Regular review: Point of care testing

Price, Christopher P.

doi:10.1136/bmj.322.7297.1285

Cited by 304 publications

(212 citation statements)

References 22 publications

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“…These findings also support the advantage of using HIV rapid testing for pregnant women in addition to other previously reported advantages of POC diagnostics over standard laboratory testing. 33,34 Poor compliance to standard protocols by healthcare providers has been listed among the most common causes of maternal deaths in South Africa. 35 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Mashamba-Thompson

Moodley

Sartorius

et al. 2018

South. Afr. j. HIV med.

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Introduction: South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN).Method: We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test.Results: Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% – 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% – 100%) and 99% (CI: 95% – 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% – 100%) and 95% (CI: 88% – 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN.Conclusion: Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Mashamba-Thompson

Moodley

Sartorius

et al. 2018

South. Afr. j. HIV med.

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“…Some studies indicate that PoCT is more expensive when compared to laboratory testing 2,21 , but this may be offset by long term societal gains such as prolonged life or reduced hospital stays. 5 It should, however, be noted that the cost effectiveness of PoCT appears likely to vary according to the disease group and the test in question. 2 The attitudes of key stakeholders and their satisfaction with PoCT form an important part of the assessment of introducing PoCT into GP.…”

Section: Summary Of the Chaptermentioning

confidence: 99%

“…1 While a large number of studies have been undertaken on the use of PoCT in the primary care setting, few studies have undertaken an economic analysis of PoCT. 5 Hobbs et al's 3 systematic review of PoCT in primary care could not draw any conclusions regarding cost effectiveness of PoCT because of insufficient research data. Some studies indicate that PoCT is more expensive when compared to laboratory testing 2,21 , but this may be offset by long term societal gains such as prolonged life or reduced hospital stays.…”

Section: Summary Of the Chaptermentioning

confidence: 99%

“…INTRODUCTION While a large number of studies have been undertaken on PoCT use in a primary care setting, few of these have included an economic analysis of PoCT. 5 The review by Hobbs et al of PoCT in primary care concluded that there was "insufficient data for conclusions to be drawn on the cost effectiveness of NPT in primary care." 3 Some studies indicate that PoCT is more expensive when compared to laboratory testing, 45 but this may be offset by long-term societal gains such as prolonged life or by reduced hospital stays.…”

Section: Cost-effectiveness Of Poct In General Practice Summary Of Thmentioning

confidence: 99%

“…3 Some studies indicate that PoCT is more expensive when compared to laboratory testing, 45 but this may be offset by long-term societal gains such as prolonged life or by reduced hospital stays. 5 However, it should be noted that the costeffectiveness of PoCT is likely to vary according to the disease group and the test in question. 45 This Trial investigated the cost-effectiveness of PoCT as it related to the three devices used and focused on the incremental costs and consequences for practices, patients and the Government, i.e.…”

Section: Cost-effectiveness Of Poct In General Practice Summary Of Thmentioning

confidence: 99%

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The impact of non‐vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia

Bellinge

Paul

Walsh³

et al. 2018

Medical Journal of Australia

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Objective: To determine the use of different anticoagulation therapies in rural Western Australia; to establish whether remoteness from health care services affects the choice of anticoagulation therapy; to gather preliminary data on anticoagulation therapy safety and efficacy. Design: Retrospective cohort study of patients hospitalised with a principal diagnosis of atrial fibrillation/flutter (AF) or venous thromboembolism (VTE) during 2014–2015. Setting: Four hospitals serving two‐thirds of the rural population of Western Australia. Participants: 609 patients with an indication for anticoagulation therapy recorded in their hospital discharge summary for index admission. Main outcome measures: Prescribing rates of anticoagulation therapies by indication for anticoagulation and distance of patient residence from their hospital. The primary safety outcome was re‐hospitalisation with a major or clinically relevant non‐major bleeding event; the primary lack‐of‐efficacy outcome was re‐hospitalisation for a thromboembolic event. Results: The overall rates of prescription of NOACs and warfarin were similar (34% v 33%). A NOAC was prescribed more often than warfarin for patients with AF (56.0% v 42.2% of those who received an anticoagulant; P < 0.001), but less often for patients with VTE (29% v 48%; P < 0.001). Warfarin was prescribed for 38% of patients who lived locally, a NOAC for 31% (P = 0.013); for non‐local patients, the respective proportions were 29% and 36% (P = 0.08). 69% of patients with AF and a CHA2DS2–VASc score ≥ 1 were prescribed anticoagulation therapy. Patients treated with NOACs had fewer bleeding events than patients treated with warfarin (nine events [4%] v 20 events [10%]; P = 0.027). Conclusions: In rural WA, about one‐third of patients with an indication for anticoagulation therapy receive NOACs, but one‐third of patients with AF and at risk of stroke received no anticoagulant therapy, and may benefit from NOAC therapy.

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Point‐of‐Care Testing in Monitoring

Price¹

2008

Evidence‐based Medical Monitoring

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Regular review: Point of care testing

Cited by 304 publications

References 22 publications

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

The impact of non‐vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia

Point‐of‐Care Testing in Monitoring

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