Operationalizing the HIV prevention cascade for PWID using the integrated bio-behavioural survey data from Ukraine

Area of Science:

• Public Health
• Epidemiology
• Behavioral Science

Background:

• People who inject drugs (PWID) are at high risk of HIV globally.
• HIV prevention cascades offer a framework to improve monitoring and delivery of prevention programs.
• Ukraine faces ongoing challenges in HIV prevention among PWID.

Purpose of the Study:

• To adapt the HIV prevention cascade framework to the context of PWID in Ukraine.
• To assess gaps in needle/syringe programs (NSP) and condom programs (CP).
• To analyze factors associated with achieving "access" and "effective use" outcomes in HIV prevention.

Main Methods:

• Utilized self-reported data from the 2017 integrated bio-behavioural survey among PWID in Ukraine.
• Constructed cascades for needle/syringe and condom programs.
• Evaluated socio-demographic and behavioral variables as correlates of cascade outcomes.

Main Results:

• NSP cascade: 35.7% accessed clean syringes, 94.8% reported effective use (no sharing).
• CP cascade: 34.5% received condoms, 25.9% reported consistent use.
• Access varied by demographics and drug use type; effective use showed different patterns.

Conclusions:

• The cascade framework effectively identified areas for improvement in HIV prevention programming for PWID in Ukraine.
• Access to NSP and CP was substantially below recommended levels.
• Effective syringe use was high, but consistent condom use was infrequent, indicating a need for enhanced strategies.