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Associação entre a região de nascimento e a reatividade para VIH, VHC, VHB e Sífilis entre utilizadores de cinco centros de base comunitária da grande Lisboa

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Abstract

Introdução: Os migrantes tendem a ser mais saudáveis que os não migrantes, mas habitualmente estão em maior risco doença que os naturais do país de acolhimento. Objetivos: Estimar a associação entre a região de nascimento e a reatividade para VIH, VHC, VHB e Sífilis entre os utilizadores de cinco centros de base comunitária da grande Lisboa. Métodos: Usamos dados dos testes rápidos point of care realizados no In-Mouraria, Move-se, Espaço Intendente, Programa de consumo vigiado móvel, e GAT'AFRIK entre 01/01/2020 e 30/06/2021. Os indivíduos foram categorizados de acordo com o seu país de nascimento (Portugal (PT); Brasil, América Latina e Caraíbas; Outros países europeus; Africa; EUA e Canada; Asia, Médio Oriente e Oceânia). A associação entre a região de nascimento e a reatividade foi medida por odds ratio (OR) bruto e intervalo de confiança (IC) a 95% calculados por regressão quasi-binomial. Neste período realizaram-se 17.328 testes para VIH, 8203 para VHC, 10.226 para VHB e 16.946 para sífilis. 55.5% dos testes de VIH, 61.7% de VHC, 63.2% de VHB e 55.4% de sífilis foram realizados em migrantes. Resultados: No global a reatividade foi de 0,7% para o VIH, 1,3% para o VHC, 1,2% para o VHB e 1,0% para a sífilis. Comparativamente aos nascidos em PT (0.4% reativos), os indivíduos nascidos no Brasil, América Latina e Caraíbas tinham um risco 3,04 vezes maior de um teste reativo para VIH (IC95% 2,15-4,34), os nascidos em África de 1,90 (IC95% 1,33-2,71), e os nascidos na Ásia, Médio Oriente, Oceânia de 2,20 (IC95% 0,64-5,47). Para a sífilis obtiveram-se resultados semelhantes ao VIH, com magnitude de associação diferentes. Relativamente ao VHC, os nascidos no Brasil, América Latina e Caraíbas tinham 79% menos risco (OR 0,33 (IC95% 0,12-0,33)) e os nascidos em Africa 73% (OR 0,27 ((IC95% 0.17-0.43)), que os nascidos em PT (2,3% reativos). Para a infeção por VHB os indivíduos nascidos em Africa e na Ásia, Médio Oriente, Oceânia apresentaram um risco cerca de 16 (IC95%9,93-29,34) e 13,58 vezes superior (IC95% 5,70-30,91), respetivamente, que os nascidos em PT (0,2%). Para indivíduos nascidos em outros países europeus não foram encontradas diferenças significativas. Conclusão: A distribuição de testes reativos variou de acordo com a região de nascimento, com diferenças por agente infecioso. O maior risco de VIH, sífilis e VHB em migrantes provenientes de regiões de menor renda suporta a necessidade de respostas especificas de prevenção e de testagem.
Presented by: Name goes here
25/02/2022, 13ª Jornadas de Atualização em Doenças Infeciosas do Hospital de Curry Cabral
Maria João Novais, Rosa Freitas, Miguel Rocha, Luís Mendão, Paula Meireles
Association between region of birth and proportion of
reactive of HIV, HCV, HBV and syphilis among users of
community-based centers in Lisbon Metropolitan area
Migrants have
better health
Deterioration of
health status
Greater
risk of
illness
Healthy migrant effect
Factors associated with the deterioration of health
HIV and migrants in Europe
Source: HIV/AIDS surveillance in Europe 2021 2020 data; ECDC SURVEILLANCE REPORT
HCV and HBV and migrants in Europe
Source: Monitoring the responses to hepatitis B and C epidemics in the EU/EEA Member States 2019, ECDC TECHNICAL REPORT
To estimate the association between region of birth
and proportion of reactive tests for HIV, HCV, HBV and
Syphilis among users of five community-based
centers in Lisbon Metropolitan area without previous
diagnosis
Objectives
Study setting
Community-based Screening Network
[Community-based screening of HIV, viral hepatitis and sexually transmitted infection
in Portugal]
Based on community-based organizations that work with key groups
People who Use Drugs (PWUD)
Sex Workers (SW)
Men who have Sex with Men (MSM)
Migrants
Face-to-face interview using a
structured questionnaire:
Sociodemographics
Testing history
Risk factors
Knowledge and use of PEP and
PrEP
Experience of violence
Point of care rapid tests:
HIV 1/2 antibodies
HCV antibodies
HBV surface antigen
Syphilis antibodies
Offered based on defined
criteria (not previously diagnosed
for HIV and Syphilis, and not
vaccinated for HBV)
Key populations are offered all
