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Trevisan S, Gasparro G, Kiros ST, Pozzi M, Malcontenti C, Campolmi I, Paggi R, Cavallo A, Farese A, Ducci F, Meli M, Pittorru M, Bartoloni A, Sterrantino G, Lagi F. Impact of rapid-antiretroviral therapy in a cohort of treatment-naïve migrants living with HIV in a high income setting. Int J STD AIDS 2024:9564624241270970. [PMID: 39106048 DOI: 10.1177/09564624241270970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND We evaluated the effect of rapid ART (RA) compared to delayed ART (DA) on viral load suppression (viral load <50 cp/mL) and loss to follow-up (LTFU) in a cohort of migrants living with HIV (MLWHs) in Italy. METHODS Data were retrospectively gathered from MLWHs who began care at the Infectious and Tropical Diseases Unit of the Careggi University Hospital from January 2014 to December 2022. RA was defined as antiretrovirals prescribed within 7 days of HIV diagnosis. The study ended on April 30, 2023, or upon patient LTFU. Chi-square and non-parametric tests assessed differences in categorical and continuous variables, respectively. Kaplan-Meyer survival analysis was performed to estimate the probability of loss to follow-up. Cox regression analysis was performed to evaluate factors associated with a loss to follow-up. RESULTS 87 MLWHs were enrolled: 20 (23%) on RA and 67 (77%) on DA. In the RA group there were more PLWH with a previous AIDS event (p < .001) however, there was no significant difference in the LTFU rates between the groups (aHR 0.6, 95%CI 0.1-3.1; p = .560; Logrank = 0.2823). Being an out-of-status MLWH was the only predictor of LTFU. By 6 months, virological suppression was achieved in 61.2% (n = 41) in DA and 70.0% in the RA group (n = 14) (Logrank p = .6747). CONCLUSIONS RA did not significantly affect LTFU rates or the achievement of viral load suppression. The study suggests that further research is needed to assess the impact of RA in high income settings.
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Affiliation(s)
- Sasha Trevisan
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Gasparro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Costanza Malcontenti
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Riccardo Paggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Farese
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Ducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Meli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Mario Pittorru
- Hospital Pharmacy, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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Poglia Mileti F, Mellini L, Tadorian M. When social, relational and sexual vulnerabilities increase vulnerability to HIV/AIDS: the case of migrants living in Switzerland. AIDS Care 2024; 36:1002-1009. [PMID: 38088934 DOI: 10.1080/09540121.2023.2289469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/22/2023] [Indexed: 07/25/2024]
Abstract
There is emerging evidence that a significant proportion of migrants acquire HIV after arrival in Europe. Thus, to strengthen prevention efforts, it is crucial to understand migrants' vulnerability to HIV/AIDS. This article contributes to this understanding by analysing the perspectives of prevention actors and migrants. Data were collected through a qualitative and participative research study conducted in Switzerland. Twenty prevention actors and 28 migrants participated in in-depth interviews. Results show that migrants' difficulties in accessing and adopting measures to prevent HIV are related to three types of situational vulnerability that increase their vulnerability to HIV/AIDS: social vulnerability, which refers to social inequalities in access to care; relational vulnerability, which refers to unequal distribution of power within intimate relationships; and sexual vulnerability, which refers to stigmatization of sexualities that some people may consider as socially nonconforming. For HIV/AIDS prevention to be successful among migrants, power structures such as sexism, heterosexism, cisgenderism, ethnocentrism, and racism need to be addressed. Reducing stigma related to HIV among migrants requires a struggle against these power structures as well as health inequities.
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Affiliation(s)
| | - Laura Mellini
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | - Marc Tadorian
- Social Work, University of Applied Sciences, Fribourg, Switzerland
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Sousa Nunes B, Marques-Matos C, Conceição C, Silva TM. Progressive multifocal leukoencephalopathy in children with HIV: still a challenge. Arch Dis Child 2024; 109:593. [PMID: 38442948 DOI: 10.1136/archdischild-2023-326609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Beatriz Sousa Nunes
- Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Cláudia Marques-Matos
- Pediatric Neurology Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Carla Conceição
- Imagiology Department, Neuroradiology, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Tiago Milheiro Silva
- Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Palich R, Arias-Rodríguez A, Duracinsky M, Le Talec JY, Rousset Torrente O, Lascoux-Combe C, Lacombe K, Ghosn J, Viard JP, Pialoux G, Ohayon M, Duvivier C, Velter A, Ben Mechlia M, Beniguel L, Grabar S, Melchior M, Assoumou L, Supervie V. High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022. Euro Surveill 2024; 29:2300445. [PMID: 38487889 PMCID: PMC10941311 DOI: 10.2807/1560-7917.es.2024.29.11.2300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024] Open
Abstract
BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Andrés Arias-Rodríguez
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Martin Duracinsky
- Paris Cité University, Patient-Reported Outcomes Unit (PROQOL), INSERM 1123, Paris, France
| | - Jean-Yves Le Talec
- Toulouse Jean Jaurès University, CERTOP, CNRS UMR 5044, Toulouse, France
| | | | | | - Karine Lacombe
- Sorbonne University, Saint Antoine hospital, AP-HP, Paris, France
| | - Jade Ghosn
- Paris Cité University, Bichat hospital, AP-HP, Paris, France
| | - Jean-Paul Viard
- Paris Cité University, Hôtel-Dieu hospital, AP-HP, Paris, France
| | - Gilles Pialoux
- Sorbonne University, Tenon hospital, AP-HP, Paris, France
| | | | - Claudine Duvivier
- Paris Cité University, Necker hospital, AP-HP; INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine; Institut Pasteur Medical Center, Paris, France
| | | | - Mohamed Ben Mechlia
- French National Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Paris, France
| | - Lydie Beniguel
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Grabar
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Maria Melchior
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Virginie Supervie
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
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5
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Solomon D, Cabecinha M, Gibbs J, Burns F, Sabin CA. How do we measure unmet need within sexual and reproductive health? A systematic review. Perspect Public Health 2024; 144:78-85. [PMID: 36127856 PMCID: PMC10916345 DOI: 10.1177/17579139221118778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing health inequality with sexual and reproductive health requires an understanding of unmet need within a range of populations. This review examined the methods and definitions that have been used to measure unmet need, and the populations most frequently assessed. METHODS Five databases (PubMed, Web of Science, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Health Management and Policy Database (HMIC)) were searched for studies that described quantitative measurement of unmet need within sexual and/or reproductive health between 2010 and 2021. A narrative synthesis was then undertaken to ascertain themes within the literature. RESULTS The database search yielded 19,747 papers; 216 papers were included after screening. 190 studies assessed unmet reproductive health need, of which 137 were analyses of trends among people living in low/lower-middle income countries; 181 used cross-sectional data, with only nine analyses being longitudinal. Eighteen studies analysed unmet sexual health need, of which 12 focused on high and upper-middle income populations. 16 papers used cross-sectional analyses. The remaining 10 studies examined unmet need for a combination of sexual and reproductive health services, eight among populations from upper-middle or high income countries. All were cross-sectional analyses. 165 studies used the Demographic and Health Surveys (DHS) definition of unmet need; no other standardised definition was used among the remaining papers. DISCUSSION There is a significant focus on unmet need for contraception among women in low income countries within the published literature, leaving considerable evidence gaps in relation to unmet need within sexual health generally and among men in particular, and unmet reproductive health need in high income settings. In addition, using an increased range of data collection methods, analyses and definitions of unmet need would enable better understanding of health inequality in this area.
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Affiliation(s)
- D Solomon
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, UK
| | - M Cabecinha
- Institute for Global Health, University College London, London, UK
| | - J Gibbs
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - CA Sabin
- Institute for Global Health, University College London, London, UK
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6
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Mann S, Mougammadou Z, Wohlfahrt J, Elmahdi R. Post-migration HIV acquisition: A systematic review and meta-analysis. Epidemiol Infect 2024; 152:e49. [PMID: 38425215 PMCID: PMC11022255 DOI: 10.1017/s0950268824000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/20/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
Migrants in Europe face a disproportionate burden of HIV infection; however, it remains unclear if this can be prevented through public health interventions in host countries. We undertake a systematic review and meta-analysis to estimate post-migration HIV acquisition (PMHA) as a proportion of all HIV cases in European migrants. MEDLINE, EMBASE, Global Health, HMIC, and Cochrane Library were searched with terms capturing 'HIV', 'migration', and 'Europe'. Data relating to the proportion of HIV acquired following migration were extracted and random-effects model (REM) meta-analysis was undertaken to calculate a pooled estimate for the proportion of PMHA in European countries. Subgroup meta-analysis was undertaken for PMHA by migrant demographic characteristics and host country. Fifteen articles were included for systematic review following retrieval and screening of 2,320 articles. A total of 47,182 migrants in 11 European countries were included in REM meta-analysis, showing an overall PMHA proportion of 0.30 (95% CI: 0.23-0.38). Subgroup analysis showed no significant difference in PMHA between host country and migrant demographic characteristics. This work illustrates that migrants continue to be at high risk of HIV acquisition in Europe. This indicates the need for targeted screening and HIV prevention interventions, ensuring resources are appropriately directed to combat the spread of HIV.
