Isabelle Haklar and Tamika Regnier, Flinders University International Centre for Point-of-Care Testing
For some rural and remote Aboriginal and Torres Strait Islander medical services, turnaround times for traditional pathology testing can span weeks, with samples needing to be transported to urban laboratories hundreds of kilometres away. Roads and runways can also become blocked off due to inclement weather in some communities, preventing samples from reaching the nearest laboratory.
These barriers can result in potential retests due to unviable samples, as well as loss to follow-up due to extended pathology wait times.
The COVID-19 pandemic has placed increased pressure on pathology providers, resulting in even longer result turnaround times for those living in rural and remote areas. This, when coupled with the spread of COVID-19 and high prevalence of comorbidity in First Nations communities, can place Aboriginal and Torres Strait Islander peoples at risk of serious illness and death.
Fortunately, point-of-care (POC) testing has helped to alleviate these challenges by ensuring timely access to pathology results and continuity of patient care during the pandemic.
What is Point-of-Care Testing?
Although the Australian public is now well acquainted with POC testing in the form of SARS-CoV-2 rapid antigen tests (RATs), many may still be unaware of what POC testing is and its varied applications.
POC testing is pathology testing carried out in a clinical setting at the time of patient consultation, generating a test result that is used to make an immediate informed clinical decision. This procedure is generally less invasive than traditional pathology collection, often requiring a small sample size such as a fingerprick of capillary blood.
The International Centre for Point-of-Care Testing (ICPOCT) is a specialist POC testing provider operating out of Flinders University in South Australia. The Centre supports rural and remote health services to establish and manage POC testing, and conducts translational research to determine the clinical, cultural, operational, and economic benefits of introducing such testing.
The Centre oversees multiple POC testing networks for the detection, diagnosis and/or monitoring of chronic, acute, and infectious diseases such as diabetes and kidney disease, myocardial infarction, atrial fibrillation, acute acid-base disorders, sepsis, and syphilis; in addition, the Centre partners with the Kirby Institute, UNSW, to manage networks for chlamydia, gonorrhoea, trichomonas, hepatitis C, and COVID-19.
Many of the Centre’s programs have a focus on placing Indigenous health in Indigenous hands, with primarily Aboriginal Health Workers and/or Aboriginal Health Practitioners being trained as POC testing operators.
POC testing conducted within the programs has also proven to be of an equivalent analytical standard to the laboratory, making it a culturally safe and clinically effective alternative to traditional pathology testing.
Point-of-care testing during the COVID-19 pandemic
The Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing Program was launched as a collaboration between the Kirby Institute (UNSW) and the Flinders University ICPOCT in April 2020.
The program has a range of partners, stakeholders, and collaborators including the National Aboriginal and Torres Strait Islander Advisory Group on COVID-19; national, state and local Aboriginal Community Controlled Health Organisations; state health departments and other government services; industry; and other centres and laboratory pathology providers. The program is funded by the Health Protection Policy Branch of the Australian Government Department of Health and Aged Care.
Since commencing operation in May 2020, over 70,000 SARS-CoV-2 molecular-based patient POC tests have been performed on the GeneXpert PCR testing system at over 100 Aboriginal and Torres Strait Islander medical services Australia-wide as of late September 2022 (refer publicly available COVID dashboard; sourced 27 September 2022).
The Program has also delivered hundreds of hours of training for remote health professionals to perform on-site tests using the GeneXpert.
The SARS-CoV-2 test on the GeneXpert has enabled result turn-around time to be decreased from approximately three days at some services to 45 minutes, significantly reducing the number of days of unnecessary patient isolation.
This reduction in patient isolation is especially beneficial in settings where connection to community is important, and social distancing is made difficult due to household overcrowding.
During the pandemic, another priority has been to reduce the spread of COVID-19 between communities by minimising unnecessary movement of community members. The Centre’s Northern Territory (NT) POCT program has assisted with this by minimising the number of unnecessary medical evacuations.
In the Centre’s NT POCT program, pathology tests conducted on the i-STAT and WBC Diff POC testing devices allow for immediate clinical evaluation of patients with suspected myocardial infarction and sepsis on-site and in community. These results enable immediate clinical decision making around whether the patient needs to be evacuated or remain on-site in the community.
The availability of these acute care tests at the point of care has resulted in the NT Government saving approximately $21 million dollars per year through prevented medical retrievals; and the Flinders University ICPOCT received an award for ‘Outstanding Engagement for Research Impact’ in the 2021 Engagement Australia Awards for its work with this NT POC testing network.
4-Plex POCT Testing: a gamechanger in the fight against soaring Influenza cases
To adapt to the changing needs of communities, the Aboriginal and Torres Strait Islander COVID-19 Program is now transitioning to a rapid 4-plex testing model. The 4-plex test will allow health professionals to determine whether a client is infected with Influenza A, Influenza B, Respiratory Syncytial Virus (RSV), or COVID-19.
This article highlights that POC testing is accurate, convenient, and patient focused, and continues to transform the way care is delivered in rural and remote First Nations communities in Australia.
Featured Image L-R: Henrique Félix/Unsplash, Prasesh Shiwakoti (Lomash)/Unsplash