Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

New HIV strain reminds us that innovation is urgent and fundamental

CNN, Updated November 8, 2019

For the first time in 19 years, a team of scientists has detected a new strain of HIV.

The strain is a part of the Group M version of HIV-1, the same family of virus subtypes to blame for the global HIV pandemic. The findings were published Wednesday in the Journal of Acquired Immune Deficiency Syndromes.
HIV has several different subtypes or strains, and like other viruses, it has the ability to change and mutate over time. This is the first new Group M HIV strain identified since guidelines for classifying subtypes were established in 2000. It is important to know what strains of the virus are circulating to ensure that tests used to detect the disease are effective.

 

New HIV Treatment factsheet series

NAPWHA, 20 Dec 2018

NAPWHA would like to thank ViiV Healthcare for an unrestricted grant to produce a new range of treatment messages.

These are ideal for someone who has been newly diagnosed, or who is unsure if they are receiving the best possible treatment for them.

Below are the first three of the series; these are downloadable in PDF format.

Please continue to check in with NAPWHA in 2019 for the next in the series.

  • Download factsheets

Harm reduction should address the specific needs of couples who inject drugs

nam/aidsmap, 21 March 2017

The sharing of drug injecting equipment most often occurs between sexual partners, but the ways in which couples manage risks and care for each other have been largely ignored by harm reduction services, say Australian researchers.

Read more here 

 

 

Hep C and you: a user’s guide to the latest information

Australian Injecting & Illicit Drug Users League (AIVL), January 2017

This booklet aims to increase knowledge and awareness of hepatitis C, allowing drug users to make informed decisions regarding their health. Produced by drug users for drug users, as part of a harm reduction, peer-based approach to health.

  • Download booklet (PDF) here 

HIV Criminal Cases: Media Guide

AFAO, Updated 2016

In Australia, each state/territory has different criminal laws under which someone can be charged with reckless, negligent or deliberate transmission of HIV to another person (generally for sexual transmission), or for exposing another person to HIV. Criminal cases in Australia involving HIV transmission or exposure are rare.

The quality of Australian media reports of criminal cases involving HIV transmission or exposure varies: on some occasions it has been accurate but on others media reports have been inaccurate  or overtly sensational.

The effect of sensationalised reporting that misrepresent the facts is that it can feed misconceptions regarding transmission and risk, dehumanise the people involved in the cases and demonise all people with HIV.

The Media Tool Kit as a whole contains the following topics:

  • Reporting on HIV prevention
  • Reporting on PrEP
  • Reporting HIV data
  • HIV cure research
  • HIV criminal cases
  • HIV exposure risk in the community
  • Reporting HIV: best practice tips +
  • Ethics and principles for HIV reporting
  • Background briefings
  • Media releases
  • HIV timeline

Read more here