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.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-013-0494-0) contains supplementary material, which is available to authorized users.
Highlights
Global estimates suggest that 8 million people, or 54 % of 14.8 million who are eligible, receive highly active antiretroviral therapy (HAART) [1]
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
Previous studies among conflict-affected groups reported high levels of adherence and good treatment outcomes, suggesting that barriers may be overcome; most of this work was conducted in Sub-Saharan Africa or with refugees based in high-income countries [6]
Summary
Global estimates suggest that 8 million people, or 54 % of 14.8 million who are eligible, receive highly active antiretroviral therapy (HAART) [1]. Refugees are persons who have fled across an international border and have a recognised international legal status that should enable them to receive access to medical care on an equivalent basis to host nationals in their countries of asylum [2]. Given potential obstacles such as language barriers, lack of employment and risk of further displacement to other countries [3, 4], there are concerns as to whether refugees who have initiated HAART are sufficiently stable and capable of sustaining optimal adherence and viral suppression. We hypothesized that refugees would exhibit inferior outcomes when compared with the surrounding host community
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