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Affiliation(s)
- Simran Mann
- School of Public Health, Imperial College London, London, UK
| | | | | | - Rahma Elmahdi
- Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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7
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Mellini L, Poglia Mileti F, Tadorian M. Migrants facing intersectional vulnerability to HIV and AIDS in Switzerland: an exploratory study. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 38415354 DOI: 10.1080/13691058.2024.2319335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
An emerging body of evidence suggests that a significant number of HIV-positive migrants to Europe acquire HIV after arriving in their host country. There is an urgent need to rethink HIV and AIDS prevention for migrant populations and to acknowledge the specific vulnerability to HIV and AIDS that migrants face. This article uses empirical data collected in a qualitative sociological study conducted in Switzerland. We provide evidence for the heuristic value of articulating an intersectional approach within a multilevel (biographical, interactional and contextual) framework to capture the complexity of the vulnerability to HIV and AIDS. We show that migrants' specific vulnerability to HIV and AIDS results from social vulnerabilities related to many social and cultural dimensions, including migration status, socioeconomic conditions, gender and sexual identity, sexual norms, the relational context in which sex occurs, power relations and sociocultural structures of the receiving country. The three case studies presented illustrate how HIV-related processes of intersectional vulnerability are embedded in sexism, cisgenderism, and racism, and how they are closely linked to social inequalities in health. Effective HIV and AIDS prevention for migrants must take greater account of these power relations and sociocultural structures.
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Affiliation(s)
- Laura Mellini
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | | | - Marc Tadorian
- School of Social Work, University of Applied Sciences, Fribourg, Switzerland
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8
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Shobowale O, Schmidt AJ, Meireles P, Rojas Castro D, Detandt S, Stutterheim SE, Weatherburn P, Jonas KJ. Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub-Saharan Africa and Other Regions Residing in 10 European Countries. AIDS Behav 2024; 28:488-506. [PMID: 38326669 PMCID: PMC10876736 DOI: 10.1007/s10461-023-04239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited. Using data from the European MSM Internet Survey (EMIS-2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses. Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75-80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01-1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11-1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21-0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV. Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.
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Affiliation(s)
- Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Axel J Schmidt
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Paula Meireles
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | | | - Sandrine Detandt
- Faculty of Psychology, Observatoire du Sida et des Sexualités Research Center, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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9
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Tieosapjaroen W, Zhang Y, Fairley CK, Zhang L, Chow EPF, Phillips TR, Schmidt HM, Bavinton BR, O'Donnell D, Mao L, Grulich A, Ong JJ. Improving access to oral pre-exposure prophylaxis for HIV among international migrant populations. Lancet Public Health 2023; 8:e651-e658. [PMID: 37421969 DOI: 10.1016/s2468-2667(23)00105-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is recommended for people susceptible to HIV acquisition, and the scale-up of PrEP programmes has contributed to new HIV case reductions at a population level. However, international migrants continue to be disproportionately affected by HIV. Understanding barriers and facilitators to PrEP implementation among international migrants can optimise PrEP use among this population and ultimately reduce HIV incidence worldwide. We reviewed the evidence regarding factors influencing PrEP implementation among international migrants; 19 studies were included. The barriers and facilitators at the individual level were related to knowledge and risk perception of HIV. Cost, provider discriminations, and health system navigation influenced PrEP use at the service level. Positive or negative perception towards LGBT+ identities, HIV, and PrEP users affected PrEP use at the societal level. Most existing PrEP campaigns do not target international migrants; therefore, culturally tailored approaches for people from different backgrounds are warranted. Potentially migration-related and HIV-related discriminatory policies must be reviewed to increase access to HIV prevention services to end HIV transmission at a population level.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ying Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Heather-Marie Schmidt
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand; Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | | | - Darryl O'Donnell
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Australian Federation of AIDS Organisations, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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10
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Owusu MW, Krankowska DC, Lourida P, Weis N. Late HIV diagnosis among migrant women living in Europe - a systematic review of barriers to HIV testing. IJID REGIONS 2023; 7:206-215. [PMID: 37128290 PMCID: PMC10148112 DOI: 10.1016/j.ijregi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
Objectives HIV transmission persists in Europe, with migrants accounting for over two-fifths of new diagnoses. Over half of all women in Europe are diagnosed late - particularly migrant women. Therefore, an updated understanding of migrant women's needs is crucial to inform inclusive and relevant HIV research, services, and policies. Methods A systematic review relating to factors influencing late HIV diagnoses among migrant women living in Europe in 2011-2021 was conducted, based on data from 12 papers relating to 13 European Union (EU) countries and three non-EU countries. Results The studies revealed a range of individual, sociocultural, and structural barriers to HIV diagnosis. Individual barriers included low perceived risk of HIV, lack of knowledge about HIV symptoms and HIV services, lack of trust in healthcare systems, and fear of societal implications of an HIV diagnosis. Sociocultural barriers included language and communication challenges, stigma, and lack of community testing opportunities. Structural factors included poverty, poor living conditions, unclear legal rights, administrative barriers to healthcare access, and lack of testing opportunities. Conclusions Barriers varied according to resident country, healthcare system, and country/region of origin. The studies highlighted the importance of inclusive research and service design and development, to address the needs of migrant women and reduce inequalities, especially given the current climate in Europe and the everchanging patterns of migration.
