Dataset Information

Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services.

ABSTRACT:

Objectives

To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing.

Methods

Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT.

Results

SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient's visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days.

Conclusion

Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.

SUBMITTER: Huntington S

PROVIDER: S-EPMC8647227 | biostudies-literature | 2021 Jan-Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services.

Huntington Susie S Weston Georgie G Adams Elisabeth E

Therapeutic advances in infectious disease 20210101

<h4>Objectives</h4>To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for <i>Chlamydia trachomatis</i> (CT) and <i>Neisseria gonorrhoeae</i> (NG) compared to laboratory-based testing.<h4>Methods</h4>Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables d ...[more]

PMID: 34881023

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Project description:Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as "change champions" for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff.

Project description:OBJECTIVES:Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. DESIGN:An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. SETTING:Baltimore City, Maryland, USA. INTERVENTIONS:PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). MAIN OUTCOME:The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. RESULTS:Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community. CONCLUSIONS:Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.

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Project description:BackgroundThe 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance.ObjectiveThe primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods.MethodsPeople with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test.ResultsThe mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points.ConclusionsIn individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.

Dataset Information

Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services.

Objectives

Methods

Results

Conclusion

Publications

Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services.

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