Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

ABSTRACT

Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012–2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

KEYWORDS:

• Health insurance
• African migrants
• undocumented migrants
• HIV
• healthcare Quality
• access
• and Evaluation

Acknowledgements

The authors would like to thank all the people who participated in the study, the RAAC-Sida, COMEDE, FORIM and SOS hepatitis associations for support in preparing and conducting the survey, Géraldine Vivier, Eva Lelièvre (INED) and Anne Gervais (AP-HP) for support in preparing the questionnaire, Agnes Guillaume for the communication tools, ClinSearch and Ipsos for data collection, Lauren Dalecky for the revision of the English text, and the staff at all participating centres.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval and consent to participate

All eligible patients, except those with major cognitive or health impairments, were asked to participate in the study and were included after their written consent was collected. The Advisory Committee on Data Collection in Health Research (CCTIRS) and the French Data Protection Authority (CNIL) approved this project. The complete survey protocol was registered with Clinicaltrials.gov (NCT02566148).

Consent for publication

All authors consented to the publication.

Availability of data and material

All the relevant data for our analyses are fully described in the paper.

Authors’ contributions

A.D.L., R.D.S., F.L. and N.L. designed the research and organized the data collection. N.V., J.P. and A.R. prepared and analysed the data. All authors participated in the data interpretation. N.V. performed the literature search and drafted the manuscript. P.C., O.B., A.D.L. and F.L. critically revised the manuscript for important intellectual content. A.D.L. had full access to all the data and was responsible for the final decision to submit for publication.

Participating centres and investigators:

HIV group: Hôpital intercommunal de Créteil, service de Médecine Interne (I Delacroix, B El Harrar V Garrait, L Richier); CHU le Kremlin Bicêtre, service de Médecine Interne (K Bourdic, M Duracinski, C Goujard, Y Quertainmont, D Peretti); Hôpital Delafontaine, service de Maladies Infectieuses (MA Khuong, J Krause, M Poupard, B Taverne, G Tran Van); Hôpital Tenon, service de Maladies Infectieuses et Tropicales (A Adda Lievin, P Bonnard, H Cordel, MG Lebrette, FX Lescure, P Thibault, N Velazquez, JP Vincensini); CHU Lariboisière, service de Médecine Interne A (JF Bergmann, E Badsi, J Cervoni, M Diemer, A Durel, P Sellier, M Bendenoun, JD Magnier); CHU Saint-Antoine, service de Maladies Infectieuses et Tropicale (E Bui, J Tredup, P Campa, N Desplanque, M Sebire); Hôpital Saint-Louis, services de Maladies Infectieuses et Tropicale et d’Immunologie Clinique (D Ponscarme, N Colin de Verdière, V de Lastours, J Gouguel, C Gatey, C Lascoux-Combe, V Garrait, F Taieb, N De Castro, L Gérard); Hôpital Bichat Claude Bernard, service de Maladies Infectieuses, VIH, et Tropicales (G Pahlavan, B Phung, F L’Heriteau, A Dia, A Lepretre, G Morau, C Rioux, V Joly, Y Yazdanpanah, S Legac); Hôpital René Dubos, service de Médecine Interne Dermatologie (L Blum, M Deschaud); Hôpital Européen George Pompidou, service d’Immunologie Clinique (M Buisson, P Kousignian, C Minozzi, M Karmochkine, D Batisse, J Pavie, M Eliaczewicz, L Weiss, G Gonzalez, P Castiel, I Pierre, M Beumont, D Jayle, J Derouinau, M Manea, E Bourzam); CHU Avicenne, service de Maladies Infectieuses et Tropicales (S Abgral, S Mattioni, R Barruet, N Sayre, O Bouchaud, M Tatay, M Gousseff, F Mechai, T Kandel, P Honoré, M Coupard); CHU Cochin Tannier, service d’unité Fonctionnelle de Pathologie Infectieuse (F Bani-Sadr, L Belarbi, G Spiridon, T Tahi, H Mehawej, D Salmon, B Silbermann, A Calboreanu, P Loulergue, H Bouchez, V Le Baut, MP Pietri); Centre hospitalier de Gonesse, service de Médecine Interne (D Trois-Vallets, V Favret); Hôtel Dieu, Centre de Diagnostic et de Thérapeutique (JP Viard, A Sobel, J Gilquin, A Cros, A Maignan); CHI Poissy/Saint-Germain-en-Laye, service de Maladies Infectieuses et Tropicales (Y Welker, H Masson, B Montoya, JL Ecobichon); CH de Lagny Marne la Vallée, service de maladies infectieuses (E Froguel, P Simon, MS Nguessan, S Tassi); Nouveau Centre Hospitalier Sud Francilien, service d’Hématologie Clinique (A Devidas, L Gerard, H Touahri); CHI Robert Ballanger, service de Médecine Interne et Maladies Infectieuses (JL Delassus, MA Bouldouyre, V Favret); Hôpital Intercommunal André Grégoire, service de Médecine Interne (C Winter); CHU La Pitié-Salpetrière, services de Médecine Interne 1 et de Maladies Infectieuses et Tropicales (S Pelletier, MC Samba, S Herson, A Simon, M Bonmarchand, N Amirat, N Smail, S Seang, H Stitou, L Schneider, R Tubiana, L Epelboin, MA Valantin, C Katlama, S Ben Abdallah, P Bourse, Y Dudoit, C Blanc); Centre Médical Institut Pasteur, consultations spécialisées (C Charlier-Woerther, O Lortholary, PH Consigny, A Gergely, M Shoai-Tehrani, G Cessot, C Duvivier, F Touam, K Benhadj); CMC de Bligny, service de Maladies Infectieuses et VIH (H Ait Mohand, E Klement, P Chardon).

