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Aljadeeah S, Payedimarri AB, Kielmann K, Michielsen J, Wirtz VJ, Ravinetto R. Access to medicines among asylum seekers, refugees and undocumented migrants across the migratory cycle in Europe: a scoping review. BMJ Glob Health 2024; 9:e015790. [PMID: 39414330 DOI: 10.1136/bmjgh-2024-015790] [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: 04/01/2024] [Accepted: 09/26/2024] [Indexed: 10/18/2024] Open
Abstract
INTRODUCTION Access to essential medicines is a critical element of health systems and an important measure of their performance. Migrants may face barriers in accessing healthcare, including essential medicines, throughout the migration cycle, which includes the stages of departure from home or residence countries, transit through non-European or European countries, reception and settlement in a country in Europe and deportation. We aim to provide an overview of research and grey literature concerning access to essential medicines for asylum seekers, refugees and undocumented migrants in or heading to Europe (European Union, European Economic Area, Switzerland and the UK). METHODS To delineate and conceptualise access to medicines, we considered the definition of the Lancet Commission on Essential Medicines and the Pharmaceutical Management framework. These frameworks were combined to guide several critical steps in our review, including defining the search terms, data extraction, data analyses and reporting. Relevant studies and reports were identified through searches in bibliographic and grey literature databases. RESULTS Out of 5760 studies and 66 grey literature reports, 108 met the inclusion criteria, with 72 focusing on medicine access. Overall, medicine use and medicine expenditure were found to be lower in migrant populations compared with the host population in many European countries. Although many studies focused on the use of infectious disease and psychotropic medicines, the most frequently used medicines by migrants were analgesics, hypertension and diabetes medicines. Determinants of medicine access were legal restrictions, language and transit times, which all contributed to interruption of and inequities in access to medicines among this population. This scoping review also indicated significant gaps in the literature regarding the evidence on access to medicine at different stages of the migration cycle, specifically in departure, transit and deportation stages. CONCLUSION Overall, our findings highlighted significant unmet medicine needs among migrants in or on the way to Europe and access disparities attributable to various interconnected barriers. Urgent access is needed to address such inequities, particularly legal barriers, including registration of certain medicines required for treatment. Future research should prioritise investigating medicine access during departure, transit and deportation stages. Policy discussions around migrants' access to medicines should be centred on framing healthcare as a fundamental right.
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Affiliation(s)
- Saleh Aljadeeah
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anil Babu Payedimarri
- Division of Public Health, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Mandroiu A, Alsubahi N, Groot W, Pavlova M. Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review. Healthcare (Basel) 2024; 12:1771. [PMID: 39273795 PMCID: PMC11395426 DOI: 10.3390/healthcare12171771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.
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Affiliation(s)
- Alexandra Mandroiu
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal
| | - Nizar Alsubahi
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Health Service and Hospital Administration, Faculty of Economics and Administration, King Abdul Aziz University, Jeddah 21589, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Maastricht Economic and Social Research Institute on Innovation and Technology, United Nations University, 6211 LK Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Gagliardini R, Giacomelli A, Bozzi G, D'Arminio Monforte A, Tavelli A, Mazzotta V, Bruzzesi E, Cervo A, Saracino A, Mussini C, Girardi E, Cozzi-Lepri A, Antinori A. Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort. Travel Med Infect Dis 2024; 58:102691. [PMID: 38336335 DOI: 10.1016/j.tmaid.2024.102691] [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: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND COVID-19 pandemic challenged the UNAIDS 90-90-90 targets. How the COVID-19 pandemic affected HIV retention in care and whether it has disproportionally affected migrant people with HIV (PWH) remained to be investigated. METHODS PWH in ICONA Cohort in follow-up in each of the study periods were included: 01/09/2019-29/02/2020 (pandemic period) and 01/03/2018-31/08/2018 (historical period, as a control). Risk of temporary loss to follow-up (LTFU, defined as no data recorded for a person for one year) was analyzed by logistic regression, with migrant status as the main exposure variable. Difference in difference (DID) analysis was applied to evaluate the effect of COVID-19 pandemic in the different risk of LTFU between natives and migrants. RESULTS 8864 (17.1% migrants) and 8071 (16.8% migrants) PWH constituted the pandemic and the historical period population, respectively. Proportion of PWH defined as LTFU in the pandemic period was 10.5% in native and 19.6% in migrant PWH. After controlling for age, sex and geographical location of enrolling site, risk of temporary LTFU was higher for migrants than native PWH [adjusted odds ratio 1.85 (95%CI 1.54-2.22)] in pandemic period. In PWH contributing to both periods, LTFU was 9.0% (95% CI 8.3-9.8) in natives vs 17.0% (95% CI 14.7-19.4) in migrants during the pandemic. Instead, LTFU was 1.2% (95%CI 0.9, 1.5) in natives vs 2.2% (95% CI 1.3-3.1) in migrants during the historical period, with a resulting DID of 7.0% (95% CI 4.4-9.6). CONCLUSIONS A greater proportion of LTFU in migrant PWH was observed in both periods, which remained unaltered over time. Interventions to reduce LTFU of migrants are necessary.
