, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - David Regan
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | | | - John Kaldor
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Mark Shephard
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - TTANGO2 Collaboration
- Kirby Institute, UNSW Sydney, New South Wales, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Queensland, Australia
- Flinders University International Centre for Point of Care Testing, South Australia, Australia
- Cepheid, California, USA
- WA Health, Western Australia, Australia
- NT Health, Northern Territory, Australia
- Aboriginal Medical Services Alliance of Northern Territory, Darwin, Northern Territory, Australia
- PathWest, Western Australia, Australia
- Burnet Institute, Victoria, Australia
- Centre for Clinical Research, University of Queensland, Australia
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
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Matthews SJ, Miller K, Andrewartha K, Milic M, Byers D, Santosa P, Kaufer A, Smith K, Causer LM, Hengel B, Gow I, Applegate T, Rawlinson WD, Guy R, Shephard M. External Quality Assessment (EQA) for SARS-CoV-2 RNA Point-of-Care Testing in Primary Healthcare Services: Analytical Performance over Seven EQA Cycles. Diagnostics (Basel) 2024; 14:1106. [PMID: 38893633 PMCID: PMC11171734 DOI: 10.3390/diagnostics14111106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
In April 2020, the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care (POC) Testing Program was initiated to improve access to rapid molecular-based SARS-CoV-2 detection in First Nations communities. At capacity, the program reached 105 health services across Australia. An external review estimated the program contributed to averting between 23,000 and 122,000 COVID-19 infections within 40 days of the first infection in a remote community, equating to cost savings of between AU$337 million and AU$1.8 billion. Essential to the quality management of this program, a customised External Quality Assessment (EQA) program was developed with the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP). From July 2020 to May 2022, SARS-CoV-2 EQA participation ranged from 93 to 100%. Overall concordance of valid EQA results was high (98%), with improved performance following the first survey. These results are consistent with those reported by 12 Australian and 4 New Zealand laboratories for three SARS-CoV-2 RNA EQA surveys in March 2020, demonstrating that SARS-CoV-2 RNA POC testing in primary care settings can be performed to an equivalent laboratory analytical standard. More broadly, this study highlights the value of quality management practices in real-world testing environments and the benefits of ongoing EQA program participation.
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Affiliation(s)
- Susan J. Matthews
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, SA 5042, Australia; (K.M.); (K.A.); (M.M.); (M.S.)
| | - Kelcie Miller
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, SA 5042, Australia; (K.M.); (K.A.); (M.M.); (M.S.)
| | - Kelly Andrewartha
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, SA 5042, Australia; (K.M.); (K.A.); (M.M.); (M.S.)
| | - Melisa Milic
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, SA 5042, Australia; (K.M.); (K.A.); (M.M.); (M.S.)
| | - Deane Byers
- Royal College of Pathologists of Australasia Quality Assurance Programs, St. Leonards, NSW 2065, Australia; (D.B.); (P.S.); (A.K.)
| | - Peter Santosa
- Royal College of Pathologists of Australasia Quality Assurance Programs, St. Leonards, NSW 2065, Australia; (D.B.); (P.S.); (A.K.)
| | - Alexa Kaufer
- Royal College of Pathologists of Australasia Quality Assurance Programs, St. Leonards, NSW 2065, Australia; (D.B.); (P.S.); (A.K.)
| | - Kirsty Smith
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - Louise M. Causer
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - Belinda Hengel
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - Ineka Gow
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - Tanya Applegate
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - William D. Rawlinson
- Serology and Virology Division (SAViD), SEALS Microbiology, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
- School of Medical Science, University of NSW, Sydney, NSW 2052, Australia
- School of Clinical Medicine, University of NSW, Sydney, NSW 2052, Australia
- School of Biotechnology and Biomolecular Sciences, University of NSW, Sydney, NSW 2052, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia; (K.S.); (L.M.C.); (B.H.); (I.G.); (R.G.)
| | - Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Bedford Park, SA 5042, Australia; (K.M.); (K.A.); (M.M.); (M.S.)
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Grebely J, Matthews S, Causer LM, Feld JJ, Cunningham P, Dore GJ, Applegate TL. We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what? Expert Rev Mol Diagn 2024; 24:177-191. [PMID: 38173401 DOI: 10.1080/14737159.2023.2292645] [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: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a 'game-changer.' These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations. AREAS COVERED This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests). EXPERT OPINION It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Louise M Causer
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Philip Cunningham
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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Zhang H, Wang N, Zhang XY, Liu C, Zhang J. Establishment of a digital electrocardiogram telemonitoring system and remote consultation service. Technol Health Care 2024; 32:1847-1857. [PMID: 38007684 DOI: 10.3233/thc-230914] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND The use of telemonitoring electrocardiogram (ECG) improves the detection rate of various arrhythmias as it offers an extended recording time and does not impose activity restrictions. However, many community hospitals lack the resources to conduct this test due to a lack of cardiac function specialists and antiquated screening equipment. OBJECTIVE To establish a digital ECG telemonitoring system and remote consultation service between tertiary hospitals and community medical service stations to improve diagnosis and treatment effectiveness. METHODS We used the PI ECG telemonitoring data acquisition system, with a personal digital assistant (PDA) or computer serving as the platform for ECG acquisition, storage, display, printing, and transmission. We introduced this system to standardize the storage and transmission of ECG telemonitoring data, and ensure accurate transmission, reproducibility, and preservation of data. RESULTS The implementation of the PI ECG telemonitoring data acquisition system enabled the sharing of remote ambulatory electrocardiography data between Beijing Shijitan Hospital and its affiliated community hospitals. This has resulted in reduced waiting times for patients to receive reports (from 0.3 to 1 hour, to 0.1 or less), shortened consultation times (from 2 hours to 0.1 hour), and improved patient satisfaction with consultations (> 20% of the patients reported they were highly satisfied). The system successfully combined the goals of intelligence, real-time synchronization, and efficiency, revolutionizing ECG telemonitoring diagnosis in the network era. CONCLUSION Sharing digital telematics information between tertiary and community hospitals enables a tiered approach to diagnosis and treatment and allows for more efficient, accurate, and convenient remote diagnostics.
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