764. Correlates of Lost to Follow-up Among Newly Diagnosed Older People with HIV in Ukraine

Abstract

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

The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine

“…While no studies in Ukraine have assessed HIV knowledge specifically among older adults, a study conducted in Ukraine among PLWH of all ages identified a lack of knowledge about HIV as a major barrier to linkage to care (Kiriazova et al, 2018). The results of this study, as well as findings globally in other settings showing that OPWH possess low levels of knowledge about HIV (Henderson et al, 2004) and do not perceive themselves to be at risk for HIV (Altschuler et al, 2008;Jackson et al, 2005;Maes & Louis, 2003), suggest that HIV knowledge and risk perception may be lower in Ukrainian OPWH compared with younger patients and may contribute to the low linkage to care seen in Ukraine (Allen et al, 2020b). In general, increased awareness of HIV in older adults and the variety of mechanisms by which HIV is transmitted is needed among the general population, providers, and at the institutional level in Ukraine.…”

“…In Ukraine, 15% of new HIV diagnoses occur in people over the age of 50, and this percentage is increasing (Rozanova, 2018). Our ongoing research has also shown that OPWH in Ukraine experience delays in antiretroviral therapy (ART) initiation and are over 3 times more likely to be lost to follow-up compared with younger patients (Allen et al, 2020a(Allen et al, , 2020b. Despite these figures, there are a lack of targeted prevention or treatment programs for OPWH in Ukraine.…”

“…No studies to our knowledge have examined coping strategies among newly diagnosed OPWH (within 6 months of their diagnosis) in any setting, as extant published studies either excluded OPWH who were newly diagnosed (Rosenfeld et al, 2018), examined OPWH diagnosed many years prior (Beuthin et al, 2015;Fumaz et al, 2015;Solomon et al, 2014), or included a mix of newly diagnosed OPWH and those who had learned about their status long ago (Emlet et al, 2011;Siegel et al, 1998;Siegel & Schrimshaw, 2002). In the Ukrainian context, this early period after diagnosis is of particular concern given ongoing work demonstrating significantly higher rates of loss to follow-up after diagnosis among OPWH compared with younger patients, highlighting the need for intervention during this critical time (Allen et al, 2020b). Furthermore, research on coping in OPWH has primarily been conducted in the United States or Western Europe (Emlet et al, 2011;Fumaz et al, 2015).…”

The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine

“…However, the vast majority of OPWH, including those with an addiction history, reported low levels of alcohol use, which is consistent with other studies, despite earlier hypotheses that lockdown will result in higher alcohol use [ 8 ]. It is possible that social support (including by trusted clinicians) to vulnerable OPWH with comorbid addictions has played a significant protective role during the COVID-19 lockdown [ 27 ]. Early findings from other global regions [ 72 ] also suggest that patients with comorbid SUD and HIV who were stably linked to addiction care had no significant changes in risk behaviours during the COVID-19 lockdown.…”

“…About a quarter of PWH in Ukraine are OPWH, defined as those aged ≥50 years [ 22 , 23 , 24 , 25 ]. While Ukraine has made significant strides in HIV care for key populations, including people who inject drugs, men who have sex with men, and persons engaged in commercial sex work, OPWH have not been a target priority population [ 26 ], with emerging challenges to the continuity of care during COVID-19 [ 27 ].…”