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Chawla S, Kaida A, Brouillette MJ, Kleiner B, Dubuc D, Skerritt L, Burchell AN, Rouleau D, Loutfy M, de Pokomandy A. Mental health service use and shortages among a cohort of women living with HIV in Canada. BMC Health Serv Res 2024; 24:923. [PMID: 39135046 PMCID: PMC11321070 DOI: 10.1186/s12913-024-11396-z] [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: 06/07/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. METHODS Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. RESULTS Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03-2.77], higher education level (aOR: 1.43, 95% CI: 1.02-2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02-1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26-0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39-0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50-0.96) were associated with lower odds of reporting service shortages. CONCLUSION Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.
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Affiliation(s)
- Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Harvard Medical School, Boston, MA, USA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Marie-Josée Brouillette
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bluma Kleiner
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danièle Dubuc
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Rouleau
- Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
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Ryan P, Manzano S, Deihim-Rahampour N, Cuevas G, Martin-Gonzalez L, Gonzalez-Baeza A, Torres P, Lazarus JV, Torres-Macho J, Valencia J, Sanchez-Conde M. HIV-infected Latin American asylum seekers in Madrid, Spain, 2022: A prospective cohort study from a major gateway in Europe. Euro Surveill 2024; 29:2300692. [PMID: 39027943 PMCID: PMC11258946 DOI: 10.2807/1560-7917.es.2024.29.29.2300692] [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: 12/02/2023] [Accepted: 04/28/2024] [Indexed: 07/20/2024] Open
Abstract
BackgroundRecent migration trends have shown a notable entry of Latin American asylum seekers to Madrid, Spain.AimTo characterise the profile of asylum-seeking Latin American migrants who are living with HIV in Spain and to outline the barriers they face in accessing HIV treatment.MethodsA prospective cohort study was conducted between 2022 and 2023 with a 6-month follow-up period. Latin American asylum seekers living with HIV were recruited mainly from non-governmental organisations and received care at an HIV clinic in a public hospital in Madrid.ResultsWe included 631 asylum seekers. The primary countries of origin were Colombia (30%), Venezuela (30%) and Peru (18%). The median age was 32 years (interquartile range (IQR): 28-37), and 553 (88%) were cis men of which 94% were men who have sex with men. Upon their arrival, 49% (n = 309) lacked social support, and 74% (n = 464) faced barriers when attempting to access the healthcare system. Upon entry in Europe, 500 (77%) participants were taking antiretroviral therapy (ART). At their first evaluation at the HIV clinic, only 386 (61%) had continued taking ART and 33% (n = 209) had detectable plasma HIV-1 RNA levels. Six months later, 99% took ART and 98% had achieved an undetectable viral load.ConclusionsLatin American asylum seekers living with HIV in Madrid, Spain encountered barriers to healthcare and to ART. One-third of these individuals presented detectable HIV viral load when assessed in the HIV clinic, highlighting this as an important public health issue.
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Affiliation(s)
- Pablo Ryan
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- These authors contributed equally to this work and share first authorship
| | - Samuel Manzano
- These authors contributed equally to this work and share first authorship
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Neda Deihim-Rahampour
- Fundación Estatal, Salud, Infancia y Bienestar Social, F.S.P. (FSCAI), Madrid, Spain
| | | | | | | | - Pedro Torres
- Fundación para la Investigación e Innovación Biomédica H.U. Infanta Leonor y H.U. Sureste, Madrid, Spain
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, United States
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Torres-Macho
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jorge Valencia
- These authors contributed equally to this work and share last authorship
- Fundación para la Investigación e Innovación Biomédica H.U. Infanta Leonor y H.U. Sureste, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Matilde Sanchez-Conde
- These authors contributed equally to this work and share last authorship
- Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Arora AK, Vicente S, Engler K, Lessard D, Huerta E, Ishak J, Routy JP, Klein M, Kronfli N, Cox J, Lemire B, de Pokomandy A, Del Balso L, Sebastiani G, Vedel I, Quesnel-Vallée A, Lebouché B. Impact of social determinants of health on time to antiretroviral therapy initiation and HIV viral undetectability for migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite B/F/TAF: 'The ASAP study'. HIV Med 2024; 25:600-607. [PMID: 38213087 DOI: 10.1111/hiv.13608] [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: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited. METHODS Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses. RESULTS Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0-50) and 57 days (range 5-365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability. CONCLUSION Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.
