Realist Review

Peer interventions to improve HIV testing uptake among immigrants: A realist review

Introduction

Human immunodeficiency virus (HIV) continues to be a major global public health issue. In 2022, 1.3 million new HIV cases were identified worldwide, where 630 000 people have died of acquired immune deficiency syndrome (AIDS)-related illnesses. The total number of people living with HIV was estimated at 39 million worldwide.¹ HIV testing and diagnosis are regarded as the key components of the 95-95-95 testing and treatment targets to end the AIDS epidemic. The effective implementation of HIV testing services has been introduced as a crucial component of success in responding to HIV control within national and global measures.²

Population mobility is recognized as a driver of the HIV epidemic^3,4 by linking geographically separate epidemics and intensifying transmission by inducing riskier sexual behaviors.³ Immigrants are considered a mobile sub-population-group in HIV targets for 2025.⁵ Complex vulnerabilities can overlap to limit immigrants’ access to existing services and put them at heightened risk of HIV, including irregular immigration status, the experience of stigma, discrimination and marginalization, poverty and lack of employment opportunities, legal barriers and lack of legal protections, language and cultural barriers.⁶ Despite the existence of high-risk HIV behaviors in immigrants and ethnic minorities,^7,8 there is evidence that immigrants face various barriers to accessing HIV testing services at individual, social, and structural levels,^9-11 and the multiplicity of these barriers indicates the complexity of the response.

According to the World Health Organization (WHO) consolidated guidelines on HIV testing services, demand creation to increase HIV testing service uptake and engage those in greatest need of services was introduced as a valuable tool for mitigating stigma, discrimination, and criminalization. These strategies include activities intended to improve an individual’s knowledge, attitudes, motivations, and intentions to test and inform the decision to obtain HIV testing services. In this area, peer-led demand creation interventions have been recommended to create the demand for HIV testing.² Similar to the target group in various aspects of their social identities, Peers can provide support in ways that non-peer professionals are less likely to accomplish. In addition, peers who constantly interact with the members of their social network have better access to hard-to-reach populations.¹² The peer education model is regarded as an effective approach to raising awareness and also providing better access to HIV/AIDS services for hard-to-reach populations,^13,14 reducing HIV infection, as well as improving HIV testing.¹⁵ HIV peer interventions have been identified as low-cost¹⁵ and cost-effective¹⁶ interventions, and it is widely recommended in areas with limited resources.¹⁵

Despite the effectiveness of peer interventions on health outcomes in different aspects of HIV prevention and control in the immigrant population,^17-20 however, relatively little is known about how these interventions work, for whom, and in what circumstances. In the methodological evidence for complex interventions, identifying the mechanisms that produce outcomes and the contexts that influence their implementation are emphasized.^21,22 In general, individuals might not have similar choices about their behavior, and such decisions, such as HIV testing, are mainly dependent on the opportunities and resources provided by the interventions.²³ In this regard, by developing Context-Mechanism-Outcome Configurations (CMOCs) during the process of analysis and generating program theory, a realist review can identify how an intervention or action under certain contextual circumstances (C) may trigger a mechanism (M) to achieve a given outcome (O).^24,25 Realist review is a type of systematic literature review with a explanatory focus.²⁵ In a realist review, the first step is to make explicit a program theory.²⁴ The term ‘program theory’ refers to “an abstracted description and/or diagram that lays out what a program (or family of programs or intervention) comprises and how it is expected to work”.²⁵ Empirical evidence is then sought to populate this theoretical framework, supporting, contradicting, or modifying the program theory.²⁴ It can help policymakers and health managers assess whether effective interventions in one setting may work so in another and tailor the interventions for specific contexts.²⁴ Considering the importance of HIV prevention and control in international immigrants,²⁶ this realist review was conducted to address why, how, and under what conditions peer interventions can improve HIV testing uptake among this population.

Material and Methods

The five steps guided us in conducting a realist review outlined by Pawson et al²⁴ and reported following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.²⁵

Clarifying the scope of the research

Our research question was proposed to determine the scope of the research: “How and under what circumstances do peer intervention strategies influence HIV test uptake among immigrants?”.

A program theory is usually a diagram describing an intervention’s activities, the intended outcomes, and the mechanisms that lead to the outcomes.²⁵ To generate the initial program theory, the review team first prepared an initial draft of the framework explaining the effect of peer interventions on immigrants’ HIV testing uptake based on their knowledge of health promotion interventions, improving access to HIV services, and immigrant health. Then, it was modified through interviews with stakeholders regarding strategies to improve access to HIV testing services among immigrants and a review of the related literature. Finally, the initial program theory was designed to test (Figure 1). The main concepts of the initial program theory are presented in Table 1.

