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Preventing Infectious Diseases in Pregnancy: A UK Initiative Case Study By Native Assignment Help
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The screening of pregnant women for communicable diseases is necessary for the safety and better health of the fetus. Based on that, the United Kingdom has included the program "Infectious Diseases in Pregnancy Screening" (IDPS) for the safety and security of pregnant women in the UK and England along with the safety of the children. In that case, the program makes sure that the communicable diseases do not transmit from the mother to the fetus. The report is based on the critical evaluation of the IDPS program and recommendations for the future. Along with that HIV testing and the Unlinked Anonymous program in pregnancy with the modification in the contemporary programme are assessed.
An infectious disease screening program plays a crucial role in enabling early assessment and treatment for different types of infectious diseases during pregnancy in terms of significantly minimizing mother-to-child infection transmission. This specific study has highlighted the significant role of the "NHS Infectious Disease Screening Programme" during Pregnancy in England. In addition, it assists in detecting other health issues, which have impacted both the baby and mother. The prime aim of the "NHS Infectious Disease Screening Programme" at the time of pregnancy is to offer various kinds of screening programs for detecting diseases like HIV, Syphilis, and hepatitis B among pregnant women in England. According to the statement of Brooks et al. (2020), it has been observed that the "UK National Screening Committee Policy" for the IDPS program it has offered and recommended screening of eligible women. Preventing infectious disease transmission among mother and child and giving safeguards to the health of pregnant women in England is considered as another aim of this program (Gov, 2023 a). Public Health in England exists to protect and improving the nation’s well-being and health and minimize health inequalities. Screening is addressed as a method of recognizing healthy people apparently, who might maximize the infection risks.
It is crucial to have some realistic expectations regarding the functions of this aforementioned screening program. It enables early treatment and detection of infectious diseases during pregnancy in terms of minimizing the infection transmission risk between mother and child. As opined by Mackin and Walker, (2021), screening programs are improving the quality of life with the help of identifying health conditions and reducing the possibility of serious health complications. It also gives all pregnant women an informed reproductive selection, which gives guarantees to prevent and protect against critical health complications. In a similar way, the UK National Screening Committee policy has been implemented to provide accurate care and treatment to all pregnant women in England who are living with infectious diseases. Moreover, all those facilities have been provided to those pregnant women who have the possibility of suffering from any infections (Gov, 2023, c). UK NSC has recommended systematic and population screening during pregnancy and those offers have been provided and recommended to pregnant women for detecting HIV, Hepatitis B, and Syphilis. However, the major impact of both the IDPS program and NSC policy is effective on pregnant women and it is supportive for those women in terms of minimizing the risks of infectious diseases in England.
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Figure 1: Infectious Disease during pregnancy screening data in England
The above figure has demonstrated the screening coverage, which has been implemented for pregnant women and three infections is over 99% in England. In addition, more than 95% of results have been reported to maternity facilities within eight working days from samples received from the laboratory (Gov, 2023, c). The aim of the IPDS program is to ensure similar access for informing and assured quality screening in England and provide all pregnant women with high-quality data. Thus, they are able to make informed choices regarding screening options and different types of pregnancy choices. Besides, as per the words of Sebghati and Khalil, (2021), some pregnant women select not to be detected or screened or they do not accept disease screening and it is crucial that this kind of choice is respected. Providing assurance to all pregnant women who have screened HIV positive, syphilis or Hepatitis B or those pregnant women who are known already that they are living with those aforementioned diseases is another aim. Therefore, it has been evaluated that all those pregnant women are required proper facilities or offers in terms of overcoming the negative impacts of infectious diseases especially HIV or AIDS in England.
The significant aim of the "IDPS advisory group" is to provide advice on the development and implementation of the screening program and its effectiveness on pregnant women's health status (Jorgensen et al. 2022). In addition, giving advice on different types of program standards, information, research and development, quality assurance and training, and education on the negative consequences of suffering from infectious diseases (Gov, 2023, a). On the other hand, the significant aim of the "Antenatal Screening Programme" is to provide offers timely screening facilities for detecting thalassemia and Antenatal cell sickle cell to women and enable their personal informed selection. Major issues have been which include a "lack of financial resources, inadequate training, poor communication" and "lack of resources" to provide proper treatment and care to pregnant women. As a result, those issues are affecting the procedure of treatment and care that support pregnant women to reduce the possibility of living with infectious diseases (van Bergen et al. 2021). Good communication and sensitivity to cultural issues have been considered very crucial particularly around the requirements for HIV-positive pregnant women in terms of avoiding breastfeeding.
