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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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Palich R, Arias-Rodríguez A, Duracinsky M, Le Talec JY, Rousset Torrente O, Lascoux-Combe C, Lacombe K, Ghosn J, Viard JP, Pialoux G, Ohayon M, Duvivier C, Velter A, Ben Mechlia M, Beniguel L, Grabar S, Melchior M, Assoumou L, Supervie V. High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022. Euro Surveill 2024; 29:2300445. [PMID: 38487889 PMCID: PMC10941311 DOI: 10.2807/1560-7917.es.2024.29.11.2300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024] Open
Abstract
BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Andrés Arias-Rodríguez
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Martin Duracinsky
- Paris Cité University, Patient-Reported Outcomes Unit (PROQOL), INSERM 1123, Paris, France
| | - Jean-Yves Le Talec
- Toulouse Jean Jaurès University, CERTOP, CNRS UMR 5044, Toulouse, France
| | | | | | - Karine Lacombe
- Sorbonne University, Saint Antoine hospital, AP-HP, Paris, France
| | - Jade Ghosn
- Paris Cité University, Bichat hospital, AP-HP, Paris, France
| | - Jean-Paul Viard
- Paris Cité University, Hôtel-Dieu hospital, AP-HP, Paris, France
| | - Gilles Pialoux
- Sorbonne University, Tenon hospital, AP-HP, Paris, France
| | | | - Claudine Duvivier
- Paris Cité University, Necker hospital, AP-HP; INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine; Institut Pasteur Medical Center, Paris, France
| | | | - Mohamed Ben Mechlia
- French National Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Paris, France
| | - Lydie Beniguel
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Grabar
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Maria Melchior
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Virginie Supervie
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
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3
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Twisk DE, Meima A, Richardus JH, van Sighem A, Rokx C, den Hollander JG, Götz HM. The roles of the general practitioner and sexual health centre in HIV testing: comparative insights and impact on HIV incidence rates in the Rotterdam area, the Netherlands - a cross-sectional population-based study. BMC Public Health 2023; 23:2553. [PMID: 38129840 PMCID: PMC10734097 DOI: 10.1186/s12889-023-17483-w] [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: 01/05/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Access to HIV testing is crucial for detection, linkage to treatment, and prevention. In less urbanised areas, reliance on general practitioners (GPs) for HIV testing is probable, as sexual health centres (SHC) are mostly located within urbanised areas. Limited insight into individuals undergoing HIV testing stems from sparse standard registration of demographics at GPs. This cross-sectional study aims (1) to assess and compare HIV testing at the GP and SHC, and (2) to assess population- and provider-specific HIV incidence. METHODS Individual HIV testing data of GPs and SHC were linked to population register data (aged ≥ 15 years, Rotterdam area, 2015-2019). We reported the proportion HIV tested, and compared GP and SHC testing rates with negative binomial generalised additive models. Data on new HIV diagnoses (2015-2019) from the Dutch HIV Monitoring Foundation relative to the population were used to assess HIV incidence. RESULTS The overall proportion HIV tested was 1.14% for all residents, ranging from 0.41% for ≥ 40-year-olds to 4.70% for Antilleans. The GP testing rate was generally higher than the SHC testing rate with an overall rate ratio (RR) of 1.61 (95% CI: 1.56-1.65), but not for 15-24-year-olds (RR: 0.81, 95% CI: 0.74-0.88). Large differences in HIV testing rate (1.36 to 39.47 per 1,000 residents) and GP-SHC ratio (RR: 0.23 to 7.24) by geographical area were observed. The GPs' contribution in HIV testing was greater for GP in areas further away from the SHC. In general, population groups that are relatively often tested are also the groups with most diagnoses and highest incidence (e.g., men who have sex with men, non-western). The overall incidence was 10.55 per 100,000 residents, varying from 3.09 for heterosexual men/women to 24.04 for 25-29-year-olds. CONCLUSIONS GPs have a pivotal role in HIV testing in less urbanised areas further away from the SHC, and among some population groups. A relatively high incidence often follows relatively high testing rates. Opportunities to improve HIV testing have been found for migrants, lower-educated individuals, in areas less urbanised areas and further away from GP/SHC. Strategies include additional targeted testing, via for example SHC branch locations and outreach activities.
