What do we know? Summary The total numbers of Chlamydia screens continue to increase across Lincolnshire. This has identified high levels of positive screens in some areas of the county. This knowledge has allowed targeted services to diagnose and treat to be developed. In 2009/10 23.7% of the target population were screened for Chlamydia and 8% of the cases tested positive. The target in 2011/12 is to screen 30% of the eligible population and achieve a positivity rate of 6.4% Positivity rates across Lincolnshire are expected to fall over the next 5 years as the screening programme identifies treats and provides health information to more people therefore reducing the numbers testing positive. Facts and figures In 2008/09: 8175 screens were obtained (9.8% of the total target population) and 7.6% of the index patients tested positive for Chlamydia. In 2009/10: 20,899 screens were obtained (23.7% of the total target population) and 8% of index patients tested positive. The increase in screening numbers observed in 2009/10 are due to the establishment of the screening programme along with the inclusion of screening samples analysed in all laboratories (but not including Genito Urinary Medicine (GUM) level 3 Chlamydia screens). Positivity rates across Lincolnshire in 2010 / 11 show that higher numbers of positive samples are found in West Lindsey, Skegness and Coast, Boston and Lincoln City. Trends We anticipate the positivity rate across Lincolnshire for 2011 to be: 6.4%. This is percentage is expected to fall over the next 5 years as the screening programme identifies, treats and provides more health information to more people therefore reducing the numbers testing positive. Targets The overall aim of the 2011/12 plan (as submitted to the SHA-awaiting ratification) is to achieve 30% coverage, equating to 25,777 screens (inclusive of GUM screens). This number includes an expected 1639 positive screens, this would give us a 6.4% positivity rate for Lincolnshire which in turn equates to a diagnostic rate of 1909 per 100,000 population. 1 of 5 May 2011 (v1)
NB: Lincolnshire's total population aged between 15 and 24 is 85,871. Performance Performance 2010/11 April 2010-February 2011: Total number of screens = 22934 (26.1% of total target population) against the projected Vital Signs plan of 27,173 screens (excluding GUM level 3 screens). The positivity rate for the index patients tested during this period was 6.1%. Monthly reports are sent to the PCT Performance and Delivery Group and Board. Chlamydia Screening is a tier 2 indicator for vital signs in the performance framework for the PCT, therefore, quarterly data is analysed by the Strategic Health Authority and Department of Health. The Health Protection Agency also monitors Chlamydia screening uptake and positivity rates locally, regionally and nationally. 2 of 5 May 2011 (v1)
What is this telling us? Summary Untreated genital Chlamydia infection has serious long term consequences, especially in women, in whom it is a well established cause of pelvic inflammatory disease, ectopic pregnancy and infertility. This results in huge financial costs to the NHS as well as human costs in terms of family life. Commissioning intentions for 2011/12: Terence Higgins Trust to provide outreach screening; Positive Health to provide Awareness Raising Sessions and screening in schools; Lincolnshire Community Health Services to provide screening in Minor Injury Units, out of Hours, sexual health and contraceptive services, schools, university practice and walk-in centre: GPs and Pharmacists through a Locally Enhanced Service; maternity service and prisons through Service Level Agreement; Chlamydia screening office coordinate activities. Utilise customer insight and Health Needs Assessment to ensure services are equitable, acceptable, accessible and appropriate, in particular to address health inequalities in Lincolnshire. The Chlamydia screening indicator: reporting diagnostic rates amongst the resident 15 to 24 year population of Lincolnshire has been proposed within the Public Health Outcomes Framework consultation document Healthy Lives, Healthy People: transparency in outcomes, proposals for a public health outcomes framework (Department of Health December 2010) Local views Focus groups have been carried out in college and university settings re awareness of campaign, barriers to accessing screening and the use of incentives. Young people have been consulted when new graphics for campaign materials are being developed. The third sector organisations, Positive Health and Terence Higgins Trust, are commissioned to provide services for the programme amongst many core service providers. They all engage in some level of customer insight activities which are shared across agencies. A short film produced and written by local young people is available on YouTube. A comprehensive Sexual Health Needs Assessment will be undertaken between April and October 2011: this process will include focus groups with service users to identify sexual health needs of the population in Lincolnshire. National and local strategies The Lincolnshire Programme is part of the National Programme (www.chlamydiascreening.nhs.uk) A robust Lincolnshire action plan is in place (attached) and progress is reported monthly to the NHS Lincolnshire Performance and Delivery Group and PCT Board. Monthly progress reports are available for 2010/2011. Current activity and services 3 of 5 May 2011 (v1)
