Abstract
BackgroundUK 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.MethodsA 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.ResultsFour 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.ConclusionsBBV 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.
Highlights
United Kingdom (UK) migrants born in intermediate to high prevalence areas for blood borne viruses (BBV) including hepatitis B, hepatitis C and Human immunodeficiency virus (HIV) are at increased risk of these infections
BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed
There were no substantial differences in knowledge of healthcare entitlements of migrants between General Practitioner (GP) and nurses; GPs were more likely to know that operations and outpatient appointments are not free, and nurses were more likely to know that care for female genital mutilation (FGM), torture etc. is free, which likely reflects their roles in general practice
Summary
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. Migrants in the UK from intermediate or high prevalence areas for HIV, hepatitis B (HBV) and hepatitis C (HCV) are at increased risk of these infections compared to the UK-born population, and experience a disproportionate burden of disease [1,2,3]. HBV and HCV testing in primary care for migrants from countries with intermediate or high prevalence (> 2%) has been recommended by National Institute for Health and Care Excellence (NICE) guidance since 2012 [10], and since 2018 European Centre for Disease Prevention and Control (ECDC) recommends screening newly arrived migrants for BBV [11]. Surveillance data indicates that an increasing proportion of BBV diagnoses take place in primary care, evidence suggests a low proportion of eligible migrants receive the recommended BBV testing in this setting [12, 13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
