Presentation on theme: "An update on the National Chlamydia Screening Programme"— Presentation transcript:
1 An update on the National Chlamydia Screening Programme Wednesday 13 March, 2013London
2 Deputy Chief Executive, Health Protection Agency WelcomeDr. Paul CosfordDirector for Health Protection and Medical Director, Public Health EnglandDeputy Chief Executive, Health Protection Agency
3 Kate Folkard NCSP Programme Manager firstname.lastname@example.org Overview of the National Chlamydia Screening Programme – challenges, successes and future directionKate FolkardNCSP Programme Manager
4 The National Chlamydia Screening Programme (NCSP) in England Aims to control chlamydia thus reducing transmission and sequelaeOpportunistic screening of sexually active < 25 year oldsAnnuallyChange of sexual partnerClinical and non-clinical venuesRoutine offer at every consultationStandards for treatment and partner notification
5 The NCSP: achievements to date High volumes screened - deliver around 2 million tests and 150,000 diagnoses per yearExpansion of sexual health services into community with range of providersEarly adoption of new technologiesQuality assurance programmeInvolvement of menReaching those at higher risk and the socio-economically deprived
6 What are young people’s views? Don’t always see chlamydia as relevant to themPrefer a blanket approach to testingWant to be asked rather than have to ask for a testDon’t want to have to give a sexual historyNeed to be sure of confidentialityWant options – healthcare professional/ ’virtual’ testingWant results quicklyWant support to be available to manage positive resultsChlamydia Screening and Sexual Health Marketing – COI for DH. Define, 2008Effectiveness of chlamydia screening will depend on several factors….to be discussed in more detail now…
7 Roles and responsibilities Cost effectiveness not discussed…
8 Trends in chlamydia screening: the impact of transition? Decline in screening activity:Drop in test volume and diagnoses over 2011/12National diagnosis rate: ,850 per 100,000 (Jul-Sep’12)Advice to local areas:Maintain sufficient investment in screeningIntegrate screening within primary care, SRH and GUM services (& reduce outreach)Ensure repeat screening annually/change of partnerAchieve PN standards
9 Future direction of the programme Emphasis on integration and delivery models; embed within primary care, SRH and GUM servicesDeliver synergies with young adults’ sexual health interventions such as contraceptive advice, condom use and wider health promotionChlamydia Testing Activity Dataset (CTAD)From coverage target to diagnostic indicatorPublic Health Outcome FrameworkEvaluation framework
10 Objectives of the dayTo bring together HPA, PHE, public health and commissioning colleagues with a remit for sexual health to:Present the latest evidence on chlamydia screening approaches and outcomesProvide an update on recent NCSP developments and future plansEnsure confidence in making the case for chlamydia screening at a local levelExplore ways to ensure the NCSP can deliver effectively during the transition year and beyond
12 Workshop Session: Delivering the NCSP during the transition 30 minute facilitated discussion around three questions:What are the priorities for the NCSP over the next two years? What do you want to deliver locally?What support do you need from NCSP nationally to deliver?Who is going to help you deliver at a local level / what are your new emerging local network?
