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Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004–2016

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Abstract

This study using the Catalan PISCIS cohort explores risk factors of migrants’ late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.

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References

  1. Centre for Epidemiological Studies of Sexually Transmitted Disease. and AIDS in Catalonia (CEEISCAT). Epidemiological Surveillance of HIV infection and AIDS in Catalonia—Annual Report 2016. 2017.

  2. European Centre for Disease Prevention and Control. HIV /AIDS surveillance in Europe (2016 data). 2017.

  3. Mocroft A, Lundgren JD, Sabin ML, d’Arminio Monforte A, Brockmeyer N, Casabona J, et al. Risk factors and outcomes for late presentation for hiv-positive persons in Europe: results from the collaboration of observational HIV epidemiological research europe study (COHERE). PLoS Med. 2013;10(9).

  4. World Health Organization. Guidelines guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for Hiv. World Heal Organ [Internet]. 2015;(September):78. http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/.

  5. Sobrino-Vegas P, Moreno S, Rubio R, Viciana P, Bernardino JI, Blanco JR, et al. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013. J Infect. 2016;72(5):587–96.

    Article  PubMed  Google Scholar 

  6. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20(10):1447–50.

    Article  Google Scholar 

  7. Apondi R, Bunnell R, Ekwaru JP, Moore D, Bechange S, Khana K, et al. Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up. Aids. 2011;25(10):1317–27.

    Article  PubMed  Google Scholar 

  8. Blaser N, Wettstein C, Estill J, Vizcaya LS, Wandeler G, Egger M, et al. Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis. AIDS. 2014;28(7):1021–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Raffetti E, Postorino MC, Castelli F, Casari S, Castelnuovo F, Maggiolo F, et al. The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years : results from the Italian MASTER Cohort. BMC Public Health [Internet]. BMC Public Health; 2016; https://doi.org/10.1186/s12889-016-3477-z.

  10. Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al. Late presentation of HIV infection: a consensus definition. HIV Med. 2011;12(1):61–4.

    Article  CAS  PubMed  Google Scholar 

  11. Porthé V, Vargas I, Belén Sanz-Barbero L, Plaza-Espuña I, Bosch L, Navarrete MLV. Changes in access to health care for immigrants in Catalonia during the economic crisis. Opinions of health professionals and immigrant users. Health Policy (New York). 2016.

  12. Institut d’Estadística de Catalunya (IDESCAT). Foreign Population Catalonia 2016 [Internet]. 2016. https://www.idescat.cat/poblacioestrangera/?b=2&lang=es. Accessed 19 June 2018.

  13. Sulis G, El Hamad I, Fabiani M, Rusconi S, Maggiolo F, Guaraldi G, et al. Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000–2010. Infection. 2014;42(5):859–67.

    Article  CAS  PubMed  Google Scholar 

  14. Op de Coul ELM, van Sighem A, Brinkman K, Benthem BH van, Ende ME van der, Geerlings S, et al. Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort. BMJ Open. 2016;6(1):e009688.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Vives N, Carnicer-Pont D, García de Olalla P, Camps N, Esteve A, Casabona J, et al. Factors associated with late presentation of HIV infection in Catalonia, Spain. Int J STD AIDS. 2012;23(7):475–80.

    Article  CAS  PubMed  Google Scholar 

  16. Vázquez ML, Vargas I, Jaramillo DL, Porth V, López-Fernández LA, Vargas H, et al. Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia. Health Policy (New York). Elsevier Ireland Ltd; 2016;1–10.

  17. Nicolás D, Esteve A, Cuadros A, Campbell CNJ, Tural C, Podzamczer D, et al. Safe reduction in CD4 cell count monitoring in stable, virally suppressed patients with HIV infection or HIV/hepatitis C virus coinfection. Clin Infect Dis. 2016;62(12):1578–1585.

    Article  CAS  Google Scholar 

  18. Mocroft A, Lundgren J, Monforte AD, Brannstrom J, Bonnet F, Furrer H, et al. Late presentation for HIV care across Europe: Update from the collaboration of observational HIV epidemiological research europe (COHERE) study, 2010 to 2013. Eurosurveillance. 2015;20(47).

