Chronic hepatitis and HIV risks amongst Pakistani migrant men in a French suburb and insights into health promotion interventions: the ANRS Musafir qualitative study

Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial

INTRODUCTION

The "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.

METHODS

The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (n = 280). All PEs and NMs (n = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.

RESULTS

At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (p < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (p < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.

CONCLUSIONS

The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not amenable to community-based harm reduction.

Design of a bilingual (FR-UR) website on the sensitive topic of sexual and mental health with Urdu speakers in a Parisian suburb: a qualitative study

BACKGROUND

This article is a continuation of the Musafir study published in 2020. Following the results of this study, we designed an educational website with Urdu-speaking volunteers, using a participatory approach. This type of approach aimed at bringing out situated knowledge around taboo/sensitive topics such as sexual and mental health, by considering the cultural, religious, economic, family, and social background of young Urdu-speaking men. This approach allowed us to build culturally-appropriate content matching the needs of targeted population. We report here the lessons learned from our approach.

METHODS

Urdu-speaking volunteers were recruited via outreach strategies, for participation in focus groups. Four focus group discussions were conducted on three distinct themes: 1/ Sexual Health Promotion, 2/Hepatitis and sexually transmitted infections, and 3/ Mental Health. The focus groups were recorded, with the written consent of the users. Thematic analysis was conducted after transcription of the focus-group discussion.

RESULTS

We succeeded in mobilizing 4 Pakistani users, aged between 19 and 30 years. The group dynamics was very rich and allowed us to highlight numerous social aspects related to the importance of the group belonging, the family, and others points of view on these topics. Many Urdu vocabulary had to be redefined and revealed the extent of the pre-existing taboo.

CONCLUSIONS

Notwithstanding the extreme difficulty of mobilizing an invisible target population on a sensitive topic such as sexual and mental health, our experience highlights the need to consider the knowledge of the people concerned. The participative approach allowed us to fit the content of our medium to, for instance: the collectivist type of society of the target population; the level of literacy in their mother tongue; and to the embodiment of some taboo in their vocabulary. Although time and energy consuming, our approach seems relevant and could be replicated to other communities.

A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region

Introduction

Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA).

Methods

Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations.

Results

The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers.

Discussion

The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.

A Network-Based HIV Prevention Intervention for Tajik Migrant Workers Who Inject Drugs

We developed and pilot-tested the Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks (MASLIHAT). We recruited 30 Tajik labor migrants who inject drugs in Moscow as peer educators (PEs) to attend the 5-session intervention, then share what they learned with their peers. Each PE recruited two drug-injecting network members for interviewing about their drug and sexual behavior at baseline, 6 weeks, 3 months, and 6 months post-intervention. GEE and mixed effects regression tested time and participant type effects on each outcome. HIV knowledge and risk perception increased among both PEs and network peers, while use of shared syringes, condomless sex, sex with a sex worker, and alcohol use decreased significantly for both groups at 6 weeks and 3 months with a sustained effect through 6 months. The MASLIHAT intervention proved successful in disseminating HIV prevention information and reducing HIV risk behavior over 6 months among both PEs and network members.