Added value of point-of-care testing for Group A <i>Streptococcus</i> in community pharmacy sore throat pathways: Analysis of the Wales Sore Throat Test and Treat service

ABSTRACT Objective To evaluate the diagnostic performance of FeverPAIN and Centor with point-of-care test (POCT) results for Group A Streptococcus (GAS) among children and adults presenting with sore throat in community pharmacies. Methods Cross-sectional analysis of patients aged six years and over with sore throat presenting to community pharmacies across Wales delivering the Sore Throat Test and Treat (STTT) service from November 2018 to September 2024. Patients who scored FeverPAIN ≥2 or Centor ≥3 and were able to undergo POCT were eligible for analysis. We described GAS positivity by age group and assessed diagnostic performance of FeverPAIN at the National Institute for Health and Care Excellence (NICE) antibiotic threshold (≥4), reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). We estimated potential overtreatment and undertreatment if antibiotics were supplied based on FeverPAIN alone. Results Among 73,617 eligible patients, 37.0% (n=27,220) tested POCT-positive for GAS. Positivity was highest in children aged 6-10 years (47.0%: 5,339/11,371). FeverPAIN was used in 92.5% (n=68,099) of assessments. At the NICE-recommended threshold for antibiotic treatment (FeverPAIN ≥4), sensitivity was 55.0% (95% CI: 54.4-55.6%) and specificity 77.0% (95% CI: 76.6-77.4%). PPV was 57.6% (95% CI: 57.0-58.2%) and NPV 75.1% (95% CI: 74.7-75.5%). Overall AUROC was 0.70 (95% CI: 0.70-0.71), with the lowest AUROC of 0.69 (95% CI: 0.68-0.70) observed among children aged 6-10 years. Using FeverPAIN alone would undertreat 44% and overtreat 23% of patients based on POCT results. Conclusions FeverPAIN alone showed limited diagnostic performance for identifying GAS, with more pronounced discordance observed among children. Incorporating POCTs within community pharmacy sore throat pathways may support more targeted antibiotic prescribing. Our findings support a re-evaluation of the role of POCTs within community pharmacy sore throat pathways.