The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: A systematic review

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

*Corresponding author for this work

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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.

Original languageEnglish
Article number1700
JournalInternational Journal of Environmental Research and Public Health
Volume15
Issue number8
Number of pages23
ISSN1661-7827
DOIs
Publication statusPublished - 9. Aug 2018

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European Union
Cost-Benefit Analysis
HIV
Population
Risk-Taking
Meta-Analysis
Counseling
Odds Ratio
Incidence

Keywords

  • AIDS
  • HIV
  • Migrants
  • Refugees
  • Stigma
  • Age Factors
  • Mass Screening/economics
  • Humans
  • Middle Aged
  • Transients and Migrants/statistics & numerical data
  • HIV Infections/diagnosis
  • Incidence
  • Ethnic Groups
  • Europe/epidemiology
  • Cost-Benefit Analysis
  • Counseling
  • Sex Factors
  • Adult
  • Female

Cite this

Pottie, Kevin ; Lotfi, Tamara ; Kilzar, Lama ; Howeiss, Pamela ; Rizk, Nesrine ; Akl, Elie A. ; Dias, Sonia ; Biggs, Beverly Ann ; Christensen, Robin ; Rahman, Prinon ; Magwood, Olivia ; Tran, Anh ; Rowbotham, Nick ; Pharris, Anastasia ; Noori, Teymur ; Pareek, Manish ; Morton, Rachael. / The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA : A systematic review. In: International Journal of Environmental Research and Public Health. 2018 ; Vol. 15, No. 8.
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title = "The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: A systematic review",
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, Age Factors, Mass Screening/economics, Humans, Middle Aged, Transients and Migrants/statistics & numerical data, HIV Infections/diagnosis, Incidence, Ethnic Groups, Europe/epidemiology, Cost-Benefit Analysis, Counseling, Sex Factors, Adult, Female",
author = "Kevin Pottie and Tamara Lotfi and Lama Kilzar and Pamela Howeiss and Nesrine Rizk and Akl, {Elie A.} and Sonia Dias and Biggs, {Beverly Ann} and Robin Christensen and Prinon Rahman and Olivia Magwood and Anh Tran and Nick Rowbotham and Anastasia Pharris and Teymur Noori and Manish Pareek and Rachael Morton",
year = "2018",
month = "8",
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doi = "10.3390/ijerph15081700",
language = "English",
volume = "15",
journal = "International Journal of Environmental Research and Public Health",
issn = "1661-7827",
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Pottie, K, Lotfi, T, Kilzar, L, Howeiss, P, Rizk, N, Akl, EA, Dias, S, Biggs, BA, Christensen, R, Rahman, P, Magwood, O, Tran, A, Rowbotham, N, Pharris, A, Noori, T, Pareek, M & Morton, R 2018, 'The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: A systematic review', International Journal of Environmental Research and Public Health, vol. 15, no. 8, 1700. https://doi.org/10.3390/ijerph15081700

The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA : A systematic review. / Pottie, Kevin; Lotfi, Tamara; Kilzar, Lama; Howeiss, Pamela; Rizk, Nesrine; Akl, Elie A.; Dias, Sonia; Biggs, Beverly Ann; Christensen, Robin; Rahman, Prinon; Magwood, Olivia; Tran, Anh; Rowbotham, Nick; Pharris, Anastasia; Noori, Teymur; Pareek, Manish; Morton, Rachael.

In: International Journal of Environmental Research and Public Health, Vol. 15, No. 8, 1700, 09.08.2018.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA

T2 - A systematic review

AU - Pottie, Kevin

AU - Lotfi, Tamara

AU - Kilzar, Lama

AU - Howeiss, Pamela

AU - Rizk, Nesrine

AU - Akl, Elie A.

AU - Dias, Sonia

AU - Biggs, Beverly Ann

AU - Christensen, Robin

AU - Rahman, Prinon

AU - Magwood, Olivia

AU - Tran, Anh

AU - Rowbotham, Nick

AU - Pharris, Anastasia

AU - Noori, Teymur

AU - Pareek, Manish

AU - Morton, Rachael

PY - 2018/8/9

Y1 - 2018/8/9

N2 - 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.

AB - 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.

KW - AIDS

KW - HIV

KW - Migrants

KW - Refugees

KW - Stigma

KW - Age Factors

KW - Mass Screening/economics

KW - Humans

KW - Middle Aged

KW - Transients and Migrants/statistics & numerical data

KW - HIV Infections/diagnosis

KW - Incidence

KW - Ethnic Groups

KW - Europe/epidemiology

KW - Cost-Benefit Analysis

KW - Counseling

KW - Sex Factors

KW - Adult

KW - Female

U2 - 10.3390/ijerph15081700

DO - 10.3390/ijerph15081700

M3 - Review

C2 - 30096905

AN - SCOPUS:85051400310

VL - 15

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 8

M1 - 1700

ER -