Quality standard

Quality statement 1: Testing and vaccination for hepatitis B

Quality statement 1: Testing and vaccination for hepatitis B

Quality statement

People who are at increased risk of hepatitis B infection are offered testing and vaccination.

Rationale

Children, young people and adults who are at increased risk of hepatitis B infection should be offered testing in a range of settings (for example, in GP practices including new registrations, prisons or immigration removal centres, drug services, sexual health and genitourinary medicine clinics) alongside appropriate vaccination. This is essential for ensuring early diagnosis, prompt treatment and prevention of infection.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that people who are at increased risk of hepatitis B infection are offered testing and vaccination.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from service pathways or protocols.

Process

a) Proportion of new GP registrants who belong to a group at increased risk of infection who are offered testing for hepatitis B.

Numerator – the number in the denominator offered testing for hepatitis B.

Denominator – the number of new GP registrants who belong to a group at increased risk of infection.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of new GP registrants who test negative for hepatitis B but remain at increased risk of infection who are offered vaccination for hepatitis B.

Numerator – the number in the denominator offered vaccination for hepatitis B.

Denominator – the number of new GP registrants who test negative for hepatitis B but remain at increased risk of infection.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

c) Proportion of prisoners or immigration detainees who are offered vaccination for hepatitis B when entering prison or an immigration removal centre.

Numerator – the number in the denominator offered vaccination for hepatitis B.

Denominator – the number of prisoners or immigration detainees entering prison or an immigration removal centre.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

d) Proportion of prisoners or immigration detainees who are offered testing for hepatitis B when entering prison or an immigration removal centre.

Numerator – the number in the denominator offered testing for hepatitis B.

Denominator – the number of prisoners or immigration detainees entering a prison or an immigration removal centre.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

e) Proportion of prisoners or immigration detainees who are offered testing for hepatitis B during their detention in prison or an immigration removal centre.

Numerator – the number in the denominator offered testing for hepatitis B.

Denominator – the number of prisoners or immigration detainees detained in a prison or an immigration removal centre.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

f) Proportion of people using drug services who are offered vaccination for hepatitis B.

Numerator – the number in the denominator offered vaccination for hepatitis B.

Denominator – the number of people using drug services.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

g) Proportion of people using drug services who are offered testing for hepatitis B.

Numerator – the number in the denominator offered testing for hepatitis B.

Denominator – the number of people using drug services.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

h) Proportion of people at increased risk of infection using sexual health and genitourinary medicine clinics who are offered vaccination for hepatitis B.

Numerator – the number in the denominator offered vaccination for hepatitis B.

Denominator – the number of people at increased risk of infection using sexual health and genitourinary medicine clinics.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

i) Proportion of people at increased risk of infection using sexual health and genitourinary medicine clinics who are offered testing for hepatitis B.

Numerator – the number in the denominator offered testing for hepatitis B.

Denominator – the number of people at increased risk of infection using sexual health and genitourinary medicine clinics.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (GP practices, prisons and immigration removal centres, drugs services and secondary care providers of sexual health and genitourinary medicine clinics) ensure that testing and vaccination for hepatitis B are offered to people who are at increased risk of infection. This includes dried blood spot testing for hepatitis B in appropriate service settings for people in whom venous access is difficult.

Health and public health practitioners offer hepatitis B testing and vaccination to people at increased risk of infection and ensure pre- and post-test discussions with appropriate information about their risk of infection. Assurance about confidentiality and privacy should also be given. Healthcare professionals ensure that they have received appropriate training and have been assessed as competent for delivering vaccinations, in line with the recommendations in the UK Health Security Agency's Immunisation against infectious disease: the Green book, chapter 18: Hepatitis B.

Commissioners (local authority commissioners, NHS England area teams and clinical commissioning groups) work with service provider partners to ensure that testing (including dried blood spot testing) and vaccination for hepatitis B are offered to people who are at increased risk of infection.

People at increased risk of hepatitis B infection are offered a blood test to check if they have the infection and a vaccination to help prevent infection.

Source guidance

Hepatitis B and C testing: people at risk of infection. NICE guideline PH43 (2012, updated 2013), recommendations 4 to 7

Definitions of terms used in this quality statement

People at increased risk of hepatitis B infection

People at increased risk of hepatitis B infection compared with the general UK population include:

  • People born or brought up in a country with an intermediate or high prevalence (2% or greater) of chronic hepatitis B. This includes all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands.

  • Babies born to mothers infected with hepatitis B.

  • People who have ever injected drugs.

  • Men who have sex with men.

  • People who may have been exposed to sexually acquired infection, particularly:

    • people who have had unprotected sex with multiple sexual partners

    • people reporting unprotected sexual contact in areas of intermediate and high prevalence

    • people presenting at sexual health and genitourinary medicine clinics

    • people diagnosed with a sexually transmitted disease

    • commercial sex workers.

  • Looked-after children and young people, including those living in care homes.

  • Prisoners, including young offenders.

  • Immigration detainees.

  • Close contacts (these could include sexual, close friends, family and household) of someone known to be chronically infected with hepatitis B.

[Adapted from NICE's guideline on hepatitis B and C testing, section on whose health will benefit?]

Testing and vaccination

Testing strategies for hepatitis B should be implemented alongside hepatitis B vaccination in line with the UK Health Security Agency's Immunisation against infectious disease: the Green book, chapter 18: Hepatitis B in the following settings:

  • GP practices including new registrations.

  • Prison or an immigration removal centre.

  • Drug services.

  • Sexual health and genitourinary medicine clinics.

[NICE's guideline on hepatitis B and C testing, recommendations 4 to 7]

Equality and diversity considerations

The offer of hepatitis B testing in a range of settings should take into account the age and culture of groups at increased risk, and their needs in relation to the format of the information and the language used. Services should be responsive to social and cultural barriers to testing, vaccination and treatment (for example, stigma). Good communication between healthcare professionals, public health practitioners and the people at increased risk of hepatitis B infection is essential.