Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infections among undocumented migrants and uninsured legal residents in the Netherlands: A cross-sectional study, 2018-2019

Hepatitis B and C Screening and Linkage to Care in Migrants From Endemic Countries in Barcelona Through a Community Action

BACKGROUND AND AIMS

Migrants from endemic areas are key populations for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection screening in Europe. This study assessed the feasibility and outcomes of a community action that combined education, screening, and simplified access to care for migrants in Barcelona.

METHODS

Adult migrants from Pakistan, Romania, and Senegal were included from 2021 to 2023, through a community action involving education, an epidemiological questionnaire, and rapid testing for HBV surface antigen (HBsAg) and HCV antibodies. If positive, DBS samples were collected for laboratory confirmation. Viremic cases were referred to an International Health Unit (IHU).

RESULTS

Overall, 786 participants were included (346 from Pakistan, 304 from Senegal and 136 from Romania). Previous screening for HBV and HCV was 8.0% and 7.7%, respectively. HBsAg prevalence was 0.9% for migrants from Pakistan, 8.2% for those from Senegal and 1.4% for those from Romania (n = 30/786, 23 new diagnoses). Among these, 69.6% attended the IHU and were HBV-DNA positive, but none met treatment criteria. Anti-HCV prevalence was 3.5%, 0.7% and 1.4% for migrants from Pakistan, Senegal and Romania, respectively (n = 16/768, 12 new diagnoses), and HCV-RNA prevalence was 0.9%, 0.3% and 0.7%, respectively (N = 6, all new diagnoses); 4 (66.6%) cases were linked to treatment and two were cured.

CONCLUSIONS

This novel community action successfully reached migrants in a situation of vulnerability and provided them access to testing and care. The high prevalence observed and the limited self-knowledge of their HBV and HCV status justify targeted screening in these groups.

Prevalence of Hepatitis C Among Migrants: A Systematic Review and Meta-Analysis

The World Health Organisation has targeted the Hepatitis C virus (HCV) to be eliminated as a public health threat by 2030. Equitable access to HCV testing and treatment services is important in achieving this goal. Migrants often face barriers to accessing health services, and understanding HCV prevalence among this population can support planning for elimination. This systematic review aimed to estimate HCV prevalence among migrants residing in high-income countries with low/intermediate HCV prevalence. Scopus, PubMed, PsycINFO and Cochrane Library were searched for peer-reviewed articles published in English between 2015 and 2024. The studies' quality was assessed using The Joanna Briggs Institute (JBI) Critical Appraisal Tools. A proportional meta-analysis was used to estimate HCV prevalence. Thirty-seven studies were included in this review. Seventeen studies included both people < 18 and ≥ 18 years old, 16 studies only included people ≥ 18 years old, and three studies included people aged 18 and younger. The pooled prevalence of HCV antibody (anti-HCV) and RNA (HCV-RNA) were 1.5% (95% CI, 1.1%-2.0%) and 0.6% (95% CI, 0.4%-0.9%), respectively. The prevalence of anti-HCV was higher among males (1.9%) than females (0.6%). Among refugees and asylum seekers, the prevalence of anti-HCV and HCV-RNA were 1.4% and 0.7%, respectively. The prevalence of HCV among migrants is comparable with that among the general population of the destination countries. Given the barriers migrants, especially refugees and asylum seekers, face in accessing health services, their access to HCV information, testing and treatment should be facilitated.

Estimating the prevalence of chronic infections among asymptomatic migrants: results of a screening programme in Catalonia, Spain

Background

Migrants are disproportionately affected by several infectious diseases differing the risk within migrant groups. This study aimed to estimate the prevalence of six chronic infections in asymptomatic migrants attended at primary care or specialized units where health assessments are offered.

Methods

A multicentric cross-sectional study was conducted to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B and C virus, Strongyloides stercoralis, Schistosoma spp., and Trypanosoma cruzi infections in the migrant population who participated in a screening programme implemented at six primary health care centres, and two infectious diseases outpatient clinics in Catalonia, Spain.

Results

Of the 314 recruited migrants, 284 (90.4 %) were tested for at least one infection. The prevalence of the infections was as follows: 1.8 % for HIV, 1.8 % for chronic hepatitis B virus, 14.1 % for previous exposure to a hepatitis B virus infection, 0.4 % for hepatitis C virus infection, 2.6 % for S.stercoralis infection, and 7.0 % for T.cruzi infection. No cases infected with Schistosoma spp. were reported. A higher prevalence of HIV, hepatitis B and C virus was observed in Sub-Saharan Africans, whereas a higher prevalence of S.stercoralis and T.cruzi infections was reported in migrants from Latin-America and the Caribbean.

