Determinants of HIV, viral hepatitis and STI prevention needs among African migrants in Germany; a cross-sectional survey on knowledge, attitudes, behaviors and practices

Santos-Hövener, Claudia; Marcus, Ulrich; Koschollek, Carmen; Oudini, Hapsatou; Wiebe, Mara; Ouedraogo, Omer Idrissa; Thorlie, Adama; Bremer, Viviane; Hamouda, Osamah; Dierks, Marie‐Luise; Heiden, Matthias an der; Krause, Gérard

doi:10.1186/s12889-015-2098-2

Cited by 21 publications

(23 citation statements)

References 23 publications

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“…Peer researchers recruited 649 study participants within 2 months and overexceeded our aimed sample size of 350 MisSA. Working with peer researchers enabled us to reach particularly vulnerable groups, such as persons without health insurance (22% of participants) [44,45]. …”

Section: Discussionmentioning

confidence: 99%

“…The study design was developed as a CBPHR project with persons working in HIV/STI prevention with MisSA, key persons from MisSA communities, and HIV/STI researchers; we conducted a pilot study to test feasibility of the study design in Hamburg before finalizing the study flow. Details on the description of the research process and the pilot study can be found elsewhere [44,45]. …”

Section: Methodsmentioning

confidence: 99%

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Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

Santos-Hövener¹,

Koschollek²,

Kuehne³

et al. 2017

JMIR Res Protoc

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BackgroundMigration has an impact on the epidemiology of viral hepatitis B and C (HEP) and HIV in Germany; migrants from sub-Saharan Africa (MisSA) in Germany are disproportionally affected by HIV. In the last 10 years, a total of 10%-15% of all newly diagnosed HIV cases were among MisSA; 20%-30% of them acquired HIV in Germany. Prevalence of HEP among MisSA in Germany is unknown, but Western Africa, from where most MisSA in Germany originate, reports the highest prevalence of hepatitis B worldwide. There is limited information on knowledge, attitudes, behaviors, and practices (KABP) regarding HIV, HEP, and sexually transmitted infections (STIs), as MisSA are not reached with surveys targeting the general population.ObjectiveOur objective was to determine the HIV, HEP, and STI information and prevention needs of MisSA in Germany.MethodsWe conducted a multicenter, cross-sectional, KABP survey regarding HIV, HEP, and STIs among MisSA living in Germany using convenience sampling. The study design was developed as a community-based participatory health research (CBPHR) project; HIV/STI-prevention specialists, key persons from MisSA communities, and HIV/STI researchers were involved in all steps of the research process. Trained peer researchers recruited participants in six study cities. Potential modes of survey administration were interview or self-completion, and the questionnaire was available in English, French, and German. Questions on knowledge about HIV, HEP, and STIs were presented as true statements; participants were asked if they had known the information before. Focus groups with MisSA were conducted to interpret results. Data collection took place from October 2014 to November 2016.ResultsRecruitment by peer researchers concluded with 3040 eligible participants. Data collection was completed in November 2016. We are currently analyzing the quantitative data and qualitative data from focus groups. We are conducting working group meetings to discuss the results in the respective study cities and to evaluate the application of participatory health research in epidemiological studies. First results are expected by the end of 2017.ConclusionsWorking with peer researchers to collect data allowed accessibility to a diverse sample of MisSA and, particularly, allowed us to reach vulnerable subgroups, such as MisSA without legal status. The ability to access hard-to-reach groups is one of the big advantages of CBPHR. The active inclusion of the persons under study in the design of the study resulted in higher acceptance and ownership of the research project in the target community; this ultimately lead to better quality of collected data. Furthermore, the participation of MisSA in the development of study design and data collection assures a better understanding of the interests, needs, and living conditions of this group.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

Santos-Hövener¹,

Koschollek²,

Kuehne³

et al. 2017

JMIR Res Protoc

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“…Results of participatory research at the Robert Koch Institute among migrants from Sub-Saharan Africa in Germany (MiSSA) show that migrants of this group were often not aware of the anonymous and free HIV-testing offer or assumed that a positive HIV-test will impact their legal status in the country [24]. These together with the fear of stigmatization of HIV-positive migrants in their communities have constituted barriers to HIV testing in African migrants in the past [22, 25–28].…”

