Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review

IntroductionIn 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status.Methods and analysisA systematic mixed studies review using a data-based convergent design will be conducted. Medline, Embase, Scopus, CINAHL and the Cochrane Library will be searched on 25 March 2020. Screening and critical appraisal will be conducted independently by the first author. Authors 3–5 will act as second reviewers, each independently conducting 33% of the screening and appraisal. Quantitative data will be transformed to qualitative data and be synthesised using thematic analysis. The Mixed Methods Appraisal Tool will be used for quality assessment. An advisory committee, composed of four migrant PLWH, will be involved in screening and appraising 5% of articles to build knowledge and experience with systematic reviews. They will also be involved in analysis and dissemination.Ethics and disseminationEthics approval was obtained from the McGill University Health Centre (15-188-MUHC, 2016-1697, eReviews 4688). Publications arising from this study will be open-access.PROSPERO registration numberCRD42020172122.

Download Full-text

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 ◽

10.1136/bmjopen-2017-018533 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018533 ◽

Cited By ~ 8

Author(s):

Juliana Maria Reyes-Urueña ◽

Colin N J Campbell ◽

Núria Vives ◽

Anna Esteve ◽

Juan Ambrosioni ◽

...

Keyword(s):

Hiv Transmission ◽

Retention In Care ◽

Hiv And Aids ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Undiagnosed Hiv ◽

Sex With Men ◽

Living With Hiv

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.

Download Full-text

Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers

AIDS and Behavior ◽

10.1007/s10461-016-1307-z ◽

2016 ◽

Vol 20 (10) ◽

pp. 2452-2463 ◽

Cited By ~ 47

Author(s):

Becky L. Genberg ◽

Sylvia Shangani ◽

Kelly Sabatino ◽

Beth Rachlis ◽

Juddy Wachira ◽

...

Keyword(s):

Systematic Review ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Living With Hiv ◽

Hiv Aids

Download Full-text

HIV care cascade and sustainable wellbeing of people living with HIV in context

Journal of the International AIDS Society ◽

10.1002/jia2.25259 ◽

2019 ◽

Vol 22 (2) ◽

pp. e25259 ◽

Cited By ~ 2

Author(s):

Hakan Seckinelgin

Keyword(s):

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Living With Hiv

Download Full-text

Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0210096 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0210096 ◽

Cited By ~ 5

Author(s):

James Wilton ◽

Juan Liu ◽

Ashleigh Sullivan ◽

Beth Rachlis ◽

Alex Marchand-Austin ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Living With Hiv

Download Full-text

Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada

BMC Public Health ◽

10.1186/s12889-021-10225-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leigh M. McClarty ◽

James F. Blanchard ◽

Marissa L. Becker

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Hiv Care ◽

People Living With Hiv ◽

Virologic Suppression ◽

Hiv Care Cascade ◽

Care Cascade ◽

History Of ◽

Living With Hiv

Abstract Background Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. National surveillance statistics and data from the provincial HIV care program suggest that epidemiological heterogeneity exists across Manitoba. New HIV cases are disproportionately reported among females, Indigenous-identifying individuals, and those with a history of injection drug use. Given the heterogeneity in acquisition, it is of interest to understand whether this translates into inequalities in HIV care across Manitoba. Methods A sample of 703 participants from a clinical cohort of people living with HIV in Manitoba, with data current to the end of 2017, was used to conduct cross-sectional, disaggregated analyses of the HIV care cascade to identify heterogeneity in service coverage and clinical outcomes among different groups receiving HIV care in Manitoba. Equiplots are used to identify and visualize inequalities across the cascade. Exploratory multivariable logistic regression models quantify associations between equity variables (age, sex, geography, ethnicity, immigration status, exposure category) and progression along the cascade. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are reported. Results Equity analyses highlight inequalities in engagement in and coverage of HIV-related health services among cohort participants. Equiplots illustrate that the proportion of participants in each cascade step is greater for those who are older, white, non-immigrants, and report no history of injection drug use. Compared to those living in Winnipeg, participants in eastern Manitoba have greater odds of achieving virologic suppression (AOR[95%CI] = 3.8[1.3–11.2]). The odds of Indigenous participants being virologically suppressed is half that of white participants (AOR[95%CI] = 0.5[0.3–0.7]), whereas African/Caribbean/Black participants are significantly less likely than white participants to be in care and retained in care (AOR[95%CI] = 0.3[0.2–0.7] and 0.4[0.2–0.9], respectively). Conclusions Inequalities exist across the cascade for different groups of Manitobans living with HIV; equiplots are an innovative method for visualizing these inequalities. Alongside future research aiming to understand why inequalities exist across the cascade in Manitoba, our equity analyses can generate hypotheses and provide evidence to inform patient-centred care plans that meet the needs of diverse client subgroups and advocate for policy changes that facilitate more equitable HIV care across the province.

