title: A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy.
abstract: BACKGROUND
  Migrant populations from countries with generalised HIV epidemics make up a significant proportion of all HIV/AIDS cases in many European Union and European Economic Area (EU/EEA) countries, with heterosexual transmission the predominant mode of HIV acquisition. While most of these infections are diagnosed for the first time in Europe, acquisition is believed to have predominantly occurred in the home country. A proportion of HIV transmission is believed to be occurring post-migration, and many countries may underestimate the degree to which this is occurring. Our objectives were to review the literature estimating the proportion of migrants believed to have acquired their HIV post-migration and examine which EU member states are able to provide estimates of probable country of HIV acquisition through current surveillance systems.
  
  
  METHODS
  A systematic review was undertaken to gather evidence of sexual transmission of HIV within Europe among populations from countries with a generalised epidemic. In addition, national surveillance focal points from 30 EU/EEA Member States were asked to complete a questionnaire about surveillance methods and monitoring of the likely place of HIV acquisition among migrants.
  
  
  CONCLUSIONS
  Twenty-seven papers from seven countries were included in the review and 24 countries responded to the survey. Estimates of HIV acquisition post-migration ranged from as low as 2% among sub Saharan Africans in Switzerland, to 62% among black Caribbean men who have sex with men (MSM) in the UK. Surveillance methods for monitoring post-migration acquisition varied across the region; a range of methods are used to estimate country or region of HIV acquisition, including behavioural and clinical markers. There is little published evidence addressing this issue, although Member States highlight the importance of migrant populations in their epidemics.
  
  
  CONCLUSIONS
  There is post-migration HIV acquisition among migrants in European countries but this is difficult to quantify accurately with current data. Migrant MSM appear at particular risk of HIV acquisition post-migration. Countries that identify migrants as an important part of their HIV epidemic should focus on using an objective method for assigning probable country of HIV acquisition. Robust methods to measure HIV incidence should be considered in order to inform national prevention programming and resource allocation.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. ibidun.fakoya@ucl.ac.uk.
authors.forename: Ibidun
authors.initials: I
authors.lastname: Fakoya
authors.affiliation: National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. dalvarez@isciii.es.|Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. dalvarez@isciii.es.
authors.forename: Débora
authors.initials: D
authors.lastname: Álvarez-del Arco
authors.affiliation: HIV & STI Department, Health Protection, Public Health England, England, UK. Melvina.WoodeOwusu@phe.gov.uk.
authors.forename: Melvina
authors.initials: M
authors.lastname: Woode-Owusu
authors.affiliation: Department of Health and Socio-medical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain. susana.monge@uah.es.|Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. susana.monge@uah.es.
authors.forename: Susana
authors.initials: S
authors.lastname: Monge
authors.affiliation: National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. yrivero@isciii.es.|Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. yrivero@isciii.es.
authors.forename: Yaiza
authors.initials: Y
authors.lastname: Rivero-Montesdeoca
authors.affiliation: HIV & STI Department, Health Protection, Public Health England, England, UK. Valerie.Delpech@phe.gov.uk.
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.affiliation: HIV & STI Department, Health Protection, Public Health England, England, UK. Brian.Rice@phe.gov.uk.
authors.forename: Brian
authors.initials: B
authors.lastname: Rice
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden. Teymur.Noori@ecdc.europa.eu.
authors.forename: Teymur
authors.initials: T
authors.lastname: Noori
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden. Anastasia.Pharris@ecdc.europa.eu.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pharris
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden. andrew.amato-gauci@ecdc.europa.eu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Amato-Gauci
authors.affiliation: National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. jdamo@isciii.es.|Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. jdamo@isciii.es.
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. f.burns@ucl.ac.uk.|Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. f.burns@ucl.ac.uk.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Burns
mesh_terms: D000328:Adult; D000352:Africa, Northern; D058872:Epidemics; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D013557:Switzerland; D014171:Transients and Migrants