Yale Department of Internal Medicine’s Section of Infectious Diseases was recently awarded two grants from the National Institutes of Health to conduct research to better support older patients with HIV in Ukraine.
Julia Rozanova, PhD, associate research scientist (infectious diseases) is the principal investigator for both projects.
“This work in Ukraine is my personal and professional calling, that builds on a longstanding relationship founded by my co-investigator and senior colleague, Dr. Rick Altice, to address HIV among disadvantaged individuals. I trained in social gerontology and am particularly interested in the health needs of older adults, especially at the intersection of HIV and addiction. From our established collaborations, I was thrilled to find colleagues in Ukraine with similar interests. Crises of COVID-19 and the ongoing war have only brought our team closer together and helped us develop new methods of doing research,” said Rozanova.
The war in Ukraine could have sidelined this work, but the researchers were agile. “‘Normal life’ was suspended in the first weeks of the war, but the readiness of people to work was amazing – our research team quickly responded to crisis realities, and was able to rethink the mechanisms and tools of research. Working has been therapeutic, for us and our participants,” said Irina Zaviryukha, MD, from the European Institute of Public Health Policy, Ukraine.
The first grant, “Adapting a disclosure decision-aid to improve HIV outcomes for older adults in Ukraine” focuses on strategies to help older adults to make informed decisions about their HIV status and disclosure, especially if such disclosure will help them additional support.
“We will adapt an evidence-based decision aid to create a self-administered version call PORADA (Pursuing Optimal Results over Aging via Decision Aid), and pilot it to assist older people with HIV make informed decisions about HIV disclosure aligned with their unique needs,” explained Rozanova. “Porada” means advice in Ukrainian.
Social workers will distribute PORADA to 80 older people with HIV who have at least one important person in their life to whom they have not disclosed their HIV status. Participants will be followed for 12 months and will be compared to 40 matched out-of-care participants receiving treatment as usual.
In 2020, older Ukrainians with HIV reported low levels of HIV status disclosure to their personal support networks. Those people who did not disclose their HIV status were 20 percent less likely to adhere to their HIV medications, and half as likely to adhere to therapy for their other health conditions, than those who disclosed their status.
“Our team has observed that patients with HIV are being newly diagnosed at an older age, or that our known patients with HIV are growing older and are socially and medically marginalized and isolated. As older parents and grandparents, they face unique medical and cultural challenges that we seek to address through this new research,” said co-investigator Sheela Shenoi, MD, MPH, associate professor of medicine (infectious diseases).
Other investigators on the grant are Yale School of Medicine and Yale School of Public Health’s Rick Altice, MD; Valerie Earnshaw, PhD, from the University of Delaware; Oleksandr Zeziulin, MD, MPH; Tetiana Kiriazova, PhD; and Zaviryukha, from the European Institute of Public Health Policy, Ukraine.
The second grant, “Adapting and coping during the war in Ukraine: lived experiences of older adults with HIV and their healthcare providers,” is to modify peer navigation to create a strategy called PROST, to assist older people with HIV to reengage in HIV care and treatment after the disruptions from war.
As the second phase of the war in Ukraine intensified on February 24, 2022, health experts have warned of possible collapse of the HIV care system and a loss of decades of gains in high-priority areas like HIV and addiction care.
The administrative supplement to the ongoing grant “Adapting Peer Navigation for Out-of-Care Older Persons with HIV in Ukraine,” conducted by Rozanova and Shenoi, builds on that previous grant, which adapted a U.S.-developed evidence-based Peer Navigation manual to build a PROST intervention.
The researchers will develop and introduce a new component of the PROST Peer Navigation strategy for use during the humanitarian crisis, using triangulated data from phone interviews with older persons with HIV and their clinicians. Additional survey data collected just before the war will compliment these interviews and included assessments of physical and mental health, social support, risky behaviors, and engagement in HIV and other healthcare.
Collaborator Kaveh Khoshnood, PhD, MPH, associate professor of epidemiology (microbial diseases), Yale School of Public Health, said, “As health professionals and academicians, we do not have the power or tools to end the Russian war in Ukraine, but we are committed to use our expertise to address the multiple negative health impacts of this war on the Ukrainian people. Understanding and addressing the challenges experienced by HIV-positive Ukrainians, 50 years old and older, is one example of our commitment.”
In addition to Rozanova, Shenoi and Khoshnood, other investigators on the grant are Altice, Zeziulin, Kiriazova, and Zaviryukha. Zeziulin and Zaviryukha commented on how, despite the war, their research has been able to continue.
“On February 24, 2022, Russia invaded Ukraine causing more than 6.3 million Ukrainians to flee the country and a third of the population displaced. Yet, despite the war, our research projects were not interrupted. Our team reformatted working schedules and technical approaches that allowed us to continue research. It is worthwhile to work in Ukraine as the country demonstrated proven democracy development, along with economic and technical advance. It is important to support this trend in our scientific sector as well as any success in Ukraine may result in positive change globally,” said Zeziulin.
“As a senior mentor, it is especially gratifying to see junior investigators succeed in their academic careers while making extraordinary differences in the lives of our colleagues working in Ukraine as well as in the lives of their patients,” stated Altice, who has worked in Ukraine since 2004.
“We are deeply grateful to the National Institute on Aging, and to the National Institute on Mental Health, for supporting our studies at this historical juncture,” said Rozanova.
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