Point of care screening tests for hepatitis B and commitment of a dedicated nurse lead to succesful linkage to care of ethnic minorities

ABSTRACT

Background and aims: In low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective to reduce the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. We previously found outreach screenings for HBV using point of care tests (POCT) to result in a 2.5 times higher LTC compared to venepunctures in an Asian migrant population. In the current study we compared LTC between different ethnic groups screened for HBsAg with POCT in an outreach setting. A secondary objective, was to compare the estimated HBsAg seroprevalence for ethnic minorities to the established prevalence in the general population in order to guide future screening initiatives. Method: Opportunistic outreach screenings using finger prick Vikia HBsAg tests were performed at municipal integration classes between 11/2017 and 03/2021. If tested positive, an appointment was given immediately at the outpatient hepatology clinic for followup and confirmation of HBsAg positivity in blood. A dedicated nurse contacted identified patients via phone, social media or home visits to motivate them for further linkage to care. The latterwas defined as having received medical care from a hepatologist, a blood test and an abdominal ultrasound. Results: A total of 521 persons with different ethnicities (Asia, Middle-East and Africa)were serologically screened using POCT tests. The seroprevalence for HBsAg was 3.45% (18/521) and was significantly higher compared to that of the general population (i.e. 0.66% in 2003 (p < 0.0001)). All HBsAg-positive patients were linked to care and assessed by a hepatologist. LTC for all ethnicities combined (p < 0.0001), for Sub-Saharan African patients (p = 0.023) and Middle- Eastern patients (p < 0.0001) was significantly higher compared to the previously observed rate of 34.38% (11/32 patients) using venepunctures as a screening method, but without the commitment of dedicated nurse. Among the HBV infected patients, 22.22% (4/18), 83.33% (15/18) and 22.22% (4/18) met criteria for treatment indication, intrafamilial transmission risk and HCC surveillance respectively. Despite COVID-19 pandemic, linkage to care remains high using POCT and through the commitment of a dedicated nurse. However, the time frame between screening and the first hospital visit is significantly higher (p = 0.0049) during the COVID-19 pandemic than in the pre-pandemic period.(Figure Presented) Conclusion: HBsAg seroprevalence in ethnic minorities is higher than the general population andwarrants targeted screening. Most of the identified patients meet the indication for treatment, counseling to prevent intrafamilial transmission or HCC surveillance. In addition, the use of POCT and commitment of a dedicated nurse can overcome previously identified barriers for linkage to care.