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Affiliation(s)
- Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Giacomelli
- III Infectious Disease Unit, ASST-Fatebenefratelli Sacco, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elena Bruzzesi
- UO Malattie Infettive, IRCCS Ospedale San Raffaele, Italy
| | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital, University of Bari, Bari, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Lagi F, Gatteschi C, Tilli M, Zocco N, Avarello A, Bellini S, Contanessi S, Zigliani MR, Stagnitta M, Mariano L, Gazzarri E, Belloni L, Fisher AD, Bartoloni A, Sterrantino G, Ierardi F. Facilitators and barriers in HIV testing and continuum of care among migrant transgender women who are sex workers residing in Florence, Italy. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:268-282. [PMID: 38681492 PMCID: PMC11044723 DOI: 10.1080/26895269.2023.2209072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background An increased risk of contracting HIV infection, suboptimal adherence, and a loss to follow-up have been observed in migrants, particularly if those individuals are transgender or sex workers. A clear picture of the HIV epidemic among migrants is complex due to the lack of specific national data. Aims We developed a qualitative study that describes the barriers and facilitators (cultural, social, and personal) in HIV testing and the continuum of care for a group of migrant transgender women who are sex workers. Methods A semi-structured interview was conducted with a group of migrant transgender women who are sex workers living with HIV or with unknown HIV serostatus residing in the Florentine metropolitan area. Results We included 12 participants: 3 had unknown HIV serostatus and 9 were living with HIV in follow-up at the Clinic of Infectious and Tropical Diseases, Careggi University hospiral, Florence, Italy. Among barriers, the perceived stigma due to their identity as migrants and transgender people, the language lack of ability and the legal position in the host country played a significant role. Moreover, the interviewees claimed having no alternative to sex work: for those individuals, changing their lifestyle condition is perceived as difficult or impossible due to social prejudices. Conversely, the interviewees considered support services, such as cultural mediators/interpreters and street units, as facilitators to HIV testing, access to care, and continuum of care. Having regular and accessible ART and the availability of a more consistent health care system, represent reasons for HIV-positive migrants living with HIV to move to Italy. Conclusions Knowledge of this population's personal experience regarding the barriers and factors that facilitate access to the HIV care system is essential for planning public health interventions capable of responding to the real needs of patients.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Marta Tilli
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
| | | | - Angelo Avarello
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sabrina Bellini
- Lega Italiana per la Lotta contro l’AIDS, LILA Toscana, Florence, Italy
| | | | | | | | | | | | - Laura Belloni
- Regional Center for Critical Relationships, Careggi University Hospital, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
| | - Gaetana Sterrantino
- Department of experimental and clinical medicine, University of Florence, Florence, Italy
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Nöstlinger C, Cosaert T, Landeghem EV, Vanhamel J, Jones G, Zenner D, Jacobi J, Noori T, Pharris A, Smith A, Hayes R, Val E, Waagensen E, Vovc E, Sehgal S, Laga M, Van Renterghem H. HIV among migrants in precarious circumstances in the EU and European Economic Area. Lancet HIV 2022; 9:e428-e437. [PMID: 35460600 DOI: 10.1016/s2352-3018(22)00032-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/22/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
HIV epidemics in the EU and European Economic Area are increasingly diverse in transmission modes and groups affected. Substantial gaps in data exist on HIV burden and access to the HIV continuum of care among migrants living in this region, particularly individuals in precarious circumstances such as migrants with irregular status. Migrants have a higher HIV burden compared with the general population, and high rates of post-migration HIV acquisition. Migrants also face challenges in access to health and HIV services, with irregular migrants, foreign-born key populations such as men who have sex with men, sex workers, and people who inject drugs, and migrants from sub-Saharan Africa being most affected. Intersecting factors negatively affect their access to services along the full continuum of care, including prevention and psychosocial services. Ensuring equitable access to general health and HIV services, regardless of immigration status, and implementing interventions to reduce stigma and discrimination are crucial to ending AIDS by 2030.