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Affiliation(s)
| | - Dagny Clea Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Panagiota Lourida
- Department of Infectious Diseases and HIV, Evaggelismos General Hospital, Athens, Greece
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Zhao P, Wang J, Hall BJ, Sakyi K, Rafiq MY, Bodomo A, Wang C. HIV testing uptake, enablers, and barriers among African migrants in China: A nationwide cross-sectional study. J Glob Health 2022; 12:11015. [PMID: 36527361 PMCID: PMC9758700 DOI: 10.7189/jogh.12.11015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background African migrants in China face social, structural, and cultural barriers to human immunodeficiency virus (HIV) testing with scarce information on their HIV testing behaviours. This study estimated the prevalence of HIV testing and its social and behavioural correlates to understand how to better provide HIV testing services for African migrants living in China. Methods We conducted a national cross-sectional survey among adult African migrants who lived in China for more than one month between January 19 to February 7, 2021. The survey was disseminated online through six African community organizations and via participant referrals. We collected data on HIV testing behaviours and history of HIV testing, social, and cultural factors and applied univariate and multivariable logistic regression to identify testing correlates. Results Among a total of 1305 participants, 72.9% (n = 951/1305) tested for HIV during their stay in China and yielded a self-reported HIV prevalence of 0.4% (n = 4/951). The most common reason for HIV testing was to comply with Chinese residence policy requirements (88.5%, n = 842/951); for not testing was "no need to be tested" (79.4%, n = 281/354). We found most African migrants have experienced low acculturation stress (54.5%, n = 750/1305), low social discrimination (65.6%, n = 856/1305), have a moderate stigma towards HIV (54.3%, n = 709/1305), and low community engagement around sexual health and HIV topics. In multivariable analysis, African migrants who were students (adjusted odds ratio (aOR) = 3.36, 95% CI = 2.40-4.71), living in student dormitories (aOR = 3.86, 95% CI = 1.51-9.84), received health services in China in past year (aOR = 1.67, 95% CI = 1.25-2.23), had lifetime sexually transmitted infections (STI) testing (aOR = 1.95, 95% CI = 1.23-3.10), had HIV testing before coming to China (aOR = 13.56, 95% CI = 9.36-19.65), and those engaged in community discussions of HIV and sexual health (aOR = 2.77, 95% CI = 1.31-5.83) were more likely to test for HIV in China. Conclusions Despite 73% of African migrants having tested for HIV in China, there are unmet needs and barriers identified in our study, such as language barriers. Access to HIV knowledge and testing services were the most important enablers for testing, including studentship, past STI/HIV testing, and community discussion on sexual health. Culturally appropriate and community-based outreach programs to provide information on HIV and testing venues for African migrants might be helpful to promote testing uptake.
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Affiliation(s)
- Peizhen Zhao
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
| | - Jiayu Wang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Kwame Sakyi
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, USA,Center for Learning and Childhood Development, Accra, Ghana
| | | | - Adams Bodomo
- School of Liberal Arts, Xi'an University, Xi'an, China,African Studies Department, University of Vienna, Vienna, Austria
| | - Cheng Wang
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
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Vaz-Pinto I, Gorgulho A, Esteves C, Guimarães M, Castro V, Carrodeguas A, Medina D. Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments. HIV Med 2022; 23:1153-1162. [PMID: 36320172 PMCID: PMC10092854 DOI: 10.1111/hiv.13431] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. METHODS The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18-64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. RESULTS After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). CONCLUSIONS People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.
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Affiliation(s)
- Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | - Ana Gorgulho
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | - Catarina Esteves
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | - Mafalda Guimarães
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | - Vanda Castro
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
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Santoso D, Asfia SK, Mello MB, Baggaley RC, Johnson CC, Chow EP, Fairley CK, Ong JJ. HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101661. [PMID: 36147629 PMCID: PMC9486043 DOI: 10.1016/j.eclinm.2022.101661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I2 =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I2 =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I2 =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I2 =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).