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Affiliation(s)
- Anish K Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Joel Ishak
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Québec, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Giada Sebastiani
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Québec, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Québec, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
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Candevir A, Kuscu F, Kurtaran B, Kömür S, İnal AS, Ertürk D, Taşova Y. Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey. Int J Gen Med 2023; 16:4227-4234. [PMID: 37745135 PMCID: PMC10516126 DOI: 10.2147/ijgm.s424561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
Background Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected. Methods The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as "not late". Results Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004). Conclusion HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.
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Affiliation(s)
| | - Ferit Kuscu
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | | | - Süheyla Kömür
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Ayşe Seza İnal
- Infectious Diseases, Çukurova University, Adana, Türkiye
| | - Damla Ertürk
- Infectious Diseases, Health Sciences University Izmir Tepecik Education and Research Hospital, İzmir, Türkiye
| | - Yeşim Taşova
- Infectious Diseases, Çukurova University, Adana, Türkiye
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Sexually Transmitted Infections Prevalence and Cascade of Care among Undocumented Sex Workers: A Twenty-Year-Long Experience. Life (Basel) 2023; 13:life13030606. [PMID: 36983762 PMCID: PMC10056054 DOI: 10.3390/life13030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Undocumented migrant sex-workers (SW) are vulnerable to Sexually Transmitted Infections (STIs). However, data regarding prevalence and linkage-to-care are lacking. Defining epidemiology is crucial to implement preventive measures. We report data from SW attending a facility for migrants in Piacenza, Italy. We collected medical records from 1999 until 2021. Quantitative variables were summarized as mean and standard deviation (SD), and qualitative ones by absolute and relative frequencies. Logistic regression analysis was performed to assess the relationship between sociodemographic, clinical variables, positive testing, and loss to follow-up (LFU). Overall, 1035 STI episodes were collected, 917 in cisgender-females (CF), and 118 in transgender-females (TF). Overall, 474 diagnoses were made. Three-hundred-ninety-two/474 (82.7%) started therapy, and 264/474 (55.7%) complied with a follow-up. Only 51.5% of HBV and 30.8% of HIV were linked to care. Having symptoms (OR 1.70 (95% CI 1.06–2.73), p = 0.028) and previous STIs (OR 1.36 (95% CI 1.04–1.77), p = 0.022) were associated with a higher chance of STIs, while at-risk intercourse to lower risk (OR 0.19 (95% CI 0.07–0.49), p = 0.001). TF had higher odds of bloodborne infections and syphilis (OR 2.61 (95% CI 1.17–5.80), p = 0.019). Regarding follow-up, the older the patient, the higher the LFU (OR 1.05 (95% CI 1.01–1.10), p = 0.021). Our data showed a high prevalence of STIs and LFU among undocumented SW. TF are even more vulnerable. Further efforts should be put into targeted interventions.
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Medeiros P, Warren L, Kazemi M, Massaquoi N, Smith S, Tharao W, Serghides L, Logie CH, Kroch A, Burchell AN, de Pokomandy A, Kaida A, Loutfy M. HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada. Int J STD AIDS 2023; 34:4-17. [PMID: 36411243 PMCID: PMC9806481 DOI: 10.1177/09564624221108034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Greater Toronto Area (GTA) is home to 39% of Canada's population living with HIV. To identify gaps in access and engagement in care and treatment, we assessed the care cascade of women living with HIV (WLWH) in the GTA versus the rest of Ontario and Canada (in this case: Quebec and British Columbia). METHODS We analyzed 2013-2015 self-reported baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study for six care cascade stages: linked to care, retained in care, initiated antiretroviral therapy (ART), currently on ART, ART adherence (≥90%), and undetectable (<50 copies/mL). Multivariable logistic regression was used to reveal associations with being undetectable. RESULTS Comparing the GTA to the rest of Ontario and Canada, respectively: 96%, 98%, 100% were linked to care; 92%, 94%, 98% retained in care; 72%, 89%, 96% initiated ART; 67%, 81%, 90% were currently using ART; 53%, 66%, 77% were adherent; 59%, 69%, 81% were undetectable. Factors associated with viral suppression in the multivariable model included: living outside of the GTA (Ontario: aOR = 1.72, 95% CI: 1.09-2.72; Canada: aOR = 2.42, 95% CI: 1.62-3.62), non-Canadian citizenship (landed immigrant/permanent resident: aOR = 3.23, 95% CI: 1.66-6.26; refugee/protected person/other status: aOR = 4.77, 95% CI: 1.96-11.64), completed high school (aOR = 1.77, 95% CI: 1.15-2.73), stable housing (aOR = 2.13, 95% CI: 1.33-3.39), income of ≥$20,000 (aOR = 1.52, 95% CI: 1.00-2.31), HIV diagnosis <6 years (6-14 years: aOR = 1.75, 95% CI: 1.16-2.63; >14 years: aOR = 1.87, 95% CI: 1.19-2.96), and higher resilience (aOR = 1.02, 95% CI: 1.00-1.04). CONCLUSION WLWH living in the GTA had lower rates of viral suppression compared to the rest of Ontario and Canada even after adjustment of age, ethnicity, and HIV diagnosis duration. High-impact programming for WLWH in the GTA to improve HIV outcomes are greatly needed.
