{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:02:23Z","timestamp":1792839743107,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Chronic hepatitis B (HBV), alongside hepatitis D virus (HDV) super-\/co-infection and chronic hepatitis C (HCV), are major contributors to cirrhosis, end-stage liver disease, hepatocellular carcinoma (HCC), and liver-related mortality. Despite significant progress in antiviral treatments and HBV vaccination, viral hepatitis remains a global health burden. Vulnerable populations, such as those experiencing homelessness, migrants, and economically disadvantaged groups, are disproportionately impacted by these infections, often facing barriers to care and exclusion from traditional health systems. This leads to undiagnosed cases and ongoing transmission, undermining global efforts to eliminate HBV and HCV by 2030, as outlined by the World Health Organization (WHO). Recent studies highlight the importance of tailored interventions to address health inequalities. For instance, on-site community-based screening initiatives targeting marginalized groups have shown promise, achieving higher linkage to care rates without monetary incentives. These approaches not only enhance diagnosis but also facilitate integration into healthcare systems, addressing both public health and social disparities. This review underscores the need for targeted strategies to promote the early detection and management of HBV and HCV in underserved populations. Such efforts are critical to advancing the WHO\u2019s elimination goals, improving health outcomes, and addressing the broader social determinants of health.<\/jats:p>","DOI":"10.3390\/v17020265","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T11:14:41Z","timestamp":1739531681000},"page":"265","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Key Importance of Screening Underprivileged People in Order to Achieve Global Hepatitis Virus Elimination Targets"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-9149","authenticated-orcid":false,"given":"Laura","family":"Gragnani","sequence":"first","affiliation":[{"name":"Department of Translational Research and New Medical and Surgical Technologies, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Monti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"De Giorgi","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Medical and Surgical Technologies, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-4166","authenticated-orcid":false,"given":"Anna Linda","family":"Zignego","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2017). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J. Hepatol., 67, 370\u2013398.","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.jhep.2020.08.018","article-title":"EASL recommendations on treatment of hepatitis C: Final update of the series","volume":"73","author":"Pawlotsky","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Stroffolini, T., and Stroffolini, G. (2023). Five Decades of HBV Infection in Italy: A Continuous Challenge. Biology, 12.","DOI":"10.3390\/biology12081075"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S2468-1253(18)30056-6","article-title":"Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: A modelling study","volume":"3","author":"Collaborators","year":"2018","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.jhep.2015.04.026","article-title":"Immigration and viral hepatitis","volume":"63","author":"Sharma","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/hep.27259","article-title":"Global distribution and prevalence of hepatitis C virus genotypes","volume":"61","author":"Messina","year":"2015","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/CMR.00046-19","article-title":"Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy","volume":"33","author":"Nguyen","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.autrev.2017.03.004","article-title":"International therapeutic guidelines for patients with HCV-related extrahepatic disorders. A multidisciplinary expert statement","volume":"16","author":"Zignego","year":"2017","journal-title":"Autoimmun. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1111\/jvh.12881","article-title":"Direct medical costs associated with the extrahepatic manifestations of hepatitis C infection in Europe","volume":"25","author":"Cacoub","year":"2018","journal-title":"J. Viral Hepat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jhep.2006.05.013","article-title":"The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide","volume":"45","author":"Perz","year":"2006","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: A modelling study","volume":"8","author":"Collaborators","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100442","DOI":"10.1016\/j.epidem.2021.100442","article-title":"Estimated prevalence of undiagnosed HCV infected individuals in Italy: A mathematical model by route of transmission and fibrosis progression","volume":"34","author":"Kondili","year":"2021","journal-title":"Epidemics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.jhep.2017.06.033","article-title":"Micro-elimination\u2014A path to global elimination of hepatitis C","volume":"67","author":"Lazarus","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/S2468-1253(20)30011-X","article-title":"Do the most heavily burdened countries have the right policies to eliminate viral