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’

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-01-11 DOI:10.1111/hiv.13608

Anish K. Arora, Serge Vicente, Kim Engler, David Lessard, Edmundo Huerta, Joel Ishak, Jean-Pierre Routy, Marina Klein, Nadine Kronfli, Joseph Cox, Benoit Lemire, Alexandra de Pokomandy, Lina Del Balso, Giada Sebastiani, Isabelle Vedel, Amélie Quesnel-Vallée, ASAP Migrant Advisory Committee, Bertrand Lebouché

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Abstract

Objective

Multidisciplinary 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.

Methods

Within 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.

Results

Thirty-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.

Conclusion

Despite 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.

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健康的社会决定因素对移民开始接受抗逆转录病毒治疗的时间和艾滋病毒检测不到的影响："ASAP 研究"。

目的：免费、快速、现场发放比特格韦/恩曲他滨/替诺福韦-阿拉非酰胺（B/F/TAF）的多学科护理可改善感染 HIV 的移民的健康状况。然而，在感染艾滋病病毒的移民中，对 B/F/TAF 快速启动模式的研究并不充分，而且对健康的社会决定因素（SDH）如何影响加入此类护理模式的移民的艾滋病相关健康结果的了解也很有限：方法：在一家多学科艾滋病诊所进行的一项为期 96 周的试点可行性前瞻性队列研究中，参与者在建立关怀联系后迅速接受了免费的 B/F/TAF 治疗。通过生存分析计算了 SDH（即出生地区、性取向、生活状况、教育、就业、法语水平、医疗保险、使用诊所外的公共卫生机构进行免费血液检测以及在加拿大的时间）和其他协变量（即年龄、性别）对开始抗逆转录病毒疗法（ART）的中位时间和护理连接后 HIV 病毒检测不到的影响：本研究共招募了 35 名移民。开始接受抗逆转录病毒疗法和检测不到 HIV 病毒的中位时间分别为 5 天（0-50 天）和 57 天（5-365 天）。开始接受抗逆转录病毒疗法所需的时间明显更长的移民年龄介于 19 至 30 岁之间：尽管提供了免费的 B/F/TAF，但一些 SDH 与抗逆转录病毒疗法的启动延迟有关。然而，一旦开始接受抗逆转录病毒疗法并参与其中，感染艾滋病毒的移民就能有效地达到艾滋病毒检测不到的水平。研究结果初步支持对感染 HIV 的移民采用这种护理模式，并建议在设计临床干预措施时考虑 SDH，以取得更公平的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.

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