Yale University

Adapting Peer Navigation for Out-of-Care Older Persons with HIV in Ukraine

Funder: National Institute on Aging
Project period: 06/15/2021 - 05/31/2023
Grant Type: Research
Further Detail

Abstract Text:

Among the 5.5 million older people with HIV (OPWH) over 50 years, 80% live in low and middle income countries (LMIC). Ukraine, an emblematic LMIC in Eastern Europe and Central Asia (EECA), is the only world region with increasing HIV incidence and mortality. Among the 240,000 PWH in Ukraine, OPWH account for 25% of people with HIV but <30% are linked to ART within 6 months of diagnosis, with substantial proportions dropping out-of- care (OOC) once on ART. Consequently, mortality is 3-11 times higher than the age-matched general population. Key barriers to ART engagement for OPWH include substance use disorder, depression, and HIV stigma. PEPFAR has prioritized OPWH as an intervention target since only 43% of women and 34% of men were receiving ART in 2019. OPWH in particular have been impacted by COVID-19. In May 2020, our phone survey of 123 OPWH revealed that 58% needed assistance with their HIV care. To achieve the 95-95-95 HIV targets by 2030, Ukraine needs effective strategies to (re-)engage and retain OPWH in ART. In line with emerging differentiated care models, peer navigation (PN) is an evidence-based strategy to link and re-engage OOC PWH, including ART. Our qualitative data in Ukraine suggest OPWH prefer peers over professionals to engage them in HIV care. Peer-navigation, however, has not yet been adapted and tailored for OPWH in resource-limited settings though lessons learned from COVID may guide its delivery. Moreover, PN has repeatedly been superior to treatment as usual (TAU), but the extent to which peer/client dyads effectively interact has not yet been explored. We intend to tailor PN for OPWH using ADAPT-ITT, an evidence-based adaptation strategy, to create PROST (Peer-Run Optimal Strategy for Treatment or “To your health” in Ukrainian), and pilot test it to (re- )engage OPWH in care and ART. We hypothesize that the tailored PROST will more effectively (re-)engage OPWH and increase ART uptake by overcoming unique barriers to care relative to TAU. During the pilot RCT 10 trained Peers will deliver PROST for 12 weeks to 60 OOC OPWH compared to 30 OOC OPWH receiving TAU. Randomization will be stratified by previous ART experience and participants will be followed for 6 months. Outcomes will include measures of acceptability, feasibility, and preliminary efficacy. Using survey items from baseline, week 12, and week 24 on trust, compatibility, and perceived quality of peer-client interactions, we will conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Innovation is high due to creating a differentiated care model to more effectively engage OPWH using a tailored strategy as well as the contribution of the novel dyadic analysis. Public health benefit is high due to the emerging need to intervene with OPWH, especially in the only major region where HIV incidence and mortality is increasing. To ensure compatibility with the community, findings will be shared with stakeholders including a Community Working Group (peers, clinicians), funders (PEPFAR, Global Fund), and implementers (MoH, NGOs) to guide a future Type I Hybrid, cluster randomized trial in Ukraine.