The feasibility of screening for viral hepatitis in immigrant populations

Abstract

Globally, it is estimated that 240 million people are infected with chronic viral hepatitis B and in excess of 185 million people with chronic hepatitis C. The burden of disease from hepatitis is concentrated in developing countries where transmission of HBV occurs predominantly from mother to child (vertical transmission) and transmission of HCV through unsafe medical procedures and the transfusion of unscreened blood products. Global patterns of migration favour the movement of individuals from countries with medium or high risk prevalence of chronic viral hepatitis to countries with traditionally low prevalence among their indigenous populations, including the United Kingdom (UK). In excess of 3.2% of the global population are international migrants, posing important implications for healthcare systems in host nations. It is predicted that up to 7 million first and second generation immigrants, originating from high prevalence countries for viral hepatitis now reside permanently in the UK. However, as a result of deficiencies in screening initiatives, the prevalence and associated burden of these diseases in these high-risk populations residing in the UK is yet to be determined. In order to establish the feasibility of inviting first and second generation immigrant populations to participate in viral hepatitis testing in primary care, as well to determine the prevalence and demography of viral hepatitis in four areas of the UK, a randomised controlled cross sectional cluster trial was conducted. In HepFree clinical computer systems in general practice surgeries were interrogated to identify the target population that was then approached using a variety of different invitations to determine the most appropriate method for engaging this population. The outcomes of viral hepatitis testing from practices in one area of the UK are described in this thesis. Despite multiple challenges encountered both in engaging practices and individuals in trial participation, results of this investigation suggest that if it is found to be cost effective, then viral hepatitis screening is feasible and the burden of disease in the UK is concentrated in first generation immigrants.