‘The waiting game’: are current chlamydia and gonorrhoea near-patient/point-of-care tests acceptable to service users and will they impact on treatment?

Abstract

The objective of this study was to assess the length of time service users were prepared to wait for chlamydia and gonorrhoea (CT/GC) near-patient/point-of-care test (NP-POCT) results and to determine the possible effect on management. Individuals attending two UK clinics from November 2013 to February 2014 were surveyed asking the maximum length of time they would wait for CT/GC NP-POCT results after consultation. Linked CT/GC prevalence and treatment rates were analysed. A total of 1817 participants were surveyed, and 1356 provided CT/GC NAAT samples, in which it was found that 115 (8.5%) could wait over 90 minutes in clinic for their result. 115 received treatment at consultation, of which 50 were CT/GC negative and 12 were treated for urethritis or cervicitis; 38 attended as CT/GC contacts. Six of this population would have waited over 90 minutes were NP-POCTs available. A total of 129 tested CT/GC positive, of whom 65 were treated at their consultation, 61 at a later date, and three were untreated. Twelve of these 129 patients would also have waited over 90 minutes for a NP-POCT result. We conclude that 90-minute NP-POCTs are not acceptable to most clinic attendees and would not have impacted on treatment rates or inappropriate prescribing, and 20-minute NP-POCTs show a marginal benefit in treating CT/GC. While NP-POCTs for CT/GC are promising, they must meet client expectations and enhance disease management in order to be accepted by patients and clinicians.

Diagnostic accuracy of a prototype rapid chlamydia and gonorrhoea recombinase polymerase amplification assay: a multicentre cross-sectional preclinical evaluation

“…The test's rapidity enhances the possibility of implementation as a POCT, enabling test and treat strategies with patients diagnosed and treated in the same clinical visit, and is potentially rapid enough to be incorporated into clinical practice with minimal change to clinical pathways. To date, a major barrier identified for STI POCT implementation has been patient willingness to wait, even for a 90-minute rapid test [11], [18], and the major changes to clinic care pathways necessary to incorporate rapid tests as POCTs as part of SHC consultations [11], [12]. Consequently, CT/NG GeneXpert implementation has enabled a same-day or next-day results service, rather than a POCT test and treat strategy [19], [20], [21].…”

Comparing different technologies for active TB case-finding among the homeless: a transmission-dynamic modelling study

“…Empirical research is required to determine the willingness to wait of patients offered single-step GeneXpert screening, and to test our assumption that patients with an abnormal CXR would be willing to wait for their GeneXpert result. Wiliness to wait is likely, however, to be low as demonstrated by a recent UK study which showed that only 8.5% of individuals tested for chlamydia and gonorrhoea were willing to wait over 90 minutes for a point-of-care test result, despite their having sought testing 41 .…”

Right-Sizing Technology in the Era of Consumer-Driven Health Care

“…A prospective cohort study examined the potential cost benefit of near-patient mPOC testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in a clinic based on reduction of contact attempts [7]. As part of the study, 1,356 patients who had CT/NG nucleic acid amplification tests (NAAT) also completed a questionnaire to ascertain the maximum time patients were willing to wait after consultation for CT/NG test results and thus the potential for immediate treatment of individuals testing positive while preventing unnecessary treatment of patients who tested negative.…”