Document Type
Article
Publication Date
6-2019
Identifier
DOI: 10.1097/MD.0000000000015994; PMCID: PMC6571245
Abstract
The aim of the study was to evaluate the human immunodeficiency virus (HIV) treatment cascade and mortality in migrants and citizens living with HIV in Botswana.Retrospective 2002 to 2016 cohort study using electronic medical records from a single center managing a high migrant case load.Records for 768 migrants and 3274 citizens living with HIV were included. Maipelo Trust, a nongovernmental organization, funded care for most migrants (70%); most citizens (85%) had personal health insurance. Seventy percent of migrants and 93% of citizens had received antiretroviral therapy (ART). At study end, 44% and 27% of migrants and citizens, respectively were retained in care at the clinic (P < .001). Among the 35% and 60% of migrants and citizens on ART respectively with viral load (VL) results in 2016, viral suppression was lower among migrants (82%) than citizens (95%) (P < .001). Citizens on ART had a median 157-unit [95% confidence interval (CI) 122-192] greater increase in CD4+ T-cell count (last minus first recorded count) than migrants after adjusting for baseline count (P < .001). Five-year survival was 92% (95% CI = 87.6-94.8) for migrants and 96% (95% CI = 95.4-97.2) for citizens. Migrants had higher mortality than citizens after entry into care (hazard ratio = 2.3, 95% CI = 1.34-3.89, P = .002) and ART initiation (hazard ratio = 2.2, 95% CI = 1.24-3.78, P = .01).Fewer migrants than citizens living with HIV in Botswana were on ART, accessed VL monitoring, achieved viral suppression, and survived. The HIV treatment cascade appears suboptimal for migrants, undermining local 90-90-90 targets. These results highlight the need to include migrants in mainstream-funded HIV treatment programs, as microepidemics can slow HIV epidemic control.
Journal Title
Medicine
Volume
98
Issue
23
First Page
15994
Last Page
15994
MeSH Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Anti-HIV Agents; Botswana; Child; Child, Preschool; Epidemics; Female; HIV; HIV Infections; Humans; Infant; Male; Middle Aged; Retrospective Studies; Transients and Migrants; Treatment Outcome; United Nations; Viral Load; Young Adult
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Anti-HIV Agents; Botswana; Child; Child, Preschool; Epidemics; Female; HIV; HIV Infections; Humans; Infant; Male; Middle Aged; Retrospective Studies; Transients and Migrants; Treatment Outcome; United Nations; Viral Load; Young Adult
Recommended Citation
Marukutira T, Yin D, Cressman L, et al. Clinical outcomes of a cohort of migrants and citizens living with human immunodeficiency virus in Botswana: implications for Joint United Nation Program on HIV and AIDS 90-90-90 targets. Medicine (Baltimore). 2019;98(23):e15994. doi:10.1097/MD.0000000000015994
Comments
This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
Publisher's Access: https://doi.org/10.1097/md.0000000000015994