**2. Examples of primary care POC testing networks in Australia**

The Flinders University International Centre for Point-of-Care Testing (ICPOCT) is a specialist POC test provider, with over 20 years of experience in the establishment, management, and evaluation of best-practice POC testing to improve access to routine pathology services. At present, the ICPOCT independently manages five POC testing networks and is a collaborating partner with the Kirby Institute at the University of New South Wales (UNSW) on a further two POC testing networks. **Table 1** summarises the ICPOCT and collaborative partnership POC testing programs indicating the POC test device used, the POC test/s performed, the time taken to generate the POC test result, and the number of participating health clinics. The complexity of the POC methodologies and device types used across these POC testing programs ranges from simple, lateral flow rapid antibody tests with qualitative results (e.g. used to detect *Treponema pallidum* (Syphilis) infection) to complex, gold-standard, nucleic acid amplification tests (NAATs) which utilise safe, closed cartridge test systems for the qualitative detection of infectious disease RNA (e.g. used to diagnose SARS-CoV-2 (COVID-19) infection) or DNA (e.g. used to detect *Chlamydia trachomatis* (Chlamydia), *Neisseria gonorrhoeae* (Gonorrhoea) and *Trichomonas vaginalis* (Trichomonas) infections) or the quantitative detection of infectious disease RNA viral load (e.g. used for diagnosis and monitoring of Hepatitis C (HCV) infection).


*^Haemoglobin A1c, # albumin:creatinine ratio, ~Haemoglobin, \* International Normalised Ratio, + Severe Acute Respiratory Syndrome Coronavirus 2, \*\*Partnership POC testing program with the Kirby Institute, University of New South Wales.*

#### **Table 1.**

*Summary of primary care POC testing networks managed by the ICPOCT (Flinders University) alone, or in collaborative partnership with the Kirby Institute (UNSW).*

The POC testing programs described in **Table 1** are primarily focussed in rural and remote Australian primary care settings, with the general location of health services participating in the seven networks represented in the series of maps in **Figure 1(A**–**F)**. Indicative of the clinical need for diagnostic test provision by POC testing, it is notable that over 50% of the health services participating in the Aboriginal and Torres Strait Islander COVID-19 POC testing program are located more than 10 hours' drive from a laboratory testing facility and thus complement laboratory services [11]. In addition, primary health care services particularly in the most remote parts of Australia (notably the Northern Territory and north-west and central Western Australia) actively participate concurrently in up to six POC testing networks so that they can facilitate a broad range of on-site diagnostic tests for patient centred-care (**Figure 2**).

The Quality Assurance in Aboriginal Medical Services (QAAMS) POC testing program for diagnosis and management of diabetes and renal disease, the Aboriginal and Torres Strait Islander COVID-19 (COVID-19) POC testing program, the Test, Treat ANd GO (TTANGO) POC testing program for sexually transmitted disease

**Figure 1.**

**(A–C)***. Point-of-care testing network maps under the jurisdiction of the ICPOCT.* **(D–F)***. Point-of-care testing network maps under the jurisdiction of the ICPOCT.*

*Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care DOI: http://dx.doi.org/10.5772/intechopen.100375*

**Figure 2.** *Merged ICPOCT point-of-care network maps.*

diagnosis and monitoring and the Enhanced Syphilis Response (ESR) POC testing program are all funded by the Australian Government and thus include site selection criteria for national testing coverage, complementary to regional and urban laboratories. The COVID-19 and ESR POC testing programs were both established as 'emergency response' initiatives under the directive of the Australian Government [12]. The Northern Territory (NT) i-STAT POC testing program for acute disease management (blood gas, urea/electrolytes and cardiac troponin I), and Prothrombin (PT)/International Normalised Ratio (INR) monitoring and the White Blood Cell (WBC) Differential (DIFF) POC testing program for sepsis diagnosis are both funded by the NT Government Department of Health and include site selection criteria and enrolled health services specific to the remote Central and Top End regions of the NT. Similar to the NT funded POC program, the Western Australian (WA) Syphilis POC testing program is a state-based network funded by the WA Government Department of Health, facilitating syphilis POC testing in broad range of decentralised setting including: remote, regional, and urban community services, hospital maternity wards, peer harm reduction outreach services, homeless health care services and prisons.

The QAAMS Program has been operational for 22 years [13], and is economically sustainable at the health service level due to the availability of specific public health (Medicare Benefits Schedule (MBS)) rebates for: (i) glycated haemoglobin A1c (HbA1c) POC testing for diabetes diagnosis or management and (ii) urine albumin to creatinine ratio (UACR) POC testing for monitoring of renal disease, when the quality management is compliant under the auspices of the QAAMS program. At present, the QAAMS program supports the only POC testing performed outside of an accredited laboratory facility within Australia to have approved MBS item numbers. Dependant on regulatory system development to facilitate accreditation processes, an equivalent MBS rebate may soon expand to HbA1c POC testing performed independently within GP clinics in Australia.

Like the QAAMS program, the NT i-STAT POC testing also has significant longevity, with 13 years of continuous operation and government funding [14]. The sustainability of the NT i-STAT POC testing program is largely associated with the demonstrated economic benefits of POC testing in acute clinical management in remote primary health care, due to averted medical evacuations [15]. The NT

government has also recently expanded the NT POC testing network to facilitate twenty total white blood cell (WBC) count POC devices (HemoCue, Radiometer) with 5-part WBC differential for sepsis management in the Top End NT sites.

The COVID-19 and TTANGO POC testing programs, and more broadly a National Health and Medical Research Council (NHMRC) Centre for Research Excellence for Infectious Disease POC Testing in the Asia-Pacific, are representative of a long-term, collaborative partnership between the ICPOCT and the Kirby Institute (UNSW). The COVID-19 and TTANGO POC networks use gold-standard NAATs within a safe, closed cartridge testing system to detect the respective infectious disease RNA or DNA, using the Cepheid GeneXpert POC device [11]. Some POC devices, including the GeneXpert (Cepheid), offer broad clinical application with extensive test menus as well as the rapid development of newer *in vitro* diagnostic tests utilising the same test cartridge design and device infrastructure. Utilising this capability, a new collaborative POC testing network (with the Kirby Institute) for capillary (fingerstick) hepatitis C viral load using the GeneXpert will be established in late 2021 to early 2022. Funded by the Australian Government, the National Hepatitis C (HCV) POC testing program, will focus on the application of a Class IV *in vitro* diagnostic POC test in a broader range of primary care settings. Justice health services, safe drug injection rooms, community needle and syringe programs and homeless health services will be eligible as high prevalence, decentralised test sites for enrolment into the National HCV POC testing program. The overall aim of the National HCV POC testing program is to support Australia's contribution to the World Health Organization's global goal to eliminate hepatitis as a public health threat by 2030 [16]. In addition, future infectious disease research to investigate the potential advantages of using multiplexed POC test cartridges, such as respiratory panel, including Influenza A, Influenza B (Flu A/B), COVID-19 and Respiratory Syncytial Virus (RSV) in primary care settings using the GeneXpert in Australia may also be warranted.
