Guidance

Infectious diseases in pregnancy screening supporting information - April 2023

Updated 7 February 2023

Applies to England

1. Introduction

Infectious diseases in pregnancy screening standards supporting information

These revised screening standards for the NHS Infectious Diseases in Pregnancy Screening programme (IDPS) replace previous versions. They apply to data collected from 1 April 2023. This is a summary of the changes from previous version of the standards which were published in 2018.

The UK National Screening Committee (UK NSC) recommends all eligible pregnant women are offered and recommended screening for HIV, hepatitis B and syphilis.

Some women may choose not to be screened or accept screening for some conditions and not others. It is important their choice is respected.

There are minor changes to the wording of some standards where necessary for clarity, sensitivity and consistency.

Changes have been made to the following:

2. IDPS-S01: coverage HIV and S02: coverage hepatitis B

• Changes to numerator to remove ‘including women who were known to be HIV/hepatitis B positive at booking and not retested’. All women, including those known to be positive for HIV should be reoffered and retested in every pregnancy. This is to make sure vulnerable women do not slip through the net and to make sure the screening team are aware of them. This change is supported by data analysis for women known to be living with HIV/hepatitis B who were not retested showing this is a very small and decreasing cohort of women. Most providers retested women in every pregnancy.
• Addition of information on formal reoffer les than or equal to 20 weeks of pregnancy (or within 2 weeks if greater than 20 weeks pregnant) to women who decline the first offer. The purpose of the formal reoffer appointment is to create an opportunity for the woman to revisit their decision, supported by a professional with relevant experience. The screening midwife should ensure the woman has received adequate information about the infections and understands why screening is recommended.
• Caveat removed in line with agreement for all screening standards.
• Low coverage sentence removed, this is not felt to be useful and providers are now aware of the importance of accounting for all women.

3. IDPS-S03: coverage syphilis

• Changes made as above from the second bullet point onwards

4. IDPS-S04a, S04b and S04c - turnaround times HIV, hepatitis B and syphilis

• Added ‘date of sample receipt in the laboratory is counted as day 1. Sample receipt is when the sample is recorded as received on the laboratory information management system’. This was not defined in previous standards and is consistent with other screening programmes and the updated IDPS laboratory handbook.
• Increase in acceptable and achievable thresholds from greater than or equal to 95.0% and greater than or equal to 97.0% to greater than or equal to 97.0% and greater than or equal to 99.0%. This was changed to drive quality and reflect improving performance. England average for 2020 to 2021 was 99.4%, all regions met the achievable threshold. It is important that women receive their results and if needed, are referred for clinical care as soon as possible to help reduce the vertical transmission rate.

5. IDPS-S05: referral: timeliness to information and support

• Change to title of standard to reinforce that this is not an assessment appointment, it is an appointment to discuss a confirmed screen positive result.
• Change from less than or equal to 10 working days to less than or equal to 5 working days for appointment with the screening team for women with confirmed screen positive result. This is to reduce the time that the woman enters specialist care for assessment/ treatment. There is evidence that waiting up to 10 days to give the result is having a clinical impact, especially for women who book late for antenatal care.
• Change to numerator and denominator to remove women who are known to be living with HIV or hepatitis B who decline in this pregnancy. All women still need to be contacted to make sure they have up to date information and understand the importance of being referred to and attending if needed appointments with specialist services. This is consistent with changes to S01 and S02.
• Added option of virtual appointments where appropriate. Face to face appointments is the default position, but not necessary for all women with confirmed screen positive results. Can delay entry to specialist care. Nature of appointment to be dependent on individual needs and the women’s choice.
• Clarity around cohort added to denominator as there appears to be some differences in the cohort that is being reported.
• Responsible for submission changed to Integrated Screening Outcome Surveillance Service (ISOSS). This data is already reported by maternity providers to the service and will relieve the burden on maternity services.

6. IDPS-S06: diagnosis/intervention: timely specialist assessment of women with hepatitis B (newly diagnosed or higher infectivity)

• Some rewording for clarity and consistency.
• Changes to higher infectivity definition in line with national guidance from the British Viral Hepatitis Group pregnancy guidelines.
• Removal of the list of potential specialists as there are many different ways in which this service is provided clinically.
• Added option for appointments to be provided virtually where appropriate if this is the woman’s choice and meets their individual needs.
• Acceptable performance threshold increased from 70% to 75%. Data analysis indicated this was supported and will help drive further improvement.
• Responsible for submission changed to ISOSS. This data is already reported by maternity providers to the service and will relieve the burden on maternity services.

7. IDPS-S07: intervention/treatment: timely administration of neonatal hepatitis B vaccination and immunoglobulin

• Some rewording for clarity and sensitivity.
• Additional text added to final bullet point in line with hepatitis B guidance.
• Responsible for submission changed to ISOSS. This data is already reported by maternity providers and will relieve the burden on maternity services.

8. IDPS-S08: diagnosis/intervention: timely specialist assessment of women with hepatitis B (lower infectivity)

• New standard to capture the remaining larger cohort of women who are known to have chronic hepatitis B infection, with lower infectivity markers in pregnancy, being seen by specialist hepatitis B services for timely assessment and intervention where appropriate.
• For assurance that this large cohort of women are receiving appropriate care in pregnancy, in line with the hepatitis B pathway launched in 2021 and in line with BVHG clinical guidelines. Accepted by majority of respondents to consultation. Will be collected annually by ISOSS for data from 2023. Acceptable and achievable thresholds not yet set.

9. Additional IDPS operational guidance is included in the:

• programme handbook
• handbook for laboratories

Pathway requirements specifications are available for NHS providers as part of the public health functions exercised by NHS England.