title: Advancing Migrant Access to Health Services in Europe (AMASE): Protocol for a Cross-sectional Study.
abstract: BACKGROUND
  Migrants form a substantial proportion of the population affected by the human immunodeficiency virus (HIV) epidemic in Europe, yet HIV prevention for this population is hindered by poor understanding of access to care and of postmigration transmission dynamics.
  
  
  OBJECTIVE
  We present the design and methods of the advancing Migrant Access to health Services in Europe (aMASE) study, the first European cross-cultural study focused on multiple migrant populations. It aims to identify the structural, cultural, and financial barriers to HIV prevention, diagnosis, and treatment and to determine the likely country of HIV acquisition in HIV-positive migrant populations.
  
  
  METHODS
  We delivered 2 cross-sectional electronic surveys across 10 countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Switzerland, and United Kingdom). A clinic survey aimed to recruit up to 2000 HIV-positive patients from 57 HIV clinics in 9 countries. A unique study number linked anonymized questionnaire data to clinical records data (viral loads, CD4 cell counts, viral clades, etc). This questionnaire was developed by expert panel consensus and cognitively tested, and a pilot study was carried out in 2 countries. A Web-based community survey (n=1000) reached those living with HIV but not currently accessing HIV clinics, as well as HIV-negative migrants. It was developed in close collaboration with a community advisory group (CAG) made up of representatives from community organizations in 9 of the participating countries. The CAG played a key role in data collection by promoting the survey to higher-risk migrant groups (sub-Saharan Africans, Latin Americans, men who have sex with men, and people who inject drugs). The questionnaires have considerable content overlap, allowing for comparison. Questions cover ethnicity, migration, immigration status, HIV testing and treatment, health-seeking behavior, sexual risk, and drug use. The electronic questionnaires, which were available in 15 languages, allowed for complex routing, preventing respondents from answering irrelevant questions.
  
  
  RESULTS
  In total, we recruited 2249 participants from 57 HIV clinics as part of the clinic survey and retrieved 1637 complete responses as part of the community survey.
  
  
  CONCLUSIONS
  The findings will provide much-needed information for improving HIV prevention interventions and access to services for migrant communities.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom. Ibidun.fakoya@ucl.ac.uk.
authors.forename: Ibidun
authors.identifier: http://orcid.org/0000-0003-3490-7607
authors.initials: I
authors.lastname: Fakoya
authors.forename: Débora
authors.identifier: http://orcid.org/0000-0003-4079-9219
authors.initials: D
authors.lastname: Álvarez-Del Arco
authors.forename: Susana
authors.identifier: http://orcid.org/0000-0003-1412-3012
authors.initials: S
authors.lastname: Monge
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0001-8968-5963
authors.initials: AJ
authors.lastname: Copas
authors.forename: Anne-Francoise
authors.identifier: http://orcid.org/0000-0001-5683-4571
authors.initials: AF
authors.lastname: Gennotte
authors.forename: Alain
authors.identifier: http://orcid.org/0000-0002-0392-7704
authors.initials: A
authors.lastname: Volny-Anne
authors.forename: Siri
authors.identifier: http://orcid.org/0000-0002-7666-4634
authors.initials: S
authors.lastname: Göpel
authors.forename: Giota
authors.identifier: http://orcid.org/0000-0002-5951-0844
authors.initials: G
authors.lastname: Touloumi
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0003-2967-0289
authors.initials: M
authors.lastname: Prins
authors.forename: Henrique
authors.identifier: http://orcid.org/0000-0003-4699-6571
authors.initials: H
authors.lastname: Barros
authors.forename: Cornelia
authors.identifier: http://orcid.org/0000-0002-1733-7051
authors.initials: C
authors.lastname: Staehelin
authors.forename: Julia
authors.identifier: http://orcid.org/0000-0002-3104-540X
authors.initials: J
authors.lastname: Del Amo
authors.forename: Fiona M
authors.identifier: http://orcid.org/0000-0002-9105-2441
authors.initials: FM
authors.lastname: Burns
keywords: HIV; community mobilization; migrants; survey