The role of primary care in hepatitis B elimination in the UK migrant context, a mixed-methods study

Background: 300 million individuals live with chronic hepatitis B (CHB), with consequences including cirrhosis and cancer. In the UK migrants are disproportionately affected. Many are unaware of their diagnosis and face barriers accessing services. The WHO has called for elimination by 2030. Primary care (PC) is ideally placed but poorly engaged and utilised in CHB care. This study aims to explore UK PC contribution and approaches to strengthen CHB care from migrant and PC perspectives.

Methods: An online survey (21 questions on CHB knowledge/practice/barriers/care delivery) was advertised to PC practitioners. In-depth views were explored through (i) PC focus groups, (ii) semi-structured interviews with migrants with CHB lived experience. Results were analysed to give descriptive statistics and qualitative data using reflexive-thematic analysis.

Findings: 218 survey questionnaires, five PC focus-groups (n=16), and sixteen migrant participant interviews were completed. 63·5% of PC practitioners reported regularly seeing patients from high-prevalence countries but only 14·2% had screening policies and 80·3% were unaware of WHO targets. Barriers to CHB screening and management included knowledge, unstandardised pathways, workload, and stigma. 75·8% were under-confident interpreting results. Facilitators included simplified algorithms, specialist support, translated materials and peer-support. Almost 60% stated they would be comfortable with a CHB shared-care model with specialist oversight and funding. Contact-tracing, vaccination, and re-engaging those lost-to-care were identified improvement areas. Focus-groups reflected survey data, preliminary themes included potential of integrated care and empowerment of PC. Migrant participant interview data highlighted the impact of missed opportunities for CHB care on patient experience, importance of “making that first contact count” and sharing power and knowledge through a culturally competent patient-centred approach.

Interpretation: Integrated CHB care is in line with patient and provider preference and could support elimination progress. PC needs to be equipped with simplified pathways, sustainable integrated-care models, specialist support, funding, and culturally competent resources.