Chronic Hepatitis B group: Hôpital Beaujon, service d’Hépatologie (A Pumpo, T Asselah, N Guilly, N Boyer, F Mouri, C Castelnaud, M Pouteau); Hôpital Pitié-Salpêtrière, service d’Hépato-Gastroentérologie et de Médecine Interne (T Poynard, Y Benhamou, G Bonyhay, P Lebray, J Massard, J Moussali, V Ratziu, M Rudler, D Thabut, R Pais, E Luckina, A Simon, MC Samba, S Pelletier, N Smail); Hôpital Paul Brousse, Centre Hépato-Biliaire (JC Duclos Vallée, D Samuel, A Coilly); CHU Henri Mondor, service d’Hépatologie (F Roudot-Thoraval, C Hezode, E Lopes); Hôpital Jean Verdier, service d’Hépato-Gastroentérologie (V Bourcier, N Ganne, P Nahon, J Cohelo, JC Trinchet, G Gnkontchou, V Grando, S Brulé); Hôpital Cochin, unité d’Hépatologie (P Sogni, H Fontaine, V Mallet, S Tripon, A Vallet Pichard, S Pol, M Corouge, M Benazra, A Noble, L Bousquet); Hôpital Saint-Antoine, service d’Hépato-Gastroentérologie (D Mohand, L Serfaty, N Carbonell, C Corpechot, M Lequoy, H Mathiex-Fortunet, A Pascale, O Rosmorduc, O Chazouillères, S Mezhoud, T Andreani, H Regnault, A Poujol-Robert, F Benjelloun); Hôpital Gouin, service d’Hépato-Gastroentérologie (S Levy); Hôpital Avicenne, services de Médecine Interne et de Maladies Infectieuses (D Roulot, U Warzocha, C Cambonie, O Bouchaud, F Mechai, M Goussef, N Vignier, T Kandel, P Honore); CH de Lagny Marne La Vallée, service de Gastroentérologie (F Harnois, G Macaigne, K Fernandes); Hôpital Lariboisière, services de Médecine Interne et d’Hépato-Gastroentérologie (JF Bergmann, P Sellier, M Bendenoun, JD Magnier, V Ozenne); Hôpital Tenon, services d’Hépato-Gastroentérologie et de Maladies Infectieuses (D Ancel, I Popa-Gregoriou, F Amiot, A Garioud, JD Grangé, D Chaslin-Ferbus, S Gil-Diez, P Bonnard, MG Lebrette, H Cordel, FX Lescure, JP Vincensini, A Adda Lievin, P Thibault, N Velazquez); Centre Hospitalier Intercommunal de Créteil, service d’Hépato-Gastroentérologie (S Barge, I Rosa, L Costes, L Richier); Réseau ARES 92 (A Seif, C Chandemerle, M Lalande, T Mazars); Réseau Paris Nord (JP Aubert, O Taulera); Centre de santé du Comede (I Alix, F Fleury, O Lefebvre, P Revault, M Petruzzi, C Menard).

