A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain

Abstract

Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use point-of-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. From 21/11/20 to 03/07/2021, 314 study participants were offered HBV screening in a community clinic. Rapid tests for HBsAg screening were used and blood samples were collected with plasma separation cards. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. Sociodemographic and clinical history were collected and descriptive statistics were utilized. 274 patients were included and 210 (76.6%) returned to receive results. The HBsAg prevalence was 9.9% and 33.2% of people had evidence of past resolved infection. Overall, 133 required vaccination, followed by post-test counselling (n = 114), and linkage to a specialist (n = 27). Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools, HBV-COMSAVA demonstrated that it was possible to diagnose, link to care, and vaccinate African migrants in community-based settings.

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

“…Logistical barriers such as finite financial resources, lack of time and geographic barriers, including transport and lack of locally available services, can be decisive ( 60 ). Also, other pressing matters, such as administrative procedures for approval of a residence permit, may require priority ( 58 , 71 ). The disadvantaged social position of migrants and socio-economic insecurity can be barriers to screening ( 61 , 83 ).…”

“…Next to proper treatment of migrants, professionals should be mindful of the range of awareness, knowledge, and emotions ( 37 , 76 ). In case of unfamiliarity with the healthcare system, a (peer) navigator can help with setting up health insurance and linkage to care and follow-up of patients ( 58 ).…”

“…For screening to be effective, a comprehensive prevention approach should be offered that includes screening, linkage to care and treatment, and ideally also source and contact tracing and vaccination ( 29 , 46 ). When comparing screening initiatives with high participation rates (>95%), we see that all studies refer positively tested patients to care ( 27 , 31 , 37 , 44 , 46 , 50 , 58 , 59 ). Other noteworthy similarities were the systematic approaches to multi-infectious disease screening, using appropriate procedures and forms, carried out by skilled personnel.…”

“…Long waiting times and other service issues, can be hindering patients' engagement in screening. Logistical barriers can be reduced by outreach and screening in the community itself ( 50 , 58 , 86 ).…”

The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda

“…HBV-COMSAVA (Community Screening and Vaccination in Africans) Study, Barcelona, Spain ( Picchio et al, 2021 ).…”