Conclusion

Findings suggest a high burden of the studied infections, including parasitic infections, in the migrant population with variations within migrant groups based on areas of birth.

Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review

Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.

Development of a risk prediction score for screening for HBV, HCV and HIV among migrants in France: results from a multicentre observational study (STRADA study)

OBJECTIVES

Migrants from high HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV) endemicity regions have a great burden of these infections and related diseases in the host countries. This study aimed to assess the predictive capacity of the Test Rapide d'Orientation Diagnostique (TROD) Screen questionnaire for HIV, HBV and HCV infections among migrants arriving in France.

DESIGN

An observational and multicentre study was conducted among migrants. A self-questionnaire on demographic characteristics, personal medical history and sexual behaviours was completed.

SETTING

The study was conducted in the centres of the French Office for Immigration and Integration (OFII).

PARTICIPANTS

Convenience sampling was used to select and recruit adult migrants between January 2017 and March 2020.

OUTCOME MEASURES

Participants were tested for HIV, HBV and HCV with rapid tests. For each infection, the test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy.

RESULTS

Among 21 133 regular migrants seen in OFII centres, 15 343 were included in the study. The participants' mean age was 35.6 years (SD±11.1). The prevalence (95% CI) of HBV, HCV and HIV was 2.0% (1.8% to 2.2%), 0.3% (0.2% to 0.4%) and 0.3% (0.2% to 0.4%), respectively. Based on the sensitivity-specificity curve analysis, the cut-off points (95% CI) chosen for the risk score were: 2.5 (2.5 to 7.5) for HBV infection in men; 6.5 (0.5 to 6.5) for HBV infection in women; 9.5 (9.5 to 12.5) for HCV infection; and 10.5 (10.0 to 18.5) for HIV infection. Test performance was highest for HIV (AUC=82.15% (95% CI 74.54% to 87.99%)), followed by that for HBV in men (AUC=79.22%, (95% CI 76.18% to 82.26%)), for HBV in women (AUC=78.83 (95% CI 74.54% to 82.10%)) and that for HCV (AUC=75.95% (95% CI 68.58% to 83.32%)).

CONCLUSION

The TROD screen questionnaire showed good overall performance for predicting HIV, HBV and HCV infections among migrants in OFII centres. It could be used to optimise screening for these infections and to propose rapid screening tests to those who are at high risk.

TRIAL REGISTRATION NUMBER

NCT02959684.

Opportunistic screening using point-of-care testing leads to successful linkage to care of HBV-infected migrant populations in a low endemic country

Background and aims

In low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective in reducing the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. This study aims to guide future screening initiatives, with 3 objectives: 1. to compare LTC between different ethnic groups screened for HBsAg with point-of-care testing (POCT) in an outreach setting; 2. to estimate the proportion of HBsAg seropositivity for ethnic minorities; and 3. to investigate the association between seropositivity and HBV risk factors.

Methods

Opportunistic outreach screenings using finger prick HBsAg tests were performed at civic integration programmes between 11/2017 and 09/2022. If an individual tested positive, an appointment was given immediately at the outpatient hepatology clinic for follow-up and confirmation of HBsAg positivity in blood. Dedicated personnel contacted these individuals to motivate them for further LTC, which was defined as being assessed by a hepatologist, a blood test and an abdominal ultrasound.

Results

A total of 677 people from different ethnicities (Asian, Middle Eastern and African) were serologically screened using POCT. The observed positivity for HBsAg was 3.4 % (95% CI 2.17-5.05, 23/677). Apart from ethnicity and male sex, none of the surveyed HBV risk factors were associated with HBsAg seropositivity. All HBsAg positive individuals were linked to care and assessed by a hepatologist, despite the COVID-19 pandemic increase in time to follow-up of 82 days (95% CI 51-112 days) vs. 24 days (95% CI 5-43 days, p = 0.008)).Among HBV-infected patients, 31.8% (7/22), 100 % (22/22) and 26.1% (6/23) met the criteria for treatment indication, intrafamilial transmission risk and need for hepatocellular carcinoma surveillance, respectively.

Conclusion

The proportion of HBsAg seropositivity in ethnic minorities was 3.4%. POCT and commitment of dedicated personnel can overcome previously identified barriers resulting in a 100% LTC.

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

Introduction

Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA).

Methods

Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations.

Results

The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers.

Discussion

The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.