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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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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Benefits of a point of care test for sexual health testing

publication_iconOur 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.

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Managing Mycoplasma genitalium as an STI

Mycoplasma genitalium is a prevalent sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. Diagnostic tests are needed to reduce the risk of the development of antimicrobial resistance and improve patient care.

publication_iconHorner P, Blee K, Adams E. Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1g! Curr Opin Infect Dis. 2014; 27:1:68-74.

 

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The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study

Switching to cheaper generic antiretroviral drugs for HIV patients may appear cost saving over fixed-dose combinations, and be an appealing way to reduce healthcare costs. However, the additional clinical costs may outweigh the initial cost savings of the drugs, and switching may cause confusion for some patients, risking loss of adherence. Our analysis provides evidence that can help commissioners make better policy decisions about drug provision.

publication_iconTaylor R, Carlin E, Sadique Z, Ahmed I, Adams EJ. The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study. Int J STD AIDS 0956462414530588, first published on April 3, 2014 as doi:10.1177/0956462414530588

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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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The cost of managing haematology patients with invasive fungal disease

We aimed to estimate the cost of care for patients with invasive fungal disease (IFD) in England. We analysed prospectively collected data from adult haematology patients in a large hospital in London. We found that the attributable cost of managing IFD was greater than £50,000 per case, with the inpatient stay accounting for 3/4 of costs. Costs for inpatient stay far outstrip the cost of antifungal drugs.

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A.
Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

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Treatment for stable HIV patients in England: can we save costs and improve patient care?

We estimated the costs of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients in England. Results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the least expensive option and could result in £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in England.

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

 

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The cost-effectiveness of point of care tests for chlamydia and gonorrhoeae in sexual health clinics

Replacing standard laboratory tests for chlamydia and gonorrhoea with a rapid point of care test could be cost-effective if implemented in genitourinary medicine clinics in England. It could save the National Health Service an estimated £10 million annually, and patients would benefit from fewer unnecessary treatments and reduced complications from infection, and it could prevent the number of transmissions.

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

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