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Observational Study
. 2025 Oct;29(10):3253-3263.
doi: 10.1007/s10461-025-04773-0. Epub 2025 Jun 11.

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
Observational Study

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. 2025 Oct.

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.

Figures

Fig. 1
Fig. 1
Flow diagram of study population inclusion
Fig. 2
Fig. 2
Probability of PrEP persistence for clients >  = 18 years who initiated PrEP from 10/1/22–9/30/23, by key population group (Kaplan Meier curve) (n = 4536). KPs key populations, MSM men who have sex with men, DC discordant couples, PWID people who inject drugs, RHB risky heterosexual behavior, SW sex workers. The single transgender client was excluded from the analysis
Fig. 3
Fig. 3
Probability of PrEP persistence for clients >  = 18 years who initiated PrEP from 10/1/22–9/30/23, by wartime location (Kaplan Meier curve) (n = 4536). A single transgender client was excluded from the analysis
See this image and copyright information in PMC

References

    1. United Nations (UN). Ukraine: Report reveals war’s long-term impact which will be felt ‘for generations’. United Nations News. https://news.un.org/en/story/2024/02/1146842 (accessed 21 October, 2024).
    1. World Health Organization (WHO). WHO records more than 1000 attacks on health care in Ukraine over the past 15 months of full-scale war. WHO/Europe Press Office. https://www.who.int/europe/news/item/30-05-2023-who-records-1-000th-atta... (accessed 21 October, 2024).
    1. Gokengin D, et al. PrEP scale-up and pep in central and eastern Europe: changes in time and the challenges we face with no expected HIV vaccine in the near future. Vaccines (Basel). 2023. 10.3390/vaccines11010122. - DOI - PMC - PubMed
    1. Vasylyev M, et al. Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine. Lancet HIV. 2022;9(6):e438–48. 10.1016/S2352-3018(22)00125-4. - DOI - PubMed
    1. Public Health Center of the Ministry of Health of Ukraine (PHC), Annual Report of the Public Health Center of the MOH of Ukraine: National Response of HIV, TB, Viral Hepatitis, and SMT Programmes in the Context of Full-Scale Russian Invasion, Ministry of Health, Kyiv, Ukraine, 2023. Accessed: 10 October 2024. [Online]. Available: https://phc.org.ua/sites/default/files/users/user90/National_response_HI...

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