JACKIE McGEAGH Regional Antenatal Screening Coordinator PHA ANTENATAL HEPATITIS B

Background Screening pregnant women since 1970s Formalised in 1998 by DHSSPS Aim to detect and prevent infection of infant HBeAG +ve 70-90% transmission HBeAG –ve 10% transmission Hepatitis B vaccine +/- HBIG at birth Further vaccine dose 1, 2, 12 months, serology at 12 months for surface antigen Vaccination confers 90% infection prevention

Standards/Guidance 2010 Antenatal Screening Standards 2011 DH Best Practice Guidance Maternal referral and appt 6 wks within receiving positive result DNA testing for all women May require treatment in 3rd trimester Referral standard implemented Aug 11 Also is a KPI standard

Audit of Referrals Retrospective audit conducted in March 2012 Number of women confirmed positive in NIBTS during 2011 Number of pregnant women referred to Liver Unit from Maternity Units Timeline from referral to appt Number seen within 6 wks of screening result Compare pre August 11 and post August 11

Findings 35 women identified for 2011 30 HBeAG –ve 5 HBeAG +ve 28 referrals received in 2011 25 referred by Maternity Units, 3 by GP 10 not referred by MU 7 GP 3 in 2011, 4 referred in previous years 1 Gastro referral 2008, not seen since then 1 2009 A/N referral had appt to attend in 2011 1 not referred – left country

Referrals 35 total positives for 2011 21 positives Jan – July 2011 14 positives August – December 2011

Maternity referrals Jan - July 12/21 were referred 57% 9 not referred to Liver Unit 43% Reasons for non referral during 3 referred from GP in 2011 1 left country prior to referral 5 previously referred before 2011 (4 GP, 1 Gastro)

Maternity referrals Aug - Dec 13/14 were referred 93% 1 not referred but as existing pt was seen during pregnancy

Appointments 12/21 received appointments within 6 wks 50% DNA/Canc first appointment

Non Maternity Referrals Of the 10 not referred from Maternity 9 were yearly review patients 1 was never referred (had care in England) Of the 9 yearly review patients 1 moved to England and transferred care 8 were seen during pregnancy

Conclusions Overall 32/35 women were seen Improvements from August 2011 Referral from Maternity units improved from 57% to 93% All women referred met the 6 wk standard Attendance is still poor with 50% DNA/CNA 1st appointment High number of repeat DNA/CNA Screening Coordinators following up in local area

Recommendations Health professionals need to refer all pregnant women during each pregnancy Women need to be advised to attend during each pregnancy even if previously seen Further work and research to improve the attendance rates of these women