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Affiliation(s)
- Devy Santoso
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Maeve B. Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C. Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
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Ortega-Gonzalez E, Martínez-Roma M, Dolores Ocete M, Jimeno C, Fornos A, Esteban A, Martinez M, Valero C, Gómez-Muñoz N, Carrodeguas A, Medina D, Garcia-Deltoro M. HIV screening and linkage to care in a health department in Valencia, Spain: Lessons learned from a healthcare quality improvement project. Medicine (Baltimore) 2022; 101:e30400. [PMID: 36254051 PMCID: PMC9575804 DOI: 10.1097/md.0000000000030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spain's rate of new human immunodeficiency virus (HIV) diagnoses exceeds that of the European Economic Area average (8.6 vs 5.6:100,000 in 2018). The country has failed to meet the first of United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV control by 2020, with 87.0% of people living with HIV knowing their status, and late presentation rates of 47.6% and 51.5% country-wide and in the Valencian autonomous community, respectively. Advancing screening and linkage to care (SLTC) practices is necessary to effectively control the epidemic. The Valencia Viral Screening (CRIVALVIR) project adopted the TEST model for opportunistic and systematic HIV SLTC in individuals aged 18 to 80 who required blood work for any purpose, as of February 2019. SLTC was integrated into routine clinical workflow across primary care centers serving a population of 360,000 people in Valencia, Spain. Our project successfully upscaled total HIV testing by 194% to over 32,000 patients tested in 14 months. We found an overall prevalence of 0.13% (0.08-0.21) among those screened per protocol (n = 13,061), with foreign-born citizens presenting a 12.5 times significantly higher likelihood of acquiring HIV (95% confidence interval 4.63-33.96, P < .0001). We improved late presentation by 18.2 percentage points and prevented an estimated 58 to 70 new secondary infections. HIV screening of the general population in primary care is an effective strategy for achieving timely diagnosis and preventing new infections. Opportunistic, systematic, opt-out approaches are essential to control the HIV epidemic.
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Affiliation(s)
- Enrique Ortega-Gonzalez
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
- * Correspondence: Enrique Ortega-Gonzalez, Fundació Investigació Hospital General Universitari València, Spain. Av. Tres Cruces, 2, 46014, Valencia, Spain (e-mail: )
| | - María Martínez-Roma
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
| | | | | | | | | | | | - Carmen Valero
- Departament Hospital General València, Valencia, Spain
| | - Neus Gómez-Muñoz
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
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Jones W, Somerset S, Evans C, Whittingham K, Middleton M, Blake H. Test@work: evaluation of workplace HIV testing for construction workers using the RE-AIM framework. BMC Public Health 2021; 21:1737. [PMID: 34560853 PMCID: PMC8464147 DOI: 10.1186/s12889-021-11739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community testing for HIV can reach previously untested populations but is rarely offered in workplaces. Targeting the construction sector could reach workers from high risk populations. METHODS The RE-AIM framework was used to evaluate Test@Work, a workplace HIV testing intervention for construction workers implemented at 21 events (10 companies) in the UK. Test@Work had three components: 1) an online health toolkit to inform managers about health screening and HIV testing; 2) general health checks; and 3) opt-in HIV consultation and testing. Quantitative data were collected using registration and exit questionnaires with workers (n = 426) and pre/post-event questionnaires with managers (n = 15), with qualitative analysis of free text responses. RESULTS Reach 426 individuals had health checks. Participants were broadly representative of the UK construction workforce, but with a higher proportion of permanent workers. Most workers reported being in good health but also believed their work had an adverse impact on their health. Effectiveness: 97% of health check participants opted to have a consultation about sexual health (n = 413) and 82% had an HIV test (n = 348), of whom 78% had not previously been tested. All HIV tests were non-reactive. HIV testing at work was considered acceptable by most participants. Participants reported learning new things about their health (74%), said they would make changes as a result (70%) and felt confident of success (median score 8/10). Adoption: Recruitment of companies was challenging and time consuming. Seven of the participating companies were very large, employing over 1000 workers, which is atypical of construction generally. IMPLEMENTATION All events were completed as planned and were considered successful by all parties. Maintenance: All managers would arrange further events if they were offered them. Six managers incorporated sexual health awareness into their health programmes, but this was not possible for many as health agendas were set centrally by their organisations. CONCLUSIONS Opt-in HIV testing, when embedded within a general health check, has high uptake and acceptability in the UK construction sector, and reaches individuals at risk for HIV who may not otherwise attend for testing. Cost-effectiveness of this approach is yet to be determined. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04292002 .
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Affiliation(s)
- Wendy Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Somerset
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK.
