Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

With collaborators at Chelsea and Westminster NHS Foundation Trust, we estimated the impact of a rapid testing and result notification service for patients testing for sexually transmitted infections at the Dean Street Express clinic. We found that a rapid testing service for asymptomatic infections resulted in 8 days’ faster time to result notification for CT and/or NG which enables faster treatment, thus reducing infectious periods and leading to fewer transmissions, unnecessary partner attendances and clinic costs, compared with those attending an existing ‘standard’ sexual health clinic.

PublicationGary G Whitlock, Daniel C Gibbons, Nick Longford, Michael J Harvey, Alan McOwan, Elisabeth J Adams Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits
International Journal of STD & AIDS. First Published October 23, 2017
https://doi.org/10.1177/0956462417736431

 

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Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising gonorrhoea treatment

In July, Emma Harding-Esch spoke at the STI and HIV World Congress in Rio on how to best manage the increasing challenge of anti-microbial resistance (AMR). The research she presented was a collaboration between Aquarius Population Health and ADREU St. Georges.  In recent years, there has been an increase in resistance to first-line therapies used to treat STIs such as gonorrhoea. The Aquarius team built a decision tree model to assess the cost-effectiveness of standard care compared to several hypothetical rapid point-of-care tests (POCT) for antibiotic susceptibility. The model simulated a cohort of sexual health clinic attendees. The results showed that while standard care is the cheapest option, AMR POCTs may be cost-effective and maximise the number of effective agents in treatment regimens, providing long-term benefits in some scenarios.

Harding-Esch EM, Huntington SE, Harvey MJ, et al. Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising the treatment of gonorrhoea STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections

We estimated costs, benefits and cost-effectiveness of three accurate 30-minute NAAT POCT strategies that detect different STI combinations, compared with standard care  (laboratory-based NAAT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)).  We found the CT-NG-MG-TV POCT strategy was the cheapest using tariff costing. It offered the most benefits, which in turn may have wider public health impacts through rapid and accurate STI diagnosis and management. Different testing strategies may be more cost-effective in different SHCs and patient groups. Further evidence is needed to capture the diversity of STI prevalence and management of patients across clinical services to better inform economic analyses.

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Harding-Esch EM, Huntington SE, Burns RM, et al. Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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Modelling how point-of-care tests can enable personalised treatment for resistant gonorrhoea infections

We created a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the life of current last-line treatments. The introduction of AMR POCT could allow clinicians to discern between the majority of gonorrhoea-positive patients with strains that could be treated with older, previously abandoned first-line treatments, and those requiring our current last-line dual therapy. Such tests could extend the useful life of dual ceftriaxone and azithromycin therapy, thus pushing back the time when gonorrhoea may become untreatable.

Publication

Turner KM, Christensen H, Adams EJ, et al Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study

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Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals

Our paper explores results of the acceptability and implementation issues of point of care tests (POCTs) in paediatric patients in three south London hospitals. Overall, we found that having a test result was thought to improve bed management and cohorting sick patients appropriately, reassure parents about their child’s condition, reduce hospital transmission, and rationalise further tests and treatment. Concerns focused on confidence about the test’s performance – particularly around false negatives not receiving proper management, how to manage discrepant results (i.e. the laboratory assay gave a different answer to the POCT), and training enough staff to run the test at the point of care.

Publication

Bustinduy AL, Jeyaratnam D, Adams EJ, et al. CLAHRC South London; Paediatric Infection Network. Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals. Acta Paediatrica,  April 2017. DOI: 10.1111/apa.13867

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Point of care testing: Disruptive innovation – is the NHS ready for it yet?

Our Managing Director, Elisabeth Adams, spoke in November about the importance of exploring the health economics of point of care testing (POCT) at the Royal Society of Medicine Telemedicine and eHealth event in London. The video of her presentation is now online – view the full talk here.

Why is it important to explore the health economics of point of care testing (POCT)?

Evaluating the health economics of POCTs can help us better understand the cost, benefits and value of implementing these tests, compared to standard laboratory tests. We need to explore the acquisition costs of innovative technology like POCTs compared to standard tests, as well as the benefits generated for patients, service providers, clinicians and public health in general. Benefits can include faster results, better care, fewer complications, more efficient services and better use of resources, and knock-on benefits like reduced prevalence of disease. Those making purchasing decisions for new tests need evidence to prove the value of the tests.

