Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds

Taye, Belaynew Wasie; Valery, Patricia C.; Liddle, Burglind; Woodward, Aidan J.; Sackey, Donata; Williams, Suzanne; Chang, Gary K. F.; Clark, Paul J.

doi:10.1007/s10903-021-01305-5

Cited by 4 publications

(4 citation statements)

References 38 publications

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“…Several experiences have demonstrated that there are inequalities in access to healthcare services between migrants and the general population, as well as an increased risk of poor health status among migrants [ 18 ]. In addition, individuals may be excluded from the general health-care system due to a language barrier and conditions related to their poor living conditions as a result of their difficulty in finding a work or a regular contract, which impedes their inclusion in the social and health systems [ 11 , 19 ]. In our survey, only 89 migrants (29%) reported having a family doctor and thus primary access to care.…”

Section: Discussionmentioning

confidence: 99%

HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study

Totaro

Patti

Segala

et al. 2023

Viruses

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Migrant populations are more susceptible to viral hepatitis and HIV due to the epidemiology from their country of origin or their social vulnerability when they arrive in Europe. The aims of the study are to explore the incidence of HIV and HCV in low-wage agricultural migrant workers and their knowledge, attitude, and practice with regard to HIV and HCV, as well as their sexual behaviour and risk factors. As part of the mobile clinic services, we performed a screening campaign for HIV-HCV involving migrants living in three Apulian establishments. Results: Between January 2020 and April 2021, 309 migrants (n. 272, 88% male, mean age 28.5 years) were enrolled in the study. Most of the migrants interviewed (n = 297, 96%) reported a stopover in Libya during their trip to Italy. Only 0.9% (n. 3) of migrants reported having been tested for HCV, while 30.7% (n. 95) reported being tested for HIV. Furthermore, screening tests found four migrants (1.3%) to be HIV positive and nine (2.9%) to be HCV positive. The median knowledge score was 1 (IQR 0-3; maximum score: 6 points) for HCV and 3 (IQR 1-4; maximum score: 7 points) for HIV and low use of condoms was 5% (n. 16), while more than 95% show an attitude score of 5 (IQR 5-6; maximum score:6 points) on HIV-HCV education campaigns. In a multivariate analysis, being male (OR = 1.72; 95% CI 1.28–1.92), being single (OR = 1.63; 95% CI 1.20–2.03), being of low educational status (OR = 2.09; 95% CI 1.29–2.21), living in shantytowns for >12 months (OR = 1.95; 95% CI 1.25–2.55), and originating from the African continent (OR = 1.43; 95% CI 1.28–2.01) are significant predictors of poor knowledge on HCV. Our data show low knowledge, especially of HCV, confirming migrants as a population with a higher risk of infection. To develop education programmes, integrated care and screening among migrants could be an effective strategy, considering the high attitude toward these items shown in our study.

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Section: Discussionmentioning

confidence: 99%

HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study

Totaro

Patti

Segala

et al. 2023

Viruses

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“…Markers of material and social privilege, such as completing higher education, and phylogenetic clustering between people living with HCV/HIV co‐infection suggest the need to tailor HCV prevention messaging in Australia to very specific population demographic groups. Further, people with lower levels of education may have lower levels of health literacy, 52 resulting in fewer of them presenting to services to get tested or treated, 53 and being underrepresented in studies such as this. This may result in phylogenetic clustering being skewed towards people with higher levels of education due to them presenting to services more frequently.…”

Section: Discussionmentioning

confidence: 99%

“…specific population demographic groups. Further, people with lower levels of education may have lower levels of health literacy,52 resulting in fewer of them presenting to services to get tested or treated,53 and being underrepresented in studies such as this. This may result in phylogenetic clustering being skewed towards people with higher levels of education due to them presenting to services more frequently.…”

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confidence: 99%

Patterns and correlates of hepatitis C virus phylogenetic clustering among people living with HIV in Australia in the direct‐acting antiviral era: A molecular epidemiology study among participants in the CEASE cohort

Martinello

Verich

Carson

et al. 2022

Health Science Reports

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Background and Aims In moving towards the elimination of hepatitis C virus (HCV) infection among people living with HIV, understanding HCV transmission patterns may provide insights to guide and evaluate interventions. In this study, we evaluated patterns of, and factors associated with HCV phylogenetic clustering among people living with HIV/HCV co‐infection in Australia in the direct‐acting antiviral era. Methods HCV RNA was extracted from dried blood spot (DBS) samples collected between 2014 and 2018 in the CEASE cohort study. The HCV Core‐E2 region was amplified by a polymerase chain reaction and Sanger sequenced. Maximum likelihood phylogenetic trees (1000 bootstrap replicates) were used to identify patterns of clustering (3% genetic distance threshold). Mixed‐effects logistic regression was used to determine correlates of phylogenetic clustering. Factors assessed were sexual risk behavior, education, injecting drug use, housing, employment, HIV viral load, age, sex, and sexuality. Results Phylogenetic trees were reconstructed for HCV subtype 1a ( n = 139) and 3a ( n = 63) sequences, with 29% (58/202) in a pair or cluster. Overall ( n = 202), phylogenetic clustering was positively associated with younger age (under 40; adjusted odds ratio [aOR] 2.52, 95% confidence interval [CI] 1.20–5.29), and among gay and bisexual men ( n = 168), was positively associated with younger age (aOR 2.61, 95% CI 1.10–6.19), higher education (aOR 2.58, 95% CI 1.09–6.13), and reporting high‐risk sexual behavior (aOR 3.94, 95% CI 1.31–11.84). During follow‐up, five reinfections were observed, but none were in phylogenetic clusters. Conclusion This study found a high proportion of phylogenetic relatedness, predominantly among younger people and gay and bisexual men reporting high‐risk sexual behavior. Despite this, few reinfections were observed, and reinfections demonstrated little relationship with known clusters. These findings highlight the importance of rapid HCV treatment initiation, together with monitoring of the phylogeny.

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“…CALD populations might have a high prevalence of HBV including immigrants arriving in Australia, and screening provides an opportunity as an entry point for increasing treatment uptake. Screening and treatment of HBV could be increased by testing migrants at the time of entry, improving the health literacy of CALD populations such as using culturally appropriate techniques such as involvement of community‐based organizations and language‐specific messages, 45,46 and engagement of general practitioners 45 . Community engagement and education are key to expanding HBV screening and treatment programmes, to ensure accessibility for people with CALD backgrounds, as well as making them sustainable and cost‐effective, and improving continuity to chronic disease care 47 .…”

Section: Discussionmentioning

confidence: 99%

Targeted antiviral treatment of hepatitis B virus in culturally and linguistically diverse populations to achieve elimination targets in Australia

Taye

Valery

Clark

2022

Journal of Viral Hepatitis

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The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale‐up and changes in migration on HBV‐related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale‐up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV‐related mortality will increase. Following the optimistic scale‐up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia‐Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale‐up could result in a 19.2%–24.5% reduction in HBV‐related mortality and a 15%–25% reduction in HCC‐related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV‐related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high‐prevalence CALD populations may be an effective strategy to reduce HBV‐related morbidity and mortality.

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Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds

Cited by 4 publications

References 38 publications

HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study

HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study

Patterns and correlates of hepatitis C virus phylogenetic clustering among people living with HIV in Australia in the direct‐acting antiviral era: A molecular epidemiology study among participants in the CEASE cohort

Targeted antiviral treatment of hepatitis B virus in culturally and linguistically diverse populations to achieve elimination targets in Australia

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