{
  "abstract": "Objective In remote Australia, where there is a substantial burden of sexually transmitted infections (STIs) among First Nations peoples, testing and timely treatment are key to reducing prevalence. We evaluated the impact of introducing molecular point-of-care (POC) testing for chlamydia/gonorrhoea and later trichomonas on STI testing (including syphilis) and positive tests.Methods We conducted a retrospective interrupted time-series analysis of routinely collected data from First Nations peoples aged 15–54 years attending 20 remote/regional clinics participating in the Test, Treat and GO programme (2016–2019). We used segmented regression models to estimate the immediate level change (first month of POC) and after-period trends in monthly tests, positive tests and proportion of concurrent syphilis tests to assess sustainability. Before and after comparisons were estimated using linear regression models.Results There were 17 437 chlamydia/gonorrhoea and 14 173 trichomonas tests performed, mostly among women (69% and 64%) and individuals aged 15–34 years (72% and 68%). Following the introduction of molecular POC testing, there were immediate level increases in monthly tests: chlamydia/gonorrhoea by 26% (+154, p<0.001) and trichomonas by 21% (+116, p=0.004) and level increases of positive tests: gonorrhoea by 30% (+13, p=0.017) and trichomonas by 29% (+14, p=0.034); chlamydia was unchanged. The proportion of chlamydia/gonorrhoea tests with concurrent syphilis tests remained unchanged (−1.7%; −0.9%; p=0.531), while the proportion increased among positive chlamydia/gonorrhoea tests by 25% (+13%; p=0.013). Increased levels of testing were sustained for gonorrhoea/chlamydia (+2.7, p=0.118) and trichomonas (−3.5, p=0.400) and syphilis among those with positive chlamydia/gonorrhoea tests (−0.2%, p=0.593).Conclusion Molecular POC testing led to immediate and sustained increases in STI testing and an immediate increase in positive tests in remote primary care. The use of POC testing is likely to result in earlier diagnosis and treatment and reduced onward transmission and sequelae, supporting a broader integration of POC testing in high-burden settings.",
  "authors": [
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Annie Tangey"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Kirsty Smith"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Belinda Hengel"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Bedford Park, South Australia, Australia"
      ],
      "name": "Kelly Andrewartha"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Handan Wand"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Amit Saha"
    },
    {
      "affiliations": [
        "Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia"
      ],
      "name": "Jessica Leonard"
    },
    {
      "affiliations": [
        "Northern Territory Department of Health, Casuarina, Northern Territory, Australia"
      ],
      "name": "Manoji Gunathilake"
    },
    {
      "affiliations": [
        "Kimberley Aboriginal Medical Services Council Inc, Broome, Western Australia, Australia"
      ],
      "name": "Lorraine Anderson"
    },
    {
      "affiliations": [
        "Communicable Disease Control Directorate, Government of Western Australia Department of Health, Perth, Western Australia, Australia"
      ],
      "name": "Donna B Mak"
    },
    {
      "affiliations": [
        "Cepheid, Sunnyvale, California, USA"
      ],
      "name": "Steven Badman"
    },
    {
      "affiliations": [
        "Cepheid, Sunnyvale, California, USA"
      ],
      "name": "David Persing"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia",
        "Sydney Sexual Health Centre, Sydney, New South Wales, Australia"
      ],
      "name": "Basil Donovan"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Lisa Maher"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Bedford Park, South Australia, Australia"
      ],
      "name": "Susan Matthews"
    },
    {
      "affiliations": [
        "Melbourne Sexual Health Centre, Carlton, Victoria, Australia"
      ],
      "name": "Christopher K Fairley"
    },
    {
      "affiliations": [
        "International Centre for Point of Care Testing, Flinders University, Bedford Park, South Australia, Australia"
      ],
      "name": "Mark Shephard"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "John Kaldor"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia",
        "Nganampa Health Council, Alice Springs, Northern Territory, Australia"
      ],
      "name": "Rae-Lin Huang"
    },
    {
      "affiliations": [
        "Poche Centre for Indigenous Health, The University of Queensland, Saint Lucia Campus, Saint Lucia, Queensland, Australia"
      ],
      "name": "James Ward"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Rebecca Guy"
    },
    {
      "affiliations": [
        "UNSW Sydney, The Kirby Institute, Kensington, New South Wales, Australia"
      ],
      "name": "Louise Causer"
    },
    {
      "affiliations": [],
      "name": "on behalf of the TTANGO2 collaboration"
    }
  ],
  "title": "Impact of decentralised, community-led molecular STI point-of-care testing on testing practices in remote First Nations communities in Australia",
  "uid": "c2d772b5-e568-50e0-93e5-eeb22e3d0a02"
}