National policies for delivering tuberculosis, HIV and hepatitis B and C virus infection services for refugees and migrants among Member States of the WHO European Region

Abstract

Rationale for review. Migrants to the WHO European Region are disproportionately affected by infections including tuberculosis, HIV and hepatitis B and C (HBV/HCV), compared with the host population. There are inequities in the accessibility and quality of health services available to refugees and migrants in the Region. This has consequences for health outcomes and will ultimately impact the ability to meet Regional infection elimination targets. We reviewed academic and grey literature to identify national policies and guidelines for tuberculosis/HIV/HBV/HCV specific to migrants in Member States of the WHO European Region, and identify: a) evidence informing policy and b) barriers and facilitators to policy implementation. Key findings Relatively few primary national policy/guideline documents were identified that related to migrants and tuberculosis (14 of 53 Member States (26%), HIV (n = 15, 28%) and HBV/HCV (n = 3, 6%), which often did not align with WHO recommendations and for some countries, violated migrants’ human rights. We found extreme heterogeneity in the implementation of WHO- and European Centre for Disease Prevention and Control-advocated policies and recommendations on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in migrants across Member States of the WHO European Region. There is great heterogeneity in implementation of WHO- and European Centre for Disease Prevention and Control-advocated policies on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in migrants across Member States in the Region. Conclusions/recommendations More transparent and accessible reporting of national policies and guidelines are required, together with the evidence base upon which these policy decisions are based. Political engagement is essential to drive changes in national legislation to ensure equitable and universal access to diagnosis and care for infectious diseases.

HIV-HCV Incidence in Low-Wage Agricultural Migrant Workers Living in Ghettos in Apulia Region, Italy: A Multicenter Cross Sectional Study

“…With regard to HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS)reports that 85% of all people living with HIV knew their status in 2021. In 2021, about 5.9 million people did not know that they were living with HIV [ 21 ]. Migrants are less likely to know if they are infected because the health care in their home countries isn’t good enough or because they live in remote areas in the country that they move to.…”

A population‐based study of reported hepatitis C diagnoses from 1998 to 2018 in immigrants and nonimmigrants in Quebec, Canada

“…Before the availability of DAA therapy, HCV‐infected immigrants were more likely to have advanced liver disease and hepatocellular carcinoma at the time of or soon after HCV diagnosis and were more likely to die during a liver‐related hospitalization compared with nonimmigrants 8,13,14 . Despite these disparities, few high‐income, low‐HCV‐prevalence countries recommend HCV screening among immigrants 15,16 . Even where official national HCV screening policies for immigrants are available, health practitioners are often unaware of such guidelines and fail to routinely screen for HCV in this population 16 …”

“…Despite these disparities, few high‐income, low‐HCV‐prevalence countries recommend HCV screening among immigrants 15,16 . Even where official national HCV screening policies for immigrants are available, health practitioners are often unaware of such guidelines and fail to routinely screen for HCV in this population 16 …”

“…8,13,14 Despite these disparities, few high-income, low-HCV-prevalence countries recommend HCV screening among immigrants. 15,16 Even where official national HCV screening policies for immigrants are available, health practitioners are often unaware of such guidelines and fail to routinely screen for HCV in this population. 16 We estimated annual rates and trends of newly reported HCV diagnosis in immigrants and nonimmigrants over 20 years in a large population-based cohort in Quebec, Canada, to identify subgroups who may benefit from targeted screening and how this may have changed over time.…”

Migrants and hepatitis: A tale of two worlds

“…Only 15 policies and guidelines on TB, HIV and viral hepatitis services for refugees and migrants can be identified in the 53 member states of the WHO European region. 8 Approaches to screening vary considerably in the WHO European region, with no agreement on the most effective and cost-effective approaches to targeted interventions for migrants or on which have the best uptake and treatment outcomes. 9,10 This lack of consensus contributes to heterogeneity across the Region of policies for the screening of migrants with infectious diseases.…”