title: Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries.
abstract: To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol.
  
  
  
  An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction).
  
  
  
  From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent.
  
  
  
  Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Abby M
authors.initials: AM
authors.lastname: Falla
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Irene K
authors.initials: IK
authors.lastname: Veldhuijzen
authors.affiliation: Department of Health Sciences, Hamburg University of Applied Sciences, Faculty Life Sciences/Public Health Research, Hamburg, Germany.
authors.forename: Amena A
authors.initials: AA
authors.lastname: Ahmad
authors.affiliation: Department of Health Sciences, Division of Hygiene, Preventive Medicine and Public Health, University of Florence, Florence, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Levi
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Hendrik Richardus
mesh_terms: D000437:Alcoholism / Q000150:complications; D005060:Europe; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000150:complications / Q000628:therapy*; D006526:Hepatitis C / Q000150:complications / Q000628:therapy*; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D012036:Refugees / Q000706:statistics & numerical data; D012306:Risk; D013222:State Medicine / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications; D014171:Transients and Migrants / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000706:statistics & numerical data*