Evaluating a COVID-19 testing program in remote First Nations communities

When COVID-19 struck, some Australian communities were particularly vulnerable. In remote First Nations communities, many people lived with chronic disease or in overcrowded housing. Combined with the virus’ highly infectious nature, transmission was difficult to prevent after an initial case.

To minimise the delay in receiving test results, the Department of Health and Aged Care established the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care Testing Program. The program aimed to provide rapid and accurate COVID-19 test results to 105 remote First Nations communities to reduce the spread of COVID-19 and ensure local health services would not be overwhelmed.

In 2022, the department asked us to evaluate the program’s appropriateness, implementation and effectiveness.

We used a mixed-methods approach to deeply understand the program and participants’ experiences:

• We engaged with 17 organisations that were closely involved in the program’s rollout, including state and territory health departments, primary health networks and peak representative bodies.
• We surveyed 194 health services across Australia – including those who participated in the testing program, and those that did not – to understand how they managed and tested for COVID-19.
• We developed five case studies in collaboration with Aboriginal Community Controlled Health Services to closely understand their experiences during the pandemic.
• We conducted quantitative analysis by updating existing theoretical modelling work undertaken by the Kirby Institute and Doherty Institute.

We provided the department with an evaluation plan, emerging insights report, final report and summary report. The final report, which included eight recommendations and 26 lessons, was made public.

We established that the program was very successful at reducing the spread of COVID-19, as the testing facilitated a broader public health response, which was vital before rapid antigen testing and vaccinations were available.

We also found that the program’s delivery through Aboriginal Community Controlled Health Services – which were trusted by their communities – was essential for public health measure compliance and healthcare provision.

We estimated that the program had averted between 23,000 and 122,000 COVID-19 infections and avoided between $337 million and $1.8 billion in health costs in the first 40 days after the identification of the first case. The final report also demonstrated that point-of-care testing can be done safely and effectively in remote communities where there is sufficient equipment and training.

The evaluation will inform decision-making on a potential broader roll-out of the program as it transitions to being used for other infectious diseases.

40 days was chosen for this modelling because it was determined that within 40 days, under conditions of a 6-day delay in lab results and 70 per cent of the community in lockdown, 87 per cent of the community were likely to have acquired COVID-19. The full methodology underpinning the modelling can be found on page 46 of the publicly available report.