Appraisal of community-based interventions for hepatitis B in underserved populations using the quadruple aim of value-based medicine: a scoping review within the VH-COMSAVAC project

Abstract

Background: Chronic viral hepatitis remains a critical public health concern, a key focus of WHO's 2030 elimination targets. High-risk populations, especially migrants often facing significant healthcare barriers, are disproportionately affected globally by this condition. Community-based interventions are crucial for enhancing access to screening, vaccination, and linkage to care. This scoping review, a foundational step within the EU co-funded VH-COMSAVAC project, identifies and analyses how these interventions map to the Quadruple Aim framework of value-based medicine.

Methods: This scoping review adhered to PRISMA-ScR guidelines. Five scientific databases (MEDLINE, Embase, GlobalHealth, Scopus, Web of Science) were systematically searched up to July 30, 2023. Titles and abstracts of studies focusing on community-based HBV interventions, primarily targeting migrants and refugees while also encompassing other underserved populations, were independently screened by five reviewers using the Rayyan platform. Data extraction was conducted using a structured Excel spreadsheet, mapping reported outcomes to the Quadruple Aim framework (patient experience, population health, cost reduction, care team wellbeing) and intervention types (prevention, linkage to care, treatment).

Results: Of 34 included publications, 94% (n = 32) focused on prevention, 29% (n = 10) on linkage to care, and 6% (n = 2) on treatment strategies. Patient experience was the most reported value domain (56%, n = 19 studies), followed by population health (50%, n = 17 studies). Cost reduction (9%, n = 3 studies) and care team wellbeing (3%, n = 1 study) were considerably less represented. Point-of-care (PoC) testing demonstrated significantly higher linkage to care (86% vs. 34% for venepuncture) and 76.5% lower costs (€12.7 vs. €54.0 per screened person). Screening uptake in targeted intervention groups (19.5%) was also significantly higher than in control groups (1.7%; p = 0.014). Major reported barriers included language (62%), cultural/religious issues (50%), and lack of knowledge (32%).

Conclusions: The review reveals a significant gap in the comprehensive, value-based evaluation of existing community-based interventions, with no established framework existing. The VH-COMSAVAC project seeks to bridge this by developing a value-based assessment tool, leveraging the Quadruple Aim, to systematically assess its prevention and linkage-to-care interventions and guide evidence-based optimization.

Keywords: Community care; Hepatitis; Hepatocarcinoma; Underserved populations; Value-based medicine.

Fig. 1

PRISMA flow chart summarizing the article selection process