Migration‐related inequalities in HIV diagnosis, treatment initiation and retention in care among migrants in Greece

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OBJECTIVES: Migrants account for a substantial proportion of people living with HIV in Europe, yet inequalities across the HIV care continuum remain insufficiently characterized. We examined migration-related differences in HIV diagnosis, treatment initiation and retention in care in Greece. METHODS: We analyzed data from the Athens Multicenter AIDS Cohort Study (AMACS), including individuals diagnosed with HIV between 1996 and 2024. Participants were classified by region of origin. Markers of HIV diagnosis (CD4 cell count, late presentation, advanced disease and time from seroconversion to diagnosis) and post-diagnosis outcomes (time to antiretroviral therapy [ART] initiation and loss to follow-up [LTFU]) were evaluated using appropriate regression and flexible parametric survival models. RESULTS: Among 11 467 individuals, 19.3% were migrants. Migrants presented with more advanced disease, including higher rates of late presentation (71.0% among those from Africa vs. 48.9% among Greek-born) and longer diagnostic delays (median 4.8 vs. 3.1 years, respectively). Over time, differences in late presentation narrowed, although advanced disease and diagnostic delay remained higher among some groups. Time to ART initiation decreased substantially with attenuated differences between groups after adjustment for CD4 levels at diagnosis. In contrast, recorded LTFU in AMACS increased over time and remained higher among migrants, reaching 49% within 3 years among individuals from Africa compared with 12% among Greek-born. CONCLUSIONS: Inequalities in HIV care outcomes across region-of-origin groups in Greece persist but have shifted along the care continuum. While timely ART initiation has largely equalized, disparities remain in delayed diagnosis and recorded follow-up. Targeted strategies to mitigate observed inequalities are essential.

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