Lack of financial resources influences the implementation of treatment and care facilities, which have been provided to pregnant women who have the possibility of getting affected by infectious diseases. According to the statement of Milligan et al. (2022), it has been stated that inadequate trained and skilled healthcare practitioners or caregivers are unable to provide proper care to pregnant women. For this reason, those caregivers are required to be more aware while advocating formula feeding. For instance, all community midwives might be a part of MDT in terms of giving support to the formula-feeding process. In a similar way, as depicted by Poon et al. (2021), poor communication is also affecting the provision of proper care and treatment for pregnant women. In addition, those caregivers are sometimes unable to communicate with pregnant women regarding their needs or expectations. As a result, they are not providing accurate treatment, which impacts on their health condition. Besides, as stated by Baggaley et al. (2023), due to having insufficient knowledge of IDSR guidelines, the caregivers are unable to assist them in overcoming infectious health issues. Therefore, all those aforementioned issues are affecting sometimes on treatment or care provision process, which has been provided to pregnant women by NHS IDSP to prevent infectious diseases in England.
It has been seen that the issues regarding "Infectious diseases in pregnancy screening" are common and mostly the communication and monitoring are highlighted issues that can be redeemed. In that case, the relevant and appropriate recommendations can be as follows-
Communication with the patients: communication with the patients is necessary as communication can help the patients to open up about their situations and the outcome will be better. On that note, transparent and clear communication between healthcare professionals and patients is highly needed.
Including adequate financial resources: financial resources are needed for better screening and infrastructure and for that reason, the government and non-government associations with the NGOs should be incorporated in the procedure that can include better financial resources.
Strong laboratory capacity: the capacity to screen the blood and other samples should be high as the increased numbers of screening techniques can be incorporated in order to increase the range of screening (McAuliffe et al. 2020). This can ensure the safety of the population in a country.
Better supervision prospects: the supervision of the patients whether they are pregnant or not might be important and with the inclusion of better supervision the health treatments and screening procedure can be fulfilled (Poon et al. 2021). In that case, technological input can be given and inserted so that the supervision of the pregnant patients can be done.
Better feedback from the staff: feedback from the workers is necessary as that can help in assessing and analyzing the situation of the affected person. In that case, the feedback should be methodical, informative, and logical from the end of the staff.
Enhanced training period for the staff: training of the staff must be top-not so that the staff can understand the importance of communicable diseases in the hospital (Hand et al. 2020). With the proper training, the employees or the staff can be able to handle the patients in a scientific and ethical way.
Acquiring better reporting tools: the reporting tools must be better so that the details of the change in the patients and the screening reports can be relevant and decent.
HIV – "Human Immunodeficiency Virus" is an infection that is globally transmitted and has no cure. No such vaccine is made for the treatment. The concern in this study is the women who are pregnant and inherited HIV. The attack virus in pregnant women is at high risk both for maternal mobility and perinatal mortality. This occurs when the virus is not treated properly or poorly controlled by the patient. This leads to further transmission to the mother's fetus during labor in pregnancy and breastfeeding which means during postpartum (Chilaka and Konje, 2021). The HIV testing program is initiated in any part of the country to protect or aware people of the disease and preventive measures.
Figure 2: Outcome for people accessing HIV services
One such program that was initiated by the government is the "National AIDS Control Organization (NACO)". That holds tests, information, and education for the people. Another such program is the "HIV Prevention England (HPE)" (Gov, 2023, b). It sets the goals to increase HIV Testing that reduces the "undiagnosed and late diagnoses", promote to use of condoms for safety, and raise awareness among people about sexual transmission.
