Integrating Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus screening for migrants from endemic countries into travel-related and sexual health care in Amsterdam, the Netherlands

Ellen Generaal^1,2*Yara Bachour¹Sara Klijzing¹Akke Cornelissen¹Roel Toering¹Elske Hoornenborg¹Eline Op De Coul³Nora Hamdiui³Annemarie Meiberg³Evelien Siedenburg¹Maria Prins^1,2,4

• ¹Public Health Service of Amsterdam, Amsterdam, Netherlands
• ²Amsterdam institute for Immunology and Infectious diseases, Infectious Diseases, Amsterdam, the Netherlands; Amsterdam Public Health, Global Health, Amsterdam, the Netherlands, Amsterdam, Netherlands
• ³Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, Netherlands
• ⁴Amsterdam UMC Locatie AMC, Amsterdam, Netherlands

Introduction: The Health Council of the Netherlands has recommended screening for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) for migrants born in countries endemic for these infections. We investigated the operational feasibility, test uptake and diagnostic outcomes of integrated HBV/HCV/HIV screening into routine care at the Public Health Service (PHS) of Amsterdam. Methods: In 2022-2023, visitors born in endemic countries (≥ 18 years) were offered free HBV, HCV and HIV testing at the Travel and Vaccination Center (TVC) of the PHS. In 2021-2022, 1172 visitors born in an endemic country for HCV (≥ 16 years) were offered free HCV testing at the Center for Sexual Health (CSH), alongside standard free HBV/HIV testing. Countries considered endemic for HBV and HCV had a prevalence of ≥2.0% or ranked among the top-10 endemic countries in the Netherlands. The screening program was considered operationally feasible if inclusion began within six months and ≥25% (TVC) or ≥50% (CSH) of eligible visitors were included within one year. Positivity rate was considered ‘low’ for prevalence < 2.0%, and ‘high’ for prevalence ≥ 2.0%. Results: At the TVC, 298 visitors participated in HBV (n=264), HCV (n=293) and/or HIV (n=290) testing. At the CSH 1,023 visitors underwent HCV testing. Inclusion targets were met. Test uptake at the CSH was 87%; data for TVC were unavailable. At the TVC, we identified five newly diagnosed chronic HBV cases (2.0%, 95%CI=0.6-4.4%) and no new cases for HCV or HIV. At the CSH, one newly diagnosed chronic HCV case was identified (0.1%, 95%CI=0.01-0.5%). Discussion: Integrating HBV, HCV and HIV screening into routine travel-related care and additional HCV screening into sexual health care is operationally feasible. HBV screening at the TVC showed a high yield, while HCV and HIV yields were low. Routine HBV screening should be further examined in similar settings for migrants from endemic countries, preferably alongside HCV and HIV testing.