Monitoring and evaluation of community interventions for viral hepatitis among migrants and refugees: a Delphi-based study
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Introduction
Migrants and refugees in Europe carry a disproportionate burden of chronic hepatitis B and C and face barriers accessing formal health systems. Community-based interventions can improve screening, prevention, and care, yet no framework exists to track the performance of these programmes. This study aimed to generate a consensus set of indicators for monitoring and evaluating such interventions.
Methods
A scoping review (PubMed, January 2005□June 2024) identified 70 studies and 275 candidate indicators. After removing redundancies, we submitted 38 primary and 17 additional indicators to a two□round online Delphi panel. Fourteen experts in viral hepatitis, migrant health and community programmes rated each indicator on relevance, measurability, accuracy, ethics and clarity (4□point Likert scale). Items with >67 % combined “agree/somewhat agree” advanced. In Round 2, revised indicators were re□rated and all accepted indicators domain□ranked. Agreement grades (U, A, B, C) reflected the final proportion of positive votes; mean ranks identified domain priorities.
Results
All 38 primary indicators and 10 of 17 additional indicators surpassed the Round 1 threshold. After expert feedback, 15 indicators were re□rated in Round 2; none were rejected. The final set comprised 50 indicators distributed across six domains: Prevention (6), Testing (9), Linkage to care (6), Treatment & Care (9), Morbidity (7) and Health System (13). Overall combined agreement averaged 95.3% (SD 7.0), with 29 indicators achieving unanimous support. Testing and Morbidity domains showed the strongest consensus. Ranking highlighted screening acceptability, infection prevalence, rapid testing results, referral success and treatment initiation as highest priorities. An 18□indicator core subset (top three per domain) was proposed for routine use.
Conclusion
This Delphi study delivers the first consensus□driven indicator suite for monitoring and evaluating community hepatitis B/C services targeting migrants and refugees. Adoption of the 50□indicator framework, and its streamlined core set, can harmonise monitoring, guide resource allocation and strengthen data□driven progress toward elimination goals.
KEY MESSAGES
What is already known on this topic
Community□based HBV/HCV initiatives can reach migrants and refugees who face barriers to facility□based care, yet there is no agreed set of indicators to gauge the performance of these programmes, hindering comparability and quality improvement.
What this study adds
Using a two□round Delphi process, experts reached high consensus on 50 monitoring indicators (of which 18□indicator form a core subset) covering prevention, testing, linkage, treatment, morbidity and health□system support specifically for migrant□ and refugee□focused community services.
How this study might affect research, practice or policy
Adopting these indicators can standardise evaluation, guide resource allocation and enable data□driven adjustments to accelerate progress toward viral hepatitis elimination targets among underserved mobile populations.
