Referral of newly diagnosed chronic hepatitis B and C patients in six EU countries: results of the HEPscreen Project.
Effective linkage to specialist care following screening is crucial for secondary prevention of chronic viral hepatitis-related consequences.



To explore the frequency of referral of patients to secondary care from the health services involved in screening and to gather information on the services responsible for the provision of post-test counselling and contact tracing, four online surveys were conducted among general practitioners (GP), and experts working in sexual health services (SHS), antenatal care (ANC) and specialist secondary care in Germany, Hungary, Italy, The Netherlands, Spain and the UK.



Overall, 60% of GPs report referring all patients to specialist care. Although 67% of specialists commonly receive patients referred by GPs, specialists in Germany rarely or never receive patients from ANC or from centres testing injecting drug users; and specialists in the Netherlands, Hungary and Germany rarely receive patients from SHS. Gastroenterologists/hepatologists are the professionals mainly responsible for the provision of counselling following a positive diagnosis of viral hepatitis according to two-thirds of specialists, 14% of SHS providers and 11% of ANC providers. Almost half of ANC providers (45%) stated that gynaecologists are the professionals responsible for the provision of counselling to positive pregnant women; among SHS providers, only 14% identified SHS as the services responsible.



Our findings suggest the existence of complex/ineffective referral practices or that opportunities to screen risk groups are missed. Recommendations clarifying the services responsible at each step of the referral pathway are needed in order to increase the success of screening programmes.
1 Department of Health Sciences, University of Florence, Viale G. B. Morgagni 48, Florence, 50134, Italy miriam.levi@unifi.it.
Miriam
M
Levi
2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands 3 Division of Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
Abby
A
Falla
1 Department of Health Sciences, University of Florence, Viale G. B. Morgagni 48, Florence, 50134, Italy.
Cristina
C
Taddei
4 Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany.
Amena
A
Ahmad
2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands 3 Division of Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
Irene
I
Veldhuijzen
1 Department of Health Sciences, University of Florence, Viale G. B. Morgagni 48, Florence, 50134, Italy.
Giuditta
G
Niccolai
1 Department of Health Sciences, University of Florence, Viale G. B. Morgagni 48, Florence, 50134, Italy.
Angela
A
Bechini
D005062:European Union; D005858:Germany / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology