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Table 2 Primary care clinical staff knowledge, perceptions and practice regarding BBV testing and care for migrant patients

From: What do primary care staff know and do about blood borne virus testing and care for migrant patients? A national survey

Question Overall - GPs and Nurses
Number (%, 95CI)
GPs
Number (%, 95CI)
Nurses
Number (%, 95CI)
P (GPs vs nurses)
Which issues do you address when speaking to new migrant patients? Vaccination history All new migrants 167 (58.2, 52.4–63.7) 58 (41.7, 33.9–50.0) 109 (73.6, 66.0–80.1) < 0.0001
Asylum seekers / refugees only 9 (3.1, 1.7–5.9) 4 (2.9, 1.1–7.2) 5 (3.4, 1.5–7.7)
Never considered 14 (4.9, 2.9–8.0) 12 (8.6, 5.0–14.5) 2 (1.4, 0.4–4.8)
Situation specific 97 (33.8, 28.6–39.5) 65 (46.8, 38.7–55.0) 32 (21.6, 15.8–28.9)
Total 287 139 148
HIV risk assessment All new migrants 86 (30.0, 25.0–35.5) 41 (29.5, 22.5–37.5) 45 (30.4, 23.6–38.2) 0.867
Asylum seekers / refugees only 7 (2.4, 1.2–4.9) 0 (0.0, 0.0–2.7) 7 (4.7, 2.3–9.4)
Never considered 23 (8.0, 5.4–11.7) 8 (5.8, 2.9–10.9) 15 (10.1, 6.2–16.0)
Situation specific 171 (59.6, 53.8–65.1) 90 (64.7, 56.5–72.2) 81 (54.7, 46.7–62.5)
Total 287 139 148
Hepatitis B risk assessment All new migrants 85 (29.6, 24.6–35.1) 40 (28.8, 21.9–36.8) 45 (30.4, 23.6–38.2) 0.763
Asylum seekers / refugees only 11 (3.8, 2.2–6.7) 1 (0.7, 0.1–4.0) 10 (6.8, 3.7–12.0)
Never considered 24 (8.4, 5.7–12.1) 10 (7.2, 4.0–12.7) 14 (9.5, 5.7–15.3)
Situation specific 167 (58.2, 52.4–63.7) 88 (63.3, 55.0–70.9) 79 (53.4, 45.4–61.2)
Total 287 139 148
Hepatitis C risk assessment All new migrants 78 (27.2, 22.4–32.6) 38 (27.3, 20.6–35.3) 40 (27.0, 20.5–34.7) 0.953
Asylum seekers / refugees only 12 (4.2, 2.4–7.2) 1 (0.7, 0.1–4.0) 11 (7.4, 4.2–12.8)
Never considered 29 (10.1, 7.1–14.1) 10 (7.2, 4.0–12.7) 19 (12.8, 8.4–19.2)
Situation specific 168 (58.5, 52.8–64.1) 90 (64.7, 56.5–72.2) 78 (52.7, 44.7–60.6)
Total 287 139 148
TB screening All new migrants 82 (28.6, 23.7–34.1) 39 (28.1, 21.3–36.0) 43 (29.1, 22.3–36.8) 0.852
Asylum seekers / refugees only 13 (4.5, 2.7–7.6) 4 (2.9, 1.1–7.2) 9 (6.1, 3.2–11.2)
Never considered 34 (11.8, 8.6–16.1) 11 (7.9, 4.5–13.6) 23 (15.5, 10.6–22.2)
Situation specific 158 (55.1, 49.3–60.7) 85 (61.2, 52.9–68.8) 73 (49.3, 41.4–57.3)
Total 287 139 148
Sexual health advice and screening All new migrants 80 (27.9, 23.0–33.3) 27 (19.4, 13.7–26.8) 53 (35.8, 28.5–43.8) 0.002
Asylum seekers / refugees only 7 (2.4, 1.2–4.9) 0 (0.0, 0.0–2.7) 7 (4.7, 2.3–9.4)
Never considered 18 (6.3, 4.0–9.7) 9 (6.5, 3.4–11.8) 9 (6.1, 3.2–11.2)
Situation specific 182 (63.4, 57.7–68.8) 103 (74.1, 66.2–80.7) 79 (53.4, 45.4–61.2)
Total 287 139 148
Family planning All new migrants 86 (30.0, 25.0–35.5) 29 (20.9, 14.9–28.4) 57 (38.5, 31.1–46.5) 0.001
