Impact of deploying multiple point-of-care tests with a sample first' approach on a sexual health clinical care pathway. A service evaluation

Emma M. Harding-Esch, Achyuta V. Nori, Aseel Hegazi, Marcus J. Pond, Olanike Okolo, Anthony Nardone, Catherine Lowndes, Phillip Hay, S. Tariq Sadiq

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)424-429
Number of pages6
JournalSexually Transmitted Infections
Volume93
Issue number6
DOIs
Publication statusPublished - Sep 2017

Keywords

  • BACTERIAL INFECTION
  • CLINICAL STI CARE
  • DIAGNOSIS
  • SERVICE DELIVERY
  • TRICHOMONAS

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