PMID- 30832665 OWN - NLM STAT- MEDLINE DCOM- 20190812 LR - 20200309 IS - 1472-698X (Electronic) IS - 1472-698X (Linking) VI - 19 IP - 1 DP - 2019 Mar 5 TI - Impact of health insurance status among migrants from sub-Saharan Africa on access to health care and HIV testing in Germany: a participatory cross-sectional survey. PG - 10 LID - 10.1186/s12914-019-0189-3 [doi] LID - 10 AB - BACKGROUND: Among all newly diagnosed HIV cases in Germany in 2015, 16% originated from sub-Saharan Africa. Twelve percent of these infections were contracted within Germany and migrants from sub-Saharan Africa (misSA) are diagnosed later than Germans. Migrants, specifically those without health insurance, face many barriers accessing health care due to their residence status and cultural, socio-economic, legal and linguistic barriers. We assessed whether misSAs' access to healthcare and utilization of HIV testing services depends on their health insurance status to inform prevention strategies. METHODS: From January 2015 to February 2016, we conducted a cross-sectional survey on knowledge, attitude, behavior, practice (KABP) regarding HIV, viral hepatitis and sexually transmitted infections among misSA in Germany. The survey was a community-based participatory research project; trained peer researchers recruited participants through outreach. To detect differences between participants with a regular health insurance card compared to asylum seekers with a medical treatment voucher or participants without health insurance or medical treatment voucher, unadjusted and adjusted Odds Ratios, chi-squared tests and 95% confidence intervals were calculated. RESULTS: A total of 1919 cases were considered. Overall, 83% had a health insurance card, 10% had a medical treatment voucher and 6% had no health insurance. Participants living in Germany for less than 5 years were less likely to have a health insurance card and more likely to have lower German language skills. Participants without health insurance visited a physician in case of health problems less often than participants with medical treatment voucher or a health insurance card (41.2% vs. 66.1% vs. 90%). Participants without health insurance reported less frequently visiting physicians or hospitals and were less likely to undergo a HIV test. CONCLUSION: Having no health insurance or medical treatment voucher decreased the odds of contact with the healthcare system more than other socio-demographic characteristics. Furthermore, misSA without health insurance had lower odds of ever having done an HIV test than participants with health insurance. To increase health care utilization and testing and to ensure adequate medical care, all migrants should get access to health insurance without increasing costs and consequences for residence status. FAU - Mullerschon, Johanna AU - Mullerschon J AUID- ORCID: 0000-0003-3584-2331 AD - University of Applied Sciences Fulda, Leipzigerstr. 123, 36037, Fulda, Germany. Johanna_muellerschoen@web.de. AD - Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. Johanna_muellerschoen@web.de. FAU - Koschollek, Carmen AU - Koschollek C AD - Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. AD - Charite - Universitatsmedizin Berlin, Berlin, Germany. FAU - Santos-Hovener, Claudia AU - Santos-Hovener C AD - Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. FAU - Kuehne, Anna AU - Kuehne A AD - Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. AD - European Programme for Intervention Epidemiology Training (EPIET), ECDC, Granits vag 8, 171 65 Solna, Stockholm, Sweden. FAU - Muller-Nordhorn, Jacqueline AU - Muller-Nordhorn J AD - Institute of Public Health, Charite - Universitatsmedizin Berlin, Seestr. 73, 13347, Berlin, Germany. FAU - Bremer, Viviane AU - Bremer V AD - Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20190305 PL - England TA - BMC Int Health Hum Rights JT - BMC international health and human rights JID - 101088678 MH - Adult MH - Africa South of the Sahara/ethnology MH - *Community-Based Participatory Research MH - Cross-Sectional Studies MH - Female MH - Germany MH - HIV Infections/*diagnosis MH - Health Knowledge, Attitudes, Practice MH - *Health Services Accessibility/statistics & numerical data MH - Humans MH - Insurance, Health/*statistics & numerical data MH - Male MH - *Mass Screening MH - Medically Uninsured MH - Patient Acceptance of Health Care MH - Surveys and Questionnaires MH - Transients and Migrants/*statistics & numerical data PMC - PMC6399910 OTO - NOTNLM OT - Access to health care OT - HIV OT - Health care utilization OT - Health insurance OT - Human migration OT - Transients and migrants COIS- AUTHORS' INFORMATION: Not applicable. ETHICS APPROVAL AND CONSENT TO PARTICIPATE: No names, addresses or other personal identifiers were documented on the questionnaires. Prior to data entry all questionnaires were given a unique identifier. Data protection procedures were cleared by the RKI data protection officer. All peer researchers received training on the meaning and importance of informed consent. Prior to any recruitment, the study participants were informed of the study objective and voluntary and anonymous nature of the study. The questionnaire was only filled out if informed consent was verbally obtained. The Ethical Committee of the Charite Berlin granted full ethical clearance in November 2014 (EA4/105/14). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/03/06 06:00 MHDA- 2019/08/14 06:00 PMCR- 2019/03/05 CRDT- 2019/03/06 06:00 PHST- 2017/08/30 00:00 [received] PHST- 2019/01/16 00:00 [accepted] PHST- 2019/03/06 06:00 [entrez] PHST- 2019/03/06 06:00 [pubmed] PHST- 2019/08/14 06:00 [medline] PHST- 2019/03/05 00:00 [pmc-release] AID - 10.1186/s12914-019-0189-3 [pii] AID - 189 [pii] AID - 10.1186/s12914-019-0189-3 [doi] PST - epublish SO - BMC Int Health Hum Rights. 2019 Mar 5;19(1):10. doi: 10.1186/s12914-019-0189-3.