Project Initiation Document
Project Name
Hepatitis (B and C) Awareness and Testing in Minority Ethnic Populations
(HATMEP)
Sponsor
Lothian Viral Hepatitis Managed Care Network
Project Leads
Mina O’Hara, Lindsay Bowden, Karen Matthews, in conjunction with MEHIS
Start Date
January 2013
Completion Date
March 2015
Aims
 To work with minority ethnic groups in Lothian representing
high/intermediate prevalence countries (for viral hepatitis) to educate,
inform and raise awareness about hepatitis B and C, including
awareness about prevention and prevention of onward transmission.
 To offer testing following education sessions to those over 16 years1,
for hepatitis B and C, and HIV if appropriate.
 Collaborate with GPs to raise awareness about potential need for
testing in these populations.
 Offer referral to secondary care to those with a positive result.
 Explore feasibility of offering a regular community-based outreach
testing clinic in conjunction with MEHIS
 Gather together a stock of resources in translation including audio
visual
Objectives
Eastern/Central European communities
 Procure or produce materials in Polish encouraging Polish people to
get tested for Hepatitis B (and at the same time Hep C) and to use
existing services e.g. GPs and other testing clinics.
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
Work with Polish community outlets e.g. shops, churches, clubs,
consulate to promote materials, and raise awareness.

Work with Harm Reduction Team regarding materials in Polish relating
to injection of performance and image enhancing drugs.
People under 16 years of age will be signposted to their GP if appropriate
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
Work with GPs to discuss why Polish people may be requesting testing
for hepatitis B.

Investigate how we can reach the Romanian, Slovenian and Lithuanian
populations, especially the Romanians whose numbers are expected to
increase in Lothian in the near future. Build links with groups or
institutions where Romanians congregate (e.g. Romanian Consulate,
Orthodox Church in Meadow Place, Streetwork and Homeless
organisations, and the car boot sale in the Omni) and consider offering
testing clinics as a way of raising the profile of Hepatitis C testing.

Advise that those placing themselves at risk when abroad can seek
hepatitis B immunisation at a private travel clinic or GP. Immunisation
for travel purposes will most likely incur a fee in general practice.
South Asian communities
 Make available materials in Urdu, Punjabi, Bengali encouraging people
from South Asia to get tested for hepatitis B and C and to use existing
services e.g. GPs and other testing clinics.

Continue to make links with community/faith groups to raise
awareness, offer on-site testing for hepatitis B and C, and refer all with
a positive result on to secondary care services.

Work with GPs to discuss why people from South Asia may be
requesting testing for hepatitis B and C.

Advise that those placing themselves at risk when abroad can seek
hepatitis B immunisation at a private travel clinic or GP. Immunisation
for travel purposes will most likely incur a fee in general practice.

Advise those identified as positive who have children to seek testing for
children at RHSC and hepatitis B immunisation for household contacts
at GP
Chinese communities
 Make available materials in Chinese languages encouraging people
from China to get tested for hepatitis B and to use existing services e.g.
GPs and other testing clinics.

Work with MEHIP to refresh the 2002 Chinese Hepatitis B Education
Project; this time offering on-site testing at the same time. Refer all with
a positive result on to secondary care services.
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
Work with GPs to discuss why people from China may be requesting
testing for hepatitis B.

Advise that those placing themselves at risk when abroad can seek
hepatitis B immunisation at a private travel clinic or GP. Immunisation
for travel purposes will most likely incur a fee in general practice.

Advise those identified as positive who have children to seek testing for
children at RHSC and hepatitis B immunisation for household contacts
at GP
African communities
In the longer term it is hoped that joint work can be carried out with African
communities in conjunction with Waverley Care.
Deliverables
 Information for communities in translation
 Operational policy describing service delivery and follow-up
 Information and awareness raising sessions, developed with
community/faith groups
 On-site testing sessions
 Materials for general practice e.g. local AIDS sheets
Rationale and policy guidance
People born or brought up in a country with an intermediate or high
prevalence (2% or greater) of chronic hepatitis B are at increased risk of
hepatitis B compared with the general UK population. This includes all
countries in Africa, Asia, the Caribbean, Central and South America, Eastern
and Southern Europe, the Middle East and the Pacific islands.
The HPA migrant health site suggests screening all Polish people for hepatitis
B and only to screen for hepatitis C if other risk factors apply (injecting drug
use is biggest risk in Poland). The same advice applies to Latvia, Bulgaria and
Estonia.
The HPA migrant health site says that for Romania, Slovenia, Lithuania have
an intermediate prevalence of hepatitis B and consideration should be given
to screening for hepatitis B, particularly among those who have recently
arrived. These countries also have a considerably higher prevalence of
hepatitis C than the UK and consideration should be given to screening for
hepatitis C.
SIGN Guideline 92 on the Management of hepatitis C advises testing for
“people who have received medical or dental treatment in countries where
HCV is common and infection control may be poor”.
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The Scottish Government’s Sexual Health and Blood Borne Virus Framework
(2011-15) sets out the following actions in relation to viral hepatitis and
minority ethnic populations:
Under outcome 3 (People affected by BBVs lead longer, healthier lives):

