Mary TooleyConsultant Nurse – Public Health

IGRA screening in primary care –’The Sandwell Experience’

To cover

• Current screening methods for new arrivals

• Background to Sandwell and TB rates• IGRA screening pilot • Funding• Processes• Results • The future

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

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

TB in Sandwell

What is the picture?

2009 2010 2011 2012 20130

5

10

15

20

25

30

35

40

45

35.133.7

32.7

37.6

39.8

Inci

den

ce (

case

s/ 1

00,0

00)

Incidence in Sandwell

TB notifications in Sandwell2005-2012

TB rates -Black Country 2002-13

2009-2013 Cases by age and sex

0-14 15-34 35-54 55-74 75+0

20

40

60

80

100

120

140

160

180

200

FemaleMale

Age

Num

ber o

f cas

es

TB cases by ethnicity 2009-13

2009 2010 2011 2012 20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mixed / OtherBlack-CaribbeanBlack-AfricanBangladeshiPakistaniIndianWhite

Year

% o

f TB

Case

s

Site of TB (2013)Miliary

2%Unknown

2%Bone (other)

2% GU2% CNS Meningitis

2%

spine3%

GI 5%

Pleural 10%

Other11%

Lymph Nodes19%

Pulmonary43%

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

Asian Mixed Black- African

Black Carribean

White0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UK BornNon-UK born

TB rate in Sandwell is 39.8/100,000

• Cases are not uniformally distributed

• Smethwick has almost 94 cases per 100,000 population

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

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

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

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

Issues to be managed

• Healthcare assistants do new patient check

• Professional development - competence

• Governance• Blood test is complicated – 3 tubes• management of sample

Results

• 102 25 24.5%

Other BBV• HIV• Hep B• Hep C

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