Figure 3: Prevention measures of HIV in pregnant women
An independent group of experts called the "U.K. National Screening Committee (U.K. NSC)" is taking place in the 4 countries of the U.K. under which the "Screening for Infectious Diseases" for HIV is taken (Gov, 2023, a). It is a "National Health Service" which is a funded health care system in the U.K. they provide treatment of various types not only focused on HIV. The comparison is based on the treatment both of them provide in the United Kingdom which describes a vast difference in the HIV program (Ajayi et al. 2021). The program for HIV depends on treating men and women, especially pregnant women. The testing, screening, and treatments are all related to HIV aids. Whereas the NHS program is responsible for providing different types of communicable diseases such as "there are 6 NHS antenatal and newborn (ANNB) screening program that follows: NHS fetal anomaly screening program (FASP), NHS infectious diseases in pregnancy screening (IDPS) program, NHS newborn and infant physical examination (NIPE) screening program, NHS newborn blood spot (NBS) screening program, NHS newborn hearing screening program (NHSP), NHS sickle cell and thalassemia (SCT) screening program" (Gov, 2023, a). They held counseling and treatments for all the programs that are associated with it and they are all funded by the government. They had all the data related to each patient affected by the diseases listed above.
Figure 4: Factors that affect HIV
The similarities between them are that they both treat communicable diseases. That is HIV aid is treated in both the programs associated. Very importantly the two programs are the initiative of the United Kingdom, and applicable in all the counties of the U.K. the two programs aim towards the treatment of HIV-affected people, especially pregnant women who are highly at risk and need proper treatment in the maternal stage (Gompels et al. 2019). The women are also at risk after the maternal stage of pregnancy as the prenatal stage starts. The breastfeeding stage is where both the mother and her child are at risk. To avoid the spread of disease from mother to child few programs are held by these organizations in different parts of the U.K. they both aim to the "zero" of the virus (Omatola et al. 2019). They had undertaken the development of new standards that involves modern approaches to providing care, they give priority to giving HIV patients the proper care. The strategy they use is "the national strategy for sexual health and HIV". They provide a care pathway for the patients and proper guidelines under the government of the United Kingdom. They aimed at educating people by continuing the development of training and profession (Hunter, 2020). The training is very important for the one who is practicing the treatment of HIV aids and other communicable diseases. The higher the literacy rate higher will be the prevention of such vulnerable diseases.
Some of the issues that are now terminated in the U.K. that was held in 1981-2006. The prevention measures that had taken place earlier were "Capacity building to improve HIV-prevention programs, Program evaluation to monitor the delivery and outcomes of prevention services, research leading to new strategies for preventing transmission of HIV/AIDS. The early activities of the CDC include programs such as "The National AIDS Information Line (1983) and National AIDS Clearinghouse (1987), the institution of nationwide America Responds to AIDS public information campaign (1987), and the distribution of Understanding AIDS (1988)" (Gov, 2023, a). They tried to provide treatment when diseases were emerging. They had come up with several counselling, and testing which had come up with evidence of screening donated blood. The CDC expanded the use of HIV- antibody testing. As stated, "These recommendations encouraged confidential and anonymous HIV-antibody testing of persons at high risk in combination with risk-reduction counselling and, for HIV-seropositive persons, referral of sex and needle-sharing partners for medical evaluation and testing. Since then, the number of CDC-supported test sites has increased to approximately 11,000, providing approximately 2.2 million HIV-antibody tests in 2004" (Gov, 2023, b). But the initiatives were not that much effective and had failed in changing the behaviour through motivating by providing proper services. The problems faced by the programs were the changing scenario of the infection of HIV aids, fatigue prevention was uncontrolled and the increase in "methamphetamine abuse and STDs" were in full phase to create new challenges to HIV prevention. The challenges were found compounded by problems related to society and inequalities in achieving treatment. But these challenges are overcome due to the new initiatives taken by the government itself for the well-being of the people of the U.K.
