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The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review

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  • Kevin Pottie

    (Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada
    Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada)

  • Tamara Lotfi

    (Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
    AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon)

  • Lama Kilzar

    (Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon)

  • Pamela Howeiss

    (Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon)

  • Nesrine Rizk

    (Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon)

  • Elie A. Akl

    (Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
    AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon
    Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon)

  • Sonia Dias

    (National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal)

  • Beverly-Ann Biggs

    (Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia)

  • Robin Christensen

    (Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
    Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark)

  • Prinon Rahman

    (Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada)

  • Olivia Magwood

    (Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada)

  • Anh Tran

    (NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia)

  • Nick Rowbotham

    (NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia)

  • Anastasia Pharris

    (European Centre for Disease Prevention and Control, 16973 Solna, Sweden)

  • Teymur Noori

    (European Centre for Disease Prevention and Control, 16973 Solna, Sweden)

  • Manish Pareek

    (Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK)

  • Rachael Morton

    (NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia)

Abstract

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.

Suggested Citation

  • Kevin Pottie & Tamara Lotfi & Lama Kilzar & Pamela Howeiss & Nesrine Rizk & Elie A. Akl & Sonia Dias & Beverly-Ann Biggs & Robin Christensen & Prinon Rahman & Olivia Magwood & Anh Tran & Nick Rowbotha, 2018. "The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review," IJERPH, MDPI, vol. 15(8), pages 1-23, August.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1700-:d:162827
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    References listed on IDEAS

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    1. Sónia Dias & Ana Gama & Milton Severo & Henrique Barros, 2011. "Factors associated with HIV testing among immigrants in Portugal," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(5), pages 559-566, October.
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    Cited by:

    1. Osnat Keidar & David S. Srivastava & Emmanouil Pikoulis & Aristomenis K. Exadaktylos, 2019. "Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?," IJERPH, MDPI, vol. 16(8), pages 1-8, April.
    2. Lukas Kratzsch & Kayvan Bozorgmehr & Joachim Szecsenyi & Stefan Nöst, 2022. "Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities," IJERPH, MDPI, vol. 19(11), pages 1-18, May.
    3. Manuela Ortega-Gil & Chaima ElHichou-Ahmed & Antonio Mata-García, 2022. "Effects of Immigrants, Health, and Ageing on Economic Growth in the European Union," IJERPH, MDPI, vol. 20(1), pages 1-17, December.

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    Keywords

    HIV; AIDS; stigma; refugees; migrants;
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