NHS Infectious Diseases in Pregnancy Screening Programme Marie Coughlin Screening Lead September 27th 2010 2

Today’s Session Fifth of 6 Antenatal & Newborn sessions throughout 2010 3

Reasons for Today’s Session As a result of ChaMPs commissioned review of screening A need to further engage public health in Antenatal & Newborn Screening Programmes At the request of public health screening leads Part of C&M Screening Action Plan Thought it useful to invite commissioners also

Aim of the Session To increase knowledge base within public health and commissioning

Session Format Overview of Programme structure Overview of Infectious Diseases in Pregnancy Screening Review of patient pathway Data, performance and QA Future developments Questions/comments

Overarching Structure UK NSC, Dept of Health & Health Protection Agency jointly responsible for Programme National team recently formed NWSHA team has some involvement

Infectious Diseases in Pregnancy Screening Infectious Diseases in Pregnancy Programme established in 2003 Screens for Hepatitis B; HIV; Syphilis; Rubella Programme Board responsible for overseeing national projects Emphasis on patient choice and uptake of 90% Objective to create focus and identity for infectious diseases in pregnancy screening

Programme Aims To ensure screening is undertaken as early in the pregnancy as possible Screen acceptance rate of at least 90% 100% of samples to be sent to Lab within 1 working day No longer need second sample to confirm positive status Lab to confirm receipt of 100% of samples within 10 working days 100% of referrals to be made within 6 weeks of positive result

Infectious Diseases in Pregnancy Statistics In the UK in 2007/8 3091/661905 (0.47%) were Hepatitis B positive 1066/637309 (0.17%) were HIV positive 1086/656689 (0.17%) tested positive for syphilis 19804/647820 (3.06%) were susceptible to rubella

Patient Pathway…

Infectious Diseases in Pregnancy Screening Pathway Rebecca Al-Ausi North West Antenatal, Newborn & Child Health Deputy Screening Coordinator Rebecca.al-ausi@alwpct.nhs.uk Tel: 07810506043

Aims Pathway Protocol Standards Mapping report Data returns Quality assurance http://infectiousdiseases.screening.nhs.uk/

Pathway

Four separate protocols Individual pathways Failsafe Named leads Communication links Accountability http://infectiousdiseases.screening.nhs.uk/

Standards Revised June 2010 http://infectiousdiseases.screening.nhs.uk/standards Confirmation bloods Timeliness Accountability http://infectiousdiseases.screening.nhs.uk/

Maternity units, laboratory leads, PCT’s & CHRD’s Pathways 2008 Mapping Report National Maternity units, laboratory leads, PCT’s & CHRD’s Pathways North West report http://infectiousdiseases.screening.nhs.uk/

HPA quarterly data & annual report Trust annual reports NSC’s KPI’s Data Returns HPA quarterly data & annual report Trust annual reports NSC’s KPI’s 2 infectious diseases KPI’s Due to be reported on from Q2 2010-2011 (ie first return by Dec 2010) HIV = Percentage of women tested (tested/eligible=%) Hep B http://infectiousdiseases.screening.nhs.uk/

Proportion of tested women (tested/eligible = %) 90% uptake HIV Quarterly returns December 2010 Proportion of tested women (tested/eligible = %) 90% uptake http://infectiousdiseases.screening.nhs.uk/

Proportion of Hepatitis B women who are referred in timely manner Quarterly returns June 2011 Proportion of Hepatitis B women who are referred in timely manner (women referred/women with hepatits B = %) 90% uptake http://infectiousdiseases.screening.nhs.uk/

Cross programme benchmarking Failsafe Structure Peer reviews Quality Assurance Cross programme benchmarking Failsafe Structure Peer reviews Governance Improvement http://infectiousdiseases.screening.nhs.uk/

Data & Performance Trusts required to produce annual report – difficult to obtain copies Programme Board produce an annual report – Details on next few slides

Hepatitis B Statistics – 2007/8 SHA No. of Tests Uptake Rate Pos Rate East Midlands 35621 98.4% 32988 0.22% East of England 61457 96.4% 72397 0.25% London 116080 95.9% 144452 1.18% North East 23414 86.1% 30612 0.13% North West 79909 91.8% 88255 0.31% South East 86174 95.4% 105907 South West 47598 93.1% 50662 0.36% West Midlands 50074 98.1% 69678 Yorkshire & Humber 60890 96.3% 66954 0.35% NATIONAL 561,217 95.0% 661,905 0.47%

HIV Statistics – 2007/8 SHA No. of Tests Uptake Rate Pos Rate East Midlands 48840 97.4% 34492 0.10% East of England 66283 95.2% 66479 0.12% London 119492 94.6% 138994 0.32% North East 24165 84.7% 29976 0.08% North West 75754 85.4% 81927 0.11% South East 84916 94.3% 104950 0.14% South West 47616 91.8% 49883 West Midlands 54953 97.0% 66291 0.15% Yorkshire & Humber 60441 95.5% 64317 0.16% NATIONAL 582,460 93.2% 637,309 0.17%

Syphilis Statistics – 2007/8 SHA No. of Tests Uptake Rate Pos Rate East Midlands 28145 82.3% 33009 0.12% East of England 60719 96.9% 69100 0.10% London 112512 95.7% 140529 0.43% North East 23691 87.2% 29732 North West 80785 94.5% 90843 0.05% South East 85982 96.0% 105897 South West 48861 95.6% 50644 0.07% West Midlands 50009 98.0% 69708 0.16% Yorkshire & Humber 56152 96.1% 67227 0.08% NATIONAL 546,856 94.7% 656,689

Rubella Statistics – 2007/8 SHA No. of Tests Uptake Rate Susceptible Rate East Midlands 25778 78.2% 25285 1.46% East of England 55710 97.5% 65723 2.37% London 115315 96.2% 139331 4.10% North East 22789 87.2% 33610 3.51% North West 82842 95.1% 90237 2.00% South East 85523 96.4% 106112 2.67% South West 49112 96.1% 50883 2.68% West Midlands 50174 98.3% 69816 2.93% Yorkshire & Humber 62082 97.0% 66823 4.41% NATIONAL 549,325 95.0% 647,820 3.06%

Key Messages in Annual Report Need to improve communications between Labs and Maternity Units Need to improve I.T. systems in Labs and Maternity Units Need to improve data collection and analysis

Quality Assurance QA function being developed – some in place for Labs

Current Projects/Future Developments Several projects underway, including: Improve I.T. systems Refine complex referral system for those needing further assessment Develop patient pathway for HIV and define roles & responsibilities in the pathway Review of confidentiality policies for HIV

Questions/Comments With regard to QA, how do we assure our Boards that local programmes run satisfactorily? Set of recommendations re Trust data issue for all 6 programmes submitted to C&M DsPH and DoCs

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