Figure 5: CDC Progression and Transmission of HIV
The Unlinked Anonymous (UA) surveys were done on the different types of people in the previous times that were pregnant or drug addicts or sexual health clinic attendees along with the "National Survey of Sexual Attitudes and Lifestyle" (NATSAL). The sexual behaviour systems were included in the "Multi-Parameter Evidence Synthesis (MPES)" that was used to provide the national plurality estimates (Sheng et al. 2020). Several issues have been seen in the UA tests and it was not voluntary testing for clinical purposes. The leftover blood was tested from the samples of the patients and anonymously tested for the screening of HIV. This signifies that people whose blood tests are approved for HIV cannot be reached or reported. In contemporary times HIV testing has become improved and it is home-based testing, hybrid approaches and mobile outreach (Nsibande et al. 2022). The tests are not done anonymously in the present times and the population data is stored for resource allocation, targeting interventions and advocacy performances. In that case, the programme has been modified to show high incorporation in "Prevention of Mother to Child Transmission (PMTCT)".
The Unlinked Anonymous testing was done previously and the vital pieces of information regarding the prevalence of HIV or AIDS were collected from the und samples. Without the informed consent the procedure was used to include in the laboratory (Filippidis et al. 2022). The privacy of the patients was not violated and the effect however not as effective as the testing in contemporary times is. With the blinded survey, the people with asymptomatic HIV were not caught and infirmed so the whole outcome of the survey was not meaningful. The effect or the result was not so effective for the people that were silently suffering from HIV.
In the case of pregnancy, the foetus is directly linked with the mother through the placenta. Based on that scenario, whatever disease the mother acquires can be transmitted to the foetus through the blood. In that case, the chance of the baby getting affected by communicable diseases was high (Bradshaw et al. 2023). HIV had a fair chance to be transmitted to the baby through the mother with the Unlinked Anonymous testing for HIV. This means the rate of the affected mother and baby was getting high in the previous time. For this reason, the Unlinked anonymous programme was discarded and modifications have been done to HIV or AIDS testing among pregnant mothers.
Conclusion
From the above discussion, it can be concluded that HIV testing on pregnant mothers is necessary for safeguarding the baby in the womb and for living a normal life. In the UK it has been seen that the "NHS Infectious Disease Screening Programme'' has been implemented in the healthcare sectors that help in screening the prevalence of infectious diseases in pregnant mothers. The occurrence of Syphilis, Gonorrhoea, Hepatitis B and HIV can be screened in pregnant mothers and almost 99% of pregnant mothers in England and other areas have been assessed for the identification of HIV in blood. In this way, the Unlinked Anonymous screening was discarded for better and modified endeavours.
References
Journals
Ajayi, A.I., Awopegba, O.E., Owolabi, E.O. and Ajala, A., 2021. Coverage of HIV testing among pregnant women in Nigeria: progress, challenges and opportunities. Journal of Public Health, 43(1), pp.e77-e84.
Baggaley, R.F., Nazareth, J., Divall, P., Pan, D., Martin, C.A., Volik, M., Seguy, N.S., Yedilbayev, A., Reinap, M., Vovc, E. and Mozalevskis, A., 2023. National policies for delivering tuberculosis, HIV and hepatitis B and C virus infection services for refugees and migrants among Member States of the WHO European Region. Journal of Travel Medicine, 30(1), p.taac136.
Bradshaw, D., Khawar, A., Patel, P., Tosswill, J., Brown, C., Ogaz, D., Mason, E., Osman, R., Mitchell, H., Dosekun, O. and Peris, B.M., 2023. HTLV seroprevalence in people using HIV pre-exposure prophylaxis in England. Journal of Infection, 86(3), pp.245-247.
Brooks, S.K., Weston, D. and Greenberg, N., 2020. Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review. Public health, 189, pp.26-36.
Chilaka, V.N. and Konje, J.C., 2021. HIV in pregnancy–An update. European Journal of Obstetrics & Gynecology and Reproductive Biology, 256, pp.484-491.
Filippidis, P., Francini, K., Jacot-Guillarmod, M., Mathevet, P., Lhopitallier, L., Cavassini, M. and Darling, K.E., 2022. HIV testing in termination of pregnancy and colposcopy services: a scoping review. Sexually Transmitted Infections, 98(2), pp.143-149.
Gompels, M., Michael, S., Davies, C., Jones, T., Macleod, J. and May, M., 2019. Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015. BMJ open, 9(11), p.e027744.
Hand, T., Rosseau, N.A., Stiles, C.E., Sheih, T., Ghandakly, E., Oluwasanu, M. and Olopade, O.I., 2021. The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all. Global Health Action, 14(1), p.1883336.
