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Maeri I, Eyul P, Getahun M, Hatchett K, Owino L, Akatukwasa C, Itiakorit H, Gutin SA, Johnson-Peretz J, Ssali S, Cohen CR, Bukusi EA, Kamya MR, Charlebois ED, Camlin CS. Nothing about us without us: Community-based participatory research to improve HIV care for mobile patients in Kenya and Uganda. Soc Sci Med 2023; 318:115471. [PMID: 36628879 PMCID: PMC10184576 DOI: 10.1016/j.socscimed.2022.115471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/11/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Population mobility is prevalent and complex in sub-Saharan Africa, and can disrupt HIV care and fuel onward transmission. While differentiated care models show promise for meeting the needs of mobile populations by addressing care cascade gaps, the voices of mobile populations need to be included when designing care delivery models. We assessed the unmet needs of mobile populations and engaged mobile stakeholders in the design and implementation of service delivery to improve care outcomes for mobile people living with HIV (PLHIV). METHODS CBPR was conducted in 12 rural communities in Kenya and Uganda participating in a mobility study within the Sustainable East Africa Research in Community Health (SEARCH) test-and-treat trial (NCT# 01864603) from 2016 to 2019. Annual gender-balanced meetings with between 17 and 33 mobile community stakeholders per meeting were conducted in local languages to gather information on mobility and its influence on HIV-related outcomes. Discussions were audio-recorded, transcribed and translated into English. Findings were shared at subsequent meetings to engage mobile stakeholders in interpretation. At year three, intervention ideas to address mobile populations' needs were elicited. After refinement, these intervention options were presented to the same communities for prioritization the following year, using a participatory ranking approach. RESULTS Transit hubs, trading centers, and beach sites were identified as desirable service locations. Communities prioritized mobile health 'cards' with electronic medical records and peer-delivered home-based services. Mobile health clinics, longer antiretroviral refills, and 24/7 (after service) were less desirable options. Care challenges included: lack of transfer letters to other clinics; inability to adhere to scheduled appointments, medication regimens, and monitoring of treatment outcomes while mobile amongst others. CONCLUSIONS Iterative discussions with mobile community stakeholders elicited communities' health priorities and identified challenges to achieving HIV care cascade outcomes. Understanding the mobility patterns and unique needs of mobile populations through responsive community engagement is critical.
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Affiliation(s)
- Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Khalela Hatchett
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, USA
| | - Lawrence Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Sarah A Gutin
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA
| | - Jason Johnson-Peretz
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda; School of Medicine, Makerere University, Kampala, Uganda
| | - Edwin D Charlebois
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA; Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, USA
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Age and regional disparity in HIV education among migrants in China: migrants population dynamic monitoring survey, 2014-2015. Int J Equity Health 2019; 18:104. [PMID: 31269954 PMCID: PMC6610800 DOI: 10.1186/s12939-019-0999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/05/2019] [Indexed: 02/03/2023] Open
Abstract
Objective A lack of education among migrants remains an important but overlooked issue that indirectly contributes to HIV transmission. It is necessary to know who has received HIV education and who has a lower probability of being educated among migrants across different regions and age groups in China. Methods We used pooled data from the 2014 and 2015 Migrants Population Dynamic Monitoring Survey. The study population included 406,937 Chinese migrants. Participants were asked whether they had received any HIV education after migrating to the destination city. Regions were categorized into east-coast, central, northwest, southwest, west-Tibet, west-Uyghur, and northeast regions. Hierarchical logistic regression modeling was conducted to investigate the relationships between the independent variables and HIV education. Results Of 406,937 participants, half (50.6%) had reported receiving HIV education. Individuals in the west-Uyghur region had the highest proportion of receiving HIV education (73.0%), followed by the southwest region (67.9%) and the west-Tibet region (54.8%). Methods of receiving HIV education varied among different age groups. Individuals who were in a region with a higher prevalence of HIV, a lower density of medical professionals, and a higher density of migrants were more likely to receive HIV education. Conclusions The study showed significant regional disparities among migrants in China. More HIV resources need to be allocated to regions with large-scale floating populations, such as the east-coast region. Providing multiple options, including both new and traditional media, for both young and elderly migrants is essential. HIV education should be tailored to the age of migrants with low educational and income levels.