13 The chlamydia screening evidence base – overview Kate Soldan
14 Chlamydia trachomatis Common sexually transmitted infectionMajority of infections are asymptomaticHighest rates of infection among young peopleEasy to detect using NAAT testsEasy to treat with antibioticsChlamydia infected culture (Wellcome Images)
15 Rationale for chlamydia screening Chlamydia infection is a known risk factor for a number of serious health problems:Pelvic inflammatory diseaseEctopic pregnancyTubal factor infertilityNeonatal pneumonia and neonatal conjunctivitisEpididymitis in menTreating chlamydia infections prevents the development of sequelaeRCT showed 83% reduction in PID among treated compared to untreated chlamydia infection (p>0.05) Oakeshott et al. BMJ 2010;340:c1642
16 Rationale for chlamydia screening Asymptomatic screening to detect chlamydia trachomatis should:Reduce the prevalence and incidence of infectionReduce the risk of developing health problems
17 What do we want to know?Impact of widespread screening for asymptomatic chlamydia infections onPrevalence and incidence of chlamydiaThe incidence of complicationsYoung adults’ sexual health and wellbeingThe predicted impactThe impact in practiceEffectiveness of chlamydia screening will depend on several factors….to be discussed in more detail now…
18 Optimal models of service delivery What do we want to know?Optimal models of service deliveryPartner notificationTesting frequencyTesting the right peopleSustainable service configurationCost effectivenessCost effectiveness not discussed…
19 The evidence base on outcomes of chlamydia screening
20 Reducing transmission and prevalence Sarah Woodhall
21 How should chlamydia screening affect prevalence and incidence? Asymptomatic screening to detect chlamydia trachomatis (plus subsequent partner notification) should:Reduce prevalence of infection by removing cases from the pool of infectionsIdentify infections earlier in the course of infectionReduce incidence of infection by preventing onward transmission to sexual partners
22 Natural course of chlamydia infection End of infection without screeningInfectionNatural clearanceDevelop symptoms/complications, treated
23 Screening reduces the duration of infection End of infection without screeningEnd of infection with screeningInfectionNatural clearanceDevelop symptoms/complications, treatedScreening test
24 Chlamydia screening can prevent transmission End of infection without screeningInfectionNatural clearanceDevelop symptoms/complications, treatedChlamydia passed on to sexual partner
25 Chlamydia screening can prevent transmission End of infection without screeningEnd of infection with screeningInfectionNatural clearanceDevelop symptoms/complications, treatedScreening testChlamydia not passed on to sexual partner
26 Mathematical modelling Randomised controlled trials What do we know about the impact of chlamydia screening on prevalence and transmission in practice?Mathematical modellingRandomised controlled trialsAnalysis of routinely collected dataPrevalence surveys
27 Mathematical modelling Randomised controlled trials What do we know about the impact of chlamydia screening on prevalence and transmission in practice?Mathematical modellingRandomised controlled trialsAnalysis of routinely collected dataPrevalence surveys
28 Chlamydia prevalence among 16-24 year olds: Modelling the effectiveness of screening Testing coverage: 9%Chlamydia prevalence (%)Testing coverage: 26%Testing coverage: 43%Years after introduction of the screening programmeKey assumptions: Baseline prevalence 6.5%; PN 20%; few cases treated in absence of screening programmeNAO, Based on: Turner et al. STI 2006
29 Mathematical modelling Randomised controlled trials What do we know about the impact of chlamydia screening on prevalence and transmission in practice?Mathematical modellingRandomised controlled trialsAnalysis of routinely collected dataPrevalence surveys
30 Randomised controlled trial of chlamydia screening, Netherlands RCT among >300, year old men and womenAnnual postal invitation to chlamydia screening for 3 yearsLower than expected uptake (10% -16%)No significant fall in prevalence was observedsome evidence for a fall in South LimburgVan den Broek et al. BMJ 2012
31 Ongoing randomised controlled trials of chlamydia screening AustraliaThe Australian Chlamydia Control Effectiveness Pilot (www.accept.org.au)Randomised controlled trial of chlamydia screening in primary care.FinlandCluster randomised controlled trial as part of an HPV vaccine trial
32 Mathematical modelling Randomised controlled trials What do we know about the impact of chlamydia screening on prevalence and transmission in practice?Mathematical modellingRandomised controlled trialsAnalysis of routinely collected dataPrevalence surveys
