Impact of deploying multiple point-of-care tests with a ‘sample first’ approach on a sexual health clinical care pathway. a service evaluation
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Authors
Harding-Esch, Emma M.
Nori, Achyuta V.
Hegazi, Aseel
Pond, Marcus J.
Okolo, Olanike
Nardone, Anthony
Lowndes, Catherine M.
Hay, Phillip
Sadiq, S. Tariq
Issue Date
2017-02-03
Type
Article
Language
en_US
Keywords
Clinical STI Care , Service Delivery , Diagnosis , Bacterial Infections , Trichomonas
Alternative Title
Abstract
Objectives:
To assess clinical service value of STI point-of-care test (POCT) use in a ‘sample first’ clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation for Trichomonas vaginalis (TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment.
Methods:
Service evaluation in a south London sexual health clinic. Symptomatic female and male patients and sexual contacts of CT/NG-positive individuals provided samples for diagnostic testing on clinic arrival, prior to clinical consultation. Tests included routine culture and microscopy; CT/NG (GeneXpert) NAAT; non-NAAT POCTs for TV and BV.
Results:
All 70 (35 males, 35 females) patients approached participated. The ‘sample first’ pathway was acceptable, with >90% reporting they were happy to give samples on arrival and receive results in the same visit. Non-NAAT POCT results were available for all patients prior to leaving clinic; rapid CT/NG results were available for only 21.4% (15/70; 5 males, 10 females) of patients prior to leaving clinic. Known negative CT/NG results led to two females avoiding presumptive treatment, and one male receiving treatment directed at possible Mycoplasma genitalium infection causing non-gonococcal urethritis. Non-NAAT POCTs detected more positives than routine microscopy (TV 3 vs 2; BV 24 vs 7), resulting in more patients receiving treatment.
Conclusions:
A ‘sample first’ clinical pathway to enable multiple POCT use was acceptable to patients and feasible in a busy sexual health clinic, but rapid CT/NG processing time was too long to enable POCT use. There is need for further development to improve test processing times to enable POC use of rapid NAATs.
Description
Citation
Harding-Esch, E. M., Nori, A. V., Hegazi, A., Pond, M. J., Okolo, O., Nardone, A., Lowndes, C. M., Hay, P., & Sadiq, S. T. (2017). Impact of deploying multiple point-of-care tests with a 'sample first' approach on a sexual health clinical care pathway. A service evaluation. Sexually transmitted infections, 93(6), 424–429. https://doi.org/10.1136/sextrans-2016-052988
Publisher
Sexually Transmitted Infections