Migrant health

Intended for Healthcare Professionals

Migrant health

David Bernard Lehane, NIHR Clinical Lecturer and General Practioner,, Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield
Other Contributors:
- Alicia Vedio, Infectious Diseases Physician, PhD Student, University of Sheffield, University of Sheffield School of Health and Related Research Section of Public Health
- Ann Gregory, Practice Nurse, Page Hall Medical Centre, Sheffield, Page Hall Medical Centre, 101 Owler Lane, Sheffield S4 8GB
- Caroline Mitchell, General Practitioner/Senior Clinical Lecturer, Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield, Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield

23 June 2016

It was with great interest that we read the articles in the recent ‘Migrant Health’ BJGP themed issue which highlights an issue of importance to UK practices serving diverse populations.^1-2 Page Hall Medical Centre adopted an ‘opt out screening’ process for blood borne viruses(BBV) in 2007 as part of our ‘new patient medical examination’. We undertook a prospective audit of the outcomes of this intervention, by self-assigned ethnicity, country of origin and language spoken, and noted increased rates of Hep B virus (HBV) positive results (9.4%)³ from migrant workers who identify themselves as Roma Slovak. This contrasts strongly to the stated HBV prevalence in the wider Slovakian population (<0.6%).⁴ Our adoption of an ‘opt out BBV screening’ policy for all new patients has identified an at risk group which would not have been screened, had we strictly adhered to NICE guidance.⁵

Presentation of our audit data prompted the commissioning of a Local Enhanced Service to facilitate testing and contact tracing for HBV of the newly arrived Slovakian citizens.

Our commitment to providing culturally congruent care alongside practice audit has led us to conclude that the stated back ground prevalence for certain countries may not accurately reflect the needs of distinct ethnic or disadvantaged groups that have recently arrived in the UK. A ‘one stop new patient medical’ with ‘opt out’ BBV screen allows a comprehensive health screen of new migrants and early BBV detection, intervention and contact tracing for high risk vulnerable groups unaccustomed to NHS models of care.

References

1. O’Kelly M, Byrne D, Naughten E, Bergin C, Williams C. Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study. Br J Gen Pract 2016; 66(647):e392–6.

2. Evlampidou I, Hickman M, Irish C, et al. Low hepatitis B testing among migrants: a cross-sectional study in a UK city. Br J Gen Pract 2016; 66(647):e382–91.

3. Gregory A, Vedio A, Stone B, Green S, Bronsdon C. Targeted testing in primary care demonstrates high prevalence of hepatitis B infection within the Slovak-Roma population in Sheffield, UK. J Viral Hepat 2014; 21(10):138–9.

4. European Centre for Disease Prevention and Control. Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease and screening policies. 2010. http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_C _EU_neighbourhood.pdf (accessed 23 Jun 2016)

5. NICE. Hepatitis B and C testing : people at risk of infection. 2012. www.nice.org.uk/guidance/ph43/resources/hepatitis-b-and-c-testing-people-at-risk-of-infection-1996356260293 (accessed 23 Jun 2016)

Competing Interests: None declared.

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