Grant: Travel Awards - Institute Community Support

Background Providing migrants living with HIV (MLWH) with free antiretroviral therapy (ART) rapidly, onsite, and within a multidisciplinary model of care may improve their health outcomes. However, there is limited evidence of how social determinants of health (SDH) may affect the HIV-related health outcomes of migrants enrolled in such care. Methods In January 2020, we initiated a 96-week cohort study at a clinic in Montreal (the 'ASAP Study'). All participants received ART for free, onsite, and as soon as possible after being linked to the clinic. MLWH received care by a multidisciplinary team of physicians, nurses, social workers, and pharmacists. The association of SDH (i.e., immigration status, age, sexual orientation, education, employment) with median time (in days) to ART initiation and undetectability from care linkage was assessed via univariate Cox regression with bootstrapping. Results Most participants: had a stable immigration status in Canada (54%); were 35 or older (57%); identified as gay or bisexual (63%); had university-level education (57%); and were unemployed (69%). Median time to initiate ART was 5 days (range: 0-50). Median time to reach undetectability was 57 days (range: 5-365). Those who had a longer median time to ART initiation: had a stable immigration status (p-value=0.001); were less than 35 years old (p-value=0.002); identified as heterosexual (p-value = <0.001); had less than a university-level education (p-value = 0.003); or were unemployed (p-value = 0.021). No factor was found to significantly affect time to undetectability. Conclusions Within a multidisciplinary care setting with rapid, onsite, cost-covered ART, 50% of MLWH began ART in 5 days and reached undetectability in 57 days. All assessed social factors significantly affected time to ART initiation. Despite this, no significant differences were identified by social factor in the attainment of undetectability, suggesting preliminary support for this model of care.