Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study

Achieving the Joint United Nations Program on human immunodeficiency virus (HIV)/AIDS Fast-Track targets requires additional strategies for mobile populations. We examined trends and socio-demographics of migrants (overseas-born) and Australian-born individuals presenting with late and advanced HIV diagnoses between 2008 and 2017 to help inform public health approaches for HIV testing coverage and linkage to care and treatment. We conducted a retrospective population-level observational study of individuals diagnosed with HIV in Australia and reported to the National HIV Registry. Annual proportional trends in late (CD4+ T-cell count <350 cells/μL) and advanced (CD4+ T-cell count <200 cells/μL). HIV diagnoses were determined using Poisson regression. Of 9926 new HIV diagnoses from 2008 to 2017, 84% (n = 8340) were included in analysis. Overall, 39% (n = 3267) of diagnoses were classified as late; 52% (n = 1688) of late diagnoses were advanced. Of 3317 diagnoses among migrants, 47% were late, versus 34% of Australian-born diagnoses (P < .001). The annual proportions of late (incidence rate ratio [IRR] 1.00; 95% confidence interval [CI] 0.99–1.01) and advanced HIV diagnoses (IRR 1.01; 95% CI 0.99–1.02) remained constant. Among migrants with late HIV diagnosis, the proportion reporting male-to-male sex exposure (IRR 1.05; 95% CI 1.03–1.08), non-English speaking (IRR 1.03; 95% CI 1.01–1.05), and individuals born in countries in low HIV-prevalence (IRR 1.02; 95% CI 1.00–1.04) increased. However, declines were noted among some migrants’ categories such as females, heterosexual exposure, English speaking, and those born in high HIV-prevalence countries. Late HIV diagnosis remains a significant public health concern in Australia. Small declines in late diagnosis among some migrant categories are offset by increases among male-to-male exposures. Reaching the Fast-Track targets in Australia will require targeted testing and linkage to care strategies for all migrant populations, especially men who have sex with men.