Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infections among undocumented migrants and uninsured legal residents in the Netherlands: A cross-sectional study, 2018–2019

Abstract

Background Migrants are not routinely screened for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in the Netherlands. We estimated the prevalence and determined factors associated with HBV, HCV and/or HIV infections among undocumented migrants and uninsured legal residents. Methods In this cross-sectional study, undocumented migrants and uninsured legal residents were recruited at a non governmental organization (NGO), healthcare facility in the Netherlands and were invited to be tested for hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibodies (anti-HBcAb), HCV-RNA, and anti-HIV antibodies or HIV antigen at a local laboratory. Results Of the 1376 patients invited, 784 (57%) participated. Participants originated from Africa (35%), Asia (30%) and North/South America (30%). 451/784 (58%) participants went to the laboratory for testing. Of participants 30% were HBV exposed (anti-HBcAb-positive), with 27% (n = 119/438, 95% CI 23.1% to 31.6%) having resolved HBV infection (HBsAg-negative) and 2.5% (n = 11/438, 95%CI 1.3% to 4.5%, 64% new infection) having chronic HBV infection (HBsAg-positive). Compared to HBV non-exposed, HBV exposed individuals were older (p = 0.034) and more often originated from Africa (p<0.001). Prevalence of chronic HCV infection (HCV-RNA-positive) was 0.7% (n = 3/435, 95%CI 0.1% to 2.0%, all new infections) and HIV infection 1.1% (n = 5/439, 95%CI 0.04% to 2.6%, 40% new infection). Conclusion Prevalence of chronic HBV, chronic HCV and HIV infections in our study population is higher compared to the Dutch population, thus emphasizing the importance of case finding for these infections through primary care and public health in this specific group of migrants. Screening uptake could be improved by on-site testing.

Sexual and reproductive health rights and service use among undocumented migrants in the EU: a systematic literature review

“…Regarding the outcomes, studies reported on higher SMM, higher pre-term and low-weight birth for newborns, higher incidence of HIV and even higher prevalence of AIDS across undocumented migrant populations. The latter was coupled with previously described risks of gender-based violence, female genital mutilation and human tra cking experienced by this population as part of their migratory journey, emphasizing the vulnerability of undocumented migrants to poor health outcomes; further accentuated by socio-economic disadvantages and poor living standards (13,24,35,50). Whilst no article reported on differences between genders, it would be interesting to study how different contexts of vulnerability to exploitation, sexual abuse and/or human tra cking play out for undocumented men and women to better assess their speci c needs and render targeted services.…”

“…One of the most occurrent themes within the appropriateness dimension of access to SRHS for undocumented migrants in the present studies is the lack of coordination and continuity of care characterizing populations who are often on the move, lack stable living and housing conditions in the host countries, and who often navigate different layers of legality and illegality (33). This lack of continuity of care and treatment is most concerning in the presence of infectious diseases requiring obligatory treatment by public health authorities, such as the cases of HIV, HBV, or Hepatitis C Virus (HCV) (24). Often the lack of coordination and the disintegrated character of healthcare services means that patients who lack the necessary knowledge and might also be subject to fear and stigma will be lost to follow-up (35).…”

“…A lack of clear information on entitlements and pricing in the case of out-of-pocket payments, stigma, together with insecurity, unfamiliarity with the healthcare system, fear of deportation and refusal of care are key factors affecting approachability to and acceptability of SRHS for undocumented migrants in the EU. This is widely reported in the reviewed literature (24,36,40,44). This translated into sub-optimal use of SRHS services, especially related to prenatal and maternal care.…”

“…Furthermore, it has been shown that when looking at screening and testing for infectious or sexually transmitted diseases, on-site screening, as opposed to external laboratory testing, increases uptake, and facilitates continuity of care (24).…”

“…Indeed, ndings from the study indicate that 35% of migrant women and 45% of migrant men are diagnosed with advanced HIV disease, and migrants account for 46% of people diagnosed with AIDS. These rates are higher amongst men having sex with men (MSM) and depend on a variety of factors, such as the endemicity of these infections in their countries of origin and susceptibility to acquiring an infection while moving and living in Europe (24). Late diagnoses and higher risks, coupled with lower testing and treatment uptake in the host countries, worsen the health prospects of undocumented migrant populations at risk of STDs and, in particular, HIV (24)(35)(50) (13).…”