Asylum seekers / refugees only 7 (2.4, 1.2–4.9) 0 (0.0, 0.0–2.7) 7 (4.7, 2.3–9.4)
Never considered 14 (4.9, 2.9–8.0) 7 (5.0, 2.5–10.0) 7 (4.7, 2.3–9.4)
Situation specific 180 (62.7, 57.0–68.1) 103 (74.1, 66.2–80.7) 77 (52.0, 44.0–59.9)
Total 287 139 148
To the best of your knowledge, as of August 2017 which of the following services are free to all irrespective of migration status? GP or nurse consultations in primary care Yes 279 (76.0, 71.4–80.1) 130 (78.8, 71.9–84.3) 149 (73.8, 67.3–79.3) 0.262
No 56 (15.3, 11.9–19.3) 23 (13.9, 9.5–20.0) 33 (16.3, 11.9–22.1)
Don’t know 32 (8.7, 6.2–12.0) 12 (7.3, 4.2–12.3) 20 (9.9, 6.5–14.8)
Total 367 165 202
Operations or outpatient services in secondary care Yes 100 (27.2, 22.9–32.0) 36 (21.8, 16.2–28.7) 64 (31.7, 25.7–38.4) 0.014
No 192 (52.3, 47.2–57.4) 98 (59.4, 51.8–66.6) 94 (46.5, 39.8–53.4)
Don’t know 75 (20.4, 16.6–24.9) 31 (18.8, 13.6–25.4) 44 (21.8, 16.6–28.0)
Total 367 165 202
Family planning Yes 259 (70.6, 65.7–75.0) 115 (69.7, 62.3–76.2) 144 (71.3, 64.7–77.1) 0.739
No 32 (8.7, 6.2–12.0) 13 (7.9, 4.7–13.0) 19 (9.4, 6.1–14.2)
Don’t know 76 (20.7, 16.9–25.1) 37 (22.4, 16.7–29.4) 39 (19.3, 14.5–25.3)
Total 367 165 202
Hepatitis B and C testing, diagnosis and management Yes 268 (73.0, 68.3–77.3) 120 (72.7, 65.5–78.9) 148 (73.3, 66.8–78.9) 0.908
No 18 (4.9, 3.1–7.6) 8 (4.8, 2.5–9.3) 10 (5.0, 2.7–8.9)
Don’t know 81 (22.1, 18.1–26.6) 37 (22.4, 16.7–29.4) 44 (21.8, 16.6–28.0)
Total 367 165 202
Treatment of mental and physical conditions caused by torture, FGM, domestic or sexual violence Yes 299 (81.5, 77.2–85.1) 125 (75.8, 68.7–81.7) 174 (86.1, 80.7–90.2) 0.011
No 14 (3.8, 2.3–6.3) 12 (7.3, 4.2–12.3) 2 (1.0, 0.3–3.5)
Don’t know 54 (14.7, 11.5–18.7) 28 (17.0, 12.0–23.4) 26 (12.9, 8.9–18.2)
Total 367 165 202
Communicable disease services Yes 305 (83.3, 79.2–86.8) 138 (83.6, 77.2–88.5) 167 (83.1, 77.3–87.6) 0.806
No 8 (2.2, 1.1–4.3) 4 (2.4, 0.9–6.1) 4 (2.0, 0.8–5.0)
Don’t know 53 (14.5, 11.2–18.5) 23 (13.9, 9.5–20.0) 30 (14.9, 10.7–20.5)
Total 366 165 201
Sexually transmitted disease services Yes 305 (83.3, 79.2–86.8) 135 (81.8, 75.2–87.0) 170 (84.6, 78.9–88.9) 0.552
No 9 (2.5, 1.3–4.6) 5 (3.0, 1.3–6.9) 4 (2.0, 0.8–5.0)
Don’t know 52 (14.2, 11.0–18.2) 25 (15.2, 10.5–21.4) 27 (13.4, 9.4–18.8)
Total 366 165 201
Emergency departments (ED) and walk in centres Yes 323 (88.3, 84.5–91.2) 147 (89.1, 83.4–93.0) 176 (87.6, 82.3–91.4) 0.565
No 17 (4.6, 2.9–7.3) 6 (3.6, 1.7–7.7) 11 (5.5, 3.1–9.5)
Don’t know 26 (7.1, 4.9–10.2) 12 (7.3, 4.2–12.3) 14 (7.0, 4.2–11.4)
Total 366 165 201
Which of the following would be a motivation or incentive to test for BBVs? Performance payment structure Yes 181 (76.1, 70.2–81.0) 91 (74.6, 66.2–81.5) 90 (77.6, 69.2–84.2) 0.588
No 21 (8.8, 5.8–13.1) 15 (12.3, 7.6–19.3) 6 (5.2, 2.4–10.8)
