Modelling the impact of improving access to healthcare on hepatitis B prevalence in the Thai–Myanmar border region

Abstract

In Thailand, hepatitis B remains endemic despite a strong elimination programme. Four neighbouring countries, with higher hepatitis B prevalence, contribute to over 90% of the migrant workforce in Thailand, and 75% migrant workers are from Myanmar. Access to healthcare for migrants is limited. Models can capture heterogeneity within populations, a useful tool to understand and quantify the impact of policies which could improve targeting of limited resources. In this study, we developed an agent-based model to capture the differences between the Thai and Myanmar migrant populations living in Thailand near the border with Myanmar, notably the higher level of mobility, lower access to healthcare and the higher prevalence of hepatitis B among migrants, by modelling the origin of each individual explicitly. We used the model to estimate future trends of hepatitis B prevalence in this region under different scenarios of intervention. Our studyshows that although the current elimination programme is effective in the Thai population, it is insufficient to reach national elimination targets owing to a higher hepatitis B prevalence in migrants. Improving access to healthcare for migrants and the border region could potentially help reach elimination targets, and we quantified the level of improvement needed to achieve elimination. Policies to make healthcare more accessible to migrants and the border regions are not yet effective owing to financial and cultural barriers. Reducing those barriers could reduce hepatitis B prevalence in those communities and regions and contribute to Thailand reaching elimination targets in a reasonable time frame.