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Affiliation(s)
- Denise E Twisk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands.
| | - Abraham Meima
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
- Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
| | | | - Casper Rokx
- Department of Internal Medicine, section of infectious diseases, Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Hannelore M Götz
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health, and the Environment (RIVM), Bilthoven, The Netherlands
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Owusu MW, Krankowska DC, Lourida P, Weis N. Late HIV diagnosis among migrant women living in Europe - a systematic review of barriers to HIV testing. IJID REGIONS 2023; 7:206-215. [PMID: 37128290 PMCID: PMC10148112 DOI: 10.1016/j.ijregi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
Objectives HIV transmission persists in Europe, with migrants accounting for over two-fifths of new diagnoses. Over half of all women in Europe are diagnosed late - particularly migrant women. Therefore, an updated understanding of migrant women's needs is crucial to inform inclusive and relevant HIV research, services, and policies. Methods A systematic review relating to factors influencing late HIV diagnoses among migrant women living in Europe in 2011-2021 was conducted, based on data from 12 papers relating to 13 European Union (EU) countries and three non-EU countries. Results The studies revealed a range of individual, sociocultural, and structural barriers to HIV diagnosis. Individual barriers included low perceived risk of HIV, lack of knowledge about HIV symptoms and HIV services, lack of trust in healthcare systems, and fear of societal implications of an HIV diagnosis. Sociocultural barriers included language and communication challenges, stigma, and lack of community testing opportunities. Structural factors included poverty, poor living conditions, unclear legal rights, administrative barriers to healthcare access, and lack of testing opportunities. Conclusions Barriers varied according to resident country, healthcare system, and country/region of origin. The studies highlighted the importance of inclusive research and service design and development, to address the needs of migrant women and reduce inequalities, especially given the current climate in Europe and the everchanging patterns of migration.
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Affiliation(s)
| | - Dagny Clea Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Panagiota Lourida
- Department of Infectious Diseases and HIV, Evaggelismos General Hospital, Athens, Greece
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence to: Prof Nina Weis, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark, Tel: +45 2636 3881
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Zhao P, Wang J, Hall BJ, Sakyi K, Rafiq MY, Bodomo A, Wang C. HIV testing uptake, enablers, and barriers among African migrants in China: A nationwide cross-sectional study. J Glob Health 2022; 12:11015. [PMID: 36527361 PMCID: PMC9758700 DOI: 10.7189/jogh.12.11015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background African migrants in China face social, structural, and cultural barriers to human immunodeficiency virus (HIV) testing with scarce information on their HIV testing behaviours. This study estimated the prevalence of HIV testing and its social and behavioural correlates to understand how to better provide HIV testing services for African migrants living in China. Methods We conducted a national cross-sectional survey among adult African migrants who lived in China for more than one month between January 19 to February 7, 2021. The survey was disseminated online through six African community organizations and via participant referrals. We collected data on HIV testing behaviours and history of HIV testing, social, and cultural factors and applied univariate and multivariable logistic regression to identify testing correlates. Results Among a total of 1305 participants, 72.9% (n = 951/1305) tested for HIV during their stay in China and yielded a self-reported HIV prevalence of 0.4% (n = 4/951). The most common reason for HIV testing was to comply with Chinese residence policy requirements (88.5%, n = 842/951); for not testing was "no need to be tested" (79.4%, n = 281/354). We found most African migrants have experienced low acculturation stress (54.5%, n = 750/1305), low social discrimination (65.6%, n = 856/1305), have a moderate stigma towards HIV (54.3%, n = 709/1305), and low community engagement around sexual health and HIV topics. In multivariable analysis, African migrants who were students (adjusted odds ratio (aOR) = 3.36, 95% CI = 2.40-4.71), living in student dormitories (aOR = 3.86, 95% CI = 1.51-9.84), received health services in China in past year (aOR = 1.67, 95% CI = 1.25-2.23), had lifetime sexually transmitted infections (STI) testing (aOR = 1.95, 95% CI = 1.23-3.10), had HIV testing before coming to China (aOR = 13.56, 95% CI = 9.36-19.65), and those engaged in community discussions of HIV and sexual health (aOR = 2.77, 95% CI = 1.31-5.83) were more likely to test for HIV in China. Conclusions Despite 73% of African migrants having tested for HIV in China, there are unmet needs and barriers identified in our study, such as language barriers. Access to HIV knowledge and testing services were the most important enablers for testing, including studentship, past STI/HIV testing, and community discussion on sexual health. Culturally appropriate and community-based outreach programs to provide information on HIV and testing venues for African migrants might be helpful to promote testing uptake.
