International Journal of Environmental Research and Public Health
Volume 15, Issue 8, 2018

The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: A systematic review (Review) (Open Access)

Pottie K.* , Lotfi T. , Kilzar L. , Howeiss P. , Rizk N. , Akl E.A. , Dias S. , Biggs B.-A. , Christensen R. , Rahman P. , Magwood O. , Tran A. , Rowbotham N. , Pharris A. , Noori T. , Pareek M. , Morton R.
  • a Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada, Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
  • b Faculty of Health Sciences, American University of Beirut, Beirut, 1107 2020, Lebanon, AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, 1107 2020, Lebanon
  • c Faculty of Health Sciences, American University of Beirut, Beirut, 1107 2020, Lebanon
  • d Department of Internal Medicine, American University of Beirut, Beirut, 1107 2020, Lebanon
  • e Department of Internal Medicine, American University of Beirut, Beirut, 1107 2020, Lebanon
  • f Faculty of Health Sciences, American University of Beirut, Beirut, 1107 2020, Lebanon, AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, 1107 2020, Lebanon, Department of Internal Medicine, American University of Beirut, Beirut, 1107 2020, Lebanon
  • g National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, Caparica, 2825-149, Portugal
  • h Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville, 3010, Australia
  • i Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, 2000, Denmark, Department of Rheumatology, Odense University Hospital, Odense, 5000, Denmark
  • j Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada
  • k Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada
  • l NHMRC Clinical, Trials Centre, The University of Sydney, Campbell, 2006, Australia
  • m NHMRC Clinical, Trials Centre, The University of Sydney, Campbell, 2006, Australia
  • n European Centre for Disease Prevention and Control, Solna, 16973, Sweden
  • o European Centre for Disease Prevention and Control, Solna, 16973, Sweden
  • p Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, United Kingdom
  • q NHMRC Clinical, Trials Centre, The University of Sydney, Campbell, 2006, Australia

Abstract

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings. © 2018 by the authors.

Author Keywords

Migrants AIDS Stigma Refugees HIV

Index Keywords

HIV Infections refugee Cost benefit analysis Human immunodeficiency virus infection mass screening economics health survey health risk Europe predictive value human middle aged Ethnic Groups statistics and numerical data ethnic group morbidity Human immunodeficiency virus monitoring system meta analysis health care cost Humans migrant counseling female enzyme linked immunosorbent assay Review diagnostic test accuracy study European Union Incidence sensitivity and specificity disease transmission health care utilization adult mortality migration age sex factor Sex Factors Age Factors marginalization Transients and Migrants systematic review cost-benefit analysis Western blotting cost effectiveness analysis immigrant population
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85051400310&doi=10.3390%2fijerph15081700&partnerID=40&md5=b91e37035d5131cf0f265be59112abd6
DOI: 10.3390/ijerph15081700
ISSN: 16617827
Cited by: 3
Original Language: English