The Core team functions: manage results, collate data, and provide resources to screening sites. Two Nurse Project Officers set up screening sites, provide support to these sites, patients and partner treatment management. Lincolnshire Community Health Services provide screening in mainstream sexual health services, Out Of Hours services, Minor Injury Units, Walk In Centres, school nursing, health visiting, prisons, Phoenix Stop Smoking services and Health Shops. Terence Higgins Trust is commissioned to provide outreach screening in areas such as streets, clubs and pubs, colleges and university. Positive Health is also a third sector charity who are commissioned to provide awareness raising in schools and screening if acceptable to school, to relevant age groups. School nurses also work with other services to deliver Chlamydia screening where appropriate. General Practices, Pharmacies and Maternity services are also commissioned to provide screening. Other sites who offer screening are RAF, Lincolnshire County Council youth services, Connexions and other voluntary organisations. In total over 400 sites offer screening across Lincolnshire. The programme also captures screens completed in some non commissioned sites such as secondary care and those screened outside Lincolnshire. Key inequalities In England the control of Chlamydia trachomatosis infection and associated complications is an NHS priority. It has been estimated that between 26% and 43% of 16 to 24 year olds who are currently sexually active need to be tested annually to control the spread of Chlamydia infection. There is research evidence available to demonstrate that areas with higher levels of deprivation tend to have higher rates of sexually transmitted infection (STI) (see HPA website for further national information). Within Lincolnshire, this is reflected in the high numbers of positive screens identified within the areas of highest deprivation across the county: Skegness and Coast, Boston, West Lindsey and Lincoln City. The National Programme was established in 2003 to opportunistically test young people who are 25 years or under. Whist the NCSP was set up in 2003, PCTs came on board in waves and Lincolnshire did not start screening until February 2008. The programme offers a large range of locations in both healthcare and non healthcare settings e.g. University Health Centre, GP surgeries, Maternity Units, Youth Clubs, Pubs and Clubs, etc. NHS Lincolnshire commission services from the Terence Higgins Trust to provide outreach to those areas where we know young people are less likely to access screening and where the rates of positive screens are expected to be high. They mainly use workers who are in their 20s to actively approach young people and offer screens. This can be in a range of settings including fresher s fairs, youth clubs, night clubs or pubs and even opportunistically in the street. Their flexible approach of contacting young people where they are most accessible using a 'peer age group' model has proven to be very successful in Lincolnshire. Nevertheless, there remain 'hard to reach' group who we struggle to screen. They are people who are not in education or work and who do not access core services. Often they are men in the 22-24 age group and they generally access core services less than women. At the end of January 2011 a total of 61.3% of Chlamydia screens were from obtained from women and only 38.7% were received from men. Key gaps in knowledge and services 4 of 5 May 2011 (v1)
We know from our monitoring process that some core services, in particular General Practices and pharmacies need to engage more fully with the Programme. This would improve access to screening and help reduce health inequalities. Outreach work remains a priority and targeting to areas where there is inequity of access to screening such as areas of higher deprivation, young men, the unemployed, etc. Risks of not doing something Untreated genital Chlamydia infection has serious long term consequences, especially in women, in whom it is a well established cause of pelvic inflammatory disease, ectopic pregnancy and infertility. This results in huge financial costs to the NHS as well as human costs in terms of family life. What is coming on the horizon? The Chlamydia screening indicator: reporting diagnostic rates amongst the resident 15 to 24 year population of Lincolnshire has been proposed within the Public Health Outcomes Framework consultation document Healthy Lives, Healthy People: transparency in outcomes, proposals for a public health outcomes framework (Department of Health December 2010) What should we be doing next? Continue to effectively project manage the screening service by: setting a realistic screening trajectory based on 2010/11 outturn and target geographical areas and screening sites with the highest positivity rates. The Sexual Health Needs Assessment taking place this year will provide insight into how this service can be improved to meet the actual needs of the population of Lincolnshire. 5 of 5 May 2011 (v1)