ВПРОВАДЖЕННЯ В УКРАЇНІ ОНОВЛЕНОЇ СИСТЕМИ ІНДИКАТОРІВ РАННЬОГО ЗАПОБІГАННЯ МЕДИКАМЕНТОЗНІЙ РЕЗИСТЕНТНОСТІ ВІЛ

The aim of the work – to evaluate the performance of institutions on the effectiveness of the formation in patient adherence to treatment (on time antiretroviral drugs (ARVD) receipt,) as well as the quality of program factors  retention in care, pharmacy ARVD stock-outs, practice of prescription of mono- or bitherapy, and Viral load (VL) suppression).Materials and Methods. Data was analyzed using an electronic tool developed by the World Health Organization (WHO) – Early Warning Indicators Drug Resistance (HIVDR EWI).Results. During 2014-2015 22.7 % of sites providing adult and 36.4% of sites providing pediatric ART managed to meet the target for on time pill pick up. Retention in care indicator was met by 36.4 % (95 % CI: 26.1-46.7) of sites.  RV stock-outs occurred in 9.1 % (95 % CI: 3.0-15.2) adult sites and 4.5 % (95 % CI: 4.1-8.9) pediatric sites. Only 31.8 % (95 % CI: 20.5-43.1) pediatric sites and 0 % adult sites reported target for VL suppression HIV at 12 months ART.Conclusion. Implementation of the annual collection and analysis HIVDR EWI in all ART sites of Ukraine will prevent the risk of the emergence of HIVDR.Вступ. Проведено одномоментні (поперечні) дослідження ретроспективно зібраних даних з 22 центрів СНІДу, які надають антиретровірусну терапію (АРТ) ВІЛ-інфікованим дорослим та дітям. Оцінювалися показники роботи закладів щодо ефективності формування у пацієнта прихильності до лікування (своєчасність отримання пацієнтом антиретровірусних препаратів (АРВП), а також щодо якості виконання програмних факторів (утримання пацієнтів під диспансерним наглядом, безперервність поставок АРВП, практика призначення моно- або бітерапії, максимальна вірусна супресія ВІЛ). Методи. Дані проаналізовані за допомогою електронного інструменту, розробленого Всесвітньою організацією охорони здоров’я (ВООЗ) – індикаторів раннього запобігання (РЗІ) медикаментозній резистентності (МР) ВІЛ. Результати. Встановлено, що в 2014-2015 рр. ВІЛ-інфіковані дорослі пацієнти своєчасно отримували АРВП тільки в 22,7 % центрів СНІДу, діти – у 36,4 % центрів. Утримати під наглядом більше 85 % пацієнтів вдалося 36,4 % центрів. У 9,1 % закладів зафіксовано дефіцит АРВП для дорослих пацієнтів, у 4,5 % – для дітей. Досягнуто максимальної вірусної супресії ВІЛ у дітей в 31,8 % закладів; по дорослим пацієнтам жодний центр СНІДу не зміг досягти цільового показника. Висновки. Впровадження щорічного збору та аналізу РЗІ в України допоможе своєчасно виявляти та вирішувати проблемні питання в системі надання послуг з АРТ, асоційовані з ризиком формування МР ВІЛ, як на рівні окремих закладів, так і на національному рівні

