Why Viral Hepatitis Persists in Europe’s Migrant Communities — and How Community Health Workers Can Help Close the Gap

Structural and language barriers keep key health tools out of reach. Discover how the HEP-HOP project is training frontline workers for decentralized care.

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[This post was written by Aina Nicolàs, Camila Picchio and Anthony Armenta, from the Public Health Liver Group at ISGlobal.]

A vaccine, rapid diagnostic tests and effective treatment options exist. You’d think that viral hepatitis must be close to elimination, but it’s far from over.

The latest World Health Organization (WHO) Global Hepatitis Report has shown that viral hepatitis infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV), continue to cause over one million deaths annually. At the same time, most people living with chronic viral hepatitis remain undiagnosed or untreated, revealing a disconnect between the tools already available and better health outcomes. When we look more closely at Europe, the picture is equally striking: elimination targets remain far out of reach, with a strong gap in both diagnosis and treatment rates.

The challenge, then, is not simply whether effective medical tools exist. It is whether people can actually access, understand and navigate the services that provide them.

The challenge is not simply whether effective medical tools exist. It is whether people can actually access, understand and navigate the services that provide them.

This is particularly important for migrant communities in Europe, who may face barriers that traditional clinic-based approaches do not adequately address. These communities are disproportionately affected and account for an estimated 25% of HBV infections and 14% of HCV infections. This happens because of a complex interplay of factors, including limited availability of preventive strategies in their home countries, and substantial barriers to access and navigate their host health systems, which are further compounded by cultural and linguistic barriers.

For someone trying to access care in a new country, these barriers can be structural as well as personal: not knowing where to go for testing, struggling to understand health information in an unfamiliar language, navigating appointments and referrals, or facing stigma and misconceptions around viral hepatitis.

Early diagnosis and timely care are therefore essential to prevent serious health problems and reduce further transmission.

The consequences of being missed by the health system can be serious. A delayed diagnosis often leads to the infection being detected only after advanced liver disease has developed. This means an increased risk of cirrhosis, liver cancer, and, ultimately, death. In parallel, when people don’t know they have the infection, they may not take the precautions needed to protect others, allowing it to spread within the community unknowingly. Early diagnosis and timely care are therefore essential to prevent serious health problems and reduce further transmission.

Bringing care closer to where people live

Reaching people who are not accessing traditional health services requires us to rethink where and how care is delivered.

According to WHO, simplifying and decentralising how we deliver screening and care services is central to viral hepatitis elimination efforts. This means moving some services beyond specialised clinical settings and closer to the communities that need them, while making it easier for people to move from testing to appropriate care.

Community health workers and other community facilitators can make this possible.

In practice, their role is very tangible. These frontline public health professionals may explain why testing matters in a language and context people understand, answer questions and address stigma and misconceptions, help someone find or access a testing service, guide them through appointments or referrals, and connect them with the formal health system when further care is needed. Because they often come from, work closely with, or have established trust within the communities they serve, they can bridge cultural, linguistic and structural gaps that healthcare services may struggle to overcome on their own.

Frontline public health professionals may explain why testing matters in a language and context people understand, answer questions and address stigma and misconceptions, help someone find or access a testing service, guide them through appointments or referrals, and connect them with the formal health system when further care is needed.

This is not a new idea.

Across different health systems, community health workers have helped extend care to communities that might otherwise be missed. In Rwanda, for example, community health workers have been instrumental in strengthening primary healthcare, with their responsibilities expanding from basic health promotion to integrated community case management. Their experience shows what can happen when community-based workers are recognised as a core part of how people reach and use health services.

Despite the substantial contribution of community health workers in health systems among low- and middle-income countries, their potential to support health systems in high-income countries is immense.

In Europe, a stronger and more integrated role for community health workers could help address persistent challenges in migrant health, including unequal access to services and growing cultural and linguistic diversity. Yet their roles are not consistently embedded within formal healthcare systems. Some countries and regions–like Belgium and the United Kingdom–have taken steps to connect community health workers more closely with primary care, while elsewhere their involvement remains fragmented or dependent on individual pilot programmes and research projects.

Realising their full potential therefore requires more than simply recognising that community-based approaches work. The people delivering these services also need the knowledge, practical tools and support to carry out their roles effectively and link communities with the wider healthcare system.

Turning this approach into action through HEP-HOP

This is one of the challenges that the Health Equity Programme: Hepatitis Outreach for Migrant Populations (HEP-HOP) project aims to address.

Leaving no one behind is at the heart of HEP-HOP, an EU-funded project focused on improving access to viral hepatitis care among migrants across Europe.

Because bringing services closer to communities must involve communities themselves, a central component of the project is decentralised, point-of-care testing for viral hepatitis, delivered with the involvement of community health workers and other community facilitators, including peer navigators, social mediators and civic integration teachers.

ISGlobal and the University of Antwerp are developing a structured training curriculum to equip frontline community workers with practical skills.

These are people who are already well positioned to build trust, communicate in culturally appropriate ways and help individuals navigate services. But for this model to be effective and scalable, they also need structured preparation for the responsibilities they are being asked to take on.

That is why ISGlobal and the University of Antwerp are developing a structured training curriculum to equip frontline community workers with the practical skills needed to:

• conduct decentralised screening,
• tackle stigma and misconceptions,
• engage with migrant communities in culturally appropriate ways, and
• increase awareness of viral hepatitis among migrants in Europe.

Designed with sustainability and scalability in mind, the curriculum has undergone an expert-led revision process involving community representatives as well as global advocacy organisations, including the World Hepatitis Alliance and the Hepatitis B Foundation, alongside other researchers and experts.

The goal is to strengthen the connections between communities and the health services already available, so that people can access testing, care and treatment earlier and more easily.

Eliminating viral hepatitis will depend on making existing tools work for everyone. Trusted community support, accessible services and stronger links to care can help ensure that no one is left behind.