Expansion of Point-of-Care Testing for Infectious Diseases in First Nations Communities

Introduction to Point-of-Care Testing

Point-of-care testing (POCT) occurs at the patient's location of care, such as clinics, community health centers, or other non-facility sites. Healthcare professionals utilize patient-collected samples for on-site testing, enabling immediate diagnosis and treatment.

Project Overview and Leadership

Scientia Professor Rebecca Guy, head of the Surveillance and Evaluation Research Program at the Kirby Institute, UNSW Sydney, conducts research focused on reducing the impact of infectious diseases, including HIV, sexually transmissible infections, COVID-19, and other respiratory infections, in vulnerable populations. Dr. Dawn Casey, Deputy CEO of the National Aboriginal Community Controlled Health Organisation, co-leads a national project with Professor Guy. This initiative aims to expand infectious disease point-of-care testing for First Nations people across rural and remote Aboriginal Health Services. Funding is provided by the Medical Research Future Fund.

Targeted Infections and Objectives

The project includes the evaluation of existing point-of-care testing programs and the implementation of testing for two additional infections: Group A streptococcus (Strep A) for the prevention of acute rheumatic fever and rheumatic heart disease, and Human Papillomavirus (HPV) for the prevention of cervical cancer. The objective is to integrate these new programs into routine care to facilitate early intervention and potentially improve health outcomes.

Development and Engagement Process

Project priorities and direction were established through an infectious disease point-of-care testing codesign workshop. This workshop involved representatives from research, laboratory, policy, and community organizations, with over 50% Aboriginal and/or Torres Strait Islander representation. Following the workshop, over 12 months of engagement with stakeholders and health services led to the development of study protocols that were evidence-based and aligned with the needs of participating health services and communities.

Implementation Phase Commences

After ethics approvals, implementation workshops were conducted with individual health services to customize implementation strategies and program resources. The project has now entered its implementation phase, with point-of-care testing for Strep A having commenced earlier this year.

Early detection and treatment of Strep A pharyngitis is a component of the strategy to prevent rheumatic heart disease. The project integrates a sore throat checklist, developed in the Missing Piece study led by Professor Asha Bowen, with Strep A point-of-care testing. This checklist is intended to support clinicians in screening children for sore throats. When combined with point-of-care testing, this model aims to facilitate timely, targeted antibiotic treatment and reduce unnecessary treatments.

Strep A point-of-care testing is planned for 30 sites nationwide, situated in areas identified with high burdens of acute rheumatic fever and rheumatic heart disease. Over the study period, increased detection of Strep A cases and a reduction in unnecessary treatments are anticipated, potentially contributing to a decrease in these diseases in participating communities. This approach, embedded within community-led and culturally safe care models, is designed for scalability and sustainability.

Community-Led Framework and Lessons Learned

The project is co-led by the National Aboriginal Community Controlled Health Organisation and has been codesigned with Aboriginal and Torres Strait Islander people and communities throughout its stages. Dr. Dawn Casey serves as the overall co-lead, and Associate Professor Lisa Whop from the Australian National University leads the HPV point-of-care testing component. Cultural oversight is provided by the First Nations Point of Care and Research Governance Group, which ensures accountability of the research team.

Observations during the project have highlighted the significance of investing time in developing genuine relationships with Aboriginal and Torres Strait Islander communities, researchers, and stakeholders. Early and ongoing engagement is considered instrumental in fostering trust, aligning priorities, and developing research that is culturally appropriate and responsive to community needs. The importance of adequately resourcing participating health services, both financially and with training support, for meaningful engagement in the research process has also been acknowledged. These strategies are intended to ensure the research is community-led, aligned with real-world service delivery, and positioned for long-term sustainability.