Bridging the Knowledge Gap in Viral Hepatitis

There is a significant knowledge gap about hepatitis B (HBV) and hepatitis C (HCV) among migrant and refugee populations in Catalonia, Spain, despite their increased risk. The VH-COMSAVAC project aims to improve testing, care, and vaccination for these communities. There is a broader lack of awareness in our local communities. Here are some basics about these diseases, their severe consequences, and the importance of early diagnosis and treatment. .

Did you know that less than half of migrant and refugee populations in Catalonia (Spain) are aware of what hepatitis B (HBV) and hepatitis C (HCV) are, despite their increased risk? This finding is the latest to be reported from EU co-funded project VH-COMSAVAC, an initiative aimed at scaling up and adapting a community-based model of care for HBV and HCV testing and linkage to care and HBV vaccination among migrant and refugees from intermediate and high prevalence countries.

But, this gap in knowledge isn’t just limited to these groups. Many people in our local communities are also unaware of these diseases, their potential life-threatening consequences, and the preventative measures available.

In recognition of World Hepatitis Day, we wanted to take a step back with our readers to review some of the basics, including common myths and misconceptions and the importance of early diagnosis and treatment. You won’t learn everything there is to know, but like those community members in our project, you’ll understand how better health knowledge can translate to better health outcomes.

HBV and HCV: Tell Me More

HBV and HCV are just two of the five known viruses that can cause viral liver infections. If chronic, and left untreated, they can lead to severe health problems such as liver cirrhosis, liver cancer, and even death. It is possible that chronic cases of HBV and HCV infections do not present any noticeable symptoms in the beginning. This is one reason why such infections are termed as “silent killers”. These viruses, nonetheless, live in the body, damaging the liver over time.

HBV has a safe and effective vaccine that offers 98-100% protection against HBV. Treatment is also available, but it is not curative. Currently, not everyone is eligible for treatment despite the update and expansion of eligibility criteria in the new WHO hepatitis B treatment guidelines.

Like HBV, HCV is a bloodborne virus. There is no vaccine available, which means other preventive approaches play a critical role in reducing the risk of exposure to the virus. Contrary to HBV, there is a cure available for HCV; and cure rates can reach more than 95% among those treated.

Busting Common Myths and Misconceptions

1. Myth: You can catch viral hepatitis by sharing food or casual contact. Reality: HBV and HCV are not spread through casual contact, such as hugging, kissing, or sharing utensils. They are blood-borne viruses, meaning they spread through blood and bodily fluids. This means that sharing razors or toothbrushes may be a route of transmission since there is possible exposure to blood.
2. Myth: There’s no effective treatment for viral hepatitis. Reality: While there's no cure for HBV, it can be managed with antiviral medications. HCV, on the other hand, can be cured with direct-acting antiviral medications, making early diagnosis and treatment vital.
3. Myth: Viral hepatitis only affects people with risky behaviours. Reality: While behaviours like injecting drug use can increase risk, viral hepatitis can affect anyone. It can be transmitted through unscreened blood transfusions, unsterilised medical equipment, and from mother to child during childbirth.

The Importance of Early Diagnosis and Treatment

Early diagnosis of hepatitis can make a world of difference. The sooner viral hepatitis is detected, the better the chances of preventing severe liver damage.

Regular screening, especially for those at higher risk, is essential. Treatments available today are more effective than ever, significantly improving quality of life and reducing the risk of liver cancer.

You can live without symptoms for years, so testing is the only way to know if you have the virus

Preventative Measures: Vaccinations and Hygiene Practices

Vaccination is a powerful tool in preventing viral hepatitis B infections. There is a safe and effective vaccine for HBV, which has been included in many countries’ childhood vaccination schedules since the early 90s. It is also recommended for adults at risk. As part of prenatal care, all pregnant women should get a blood test for HBV to reduce the risk of mother-to-child transmission at birth.

For HCV, while no vaccine exists, preventive measures are crucial, e.g., harm reduction strategies for migrants who use drugs. This includes needle and syringe programmes (NSPs), safe consumption spaces, opioid substitution therapy (OST), and access to health and social services.

The Impact of Viral Hepatitis on Vulnerable Populations

For many of us, accessing healthcare is relatively straightforward. However, for migrant and refugee populations coming from intermediate or high prevalence countries, the reality can be starkly different.

Within the scope of the VH-COMSAVAC Project, our researchers were able to collect and present some initial findings from 1-year data retrieved while implementing the community-based model for HBV and HCV testing, HBV vaccination and linkage to care among these populations with documented mid/high incidence and prevalence.

We found that viral hepatitis continues to impact these individuals negatively. For example:

• Migrants residing in Europe who originated from regions with a mid/high prevalence of HBV and HCV might be unaware of their status due to the inadequacy of testing and vaccination in their home countries or complicated care pathways in their host countries.
• Of the 470 people screened across three European countries (Greece, Italy and Spain), less than half (43%) of these populations knew what HBV and HCV were.
• Most (58.3%) reported never having been tested for HBV or HCV.
• Only 8.3% of participants reported being fully vaccinated against HBV.

These figures highlight how higher-risk migrants and refugees continue to face hurdles when it comes to viral hepatitis knowledge, testing, and care. Aspects like language barriers and cultural differences can make it harder for these individuals to navigate their country's host health systems, get diagnosed, and receive timely treatment. At the same time, because migrants experience structural, cultural, and legal challenges to accessing healthcare, services like testing remain underused.

The Time Has Come to Act

In the spirit of World Hepatitis Day's theme, "Act Now", VH-COMSAVAC is determined to change the status quo and meet the 2030 World Health Organization (WHO) hepatitis elimination targets. Our current work highlights the need for community-based viral hepatitis testing strategies to be culturally and linguistically appropriate, so migrant and refugee populations at higher risk of HBV and HCV acquisition may also receive the care we all deserve.

In the same vein, we urge community members to get tested at local community and primary care centres. If you too are working in healthcare or community services, we invite you to learn from our experience and consider how you can make your materials more culturally and linguistically inclusive for more diverse populations.

Every step we take—whether for ourselves or others—raises awareness, reduces the risk of viral hepatitis transmission, and improves care. By understanding viral hepatitis, debunking myths, advocating for early diagnosis, and supporting preventive measures, we can bridge the knowledge gap and welcome healthier outcomes for all.