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Roche R, Simmons R, Crawshaw AF, Fisher P, Pareek M, Morton W, Shryane T, Poole K, Verma A, Campos-Matos I, Mandal S. What do primary care staff know and do about blood borne virus testing and care for migrant patients? A national survey. BMC Public Health 2021; 21:336. [PMID: 33573638 PMCID: PMC7877334 DOI: 10.1186/s12889-020-10068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND UK migrants born in intermediate to high prevalence areas for blood borne viruses (BBV) including hepatitis B, hepatitis C and HIV are at increased risk of these infections. National guidance from Public Health England (PHE) and National Institute for Health and Care Excellence (NICE) recommends primary care test this population to increase diagnoses and treatment. We aimed to investigate primary care professionals' knowledge of entitlements, and perceptions of barriers, for migrants accessing healthcare, and their policies, and reported practices and influences on provision of BBV testing in migrants. METHODS A pre-piloted questionnaire was distributed between October 2017 and January 2018 to primary care professionals attending the Royal College of General Practitioners and Best Practice in Primary Care conferences, via a link in PHE Vaccine Updates and through professional networks. Survey results were analysed to give descriptive statistics, and responses by respondent characteristics: profession, region, practice size, and frequency of seeing migrant patients. Responses were considered on a per question basis with response rates for each question presented with the results. RESULTS Four hundred fourteen questionnaires were returned with responses varying by question, representing an estimated 5.7% of English GP practices overall. Only 14% of respondents' practices systematically identified migrant patients for testing. Universal opt-out testing was offered to newly registering migrant patients by 18% of respondents for hepatitis B, 17% for hepatitis C and 21% for HIV. Knowledge of healthcare entitlements varied; fewer clinical staff knew that general practice consultations were free to all migrants (76%) than for urgent care (88%). Performance payment structure (76%) had the greatest reported influence on testing, followed by PHE and Clinical Commissioning Group recommendations (73% each). Language and culture were perceived to be the biggest barriers to accessing care. CONCLUSIONS BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed. Knowledge of migrants' entitlements to healthcare varies and could affect access to care. Interventions to improve professional awareness and identification of migrant patients requiring BBV testing are needed to reduce the undiagnosed and untreated burden of BBVs in this vulnerable population.
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Affiliation(s)
- Rachel Roche
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, Gower St, London, WC1E 6BT, UK.
| | - Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, Gower St, London, WC1E 6BT, UK
| | - Alison F Crawshaw
- Migration Health, Health Improvement, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
- Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Pip Fisher
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Will Morton
- Public Health England Yorkshire and the Humber, 2nd Floor, Blenheim House, Duncombe Street, Leeds, LS1 4PL, UK
| | - Theresa Shryane
- Public Health England North West, 2nd Floor, 3 Piccadilly Place, London Road, Manchester, M1 3BN, UK
| | - Kristina Poole
- Public Health England North West, 2nd Floor, 3 Piccadilly Place, London Road, Manchester, M1 3BN, UK
| | - Arpana Verma
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Ines Campos-Matos
- Migration Health, Health Improvement, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
- Institute of Epidemiology and Healthcare, University College London (UCL), 1-19 Torrington Place WC1E 7HB, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, Gower St, London, WC1E 6BT, UK
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Sira J, Brown M, Ambegaokar S, Modin L, Kelly DA. The necessity of education and hepatitis B vaccination for young people: A study of high risk behaviour for blood borne viruses in the United Kingdom. J Child Health Care 2019; 23:437-445. [PMID: 30818996 DOI: 10.1177/1367493519831499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood borne virus (BBV) infection in adults involved in high risk behaviour is well recognized. There are limited reported data on young people involved in high risk behaviour. A descriptive questionnaire was used to ascertain risk behaviour at the Young People's Substance Misuse Service (Birmingham). Data collection included risk behaviour and serological tests for hepatitis B, C and HIV. Sixty-five of one-hundred three (63%) young people participated; 37/65 male; age range 13.9-18.9 (median 17.4 years). Risk behaviour included 6 intravenous drug, 58 cannabis, and 61 had sexual partners, of whom 52 (85%) engaged in unprotected sex. Sixty-five participants were negative for BBV infection: 9 were HBV immune. HB vaccination was not available at the centre (for <18 year), and all refused referral to their general practitioner for vaccination due to fear of disclosure. The main risk for BBV acquisition was unprotected sex with multiple sexual partners and illicit drug use. Most were unaware of the risks related to high risk behaviour. Effective education programmes of relevant risk factors with HBV vaccination should be implemented during preadolescence. We recommend an integrated service via specialized centres, to work together to improve awareness and increase efforts to vaccinate adolescents at risk for HBV infection.
