1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Knowledge on HIV and hepatitis
Claudia Santos-Hövener
HIV and HEP knowledge among migrants from sub-Saharan Africa in Germany

9. 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

10. 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

11. 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

12. Many thanks to all participants, peer researchers, other partners and the federal ministry of health. And thank you for your attention.
Source: RKI 2016