The changing epidemiological profile of HIV-1 subtype B epidemic in Ukraine

Background While HIV‐1 subtype B has caused a large epidemic in the western world, its transmission in Ukraine remains poorly understood. We assessed the genetic diversity of HIV‐1 subtype B viruses circulating in Ukraine, characterized transmission group structure, and estimated key evolutionary and epidemiological parameters. Methods We analysed 120 HIV‐1 subtype B pol sequences (including 46 newly generated) sampled from patients residing in 11 regions of Ukraine between 2002‐2017. Phylogenies were estimated using maximum likelihood and Bayesian phylogenetic methods. A Bayesian molecular clock coalescent analysis was used to estimate effective population size dynamics and to date the most recent common ancestors of identified clades. A phylodynamic birth‐death model was used to estimate the effective reproductive number (Re) of these clades. Results We identified two phylogenetically distinct predominantly Ukrainian (≥75%) clades of HIV‐1 subtype B. We found no significant transmission group structure for either clade, suggesting frequent mixing among transmission groups. The estimated dates of origin of both subtype B clades were around early 1970s, similar to the introduction of HIV‐1 subtype A into Ukraine. Re for Clade 1 was estimated to be 1.42 (95% HPD 1.26‐1.56) and 1.69 (95% HPD 1.49‐1.84) for Clade 2. Discussion The subtype B epidemic in the country is no longer concentrated in specific geographical regions or transmission groups. The study results highlight the necessity for strengthening preventive and monitoring efforts to reduce the further spread of HIV‐1 subtype B.</p

The changing epidemiological profile of HIV-1 subtype B epidemic in Ukraine

Background While HIV‐1 subtype B has caused a large epidemic in the western world, its transmission in Ukraine remains poorly understood. We assessed the genetic diversity of HIV‐1 subtype B viruses circulating in Ukraine, characterized transmission group structure, and estimated key evolutionary and epidemiological parameters. Methods We analysed 120 HIV‐1 subtype B pol sequences (including 46 newly generated) sampled from patients residing in 11 regions of Ukraine between 2002‐2017. Phylogenies were estimated using maximum likelihood and Bayesian phylogenetic methods. A Bayesian molecular clock coalescent analysis was used to estimate effective population size dynamics and to date the most recent common ancestors of identified clades. A phylodynamic birth‐death model was used to estimate the effective reproductive number (Re) of these clades. Results We identified two phylogenetically distinct predominantly Ukrainian (≥75%) clades of HIV‐1 subtype B. We found no significant transmission group structure for either clade, suggesting frequent mixing among transmission groups. The estimated dates of origin of both subtype B clades were around early 1970s, similar to the introduction of HIV‐1 subtype A into Ukraine. Re for Clade 1 was estimated to be 1.42 (95% HPD 1.26‐1.56) and 1.69 (95% HPD 1.49‐1.84) for Clade 2. Discussion The subtype B epidemic in the country is no longer concentrated in specific geographical regions or transmission groups. The study results highlight the necessity for strengthening preventive and monitoring efforts to reduce the further spread of HIV‐1 subtype B.</p

Phylodynamics helps to evaluate the impact of an HIV prevention intervention

Assessment of the long-term population-level effects of HIV interventions is an ongoing public health challenge. Following the implementation of a Transmission Reduction Intervention Project (TRIP) in Odessa, Ukraine, in 2013-2016, we obtained HIV pol gene sequences and used phylogenetics to identify HIV transmission clusters. We further applied the birth-death skyline model to the sequences from Odessa (n = 275) and Kyiv (n = 92) in order to estimate changes in the epidemic&apos;s effective reproductive number (Re) and rate of becoming uninfectious (δ). We identified 12 transmission clusters in Odessa; phylogenetic clustering was correlated with younger age and higher average viral load at the time of sampling. Estimated Re were similar in Odessa and Kyiv before the initiation of TRIP; Re started to decline in 2013 and is now below Re = 1 in Odessa (Re = 0.4, 95%HPD 0.06-0.75), but not in Kyiv (Re = 2.3, 95%HPD 0.2-5.4). Similarly, estimates of δ increased in Odessa after the initiation of TRIP. Given that both cities shared the same HIV prevention programs in 2013-2019, apart from TRIP, the observed changes in transmission parameters are likely attributable to the TRIP intervention. We propose that molecular epidemiology analysis can be used as a post-intervention effectiveness assessment tool. © 2020 by the authors

Molecular epidemiology reveals the role of war in the spread of HIV in Ukraine.