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Affiliation(s)
- J Sira
- 1 Liver Unit, Birmingham Women and Children's Hospital NHS Trust (BWCH), Birmingham, UK
| | - M Brown
- 1 Liver Unit, Birmingham Women and Children's Hospital NHS Trust (BWCH), Birmingham, UK
| | - S Ambegaokar
- 2 Child and Adolescent Mental Health Services (CAMHS), Birmingham Children's Hospital NHS Trust (BCH), Birmingham, UK
| | - L Modin
- 1 Liver Unit, Birmingham Women and Children's Hospital NHS Trust (BWCH), Birmingham, UK
| | - D A Kelly
- 1 Liver Unit, Birmingham Women and Children's Hospital NHS Trust (BWCH), Birmingham, UK
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Davies EL, Fielding S, Noble G, Okpo E. "It's just in that sea of things that I never cared about": perception of hepatitis B amongst university students in Aberdeen, North-East Scotland. BMC Public Health 2019; 19:332. [PMID: 30898127 PMCID: PMC6429810 DOI: 10.1186/s12889-019-6654-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background A significant proportion of international students at UK universities are from regions with medium to high hepatitis B prevalence rates. Understanding the perception of students regarding hepatitis B infection is crucial for the development of appropriate information and services for this population group. Methods Twenty semi-structured interviews were conducted with students from the University of Aberdeen. The following key areas were covered: knowledge, awareness, practices including testing, cultural and social aspects and general attitudes to health information and services. Interviews were transcribed verbatim and coded using a framework analysis approach. Results The participants acknowledged hepatitis B to be a serious disease yet did not consider themselves to be at risk. They felt able to go to their General Practitioner if concerned about hepatitis B but emphasised that there was no indication that this was required. There was a general lack of knowledge about the disease including confusion over other types of hepatitis. This was linked to the perceived lack of attention given to hepatitis B in, for example, sexual health education and disease awareness raising campaigns. The participants expressed a desire for information on hepatitis B to be relevant to the student population, easy to understand, socially acceptable and easily accessible on student portals and social media platforms. Conclusions Our study suggests that students in Aberdeen, North East Scotland lack knowledge and awareness of hepatitis B and do not perceive themselves as being at risk of hepatitis B infection. There is a need for more tailored hepatitis B messages to be incorporated into a range of contexts with clearer risk communication for the student population.
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Affiliation(s)
- Emma L Davies
- Public Health, NHS Grampian and University of Aberdeen, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.
| | - Shona Fielding
- Institute of Applied Health Sciences, NHS Grampian and University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Emmanuel Okpo
- Public Health, NHS Grampian and University of Aberdeen, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.,Institute of Applied Health Sciences, NHS Grampian and University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Gilchrist G, Swan D, Widyaratna K, Marquez-Arrico JE, Hughes E, Mdege ND, Martyn-St James M, Tirado-Munoz J. A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs. AIDS Behav 2017; 21:1791-1811. [PMID: 28365913 PMCID: PMC5491643 DOI: 10.1007/s10461-017-1755-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Opiate substitution treatment and needle exchanges have reduced blood borne virus (BBV) transmission among people who inject drugs (PWID). Psychosocial interventions could further prevent BBV. A systematic review and meta-analysis examined whether psychosocial interventions (e.g. CBT, skills training) compared to control interventions reduced BBV risk behaviours among PWID. 32 and 24 randomized control trials (2000-May 2015 in MEDLINE, PsycINFO, CINAHL, Cochrane Collaboration and Clinical trials, with an update in MEDLINE to December 2016) were included in the review and meta-analysis respectively. Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information (SMD −0.52; 95% CI −1.02 to −0.03; I2 = 10%; p = 0.04) or HIV testing/counselling (SMD −0.24; 95% CI −0.44 to −0.03; I2 = 0%; p = 0.02); sharing of other injecting paraphernalia (SMD −0.24; 95% CI −0.42 to −0.06; I2 = 0%; p < 0.01) and unprotected sex (SMD −0.44; 95% CI −0.86 to −0.01; I2 = 79%; p = 0.04) compared to interventions of a lesser time/intensity, however, moderate to high heterogeneity was reported. Such interventions could be included with other harm reduction approaches to prevent BBV transmission among PWID.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- Department of General Practice, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Kideshini Widyaratna
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Julia Elena Marquez-Arrico
- Department of Psychiatry and Clinical Psychobiology, School of PsychologyUniversity of Barcelona, 08036, Barcelona, Spain
| | | | - Noreen Dadirai Mdege
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO24 2YD, UK
| | - Marrissa Martyn-St James
- School for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Judit Tirado-Munoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de Barcelona, 08003, Barcelona, Spain
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Abstract
An estimated 3% of the world population is infected with Hepatitis C virus (HCV), a hepatotropic RNA virus, transmitted primarily via the blood route. The major modes of transmission of the virus include injection drug use, unsafe injection practices, blood transfusion etc. HCV causes chronic hepatitis in about 80% of those infected by it. The mainstay in diagnosing infection with HCV is to initially screen high risk groups for antibodies to HCV (anti-HCV). The inclusion of serum to cut-off ratio (S/CO) in recent guidelines is helpful in deciding the supplemental assay to be used to confirm initially reactive screening results. Nucleic acid amplification tests (NAT) are used as confirmatory tools, and also to determine viral load prior to initiating treatment. Quantitative NAT has replaced qualitative assays. Genotyping is an important tool in clinical management to predict the likelihood of response and determine the optimal duration of therapy. The impact of this infection has begun to emerge in India. The problem of professional blood donation despite an existing law against it, and flourishing unsafe injection practices, are potential sources for the spread of hepatitis C in our country. All health care practitioners need to understand how to establish or exclude a diagnosis of HCV infection and to interpret the tests correctly. In the absence of a preventive or therapeutic vaccine, and also of post-exposure prophylaxis against the virus, it is imperative to diagnose infection by HCV so as to prevent hepatic insult and the ensuing complications that follow, including primary hepatocellular carcinoma (HCC). This review aims to help blood bank staff regarding options for diagnosis and management of donors positive for HCV.
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Affiliation(s)
- Ekta Gupta
- Department of Virology and Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Department of Virology and Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Aashish Choudhary
- Department of Virology and Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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