Young people in HIV care in Ukraine: a national survey on characteristics and service provision

Qualitative study of barriers and facilitators to HIV detection and treatment among women who inject drugs during the war against Ukraine

BACKGROUND

The Russian Federation's invasion in Ukraine has resulted social hardship, millions of internally displaced persons, the destruction of medical infrastructure, and limited access to HIV services. There is no available information regarding the impact of the war on the HIV treatment cascade among women who inject drugs (WWID) in Ukraine. In this study, we examine the barriers and facilitators of HIV detection, initiation of treatment, and adherence to antiretroviral therapy (ART) among WWID.

METHODS

During the in-depth interviews, participants were queried about their needs for HIV testing, treatment and related services, as well as barriers to HIV testing, initiation and retention on ART, including organizational barriers and changes in existing preventive and treatment programs. Thematic content analysis was used to employed to derive the results.

RESULTS

From August to September 2022, we conducted in-depth interviews among 38 WWID in Kryvyi Rih, Kyiv, and in the Ivano-Frankivsk and Odesa regions of Ukraine. The most persistent personal facilitator for HIV detection, ART initiation, and retention in services was a combination of several factors, including strong ties with relatives and a sense of responsibility for loved ones, support from the family, willingness to cooperate with specialists, a higher level of education, and a relatively prosperous financial situation. Barriers such as war-related stress and disruptions to healthcare facilities are directly linked to the ongoing war. The influence of other barriers (fear of discovering the presence of the disease, potential social restrictions, and drug use) was universal and only indirectly related to the state of war. The majority of WWID provided positive assessments of the quality of work and the availability of preventive HIV services.

CONCLUSION

The ongoing war against Ukraine continues to have a detrimental impact on all aspects of the population's life, particularly affecting WWID. Providers of HIV services must make every effort to sustain and optimize these services, taking into account the evolving context and new requirements. The changing life situation and shifting priorities of WWID necessitate a dynamic and comprehensive assessment of existing challenges.

The epidemiological situation in Ukraine in terms of the implementation of preventive vaccinations according to the Protective Vaccination Program

The level of immunization of children and adolescents under the Protective Vaccination Program in Ukraine is lower than in Poland, and, due to the outbreak of the war in Ukraine, many people now live in conditions that are often unsanitary. Centers for refugees are also places of increased risk of outbreaks of infectious diseases. This risk is increased by the low percentage of the vaccinated, limited access to healthcare (including diagnostics) and overcrowding.

The paper presents the state of vaccination in Ukraine against poliomyelitis, measles, diphtheria, tetanus and pertussis, the most important problems in the field of infectious diseases, as well as the resulting risks and the need to prevent them.

Transitioning from pediatric to adult care and the HIV care continuum in Ghana: a retrospective study

BACKGROUND

In Sub-Saharan Africa, there are now a significant number of adolescents living with HIV (ALHIV), due to increased access to effective antiretroviral therapy. However, these adolescents are at high risk of dying during the transition to adult care due to various reasons, including lack of preparation for the transition and poor transition arrangements. More knowledge about this issue will lead to a better planned healthcare transition process and preparation for transition from pediatric care to adult care. The aim of this study was to explore the healthcare transitional experiences of ALHIV as they moved from pediatric to adult care.

METHODS

A descriptive exploratory qualitative study was conducted. Purposive sampling method was used to recruit adolescents between 12 and 19 years old. Saturation was realized by the 10th participant. Data were analyzed using thematic content analysis.

RESULTS

Four main themes emerged from the interview data: the transition process, factors facilitating the transition experience, challenges and coping mechanisms of the ALHIV during transition, and suggestions for improvement based on perceptions on the current transitioning approach. A key finding of this study was the sudden preparation for transition, linked to the absence of a structured transition protocol. Even though age was the main reason for transferring the participants from the pediatric to adult clinic, participants' age did not influence whether they attended clinic appointment on their own or accompanied by a care provider; it was dependent on the availability of their parents or caregivers. Participants' parents and adult family caregivers were also integrated into the transition process to some extent. We also found that most of the participants had good patient-provider relationship with their health care providers in both pediatric and adult clinics.

CONCLUSION

Findings support the need to develop a structured healthcare transition policy and age-appropriate transition within the clinic environment. There is also a need for social and community support as ALHIV transition from pediatric to adult care.

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

Background

During adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology.

Methods

In this cross-sectional study, we included 10–19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine.

Results

Among 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% of new and 29.7% of recurrent cases. Of 88 HIV-infected adolescents, 59.1% were not on antiretroviral therapy at TB diagnosis. Among 10–14-year-olds, boys had more pleural disease (adjusted OR (aOR) 2.12, 95% CI: 1.08–4.37). Extrathoracic TB was associated with age 15–19 years (aOR 0.26, 95% CI: 0.18–0.37) and HIV (aOR 3.25, 95% CI: 1.55–6.61 in 10–14-year-olds; aOR 8.18, 95% CI: 3.58–17.31 in 15–19-year-olds). Cavitary TB was more common in migrants (aOR 3.53, 95% CI: 1.66–7.61) and 15–19-year-olds (aOR 4.10, 95% CI: 3.00–5.73); among 15–19-year-olds, it was inversely associated with HIV (aOR 0.32, 95% CI: 0.13–0.70). RR-TB was associated with recurrent disease (aOR 1.87, 95% CI: 1.08–3.13), urban residence (aOR 1.27, 95% CI: 1.01–1.62) and cavitation (aOR 2.98, 95% CI: 2.35–3.78).

Conclusions

Age, sex, HIV and social factors impact the presentation of adolescent TB. Preventive, diagnostic and treatment activities should take these factors into consideration.

Analysing 2491 cases of adolescent tuberculosis in Ukraine, associations were observed between four clinical presentations – cavitary, pleural, extrathoracic and rifampicin-resistant TB – and age, sex, HIV status, prior treatment and social factors.https://bit.ly/2XplZFt