Challenges and Solutions to Infectious Disease Screening and Catch-Up Vaccination of Migrants in Primary Care: an In-depth Qualitative Study

Conference:

SAPC ASM 2021 - virtual

Talk Code:

1E.1

Presenter:

Felicity Knights

Co-authors:

Jessica Carter 1, Felicity Knights 1, Anna Deal 1, 2, Sally E Hayward 1, 2, Alison Crawshaw 1, Sally Hargreaves 1

Author institutions:

1) Institute for Infection and Immunity, St George’s, University of London, UK - London (United Kingdom), 2Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK - London (United Kingdom)

Problem

Migrants in Europe face a disproportionate burden of infections such as tuberculosis, HIV, hepatitis B/C and chronic parasitic infection which go undiagnosed, and may be under-immunised. The ECDC has called for innovative strategies to deliver integrated multi-disease screening/catch-up vaccination to migrants within the primary-care/community context. We did an in-depth qualitative UK study to understand current practice, and seek views on a digitalised novel integrated screening Health Catch-Up tool (designed to identify screening requirements of migrants based on age and country-of-origin https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-wit...) to support primary healthcare professionals (PCPs) in better meeting needs of migrant patients.

Approach

We completed an in-depth qualitative study of primary healthcare professionals (PCPs). Participants were recruited from urban, suburban and rural settings (REC: 20/HRA/1674). Phase 1 consisted of interviews with clinical PCPs (general practitioners, nurses, health-care-assistants) and informed data collection and analysis for phase 2 (administrative PCPs). In-depth semi-structured telephone-interviews were conducted. Data were analysed iteratively, informed by thematic analysis

Findings

64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 pharmacist); Phase 2 comprised administrative staff (11 Practice-Managers, 5 receptionists). There was lack of consistency in delivery of screening for key infectious diseases and catch-up vaccination. The majority of practices either had their own or no system in place. HIV and hepatitis B/C were most likely to be screened for, with limited screening for parasitic infection. Barriers to screening were: perceived lack of knowledge/training and limited financial resources. Facilitators included having an infectious disease/migrant-health champion, incentivisation, and clear protocols. The majority of PCPs reported challenges to implementation of current screening programmes (e.g. latent TB) with complex pathways and workload as key reasons for poor rollout. Participants responded positively to the integrated Health Catch-Up tool, confirming that it would increase screening and vaccination, reduce missed opportunities for preventative healthcare, and raise awareness of migrant health.

Consequences

Infectious disease screening and catch-up vaccination is not currently delivered well in UK primary-care, with concerns raised in other high-migrant receiving European countries. Innovative digital tools like Health Catch-Up are considered valuable in increasing disease detection and facilitating improved health-outcomes for migrants, and need to be robustly tested

Submitted by:

Jessica Carter

Funding acknowledgement:

Dr Jessica Carter and Dr Sally Hargreaves are funded by the NIHR, Dr Sally Hargreaves is also funded by Academy of Medical Sciences.