Each year, more than 20,000 new HIV cases are registered in Ukraine, about 40% of them simultaneously with AIDS. Of the newly diagnosed HIV-positive individuals, only about 60% enroll in HIV care in the same calendar year. As a result, in the antiretroviral era, AIDS morbidity and mortality in Ukraine remain high and keep rising. While patients of specialized health care facilities (SHCFs) (substance abuse, TB, and STI clinics), where most patients with HIV risky behaviors are seen, have access to free HIV testing, there remains a critical need to improve engagement (linkage and retention) in appropriate HIV care for HIV-infected persons. A model of enhancing linkage to HIV care exists and proved to be effective over the U.S., but has not been tested in Ukrainian cultural context. The goal of this study is to pilot, implement and evaluate an intervention designed to motivate and manage recently HIV diagnosed patients of SHCFs in three regions of Ukraine, who will be supported and motivated to initiate and remain in HIV medical care. We will study the impact of the Modified Antiretroviral Treatment Access Study (MARTAS) intervention, based on the Social Cognitive Theory, motivational sessions and nurse case management, on the engagement in HIV care of recently detected HIV-positive patients. In our study we will use available health care infrastructure and human resources. This project will be implemented in Odesa, Dnipropetrovsk and Mykolaiv regions of Ukraine, at the SHCFs, where the system of patronage nurses exists, and provider-initiated HIV testing and counseling (PITC) approach has been implemented recently.
The specific aims of the study are: 1) to adapt the ARTAS intervention protocol for implementation among recently diagnosed HIV positive patients in a Ukrainian cultural context using the results of formative assessment (in- depth interviews with patients and focus-group discussion with health care providers in Dnipropetrovsk); 2) to test the feasibility and acceptability of the intervention implementation at three sites of Mykolaiv region with 30 recently diagnosed HIV-positive patients; and 3) to evaluate the intervention effectiveness using prospective cohort study at 9 sites in three regions (n=300 recently HIV diagnosed patients) comparing the observed indicators of enrollment/retention in HIV care among study participants with the year prior to intervention implementation. We hypothesize that an intervention that involves coordination between specialized health care and HIV systems via a) linkage coordination delivered by a nurse of the SHCF, b) structured motivational sessions and further communication between these linkage coordinators (LCs) and patients, and c) communication between LC and HIV care provider will lead to increased engagement in HIV medical care. The proposed research addresses a significant public health threat of non-/late enrollment of HIV-positive individuals in HIV care and treatment. Our study is highly innovative, as we will extend the international borders of ARTAS implementation research to Ukraine, adapting it to the local infrastructure.
Of the newly diagnosed HIV-positive individuals in Ukraine, only about 60% enroll in HIV care in the same year. In specialized health care facilities (substance abuse, TB, and STI clinics), where free HIV testing is available, there is a critical need to improve engagement (linkage and retention) in HIV care for HIV-infected patients. This study proposes to assess whether a modified Antiretroviral Treatment Access Study intervention, proved to be effective in the U.S. and based on the nurse case management approach, can impact the engagement in HIV care of recently detected HIV-positive patients in specialized health care clinics in three regions in Ukraine, using the existing local infrastructure. The proposed study addresses a significant public health issue of non-/late enrollment of HIV-positive persons in HIV care and treatment.
