Point-of-care test to monitor adherence to anti-tuberculous treatment.

BACKGROUND: In the fight against the global tuberculosis epidemic, it is essential to ensure that patients adhere to the treatment prescribed. As the treatment is given for a minimum of 6 months it is common for patients not to take their drugs regularly. Strategies are therefore needed to assess adherence to treatment. One established method is to examine the patient's urine for the presence of drug metabolites. A rapid point-of-care test would overcome some of the drawbacks associated with currently available methods. METHOD: A rapid, safe point-of-care test for isoniazid metabolites (IsoScreen, Surescreen Diagnostics Limited, Derby, UK) has been developed and used to help assess adherence to treatment in a busy clinic for tuberculosis patients in South London. RESULTS: Urine samples were examined from 191 patients receiving isoniazid, usually in combination with rifampicin and other anti-tuberculous drugs. Isoscreen was positive in 93.2% of patients, suggesting that 6.8% might be poorly adhering to treatment. By contrast, examining the same urine samples for evidence of rifampicin ingestion gave positive results in only 43.5%, due to the fact that this test is only positive for a few hours after drug ingestion. CONCLUSION: IsoScreen has been shown to provide a rapid and safe point-of-care test, which contributes to the detection of non-adherence in patients with tuberculosis.

Feedback from a point-of-care test for nicotine intake to reduce smoking during pregnancy.

BACKGROUND: Smoking is the most important modifiable risk factor for adverse pregnancy outcome in the UK. New tools are needed to improve smoking cessation advice. The aim was to investigate a point-of-care urine test for smoking, to provide feedback to women, to improve awareness about the effects of smoking during pregnancy and to relate the test results to pregnancy outcome. METHODS: A cross-sectional randomized controlled trial involving 856 pregnant women. All intervention patients were interviewed at their initial visit and tested for smoking. The test provided visual and numerical feedback. Smokers were followed up and retested at subsequent visits. The control group received anti-smoking counselling as part of routine care, but their smoking was monitored using the test. Both groups were interviewed and retested at 36 weeks' gestation. RESULTS: Self-reported cigarette consumption fell significantly (P < 0.001) in the intervention group, with 16.2% giving up and 33.3% significantly reducing their cigarette consumption. There was a significant fall in test results from 'booking' to 36 weeks' gestation (P < 0.0001). In the control group, only 8% reported stopping and 23% reducing their cigarette consumption. Combined smoking test results at 36 weeks correlated significantly with birth weight (P = 0.006) and body length (P = 0.011). CONCLUSIONS: Point-of-care testing and feedback coupled with counselling can significantly reduce smoking during pregnancy and increase birthweight.

Effect of incorporating a 10 minute point of care test for salivary nicotine metabolites into a general practice based smoking cessation programme: randomised controlled trial.

OBJECTIVE: To investigate the effect of immediate feedback from a point of care test for salivary nicotine metabolites in promoting smoking cessation and reduction in tobacco use. DESIGN: Prospective, operator blinded, randomised controlled trial. SETTING: General dental practice, London. PARTICIPANTS: 100 adult smokers. INTERVENTIONS: Participants completed a questionnaire on smoking, undertook a clinical examination, and received counselling in smoking cessation. Saliva samples were analysed at presentation and at eight weeks for salivary nicotine metabolites using a 10 minute semiquantitative point of care test. MAIN OUTCOME MEASURES: Smoking cessation measured by salivary nicotine metabolite values (scale 0-6), patient feedback on the perceived value of the test (visual analogue scale) in quitting, and reduction in tobacco use. RESULTS: A higher smoking quit rate was achieved with the point of care test (23% cases v 7% controls; P < 0.039), and overall tobacco use also decreased (68% cases v 28% controls; P < 0.001). Baseline values for salivary nicotine metabolites did not differ between the groups (cases, mean 4.1, SD 1.3 and 4.3, 1.4; P = 0.51). 87 participants reattended at eight weeks (44 cases, 43 controls). Mean nicotine metabolite values at eight weeks were 2.58 (2.0) for cases and 4.29 (1.8) for controls (P < 0.001). CONCLUSION: Incorporation of individualised personal feedback using a point of care test for salivary nicotine metabolites into a general practice based smoking cessation programme increased quit rates by 17% at eight weeks and reduced tobacco use.