Article type
Year
Abstract
Background: Over 350,000 deaths are attributed to viral hepatitis infection annually, a high proportion of which are among migrants from high endemic regions. Socio-economic barriers and the lack of an effective viral hepatitis model of care for migrants contribute to hepatitis mortality and morbidity. Given the multi-faceted nature of the hepatitis care cascade for migrants and the dynamic change of migrant care policy, there is a need to synthesize evidence on the effectiveness of the hepatitis care cascade, as well as barriers and facilitators at each step along the continuum.
Objectives:
1. To assess the effectiveness of interventions along the hepatitis care cascade on screening, referral, treatment uptake and completion among migrant populations
2. To identify barriers and facilitators along the care cascade for migrants living with viral hepatitis
Methods: We searched five databases and grey literature published until January 2020. We conducted a mixed-method synthesis by developing a conceptual framework (Fig.1), undertaking qualitative comparative analysis (QCA), and meta-analysing outcomes where appropriate. The certainty of the evidence was assessed using the GRADE and GRADE CERQual approaches.
Results: 1448 studies were screened by title and abstract, followed by full-text. We Included 52 studies providing information for our QCA and 84 quantitative studies measuring the effect of interventions. Our preliminary results highlighted the importance of access to screening and treatment. Facilitators included trust in the provider, and peer and navigation support. Language differences, health literacy, hepatitis-related stigma, and a lack of migrant resources were identified as barriers to successful implementation of the hepatitis care cascade. The estimated yield of hepatitis C screening was 31.20 cases per 1000 screened (95% CI: 25.65-37.86; I2=35.83%). The comparison of the screening uptake of physician-delivered clinic-based programs versus community outreach programs was 80.30% versus 20.51% (95% CI: 57.59-92.44% vs. 9.66-38.37%; p-value < 0.001)(Fig.2). Effects of interventions on linkage to viral hepatitis treatment are uncertain due to the variation between the results of the studies. Interventions that engaged parents, community members, and healthcare providers might be associated with successful implementation. Evidence is insufficient to show whether sustained viral suppression is affected by specific features of interventions.
Conclusions: Our study provides evidence on effective interventions to optimize screening uptake along the care cascade for migrants living with chronic viral hepatitis. We identified the facilitators and barriers of successful implementation of viral hepatitis care for migrants from the perspective of healthcare providers and patients to inform future implications.
Patient or healthcare consumer involvement: The input of the clinicians specialized in migrant health and hepatitis and the patients had been incorporated into our outcome choice process along with data interpretation.
Objectives:
1. To assess the effectiveness of interventions along the hepatitis care cascade on screening, referral, treatment uptake and completion among migrant populations
2. To identify barriers and facilitators along the care cascade for migrants living with viral hepatitis
Methods: We searched five databases and grey literature published until January 2020. We conducted a mixed-method synthesis by developing a conceptual framework (Fig.1), undertaking qualitative comparative analysis (QCA), and meta-analysing outcomes where appropriate. The certainty of the evidence was assessed using the GRADE and GRADE CERQual approaches.
Results: 1448 studies were screened by title and abstract, followed by full-text. We Included 52 studies providing information for our QCA and 84 quantitative studies measuring the effect of interventions. Our preliminary results highlighted the importance of access to screening and treatment. Facilitators included trust in the provider, and peer and navigation support. Language differences, health literacy, hepatitis-related stigma, and a lack of migrant resources were identified as barriers to successful implementation of the hepatitis care cascade. The estimated yield of hepatitis C screening was 31.20 cases per 1000 screened (95% CI: 25.65-37.86; I2=35.83%). The comparison of the screening uptake of physician-delivered clinic-based programs versus community outreach programs was 80.30% versus 20.51% (95% CI: 57.59-92.44% vs. 9.66-38.37%; p-value < 0.001)(Fig.2). Effects of interventions on linkage to viral hepatitis treatment are uncertain due to the variation between the results of the studies. Interventions that engaged parents, community members, and healthcare providers might be associated with successful implementation. Evidence is insufficient to show whether sustained viral suppression is affected by specific features of interventions.
Conclusions: Our study provides evidence on effective interventions to optimize screening uptake along the care cascade for migrants living with chronic viral hepatitis. We identified the facilitators and barriers of successful implementation of viral hepatitis care for migrants from the perspective of healthcare providers and patients to inform future implications.
Patient or healthcare consumer involvement: The input of the clinicians specialized in migrant health and hepatitis and the patients had been incorporated into our outcome choice process along with data interpretation.