  19. Patrascioiu I, López CQ, Porta MM, Velazquez GBA, Hanzu FA, Gómez-Gil E, et al. Characteristics of the HIV positive transgender population of Catalonia. In: Endocrine Abstracts. 15th European Congress of Endocrinology, Copenhagen; 2013. p. 341.

  20. Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72:210–9.

    Article  Google Scholar 

  21. World Health Organization. Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy. 2017.

  22. O’Riordan M, Fitzpatrick F. The impact of economic recession on infection prevention and control. J Hosp Infect Elsevier Ltd. 2015;89(4):340–5.

    Article  Google Scholar 

  23. Nikolopoulos G, Sypsa V. Big events in Greece and HIV infection among people who inject drugs. Subst Use Misuse. 2015;50(7):825–38.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hernando V, Alvárez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, et al. HIV infection in migrant populations in the European Union and European Economic area in 2007–2012. JAIDS J Acquir Immune Defic Syndr. 2015;70(2):204–11.

    Article  PubMed  Google Scholar 

  25. De G, Aguilar AA, Badenes M, Massagué C, Gispert B, De, Fernández J, et al. Guide for primary care for immigrant patients (Guía de atención primaria al paciente inmigrante). 2011.

  26. Loos J, Manirankunda L, Hendrickx K, Remmen R, Nöstlinger C. HIV Testing in primary care: feasibility and acceptability of provider initiated HIV testing and counselling for sub-Saharan African migrants. AIDS Educ Prev. 2014;26(1):81–93.

    Article  PubMed  Google Scholar 

  27. Balbuena SF, Hoyos J, Belza MJ, Pujol F, Alvarez J, Zulaica D, et al. HIV rapid testing programs in non-clinical settings have the potential to constitute a major diagnostic option for MSM in Spain. AIDS Behav. 2017;21(2):525–33.

    Article  PubMed  Google Scholar 

  28. Reyes-urueña JM, Campbell CNJ, Vives N, Esteve A, Ambrosioni J, Tural C, et al. 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. BMJ Open. 2018;8:1–9.

    Article  Google Scholar 

  29. Hoyos J, Fernández-Balbuena S, De Fuente L, Sordo L, Ruiz M, Barrio G, et al. Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers. J Int AIDS Soc. 2013;16(18560):1–8.

    Google Scholar 

  30. Ríos E, Ferrer L, Casabona J, Caylá J, Avecilla Á, Prat JG. i, et al. Knowledge of HIV and sexually-transmitted diseases in Latin American and Maghrebi immigrants in Catalonia. Gac Sanit. 2009;23(6):533–8.

    Article  PubMed  Google Scholar 

  31. Rodrıguez-Alvarez E, Lanborena N, Bacigalupe A, Martin U. Social factors associated with the knowledge about HIV of the Immigrants from China, Latin America, the Maghreb and Senegal in the Basque Country (Spain). J Immigr Minor Heal. 2013;24–33.

  32. Krummenacher I, Spencer B, Cavassini M, Schneider MP. Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme. Int J Clin Pharm. 2014;36(4):716–24.

    Article  PubMed  Google Scholar 

  33. Reyes-Urueña J, Campbell C, Hernando C, Vives N, Folch C, Ferrer L, et al. Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia : an analysis using multiple data sources. Epidemiol Infect. 2017;145(8):1670–81.

    Article  PubMed  Google Scholar 

  34. Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kanters S, Park JJH, Chan K, Socias ME, Ford N, Forrest JI, et al. Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis. Lancet HIV. 2017;4(1):e31–40. https://doi.org/10.1016/S2352-3018(16)30206-5.

