Abstract
Objectives
To examine regional and temporal trends in migration among patients receiving HIV treatment in British Columbia (BC).
Methods
Patients initiating antiretroviral therapy in BC between January 1993 and November 2004 were followed until November 2005. Migration was calculated as the cumulative number of times a patient’s residential address changed during their course of treatment. Analyses were performed at the provincial and at the regional health authority (HA) and local health area levels. Demographic methods were used to estimate the in- and out-migration rates, indices of dissimilarity and concentration across regions over time.
Results
A total of 3,588 participants were followed during the study period. Individuals who migrated most often migrated to the Vancouver Coastal HA (from the Interior: 30%, Fraser: 41%, Vancouver Island: 28%, and Northern: 19%), specifically the city of Vancouver, which has been treating the most patients with HIV since the early stages of the epidemic. We also showed that this movement intensified as more contemporary HAART regimens became available (p-value for trend <0.01).
Discussion
Our results demonstrate that migration among people with HIV in BC is not homogeneous, with areas around large urban centres having the highest influx of patients. It is thus important that health authorities in BC work in partnership to monitor and evaluate accessibility of HIV-related health care services to ensure universal access for all patients. Furthermore, enhanced HIV care and support services need to be developed, on a province-wide basis, and funding allocation needs to be adjusted to reflect patient migration in BC.
Keywords: HIV/AIDS, migration, regional analysis, trend, British Columbia, Canada
Résumé
Objectifs
Examiner les tendances migratoires régionales et temporelles chez les patients traités contre le VIH en Colombie-Britannique (C.-B.).
Méthode
Nous avons suivi jusqu’en novembre 2005 les patients ayant commencé un traitement antirétroviral en C.-B. entre janvier 1993 et novembre 2004. Leurs migrations ont été calculées selon le nombre total de changements d’adresse domiciliaire des patients durant leur traitement. Nous avons analysé les données à l’échelle provinciale et à l’échelle des régies régionales de la santé (RRS) et des services de santé municipaux. Des méthodes démographiques ont servi à estimer les taux d’immigration et d’émigration, les indices de dissimilarité et la concentration par région au fil du temps.
Résultats
Nous avons suivi 3 588 participants durant la période de l’étude. Les sujets ayant migré se déplaçaient le plus souvent vers la RRS de la région côtière de Vancouver (en provenance de l’intérieur de la province: 30%, de la vallée du Fraser: 41%, de l’île de Vancouver: 28%, et du Nord de la province: 19%), plus précisément vers la ville de Vancouver, qui traite le plus grand nombre de patients atteints de VIH depuis les premières manifestations de l’épidémie. Nous avons également montré que ce mouvement s’est intensifié lorsque la multithérapie antirétrovirale est devenue disponible (valeur prédictive de la tendance <0,01).
Discussion
Nos résultats montrent que les flux migratoires des personnes atteintes du VIH en C.-B. ne sont pas homogènes, car ce sont les zones périphériques des grands centres urbains qui reçoivent le plus de patients. Il est donc important que les autorités sanitaires de la province travaillent en partenariat pour surveiller et évaluer l’accessibilité des services de santé liés au VIH pour que tous les patients y aient droit. Il faudrait aussi mettre au point des services de soins et de soutien améliorés, dans toute la province, et réviser l’affectation des fonds en fonction des flux migratoires des patients atteints du VIH.
Motsclés: VIH, migration, analyse régionale, tendance, Colombie-Britannique, Canada
Footnotes
Conflict of Interests: Drs. Hogg and Montaner have received honoraria, travel grants to attend conferences and research grants from pharmaceutical companies working in the area of HIV/AIDS. Dr. Lima and Mr. Druyts declare no conflict.
References
- 1.Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance Report to June 30, 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. 2006. [Google Scholar]
- 2.Statistics Canada. Estimates of population, by age group and sex, Canada, provinces and territories, annual. CANSIM Table 051-0001. Available at: https://doi.org/www40.statcan.ca/l01/cst01/demo02a.htm (Accessed January 29, 2009).
- 3.Bitera R, Alary M, Fauvel M, Parent R; Institut national de santé publique du Québec. Programme de surveillance de l’infection par le virus de l’immuno-déficience humaine (VIH) au Québec - Mise à jour des données au 30 juin 2008. Available at: https://doi.org/www.inspq.qc.ca/pdf/publications/895_SurvVIH.pdf (Accessed September 2, 2009).
