Abstract
Background: 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. 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. Methods: A 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. Results: Four 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. Conclusions: BBV 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.
| Original language | English |
|---|---|
| Article number | 336 |
| Number of pages | 23 |
| Journal | BMC Public Health |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 11 Feb 2021 |
Bibliographical note
Funding Information:The research was funded by the National Institute for Health Research Health Protection Research Unit [NIHR HPRU] in Blood Borne and Sexually Transmitted Infections at UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Public Health England. MP is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr. Manish Pareek, PDF-2015-08-102). The funders had no role in study design, data collection and analysis, or preparation of the manuscript. The final draft was circulated with the NIHR HPRU steering group prior to submission. AFC is funded by the Academy of Medical Sciences (SBF005\1111) and the NIHR (NIHR300072).
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords
- Blood borne virus
- General practice
- HIV
- Healthcare access
- Hepatitis B
- Hepatitis C
- Migrants
- Screening
- Testing
- UK
