Seedat Farah, Hargreaves Sally, Friedland Jonathan S
International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, United Kingdom.
PLoS One. 2014 Oct 15;9(10):e108261. doi: 10.1371/journal.pone.0108261. eCollection 2014.
Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants.
在过去几十年中，移民到欧洲——尤其是英国——的人数急剧增加，这对公共卫生服务产生了影响。移民更容易感染传染病（70%的结核病病例和60%的艾滋病毒病例发生在移民中），并且在获得医疗保健方面面临多重障碍。目前，对于如何针对这个往往难以接触到的群体进行传染病筛查的最佳方法存在相当大的争议，迫切需要创新方法。很少有研究关注新移民的具体经历，也没有征求他们对未来方向的看法。我们对代表英国伦敦主要新移民群体的移民社区医疗保健负责人进行了一项定性半结构化访谈研究，以探讨他们对筛查障碍、筛查可接受性以及四种关键疾病（艾滋病毒、结核病、乙型肝炎和丙型肝炎）筛查创新方法的看法。参与者一致认为，目前的筛查模式被认为新移民社区无法广泛获得。阻碍人们接受筛查的主要障碍包括他们自己社区中存在的与疾病相关的污名，以及服务被认为对移民不友好。新移民可能会受到这些障碍的不成比例影响，这对健康状况产生影响。然而，筛查对于新移民来说肯定是可以接受的，服务需要发展得更加以社区为基础、更加积极主动，并与社区组织更紧密地合作；这些发现反映了欧洲和国际上移民及医疗保健提供者的观点。在新移民社区提高对筛查益处的认识至关重要。参与者提出的一种创新方法是将所有关键疾病整合到一次全面健康检查中的基于社区的健康筛查套餐，以减少相关污名。需要进一步开展研究，以借鉴其他接收大量移民国家的最佳实践模式，开发基于证据的以社区为重点的筛查模式。
