Impact of social determinants of health on time to antiretroviral therapy initiation and HIV viral undetectability for migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite B/F/TAF: ‘The ASAP study’

Abstract

ObjectiveMultidisciplinary care with free, rapid, and on‐site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV‐related health outcomes for migrants enrolled in such care models is limited.MethodsWithin a 96‐week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses.ResultsThirty‐five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0–50) and 57 days (range 5–365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university‐level education, or were unemployed. No factor was found to significantly affect time to undetectability.ConclusionDespite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.

Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV from the Canadian cohort of the observational BICSTaR study

“…[31] Another analysis from the same study in 35 migrant people with HIV identified social determinants associated with a longer timeframe to initiate B/F/TAF; none of these factors had a statistically significant impact on the time to achieve viral suppression (HIV viral load of < 50 copies/mL). [32] A retrospective chart review conducted at the University of Alberta, Edmonton, confirmed the efficacy of B/F/TAF in 50 people with previously documented primary NRTI resistance. [30] Our study provides the first prospective RWE for B/F/TAF treatment in a broad range of people with HIV across Canada.…”

“…[3,8,[19][20][21] Several small real-world evidence (RWE) studies have shown the effectiveness and safety of B/F/TAF in routine clinical practice. [22][23][24][25][26][27][28][29][30][31][32] However, there is little RWE with B/F/TAF in the Canadian population. The only available evidence from Canada comes from specific population groups, such as TN migrant people in a Montreal-based multidisciplinary HIV care clinic receiving rapid cost-covered B/F/TAF initiation, [31,32] and a retrospective chart review in people with previously documented primary nucleoside reverse transcriptase inhibitor (NRTI) resistance at a single center in Alberta.…”

“…[22][23][24][25][26][27][28][29][30][31][32] However, there is little RWE with B/F/TAF in the Canadian population. The only available evidence from Canada comes from specific population groups, such as TN migrant people in a Montreal-based multidisciplinary HIV care clinic receiving rapid cost-covered B/F/TAF initiation, [31,32] and a retrospective chart review in people with previously documented primary nucleoside reverse transcriptase inhibitor (NRTI) resistance at a single center in Alberta. [30] BICSTaR (BICtegravir Single Tablet Regimen) is an ongoing, observational cohort study that has enrolled 2379 TN and TE participants from 14 countries across 5 cohorts.…”

Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: the ‘ASAP’ study

“…The CVIS/MUHC offers multidisciplinary HIV care through a team of HIV-specialist physicians, nurses, pharmacists, a social worker, a psychologist, and a psychiatrist. In this study, all participants were initiated on bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) rapidly (i.e., within a median of 5 days) after linkage to our clinic [ 18 ]. This manuscript presents an interim analysis of patient-reported quantitative data collected from MLWH enrolled in the ASAP study up to week 48.…”

“…As a non-probabilistic sampling method was used, no formal sample size calculation based on power considerations and effect sizes was done. However, it is important to note that pilot feasibly studies generally have a sample size of approximately 30 participants on average per intervention arm [ 18 , 19 ]. This small sample of participants does not compromise comparisons between groups of interest.…”