Screening for hepatitis B and C among migrants in the European Union

Transcription

1 Screening for hepatitis B and C among migrants in the European Union Conference on Migrants and Health 12 th May 2016, Lisbon, Portugal Amena Ahmad Hamburg University of Applied Sciences Germany Amenaalmes.ahmad@haw-hamburg.de Visit: Responsibility for the information in this presentation lies entirely with the authors. The European Commission is not responsible for any use that may be made of the information contained herein.

2 Background Chronic viral hepatitis B and C are important public health issues in Europe, with migrants from endemic areas being specifically affected Viral hepatitis related liver disease is predicted to rise in Europe until 2030 High scope for secondary prevention of hepatitis B and C related liver disease though advances in antiviral treatment Most viral hepatitis cases remain undetected Active identification of cases is needed

3 HEPscreen Duration: 3 years (Oct.2011 Sep.2014) Funding: Co-funded by the Health Programm of the European Union Partners: 10 partners from 6 countries (academic, public health organizations, patient association) Overall Aim: To assess, describe and communicate to public health professionals the tools and conditions necessary for implementing successful screening programmes for hepatitis B and C among migrants in the European Union

4 Objectives & Methods: 6 EU MEMBER STATES Estimate the burden of hepatitis B and C among migrants Collect, assess and share evidence on screening, counselling, referral, treatment and patient management for hepatitis B and C in migrants Collate information on effective communication strategies and materials aimed at migrant groups Pilot different approaches to screening Integrate the findings and develop a tool kit for public health professionals

5 Results and Outputs: Epidemiology and burden of disease First generation migrants 4-15% Large chronic hepatitis B Burden (10-45%) - among top five migrant groups from endemic countries Data Gaps Reliability Issues Age & Cohort Effects HEPscreen Assess the burden tool Extension to 31 EU/EEA Countries

6 Results: Current screening, counselling and care practices in Europe SUMMARY FINDINGS Some systematic screening (antenatal, blood donors) But among migrant groups? Small scale, time limited Pre- and Post-test counselling delivery & content (Non) availability of translated materials Complex, ineffective patient pathways Access to treatment patients and drugs Health system context LESSONS LEARNT Scaling up is urgently needed Guidelines are a first step - good examples exist As with HIV, viral hepatitis is undertreated Effective pathways ensure linkage to specialist care and treatment Counselling as a form of health promotion

7 Outputs: Screening in Europe Country profiles summaries of evidence

8 Outputs: Pre-test discussion SUPPORT FOR FUTURE ACTION Multi-lingual leaflet tool for people offered testing HEPscreen Pre-test discussion checklist

9 The HEPscreen Pilot Studies IMPACT Implementation Logistics Linkage to care Prevalence Equity

10 The HEPscreen Pilot Studies LESSONS LEARNT Minimise drop out through short and efficient linkage between services Consider expected prevalence of the target population Work in partnership from the start: Involve specialist services Involve communities and institutions Integrate testing in routine primary care Register country of birth as part of medical history

11 Conclusion: Screening for hepatitis B and C among migrants SUMMARY FINDINGS Minority populations, large CHB / CHC burden Hardly any screening in migrant groups Complex ineffective patient pathways Variable access to treatment Different ways of screening possible LESSONS LEARNT Scaling up of screening urgently needed Work in partnership, minimise drop out Consider expected prevalence in target pop. Ensure linkage to care

12 Epidemiological tool to assess burden SUPPORT FOR FUTURE ACTION Visit: Multi-lingual leaflet tool for people offered testing Pre-test discussion checklist Repository of best practice studies Videos and animations How to screen and pilot case studies

13 HEPscreen Partners Country Partner The Netherlands Erasmus University Medical Center Germany Hamburg University of Applied Sciences Hungary National Centre of Epidemiology Italy The Netherlands The Netherlands Spain UK - England UK - Scotland United Kingdom University of Florence Municipal Public Health Service, Rotterdam National Institute for Public Health and The Environment Public Health Agency of Barcelona Queen Mary's University London NHS Grampian Hepatitis C Trust