A mixed method study design to explore the adherence of haematological cancer patients to oral anticancer medication in a multilingual and multicultural outpatient setting: The MADESIO protocol.

BACKGROUND: Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined. METHODS: Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients' subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. DISCUSSION: Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.

How Diversity Approaches Affect Ethnic Minority and Majority Adolescents: Teacher-Student Relationship Trajectories and School Outcomes.

This study aimed to relate school diversity approaches to continuity and change in teacher-student relationships, comparing Belgian-majority (N = 1,875, Mage  = 14.56) and Turkish and Moroccan-minority adolescents (N = 1,445, Mage  = 15.07). Latent-Growth-Mixture-Models of student-reported teacher support and rejection over 3 years revealed three trajectories per group: normative-positive (high support, low rejection) and decreasing-negative (moderate support, high-decreasing rejection) for both groups, increasing-negative (moderate support, low-increasing rejection) for minority, moderate-positive (moderate support, low rejection) for majority youth. Trajectories differed between age groups. Student and teacher perceptions of equality and multiculturalism afforded, and assimilationism threatened, normative-positive trajectories for minority youth. Diversity approaches had less impact on majority trajectories. Normative-positive trajectories were related to improved school outcomes; they were less likely, but more beneficial for minority than majority youth.

Dementia with Lewy bodies in first-generation immigrants in a European memory clinic.

We wanted to explore possible differences in disease presentation, frequency, and age of onset of dementia with Lewy bodies (DLB) between first-generation immigrants (FGI) and patients born in Belgium (PBIB). We conducted a retrospective study on all patients of our Memory Clinic between June 1, 2010 and January 31, 2020. A synucleinopathy was diagnosed in 150 of 2702 patients (5.5%): 91 received a diagnosis of DLB (3.4%). FGI were two times more likely to receive a diagnosis of DLB, due to a higher prevalence in North-Africans and Latin-Americans. Visual hallucinations were less frequent in North-Africans than in other immigrants. FGI were younger than PBIB and reported more often parasomnia. Our data suggest a higher risk for DLB in certain immigrant groups. Especially for North-African patients, a genetic factor can be suspected, namely mutations in Leucine-rich repeat kinase 2 (LRRK2). Memory clinics with a high rate of FGI may provide interesting data and insights into the prevalence of DLB, genetic and environmental differences.

My emotions belong here and there: extending the phenomenon of emotional acculturation to heritage culture fit.

When immigrant minorities engage in a new cultural context, their patterns of emotional experience come to change - a process we coined emotional acculturation. To date, research on emotional acculturation focused on the antecedents and consequences of changes in minorities' fit with the new culture. Yet, most minorities also continue to engage in their heritage culture. Therefore, the current research investigated which personal and situational factors afford minorities to maintain emotional fit with their heritage culture. Two studies compared the emotional patterns of Korean Americans (n = 49) with those of Koreans in Korea (n = 80), and the emotional patterns of Turkish Belgians (n = 144) with those of Turks in Turkey (n = 250), respectively. As expected, we found that although minorities did not fit the heritage emotional patterns as well as participants in their home countries, spending time with heritage culture friends and interacting in heritage culture settings explained within-group differences in minorities' heritage culture fit. Therefore, the current research shows that minorities' emotional patterns are not only cultivated, but also activated by their interactions in different socio-cultural contexts. Moreover, it provides further evidence for cultural frame-switching in the domain of emotion.

Breast cancer by migrant background in Belgium: Lower risk, but worse survival in women of non-European origin.

