The burden of disease and the cost of illness attributable to Tuberculosis and HIV/AIDS associated to massive migration between Colombia and Venezuela

Aims & objectives: The Venezuelan socio-political crisis has boosted massive exodus of Venezuelan citizens due to the shortage of medicines and spread of some preventable infectious diseases. We aimed to assess the impact of tuberculosis (TB) and HIV burden, health expenditure and the cost of illness under the framework of Colombian-Venezuelan migration flow focused on Norte de Santander, Santander, and La Guajira provinces. Methods: A retrospective study was conducted including TB and HIV data between 2009-2018. A database was made based on the records from the Colombian Surveillance System (SIVIGILA), official reports of the World Health Organization, Indexmundi, Global Health Observatory, IHME HIV Atlas and UNAIDS. Disability metrics in terms of DALYs (Disability Adjusted Life Years) and YLDs (Years Lived with Disability), were compared between both countries. Interactive maps were carried out by using ArcGIS program and the official migration data of Venezuelan citizens. We performed a phylogenetic analysis by retrieving pol sequences based in HIV cases from Venezuela and Colombia by using MEGA X and HIV Alamos database. Results: TB country profiles from Colombia and Venezuela were identical in terms of disease burden in 2017 and 2018. However, the Colombian public health settings reported an increase in the TB incidence above national average (22.1 cases per 100,000 inhabitants) in Santander, Norte de Santander and La Guajira provinces during the last years. Similar situation was observed regarding TB multidrug-resistant, prolonged hospital stays (150 days) and low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%). We identified an underfunding for HIV/AIDS control programs and patient care. Our DALY analysis showed an increased disability in HIV/AIDS patients (362.35 for 2017). Moreover, our phylogenetic analysis shows three defined clusters, which indicate specific linages through specific areas, and shared cluster in the Colombo-Venezuela border. Conclusions: This study suggests that the massive migration and program underfunding in Venezuela might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombo-Venezuelan border.