General practitioners' knowledge and management of viral hepatitis in the migrant population.

BACKGROUND: Escalating morbidity and mortality associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent a major health burden in Australia, particularly among migrants from endemic areas who may present late. METHODS AND AIMS: We evaluated the knowledge and educational needs of general practitioners (GPs) in the St George Division, Sydney which serves a large migrant population. The aims of the study were to identify gaps in knowledge about viral hepatitis that may affect management and referral patterns. GPs completed a survey comprised of 15 questions. They were also invited to comment on barriers to managing viral hepatitis in migrant patients. RESULTS: A 44% response rate was achieved from 280 eligible GPs. Forty-two per cent of GPs lacked confidence in interpreting HCV serology and 20% for HBV serology. Twenty-two per cent of GPs did not recognise HCC as a complication of HBV and 18% for HCV. Twenty per cent of GPs were unaware of treatment for HBV. Forty-seven per cent of GPs were uncertain whether pregnant women could receive HCV treatment. Twenty-three per cent and 21% of respondents believed that all HCV- or HBV-infected mothers, respectively, should not breast-feed. Eighty-nine per cent of GPs identified language difficulties as the main barrier to treatment among the migrant population. CONCLUSIONS: There were gaps in the knowledge of GPs particularly concerning natural history, diagnosis, treatment availability and management of pregnant or lactating women with viral hepatitis. Specific educational initiatives targeting these deficits are required as well as increased availability of language resources for managing patients from a non-English-speaking background.

Barriers faced by migrants in accessing healthcare for viral hepatitis infection.

BACKGROUND: The morbidity and mortality of hepatitis B virus- and hepatitis C virus-related complications are disproportionately higher in the culturally and linguistically diverse population (CALD) when compared with Australian-born individuals. AIM: This project aims to elucidate the barriers faced by the CALD population in accessing viral hepatitis management. METHOD: CALD outpatients attending a viral hepatitis clinic in a tertiary teaching hospital were invited to participate in interviews. Questions pertained to: reason for screening for viral hepatitis, barriers to healthcare, perceived community view of viral hepatitis, main source of information of viral hepatitis and suggestions to engage members of CALD to seek healthcare. RESULTS: The total number of participants was 60. The two major countries of birth included China (40%) and Egypt (17%). In 40% of the cohort, viral hepatitis was identified through screening programmes. Importantly, 37% were diagnosed as a result of complications of hepatitis infection, presenting late in the stage of disease. Forty-five per cent of participants perceived language to be a chief barrier. twenty-two per cent reported cultural barriers to accessing healthcare. Of these, 53% reported fear of discrimination/stigma. The lack of knowledge of available treatments/options was stated as a major obstacle in 40%. The two prevailing recommendations were greater education and awareness (85%) and changes in the health system itself (11%). CONCLUSION: Substantial hurdles identified by participants include cultural differences, language difficulties, cultural beliefs, stigma and misinformation. These data demonstrate the need for the greater dissemination of information in culturally and linguistically appropriate mediums to raise awareness about viral hepatitis, pathogenesis and available treatments.