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Figure 1.

The initial program theory explaining the effect of peer interventions on immigrants’ HIV testing uptake.

Figure 1.

The initial program theory explaining the effect of peer interventions on immigrants’ HIV testing uptake.

Searching for evidence and selecting studies

The search resources included the following electronic databases: PubMed, Web of Science, Scopus, Embase, and Cochrane; the websites of related international organizations: The Joint United Nations Programmes on HIV/AIDS (UNAIDS), the World Bank, Global Fund, WHO, and International Organization for Migration (IOM); as well as the reference list of the related studies. The keywords were obtained from various resources such as related articles and experts’ opinions.

Inclusion criteria

For a realistic review, several primary studies (interventional or non-interventional) were taken into account with a variety of designs, provided that these studies have targeted the international immigrants or refugees population. Interventional studies (based on RCT or non-RCT design) should be conducted with any educational, supportive, or counseling interventions performed by an individual or a group of peers, and HIV testing should be considered as one of the intervention outcomes. In the case of non-interventional studies, the researchers selected empirical or conceptual/theoretical studies with a variety of designs as well as quantitative, qualitative, and/or mixed methods that describe or explain the concepts and relationships in the initial program theory. In other words, the selected studies should include data on how an intervention or service under certain contextual circumstances may trigger a mechanism to improve HIV testing uptake. Given that new HIV testing for the public was first approved in 1985,²⁷ the search period was considered from the beginning of 1985.

Exclusion criteria

Secondary studies or studies that were published in a non-English language; studies with the target populations such as domestic immigrants, non-immigrant ethnic/racial minorities, or indigenous populations; no report on HIV testing as the study outcome, and the studies whose findings were not relevant to confirm, refute, or refine initial theory.

Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.²⁸First, the abstracts were screened based on the study selection criteria. Then, two reviewers independently evaluated the full text of the articles to select relevant studies. In other words, studies were selected based on whether they could inform the development of the initial program theory or clarify the CMOCs.²⁴ Disagreements between the two reviewers were resolved through consensus.

Quality appraisal

In a realist review, the evaluation of the quality of the included studies is mainly based on the researchers’ judgments about the relevance and rigor criteria. For relevance, we should assess whether the study addresses the theory under test. Rigor also refers to whether a certain investigator’s inference has sufficient weight to provide a valid methodological contribution to the testing of the intervention theory.^24,25 The present study selected relevant articles containing data regarding the initial program theory. In other words, these articles would be judged to determine whether the content of a part of the study contained the data pertinent to the formation of the program theory. In addition, and according to each study type, the Joanna Briggs Institute (JBI)’s Critical Appraisal Tools²⁹ were used for quality appraisal. Eventually, the quality of selected studies was evaluated based on the relationship between studies data in explaining the program theory, the number of CMOCs extracted from studies, as well as the results of the assessments by JBI tools. In the present study, this step was also performed by two reviewers independently. In case of any disagreement, they would discuss the issue to reach an agreement.

Data extraction

The data extraction form included items pertaining to the study characteristics, strategies, and theory concepts, such as contextual factors, mechanism, and outcome. Then, the data were extracted from three studies using different designs to finalize this form. The two reviewers independently completed the ultimate data extraction form for the selected studies. Then, the respective results were compared by the two reviewers, and agreement was also reached over contradictory issues.

Data analysis, synthesis, and conclusion

The thematic analysis method was used to analyze the data. At first, each study was reviewed several times, and the meaning units of data extracted from each study were identified in terms of intervention strategies, contextual factors, and mechanisms. In the next step, the meaning units were coded. The codes were compared in terms of similarities and differences. These were then reviewed, compared, and grouped to determine the categories. Similar categories were merged, and themes were extracted.

Furthermore, CMOCs were identified and validated by comparing the mechanisms in CMOCs in similar and different contexts to summarize the nature of CMOCs relationships. The pathways were identified and verified accordingly. Finally, the initial program theory was refined to reflect the evidence-supported mechanisms. All interpretive processes were discussed and agreed upon among the review’s contributors.

Results

The selection process for the studies is presented in PRISMA flowchart (Figure 2). It should be noted that a total of 5846 study titles and abstracts were reviewed; consequently, 17 studies were eligible to enter the present realist review.

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Figure 2.

PRISMA flowchart for study selection

Figure 2.

