The value of molecular point-of-care testing for Group A Streptococcal pharyngitis in a remote, non-clinical Australian setting

<h2>Abstract</h2><h3>Objectives</h3> <b>:</b> Group A Streptococcal (GAS) pharyngitis is an important precursor infection to severe complications including rheumatic fever and invasive GAS. Rapid molecular point of care testing (POCT) for GAS infection has advantages over traditional microbiological culture, especially in settings with limited or absent laboratory infrastructure and where GAS complications predominate. Evaluation of POCT is necessary to inform adoption of this highly sensitive, modern technology. We evaluated molecular POCT for GAS detection in school-aged children in remote Australia where laboratory infrastructure is limited. <h3>Methods</h3> <b>:</b> GAS POCT evaluation was nested within a larger prospective surveillance study capturing GAS pharyngitis and impetigo infections in children. From 20^th April 2021 to 21^st September 2022, 152 children from two schools in the Kimberley region of Western Australia were clinically assessed in weekly screens; those presenting with sore throat symptoms provided throat swabs for molecular POCT and laboratory culture for GAS detection following several days of transport at 4-8°C. <h3>Results</h3> <b>:</b> Seventy-seven of 152 children presented with sore throat symptoms at least once and obtained a POCT evaluation. One-hundred and eighty-three POC tests were performed, and matched culture was available for 181 (98.9%) swabs. We report a POCT sensitivity of 85.0%, specificity of 81.0%, positive predictive value of 35.4% and negative predictive value of 97.7%. <h3>Conclusion</h3> <b>:</b> Sore throats were prevalent in children attending school. POCT increased detection of GAS compared with delayed culture. GAS POCT implementation globally remains a critical strategy for primary prevention of rheumatic fever and GAS complications in remote settings and in settings where laboratory testing is unavailable.