The document discusses standards for infectious disease screening in pregnancy. It outlines 7 standards for screening coverage and test turnaround time. Standard 4 focuses on the test turnaround time for HIV, hepatitis B, and syphilis screening, requiring results be reported within 8 working days of sample receipt. Performance is tracked by region. Common issues with submitting data are outlined, and a proposed change to the submission template is presented to help clarify reporting of pending or inconclusive results. Laboratories are responsible for submitting Standard 4 data to maternity services by the end of June for the previous year's reporting period.

1. Infectious diseases in pregnancy screening
(IDPS) standards
13 March 2019

2. Overview
• IDPS standards
• Standard 4 – test turnaround time
• performance
• data quality
• submission template
• pitfalls and issues
• proposed change to submission template
• data submission
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3. IDPS standards
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Standard Reporting
Focus
Responsible for
submission
Reporting
period
1. HIV coverage
Maternity
Service
Maternity service
Quarterly
(KPI)
2. Hepatitis B coverage
3. Syphilis coverage
4. Test turnaround time (HIV,
hepatitis B, syphilis)
Laboratory Annual
5. Timely assessment for screen
positive and known positive women
Maternity
Service
Annual
6. Timely assessment of women
with hepatitis B
Quarterly
(KPI)
7. Hepatitis B timely neonatal
vaccination and immunoglobulin
Annual

4. Standard 4 – test turnaround time
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Description
The proportion of antenatal screening samples for HIV, hepatitis B and
syphilis where a result is available (confirmed positive or negative) and
reported to maternity services within 8 working days of sample receipt in
the screening laboratory in line with the IDPS laboratory handbook
Standard 4a, 4b and 4c for HIV, hepatitis B and syphilis respectively
Only includes confirmed results
(confirmed screening positive or
negative)
Excludes samples received that are
not fit for analysis and a repeat
sample is requested from the
screening team

5. Standard 4 – test turnaround time
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Performance thresholds
Acceptable: ≥ 95.0%
Achievable: ≥ 97.0%
Mitigations –
Where samples received are fit for analysis but results are
pending or inconclusive these must be accounted for in the
submission commentary and follow-up of any missed results.

6. Standard 4 performance
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Standard 4a: HIV test turnaround time
2017/18 data is subject to change
Year Median Range
2016/17 99.8 13.0-100.0
2017/18 99.7 94.7-100.0
99.6
97.9
99.0
99.2
99.2
99.2
98.7
99.2
0.0 20.0 40.0 60.0 80.0 100.0
London
Midlands and East
North
South
Results reported ≤8 working days of sample receipt %
2016/17 2017/18

7. Standard 4 performance
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Standard 4b: hepatitis B test turnaround time
2017/18 data is subject to change
Year Median Range
2016/17 99.8 13.0-100.0
2017/18 99.9 94.7-100.0
99.5
97.9
99.0
99.2
99.4
99.2
98.8
97.1
0 20 40 60 80 100
London
Midlands and East
North
South
Results reported ≤8 working days of sample receipt %
2016/17 2017/18

8. Standard 4 performance
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Standard 4c: syphilis test turnaround time
2017/18 data is subject to change
Year Median Range
2016/17 99.8 13.0-100.0
2017/18 99.8 94.7-100.0
99.6
97.9
99.1
99.2
99.4
99.2
98.8
99.4
0 20 40 60 80 100
London
Midlands and East
North
South
Results reported ≤8 working days of sample receipt %
2016/17 2017/18

9. Standard 4 data quality
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2016/17 2017/18*
Returns received
(received/expected) 126/145 130/147
Acceptable returns
(acceptable/received) 70/126 101/130
% acceptable 56% 78%
Data quality of initial data returns, 2016/17 and 2017/18
* Data validation for 2017/18 is ongoing. Therefore, the number of returns
included in final analysis is likely to increase as incorrect data is re-
submitted
Data quality has gone up ☺
We will go through some common pitfalls to improve this
further.

10. Standard 4 data submission template
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The 2017/18 data submission template:

11. Standard 4 data submission template
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This must be antenatal screening samples
Do not include samples where the test for that infection was declined
(even if the other infections were not declined)
Only include samples that could not be analysed here

12. Standard 4 data submission template
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This is calculated automatically. It is the total number of samples
received for each infection, which could be analysed.
This is the number of confirmed results reported ≤ 8 working days of
sample receipt. Date of sample receipt = day 1.
This should be lower than or equal to the denominator.
Only confirmed screening results to be included.

13. Standard 4 data submission template
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This is only those samples which were fit for analysis but results are
pending or inconclusive
Not a field to record any sample which did not meet the 8 day turnaround.
Pending or inconclusive results are expected to be low. They should be
accounted for in the comments box
For future data returns, this data field will be titled ‘Pending or
inconclusive results’

14. Standard 4 pitfalls
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What might have gone wrong here?

15. Standard 4 pitfalls
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What might have gone wrong here?
The numerator here is very low
Make sure that the numerator is the results that were reported in less than
or equal to 8 working days, not those that weren’t.

16. Standard 4 pitfalls
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What’s the problem here?

17. Standard 4 pitfalls
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What’s the problem here?
The numerator should not be higher than the denominator.
Make sure that samples which were excluded from the
denominator weren’t included in the numerator.

18. Standard 4 pitfalls
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What’s the problem here?

19. Standard 4 pitfalls
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What’s the problem here?
The numerator + mitigations cannot equal more than the
denominator
Samples cannot appear in both the numerator and the pending or
inconclusive results

20. Standard 4 pitfalls
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What’s the problem here?

21. Standard 4 pitfalls
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What’s the problem here?
No field should be left blank.
If a field cannot be completed, please specify this.

22. Standard 4 – main issues with data
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Numerator > denominator or Numerator + pending or inconclusive
results > denominator
Please re-check data. Ensure that only confirmed screening
results reported in the time frame are included in the numerator
Incomplete data return or unable to provide data e.g. exclusions not
available
Please specify if any fields cannot be completed
Data cannot be provided by individual infection
Please indicate if it is not possible to provide data by individual
infection

23. Standard 4 – proposed change to template
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• We propose a new auto-calculated data field
No
change

24. Standard 4 – proposed change to template
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Auto-calculates the number of results that are available (confirmed
screening positive or negative) and not reported ≤ 8 days i.e. denominator
minus numerator minus pending or inconclusive results

25. Standard 4 – proposed change to template
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Please provide comments to account for these results
If multiple results, general comments can be provided e.g. analyser
downtime caused turnaround breaches in December 2018

26. Standard 4 – proposed change to template
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27. Standard 4 – proposed change to template
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This field should be 0 or a positive number. A negative
number will indicate an error in the inputted fields.

28. Standard 4 data submission
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Data for all standards is requested from maternity services in April (i.e.
data for 1 April 2018 – 31 March 2019 requested in April 2019)
Maternity services will request standard 4 data from screening labs
Maternity services responsible for submission to PHE alongside the
other antenatal standards
Deadline will be end of June 2019

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Important messages
Watch out for numerator > denominator and numerator + pending
or inconclusive > denominator – this should not happen
Mitigations (caveats) are only results which are pending or
inconclusive – template to be updated to make this clearer for 18/19
Each infection should be reported on separately
Do not count samples where the test for that infection was declined
If a field cannot be completed please state this, don’t put a 0 unless
it is a true 0
Need further guidance? The data submission template has
guidance for each data field or contact
phe.screeninghelpdesk@nhs.net

30. Any questions?
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IDPS standards 13 March 2019