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Background Comorbidities, such as cardiovascular disease, diabetes, kidney disease, liver disease, and mental health issues, negatively impact the health-related quality of life (HRQoL) of people living with HIV (PLHIV). Comorbidities can increase the symptom burden, reduce functional or cognitive capacity, increase psychological distress, and reduce adherence to treatment, which can lead to poor viral suppression and other complications. Methods This study aimed to identify and explore comorbidities and related contextual determinants of HRQoL and long-term well-being in PLHIV that could be monitored in routine care in Spain. Seven online focus groups were conducted with 115 participants consisting of members of community advocacy organizations ( n  = 33, 29%), HIV care providers ( n  = 78, 68%) and researchers ( n  = 4, 3%) in seven autonomous communities in Spain with the highest incidence of HIV. Results Focus group results revealed a prioritised list of comorbidities to monitor: diabetes, cardiovascular diseases, neurologic diseases, substance use problems, bone diseases, renal diseases, liver diseases, including metabolic dysfunction-associated steatotic liver disease, cancers and neoplasms, mental health problems, and pulmonary diseases. Conclusions This study emphasises the impact of comorbidities on PLHIV in Spain and the need for a comprehensive approach to HIV care that addresses comorbidities, including mental health. These data can inform the development of policies and interventions to reduce multimorbidity burden among PLHIV.

Background Agricultural workers face high heat stress risk due to environmental and working conditions. Migrant agricultural workers (MAW) are especially vulnerable due to additional structural factors including irregular migratory status and high economic needs. Our study explores the lived experiences of occupational heat stress among MAW and its impact on health. Methods An interpretive, qualitative design was employed. Through purposive sampling we selected MAW in Almeria, Lleida, and Huelva for semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Results Thirty interviews were conducted with six female and 24 male MAW, predominantly from sub-Saharan and North-Africa. The findings were organized into five overarching themes: Working under the sun: exposure and embodiment; The dilemma of heat: work or wellbeing; Employer´s efforts to protect workers: a regime of discretion; Protecting oneself from the heat: navigating limited agency; and non-work-related factors: compounding vulnerabilities. Participants described discomfort and heat-related illness symptoms. Protective strategies included drinking water, wearing appropriate clothing, and taking breaks, but pressure from supervisors to maintain a fast work pace and limit breaks often compromised these protective efforts. Employer discretion largely determined access to heat-protective measures. Participants also reported limited ability to cool down after work due to high indoor temperatures in substandard housing. Conclusions Occupational heat risk for MAW extends beyond environmental factors and is amplified by socioeconomic inequities. Implementation of more specific and enforceable heat-protection measures and improved enforcement mechanisms, alongside mandated improvements to working and living conditions, are needed to reduce heat-related health risks.

Background Persons who migrate for economic reasons, along with asylum seekers and refugees, face multiple personal experiences and societal inequalities that increase the risk of mental health problems and substance dependency, compounded by intersectional social and economic vulnerabilities. The precarious situation and limited access to care of persons with a migration background who use drugs (PMWUD) in Europe raises concern. Therefore, this qualitative study explores the challenges and support needs of a sample of PMWUD in vulnerable situations living in Amsterdam, Athens, Berlin and Paris. Methods This study employed a community-based participatory approach. Through semi-structured interviews with PMWUD (n = 99), we identified  (service) needs of a diversity of PMWUD in Europe. Participants were recruited through a combination of community gatekeepers, venue-based sampling, and snowball sampling. Trained community researchers conducted the interviews, which focused on participants’ living situation, substance use, physical and mental health, and employment opportunities. Results Despite substantial heterogeneity among the PMWUD, several common themes emerged across all groups. Participants frequently mentioned early childhood adversity, limited social networks leading to loneliness, medical, psychological, and substance use issues, histories of personal violence or poverty, homelessness, lack of necessary documents for health care, social security, and employment, and encounters with the criminal justice system. These intertwined and mutually reinforcing factors simultaneously functioned as barriers to care and support, alongside other barriers such as linguistic and cultural differences, and stigma and discrimination. Due to social exclusion, migration, and substance dependence, participants had limited reliable social networks. Therefore, they often had to rely on accessible and low-threshold services. Harm reduction services played a significant role in providing support to PMWUD. Most PMWUD indicated that basic needs for hygiene and food were met thanks to local organizations. Differences in housing opportunities and access to harm reduction services were identified in each city. Conclusion Structural barriers toward treatment and care, often related to administrative requirements, stand in the way of appropriate care for PMWUD. Linguistically and culturally sensitive outreach activities with limited practical requirements could break down social and treatment barriers.

Each year, thousands of migrants enter the EU. Data on drug use in migrant populations are scarce and inconclusive. However, several risk factors make them particularly vulnerable to engaging in problematic drug use. In this perspective, we summarize the limited information that is available on migrants who use drugs and make a case as to why it is essential to improve access to health and social services, including harm reduction services, for this population. With this aim, we call for the co-creation of integrated services that better address the needs of migrants who use drugs in Europe.