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Affiliation(s)
- Peizhen Zhao
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
| | - Jiayu Wang
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Kwame Sakyi
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, Michigan, USA,Center for Learning and Childhood Development, Accra, Ghana
| | | | - Adams Bodomo
- School of Liberal Arts, Xi'an University, Xi'an, China,African Studies Department, University of Vienna, Vienna, Austria
| | - Cheng Wang
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, China,Southern Medical University Institute for Global Health, Guangzhou, China
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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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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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8
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van Bilsen WPH, Bil JP, Prins JM, Brinkman K, Leyten E, van Sighem A, Bedert M, Davidovich U, Burns F, Prins M. Testing and healthcare seeking behavior preceding HIV diagnosis among migrant and non-migrant individuals living in the Netherlands: Directions for early-case finding. PLoS One 2022; 17:e0264435. [PMID: 35245293 PMCID: PMC8896686 DOI: 10.1371/journal.pone.0264435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess differences in socio-demographics, HIV testing and healthcare seeking behavior between individuals diagnosed late and those diagnosed early after HIV-acquisition. Design Cross-sectional study among recently HIV-diagnosed migrant and non-migrant individuals living in the Netherlands. Methods Participants self-completed a questionnaire on socio-demographics, HIV-testing and healthcare seeking behavior preceding HIV diagnosis between 2013–2015. Using multivariable logistic regression, socio-demographic determinants of late diagnosis were explored. Variables on HIV-infection, testing and access to care preceding HIV diagnosis were compared between those diagnosed early and those diagnosed late using descriptive statistics. Results We included 143 individuals with early and 101 with late diagnosis, of whom respectively 59/143 (41%) and 54/101 (53%) were migrants. Late diagnosis was significantly associated with older age and being heterosexual. Before HIV diagnosis, 89% of those with early and 62% of those with late diagnosis had ever been tested for HIV-infection (p<0.001), and respectively 99% and 97% reported healthcare usage in the Netherlands in the two years preceding HIV diagnosis (p = 0.79). Individuals diagnosed late most frequently visited a general practitioner (72%) or dentist (62%), and 20% had been hospitalized preceding diagnosis. In these settings, only in respectively 20%, 2%, and 6% HIV-testing was discussed. Conclusion A large proportion of people diagnosed late had previously tested for HIV and had high levels of healthcare usage. For earlier-case finding of HIV it therefore seems feasible to successfully roll out interventions within the existing healthcare system. Simultaneously, efforts should be made to encourage future repeated or routine HIV testing among individuals whenever they undergo an HIV test.
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Affiliation(s)
- Ward P. H. van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Janneke P. Bil
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Jan M. Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Division of Infectious Diseases, OLVG, Amsterdam, The Netherlands
| | - Eliane Leyten
- Department of Internal Medicine, Division of Infectious Diseases, Haaglanden Medical Center, Den Haag, The Netherlands
| | | | - Maarten Bedert
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Fiona Burns
- Insitute for Global Health, University College London, London, United Kingdom
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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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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10
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Bedert M, Davidovich U, de Bree G, van Bilsen W, van Sighem A, Zuilhof W, Brinkman K, van der Valk M, de Wit J. Understanding Reasons for HIV Late Diagnosis: A Qualitative Study Among HIV-Positive Individuals in Amsterdam, The Netherlands. AIDS Behav 2021; 25:2898-2906. [PMID: 33788120 PMCID: PMC8373722 DOI: 10.1007/s10461-021-03239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Since the introduction of effective anti-retroviral therapy, early diagnosis and treatment of HIV have become increasingly important from individual and public health perspectives. People who are diagnosed with a CD4 count below 350 cells/µL blood are today considered to be “late” diagnoses. In an effort to understand the reasons for late diagnosis, we conducted in-depth interviews (n = 14) in Amsterdam, the Netherlands. Two main factors were identified: psychosocial factors and health-system factors. Psychosocial factors relate to people’s personal relationship with health professionals, low risk perception, fear related to the outcome of testing, and trauma from observed past experiences of living with HIV. Health-system factors relate to institutional barriers and missed opportunities during client-provider interactions. We conclude that in order to mitigate late diagnosis, the social and institutional context within which HIV testing is conducted should be addressed.
