Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

Vasylyev, Marta; Skrzat‐Klapaczyńska, Agata; Bernardino, José I; Săndulescu, Oana; Gilles, Christine; Libois, Agnès; Curran, Adrián; Spinner, Christoph D.; Rowley, Dominic; Bickel, Markus; Aichelburg, Maximilian C.; Nozza, Silvia; Wensing, Annemarie; Barber, Tristan; Waters, Laura; Jordans, Carlijn; Bramer, Wichor M.; Lakatos, Botond; Tovba, Lidia; Koval, Tetyana; Kyrychenko, Tetyana; Dumchev, Kostyantyn; Buhiichyk, Vira; Smyrnov, Pavlo; Antoniak, Svitlana; Antoniak, Sergii; Vasylyeva, Tetyana I.; Mazhnaya, Alyona; Kowalska, Justyna D.; Rokx, Casper

doi:10.1016/s2352-3018(22)00125-4

Cited by 42 publications

(35 citation statements)

References 55 publications

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“…A significant number of patients had a recorded coinfection. In Ukraine, TB coinfection has been identified in over 12% of patients with newly diagnosed HIV, and multidrug-resistant TB is a major problem [19].…”

Section: Discussionmentioning

confidence: 99%

HIV-positive Ukrainian refugees in the Czech Republic: a retrospective, observational study

Massmann

Groh

Jilich

et al. 2023

Aids

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Objective: Over 480 000 Ukrainian refugees have arrived in the Czech Republic since the Russian invasion of Ukraine in 2022, including over 500 people with HIV. This study describes the demographics, characteristics, and management of Ukrainian refugees with HIV in the Czech Republic. Design: Retrospective, observational, non-interventional study. Methods: Ukrainian nationals registering at HIV centers in the Czech Republic with war refugee status were included. Data were collected from medical records between 1 March and 31 July 2022. The study was registered with the Czech State Institute for Drug Control, ID number 2301200000. Results: 482 patients were included in the study. Most patients were female (69.5%; n = 335/482) with well-controlled HIV. The median [interquartile range] CD4+ cell count was 597 [397] cells/mm3 of blood, and 79.3% (n = 361/455) of patients had HIV RNA <40 copies/ml. Coinfections of hepatitis C virus, hepatitis B virus, and/or tuberculosis were reported for 17.4% (n = 78/449), 9% (n = 40/446) and 1.3% (n = 6/446) of patients, respectively. In Ukraine, 85.7% (n = 384/448) of patients had been receiving an integrase strand transfer inhibitor-based regimen and most (69.7%; n = 310/445) did not switch therapy upon arrival in the Czech Republic. Conclusion: Migration from Ukraine is changing the characteristics of HIV epidemiology in the Czech Republic. Ukrainian refugees with HIV have been provided with a high standard of medical care in the Czech Republic. Improved coordination between medical services within the Czech Republic and between countries in the European Union is necessary to optimize patient care.

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Section: Discussionmentioning

confidence: 99%

HIV-positive Ukrainian refugees in the Czech Republic: a retrospective, observational study

Massmann

Groh

Jilich

et al. 2023

Aids

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“…In connection with the above, strategies are needed to optimize health care systems to cope with humanitarian crises, to define the most important challenges to appropriate support for Ukrainian refugees living with HIV, both diagnosed, and already on ART, as well as those who are unaware of their infection. In optimizing these systems, it is important to remember that refugees living with HIV may experience additional health consequences such as depression, social isolation and post-traumatic stress disorder (23). This is especially important for women, Mothers, a unique peer-led programme by migrant women who train women living with HIV across the UK to provide psycho-social support to peers during and after pregnancy (https://4mmm.org/).…”

Section: Experiences From Polish Perspective On the War In Ukrainementioning

confidence: 99%

Recent perspectives on the link between migration, human rights and HIV among women.

Rosińska

Bociąga‐Jasik

Ayoubi³

et al. 2023

Przegl Epidemiol

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There is a well-documented link between infectious diseases, especially HIV, armed conflict, lack of respect for human rights and migration. War leads to disruption of services, increased vulnerability to violence and social hardships that put individuals and especially women at risk of infections such as HIV. HIV in Europe is highly associated with migration, with over 40% of new infections being diagnosed among migrants. Our aim was to provide an overview of the factors that put migrant populations, and especially migrant women, at risk for HIV infection and to illustrate this from three different perspectives: 1) recent migration from the Ukraine, and Polish experiences in provision of HIV care to Ukrainian migrants; 2) successful HIV programs targeting African migrant women in the United Kingdom (UK); 3) the impact of the prolonged crisis and women’s rights violations during the internal Afghanistan conflict. We conclude that although they may be dramatically different, situations having detrimental health effects in women often share common underlying causes, and therefore may potentially be addressed by applying universal principles that emphasise the importance of self-management of health needs, empowerment of vulnerable communities and building community strengths. As crisis situations are often unpredictable, and shortage of resources common, empowerment of communities and creation of systematic policies that proactively address women’s specific needs is crucial to ensuring that vulnerable populations are able to thrive in their new environment, thereby becoming contributors to, rather than being seen as burdens to society. This can only be achieved by continuous dialogue between women’s communities, health care providers, policy makers and other stakeholders involved in the care of women.

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“…On a structural level, high adherence and good clinical outcomes in displaced people might be attributed to strong regional collaboration and contingency planning, such as providing patients with surplus medication in case of disruptions [67]. In Ukraine, where a recent escalation of the war has forced more than 10 million people to flee their homes and is threatening to significantly affect the HIV epidemic in the country, public health organizations have been coordinating with medical suppliers, AIDS clinics and non-governmental organizations to assess the remaining stock of medications in order to keep an uninterrupted provision of HIV care and opioid agonist therapy, though provision challenges remain in this fast-evolving situation [68,69]. Facilitating treatment adherence in dynamic situations, where periods of renewed or heightened conflict may be unpredictable, presents a significant challenge, particularly with regard to drug-resistant mutations arising as a result of treatment interruptions [70].…”

Section: Antiretroviral Therapy (Art) Initiation and Adherencementioning

confidence: 99%

Left behind on the path to 90‐90‐90: understanding and responding to HIV among displaced people

et al. 2022

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Introduction:In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower-and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resourcelimited environments. Discussion: HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. Conclusions: Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.

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Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

Cited by 42 publications

References 55 publications

HIV-positive Ukrainian refugees in the Czech Republic: a retrospective, observational study

HIV-positive Ukrainian refugees in the Czech Republic: a retrospective, observational study

Recent perspectives on the link between migration, human rights and HIV among women.

Left behind on the path to 90‐90‐90: understanding and responding to HIV among displaced people

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