澳大利亚偏远基层医疗服务中衣原体和淋病分子即时检测的公共卫生影响：一项定性研究
Public health implications of molecular point-of-care testing for chlamydia and gonorrhoea in remote primary care services in Australia: a qualitative study.
作者信息
Natoli L, Guy R J, Shephard M, Whiley D, Tabrizi S N, Ward J, Regan D G, Badman S G, Anderson D A, Kaldor J, Maher L
机构信息
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Burnet Institute, Melbourne, Victoria, Australia.
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
BMJ Open. 2015 Apr 28;5(4):e006922. doi: 10.1136/bmjopen-2014-006922.
OBJECTIVES
With accurate molecular tests now available for diagnosis of chlamydia and gonorrhoea (Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG)) at the point-of-care (POC), we aimed to explore the public health implications (benefits and barriers) of their integration into remote primary care in Australia.
METHODS
Qualitative interviews were conducted with a purposively selected group of 18 key informants reflecting sexual health, primary care, remote Aboriginal health and laboratory expertise.
RESULTS
Participants believed that POC testing may decrease community prevalence of sexually transmitted infections (STIs), and associated morbidity by reducing the time to treatment and infectious period and expediting partner notification. Also, POC testing could improve acceptability of STI testing, increase testing coverage and result in more targeted prescribing, thereby minimising the risk of antibiotic resistance. Conversely, some felt the immediacy of diagnosis could deter certain young people from being tested. Participants also noted that POC testing may reduce the completeness of communicable disease surveillance data given the current dependence on reporting from pathology laboratories. Others expressed concern about the need to maintain and improve the flow of NG antibiotic sensitivity data, already compromised by the shift to nucleic acid-based testing. This is particularly relevant to remote areas where culture viability is problematic.
CONCLUSIONS
Results indicate a high level of support from clinicians and public health practitioners for wider access to CT/NG POC tests citing potential benefits, including earlier, more accurate treatment decisions and reductions in ongoing transmission. However, the data also highlight the need for new systems to avoid adverse impact on disease surveillance.
TRIAL REGISTRATION NUMBER
Australian and New Zealand Clinical Trials Registry: ACTRN12613000808741.
目的
鉴于现在有准确的分子检测方法可用于即时检测（POC）沙眼衣原体（CT）和淋病奈瑟菌（NG），我们旨在探讨将其整合到澳大利亚偏远地区初级医疗保健中的公共卫生影响（益处和障碍）。
方法
对一组经过有目的挑选的18名关键信息提供者进行了定性访谈，这些人反映了性健康、初级医疗保健、偏远地区原住民健康和实验室专业知识。
结果
参与者认为即时检测可能会降低性传播感染（STIs）的社区流行率，并通过减少治疗时间和传染期以及加快性伴侣通知来降低相关发病率。此外，即时检测可以提高性传播感染检测的可接受性，增加检测覆盖率，并导致更有针对性的处方，从而将抗生素耐药性风险降至最低。相反，一些人认为诊断的即时性可能会阻止某些年轻人进行检测。参与者还指出，鉴于目前对病理实验室报告的依赖，即时检测可能会降低传染病监测数据的完整性。其他人对维持和改善NG抗生素敏感性数据的流动表示担忧，这种数据流动已经因向基于核酸的检测转变而受到影响。这在培养生存能力有问题的偏远地区尤为相关。
结论
结果表明，临床医生和公共卫生从业者高度支持更广泛地使用CT/NG即时检测，理由是其潜在益处，包括更早、更准确的治疗决策以及减少持续传播。然而，数据也凸显了需要新系统以避免对疾病监测产生不利影响。
试验注册号
澳大利亚和新西兰临床试验注册中心：ACTRN12613000808741。
Zotero 插件