Low hepatitis B testing among migrants: a cross-sectional study in a UK city

Evlampidou, Iro; Hickman, Matthew; Irish, Charles; Oliver, Isabel; Gillett, Sophie; Cochrane, Alexandra

doi:10.3399/bjgp16x684817

Cited by 31 publications

(43 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The asymptomatic nature of the disease until its late stages and the lack of awareness of risk among migrants and often also among health care providers limit early detection. Other barriers to screening include language, health care access and entitlement issues, high work-load among health care staff, and the potential stigma or fear associated with being diagnosed positive [ 26 , 27 ]. The EU-funded HEPscreen project describes four different screening approaches: (i) outreach screening (e.g.…”

Section: Discussionmentioning

confidence: 99%

Estimating the scale of chronic hepatitis B virus infection among migrants in EU/EEA countries

et al. 2018

View full text Add to dashboard Cite

BackgroundChronic hepatitis B (CHB) related morbidity and mortality can be reduced through risk group screening, linkage to care and anti-viral treatment. This study estimates the number of CHB cases among foreign-born (migrants) in the European Union and European Economic Area (EU/EEA) countries in order to identify the most affected migrant populations.MethodsThe CHB burden was estimated by combining: demographic data on migrant population size by country of birth in the EU/EEA, extracted from European statistical databases; and CHB prevalence in migrants’ countries of birth and in EU/EEA countries, derived from a systematic literature search. The relative contribution of migrants from endemic countries to the total CHB burden in each country was also estimated. The reliability of using country of birth prevalence as a proxy for prevalence among migrants was assessed by comparing it to the prevalence found in studies among migrants in Europe.ResultsAn estimated 1–1.9 million CHB-infected migrants from endemic countries (prevalence ≥2%) reside in the EU/EEA. Migrants from endemic countries comprise 10.3% of the total EU/EEA population but account for 25% (15%–35%) of all CHB cases. Migrants born in China and Romania contribute the largest number of infections, with over 100,000 estimated CHB cases each, followed by migrants from Turkey, Albania and Russia, in descending order, with over 50,000 estimated CHB cases each. The CHB prevalence reported in studies among migrants in EU/EEA countries was lower than the country of birth prevalence in 9 of 14 studies.ConclusionsMigrants from endemic countries are disproportionately affected by CHB; their contribution however varies between EU/EEA countries. Migrant focused screening strategies would be most effective in countries with a high relative contribution of migrants and a low general population prevalence. In countries with a higher general population prevalence and a lower relative contribution of migrants, screening specific birth cohorts may be a more effective use of scarce resources. Quantifying the number of CHB infections among 50 different migrant groups residing in each of the 31 EU/EEA host countries helps to identify the most affected migrant communities who would benefit from targeted screening and linkage to care.

show abstract

Section: Discussionmentioning

confidence: 99%

Estimating the scale of chronic hepatitis B virus infection among migrants in EU/EEA countries

et al. 2018

View full text Add to dashboard Cite

show abstract

“…This is despite the availability of national guidelines for the screening of high-risk groups – including migrants – in the primary care context and secondary-care settings, particularly for HIV testing, which is being advocated for across healthcare settings including emergency departments [ 22 , 59 ]. This is supported by the work of others: in one study exploring hepatitis B screening in a primary care setting, only 9627 (12%) of 82561 migrants eligible for screening in accordance with national guidelines migrants were offered screening by clinicians, with lack of knowledge and lack of resourced cited by clinicians as key barriers [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data suggest high acceptability of screening for LTBI and other infections among migrants [ 21 ]. However, formal on-arrival screening programmes miss many migrant groups, with evidence of significant barriers to migrant engagement with primary care where screening is routinely delivered [ 12 , 25 ], and lack of consistency in provision of screening [ [26] , [27] , [28] , [29] , [30] ]. There remain significant evidence-gaps around effective and cost-effective approaches to implementing TB and other infectious diseases screening and ensuring successful treatment outcomes [ 6 , 21 , 24 , [31] , [32] , [33] ].…”

Section: Introductionmentioning

confidence: 99%

Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study

Hargreaves

Nellums

Johnson

et al. 2020

Travel Medicine and Infectious Disease

View full text Add to dashboard Cite

Background Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. Methods We did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. Results 96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18–73]; mean time in the UK 4.8 years [SD 3.2; range 0–10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. Conclusion Multi-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.

show abstract

“…Nonetheless the evidence is compelling and strong enough to recommend implementation and moving to phase IV evaluation. 'Treatment as usual' is failing to screen migrant populations -in the HepFree control less than 2% of patients were screened -and other studies also have shown low levels of screening except for pregnant women (because there is a commissioned universal antenatal HBV screening programme in the UK) 8 . Local commissioners and primary care services need help on how to take forward NICE guidance.…”

mentioning

confidence: 99%