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日乌克兰战争爆发以来，专家们一直警告说，艾滋病毒护理可能会崩溃 在艾滋病毒和成瘾护理等高优先领域，几十年来来之不易的成果遭到了损失。更老的 艾滋病毒携带者需要有针对性的干预措施，以便与艾滋病毒护理建立联系和重新联系。我们的母公司R21赠款专注于 在乌克兰为OPWH量身定做对等导航以创建PROST(对等最优治疗策略 或乌克兰语中的“为您的健康”)，并对其进行试点测试，以(重新)让OPWH参与艾滋病毒护理。到目前为止，使用适配器- 在ITT框架下，我们采用FHI PN手册为乌克兰OPWH构建了Prost PN。我们剩下的目标包括 PROST与常规治疗(TAU)的试验性随机对照试验，以衡量可接受性和可行性；并使用数据 从试点到对同行和受益者进行二元分析，以了解共享决策和 与护理结果的联系。由于乌克兰的战争仍在继续，了解OPWH和艾滋病毒是如何 和其他医疗保健提供者应对并在Prost PN手册中添加基于此知识的章节，了解如何 PN可能会帮助OPWH(重新)在人道主义危机期间将艾滋病毒护理联系起来。年，我们在基辅进行了电话采访 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 由于对家的感情依恋，害怕搬到陌生的地方，行动不便，几乎没有 资源，没有人支持他们疏散，照顾虚弱的家庭或宠物的责任，以及渴望 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。在这份行政副刊中，我们建议 为PROST手册编写关于人道主义危机期间OPWH对等导航的一章，基于 基辅妇幼保健院及其临床医生的生活经历分析。用有目的的样本进行深入访谈 在基辅的25个OPWH和艾滋病毒、成瘾和10个精神卫生保健提供者中，将检查涉及的内容 在人道主义危机中生存并给予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四波。第三波就在战争结束前完成 有机会了解OPWH的身心健康、社会支持、危险行为、 以及自战争开始以来对艾滋病毒和其他医疗保健的参与。我们的社区工作组(CWG) 由OPWH和乌克兰的临床医生组成，将指导将研究结果纳入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。所有同事都很好，所有临床医生都留在基辅的岗位上和身体上。我们继续每周一次 扩大团队会议，讨论正在进行的实地考察工作和战略计划。我们可以采访和调查OPWH 完全通过电话(并在他们上网的时间处理支付)。利用乌克兰同事的合作伙伴关系 在乌克兰卫生部、乌克兰公共卫生联盟和大型非政府组织支持威尔斯亲王医院的情况下， 我们将向这些利益相关者提供人道主义设置的PN手册，以促进发展国家 HIV护理中的PN指南。这将有助于确保人道主义危机中的小岛屿发展中国家能够实现第4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