Point of care testing takes place where the patient is seeking care. This could be in a clinic, a community health centre, or even in other locations outside of a health facility. A health worker, nurse or doctor can use a sample collected by the patient and test it on site. The result is available to make a fast diagnosis and offer treatment at the same time.
"Detecting infections earlier enables timely treatment and reduces the risk of disease progression," says Scientia Professor Rebecca Guy. She heads the Surveillance and Evaluation Research Program at the Kirby Institute, UNSW Sydney, and has expertise in epidemiology, health services, implementation research and translational research.
Rebecca's research focuses on reducing the impact of infectious diseases such as HIV, sexually transmissible infections, COVID-19 and other respiratory infections in vulnerable populations.
Expanding infectious disease testing
Rebecca and her colleagues are supporting rural and remote Aboriginal Health Services to scale up infectious disease point of care testing for First Nations people nationally. Dr Dawn Casey, Deputy CEO of the National Aboriginal Community Controlled Health Organisation is the co-lead of this project. Funding is from the Medical Research Future Fund.
"We will evaluate existing point of care testing programs, as well as implement point of care testing for two new 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," explains Rebecca.
"Our goal is to embed these new programs into routine care, improving health outcomes through early intervention."
An infectious disease point of care testing codesign workshop helped set the project's priorities and direction. "We brought together people from across research, laboratory, policy and community organisations," says Rebecca. "Workshop representation was more than 50 per cent Aboriginal and/or Torres Strait Islander."
"This was followed by more than 12 months of ongoing engagement with stakeholders and health services to develop study protocols that were both evidence-based and met the needs and priorities of participating health services and communities."
From planning to implementation: Testing begins
"Following ethics approvals, implementation workshops were held with individual health services to further tailor implementation strategies and program resources. We have now moved into the implementation phase, with point of care testing for Strep A commencing earlier this year."
"Early detection and treatment of Strep A pharyngitis is a critical strategy in preventing rheumatic heart disease," explains Rebecca. "Our project combines the use of a sore throat checklist, developed in the Missing Piece study, led by Professor Asha Bowen, with Strep A point of care testing.
The checklist ensures clinicians are actively screening children for sore throats, even mild ones that may otherwise go unnoticed. When paired with point of care testing, this model supports timely, targeted antibiotic treatment and reduces unnecessary treatment."
Strep A point-of-care testing will be offered to 30 sites nationwide, in areas with the highest burden of acute rheumatic fever and rheumatic heart disease.
"We expect that over the study period we will detect more cases of Strep A, reduce the number of unnecessary treatments and, over time, contribute to the reduction of these diseases in participating communities."
"Embedding this approach within culturally safe, community-led models of care offers a scalable and sustainable way to prevent acute rheumatic fever and rheumatic heart disease. These early implementation steps represent a major step forward towards improving health outcomes for Aboriginal and Torres Strait Islander peoples and communities."
Community-led, culturally safe care at the core
"This 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 at every stage," Rebecca told us.
Dr Dawn Casey is the overall co-lead, and Associate Professor Lisa Whop from the Australian National University leads the HPV point of care testing project. The First Nations Point of Care and Research Governance Group provides cultural oversight. "Forming this dedicated governance group ensures accountability of the research team throughout the life of the project," she says.
"A key lesson that was reinforced has been the importance of taking time to build genuine, respectful relationships with Aboriginal and Torres Strait Islander communities, researchers and stakeholders. Investing in early and ongoing engagement helps to build trust, align priorities, and shape research that is culturally appropriate, practical and meets community needs."
"We also recognised the importance of resourcing participating health services appropriately, both financially and with training support to ensure meaningful engagement in the research process.
These strategies have helped ensure the research is community-led, better aligned to real-world service delivery, and positioned for long-term sustainability."