Ukraine has one of the largest HIV epidemics in Europe, historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilization in 2012, but the recent war in eastern Ukraine may be reigniting virus spread. We investigated the movement of HIV-infected people within Ukraine before and during the conflict. We analyzed HIV-1 subtype-A pol nucleotide sequences sampled during 2012-2015 from 427 patients of 24 regional AIDS centers and used phylogeographic analysis to reconstruct virus movement among different locations in Ukraine. We then tested for correlations between reported PWID behaviors and reconstructed patterns of virus spread. Our analyses suggest that Donetsk and Lugansk, two cities not controlled by the Ukrainian government in eastern Ukraine, were significant exporters of the virus to the rest of the country. Additional analyses showed that viral dissemination within the country changed after 2013. Spearman correlation analysis showed that incoming virus flow was correlated with the number of HIV-infected internally displaced people. Additionally, there was a correlation between more intensive virus movement and locations with a higher proportion of PWID practicing risky sexual behaviors. Our findings suggest that effective prevention responses should involve internally displaced people and people who frequently travel to war-affected regions. Scale-up of harm reduction services for PWID will be an important factor in preventing new local HIV outbreaks in Ukraine

Author Correction: Tracking SARS-COV-2 variants using Nanopore sequencing in Ukraine in 2021

Since spring 2020, Ukraine has experienced at least two COVID-19 waves and has just entered a third wave in autumn 2021. The use of real-time genomic epidemiology has enabled the tracking of SARS-CoV-2 circulation patterns worldwide, thus informing evidence-based public health decision making, including implementation of travel restrictions and vaccine rollout strategies. However, insufficient capacity for local genetic sequencing in Ukraine and other Lower and Middle-Income countries limit opportunities for similar analyses. Herein, we report local sequencing of 24 SARS-CoV-2 genomes from patient samples collected in Kyiv in July 2021 using Oxford Nanopore MinION technology. Together with other published Ukrainian SARS-COV-2 genomes sequenced mostly abroad, our data suggest that the second wave of the epidemic in Ukraine (February-April 2021) was dominated by the Alpha variant of concern (VOC), while the beginning of the third wave has been dominated by the Delta VOC. Furthermore, our phylogeographic analysis revealed that the Delta variant was introduced into Ukraine in summer 2021 from multiple locations worldwide, with most introductions coming from Central and Eastern European countries. This study highlights the need to urgently integrate affordable and easily-scaled pathogen sequencing technologies in locations with less developed genomic infrastructure, in order to support local public health decision making

How war and risky sexual behaviours shape the Ukrainian HIV epidemic: A phylogeographic analysis

Ukraine has one of the largest HIV epidemics in Europe that was historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilisation since 2012, but the recent war in the East of the country might be reinforcing the virus spread. We have studied HIV flow within Ukraine in recent years and explored factors that might explain it

Molecular epidemiology reveals the role of war in the spread of HIV in Ukraine.

Ukraine has one of the largest HIV epidemics in Europe, historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilization in 2012, but the recent war in eastern Ukraine may be reigniting virus spread. We investigated the movement of HIV-infected people within Ukraine before and during the conflict. We analyzed HIV-1 subtype-A pol nucleotide sequences sampled during 2012-2015 from 427 patients of 24 regional AIDS centers and used phylogeographic analysis to reconstruct virus movement among different locations in Ukraine. We then tested for correlations between reported PWID behaviors and reconstructed patterns of virus spread. Our analyses suggest that Donetsk and Lugansk, two cities not controlled by the Ukrainian government in eastern Ukraine, were significant exporters of the virus to the rest of the country. Additional analyses showed that viral dissemination within the country changed after 2013. Spearman correlation analysis showed that incoming virus flow was correlated with the number of HIV-infected internally displaced people. Additionally, there was a correlation between more intensive virus movement and locations with a higher proportion of PWID practicing risky sexual behaviors. Our findings suggest that effective prevention responses should involve internally displaced people and people who frequently travel to war-affected regions. Scale-up of harm reduction services for PWID will be an important factor in preventing new local HIV outbreaks in Ukraine

HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074.

BackgroundPersons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment.MethodsHPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment.ResultsFifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm.ConclusionsIn HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART