Closing the hepatitis equity gap for migrants: implementation lessons from three European countries

Background

Migrants and refugees account for an estimated 25% of chronic HBV and 14% of HCV cases in Europe, approximately 2.9 million people, yet remain underserved by conventional health services due to legal, linguistic, cultural and structural barriers. Evidence-based, community-adapted guidance is needed to close this equity gap.

Methods

Building on community-based hepatitis interventions implemented across three European countries between 2022 and 2025, a participatory cross-country process was conducted in Greece (Athens), Italy (Milan) and Spain (Madrid/Catalonia). Implementing partners documented barriers, facilitators and locally adapted solutions encountered during field implementation. Findings were thematically mapped onto the socio-ecological model across five levels and iteratively reviewed to generate consensus-based, transferable recommendations.

Results

Barriers were identified across all five socio-ecological levels, including low health literacy, distrust of services, language barriers, misinformation, high mobility, fragmented referrals, waiting times, and legal or administrative restrictions. Key facilitating strategies included culturally adapted education, peer engagement, decentralized point-of-care screening, intercultural mediation, flexible scheduling, direct specialist referral, follow-up support and temporary access pathways for undocumented people. A previously developed set of 50 monitoring indicators, including 18 prioritized as core, was recommended to enable cross-setting evaluation.

Conclusions

Community-based models, when grounded in intercultural mediation and integrated into formal health systems, can help reduce hepatitis-related inequities among migrant populations. The implementation guide provides policymakers and practitioners with a replicable, evidence-informed framework adaptable across European contexts and aligned with WHO and EU viral hepatitis elimination targets.

Key messages

• Community-based hepatitis care can make prevention, testing and linkage to care more accessible for migrant and refugee communities.

• Field-based implementation lessons can inform scalable strategies for equitable hepatitis elimination in Europe.