Hunter, D.J., 2020. Trying to "Protect the NHS" in the United Kingdom. New England Journal of Medicine, 383(25), p.e136.
Jorgensen, S.C., Miljanic, S., Tabbara, N., Somanader, D., Christopher, L.Y., De Castro, C., Malhamé, I., LapinskY, S.E. and Burry, L., 2022. Characterizing the inclusion of pregnant and breastfeeding people in infectious diseases randomized controlled trials: a targeted literature review. Clinical Microbiology and Infection, 28(6), pp.801-811.
Mackin, D.W. and Walker, S.P., 2021. The historical aspects of vaccination in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 76, pp.13-22.
McAuliffe, F.M., Killeen, S.L., Jacob, C.M., Hanson, M.A., Hadar, E., McIntyre, H.D., Kapur, A., Kihara, A.B., Ma, R.C., Divakar, H. and Hod, M., 2020. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non?Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline. International Journal of Gynaecology and Obstetrics, 151(Suppl 1), p.16.
Milligan, A.L., Koay, S.Y. and Dunning, J., 2022. Monkeypox as an emerging infectious disease: the ophthalmic implications. British Journal of Ophthalmology, 106(12), pp.1629-1634.
Nsibande, D.F., Woldesenbet, S.A., Puren, A., Barron, P., Maduna, V.I., Lombard, C., Cheyip, M., Mogashoa, M., Pillay, Y., Magasana, V. and Ramraj, T., 2022. Investigating the quality of HIV rapid testing practices in public antenatal health care facilities, South Africa. Plos one, 17(8), p.e0268687.
Omatola, C.A., Lawal, C., Omosayin, D.O., Okolo, M.L.O., Adaji, D.M., Mofolorunsho, C.K. and Bello, K.E., 2019. Seroprevalence of HBV, HCV, and HIV and associated risk factors among apparently healthy pregnant women in Anyigba, Nigeria. Viral immunology, 32(4), pp.186-191.
Poon, L.C., Magee, L.A., Verlohren, S., Shennan, A., von Dadelszen, P., Sheiner, E., Hadar, E., Visser, G., Da Silva Costa, F., Kapur, A. and McAuliffe, F., 2021. A literature review and best practice advice for second and third-trimester risk stratification, monitoring, and management of pre?eclampsia: Compiled by the Pregnancy and Non?Communicable Diseases Committee of FIGO (the International Federation of Gynecology and Obstetrics). International Journal of Gynecology & Obstetrics, 154, pp.3-31.
Sebghati, M. and Khalil, A., 2021. Uptake of vaccination in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 76, pp.53-65.
Sheng, B., Eaton, J.W., Mahy, M. and Bao, L., 2020. Comparison of HIV prevalence among antenatal clinic attendees estimated from routine testing and unlinked anonymous testing. Statistics in biosciences, 12, pp.279-294.
van Bergen, J.E., Hoenderboom, B.M., David, S., Deug, F., Heijne, J.C., van Aar, F., Hoebe, C.J., Bos, H., Dukers-Muijrers, N.H., Götz, H.M. and Low, N., 2021. Where to go to in chlamydia control? From infection control towards infectious disease control. Sexually transmitted infections, 97(7), pp.501-506.
Websites
Gov, 2023 c. UK National Screening Committee policy. Available at: https://www.gov.uk/government/organisations/uk-national-screening-committee [Accessed on 24th March 2023]
Gov, 2023, a. Infectious diseases in pregnancy screening (IDPS): program overview. Available at: https://www.gov.uk/guidance/infectious-diseases-in-pregnancy-screening-programme-overview#:~:text=IDPS%20is%20one%20of%2011,reasonable%20cost%20to%20the%20NHS. [accessed on 24th March 2023]
Gov, 2023, b. HIV: overall prevalence. Available at: https://www.gov.uk/guidance/hiv-overall-prevalence [accessed on 24th March 2023]
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Patel, P., Rose, C.E., Kjetland, E.F., Downs, J.A., Mbabazi, P.S., Sabin, K., Chege, W., Watts, D.H. and Secor, W.E., 2021. Association of schistosomiasis and HIV infections: A systematic review and meta-analysis. International Journal of Infectious Diseases, 102, pp.544-553.
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