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. 2023 Dec 14;3(1):182.
doi: 10.1038/s43856-023-00420-8.

Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain

Camila A Picchio  1 , Daniel K Nomah  2 , Ariadna Rando-Segura  3   4 , Maria Buti  4   5 , Sabela Lens  4   6 , Xavier Forns  4   6 , Sergio Rodriguez Tajes  4   6 , Emma Fernández  7 , Javier Pamplona Portero  8 , Carmen López Nuñez  9 , Lena van Selm  7 , Marina MacKinnon  7 , Silvia G Araujo  7 , Elisa Martró  10   11 , Francisco Rodríguez-Frías  12 , Jeffrey V Lazarus  7   13
Affiliations

Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain

Camila A Picchio et al. Commun Med (Lond). .

Abstract

Background: Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain.

Methods: This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed.

Results: In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days.

Conclusions: This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.

Plain language summary

A large proportion of hepatitis B virus (HBV) infections occur within countries in sub-Saharan Africa. With recent increased migration from these countries to Catalonia Spain, the prevalence of HBV is greater in migrants than in host populations. However, migrants face additional barriers when trying to access care. We developed a community-based care pathway to provide migrants in Catalonia with access to HBV testing, post-test counseling, vaccinations, and appointments with specialists when needed. The results showed that this strategy was successful in increasing testing, linkage to care, and vaccination among at-risk migrant populations in Catalonia, Spain. It may be worthwhile implementing this strategy on a wider scale and with other at-risk populations to reduce HBV infections and improve outcomes.

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Conflict of interest statement

The authors declare the following competing interests: C.A.P., D.K.N., A.R.S., E.F., Lv.S., M.M., S.G.A. and F.R.F. have no competing interests to report. S.L. has received research grants from Gilead Sciences and speaker and travel fees from Gilead and Abbvie; M.B. has acted as an advisor for Gilead Sciences, GSK, Abbvie, and Roche Diagnostics; X.F. has acted as an advisor for Gilead Sciences and Abbvie; S.R.T. reports speaker fees from Gilead Sciences and Abbvie, outside the submitted work; J.P.P. has received speaker fees from Gilead Sciences and Abbvie; C.L.N. has received speaker fees from Gilead Sciences and Abbvie; E.M. has received lecture fees and research grants from Abbott GmbH & Co. K.G., Gilead Sciences, Cepheid and Abbvie, outside of the submitted work; J.V.L. acknowledges grants and speaker fees from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics to his institution, speaker fees from Echosens, Janssen, Novo Nordisk, and ViiV, and consulting fees from Novavax, outside of the submitted work.

Figures

Fig. 1
Fig. 1. Overview of the HBV-COMSAVA study period and intervention setting for screening.
Time of implementation (month/year) and location type. Community space/African association includes leisure spaces, community events, and association offices.
Fig. 2
Fig. 2. The HBV-COMSAVA care pathway.
Hepatitis B surface antigen (HBsAg); plasma separation card (PSC); Hepatitis Delta antibodies (anti-HDV); antibodies against hepatitis B core antigen (anti-HBc); rapid detection test (RDT).
Fig. 3
Fig. 3. Overall successful linkage to care (blue) among participants and by infection status.
Current HBV infection linkage to care was reported among those with a confirmed documented visit in one of the participating tertiary hospitals (n = 24/28).
Fig. 4
Fig. 4. Median number of days for successful linkage to care among participants.
Box and whisker chart indicating the median, 25th, and 75th percentile in number of days for successful linkage to care in participants being linked to participating tertiary hospitals (a) and those returning for a second visit (b) in the community for vaccination or post-test counseling.
See this image and copyright information in PMC

References

    1. World Health Organization. Global Hepatitis Report 2017. (accessed 10 Nov 2022); https://www.who.int/publications/i/item/9789241565455.
    1. Mukthinuthalapati VVPK, et al. Hepatocellular carcinoma in sub-Saharan Africa. JCO Glob. Oncol. 2021;7:756–766. doi: 10.1200/GO.20.00425. - DOI - PMC - PubMed
    1. International Organization on Migration (IOM). World Migration Report 2022. (accessed 9 Nov 2022); https://publications.iom.int/books/world-migration-report-2022.
    1. European Commission. Statistics on Migration to Europe. (accessed 9 Nov 2022); https://ec.europa.eu/info/strategy/priorities-2019-2024/promoting-our-eu....
    1. Instituto Nacional de Estadistica. Cifras de población a 1 de enero 2021. Estadisticas de migraciones, año 2020. (accessed 9 Nov 2022); https://www.ine.es/prensa/cp_e2021_p.pdf.