Yale University

Barriers to HIV Care for Adults 50yo+, a Neglected but at-risk Population in Ukraine

Funder: National Institute of Mental Health
Project period: 01/29/2018 - 01/28/2019
Grant Type: Pilot Project

Abstract Text:

Ukraine has the most volatile HIV epidemic in the world with over 240,000 people living with HIV(PLWH). HIV incidence among young people is declining due to successful prevention efforts, however, with Ukrainian colleagues, we have identified a new increase in HIV incidence among Ukrainians 50yo+ who comprised 20% of all newly registered HIV infections in 2016. This major change to HIV epidemiology in Eastern Europe may require revising current HIV diagnosis, treatment, and preventive efforts. Preliminary data suggest that since January 2017 in Ukraine, 40% of 50yo+ clients with newly registered HIV infections came in late to care with CD4 count under 200, compared to 21% among younger adults, p-value <0.0001. Data from other global regions suggest that older adults are a source of transmission of HIV for younger demographic groups. Our previous research extended the theory of ageism to healthcare systems, explaining how cultural blueprints of age-related stigma, including the stigma of later-life sexuality, inform both healthcare providers' and patients' decisions about (non-)linkage and (non-)adherence to care. This grant proposes the first qualitative exploration of factors shaping linkage and adherence to HIVcare in Ukraine fromthe perspective of both HIV doctors and of patients 50yo+ newly diagnosed with HIV. This timely application builds upon a parent PEPFAR implementation science study launched by Ukrainian Alliance for Public Health and Ukrainian Institute on PublicHealthPolicy in January 2016 to conduct 3-year evaluations of effectiveness and cost-effectiveness of linkage of key populations to HIV care in 14 regions of Ukraine. Aligned with the NIH's HIV research priorities to reduce incidence through effective linkage to HIV prevention and treatment services, this application proposes a series of qualitative interviews with HIV doctors and patients 50yo+ embedded within PEPFAR project. We aim to explore challenges experienced by HIV doctors caring for the population of 50yo+ newly diagnosed with HIV in Ukraine describing the circumstances for (non-)prescribing antiretroviral therapy (ART), attitudes toward and opportunities for PrEP for partners, and management of comorbidities; and exploring how access and adherence to ART among 50yo+ patients newly HIV diagnosed is shaped by socio-cultural, bio-medical, and healthcare system factors.

Our productive team consists of Yale researchers and Ukraine collaborating sites with demonstrated successes working in the bio-medical and socio-cultural HIV context in Ukraine. Our collective research experience includes qualitative health research methods, social gerontology, implementation science, internal medicine, virology, healthcare organizations settings, expanding ART, and HIV prevention including PrEP. This project will contribute to the paucity of data in the literature regarding barriers to HIV careamong older adults in global settings. The data from this project will inform NIH R21 and R01 grant applications for randomized trials testing interventions to improve linkage and retention in care and expand adoption of PrEP. Findings will be presented to key Ukrainian public and private stakeholders and rapidly integrated through our existing collaboration with the All-Ukrainian Network for PLWH to inform linkage to HIV care and provision of social support for their 50 yo+ clients newly diagnosed with HIV in Ukraine.