An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.

<h4>Introduction</h4>The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all o...

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Autores principales:	Julia Rozanova, Oleksandr Zeziulin, Katherine M Rich, Frederick L Altice, Tetiana Kiriazova, Irina Zaviryukha, Tetiana Sosidko, Komal Gulati, Constance Carroll, Sheela V Shenoi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a90a40355bbd49c780c883cca2563d1a
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spelling	oai:doaj.org-article:a90a40355bbd49c780c883cca2563d1a2021-12-02T20:13:59ZAn expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.1932-620310.1371/journal.pone.0256627https://doaj.org/article/a90a40355bbd49c780c883cca2563d1a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256627https://doaj.org/toc/1932-6203<h4>Introduction</h4>The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all older people living with HIV (OPWH), defined as ≥50 years, extant literature observed that newly diagnosed OPWH represent the lowest proportion in EECA relative to all other global regions. We examined HIV diagnoses in OPWH in Ukraine, a country emblematic of the EECA region.<h4>Methods</h4>We analysed incident HIV diagnoses from 2015-2018 and mortality trends from 2016-2018 for three age groups: 1) 15-24 years; 2) 25-49 years; and 3) ≥50 years. AIDS was defined as CD4<200cells/mL. Mortality was defined as deaths per 1000 patients newly diagnosed with HIV within the same calendar year. Mortality rates were calculated for 2016, 2017, and 2018, compared to age-matched general population rates, and all-cause standardized mortality ratios (SMRs) were calculated.<h4>Results</h4>From 2015-2018, the proportion of OPWH annually diagnosed with HIV increased from 11.2% to 14.9% (p<0.01). At the time of diagnosis, OPWH were also significantly (p<0.01) more likely to have AIDS (43.8%) than those aged 25-49 years (29.5%) and 15-24 years (13.3%). Newly diagnosed OPWH had the same-year mortality ranging from 3 to 8 times higher than age-matched groups in the Ukrainian general population.<h4>Conclusions</h4>These findings suggest a reassessment of HIV testing, prevention and treatment strategies in Ukraine is needed to bring OPWH into focus. OPWH are more likely to present with late-stage HIV and have higher mortality rates. Re-designing testing practices is especially crucial since OPWH are absent from targeted testing programs and are increasingly diagnosed as they present with AIDS-defining symptoms. New strategies for linkage and treatment programs should reflect the distinct needs of this target population.Julia RozanovaOleksandr ZeziulinKatherine M RichFrederick L AlticeTetiana KiriazovaIrina ZaviryukhaTetiana SosidkoKomal GulatiConstance CarrollSheela V ShenoiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256627 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Julia Rozanova Oleksandr Zeziulin Katherine M Rich Frederick L Altice Tetiana Kiriazova Irina Zaviryukha Tetiana Sosidko Komal Gulati Constance Carroll Sheela V Shenoi An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
description	<h4>Introduction</h4>The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all older people living with HIV (OPWH), defined as ≥50 years, extant literature observed that newly diagnosed OPWH represent the lowest proportion in EECA relative to all other global regions. We examined HIV diagnoses in OPWH in Ukraine, a country emblematic of the EECA region.<h4>Methods</h4>We analysed incident HIV diagnoses from 2015-2018 and mortality trends from 2016-2018 for three age groups: 1) 15-24 years; 2) 25-49 years; and 3) ≥50 years. AIDS was defined as CD4<200cells/mL. Mortality was defined as deaths per 1000 patients newly diagnosed with HIV within the same calendar year. Mortality rates were calculated for 2016, 2017, and 2018, compared to age-matched general population rates, and all-cause standardized mortality ratios (SMRs) were calculated.<h4>Results</h4>From 2015-2018, the proportion of OPWH annually diagnosed with HIV increased from 11.2% to 14.9% (p<0.01). At the time of diagnosis, OPWH were also significantly (p<0.01) more likely to have AIDS (43.8%) than those aged 25-49 years (29.5%) and 15-24 years (13.3%). Newly diagnosed OPWH had the same-year mortality ranging from 3 to 8 times higher than age-matched groups in the Ukrainian general population.<h4>Conclusions</h4>These findings suggest a reassessment of HIV testing, prevention and treatment strategies in Ukraine is needed to bring OPWH into focus. OPWH are more likely to present with late-stage HIV and have higher mortality rates. Re-designing testing practices is especially crucial since OPWH are absent from targeted testing programs and are increasingly diagnosed as they present with AIDS-defining symptoms. New strategies for linkage and treatment programs should reflect the distinct needs of this target population.
format	article
author	Julia Rozanova Oleksandr Zeziulin Katherine M Rich Frederick L Altice Tetiana Kiriazova Irina Zaviryukha Tetiana Sosidko Komal Gulati Constance Carroll Sheela V Shenoi
author_facet	Julia Rozanova Oleksandr Zeziulin Katherine M Rich Frederick L Altice Tetiana Kiriazova Irina Zaviryukha Tetiana Sosidko Komal Gulati Constance Carroll Sheela V Shenoi
author_sort	Julia Rozanova
title	An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
title_short	An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
title_full	An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
title_fullStr	An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
title_full_unstemmed	An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
title_sort	expanding hiv epidemic among older adults in ukraine: implications for patient-centered care.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a90a40355bbd49c780c883cca2563d1a
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An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.

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