Patient-reported outcomes reveal disparities in HIV care: migrants in Sweden experience lower adherence and more side effects

Migrants in Europe are disproportionally affected by HIV and often experience poorer health outcomes, including lower rates of viral suppression. Integration of patient-reported outcome measures (PROM) in routine HIV care is recommended to improve health-related quality of life. In Sweden, a PROM questionnaire has been implemented in routine HIV care. The aim was to investigate differences in PROMs between migrants, defined as individuals born abroad, and Swedish-born people with HIV (PWH). This is a cross-sectional registry-based observational study including adult PWH who completed PROMs in 2020. Multivariable logistic regression models were used to analyze associations between patient characteristics and PROMs. Of 7766 PWH in the national cohort, 2145 (27.6%) individuals completed PROMs of whom 53.3% were migrants. Missed doses of antiretroviral treatment (ART) were associated with being born abroad, aOR 1.94 (95% CI 1.4–2.7), and WHO birth region Africa aOR 2.71 (95% CI 1.8–4.1) and Americas aOR 2.60 (95% CI 1.6–4.3). Experience of ART side effects was more common among migrants 14% vs 10.2% p = 0.01, borderline significant in the adjusted analyses aOR 1.35 (95% CI 0.97–1.89) p = 0.08. Migrants were nearly twice as likely to report satisfaction with their physical health. Both groups felt equally involved in their HIV care and experienced high satisfaction with HIV care (94.5% of migrants and 95.7% of Swedish-born) with a trend for migrants being less satisfied aOR 0.65 (95% CI 0.4–1.1) p = 0.08. Further research is needed to understand underlying factors of disparities in PROM to enable improved treatment adherence and equitable healthcare outcomes.