"I Do Feel Like a Scientist at Times": A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting

PLoS One. 2015 Dec 29;10(12):e0145993. doi: 10.1371/journal.pone.0145993. eCollection 2015.

Abstract

Background: Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia.

Methods: In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis.

Results: Most participants displayed positive attitudes, indicating the test was both easy to use and useful in their clinical context. Participants indicated that point-of-care testing had improved management of STIs, resulting in more timely and targeted treatment, earlier commencement of partner notification, and reduced follow up efforts associated with client recall. Staff expressed confidence in point-of-care test results and treating patients on this basis, and reported greater job satisfaction. While point-of-care testing did not negatively impact on client flow, several found the manual documentation processes time consuming, suggesting that improved electronic connectivity and test result transfer between the GeneXpert and patient management systems could overcome this. Managing positive test results in a shorter time frame was challenging for some but most found it satisfying to complete episodes of care more quickly.

Conclusions: In the context of a RCT, health professionals working in remote primary care in Australia found the GeneXpert highly acceptable. These findings have implications for use in other primary care settings around the world.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Australia / epidemiology
  • Chlamydia Infections / diagnosis*
  • Chlamydia Infections / epidemiology
  • Chlamydia Infections / therapy
  • Chlamydia Infections / transmission
  • Cost of Illness*
  • Female
  • Gonorrhea / diagnosis*
  • Gonorrhea / epidemiology
  • Gonorrhea / therapy
  • Gonorrhea / transmission
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Job Satisfaction
  • Lost to Follow-Up
  • Male
  • Middle Aged
  • Point-of-Care Testing / statistics & numerical data*
  • Power, Psychological
  • Primary Health Care / statistics & numerical data*
  • Quality Assurance, Health Care
  • Specimen Handling
  • Time Factors
  • Unnecessary Procedures

Grants and funding

TTANGO is funded by a National Health and Medical Research Council (NHMRC) Project Grant #109902. The Kirby Institute receives funding from the Australian Government Department of Health and Ageing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.