Dépistage des hépatites au sein d'une association culturelle et cultuelle pakistanaise : retour d'expérience.

INTRODUCTION: Pakistan has the second highest prevalence of hepatitis C globally. The Musafir study, set up in 2018 in a Parisian suburb to understand the representations of hepatitis and HIV within the Urdu-speaking, male, migrant community living there, provided an opportunity to think about culturally acceptable health promotion interventions. These included awareness campaigns on hepatitis—which did not cover the question of HIV, considered taboo—, held in a mosque. PURPOSE OF THE RESEARCH: The aim of this article is to describe the implementation of awareness and testing campaigns within a Pakistani religious and cultural association. METHOD: A partnership with a Pakistani association that runs a place of worship enabled awareness and testing campaigns for hepatitis and HIV to be carried out, thanks to the involvement of the association’s managers and the imam. RESULTS: Between February and June 2023, 113 people were tested during the five campaigns that were carried out. The population screened consisted almost exclusively of Urdu-speaking men. Anti-HCV antibodies were found in six people, three of whom had already recovered, and two people tested positive for HBV. No cases of HIV were detected. CONCLUSIONS: The prevalence of hepatitis C found was 5.3 percent, in line with the prevalence in Pakistan. This experiment highlighted the feasibility conditions of a partnership with a faith-based organization and offers ideas for developing this type of initiative in France.

Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study.

BACKGROUND: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. OBJECTIVE: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. METHODS: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. RESULTS: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. CONCLUSIONS: First, our study revealed the breadth of patient's unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator's work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination.