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HIV and viral hepatitis knowledge and information needs among migrants from sub-Saharan Africa residing in Germany – results of a multi-center cross-sectional survey Claudia Santos-Hövener, Carmen Koschollek and Viviane Bremer Robert Koch-Institut, Berlin 1st Congress on Migration, Ethnicity, Race and Health, May 2018, Edinburgh
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Epidemiology of HIV in Germany
10-15% of all HIV-diagnoses in migrants from sub-Saharan Africa Often late presenters Quelle: RKI 2017 Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Hepatitis B Schweitzer et al, The Lancet 2015
Studien zeigen eine erhöhte Prävalenz von HEP B bei Migrantenpopulation in DE ( %) Global HBsAg endemicity (1957–2013) Die Prävalenz von chronischer HBV im westlichen SSA ist die höchste weltweit. Zwischen 5% -14% der Bevölkerung ist betroffen im Gegensatz zu 0,3% der deutschstämmigen Bev. In the WHO European Region, approximately 13 million people are chronically infected with HBV, which leads to about deaths a year from hepatitis B-related liver cancer and cirrhosis. The epidemiology of hepatitis B in the Region is diverse, with a prevalence of hepatitis B surface antigen ranging from extremely low (< 0.1% in Hungary) to high (13% in Uzbekistan). The map below shows the estimated prevalence of hepatitis B surface antigen carriage in countries in the Region.1 Schweitzer et al, The Lancet 2015 Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Main objectives of the MiSSA-study
to determine the information needs regarding HIV, HEP and to develop culturally sensitive recommendations for prevention with migrants from sub-Saharan Africa to build sustainable networks for prevention work and to work TOGETHER WITH African communities Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Standardized questionnaire Recruitment by peer researchers
Study Design cross-sectional KAPB survey as a community-based participatory research project Standardized questionnaire Recruitment by peer researchers Optional HIV testing Establishing local networks – 6 study regions in Germany – 3000 participants Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Study Population (n=3.040) Gender: 46% women Age median: 31 yrs
Region: 49% West Africa School education: 35% high school Median time in Germany: 5 yrs German skills: 54% good/very good Health insurance: 17% limited/no insurance Religion: 66% Christian 24% primary school 31% uni Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Knowledge on HIV and viral hepatitis
82-96% knew presented statements on HIV transmission and infection 23% - 57% knew the presented information on HEP Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Knowledge on HIV and hepatitis
Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Factors associated with knowledge on HIV in Germany
Variable Multivariate analysis % aOR 95%-CI Age 54% 0.88 26 – 35 years 18 – 25 years 44% 0.63 36 – 45 years 60% Ref. 65% 1.06 - > 45 years - Duration of residence in Germany 46% 0.54 > 1 year - ≤ 5 years ≤ 1 year 38% 0.53 > 5 years 65% Ref. 53% 0.64 - Born in Germany - Religion 46% 0.72 Islam Christianity 58% Ref. No religion 55% 0.89 - 48% 0.62 Other/unknown Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Factors associated with knowledge on HEP (examples)
Variable Multivariate analysis % aOR 95%-KI School education (ref.high school) No school degree 22% 0.30 - 52% 1.79 University degree Primary/secondary school 28% 0.48 Monthly income (ref €) 32% 0.67 < 500 € No income 31% 0.63 - German language skills (ref. good) 30% 0.66 Very limited none 22% 0.53 - 52% 1.47 Very good Health insurance in Germany (ref. insurance card) 21% 0.56 Medical treatment voucher No health insurance 27% 0.60 - *adjusted for sex, religious affiliation, time of residence, mode of administration Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Prevention should include HEP Prevention for ALL
Conclusions Prevention should include HEP Prevention for ALL Focus particulary on recent migrants and persons with socio-economic status, muslims and young adults Intervention planning with migrants from sub-Saharan Africa Claudia Santos-Hövener HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany
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Many thanks to all participants, peer researchers, other partners and the federal ministry of health. And thank you for your attention. Source: RKI 2016
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