33 Chlamydia diagnosis rate (per 100,000 pys), 15-24 year old females GUM diagnoses represent uncomplicated CT; NNNG (Non-NCSP, non-GUM) diagnoses available from April 2008 onwards.GUM data as at Feb 2013; NCSP/NNNG data as at November 2012
34 Number of tests and proportion testing positive by gender (NCSP tests)
35 Number of tests and proportion testing positive by gender (NCSP tests)
36 Mathematical modelling Randomised controlled trials What do we know about the impact of chlamydia screening on prevalence and transmission in practice?Mathematical modellingRandomised controlled trialsAnalysis of routinely collected dataPrevalence surveys
37 Population based prevalence surveys United StatesNational Health and Nutrition Examination SurveyIncludes urine test for chlamydiaUKNational Surveys of Sexual Attitudes and LifestylesChlamydia prevalence in 2000 and ~2010Comparability between survey years limitedPilot postal survey among young women conducted in 2 PCTs in 2011Low response rate, therefore open to substantial biasUnlikely to be a feasible or appropriate method of monitoring prevalence over timeWoodhall et al, Under review
38 SummaryIn the absence of changes in any other risk factors, chlamydia screening should reduce the prevalence and incidence of chlamydiaMathematical modelling and routine data are consistent with a fall in chlamydia prevalence in recent yearsNo empirical evidence to demonstrate a fall in prevalenceChanges in chlamydia in the context of testing and trends in other STI will become more informative in the future
39 Kate Soldan email@example.com Preventing sequelaeKate Soldan
40 Chlamydia is an important cause of reproductive health problems in women Ectopic Pregnancy7.6%Pelvic Inflammatory Disease1% / 10% / 30%Chlamydia infection10.8%Tubal Factor InfertilitySource: Adams et al. STI 2007; 83;
41 ~10% to 20% risk of developing PID after a chlamydia infection[1,2] Chlamydia is an important cause of reproductive health problems in women~10% to 20% risk of developing PID after a chlamydia infection[1,2]~45% of tubal factor infertility is caused by chlamydia7/74 (9.5%) year old women with untreated chlamydia developed PID within one year[*POPI]Synthesis of results from 8 studies estimates 16% - 20% risk of PID[*Price] Oakeshott et al. BMJ 2010;340:c1642;  Price et al. Am J Epi. In press;  Price STD 2012;39(8)
42 Can chlamydia screening prevent PID? Chlamydia infectionPID not preventedPID prevented
43 Can chlamydia screening prevent PID? Synthesis of published studies has estimated that~41% to 61% of chlamydia-related ‘PID’ can be prevented by annual screeningThree randomised controlled trials have evaluated the effect of a single round of chlamydia screening on PID 1 year later Price et al. Am J Epi. In press
45 Rate of PID diagnoses in General Practice by definition (Females 16 to 44 years old) Source: French et al. STD 2011: 38(3):158-62
46 Rate of PID diagnoses* in General Practice by age group (Females 16 to 44 years old) Rates [of definite/probable PID] declined in all areas and among all age groups with greatest decline in women aged 16 to 19 years.” Levels of chlamydia screening amongst young women were relatively low during the study period. Re-analysis of data to the end of 2011, i.e. including years of higher chlamydia screening amongst under 25 year olds, is now in progress and should show whether screening at levels reached in is associated – in ecological analyses - with declines in PID.*Definite/probable PID diagnosesSource: French et al. STD 2011: 38(3):158-62
47 SummaryAsymptomatic screening to detect chlamydia trachomatis can prevent the subsequent development of sequelaeThe proportion of PID and ectopic pregnancy episodes that can be prevented by screening depends onlevels of screeningnatural history of infection
48 NCSP web survey 2012 – Attitudes to chlamydia screening and subsequent impact on behaviour Chlamydia Operations Group13 Mar 2013Tom Hartney, Paula Baraitser, Anthony NardoneSexual Health Promotions Team
49 Web survey backgroundLittle data on attitudes of young people to chlamydia screeningQualitative study reported generally positive attitudes1Little information on impact of screening on subsequent behaviour. Self-reported changes in sexual behaviour following a positive result for STIs:Increase of condom use post-treatment for STIs2,3.Decrease in sexual partners21 Hogan et al 2010; 2 Sznitman et al 2009; 3 Fortenberry et al 2002
50 AimsAim: to inform the development of the NCSP through a survey of young people, both tested and non-tested.What are young people’s attitudes towards chlamydia and chlamydia testing?What impact does being tested have on future behaviour?