‘awareness raising and other initiatives among migrant populations to
encourage test uptake among people who have come from areas of
high prevalence for hepatitis C such as Pakistan and other South Asian
countries.’
And
Under outcome 2 (A reduction in the health inequalities gap in sexual health
and BBVs)

‘multi-agency partners should work together to ensure that prevention,
treatment and care pathways for hepatitis B consider the language,
literacy and/or cultural challenges to risk populations accessing these
services in Scotland to optimise their uptake.’
NICE guidance ‘Hepatitis B and C: ways to promote and offer testing to
people at increased risk of infection’ (2012) recommends that local community
services serving migrant populations work in partnership with primary care
practitioners to provide testing of adults and children at increased risk of
infection. This should include raising awareness of hepatitis B and C,
promoting the availability of primary care testing facilities and providing
support to access these services.
However, the UK National Screening Committee published a position
statement in March 2011 saying that screening for Hepatitis B and Hepatitis C
amongst ethnic minorities born outside the UK was not recommended, but
that the position would be reviewed in 2014. A number of research questions
were identified that would help to inform a decision on screening for Hep B
and C.
Prevalence
Eastern/Central European populations
Since 2004, when the EU opened up to Eastern European countries, there
has been an increased number of migrants from EU8 countries (primarily
Poland but also Czech Republic, Slovakia, Hungary and to a lesser extent
Lithuania, Latvia and Estonia) coming into Scotland. Scotland will
have new migrant groups from Bulgaria and Romania arriving in larger
numbers from later this year when restrictions on entry are lifted.
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The prevalence of hepatitis C in these countries is estimated to be 1.90% in
Poland, 0.75% in the Czech Republic, 1.50% in Slovakia, and 3.5% in
Romania. This compares with 0.9% prevalence in Scotland.
The prevalence of hepatitis B (surface antigen) is between 2% and 7% in all
of Eastern Europe except Slovakia (ECDC: Hepatitis B and C in the European
neighbourhood 2010) and it would be expected that similar proportions of
migrant communities in Scotland would be affected by these viruses.
South Asian populations
The estimated prevalence of hepatitis C in South Asian populations living in
Glasgow is 4.1% (South Asian Study and HCV test database).
Chinese populations
The Chinese Hepatitis B Education Project, started in Lothian in 2002,
established that 10% of Edinburgh’s Chinese population were chronically
infected with hepatitis B.
Previous/ongoing activity in Lothian
Chinese communities (Edinburgh)
Chinese Hepatitis B Education Project (started 2002), Liver Unit, Royal
Infirmary
Awareness raising and testing with Chinese community/faith groups (restarting March 2013)
South Asian communities
Awareness raising and testing with South Asian community/faith groups
(started 2010) e.g. Pakistan Society, NKS, mosques in Edinburgh.
Eastern/Central European communities
Hepatitis C Trust: Awareness raising in preparation for one testing day in
Hepatitis C Trust Van offered September 2012. with Svetlika, Fort Community
Centre.
MELA
Hepatitis C Trust stall/ testing van at MELA in Sept 2012, and stall only in
Sept 2010
Materials currently available in Lothian
English
BBV testing leaflet (NHS Lothian)
Take Control (for new hepatitis C diagnoses) NHS Health Scotland, 2011
Hepatitis B: pioneering liver health (British Liver Trust)
Polish
Awareness raising leaflet (Hepatitis C Trust)
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Take Control (for new hepatitis C diagnoses) NHS Health Scotland, 2011
Urdu
Hepatitis C: The more you know the better (NHS England, Hepatitis C Trust,
2009)
Chinese languages
Knowing about Hepatitis B (NHS Lothian, MEHIP 2005)
Hepatitis B in Cantonese (British Liver Trust)
All available from Lothian Viral Hepatitis Managed Care Network, Laura
Weddell Tel 0131 465 5450
Hepatitis Scotland and Glasgow and Greater Clyde Health Board are working
to develop patient information in translation for new diagnoses of hepatitis B
and C, for all health boards to use.
Costs
Of purchasing leaflets in translation.
BBV nurse specialist time to develop relationships with community/faith
groups in order to jointly work up awareness-raising sessions and on-site
testing.
Assumptions
That the interpreting services LITS can support this work
That the relevant link workers at MEHIS act as ‘enablers’ between community
/faith groups and the BBV nurse specialists.
Risks


That people testing positive cannot be contacted for follow-up
That people testing positive do not attend for follow up.
Stakeholders








Minority Ethnic Health Inclusion Service (NHS)
LMC (GP sub-committee)
Hepatitis C Trust
Minority Ethnic community groups/faith organisations
BBV clinical nurse specialists
C Plus
Annette Wilson, Waverley Care
Jessie Anderson, Access Practice
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

Viral Hepatitis Managed Care Network Testing and Referral Action
Group
Christine Evans, NHS Lothian Executive Lead for Viral Hepatitis
Project control and reporting
Planning meetings with stakeholders will be organised by the project
leads/MCN. Project outcomes will report in to the MCN Testing and Referral
Action Group.
Hilda Stiven
Lothian Hepatitis MCN Co-ordinator
16/02/2016
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