Gonorrhea treatment in sub-Saharan Africa relies on syndromic management, which has poor diagnostic performance and misses asymptomatic infections. Point-of-care tests (POCTs) could address these limitations, but anticipated supply constraints necessitate strategic allocation to maximize impact.MethodsWe developed a deterministic compartmental model of gonorrhea transmission in Kenya to evaluate allocating POCTs for diagnostic confirmation of symptomatic care attendees versus screening of routine healthcare service attendees across five priority populations: female sex workers (FSW), their male clients (CFSW), pregnant women, adolescent girls and young women, or total population men. We modeled constrained and unrestricted POCT availability during 2025–2030, and estimated infections averted relative to baseline syndromic management. Quality-adjusted life years (QALYs) gained were quantified using probability tree models.ResultsAt baseline, incidence was highest among FSW (11.9 [UI: 5.7–18.6] per 100 per year) and CFSW (13.1 [6.9–24.8]), while most QALY losses (80.6% [76.1%–83.8%]) were among pregnant women and their infants. With constrained POCTs (sufficient to test 0.1% of adults annually), diagnostic confirmation averted the most transmission when among symptomatic FSW (2.1% [0.6%–5.6%] of infections) or CFSW (2.2% [0.8%–5.3%]), and the most morbidity when among symptomatic pregnant women (3.5% [1.8%–7.2%] of QALY losses). Screening averted <1% of infections or QALY losses across populations. With unrestricted POCTs, screening had larger absolute impacts but lower per-test efficiency than diagnostic confirmation.ConclusionsOur modeling supports prioritizing diagnostic confirmation over screening, consistent with WHO guidance to strengthen etiologic diagnosis within syndromic care. Diagnostic testing among symptomatic pregnant women had the largest impact on mitigating gonorrhea-related morbidity.

Point-of-care testing for Group A β-hemolytic streptococcus (StrepA POCT) allows for rapid testing for streptococcal infection in patients with signs of pharyngitis. We conducted a systematic review and meta-analysis of the impact of StrepA POCTs on antibiotic prescribing and health outcomes in patients with signs of pharyngitis in outpatient care.MethodsMEDLINE, Web of Science, Scopus and CENTRAL were searched for randomized controlled trials (RCTs, 01/2000 - 01/2025). Random effect models were used to calculate pooled risk ratios (RR) with 95% confidence intervals (95%CI) for summary effect sizes.ResultsFrom 15,097 unique records, we identified eight eligible RCTs comparing the use of StrepA POCTs with standard care. The use of StrepA POCTs reduced the number of antibiotics prescribed by 38 % (RR: 0.62, 95%CI: 0.51-0.77, p<0.001). In studies with StrepA POCTs as the sole intervention, antibiotic prescribing was reduced by 41 % (RR: 0.59, 95%CI: 0.44-0.78, p<0.001, 5 RCTs). The reduction in antibiotic prescribing was observed in children (RR: 0.56, 95%CI: 0.39-0.81, p=0.002, 4 RCTs) and adults (RR: 0.57, 95%CI: 0.39-0.85, p=0.006, 2 RCTs).The number of follow-up healthcare visits did not differ between StrepA POCT and standard care (RR: 0.56, 95%CI: 0.29-1.09, p = 0.086, 3 RCTs). There were no differences between point estimates of individual RCTs for other patient health outcomes, such as days until pain resolution and days of school/work missed.ConclusionsThe use of StrepA POCTs in children and adults with signs of pharyngitis likely reduces the number of antibiotics prescribed without compromising patient health outcomes.

Dr Marta Wanat from University of Oxford delivers a talk titled 'What can we learn from implementing POCTs in European primary care to support prudent antibiotic prescribing behaviour?' at IOI Early Career Researcher Conference 2025, held at Saïd Business School on Friday 21 March.

The growing cancer burden and suboptimal diagnostic capacity in low- and middle-income countries calls for urgent innovation in diagnostic solutions. Point-of-care technologies (POCTs) offer a transfo...

Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo ... View article...

