Material deprivation and its correlates in treatment-naïve migrants with HIV with rapid access to B/F/TAF at no cost: A sub-study of the ASAP cohort.

Abstract

ObjectivesMaterial deprivation (MD), the inability to afford essentials, is linked with poorer HIV clinical outcomes. In Canada, migrants living with HIV are a growing group, yet little is known about their experience of MD, especially early in treatment. This study examined the prevalence, nature, sociodemographic and clinical correlates and longitudinal changes in MD among migrants living with HIV initiating antiretroviral therapy (ART).MethodsAnalyses used data from 56 ART-naïve migrants enrolled in the Antiretroviral Speed Access Program (ASAP), a cohort at the McGill University Health Centre, Montreal, Canada receiving access to rapid, no-cost and onsite bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). MD was assessed at Weeks 4 and 48 using the 17-item Canadian Material Deprivation Index (CMDI), with deprivation defined as checking ≥2 items. Statistical tests included Fisher's exact, Wilcoxon signed-rank, McNemar's exact and correlation coefficients.ResultsAt Week 4, 48 (85.7%) participants were materially deprived, most commonly reporting inability to cover an unexpected expense (87.5%), afford dental care (73.2%) or buy small gifts (73.2%). Week 4 MD was significantly associated with occupation (p = 0.020) and migration status (p = 0.016). No statistically significant associations were observed between MD and HIV clinical outcomes. Between Weeks 4 and 48, MD scores declined significantly (median: 7.5 to 4.0; p ConclusionsAssociated with occupation and migrant status, MD was highly prevalent and persistent among migrants living with HIV, despite partial improvement over time, underscoring the need for structural supports. Short-term HIV clinical outcomes appeared unaffected, which may reflect access to rapid, no-cost and onsite ART delivery.