PRISMA flowchart for study selection

Study characteristics

Ten studies used a quantitative approach (with various RCT, quasi-experimental, cross-sectional, and cohort designs), and 7 studies used a qualitative approach. In studies with the interventional design (n = 6), the effectiveness of interventions on the outcome of HIV testing was reported. In terms of providing intervention or service, 10 studies were regarded as interventional studies, while no intervention or service was provided in the other 7 studies. The majority of studies had focused on key populations for HIV, including sex workers, men who have sex with men (MSM), and gay, bisexual and other men who have sex with men (GBMSM) immigrants. Most studies were conducted on the Latin immigrants population in the United States (n = 10), with one of these along the US-Mexico border. The remaining seven studies were conducted in the Mexico-Guatemala borderline (n = 2), Asia (n = 2), Europe (n = 1), Oceania (n = 1), and Africa (n = 1). Further information regarding the included studies is provided in Table 2.

Results of studies’ quality appraisal

Regarding the criteria (particularly relevance) for the quality assessment of the studies, all the studies included data that researchers had used to test the initial program theory. In addition, a total of 84 CMOCs were extracted from these 17 studies, indicating the appropriate quality of such studies in terms of relevance. Moreover, the qualitative evaluation results also revealed that most of these studies (n = 15) obtained the necessary criteria (over 70%) in the qualitative appraisal tool. On the other hand, the lowest number of CMOCs was extracted from the remaining two studies (see Table 2). Besides, the required explanations are given in the results section for the pathways.

Concepts of program theory

1. Intervention/service strategies

All the 10 interventional studies (Studies in which an intervention or a service was provided) employed multiple strategies. The strategies were categorized into the following four groups:

1.1. Providing information about HIV and available services

This strategy has been used in 10 interventional studies.^{17-20,30,33-35,41,42} It is crucial to note that the design and implementation of interventions/services were highlighted according to the characteristics, needs, and conditions of immigrants and provided the necessary information accordingly, particularly based on the Community-Based Participatory Research (CBPR) approach.^{18-20,30,34,35} These studies have used multiple methods or materials to provide information, including group discussions based on immigrants’ culture and language, as well as sharing information through PowerPoint, DVDs, role-playing scenarios, group activities, or the distribution of brochures. The training was provided individually or in groups. In addition, the peers would have undergone training before peer intervention/service provision.

1.2. Providing support

This strategy has been used in 6 studies,^{18-20,34,35,42} where peers acted as supporters or advocators for the immigrants and provided formal and informal assistance to immigrants to meet their needs and overcome existing obstacles during the service/intervention provision. These supports included providing information and counseling, contacting the members of the social network, accompanying the immigrants to take the test, defending the immigrants while facing violence, etc.

1.3. Community-based strategy

This strategy has been used in all 10 interventional studies. Six studies have used the CBPR approach and attempted to increase awareness and change the attitude and behavior of immigrants through community participation.^{18-20,30,34,35} Moreover, the peers in other studies have also implemented community-based strategies to provide outreach and chain referral services,¹⁷ door-to-door outreach services,³³ outreach educational training, support and referral services,⁴² and STI/HIV testing services directed by the peers in a national community-based study.⁴¹

1.4. Provision of HIV testing services

Providing HIV testing services was identified as one of the strategies. Two studies indicated that rapid HIV testing was performed by the intervention team (including peers).^33,41 However, in other studies, peers only suggested the immigrants take HIV tests and referred them to the center.

2. Contextual factors

Influential contextualfactors were categorized into three groups of individual/interpersonal factors (language, values, and beliefs, socio-economic status, immigration status, fear and stigma, gender), health service-related factors (accessibility, availability, acceptability, affordability), and structural factors (regulations and policies, supportive resources, discrimination).

3. Mechanisms and pathways of peer interventions for HIV testing uptake

According to the review results, four mechanisms that were proposed in the initial program theory, including increasing awareness, reducing stigma, supporting, and increasing access to services, were confirmed. In addition, the improvement of communication was identified as a proximal mechanism. Peers’ familiarity with social network members, their ability to reach more immigrants, and their ability to build trust could play a significant role in developing effective communication and generating other mechanisms. After comparing the existing mechanisms in all the 84 CMOCs extracted, 4 pathways were identified. Eventually, the refined program theory resulted from the realist review (Figure 3).

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Figure 3.

The refined program theory explaining the effect of peer interventions on immigrants’ HIV testing uptake

Figure 3.

