Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia

• Published in: AIDS and behavior Vol. 18; no. 2; pp. 323 - 334
• Main Authors: Mendelsohn, Joshua B., Schilperoord, Marian, Spiegel, Paul, Balasundaram, Susheela, Radhakrishnan, Anuradha, Lee, Christopher K. C., Larke, Natasha, Grant, Alison D., Sondorp, Egbert, Ross, David A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2014; Springer Nature B.V
• Subjects: Acquired Immune Deficiency Syndrome; Adolescent; Adult; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Clinical outcomes; Cross-Sectional Studies; Emigration and Immigration; Female; Females; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - virology; Human immunodeficiency virus; Humans; Infectious Diseases; Kuala Lumpur, Malaysia; Malaysia; Medications; Medicine; Medicine & Public Health; Migration; Multivariate Analysis; Original Paper; Patient Compliance; Public Health; Refugees; Socioeconomic Factors; Treatment Outcome; Treatment Outcomes; Urban Areas; Viral Load - drug effects; Malaysia; Adherence; Antiretrovirals; Forced migration; Refugees; HIV; Outcomes
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-013-0494-0

In response to an absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (≥18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral loads. The primary outcome was unsuppressed viral load (≥40 copies/mL). Among a sample of 153 refugees and 148 host community clients, refugees were younger (median age 35 [interquartile range, IQR 31, 39] vs 40 years [IQR 35, 48], p  < 0.001), more likely to be female (36 vs 21 %, p  = 0.004), and to have been on HAART for less time (61 [IQR 35, 108] vs 153 weeks [IQR 63, 298]; p  < 0.001). Among all clients, similar proportions of refugee and host clients were <95 % adherent to pharmacy refills (26 vs 34 %, p  = 0.15). When restricting to clients on treatment for ≥25 weeks, similar proportions from each group were not virologically suppressed (19 % of refugees vs 16 % of host clients, p  = 0.54). Refugee status was not independently associated with the outcome (adjusted odds ratio, aOR = 1.28, 95 % CI 0.52, 3.14). Overall, the proportions of refugee and host community clients with unsuppressed viral loads and sub-optimal adherence were similar, supporting the idea that refugees in protracted asylum situations are able to sustain good treatment outcomes and should explicitly be included in the HIV strategic plans of host countries with a view to expanding access in accordance with national guidelines for HAART.