Chronic Hepatitis B and C among Migrants and At‐Risk Groups:A Systematic Literature Review of Screening Practices and Approaches to Minimize Morbidity and Mortality in Europe

Abstract

Background: Viral hepatitis B and C are global health problems and major risk factors for liver cirrhosis and primary liver cancer, if becoming chronic. Worldwide, over 240 million people live with a chronic hepatitis B infection and about 150 million people are chronically infected with hepatitis C (WHO, 2012a, 2013); both contributing to a yearly amount of around one million deaths. Within Europe, chronic viral hepatitis B and C account for about 14 and nine million infected people (Hatzakis et al., 2011). Due to its largely asymptomatic nature, most people are unaware of their infection. Advancements in antiviral treatment emphasize the need for early identification of patients who qualify for treatment. Increase and diversification of global population movements have changed the global distribution of viral hepatitis. Especially migrants from high‐ or intermediate‐prevalence countries are a vulnerable group and at risk for having, acquiring, and transmitting hepatitis infection. Despite migration being a determining factor for hepatitis B and C infection, migrants are currently not targeted routinely in European screening programs. Objectives: To provide a comprehensive and detailed overview of the current situation of screening for (chronic) viral hepatitis B and C among migrants and at‐risk groups in Europe. Determinants of screening among migrants are considered and recommendations for national actions and campaigns to confront viral hepatitis are formulated. Methods: A systematic literature search among published and grey literature was carried out using scientific databases and websites of organizations involved in the field of viral hepatitis. Information concerning general and migrant/at‐risk group specific screening approaches, policy, as well as determinants of screening was included and assessed. Results: Guidelines and recommendations are available, but except for hepatitis B screening in pregnant women and hepatitis B and C screening in blood donors, no definite laws or obligatory guidelines could be identified. For numerous other risk groups screening is strongly recommended but there is no clear evidence how and if this advice was followed. On European level, the inclusion of migrants in screening recommendations is scarce; however several good practice examples of pilot projects could be identified, as well as worldwide good practice models. Discussion: Several determinants are influencing the uptake of viral hepatitis screening. All of them depending on specific prerequisites of the local and national situation; including the target population or the health system infrastructure. Barriers and motivating factors of screening among migrants, and recommendations for implementing cultural‐tailored viral hepatitis screening programs were provided.