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Infectious disease testing often boils down to location, location, location: An appropriate testing venue for hepatitis may not work for influenza or a sexually transmitted infection. A session at the 71st AACC Annual Scientific Meeting & Clinical Lab Expo, Tackling Infectious Disease Testing and Interpretation: Considering the Perspectives of the Core Clinical Laboratory and Point of Care Testing (34218) will explore options for six major infectious diseases: HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Clostridioides difficile (CDI), influenza, and syphilis. “Through case-based discussions, we will present practical information many clinical chemists might not have much exposure to during training,” said Nicole Tolan, BA, PhD, DABCC, the moderator and a co-presenter of this scientific session and associate medical director of clinical chemistry and medical director of point-of-care testing at Brigham and Women’s Hospital in Boston.
Testing strategies have undergone significant changes over the years as a result of technology improvements, said Tolan, who will discuss the clinical considerations and method limitations for HIV, HCV, and flu testing. Gary Horowitz, MD, a professor and director of informatics at Tufts Medical Center in Boston, will follow up with a talk on the clinical considerations and method limitations of HBV, CDI, and syphilis testing. Both Tolan and Horowitz will discuss each infectious disease as a case, cover relevant background information, then invite attendees to work through a set of questions in small groups, and provide a final interpretation of each case.
Testing for these six infectious diseases usually takes place in central core/chemistry labs, “as serologic testing can be performed on the same high-volume analyzers used for routine chemistries,” Tolan said. This allows laboratory directors to review results, provide interpretative comments, and suggest/reflex additional testing to expedite diagnosis and treatment, she added.
In addition, a number of molecular tests now can be performed at the point-of-care (POC). “These tests offer the advantages of reduced turnaround time, increased workflow efficiencies (particularly in managing patients who require infectious disease precautions), real-time clinician-patient interactions to inform medication prescription, and the ability to reduce the number of patients who are lost to follow up when results are only available after patient encounters,” Tolan said.
A good example of this involves polymerase chain reaction-based POC testing for influenza. Molecular assays that can be readily performed at the POC are far superior to the rapid antigen assays that many institutions still use for flu, she added.
Whether testing should take place at the POC or in central labs depends on how important it is to obtain results during a patient encounter, Horowitz told CLN Stat. “If POC testing could be offered with the same quality (including interfacing to the medical record, comparability of overall cost, etc.), then perhaps all testing should be done at the POC,” he offered. “Again, molecular testing for influenza and perhaps serologic testing for CDI provide interesting examples; a molecular test for HCV would be particularly useful as well.”
Lab directors should be aware that several POC methods are available for use in central/core laboratories to solve the types of problems they face, Horowitz emphasized. Location and technology will vary with the disease in question. “For example, molecular testing at the POC may be best for influenza; serologic testing using POC methods in the central/core lab may be the best choice for CDI,” he added.
The session’s objective is to demonstrate some scenarios in which clinical laboratory professionals can add value to testing performed in their labs and at ambulatory sites (urgent care, physician office labs, etc.) by presenting the current, best-practice recommendations for routine infectious disease testing, Tolan summarized.
The scientific session will take place at the 71st AACC Annual Scientific Meeting & Clinical Lab Expo in Anaheim, California, on August 7 from 2:30 p.m. to 5 p.m. and is worth 2.5 ACCENT credit hours.