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Affiliation(s)
| | - Theo Cosaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gary Jones
- Fast Track Implementation Department, UNAIDS, Geneva, Switzerland
| | - Dominik Zenner
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Teymur Noori
- Air-Borne, Blood-Borne and Sexually Transmitted Infections, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- Air-Borne, Blood-Borne and Sexually Transmitted Infections, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Alyna Smith
- Platform for International Cooperation on Undocumented Migrants (PICUM), Brussels, Belgium
| | - Rosalie Hayes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Val
- Migration Health Division, International Organisation of Migration (IOM), Brussels, Belgium
| | - Elisabeth Waagensen
- Migration and Health Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Elena Vovc
- HIV/viral Hepatitis, STIs Unit of the Joint Infectious Diseases Program, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Sarita Sehgal
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Gasbarrini N, Dubravić D, Combs L, Dišković A, Ankiersztejn-Bartczak M, Colaiaco F, Wawer I, Wysocki P, Rosińska M, Marzec-Boguslawska A, Collins B, Simões D, Jakobsen ML, Raben D. Increasing integrated testing in community settings through interventions for change, including the Spring European Testing Week. BMC Infect Dis 2021; 21:874. [PMID: 34517819 PMCID: PMC8438814 DOI: 10.1186/s12879-021-06555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximising access to testing by targeting more than one infection is effective in identifying new infections in settings or populations. Within the EU funded Joint Action INTEGRATE, this paper examined the feasibility and impact of expanding integrated testing for HIV, hepatitis C (HCV), chlamydia, gonorrhoea and/or syphilis in four community-based pilots through targeted interventions in Croatia, Italy and Poland and the Spring European Testing Week since community settings are key in detecting new infections and reaching key populations. METHODS Pilots led by local INTEGRATE partners prioritised testing for other infections or key populations. The Croatian pilot expanded testing for men who have sex with men to syphilis, chlamydia and gonorrhoea. Italian partners implemented a HIV and HCV testing/information event at a migrant centre. A second Italian pilot tested migrants for HIV and HCV through outreach and a low-threshold service for people who use drugs. Polish partners tested for HIV, HCV and syphilis among people who inject drugs in unstable housing via a mobile van. Pilots monitored the number of individuals tested for each infection and reactive results. The pilot Spring European Testing Week from 18 to 25 May 2018 was an INTEGRATE-driven initiative to create more testing awareness and opportunities throughout Europe. RESULTS The Croatian pilot found a high prevalence for each syphilis, chlamydia and gonorrhoea respectively, 2.1%, 12.4% and 6.7%. The Italian migrant centre pilot found low proportions who were previously tested for HIV (24%) or HCV (11%) and the second Italian pilot found an HCV prevalence of 6.2%, with low proportions previously tested for HIV (33%) or HCV (31%). The Polish pilot found rates of being previously tested for HIV, HCV and syphilis at 39%, 37%, and 38%, respectively. Results from the Spring European Testing Week pilot showed it was acceptable with increased integrated testing, from 50% in 2018 to 71% in 2019 in participants. CONCLUSIONS Results show that integrated testing is feasible and effective in community settings, in reaching key populations and minimising missed testing opportunities, and the pilots made feasible because of the European collaboration and funding. For sustainability and expansion of integrated community testing across Europe, local government investment in legislation, financial and structural support are crucial.