The refined program theory explaining the effect of peer interventions on immigrants’ HIV testing uptake

Pathway 1. Following improved communication, increasing awareness could lead to improved HIV testing uptake

This pathway was identified according to 37 CMOCs extracted from 12 studies.^{17-19,30,33-38,40,42} Besides, 8 studies were interventional (intervention/service delivery), using multiple strategies to perform the intervention.^{17-19,30,33-35,42} Familiarity with and trust in peers as well as the comfortable feeling while talking about sex with peers (i.e., improved peer communication with immigrants in the target group), could facilitate the knowledge exchange. Peers can help immigrants use HIV testing services by sharing knowledge, correcting misunderstandings, as well as increasing immigrants’ awareness of HIV and available services. According to the qualitative evaluation results regarding this pathway, 11 studies reported acceptable quality (score: ≥ 70%). One study with a score of < 70%,³⁸ accounts for only two of the 37 extracted CMOCs. Therefore, in total, the evidence related to this pathway can be considered of acceptable quality.

Pathway 2. Following improved communication, the reduction of stigma could lead to improved HIV testing uptake

This pathway was identified according to the evidence from 8 CMOCs, which were extracted from 5 studies.^{17,18,33,34,40} In 4 studies, the intervention/service was provided.^17,18,33,34

Some studies have reported that the peers’ performance characteristics has led to an increase in the use of tests among immigrants, including building trust and also creating an enabling environment where immigrants experience less stigma (by providing outreach, door-to-door, and rapid testing services, as well as ensuring the confidentiality of the information).^18,33 The fear of stigma was regarded as a critical factor leading to the failure of the intervention/service program. Immigrants would avoid interacting with peers due to stigma issues and fear of disclosing information to their family members,¹⁷ or lack of trust and fear of rejection by peers;³⁴ thus, they would not perform HIV testing despite peer support. The evidence pertaining to this pathway was reported to have acceptable quality. The qualitative evaluation of these studies revealed acceptable scores ( ≥ 70%) for these 5 studies.

Pathway 3. Following improved communication, enhanced support would lead to lead to improved HIV testing uptake

The third pathway was identified according to the evidence from 17 CMOCs, which were extracted from 7 studies.^{18,20,35-37,40,42} 4 studies were conducted based on the provision of intervention/service.^18,20,35,42 Peers can effectively facilitate successful implementation of interventions and improvement of using HIV tests among immigrants by means of developing communications within trust through information support, empathy, encouraging immigrants to demonstrate health behaviors, accompanying them while taking HIV test services, and expressing a strong commitment to providing continuous support to these immigrants. The qualitative evaluation results revealed that six studies reported an acceptable quality (over 70%). Notably, only one of the 17 cases of CMOCs related to this pathway was extracted from one study with a quality appraisal score of < 70%.²⁰

Pathway 4. Following improved communication, increasing access to services would lead to improved HIV testing uptake

This pathway was identified according to the evidence from 22 CMOCs, which were extracted from 11 studies.^{17-19,32-34,36,37,39-41} 6 studies reported provision of intervention/service using multiple strategies.^{17-19,33,34,41} Following effective communication, there was an improvement in taking HIV tests among immigrants. Such an enhancement was the result of different interventions, which were performed through mechanisms related to improving access to services (e.g., the specialization of activities in accordance with the immigrants’ needs and different priorities in their social network, providing acceptable services to this group, providing various services such as rapid and accessible HIV testing, providing outreach HIV testing services during non-working hours, improving peers’ access to a large number of members of the target community).^18,19,34 While financial support and access to free testing services could play a critical role in immigrants’ HIV testing uptake, one study reported that the high cost of testing, as well as the limitation of using private insurance, led to a reduction in taking HIV testing among immigrants.⁴¹ Contextual factors, such as lack of continuity of service delivery, inaccessible services, or perceived long waiting times, have been regarded as crucial challenges for some immigrants.¹⁷ The evidence pertaining to this pathway revealed an acceptable quality, where the findings of the qualitative appraisal reported an obtained score of over 70% for these 11 studies.

Discussion

In order to achieve the first target of the 95-95-95 HIV testing and treatment targets (95% of people within the subpopulations who are living with HIV know their HIV status), it is imperative to design and implement interventions aiming to improve HIV testing in immigrants as one of target sub-populations.⁵ This realist review revealed how a successful peer intervention under certain contextual circumstances might trigger mechanisms to improve HIV testing uptake among international immigrants. These interventions encompassed multiple strategies and were implemented in accordance with immigrants’ needs and conditions as well as the existing HIV testing barriers.

