Psychosocial vulnerabilities and loss to follow-up in people living with HIV in France

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).

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.

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.

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.