The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence
Ben B. Hui A D , David P. Wilson A , James S. Ward B , Rebecca J. Guy A , John M. Kaldor A , Matthew G. Law A , Jane S. Hocking C and David G. Regan A
+ Author Affiliations
- Author Affiliations
A The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
B Baker IDI Heart and Diabetes Institute, Alice Springs, NT 0871, Australia.
C Centre for Women’s Health, Gender and Society, The University of Melbourne, Carlton, Vic. 3053, Australia.
D Corresponding author. Email: bhui@kirby.unsw.edu.au
Sexual Health 10(4) 348-356 https://doi.org/10.1071/SH13026
Submitted: 22 February 2013 Accepted: 4 May 2013 Published: 28 June 2013
Abstract
Background: Despite the availability of testing and treatment, bacterial sexually transmissible infections (STIs) continue to occur at endemic levels in many remote Indigenous communities in Australia. New generation molecular point-of-care (POC) tests have high sensitivity, comparable with conventional diagnostic tests, and have the potential to increase the impact of STI screening. Methods: We developed mathematical models of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) transmission in remote Indigenous communities in Australia to evaluate screening and treatment strategies that utilise POC tests. Results: The introduction of POC testing with 95% sensitivity could reduce the prevalence of gonorrhoea and chlamydia from 7.1% and 11.9% to 5.7% and 8.9%, respectively, under baseline screening coverage of 44% per year. If screening coverage is increased to 60% per year, prevalence is predicted to be reduced to 3.6% and 6.7%, respectively, under conventional testing, and further reduced to 1.8% and 3.1% with the introduction of POC testing. Increasing screening coverage to 80% per year will result in a reduction in the prevalence of gonorrhoea and chlamydia to 0.6% and 1.5%, respectively, and the virtual elimination of both STIs if POC testing is introduced. Conclusions: Modelling suggests that molecular POC tests of high sensitivity have great promise as a public health strategy for controlling chlamydia and gonorrhoea. However, evaluation of the cost-effectiveness of POC testing needs to be made before widespread implementation of this technology can be considered.
Additional keywords: Australia, Indigenous, mathematical model, rapid tests, STIs, vulnerable populations.
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