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Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Priscilla Medeiros, PhD, Women’s College
Research Institute, Women’s College Hospital, 76 Grenville Street, Room 6415,
Toronto, ON M5G 1N8, Canada. E-mail:
| | - Laura Warren
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | | | - Stephanie Smith
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands
Community Health, Toronto, ON, Canada
| | - Lena Serghides
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Toronto General Hospital Research
Institute, University Health
Network, Toronto, ON, Canada,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Ann N Burchell
- Department of Family and Community
Medicine, St. Michael’s Hospital, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health
Centre, Montreal, QC, Canada,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Mate KKV, Lebouché B, Brouillette MJ, Fellows LK, Mayo NE. Development of a Prototype for a Bilingual Patient-Reported Outcome Measure of the Important Health Aspects of Quality of Life in People Living with HIV: The Preference Based HIV Index (PB-HIV). J Pers Med 2022; 12:jpm12122080. [PMID: 36556300 PMCID: PMC9781994 DOI: 10.3390/jpm12122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: The aim of this project was to develop a short, HIV-specific, health-related quality of life measure with a scoring system based on patient preferences for the different dimensions of the Preference-Based HIV Index (PB-HIV). (2) Methods: This study is a cross-sectional analysis of data from the Canadian Positive Brain Health Now cohort (n = 854; mean age 53 years). Items from the standardized measures were mapped to the areas from the Patient-Generated Index and formed the domains. A Rasch analysis was used to identify the best performing item to represent each dimension. Each item was then regressed on self-rated health (scored 0 to 100) and the regression parameters were used as scaling weights to form an index score for the prototype measure. (3) Results: Seven independent dimensions with three declarative statements ordered as response options formed the PB-HIV Index (pain, fatigue, memory/concentration, sleep, physical appearance/body image, depression, motivation). Regression parameters from a multivariable model yielded a measure with a scoring range from 0 (worst health) to 100 (perfect health). (4) Conclusions: Preference-based measures are optimal, as the total score reflects gains in some dimensions balanced against losses in others. The PB-HIV Index is the first HIV-specific preference-based measure.
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Affiliation(s)
- Kedar K. V. Mate
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 1Z1, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Correspondence:
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 1Z1, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
| | - Marie-Josée Brouillette
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Psychiatry, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lesley K. Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Nancy E. Mayo
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
- Divisions of Clinical Epidemiology, Geriatrics, Experimental Medicine, Department of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
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8
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Vasylyeva TI, Horyniak D, Bojorquez I, Pham MD. Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people. J Int AIDS Soc 2022; 25:e26031. [PMID: 36352546 PMCID: PMC9646984 DOI: 10.1002/jia2.26031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments. DISCUSSION HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. CONCLUSIONS Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.
