TTANGO (Test, Treat ANd GO)

Date Commenced:
05/2011
Project Status
Ongoing
Expected Date of Completion:
12/2014
Project Supporters

NHMRC Project Grant

Currently recruiting
No
image - TTANGO284x284

About the Project

TTANGO (Test, Treat ANd GO) -  A randomised trial of point-of-care tests for chlamydia and gonorrhoea infections in remote Aboriginal communities

Rationale

Rates of sexually transmissible infections (STIs) in remote Aboriginal communities are among the highest in the world. Bacterial STIs are important causes of ill health, can be personally distressing and are associated with stigma. These infections can have serious clinical consequences such as pelvic inflammatory disease (PID), infertility and systemic disease and place a substantial burden on health services. STIs can also increase an individual’s susceptibility to transmitting and acquiring HIV infection.

In order to interrupt disease transmission in populations at higher risk of chlamydia and gonorrhoea, it is essential to make a diagnosis and undertake treatment as early as possible in people who have infection. Without treatment, infection with chlamydia can persist for many months. Timely diagnosis also enables potentially infected sex partners to be identified through partner notification strategies, and treated.

Because of the rarity of symptoms and the inherent delays in the majority of cases that are asymptomatic and therefore depend on a laboratory finding to initiate treatment, currently available diagnostic strategies for chlamydia and gonorrhoea are not ideal in remote settings. A potential solution to this problem is the use of rapid point-of-care tests that can provide an immediate result in field settings, thereby allowing clinical services to offer treatment and begin the process of partner notification at the time when the specimen is taken.  

Aims

To measure the effectiveness, cost-effectiveness and cultural and operational acceptability of point-of-care testing for chlamydia and gonorrhoea infections in remote Aboriginal communities.

Design & Method

The study employs a cross-over randomised trial design. A total of twelve health services in Queensland, Western Australia and South Australia have been recruited to participate in the trial. Each clinic will undertake the clinical management of chlamydia and gonorrhoea under two different modalities for one year each, in a randomly assigned order. In the first year, half of the health services will be randomly assigned to manage these infections under current guidelines, and the other half will supplement standard guidelines with point-of-care (POC) testing, such that treatment is offered at the time of diagnosis for those found to be positive by the POC test. In the second year, the clinics will cross over to the opposite management modality. The POC test that is being used in TTANGO is the GeneXpert CT/NG (Cepheid), a new molecular based test that performs on par with routine laboratory tests. The study will require four years to complete, including 18 months preparation, two years for the intervention and 6 months for analysis and reporting.

Progress/Update

Preparation, consultation and ethics approval processes are complete, and the intervention phase recently commenced.

Benefits

Current strategies for diagnosing and treating bacterial STIs have had limited success in decreasing community level prevalence of chlamydia and gonorrhoea. Rapid point-of-care tests are available but not used because there is uncertainty about their overall benefit and clinical acceptability. The results of this definitive, randomised trial will provide crucial information to guide sexual health clinical practice in remote Aboriginal communities. If successful, the trial will provide clear evidence that rapid point-of-care tests are capable of improving the timelines of treatment and decreasing re-infection rates. Mathematical modelling and health economic analyses can then be used to make the case for large scale implementation of this technology

Output

Two to three manuscripts expected

Project Members
image - 1338435941 Rebecca Guy
Associate Professor
Ph +61 (0)2 9385 0900
image - Basildonovan Head Shoulders 2013
Professor and Program Head
Ph +61 (0)2 9385 9956
image - 1343188801 David Wilson
Associate Professor and Program Head
Ph +61 (0)2 9385 0900
image - 1338426757 David Regan.jpg
Senior Lecturer
Ph +61 (0)2 9385 0900
image - Handan Wand2
Associate Professor
Ph +61 (0)2 9385 0861
image - 1339124418 Jk2
Professor and Program Head
Ph +61 (0)2 9385 0961
image - 1338431876 Louise
Lecturer
Ph +61 (0)2 9385 0900
image - Stevebadman
WA TTANGO Trial Coordinator
Other Investigators

Mr James Ward, Dr David Whiley, A/Professor Sepehr Tabrizi, Professor Christopher Fairley, A/Prof Mark Shephard, A/Prof David Anderson, Ms Lisa Natoli, Ms Belinda Hengel, Ms Annie Tangey,

Project Collaborators: External

Baker IDI, Central Australia

University of QLD/Queensland Paediatric Infectious Diseases Laboratory

Royal Women’s Hospital

University of Melbourne/Melbourne Sexual Health Centre

Flinders University, SA

Burnet Institute, VIC

Ngaanyatjarra Health Service, NT

Apunipima Cape York Health Council, QLD

Project Contacts

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