Health service implications of the introduction of STI point-of-care testing in Australia

Abstract

Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) are curable sexually transmissible infections (STIs) which represent a significant public health burden, particularly in young Australia Aboriginal people in remote communities. Prompt testing and treatment is fundamental to STI control yet distance to urban laboratories is a significant barrier. CT/NG point-of-care (POC) testing offers an ideal solution, but until recently had been unavailable. This thesis aims to identify settings where POC testing could be beneficial, benefits and barriers to implementation and health service staff acceptability. The thesis was based on two sets of qualitative interviews. The first occurred with 18 Australian key informants with remote, sexual health and laboratory expertise, and generated three discrete studies. The second occurred with 16 trained nurses and Aboriginal health workers (AHWs) from the first 12 remote primary care services internationally to use GeneXpert CT/NG POC testing and resulted in study four. Study one focused on settings where the technology would have greatest benefit, with remote Aboriginal communities most commonly identified, as well as juvenile justice and outreach services to highly mobile or marginalised populations. In study two, informants identified the benefits of POC use for clinical practice including improved management of STIs- more timely and targeted treatment, earlier commencement of partner notification, and reduced effort associated with client recall, but noted it will result in changes to the STI management pathway, and policy and clinical guidelines may need to be altered. Study three focused on the public health implications; with the key perceived benefit being STI control, and barriers including the potential to negatively impact on disease notification and NG antibiotic sensitivity surveillance. In study four, most nurses and AHWs found the test easy to use and useful, and reported improved management of STIs consistent with the key informant’s perceived benefits. In conclusion, this thesis has provided information to inform implementation of CT/NG POC testing, including selection of appropriate settings, and the need to review clinical guidelines and establish systems to avoid adverse impact on public health surveillance. Importantly the research demonstrated the new technology was highly acceptable to staff working in remote primary care.