Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan.
Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exam. Descriptive characteristics of HIV-positive migrant who had lived in the Russian Federation (n=503) were calculated and compared with those of HIV-positive non-migrants (n=9519). Missing data were imputed using a multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model is shows multivariable associations between significant study variables identified in the univariate model, and late presentation.
Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers.. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation.
Conclusion The results of this paper suggest that if the Russian Federation were to loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.