Results from the aMASE study

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Presentation transcript:

Results from the aMASE study Are migrants acquiring HIV before or after migration to Spain? Results from the aMASE study D. Álvarez-del Arco, J. del Romero, F. Pulido, C Thomadakis, M. Velasco Arribas, F. Dronda, JR. Blanco, P. Garcia de Olalla, I. Ocaña, J. Belda Ibáñez, MJ. Barberá, S. Cuéllar, J. Iribarren, A. López-Lirola, M. Masiá, E. Fernández, G. Mateu, A. Peña, P. Ndumbi, G Touloumi , N Pantazis J. del Amo

Conflict of Interest Julia del Amo has received research grants awarded to her team from Companies BMS, MSD, Gilead, ViiV. Julia del Amo has received teaching fees from Companies MSD, Gilead, ViiV.

Objective To estimate the proportion of post-migration HIV acquisition among HIV-positive migrants in Spain

2 electronic questionnaires Methods Study desing: Multicenter cross-sectional study 2 electronic questionnaires Patient’s questionnaire Clinical notes Largely self-administered 20 minutes duration Closed questions Translated to 14 languages Consent given by patients On-line and off-line solutions Filled in by researcher On-line and off-line solutions

Methods Setting Participants Migrants diagnosed with HIV in the preceding 5 years and living in Spain at least 6 months

Methods Variables and definitions We collected extensive epidemiological, socioeconomic, clinical, behavioral, migratory trajectory, previous HIV serology, CD4 determinations, viral load and viral subtype data

Methods Statistical methods to estimate postmigration HIV acquisition Bayesian approach combining information on: Migration history Risk factors & behaviours CD4 cell count & HIV viral load at HIV diagnosis CD4 & VL trajectories derived from seroconverters HIV-positive June 2013 Arrival to Spain June 2005 CD4 800 cells/mm3

Results Of 710 participants, 685 had data to estimate HIV acquisition time 77% Men 60% MSM 20% Heterosexual women 14% Heterosexual men Median 35 years of age [IR:29-42] Median 9 years in Spain [IR:6-13]

Geographical area of origin Europe 17% Others 6% Sub-Saharan Africa 13% Latin-America 64%

Estimated post-migration HIV acquisition probability by geographical origin and mode of transmission 72%

Estimated post-migration HIV acquisition probability by geographical origin and mode of transmission 75%

Estimated post-migration HIV acquisition probability by geographical origin and mode of transmission 77%

Factors associated with HIV post-migration acquisition [adjusted OR (95% CI)] OR 95% CI Area of origin p=0.723 European migrants 1.0 Referent Sub-Saharan African 0.6 (0.2-1.7) LA & Caribbean (0.5-2.0) Other 1.2 (0.3-5.4) Length of stay p<0.001 5 years or less Between 6 and 10 years 6.4 (3.1-13.2) More than 10 years 34.2 (13.5-87.0) Age at arrival p=0.557 36 and more years old 26-35 years old (0.5-2.6) 18-25 years old 1.4 (0.6-3.4) 17 years old or less 3.1 (0.6-17.2) (n=640)

Factors associated with HIV post-migration acquisition [adjusted OR (95% CI)] Year of HIV diagnosis p=0.001 2008-2009 1.0 Referent 2010-2012 2.7 (1.2-5.8) 2013-2015 5.2 (2.2-12.3) Legal status p=0.278 EU nationals In visa/asilum 0.7 (0.2-2.5) Uncertain status 0.5 (0.2-1.2) Transmission mode p=0.205 Heterosexual female Heterosexual male (0.4-2.6) MSM 1.9 (0.9-4.4)

Conclusions 7 out of 10 migrants living with HIV in Spain acquired HIV after migration. The proportion of post-migration HIV acquisition is higher among MSM and in people from LAC. The risk of post-migration acquisition increases with time and is higher in more recent periods. These results show a failure in preventive interventions in specific migrants’ groups and emphasize the need to design interventions taking into account migrants heterogeneity which would require PreP for some groups.

Advancing Migrant Access to Health Services in Europe Acknowledments aMASE Advancing Migrant Access to Health Services in Europe Study participants aMASE co-investigators

CIPS Alicante Centro Sanitario Sandoval (Madrid) Hospital de Elche (Alicante) Hospital Ramón y Cajal (Madrid) Hospital de Poniente (Almería) Hospital de Alcorcón (Madrid) Hospital de Sant Pau (Barcelona) Hospital Doce de Octubre (Madrid) Hospital del Mar (Barcelona) Hospital Universitario de Donostia (Donostia) Hospital Clínic (Barcelona) Hospital Virgen del Rocío (Sevilla) Hospital de la Vall d’Hebron (Barcelona) Hospital Universitario de Canarias (Tenerife) Unidad de ITS de Drassanes (Barcelona) Hospital la Fe (Valencia) Hospital Campus de la Salud (Granada) Hospital de San Pedro de La Rioja (Logroño)