Foreign and native populations differ in terms of breast cancer outcomes. Studies rarely distinguish between premenopausal and postmenopausal breast cancer, although the risk profile is different; nor between migrants of the first and second generation (FG and SG), which is crucial to examine genetic and environmental influences on breast cancer. This research fills these gaps by investigating patterns in breast cancer incidence and survival in different migrant groups by menopausal and migrant generational status, taking various risk factors into account. To this end, individually linked data from the 2001 census, the Belgian Cancer Registry and the Crossroads Bank for Social Security are used. Age-standardised incidence rates and incidence rate ratios are calculated by migrant background group, stratified according to ages 30-50 (premenopausal) and 50-70 (postmenopausal). Incidence rate ratios are examined with and without taking reproductive factors and socioeconomic position (SEP) into account. Relative survival percentages and relative excess risks of dying among premenopausal and postmenopausal patients are computed with and without controlling for the stage at diagnosis and SEP. Premenopausal breast cancer is further examined by migrant generational status. Breast cancer incidence is lower among non-European migrants compared to Belgians. Keeping SEP and known risk factors constant reduces much, but not all of the observed discrepancies. A risk convergence between SG migrants and Belgians for the development of premenopausal breast cancer is observed. Premenopausal breast cancer survival is worse among Moroccan patients due to a higher stage at diagnosis. This disadvantage is concentrated in the FG.

Chromametric assessment of drug skin tolerance: A comparative study between Africans and Caucasians skins.

BACKGROUND/AIMS: During dermatological forms development, one of the simplest non-invasive techniques used to evaluate cutaneous tolerance of formulations is to monitor the color changes using a tristimulus chromameter. Most published tolerance studies involving chromametric measurements are performed on Caucasian subjects. However, in the context of drug formulation for African-type populations, it is not always relevant to transpose tolerance results obtained on Caucasians populations to African-type ones due to histological ethnic differences of the skin. The goal of this work was to assess whether tristimulus chromameter can be used to highlight color variations following the application of dermatological topics on black skin in order to validate skin tolerance studies made on African-type subjects. MATERIALS AND METHODS: After application of two commercial creams with opposite side effects (skin irritation and skin blanching) in both Africans and Caucasians populations, color variations were evaluated using a tristimulus chromameter in L* a* b* color system and compared between both populations. L* indicating color brightness, a* represents green and red directions and b* represents blue and yellow directions. RESULTS: While skin irritation resulted in a significant increase of a* parameter in both studied populations, the skin blanching resulted in a decrease of a* associated with an increase of L* . CONCLUSION: We established that tristimulus chromameter can be used to achieve in vivo skin tolerance study of dermatologic formulations in Africans despite their dark skin even though it appeared less sensitive. This study can speed up the development of dermatological forms dedicated to Africans and/or Caucasians subjects.

Student nurse perceptions of Gypsy Roma Travellers; A European qualitative study.

BACKGROUND: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.

Migrant mortality differences in the 2000s in Belgium: interaction with gender and the role of socioeconomic position.

BACKGROUND: Belgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox. METHODS: Individually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001-2011 were used. Migrant origin was based on both own and parents' origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status. RESULTS: We observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death. CONCLUSIONS: Adjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata.

Incidence of Zika virus infection in a prospective cohort of Belgian travellers to the Americas in 2016.

BACKGROUND: The incidence rate of Zika virus (ZIKV) infection in travellers from non-endemic areas to the Americas during the ZIKV outbreak in 2016 is unknown. METHODS: Belgian adults who planned to travel to South America, Central America, and the Caribbean were recruited prospectively to study the incidence and characteristics of ZIKV. Demographic data and sera were collected at baseline. Participants were trained to collect capillary blood on filter paper (BFP). When ill during travel, the participants completed a questionnaire and they sampled BFP for post-hoc analysis. All symptomatic participants were screened for ZIKV using ZIKV-specific RT-PCR on serum or urine, or BFP, and antibody detection assays (ELISA). Follow-up sera of asymptomatic travellers, obtained at least 20 days post travel, were tested by ZIKV ELISA only. All positive ELISA results were subject to confirmation by virus neutralization testing (VNT). RESULTS: Forty-nine participants completed follow-up: 38 women and 11 men, with a median age of 32 years (range 19-64 years). Travel destinations were countries in South America (n=20), Central America (n=24), and the Caribbean (n=5). The total travel duration was 67.8 person-months. Illness was reported by 24 participants (49.0%). ZIKV infection was confirmed in nine cases, by RT-PCR (n=5) and by VNT (n=4). Only one of nine ZIKV cases (11.1%) was asymptomatic. The ZIKV incidence rate was 17.0% (95% confidence interval 7.8-32.2%) per month of travel. CONCLUSIONS: The ZIKV incidence rate in adult travellers from non-endemic countries to the epidemic territories during the 2016 outbreak was high. Asymptomatic ZIKV infection was rare in this population.

