Exploring an Infectious Disease Service Pathway for Unaccompanied Asylum-Seeking Children: An Audit and Retrospective Analysis.

Abstract

Unaccompanied asylum-seeking children (UASC) experience a high burden of infectious diseases (IDs) and are a highly vulnerable population group with significant mental, physical, social and developmental needs. However, currently in the United Kingdom, there is no framework regarding how to implement ID screening guidance for UASC, leading to a wide variation in outcomes. This project is aimed at exploring the ID pathway for UASC within a single South-East UK local authority, spanning two trusts-including one with a 'one-stop' clinic-to inform service improvement recommendations. The study was conducted by retrospective case note review of routinely collected, anonymised patient data from all UASC under the care of the local authority over a 1-year timeframe. The study design consisted of (a) an audit of UASC ID referrals for all children in the local authority against RCPCH guidance, (b) analysis of attendance rates and (c) analysis of reasons for noncompletion. Thirty-seven patients were analysed (local trust n = 30, neighbouring trusts n = 7). The pathway's success varied across different aspects. Tuberculosis (TB) and blood-borne virus (BBV) testing showed notably higher referral and attendance rates compared to other single-centre studies. However, gaps in the process were evident in areas such as testing for schistosomiasis and strongyloidiasis. Additionally, the appointment completion rate varied across ID services, highlighting some themes in low attendance, in particular a low attendance rate for those 'out of area'. Our key recommendation is the undertaking of further research to inform the development of a more robust pathway for UASC in the region, with consideration of a county-wide pathway.