RUclear? Summary 10/11

Transcription

1 RUclear? Summary 10/11 The National Chlamydia Screening Programme (NCSP) is a control and prevention programme targeted at sexually active young people under the age of 25. Chlamydia is the most common bacterial sexually transmitted infection (STI) in the UK; affecting both men and women. RUclear? Greater Manchester (GM) Chlamydia Screening Programme is the largest screening programme in the country. Ruclear? Work closely with Commissioners to identify agencies that can expand their services to offer chlamydia and gonorrhoea testing to their client group. RUclear? Manage all results and arrange treatments for chlamydia positive patients. We work closely with Genito-urinary (GU) clinics across GM; positive gonorrhoea patients as well as complicated chlamydia cases are fast tracked to GU of the patients choice. RUclear? is a patient focused service, and aims to get positive patients and their current partners treated as quickly as possible at a venue and time that is most convenient for them and therefore minimising onward transmission. All treatment sites are trained by Sector Coordinators to treat using Patient Group Directions. Coordinators also provide these sites with training in Partners Notification (PN), partner information is passed back to RUclear for follow up. Partners are offered treatment and/ or testing regardless of age. Ruclear? staffing levels remain at 15 WTE (1.5 per PCT) 10/11 Target. The Vital Signs Indicator (VSI) for 10/11 was to opportunistically screen 35% of the age group. GM population 380,400. Final screening figures for 10/11 were published mid June. GM PCTs through RUclear contributed 36.4% of the NW total and 5% of the National total number of. 1

2 Total needed to hit the target 133,320. RUclear? handled 90,000 through the screening office an increase of 20,000 on the previous year, just under 70,000 counted towards the target. Although no GM PCT reached the set target all PCTs had a positivity rate higher than the National rate of 5.2 % (GM positivity 7.4% NW region 6.6%) this will be crucial to meet the diagnosis rate outcome measure for 12/13.. Table 1 PCT National Ranking by screening volume Positivity Rate National Ranking by positivity Rate Number of tests taken per 1 positive Diagnosis Rate National Ranking by Diagnosis rate ALW =22 Bolton =16 Bury = =41 HMR = =27 M/C =33 Oldham = =27 Salford =7 Stockport =33 T&G =41 Trafford =55 GM Table 1 shows the number of tests taken per positive test ( compare to table 2, which shows the top 10 PCTs by screening volume) this is a good indication that GM is targeting the appropriate cohort of young people, making the programme more cost effective than in PCTs that have gone for high volume in low prevalence areas. Table 1 also gives National ranking by positivity rate and a guide to the position of PCTs if the diagnosis rate measure had been in place for 10/11. 2

3 Table 2 PCT National Ranking by screening volume Positivity Rate National Ranking by positivity Rate Number of tests taken per 1 positive Diagnosis Rate National Ranking By Diagnosis rate Lambeth Lewisham Portsmouth =33 Teaching County =41 Durham NE Essex =70 Southwark Newham =41 Barking =11 And Dagenham Waltham =70 Forrest Greenwich Teaching

4 Greater Manchester Core Services The national target remains to achieve 60% of through core services to ensure sustainability 63.4% of GM were taken through core services compared to 47.9% nationally GM % in core services SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP PHARMACY 45.5 ToP (Data source NCSP 3/6/11) GP s RUclear held a Sharing Best Practice Seminar for staff working in Primary care. Workshops facilitated by Sector Coordinators and a GP Champion from each PCT. The aim of the day was to work with GP Practices, to look at the barriers to screening, share good practice and come up with top tips for Chlamydia screening based on the experiences of Greater Manchester GP s appendix 1 The event was well evaluated by those who attended. Although attendance was disappointing. GP s this year have become the second most popular screening venue. Sexual Health Services 4

5 Sexual health services continue to be the prime providers of. Pharmacies Although pharmacies continue to screen low numbers and are likely to be removed from the core service list, it is interesting to note that some PCTs are getting high positivity rates in this venue ( see individual PCT breakdown ) TOP TOP providers across GM continue to be engaged with the programme GM top Screening venues. Top 10 Screening Venues RUCO 10/11 % of total Sexual Health Services Remote Testing Outreach GP's Youth Education TOP CSO Ante natal Prison Postal kits The above chart shows that postal kits are the 3 rd most popular way of taking a test. There was a reduction in number of kits requested this year possibly due to the fact there was no national TV campaign. The National TV campaign which ran the previous year, followed on by a GM radio campaign saw kit requests rise considerably in the weeks that followed. 5

