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

Abstract

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.

The contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018

“…In the period 1995–2018, 57.2% of tests were performed on MSM, 7.6% on SW (FSW plus MSW), 2.6% on PWID, 1.5% on transgender people and 45.2% on foreign nationals (including migrant population). A recent study showed that in Catalonia, 12.3% of those living with HIV were still undiagnosed, and this proportion was higher in migrants [ 28 ]. Therefore, in Catalonia, providing access to HIV POCT in the community is important, especially for populations facing barriers to accessing the healthcare system, such as the migrant population.…”

An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam

“…Causes of HIV transmission among MSM have been well documented, such as sexual risk behaviors including unprotected sexual intercourses and multiple sex partners, as well as a high frequency of substance use and abuse [2,[5][6][7][8][9][10]. However, many MSM living with HIV do not acknowledge their HIV serostatus, ranging from 16% in the United States [11], 21% in New Zealand [12], 22% in Spain [13] to 86% in China [14] and 90.4% in Malawi [15]. Consequently, they receive delayed care, which threatens their health and accelerates HIV progression [16,17].…”

Declining trend in HIV new infections in Guangxi, China: insights from linking reported HIV/AIDS cases with CD4-at-diagnosis data

“…Lots of experts has been devoting to the estimation of HIV new infections and HIV undiagnoses in recent years [18][19][20], but accurate estimation of real-time HIV infection in China becomes challenging because of the differences in various transmission routes, patterns of risk behaviours, the intensities of interventions for various regions, high loss ratio of follow-up and etc [1,21]. HIV epidemic in Guangxi, representing national wide pattern of HIV infection to some extent, has new features including quick increase of HIV infections caused by heterosexual transmission [2,[9][10][11][12]22], increasing of reported cases with age older than 50 [10] and regional itself characteristics, which will bring new challenges to the estimation.…”