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Effect of Legal Status on the Early Treatment Outcomes of Migrants Beginning Combined Antiretroviral Therapy at an Outpatient Clinic in Milan, Italy.
- Source :
-
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2017 Jul 01; Vol. 75 (3), pp. 315-321. - Publication Year :
- 2017
-
Abstract
- Objective: In a setting of free access to HIV care, we compared the early treatment outcomes of HIV-infected undocumented migrants (UMs), documented migrants (DMs), and Italian subjects.<br />Methods: The clinical data of 640 Italians and 245 migrants who started combined antiretroviral therapy (cART) at an HIV clinic in Milan, Italy, were reviewed. The migrants were mainly Latin Americans (83 DMs and 56 UMs) or sub-Saharan Africans (52 DMs and 11 UMs), but a minority were of other origin (33 DMs and 10 UMs). Retention in follow-up and HIV suppression were compared between UMs, DMs, and natives 12 months ± 90 days after start of cART.<br />Results: There were no significant between-group differences in the stage of HIV infection at the start of cART or the type of regimen received. The Latin American DMs and UMs included a higher proportion of transgender women than the other ethnic groups (P < 0.001). The UMs were less frequently followed up after 12 months than the DMs and natives (P = 0.004) and were more frequently permanently lost to follow-up (P < 0.001). UM status was an independent predictor of lost to follow-up (adjusted odds ratio 8.05, P < 0.001). The DMs and UMs were less frequently HIV suppressed after 12 months than the natives (78% and 80.7% vs 90.5%, P = 0.001), and Latin American migrants were significantly less likely to be virologically suppressed than the natives (adjusted odds ratio 0.30, P = 0.001).<br />Conclusions: Despite their free access to cART, subgroups of migrants facing multiple levels of vulnerability still have difficulties in gaining optimal HIV care.
- Subjects :
- Adult
CD4 Lymphocyte Count
Female
Health Status Disparities
Humans
Italy epidemiology
Lost to Follow-Up
Male
Middle Aged
Ambulatory Care Facilities
Anti-HIV Agents therapeutic use
HIV Infections drug therapy
Health Services Accessibility legislation & jurisprudence
Health Services Accessibility statistics & numerical data
Transients and Migrants legislation & jurisprudence
Transients and Migrants statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1944-7884
- Volume :
- 75
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of acquired immune deficiency syndromes (1999)
- Publication Type :
- Academic Journal
- Accession number :
- 28418991
- Full Text :
- https://doi.org/10.1097/QAI.0000000000001388