6 This year we commenced offering young women the choice of self taken swab or urine test, this is in line with current research that swabs are marginally more sensitive. Increasingly clinical settings have found self taken swabs to be an acceptable test for young women. Appendix 2 is full breakdown of postal kit return rate by PCT, age and gender. Overall return rate 55% Overall positivity 8% We identified this year an increase in out of area postal kits being received at the lab, post codes are rigorously checked before kits are sent out. On investigation this seems to be students using their student address when requesting a kit, but using their home addresses when filling in the lab form. To minimise this happening we have included a note advising the use of student addresses on the screening form. Postal kits continue to be available to over 16 s only Under 16 s that access our website are directed to their local Young Peoples clinic. 6

7 Ante Natal Screens The National Screening Committee Review (2011) found insufficient evidence to support Chlamydia screening in Ante Natal, however across GM Midwifery services, especially those working with under19 s screen through RUclear? Current advice is to keep screening, if already doing so. In conjunction with Commissioners RUclear? are forming a working party, consisting of interested people both commissioners and clinicians to give a GM response. Reference DrClaire Thorne. UK National Screening Committee Policy Review. Chlamydia Screening in Pregnancy: an evidence review. University College London 7

8 Testing venues % in Community Core Services Proportion in Core services 55.6% 8

9 Positivity by Venue England 11/Q1-4% %20ENGLAND.pdf link to Q1-4 April 2010-March

10 Breakdown per PCT of Screening venues ALW (Data Source NCSP 3/6/11) 17.8 ALW %Screens by venue (n=7320) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION YOUTH A&E, MIU, NHS WALK IN, HOSPITALS OCCUPATIONAL HEALTH ANTENATAL & OBS Positivity 8.5 % (09/10 8.9) Core services National % ALW % Positivity rate ALW GP 12.8% 9.4% 7.4% Sexual Health 31.8% 46.9% 12% services including CASH and Other community core Pharmacy 1.9% 0.3% 20.8% TOP 1.4% 1.8% 8.4% Total 47.9% 58.4% 10

11 Bolton (Data Source NCSP 3/6/11) Bolton % by venue 9n=7684) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP 13.2 GUM GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION 16.2 YOUTH A&E, MIU, NHS WALK IN, HOSPITALS OCCUPATIONAL HEALTH ANTENATAL & OBS Positivity 7.1% (09/10 9.1%) Core services National % Bolton% Positivity rate Bolton GP 12.8% 9.8% 7.3% Sexual Health 31.8% 46.1% 9.1% services including CASH and Other community core Pharmacy 1.9% 0.8% 0% TOP 1.4% 2.4% 6.6% Total 47.9%

12 BURY (Data Source NCSP 3/6/11) Bury by venue (n= 3148) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION YOUTH A&E, MIU, NHS WALK IN, HOSPITALS OCCUPATIONAL HEALTH ANTENATAL & OBS Positivity 8.3 % (09/10 9.6%) Core services National % Bury% Positivity rate Bury GP 12.8% 7.7% 9.6% Sexual Health 31.8% 46.3% 9.9% services including CASH and Other community core Pharmacy 1.9% 2.7% 5.9% TOP 1.4% 5.3% 8.3% Total 47.9% 62.0% 12

13 HMR (Data Source NCSP 3/6/11) HMR % by venue()n=5059) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION YOUTH 0.4 ANTENATAL & OBS Positivity 7.7% (09/10 7.9) Core services National % HMR % Positivity rate HMR GP 12.8% 22.0% 7.1% Sexual Health 31.8% 26.9% 11.4% services including CASH and Other community core Pharmacy 1.9% 0.5% 13.0% TOP 1.4% 2.8% 7.9% Total 47.9% 52.2% 13

14 Manchester (Data Source NCSP 3/6/11) Manchester % by venue (n=15702) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH 1.6 PHARMACY REMOTE TESTING PRISON & YOI ToP 1.2 EDUCATION YOUTH 9.2 other Positivity 7.0% (09/10 6.5%) Core services National % Manchester % Positivity rate Manchester GP 12.8% 9.2% 6.7 Sexual Health 31.8% 49.6% 9.4 services including CASH and Other community core Pharmacy 1.9% 1.6% 10.4 TOP 1.4% 5.4% 6.5 Total 47.9% 65.8% 14

15 Oldham (Data Source NCSP 3/6/11) Oldham % screes by venue (n= 7262) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GUM GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP 19.1 EDUCATION ANTENATAL & OBS Positivity 6.2 % (09/10 7.7%) Core services National % Oldham % Positivity rate Oldham GP 12.8% 19.1% 5.4% Sexual Health 31.8% 49.9% 7.5% services including CASH and Other community core Pharmacy 1.9% 0.4% 11.5% TOP 1.4% 2.1% 7.2% Total 47.9% 71.5% 15

