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. 2025 Jun 11.
doi: 10.1007/s10461-025-04773-0. Online ahead of print.

HIV Pre-exposure Prophylaxis (PrEP) Uptake and Persistence in Wartime Ukraine: Analysis of Data from a Scaled PrEP Program

Ellis G Moon  1 , Alyona P Ihnatiuk  2 , Anna P Kazanzhy  2 , Oksana V Danylenko  2 , Larisa I Hetman  3 , Lisa E Manhart  1 , Misti R Mcdowell  2   4 , Anna Y Shapoval  2 , Nancy H Puttkammer  5   6
Affiliations

HIV Pre-exposure Prophylaxis (PrEP) Uptake and Persistence in Wartime Ukraine: Analysis of Data from a Scaled PrEP Program

Ellis G Moon et al. AIDS Behav. .

Abstract

Russia's invasion of Ukraine and the ongoing war have had devastating effects on health programs. This observational study assessed uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) during wartime. The study included newly-initiating daily PrEP users from 94 clinics who enrolled on PrEP from October 2022 through September 2023. PrEP persistence was defined as returning for a PrEP refill no later than 7 days after the expected refill date. We used Kaplan-Meier curves and sex-stratified Cox regression to explore PrEP discontinuation by sex, key population group, age group, and wartime location. 4537 clients initiated daily PrEP, with 31.9% being men who have sex with men (MSM), 29.7% based in a frontline location, and 16.7% aged 18-25. Six-month persistence was 37.3% overall. It was lower among MSM (28.6%), young adults aged 18-25 (17.2%), and frontline residents (15.6%), and higher among sex workers (SW) (81.5%). In adjusted analysis among women, SW had a lower risk of discontinuing PrEP compared with discordant couples (adjusted hazard ratio [aHR]: 0.22, 95% confidence interval [CI] 0.14-0.34). In both sexes, clients aged 18-25 had a higher risk of discontinuing PrEP (aHR: 1.43, 95% CI 1.25-1.65 for men; aHR: 1.60, 95% CI 1.16-2.20 for women), as did those based in frontline locations (aHR: 2.19, 95% CI 1.99-2.41 for men; aHR: 1.26, 95% CI 1.04-1.53 for women). The findings highlight the resilience of Ukraine's PrEP program and the need to support PrEP persistence among younger and frontline populations.

Keywords: Delivery of health care; HIV pre-exposure prophylaxis (PrEP); Key populations; Routinely collected health data; Ukraine; War and health.

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Conflict of interest statement

Declarations. Conflict of interest: L.E.M. as received research materials and funding from Hologic, Inc. and Nabriva Therapeutics, Ltd. and conference support from Hologic, Inc., unrelated to this work. This publication was made possible by a grant to the International Training and Education Center for Health (number U91HA06801) from the U. S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Office of Global Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the government.

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