Psychosocial vulnerabilities and loss to follow‐up in people living with
HIV
in France
Charlène Mafuta, Sophie Grabar, Laurence Lievre, Cécile Goujard, Jean‐Paul Viard, Olivier Bouchaud, Laurence Meyer, Rémonie Seng, Sophie Abgrall Abstract
Background
Migration status is consistently associated with a higher risk of loss to follow‐up (LTFU). We investigated how sex, sexual orientation and social vulnerabilities affect the association between migration status and LTFU for hospital care in people living with HIV, using data from the ANRS CO9‐COPANA cohort linked to the nationwide French hospital database on HIV (ANRS CO4‐FHDH).
Methods
The COPANA prospective cohort enrolled antiretroviral drug‐naïve adults newly diagnosed with HIV‐1 between 2004 and 2008 in France. LTFU in the hospital setting was defined as no clinical follow‐up for ≥24 months before the study end. Fine and Gray models accounting for death as a competing event were used to assess factors associated with LTFU.
Results
The 616 participants included 333 born in France, 209 born in sub‐Saharan Africa and 74 born in other regions. There were 432 male participants, including 281 men who have sex with men (MSM). The cumulative incidence of LTFU was 17% (95% CI: 14–20) at 10 years. Migrant MSM and migrant women had a higher crude risk of LTFU than French‐born MSM. After adjustment for several social factors, the risk of LTFU remained higher in migrant MSM. Lack of psychological support and non‐disclosure of HIV status to friends were associated with a higher risk of LTFU and had the greatest impact on the difference between crude and adjusted sub‐distribution hazard ratios for LTFU in both male and female migrants.
Conclusion
The higher risk of LTFU from hospital‐based care in migrant MSM and women was attenuated after adjustment for social vulnerabilities, suggesting that these factors contribute to the observed association.