16 Salford (Data Source NCSP 3/6/11) 2.1 Oldham% by venue (n=7805) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP 14.0 GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION 18.2 YOUTH A&E, MIU, NHS WALK IN, HOSPITALS ANTENATAL & OBS Positivity 8.1% (09/10 6.5%) Core services National % Salford% Positivity rate Salford GP 12.8% 8.3% 8.6% Sexual Health 31.8% 42.4% 10.7% services including CASH and Other community core Pharmacy 1.9% 0.5% 10.0% TOP 1.4% 1.3% 3.0% Total 47.9% 52.5% 16

17 Stockport (Data Source NCSP 3/6/11) Stockport % by venue (n=5477) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GUM GYNAE & FERTILITY OUTREACH 10.1 PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION 10.9 YOUTH ANTENATAL & OBS Positivity 7.7% (09/10 7.7%) Core services National % Stockport % Positivity rate Stockport GP 12.8% Sexual Health 31.8% services including CASH and Other community core Pharmacy 1.9% TOP 1.4% Total 47.9%

18 Tameside and Glossop (Data Source NCSP 3/6/11) T&G % by venue (n= CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION 24.3 YOUTH ANTENATAL & OBS Core services National % T&G % Positivity rate T&G GP 12.8% 24.3% 6.5% Sexual Health 31.8% 38.1% 7.0% services including CASH and Other community core Pharmacy 1.9% 0.2% 0.0% TOP 1.4% 6.8% 3.5% Total 47.9% 69.4% 18

19 Trafford (Data Source NCSP 3/6/11) Trafford % by venue (n=4136) CSO SEXUAL AND REPRODUCTIVE HEALTH SERVICES GP GYNAE & FERTILITY OUTREACH 37.0 PHARMACY REMOTE TESTING PRISON & YOI ToP EDUCATION YOUTH ANTENATAL & OBS Positivity 7.6 (09/10 8.8%) National % Trafford% Positivity rate Trafford GP 12.8% 17.3% 6.8% Sexual Health 31.8% 37.0% 9.3% services including CASH and Other community core Pharmacy 1.9% 1.9% 12.3% TOP 1.4% 4.3% 6.2% Total 47.9% 19

20 Screens accredited to CSO The activity on the individual PCT charts showing accredited to CSO are due to screening sites omitting their RUclear? site code from their screening forms. Screens will still go towards PCTs targets but not attributed to the correct agency which could be an issue for sites being paid under a LES for number of taken. Laboratory From 3 rd May 2011 RUclear? returned to commissioning one lab, Manchester Royal Infirmary for the programme, to enable negotiation of the best price by ensuring high volume of through one provider The price per test for 11/12 is a reduction on the price for 10/11 of 25p. Quality Assurance targets Results given within 10 days of screen being received at the lab Treated within 14 days of screen Treated within 30 days of screen National standard RUclear? 10/11 90% 99% (95% 9/10) 50% 76.8% (65% 9/10) 90% 90.3% (80% 09/10) (86% 9/10) Treatment rate National standard for treatment of chlamydia positive patients is 95% Ruclear? achieved a treatment rate of 94.6% for 10/11, compared with 81% the previous year The improvement in QA targets is a result of establishing a dedicated results team 09/10 Untreated patients are audited every quarter to maximise the treatment rate and identify any issue around treatments. Partner Notification Provisional figure for Partner notification (PN) for 10/11 are 21% an increase of 1% on the previous year). PN for NCSP is number of partners treated per index. However partners who cannot be linked back to an index patient may be counted as an index themselves. Some partners contacted elect to only take a test, this may come back negative and therefore they do not receive treatment and are not counted towards PN targets, making figures for PN inaccurate. 32% of identified partners were treated through the programme. RUclear? have raised the issue of the inaccuracy of the PN data and had it agreed that in the PN audit for 11/12 a recording will be made 20