Background This scoping review aimed to summarize existing research on point-of-care tests (POCTs) within emergency medical services (EMS). There is a lack of comprehensive reviews covering the breadt...

CONCLUSION: Our review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.

Background This scoping review aimed to summarize existing research on point-of-care tests (POCTs) within emergency medical services (EMS). There is a lack of comprehensive reviews covering the breadt...

and objectivesAntimicrobial resistance (AMR) is a growing threat to child health in low- and middle-income countries (LMICs), where inadequate antibiotic access frequently causes morbidity and mortality. We sought to identify effective interventions to optimize antibiotic use in children with suspected infections in LMIC ambulatory healthcare settings.MethodsMEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Infectious Disease Group Specialized Register, Web of Science, PsycInfo, WHO library database (WHOLIS) and regional databases (inception until 16 December 2024) were searched to identify studies of interventions to optimize antibiotic use in children in LMIC peripheral healthcare settings.ResultsOur search identified 7154 articles post de-duplication; 23 studies met the inclusion and Integrated quality Criteria for the Review of Multiple Study designs (ICROMS) assessment criteria. Seventeen were randomized trials, conducted in five LMICs, four upper-middle income countries (UMICs) and two low-income countries (LICs). Single-intervention studies investigated electronic algorithms (n = 3) and point-of-care tests (POCTs) (n = 4). Electronic algorithms and enhanced POCTs reduced antibiotic prescriptions for children with acute illness at primary care facilities in Tanzania. C-reactive protein POCTs achieved modest reductions in antibiotic prescribing for children in Vietnam and Uganda but not for those with febrile illness in Myanmar and Thailand. A diagnostic tool algorithm showed reduction of antibiotic prescriptions in Ghana and Burkina Faso, but not in Uganda.ConclusionsInitial evidence suggests that algorithmic decision-support tools combined with point-of-care diagnostics and provider education can reduce antibiotic prescribing in children attending ambulatory healthcare settings in LMICs, with most studies demonstrating no compromise of clinical outcomes. However, few studies assessed prescription appropriateness or microbiological outcomes, limiting conclusions about long-term impact. Future interventions should prioritize context-adaptable strategies that incorporate rapid diagnostics, evaluate clinical and appropriateness outcomes, and consider implementation feasibility across diverse LMIC settings.

Gonorrhoea treatment in sub-Saharan Africa relies on syndromic management, which has poor diagnostic performance and misses asymptomatic infections. Point-of-care tests (POCTs) could address these limitations, but anticipated supply constraints necessitate strategic allocation to maximise impact.MethodsWe developed a deterministic compartmental model of gonorrhoea transmission in Kenya to evaluate allocating POCTs for diagnostic confirmation of symptomatic care attendees versus screening of routine healthcare service attendees across five priority populations: female sex workers (FSW), their male clients (CFSW), pregnant women, adolescent girls and young women, or total population men. We modelled constrained and unrestricted POCT availability during 2025-2030, and estimated infections averted relative to baseline syndromic management. Quality-adjusted life years (QALYs) gained were quantified using probability tree models.ResultsAt baseline, incidence was highest among FSW (11.9 [UI:5.7-18.6] per 100 per year) and CFSW (13.1 [6.9-24.8]), while most QALY losses (80.6% [76.1-83.8%]) were among pregnant women and their infants. With constrained POCTs (sufficient to test 0.1% of adults annually), diagnostic confirmation averted the most transmission when among symptomatic FSW (2.1% [0.6-5.6%] of infections) or CFSW (2.2% [0.8-5.3%]), and the most morbidity when among symptomatic pregnant women (3.5% [1.8-7.2%] of QALY losses). Screening averted <1% of infections or QALY losses across populations. With unrestricted POCTs, screening had larger absolute impacts but lower per-test efficiency than diagnostic confirmation.ConclusionsOur modelling supports prioritising diagnostic confirmation over screening, consistent with WHO guidance to strengthen aetiologic diagnosis within syndromic care. Diagnostic testing among symptomatic pregnant women had the largest impact on mitigating gonorrhoea-related morbidity.