Submission ID 132043
| Issue/Objective | Asylum seekers have historically experienced many barriers to timely HIV care. In Québec, this population represents an increasing proportion of individuals accessing HIV services, especially at the Chronic Viral Illness Service of the McGill University Health Centre (CVIS, MUHC), Montréal. This study aims to describe contemporary delays in the HIV care cascade among asylum seekers newly registered at the CVIS. |
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| Methodology/Approach | We conducted a retrospective cohort study of adult asylum seekers living with HIV newly registered at the CVIS between January 2022 and December 2024. Data were obtained from electronic medical records and the CVIS HIV surveillance system, including dates of HIV care cascade milestones. We describe median time intervals and interquartile ranges (IQR) in days across main care cascade milestones. |
| Results | Between 2022 and 2024, of 695 patients initiating care at the CVIS, 528 were asylum seekers (76% ). Among them, 245/528 (47%) were newly diagnosed, 236/528 (45%) arrived in Canada aware of their HIV status and on antiretroviral therapy (ART), and 40/528 (8%) arrived aware of their status, but not being on ART at first visit. Overall, 76% achieved viral suppression. Median times from entry to Canada until viral suppression varied: 127 days for those newly diagnosed, 114 days for those previously diagnosed on ART, and 124 days for those previously diagnosed but not on ART. Among newly diagnosed individuals, median delays were 28 days (IQR:18-42) from diagnosis to first clinic visit and 18 days (IQR:7-27) from first clinic visit to ART prescription. Among previously diagnosed individuals, those already on ART experienced no excess delay, as timelines were consistent with expected care cascade intervals, whereas those not on ART experienced a longer delay of 17 days (IQR: 7-28) from linkage to care to ART prescription, similar to newly diagnosed patients. |
| Discussion/Conclusion | Despite rapid diagnosis via the IME, delays persist in linkage to care across all groups, including those already aware of their status prior to arrival. Areas to improve are missed opportunities for promoting rapid access to treatment such as gaps in communication between IME physician and patients, intake processes, and triaging within the CVIS which delay cascade progression. |
| Presenters and Affiliations | Amrita N. Verma McGill University Claire Dufrêne-Boelen McGill University Bertrand Lebouché McGill University Health Centre Kathy Nodzynski McGill University Health Centre David Lessard McGill University Health Centre Research Institute |