Don’t know 36 (15.1, 11.1–20.2) 16 (13.1, 8.2–20.2) 20 (17.2, 11.4–25.1)
Total 238 122 116
Local targets Yes 164 (69.2, 63.1–74.7) 74 (61.2, 52.3–69.4) 90 (77.6, 69.2–84.2) 0.006
No 41 (17.3, 13.0–22.6) 31 (25.6, 18.7–34.1) 10 (8.6, 4.7–15.1)
Don’t know 32 (13.5, 9.7–18.4) 16 (13.2, 8.3–20.4) 16 (13.8, 8.7–21.2)
Total 237 121 116
National goals Yes 133 (56.1, 49.8–62.3) 56 (46.3, 37.6–55.1) 77 (66.4, 57.4–74.3) 0.002
No 58 (24.5, 19.4–30.3) 45 (37.2, 29.1–46.1) 13 (11.2, 6.7–18.2)
Don’t know 46 (19.4, 14.9–24.9) 20 (16.5, 11.0–24.2) 26 (22.4, 15.8–30.8)
Total 237 121 116
CCG recommendations Yes 174 (73.1, 67.1–78.3) 80 (65.6, 56.8–73.4) 94 (81.0, 73.0–87.1) 0.007
No 35 (14.7, 10.8–19.8) 28 (23.0, 16.4–31.2) 7 (6.0, 3.0–11.9)
Don’t know 29 (12.2, 8.6–17.0) 14 (11.5, 7.0–18.3) 15 (12.9, 8.0–20.2)
Total 238 122 116
PHE recommendations Yes 174 (73.1, 67.1–78.3) 84 (68.9, 60.2–76.4) 90 (77.6, 69.2–84.2) 0.129
No 29 (12.2, 8.6–17.0) 21 (17.2, 11.5–24.9) 8 (6.9, 3.5–13.0)
Don’t know 35 (14.7, 10.8–19.8) 17 (13.9, 8.9–21.2) 18 (15.5, 10.0–23.2)
Total 238 122 116
NICE guidance Yes 161 (67.4, 61.2–73.0) 75 (61.0, 52.1–69.1) 86 (74.1, 65.5–81.2) 0.03
No 39 (16.3, 12.2–21.5) 31 (25.2, 18.4–33.5) 8 (6.9, 3.5–13.0)
Don’t know 39 (16.3, 12.2–21.5) 17 (13.8, 8.8–21.0) 22 (19.0, 12.9–27.0)
Total 239 123 116
NHSE recommendations Yes 105 (44.5, 38.3–50.9) 51 (42.5, 34.0–51.4) 54 (46.6, 37.7–55.6) 0.531
No 50 (21.2, 16.5–26.8) 39 (32.5, 24.8–41.3) 11 (9.5, 5.4–16.2)
Don’t know 81 (34.3, 28.6–40.6) 30 (25.0, 18.1–33.4) 51 (44.0, 35.3–53.0)
Total 236 120 116
CMO letter Yes 104 (43.7, 37.5–50.0) 50 (41.0, 32.7–49.9) 54 (46.6, 37.7–55.6) 0.387
No 53 (22.3, 17.4–28.0) 39 (32.0, 24.4–40.7) 14 (12.1, 7.3–19.2)
Don’t know 81 (34.0, 28.3–40.3) 33 (27.0, 20.0–35.5) 48 (41.4, 32.8–50.5)
Total 238 122 116
What tests are requested when you test for hepatitis B? HBsAg + HBcAb 76 (33.9, 28.0–40.4) 39 (35.8, 27.4–45.1) 37 (32.2, 24.3–41.2) 0.138
HBsAg 73 (32.6, 26.8–39.0) 36 (33.0, 24.9–42.3) 38 (33.0, 25.1–42.1)
HBcAb 10 (4.5, 2.4–8.0) 5 (4.6, 2.0–10.3) 5 (4.3, 1.9–9.8)
Not known 45 (20.1, 15.4–25.8) 17 (15.6, 10.0–23.6) 27 (23.5, 16.7–32.0)
Other, please specify 20 (8.9, 5.9–13.4) 12 (11.0, 6.4–18.3) 8 (7.0, 3.6–13.1)
Total 224 109 115
What tests are requested when you test for HCV? Anti-HCV + HCV RNA 32 (14.3, 10.3–19.5) 17 (15.6, 10.0–23.6) 15 (13.0, 8.1–20.4) 0.007
Anti-HCV 56 (25.0, 19.8–31.1) 36 (33.0, 24.9–42.3) 20 (17.4, 11.5–25.3)
HCV RNA 24 (10.7, 7.3–15.4) 11 (10.1, 5.7–17.2) 13 (11.3, 6.7–18.4)
Not known 86 (38.4, 32.3–44.9) 32 (29.4, 21.6–38.5) 54 (47.0, 38.1–56.0)
Other, please specify 26 (11.6, 8.0–16.5) 13 (11.9, 7.1–19.3) 13 (11.3, 6.7–18.4)
Total 224 109 115
What tests are requested when you test for HIV? Anti-HIV 118 (52.7, 46.2–59.1) 72 (66.1, 56.8–74.3) 47 (40.9, 32.3–50.0) < 0.0001
