How do migrants living with HIV adhere to the HIV care process in high-income countries? A systematic review

Abstract

Background: In high-income countries (HICs), migrants living with HIV (MLHIV) are more likely than other HIV subpopulations to encounter problems which hamper their adherence to the care process; these include social and administrative insecurity, discrimination and psychological distress.

Objective: This systematic review aimed to determine the specific features of adherence to the HIV care process among MLHIV in HIC.

Method: Three researchers independently selected studies from a search for papers focusing on empirical studies on MLHIV's adherence to the care process in HIC, published between 1 January 2010 and 1 November 2024 in the following databases: MEDLINE, Embase, CINAHL, PsycINFO and Google Scholar. The three dimensions evaluated for adherence to the care process were adherence to treatment, retention in care and virological response. HICs were characterised according to the World Bank's definition.

Results: Of 601 studies screened, 69 were included (26 (38%) analysing treatment adherence 44 (64%) 44 (64%) retention in care and 34 (48%) virological response). In 49 (71%) of these studies, MLHIV from sub-Saharan Africa accounted for the majority of persons included. MLHIV were mainly categorised according to their geographical region of origin. Only one study considered the reasons for migration. Of 52 statistically significant associations, only five found that being a migrant (vs being a non-migrant) was associated with a better HIV care process. Moreover, several individual (sociodemographic, clinical and psychological), and structural (care system organisation and political) factors associated with difficulties in adhering to the HIV care process were identified.

Discussion: MLHIV living in HIC had poorer adherence to the HIV care process for all three dimensions studied (ie, treatment adherence, retention in care and virological response). Research studies categorise MLHIV according to their geographical origin. However, this type of categorisation does not adequately capture social inequalities in health. To overcome this, studies must instead categorise MLHIV according to various intersecting factors, including, among other things, their reason for migrating, the length of time living in the destination country and violence experienced during their migratory journey.

Prospero registration number: CRD42021253280.

Keywords: Follow-Up Studies; HIV & AIDS; Medication Adherence; Patient Care Management; VIROLOGY.

Figure 1. Systematic reviews flow diagram of studies on migration and HIV care pathway.

Figure 2. Adherence (A) and non-adherence (B) to antiretroviral therapy among migrants and non-migrants LWH in the high-income countries (adjusted OR, adjusted incidence ratio (IR), adjusted relative risk (RR) and 95% CI). Figures have been rounded off to the decimal point. *Unadjusted. IR, incidence ratio; LWH, living with HIV; M, men, Mig., migrants; Ref, reference; RR, relative risk; SSA, sub-Saharan Africa; W, women.

Figure 3. Retention in care (A) and lost to follow-up (B) for migrants living in high-income country (adjusted HR, adjusted incidence ratio (IR), adjusted OR, adjusted relative risk (RR)). Figures have been rounded off to the decimal point except for retention in care. EE, Eastern Europe; Immig, immigrants; IR, incidence ratio; LAC, Latin America Caribbean; M, men, NA, Nord Africa; Mig, migrants; NWR, North-Western Region; MSM, men who have sex with men; Ref, reference; SSA, sub-Saharan Africa; SE, Southern Europe; W, women.

Figure 4. HIV virological suppression for migrants and non-migrants LWH in high-income countries (adjusted OR, adjusted HR, adjusted relative risk (RR), 95% CI). Figures have been rounded off to the decimal point. FRA, French natives; LAC, Latin America Caribbean; LMICs, low-income and middle-income countries; LWH, living with HIV; M, men; NAME, North Africa and the Middle East; NFW, non-French West Indies; Mig, migrants; NWR, North-Western Region; MSM, men who have sex with men; Pop., population; Ref., reference; SSA, sub-Saharan Africa; W, women.

Figure 5. HIV virological failure for migrants living in high-income country (adjusted OR, HR, incidence ratio (IR)). *Unadjusted OR. Figures have been rounded off to the decimal point. LMIC, low-income and middle-income countries; M, men; Mig, migrants; M/NM LWH, migrants and non-migrants living with HIV; Ref., reference; SSA, sub-Saharan Africa; W, women.