HIV care and support services and the treatment outcomes of newcomers living with HIV in Manitoba

BACKGROUND: Despite the over-representation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, there is limited research on their HIV care needs and treatment outcomes. This study addressed this knowledge gap by describing how newcomers are linked into HIV care in Manitoba, challenges faced when accessing care and their treatment outcomes. METHODS: An environmental scan was performed to collect data from literature sources and from semi-structured interviews with key informants who provide services to newcomers. The scan data were examined using qualitative content analysis. Clinical data from 1986 to 2017 were obtained from a cohort of people who receive care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed to compare differences in socio-demographic and clinical characteristics and treatment outcomes between newcomers, Indigenous and Canadian-born non-Indigenous persons in HIV care. RESULTS: Newcomers are linked to the Manitoba HIV Program through pathways that involve the Surveillance Unit at Manitoba Health, Seniors and Active Living, Regional Health Authorities’ Public Health Departments, Settlement Coordinators and physicians. Effective linkage and engagement in care may be limited by language barriers, stigma, distrust of medical systems, trauma, financial insecurity and lack of holistic support. By the end of 2017, there were 86 newcomers, 259 Indigenous and 356 Canadian-born non-Indigenous persons enrolled in the cohort. Newcomers in the cohort were younger, with a mean age of 43 years compared to the Indigenous group (45 years) and Canadian-born non-Indigenous group (52 years) (p<0.05). Newcomers were more likely to be female (45%) compared to Indigenous (42%) and Canadian-born non-Indigenous (13%) cohort participants (p<0.05). A higher proportion of newcomers self-reported their HIV risk exposure as heterosexual contact (80%) compared to the Indigenous group (53%) and Canadian-born non-Indigen