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      Timing of chronic hepatitis B diagnosis after migration and its determinants among Sub-Saharan African migrants living in France

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          Abstract

          Objective

          In European countries, chronic hepatitis B (CHB) disproportionately affects migrants from medium- and high-endemic areas and is largely underdiagnosed. To inform policy and improve screening strategies, we measured the timing of CHB diagnosis after migration and its determinants among sub-Saharan migrants living in the Paris metropolitan area (France).

          Design

          The PARCOURS study is a retrospective life-event history survey conducted in health care services in 2012–2013 among 779 migrants from sub-Saharan Africa who were receiving care for CHB. We investigated the timing of CHB diagnosis from the time of arrival in France using the Kaplan-Meier method and characteristics associated with CHB diagnosis since the time of arrival in France using discrete-time multivariate logistic regression models.

          Results

          The median CHB diagnosis occurred during the fourth year spent in France for men and during the second year spent in France for women. Among men, the probability of CHB diagnosis increased during years with (versus without) a temporary resident permit (aOR: 1.6, 95%CI: 1.1–2.2), a precarious accommodation (aOR: 1.7, 95%CI: 1.1–2.6), and hospitalization (aOR: 7.7, 95%CI: 3.4–15.1). Among women, CHB diagnosis was more likely to occur during years with unemployment (aOR: 1.9, 95%CI: 1.1–3.94), pregnancy (aOR: 6.6, 95%CI: 3.5–12.5) and hospitalization (aOR: 9.0, 95%CI: 2.95–32.3). For both sexes, the probability of CHB diagnosis was higher among those who migrated to France because they were threatened in their country.

          Conclusion

          This study shows that social hardships (residential, economic, administrative) and contact with the health care system after arrival in France hasten access to a CHB diagnosis.

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          Most cited references23

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          Time trends of chronic HBV infection over prior decades - A global analysis.

          Information on trends in chronic hepatitis B virus (HBV) prevalence across countries is lacking. We studied changes in chronic HBV infection over previous decades by country, and assessed patterns of change between and within WHO-defined regions.
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            Seroprevalence of Chronic Hepatitis B Virus Infection and Prior Immunity in Immigrants and Refugees: A Systematic Review and Meta-Analysis

            Background International migrants experience increased mortality from hepatocellular carcinoma compared to host populations, largely due to undetected chronic hepatitis B infection (HBV). We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in low HBV prevalence countries to identify those at highest risk in order to guide disease prevention and control strategies. Methods and Findings Medline, Medline In-Process, EMBASE and the Cochrane Database of Systematic Reviews were searched. Studies that reported HBV surface antigen or surface antibodies in migrants were included. The seroprevalence of chronic HBV and prior immunity were pooled by region of origin and immigrant class, using a random-effects model. A random-effects logistic regression was performed to explore heterogeneity. The number of chronically infected migrants in each immigrant-receiving country was estimated using the pooled HBV seroprevalences and country-specific census data. A total of 110 studies, representing 209,822 immigrants and refugees were included. The overall pooled seroprevalence of infection was 7.2% (95% CI: 6.3%–8.2%) and the seroprevalence of prior immunity was 39.7% (95% CI: 35.7%–43.9%). HBV seroprevalence differed significantly by region of origin. Migrants from East Asia and Sub-Saharan Africa were at highest risk and migrants from Eastern Europe were at an intermediate risk of infection. Region of origin, refugee status and decade of study were independently associated with infection in the adjusted random-effects logistic model. Almost 3.5 million migrants (95% CI: 2.8–4.5 million) are estimated to be chronically infected with HBV. Conclusions The seroprevalence of chronic HBV infection is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe, and more than 50% were found to be susceptible to HBV. Targeted screening and vaccination of international migrants can become an important component of HBV disease control efforts in immigrant-receiving countries.
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              Simultaneous Human Immunodeficiency Virus-Hepatitis B-Hepatitis C Point-of-Care Tests Improve Outcomes in Linkage-to-Care: Results of a Randomized Control Trial in Persons Without Healthcare Coverage

              In this randomized-control trial, conducted at a free clinic in France for predominately immigrant populations without healthcare, we demonstrate that simultaneous HIV/HBV/HCV point-of-care rapid testing improves screening outcomes. Increased awareness of infection status likely helped link these patients to care.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 December 2017
                2017
                : 12
                : 12
                : e0189196
                Affiliations
                [1 ] CEPED, IRD, Université Paris Descartes, INSERM, équipe SAGESUD, Paris, France
                [2 ] Department of social epidemiology, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS1136), UPMC Univ Paris 06, Sorbonne University, INSERM, Paris, France
                [3 ] Santé publique France, Saint-Maurice, France
                University of North Carolina at Chapel Hill School of Medicine, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0913-9650
                Article
                PONE-D-17-22780
                10.1371/journal.pone.0189196
                5746227
                29283994
                5497e607-4b2d-4d7a-a83d-32ae14b0b308
                © 2017 Pannetier et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 July 2017
                : 21 November 2017
                Page count
                Figures: 1, Tables: 3, Pages: 14
                Funding
                Funded by: French National Agency for research on AIDS and Viral hepatitis (ANRS)
                Award Recipient :
                Funded by: the General Direction of Health (DGS, French Ministry of Health)
                Award Recipient :
                Funded by: Santé Publique France
                Award Recipient :
                This study was supported by the French National Agency for research on AIDS and Viral hepatitis (ANRS), the General Direction of Health (DGS, French Ministry of Health) and Santé Publique France. The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation or in the writing of the paper.
                Categories
                Research Article
                People and places
                Geographical locations
                Europe
                European Union
                France
                Medicine and health sciences
                Infectious diseases
                Viral diseases
                Hepatitis
                Hepatitis B
                Medicine and health sciences
                Gastroenterology and hepatology
                Liver diseases
                Infectious hepatitis
                Hepatitis B
                Medicine and health sciences
                Diagnostic medicine
                HIV diagnosis and management
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medical Doctors
                Physicians
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
                Physicians
                People and Places
                Geographical Locations
                Africa
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Public and Occupational Health
                Health Screening
                Social Sciences
                Economics
                Human Capital
                Economics of Migration
                Custom metadata
                All relevant data are within the paper.

                Uncategorized
                Uncategorized

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