1. Mary Tooley Consultant Nurse – Public Health IGRA screening in primary care – ’The Sandwell Experience’

2. To cover Current screening methods for new arrivals Background to Sandwell and TB rates IGRA screening pilot Funding Processes Results The future

3. Background to Sandwell Sandwell is a Metropolitan Borough and is one of seven authorities that makes up the West Midlands conurbation. The population is growing 309,000 (Jun'11) Ethnicity: Sandwell is an ethnically diverse borough, in the ten years between 2001 and 2011, the White British population decreased from 78% to 65.8%. The White 'Other' category, (excluding Irish) has increased by 78% to 10,463. The Asian groups, including Indian, Pakistani, Bangladeshi, Chinese and other Asian, account for 19.2% of the population Source Sandwell Trends http://www.sandwelltrends.info/themedpages/FactsFigures

4. Continued……… Deprivation in Sandwell: Sandwell has high levels of deprivation, which is widespread they are ranked 12 th worst/326 local authorities Economy 7.4% of working population claim job seekers allowance compares to 3.8% nationally ----------- Strong commitment by DPH/LA to reduce the numbers of notified cases of TB

5. TB in Sandwell What is the picture?

6. Incidence in Sandwell

7. TB notifications in Sandwell 2005-2012

8. TB rates -Black Country 2002-13

9. 2009-2013 Cases by age and sex

10. TB cases by ethnicity 2009-13

11. Site of TB (2013)

12. TB diagnosed patients in Sandwell; UK/non UK born (5 yrs)

13. TB rate in Sandwell is 39.8/100,000 Cases are not uniformally distributed Smethwick has almost 94 cases per 100,000 population

14. new entrant screening Previously CXR were taken at ports of entry Health were informed of new migrants via a port form Screening opportunity offered – variable success Now Pre entry check and CXR in 109 countries (TB rates > 40/100,000) Visa issued Issue Flag 4 data not available to LA A solution to make information on migrants available to local services is being actively pursued

15. Pre entrant screening does not check for latent TB What is latent TB Why is it significant Most TB in England is a result of reactivation of old infection Benefit of finding and treating latent TB

16. Would latent TB testing be useful in Sandwell Project in Sandwell to screen a high risk group for latent TB Good relationship with a large practice in Smethwick (11,300 patients) Committed to improving BBV diagnosis Happy to include IGRA as part of this No remuneration to the practice

17. Agreement to …. Use the opportunity at the new patient assessment to take blood for IGRA/BBV if epidemiology suggests http://www.hpa.org.uk/migranthealthgui dehttp://www.hpa.org.uk/migranthealthgui de

18. Issues to be managed Healthcare assistants do new patient check Professional development - competence Governance Blood test is complicated – 3 tubes management of sample

19. Results 102 25 24.5% Other BBV HIV Hep B Hep C

20. The future of new patient screening for IGRA/BBV The local Authority agreed to fund a new migrant latent TB screening service Competitive tender process was put in place New provider appointed Collaborative Tuberculosis Strategy for England -2014 to 2019