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Meta-Analysis
. 2018 Aug 9;15(8):1700.
doi: 10.3390/ijerph15081700.

The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review

Kevin Pottie  1   2 , Tamara Lotfi  3   4 , Lama Kilzar  5 , Pamela Howeiss  6 , Nesrine Rizk  7 , Elie A Akl  8   9   10 , Sonia Dias  11 , Beverly-Ann Biggs  12 , Robin Christensen  13   14 , Prinon Rahman  15 , Olivia Magwood  16 , Anh Tran  17 , Nick Rowbotham  18 , Anastasia Pharris  19 , Teymur Noori  20 , Manish Pareek  21 , Rachael Morton  22
Affiliations
Meta-Analysis

The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review

Kevin Pottie et al. Int J Environ Res Public Health. .

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.

Keywords: AIDS; HIV; migrants; refugees; stigma.

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Conflict of interest statement

Pareek is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Pareek reports an institutional grant (unrestricted) for project related to blood-borne virus testing from Gilead Sciences outside the submitted work. Pottie received a research contract from the Public Health Agency of Canada (2012) to prepare a report on migrants and HIV for the World AIDS Conference. Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital (R. Christensen) is supported by a core grant from the Oak Foundation (OCAY-13-309). RL Morton is supported by an Australian National Health and Medical Research Council, Sidney Sax Public Health Fellowship #1054216. All other authors report no conflicts of interest.

Figures

Figure A1
Figure A1
Logic Model.
Figure 1
Figure 1
(a) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA0 flow diagram (effectiveness); (b) PRISMA flow diagram (cost-effectiveness). HIV—human immunodeficiency virus.
Figure 1
Figure 1
(a) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA0 flow diagram (effectiveness); (b) PRISMA flow diagram (cost-effectiveness). HIV—human immunodeficiency virus.
Figure 2
Figure 2
Meta-analysis (taken from Pottie et al., 2014 [26]). Forest plot of rapid HIV voluntary counselling and testing versus conventional care (A) on uptake of HIV testing and (B) on receipt of HIV results. Copyright received from BMJ. License Number 4403690523053.
See this image and copyright information in PMC

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