HIV testing behaviour of Vietnamese-born migrants in greater-Brisbane, Queensland ​​​​​​​

Abstract

nnnnnnnnn Timely diagnosis of human immunodeficiency virus (HIV) is important for management and prevention of HIV. In high-income countries (HICs), migrants often have disproportionately high rates of HIV, as compared to the host population, and high rates of late diagnosis of HIV. A small body of evidence exists on the HIV testing behaviour of migrants in HICs; although, there are numerous gaps. This study addresses several gaps in the evidence-base by examining the uptake of, and willingness to use/accept, HIV testing approaches by Vietnamese-born migrants in Australia (as compared to Australian-born adults; Objective One); quantitatively and qualitatively identifying barriers and facilitators to accessing HIV testing approaches for Vietnamese-born migrants in Australia (Objectives Two and Three, respectively); and assessing selected psychometric properties, i.e. construct validity and internal consistency reliability, of an HIV-related knowledge and HIV-related stigma scale in Vietnamese-born migrants and Australian-born adults (Objective Four).nnnnnnnnn This study was cross-sectional and used an explanatory sequential mixed methods design across three phases. Phase One was the quantitative data collection (quantitative questionnaire; n=350; Vietnamese-born n=177 and Australian-born n=173) and analysis (HIV testing behaviour: logistic regression; selected psychometric properties: Rasch analysis). Phase Two was the qualitative data collection (qualitative interviews; Vietnamese-born n=10) and analysis (the Framework method). Phase Three was interpretation, where findings from Phases One and Two were presented and synthesised. All phases drew on the Behavioural Model of Healthcare Utilisation (BMHU).nnnnnnnnn In multivariate analyses, uptake of, and willingness to use/accept, HIV testing approaches was largely not significantly different between Vietnamese-born migrants and Australian-born adults in the quantitative questionnaire (Objective One). Vietnamese-born migrants, however, had significantly lower odds of willingness to use rapid HIV testing, compared with Australian-born adults. In qualitative interviews, provider-initiated testing and counselling (PITC) was suggested to be widely acceptable to Vietnamese-born migrants, in contrast to client-initiated testing and counselling (CITC). Contrary to quantitative questionnaire findings, rapid HIV testing was largely acceptable to qualitative interview participants.n HIV self-testing (HIV ST) was largely acceptable to female participants, but not male participants.nnnnnnnnn Few significant barriers and facilitators were identified across HIV testing approaches for Vietnamese-born migrants after adjustments (Objective Two). Those identified were marital status, HIV-related knowledge, HIV risk behaviour and finding the cost of healthcare prohibitive. Qualitative interview participants identified numerous barriers and facilitators to HIV testing approaches (Objective Three), including gender, marital status, HIV-related knowledge, internalised HIV-related stigma, cost, convenience, accuracy of HIV testing, perceived HIV risk, HIV risk behaviour and symptoms. Additionally, qualitative interviewees contextualised quantitative findings. HIV risk behaviour was not widely significantly associated with HIV testing approaches in quantitative analyses. Qualitative interviews, however, highlighted that a subset of Vietnamese-born migrants have increased HIV risk, which was likely not well captured in the quantitative questionnaire. Likewise, qualitative interview participants discussed internalised HIV-related stigma as a salient barrier to HIV testing, but only externalised HIV-related stigma was captured in the quantitative questionnaire. Vietnamese-born migrants were also suggested to have insufficient HIV-related knowledge, particularly related to treatment and prognosis, but this was not captured in the Brief HIV Knowledge Questionnaire (HIV-KQ-18).nnnnnnnnn In Rasch analysis, neither the revised HIV-KQ-18 nor the revised AIDS-Related Stigma Scale (ARSS) were adequate measures of HIV-related knowledge and externalised HIV-related stigma, respectively (Objective Four). The revised HIV-KQ-18, after all appropriate revisions (from 18 to 14 items), did not fit the Rasch model, demonstrating poor construct validity within the study populations (however, internal consistency reliability was adequate). The revised ARSS fit the Rasch model and, therefore, had adequate construct validity in this study. The internal consistency reliability of the revised ARSS was below adequate in the current sample. Additionally, the revised ARSS was significantly reduced (from 9 to 6 items). The inadequacy of these scales in the study populations likely stemmed from multiple reasons, but particularly as both scales were quite dated. HIV-related knowledge and HIV-related stigma are theoretically complex and socially dynamic constructs, and scales measuring these constructs require regular updating and psychometric assessment.nnnnnnnnn At least a subset of Vietnamese-born migrants are at HIV risk and, therefore, require ongoing HIV testing. Timely uptake of HIV testing by these Vietnamese-born migrants is required for optimal HIV-related outcomes. Several interventions may facilitate HIV testing. These include increasing HIV-related knowledge and addressing internalised HIV-related stigma. There is also a need for up-to-date scales to measure these constructs. Additional research among migrants on newer HIV testing approaches, i.e. rapid HIV testing and HIV ST, is warranted, as well as research among healthcare providers on increased use of PITC with migrants. Increasing HIV testing is, however, only the first step in ensuring optimal outcomes, and appropriate care pathways are also required.