[Late Neuroborreliosis in an Erasmus Programme Student]. / Neuroborreliose Tardia num Estudante em Programa Erasmus.

Lyme disease is an endemic zoonosis, the most prevalent tick-transmitted infection in temperate areas of Europe, North America and Asia. It is a multisystemic disease with cutaneous, musculoskeletal, neurologic and cardiac manifestations, according to the stage of the disease. We describe a case of late neuroborreliosis in an Erasmus programme student living in Porto. We discuss the importance of the epidemiological suspicion, the clinical approach, the diagnostic criteria and the most adequate treatment.

A doença de Lyme é uma zoonose endémica nos Estados Unidos da América (EUA), na Ásia e no continente europeu, nomeadamente nos países do centro da Europa. Trata-se de uma doença multissistémica, com manifestações cutâneas, articulares, neurológicas e cardíacas, que variam de acordo com a fase da doença. Apresentamos o caso de uma neuroborreliose tardia num jovem estudante belga a residir temporariamente no Porto. Discutimos a importância da suspeita epidemiológica, a investigação etiológica, os critérios de diagnóstico e o tratamento mais adequado.

Efficacy of golimumab in Belgian patients with active rheumatoid arthritis despite treatment with non-biologic disease-modifying anti-rheumatic drugs: sub-analysis of the GO-MORE study.

OBJECTIVES: The GO-MORE trial (NCT00975130) was a phase 3 study in 40 countries evaluating the efficacy and safety of golimumab as add-on therapy in biologic-naïve adults with active rheumatoid arthritis despite stable treatment with disease-modifying anti-rheumatic drugs. To inform local practice in Belgium and examine the role of baseline disease activity in treatment response, we compared the efficacy of golimumab in the Belgian subpopulation and the rest of the world. METHODS: Baseline disease activity and six-month efficacy rates in the GO-MORE trial were compared for the Belgian subpopulation and the rest of the world by t-tests and chi-squared tests. RESULTS: Except for functional impairment, all measures of baseline disease activity were significantly lower (p < 0.0001) in the Belgian population (n = 123) than in the rest of the world (n = 3157). At month six, the rate of good/moderate EULAR response was similar in Belgium and the rest of the world (78.9% vs. 82.2%; p = 0.34), but remission rates were higher in Belgium according to the DAS28-ESR (43.1% vs. 23.2%; p < 0.0001) and Simplified Disease Activity Index (22.0% vs. 13.8%; p = 0.01). Rates of low DAS28-ESR disease activity were also higher in Belgium (54.5% vs. 36.8%; p < 0.0001). Within the Belgian subpopulation, efficacy measures were not significantly different between patients with moderate (n = 73) and high baseline activity (n = 49). Rates of functional impairment at month six did not differ between the two populations. CONCLUSION: In the Belgian population of the GO-MORE trial, baseline disease activity was lower and six-month remission rates were higher than in the rest of the world.

The Relation Between Valence and Arousal in Subjective Experience Varies With Personality and Culture.

