Opportunistic screening using point-of-care testing leads to successful linkage to care of HBV-infected migrant populations in a low endemic country

In low endemic countries, screening for hepatitis B surface antigen (HBsAg) in migrants is cost-effective in reducing the disease burden of hepatitis B virus (HBV) infections, but linkage to care (LTC) remains a challenge. This study aims to guide future screening initiatives, with 3 objectives: 1. to compare LTC between different ethnic groups screened for HBsAg with POCT in an outreach setting; 2. to estimate the proportion HBsAg seropositivity for ethnic minorities; and 3. to investigate the association between seropositivity and HBV risk factors. Opportunistic outreach screenings using finger prick HBsAg tests were performed at civic integration programmes between 11/2017 and 09/2022. If the patient tested positive, an appointment was given immediately at the outpatient hepatology clinic for follow-up and confirmation of HBsAg positivity in blood. Dedicated personnel contacted identified patients to motivate them for further linkage to care, which was defined as being assessed by a hepatologist, a blood test and an abdominal ultrasound. A total of 677 people from different ethnicities (Asian, Middle Eastern and African) were serologically screened using POCT tests. The observed positivity for HBsAg was 3.4 % (95% CI 2.17-5.05, 23/677). Apart from ethnicity and male sex, none of the surveyed HBV risk factors were associated with HBsAg seropositivity. All HBsAg-positive patients were linked to care (LTC) and assessed by a hepatologist, despite the COVID-19 pandemic increase in time-to-follow-up (82 days (95% CI 51–112 days) vs. 24 days (95% CI 5–43 days, p = 0.008)). Among the HBV-infected patients, 31.8% (7/22), 100 % (22/22) and 26.1% (6/23) met the criteria for treatment indication, intrafamilial transmission risk and need for HCC surveillance, respectively. The proportion of HBsAg seropositivity in ethnic minorities was 3.4%. The use of POCT and commitment of dedicated personnel can overcome previously identified barriers resulting in a 100% LTC.