According the results, the interventions aimed to improve the use of HIV testing by raising awareness of HIV, reducing stigma, supporting, and increasing access to testing services. The “increasing HIV awareness” mechanism had the highest frequency among the reviewed studies in the first pathway, which was the result of 37 cases of CMOCs extracted from 12 studies. Accordingly, immigrants as peers were able to play an important role in increasing immigrants’ HIV knowledge through access to a large number of social network members, creating effective communication and building trust to talk and share knowledge about sexual and HIV issues, and moderate misunderstandings. Linguistic skills and cultural knowledge of peers could also facilitate the establishment of effective communication and knowledge transfer by decoding and interpreting the consequences of using available services. Among various community-based educational models, peer education models are recognized as an effective approach to raising awareness as well as access to HIV/AIDS services, specifically for hard-to-reach populations.^13,14

The results showed that peer interventions through the stigma reduction mechanism could increase HIV testing in this group. The number of CMOCs related to this pathway was lower and was extracted from only 5 studies. Accordingly, these interventions helped improve the use of HIV testing in immigrants by reducing perceived or experienced stigma as a result of creating a safe environment, reducing the fear of experiencing stigma, implementing community-based strategies with confidentiality considerations, as well as providing outreach and door-to-door services. In particular, it was facilitated by peers’ skills and capabilities to build trust for talking about sexual issues that were considered taboo in society. A meta-synthesis study also revealed that the easy acceptance of each other in the peer support worker teams created a safe and positive work environment, reduced stigma, and increased recovery.⁴³ Sharing experiences and speaking a common language as peers might lead to the building of trust, the involvement of these populations in related interventions, and the use healthcare services.⁴⁴

The results further showed that providing services by peers through support could lead to increased HIV testing in immigrants. Peer support was typically provided in the form of assistance, accompanying immigrants to HIV testing centers, or knowledge sharing. In the meantime, establishing effective communication through trust-building prepares the ground for efficient social support. In addition, other factors, including the acquisition of communication skills as well as the ability to understand the contextual conditions and needs of the target group, could play an essential role in providing appropriate support to peers. It was assumed that peers, who are similar to the target group in terms of social identity, experiences, and social role, are more likely to support the target group in a way that even non-peer professionals might be unable to perform. It is also noteworthy that the power difference between the service recipient and the provider (as a peer) would be minimized in the case of peer support interventions. It can help and motivate service recipients, especially marginalized groups who are reluctant due to fear of stigma and discrimination, to involve in the intervention.¹²

Moreover, the findings indicated that the interventions attempting to improve various dimensions of access to services, including the provision of accessible, available, affordable, as well as acceptable services in line with the immigrants’ needs, attitudes, and priorities, led to desirable results concerning the rate of HIV testing among immigrants. Conversely, HIV testing would be less common among immigrants due to different restrictions, such as lack of financial or geographical access to such services. The peers’ personal and functional characteristics were assumed to play a crucial role in the acceptance of services and the increase in HIV testing in immigrants. Similarly, peers’ access to a large number of community members and their ability to reach out to distant individuals, particularly based on chain referral strategies, could lead to increased referrals and testing by a greater population of immigrants. Evidence has also confirmed the value of peer support models in improving access to such services in target groups.⁴³ These findings highlight the need to pay attention to different aspects of access to services while designing and implementing interventions. Consequently, these services should be accessible, available, continuous, affordable, and in line with the target group’s culture and attitude, so HIV testing will be promoted in the immigrant group.

According to the refined program theory, the process of implementation of interventions and the decision-making by immigrants on whether to use these available services and opportunities are affected by several contextual factors, including individual/interpersonal factors, health service-related factors, and structural factors. Interventions that effectively address such barriers could succeed in improving HIV testing among immigrants. In contrast, such intervention may not be fully effective if immigrants continue to encounter barriers while accessing HIV testing services. These findings emphasize the necessity to consider various contextual factors at micro, meso, and macro levels while designing interventions to increase HIV testing and diagnosis and reduce disease transmission. These findings confirm previous evidence regarding the contextual factors influencing access to HIV services. In this regard, previous systematic review studies have highlighted a wide range of factors affecting access to HIV services at various levels.^10,45

It is also noteworthy to mention that most studies were conducted in the United States (n = 12), where the major focus is on the Latin American immigrant population. According to the reports of IOM, Asia and Europe hosted 84 million and 82 million international immigrants in 2019, respectively. These figures represent 62% of the world’s total population of international immigrants. North America accounts for 22 percent of the world’s immigrant population, followed by Africa (10%), Latin America and the Caribbean (4%), and Oceania (3%).⁴⁶ It is also likely that some interventions have been conducted or are being implemented, but there have been no reports in the literature. These findings are consistent with the results of another systematic review study on the interventions aiming to increase the use of HIV testing in immigrants. Since the researchers asserted that almost all of the related interventional studies were conducted in the United States,⁴⁷ therefore, the finding of the present realist review may indicate the necessity for further research in different countries with a focus on immigrant populations.