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
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Dhairyawan R, Okhai H, Hill T, Sabin CA. Differences in HIV clinical outcomes amongst heterosexuals in the United Kingdom by ethnicity. AIDS 2021; 35:1813-1821. [PMID: 33973878 PMCID: PMC7611528 DOI: 10.1097/qad.0000000000002942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN Cohort analysis. METHODS Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
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Affiliation(s)
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Teresa Hill
- Institute for Global Health, University College London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, UK
- National Institute for Health Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, University College London, London, UK
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Norman FF, Comeche B, Martínez-Lacalzada M, Pérez-Molina JA, Gullón B, Monge-Maillo B, Chamorro S, López-Vélez R. Seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants in Spain. J Travel Med 2021; 28:6145914. [PMID: 33611577 DOI: 10.1093/jtm/taab025] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Updated seroprevalence studies of infections in migrants may aid the design of tailored vaccination and prevention programmes. The objective of this study was to describe the seroprevalence rates for potentially transmissible viral infections in migrants attended at a referral centre in a major European city. METHODS Descriptive analysis of seroprevalence of vaccine-preventable and non-vaccine-preventable infections in migrants attended at a centre in Madrid, Spain (2018-19). Recorded variables included age, gender, country of birth/continent of origin, time from arrival to Spain until first clinic visit, rubella, measles, mumps, varicella (VZV), hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis C virus (HCV) and HIV serology. RESULTS In total, 468 patients were included, 135 females (28.8%) and 333 males (71.2%), mean age 30.4 years. The majority of patients were from Africa (52.5%, of which 88.2% from sub-Saharan Africa), followed by Latin America (38.5%) and other areas (9%). Seroprevalence for tested migrants for rubella, measles and mumps was < 95% in the group overall (91% rubella, 88% measles, 83% mumps) and lower rates were observed in migrants >20 years (compared with those ≤ 20 years). Over 10% of females were potentially susceptible (negative/indeterminate serology) to rubella (11.4%), measles (12.7%) or mumps (10.3%). Lowest rates of rubella seropositivity were in Latin American migrants (over 12% potentially susceptible); measles and mumps seropositivity was lowest in migrants from areas other than Africa/Latin America (74% and 68%, respectively). Seroprevalence rates were 91% for VZV, 90% overall for HAV, ~6% for HBV chronic infection (~50% of migrants tested susceptible), 2% for HCV and 6% for HIV. CONCLUSIONS Differences in seroprevalence for vaccine-preventable and transmissible infections according to gender, age range and area of origin were observed. Tailored screening, vaccination and prevention strategies in potentially vulnerable migrant groups should be designed.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Belén Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Miguel Martínez-Lacalzada
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Beatriz Gullón
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Sandra Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Rava M, Domínguez-Domínguez L, Bisbal O, López-Cortés LF, Busca C, Antela A, González-Ruano P, Hernández C, Iribarren JA, Rubio R, Moreno S, Jarrín I. Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018. PLoS One 2021; 16:e0249864. [PMID: 33882093 PMCID: PMC8059864 DOI: 10.1371/journal.pone.0249864] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. METHODS CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). RESULTS 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). CONCLUSIONS LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
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Affiliation(s)
- Marta Rava
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
| | | | | | | | | | - Antonio Antela
- University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Cristina Hernández
- Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Josè-Antonio Iribarren
- Department of Infectious Diseases, University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Rafael Rubio
- 12 de Octubre University Hospital, Madrid, Spain
| | | | - Inmaculada Jarrín
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
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Abstract
"Currently, an estimated 70.8 million individuals worldwide are forcibly displaced due to war, violence, and persecution. Barriers to providing dermatologic care include the large number of affected people, their movement within and across international borders, security issues, and limited access to dermatology expertise and formularies. Screening protocols for skin diseases and sexually transmitted infections differ worldwide, raising the need for shared guidelines to assess migrants' health. This article reviews the literature of skin and sexually transmitted infections in migrants and displaced persons, highlighting the impact of social determinants on skin health and challenges faced in providing care."
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Abstract
PURPOSE OF REVIEW Knowledge of HIV status is the gateway to HIV treatment and prevention, and optimizing this pillar is essential to bend the curve of the HIV epidemic toward zero new infections. This review will discuss the epidemiology of serostatus awareness, including disparities among key populations, and explore interventions and societal barriers. RECENT FINDINGS Rates of serostatus awareness have improved overall; however, progress is lagging in many regions, nations and populations, with substantial disparities seen among key populations. These populations and their partners now contribute the majority of new infections, fueling the epidemic. Data support a variety of interventions that have demonstrated effectiveness in increasing new diagnoses, particularly among underserved populations. Structural and societal barriers such as stigma, discriminatory laws and policies, and social determinants of health disproportionately affect key populations, and these must be addressed to achieve equity and end the epidemic. SUMMARY According to United Nations Programme on HIV/AIDS (UNAIDS), the pace of progress toward epidemic control has slowed. Achieving substantial increases in serostatus awareness to meet 2020 and 2030 UNAIDS goals will require attacking complex societal barriers while bringing evidence-based interventions to scale in each nation and key population. A robust advocacy effort is now needed as political will and funding wane.
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Affiliation(s)
- Catherine Dodds
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Ibidun Fakoya
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Mobility and its Effects on HIV Acquisition and Treatment Engagement: Recent Theoretical and Empirical Advances. Curr HIV/AIDS Rep 2020; 16:314-323. [PMID: 31256348 DOI: 10.1007/s11904-019-00457-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW We reviewed literature across multiple disciplines to describe issues with the measurement of population mobility in HIV research and to summarize evidence of causal pathways linking mobility to HIV acquisition risks and treatment engagement, with a focus on sub-Saharan Africa. RECENT FINDINGS While the literature on mobility and HIV remains hampered by problems and inconsistency in measures of mobility, the recent research reveals a turn towards a greater attentiveness to measurement and gender. Theoretical and heuristic models for the study of mobility and HIV acquisition and treatment outcomes have been published, but few studies have used longitudinal designs with clear ascertainment of exposures and outcomes for measurement of causal pathways. Notwithstanding these limitations, evidence continues to accumulate that mobility is linked to higher HIV incidence, and that it challenges optimal treatment engagement. Gender continues to be important: while men are more mobile than women, women's mobility particularly heightens their HIV acquisition risks. Recent large-scale efforts to find, test, and treat the individuals in communities who are most at risk of sustaining local HIV transmission have been severely challenged by mobility. Novel interventions, policies, and health systems improvements are urgently needed to fully engage mobile individuals in HIV care and prevention. Interventions targeting the HIV prevention and care needs of mobile populations remain few in number and urgently needed.