51 Methods Questionnaire took around 20 minutes, covered Web-based cross-sectional anonymous surveyUsed panel of young people accessed via market research company (small incentive, <£1)Eligibility criteria:Aged between 16-24Resident in EnglandRepresentative by age, sex and regionQuestionnaire took around 20 minutes, coveredTesting historySexual behaviourDemographicsAttitudes and impact of testing on behaviour
52 Results 1,521 responses over 2 weeks in June 2012 Demographically weighted sample: 51% male, 81% white46% ever tested (29% in last year)57% of these tested more than once13% had had a previous positive result11% had >1 partner in last year (39% among tested)29% had unprotected sex in last 3 months (61% among tested)70% of those not tested didn’t consider themselves at risk
53 Assessing attitudesQuestions use framework of Theory of Planned BehaviourLikert scale 1-5 (strongly disagree to strongly agree)“Please read the following statements and decide to what extent you agree or disagree with each of them...”“I should get tested for chlamydia every year if I am sexually active”“Getting tested for chlamydia is a normal part of young people’s lives”“My friends get tested for chlamydia”“Chlamydia is a problem that does not concern me”“I would be too embarrassed to ask for a chlamydia test”“Only people who sleep around get chlamydia”Cost effectiveness not discussed…
56 Combined attitudes scores Each statement either positively or negatively associated with testing“I should get tested for chlamydia every year if I am sexually active”“Getting tested for chlamydia is a normal part of young people’s lives”“My friends get tested for chlamydia”“Chlamydia is a problem that does not concern me”“I would be too embarrassed to ask for a chlamydia test”“Only people who sleep around get chlamydia”Level of agreement used to score each response from -2 to +2Combined to form overall attitude score for each respondent
58 Behavioural questions “Would you say that having been tested for chlamydia has made you more or less likely to...”(1 = “Much less likely” to 5 = “Much more likely”)Know how to avoid getting chlamydiaDiscuss contraception with a new partnerUse condoms every time I have sexAsk a new partner to have a test for chlamydia?Have fewer sexual partnersDiscuss my sexual health with a nurse or doctorTest for chlamydia again in futureAsk my GP or practice nurse for a chlamydia testRecommend a chlamydia test to a friend
62 ConclusionsPositive attitudes towards chlamydia and chlamydia testing are strongly associated with being testedMore than half (55%) of those never tested agree that they should be tested every yearMajority of young people report that testing has a positive impact on their behaviourMore impact on health-care seeking than sexual behaviourpositive result: more impact on condom use and discussing sexual health with professionalsrecent testing (<3 months): more impact on partner numbersRepeat of survey in summer 2013:track changes over timeexplore impact of testing in more detail
76 Making CTAD a success New data system at a time of change Improve data quality - testing services and laboratoriesPostcode of residenceTesting service typeSuccessEasier to collect dataBetter dataInform commissioning
77 Thank you! Laboratories Testing services Sexual health commissioners HPA sexual health leadsHPA Regional information managersChlamydia screening officersSexual health facilitatorsGUMCAD surveillance teamCTAD surveillance teamNCSP teamAll other contributors
79 Internet testing for Chlamydia trachomatis in England, 2006 to 2010* Sarah Woodhall*Woodhall et al. BMC Public Health 2012;12:1095
80 BackgroundThe NCSP offers free chlamydia tests to under 25 year old men and women in EnglandTesting services are delivered locallyChlamydia tests are available from testing venues, for example:General practiceSexual and reproductive health servicesNon-clinical venues including the internet
81 The internet testing pathway Please call us to get your chlamydia test result.Laboratory
82 AimsTo describe online access to chlamydia testing within the NCSPTo evaluate websites offering testing in terms of signposting and health promotion advice
83 Methods (1)Data sourceNCSP chlamydia testing data, 2006 to 201015-24 year old men and women71/95 programme areas with available dataCompared reported characteristics for test from three settings (2010):Internet testsGeneral Practice (GP) clinicsSexual and reproductive health services (SRH)
84 Identified websites offering chlamydia tests: Methods (2)Identified websites offering chlamydia tests:Free chlamydia tests through the NCSPTests offered on a commercial basisEvaluated websites:Signposting to clinical servicesHealth promotion information
85 What proportion of NCSP tests are carried out through the internet ? *Includes 71 programme areas (covering 111 PCTs) with specific codes for tests accessed through the internet.
86 Contribution of internet tests Percentage of programme areas What proportion of NCSP tests were carried out through the internet in each programme area? (2010)Contribution of internet testsPercentage of programme areasUnder 2%30%2% to <10%40%10% to 38%*Includes 71 programme areas (covering 111 PCTs) with specific codes for tests accessed through the internet.
