HIV treatment cascade among people who inject drugs in Ukraine

Abstract

The HIV treatment cascade is an effective tool to track progress and gaps in the HIV response among key populations. People who inject drugs (PWID) remain the most affected key population in Ukraine with HIV prevalence of 22% in 2015. We performed secondary analysis of the 2017 Integrated Bio-Behavioral Surveillance (IBBS) survey data to construct the HIV treatment cascade for PWID and identify correlates of each indicator achievement. The biggest gap in the cascade was found in the first “90”, HIV status awareness: only 58% [95% CI: 56%-61%] of HIV-positive PWID reported being aware of their HIV-positive status. Almost 70% [67%-72%] of all HIV-infected PWID who were aware of their status reported that they currently received antiretroviral therapy (ART). Almost three quarters (74% [71%-77%]) of all HIV-infected PWID on ART were virally suppressed. Access to harm reduction services in the past 12 months and lifetime receipt of opioid agonist treatment (OAT) had the strongest association with HIV status awareness. Additionally, OAT patients who were aware of HIV-positive status had 1.7 [1.2–2.3] times the odds of receiving ART. Being on ART for the last 6 months or longer increased odds to be virally suppressed; in contrast, missed recent doses of ART significantly decreased the odds of suppression. The HIV treatment cascade analysis for PWID in Ukraine revealed substantial gaps at each step and identified factors contributing to achievement of the outcomes. More intensive harm reduction outreach along with targeted case finding could help to fill the HIV awareness gap among PWID in Ukraine. Scale up of OAT and community-level linkage to care and ART adherence interventions are viable strategies to improve ART coverage and viral suppression among PWID.

Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

“…10 These groups have been identified as facing challenges to diagnosis, treatment, and remaining in care. 11,12 Other key populations also face challenges with high numbers of undiagnosed HIV, high HIV prevalence, less ART initiation, and low rates of viral suppression. 13 In addition to low ART rollout, the uncontrolled HIV epidemic is also driven by a notable prevention gap.…”

HIV Continuum of Care Among People Who Inject Drugs in Iran

“…There is a wide diversity between countries with a broad spectrum of political, economic, and HIV epidemic status in reaching 90-90-90 targets among PWID. Comparison the rst cascade indicator in Iran with other countries revealed that this proportion was relatively higher than in Central Asia or other European countriesand some countries like Mexico (7)(8)(9)(10).Regarding the 57% ART coverage among PWID who were aware of their HIV status, we have found that in this study is lower than the average in other Low-Middle income countries globally and within Eastern Europe and Central Asia (7,11). The level of viral load suppression in Iranian PWID is not comparable and desirable compared to other countries globally which is reported about three quarters of all HIV-infected PWID on ART (7).…”

Comparative Clinical Outcomes With Scale-up of Dolutegravir as First-Line Antiretroviral Therapy in Ukraine

“…This effect may be explained by the lack of motivation to engage in care, 25 the role of stigma and discrimination in deterring optimal care, 26,27 or other structural barriers. 28,29…”

“…This effect may be explained by the lack of motivation to engage in care, 25 the role of stigma and discrimination in deterring optimal care, 26,27 or other structural barriers. 28,29 Substance use, especially IDU, is known to decrease the chance of VS 30 because of adherence issues 31 and through other pathways. We observed this association in bivariate analyses, as expected.…”