FIVE times NINETY
Euroguidelines in Central and Eastern Europe (ECEE) Network Group (www.eceenetwork.com)
Prof Justyna Kowalska, Hospital for Infectious Diseases, Medical University of Warsaw, Poland
Dr Sergii Antoniak, Gromashevsky Institute of Epidemiology and Infectious Diseases, Viral Hepatitis and AIDS Department, Kyiv, Ukraine. Public Health Center of the Ministry of Health, Kyiv, Ukraine
During the first four weeks of the Russian military aggression in Ukraine, over 2.5 million refugees entered Poland and the population of Warsaw city increased by 15%. An estimated 1% of these people are living with HIV (and aware of their infection) while further 1% are estimated to be living with HIV but unaware of being HIV-positive. Those already diagnosed need to be linked to specialist care and those undiagnosed need to be tested. Until 31st March 2022 over 600 HIV positive refugees from Ukraine were registered in Polish HIV clinics, including 170 in Warsaw’s HIV Out-Patients Clinic. Recently a ‘Standardized protocol for clinical management and medical data sharing for PLHIV among refugees from Ukraine’ (the Standardized protocol) was developed by key stakeholders (WHO, ECDC, EACS, CHIP) under the umbrella of WHO. A pilot “proof of concept” assessment of the Standardized protocol was performed using seven consecutive patients among whom retrieval of medical data from Ukraine was possible for six.
This project aims to A) assess patterns of migration among 200 HIV-positive war refugees seen for care in the Warsaw HIV Out-Patients Clinic and its influence on linkage to care and retention in care; B) assess the proportion of patients returning to HIV care in Ukraine; C) evaluate the practical implementation of the Standardized protocol, including to discuss and revise it with key stakeholders (WHO, ECDC, EACS, ECEE); and D) assess the utility and acceptance of HIV testing in this population group.
Based on the Standardized protocol and an algorithm provided by the Public Health Center of the Ministry of Health (PHC MOH) of Ukraine, patients will be asked to sign and informed consent form which will be sent to the PHC MOH, prompting sharing of medical data (regarding HIV treatment and other medical/demographic information) back to the Warsaw outpatient clinic in a standardized format. A sample of approximately 200 war refugees seen for care in Warsaw will be prospectively enrolled in the study. In addition, to increase the study’s follow-up time, retrospective inclusion into the study will be allowed for patients who were registered for care before study initiation and still seen for care in the clinic. To assess the acceptance of HIV testing and decrease the number of people who are unaware of their HIV infection, refugees living with HIV who are engaged into HIV care will be offered to distribute HIV self-tests to their partners and/or within their community.
Overall characteristics of people who either remain in migration or return to Ukraine at the end of the study period will be described, with the following concrete output measures to be derived from the study:
- Number and proportion of patients registered in the HIV Out-Patients Clinic in Warsaw for whom the request was sent to Ukraine (100%)
- Number and proportion of patients whose medical records were linked and data shared with the clinic in Warsaw
- Number and proportion of patients who returned for second visit to the clinic in Warsaw
- Number and proportion of patients returning to Ukraine and re-engaging in HIV care locally.
The preliminary findings will be presented and discussed with key stakeholders from WHO, ECDC, CHIP, EACS, Ukraine (PHC MOH) and representatives of the Euroguidelines in Central and Eastern Europe (ECEE) Network, including practitioners from other countries in central and eastern Europe (Albania, Bulgaria, Czech Republic, Estonia, Georgia, Greece, Hungary, Poland, Republic of Moldova, Romania and Serbia) who were exposed to first wave of war migration. As relevant, possible revisions to the protocol will be proposed and discussed, including the minimal dataset format needed and the optimal communication channels.