Abstract
BackgroundEngagement with HIV medical care is critical to successful HIV treatment and prevention efforts. However, in Ukraine, delays in the timely initiation of HIV treatment hamper viral suppression. By January 01, 2016, only 126,604 (57.5%) of the estimated 220,000 people living with HIV (PLWH) had registered for HIV care, and most (55.1%) of those who registered for HIV care in 2015 did that at a late stage of infection. In the US, Anti-Retroviral Treatment and Access to Services (ARTAS) intervention successfully linked newly diagnosed PLWH to HIV services using strengths-based case management with a linkage coordinator. To tailor the ARTAS intervention for Ukraine, we conducted a qualitative study with patients and providers to understand barriers and facilitators that influence linkage to HIV care.MethodsDuring September–October 2014, we conducted 20 in-depth interviews with HIV-positive patients and two focus groups with physicians in infectious disease, sexually transmitted infection (STI), and addiction clinics in Dnipropetrovsk Region of Ukraine. Interviews and focus groups were audio-recorded and transcribed verbatim. We translated illustrative quotes into English. We used thematic analysis for the data analysis.ResultsParticipants (20 patients and 14 physicians) identified multiple, mostly individual-level factors influencing HIV care initiation. Key barriers included lack of HIV knowledge, non-acceptance of HIV diagnosis, fear of HIV disclosure, lack of psychological support from health providers, and HIV stigma in community. Responsibility for one’s health, health deterioration, and supportive provider communication were reported as facilitators to linkage to care. Expected benefits from the case management intervention included psychological support, HIV education, and help with navigating the segmented health system.ConclusionsThe findings from the study will be used to optimize the ARTAS for the Ukrainian context. Our findings can also support future linkage-to-care strategies in other countries of Eastern Europe and Central Asia.
Highlights
Engagement with Human immunodeficiency virus (HIV) medical care is critical to successful HIV treatment and prevention efforts
Health care providers Twenty health care providers (HCP) were eligible for the study and provided informed consent; of them, 14 HCPs without a work schedule conflict participated in the Focus group (FG)
Using data obtained from patients and providers, we summarized their perceptions of barriers and facilitators to HIV care, and opinions and expectations following a description of the Anti-retroviral treatment and access to services (ARTAS) linkage-to-care intervention
Summary
Engagement with HIV medical care is critical to successful HIV treatment and prevention efforts. In Ukraine, delays in the timely initiation of HIV treatment hamper viral suppression. By January 01, 2016, only 126,604 (57.5%) of the estimated 220,000 people living with HIV (PLWH) had registered for HIV care, and most (55.1%) of those who registered for HIV care in 2015 did that at a late stage of infection. In Ukraine, delays in initiation of HIV treatment hamper viral suppression. As of January 01, 2016, only 126,604 of the estimated 220,000 people living with HIV (PLWH) in Ukraine had registered for HIV care at the AIDS Centers. In 2015, 55.1% of newly registered PLWH enrolled in HIV care at the III-IV clinical stages of HIV infection, as defined by the World Health Organization [2, 3]
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