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ID: HR19-1267

Presenting author: Kostyantyn Dumchev

Presenting author biography:

Dr Dumchev is a Scientific Director at the Ukrainian Institute on Public Health Policy. He conducts research in the areas related to substance use and HIV/AIDS, including epidemiology, estimation, and program effectiveness. Dr Dumchev received his MD from Vinnitsya National Medical University, and MPH from University of Alabama at Birmingham.

Effective viral suppression despite delayed initiation of ART among HIV-positive PWID in Ukraine

Kostyantyn Dumchev, Iiulia Novak, Tetiana Saliuk

Quick linkage to HIV care, immediate initiation of ART, and proper adherence support are important strategies for reaching the ambitious 90-90-90 goals in Ukraine and globally. People who inject drugs (PWID) face significant challenges related to stigma and discrimination in accessing these services in many countries. This study was commenced to obtain reliable data on key HIV treatment quality indicators, contributing factors and trends to inform program planning.
Data from medical charts of all patients who received care at HIV facilities in 2010-2016 in 18 out of 27 regions of Ukraine were entered into an electronic medical record system. After verification of data quality, depersonalized datasets linked by unique patient code were extracted at each facility and merged for analysis.
This analysis focused on the differences between PWID and other HIV-positive patients in ART initiation and viral suppression (<200cp/ml). The entire dataset, excluding children younger than 15 at diagnosis, was analyzed using Kaplan-Meier and chi-square methods.
The cohort included 32,124 patients (47.2% females). Time from diagnosis to ART initiation for patients with heterosexual mode of transmission was significantly lower compared to those who acquired HIV through injecting drug use (average 38.6 months compared to 47.3). In both groups this time decreased over time, but the difference (8.1 vs 11.7) remained significant. Time from ART initiation to viral suppression was almost equal in both groups, at average 26.2 months, with insignificant decline over time.
HIV-positive PWID in Ukraine continue to suffer from disproportionately slower access to life-saving ARV treatment. However, when prescribed ARV, they achieve viral suppression at the same rate as non-drug-using patients. Our findings confirm that scale-up of community-based interventions is needed to ensure timely linkage of PWID to HIV care. When in care, PWID should not be discriminated by clinical providers in ART prescription.