Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000–2010

Sulis, Giorgia; Hamad, Issa El; Fabiani, Massimo; Rusconi, Stefano; Maggiolo, Franco; Guaraldi, Giovanni; Bozzi, Giorgio; Bernardini, Claudia; Lichtner, Miriam; Stentarelli, Chiara; Carenzi, Laura; Francisci, Daniela; Saracino, Annalisa; Castelli, Francesco

doi:10.1007/s15010-014-0648-7

Cited by 18 publications

(10 citation statements)

References 34 publications

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“…Indeed, patients presenting late were mostly males, migrants and older than individuals who presented earlier. Only in specific contexts female patients accounted for the majority of late presentations, especially because of the female component of the migrant population coming from Sub Saharian Africa [30–32]. …”

Section: Discussionmentioning

confidence: 99%

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

et al. 2016

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BackgroundWe aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort.MethodsAll antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods.Results19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004–2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease.ConclusionScreening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3477-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

et al. 2016

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“…Notably, immigrant patients represent a more vulnerable population: it has been already demonstrated that immigrants are more likely to have a delayed in access to HIV care and with concurrent advanced AIDS. 34 , 35 Furthermore in HIV-infected immigrants, the rate of retention to care is lower 36 and the rate of adherence to cART. 37 For these reasons, Italian physicians might have used different patterns of prescription for this population (eg, using regimens with high barrier to resistance) and subsequently immigrants have reduced possibility to discuss treatment simplifications with their treating physician.…”

Section: Discussionmentioning

confidence: 99%

Discontinuation of Initial Antiretroviral Therapy in Clinical Practice

Biagio

Cozzi‐Lepri

Prinapori

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Considering many undocumented migrants who were referred to the program had extremely low CD4 levels (Table 3), HIV care was essential to undocumented migrants in terms of improving quality of life for PLWHIV and preventing its spread in tight-knit communities. Such a situation is not unique to Israel; other researchers also described the high rate of delayed diagnosis among undocumented migrants in high income countries, with a significant percentage of AIDS-defining diseases at first presentation [29, 30]. While the program is limited to HIV care, it allows otherwise uninsured migrants some access to health services.…”

Section: Resultsmentioning

confidence: 99%

Ensuring HIV care to undocumented migrants in Israel: a public-private partnership case study

Chemtob

Rich

Harel

et al. 2019

Isr J Health Policy Res

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BackgroundUndocumented migrants in Israel, mostly originating from HIV endemic countries, are not covered by Israel’s universal healthcare coverage. We initiated a Public-Private Partnership (PPP) to handle this public health and humanitarian challenge. The PPP venture included the Ministry of Health (MoH), pharmaceutical companies, pharmacies, and specialized HIV clinics, the Israeli HIV Medical Society (from the Israel Medical Association), and non-governmental organizations. This study describes the national policy process in conceptualizing and implementing access to HIV services for undocumented migrants through a PPP, and analyzes the preliminary results.MethodsThis case study describes the process of creating a temporary Public-Private Partnership to provide HIV care for undocumented migrants based on institutional records of the Department of Tuberculosis and AIDS (DTA) and memories and reflections from partners.This case was analyzed according to the OECD-DAC criteria for development assistance (relevance, effectiveness, efficiency, sustainability and impact). Demographic and serological data of patients referred between 2014 to 2018 were collected to monitor progress. and analyze preliminary medical and biological outcomes. Ethical approval was obtained from the Ministry of Health.ResultsCreating a policy to extend HIV care to undocumented migrants was a 15 year process that confronted several challenges within Israeli and international discourse, particularly concerning governmental response to the migration crisis. The use of a PPP model involving numerous stakeholders provided a solid, local feasibility demonstration that extending HIV care as a matter of policy would have positive implications for public health in Israel. During the first 2 years of the program (2014–2015), the MoH funded medical follow-up and the pharmaceutical companies provided antiretroviral treatment (ART) free of charge for only 100 patients at any given time, in addition to ART provided by the MoH for pregnant women. Since 2016, the MoH has fully covered this service and integrated it within the Israeli health system; this constitutes the major success of the PPP program. As of December 2018, the national program has monitored 350 patients and treated 316 (90.3%). The most prevalent disease present upon referral was Tuberculosis.ConclusionsTo our knowledge, this study documents the first example of a successful PPP with government partnership in a high-income country to address undocumented migrants’ lack of access to health services in general and HIV care in particular. In light of the intensification of North-South migration, this Israeli case study could be useful for other countries facing similar challenges. It also has lessons within Israel, as the country grapples with other health problems among uninsured communities.

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Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000–2010

Cited by 18 publications

References 34 publications

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

Discontinuation of Initial Antiretroviral Therapy in Clinical Practice

Ensuring HIV care to undocumented migrants in Israel: a public-private partnership case study

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