Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources

Reyes-Urueña, Juliana; Campbell, Colin; Hernándo, Cristina; Vives, Núria; Folch, Cinta; Ferrer, Laia; Fernàndez‐López, Laura; Esteve, Anna; Casabona, Jordi

doi:10.1017/s0950268817000437

Cited by 20 publications

(15 citation statements)

References 32 publications

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“…However we did not collect data to compare with non-migrants. Another study found higher default rates among migrants compared to Spanish born populations (9.2% versus 6.3%) [ 13 ]. On the contrary, a study in Johannesburg, South Africa, found default rates to be significantly lower in foreigners compared to local citizens (12% versus 31%) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Faturiyele¹,

Karletsos²,

Ntene-Sealiete

et al. 2018

BMC Public Health

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BackgroundHIV treatment and care for migrants is affected by their mobility and interaction with HIV treatment programs and health care systems in different countries. To assess healthcare needs, preferences and accessibility barriers of HIV-infected migrant populations in high HIV burden, borderland districts of Lesotho.MethodsWe selected 15 health facilities accessed by high patient volumes in three districts of Maseru, Leribe and Mafeteng. We used a mixed methods approach by administering a survey questionnaire to consenting HIV infected individuals on anti-retroviral therapy (ART) and utilizing a purposive sampling procedure to recruit health care providers for qualitative in-depth interviews across facilities.ResultsOut of 524 HIV-infected migrants enrolled in the study, 315 (60.1%) were from urban and 209 (39.9%) from rural sites. Of these, 344 (65.6%) were women, 375 (71.6%) were aged between 26 and 45 years and 240 (45.8%) were domestic workers. A total of 486 (92.7%) preferred to collect their medications primarily in Lesotho compared to South Africa. From 506 who responded to the question on preferred dispensing intervals, 63.1% (n = 319) preferred 5–6 month ARV refills, 30.2% (n = 153) chose 3–4 month refills and only 6.7% (n = 34) opted for the standard-of-care 1–2 month refills. A total of 126 (24.4%) defaulted on their treatment and the primary reason for defaulting was failure to get to Lesotho to collect medication (59.5%, 75/126). Treatment default rates were higher in urban than rural areas (28.3% versus 18.4%, p = 0.011). Service providers indicated a lack of transfer letters as the major drawback in facilitating care and treatment for migrants, followed by discrimination based on nationality or language. Service providers indicated that most patients preferred all treatment services to be rendered in Lesotho, as they perceive the treatment provided in South Africa to be different often less strong or with more serious side effects.ConclusionExisting healthcare systems in both South Africa and Lesotho experience challenges in providing proper care and treatment for HIV infected migrants. A need for a differentiated model of ART delivery to HIV infected migrants that allows for multi-month scripting and dispensing is warranted.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5594-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Faturiyele¹,

Karletsos²,

Ntene-Sealiete

et al. 2018

BMC Public Health

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“… 22 23 In Catalonia, this could be explained by the fact that migrants experienced a higher number of barriers to access HIV testing services than the Spanish-born population and that these needs might be driven primarily by shared risk factors. 24 This also can be due to the fact that migrants face cultural and linguistic barriers as well as legal and administrative impediments to accessing health services and thus HIV testing facilities. 25 In Europe, the HIV testing uptake among migrants range from 23% to 64%.…”

Section: Discussionmentioning

confidence: 99%

Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

et al. 2018

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ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

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“…Although the number of new infections decreased in Australia, particularly among men who have sex with men (MSM), new HIV infections among migrants increased [6]. Migrants were also more likely to present with a late HIV diagnosis than citizens [6,8,9]. These differences raise concerns that migrants are being 'left behind', highlighting the need to focus on this group if Australia is to achieve the Fast-Track targets.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, temporary residents from countries with a reciprocal healthcare agreement (RHCA) with Australia (i.e., Belgium, Finland, Italy, Malta, Netherlands, New Zealand, Norway, Ireland, Slovenia, Sweden, and United Kingdom) are eligible for subsidised access through Medicare. However, migrants outside of these categories are not eligible for Medicare, although some may access HIV care and treatment through compassionate access programmes or private health insurance [6,8]. When reporting HIV diagnosis and care cascades, it is important to provide subpopulation cascades to track progress toward Fast-Track targets and ensure no one is left behind.…”

Section: Introductionmentioning

confidence: 99%

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

et al. 2020

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Background Globally, few studies compare progress toward the Joint United Nations Program on HIV/ AIDS (UNAIDS) Fast-Track targets among migrant populations. Fast-Track targets are aligned to the HIV diagnosis and care cascade and entail achieving 90-90-90 (90% of people living with HIV [PLHIV] diagnosed, 90% of those diagnosed on treatment, and 90% of those on treatment with viral suppression [VS]) by 2020 and 95-95-95 by 2030. We compared cascades between migrant and nonmigrant populations in Australia. Methods and findings We conducted a serial cross-sectional survey for HIV diagnosis and care cascades using modelling estimates for proportions diagnosed combined with a clinical database for proportions on treatment and VS between 2013-2017. We estimated the number of PLHIV and number diagnosed using New South Wales (NSW) and Victorian (VIC) data from the Australian National HIV Registry. Cascades were stratified by migration status, sex, HIV exposure, and eligibility for subsidised healthcare in Australia (reciprocal healthcare agreement [RHCA]). We found that in 2017, 17,760 PLHIV were estimated in NSW and VIC, and 90% of them were males. In total, 90% of estimated PLHIV were diagnosed. Of the 9,391 who were diagnosed and retained in care, most (85%; n = 8,015) were males. We excluded 38% of PLHIV with missing data for country of birth, and 41% (n = 2,408) of eligible retained PLHIV were migrants. Most migrants were from Southeast Asia (SEA; 28%), northern Europe (12%), and eastern Asia (11%). Most of the migrants and nonmigrants were males (72% and 83%, respectively). We found that among those retained in care, 90% were on antiretroviral therapy (ART), and 95% of those on ART had VS (i.e., 90-90-95). Migrants had larger gaps in their HIV diagnosis and care cascade (85-85-93) compared with

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Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources

Cited by 20 publications

References 32 publications

Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

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