Référence group: Centre municipal de santé Gentilly (JJ Bourcart); PASS Hôpital Saint-Louis (C Georges, M Andlauer, Y Girardeau, F Tapié de Celeyran, P Bordon, N Dardel, D Levy, O Taulera, ML Pintir Rageau, S Dehaudt); PASS Hôpital Lariboisière (C Aparicio, U Loeung, C Toussaint); PASS Hôpital Saint-Antoine (V Vasseur, A Andel, O Cha, P Xu, V Sivalingam, I Hiesse, S Ouaret, L Zahzam, E Bui); PASS hôpital La Pitié-Salpêtrière (E Baut, MA Temple, A Gillet, C Leata, J Legoff); Centre médical et dentaire Henri Barbusse-Gagny (F Jardin, E Jean Baptiste); Centre d’Accueil de Soins et d’Orientation (E Corp, J Nau, B Chatelin, P Weeger, N Hervier, L Lacroze); Centre municipal de santé Colombes (L Ballonard, A. Seif); Centre médico-social COMEDE (I Alix, F Fleury, O Lefebvre, P Revault, M Petruzzi, C Menard); Centre médico-social Fresnes (Y Chahan, J Prost); Centre médico-social Livry-Gargan (D Spindler, L Rodin Zita, Nguyen, K Dambielle); Centre médico-social Ambroise Croizat Franconville (P Bourlier, P Zaidi); Centre médico-social Mai-Politzer Arcueil (F Block); Centre de santé Françoise Dolto Tremblay-en-France (N Bessah); Centre médico-social Fontenay aux roses (G Barbier, G Pilorget, N Touazi); Centre Polyvalent de Santé Aimé Césaire Bobigny (F Rouges, C Chalal); Centre médical Pierre Rouques Villejuif (L Cavanna, A Sabah, M C Charansonnet, G Ibanez); Centre de santé C.P.A.M. Choisy-le-Roi (M Lesourd); Centre municipal de santé Issy-les-Moulineaux (M Orbach-Roulière, JP Vilanova); Centre médical Elio Habib – Paris (M Smadja, E Rozenkier); Centre de santé Pierre Rouquès Le Blanc-Mesnil (C Vincent, V Bontemps, A Ngaleu, F Bensidhoum); Centre de santé Centre médico-social JA Dolidier Pierrefitte (M Gharmaoui, B Hubert-Andreani, V Vinçon, K Royer, S Vernerey-Martin, C Meunier, S Djouhri, V Ngadjeu); Centre médico-social Maurice Ténine Champigny-sur-Marne (F Villebrun, D Soletchnik, M Deroche, S Henry, M Geminel, C Tison, M Dupuy, E Balgone); Centre municipal de santé Nanterre (M Esteve, C Terra, Charles, L Rossignol, C Bismuth, G Gillemot, M Vanbana); Centre de santé Henri Barbusse Saint-Ouen (M Djouab, G Lyon, F Ogier, J.Gelly); Centres de santé Savattero Montreuil (P Vidigal, A Gibier, A Simonnet-Richard, C Alvarez-Malgras); Dispensaire C.R.F. Boulogne Billancourt (C Dufresne, B Huault, I Cornuche); Centre municipal de Santé Louis-Fernet Sevran (H Touitou, S D’Epiro, F Michard, N Guesnier, F Siecat); Centre médico-social Haxo Paris (N Pinard, H Gaborieau); Centre médico-social Pierre Rouques Vitry-sur-Seine (A Beaupin, G Albouy, C Besacier, A Soares, J Le Breton).

The PARCOURS Study Group included A.D.L., F.L., R.D.-S., Nathalie Bajos, N.L. (scientific coordinators), J.P., A.R., A.G., N.V., Elise Rodary, Dolorès Pourette, Joseph Situ, Pascal Revault, Philippe Sogni, Julien Gelly, Yann Le Strat, Nicolas Razafindratsima.

ORCID

Nicolas Vignier http://orcid.org/0000-0002-9410-9327

Additional information

Funding

This study was supported by the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and the Directorate-General of Health (DGS, French Ministry of Health). AR was granted by Santé Publique France. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the article and the decision to submit the paper for publication.