Wolfson Institute of Preventive Medicine - Barts and The London

Chronic viral hepatitis B & C in ethnic migrants: a controlled randomised cross-sectional cluster trial to assess the impact of identifying, screening, and treating immigrants with viral hepatitis

Centre for Psychiatry

Project Investigator:  Graham Foster


Chronic viral hepatitis (persistent infection with either hepatitis B or hepatitis C) causes an asymptomatic disease that leads to cirrhosis and death in a large proportion of those who are infected. These asymptomatic diseases are often not associated with abnormalities of liver function tests precluding identification by simple non-specific testing. The prevalence of viral hepatitis is at least ten fold greater in immigrants than in the indigenous community (prevalence in the UK is ~0.5% but > 5% in immigrants) and there is abundant data (from the Health Protection Agency and liver transplant programs that the mortality and morbidity in ethnic minorities is growing rapidly. Early identification of people with chronic viral hepatitis allows effective therapy, shown by NICE to be highly cost effective. Given the rising mortality in ethnic minorities from chronic viral hepatitis the Advisory Group on Hepatitis and The National Screening Committee have considered screening in immigrants but there is no data on whether this is feasible and clinically/cost effective.

The UK has one of the lowest rates of therapy for viral hepatitis in Europe and this is undoubtedly contributing to the rising mortality from liver disease in the UK (mortality is falling in the rest of Europe). UK studies have shown that access to therapy for patients known to have viral hepatitis is poor with only a tiny minority of diagnosed patients going on to receive treatment. Strategies that improve access to treatment are likely to have a major impact on treatment uptake but alternatives to hospital based treatment have not been studied.

Aims & Objectives

  • To determine whether screening immigrants for chronic viral hepatitis in primary care is feasible, acceptable to the communities at risk, and cost effective.
  • To determine whether therapy for viral hepatitis in primary care is achievable, and both clinically and cost effective
  • To determine whether community treatment improves engagement and increases the number of patients who access the effective therapies that are NICE approved for these potentially lethal infections.

Activities and Outputs

This project is an NIHR-funded Programme Grant led by PI Prof Graham Foster (Blizard Institute). It is a collaborative project between the Centre for Digestive Diseases, the Centre for Psychiatry, and the Centre for Primary Care and Public Health. (http://blizard.qmul.ac.uk/research-generation/738-hepfree.html).

The Centre for Psychiatry and Centre for Primary Care and Public Health is involved in Work Package 1 of the project, specifically with regards to identifying approaches that might improve engagement with screening and treatment for chronic viral hepatitis B and C, and identifying reasons for non-engagement in immigrant communities. We have done a systematic review of the literature on lay perceptions of viral hepatitis B and C by migrants and refugees. Focus group discussions have also been carried out to identify attitudes to screening for viral hepatitis in immigrant communities in the UK. Outcomes from these have been used to adapt Barts Explanatory Model Interview for use in telephone surveys to capture explanatory models of viral hepatitis as well contextual variables related to uptake of screening and treatment. Systematic review of evidence of barriers to uptake of screening and treatments is ongoing as well as the general preparation of outputs.


  • Graham Foster (PI, Centre for Digestive Diseases)
  • Kam Bhui, (Co-I, Centre for Psychiatry)
  • Trish Greenhalgh (Co-I, Centre for Primary Care and Public Health)
  • John Owiti, (Research Fellow, Centre for Psychiatry)
  • Lorna Sweeney (Research Fellow, Centre for Primary Care and Public Health)

Main Contact

Jessica Gomes
Research Project Coordinator
020 7882 3854