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Affiliation(s)
| | - Davor Dubravić
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Lauren Combs
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | | | | | - Iwona Wawer
- National AIDS Centre, Agency of the Ministry of Health, Warsaw, Poland
| | - Piotr Wysocki
- National AIDS Centre, Agency of the Ministry of Health, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | | | - Ben Collins
- ReShape/International HIV Partnerships, London, UK
| | - Daniel Simões
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marie Louise Jakobsen
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Dorthe Raben
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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Ahmed A, Dujaili J, Sandhu AK, Hashmi FK. Concerns of HIV-positive migrant workers in COVID-19 pandemic: A call for action. J Glob Health 2020; 10:020342. [PMID: 33110542 PMCID: PMC7566657 DOI: 10.7189/jogh.10.020342] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Malaysia
| | - Juman Dujaili
- School of Pharmacy, Monash University, Bandar Sunway, Malaysia
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Abgrall S, Raho-Moussa M, Seng R, Ghislain M, Matheron S, Pialoux G, Goujard C, Meyer L. Elevated risk of viral rebound on ART in migrants living in France: role of socioeconomic factors. Antivir Ther 2020; 24:541-552. [PMID: 31868654 DOI: 10.3851/imp3339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Western countries, viral rebound on antiretroviral therapy (ART) appears to occur more frequently in migrants. We aimed to assess the respective roles of socioeconomic factors and migration on viral rebound in people living with HIV (PLHIV) in France. METHODS We included PLHIV in France, enrolled from 2004 to 2008 in the French ANRS-COPANA cohort, who started a first ART and achieved undetectability (<50 copies/ml) within 1 year. Determinants of viral rebound were assessed using Cox models including geographical origin, HIV transmission group, and clinicobiological and sociodemographic data. RESULTS Of 499 included individuals, 288 were born in France, 158 in sub-Saharan Africa (SSA) and 53 in another country. Kaplan-Meier probabilities of viral rebound-free survival were similar for men having sex with men (MSM) and heterosexuals born in France, and lower in migrants from SSA or other countries (P<0.001). The crude hazard ratio (HR) of viral rebound was 2.49 (95% CI, 1.59, 3.90) in migrants from SSA and 1.78 (0.94, 3.88) in migrants from other countries compared with MSM born in France. Educational level, financial difficulties and HIV status disclosure had the biggest impact on the difference between the crude and adjusted HRs for viral rebound in migrants. In multivariable analysis, viral rebound was no longer associated with geographical origin, but with protease inhibitor-containing ART, a VACS index ≥35 as a potential indicator of frailty, poor financial status (difficulties or debts) and non-disclosure to friend(s). CONCLUSIONS Socioeconomic factors affect outcomes on ART, even in the context of free access to HIV care and treatment. Patient-centred strategies should be encouraged with the intervention of social workers to address basic needs and promote social support for more socially vulnerable individuals.
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Affiliation(s)
- Sophie Abgrall
- APHP, Hôpital Béclère, Service de Médecine Interne, Clamart, France.,APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mariem Raho-Moussa
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Rémonie Seng
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Mathilde Ghislain
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Sophie Matheron
- APHP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gilles Pialoux
- APHP, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France.,UPMC, Univ Paris 06, Paris, France
| | - Cécile Goujard
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Médecine Interne, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- APHP, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP INSERM U1018, Le Kremlin-Bicêtre, France.,APHP, Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France
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Marukutira T, Gray RT, Douglass C, El-Hayek C, Moreira C, Asselin J, Donovan B, Vickers T, Spelman T, Crowe S, Guy R, Stoove M, Hellard M. Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013-2017: A cross-sectional study. PLoS Med 2020; 17:e1003044. [PMID: 32155145 PMCID: PMC7064172 DOI: 10.1371/journal.pmed.1003044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/31/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Globally, few studies compare progress toward the Joint United Nations Program on HIV/AIDS (UNAIDS) Fast-Track targets among migrant populations. Fast-Track targets are aligned to the HIV diagnosis and care cascade and entail achieving 90-90-90 (90% of people living with HIV [PLHIV] diagnosed, 90% of those diagnosed on treatment, and 90% of those on treatment with viral suppression [VS]) by 2020 and 95-95-95 by 2030. We compared cascades between migrant and nonmigrant populations in Australia. METHODS AND FINDINGS We conducted a serial cross-sectional survey for HIV diagnosis and care cascades using modelling estimates for proportions diagnosed combined with a clinical database for proportions on treatment and VS between 2013-2017. We estimated the number of PLHIV and number diagnosed using New South Wales (NSW) and Victorian (VIC) data from the Australian National HIV Registry. Cascades were stratified by migration status, sex, HIV exposure, and eligibility for subsidised healthcare in Australia (reciprocal healthcare agreement [RHCA]). We found that in 2017, 17,760 PLHIV were estimated in NSW and VIC, and 90% of them were males. In total, 90% of estimated PLHIV were diagnosed. Of the 9,391 who were diagnosed and retained in care, most (85%; n = 8,015) were males. We excluded 38% of PLHIV with missing data for country of birth, and 41% (n = 2,408) of eligible retained PLHIV were migrants. Most migrants were from Southeast Asia (SEA; 28%), northern Europe (12%), and eastern Asia (11%). Most of the migrants and nonmigrants were males (72% and 83%, respectively). We found that among those retained in care, 90% were on antiretroviral therapy (ART), and 95% of those on ART had VS (i.e., 90-90-95). Migrants had larger gaps in their HIV diagnosis and care cascade (85-85-93) compared with nonmigrants (94-90-96). Similarly, there were larger gaps among migrants reporting male-to-male HIV exposure (84-83-93) compared with nonmigrants reporting male-to-male HIV exposure (96-92-96). Large gaps were also found among migrants from SEA (72-87-93) and sub-Saharan Africa (SSA; 89-93-91). Migrants from countries ineligible for RHCA had lower cascade estimates (83-85-92) than RHCA-eligible migrants (96-86-95). Trends in the HIV diagnosis and care cascades improved over time (2013 and 2017). However, there was no significant increase in ART coverage among migrant females (incidence rate ratio [IRR]: 1.03; 95% CI 0.99-1.08; p = 0.154), nonmigrant females (IRR: 1.01; 95% CI 0.95-1.07; p = 0.71), and migrants from SEA (IRR: 1.03; 95% CI 0.99-1.07; p = 0.06) and SSA (IRR: 1.03; 95% CI 0.99-1.08; p = 0.11). Additionally, there was no significant increase in VS among migrants reporting male-to-male HIV exposure (IRR: 1.02; 95% CI 0.99-1.04; p = 0.08). The major limitation of our study was a high proportion of individuals missing data for country of birth, thereby limiting migrant status categorisation. Additionally, we used a cross-sectional instead of a longitudinal study design to develop the cascades and used the number retained as opposed to using all individuals diagnosed to calculate the proportions on ART. CONCLUSIONS HIV diagnosis and care cascades improved overall between 2013 and 2017 in NSW and VIC. Cascades for migrants had larger gaps compared with nonmigrants, particularly among key migrant populations. Tracking subpopulation cascades enables gaps to be identified and addressed early to facilitate achievement of Fast-Track targets.
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Affiliation(s)
- Tafireyi Marukutira
- Public Health Discipline, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | | | - Caitlin Douglass
- Public Health Discipline, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Carol El-Hayek
- Public Health Discipline, Burnet Institute, Melbourne, Australia
| | - Clarissa Moreira
- Public Health Discipline, Burnet Institute, Melbourne, Australia
| | - Jason Asselin
- Public Health Discipline, Burnet Institute, Melbourne, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | | | - Tim Spelman
- Public Health Discipline, Burnet Institute, Melbourne, Australia
| | - Suzanne Crowe
- Public Health Discipline, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Mark Stoove
- Public Health Discipline, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Public Health Discipline, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Marukutira T, Gunaratnam P, Douglass C, Jamil MS, McGregor S, Guy R, Gray RT, Spelman T, Horyniak D, Higgins N, Giele C, Crowe SM, Stoove M, Hellard M. Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study. Medicine (Baltimore) 2020; 99:e19289. [PMID: 32080144 PMCID: PMC7034696 DOI: 10.1097/md.0000000000019289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Achieving the Joint United Nations Program on human immunodeficiency virus (HIV)/AIDS Fast-Track targets requires additional strategies for mobile populations. We examined trends and socio-demographics of migrants (overseas-born) and Australian-born individuals presenting with late and advanced HIV diagnoses between 2008 and 2017 to help inform public health approaches for HIV testing coverage and linkage to care and treatment.We conducted a retrospective population-level observational study of individuals diagnosed with HIV in Australia and reported to the National HIV Registry. Annual proportional trends in late (CD4+ T-cell count <350 cells/μL) and advanced (CD4+ T-cell count <200 cells/μL). HIV diagnoses were determined using Poisson regression.Of 9926 new HIV diagnoses from 2008 to 2017, 84% (n = 8340) were included in analysis. Overall, 39% (n = 3267) of diagnoses were classified as late; 52% (n = 1688) of late diagnoses were advanced. Of 3317 diagnoses among migrants, 47% were late, versus 34% of Australian-born diagnoses (P < .001).The annual proportions of late (incidence rate ratio [IRR] 1.00; 95% confidence interval [CI] 0.99-1.01) and advanced HIV diagnoses (IRR 1.01; 95% CI 0.99-1.02) remained constant. Among migrants with late HIV diagnosis, the proportion reporting male-to-male sex exposure (IRR 1.05; 95% CI 1.03-1.08), non-English speaking (IRR 1.03; 95% CI 1.01-1.05), and individuals born in countries in low HIV-prevalence (IRR 1.02; 95% CI 1.00-1.04) increased. However, declines were noted among some migrants' categories such as females, heterosexual exposure, English speaking, and those born in high HIV-prevalence countries.Late HIV diagnosis remains a significant public health concern in Australia. Small declines in late diagnosis among some migrant categories are offset by increases among male-to-male exposures. Reaching the Fast-Track targets in Australia will require targeted testing and linkage to care strategies for all migrant populations, especially men who have sex with men.
