1. 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

2. 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.

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

4. 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

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

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

7. 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

9. 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]

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

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

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

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

14. 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
( )
LA & Caribbean
( )
Other
1.2
( )
Length of stay
p<0.001
5 years or less
Between 6 and 10 years
6.4
( )
More than 10 years
34.2
( )
Age at arrival
p=0.557
36 and more years old
26-35 years old
( )
18-25 years old
1.4
( )
17 years old or less
3.1
( )
(n=640)

15. Factors associated with HIV post-migration acquisition [adjusted OR (95% CI)]
Year of HIV diagnosis
p=0.001
1.0
Referent
2.7
( )
5.2
( )
Legal status
p=0.278
EU nationals
In visa/asilum
0.7
( )
Uncertain status
0.5
( )
Transmission mode
p=0.205
Heterosexual female
Heterosexual male
( )
MSM
1.9
( )

16. 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.

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

18. 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)