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A community-based action led by IGTP facilitates screening and access to treatment for viral hepatitis among migrant populations in Catalonia

28 July, World Hepatitis Day

- Campus Can Ruti, Projects, Research

On the occasion of World Hepatitis Day, IGTP presents the results of the HepBClink project, which has combined community educational actions on hepatitis B and C with screening and referral to treatment for migrants from Pakistan, Senegal and Romania. The project has involved the participation of the Pathogen Diagnostics and Genomic Epidemiology group (DxEpiPath) at IGTP and is part of the Tranversal Program in Public Health and Primary Care (CORE).

A transdisciplinary team led by Dr Elisa Martró has developed and implemented a new community-based action to improve diagnosis and access to treatment for hepatitis B and C among migrant populations in the province of Barcelona. The HepBClink project builds on previous experience focused on the Pakistani community (HepClink) and expands the action to migrants from Senegal and Romania, three communities with high representation in Catalonia and a high prevalence of these viral infections.

Community screening and dried blood spots to improve detection

The DxEpiPath group has applied its expertise in the use of dried blood spot (DBS) samples since 2015 for confirmatory detection of the hepatitis C virus (HCV) genome, as well as for virus genotyping through sequencing. Within the framework of the HepBClink project, the usefulness of DBS samples for detecting the DNA of the hepatitis B virus (HBV) in these populations has also been evaluated.

The results show that this type of sample makes it possible to identify most people with viral loads above 2,000 IU/mL, who may require treatment. This complements rapid testing (detection of the hepatitis B surface antigen, HBsAg) and facilitates linkage to the healthcare system for liver tests and therapeutic assessment.

High acceptance and impact among populations with access barriers

Of the 849 migrants contacted, 92.6% (786 people) took part in the project. A total of 68 community actions were carried out in locations relevant to each group: consulates, mosques and taxi schools for the Pakistani community; associations and settlements for the Senegalese community; and churches, homes and institutional spaces for the Romanian community. Most participants (78.9%) had been living in Spain for more than five years, and 92.4% held a health card, but only 9% had previously been tested for these infections.

Knowledge about hepatitis B and C was very limited, especially among men, and nearly 80% of participants were unaware of their vaccination status for HBV. These results highlight the need for integrated education, screening and vaccination programmes aimed at migrant populations.



New diagnoses and access to treatment

The results obtained show an HBV prevalence (HBsAg carriers) of 0.9% among the Pakistani population, 8.2% among the Senegalese and 1.4% among the Romanian population. The prevalence of previous HCV infection (presence of antibodies) was 3.5%, 0.7% and 1.4% among migrants from Pakistan, Senegal and Romania, respectively. In total, 23 new HBV diagnoses and 16 HCV diagnoses were detected, of which 6 cases were active infections (HCV-RNA positive). Of these, 4 initiated treatment and 2 were cured. Despite the difficulties in reaching and referring individuals to the healthcare system during the COVID-19 pandemic, the project has proven effective in reaching groups facing barriers to accessing healthcare.

A model with potential for scaling up

The HepBClink community action exemplifies research with an integrated and collaborative approach aimed at generating knowledge and impact on public health policies. It has involved the collaboration of professionals from Hospital Germans Trias, IGTP and CEEISCAT, together with the Public and Community Health Team (eSPIc) of the Vall d'Hebron-Drassanes International Health Unit (which coordinated the community actions), hepatologists from Vall d'Hebron Hospital and the Catalan Public Health Agency.

"This project is an example of research with an integrated and collaborative approach that has enabled us to generate knowledge to guide the management and development of public health policies based on scientific evidence, while also empowering migrant communities and improving equity in access to healthcare through an innovative, people-centred model," says Dr Elisa Martró, IGTP researcher and project coordinator.

The results have been shared in international forums and publications such as INHSU, ACHIEVE Coalition and the Viral Hepatitis Prevention Board (VHPB). They have also served as the basis for the MiCatC project of the Catalan Public Health Agency, which explores the feasibility of scaling up this decentralised model to other regions as part of the Catalan Plan for the Prevention and Control of Hepatitis C. "The HepClink and HepBClink projects have been the foundation for piloting this decentralised care model in other regions, as a strategy to move towards the hepatitis elimination goals set by the WHO," she adds.

This article is part of Anna Not's PhD thesis: "Micro-elimination of hepatitis B and C in vulnerable populations through new strategies of education, screening and treatment".
 

This study was supported to E.M. by the Instituto de Salud Carlos III through the project PI19/0568 (co-funded by the European Regional Development Fund, 'A way to make Europe'). A.N. held a PFIS grant (Ref. FI20/00211, Instituto de Salud Carlos III, European Social Fund).

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