Resum

Background : In recent years, the HIV epidemic in the Dominican Republic and surrounding regions in Latin America has disproportionately affected migrants, particularly those from Haiti and Venezuela. Migrants often face unique challenges along the HIV continuum of care that require tailored interventions. We conducted a study to understand the drivers of retention, attrition, and viral suppression in this population to identify intervenable factors, improve outcomes and control HIV in the region. Methods : We conducted a retrospective analysis of 1,326 patients enrolled in HIV care from 2019 to 2021 at a major HIV clinic in the Dominican Republic. We used multivariable Cox proportional hazards and logistic regression models to assess sociodemographic and clinical factors associated with retention in care (as of May 1st, 2024) and viral suppression (VL < 200 copies/mL). Key variables included age, nationality, legal documentation status, key population status (e.g., MSM), CD4 count, and site of ART delivery (community- vs. health center-based). Results : Of 1,326 participants, 773 (58.3%) remained in care. Retention was associated with older age (40-49 years: HR 0.67, p=0.002; =50 years: HR 0.74, p=0.05), identifying as MSM (HR 0.70, 95%CI 0.54-0.90, p<0.001) and receiving ART in community settings (HR 0.14, 95%CI 0.07–0.30, p<0.001). Attrition was more common among undocumented individuals (HR 2.61, 95%CI 2.09-3.25, p<0.001), people from Haiti (HR 1.95, 95%CI 1.55-2.46, p<0.001), and non-Dominican nationals (HR 2.02, 95%CI 1.31-3.13, p=0.002). Among the 759 patients retained in care who had available viral load data, 674 (88.8%) achieved viral suppression. Factors positively associated with viral suppression included being part of a key population (predominantly MSM: OR 0.38, 95%CI 0.14-0.91, p=0.04) and an initial CD4 count =200 cells/mm³ (OR 0.59, 95%CI 0.35-1.03, p=0.06). Detectable viral loads were associated with undocumented status (OR 2.15, 95%CI 1.08 – 4.23, p=0.03) and non-Dominican nationality (OR 2.73, 95%CI 1.43-5.26, p=0.002). Conclusions : In the Dominican Republic, older age, identifying as MSM, and receiving ART in the community were associated with better retention and outcomes. However, challenges remain for undocumented individuals and migrants, highlighting the need for inclusive strategies that address access to care for this population. By considering these diverse factors, targeted interventions can be developed to improve HIV outcomes and advance epidemic control in the region.