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Affiliation(s)
- Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Danielle's Horyniak
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Ietza Bojorquez
- Department of Population StudiesEl Colegio de la Frontera NorteTijuanaMexico
| | - Minh Duc Pham
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study. J Pers Med 2022; 12:jpm12091497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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Borchmann O, Omland LH, Gerstoft J, Larsen CS, Johansen IS, Lunding S, Jensen J, Obel N, Hansen ABE. Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904057 PMCID: PMC9336168 DOI: 10.2807/1560-7917.es.2022.27.30.2100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundMigrants face an increased risk of HIV infection and late presentation for HIV care.AimTo examine delays in HIV diagnosis, linkage to care (LTC), and risk of late presentation for migrants living with HIV in Denmark.MethodsWe conducted a population-based, nationwide study of adult migrants (n = 2,166) presenting for HIV care between 1 January 1995 and 31 December 2020 in Denmark. Time from immigration to HIV diagnosis and from diagnosis to LTC, and late presentation were assessed, stratified by migrants' geographical regions of origin, using descriptive statistics.ResultsThe demographics of the migrant population changed over time. Overall, migrants diagnosed with HIV after immigration to Denmark resided a median of 3.7 (IQR: 0.8-10.2) years in Denmark before diagnosis. Median time from HIV diagnosis to LTC was 6 (IQR: 0-24) days. Migrants diagnosed with HIV infection before immigration had a median of 38 (IQR: 0-105) days from arrival in Denmark to LTC. The corresponding median times for 2015-20 alone were 4.1 (IQR: 0.9-13.1) years, 0 (IQR: 0-8) days, and 62 (IQR: 25-152) days, respectively. The overall proportion of late presentation among migrants diagnosed with HIV after immigration was 60%, and highest among migrants from sub-Saharan Africa and East and South Asia.ConclusionHIV diagnosis is still substantially delayed in Danish migrants, while LTC is timely. The proportions with late presentation are high. These results call for targeted interventions to reduce the number of migrants with undiagnosed HIV infections and of late presenters.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Suzanne Lunding
- Department of Internal Medicine, Herlev University Hospital, Herlev, Denmark
| | - Janne Jensen
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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Giguère K, Vaziri M, Olivier C, Charest L, Szabo J, Thomas R, Maheu-Giroux M. Characteristics of new HIV diagnoses over 1995-2019: A clinic-based study in Montréal, Canada. PLoS One 2021; 16:e0258383. [PMID: 34618875 PMCID: PMC8496787 DOI: 10.1371/journal.pone.0258383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Characterization of populations at risk of acquiring HIV is required to inform the public health response to HIV. To identify potential changing needs in HIV prevention and care cascade, we aim to describe how the demographic profiles and exposure categories of newly diagnosed HIV positive individuals attending a large sexual health clinic in Montréal (Canada) evolved since the beginning of the antiretroviral therapy era in the mid-1990s. METHODS Using diagnosis data from participants of the Clinique médicale l'Actuel cohort of HIV-positive patients, we examined the distribution of exposure categories (sexual orientation, sexual behaviours, injection drug use, being born in an HIV-endemic country) by gender and year of diagnosis. Time trends in mean age and in the proportion of patients with late (CD4 <350 cells/μL) or advanced stage (CD4 <200 cells/μL) of HIV infection at diagnosis were assessed through meta-regressions. RESULTS A total of 2,612 patients diagnosed with HIV between January 1st, 1995 and December 31st, 2019 were included. Overall, mean age was 35 years (standard deviation: 10 years) and remained stable over time. The proportion of patients with advanced stage of HIV infection decreased from 16% in 1995 to 4% in 2019. Although men who have sex with men (MSM) consistently accounted for the highest proportion of new diagnoses (77%, 2,022/2,612 overall), their proportion decreased since 2013. There was also a concomitant decrease in the proportion of people who inject drugs, with none of the newly diagnosed participants reporting injection drug use since 2017, and an important increase in the proportion of patients born in an HIV-endemic country (24%, 7/29 in 2019), especially among women. Compared to patients from non-endemic countries, those from HIV-endemic countries were characterized by higher proportions of heterosexuals (88% vs 17%) and of women (52% vs 7%), and were twice likely to get diagnosed at an advanced stage of HIV infection (32% vs 15%). CONCLUSIONS In absolute numbers, MSM continue to account for the largest exposure category. However, patients from HIV-endemic countries, who tend to be diagnosed at later stages of HIV infection, constitute an increasing proportion of newly diagnosed individuals. These persons could face distinct barriers to rapid diagnosis. Tailoring HIV testing strategies and other prevention interventions to the specific unmet prevention needs of these individuals is warranted.
