Improving access to COVID-19 testing

Testing in Aboriginal communities using point-of-care testing

It is widely agreed that in all countries including Australia, control of the COVID-19 pandemic requires testing as many people as possible. This was highlighted in a recent article in the BMJ entitled: COVID-19: testing times, which reviewed the methods of testing for both the virus itself and the antibody response.

The main conclusion of the article was that even in a relatively small country such as England there is a need to take testing closer to the consumer in order to ensure that testing reaches all communities and the results can be acted on quickly. This would require what is known as point-of-care testing or PoCT in addition to sending samples to large central laboratories.

Testing for the virus in Australia has until now relied on using public and private central laboratories in the major cities to perform the vast majority of testing. This means that samples collected from people who are living in regional and remote areas must be transported to the nearest city laboratory for analysis. This extends the test turnaround time and a result may not be available for many days.

Northern and central indigenous communities are both more remote and more vulnerable to the virus than the rest of Australia.  To address this problem, the Australian Government recently announced a $3.3 million program to establish a Point-of-Care Testing COVID-19 Program for remote and rural Aboriginal and Torres Strait Islander communities.
The program will use portable devices for detection of COVID-19 which can produce a result in 45 minutes. The aim is to collect the sample, test and provide a consultation all in one visit. In a region such as the Kimberley, the current test turnaround time is up to 10 days.
This newly announced program is an extension of a point-of-care testing program that has been operating in Aboriginal communities for some years. Called TTANGO – Test, Treat and Go - the program is a collaboration between Aboriginal communities, the Kirby Institute and Flinders University. Its focus is on sexually transmitted diseases where the rapid turnaround time achieved with point-of-care testing provides the ability to reduce the number of infected individuals in the community.

Similar benefits are likely to be achieved for the COVID-19 testing program as indicated by the Federal Health Minister, Greg Hunt, who said that the program would allow local health services to respond quickly and decisively if COVID-19 was identified in their communities.

Other pathology providers are taking advantage of these smaller and more portable testing devices, including Queensland Pathology and SA Pathology, who are using them in some of their regional laboratories as a way to improve access to rapid COVID-19 testing.

At the moment, detection of the virus’s genetic material is seen as the most suitable test to control the spread of COVID-19.  However, a different way of testing has attracted attention in recent weeks. This measures a person’s antibody response to the virus. This form of test can be done in a laboratory but is available as a point-of-care device requiring just a fingerstick sample of blood which is placed on a small test strip device with visual reading of the result some minutes later. Further details of these devices can be found in the COVID-19 section on this website.

While convenient, the performance of these devices is unproven and undergoing evaluation at the Doherty Institute in Melbourne. These antibody tests are not useful for diagnosis of people who are currently unwell. They are used to show that a person was previously exposed to COVID-19. If such devices are shown to be clinically useful then it is likely that many more people in the community will experience the benefits of point-of-care testing, as COVID-19 is going to be with us for some time.

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