National policies for delivering tuberculosis, HIV and hepatitis B and C virus infection services for refugees and migrants among Member States of the WHO European Region.

BACKGROUND/OBJECTIVE: Refugees and migrants to the World Health Organization (WHO) European Region are disproportionately affected by infections, including tuberculosis (TB), human immunodeficiency virus (HIV) and hepatitis B and C (HBV/HCV) compared with the host population. There are inequities in the accessibility and quality of health services available to refugees and migrants in the Region. This has consequences for health outcomes and will ultimately impact the ability to meet Regional infection elimination targets. METHODS: We reviewed academic and grey literature to identify national policies and guidelines for TB/HIV/HBV/HCV specific to refugees and migrants in the Member States of the WHO European Region and to identify: (i) evidence informing policy and (ii) barriers and facilitators to policy implementation. RESULTS: Relatively few primary national policy/guideline documents were identified which related to refugees and migrants and TB [14 of 53 Member States (26%), HIV (n = 15, 28%) and HBV/HCV (n = 3, 6%)], which often did not align with the WHO recommendations, and for some countries, violated refugees' and migrants' human rights. We found extreme heterogeneity in the implementation of the WHO- and European Centre for Disease Prevention and Control (ECDC)-advocated policies and recommendations on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection among migrants across the Member States of the WHO European Region.There is great heterogeneity in implementation of WHO- and ECDC-advocated policies on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in refugees and migrants across the Member States in the Region. CONCLUSION: More transparent and accessible reporting of national policies and guidelines are required, together with the evidence base upon which these policy decisions are based. Political engagement is essential to drive the changes in national legislation to ensure equitable and universal access to the diagnosis and care for infectious diseases.

Фактические данные о существующих национальных мерах политики и руководствах по предоставлению беженцам и мигрантам эффективных услуг в связи с туберкулезом, ВИЧ-инфекцией и вирусными гепатитами в государствах-членах в Европейском регионе ВОЗ

Европейское региональное бюро ВОЗ разработало несколько планов действий по предоставлению эффективных услуг для беженцев и мигрантов в связи с туберкулезом (ТБ), вирусными гепатитами и ВИЧ-инфекцией в Европейском регионе ВОЗ. В данном докладе рассматриваются имеющиеся фактические данные о существующих национальных мерах политики и рекомендациях по предоставлению эффективных услуг беженцам и мигрантам в государствах-членах в Европейском регионе ВОЗ. Обзор выявил крайнюю неоднородность в наличии соответствующих национальных руководств и рекомендаций, а также в уровне реализации положений этих документов в странах Региона. В 53 государствах-членах в Регионе было выявлено лишь 15 первичных документов по вопросам политики/руководств, касающихся мигрантов и проблем вирусных гепатитов, ВИЧ-инфекции или ТБ. Для успешного продвижения в государствах-членах мер политики, в поддержку которых выступают ВОЗ и Европейский центр профилактики и контроля заболеваний, необходимо обеспечить понимание существующих на макроуровне барьеров на пути к реализации этих мер. Кроме того, при разработке национальных программ необходимо учитывать барьеры на микро- (индивидуальном) и мезо- (сообщества) уровнях, затрудняющие использование таких услуг мигрантами и применение предписанных подходов практикующими врачами.

What is the evidence on existing national policies and guidelines for delivering effective tuberculosis, HIV and viral hepatitis services for refugees and migrants among Member States of the WHO European Region?

The WHO Regional Office for Europe has developed several action plans to deliver effective tuberculosis (TB)-, viral hepatitis- and HIV-related services for refugees and migrants within the WHO European Region. This report examines the available evidence on existing national policies and guidelines for delivering effective TB-, viral hepatitis- and HIV-related services for refugees and migrants in Member States of the WHO European Region.The review highlighted extreme heterogeneity between countries in the Region in the availability of relevant national guidelines and recommendations and in implementation of these documents. In the 53 Member States of the WHO European Region, only 15 primary policy/guideline documents relating to migrants and viral hepatitis, HIV or TB were identified. The promotion in Member States of policies advocated by WHO and the European Centre for Disease Prevention and Control requires an understanding of the macro-level barriers to implementation. Furthermore, the design of national programmes needs to take account of barriers at the micro (individual) and meso (community) levels to uptake by migrant populations and to the adoption of policies by health-care practitioners.