A collaborative and rapidly rolled out point-of-care testing program helped avert a major COVID-19 outbreak in remote Aboriginal communities during the pandemic.
A new evaluation commissioned by the Australian Government has determined a national program rapidly established to avoid a COVID-19 outbreak in rural and remote First Nations communities was highly successful. The Program, funded by the Australian Government Department of Health and Aged Care, is co-led by the Kirby Institute and Flinders University International Centre for Point-of-Care Testing and co-designed alongside Aboriginal community-controlled health organisations, health providers and peak bodies.
The program commenced in April 2020 with the first point-of-care test being delivered by May that year. By September 2020, a total of 86 remote and regional health clinics predominantly servicing Aboriginal and Torres Strait Islander people had enrolled in the Program. This was expanded to 105 services across Australia by mid 2022.
The evaluation, undertaken by independent consultants Nous Group, used a range of models and projections to determine averted cases and costs to the health system up to the end of August 2022. It shows that during the first two years, the Program averted around 122,000 infections that would be likely to have arisen in the months after the first infection was identified in a remote Aboriginal and/or Torres Strait Islander community, and has led to a cost saving of between $337 million and $1.8 billion for the Australian health care system.
In June 2022, the program began transitioning to testing for other respiratory illnesses including COVID-19, influenza A and B, and respiratory syncytial virus (RSV). At the time of the evaluation being published, 85 sites had transitioned to this expanded testing.
Delivering technology to where it’s needed
The program is the largest in the world to utilise innovative, molecular point-of-care testing technology to enable rapid testing and diagnosis of COVID-19. It is a highly accurate test, and results are delivered within a short clinic visit; approximately 45 minutes. Early in the pandemic, it was one of the only health tools available to provide timely, accurate diagnosis of COVID-19, to facilitate actions to prevent the virus’ spread. “When the program was established in early 2020, there was no vaccine nor rapid antigen tests available. On this backdrop, the need to control the virus was urgent,” says the Kirby Institute’s Professor Rebecca Guy.
The COVID-19 pandemic has posed a particularly serious risk to remote Aboriginal and Torres Strait Islander communities. The high burden of a number of chronic diseases can make people more susceptible to the serious health complications from the virus. “One case in a remote community at that time could have been devastating,” says Dr Dawn Casey, who is Deputy CEO of the National Aboriginal Community Controlled Health Service (NACCHO). “Among the challenges, many people in these remote communities live in very close proximity, so cases would spread rapidly and isolation would be challenging. A large outbreak would have placed immense strain on health systems which are already stretched.”
Geographical remoteness was also a barrier to testing, as health and pathology services are located hundreds, and sometimes thousands of kilometres away. “Time is of the essence when controlling infectious diseases, and through various programs, point-of-care testing has been proven to be highly effective and acceptable to people living in remote communities,” says Prof Guy.
Partnership and community leadership key to success
According to the report, ‘a major strength of the Program, was the creation of and enabling a trusting environment where lessons were shared, and practices continually improved.’ This was enhanced through the establishment by NACCHO and Australian Government of the Aboriginal and Torres Strait Islander Advisory Group on COVID-19*, co-chaired by Dr Casey and comprised representatives from the Aboriginal community-controlled health sector, Aboriginal health service providers, clinicians and peak bodies, as well as state and federal health sector representatives.
The point-of-care technology enabled rapid identification of the first case in communities and triggered a range of local clinical and public health responses, often on the same day, which were critical to controlling the virus. Dr Casey says that Aboriginal and Torres Strait Islander leadership in the design and implementation of such health interventions is essential to their success. “First Nations people know what is best and what will work for our communities, and this may look different across the many communities in this country, which is why local knowledge is so critical. What the Program has done well is to rapidly scale up access to quality molecular point-of-care technology, which provided results in less than an hour, enabling Aboriginal Community Controlled Health Services to use their local knowledge and clinical expertise to rapidly respond to COVID-19 in their communities.”
Since 2011, the Kirby Institute and Flinders University International Centre for Point-of-Care Testing have worked in partnership alongside Aboriginal community-controlled health organisations, State and Territory Health Services and Aboriginal and Torres Strait Islander communities, to deliver point-of-care testing for sexually transmissible infections in remote communities. At the onset of the COVID-19 pandemic, the Australian Government provided funding to build upon this existing network and infrastructure, enabling the expansion to additional sites to test for COVID-19.
The evaluation states that the Program ‘has achieved its intended aim of improved health outcomes for First Nations people through better access to COVID-19 testing’ and attributes a key factor in its success to partnership and Aboriginal and Torres Strait Islander leadership in the design and delivery of the program. It pointed to the dedication of the frontline workforce, who were trained in using the testing system, as essential to the program’s success, and also highlights the utilisation of the innovative testing technology and the technical support given by the Kirby Institute and Flinders University International Centre for Point-of-Care Testing.
“The Aboriginal Community-Controlled and state and territory health services went above and beyond for their communities,” says Professor Mark Shepherd, Director of the Flinders University International Centre for Point-of-Care Testing. “Their leadership of the program development and implementation meant that important information and testing reached their communities. We are proud to work alongside our Aboriginal and Torres Strait Islander colleagues and support primary care services to deliver what has been a widely successful program, which has unequivocally improved health and saved lives.”
With the evaluation demonstrating the program’s success, Prof Guy says that there is continuing scope for point-of-care testing services to become an integrated part of primary health in remote settings. “Through delivering point-of-care testing in this community-led model, together we have demonstrated how to effectively co-design programs that meet the needs of those they seek to help. We hope that this approach, that has been so critical to this Program’s success, is adopted more widely and sustainably across the health and other sectors, to deliver positive outcomes for Aboriginal and Torres Strait Islander people.”
*On 17 October 2022, the Advisory Group became the National Aboriginal and Torres Strait Islander Health Protection sub-committee of the Australian Health Protection Principal Committee.
Read the evaluation in full on the Department of Health and Aged Care website.