- 4.Remis RS, Swantee C, Schiedel L, Lui J. Report on HIV/AIDS in Ontario 2006. Ontario Ministry of Health and Long-Term Care. 2008. [Google Scholar]
- 5.Wood E, Low-Beer S, Bartholomew K, Landolt M, Oram D, O’Shaughnessy MV, et al. Modern antiretroviral therapy improves life expectancy of gay and bisexual males in Vancouver’s West End. Can J Public Health. 2000;91(2):125–28. doi: 10.1007/BF03404927. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.British Columbia Centre for Disease Control. STI/HIV Prevention and Control. 2007. [Google Scholar]
- 7.Hogg RS, Schechter MT, Schilder A, Le R, Strathdee SA, Goldstone IL, et al. Access to health care and geographic mobility of HIV/AIDS patients. AIDS Patient Care. 1995;9(6):297–302. doi: 10.1089/apc.1995.9.297. [DOI] [PubMed] [Google Scholar]
- 8.Hogg RS, Whitehead J, Ricketts M, Heath KV, Ng E, Lalonde P, et al. Patterns of geographic mobility of persons with AIDS in Canada from time of AIDS index diagnosis to death. Clin Invest Med. 1997;20(2):77–83. [PubMed] [Google Scholar]
- 9.Heath KV, Bally G, Yip B, O’Shaughnessy MV, Hogg RS. HIV/AIDS care giving physicians: Their experience and practice patterns. Int J STD AIDS. 1997;8(9):570–75. doi: 10.1258/0956462971920802. [DOI] [PubMed] [Google Scholar]
- 10.Lima VD, Johnston K, Hogg RS, Levy AR, Harrigan PR, Montaner JSG. Expanded access to highly active antiretroviral therapy: A potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis. 2008;198(1):59–67. doi: 10.1086/588673. [DOI] [PubMed] [Google Scholar]
- 11.Lima VD, Hogg RS, Harrigan PR, Moore D, Yip B, Wood E, et al. Continued improvement in survival among HIV infected individuals following initiation of triple and boosted combination antiretroviral regimens. AIDS. 2007;21(6):685–92. doi: 10.1097/QAD.0b013e32802ef30c. [DOI] [PubMed] [Google Scholar]
- 12.British Columbia Centre for Excellence in HIV/AIDS. Therapeutic Guidelines. 2006. [Google Scholar]
- 13.British Columbia Ministry of Health Services. Health Authorities. Roles and Responsibilities of Health Authorities. Available at https://doi.org/www.healthser-vices.gov.bc.ca/socsec/roles.html. (Accessed December 15, 2008).
- 14.Shryock H, Siegel J. The Methods and Materials of Demography. Washington, DC: U.S. Department of Commerce, Bureau of Census; 1980. [Google Scholar]
- 15.Kpedekpo GMK. Essentials of Demographic Analysis for Africa. London, UK: Heinemann; 1982. [Google Scholar]
- 16.Lima VD. Small-Area Disability-Adjusted Life Years: A New Approach to the Spatio-Temporal Analysis of Public Health Surveillance Data. 2005. [Google Scholar]
- 17.BC Stats, BC Ministry of Labour and Citizens’ Services, Government of British Columbia. Population Estimates and Projections (P.E.O.P.L.E. 31) by Standard Age Groups. Available at https://doi.org/www.bcstats.gov.bc.ca/data/pop/pop/est-spop.asp (Accessed September 10, 2008).
- 18.Agee BS, Funkhouser E, Roseman JM, Fawal H, Holmberg SD, Vermund SH. Migration patterns following HIV diagnosis among adults residing in the nonurban Deep South. AIDS Care. 2006;18(Suppl1):S51–S58. doi: 10.1080/09540120600839355. [DOI] [PubMed] [Google Scholar]
- 19.Berk ML, Schur CL, Dunbar JL, Bozzette S, Shapiro M. Short report: Migration among persons living with HIV. Soc Sci Med. 2003;57(6):1091–97. doi: 10.1016/S0277-9536(02)00487-2. [DOI] [PubMed] [Google Scholar]
- 20.Harris NS, Dean HD, Fleming PL. Characteristics of adults and adolescents who have migrated from place of AIDS diagnosis to place of death, United States, 1993–2001. AIDS Educ Prev. 2005;17(6SupplB):39–48. doi: 10.1521/aeap.2005.17.Supplement_B.39. [DOI] [PubMed] [Google Scholar]
- 21.Rachlis B, Brouwer KC, Mills EJ, Hayes M, Kerr T, Hogg RS. Drug Alcohol Depend. 2007. Migration and transmission of blood-borne infections among injection drug users: Understanding the epidemiologic bridge. [DOI] [PubMed] [Google Scholar]
- 22.Delgado J, Heath KV, Yip B, Marion S, Alfonso V, Montaner JS, et al. Highly active antiretroviral therapy: Physician experience and enhanced adherence to prescription refill. Antivir Ther. 2003;8(5):471–78. [PubMed] [Google Scholar]