Background: Monitoring and evaluation of HIV cascade has become a standard approach to measuring the progress achieved in detecting and treating HIV. Aim of this study was to identify trends in HIV cascade among PWID, a key population that constitutes almost half of estimated number of people living with HIV (PLHIV) and accounts for 75% of new HIV cases in Ukraine. During the period taken for the analysis (2011 - 2017) significant scale-up of community-based services for PWID (e.g. harm reduction and case management) occurred. These services are important interventions that were shown to improve access to ART in other settings.
Methods: We conducted secondary analysis of 2011 and 2017 IBBS data collected in all 27 regions of Ukraine using respondent-driven sampling. Results of rapid HIV testing and self-reported data on HIV status awareness and enrollment into HIV care and treatment were used to construct HIV services cascades. Chi-square test was used to determine significance of differences between the two years.
Results: In 2017, 10,076 PWID were recruited (18% females) and 21.1% tested positive for HIV. In 2011, 9,069 PWID were recruited (28% females) and 21.9% tested HIV-positive. Among those who tested positive for HIV, improvements in access to care and ART coverage were significant (p< 0.001), while awareness of HIV status remained stable. Linkage to HIV care increased from 47% to 52%, and treatment uptake from 18% to 38%.

HIV Cascade among PWID in Ukraine, IBBS 2011 - 2017
[HIV Cascade among PWID in Ukraine, IBBS 2011 - 2017]

Conclusions: Enrollment into HIV care and ART coverage among HIV-positive PWID in Ukraine significantly improved from 2011 to 2017. Nevertheless, considerable gaps exist in the cascade, mainly in HIV status awareness and access to ART among those in care. Services such as case management are important interventions that may further improve access to treatment for PWID. IBBS may serve as a valuable source of data to analyze HIV service cascade outcomes for key populations.