Abstract
BACKGROUND: The Russian Federation's invasion in Ukraine has resulted social hardship, millions of internally displaced persons, the destruction of medical infrastructure, and limited access to HIV services. There is no available information regarding the impact of the war on the HIV treatment cascade among women who inject drugs (WWID) in Ukraine. In this study, we examine the barriers and facilitators of HIV detection, initiation of treatment, and adherence to antiretroviral therapy (ART) among WWID. METHODS: During the in-depth interviews, participants were queried about their needs for HIV testing, treatment and related services, as well as barriers to HIV testing, initiation and retention on ART, including organizational barriers and changes in existing preventive and treatment programs. Thematic content analysis was used to employed to derive the results. RESULTS: From August to September 2022, we conducted in-depth interviews among 38 WWID in Kryvyi Rih, Kyiv, and in the Ivano-Frankivsk and Odesa regions of Ukraine. The most persistent personal facilitator for HIV detection, ART initiation, and retention in services was a combination of several factors, including strong ties with relatives and a sense of responsibility for loved ones, support from the family, willingness to cooperate with specialists, a higher level of education, and a relatively prosperous financial situation. Barriers such as war-related stress and disruptions to healthcare facilities are directly linked to the ongoing war. The influence of other barriers (fear of discovering the presence of the disease, potential social restrictions, and drug use) was universal and only indirectly related to the state of war. The majority of WWID provided positive assessments of the quality of work and the availability of preventive HIV services. CONCLUSION: The ongoing war against Ukraine continues to have a detrimental impact on all aspects of the population's life, particularly affecting WWID. Providers of HIV services must make every effort to sustain and optimize these services, taking into account the evolving context and new requirements. The changing life situation and shifting priorities of WWID necessitate a dynamic and comprehensive assessment of existing challenges.