Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia
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 surv...
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| Veröffentlicht in: | AIDS and behavior 2014-02, Vol.18 (2), p.323-334 |
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| creator | 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. |
| description | 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
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| doi_str_mv | 10.1007/s10461-013-0494-0 |
| format | Article |
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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.</description><identifier>ISSN: 1090-7165</identifier><identifier>EISSN: 1573-3254</identifier><identifier>DOI: 10.1007/s10461-013-0494-0</identifier><identifier>PMID: 23748862</identifier><identifier>CODEN: AIBEFC</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>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</subject><ispartof>AIDS and behavior, 2014-02, Vol.18 (2), p.323-334</ispartof><rights>The Author(s) 2013</rights><rights>Springer Science+Business Media New York 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-725f26f74b959f8e9e154705275bb13148fff8312b6e652129e28cfe5db795b23</citedby><cites>FETCH-LOGICAL-c536t-725f26f74b959f8e9e154705275bb13148fff8312b6e652129e28cfe5db795b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10461-013-0494-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10461-013-0494-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27343,27923,27924,33773,33774,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23748862$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mendelsohn, Joshua B.</creatorcontrib><creatorcontrib>Schilperoord, Marian</creatorcontrib><creatorcontrib>Spiegel, Paul</creatorcontrib><creatorcontrib>Balasundaram, Susheela</creatorcontrib><creatorcontrib>Radhakrishnan, Anuradha</creatorcontrib><creatorcontrib>Lee, Christopher K. C.</creatorcontrib><creatorcontrib>Larke, Natasha</creatorcontrib><creatorcontrib>Grant, Alison D.</creatorcontrib><creatorcontrib>Sondorp, Egbert</creatorcontrib><creatorcontrib>Ross, David A.</creatorcontrib><title>Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia</title><title>AIDS and behavior</title><addtitle>AIDS Behav</addtitle><addtitle>AIDS Behav</addtitle><description>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.</description><subject>Acquired Immune Deficiency Syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>CD4 Lymphocyte Count</subject><subject>Clinical outcomes</subject><subject>Cross-Sectional Studies</subject><subject>Emigration and Immigration</subject><subject>Female</subject><subject>Females</subject><subject>Health Psychology</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - virology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infectious Diseases</subject><subject>Kuala Lumpur, Malaysia</subject><subject>Malaysia</subject><subject>Medications</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Migration</subject><subject>Multivariate Analysis</subject><subject>Original Paper</subject><subject>Patient Compliance</subject><subject>Public Health</subject><subject>Refugees</subject><subject>Socioeconomic Factors</subject><subject>Treatment Outcome</subject><subject>Treatment Outcomes</subject><subject>Urban Areas</subject><subject>Viral Load - drug effects</subject><issn>1090-7165</issn><issn>1573-3254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>BHHNA</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFks1uEzEUhUcIRH_gAdggS2xYdMC_Y3tDVSJKIlJVIoWt5Zmxg6sZO9hjpLwLD4tDShWQUFe2db57rHvvqaoXCL5BEPK3CUHaoBoiUkMqaQ0fVceIcVITzOjjcocS1hw17Kg6SekWQigbLp9WR5hwKkSDj6ufiwQuQ-xMD67cOurJBQ80eK9jdCaCKYCbaPQ0Gj-BVe46k9I5WLnRDTqC-eLrgXydpy6MJoGLMfg1-GxsXpvy1L4vjqscY8i-d0WahzSBWRjH7N20Bc6DT1kPGizzuMnxDFyVxzY5_ax6YvWQzPO787T6cvnhZjavl9cfF7OLZd0x0kw1x8zixnLaSiatMNIgRjlkmLO2RQRRYa0VBOG2MQ3DCEuDRWcN61suWYvJafVu77vJ7Wj6rnQT9aA20Y06blXQTv2tePdNrcMPRSRkiJNi8PrOIIbv2aRJjS51Zhi0NyEnhRoBESvLwg-jrGyWEyqah1EqMYdQiJ3rq3_Q25CjL0P7TWGIKGeFQnuqiyGlaOx9iwiqXaLUPlGqJErtEqVgqXl5OJv7ij8RKgDeA6lIfm3iwdf_df0F3m7WYA</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Mendelsohn, Joshua B.</creator><creator>Schilperoord, Marian</creator><creator>Spiegel, Paul</creator><creator>Balasundaram, Susheela</creator><creator>Radhakrishnan, Anuradha</creator><creator>Lee, Christopher K. 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Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia</title><author>Mendelsohn, Joshua B. ; Schilperoord, Marian ; Spiegel, Paul ; Balasundaram, Susheela ; Radhakrishnan, Anuradha ; Lee, Christopher K. 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C.</creatorcontrib><creatorcontrib>Larke, Natasha</creatorcontrib><creatorcontrib>Grant, Alison D.</creatorcontrib><creatorcontrib>Sondorp, Egbert</creatorcontrib><creatorcontrib>Ross, David A.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Social Services Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Criminal Justice Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Criminology Collection</collection><collection>Sociological Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Sociology Collection</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Criminal Justice Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Sociology Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>AIDS and behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mendelsohn, Joshua B.</au><au>Schilperoord, Marian</au><au>Spiegel, Paul</au><au>Balasundaram, Susheela</au><au>Radhakrishnan, Anuradha</au><au>Lee, Christopher K. C.</au><au>Larke, Natasha</au><au>Grant, Alison D.</au><au>Sondorp, Egbert</au><au>Ross, David A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia</atitle><jtitle>AIDS and behavior</jtitle><stitle>AIDS Behav</stitle><addtitle>AIDS Behav</addtitle><date>2014-02-01</date><risdate>2014</risdate><volume>18</volume><issue>2</issue><spage>323</spage><epage>334</epage><pages>323-334</pages><issn>1090-7165</issn><eissn>1573-3254</eissn><coden>AIBEFC</coden><abstract>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.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23748862</pmid><doi>10.1007/s10461-013-0494-0</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS and behavior, 2014-02, Vol.18 (2), p.323-334 |
| issn | 1090-7165 1573-3254 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3905173 |
| source | MEDLINE; Sociological Abstracts; SpringerLink Journals - AutoHoldings |
| 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 |
| title | Is Forced Migration a Barrier to Treatment Success? Similar HIV Treatment Outcomes Among Refugees and a Surrounding Host Community in Kuala Lumpur, Malaysia |
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