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Affiliation(s)
- Maarten Bedert
- Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Wim Zuilhof
- SOA AIDS Nederland, Amsterdam, The Netherlands
| | - Kees Brinkman
- Onze Lieve Vrouwenziekenhuis, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam UMC, Location AMC & DC Klinieken Valeriusplein, Amsterdam, The Netherlands
| | - John de Wit
- Utrecht University, Utrecht, The Netherlands
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11
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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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12
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Miranda MNS, Pingarilho M, Pimentel V, Martins MDRO, Vandamme AM, Bobkova M, Böhm M, Seguin-Devaux C, Paredes R, Rubio R, Zazzi M, Incardona F, Abecasis A. Determinants of HIV-1 Late Presentation in Patients Followed in Europe. Pathogens 2021; 10:pathogens10070835. [PMID: 34357985 PMCID: PMC8308660 DOI: 10.3390/pathogens10070835] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
To control the Human Immunodeficiency Virus (HIV) pandemic, the World Health Organization (WHO) set the 90-90-90 target to be reached by 2020. One major threat to those goals is late presentation, which is defined as an individual presenting a TCD4+ count lower than 350 cells/mm3 or an AIDS-defining event. The present study aims to identify determinants of late presentation in Europe based on the EuResist database with HIV-1 infected patients followed-up between 1981 and 2019. Our study includes clinical and socio-demographic information from 89851 HIV-1 infected patients. Statistical analysis was performed using RStudio and SPSS and a Bayesian network was constructed with the WEKA software to analyze the association between all variables. Among 89,851 HIV-1 infected patients included in the analysis, the median age was 33 (IQR: 27.0-41.0) years and 74.4% were males. Of those, 28,889 patients (50.4%) were late presenters. Older patients (>56), heterosexuals, patients originated from Africa and patients presenting with log VL >4.1 had a higher probability of being late presenters (p < 0.001). Bayesian networks indicated VL, mode of transmission, age and recentness of infection as variables that were directly associated with LP. This study highlights the major determinants associated with late presentation in Europe. This study helps to direct prevention measures for this population.
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Affiliation(s)
- Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Correspondence: ; Tel.: +351-213-652-600
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Maria do Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
| | - Anne-Mieke Vandamme
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
- Laboratory Clinical and Epidemiological Virology, Department of Microbiology and Immunology, KU Leuven, Rega Institute for Medical Research, 3000 Leuven, Belgium
| | - Marina Bobkova
- Gamaleya Research Center of Epidemiology and Microbiology, Department of General Virology, Gamaleya Scientific Research Institute, 123098 Moscow, Russia;
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, 66421 Homburg, Germany;
| | - Carole Seguin-Devaux
- Laboratory of Retrovirology, Department of Infection and Immunity, Luxembourg Institute of Health, L-4354 Esch-sur-Alzette, Luxembourg;
| | - Roger Paredes
- Infectious Diseases Department and IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, 28026 Madrid, Spain;
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Francesca Incardona
- IPRO—InformaPRO S.r.l., 98, 00152 Rome, Italy;
- EuResist Network, 98/100, 00152 Rome, Italy
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, New University of Lisbon (IHMT/UNL), 1349-008 Lisbon, Portugal; (M.P.); (V.P.); (M.d.R.O.M.); (A.-M.V.); (A.A.)
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13
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Vujcich D, Wangda S, Roberts M, Lobo R, Maycock B, Kulappu Thanthirige C, Reid A. Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review. PLoS One 2020; 15:e0236821. [PMID: 32745106 PMCID: PMC7398552 DOI: 10.1371/journal.pone.0236821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
There has been a growing number of sexual health and blood-borne virus (SHBBV) surveys specifically administered to migrant populations. The purpose of this scoping review is to collate available information about how SHBBV surveys have been administered in migrant populations and the effect that mode of administration has on data quality, reliability and other practical considerations, e.g. response rates (RR) and social desirability bias. A methodological framework for scoping reviews was applied. SHBBV survey studies administered to international migrants published since 2000 were included if they contained some description of mode of administration. Ninety one studies were identified for inclusion from Embase, Medline, Web of Science, Google Scholar and supplementary grey literature. 'Interview only' was the most common mode of administration (n = 48), predominately comprising face-to-face interviews. Thirty six studies reported data from 'self-completed' surveys only, with pen-and-paper being most common (n = 17). Few studies (n = 7) combined interview and self-completed methods of survey administration. Sixty one studies did not report (or only partially reported) RR or the data necessary to calculate RR. Of the studies that reported RR, most were missing other key information including method of recruitment, consent procedures and whether incentives were offered. Strengths and limitations of all administration modes are summarised. Guidelines to inform future SHBBV survey research in migrant populations are presented.
