Background: Suboptimal HIV detection leads to poor engagement in HIV care. In Ukraine, 43% of PWID and 42% of MSM living with HIV are not aware of their status [IBBS, 2018]. These key populations (KPs) significantly contribute to continued spread of HIV infection. Exploring barriers and facilitators to HIV testing among KPs in Ukraine will inform strategies enabling them to be diagnosed and treated sooner.
Methods: In July-September 2018, we conducted qualitative interviews with 43 PWID and 20 MSM (receiving and not receiving HIV services) and HIV care providers in Kyiv, Dnipro, and Odesa cities. Interviews were transcribed verbatim, imported into MAXQDA, and inductively analyzed for themes.
Results: Median age of PWID was 38 years, and 17 (39.5%) were females; median age of MSM was 31. 12 physicians and 11 community-based organizations'' staff participated in the interviews. Thematic analyses concurred that across all cities, conventional HIV testing of PWID clients of mobile clinics and needle exchange programs demonstrated very limited yield in new case finding (“we found 2 HIV cases in 8 months”), while index testing (testing of HIV-positive PWID'' sexual or injecting partners in PEPFAR-funded interventions) detected “20 positives within a month”. While physicians recommended engaging KPs in HIV services via TV and billboard advertising, MSM considered social networks and dating applications to be more appropriate in providing HIV testing information. For PWID, the main source of HIV-related information was their social circle (mostly peers). According to providers and KPs, the main concern for MSM accessing HIV services was fear of confidentiality breach, while monetary reimbursement was named as the best motivator for PWID to access HIV services.
Conclusions: These data demonstrate that traditional approaches to HIV case finding may have exhausted their capacity and are not appropriate for reaching the remaining undiagnosed subgroups of HIV-positive KPs. To find new HIV cases among KPs and engage them in care, we should implement novel testing modalities and utilize appropriate communication channels. Scaling-up targeted interventions such as Index-Testing and Enhanced Peer Outreach for PWID, as well as Index and Self-Testing among MSM, might improve the first “90” of the HIV care cascade.