Mary Tooley Consultant Nurse – Public Health

1. Mary TooleyConsultant 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 12th 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 Sandwell2005-2012

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 Sandwellis 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/migranthealthguide

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 • 1022524.5% 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