Download Full-text

Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

Current HIV/AIDS Reports ◽

10.1007/s11904-020-00522-1 ◽

2020 ◽

Vol 17 (5) ◽

pp. 458-466

Author(s):

Anna Grimsrud ◽

Lynne Wilkinson ◽

Ingrid Eshun-Wilson ◽

Charles Holmes ◽

Izukanji Sikazwe ◽

...

Keyword(s):

Quality Care ◽

Treatment Interruption ◽

Patient Choice ◽

Hiv Care ◽

People Living With Hiv ◽

Engagement In Care ◽

Hiv Status ◽

Hiv Care Cascade ◽

Left Behind ◽

Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

Download Full-text

Mandatory HIV screening, migration and HIV stigma in Canada: exploring the experiences of sub-Saharan African immigrants living with HIV in western Canada

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.40.2.02 ◽

2020 ◽

Vol 40 (2) ◽

pp. 38-46

Author(s):

Aniela dela Cruz ◽

San Patten ◽

Inusa Abdulmalik ◽

Jean Harrowing ◽

Marc Hall ◽

...

Keyword(s):

Qualitative Data ◽

Hiv Stigma ◽

Hiv Care ◽

Hiv Screening ◽

Canadian Province ◽

Hiv Care Cascade ◽

Care Cascade ◽

Canadian Immigration ◽

Sub Saharan ◽

Living With Hiv

Introduction In this mixed-methods pilot study, we examined the intersections of the current Canadian immigration policy, mandatory HIV screening during the Immigration Medical Exam (IME) and enacted and internalized stigma for HIV-positive immigrants from sub-Saharan Africa (SSA) in a western Canadian province. We focus on qualitative findings from this study. Methods Using the Internalized HIV Stigma Scale (IHSS), we collected data from eight immigrants from SSA living with HIV in a western Canadian province. We then conducted semistructured interviews with seven of the eight participants. Due to the small sample size, survey data were summarized using descriptive analysis. Qualitative data were analyzed through constant comparative analysis. Results The following key themes emerged from analysis of qualitative data: experiences of HIV-related emotional distress during the IME; varied experiences of HIV testing during the IME; and inconsistent patterns of linkage to medical care, psychosocial supports and engagement in the HIV care cascade. Conclusion Findings from this pilot study cannot be generalized to the broader population of immigrants living with HIV in Canada. However, we found that the experiences of internalized HIV stigma and enacted stigma during the IME potentially influence the long-term engagement in the HIV care cascade during the process of migration and settlement in Canada. Further study in this population is recommended to examine the intersections of current mandatory HIV screening process during the Canadian immigration process, migration, settlement, culture, stigma and engagement in the HIV care cascade.

Download Full-text

Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0280 ◽

2021 ◽

Author(s):

Noelle A. Benzekri ◽

Jacques F. Sambou ◽

Sanou Ndong ◽

Mouhamadou Baïla Diallo ◽

Ibrahima Tito Tamba ◽

...

Keyword(s):

Longitudinal Study ◽

Traditional Healers ◽

Cd4 Count ◽

Sub Saharan Africa ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Art Initiation ◽

Care Cascade ◽

Prospective Longitudinal

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

Download Full-text

Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior change (COM-B) model

10.21203/rs.3.rs-49530/v1 ◽

2020 ◽

Author(s):

Martin Muddu ◽

Isaac Ssinabulya ◽

Simon P. Kigozi ◽

Rebecca Ssennyonjo ◽

Florence Ayebare ◽

...

Keyword(s):

Mixed Methods ◽

Mixed Methods Study ◽

Barriers And Facilitators ◽

Hiv Care ◽

Hiv Care Cascade ◽

Care Cascade ◽

Increased Risk ◽

Persons Living With Hiv ◽

One Year ◽

Hiv Integration

Abstract Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.

Download Full-text