    Article  Google Scholar 

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Acknowledgements

PISCIS Study Group Coordination: Jordi Casabona (Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya: [CEEISCAT]-CIBERESP), Jose M. Miró (Hospital Clínic-IDIBAPS, Universitat de Barcelona). Project coordinator: Juliana Reyes Ureña (CEEISCAT). Field coordinator: Andreu Bruguera Riera (CEEISCAT). Steering committee: Jordi Casabona (CEEISCAT-CIBERESP), Alexandra Montoliu, Juliana Reyes, Esteve Muntada, Andreu Bruguera (CEEISCAT), Jose M. Miró (Hospital Clínic-IDIBAPS, Universitat de Barcelona), D. Podzamczer (Hospital Universitari de Bellvitge-IDIBELL), Pere Domingo (Hospital de la Santa Creu i Sant Pau), Josep M Llibre (Hospital Universitari Germans Trias i Pujol), Sio Riera (Hospital Son Espases de Mallorca), Gemma Navarro (Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona), Cristina Cortés (Hospital General d’Hospitalet), Vicenç Falcó (Hospital Universitari Vall d’Hebron). Scientific committee: JM Gatell, C. Manzardo (Hospital Clínic-Idibaps, Universitat de Barcelona), B. Clotet (Fundació Lluita contra la Sida, Fundacio irsicaixa, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona), E. Ferrer (Hospital Universitari de Bellvitge-IDIBELL), F. Segura (Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona), L. Force (Hospital de Mataró, Consorci Sanitari del Maresme), J. Vilaró (Hospital General de Vic), A. Masabeu (Hospital de Palamós), E. Leon (Hospital General d’Hospitalet), C. Cifuentes, F Homar (Hospital Son Llàtzer), D. Dalmau, À. Jaen (Hospital Universitari Mútua de Terrassa), Mª. Gracia Mateo, Mª del Mar Gutierrez, (Hospital de la Santa Creu i Sant Pau), V. Falcó, A. Curran (Hospital Universitari Vall d’Hebron), T. Puig (Hospital de Santa Maria) C. Agustí (CEEISCAT), F. Vidal, J Peraire (Hospital Joan XXIII), A. Orti (Hospital Verge de la Cinta de Tortosa), A. Almuedo (Hospital General de Granollers). Data Management and statistical analysis: A. Montoliu (CEEISCAT), E. De Lazzari (Hospital Clínic- Idibaps, Universitat de Barcelona), Dolors Giralt (Hospital Universitari de Bellvitge-IDIBELL). Informatics: E. Loureiro (CEEISCAT), F. Gargoulas, (Hospital Son Espases y Hospital Son Llàtzer), JC Rubia (Hospital General d’Hospitalet), J Vilà (Serveis de Salut Integrats Baix Emporda). Participating physicians and centers: J. Ambrosioni, L. Zamora, J.L. Blanco, F. Garcia- Alcaide, E. Martínez, J. Mallolas, (Hospital Clínic- Idibaps, Universitat de Barcelona), G. Sirera, J. Romeu, A. Jou, E. Negredo, (Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona), M. Saumoy, A Imaz, F. Bolao, C. Cabellos, C. Peña, S. DiYacovo, E. Van Den Eynde (Hospital Universitari de Bellvitge-IDIBELL), M. Sala, M. Cervantes, M.J. Amengual, M. Navarro, V. Segura (Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona,) P. Barrufet, (Hospital de Mataró, Consorci Sanitari del Maresme), T. Payeras (Hospital Son Llàtzer), M. Gurgui, (Hospital de la Santa Creu i Sant Pau), L. Utrillo, (Hospital de Santa Maria). Civil society representatives: Sebastián Meyer & Juanse Hernández (Comitè 1er de Desembre).

Funding

This research received partial funding from the Agència de Salut Pública de Catalunya (ASPCAT) in the Department of Health and Fundació Bancaria “La Caixa” o Obra Social “La Caixa”.

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Authors and Affiliations

  1. Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Dept Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain

    Anna S. Conway, Anna Esteve & Jordi Casabona

  2. CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain

    Anna Esteve & Jordi Casabona

  3. Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain

    Anna S. Conway, Anna Esteve & Jordi Casabona

  4. Department Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Univ. Autonoma de Barcelona, Badalona, Spain

    Anna Esteve & Jordi Casabona

  5. Agència de Salut Pública de Barcelona, Barcelona, Spain

    Manuel Fernández-Quevedo

Authors
  1. Anna S. Conway
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  2. Anna Esteve
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  3. Manuel Fernández-Quevedo
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  4. Jordi Casabona
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PISCIS Study Group

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Correspondence to Anna S. Conway.

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The authors declared no conflict of interest.

Ethical Approval

Confidentiality was ensured through nonpersonal identification. The PISCIS Cohort is approved by the ethics committees of the participating hospitals.

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PISCIS Study Group listed in “Acknowledgements”.

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Conway, A.S., Esteve, A., Fernández-Quevedo, M. et al. Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004–2016. J Immigrant Minority Health 21, 920–930 (2019). https://doi.org/10.1007/s10903-018-0834-2

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