Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries

Abstract

Background: To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol. Methods: An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction). Results: From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent. Conclusions: Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.

Percepciones sobre acceso y uso de servicios de salud mental por parte de inmigrantes en Chile, desde la perspectiva de trabajadores, autoridades e inmigrantes

“…2019, 3(1): 21-31 Sofía Astorga, s.astorga@udd.cl que debe ser garantizado por los gobiernos de cada país (3). Si bien varios países han desarrollado una serie de iniciativas para incluir a inmigrantes, otros han planteado políticas restrictivas que limitan su acceso y atención, especialmente a inmigrantes en situación de irregularidad (4,5), pese a que este tipo de estrategias genera un mayor costo económico que ofrecer acceso al sistema de salud (6) La literatura internacional indica que, en general, los inmigrantes presentan menor acceso y uso de servicios de salud que la población nativa (7)(8)(9)(10), observándose excepciones para algunos servicios de salud (11,12). En el caso de los servicios de salud mental, incluyendo atención primaria (APS) y hospitalización, los inmigrantes presentan menor uso de estos servicios, sin presentar diferencias según país de procedencia y país receptor (13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Significant Improvement in Diagnosis of Hepatitis C Virus Infection by a One-Step Strategy in a Central Laboratory: an Optimal Tool for Hepatitis C Elimination?

“…The spectacular increase in diagnostic rates in drug treatment centers is particularly relevant in terms of public health, due to the high prevalence of HCV infection among drug users. An effective diagnosis in this setting enables starting antiviral treatment, likely to result in HCV curation (15), a key cornerstone for HCV infection elimination (2, 7). However, a low rate of anti-HCV-positive cases remain undiagnosed due to lack of viral load testing; in our case, most are due to lack of hematimetry requests, meaning no samples for HCV RNA testing.…”

HIV, HCV and HBV: A Review of Parallels and Differences

“…In contrast, some upper-middle-income countries with moderate to high prevalence rates, such as Albania and Iran, have restrictions on diagnostics and/or management [ 74 ]. Throughout Europe (and other regions), limited access to treatment of HBV and HCV infections occurs among vulnerable populations such as undocumented migrants, asylum seekers and people without insurance [ 75 ]. In 2015, only 7% of the 71 million people with chronic hepatitis C had access to treatment.…”