Section: Discussionmentioning

confidence: 99%

CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care—a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999–2013

Zeitlmann

Gunsenheimer‐Bartmeyer

Santos-Hövener

et al. 2016

BMC Infect Dis

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BackgroundAlthough early presentation to HIV-care is essential to ensure timely initiation of antiretroviral therapy, recent studies have shown that especially migrants present to HIV-care at a later stage of HIV-infection. Currently, thirty percent of all newly diagnosed HIV cases in Germany originate from abroad. So far it is unknown, which specific migrant groups in Germany are particularly at risk for late presentation to HIV-care.MethodsWe used data from the Clinical Surveillance of HIV Disease (ClinSurv) cohort, a multi-centre observational cohort (01/01/1999 and 31/07/2013) and included treatment-naïve patients with valid information on country of origin and date of enrolment. Migrants were patients with country of origin outside Germany. We compared time trends for percentage of AIDS (CDC Stage C) and mean CD4-count at enrolment between migrants from Western Europe (WE), Central Europe (CE), Eastern Europe (EE), Sub-Saharan Africa (SSA), South East Asia (SEA) and non-migrants using multivariable regressions. Male non-migrants with mean age of 38-years constituted the reference group.ResultsIn total, 10,211 patients fulfilled the inclusion criteria, of which 2784 were migrants (SSA: 42%, CE: 17%, WE: 11%, EE: 10%, SEA: 9%). The percentage of patients with AIDS at enrolment was higher in SSA (Odds Ratio (OR)SSA: 1.44, 95%-confidence interval (95%-CI):1.12–1.84) and SEA-migrants (ORSEA:2.16, 95%-CI:1.43–3.27). In addition, female SEA-migrants, were more likely to present with AIDS than their male counterparts (OR:2.22, 95%-CI:1.18–4.17). Mean CD4-count at enrolment was lower for SSA- (Mean CD4-count ratio (IRR):0.72; 95%-CI:0.64-0.82) and SEA-migrants (IRR:0.62, 95%-CI:0.49-0.78). Over time, it increased in non-migrants and CE-migrants (by 1 and 3%/year, respectively), whereas no increase was seen for SEA and SSA.ConclusionsSSA and SEA-migrants in Germany present to HIV-care at a later stage of HIV infection than non-migrants. Additionally, previous research found a higher risk for late HIV-testing for migrants. Collecting information about the arrival date of migrants in Germany in the HIV notification system would help to understand to which extent these problems could be tackled in Germany. Moreover, participatory approaches for HIV-testing and care as well as research regarding knowledge, behaviour and attitudes towards these topics for SSA and SEA migrants should be expanded.

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“…To determine risk of acquiring STIs among other behaviours, each participant completed a self-guided Knowledge Attitude Behaviour and Perception (KABP) questionnaire. KABP questionnaires are commonly used in research to identify information related to sexual behaviours and stigmas associated with STIs (16,17). The KABP questionnaire used in this project was a modified version of the assessment administered to conscripts in 2012 (18).…”

Section: Methodsmentioning

confidence: 99%

Sexually Transmitted Infections - Prevalence, Knowledge and Behaviours among Professional Defence Forces in Estonia: a Pilot Study

Parker

2017

Cent Eur J Public Health

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These findings indicate a lower STI occurrence among professional defence forces in Estonia compared with the non-military population. While these rates were lower than expected, as a voluntary study, people suspicious of having an STI might opt not to participate, limiting generalizability to the remainder of the military. Militaries without regular screening programmes could consider regular scheduled testing for STIs, HIV and blood borne pathogens, even if voluntary, especially prior to foreign deployment. Consistent testing would align across many militaries who deploy international peace keepers.

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Determinants of HIV, viral hepatitis and STI prevention needs among African migrants in Germany; a cross-sectional survey on knowledge, attitudes, behaviors and practices

Cited by 21 publications

References 23 publications

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

CD4-cell counts and presence of AIDS in HIV-positive patients entering specialized care—a comparison of migrant groups in the German ClinSurv HIV Cohort Study, 1999–2013

Sexually Transmitted Infections - Prevalence, Knowledge and Behaviours among Professional Defence Forces in Estonia: a Pilot Study

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