BMJ Open
Volume 8, Issue 2, 2018

Estimating the HIV undiagnosed population in Catalonia, Spain: Descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population (Article) (Open Access)

Reyes-Urueña J.M.* , Campbell C.N.J. , Vives N. , Esteve A. , Ambrosioni J. , Tural C. , Ferrer E. , Navarro G. , Force L. , García I. , Masabeu À. , Vilaró J.M. , García De Olalla P. , Caylà J.A. , Miró J.M. , Casabona J.
  • a Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics Sobre les Infeccions de Transmissio Sexual i Sida de Catalunya, Badalona, Spain, CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain, Departament de Pediatria, D'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
  • b Tuberculosis Section, Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London, United Kingdom
  • c Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics Sobre les Infeccions de Transmissio Sexual i Sida de Catalunya, Badalona, Spain, CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain, Departament de Pediatria, D'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
  • d Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics Sobre les Infeccions de Transmissio Sexual i Sida de Catalunya, Badalona, Spain, CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain, Departament de Pediatria, D'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
  • e Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
  • f Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  • g Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
  • h Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
  • i Hospital de Mataró, Mataró, Spain
  • j Hospital General d'Hospitalet, Barcelona, Spain
  • k Hospital de Palamós, Palamós, Spain
  • l Consorci Hospitalari de Vic, Barcelona, Spain
  • m CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Agencia de Salud Pública de Barcelona, Barcelona, Spain
  • n CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Agencia de Salud Pública de Barcelona, Barcelona, Spain
  • o Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
  • p Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics Sobre les Infeccions de Transmissio Sexual i Sida de Catalunya, Badalona, Spain, CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain, Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain, Departament de Pediatria, D'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain

Abstract

Objective Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations. Methods To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort. Results The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%). Conclusions By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Author Keywords

Continuum of care HIV undiagnosed infection HIV surveillance migrant MSM Cascade

Index Keywords

personal experience descriptive research patient care Forecasting Catalonia HIV Infections transmission Human immunodeficiency virus infection human statistics and numerical data Human immunodeficiency virus infected patient comparative study population differentiation sexual transmission men who have sex with men Homosexuality, Male male homosexuality Humans migrant Spaniard male CD4 lymphocyte count Spain female risk factor Risk Factors high risk population population research Incidence Article epidemic major clinical study adult migration antiretroviral therapy data analysis Models, Statistical cohort analysis virus transmission statistical model Transients and Migrants anti human immunodeficiency virus agent
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053014860&doi=10.1136%2fbmjopen-2017-018533&partnerID=40&md5=4ae466f5a91df160417d90a73bda6f84
DOI: 10.1136/bmjopen-2017-018533
ISSN: 20446055
Cited by: 3
Original Language: English