Predictors of Late Presentation for HIV among HIV-positive Tajik Migrants to the Russian Federation

Abstract

Between 800 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants in to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV upon their return to Tajikistan. This study uses data from the Tajikistan Ministry of Health surveillance system. The dataset contains all new known HIV diagnoses between 2006 and 2018. At time of diagnosis, patients are interviewed by staff of AIDS centers, complete routine intake forms and complete medical exam and related forms by doctors. HIV-positive returned migrants who had lived in the Russian Federation (n = 770) were included in final data-analysis after data cleaning. Data were analyzed using three logistic (logit) models. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 10.3% (95% CI: 5.5-15.3). The saturated multivariate model showed that when holding all study variables constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 9.5% (95% CI: 2.6-16.9). The parsimonious multivariate model showed that when current age and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 6.3 (95% CI: 1.1-11.8). Even when other potential predictors are included in the logistic model, only age and length of time abroad remain statistically significant. The results of this paper suggest that if the Russian Federation were to adopt a reciprocal policy, it might improve treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis. Key messages Structural factors are the strongest predictors of HIV late presentation among returned Tajik migrants to the Russian Federation. Further research is needed to explicate the causal pathways of the associations found in the present analysis.

Association between time spent in the Russian Federation and late presentation for HIV among Tajikistani migrants

“…The authors would like to acknowledge the Tajikistan Ministry of Health and Republican AIDS Center for their support in providing the dataset used in this analysis, reviewing several iterations of the manuscript, and general support in conducting this research. Abstract has been published in the European journal of public health [43].…”