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Copy of FINAL DRAFT data collection matrixv8b

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Copy of FINAL DRAFT data collection matrixv8b Powered By Docstoc
					EVALUATING THE BLOOD BORNE VIRAL HEPATITIS ACTION PLAN
Data collection required from substance misuse agencies offering diagnostic HCV, HBV, and HIV testing (please refer to guidance notes)

FOR PERIOD (please tick as appropriate) 1st April to 30th Sept                          or 1st Oct to 31st March

Name of substance misuse service providing data:                                                  Name of HCV treatment centre receiving data:

Code                HCV data                                                                                                                                                           Totals
A       Target population: number of individuals with no evidence of current HCV infection or unknown status in contact with agency over the data collection period
B       Number of individuals in target population tested for HCV within the six month period identified above
C       Number of individuals HCV antibody positive in six month period
D       Number of individuals PCR tested within six month period        (locally: information on why individuals do not have PCR test)*
E1      Number of individuals PCR positive within six month period
E2      Number of individuals informed of PCR positive result within six month period
F       Number of individuals referred to treatment/specialist hepatology services within six month period
                    HBV data
G       Target population: number with no evidence of HBV infection/unknown status and two or less doses of vaccine in contact with agency over six month period**
H       Number of individuals in target population tested for HBV within the six month period identified above
I       Number of individuals HBV core antibody positive within six month period
J       Number of individuals HBsAg tested within one month of antibody positive result within six month period       (locally: info on why individuals do not have followup test?)*
K       Number of individuals HBsAg positive within six month period
L       Number of individuals referred to treatment/specialist hepatology services within six month period
M       Number of individuals HBsAg positive reported/notified to Health Protection Team PHWT in six month period
N       Number of open case load of service with no markers of immunity who were successfully immunised (three or more vaccine doses) within six month period
                    HIV data
O       Target population: number with no evidence of HIV infection or unknown status in contact with agency offering testing over the data collection period
P       Number of individuals in target population tested for HIV within the six month period identified above
Q       Number of individuals confirmed HIV positive within six month period
R       Number of individuals referred to treatment/specialist services within six month period
Guidance notes: This data should be collected on a six monthly basis. The first data collection period should cover the period from the date on which the
dried blood spot test is available within the agency until 31st September 2010, after which data should be collected every six months.
Please ensure the definition of the target population for each of the three blood borne viruses (HCV. HBV and HIV) is closely followed, this
is outlined in data point A, G, O respectively. Include in A, G and O the total number of problematic drug using patients/clients who have been open to the
service/agency at any time within the data collection period (this will thus include clients now closed to the agency but should not include alcohol only clients).
If you have any questions about how to collect this data please contact the BBV group in Public Health Wales Trust on 029 2040 2478 / 01248 384507
When completed please send to clinical lead in regional treatment center (see overleaf for contact details).
* Please keep a local record of reasons why individuals are not tested for HCV by PCR or do not have HBV follow up tests.
** This should include non-responders to HBV vaccination.

         Glossary

         HCV                   hepatitis C virus
         HBV                   hepatitis B virus
         PCR                   polymerase chain reaction, used to test for the presence of HCV RNA (HCV virus)
         HBsAg                 Hepatitis B surface antigen
         PHWT                  Public Health Wales Trust
         SVR                   Sustained virological response
         Contact details for return of data sheet

         Clinical Lead           Treatment Centre        Address
EVALUATING THE BLOOD BORNE VIRAL HEPATITIS ACTION PLAN
Data collection required from treatment centers treating HCV or HBV

FOR PERIOD (please tick as appropriate) 1st April to 30th Sept                             or 1st Oct to 31st March

Name of treatment centre:

Code                  HCV data                                                                                                                                   Totals
S        Number of referrals received within six month data collection period by treatment centre - stratified by referral source   Substance Misuse Services:
                                                                                                                                    Primary care:
                                                                                                                                    Secondary Care
                                                                                                                                    Prisons
                                                                                                                                    Other name: …………………….

T        Number of new referrals seen in clinic within six month data collection period
U        Number of new people offered treatment for HCV infection within six month data collection period
V        Number of new people commencing treatment within six month data collection period
W        Total number of people currently on treatment within six month data collection period
X        Number of people completed treatment within six month data collection period
Y        Number of people achieving SVR within six month data collection period
                      HBV data
Z        Number of new referrals received in six month data collection period by treatment centre - stratified by referral source   Substance Misuse Services:
                                                                                                                                    Primary care:
                                                                                                                                    Secondary Care
                                                                                                                                    Prisons
                                                                                                                                    GUM
                                                                                                                                    Other name: ……………………………..
                                                                                                                                    (e.g. occupational health)

Z1       Number of new referrals seen in clinic within six month period
Z2       Number of new referrals commencing treatment within six month period
Z3       Total number treated in line with guidelines within six month data collection period

Guidance notes: This data should be collected on a six monthly basis. The first data collection period should cover from 1st April 2010 to 30th September 2010
Please add appropriate stratification by referral source relevant to your service or department e.g. substance misuse service (Name), Primary care etc.
If you have any questions about how to collect this data please contact the BBV group in Public Health Wales Trust on 029 2040 2478 / 01248 384507
When completed, please return to: Health Protection Administration, Public Health Wales Trust, Temple of Peace and Health, Cathays Park, Cardiff, CF10 3NW
                                             email:marion.lyons@wales.nhs.uk

				
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