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Ukraine AIDS 2024
Overcoming Barriers to HIV Care During Adversity: AIDS 2024

Released: September 03, 2024

Expiration: September 02, 2025

Olga Gvozdetska
Olga Gvozdetska,
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Delivering care at the site of communities in need is an effective way to retain people in HIV care and expand PrEP access.
  • Eradicating HIV-related stigma requires coordinated effort at both the national and regional level.

AIDS 2024 is one of the largest gatherings on HIV and AIDS, uniting researchers and stakeholders on health policy to promote an evidence-based approach to the HIV response. My team from our state institution—the Public Health Center of the Ministry of Health of Ukraine—took part in this event to showcase our national strategies against HIV, tuberculosis, and viral hepatitis and to highlight the approaches that Ukraine successfully implemented to overcome these infections amidst the challenges of war.

Retaining People in Care During Unstable Times
In the plenary session, “Putting People First: The Way Forward,” I spoke about integrated HIV, tuberculosis, and viral hepatitis programming. I focused on our system for surveillance of recent HIV cases, a system that launched in 3 regions in 2021 and will be implemented at the national level by the end of 2024. Tracking the frequency of new cases and the spread of HIV infection is crucial for understanding how the epidemic evolves, pinpointing populations at greater risk, and evaluating the success of interventions aimed at control and prevention.

Healthcare professionals in Ukraine face a critical challenge in retaining people with HIV in care. Before the war, quarterly antiretroviral therapy nonadherence rates were below 4%. In the first quarter after the full-scale invasion in 2022, the rate of loss of individuals to follow-up was a staggering 11.1%. However, by 2023, quarterly losses had improved to just more than 4%.

I attribute this improvement to our Monitoring Socially Significant Diseases system, which helps to track of people and maintain communication. To provide treatment and prevent interruptions for people with HIV who have been displaced, we also created an extensive network of decentralized service delivery points, so people could more easily access care.

I believe that other European countries can use this example as a model for expanding HIV management and pre-exposure prophylaxis (PrEP) services. I also recommend bringing services as close to patients as possible and scaling the number of integrated service delivery points in accordance with the needs of each community.

We realize that each of our actions can affect many lives. The coordinated work between our Public Health Center and nongovernmental organizations at the national level—and between healthcare professionals and social workers at the regional level—is critical to retaining people in care. We do our best to reach out to every patient; just one call or visit from a social worker can make a world of difference.

Expansion of PrEP Despite Instability
As with HIV care, disruptions in access to PrEP also required urgent and effective solutions after the full-scale invasion of Ukraine. At AIDS 2024, I shared my experience with implementing measures to improve access to PrEP, including dispensing PrEP at peoples’ locations and expanding the network of PrEP service providers.

Excluding the occupied territories, where PrEP services have not been provided since the beginning of the invasion, our Public Health Center managed to initiate PrEP in more than 6000 new people in 2022 and more than 7000 new people in 2023. Furthermore, during the first quarter of 2024, approximately 400 new people were engaged in PrEP services in areas with active hostilities. This would not have been possible without the dedication of the people running the network of PrEP facilities, even during wartime.

Our successes with PrEP expansion demonstrate that dispensing PrEP at or near the communities that need it is an effective strategy for increasing initiation of PrEP, and it can be implemented in many areas in Western and Eastern Europe. In fact, this strategy has been so successful that Ukraine has begun to introduce injectable cabotegravir as an option for long-acting PrEP.

Eradicating Stigma
Especially in times of uncertainty, HIV-related stigma and discrimination remain one of the barriers to effective and equitable HIV care. At AIDS 2024, I discussed how our Public Health Center implements several types of programs to reduce HIV-related stigma and discrimination in Ukraine:

  1. At a national level, measures to reduce stigma and discrimination are included in our official state strategies through the year 2030.
  2. We have created and continue to provide a coordination platform to ensure a comprehensive response to human rights barriers in the prevention and treatment of HIV infection and tuberculosis.
  3. We have used the framework of the UNAIDS Global Partnership to develop interventions to overcome all forms of HIV-related stigma.
  4. We have assessed and researched the manifestations of stigma and discrimination, implemented conceptual training for doctors, social workers, and the National Police of Ukraine, and created informational campaigns. 
  5. We have improved access to paralegal assistance: The Public Health Center actively cooperates with the Coordinating Center for the provision of legal assistance and has established procedures to direct people with HIV to free legal assistance.
  6. We have developed digital resources outlining processes to respond to manifestations of stigma at all levels: In Ukraine, more than 4 mobile applications and systems are aimed at monitoring, evaluating, and responding to rights violations, including manifestations of stigma and discrimination.   

The success of these initiatives gives me hope that, even in the challenges of war, these are effective lessons that many countries can use to overcome adversity in HIV prevention and care.

Your Thoughts?
How can the strategies used in Ukraine to retain people in care and expand PrEP access be applied to overcome barriers to care in your practice? Leave a comment to join the discussion!