Adapting and coping during the war in Ukraine: lived experiences of older adults with HIV and their healthcare providers

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Since the war in Ukraine began on February 24, 2022, experts have warned of possible collapse of the HIV care system and a loss of decades of hard-earned gains in high-priority areas like HIV and addiction care. Older people with HIV require tailored intervention for linkage and re-linkage to HIV care. Our parent R21 grant focuses on tailoring Peer Navigation to OPWH in Ukraine to create PROST (Peer-Run Optimal Strategy for Treatment or “To your health” in Ukrainian), and pilot test it to (re-) engage OPWH in HIV care. To date, using the ADAPT- ITT framework, we adapted FHI PN manual to build PROST PN for Ukrainian OPWH. Our remaining aims include a pilot RCT of PROST vs. treatment as usual (TAU) to measure acceptability and feasibility; and using the data from the pilot to conduct dyadic analyses of peers and beneficiaries to understand shared decision-making and linkage to care outcomes. As the war in Ukraine is ongoing, it is essential to understand how OPWH and HIV and other healthcare providers cope and add to PROST PN manual a chapter based on this knowledge for how PN may help OPWH (re) link to HIV care during humanitarian crisis. Phone interviews we conducted in Kyiv in April 2022 suggest that HIV and addiction care doctors remain in post during the war, and OPWH do not evacuate due to sentimental attachment to home, fear of moving to a strange place, mobility limitations, having few resources and nobody to support them in evacuation, caregiving responsibilities for frail family or pets, and desire to stay close to their trusted HIV and other healthcare providers. In this Administrative Supplement, we propose to develop a chapter for the PROST manual on OPWH Peer Navigation during humanitarian crisis, based on analyses of lived experiences of OPWH and their clinicians in Kyiv. In-depth interviews with a purposive sample of 25 OPWH and HIV, addiction, and 10 mental healthcare providers in Kyiv will examine what is involved in surviving and giving and receiving HIV care in humanitarian crisis. Findings will inform the questions added to Wave 4 of the longitudinal survey of 123 OPWH participants in Kyiv. Wave 3 completed just before the war offers an opportunity to understand changes in OPWH's physical and mental health, social support, risky behaviors, and participation in HIV and other healthcare since the war began. Our Community Working Group (CWG) comprising OPWH and clinicians in Ukraine will guide the inclusion of findings into the new chapter of PN manual. Feasibility is high as our collaboration with EIPHP, CWG, Kyiv AIDS Center, and Kyiv Addiction Treatment Clinic stays robust. All colleagues are well, all clinicians remain in post and physically in Kyiv. We continue weekly Zoom team meetings to discuss ongoing fieldwork and strategic plans. We can interview and survey OPWH entirely by phone (and process payments for their time online). Drawing on Ukrainian colleagues' partnerships with the Ministry of Health of Ukraine, Ukrainian Alliance for Public Health, and large NGOs supporting PWH, we will present the PN manual for humanitarian setting to these stakeholders, to promote developing national guidelines for PN in HIV care. It will help ensuring that LMICs in humanitarian crises may achieve the 4th 90.