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.
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.
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
Prevention of cervical cancer in women is the focus of vaccination and screening programmes globally. However, there is no consensus on the best way to approach screening, and screening across Europe varies considerably. Innovations in diagnostic testing and new ways to engage women in screening may improve screening uptake and increase the efficiency of screening pathways. In this talk, we explore opportunities for a rapid or point of care test for HPV as part of the screening pathway, and how self-sampling may be an effective way to engage women in screening.
We explored the impact of introducing a high performance point of care test (POCT) for influenza and respiratory syncytial virus (RSV) on an acute paediatric ward of a large London hospital during influenza season compared to standard care of using a laboratory-based test. We estimated the outcomes before and after implementing a POCT (Enigma® MiniLab™ FluAB-RSV test) for paediatric patients admitted to an acute respiratory ward in the 2013/14 and 2014/15 respiratory seasons. There was a significant reduction in reimbursement charges for influenza- and RSV-negative patients, for the full hospital stay and the period on the acute paediatric ward after implementing the POCT, however, these differences disappeared when controlling for top-up service charges. More appropriate treatment of patients with influenza occurred after implementing the POCT (40% versus 13% received oseltamivir, p=0.02). There was no difference in length of stay between the two periods. Findings indicate cost savings for commissioners and hospitals, even without a reduction in the length of stay.
Vecino-Ortiz AI, Glover RE, Douthwaite ST, et al. Estimating the clinical impact and costs of implementing a point of care test for influenza A/B and respiratory syncytial virus on an acute paediatric hospital inpatient ward. Society for Medical Decision Making. 12-14 June 2016. London, UK.
We created a decision tree to estimate the unnecessary isolation days averted by early diagnosis of false positive patients with a point of care test for influenza compared to presumptive isolation and standard laboratory testing (12 versus 2 hours’ time to results). Assuming a 7% prevalence of influenza in a cohort of 300 patients with suspected influenza, average hospital stay of 3 days, and the cost of an isolation bed being 10% more than a ward bed, using a point of care test could avert 80-95% of the unnecessary isolation days, with an associated estimated cost savings of roughly £7000-£9000, depending on if they test were implemented on the ward or in A&E, respectively. Point of care tests could improve bed management and reduce unnecessary isolation days and the associated costs, and reduce hospital transmission of infection.
Vecino-Ortiz AI, Glover RE, Rabe AJ, et al. A rapid influenza test in hospitals could avoid unnecessary paediatric isolation bed days and save cost. Society for Medical Decision Making. 12-14 June 2016. London, UK.
We assessed the performance of the new point-of-care Enigma® MiniLab™ assay for Influenza A, B and RSV compared to a centralised laboratory respiratory virus panel. The positive per cent agreement was >95% for Influenza B and RSV but was 79.2% (95% CI 57.8-92.9%) for Influenza A, and the negative per cent agreement was >95% for Influenza A and B, and 94.5% (95% CI 91.9-96.4%) for RSV. The turnaround time for the laboratory respiratory virus panel was 24 hours, compared to ~90 minutes for the Enigma® MiniLab™ test.
Douthwaite ST, Walker C, Adams EJ, et al. Performance of a novel point-of-care molecular assay for the detection of Influenza A, B and Respiratory Syncytial Virus (Enigma® MiniLab™) in children with acute respiratory infection. JCM, online first 11 Nov 2015. doi: 10.1128/JCM.02887-15
We conducted a literature review on cervical cancer incidence, screening algorithms and coverage across Europe. Data on the structure and provision of screening programmes are sparse, with large heterogeneity reported by sources. A lack of comparable data across countries makes it challenging for researchers and policy-makers to assess screening effectiveness and what is most beneficial for women. A central data repository could facilitate effectiveness and cost-effectiveness analyses to support the adoption of the best screening algorithm.
Adams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.
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.
Adams 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.
Our recently published studies have highlighted the economic and clinical benefits of incorporating a point-of-care nucleic acid amplification test for chlamydia and gonorrhoeae into sexual health clinics. In this article, some of the papers’ authors highlight the advantages over traditional immunoassay techniques for point-of-care detection.
The Clinical Services Journal. May 2014, p59-61.
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.
Price C, Adams E, Horner P. Point-of-care testing leads the way. Parliamentary review: Sept 2014