Alona Mazhanaia

Fellowship Site: Ukrainian Institute On Public Policy, Ukraine

US Institution: Yale University

Project Title: The Syndemic Approach to Addressing HIV, Opioid Use Disorder, and Depression within a Primary Healthcare Setting in Ukraine

HIV in Ukraine is concentrated among people who inject drugs (PWID).2,4,5 Previous studies have shown that HIV and opioid use are syndemic with and compounded by underlying depression and anxiety.6-8 The prevalence of psychiatric disorders among PWID in Ukraine exceeds 50%,9,10 and is higher among PWID with HIV.11 These mental health states increase HIV risk and also impede HIV treatment, as my previous work in Ukraine suggests.11 Moreover, international guidelines suggest that all people with HIV (PWH) should be screened for depression, but screening and treatment is suboptimal in most settings, including Ukraine.

In order to prepare for a future trial of integrating screening and treatment for depression in clinical care settings, specifically for PWH, we will explore the effects of depression on a number of HIV outcomes in PWH at both primary care and addiction treatment settings. Therefore, the aims of this research are:

1. To examine the prevalence and variation of depression among PWID with HIV on MOUD and assess whether and how depression and depression severity contribute to HIV treatment outcomes, using the subset of PWH in the MEDIUM and IMPACT studies.

2. Because of the concentration of PWH in PCC and addiction treatment programs is high (45-50%), we will explore the barriers and facilitators of integrating depression screening and subsequent treatment for for depression for PWH in these settings. We will assess barriers and facilitators using nominal group technique (NGT). Because these barriers may differ based on whether a PCC has already integrated other services (e.g., IMPACT sites), I will match PCC at 6 IMPACT sites with providers in the same city for six non-IMPACT sites. During NGT, I will explore: a) what gets in the way of integrating screening and care for depression for PWH into your clinic; and b) what would need to change before integrating care for depression for PWH into your setting. Findings from aims 1 and 2 will help guide a future pilot study of integrating care for depression for PWH into primary care settings to improve HIV incidence and treatment outcomes.