tests they never undertook
Study procedures
Performed by a community health workers (including peers)
Inclusion:
A visit from January 2020 to June 2021 to one of the CBO;
Without previous diagnosis of each infection
N= 17,614 persons
Exclusion:
Born in the US or Canada (n=27)
Total sample: 17,587 participants over 19,109 visits
Participants
PWUD SW MSM Migrants SW Migrants Migrants from Africa PWUD PWID
Statistical analysis:
Associations measured by crude and adjusted odds ratios computed using a quasi-
binomial regression
Adjustments for age and gender (model 1) and further for key populations MSM, sex work
at any point in their lives and use of drugs at any point in their lives (model 2)
% of migrants among participants tested and
reactive tests
7715 3139 3763
7562
9613 5064 6463
9384
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV
(n=17,328)
HCV
(n=8203)
HBV
(n=10,226)
Syphilis
(n=16,946)
Number of tests
Born in PT Born outside PT
29
72
6
55
83
34
120
112
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV
(n=112)
HCV
(n=106)
HBV
(n=126)
Syphilis
(n=167)
Reactive Tests
Born in PT Born outside PT
HIV
7715
3261
688
5423
241
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested
HIV
7715
3261
688
5423
241
0,4%
1,2%
0,4%
0,7%
0,8%
0,0%
0,2%
0,4%
0,6%
0,8%
1,0%
1,2%
1,4%
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested Persons with reactive test
HIV
Model 1 adjusted for age and gender; Model 2 further adjusted for key population (MSM, Sex worker, people who use drugs).
Crude
Model 1
Model 2
Ref
3,04 2,64
1,78
1,17 1,1
0,39
1,9 1,88 1,72
2,2 1,76 1,42
0,01
0,1
1
10
crude model 1 model 2 crude model 1 model 2 crude model 1 model 2 crude model 1 model 2
Portugal Brazil, Latin America, and
Caribbean
Other European Country African country Asia, Middle East, Oceania
OR /aOR(IC 95%)
HCV
3139
1869
429
2620
146
0
500
1000
1500
2000
2500
3000
3500
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested
HCV
3139
1869
429
2620
146
2,3%
0,5%
1,9%
0,6% 0,7%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
0
500
1000
1500
2000
2500
3000
3500
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested Persons with reactive test
HCV
Crude
Model 1
Model 2
Model 1 adjusted for age and gender; Model 2 further adjusted for key population (MSM, Sex worker, people who use drugs).
HBV
3763
1597
312
4367
187
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested
HBV
3763
1597
312
4367
187
0,2%
0,0%
0,3%
2,7%
1,6%
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested Persons with reactive test
HBV
Crude
Model 1
Model 2
Model 1 adjusted for age and gender; Model 2 further adjusted for key population (MSM, Sex worker, people who use drugs).
Ref
2,04
1,38
16,34
11,57 10,46
13,58
7,32
5,64
0,1
1
10
100
crude model 1 model 2 crude model 1 model 2 crude model 1 model 2
Portugal Other European Country African country Asia, Middle East, Oceania
OR /aOR(IC 95%)
Syphilis
7562
3100
665
5385
234
0
1000
2000
3000
4000
5000
6000
7000
8000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested
Syphilis
7562
3100
665
5385
234
0,7%
1,6%
0,6%
1,0%
1,7%
0,0%
0,2%
0,4%
0,6%
0,8%
1,0%
1,2%
1,4%
1,6%
1,8%
0
1000
2000
3000
4000
5000
6000
7000
8000
Portugal Brazil, Latin America,
and Caribbean
Other European
Country
African country Asia, Middle East,
Oceania
Persons tested Persons with reactive test
Syphilis
Crude
Model 1
Model 2
Model 1 adjusted for age and gender; Model 2 further adjusted for key population (MSM, Sex worker, people who use drugs).
Ref
2,22 2,52
1,68
0,83
1,02
0,6
1,31 1,48 1,68
2,33 2,38 2,36
0,1
1
10
crude model 1 model 2 crude model 1 model 2 crude model 1 model 2 crude model 1 model 2
Portugal Brazil, Latin America, and
Caribbean
Other European Country African country Asia, Middle East, Oceania
OR /aOR(IC 95%)
Migrants present an higher risk for HIV, HBV and syphilis infection:
For HIV and Syphilis: Brazil, Latin America and Caribbean, African countries;
For HBV: African countries and Asia, Middle East and Oceania.
The Portuguese population presents a higher risk for an HCV infection.
Social factors that migrants are subjected in the host country are key factor
to this higher risk presented.
There is a need for specific prevention and testing responses according to
the region of birth and infectious agent.
Acknowledgements
ISPUP: Milton Severo
FOLLOW ISPUP ON SOCIAL MEDIA
www.ispup.up.pt
mjnovais@ispup.up.pt
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