Strengths and limitations

This study can be regarded to identify the strategies, mechanisms, and contextual factors of interventions to improve using HIV testing among international immigrants. The refined theory extracted from the present realist review can be used as a framework for policymakers and researchers to design interventions aimed at increasing HIV testing with respect to contextual factors. Considering the heterogeneity of the international immigrant population in terms of individual characteristics and especially different social, economical, political, and cultural structures in different countries, the findings cannot be generalized to a specific context. Therefore, researchers and policy makers should use the findings of the present study by considering the context in which their intervention or program is to be developed, implemented and evaluated. The researchers were also faced with another limitation, including the selection of studies that targeted only international immigrants, which would lead to the exclusion of interventions on a broader range of groups such as domestic immigrants, non-immigrant ethnic/racial minorities, or indigenous populations. Therefore, it is suggested to consider a wider variety of populations for future studies.

Conclusion

In immigrants population, as a vulnerable group in HIV control programs, peer interventions with multiple strategies to be designed and implemented considering the barriers to HIV testing and also moving beyond one-size-fits-all approaches can successfully improve HIV testing uptake. Employing peers as an available resource in the community is effective for designing and implementing interventions based on the immigrants’ culture and needs. By addressing contextual factors, peer interventions for immigrants could develop effective communication, raise awareness of HIV, reduce stigma, improve support, and increase access to HIV services. As a comprehensive framework, the presented theory can help policymakers and decision-makers in HIV/AIDS control programs promote the use of HIV testing in immigrants and reduce the risk of disease transmission.

Acknowledgements

The authors are grateful for the financial support of Tehran University of Medical Sciences (TUMS), Grant No: 96-03-62-36567.

Competing Interests

The authors declare that they have no competing interests.

Ethical Approval

Not applicable.

