In Ukraine, about one-third of identified HIV-positive individuals are not connected to care. We conducted a cross-sectional survey (n = 200) among patients registered at Odessa AIDS centers in October to December 2011. Factors associated with delayed enrollment in HIV care (>3 months since positive HIV test) were evaluated using logistic regression. Among study participants (mean age 35 ± 8.2 years, 47.5% female, 42.5% reported history of injecting drugs), 55% delayed HIV care enrollment. Odds of delayed enrollment were higher for those with lower educational attainment (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [CI]: 1.04-6.76), not feeling ill (aOR: 2.98, 95% CI: 1.50-5.93), or not having time to go to the AIDS center (aOR: 3.89, 95% CI: 1.39-10.89); injection drug use was not associated with delayed enrollment. Programs linking HIV-positive individuals to specialized care should address enrollment barriers and include education on HIV care benefits and case management for direct linkage to care. HIV testing and treatment should be coupled to ensure a continuum of care.
Between October 2015 and March 2018, we conducted the Modified Antiretroviral Treatment Access Study (MARTAS), a nurse-delivered case management intervention to improve linkage-tocare for persons recently tested HIV positive. Adult participants from nine urban clinics in three regions of Ukraine were randomized to either MARTAS or standard of care (SOC) using individual, parallel, two-arm design. The main study outcome was linkage-to-care (defined as registration at an HIV clinic) within a 3-month period from enrollment in the study. Intention-totreat analysis of MARTAS (n = 135) versus SOC (n = 139) showed intervention efficacy in linkage to HIV care (84.4% vs. 33.8%; adjusted RR 2.45; 95% CI 1.72, 3.47; p < 0.001). MARTAS is recommended for implementation in Ukraine and may be helpful in other countries with similar gaps in linkage-to-care. Clinicaltrials.gov registration number: NCT02338024.
Background Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia. Older People with HIV (OPWH) are at increased risk of poor outcomes compared to younger patients. We examined the prevalence and correlates of loss to follow-up (LTFU) among newly diagnosed patients in Ukraine. Methods Retrospective chart review was conducted of 400 patients newly diagnosed with HIV July 1, 2017 - Dec 1, 2018. Data was collected from clinics in the city of Odessa and surrounding regions. OPWH were ≥50 years old at diagnosis and LTFU was defined as no contact with the HIV clinic for 90 days. Demographic, clinical characteristics, and follow-up outcomes were examined, and multivariate logistic regression was used to estimate the adjusted odds ratios at 95% confidence intervals. Results Of the 400 people living with HIV, median age was 50 (IQR35-55), 196 (49%) were women, and 177 (44%) had CD4< 200cell/mm3 at diagnosis. Overall, 65 (16.5%) were LTFU from diagnosis and 54/65 (83%) were lost after their first appointment at the HIV clinic. Among those lost to follow-up, 49 (75%) were ≥50 at the time of diagnosis. Multivariate analysis showed LTFU was associated with age >50years (aOR 3.6, CI 1.8-7.3, p=0.001), lack of ART prescription (aOR 16.4, CI 8.5-31.8, p= 0.001), and living outside the city of Odessa (aOR 2.9, CI 1.5-5.7, p=0.002). Figure 1 shows the breakdown of lost to follow-up for OPWH. Figure 1. Retainment in HIV Care for OPWH compared to those <50 years old. Conclusion LTFU among OPWH is significantly greater than younger people with HIV, and associated with lack of ART and living in nonurban settings. OPWH may benefit from differentiated HIV service delivery to reduce loss to follow up and interventions tailored to improving HIV outcomes for OPWH in resource-limited settings are urgently needed. Disclosures All Authors: No reported disclosures
Background Ukraine has a high burden of HIV, with only 52% of people living with HIV receiving Antiretroviral Therapy (ART) despite test and treat policies and free medications. An underrecognized but significantly increasing proportion of older people with HIV (OPWH) contribute 15% of new HIV diagnoses and demonstrate increased mortality compared to the age-matched general population. To assess the impact of age on HIV treatment outcomes, we examined correlates of ART initiation among newly diagnosed HIV patients in Ukraine. Methods A retrospective chart review was conducted of 400 patients newly diagnosed with HIV between July 1, 2017- Dec 1, 2018 in Odessa, Ukraine. OPWH were defined as those ≥50 years old at the time of diagnosis, while ART initiation was defined as prescription and dispensing of medication. Outcomes were censored 6 months from diagnosis. Demographic, clinical characteristics, and ART outcomes were examined and multivariable logistic regression models were used to estimate correlates of ART initiation with adjusted odds ratios at 95% confidence intervals. Results Of the 400 included patients, 198 (49.5%) were < 50 years old and 202 (50.5%) were ≥ 50 years old at the time of diagnosis. Patients ≥50 years old were more likely to have a lower CD4 count (median 148 (IQR 60-316) vs 295 (IQR 111-478), p=0.001). Correlates of ART initiation included age less than 50 and history of opportunistic infection within 12 months of diagnosis. After controlling for opportunistic infection history, OPWH were 51% less likely to receive ART than those < 50 years old at the time of diagnosis (AOR 0.496, CI 0.301-0.816, p=0.006). Conclusion OPWH exhibit an ART gap associated with advanced disease at presentation compared to younger individuals newly diagnosed with HIV. This is the first clinical data examining OPWH in Ukraine. Interventions to improve linkage to care for OPWH are urgently needed in a population already at increased risk for HIV related mortality. The results of this study emphasize the need for further studies to examine patient and systemic causes of decreased ART initiation among Ukrainian OPWH. Disclosures All Authors: No reported disclosures
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