BACKGROUND AND OBJECTIVE: HIV infection continues to be a priority public health problem in Catalonia. Since available resources are limited, health systems must use accurate data to justify investments. The general objective of this thesis is to contribute to the improvement of health policies and preventive strategies directed at high risk and vulnerable populations, through the improvement, use and integration of different sources of strategic information. METHODS: Descriptive and population-based estimation studies. Study 1: Descriptive analysis comparing the number of cases reported and their epidemiological characteristics in two different periods of time; Period of voluntary notification (2001-2009) and mandatory notification (2010-2011). Study 2: Statistical analysis identified factors associated with self-reported HIV, HCV and co-infection. Study 3: analysis according to the cascade of HIV services, describing risk behaviours, access to test, HIV trends and clinical-epidemiological characteristics among migrant and Spanish population. Study 4: The estimation of the incidence of HIV, time between infection and diagnosis, and undiagnosed population was stratified by CD4, using the ECDC HIV modelling tool, v1.2.2. RESULTS: Study 1: Time series analysis showed that the decree increased 2.8 times (IC 95% = 2.4-3.3) the probability of a case being reported. In addition, described that after the entry into force of the decree the proportion of people under 30 years of age increased from 8.1% to 29.5% (p <0.001); and that the proportion of migrants and the proportion of cases reporting sexual transmission from 64.2% to 80.4% (p<0.001), also increased. Study 2: Overall, 39.65% declared to be HCV+, 14.84% HIV+, and 13.48% were co-infected. From the 224 PIDs, 187 (83.48%), 68 (30.36%) and 66 (29.46%) reported being HCV+, HIV+ and co-infected, respectively. A higher proportion of HIV + cases were observed in women, 18.33% vs. 13.78% in men. The prevalence of HCV, HIV and co-infection was higher in those who indicated early drug use, longer injection periods, or being unemployed. Study 3: A greater number of barriers to accessing HIV testing services in migrants were evidenced. Between 2001-2013 new HIV diagnoses increased among migrants, from 24% (2001) to 41% (2013). By 2013, 6,000 HIV+ patients were followed up, of which 1,837 (30.6%) were migrants, 83.1% were retained in care and 67% were viral suppressed (SV). While local, 88% were retained and 75.8% were in SV. Study 4: In 2013, the estimated total number of people living with HIV in Catalonia was 34,729 (95% CI =32,740-36,827), with 12.3% (95% CI =11.8-18.1) undiagnosed. In the same year, 8,458 (8,101, 9,079) Spanish MSM were living with HIV, with 16.4% undiagnosed (14.2, 17.7), while the total number of migrant MSM was 2,538 (2,334, 2,918) with 32.3% (28.4, 34.4) undiagnosed. CONCLUSIONS: Based on this integration, it has been identified that the local endemic is focused on at-risk and vulnerable populations. Immigrants are a population vulnerable to HIV infection, and are at risk of late access to diagnosis, linkage to care and ART treatment. In addition, HIV infection in Catalonia has continued to expand during the last decade because of MSM, the at-risk group sustaining HIV transmission, since a large proportion living with HIV are unaware of their HIV status and are asymptomatic.
| Date of Award | 26 Sept 2017 |
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| Original language | Spanish |
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| Supervisor | Jordi Casabona Barbara (Director), Juan Arturo Cayla Buqueras (Director) & Patricia Garcia de Olalla (Director) |
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