P101 Cutting the time to treatment of chlamydia trachomatis (CT) and neisseria gonorrhoeae (NG) with near-patient molecular diagnostics: the utility of the cepheid genexpert system

Abstract

IntroductionThe Cepheid GeneXpert® provides near-patient molecular detection of CT/NG, with results available in 90 minutes. Previous studies have illustrated the benefits to asymptomatic individuals and their partners in reducing time to treatment.MethodsA case-control study was undertaken to investigate the impact of introducing GeneXpert to a Level 3 symptomatic service. 100 patients diagnosed with CT+/-NG before and after introduction were identified. Time from attendance to treatment was measured. Using self-report over the previous three months and assuming that rate of new sexual partners remained the same and spaced equally in time, we modelled the number of partners spared exposure due to earlier treatment of CT/NG.ResultsCharacteristics of the study populations, and of the time to treatment and partners spared analyses are shown in the table:Abstract P101 Table 1Time to treatmentPre-implementation of GeneXpert (n=100)Post-implementation of GeneXpert (n=100)Male (%)4061Age (median [range])28.1 [15–69]30.6 [14–70]MSM/WSW (%)33/037/1Symptomatic (%)5028Time to treatment (days (mean) [SD])9.5 [13.23]3.3 [4.94]Sexual partners in preceding 3 months (mean [SD])2.1 [1.71]4.0 [10.48]Partners exposed in interval between test and treatment/100 index cases19.99.12The time from testing to treatment was reduced by 6.2 days. The number of partners exposed/100 index patients was 19.9 pre-GeneXpert and 9.12 post-GeneXpert.DiscussionUse of GeneXpert reduced time to treatment by 66%, and 54% fewer partners were exposed to CT/NG. This study supports the personal and public health benefits of innovative, near-patient molecular diagnostics coupled with effective recall mechanisms.

Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development

“…Implementation of the Cepheid CT/NG GeneXpert demonstrated that faster (and appropriate) treatment was achieved in all settings. This was facilitated by reduced time to notification of results, which was a specific outcome for some studies [ 47 , 58 , 60 , 63 , 69 ] but same-day treatment was hindered by patients not waiting for test results at the point of care [ 61 , 65 ], and one study specifically reported increased patient waiting time in-clinic [ 57 ]. However, implementation of the test was broadly acceptable in all settings reporting this as an outcome [ 55 , 61 , 66 – 68 , 72 ].…”