Accessing HIV Care to Irregular Migrants in Israel, 2019-2024

Area of Science:

• Public health
• Infectious diseases
• Health policy

Background:

• Irregular migrants (IMs) living with HIV-1 in Israel lack access to regular health insurance.
• A public-private partnership (PPP) program was established in 2014 to provide HIV-1-related healthcare coverage.
• Characterization of IMs referred to the PPP between 2019-2024 is essential for understanding program effectiveness.

Purpose of the Study:

• To characterize irregular migrants (IMs) with HIV-1 referred to the Israeli public-private partnership (PPP) program.
• To evaluate the immunological and virological outcomes of antiretroviral treatment (ART) in this cohort.
• To identify resistance mutations and phylogenetic relationships in cases of viral failure.

Main Methods:

• A cohort of IMs referred to the PPP from 2019-2024 was characterized.
• A linear mixed-effects model was used to track CD4 counts and HIV-1 viral load (VL) over a median of 16 months.
• Subtyping, resistance mutation analysis, and phylogenetic analysis were performed on samples from patients with viral failure.

Main Results:

• Most referred IMs (231/238) initiated ART, primarily with nucleoside reverse transcriptase inhibitors (NRTIs) combined with NNRTIs or PIs.
• All patients showed significant increases in CD4 counts and decreases in VL (p < 0.001).
• Two CD4 trajectory patterns were identified: Class-1 (lower initial CD4, slower recovery, often from Africa) and Class-2 (higher initial CD4, faster recovery). Treatment failure occurred in 5.6%, with M184V and K103N being the most common resistance mutations.

Conclusions:

• Despite ART regimens not fully aligning with current first-line recommendations, the PPP program demonstrated favorable virological and immunological responses in most IMs with HIV-1.
• The prevalence of resistance mutations was comparable to that in the general HIV-1-positive population covered by national health insurance.
• The PPP offers a valuable therapeutic avenue for irregular migrants living with HIV-1, addressing a critical gap in healthcare access.