Integrating hepatitis B virus, hepatitis C virus and human immunodeficiency virus screening for migrants from endemic countries into travel-related and sexual health care in Amsterdam, the Netherlands.
Generaal E, Bachour Y, et al. • Frontiers in public health • 2025
Integrating HBV, HCV and HIV screening into routine travel-related and sexual health care for migrants from endemic countries is operationally feasible, with HBV screening at the Travel and Vaccination Center showing a high yield while HCV and HIV yields were low.
Key Findings
Results
The integrated screening program was operationally feasible at both the Travel and Vaccination Center (TVC) and the Center for Sexual Health (CSH), with inclusion targets met at both sites.
Feasibility was defined as inclusion beginning within six months and ≥25% (TVC) or ≥50% (CSH) of eligible visitors included within one year.
Both inclusion targets were met at their respective sites.
The TVC enrolled 298 visitors in 2022–2023; the CSH enrolled 1,023 visitors in 2021–2022.
Test uptake at the CSH was 87%; data on test uptake at the TVC were unavailable.
Results
At the TVC, five newly diagnosed chronic HBV cases were identified, yielding a positivity rate of 2.0%, which met the threshold for 'high' yield.
264 visitors underwent HBV testing at the TVC.
Five newly diagnosed chronic HBV cases were found (positivity rate 2.0%, 95% CI = 0.6–4.4%).
A positivity rate ≥2.0% was defined as 'high' yield in the study protocol.
Countries considered endemic for HBV had a prevalence of ≥2.0% or ranked among the top-10 endemic countries in the Netherlands.
Results
No new HCV or HIV cases were identified at the TVC, indicating low yield for these infections in this setting.
293 visitors underwent HCV testing and 290 underwent HIV testing at the TVC.
Zero new cases of HCV or HIV were detected at the TVC.
A positivity rate <2.0% was defined as 'low' yield.
The HCV and HIV yields were therefore classified as 'low' per the study's predefined criteria.
Results
At the CSH, only one newly diagnosed chronic HCV case was identified among 1,023 tested visitors, yielding a positivity rate of 0.1%.
1,023 visitors born in an HCV-endemic country underwent HCV testing at the CSH.
One newly diagnosed chronic HCV case was identified (positivity rate 0.1%, 95% CI = 0.01–0.5%).
This yield was classified as 'low' (below the 2.0% threshold).
HBV and HIV testing were already standard (free) practice at the CSH; only HCV testing was newly integrated.
Methods
The study screened migrants born in countries endemic for HBV, HCV, and/or HIV, consistent with recommendations from the Health Council of the Netherlands.
The Health Council of the Netherlands recommended screening for HBV, HCV, and HIV for migrants born in endemic countries.
Endemicity for HBV and HCV was defined as a national prevalence of ≥2.0% or ranking among the top-10 endemic countries in the Netherlands.
TVC participants were aged ≥18 years; CSH participants were aged ≥16 years.
Testing was offered free of charge at both sites.
Conclusions
The authors concluded that routine HBV screening should be further examined in similar travel-related care settings for migrants from endemic countries, preferably alongside HCV and HIV testing.
HBV screening at the TVC showed a high yield (2.0%), supporting further investigation.
The authors recommended combined HBV/HCV/HIV testing in similar settings rather than HBV alone.
The low HCV yield at the CSH suggests that sexual health care may not be the optimal setting for HCV screening in this population.
The authors noted that the TVC provides a potentially underutilized opportunity to reach migrants from endemic countries.
What This Means
This research suggests that offering free hepatitis B (HBV), hepatitis C (HCV), and HIV tests to migrants from high-burden countries during routine visits to a travel clinic or sexual health clinic in Amsterdam is both practical and achievable. The study, conducted between 2021 and 2023, found that enrollment targets were met at both sites and that nearly 9 in 10 eligible visitors at the sexual health clinic accepted HCV testing, indicating strong patient willingness to participate in integrated screening.
The most notable finding was at the travel clinic, where 2% of tested migrants were newly diagnosed with chronic hepatitis B — a rate high enough to be clinically meaningful and consistent with the known burden of HBV in many migrants' countries of origin. In contrast, no new HCV or HIV cases were found at the travel clinic, and only one HCV case was found among over 1,000 people tested at the sexual health clinic, suggesting these settings may not be the most efficient places to detect HCV or HIV in this population.
This research suggests that embedding hepatitis B screening into travel vaccination appointments for migrants from endemic countries could be a practical way to identify undiagnosed infections that might otherwise go untreated for years. The findings support exploring this approach more broadly in similar public health settings, ideally offering all three tests together to maximize the benefit of each clinical encounter.
Generaal E, Bachour Y, Klijzing S, Cornelissen A, Toering R, Hoornenborg E, et al.. (2025). Integrating hepatitis B virus, hepatitis C virus and human immunodeficiency virus screening for migrants from endemic countries into travel-related and sexual health care in Amsterdam, the Netherlands.. Frontiers in public health. https://doi.org/10.3389/fpubh.2025.1636918