@article{3107210,
    title = "HIV testing history and access to treatment among migrants living with HIV in Europe",
    author = "Fakoya, I. and Álvarez-Del Arco, D. and Monge, S. and Copas, A.J. and Gennotte, A.-F. and Volny-Anne, A. and Wengenroth, C. and Touloumi, G. and Prins, M. and Barros, H. and Darling, K.E.A. and Prestileo, T. and Del Amo, J. and Burns, F.M. and Aerssens, A. and Aguado, M. and Alimi, B. and Anagnostou, O. and Anderson, J. and Antoniadou, A. and Arando, M. and Barberà, M.J. and Barthélemy, A. and Belda-Ibáñez, J. and Bertisch, B. and Bil, J. and Blanco, J.R. and Block, K. and Boesecke, C. and Boura, M. and Burgos, J. and Cabo, J. and Calabuig, E. and Campbell, L. and Cardoso, O. and Claudia, W. and Clumeck, N. and Colucci, A. and Corrao, S. and Cuellar, S. and Cunha, J. and Daikos, G. and Darling, K. and del Romero, J. and Dellot, P. and Domingo, P. and Dronda, F. and Ebeling, F. and Engelhardt, A. and Engler, B. and Farrell, J. and Fehr, J. and Feijó, M. and Fernández, E. and Fernández García, E. and Fernandez, T. and Fortes, A.L. and Fox, J. and Garcia de Olalla, P. and García, F. and Gargalianos-Kakolyris, P. and Germano, I. and Gilleran, G. and Gilson, R. and Goepel, S. and Gogos, H.A. and Gómez Sirvent, J.L. and Gountas, I. and Gregg, A. and Gutiérrez, F. and Gutierrez, M.M. and Hermans, I. and Iribarren, J.A. and Knobel, H. and Koulai, L. and Kourkounti, S. and La Morté, C. and LeCompte, T. and Ledergerber, B. and Leonidou, L. and Ligero, M.C. and Lindergard, G. and Lino, S. and Lopes, M.J. and Lopez Lirola, A. and Louhenapessy, M. and Lourida, G. and Luzi, A.M. and Maltez, F. and Manirankunda, L. and Martín-Pérez, A. and Martins, L. and Masía, M. and Mateu, M.G. and Meireles, P. and Mendes, A. and Metallidis, S. and Mguni, S. and Milinkovic, A. and Miró, J.M. and Mohrmann, K. and Montero, M. and Mouhebati, T. and Moutschen, M. and Müller, M. and Murphy, C. and Nöstlinger, C. and Ocaña, I. and Okumu-Fransche, S. and Onwuchekwa, G. and Ospina, J.E. and Otiko, D. and Pacheco, P. and Palacios, R. and Paparizos, V. and Papastamopoulos, V. and Paredes, V. and Patel, N. and Pellicer, T. and Peña, A. and Petrosillo, N. and Pinheiro, A. and Poças, J. and Portillo, A. and Post, F. and Prestileo, F. and Prins, P. and Protopapas, K. and Psichogiou, M. and Pulido, F. and Rebollo, J. and Ribeirinho, A. and Río, I. and Robau, M. and Rockstroh, J.K. and Rodrigues, E. and Rodríguez, M. and Sajani, C. and Salavert, M. and Salman, R. and Sanz, N. and Schuettfort, G. and Schüttfort, G. and Schwarze- Zander, C. and Serrão, R. and Silva, D. and Silva, V. and Silverio, P. and Skoutelis, A. and Staehelin, C. and Stephan, C. and Stretton, C. and Styles, F. and Sutre, A.F. and Taylor, S. and Teixeira, B. and Thierfelder, C. and Tsachouridou, O. and Tudor, K. and Valadas, E. and van Frankenhuijsen, M. and Vázquez, M. and Velasco Arribas, M. and Vera, M. and Vinciana, P. and Voudouri, N. and Wasmuth, J.C. and Wilkins, E. and Young, L. and Yurdakul, S. and Zafra Espinosa, T. and Zuilhof, W. and Zuure, F. and the aMASE Study Team",
    journal = "Journal of the International Aids Society",
    year = "2018",
    volume = "21",
    number = "S4",
    publisher = "John Wiley and Sons Inc",
    issn = "1758-2652",
    doi = "10.1002/jia2.25123",
    keywords = "antiretrovirus agent, adult;  bisexuality;  cross-sectional study;  epidemiology;  Europe;  female;  health care delivery;  heterosexuality;  human;  Human immunodeficiency virus infection;  male;  migration;  pregnancy;  primary health care;  serodiagnosis;  sexual and gender minority;  sexual behavior;  statistical model, Adult;  AIDS Serodiagnosis;  Anti-Retroviral Agents;  Bisexuality;  Cross-Sectional Studies;  Europe;  Female;  Health Services Accessibility;  Heterosexuality;  HIV Infections;  Humans;  Logistic Models;  Male;  Pregnancy;  Primary Health Care;  Sexual and Gender Minorities;  Sexual Behavior;  Transients and Migrants",
    abstract = "Introduction: Migrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe. Methods: A cross-sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV-positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign-born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men. Results: A total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post-migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three-quarters of people on antiretrovirals had an HIV viral load <50 copies/mL. Conclusions: Migrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society."
}