Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions—A prospective descriptive study

Abstract

Background: Chronic viral hepatitis (CVH) is a leading contributor to the UK liver disease epidemic, with global migration from high prevalence areas (e.g., South Asia). Despite international guidance for testing high-risk groups in line with elimination targets, there is no consensus on how to achieve this. The objectives of this study were to assess the following: (1) the feasibility of recruiting South Asian migrants to view an educational film on CVH, (2) the effectiveness of the film in promoting testing and increasing knowledge of CVH, and (3) the methodological issues relevant to scale-up to a randomized controlled trial. Methods: South Asian migrants were recruited to view the film (intervention) in community venues (primary care, religious, community), with dried blood spot CVH testing offered immediately afterwards. Pre/post-film questionnaires assessed the effectiveness of the intervention. Results: Two hundred and nineteen first-generation migrants 18 years of age (53% female) were recruited to view the film at the following sites: religious, n = 112 (51%), community n = 98 (45%), and primary care, n = 9 (4%). One hundred and eighty-four (84%) underwent CVH testing; hepatitis B core antibody or hepatitis C antibody positivity demonstrated exposure in 8.5%. Pre-intervention (n = 173, 79%) and post-intervention (n = 154, 70%) questionnaires were completed. Conclusions: This study demonstrated the feasibility of recruiting first-generation migrants to view a community-based educational film promoting CVH testing in this higher risk group, confirming the value of developing interventions to facilitate the global World Health Organization plan for targeted case finding and elimination, and a future randomized controlled trial. We highlight the importance of culturally relevant interventions including faith and culturally sensitive settings, which appear to minimize logistical issues and effectively engage minority groups, allowing ease of access to individuals 'at risk'.

A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region

“…Furthermore, a proactive approach of professionals is desirable because this facilitates timely linkage to care and vaccination ( 54 ). In contrast, a low alerting role and low motivation of health professionals can hinder the identification and uptake of screening ( 47 ).…”

“…To increase the reach of screening, religious key figures can be deployed to further disseminate screening aims and importance ( 29 ). For example, imams (mosque leaders) can spread knowledge about the purpose of screening during mosque attendance ( 47 ). Community stakeholders, such as councilors, can also be involved to raise knowledge and (political) awareness ( 47 ).…”

A multimedia multilanguage web‐based platform can assess and increase the awareness on HCV infection of Pakistani people living in Italy

“…This might be of particular interest for healthcare promoters, in light of the current social restrictions owing to the SARS-CoV-2 pandemic. However, the 20% rate of participants answering the questionnaire after viewing the educational video is dissatisfactory, even though suboptimal results were obtained also by other studies 10 . The web-based design of our project might partly explain such result, as participants were not subject to any control nor committed to compile the questionnaire twice.…”

“…However, only a subset of subjects repeated the questionnaire on HCV infection after watching the educational video; thus, our results on the effectiveness of the multimedia platform in improving the knowledge of HCV infection are exploratory and not conclusive. Nevertheless, looking at other studies with a similar educational approach to ours, multilingual informative videos can be considered valid strategies to improve HCV awareness among high‐risk ethnic groups 10 . We invited Pakistani people through a mailing list derived from a social network group, probably introducing a selection bias as the mean age of the participants was 29 years.…”

“…Achieving a linkage to care for HCV through awareness-raising campaigns might be a sound option. Most of the existing studies focused on educational interventions among high-risk groups such as people who inject drugs (PWID) 8,9 , while only a few studies targeted ethnic communities with culturally and linguistically appropriate interventions 10,11 . Given that around 130,000 Pakistani citizens (71,6% males) are esteemed to be legally residing in Italy, with the majority of them being settled in the northern regions of Lombardy (32,5%), Emilia-Romagna (17,4%) and Tuscany (7%) 12 , and the high prevalence of HCV infection in Pakistan (8.6%) 6 , compared to 2.3% in the general population in Italy 13 , Italian-Pakistanis can potentially represent both a high-risk and high-prevalence group for hepatitis C in Italy.…”