An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care

Rozanova, Julia and Zeziulin, Oleksandr and Rich, Katherine M. and Altice, Frederick L. and Kiriazova, Tetiana and Zaviryukha, Irina and Sosidko, Tetiana and Gulati, Komal and Carroll, Constance and Shenoi, Sheela (2021) An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care. PLoS ONE, 16 (9). ISSN 1932-6203, DOI

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The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all older people living with HIV (OPWH), defined as >= 50 years, extant literature observed that newly diagnosed OPWH represent the lowest proportion in EECA relative to all other global regions. We examined HIV diagnoses in OPWH in Ukraine, a country emblematic of the EECA region. Methods We analysed incident HIV diagnoses from 2015-2018 and mortality trends from 2016-2018 for three age groups: 1) 15-24 years; 2) 25-49 years; and 3).50 years. AIDS was defined as CD4<200cells/mL. Mortality was defined as deaths per 1000 patients newly diagnosed with HIV within the same calendar year. Mortality rates were calculated for 2016, 2017, and 2018, compared to age-matched general population rates, and all-cause standardized mortality ratios (SMRs) were calculated. Results From 2015-2018, the proportion of OPWH annually diagnosed with HIV increased from 11.2% to 14.9% (p< 0.01). At the time of diagnosis, OPWH were also significantly (p < 0.01) more likely to have AIDS (43.8%) than those aged 25-49 years (29.5%) and 15-24 years (13.3%). Newly diagnosed OPWH had the same-year mortality ranging from 3 to 8 times higher than age-matched groups in the Ukrainian general population. Conclusions These findings suggest a reassessment of HIV testing, prevention and treatment strategies in Ukraine is needed to bring OPWH into focus. OPWH are more likely to present with latestage HIV and have higher mortality rates. Re-designing testing practices is especially crucial since OPWH are absent from targeted testing programs and are increasingly diagnosed as they present with AIDS-defining symptoms. New strategies for linkage and treatment programs should reflect the distinct needs of this target population.

Item Type: Article
Funders: Center for Interdisciplinary Research on AIDS at Yale University, MacMillan Center for International and Area Studies under the pilot grant, Yale LGBT Studies Program under Fund for Lesbian and Gay Studies (FLAGS) Research Award, Doris Duke Charitable Foundation (DDCF)[2015216], Doris Duke Charitable Foundation (DDCF)[K01DA047194]
Uncontrolled Keywords: Opioid agonist treatment;Health;Experiences;Infection
Subjects: R Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 26 Oct 2022 08:25
Last Modified: 26 Oct 2022 08:25

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