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Affiliation(s)
- Tafireyi Marukutira
- Public Health, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | | | - Caitlin Douglass
- Public Health, Burnet Institute
- School of Population and Global Health, University of Melbourne, Melbourne
| | | | | | | | | | | | - Danielle Horyniak
- Public Health, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | | | - Carolien Giele
- Department of Health and Human Services, Public and Aboriginal Health Division, Western Australia
| | - Suzanne Mary Crowe
- Public Health, Burnet Institute
- Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Mark Stoove
- Public Health, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Margaret Hellard
- Public Health, Burnet Institute
- School of Public Health and Preventive Medicine, Monash University, Melbourne
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HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis 2019; 31:25-32. [PMID: 29095720 DOI: 10.1097/qco.0000000000000415] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries. RECENT FINDINGS High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants. SUMMARY Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
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Marukutira T, Yin D, Cressman L, Kariuki R, Malone B, Spelman T, Mawandia S, Ledikwe JH, Semo BW, Crowe S, Stoove M, Hellard M, Dickinson D. Clinical outcomes of a cohort of migrants and citizens living with human immunodeficiency virus in Botswana: implications for Joint United Nation Program on HIV and AIDS 90-90-90 targets. Medicine (Baltimore) 2019; 98:e15994. [PMID: 31169739 PMCID: PMC6571245 DOI: 10.1097/md.0000000000015994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to evaluate the human immunodeficiency virus (HIV) treatment cascade and mortality in migrants and citizens living with HIV in Botswana.Retrospective 2002 to 2016 cohort study using electronic medical records from a single center managing a high migrant case load.Records for 768 migrants and 3274 citizens living with HIV were included. Maipelo Trust, a nongovernmental organization, funded care for most migrants (70%); most citizens (85%) had personal health insurance. Seventy percent of migrants and 93% of citizens had received antiretroviral therapy (ART). At study end, 44% and 27% of migrants and citizens, respectively were retained in care at the clinic (P < .001). Among the 35% and 60% of migrants and citizens on ART respectively with viral load (VL) results in 2016, viral suppression was lower among migrants (82%) than citizens (95%) (P < .001). Citizens on ART had a median 157-unit [95% confidence interval (CI) 122-192] greater increase in CD4+ T-cell count (last minus first recorded count) than migrants after adjusting for baseline count (P < .001). Five-year survival was 92% (95% CI = 87.6-94.8) for migrants and 96% (95% CI = 95.4-97.2) for citizens. Migrants had higher mortality than citizens after entry into care (hazard ratio = 2.3, 95% CI = 1.34-3.89, P = .002) and ART initiation (hazard ratio = 2.2, 95% CI = 1.24-3.78, P = .01).Fewer migrants than citizens living with HIV in Botswana were on ART, accessed VL monitoring, achieved viral suppression, and survived. The HIV treatment cascade appears suboptimal for migrants, undermining local 90-90-90 targets. These results highlight the need to include migrants in mainstream-funded HIV treatment programs, as microepidemics can slow HIV epidemic control.
