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

Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada
Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon
Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal
Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia
Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark
NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia
European Centre for Disease Prevention and Control, 16973 Solna, Sweden
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(8), 1700;
Received: 21 June 2018 / Revised: 19 July 2018 / Accepted: 1 August 2018 / Published: 9 August 2018
(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)
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. View Full-Text
Keywords: HIV; AIDS; stigma; refugees; migrants HIV; AIDS; stigma; refugees; migrants
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Pottie, K.; Lotfi, T.; Kilzar, L.; Howeiss, P.; Rizk, N.; Akl, E.A.; Dias, S.; Biggs, B.-A.; Christensen, R.; Rahman, P.; Magwood, O.; Tran, A.; Rowbotham, N.; Pharris, A.; Noori, T.; Pareek, M.; Morton, R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 1700.

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