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

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journal contribution
posted on 07.09.2018, 15:43 by Kevin Pottie, Tamara Lotfi, Lama Kilzar, Pamela Howeiss, Nesrine Rizk, Elie A. Akl, Sonia Dias, Beverly-Ann Biggs, Robin Christensen, Prinon Rahman, Olivia Magwood, Anh Tran, Nick Rowbotham, Anastasia Pharris, Teymur Noori, Manish Pareek, Rachael Morton
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.

Funding

European Centre for Disease Prevention and Control—EHG Project No. 2169 “Evidence-based guidance on screening for infectious diseases among migrants to the EU/EEA”.

History

Citation

International Journal of Environmental Research and Public Health , 2018, 15 (8), 1700

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

VoR (Version of Record)

Published in

International Journal of Environmental Research and Public Health

Publisher

MDPI

issn

1661-7827

eissn

1660-4601

Acceptance date

01/08/2018

Copyright date

2018

Available date

07/09/2018

Publisher version

http://www.mdpi.com/1660-4601/15/8/1700

Language

en

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