title: Barriers and opportunities for hepatitis B testing and contact tracing in a UK Somali population: a qualitative study.
abstract: Chronic hepatitis B virus (HBV) infection frequently causes liver disease, and early identification can improve outcome. The burden of chronic HBV infection in many economically developed nations lies in migrant populations. Targeted HBV testing of migrants, and contact tracing for those diagnosed, are public health objectives but uptake has been fragmentary. This qualitative study aimed to investigate understanding of hepatitis B and response to testing and contact tracing amongst people of Somali ethnicity living in Bristol, UK.
  
  
  
  The views of 30 people of Somali ethnicity living in Bristol were explored through focus groups and semi-structured interviews. Transcripts of audio-recorded interviews and focus groups were imported into NVivo10 and inductive thematic analysis undertaken.
  
  
  
  Most participants lacked awareness of hepatitis B, and often co-identified hepatitis B with 'jaundice'. There were frequent misconceptions regarding transmission, natural history and diagnosis, with hepatitis B commonly viewed as a relatively trivial, short lived, symptomatic disease. Hepatitis B was generally not stigmatised. Lack of understanding of the disease was cited as the major barrier to targeted testing and contact tracing.
  
  
  
  These findings suggest public health initiatives to promote hepatitis B testing and contact tracing within migrant Somali populations should focus on improving hepatitis B understanding, particularly its natural history and diagnosis, and avoid translation of 'hepatitis B' into terms meaning 'jaundice' to address misperception of low susceptibility and low severity.
authors.affiliation: School of Cellular and Molecular Medicine, University of Bristol, University Walk, Bristol BS8 1TD, UK alex.cochrane@bristol.ac.uk.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cochrane
authors.affiliation: Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, Avon BS2 8HW, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Horwood
mesh_terms: D000328:Adult; D000368:Aged; D016358:Contact Tracing / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012307:Risk Factors; D012998:Somalia / Q000208:ethnology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology