A novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain

Camila A Picchio,Emma Fernández,Daniel K Nomah,Ariadna Rando-Segura,Jeffrey V Lazarus,Silvia G Araujo,Maria Buti,Sabela Lens,Sergio Rodríguez-Tajes,Francisco Rodríguez-Frías

doi:10.1038/s41598-021-96350-3

Abstract

Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use point-of-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. From 21/11/20 to 03/07/2021, 314 study participants were offered HBV screening in a community clinic. Rapid tests for HBsAg screening were used and blood samples were collected with plasma separation cards. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. Sociodemographic and clinical history were collected and descriptive statistics were utilized. 274 patients were included and 210 (76.6%) returned to receive results. The HBsAg prevalence was 9.9% and 33.2% of people had evidence of past resolved infection. Overall, 133 required vaccination, followed by post-test counselling (n = 114), and linkage to a specialist (n = 27). Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools, HBV-COMSAVA demonstrated that it was possible to diagnose, link to care, and vaccinate African migrants in community-based settings.

Highlights

Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the World Health Organization (WHO) elimination targets
In West Africa, hepatocellular carcinoma (HCC) is the leading cause of cancer deaths in males and estimates report that 25% of young adults which have been infected during childhood will die prematurely from chronic HBV complications[5]
In Spain, the number of migrants arriving from African countries such as Ghana has increased substantially in the last years, and the prevalence of HBV among these migrant groups needs to be addressed by the Spanish public health system[6]

Summary

Introduction

Chronic hepatitis B virus (HBV) infection is a major public health threat for migrant populations in Spain and efforts to scale up testing are needed to reach the WHO elimination targets. The Hepatitis B Virus Community Screening and Vaccination in Africans (HBV-COMSAVA) study aims to use pointof-care testing and simplified diagnostic tools to identify, link to care, or vaccinate African migrants in Barcelona during the COVID-19 pandemic. Patients received results and were offered: linkage to specialist care; post-test counselling; or HBV vaccination in situ. A systematic review and meta-analysis in Ghana reported that the hepatitis B surface antigen (HBsAg) prevalence ranged from 0.55 to 14.3%7 and the risk of being infected with HBV in most subSaharan African countries is estimated to be more than 60%8,9. Refer to specialist care^ Past resolved infection, inform of status and provide post-test counselling If no prior vaccination reported, offer vaccination against HBV. Decision algorithm for care in the HBV-COMSAVA study, November 2020–July 2021. ^Those who were HBsAg + were referred to a specialist irrespective of the HBV-DNA viral load detected on the PSC

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Methods

Results

Discussion

Conclusion