hepatitis B and C?","volume":"5","author":"Palayew","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fiore, V., Manca, V., Colpani, A., De Vito, A., Maida, I., Madeddu, G., and Babudieri, S. (2023). Facing HCV as a Major Public Healthcare Threat in Italy: Epidemiology and Micro-Elimination Pathways among Underserved Populations. Healthcare, 11.","DOI":"10.3390\/healthcare11142109"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.dld.2022.11.003","article-title":"Highly dynamic changes of regional HBV epidemiology over two decades","volume":"55","author":"Ricco","year":"2023","journal-title":"Dig. Liver Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jhepr.2019.04.002","article-title":"Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017","volume":"1","author":"Smith","year":"2019","journal-title":"JHEP Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.drugalcdep.2004.02.002","article-title":"Correlates of hepatitis C virus infection in homeless men: A latent variable approach","volume":"75","author":"Stein","year":"2004","journal-title":"Drug Alcohol. Depend."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/003335491212700409","article-title":"Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles","volume":"127","author":"Gelberg","year":"2012","journal-title":"Public Health Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1353\/hpu.2012.0047","article-title":"Hepatitis C among clients of health care for the homeless primary care clinics","volume":"23","author":"Strehlow","year":"2012","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1353\/hpu.0.0023","article-title":"Seroprevalence of HCV infection in homeless Baltimore families","volume":"19","author":"Schwarz","year":"2008","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pereira, L.M., Martelli, C.M., Moreira, R.C., Merchan-Hamman, E., Stein, A.T., Cardoso, M.R., Figueiredo, G.M., Montarroyos, U.R., Braga, C., and Turchi, M.D. (2013). Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: A cross-sectional study. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-60"},{"key":"ref_23","first-page":"54","article-title":"Health status of homeless persons: A pilot study in the Padua municipal dorm","volume":"29","author":"Levorato","year":"2017","journal-title":"Ann. Ig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s10461-005-9049-3","article-title":"HIV, HBV, and HCV infections among drug-involved, inner-city, street sex workers in Miami, Florida","volume":"10","author":"Inciardi","year":"2006","journal-title":"AIDS Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/hep4.1791","article-title":"Shelter-Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness","volume":"6","author":"Khalili","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_26","first-page":"615","article-title":"[Sexually transmitted infections in a cohort of female sex workers in Palermo]","volume":"104","author":"Prestileo","year":"2013","journal-title":"Recenti Prog. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/1557988312456068","article-title":"Correlates of hepatitis B virus and HIV knowledge among gay and bisexual homeless young adults in Hollywood","volume":"7","author":"Nyamathi","year":"2013","journal-title":"Am. J. Men\u2019s Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101551","DOI":"10.1016\/j.tmaid.2020.101551","article-title":"Blood-borne chronic viral infections in a large cohort of immigrants in southern Italy: A seven-centre, prospective, screening study","volume":"35","author":"Coppola","year":"2020","journal-title":"Travel. Med. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jiph.2018.10.004","article-title":"Migration and health: A retrospective study about the prevalence of HBV, HIV, HCV, tuberculosis and syphilis infections amongst newly arrived migrants screened at the Infectious Diseases Unit of Modena, Italy","volume":"12","author":"Cuomo","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Tafuri, S., Prato, R., Martinelli, D., Melpignano, L., De Palma, M., Quarto, M., and Germinario, C. (2010). Prevalence of Hepatitis B, C, HIV and syphilis markers among refugees in Bari, Italy. BMC Infect. Dis., 10.","DOI":"10.1186\/1471-2334-10-213"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1093\/cid\/cix295","article-title":"Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans","volume":"65","author":"Noska","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/eurpub\/ckl233","article-title":"Screening campaign of hepatitis C among underprivileged people consulting in health centres of Lyon area, France","volume":"17","author":"Sahajian","year":"2007","journal-title":"Eur. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"103055","DOI":"10.1016\/j.drugpo.2020.103055","article-title":"HCV testing and treatment initiation in an Italian prison setting: A step-by-step model to micro-eliminate hepatitis C","volume":"90","author":"Fiore","year":"2020","journal-title":"Int. J. Drug Policy"},{"key":"ref_34","first-page":"101172","article-title":"HBV and HCV testing outcomes among marginalized communities in Italy, 2019\u20132024: A prospective study","volume":"49","author":"Monti","year":"2025","journal-title":"Lancet Reg. Health\u2013Eur."