Debora Alvarez-Del Arco1, Ibidun Fakoya, Christos Thomadakis, Nikos Pantazis, Giota Touloumi, Anne-Francoise Gennotte, Freke Zuure, Henrique Barros, Cornelia Staehelin, Siri Göpel, Christoph Boesecke, Tullio Prestileo, Alain Volny-Anne, Fiona Burns, Julia Del Amo. 1. aNational Centre for Epidemiology, Instituto de Salud Carlos III, Madrid bUniversidad Complutense de Madrid cCIBERESP, Instituto de Salud Carlos III, Madrid, Spain dResearch Department of Infection and Population Health, University College London, London, UK eDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece fDepartment of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium gDepartment of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam hDepartment of Internal Medicine, Center of Infectious Diseases and Immunology, Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands iDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal jClinic for Infectious Diseases, Bern University Hospital, Bern, Switzerland kDepartment of Infectious Diseases, Medical Clinic II, University Clinic Frankfurt, Frankfurt am Main lDepartment of Medicine I, Bonn University Hospital, Bonn, Germany mUnit of Infectious Diseases and Assistance, Coordination and Territorial Integration for Migrants' Emergency, Civico-Benfratelli Hospital, Palermo, Italy nEuropean AIDS Treatment Group, Brussels, Belgium. *Fiona Burns and Julia del Amo are both senior coauthors.
Abstract
OBJECTIVE: We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe. DESIGN: To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics. METHODS: The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression. RESULTS: Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year. CONCLUSION: A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.
OBJECTIVE: We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe. DESIGN: To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics. METHODS: The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression. RESULTS: Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year. CONCLUSION: A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.
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