title: Low hepatitis B testing among migrants: a cross-sectional study in a UK city.
abstract: BACKGROUND
  In 2012, hepatitis B virus (HBV) testing of people born in a country with a prevalence of ≥2% was recommended in the UK. Implementation of this recommendation requires an understanding of prior HBV testing practice and coverage, for which there are limited data.
  
  
  OBJECTIVE
  To estimate the proportion of migrants tested for HBV and explore GP testing practices and barriers to testing.
  
  
  METHODS
  A cross-sectional study of (a) migrants for whom testing was recommended under English national guidance, living in Bristol, and registered with a GP in 2006-2013, and (b) GPs practising in Bristol.
  
  
  METHODS
  NHS patient demographic data and HBV laboratory surveillance data were linked. A person was defined as 'HBV-tested' if a laboratory result was available. An online GP survey was undertaken, using a structured questionnaire.
  
  
  RESULTS
  Among 82 561 migrants for whom HBV testing was recommended, 9627 (12%) were 'HBV-tested'. The HBV testing coverage was: Eastern Africa 20%; Western Africa 15%; South Eastern Asia 9%; Eastern Asia 5%. Of 19 GPs, the majority did not use guidelines to inform HBV testing in migrants and did not believe routine testing of migrants was indicated; 12/17 GPs stated that workload and lack of human, and financial resources were the most significant barriers to increased testing.
  
  
  CONCLUSIONS
  The majority of migrants to a multicultural UK city from medium-/high-prevalence regions have no evidence of HBV testing. Much greater support for primary care in the UK and increased GP awareness of national guidance are required to achieve adherence to current testing guidance.
authors.affiliation: Public Health England, Bristol, and European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm.
authors.forename: Iro
authors.initials: I
authors.lastname: Evlampidou
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, and NIHR Health Protection Unit on Evaluation of Interventions, University of Bristol, Bristol.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: Public Health Laboratory Bristol, Bristol and South West Health Protection Team, Public Health England, Bristol.
authors.forename: Charles
authors.initials: C
authors.lastname: Irish
authors.affiliation: Public Health England, South West Centre, Exeter.
authors.forename: Nick
authors.initials: N
authors.lastname: Young
authors.affiliation: Field Epidemiology Service, Public Health England, Bristol, and NIHR Health Protection Unit on Evaluation of Interventions, University of Bristol, Bristol.
authors.forename: Isabel
authors.initials: I
authors.lastname: Oliver
authors.affiliation: Public Health Laboratory Bristol, Bristol.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gillett
authors.affiliation: School of Cellular and Molecular Medicine, University of Bristol, Bristol.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cochrane
mesh_terms: D000328:Adult; D002947:Cities / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D013222:State Medicine / Q000458:organization & administration; D014171:Transients and Migrants / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D019037:Urban Health Services
keywords: UK; cross-sectional studies; diagnosis; general practice; hepatitis B; transients and migrants