Journey Towards Piloting Helicobacter pylori Screen-and-Treat to Address Health Inequities in Aotearoa New Zealand

Abstract

Background

Māori and Pacific peoples in Aotearoa New Zealand (Aotearoa) face the greatest barriers to healthcare access, poorest health outcomes, and disproportionate levels of deprivation.

Methods

This paper outlines the (1) epidemiology of H. pylori and its sequelae, (2) inequities in the current H. pylori approach, (3) research into screen-and-treat, and (4) our recommendations going forward.

Results

There are stark ethnic differences in prevalence of H. pylori infection and its sequelae in Aotearoa—with higher H. pylori infection prevalence and gastric cancer incidence and higher numbers of hospitalisations for peptic ulcer in Māori, Pacific, and Asian ethnicities than in European. The opportunistic approach taken to H. pylori testing has created inequities. Māori and Pacific are less likely to be tested for H. pylori than European, despite the higher prevalence of infection in these populations. In Aotearoa, a targeted screen-and-treat approach has been shown to be more cost-effective than a population–wide strategy.

Conclusion

There is an urgent need to introduce a screen-and-treat pilot in Aotearoa, which should be led by Māori. Piloting of screen-and-treat is useful for evaluating invitation, testing and treatment strategies. Further cost–effectiveness modeling could support the evaluation of more specific targeting, test choice, and treatment choice where input data allow.