88 Who accessed chlamydia tests in each setting? *Proportions presented among those with available data. GP=General practice ; SRH= Sexual and Reproductive Health Services
89 Health promotion information and signposting NCSP websites(n=58)Commercial services(n=32)Condom use85%29%Contraception33%0%How to access other STI tests47%60%Signposting if symptomatic79%32%N=58 NCSP websites; 32 commercial websites
90 SummaryInternet testing is an important component of chlamydia controlAccess to free chlamydia testing via the internet is widely available in EnglandBut fragmentation and duplication of services is a problemInternet testing reaches a population with a high risk of chlamydia (e.g. men, higher risk sexual behaviour)Websites should signpost to clinical care and health promotion informationRoutine audit tools now under development
91 Repeat testing after a positive test for chlamydia Sarah Woodhall
92 QuestionShould the NCSP routinely recommend repeat testing following a positive chlamydia test result?
93 Overview Current NCSP policy related to repeat chlamydia testing Summary of available evidence relating to repeat chlamydia testingRisk of re-infectionCurrent repeat testing patternsDifferent approaches to repeat testingThe role of reinfection in relation to other interventionsAcceptability and cost
94 Current pertinent NCSP policy Opportunistic screening in a variety of venuesScreening annually and on change of partnerSexual health advice for allTreatment and partner notification standardsNo routine ‘test of cure’
95 Risk of re-infection following a positive chlamydia test Young people who test positive for chlamydia are at higher risk of subsequently testing positive for chlamydia[1-3]Lamontagne. STI 2007;  PLoS.One. 2012; Batteiger JID. 2010
96 Risk of re-infection following a positive chlamydia test High rates of re-infection have been consistently reported in several settings[4-8]Systematic reviews show:median of 14% of women re-infected at repeat testmedian of 11% of men infected at repeat test Woodhall STI 2012;  Turner STI 2012;  Rietmeijer STD 2002;  Hosenfeld STD 2009;  Fung STI 2007
97 Impact on progression to sequelae, chlamydia incidence and prevalence Data from observational studies and mathematical models suggest that:Repeat chlamydia infections are associated with an increased risk of adverse sequelae[9,10]Re-infections within existing sexual partnerships are likely to be important in maintaining levels of chlamydia prevalenceThere is limited evidence on the potential impact of increasing repeat testing on the incidence or prevalence of chlamydia or on the development of chlamydia-related sequelaeCould assume to be at least as beneficial as diagnoses made through asymptomatic screening Haggerty et al. JID 2010;201 Suppl 2:S134-S155;  Darville et al. JID 2010;201 Suppl 2:S114-S125;  Heijne et al. JID 2011;203:372-7
98 Current practice: Repeat testing rates in England Moderate rates of repeat testing already occur among young adults in England- NCSP: 18 per 100 pys (see figure)- GUM clinics:26 per 100 pysRates of repeat testing are 25% to 50% lower than might be expected if all young people were re-tested on change of sexual partnerThe number of infections that would be diagnosed in addition to existing testing patterns has not been demonstrated in practiceCumulative proportion re-testingNumber of weeks from baseline testCumulative proportion re-testing after 6 weeks, NCSP tests 2010 Woodhall et al. STI 2013;89(1):51-6
99 Current practice: Delivery models Scoping exercise, 19 services (CSP, GUM, SRH)Identified a range of existing recommendations and service delivery modelsNo recommendationRepeat test recommended, but no active recallRepeat appointmentsText messages, telephone or letter remindersMailed testing kitsVarying intervalsSome categorisation by complexity of patient
100 International experience: Uptake rates by different approaches Reported uptake rates varySMS reminders and mailed testing kits have been found to increase rates of repeat testing Guy . STI 2013;  Downing STI 2013;  Dukers-Muijrers STI 2012;  Hoover CID 2012;  Gindi . Ntnl STD Prevention Conference. Philadelphia, PA, 2004;  Malotte STD 2004;31:637-42;  Paneth-Pollak . STD 2010;37:365-8;  Gudgel . National STD Prevention Conference 2006;  Kohn . Ntnl STD Prevention Conference 2010;  Xu . Obstet.Gynecol. 2011;118:231-9;  Sparks . STD 2004;31:113-6.