OBJECTIVE: While in general arousal increases with positive or negative valence (a so-called V-shaped relation), there are large differences among individuals in how these two fundamental dimensions of affect are related in people's experience. In two studies, we examined two possible sources of this variation: personality and culture. METHOD: In Study 1, participants (Belgian university students) recalled a recent event that was characterized by high or low valence or arousal and reported on their feelings and their personality in terms of the Five-Factor Model. In Study 2, participants from Canada, China/Hong Kong, Japan, Korea, and Spain reported on their feelings in a thin slice of time and on their personality. RESULTS: In Study 1, we replicated the V-shape as characterizing the relation between valence and arousal, and identified personality correlates of experiencing particular valence-arousal combinations. In Study 2, we documented how the V-shaped relation varied as a function of Western versus Eastern cultural background and personality. CONCLUSIONS: The results showed that the steepness of the V-shaped relation between valence and arousal increases with Extraversion within cultures, and with a West-East distinction between cultures. Implications for the personality-emotion link and research on cultural differences in affect are discussed.

A social network analysis of substance use among immigrant adolescents in six European cities.

BACKGROUND: Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents' social networks according to migration background, and to examine how social networks are associated with substance use. METHOD: In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home. We computed two groups of network structural positions, the centrality of individual adolescents in networks, and the homophily of their social ties regarding migration (same-migration). Multilevel logistic regression was used to model the association between network structural position and smoking, alcohol use, and cannabis use. RESULTS: Compared with non-migrant adolescents, adolescents with migration backgrounds had similar relationship patterns. But almost half their social ties were with same-migration-background adolescents; non-migrants had few social ties to migrants. For adolescents with a migration background, a higher proportion of social ties with non-migrants was associated with increased use of cannabis (OR = 1.07, p = 0.03) and alcohol (OR = 1.08, p < 0.01), but not with increased smoking (p = 0.60). Popular migrant adolescents were at less risk of smoking, alcohol use, and cannabis use than popular non-migrant adolescents. CONCLUSION: Homophily of social ties by migration background is noticeable in European schools. The tendency of migrant adolescents to have same-migration social ties may isolate them from non-migrant adolescents, but also reduces their risky health behaviours, in particular cannabis and alcohol use.

Minority Adolescents in Ethnically Diverse Schools: Perceptions of Equal Treatment Buffer Threat Effects.

Can perceptions of equal treatment buffer the negative effects of threat on the school success of minority students? Focusing on minority adolescents from Turkish and Moroccan heritage in Belgium (Mage  = 14.5; N = 735 in 47 ethnically diverse schools), multilevel mediated moderation analyses showed: (a) perceived discrimination at school predicted lower test performance; (b) experimentally manipulated stereotype threat decreased performance (mediated by increased disengagement); (c) perceived equal treatment at school predicted higher performance (mediated by decreased disengagement); and (d) personal and peer perceptions of equal treatment buffered negative effects of discrimination and stereotype threat. Thus, (situational) stereotype threat and perceived discrimination at school both undermine minority student success, whereas perceived equal treatment can provide a buffer against such threats.

Ageism in Belgium and Burundi: a comparative analysis.

BACKGROUND: Recent cross-cultural comparisons between Asian and Western cultures have shown that ageism arises more from the lack of availability of social and economic resources for older adults than from the culture itself. We tested this assumption by conducting a survey among people living in a least developed country compared with those living in a developed country. PARTICIPANTS AND METHODS: Twenty-seven Belgians living in Belgium, 29 Burundians living in Belgium, and 32 Burundians living in Burundi were included in this study. Their attitudes toward older adults were assessed using several self-reported measures. RESULTS: Statistical analyses confirmed that older people are more negatively perceived by Burundians living in Burundi than by Burundians and Belgians living in Belgium, whose attitudes did not differ from each other. CONCLUSION: Consistent with our hypothesis, our results suggest that the level of development of a country and more particularly the lack of government spending on older people (pension and health care systems) may contribute to their younger counterparts perceiving them more negatively.

Minority acculturation and peer rejection: Costs of acculturation misfit with peer-group norms.

