HIV Infection and Engagement in the Care Continuum Among Venezuelan Migrants and Refugees: Results of a Biobehavioral Survey in Colombia

Background: Migration and forced displacement are long-standing but rapidly evolving global phenomena. HIV research is necessary to inform programming for displaced and host communities but limited by logistical, methodological and ethical challenges. Policies related to legal migration status affect access to HIV services in some receiving countries. This study aimed to estimate HIV prevalence and associated indicators among Venezuelan migrants and refugees in Colombia, the largest receiving country, to inform treatment distribution.Methods: We conducted a biobehavioral survey using respondent-driven sampling among Venezuelan adults who arrived in Colombia since 2015 and resided in four cities. Participants completed socio-behavioral questionnaires and rapid HIV and syphilis screening with laboratory-based confirmatory testing and viral load quantification. Legal assistance was provided for participants with HIV for sustained access to treatment. Population-based estimates were weighted for the complex sampling design. Penalized multivariable logistic regression analysis was used to identify correlates of viral suppression (HIV RNA<1,000 copies/mL).Findings: Between July 2021–February 2022, 6,221 participants were enrolled. Population HIV prevalence was 0·9% (95%CI: 0·6-1·4). Among the sample living with HIV, 47·9% were previously diagnosed and 35·2% virally suppressed. Individuals with irregular migration status (reference: regular; aOR:0·3, 95%CI: 0·1-0·9), and with a last HIV test in Colombia (reference: Venezuela; aOR:0·2, 95%CI: 0·1-0.8) were independently less likely to have suppressed viral loads.Interpretation: The HIV epidemic is close to a generalized stage and marked by low testing and diagnosis among Venezuelan migrants and refugees in Colombia. There is a clear link between legal migration status and viral suppression, conferring clinical and epidemiological implications. HIV service delivery may be supported by innovative testing strategies, coordination with humanitarian programs, and inclusion of migrants and refugees in local HIV services. Legal aid may support early detection and treatment for people with irregular migration status.Funding Statement: (Centers for Disease Control and Prevention) This work was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement number NU2GGH002000-03-01. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of PEPFAR, the CDC, or the Department of Health and Human Services.Declaration of Interests: The authors declare not conflicts of interest.Ethics Approval Statement: Study activities were reviewed and approved by the Ethical Review Committee at theUniversidad El Bosque in Bogotá, Colombia, and the Institutional Review Board at Johns Hopkins School of Public Health. The protocol was also reviewed in accordance with CDC human research protection procedures. Participants were provided with referrals as needed for HIV services, mental health, violence, health, and humanitarian services. To mitigate risks associated with the ongoing pandemic, study implementation followed approved biosecurity protocols and local COVID-19 policies.