Benefits and Barriers to Integration of Chlamydia and Gonorrhoea Point-of-Care Testing into Remote Communities

Background: The GeneXpert- is a new molecular point-of-care (POC) test device for diagnosing Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). It recently received regulatory approval in the US, Europe and Australia, and is being used routinely in remote Aboriginal health services in Australia as part of the TTANGO (Test, Treat, ANd GO) Trial. Previously, most CT/NG POC tests have suffered from being inaccurate and complex.

Methods: We conducted in-depth interviews with 18 purposively selected Australia experts in sexual health, primary health care, microbiology and policy, to explore benefits and challenges of integrating CT/NG POC tests (not exclusively molecular tests) into remote health services.

Results: Interview participants thought CT/NG POC testing would have greatest utility in areas of high CT/NG prevalence, remote locations and in settings where treatment is frequently delayed or patients are lost-to-treatment. Stakeholders identified more targeted and immediate treatment as a key benefit (with flow on benefits of reducing sequelae, infectious period, and prevalence). Other benefits included increased health service efficiencies by reducing the number of treatment recalls, greater acceptability and satisfaction, and reduced stigma. Key challenges identified included ensuring the test was accurate, robust and user friendly. Other challenges included conforming to the regulatory/accreditation framework when/where such a framework exists, financing, adapting clinical practice and policy, training in areas with high staff turn-over, staff attitudes,   quality management, and the potential to reduce surveillance data (for case reporting and NG resistance). The immediacy of the result was reported as both a benefit and challenge. Participants noted that identified benefits and challenges would be contingent on the POC test device.

Conclusions: Stakeholders saw CT/NG POC tests as a useful clinical and public health strategy for remote primary care facilities in settings of high STI prevalence, but identified significant challenges which will inform integration into clinical practice in such settings.