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Affiliation(s)
- Daniel Vujcich
- School of Public Health, Curtin University, Perth, Australia
- * E-mail:
| | | | - Meagan Roberts
- School of Public Health, Curtin University, Perth, Australia
| | - Roanna Lobo
- School of Public Health, Curtin University, Perth, Australia
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Exeter, United Kingdom
| | | | - Alison Reid
- School of Public Health, Curtin University, Perth, Australia
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14
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Kronfli N, Linthwaite B, Sheehan N, Cox J, Hardy I, Lebouché B, de Pokomandy A, Frenette C, Roger M, Klein MB. Delayed linkage to HIV care among asylum seekers in Quebec, Canada. BMC Public Health 2019; 19:1683. [PMID: 31842822 PMCID: PMC6916083 DOI: 10.1186/s12889-019-8052-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. Methods We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. Results Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. Conclusions While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada. .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Sheehan
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Faculté de Pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Hardy
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Charles Frenette
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada
| | - Michel Roger
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Glen site, McGill University Health Centre, 1001 Decarie Boulevard D02.4110, Montreal, Quebec, H4A 3J1, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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15
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Bil JP, Zuure FR, Alvarez-Del Arco D, Prins JM, Brinkman K, Leyten E, van Sighem A, Burns F, Prins M. Disparities in access to and use of HIV-related health services in the Netherlands by migrant status and sexual orientation: a cross-sectional study among people recently diagnosed with HIV infection. BMC Infect Dis 2019; 19:906. [PMID: 31664925 PMCID: PMC6819557 DOI: 10.1186/s12879-019-4477-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background Migrants often face barriers to accessing healthcare. We examined disparities in access to and use of HIV-related health services between migrant and non-migrant people recently diagnosed with HIV living in the Netherlands, taken into account sexual orientation. Also, we examined differences in experiences in living with HIV between these groups. Methods We used a questionnaire and clinical data collected between July 2013 and June 2015 among migrant and non-migrant participants of the European cross-sectional aMASE (Advancing Migrant Access to health Services in Europe) study in the Netherlands. Using univariable logistic regression analyses, we compared outcomes on between migrants and non-migrants, stratified by sexual orientation (with non-migrant men having sex with men [MSM] as the reference group). Results We included 77 migrant MSM, 115 non-migrant MSM, 21 migrant heterosexual men, 14 non-migrant heterosexual men and 20 migrant women. In univariable analyses, all heterosexual groups were less likely to ever have had an HIV-negative test before their diagnosis and were more likely to be diagnosed late than non-migrant MSM. All migrant groups were more likely to have experienced difficulties accessing general healthcare in the Netherlands and were less likely to have heard of post-exposure prophylaxis than non-migrant MSM. Migrants frequently reported uncertainty about their rights to healthcare and language barriers. Most (93%) participants visited a healthcare facility in the 2 years before HIV diagnosis but only in 41% an HIV test was discussed during that visit (no statistical difference between groups). Migrant heterosexuals were more likely to have missed appointments at their HIV clinic due to the travel costs than non-migrant MSM. Migrant MSM and women were more likely to have experienced HIV discrimination in the Netherlands than non-migrant MSM. Conclusion Disparities in access to and use of HIV-related health services and experiences exist by migrant status but also by sexual orientation. Our data suggests heterosexual men and women may particularly benefit from improved access to HIV testing (e.g., through provider-initiated testing), while migrant MSM may benefit from improved access to HIV prevention interventions (e.g., pre-exposure prophylaxis).
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands. .,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands. .,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Freke R Zuure
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Debora Alvarez-Del Arco
- National Centre for Epidemiology. Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Jan M Prins
- Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - Eliane Leyten
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | | | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, the Netherlands
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16
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Moreira C, Boughey A, Ryan KE, Higgins N, Rotty J, West M, Hellard M, Stoové M, El-Hayek C. Two decades of surveillance data show late presentation among a diverse group of women diagnosed with HIV in Victoria, Australia. Aust N Z J Public Health 2019; 43:413-418. [PMID: 31180616 DOI: 10.1111/1753-6405.12910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/01/2019] [Accepted: 04/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To develop an HIV response suited to women and to inform appropriate services, we describe the characteristics of women diagnosed and living with HIV using 22 years of high-quality surveillance data. METHODS Data on women newly diagnosed with HIV between 1994 and 2016 and women living with diagnosed HIV in Victoria at 31 December 2016 were extracted from the Victorian Public Health Surveillance System. Descriptive analysis by place of birth was performed and Poisson regression used to assess trends over time. RESULTS There were 465 new diagnoses among women in Victoria between 1994 and 2016 and 613 women living with HIV in 2016. Women were diagnosed late, and frequently reported no HIV testing history, AIDS-defining illness or other symptoms of HIV at diagnosis. These indicators of delayed diagnosis were even greater for non-Australian-born women. Conclusions and implications for public health: For Victoria to reach the ambitious targets for diagnosis, treatment and viral suppression in 95% of people living with HIV, prevention programs and efforts to increase early diagnosis as well as support services must consider the epidemiology and diversity of women.
