Systematic review exploring the burden of sexually transmissible infections and bloodborne viruses in refugees and asylum seekers: insights to inform policy and practice

Abstract

BACKGROUND: In 2022, the number of refugees and asylum seekers (RAS) have reached an all-time high of 40.7 million globally. The surge in RAS, coupled with their limited access to healthcare (at their home and destination countries), has led to the risk of transmitting/acquiring sexually transmissible infections (STIs) and bloodborne viruses (BBVs). This situation threatens the health of RAS and poses a public health challenge to destination countries, potentially placing a burden on healthcare systems and resources. Healthcare recommendations for screening programmes for RAS vary between countries, leading to disparities in STI/BBV screening practices on arrival. These disparities can impact early detection and treatment of STIs/BBVs, increasing the risk of onward transmission and long-term negative sequelae. Therefore, this systematic review aims to investigate the prevalence and factors associated with STIs/BBVs among RAS. METHODS: Six databases (ie, PubMed, Embase, Scopus, Cochrane Library, Web of Science and CINAHL) were searched for observational studies reporting STIs/BBVs prevalence and/or risk factors among RAS. The inverse variance heterogeneity model with double arcsine transformation was applied to prevalence meta-analysis of STIs/BBVs by region of origin of RAS. Narrative data synthesis was undertaken to summarise risk factors associated with STIs/BBVs. RESULTS: A total of 21 studies (n=504 432 RAS) were included. Most studies were conducted among RAS arriving in Europe (n=14), followed by North America (n=5) and Australia (n=2). The highest prevalence of HIV (1.55%; 95% CI 0.53 to 3.04), syphilis (1.29%; 95% CI 0.59 to 2.24) and hepatitis B (6.50%; 95% CI 2.29 to 12.46) were observed among RAS from sub-Saharan Africa. The highest prevalence of hepatitis C was found in RAS from Southeast Asia (3.96%; 95% CI 2.74 to 5.38) and North Africa (3.59%; 95% CI 1.33 to 6.79). The highest prevalence of chlamydia was reported among RAS from the Middle East (1.48%; 95% CI 0.00 to 4.73) and Eastern Europe (1.40%; 95% CI 0.38 to 4.96). History of STIs, torture, blood transfusion and African origin were identified as factors associated with increased prevalence of STIs/BBVs. CONCLUSIONS: This study underscores the regional disparities in the burden of STIs/BBVs among RAS. These findings highlight the importance of targeted screening for STIs/BBVs based on the country/region of origin and individual risk factors, and implementation of mitigation measures (eg, improving healthcare access and raising awareness) tailored to their unique needs. Such measures are crucial for reducing the impact of STIs/BBVs in both RAS and host countries. PROSPERO REGISTRATION NUMBER: CRD42024546750.