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Gray C, Crawford G, Lobo R, Maycock B. Co-Designing an Intervention to Increase HIV Testing Uptake with Women from Indonesia At-Risk of HIV: Protocol for a Participatory Action Research Study. Methods Protoc 2019; 2:E41. [PMID: 31164620 PMCID: PMC6632167 DOI: 10.3390/mps2020041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Early diagnosis is a critical component of the global response to the human immunodeficiency virus (HIV). In Australia, more than two-thirds of women from Southeast Asia are diagnosed late with HIV. There is limited evidence regarding the barriers to HIV testing and which interventions work to increase an uptake among migrants living in high-income countries. This participatory action research (PAR) project will work with women from Indonesia to co-design an intervention to increase HIV testing uptake in Western Australia. The project will involve trained community researchers, representatives from relevant organizations, and community women born in Indonesia. We will conduct three PAR cycles. Phase one will use focus groups to understand enablers for HIV testing among community members. In phase two, data will be presented back to members of the participating communities who will be invited to co-design an intervention to increase HIV testing. The final cycle will focus on implementing and evaluating the resulting intervention. This project will add to the small body of literature on pathways and enablers to HIV testing, and to new insights regarding interventions that work for women from migrant communities and why.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
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Wanigaratne S, Rashid M, Gagnon A, Cole DC, Shakya Y, Moineddin R, Blake J, Yudin MH, Campbell D, Ray JG, Urquia ML. Refugee mothers, migration pathways and HIV: a population-based cohort study. AIDS Care 2019; 32:30-36. [PMID: 31060379 DOI: 10.1080/09540121.2019.1612009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/- 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (p-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.
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Affiliation(s)
- Susitha Wanigaratne
- Centre for Urban Health Solutions, St. Michaels Hospital, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Meb Rashid
- The Crossroads Clinic, Women's College Hospital, Toronto, Canada
| | - Anita Gagnon
- Ingram School of Nursing, McGill University, Montreal, Canada
| | | | - Yogendra Shakya
- Dalla Lana School of Public Health, Toronto, Canada.,Access Alliance Multicultural Health, Toronto, Canada
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Blake
- The Society for Obstetricians and Gynecologists of Canada, Ottawa, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
| | - Douglas Campbell
- Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Keenan Research Centre, St. Michael's Hospital, Toronto, Canada
| | - Marcelo L Urquia
- Centre for Urban Health Solutions, St. Michaels Hospital, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Dalla Lana School of Public Health, Toronto, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
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What Works? Prevention and Control of Sexually Transmitted Infections and Blood-Borne Viruses in Migrants from Sub-Saharan Africa, Northeast Asia and Southeast Asia Living in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071287. [PMID: 30974851 PMCID: PMC6480002 DOI: 10.3390/ijerph16071287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/05/2023]
Abstract
Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.
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Push and Pull: Migration Patterns and Links to Harm Reduction Services Among People Who Use Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Crawford G, Lobo R, Brown G, Macri C, Smith H, Maycock B. HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1249. [PMID: 27999275 PMCID: PMC5201390 DOI: 10.3390/ijerph13121249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
In some high-income countries, a proportion of human immunodeficiency virus (HIV), other blood-borne virus (BBV) or sexually transmitted infection (STI) diagnoses have been reported as acquired overseas in low- and middle-income countries. A review was conducted to explore HIV, other BBV or STI related knowledge, risk behavior and acquisition amongst expatriates and travelers, particularly males, travelling from high to low- and middle-income countries. Seven academic databases were searched for 26 peer reviewed articles that met inclusion criteria. Significant variability in the studies was noted, in age, travel duration and frequency and outcomes/risk factors measured and reported on. Risk factors described included longer duration of stay; being single; travel for romance or sex; alcohol and other drug use; lack of travel advice; being male; higher number of sexual partners; and inconsistent condom use. Vaccination, pre-travel health advice, and having fewer sexual partners were described as protective. Studies are needed focusing on the social context in which risk-taking occurs. Better collaboration is essential to deliver comprehensive health promotion interventions alongside more consistent pre- and post- travel testing and advice. Policy measures are crucial, including consistent evaluation indicators to assess impacts of HIV, other BBVs or STIs in the context of mobility. Risks and responses for these epidemics are shared globally.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne 3083, Australia.
