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

Abstract

Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.

Barriers to access to HIV care services in host countries: views and experiences of Indonesian male ex-migrant workers living with HIV

“…Our study also reported several novel findings which have not been explored in previous studies involving MLHIV (8, 9). We found that the unavailability of HIV care services in the areas where they worked (e.g., plantation areas) and a lack of public transportation between workplaces and healthcare facilities created a significant barrier for some participants to access the services.…”

“…Although stigma and discrimination were not specifically identified as a primary concern of the participants in this study, previous investigations have reported that stigma and discrimination were experienced by MLHIV as barriers that hampered their access to HIV care services (18, 20, 31, 48, 49). Our findings also identified that the mobile, transient nature of their work across districts made it difficult for them to access HIV care services, which has not been reported in previous studies with MLHIV (8, 9). It is apparent that to fully understand HIV care access procedures and systems in different areas requires intensive effort, which seemed challenging for participants in this study who faced language barriers and have limited knowledge and low levels of education.…”

“…Migrant workers are defined as people who migrate from one country to another for work purposes and without an intention to stay permanently in the country where they work (6,7). Migrant workers are a group at high risk for HIV transmission and its consequences (8,9), with studies showing higher HIV prevalence and higher frequency of delayed HIV diagnosis among migrants than the general populations (10)(11)(12)(13). Migrant workers are also reported to experience delayed entry or linkage into HIV services and have poorer HIV-related health outcomes compared to the general population in host countries (14)(15)(16).…”

“…Despite a range of different level of barriers to access to HIV care services by migrant populations in general who are living with HIV as reported in the aforementioned studies, most of these studies were conducted in developed countries, such as in Europe, USA, Canada and Australia (8, 9). There is a paucity of evidence about barriers to access of HIV services for MLHIV in developing countries.…”

Brief Report: It's Time to Embed Health-Related Quality of Life Across all Steps of the HIV Care Cascade

“…2,4 Numerous barriers affect PLWH's experiences and can delay any step of the cascade or lead to disengagement throughout HIV care. 2,[4][5][6] The linear approach to the cascade also disregards the pathways by which PLWH re-engage with care and treatment, for instance, after moving to a new jurisdiction. In summary, linearity may veil PLWH's actual narratives of disengagement, loss to follow-up, and re-engagement in care.…”