• Causer, Louise
• Bowen, Asha
• Patel, Prital
• Wong, Bernadette
• Phillips, Emily
• Fernando, Mel
• Guy, Rebecca

Abstract

Background and Aims<br/>In remote Australia, presumptive treatment of sore throats is recommended, as air transportation of samples for culture results in delays of 5 – 7 days from time of collection, which greatly impacts timely treatment to prevent ARF. Whilst molecular point-of-care testing for Strep A (PoCT) in the throat is now available, there have been no studies to date that have applied this tool to revolutionise primary prevention strategies in children at high risk of acute rheumatic fever (ARF). The burden of ARF in remote, northern Australia is at the highest reported rates in the world, associated with the social determinants of health. <br/>Methods<br/>A Strep A PoCT program will be co-designed and implemented across ~20 remote health services spanning multiple states. A national PoC program will be leveraged to develop local testing capacity, data connectivity systems, and quality frameworks that adhere to national PoCT guidelines. Informed by recent studies demonstrating (a) the contribution of asymptomatic infections to transmission and (b) the paucity in self-reported sore throats in the backdrop of high ARF rates, a new model of care where children aged 3 – 15 years attending clinics for any reason are offered a PoCT will be proposed. Guideline-adherent treatment will be provided for positive testers and impact of timely treatment on ARF will be evaluated. The primary outcome is the proportion of suspected or confirmed Strep A in the throat, who received same-day treatment. Secondary outcomes will assess the cost, impact on ARF rates and acceptability to clinicians and families. <br/>Results <br/>Co-design with Aboriginal Community Controlled Health Organisations (ACCHOs) has commenced to ensure all features are acceptable, feasible and useful for remote living Aboriginal and Torres Strait Islander children and their families. An initial co-design workshop with national stakeholders from across sectors, including clinical staff, policy makers, research and laboratory (&gt;50% Aboriginal and/or Torres Strait Islander peoples), highlighted that for long-term sustainability of PoCT programs, there needs to be consideration of greater workforce support, flexible training modalities, funding and integration with other molecular PoCTs currently available.The full protocol for the world first programmatic approach to Strep A molecular PoCT for prevention of ARF will be presented. The four-year study (two-year retrospective period, two-year prospective period) is expected to roll out in clinics across Australia in early 2024, and rapidly increase treatment of Strep A in the throat rapidly as a key part of the national strategy for ARF prevention.<br/>Conclusions <br/>The availability of new diagnostic tools for early detection and treatment of Strep A in the throat at the clinic (irrespective of symptoms), despite being far from traditional microbiology laboratories, is a potential game changer for ARF prevention. This study will demonstrate the potential utility for opportunistic screening, co-design of clinical pathways, and incorporation of Indigenous methodologies to evaluate and define new models of care that better suit local populations. The findings are anticipated to have learnings for programs globally to consider. <br/>

Topics

• impedance spectroscopy