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Affiliation(s)
- Katia Giguère
- Centre de Recherche du CHUM, Université de Montréal, Montréal, QC, Canada
| | | | | | | | - Jason Szabo
- Clinique médicale l’Actuel, Montréal, QC, Canada
| | | | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
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12
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Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KK, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2021; 35:288-307. [PMID: 34375137 PMCID: PMC8380795 DOI: 10.1089/apc.2021.0079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Kedar K.V. Mate
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Joseph Cox
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
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Park H, Brenner B, Ibanescu RI, Cox J, Weiss K, Klein MB, Hardy I, Narasiah L, Roger M, Kronfli N. Phylogenetic Clustering among Asylum Seekers with New HIV-1 Diagnoses in Montreal, QC, Canada. Viruses 2021; 13:v13040601. [PMID: 33915869 PMCID: PMC8066823 DOI: 10.3390/v13040601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023] Open
Abstract
Migrants are at an increased risk of HIV acquisition. We aimed to use phylogenetics to characterize transmission clusters among newly-diagnosed asylum seekers and to understand the role of networks in local HIV transmission. Retrospective chart reviews of asylum seekers linked to HIV care between 1 June 2017 and 31 December 2018 at the McGill University Health Centre and the Jewish General Hospital in Montreal were performed. HIV-1 partial pol sequences were analyzed among study participants and individuals in the provincial genotyping database. Trees were reconstructed using MEGA10 neighbor-joining analysis. Clustering of linked viral sequences was based on a strong bootstrap support (>97%) and a short genetic distance (<0.01). Overall, 10,645 provincial sequences and 105 asylum seekers were included. A total of 13/105 participant sequences (12%; n = 7 males) formed part of eight clusters. Four clusters (two to three people) included only study participants (n = 9) and four clusters (two to three people) included four study participants clustered with six individuals from the provincial genotyping database. Six (75%) clusters were HIV subtype B. We identified the presence of HIV-1 phylogenetic clusters among asylum seekers and at a population-level. Our findings highlight the complementary role of cohort data and population-level genotypic surveillance to better characterize transmission clusters in Quebec.
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Affiliation(s)
- Hyejin Park
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
| | - Bluma Brenner
- McGill AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (B.B.); (R.-I.I.)
| | - Ruxandra-Ilinca Ibanescu
- McGill AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (B.B.); (R.-I.I.)
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada
| | - Karl Weiss
- Department of Medicine, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Marina B. Klein
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Isabelle Hardy
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC H3T 1J4, Canada; (I.H.); (M.R.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Lavanya Narasiah
- Direction Régionale de Santé Publique, CIUSSS Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H2L 1M3, Canada;
- Clinique des Réfugiés, CISSS Montérégie Centre, Brossard, QC J4Z 1A5, Canada
| | - Michel Roger
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC H3T 1J4, Canada; (I.H.); (M.R.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-934-1934; Fax: +1-514-843-2092
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Arora A, Quesnel-Vallee A, Lessard D, Mate K, Rodriguez-Cruz A, Kronfli N, Engler K, Vedel I, Lebouché B. Barriers and facilitators associated with steps of the HIV care cascade for migrants in OECD countries: a systematic mixed studies review protocol. BMJ Open 2020; 10:e040646. [PMID: 33158835 PMCID: PMC7651739 DOI: 10.1136/bmjopen-2020-040646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status. METHODS AND ANALYSIS A systematic mixed studies review using a data-based convergent design will be conducted. Medline, Embase, Scopus, CINAHL and the Cochrane Library will be searched on 25 March 2020. Screening and critical appraisal will be conducted independently by the first author. Authors 3-5 will act as second reviewers, each independently conducting 33% of the screening and appraisal. Quantitative data will be transformed to qualitative data and be synthesised using thematic analysis. The Mixed Methods Appraisal Tool will be used for quality assessment. An advisory committee, composed of four migrant PLWH, will be involved in screening and appraising 5% of articles to build knowledge and experience with systematic reviews. They will also be involved in analysis and dissemination. ETHICS AND DISSEMINATION Ethics approval was obtained from the McGill University Health Centre (15-188-MUHC, 2016-1697, eReviews 4688). Publications arising from this study will be open-access. PROSPERO REGISTRATION NUMBER CRD42020172122.
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Affiliation(s)
- Anish Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Amelie Quesnel-Vallee
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Kedar Mate
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
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