Slowing of the HIV Epidemic in Ukraine: Evidence from Case Reporting and Key Population Surveys, 2005–2012

Vitek, Charles; Čakalo, Jurja-Ivana; Kruglov, Yuri; Dumchev, Konstantin; Salyuk, Tetyana; Božičević, Ivana; Baughman, Andrew L.; Spindler, Hilary; Martsynovska, Violetta A.; Kobyshcha, Yuri; Abdul-Quader, Abu; Rutherford, George W.

doi:10.1371/journal.pone.0103657

Cited by 68 publications

(74 citation statements)

References 7 publications

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“…Higher alcohol use was found to be associated with more frequent injection risk practices [24,25]. In Ukraine, the overall number of HIV-infected PWIDs remains high, and this predominantly male group continues to be a major source for new heterosexual infections, especially among their female partners [1].…”

Section: Introductionmentioning

confidence: 96%

“…Ukraine is a country with an HIVepidemic concentrated mainly among people who inject drugs (PWIDs) [1]. From the beginning of the HIV epidemic in 1995 to 2007, about 60% of newly diagnosed HIV cases were related to injection drug use [2].…”

Section: Introductionmentioning

confidence: 99%

“…Among the programs implemented in Ukraine are access to needle and syringe exchange programs (NSPs) and opioid agonist treatment (OAT). HIV incidence has been steadily decreasing among young (15-24 year olds) PWIDs in Ukraine since 2008 [1]. This apparent decrease in HIV prevalence among PWIDs with short lifetime duration of injection drug use may be explained by the annual increase in prevention program coverage [29].…”

Section: Introductionmentioning

confidence: 99%

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Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007–2013

et al. 2017

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The study examined trends in injection risk behaviors among people who inject drugs (PWIDs) and assessed the impact of harm reduction programs in Ukraine during [2007][2008][2009][2010][2011][2012][2013]. We performed a secondary analysis of the data collected in serial cross-sectional bio-behavioral surveillance surveys administered with PWIDs in Ukraine in 2007, 2008, 2011, and 2013. Using data from 14 Ukrainian cities, we assessed short-term trends in injection risk behaviors with the Cochran-Armitage test for trend and multivariable logistic regression models, adjusted for age, sex, region, marital status, education level, occupation, age at injection drug use initiation, experience of overdose, and self-reported HIV status. The overall test for trend indicated a statistically significant decrease over time for sharing needle/syringe during the last injection (p < 0.0001), sharing needle/syringe at least once in the last 30 days (p < 0.0001), and using a common container for drug preparation (p < 0.0001). The prevalence of injecting drugs from pre-loaded syringes was high (61.0%) and did not change over the study period. The observed reduction in the prevalence of injection risk behavior over time is encouraging. Our findings suggest that prevention programs in Ukraine have positive impact and provide support for governmental expansion of these programs.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007–2013

et al. 2017

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“…kraine experienced the most severe human immunodeficiency virus (HIV) epidemic in Europe before prevention measures began to slow transmission (1)(2)(3). In 2013, approximately 210,000 persons were living with HIV, and the HIV prevalence was 0.8% among adults 15 to 49 years of age and women at childbirth (1)(2)(3).…”

mentioning

confidence: 99%

“…In 2013, approximately 210,000 persons were living with HIV, and the HIV prevalence was 0.8% among adults 15 to 49 years of age and women at childbirth (1)(2)(3). HIV infections in Ukraine mainly are the result of injection drug use (4).…”

mentioning

confidence: 99%

Performance of an Early Infant Diagnostic Test, AmpliSens DNA-HIV-FRT, Using Dried Blood Spots Collected from Children Born to Human Immunodeficiency Virus-Infected Mothers in Ukraine

et al. 2015

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U kraine experienced the most severe human immunodeficiency virus (HIV) epidemic in Europe before prevention measures began to slow transmission (1-3). In 2013, approximately 210,000 persons were living with HIV, and the HIV prevalence was 0.8% among adults 15 to 49 years of age and women at childbirth (1-3). HIV infections in Ukraine mainly are the result of injection drug use (4). However, heterosexual HIV transmission in Ukraine is increasing (4). Because of women's biological and social vulnerability (e.g., women engaging in commercial sex work to provide funds for drugs for their male partners), women are more prone to infection (4, 5). Women now represent 45% of all adults living with HIV in Ukraine, and the majority of those women are of reproductive age (4, 5). In 2001, the Ukrainian government implemented a national program for prevention of mother-to-child transmission. Since then, the rate of mother-tochild transmission has decreased from 21% to 3.7% (6), as of 2011. Although the numbers of HIV-infected pregnant women have plateaued, approximately 4,000 HIV-exposed children are born each year (1, 4).In order for HIV-infected children to receive antiretroviral treatment as early as possible, accurate accessible early infant diagnosis (EID) of HIV is crucial. The World Health Organization (WHO) strongly recommends using virological tests for EID, because infants and children of HIV-positive mothers acquire antibodies transplacentally and the antibodies can persist in the infants for up to 18 months after birth (7). Ukraine has had insufficient capacity for full coverage with EID virological methods. Since 2006, Ukrainian laboratories have been using a DNAbased PCR test, the AmpliSens DNA-HIV-FRT PCR assay (InterLabService, Moscow, Russia), for EID using infants' venous whole blood (8). Using venous whole blood for EID presents challenges in resource-limited settings and remote areas, because wholeblood samples require cold-chain transportation and the conditions for sample storage and processing are more stringent. Dried blood spot (DBS) samples offer multiple advantages for EID, because the samples can be collected easily by heel prick or finger stick and can be stored at ambient temperature for long periods (9-15). Because of their greater stability at ambient temperature, DBS samples can be transported by postal mail to centralized laboratories for testing and, if packaged correctly, do not raise biosafety concerns regarding the health of postal workers (9-15). Published data indicate that DBS samples are suitable and practical for quality EID and have aided service expansion in sub-Saharan Africa (16-21). In our study, for the first time, the performances of the AmpliSens DNA PCR assay and two commercially Performance of an early infant diagnostic test, AmpliSens DNA-HIV-FRT, using dried blood spots collected from children born to human immunodeficiency virus-infected mothers in Ukraine.

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Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine

et al. 2018

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IntroductionProviding HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach‐based testing or respondent‐driven sampling (RDS) in Odessa, Ukraine.MethodsThe Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently‐infected and longer‐term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects.Results TRIP tested 1252 people (21% women) in seeds’ risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently‐infected participants’ networks contained higher proportions of undiagnosed positives (16.3%) than LTs’ networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing.Conclusions TRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV‐positive people efficiently. They should be integrated with standard practice to improve case‐finding. Research should test these techniques in other socio‐epidemiologic contexts.Clinical trial registryRegistered ClinicalTrials.gov: NCT01827228.

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Slowing of the HIV Epidemic in Ukraine: Evidence from Case Reporting and Key Population Surveys, 2005–2012

Cited by 68 publications

References 7 publications

Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007–2013

Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007–2013

Performance of an Early Infant Diagnostic Test, AmpliSens DNA-HIV-FRT, Using Dried Blood Spots Collected from Children Born to Human Immunodeficiency Virus-Infected Mothers in Ukraine

Risk network approaches to locating undiagnosed HIV cases in Odessa, Ukraine

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