Social Support is Key to Retention in Care during Covid-19 Pandemic among Older People with HIV and Substance Use Disorders in Ukraine

Abstract

Background

Older people with human immunodeficiency virus - HIV (OPWH) defined as ≥50 years old account for a growing proportion of newly diagnosed infections in Ukraine (16% in 2018), but the prevalence of substance use disorder among OPWH in Ukraine remains unknown. Ukraine responded to the Covid-19 pandemic with a comprehensive lockdown in late March 2020. Objectives: We conducted a phone survey among 123 OPWH with substance use disorders (SUD) in Kyiv in May 2020 to learn if these older adults may continue HIV and SUD therapy while coping with the Covid-19 pandemic. Results: Data from the survey demonstrated that while OPWH with SUD maintained HIV and SUD therapy throughout Covid-19 lockdown, social support is critical to avoiding treatment interruption for OPWH with SUD. Conclusions/Importance: During reopening, reduction of support may lead to OPWH feeling even more isolated. Post-Covid-19 pharmacological approaches to SUD treatment without social support are like vehicles without gas. The research agenda for OPWH patients with SUD going forward must include determining the type of telehealth support that will be optimally effective to retain OPWH including people who inject drugs (PWID), provision of support by lay health workers, and cost-effectiveness of such interventions. The lessons learned may be relevant to other countries as well.

Keywords:

• Social support
• medication-assisted treatment
• older adults with HIV
• Covid-19 lockdown
• low- and middle-income settings

Acknowledgements

We wish to thank Drs. Oleksandr Shipunov, Natalya Vykhtyk, Tetiana Bodnaruk, Oleg Tandavkiy, and Natalya Knyazeva for sharing their experiences of providing front-line care to OPWH with SUD during Covid-19 lockdown. We wish to thank Yuliia Minster, Tetiana Orlova, and Nataliia Radych for their assistance in conducting phone interviews with OPWH participants.

Declaration of interest

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the National Institutes of Health [grant number K01DA047194-01 to J. Rozanova]; the Yale Women’s Faculty Forum Award to J. Rozanova, the Yale Fund for Lesbian and Gay Studies Award to J. Rozanova, and the Yale MacMillan International and Area Studies Center Award to S. Shenoi and J. Rozanova.