Not known 71 (31.7, 26.0–38.1) 20 (18.3, 12.2–26.6) 50 (43.5, 34.8–52.6)
Other, please specify 35 (15.6, 11.5–21.0) 17 (15.6, 10.0–23.6) 18 (15.7, 10.1–23.4)
Total 224 109 115
Do you use Dried Blood Spot (DBS) testing? Yes 21 (9.4, 6.2–13.9) 6 (5.5, 2.5–11.5) 15 (13.0, 8.1–20.4)  
No 172 (76.8, 70.8–81.8) 89 (81.7, 73.4–87.8) 83 (72.2, 63.4–79.5)
Don’t know 31 (13.8, 9.9–19.0) 15 (13.8, 8.5–21.5) 16 (13.9, 8.7–21.4)
Total 224 109 115
These questions relate to diagnosed patients Are all patients with hepatitis B referred to secondary care? Yes 176 (78.9, 73.1–83.8) 99 (91.7, 84.9–95.6) 77 (67.0, 57.9–74.9) < 0.0001
No 13 (5.8, 3.4–9.7) 8 (7.4, 3.8–13.9) 5 (4.3, 1.9–9.8)
Don’t know 34 (15.2, 11.1–20.5) 1 (0.9, 0.2–5.1) 33 (28.7, 21.2–37.5)
Total 223 108 115
Are all patients with hepatitis C referred to secondary care? Yes 180 (80.7, 75.0–85.4) 102 (94.4, 88.4–97.4) 78 (67.8, 58.8–75.7) < 0.0001
No 9 (4.0, 2.1–7.5) 5 (4.6, 2.0–10.4) 4 (3.5, 1.4–8.6)
Don’t know 34 (15.2, 11.1–20.5) 1 (0.9, 0.2–5.1) 33 (28.7, 21.2–37.5)
Total 223 108 115
Do you receive information or check whether a patient has attended? Yes 123 (55.2, 48.6–61.5) 67 (62.0, 52.6–70.6) 56 (48.7, 39.8–57.7) 0.045
No 37 (16.6, 12.3–22.0) 26 (24.1, 17.0–32.9) 11 (9.6, 5.4–16.3)
Don’t know 63 (28.3, 22.7–34.5) 15 (13.9, 8.6–21.7) 48 (41.7, 33.1–50.9)
Total 223 108 115
Do you follow up patients that have not attended secondary care appointments? Yes 104 (46.6, 40.2–53.2) 57 (52.8, 43.4–61.9) 47 (40.9, 32.3–50.0) 0.075
No 51 (22.9, 17.8–28.8) 37 (34.3, 26.0–43.6) 14 (12.2, 7.4–19.4)
Don’t know 68 (30.5, 24.8–36.8) 14 (13.0, 7.9–20.6) 54 (47.0, 38.1–56.0)
Total 223 108 115
Are close contacts of HBV cases offered testing? Yes 161 (72.2, 66.0–77.7) 80 (74.1, 65.1–81.4) 81 (70.4, 61.5–78.0) 0.544
No 13 (5.8, 3.4–9.7) 9 (8.3, 4.4–15.1) 4 (3.5, 1.4–8.6)
Don’t know 49 (22.0, 17.0–27.9) 19 (17.6, 11.6–25.8) 30 (26.1, 18.9–34.8)
Total 223 108 115
Are close contacts of HBV cases offered vaccination? Yes 165 (74.0, 67.9–79.3) 79 (73.1, 64.1–80.6) 86 (74.8, 66.1–81.8) 0.781
No 14 (6.3, 3.8–10.3) 9 (8.3, 4.4–15.1) 5 (4.3, 1.9–9.8)
Don’t know 44 (19.7, 15.0–25.4) 20 (18.5, 12.3–26.9) 24 (20.9, 14.4–29.2)
Total 223 108 115
  1. Abbreviation Definition
  2. anti-HCV Hepatitis C antibody
  3. anti-HIV HIV antibodies
  4. BBV Blood borne virus
  5. CCG Clinical commissioning group
  6. CMO Chief Medical Officer
  7. HBcAb Hepatitis B core antibody
  8. HBsAg Hepatitis B surface antigen
  9. HBV Hepatitis B virus
  10. HCV Hepatitis C virus
  11. HCV RNA Hepatitis C virus ribonucelic acid
  12. HIV Human immunideficiency virus
  13. NHSE NHS England
  14. NICE National Institute for Health and Care Excellence
  15. PHE Public Health England
  16. Responses in bold indicate response used when creating dichotomised responses for Chi squared tests