Barriers and Facilitators to Identifying and Treating Chronic Viral Hepatitis in Immigrants in Primary Care: the HepFREE Trial.

Abstract

Chronic viral hepatitis, caused by Hepatitis B (HBV) or Hepatitis C (HCV) infection is a global public health concern, and contributes considerable health burdens from chronic liver disease, liver cirrhosis, hepatocellular carcinoma and death. The advent of new curative directly-acting antiviral drugs for HCV, and better treatment and management for HBV, offers an opportunity to improve outcomes for more than 300 million affected individuals. In the UK approximately 0.4% of the population are infected with chronic HBV or chronic HCV, but prevalence is higher in immigrant populations. Primary care can provide an important opportunity for case-finding infected individuals by offering testing to high-risk populations. The HepFREE Trial: “Chronic Viral Hepatitis in First and Second Generation Immigrants from ‘At Risk’ Countries. A controlled randomised cross sectional cluster trial to assess the impact of identifying, screening and treating immigrants with viral hepatitis” reports on screening of immigrants in Bradford, London and Oxfordshire in the UK, and subsequent follow-up care. In this thesis, I outline the background to viral hepatitis screening in primary care and the methodology of the HepFREE Trial. I analyse screening outcomes, disease staging and follow-up care of positive subjects, as well as qualitative research on the experience of healthcare professionals involved in trial delivery. I analyse a pre-screening survey exploring demographics, knowledge of viral hepatitis and treatment experience of a population of eligible individuals before the screening began. I present current knowledge about viral hepatitis screening in primary care, the outcomes of a large multicentre national screening and follow-up trial, and the barriers and facilitators to screening as identified by healthcare providers and the high-risk patient population. I discuss my findings and how they contribute to our current understanding and future strategies for improvement of case-finding for viral hepatitis in primary care in the UK.