TP 182 Ttango: Operational Performance of a Molecular Based Chlamydia and Gonorrhoea Point-of-Care Testing in Remote Australian Aboriginal Communities

Tuesday, June 10, 2014
Exhibit Hall
Belinda Hengel, MPH1, Steven Badman, MPH, PhD Candidate2, Louise Causer, MBBS MScPh DTM&H3, Lisa Natoli, MPH4, Annie Tangey, MPH5, James Ward, BA6, Sepehr Tabrizi, MS PhD FFSc(RCPA) FASM7, David Whiley, PhD8, Basil Donovan, MBBS DipVen PhD FAChSHM2, Christopher “Kit” Fairley, MBBS PhD FAChSHM9, David Wilson, PhD3, David Regan, PhD3, Handan Wand, PhD3, Mark Shephard, PhD OAM10, David Anderson, PhD11, John Kaldor, PhD3 and Rebecca Guy, PhD3, 1Kirby Institute, University of New South Wales, Coogee, Australia, 2Kirby Institute, University of New South Wales, Coogee, Sydney, Australia, 3Kirby Institute, University of New South Wales, Sydney, Australia, 4Office for Business Development, Innovation and Research, Burnet Institute, on behalf of the TTANGO Investigator Group, Melbourne, Victoria, 3001, Australia, 5Ngaanyatjarra Health, 6Baker IDI Alice Springs, 7The Royal Womens Hospital, Parkville, Australia, 8Royal Childrens Hospital/The University of Queensland, Herston, Brisbane, Australia, 9University of Melbourne, 10Flinders University, 11Burnet Institute

Background: TTANGO (Test, Treat ANd GO) will measure the clinical effectiveness, cost-effectiveness, and acceptability of a molecular-based point-of-care (POC) test (GeneXpert) for chlamydia (CT) and gonorrhoea (NG) infections in remote Australian Aboriginal communities. TTANGO is a crossover randomised control trial, with 12 participating primary health care centres; six services will use POC in year 1, and the other six in year 2.  Services not using POC will maintain standard practice in each year. Routine reference laboratory tests for CT and NG will continue throughout the trial in both study arms.

Methods: Since June 2013, five of the six sites have been randomised to using the GeneXpert CT/NG test. We describe the sensitivity and specificity of the GeneXpert CT/NG test compared to routine laboratory NAAT tests.

Results: Of the 444 POC tests performed, the sensitivity and specificity of the GeneXpert test for CT infection was 100% (95%CI:92.3-100.0) and 99.2% (95%CI:97.8-99.8), respectively and for NG infection the sensitivity and specificity was 100% (95%CI:88.4-100.0) and 100% (95%CI:99.1-100.0), respectively.  There were three discordant CT results which were positive on GeneXpert and negative on the laboratory NAAT test. There were 25 errors (5.6% of all tests) predominately due to operator error in sample preparation; repeat testing of all samples gave valid results. Further errors have been minimised with training and/or changes to the sample transfer device (plastic pipette to syringe).

Conclusions: The sensitivity and specificity of the GeneXpert CT/NG test is both excellent and consistent with laboratory and field evaluations. An updated sensitivity and specificity estimate will be provided in June 2014. The uptake of CT and NG testing generally has been higher than expected, possibly related to initial enthusiasm surrounding the use of this new technology and increased awareness about STI screening during trial implementation.  Testing rates will be monitored to confirm if this unexpected benefit is sustained.