101 Time between treatment and repeat testing The optimum interval for repeat testing has not been establishedThis will depend on logistical and biological considerationsCountryRecommended re-testing intervalUSAApproximately 3 monthsCanada6 monthsAustralia3 monthsNew ZealandScotland3-12 months, or sooner if there is a change of partner
102 Repeat testing in the context of other interventions Re-infection is not inevitable; it reflects repeat exposure and is therefore preventableInterventions to reduce risk behavioursPartner notificationBut! High rates of re-infection have been observed even in studies with high levels of PNLamontagne: 22.3 per 100 pys following a positive when all partners treatedSchillinger: 12% re-infected, 85% partners treatedCameron et al: 13% - 22% re-infected in trial to increase PNBatteiger: 65% of re-infections due to different partner, and 17% likely due to existing partnerLamontagne. STI 2007; ; Batteiger JID. 2010;  Schillinger STD 2003;30:49-56;  Cameron. Hum.Reprod. 2009;24:
103 Acceptability & cost-effectiveness of repeat testing The acceptability of different approaches to encouraging re-testing has not been investigatedNo studies have reported the costs of different methods of repeat testing in EnglandOne study from the US found phone reminders to be more cost effective compared to motivational interviewing or a brief recommendation Gift et al. STD 2005;32:542-9
104 Summary: What do we know? Young people who test positive for chlamydia are at increased risk of subsequent infectionHigh rates of repeat infection are consistently reportedRepeat infections may be important causes of morbidity and maintaining chlamydia epidemicsRates of repeat testing in England are moderate, but could be higherMailed screening kits, and telephone or text message reminders appear to increase repeat testing rates
105 Summary: What are the remaining questions? The number of infections that would be diagnosed and treated, over and above those identified via existing testing patternsOptimum interval for re-testing (3 months is consistent with evidence and international practice)Cost, acceptability and feasibility of different approaches to re-testingImpact of increasing repeat testing on the incidence/prevalence of infection, or the development of sequelae
106 Consultation and policy development Expert meeting held in December 2012supported the introduction of a recommendation for routine retesting of young adults who test positive for chlamydia around 3 months after treatmentNext stepsExternal stakeholder consultation (March - April)Young person consultationPolicy review and development of implementation materials
108 Chlamydia, Contraception and Condoms (& HIV) 3Cs (& HIV) ProgrammeChlamydia, Contraception and Condoms (& HIV)A programme to support basic sexual health provision in general practicePaula Baraitser
109 Why 3Cs?Source: Adams et al. STI 2007; 83;All part of a basic sexual health offer – providing young adults with information and technologies to avoid sexually transmitted infection and unplanned pregnancy - It makes sense to offer them togetherSupports existing practice in primary care – this is nothing new but it is important and it is not consistently offeredTakes minimal time – this is all about permission to discuss and signposting
110 Why HIV testing? HIV in the UK, 2011:1 Estimated 96,000 people living with HIV – 24% (22,600) are unaware of their infectionEstimated prevalence of 1.5 per 1,000 population – higher among MSM and black Africans47% of HIV cases diagnosed late (CD4<350) in 2011Why focus on reducing late HIV diagnoses?Public health impact – treatment can prevent onward transmission2 - indicator within Public Health Outcome FrameworkIndividual prognosis - early diagnosis can lead to near-normal life expectancy3Cost - expanded HIV testing shown to be cost effective4-5 and increased costs of a late versus early diagnosis (x2-3 times) which persist longer term7,8The proportion of late HIV diagnoses remained high (47%) in 2011Public health impactLate HIV diagnoses indicator within Public Health Outcome FrameworkApproximately 25% of those with HIV unaware of infection, responsible for 50-75% of transmissionTransmission risk reduced if aware of status and if on treatmentIndividual prognosisLate HIV diagnosis a major predictor of morbidity and short-term mortality. Early diagnosis can lead to near-normal life expectancy1CostThe costs of a late HIV diagnosis are x3 those of an early HIV diagnosis (CD4 >500)Expanded HIV testing shown to be cost effective in studies1. HPA HIV in the UK 2012 report; 2. Cohen et al NEJM Nakagawa et al AIDS 2012; 4. Paltiel et al N Engl J Med 2006; 5. Yazadanpanah et al Plos One 2011; 6. MMWR 2006; 7. Krentz et al HIV Med 2008; 8. Beck et al Plos One 2011110
111 Implementation NCSP develops the materials and training package NCSP (SHFs) train local trainers in each regionLocal trainers train individual GP practices (up to 1500 across England)Training adapted to each practiceOngoing support and feedbackResource pack and websiteNCSP coordinates, monitors and evaluates
