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

乌克兰战争期间的适应和应对：感染艾滋病毒的老年人及其医疗保健提供者的生活经历

• 批准号: 10614174
• 负责人: Julia Rozanova
• 金额: $ 18.67万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10614174
• 关键词: Acquired Immunodeficiency Syndrome; Administrative Supplement; Age-Years; Aging; Area; Biometry; COVID-19 pandemic; Caring; Child; Clinic; Collaborations; Communities; Country; Data; Deterioration; Diagnosis; Elderly; Elements; Ensure; Europe; Exposure to; Family; Fright; Funding; Gerontology; Goals; Grant; Guidelines; HIV; Health; Health Personnel; Healthcare; Home; Human Resources; Intervention; Interview; Knowledge; Laws; Link; Longitudinal Surveys; Manuals; Measures; Mental Health; Mental Health Services; Parents; Participant; Patients; Persons; Process; Provider; Public Health; Questionnaires; Recording of previous events; Research; Research Personnel; Resource-limited setting; Resources; Risk Behaviors; Running; Sampling; Scientist; Social support; Strategic Planning; Surveys; Telephone; Time; Training; Trust; Ukraine; War; Woman; Work; Zygote Intrafallopian Transfer; acceptability and feasibility; addiction; base; beneficiary; care outcomes; care systems; caregiving; coping; evidence base; experience; improved outcome; low and middle-income countries; man-made disasters; meetings; men; payment; peer; pet animal; physical conditioning; pilot test; shared decision making; stressor; treatment as usual; treatment strategy; virtual; working group

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.

自2022年2月24日乌克兰战争开始以来，专家们警告说，艾滋病毒护理可能会崩溃。 在艾滋病毒和成瘾护理等高度优先领域，几十年来来之不易的成果正在流失。老年 艾滋病毒感染者需要有针对性的干预措施，以便与艾滋病毒护理挂钩和重新挂钩。我们的R21补助金专注于 关于在乌克兰为OPWH定制同行导航，以创建PROST（同行运行最佳治疗策略 或乌克兰语“祝您健康”），并进行试点测试，以（重新）让OPWH参与艾滋病毒护理。到目前为止，使用ADAPT- ITT框架，我们改编了FHI PN手册，为乌克兰OPWH构建PROST PN。我们剩下的目标包括 PROST与常规治疗（TAU）的试点RCT，以衡量可接受性和可行性;并使用数据 从试点开始，对同行和受益人进行二元分析，以了解共同决策， 与护理结果的联系。由于乌克兰的战争正在进行，了解OPWH和艾滋病毒如何传播至关重要。 和其他医疗保健提供者科普并在PROST PN手册中添加一个基于此知识的章节，以了解如何 PN可帮助OPWH在人道主义危机期间（重新）与艾滋病毒护理联系起来。我们在基辅进行的电话采访， 2022年4月建议艾滋病毒和成瘾护理医生在战争期间留在岗位上，OPWH不撤离 由于对家乡的眷恋，害怕搬到陌生的地方，行动不便， 资源和没有人支持他们撤离，承担责任，脆弱的家庭或宠物，并希望 与他们信任的艾滋病毒和其他医疗保健提供者保持密切联系。在本行政补充文件中，我们建议 为PROST手册编写关于人道主义危机期间OPWH同行导航的章节， 分析OPWH及其临床医生在基辅的生活经历。有目的样本的深度访谈 在基辅，25名OPWH和艾滋病毒，成瘾和10名精神卫生保健提供者将研究 在人道主义危机中生存并提供和接受艾滋病毒护理。调查结果将告知添加到 在基辅对123名OPWH参与者进行的纵向调查的第4波。第三波在战前完成， 有机会了解OPWH的身心健康、社会支持、危险行为的变化， 以及参与艾滋病和其他医疗保健的人数。社区工作组（CWG） 由OPWH和乌克兰的临床医生组成的一个小组将指导将结果纳入PN手册的新章节。 可行性很高，因为我们与EIPHP，CWG，基辅艾滋病中心和基辅成瘾治疗诊所合作 保持健壮。所有的同事都很好，所有的临床医生都留在基辅的岗位上。我们每周继续 缩放团队会议，讨论正在进行的实地工作和战略计划。我们可以采访和调查OPWH 完全通过电话（并在线处理他们的时间付款）。利用乌克兰同事的伙伴关系 与乌克兰卫生部、乌克兰公共卫生联盟和支持威尔斯亲王医院的大型非政府组织合作， 我们将向这些利益相关者提交人道主义环境PN手册，以促进发展中国家 艾滋病护理中的PN指南。这将有助于确保处于人道主义危机中的中低收入国家实现第四个90。

项目成果

The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine.

• DOI: 10.1177/10497323211026914
• 发表时间: 2021-10
• 期刊: Qualitative health research
• 影响因子: 3.2
• 作者: Allen A;Zaviryukha I;Kiriazova T;Shenoi S;Rozanova J
• 通讯作者: Rozanova J

The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine.

• DOI: 10.3390/geriatrics7060138
• 发表时间: 2022-12-06
• 期刊: Geriatrics (Basel, Switzerland)

Human costs of healthcare resilience during the war in Ukraine: Lessons from addiction and HIV treatment.

乌克兰战争期间医疗保健复原力的人力成本：成瘾和艾滋病毒治疗的教训。

• DOI: 10.1111/add.16406
• 发表时间: 2023
• 期刊: Addiction (Abingdon, England)
• 作者: Rozanova,Julia;Zaviryukha,Irina;Deac,AlexandraA;Zeziulin,Oleksandr;Kiriazova,Tetiana;Earnshaw,Valerie;Rich,KatherineM;Shenoi,SheelaV;Skipper,Harry;Yariy,Volodymyr;Strang,SirJohn
• 通讯作者: Strang,SirJohn