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Dias S, Gama A, Loos J, Roxo L, Simões D, Nöstlinger C. The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities. PLoS One 2020; 15:e0228584. [PMID: 32023309 PMCID: PMC7001961 DOI: 10.1371/journal.pone.0228584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. METHODS Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi- and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. RESULTS Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95%CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions among travellers and non-travellers. Also, among the n = 75 participants with reactive HIV test-results, condomless sex occurred (n = 40) and was associated with mobility. CONCLUSIONS Sub-Saharan African migrants are mobile and engage in sexual risk behaviours in the countries of residence and while travelling, increasing risk of post-migration HIV-acquisition. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants' HIV risk related to their mobility.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
- * E-mail:
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis Roxo
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
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Kronfli N, Linthwaite B, Sheehan N, Cox J, Hardy I, Lebouché B, de Pokomandy A, Frenette C, Roger M, Klein MB. Delayed linkage to HIV care among asylum seekers in Quebec, Canada. BMC Public Health 2019; 19:1683. [PMID: 31842822 PMCID: PMC6916083 DOI: 10.1186/s12889-019-8052-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. Methods We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. Results Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. Conclusions While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada. .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Sheehan
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Faculté de Pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Hardy
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Charles Frenette
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada
| | - Michel Roger
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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Estimating and projecting the number of new HIV diagnoses and incidence in Spectrum's case surveillance and vital registration tool. AIDS 2019; 33 Suppl 3:S245-S253. [PMID: 31385865 PMCID: PMC6919234 DOI: 10.1097/qad.0000000000002324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text Objective: The Joint United Nations Programme on HIV/AIDS-supported Spectrum software package is used by most countries worldwide to monitor the HIV epidemic. In Spectrum, HIV incidence trends among adults (aged 15–49 years) are derived by either fitting to seroprevalence surveillance and survey data or generating curves consistent with case surveillance and vital registration data, such as historical trends in the number of newly diagnosed infections or AIDS-related deaths. This article describes development and application of the case surveillance and vital registration (CSAVR) tool for the 2019 estimate round. Methods: Incidence in CSAVR is either estimated directly using single logistic, double logistic, or spline functions, or indirectly via the ‘r-logistic’ model, which represents the (log-transformed) per-capita transmission rate using a logistic function. The propensity to get diagnosed is assumed to be monotonic, following a Gamma cumulative distribution function and proportional to mortality as a function of time since infection. Model parameters are estimated from a combination of historical surveillance data on newly reported HIV cases, mean CD4+ at HIV diagnosis and estimates of AIDS-related deaths from vital registration systems. Bayesian calibration is used to identify the best fitting incidence trend and uncertainty bounds. Results: We used CSAVR to estimate HIV incidence, number of new diagnoses, mean CD4+ at diagnosis and the proportion undiagnosed in 31 European, Latin American, Middle Eastern, and Asian-Pacific countries. The spline model appeared to provide the best fit in most countries (45%), followed by the r-logistic (25%), double logistic (25%), and single logistic models. The proportion of HIV-positive people who knew their status increased from about 0.31 [interquartile range (IQR): 0.10–0.45] in 1990 to about 0.77 (IQR: 0.50–0.89) in 2017. The mean CD4+ at diagnosis appeared to be stable, at around 410 cells/μl (IQR: 224–567) in 1990 and 373 cells/μl (IQR: 174–475) by 2017. Conclusion: Robust case surveillance and vital registration data are routinely available in many middle-income and high-income countries while HIV seroprevalence surveillance and survey data may be scarce. In these countries, CSAVR offers a simpler, improved approach to estimating and projecting trends in both HIV incidence and knowledge of HIV status.