21 of number of partners contacted that cannot be linked back to index cases to provide a truer reflection of work completed. Safeguarding We continue to act as failsafe and check all received from under 13 s regardless of results to ensure agencies have followed local policies and procedures. Over the last year as awareness of Sexual Exploitation (SE) has increased, it has become evident that some young girls who are taking multiple tests may be victims of SE. RUclear? are working with Designated Nurses for Safeguarding to ensure care pathways are in place to protect this vulnerable group of young people. The team have received awareness training on SE and we are currently looking at ways of improving our website and telephone messages so that victims of SE are made aware of help lines and help available. Social Marketing and Outreach companies Although some PCTs used social marketing companies to help with screening targets again this year, the work was more targeted and didn t adversely affect positivity rates. Gonorrhoea RUclear? diagnosed 134 cases of gonorrhoea 10/11 positivity of 0.15 % Ruclear contributed to recent article published in the International Journal of STD and Aids. Evaluating GC screening as part of the National Chlamydia Screening Programme, by Sue Skidmore. Reference Skidmore S, Positive nucleic acid amplification tests for Neisseria gonorrrhoeae in young people tested as part of the National Chlamydia Programme. International Journal of STD and Aids 2011;22: Dried Blood Spot In line with current national guidance from British HIV Association (2008) to normalise and increase HIV testing in all Health Care settings to reduce the levels of undiagnosed HIV, RUclear? commenced a pilot in June offering HIV and Syphilis testing in the form of dried blood spot test ( fourth generation test) via our website and to chlamydia positive patients who opt for treatment in non clinical settings i.e pharmacies. It is well documented that late diagnosis of HIV is costly. 1 in 4 people with HIV are unaware of their diagnosis. HPA (2011) state expanding HIV testing on a large scale outside traditional settings has the potential to reduce the number of late diagnosis and reduce premature deaths. 21

22 Ruclear has the backing of the HPA and NCSP, who both support this pilot and are interested in the evaluation. A universal offer of HIV testing is estimated to be cost-effective where the diagnostic rate of HIV is greater than one per 1,000. However, the evidence on the cost effectiveness of expanding HIV testing in the general population of England is sparse. Therefore, local innovations to expand HIV testing should be the subject of formally designed service evaluations and be sufficiently large so as to better inform the implementation of the guidelines and the development of national policy. The HPA are working with us to evaluate the pilot. This project offers two unique features: A chance to review feasibility, acceptability and effectiveness in a setting not tested before (through Chlamydia screening). By looking at the whole of GM, we have the opportunity to review uptake and positivity across both high prevalence and low prevalence areas. To our knowledge, no project has compared this so far. An analysis of the data would help to compare and contrast the two and the lessons learnt will allow us to target our resources better. MRI laboratory will also be evaluating this project in conjunction with their evaluation of the DBS service they offer to the Renal Service Ruclear have applied for a Gilead Grant and some non recurrent funding, thus making the pilot cost neutral to PCT for the prosed12 months pilot or until the money runs out. We are averaging approximately 10 requests a day and have sent over 300 kits so far, too early to asses return rate as yet, however users comments so far have been very positive. Some comment so far 24 year old male. Home testing is a great idea, people not having the time, ability to go to a clinic, or are too embarrassed to go to a clinic. This should be available everywhere 23 year old female. I think it is an excellent service. It really helps people too embarrassed or who feel ashamed or dirty to go to a clinic. The persistent theme seems to be people are too embarrassed to attend clinics. 22

23 Target 2011/12 This year is being seen as a transitional year as NCSP move from a screening volume target to a diagnosis target for 11/12. NCSP recommendations are, to achieve 2.4% diagnostic rate there needs to be test coverage of 35% with positivity around 7%. 12/13 figures will probably include GU figures. National Chlamydia Screening Programme (NCSP) Briefing Document, Proposed Public Health outcome for chlamydia control (2011) states that if local GU test 9% of the population with a positivity of 10% (national average) then local areas will need to screen 26% of the population with a positivity rate of around 6% to achieve 35% coverage with a diagnostic rate of 2,400/100,000. GUM figures for 2010 suggest that GM would with all taken into account have achieved a diagnostic rate of 2.5%. Publicity 2011/12 Previously we have found radio advertising to be very influential and have seen rises for requests for postal kits followingradio campaigns, however Galaxy radio changed their name to Capital radio just before our ads were die to air on 10/11, this seemed to change their target audience and our campaign was not as successful as anticipated. This year we are running a campaign with Unity Radio, a new radio station with a young listenership, they cover GM PCTs not only on digital radio but also through web based radio (an increasing popular way of listening by young people). Unity radio also run street campaigns and will be advertising RUClear on their Street bus at all events over the next year. Our website has also had a make over this year and we have posters to accompany the creative of the website. Relocation of Office Ruclear moved to: Moss Side Health Centre Monton Street Manchester M14 4 GP In February 2011, this has enabled us to extend our opening times for results to Monday, Wednesday Thursday and Friday and on Tuesdays. New opening times enable us to contact more positives on first contact and improve treatment turn around times. 23

24 Useful links Link to National data presentation sentations11/q1-4% %20england.pdf Briefing for NHS: Proposed Public Health outcome for chlamydia control 2011 National Chlamydia Screening Programme _briefing_and_faq.pdf Herzog Variatin in PN outcomes for chlamyd Satterwhite. CT positivity trends amon Attachment Postal kit return rates by gender age and PCT 24