References

1. UNAIDS. Global HIV Statistics—Fact Sheet. 2023. Available from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf.
2. World Health Organization (WHO). Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240031593.
3. Deane KD, Parkhurst JO, Johnston D. Linking migration, mobility and HIV. Trop Med Int Health 2010; 15(12):1458-63. doi: 10.1111/j.1365-3156.2010.02647.x [Crossref] [ Google Scholar]
4. Eshraghian EA, Ferdos SN, Mehta SR. The impact of human mobility on regional and global efforts to control HIV transmission. Viruses 2020; 12(1):67. doi: 10.3390/v12010067 [Crossref] [ Google Scholar]
5. UNAIDS. 2025 AIDS Targets. 2021. Available from: https://www.unaids.org/sites/default/files/2025-AIDS-Targets_en.pdf.
6. UNAIDS. Mobility and Stability. 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/advancing-the-health-and-rights-of-migrants-in-latin-america-and-the-caribbean_en.pdf.
7. Lewis NM, Wilson K. HIV risk behaviours among immigrant and ethnic minority gay and bisexual men in North America and Europe: a systematic review. Soc Sci Med 2017; 179:115-28. doi: 10.1016/j.socscimed.2017.02.033 [Crossref] [ Google Scholar]
8. Spiegel PB, Schilperoord M, Dahab M. High-risk sex and displacement among refugees and surrounding populations in 10 countries: the need for integrating interventions. AIDS 2014; 28(5):761-71. doi: 10.1097/qad.0000000000000118 [Crossref] [ Google Scholar]
9. Blondell SJ, Kitter B, Griffin MP, Durham J. Barriers and facilitators to HIV testing in migrants in high-income countries: a systematic review. AIDS Behav 2015; 19(11):2012-24. doi: 10.1007/s10461-015-1095-x [Crossref] [ Google Scholar]
10. Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health 2013; 23(6):1039-45. doi: 10.1093/eurpub/cks130 [Crossref] [ Google Scholar]
11. Noori T, Hargreaves S, Greenaway C, van der Werf M, Driedger M, Morton RL. Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps?. Travel Med Infect Dis 2021; 39:101715. doi: 10.1016/j.tmaid.2020.101715 [Crossref] [ Google Scholar]
12. Simoni JM, Franks JC, Lehavot K, Yard SS. Peer interventions to promote health: conceptual considerations. Am J Orthopsychiatry 2011; 81(3):351-9. doi: 10.1111/j.1939-0025.2011.01103.x [Crossref] [ Google Scholar]
13. McKeganey SPN. The rise and rise of peer education approaches. Drugs (Abingdon Engl) 2000; 7(3):293-310. doi: 10.1080/09687630050109961 [Crossref] [ Google Scholar]
14. Medley A, Kennedy C, O’Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev 2009; 21(3):181-206. doi: 10.1521/aeap.2009.21.3.181 [Crossref] [ Google Scholar]
15. He J, Wang Y, Du Z, Liao J, He N, Hao Y. Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis. BMC Infect Dis 2020; 20(1):338. doi: 10.1186/s12879-020-05003-9 [Crossref] [ Google Scholar]
16. Okoboi S, Castelnuovo B, Van Geertruyden JP, Lazarus O, Vu L, Kalibala S. Cost-effectiveness of peer-delivered HIV self-tests for MSM in Uganda. Front Public Health 2021; 9:651325. doi: 10.3389/fpubh.2021.651325 [Crossref] [ Google Scholar]
17. Ramos RL, Green NL, Shulman LC. Pasa la Voz: using peer driven interventions to increase Latinas’ access to and utilization of HIV prevention and testing services. J Health Care Poor Underserved 2009; 20(1):29-35. doi: 10.1353/hpu.0.0124 [Crossref] [ Google Scholar]
18. Rhodes SD, Alonzo J, Mann-Jackson L, Song EY, Tanner AE, Garcia M. A peer navigation intervention to prevent HIV among mixed immigrant status Latinx GBMSM and transgender women in the United States: outcomes, perspectives and implications for PrEP uptake. Health Educ Res 2020; 35(3):165-78. doi: 10.1093/her/cyaa010 [Crossref] [ Google Scholar]
19. Rhodes SD, Hergenrather KC, Bloom FR, Leichliter JS, Montaño J. Outcomes from a community-based, participatory lay health adviser HIV/STD prevention intervention for recently arrived immigrant Latino men in rural North Carolina. AIDS Educ Prev 2009; 21(5 Suppl):103-8. doi: 10.1521/aeap.2009.21.5_supp.103 [Crossref] [ Google Scholar]
20. Rhodes SD, McCoy TP, Vissman AT, DiClemente RJ, Duck S, Hergenrather KC. A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men. AIDS Behav 2011; 15(8):1764-75. doi: 10.1007/s10461-011-9903-4 [Crossref] [ Google Scholar]
21. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015; 350:h1258. doi: 10.1136/bmj.h1258 [Crossref] [ Google Scholar]
22. Craig P, Di Ruggiero E, Frohlich KL, Mykhalovskiy E, White M, Campbell R, et al. Taking Account of Context in Population Health Intervention Research: Guidance for Producers, Users and Funders of Research. NIHR Journals Library; 2018. 10.3310/CIHR-NIHR-01
23. Thapa S, Hannes K, Cargo M, Buve A, Peters S, Dauphin S. Stigma reduction in relation to HIV test uptake in low- and middle-income countries: a realist review. BMC Public Health 2018; 18(1):1277. doi: 10.1186/s12889-018-6156-4 [Crossref] [ Google Scholar]
24. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy 2005; 10 Suppl 1:21-34. doi: 10.1258/1355819054308530 [Crossref] [ Google Scholar]
25. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. BMC Med 2013; 11:21. doi: 10.1186/1741-7015-11-21 [Crossref] [ Google Scholar]
26. International Organization for Migration (IOM). Glossary on Migration. 2019. Available from: https://publications.iom.int/system/files/pdf/iml_34_glossary.pdf.
