{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:46:47Z","timestamp":1782755207197,"version":"3.54.5"},"reference-count":66,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1009902"],"award-info":[{"award-number":["1009902"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2027224"],"award-info":[{"award-number":["2027224"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["568971"],"award-info":[{"award-number":["568971"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1092503"],"award-info":[{"award-number":["APP1092503"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2008099"],"award-info":[{"award-number":["GNT2008099"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2026,5,19]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In remote Australian First Nations communities, the burden of curable sexually transmitted infections (STIs) is highest for young women and men aged 16\u201329 years and for women is associated with two-fold higher rates of hospitalisations for pelvic inflammatory disease (PID) than for non-First Nations women. Following a randomised trial, decentralised community-led molecular point-of-care (POC) testing for STIs has operated in remote primary care across Australia for more than 7 years, improving uptake and timeliness of treatment for chlamydia, gonorrhoea and trichomonas infections. However, cost-effectiveness remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision analytic model was devised to compare costs and outcomes associated with a POC testing programme for chlamydia, gonorrhoea and trichomonas infections in women and men aged 16\u201329 years seeking care, compared with standard care (laboratory-based testing). The analysis used a government payer perspective and 10-year time horizon. The primary outcome was the cost ($A) per quality-adjusted life year (QALY) gained. Sensitivity analyses examined uncertainty around the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on a combined testing positivity rate of 36% and 29% for chlamydia, gonorrhoea and trichomonas for women and men, respectively, the POC testing programme, compared with laboratory testing, produced an estimated incremental cost per QALY ratio (ICER) of $A19 714 (95% CIs $A19\u2009608 to $A19 821) over 10 years. Among those with an STI, the POC testing programme was predicted to reduce diagnosed PID by 30% and preterm\/low birth weight babies by 17%. Sensitivity analyses indicated that the ICER was most sensitive to the probability of infection and receiving treatment within 2\u2009days, based on a willingness-to-pay threshold of $A50 000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This health economic evaluation indicates that a scaled molecular POC testing programme for the management of STIs in remote primary care settings is cost-effective compared with standard care. Sustained POC testing in this setting is likely to improve reproductive health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056863","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:20:37Z","timestamp":1782753637000},"page":"sextrans-2025-056863","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of a decentralised molecular point-of-care testing programme for sexually transmitted infections in remote primary care health services in Australia"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3811-4797","authenticated-orcid":false,"given":"Caroline G","family":"Watts","sequence":"first","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8814-0678","authenticated-orcid":false,"given":"Louise M","family":"Causer","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan J","family":"Matthews","sequence":"additional","affiliation":[{"name":"International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Smith","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Andrewartha","sequence":"additional","affiliation":[{"name":"International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Tangey","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6567-5821","authenticated-orcid":false,"given":"Ben B","family":"Hui","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rae-Lin","family":"Huang","sequence":"additional","affiliation":[{"name":"Nganampa Health Council, South Australia, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Anderson","sequence":"additional","affiliation":[{"name":"Infection and Global Health Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia"},{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G","family":"Badman","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Cepheid, Sunnyvale, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Donovan","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9081-1664","authenticated-orcid":false,"given":"Christopher K","family":"Fairley","sequence":"additional","affiliation":[{"name":"Central Clinical School, Monash University, Melbourne, Victoria, Australia"},{"name":"Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoji","family":"Gunathilake","sequence":"additional","affiliation":[{"name":"Public Health Unit, Northern Territory Centre for Disease Control, Casuarina, Northern New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda","family":"Hengel","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kaldor","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Maher","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna B","family":"Mak","sequence":"additional","affiliation":[{"name":"The University of Notre Dame Australia, Perth, Western Australia, Australia"},{"name":"Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Persing","sequence":"additional","affiliation":[{"name":"Cepheid, Sunnyvale, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G","family":"Regan","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D","family":"Shephard","sequence":"additional","affiliation":[{"name":"International Centre for Point of Care Testing, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Speers","sequence":"additional","affiliation":[{"name":"Pathwest Laboratory Medicine WA, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8279-7652","authenticated-orcid":false,"given":"Handan","family":"Wand","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Ward","sequence":"additional","affiliation":[{"name":"Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Whiley","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, 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