HIV testing history and access to treatment among migrants living with HIV in Europe

the aMASE Study Team

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    Abstract

    Introduction: Migrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe. Methods: A cross-sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV-positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign-born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men. Results: A total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post-migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three-quarters of people on antiretrovirals had an HIV viral load <50 copies/mL. Conclusions: Migrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention.

    Original languageEnglish
    Article numbere25123
    JournalJournal of the International AIDS Society
    Volume21
    Issue numberS4
    DOIs
    Publication statusPublished - Jul 2018

    Bibliographical note

    Funding Information:
    This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n? 260,694. Ms Fakoya was funded by a Doctoral Research Fellowship from the National Institute for Health Research. The views expressed in this study are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Additional funding was received from: Gilead Sciences Europe Ltd.; NIHR Clinical Research Network, UK; Foundation for AIDS Research and Prevention in Spain (FISPSE) Project 361,036/10; Consortium of Biomedical Research in Epidemiology and Public Health, Spain; Spanish HIV Research Network for Excellence (RD06/006 and RD12/0017/0018); FIPSE (Fundaci?n para la Prevenci?n de SIDA en Espa?a) 361,036/10, Consortium of Biomedical Research in Epidemiology and Public Health, Spain (CIBER). Research and Development Fund, Public Health Service of Amsterdam; and the Swiss HIV Cohort study (project #727), supported by the Swiss National Science Foundation (grant #148,522) and by the SHCS Research Foundation. No funder had any role in the study, writing of the manuscript or decision to submit for publication This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n? 260,694. Ms Fakoya was funded by a Doctoral Research Fellowship from the National Institute for Health Research. The views expressed in this study are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Additional funding was received from: Gilead Sciences Europe Ltd.; NIHR Clinical Research Network, UK; Foundation for AIDS Research and Prevention in Spain (FISPSE) Project 361,036/10; Consortium of Biomedical Research in Epidemiology and Public Health, Spain; Spanish HIV Research Network for Excellence (RD06/006 and RD12/0017/0018); FIPSE (Fundaci?n para la Prevenci?n de SIDA en Espa?a) 361,036/10, Consortium of Biomedical Research in Epidemiology and Public Health, Spain (CIBER). Research and Development Fund, Public Health Service of Amsterdam; and the Swiss HIV Cohort study (project #727), supported by the Swiss National Science Foundation (grant #148,522) and by the SHCS Research Foundation. No funder had any role in the study, writing of the manuscript or decision to submit for publication

    Funding Information:
    This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n˚ 260,694. Ms Fakoya was funded by a Doctoral Research Fellowship from the National Institute for Health Research. The views expressed in this study are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Additional funding was received from: Gilead Sciences Europe Ltd.; NIHR Clinical Research Network, UK; Foundation for AIDS Research and Prevention in Spain (FISPSE) Project 361,036/10; Consortium of Biomedical Research in Epidemiology and Public Health, Spain; Spanish HIV Research Network for Excellence (RD06/006 and RD12/0017/0018); FIPSE (Fundación para la Prevención de SIDA en España) 361,036/10, Consortium of Biomedical Research in Epidemiology and Public Health, Spain (CIBER). Research and Development Fund, Public Health Service of Amsterdam; and the Swiss HIV Cohort study (project #727), supported by the Swiss National Science Foundation (grant #148,522) and by the SHCS Research Foundation. No funder had any role in the study, writing of the manuscript or decision to submit for publication

    Publisher Copyright:
    © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

    Keywords

    • HIV
    • HIV serodiagnosis
    • health services accessibility
    • migrants
    • primary healthcare

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