27. Dortzbach D, Long WM. The AIDS Crisis: What We Can Do. InterVarsity Press; 2006.
28. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1):1. doi: 10.1186/2046-4053-4-1 [Crossref] [ Google Scholar]
29. Joanna Briggs Institute. Critical Appraisal Tools. Available from: https://jbi.global/critical-appraisal-tools.
30. Alonzo J, Mann L, Tanner AE, Sun CJ, Painter TM, Freeman A. Reducing HIV risk among Hispanic/Latino men who have sex with men: qualitative analysis of behavior change intentions by participants in a small-group intervention. J AIDS Clin Res 2016; 7(5):572. doi: 10.4172/2155-6113.1000572 [Crossref] [ Google Scholar]
31. Dolwick Grieb SM, Desir F, Flores-Miller A, Page K. Qualitative assessment of HIV prevention challenges and opportunities among Latino immigrant men in a new receiving city. J Immigr Minor Health 2015; 17(1):118-24. doi: 10.1007/s10903-013-9932-3 [Crossref] [ Google Scholar]
32. Massengale KE, Morrison SD, Sudha S. Community health advocate-identified enablers of HIV testing for Latina immigrant women. AIDS Educ Prev 2016; 28(4):325-40. doi: 10.1521/aeap.2016.28.4.325 [Crossref] [ Google Scholar]
33. Seña AC, Hammer JP, Wilson K, Zeveloff A, Gamble J. Feasibility and acceptability of door-to-door rapid HIV testing among Latino immigrants and their HIV risk factors in North Carolina. AIDS Patient Care STDS 2010; 24(3):165-73. doi: 10.1089/apc.2009.0135 [Crossref] [ Google Scholar]
34. Vissman AT, Eng E, Aronson RE, Bloom FR, Leichliter JS, Montaño J. What do men who serve as lay health advisers really do?: Immigrant Latino men share their experiences as Navegantes to prevent HIV. AIDS Educ Prev 2009; 21(3):220-32. doi: 10.1521/aeap.2009.21.3.220 [Crossref] [ Google Scholar]
35. Wagoner KG, Downs M, Alonzo J, Daniel-Ulloa J, Rhodes SD. Latino men’s qualitative perspectives on a lay health advisor intervention to promote their sexual health. Health Soc Care Community 2015; 23(3):304-12. doi: 10.1111/hsc.12148 [Crossref] [ Google Scholar]
36. Febres-Cordero B, Brouwer KC, Jimenez TR, Fernandez-Casanueva C, Morales-Miranda S, Goldenberg SM. Communication strategies to enhance HIV/STI prevention, sexual and reproductive health, and safety among migrant sex workers at the Mexico-Guatemala border. J Health Care Poor Underserved 2020; 31(2):767-90. doi: 10.1353/hpu.2020.0060 [Crossref] [ Google Scholar]
37. Febres-Cordero B, Brouwer KC, Rocha-Jimenez T, Fernandez-Casanueva C, Morales-Miranda S, Goldenberg SM. Influence of peer support on HIV/STI prevention and safety amongst international migrant sex workers: a qualitative study at the Mexico-Guatemala border. PLoS One 2018; 13(1):e0190787. doi: 10.1371/journal.pone.0190787 [Crossref] [ Google Scholar]
38. Khatoon S, Budhathoki SS, Bam K, Thapa R, Bhatt LP, Basnet B. Socio-demographic characteristics and the utilization of HIV testing and counselling services among the key populations at the Bhutanese refugees camps in Eastern Nepal. BMC Res Notes 2018; 11(1):535. doi: 10.1186/s13104-018-3657-2 [Crossref] [ Google Scholar]
39. Tohme J, Egan JE, Friedman MR, Stall R. Psycho-social correlates of condom use and HIV testing among MSM refugees in Beirut, Lebanon. AIDS Behav 2016; 20(Suppl 3):417-25. doi: 10.1007/s10461-016-1498-3 [Crossref] [ Google Scholar]
40. den Daas C, Geerken MB, Bal M, de Wit J, Spijker R, Op de Coul EL. Reducing health disparities: key factors for successful implementation of social network testing with HIV self-tests among men who have sex with men with a non-western migration background in the Netherlands. AIDS Care 2020; 32(1):50-6. doi: 10.1080/09540121.2019.1653440 [Crossref] [ Google Scholar]
41. Ryan KE, Wilkinson AL, Asselin J, Leitinger DP, Locke P, Pedrana A. Assessment of service refinement and its impact on repeat HIV testing by client’s access to Australia’s universal healthcare system: a retrospective cohort study. J Int AIDS Soc 2019; 22(8):e25353. doi: 10.1002/jia2.25353 [Crossref] [ Google Scholar]
42. Rosenberg JS, Bakomeza D. Let’s talk about sex work in humanitarian settings: piloting a rights-based approach to working with refugee women selling sex in Kampala. Reprod Health Matters 2017; 25(51):95-102. doi: 10.1080/09688080.2017.1405674 [Crossref] [ Google Scholar]
43. MacLellan J, Surey J, Abubakar I, Stagg HR. Peer support workers in health: a qualitative metasynthesis of their experiences. PLoS One 2015; 10(10):e0141122. doi: 10.1371/journal.pone.0141122 [Crossref] [ Google Scholar]
44. Gamariel F, Isaakidis P, Pulido Tarquino IA, Beirão JC, O’Connell L, Mulieca N. Access to health services for men who have sex with men and transgender women in Beira, Mozambique: a qualitative study. PLoS One 2020; 15(1):e0228307. doi: 10.1371/journal.pone.0228307 [Crossref] [ Google Scholar]
45. Asghari S, Hurd J, Marshall Z, Maybank A, Hesselbarth L, Hurley O. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis. AIDS Care 2018; 30(8):963-72. doi: 10.1080/09540121.2018.1435848 [Crossref] [ Google Scholar]
46. International Organization for Migration (IOM). World Migration Report 2020. 2019. Available from: https://publications.iom.int/system/files/pdf/wmr_2020.pdf.
47. Aung E, Blondell SJ, Durham J. Interventions for increasing HIV testing uptake in migrants: a systematic review of evidence. AIDS Behav 2017; 21(10):2844-59. doi: 10.1007/s10461-017-1833-3 [Crossref] [ Google Scholar]