Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis

Daniel K Nomah; Yesika Díaz; Andreu Bruguera; Sergio Moreno-Fornés; Jordi Aceiton; Juliana Reyes-Urueña; Josep M Llibre; Vicenç Falcó; Arkaitz Imaz; Francisco Javier Fanjul; Joaquim Peraire; Elisabet Deig; Pere Domingo; Alexy Inciarte; Jordi Casabona; José M Miró

doi:10.1093/ofid/ofad693

Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis

Open Forum Infect Dis. 2024 Jan 5;11(1):ofad693. doi: 10.1093/ofid/ofad693. eCollection 2024 Jan.

Authors

Daniel K Nomah^{1

2}, Yesika Díaz^{1

2

3}, Andreu Bruguera^{1

2

3

4}, Sergio Moreno-Fornés^{1

2

3}, Jordi Aceiton^{1

2}, Juliana Reyes-Urueña¹, Josep M Llibre⁵, Vicenç Falcó⁶, Arkaitz Imaz⁷, Francisco Javier Fanjul⁸, Joaquim Peraire^{9

10}, Elisabet Deig¹¹, Pere Domingo¹², Alexy Inciarte¹³, Jordi Casabona^{1

2

3

4}, José M Miró^{10

13}

Affiliations

¹ Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain.
² Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain.
³ CIBER Epidemiologia y Salud Pública, Barcelona, Spain.
⁴ Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain.
⁵ Fight Against Infections Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
⁶ Infectious Disease Division, Hospital Universitari Vall D'Hebron, Barcelona, Spain.
⁷ HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.
⁸ Infectious Diseases Unit, Hospital Son Espases, Palma de Mallorca, Spain.
⁹ Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain.
¹⁰ CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
¹¹ Infectious Diseases Unit, Hospital General de Granollers, Granollers, Spain.
¹² Department of Infectious Diseases, HIV Infection Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹³ Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.

Abstract

Background: Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors.

Methods: Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression.

Results: The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants.

Conclusions: MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.

Keywords: COVID-19; HIV; SARS-CoV-2; migrants; vaccination.