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Affiliation(s)
- Tafireyi Marukutira
- Burnet Institute
- Monash University, Melbourne, Australia
- Independence Surgery, Gaborone, Botswana
| | - Dwight Yin
- Children's Mercy
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | | | | | | | | | - Shreshth Mawandia
- I-TECH Botswana, Gaborone, Botswana
- University of Washington, Seattle, WA
| | - Jenny H. Ledikwe
- I-TECH Botswana, Gaborone, Botswana
- University of Washington, Seattle, WA
| | - Bazghina-Werq Semo
- I-TECH Botswana, Gaborone, Botswana
- University of Washington, Seattle, WA
| | - Suzanne Crowe
- Burnet Institute
- Monash University, Melbourne, Australia
| | - Mark Stoove
- Burnet Institute
- Monash University, Melbourne, Australia
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Yoshida K, Post G, Shimakawa Y, Thursz M, Brown A, Ingiliz P, Lemoine M. Clinical utility of TREAT-B score in African and non-African HBV-infected patients living in Europe. J Hepatol 2019; 70:1295-1297. [PMID: 30982592 DOI: 10.1016/j.jhep.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Kyoko Yoshida
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital NHS, Imperial College London, UK
| | - Gerrit Post
- Center for Infectious Diseases, Berlin, Germany; Department of Hepatology & Gastroenterology, Charité University Medical Center Berlin, Germany
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Mark Thursz
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital NHS, Imperial College London, UK
| | - Ashley Brown
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital NHS, Imperial College London, UK
| | - Patrick Ingiliz
- Center for Infectious Diseases, Berlin, Germany; Department of Hepatology & Gastroenterology, Charité University Medical Center Berlin, Germany
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, St Mary's Hospital NHS, Imperial College London, UK.
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Fournier AL, Yazdanpanah Y, Verdon R, Lariven S, Mackoumbou-Nkouka C, Phung BC, Papot E, Parienti JJ, Landman R, Champenois K. Incidence of and risk factors for medical care interruption in people living with HIV in recent years. PLoS One 2019; 14:e0213526. [PMID: 30865722 PMCID: PMC6415828 DOI: 10.1371/journal.pone.0213526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives With HIV treatment as a prevention strategy, retention in care remains a key for sustained viral suppression. We sought to identify HIV-infected patients at risk for medical care interruption (MCI) in a high-income country. Methods The HIV-infected patients enrolled had to attend the clinic at least twice between January 2010 and October 2014 and were followed up until May 2016. MCI was defined as patients not seeking care in or outside the clinic for at least 18 months, regardless of whether they returned to care after the interruption. The association between MCI and sociodemographic, clinical, and immuno-virological characteristics at HIV diagnosis and during follow-up was assessed using Cox models. Results The incidence rate of MCI was 2.5 per 100 persons-years (95% confidence interval [CI] = 2.3–2.7). MCI was more likely in patients who accessed care >6 months after diagnosis (hazard ratio [HR] = 1.30, 95% CI = 1.10–1.54 vs. ≤6 months) or did not report a primary care physician (HR = 2.40; 95% CI = 2.03–2.84). MCI was less likely in patients born in sub-Saharan Africa (HR = 0.75, 95% CI = 0.62–0.91 vs. born in France). During follow-up, the risk of MCI increased when the last CD4 count was ≤350 (HR = 2.85, 95% CI = 2.02–4.04 vs. >500 cells/mm3) and when the patient was not on antiretroviral therapy (HR = 3.67, 95% CI = 2.90–4.66). Conclusions The incidence of MCI is low in this hospital that serves a large proportion of migrants. Low or no recorded CD4 counts for a medical visit could alert of a higher risk of MCI, even more in patients who accessed HIV care late or did not report a primary care physician.
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Affiliation(s)
- Anna Lucie Fournier
- IAME, UMR1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France
- * E-mail:
| | - Yazdan Yazdanpanah
- IAME, UMR1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Renaud Verdon
- Infectious and Tropical Diseases Department, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France
- GRAM 2.0, EA2656, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France
| | - Sylvie Lariven
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Claude Mackoumbou-Nkouka
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Bao-Chau Phung
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Emmanuelle Papot
- IAME, UMR1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Jean-Jacques Parienti
- Infectious and Tropical Diseases Department, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France
- GRAM 2.0, EA2656, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France
| | - Roland Landman
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Karen Champenois
- IAME, UMR1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
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