Who is being missed? Exploring hepatitis risk and access to care in underserved populations

‍🧪 What was the study about?

This body of work focused on developing and applying methods to identify and better understand populations who are underserved and disproportionately affected by hepatitis B and hepatitis C. These include groups who may face barriers to healthcare, such as migrants, ethnic minority communities, people who inject drugs, sex workers, and people attending sexual health services. By bringing together different national datasets and research approaches, the studies looked at who is most affected, who is accessing testing and prevention services, and where gaps in care exist.

❓ Why is this important?

Hepatitis B and C often do not cause symptoms early on, meaning many people remain undiagnosed until serious liver disease develops. If left untreated, these infections can lead to liver failure or cancer.

Eliminating hepatitis as a public health threat by 2030 is a major UK and global goal. However, this cannot be achieved unless services effectively reach the populations most at risk, many of whom experience stigma, discrimination, or difficulties accessing healthcare.

Understanding who is being missed, and why, is essential to: improve early diagnosis, increase vaccination uptake, ensure people receive treatment, and reduce health inequalities.

🔍 What did we do?

Across the studies, we used a mixture of different methods to better characterise underserved populations:

• We combined information from national datasets (including sexual health clinic attendance and laboratory testing data) to track hepatitis testing, diagnoses, and vaccination.

• We looked at differences in infection rates and service use by factors such as age, ethnicity, country of birth, sexual orientation, and socioeconomic deprivation.

• We examined how testing and care changed over time, including during the COVID-19 pandemic.

• We identified patterns of engagement with healthcare and gaps in vaccination and follow-up care.

This approach allowed us to build a more complete picture of who is being reached by services and who is not.

📊 Key findings

Across the studies, several key findings emerged:

• Higher infection rates in underserved groups: those born outside the UK, particularly from Africa, Asia, and Eastern Europe, were more likely to have hepatitis B. Certain groups, including those with previous HIV diagnoses, recent STIs, or involvement in sex work, had higher hepatitis C positivity.

• Unequal access to care: some groups with higher infection risk, such as people of Black ethnicity, were less likely to receive hepatitis B vaccination, despite attending services.

• Low vaccination rates: even among groups eligible for vaccination, uptake was relatively low, indicating missed opportunities for prevention.

• Impact of COVID-19: testing for COVID-19 dropped significantly during the pandemic, while positivity increased, suggesting services were reaching fewer people but focusing on higher-risk individuals.

• Role of sexual health services: these services are an important access point for underserved populations, but they are not consistently reaching everyone who could benefit.

💡 What do these findings mean?

The findings show that while current services are successfully engaging some high‑risk groups, significant gaps remain in reaching underserved populations.

To eliminate hepatitis, efforts need to go beyond existing approaches by:

• Expanding targeted and culturally appropriate outreach to underserved communities.

• Reducing stigma associated with hepatitis testing and care.

• Improving access to vaccination and ensuring it is routinely offered and completed.

• Strengthening links between testing, follow-up care, and treatment services.

• Considering broader strategies, such as more universal or opt-out testing approaches.

Overall, this work highlights that better data and improved methods for identifying underserved populations are critical to reducing inequalities and achieving hepatitis elimination goals.

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