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1177\/0033354920943528","article-title":"Susceptibility to Hepatitis A and B Virus Among Clients at a Syringe Services Program in Philadelphia, 2018","volume":"135","author":"Figgatt","year":"2020","journal-title":"Public Health Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1080\/09540121.2016.1231886","article-title":"Out-of-Hospital screening for HIV, HBV, HCV and Syphilis in a vulnerable population, a public health challenge","volume":"29","author":"Legoupil","year":"2017","journal-title":"AIDS Care"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Evans, H., Balasegaram, S., Douthwaite, S., Hunter, L., Kulasegaram, R., Wong, T., Querol-Rubiera, A., and Nebbia, G. (2018). An innovative approach to increase viral hepatitis diagnoses and linkage to care using opt-out testing and an integrated care pathway in a London Emergency Department. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198520"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"v39","DOI":"10.1093\/jac\/dkz455","article-title":"HepCare Europe: A service innovation project. HepCheck: Enhancing HCV identification and linkage to care for vulnerable populations through intensified outreach screening. A prospective multisite feasibility study","volume":"74","author":"Barror","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","first-page":"goad077","article-title":"Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain","volume":"12","author":"Aranda","year":"2024","journal-title":"Gastroenterol. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5334\/aogh.4388","article-title":"Prevalence of Sexually Transmitted Infections and Predictors for Loss to Follow Up among Marginalized Homeless and Migrant Communities: A Cross-Sectional Study","volume":"90","author":"Segala","year":"2024","journal-title":"Ann. Glob. Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/hep.30297","article-title":"Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013\u20132016","volume":"69","author":"Hofmeister","year":"2019","journal-title":"Hepatology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"293","DOI":"10.7326\/M13-1133","article-title":"Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010","volume":"160","author":"Denniston","year":"2014","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/pubmed\/fdg088","article-title":"A survey of hepatitis C prevalence amongst the homeless community of Oxford","volume":"25","author":"Sherriff","year":"2003","journal-title":"J. Public Health Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1002\/hep.28109","article-title":"Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988\u20132012","volume":"63","author":"Roberts","year":"2016","journal-title":"Hepatology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/FCH.0000000000000246","article-title":"Opiate Dependence: A Risk Factor for Hepatitis B Virus Exposure in Homeless Adults","volume":"43","author":"Khouzam","year":"2020","journal-title":"Fam. Community Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Taylor, J.E.B., Surey, J., MacLellan, J., Francis, M., Abubakar, I., and Stagg, H.R. (2019). Hepatitis B vaccination uptake in hard-to-reach populations in London: A cross-sectional study. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3926-2"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e00109216","DOI":"10.1590\/0102-311x00109216","article-title":"Prevalence, risk factors and hepatitis B immunization: Helping fill the gap on hepatitis B epidemiology among homeless people, Goi\u00e2nia, Central Brazil","volume":"33","author":"Carvalho","year":"2017","journal-title":"Cad. Saude Publica"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"7049","DOI":"10.1016\/j.vaccine.2011.07.030","article-title":"Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009","volume":"29","author":"Lu","year":"2011","journal-title":"Vaccine"},{"key":"ref_49","first-page":"21","article-title":"Health status, diseases and vaccinations of the homeless in the city of Palermo, Italy","volume":"31","author":"Alagna","year":"2019","journal-title":"Ann. Ig."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Page, K., Yu, M., Cohen, J., Evans, J., Shumway, M., and Riley, E.D. (2017). HCV screening in a cohort of HIV infected and uninfected homeless and marginally housed women in San Francisco, California. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4102-5"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"van Laere, I.R., de Wit, M.A., and Klazinga, N.S. (2009). Pathways into homelessness: Recently homeless adults problems and service use before and after becoming homeless in Amsterdam. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-3"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.2105\/AJPH.2009.180109","article-title":"The unmet health care needs of homeless adults: A national study","volume":"100","author":"Baggett","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/jvh.13762","article-title":"Poor linkage to care may compromise the Brazilian plan for hepatitis C elimination","volume":"30","author":"Bittencourt","year":"2023","journal-title":"J. Viral Hepat."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/2\/265\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:34:33Z","timestamp":1760027673000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/2\/265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["v17020265"],"URL":"https:\/\/doi.org\/10.3390\/v17020265","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,14]]}}}