112 Evaluation National NCSP monitoring – CTAD Practice specific data on: Chlamydia tests and positivesContraceptive prescribing for year oldsHIV testing in new practice registrants > 16 years oldCondoms given out or use of C-card and local condom programmes
113 Summary3Cs are already widely and expertly provided in general practice – we will encourage signposting to these services in most consultations young adultsSexual health service provision is variably supported in general practice – we will provide training and resources ongoing support and feedbackThis is an ambitious roll out - reaching 1500 practices – if successful it will have an important impact on sexual health among young adults
114 NCSP Quality Assurance Framework Erna Buitendamfrom 1st April 2013:m:
115 Elements of the NCSP QA framework Minimum standards for implementation of chlamydia screening plansGuidance on applying the standards for both commissioners and providersPosition statements as requiredSurveys or audits on selected topicsIncident monitoring and dissemination of anonymised ‘lessons learned’ reportsThe NCSP is committed to supporting the highest possible standards in the commissioning and provision of chlamydia screening.The NCSP QA framework sets out the NCSP Strategy for quality assurance.The framework consists of the following elements:minimum standards for implementation of chlamydia screening plans (aligned to those of British Association for Sexual Health and HIV);guidance on applying the standards for both commissioners and providers;position statements as required;surveys or audits on selected topics, andincident monitoring and dissemination of anonymised ‘lessons learned’ reports.
116 Standards Guidance Service Planning, e.g.: Data collection: NCSP integration into core services (March 2012),Outreach services (November 2011)Data collection:CTADManagement of resultsOther, e.g.Azithromycin Patient Group DirectionAlso Accompanying Document with more detail
117 Position statements Audits & Surveys Treatment of positive patients and retesting –February 2012CQC registration impact on providers – May 2011Dual testing for chlamydia and gonorrhoea - August 2010Managing equivocal or ‘unconfirmed positive’ chlamydia results – August 2010Equity of access (November 2012)Partner notification practice (March 2012)Patient and public engagement (January 2012)Treatment rates (July 2011 and July 2010)These statements clarified the NCSP’s approach to topics, not covered in the standards in that year, and that were frequently raised by providers and commissioners. This has also proven to be useful resource as this guidance facilitates a national consistent approach.
118 Incident monitoring and lessons learned When incident occurs: local reporting policy should be followedThe NCSP Incident Policy aims to encourage reporting of incidents nationally so that:Any risks or lessons learnt, are shared with other programme areas in order to continue to improve performance and minimise risk across the countryNational guidance can be updated as appropriateWe can provide support and respond to queries from other external parties as a result of the incidentPlease report to:
119 QA framework priorities 2013-14 Review of QA framework to reflect learning from:The NCSP QA programmeQA frameworks from related organisationsChanging policy context from April 2013Priorities for 2013/14:Expand the remit of future audits by measuring additional aspects of good practice in service commissioning and provision (as opposed to only measuring achievement of NCSP standards)Analyse existing data sets to inform service improvementIdentify patterns of good practice to inform service improvement and share findings through SHF network and NCSP/PHE communications channelsThe QA framework requires regular review to reflect new learning from the NCSP QA programme, QA frameworks from related organisations, and predicted changes to the context for QA from April 2013.Review considered other organisations’ approach to QA and the implications of the changing environment in which the NCSP operates (increased plurality of providers and commissioners, impacts on audiences for audit & performance against standards needs to be maintained during transfer).
120 QA framework priorities 2013-14 Adapt audit methodologies to:Facilitate benchmarking,Include patient experience indicatorsTailor methodologies to different audiencesApply to different screening settings/venuesProvide online access to a menu of audit tools Planned audits/audit tools :Internet testing auditTest-result-treatment auditPN audit toolAccess to menu of audit tools:for local use to assist providers and commissioners in undertaking self assessments when implementing standards or guidanceThis may be subject to change.
121 Workshop Session: Delivering the NCSP during the transition 30 minute facilitated discussion around three questions:What are the priorities for the NCSP over the next two years? What do you want to deliver locally?What support do you need from NCSP nationally to deliver?Who is going to help you deliver at a local level / what are your new emerging local network?
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