General practitioners' knowledge and management of viral hepatitis in the migrant population

Background: Escalating morbidity and mortality associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent a major health burden in Australia, particularly among migrants from endemic areas who may present late. Methods and Aims: We evaluated the knowledge and educational needs of general practitioners (GPs) in the St George Division, Sydney which serves a large migrant population. The aims of the study were to identify gaps in knowledge about viral hepatitis that may affect management and referral patterns. GPs completed a survey comprised of 15 questions. They were also invited to comment on barriers to managing viral hepatitis in migrant patients. Results: A 44% response rate was achieved from 280 eligible GPs. Forty-two per cent of GPs lacked confidence in interpreting HCV serology and 20% for HBV serology. Twenty-two per cent of GPs did not recognise HCC as a complication of HBV and 18% for HCV. Twenty per cent of GPs were unaware of treatment for HBV. Forty-seven per cent of GPs were uncertain whether pregnant women could receive HCV treatment. Twenty-three per cent and 21% of respondents believed that all HCV- or HBV-infected mothers, respectively, should not breast-feed. Eighty-nine per cent of GPs identified language difficulties as the main barrier to treatment among the migrant population. Conclusions: There were gaps in the knowledge of GPs particularly concerning natural history, diagnosis, treatment availability and management of pregnant or lactating women with viral hepatitis. Specific educational initiatives targeting these deficits are required as well as increased availability of language resources for managing patients from a non-English-speaking background.