How do minority adolescents' personal acculturation preferences and peer norms of acculturation affect their social inclusion in school? Turkish and Moroccan minority adolescents (N = 681) reported their preferences for heritage culture maintenance, mainstream culture adoption, and their experiences of peer rejection as a key indicator of adjustment problems. Additionally, we aggregated peer acculturation norms of maintenance and adoption within ethnically diverse classrooms (N = 230 in 50 Belgian schools), distinguishing between co-ethnic (Turkish or Moroccan classmates only, N = 681) and cross-ethnic norms (also including N = 1,930 other classmates). Cross-ethnic peer-group norms (of adoption and maintenance) and co-ethnic norms (of maintenance, marginally) predicted minority experiences of peer rejection (controlling for ethnic composition). Moreover, misfit of minorities' own acculturation preferences with both cross-ethnic and co-ethnic peer-group norms was harmful. When cross-ethnic norms stressed adoption, 'integrationist' minority youth - who combined culture adoption with maintenance - experienced most peer rejection. Yet, when co-ethnic peers stressed maintenance, 'assimilationist' minority youth experienced most rejection. In conclusion, acculturation misfit with peer-group norms is a risk factor for minority inclusion in ethnically diverse environments.

The ethnic prejudice of Flemish teachers: The role of ethnic school composition and of teachability.

OBJECTIVES: The aim of this study is to investigate the association between ethnic composition in school and the ethnic prejudice of teachers, controlling for the individual characteristics of teachers and their perceptions of pupils' teachability. METHOD: Multilevel analyses were carried out on data for 499 Flemish teachers in 44 Flemish (Belgian) secondary schools, collected through an online questionnaire. In this study, ethnic prejudice means a negative attitude to Moroccans, Turks, and Eastern Europeans. A scale was created by taking the mean scores for 18 items, with higher scores indicating greater ethnic prejudice (Quillian, 1995; Witte, 1999). RESULTS: Teachers with long-term higher education or a university diploma are shown to be less ethnically prejudiced than teachers with a lower level of education. Moreover, teachers who work at a school with a greater number of ethnic minority pupils, and at the same time evaluate their pupils as more teachable, are less ethnically prejudiced. CONCLUSIONS: These findings highlight the need for more research into the underlying processes, such as pupils' teachability, that influence the relationship between school characteristics and the ethnic prejudice of teachers. More knowledge about the context-specific factors and processes that mediate and/or moderate this relationship can increase the theoretical understanding of the development of ethnic prejudice. It can also highlight particular social characteristics, which can be the focus of social and organizational policy aimed at reducing ethnic prejudices. (PsycINFO Database Record

Accessible health care for Roma: a gypsy's tale a qualitative in-depth study of access to health care for Roma in Ghent.

BACKGROUND: In general, vulnerable populations experience more problems in accessing health care. This also applies to the Roma-population. In the City of Ghent, Belgium, a relatively large group of Roma resides more or less permanently. The aim of this study is to explore the barriers this population encounters in their search for care. METHODS: In this qualitative study using in-depth interviews the barriers to health care for the Roma in Ghent are explored. We interviewed 12 Roma and 13 professionals (volunteers, health care providers,...) who had regular contact with the Roma-population in Ghent. For both groups purposive sampling was used to achieve maximal variation regarding gender, age, nationality and legal status. RESULTS: The Roma-population in Ghent encounters various barriers in their search for care. Financial constraints, not being able to reach health care and having problems to get through the complexity of the system are some of the most critical problems. Another important finding is the crucial role of trust between patient and care provider in the care-giving process. CONCLUSION: Roma share several barriers with other minority groups, such as: financial constraints, mobility issues and not knowing the language. However, more distinctive for this group is the lack of trust in care providers and health care in general. As a result, restraint and lack of communication form serious barriers for both patient and provider in their interaction. In order to ensure equitable access for Roma, more emphasis should be on establishing a relationship of mutual respect and understanding.

Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants.

BACKGROUND: The Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors. METHODS: Data on new HIV diagnoses 2007-2010 and HIV-infected patients in care in 2010-2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied. RESULTS: Of all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2% were linked to HIV care, 90.8% were retained in care, 83.3% received antiretroviral therapy and 69.5% had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression. CONCLUSIONS: The continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20% based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.