# Exploring HIV care disparities among foreigners in Taiwan: Insights from a multicenter study (2017-2023)

## TL;DR

Foreigners in Taiwan face significant challenges in HIV care, including late diagnosis and poor treatment retention, with factors like job type and government-funded treatment playing key roles.

## Contribution

This study identifies factors affecting HIV care outcomes among foreigners in Taiwan, highlighting the impact of occupation and funding sources on treatment adherence and viral suppression.

## Key findings

- Blue-collar work and opportunistic infections reduce the likelihood of starting antiretroviral therapy.
- Government-funded treatment increases the chances of achieving viral suppression.
- Only 42.6% of ART-naïve foreigners achieved viral suppression within one year.

## Abstract

•Late diagnosis is very common in foreigners with newly diagnosed HIV in Taiwan.•Less than half of foreigners with newly diagnosed HIV remained in care at 1 year.•Blue-collar work, joblessness, and opportunistic infections reduced therapy uptake.•Those who started antiretroviral therapy were more likely to stay in care at 1 year.•Government-funded treatment improved the likelihood of viral suppression.

Late diagnosis is very common in foreigners with newly diagnosed HIV in Taiwan.

Less than half of foreigners with newly diagnosed HIV remained in care at 1 year.

Blue-collar work, joblessness, and opportunistic infections reduced therapy uptake.

Those who started antiretroviral therapy were more likely to stay in care at 1 year.

Government-funded treatment improved the likelihood of viral suppression.

The proportion of foreigners among newly diagnosed people with HIV in Taiwan has steadily increased. We evaluated HIV care quality indices among foreigners with HIV (FWH) and explored associated factors.

FWH who first sought care at 10 Taiwanese hospitals between 2017 and 2023 were included. Information on AIDS at presentation, antiretroviral therapy (ART) prescription, care retention, and viral suppression was collected. Factors associated with these indices were analyzed using logistic regression and Cox proportional hazards models.

We included 144 FWH (median age of 32 years); 74.3% were from Southeast Asia. Overall, 58.3% remained in care at 1 year. Among 94 ART-naïve individuals, 47.9% presented with AIDS and 83.0% initiated ART; however, only 42.6% achieved viral suppression at 1 year. In multivariable analysis, white-collar occupations (vs blue-collar or unemployed) were associated with ART initiation (adjusted odds ratio [aOR], 5.481), while opportunistic infections decreased the odds (aOR, 0.284). ART prescription predicted care retention (adjusted hazard ratio, 6.03), and government-subsidized ART (vs self-funded ART) was linked to higher viral suppression rates (aOR, 3.817).

Substantial gaps in the HIV care cascade were observed among FWH in Taiwan. Strategies to promote earlier diagnosis and improve care retention are urgently needed.

Image, graphical abstract