Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe

Monge, Susana; Jarrín, Inma; Pantazis, Nikos; Mocroft, Amanda; Sabin, Caroline; Touloumi, Giota; Sighem, Ard van; Abgrall, Sophie; Dray‐Spira, Rosemary; Spire, Bruno; Castagna, Antonella; Mussini, C.; Zangerle, Robert; Hessamfar, Mojgan; Anderson, J.; Hamouda, Osamah; Ehren, Kathrin; Obel, Niels; Kirk, Ole; Monteynard, L.-A. de; Antinori, Andrea; Girardi, Enrico; Saracino, Annalisa; Calmy, Alexandra; Wit, Stéphane De; Wittkop, Linda; Bucher, HC; Montoliu, Alexandra; Raben, Dorthe; Prins, Maria; Meyer, Laurence; Chêne, Geneviève; Burns, Fiona; Amo, Julia del

doi:10.1097/qad.0000000000001411

Cited by 13 publications

(4 citation statements)

References 34 publications

(41 reference statements)

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“…Regardless of place of acquisition, migrants present late to care. In two very large, multi-country European cohort studies, the median CD4 count at entry to care was substantially lower among migrants compared to European natives [6, 40**]. In both studies, migrants from sub-Saharan Africa – who comprised over half of migrants in each analysis – were more likely to be diagnosed with AIDS and had the lowest median CD4 counts.…”

Section: Entry Into Hiv Carementioning

confidence: 99%

“…Despite having access to medical insurance, undocumented migrants with HIV infection in Italy were eight times more likely to be lost to follow-up than persons born in Italy [61]. Recently published data from the COHERE collaborative demonstrate that, depending on region of origin, migrant men were 25–45% less likely to initiate antiretroviral therapy (ART) even when adjusting for baseline CD4 count [40, 62]. In several European studies, migrants were also more likely than native-born persons to experience virologic failure [63, 64].…”

Section: Hiv Outcomes Once In Carementioning

confidence: 99%

See 1 more Smart Citation

HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence

Ross

Cunningham

Hanna

2018

Current Opinion in Infectious Diseases

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Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.

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Section: Entry Into Hiv Carementioning

confidence: 99%

Section: Hiv Outcomes Once In Carementioning

confidence: 99%

HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence

Ross

Cunningham

Hanna

2018

Current Opinion in Infectious Diseases

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“…The respective role of sociodemographic characteristics and economic factors on response to ART cannot be easily distinguished. In absence of data on socioeconomic status, geographical origin, sex and HIV transmission group have been shown to modify outcome after ART initiation, partly because of later ART initiation in migrant men than in non-migrants [15,16,17]. In various contexts, migrants have been reported to have poorer outcomes with higher risk of virological failure [1,2,6] possibly due to lower rates of adherence or retention in care [18,19].…”

Section: Discussionmentioning

confidence: 99%

Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

et al. 2019

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Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2–7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.

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“…They are a priority population group for which targeted interventions are required for ending the HIV epidemic [13]. Migrants face numerous challenges in accessing HIV services across all levels of the care continuum, experiencing delayed initiation into HIV care, poor retention in HIV services, and frequent interruptions in treatment, which negatively impacts viral load suppression and increases the risk of developing HIV drug resistance [13][14][15][16][17]. Identified challenges to utilizing HIV care include language barriers, stigmatizing cultural norms, legal status, and discrimination by healthcare providers [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review

Li,

Thaweesee,

Kimmel

et al. 2024

PLOS Glob Public Health

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Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15–24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.

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Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe

Abstract: Most migrant men initiate cART at lower CD4 cell count than natives, whereas this does not hold for migrant women.

Cited by 13 publications

References 34 publications

HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence

HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence

Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France

Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review

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