| | - Chloe Macri
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Hannah Smith
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
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Gill MJ, Krentz HB. Mortality in migrants with HIV in western Europe. Lancet HIV 2015; 2:e508-9. [PMID: 26614963 DOI: 10.1016/s2352-3018(15)00210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Affiliation(s)
- M John Gill
- Departments of Medicine and Anthropology University of Calgary, Calgary, AB, Canada; Southern Alberta HIV Clinic, Calgary, AB T2R 0X7, Canada.
| | - Hartmut B Krentz
- Departments of Medicine and Anthropology University of Calgary, Calgary, AB, Canada; Southern Alberta HIV Clinic, Calgary, AB T2R 0X7, Canada
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Martinez-Donate AP, Hovell MF, Rangel MG, Zhang X, Sipan CL, Magis-Rodriguez C, Gonzalez-Fagoaga JE. Migrants in transit: the importance of monitoring HIV risk among migrant flows at the Mexico-US border. Am J Public Health 2015; 105:497-509. [PMID: 25602882 PMCID: PMC4330846 DOI: 10.2105/ajph.2014.302336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/04/2022]
Abstract
We conducted a probability-based survey of migrant flows traveling across the Mexico-US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.
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Affiliation(s)
- Ana P Martinez-Donate
- Ana P. Martinez-Donate and Xiao Zhang are with the Department of Population Health Sciences, University of Wisconsin, Madison. Melbourne F. Hovell is with the Graduate School of Public Health, San Diego State University, San Diego, CA. Maria Gudelia Rangel and J. Eduardo Gonzalez-Fagoaga are with El Colegio de la Frontera Norte, Tijuana, Mexico. Carol L. Sipan is with the School of Social Sciences, University of California, Merced. At the time of the study, Carlos Magis-Rodriguez was with the Sexually Transmitted Infections Research Center, HIV/AIDS Program, Mexico City, Mexico
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Brown G, Ellard J, Mooney-Somers J, Prestage G, Crawford G, Langdon T. ‘Living a life less ordinary’: exploring the experiences of Australian men who have acquired HIV overseas. Sex Health 2014; 11:547-55. [DOI: 10.1071/sh13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/03/2014] [Indexed: 11/23/2022]
Abstract
Background
Increasing international mobility has led to a growth of cross-border HIV transmission around the world. In Australia, increasing rates of HIV infections acquired overseas have been reported, particularly among men. This qualitative study explored experiences and risk perceptions of 14 Australian men who acquired HIV while living or travelling overseas from the year 2000. Methods: Symbolic interaction provided the study’s theoretical perspective and analytical framework. Australian men living with HIV who were aged 18 years and older, believed they had acquired their infection while working or travelling overseas during or after the year 2000, and were diagnosed from 2003 onwards were eligible to participate. A semistructured interview schedule was developed and tested for content validity with the study reference group. Analysis was conducted using an adapted form of grounded theory to form the basis for the development of the experiences domains. Results: Analysis produced four domains of experience: (1) a fantasy realised, (2) escaping and finding a new self or life, (3) living a life less ordinary and (4) living local but still an outsider. The description of the four experience domains highlights how risk generally, particularly sexual risk, did or did not feature in these men’s understanding of their experiences. Conclusion: Perceptions and experiences of long-term travel played a decisive role for men who acquired HIV when travelling overseas. Appealing to desired experiences such as connection to local culture or sustaining a new or adventurous life may provide important implications for guiding health promotion programs and policy.
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