Appraisal of community-based interventions for hepatitis B in underserved populations using the quadruple aim of...

Chronic viral hepatitis remains a critical public health concern, a key focus of WHO's 2030 elimination targets. High-risk populations, especially migrants often facing significant healthcare barriers, are disproportionately affected globally by this condition. Community-based interventions are crucial for enhancing access to screening, vaccination, and linkage to care. This scoping review, a foundational step within the EU co-funded VH-COMSAVAC project, identifies and analyses how these interventions map to the Quadruple Aim framework of value-based medicine.

This scoping review adhered to PRISMA-ScR guidelines. Five scientific databases (MEDLINE, Embase, GlobalHealth, Scopus, Web of Science) were systematically searched up to July 30, 2023. Titles and abstracts of studies focusing on community-based HBV interventions, primarily targeting migrants and refugees while also encompassing other underserved populations, were independently screened by five reviewers using the Rayyan platform. Data extraction was conducted using a structured Excel spreadsheet, mapping reported outcomes to the Quadruple Aim framework (patient experience, population health, cost reduction, care team wellbeing) and intervention types (prevention, linkage to care, treatment).

Of 34 included publications, 94% (n = 32) focused on prevention, 29% (n = 10) on linkage to care, and 6% (n = 2) on treatment strategies. Patient experience was the most reported value domain (56%, n = 19 studies), followed by population health (50%, n = 17 studies). Cost reduction (9%, n = 3 studies) and care team wellbeing (3%, n = 1 study) were considerably less represented. Point-of-care (PoC) testing demonstrated significantly higher linkage to care (86% vs. 34% for venepuncture) and 76.5% lower costs (€12.7 vs. €54.0 per screened person). Screening uptake in targeted intervention groups (19.5%) was also significantly higher than in control groups (1.7%; p = 0.014). Major reported barriers included language (62%), cultural/religious issues (50%), and lack of knowledge (32%).

The review reveals a significant gap in the comprehensive, value-based evaluation of existing community-based interventions, with no established framework existing. The VH-COMSAVAC project seeks to bridge this by developing a value-based assessment tool, leveraging the Quadruple Aim, to systematically assess its prevention and linkage-to-care interventions and guide evidence-based optimization.