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Exploring the value of a rapid, on-demand test for the detection of human papillomavirus

We explored the use of a rapid, on-demand human papillomavirus (HPV) test as part of a cervical screening programme. Through semi-structured interviews with experts from across the UK, we found that a co-located, laboratory-based, and on-demand HPV test following cytology could reduce the time to results by up to a week, whilst a near-patient test under primary HPV screening followed by cytology triage could radically change the testing paradigm, with most women notified the same day.

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

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The benefits and cost-savings of a new point-of-care test for chlamydia and gonorrhoea

Problem: Cepheid’s Xpert® CT/NG test is a high performance point-of-care test for chlamydia and gonorrhoea, and offers a promising advance in the diagnosis and control of two common sexually transmitted infections. When the test was launched in 2013, Cepheid wanted to understand how sexual health clinics in England might use it and to develop evidence comparing its costs and benefits to standard laboratory tests.

Approach: We approached the challenge in two projects. For the first, we defined the current patient pathways for chlamydia and gonorrhoea testing treatment and compared them to what they would be if a rapid POCT was used. We held workshops with staff in four sexual health clinics, asking them to map out the current patient pathways for chlamydia and gonorrhoea diagnosis and treatment. We then helped them brainstorm ways in which their services might include a point-of-care chlamydia and gonorrhoea test, and describe how this would change their patient pathways. Finally, we used Dots, our cloud-based pathway builder tool, build to estimate the costs of the pathways. The work indicated that the pathways could be streamlined with a point-of-care test, and we estimated that this would cost less to deliver than current practice.

For the second project, we developed an economic model to compare the overall costs and benefits of a point-of-care test to standard care. We combined the results of our first project with previous work our team had conducted on chlamydia and gonorrhoea testing and management. The model showed that the test could deliver £10million in cost savings, and give far more effective management of chlamydia and gonorrhoea at a population level. Our results were published in Sexually Transmitted Infections, and have been presented at national and international conferences.

Impact: Our work gave Cepheid the empirical evidence to demonstrate the value and potential impact of adopting their test in clinics. Since our projects, Cepheid has had increasing interest in the test, and several centres have purchased it. This includes a major London sexual health clinic which has introduced a new testing service as a result.

 

Testimonial

“I started working with Aquarius in 2012. Elisabeth and her team have always delivered great results, including 2 peer-reviewed publications, that add real value and insight, and they come up with creative ways to answer our questions. I enjoy collaborating with them and look forward to continuing our work on a range of disease areas in the future.”

  • Dr. Anne Postulka, Senior Director Medical & Economic Value, Cepheid

 

Related publications

publication_iconAdams EJ, Ehrlich A, Turner KME, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014;4: e005322. doi:10.1136/bmjopen-2014-005322

publication_iconTurner KME, Round J, Horner PJ, et. al. What are the clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England? Sex Transm Infect. Published online 22 Nov 2013: doi:10.1136/sextrans-2013-051147

Featured article: Read the Clinical Services Journal about this work.

 

Point-of-care testing leads the way: article in the Parliamentary Review 2014

Rapid point of care test for sexually transmitted infection diagnosis will allow greater access to high quality care, ensure patients get the correct treatment for their infections, and return to health sooner, reducing the need for follow-up care and preventing onward transmission and complications.

publication_iconPrice C, Adams E, Horner P. Point-of-care testing leads the way. Parliamentary review: Sept 2014

 

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Mapping patient pathways and cost of point of care versus standard testing and treatment for chlamydia and gonorrhoea in sexual health clinics

This study aimed to explore the current patient pathways for the diagnosis and treatment of chlamydia and gonorrhoea in England. We conducted workshops in four sexual health clinics, and asked them detail the steps and resources used in screening, diagnosis and treatment, and what would change if they had a point of care test (POCT) for chlamydia and gonorrhoea diagnosis. Using a POCT could lead to reduced clinical time and costs, and may lead to more appropriate and quicker care for patients.

Read Journal ArticleAdams EJ, Ehrlich A, Turner KME, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014;4:e005322. doi:10.1136/bmjopen-2014-005322

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