Background Chronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain. Methods This was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed. Results In the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days. Conclusions This community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care. Plain language summary A large proportion of hepatitis B virus (HBV) infections occur within countries in sub-Saharan Africa. With recent increased migration from these countries to Catalonia Spain, the prevalence of HBV is greater in migrants than in host populations. However, migrants face additional barriers when trying to access care. We developed a community-based care pathway to provide migrants in Catalonia with access to HBV testing, post-test counseling, vaccinations, and appointments with specialists when needed. The results showed that this strategy was successful in increasing testing, linkage to care, and vaccination among at-risk migrant populations in Catalonia, Spain. It may be worthwhile implementing this strategy on a wider scale and with other at-risk populations to reduce HBV infections and improve outcomes. Picchio et al. report findings from a community-based hepatitis B virus (HBV) screening program for sub-Saharan African migrants in Catalonia, Spain, utilizing simplified testing and expedited referral to specialist care. Their findings support the adoption of these strategies to increase HBV testing and linkage to care among at-risk populations.

BackgroundLeprosy, cutaneous leishmaniasis (CL) and Chagas disease (CD) are neglected tropical diseases (NTDs) with a high psychosocial burden in Norte de Santander and Arauca in Colombia. This study provides insights into affected persons' feelings, perceptions and experiences to better understand the nature of this burden.MethodsIn 2018, 34 leprosy, CD and CL patients participated in four focus groups discussing the influence of the disease on mental well-being, social participation and stigma. Additionally, 13 leprosy patients participated in semi-structured interviews to further explore the health-related stigma related to this disease. Audio recordings were transcribed verbatim, and open coding was used to identify the most relevant categories and themes.ResultsPersons suffering from CD reported that their mental distress was mainly caused by impairments and stress related to the progressive and incurable nature of the disease. Persons affected by CL perceived the treatment for the disease as having the most impact on their psychosocial well-being. Persons affected by leprosy reported suffering most from anticipated and experienced stigma.ConclusionsThe findings indicate that these diseases are likely to impose a significant psychosocial burden on patients in the studied regions, even though these vary per condition. Consistent data collection on the psychosocial burden and the sharing of knowledge of effective interventions can contribute to the holistic approach needed to win the fight against NTDs.

Farmworkers are at risk for heat-related illnesses (HRI) due to intensifying heat exposure resulting from climate change. Migrant farmworkers might be at further increased risk due to limited control over workplace conditions and language and cultural barriers. This systematic literature review and meta-analysis aims to assess the global prevalence of self-reported heat-related illnesses among migrant farmworkers. We searched five databases for peer-reviewed literature and additional sources to capture grey literature in any language up to October 2024. Studies providing self-reported heat-related symptoms among migrant farmworkers were included. A random effects model was used to calculate the pooled proportion of individual and combined heat-related health outcomes. Separate pooled estimates were included for each symptom as well as the number of symptoms. Risk of bias was assessed using the JBI quality assessment tool. Seventeen papers were included, including data from 2966 migrant farmworkers. The pooled proportion for having at least one HRI symptom was 52% (95%CI 39-65) and 21% (95%CI 4-44) reported at least three HRI symptoms. Heterogeneity was high across all pooled estimates (I² ranging from 83% to 99%). The most common symptoms were extreme sweating (46%), weakness (45%), and headache (36%). No differences were found between internal and international migrants nor between studies asking about HRI symptoms experienced in a short-term (e.g., the past week) versus longer periods. Migrant farmworkers reported a high proportion of HRI symptoms. Standardized HRI symptom questionnaires and physiological monitoring can aid in early detection to prevent more serious health issues, allow comparison across settings, and support interventions to mitigate heat-related occupational health risks.

Background Seasonal migrant farmworkers (SMF) make up a significant part of Spain's agricultural labour force. Due to precarious labour conditions, housing insecurity and factors related to migration, SMF are at risk of specific health issues and occupational accidents. In addition, migrants in Spain face barriers when accessing healthcare services. This study explores factors that influence the acceptability of healthcare services among SMF in Spain from the point of view of professionals working with this population. Methods Semi‐structured interviews were conducted among 92 professionals working with SMF in four regions of Spain, including NGO workers, healthcare workers, employees of worker unions, public social services and governmental institutions. A thematic content analysis was performed using Atlas.ti. Results Professionals identified several barriers and facilitators that influence the acceptability of healthcare services among SMF. The main identified barriers were language, different perceptions of health and healthcare between SMF and Spanish professionals, a limited understanding of the Spanish healthcare system, and precarious working and living conditions. The main identified facilitators were professionals taking time to explain healthcare procedures and rights to SMF and support and information from friends, family and other community members. Discussion and Conclusion To overcome barriers, the use of translational services and cultural mediators should be increased. In addition, educational interventions are needed for migrants to better understand the Spanish healthcare system and for healthcare workers to provide culturally appropriate care to migrant patients. Finally, it needs to be considered that inequalities in health and healthcare between SMF and the Spanish native‐born population reach beyond healthcare institutions. They are rooted in structural factors, which include their living and working conditions, social exclusion, and discrimination. Patient or Public Contribution As this study, which is part of a bigger project, aimed to focus on healthcare access mainly from the healthcare system perspective, patients and service users were not involved in this part. Another sub‐study within the project will focus on the experience of SMF. Caregivers were included as study participants and despite not having been directly included in the study design, the open‐ended questions used in this study allowed them to bring up the topics they considered important in the context of this study.