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Affiliation(s)
| | | | - Kathleen Elizabeth Ryan
- The Burnet Institute, Victoria.,School of Public Health and Preventative Medicine, Monash University, Victoria
| | - Nasra Higgins
- The Victorian Department of Health and Human Services
| | - Jessica Rotty
- The Victorian Department of Health and Human Services
| | - Michael West
- The Victorian Department of Health and Human Services
| | - Margaret Hellard
- The Burnet Institute, Victoria.,School of Public Health and Preventative Medicine, Monash University, Victoria
| | - Mark Stoové
- The Burnet Institute, Victoria.,School of Public Health and Preventative Medicine, Monash University, Victoria
| | - Carol El-Hayek
- The Burnet Institute, Victoria.,School of Public Health and Preventative Medicine, Monash University, Victoria
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17
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Bil JP, Prins M, Fakoya I, Volny-Anne A, Burns F, Zuure FR. Usage of purchased self-tests for HIV infections among migrants living in the UK, France and the Netherlands: a cross-sectional study. Sex Transm Infect 2018; 95:629-632. [PMID: 30171170 DOI: 10.1136/sextrans-2018-053583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Self-tests are performed and interpreted autonomously by a person without involving a healthcare professional or a certified laboratory. To gain insight into the usage of purchased HIV self-tests (HIVST) among migrants living in high-income countries, we studied the prevalence and determinants of HIVST usage among migrants living in the UK, France and the Netherlands. METHODS We used web-based questionnaire data collected between April 2014 and July 2015 among migrants living in the UK, France and the Netherlands who participated in the cross-sectional community survey of the aMASE (advancing Migrant Access to health Services in Europe) study. HIVST usage in the preceding 12 months and the corresponding 95% CIs were calculated. Using univariate logistic regression analyses, determinants of HIVST usage were evaluated. RESULTS Among 477 migrants living in the UK (n=235), France (n=98) and the Netherlands (n=144), HIVST usage in the preceding 12 months was 1.89% (9/477, 95% CI 0.66% to 3.11%). As all nine HIVST users were men who have sex with men (MSM), we restricted our univariate analyses to MSM (n=240). HIVST usage was borderline significantly lower among MSM living in France and the Netherlands compared with those living in the UK (UK: reference; France: OR 0.20, 95% CI 0.03 to 1.14; the Netherlands: OR 0.06, 95% CI 0.00 to 1.05). Age, region of birth, educational level, registration at a general practitioner, recent number of male sexual partners and hard drug use were not associated with HIVST usage among MSM. CONCLUSIONS HIVST usage among migrants from the UK, France and the Netherlands was relatively low between 2014 and 2015 but higher among migrant MSM. To increase HIV testing rates among migrants, programmes need to be developed to promote HIVST among this group. Also, as more countries approve usage of HIVST, systems need to be established to ensure linkage to confirmatory testing and care following a positive test.
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands .,Department of Internal Medicine Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ibidun Fakoya
- Institute of Global Health, University College, London, UK
| | | | - Fiona Burns
- Institute of Global Health, University College, London, UK
| | - Freke R Zuure
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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18
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Navarro M, Navaza B, Guionnet A, López-Vélez R. Overcoming Barriers to HIV Prevention and Healthcare Among Sub-Saharan African Migrants in Spain. JMIR Public Health Surveill 2018; 4:e10478. [PMID: 29764802 PMCID: PMC5974456 DOI: 10.2196/10478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Miriam Navarro
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Salud Entre Culturas, Madrid, Spain
| | - Bárbara Navaza
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Salud Entre Culturas, Madrid, Spain
| | - Anne Guionnet
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Salud Entre Culturas, Madrid, Spain
| | - Rogelio López-Vélez
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Salud Entre Culturas, Madrid, Spain
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