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Chen Q, Zeng D, She Y, Lyu Y, Gong X, Feinstein MJ, Yang Y, Jiang H. Different transmission routes and the risk of advanced HIV disease: A systematic review and network meta-analysis of observational studies. EClinicalMedicine 2019; 16:121-128. [PMID: 31832626 PMCID: PMC6890975 DOI: 10.1016/j.eclinm.2019.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A substantial proportion of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), which may result in difficulty reaching the "90-90-90" target to end AIDS in 2030. We assessed the risk of AHD for different transmission routes to summarize the evidence for priority prevention strategies for key populations. METHODS Observational studies published before September 10th, 2019 in the PubMed, EMBASE, Web of Science and Chinese electronic databases were analysed. The outcomes of interest were the number of PLHIV and AHD patients and their associated transmission routes. We assessed the risk of AHD among the different transmission routes using the multi-armed network meta-analysis based on the Bayesian method. The associations between AHD and regional policies for sex work and compulsory drug treatment were estimated using ecological linear regression. FINDINGS One hundred and one articles were included, covering 129,780 PLHIV with 478,830 patients who developed AHD. The network analysis revealed that among PLHIV, heterosexual contact was associated with the highest risk of AHD, followed by injection drug use (odds ratio [OR]=0•56, 95% credible interval [CrI] 0•47-0•68), and men who have sex with men (OR=0•54, 95% CrI 0•46-0•63). Regions that criminalized sex work and compulsory drug treatment had higher risks for AHD than those that did not. INTERPRETATION Our findings suggest HC is at a higher risk of AHD compared to IDU and MSM. This justifies the need to expand prevention campaigns and maintain efforts to increase HIV testing in the heterosexual population.
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Affiliation(s)
- Qiaosen Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ding Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yangyang She
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuhan Lyu
- School of Health Science, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiao Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Matthew J. Feinstein
- Departments of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Co-Corresponding to: Yi Yang Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China.
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Corresponding to: Hongbo Jiang Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China.
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Bil JP, Zuure FR, Alvarez-Del Arco D, Prins JM, Brinkman K, Leyten E, van Sighem A, Burns F, Prins M. Disparities in access to and use of HIV-related health services in the Netherlands by migrant status and sexual orientation: a cross-sectional study among people recently diagnosed with HIV infection. BMC Infect Dis 2019; 19:906. [PMID: 31664925 PMCID: PMC6819557 DOI: 10.1186/s12879-019-4477-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background Migrants often face barriers to accessing healthcare. We examined disparities in access to and use of HIV-related health services between migrant and non-migrant people recently diagnosed with HIV living in the Netherlands, taken into account sexual orientation. Also, we examined differences in experiences in living with HIV between these groups. Methods We used a questionnaire and clinical data collected between July 2013 and June 2015 among migrant and non-migrant participants of the European cross-sectional aMASE (Advancing Migrant Access to health Services in Europe) study in the Netherlands. Using univariable logistic regression analyses, we compared outcomes on between migrants and non-migrants, stratified by sexual orientation (with non-migrant men having sex with men [MSM] as the reference group). Results We included 77 migrant MSM, 115 non-migrant MSM, 21 migrant heterosexual men, 14 non-migrant heterosexual men and 20 migrant women. In univariable analyses, all heterosexual groups were less likely to ever have had an HIV-negative test before their diagnosis and were more likely to be diagnosed late than non-migrant MSM. All migrant groups were more likely to have experienced difficulties accessing general healthcare in the Netherlands and were less likely to have heard of post-exposure prophylaxis than non-migrant MSM. Migrants frequently reported uncertainty about their rights to healthcare and language barriers. Most (93%) participants visited a healthcare facility in the 2 years before HIV diagnosis but only in 41% an HIV test was discussed during that visit (no statistical difference between groups). Migrant heterosexuals were more likely to have missed appointments at their HIV clinic due to the travel costs than non-migrant MSM. Migrant MSM and women were more likely to have experienced HIV discrimination in the Netherlands than non-migrant MSM. Conclusion Disparities in access to and use of HIV-related health services and experiences exist by migrant status but also by sexual orientation. Our data suggests heterosexual men and women may particularly benefit from improved access to HIV testing (e.g., through provider-initiated testing), while migrant MSM may benefit from improved access to HIV prevention interventions (e.g., pre-exposure prophylaxis).
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands. .,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands. .,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Freke R Zuure
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Debora Alvarez-Del Arco
- National Centre for Epidemiology. Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Jan M Prins
- Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - Eliane Leyten
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | | | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
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28
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Heywood AE, López-Vélez R. Reducing infectious disease inequities among migrants. J Travel Med 2019; 26:5198602. [PMID: 30476162 DOI: 10.1093/jtm/tay131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. METHODS This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. RESULTS For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. CONCLUSIONS Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.
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Affiliation(s)
- Anita E Heywood
- Level 3, Samuels Building, School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
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Camlin CS, Cassels S, Seeley J. Bringing population mobility into focus to achieve HIV prevention goals. J Int AIDS Soc 2018; 21 Suppl 4:e25136. [PMID: 30027588 PMCID: PMC6053544 DOI: 10.1002/jia2.25136] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology and Reproductive SciencesDepartment of MedicineUniversity of CaliforniaSan FranciscoUSA
| | - Susan Cassels
- Department of GeographyUniversity of CaliforniaSanta BarbaraUSA
| | - Janet Seeley
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
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