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The Russian war in Ukraine poses many risks for the spread of HIV, TB and associated conditions, including possible increases in the numbers of people who inject drugs or engage in sex work in the years ahead. Ukrainian civil society and volunteer efforts have been able to maintain and at times expand services for HIV Key Populations. The extent of mutual-aid and volunteer efforts as well as the continued strength and vitality of harm reduction organizations such as the Alliance for Public Health and the rest of civil society will be crucial resources for postwar efforts to assist Key Populations and prevent the spread of HIV, TB and other diseases. The postwar period will pose great economic and political difficulties for Ukrainians, including large populations of people physically and/or psychically damaged and in pain who might become people who inject drugs. Local and international support for public health and for harm reduction will be needed to prevent potentially large-scale increases in infectious disease and related mortality. [ABSTRACT FROM AUTHOR]

Background: Due to practical challenges associated with genetic sequencing in low-resource environments, the burden of hepatitis C virus (HCV) in forcibly displaced people is understudied. We examined the use of field applicable HCV sequencing methods and phylogenetic analysis to determine HCV transmission dynamics in internally displaced people who inject drugs (IDPWID) in Ukraine. Methods: In this cross-sectional study, we used modified respondent-driven sampling to recruit IDPWID who were displaced to Odesa, Ukraine, before 2020. We generated partial and near full length genome (NFLG) HCV sequences using Oxford Nanopore Technology (ONT) MinION in a simulated field environment. Maximum likelihood and Bayesian methods were used to establish phylodynamic relationships. Results: Between June and September 2020, we collected epidemiological data and whole blood samples from 164 IDPWID (PNAS Nexus.2023;2(3):pgad008). Rapid testing (Wondfo® One Step HCV; Wondfo® One Step HIV1/2) identified an anti-HCV seroprevalence of 67.7%, and 31.1% of participants tested positive for both anti-HCV and HIV. We generated 57 partial or NFLG HCV sequences and identified eight transmission clusters, of which at least two originated within a year and a half post-displacement. Conclusions: Locally generated genomic data and phylogenetic analysis in rapidly changing low-resource environments, such as those faced by forcibly displaced people, can help inform effective public health strategies. For example, evidence of HCV transmission clusters originating soon after displacement highlights the importance of implementing urgent preventive interventions in ongoing situations of forced displacement. [ABSTRACT FROM AUTHOR]

Introduction: In light of the COVID‐19 pandemic, considerable effort is going into identifying and protecting those at risk. Criminalization, stigmatization and the psychological, physical, behavioural and economic consequences of substance use make people who inject drugs (PWID) extremely vulnerable to many infectious diseases. While relationships between drug use and blood‐borne and sexually transmitted infections are well studied, less attention has been paid to other infectious disease outbreaks among PWID. Discussion: COVID‐19 is likely to disproportionally affect PWID due to a high prevalence of comorbidities that make the disease more severe, unsanitary and overcrowded living conditions, stigmatization, common incarceration, homelessness and difficulties in adhering to quarantine, social distancing or self‐isolation mandates. The COVID‐19 pandemic also jeopardizes essential for PWID services, such as needle exchange or substitution therapy programmes, which can be affected both in a short‐ and a long‐term perspective. Importantly, there is substantial evidence of other infectious disease outbreaks in PWID that were associated with factors that enable COVID‐19 transmission, such as poor hygiene, overcrowded living conditions and communal ways of using drugs. Conclusions: The COVID‐19 crisis might increase risks of homelessnes, overdoses and unsafe injecting and sexual practices for PWID. In order to address existing inequalities, consultations with PWID advocacy groups are vital when designing inclusive health response to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: People who inject drugs (PWID) remain at high risk of HIV in many countries. The HIV prevention cascades have been proposed to replicate the success of the treatment cascades and reinvigorate the prevention programmes through improved monitoring, planning and delivery. We adapted the cascade framework to the PWID context in Ukraine, assessed gaps and analysed factors associated with achieving "access" and "effective use" outcomes. Methods: Self‐reported data on the use of prevention services and risk behaviours from the 2017 integrated bio‐behavioural survey among PWID in Ukraine were used to construct cascades for needle/syringe and condom programmes (NSP and CP). Socio‐demographic and behavioural variables were evaluated as potential correlates of cascade outcomes. Results: The NSP cascade analysis included 7815 HIV‐negative PWID. Motivation to use clean syringes was not assessed and assumed at 100%. Access to clean syringes through NSP in the past 12 months was reported by 2789 participants (35.7%). Effective use of syringes (no sharing in the past 30 days) was reported by 7405 participants (94.8%). NSP access was higher among women, individuals older than 44, and mixed drug users; while effective use was reported more frequently by men and opioid users, with no difference by age. The CP cascade analysis included 6606 (85%) of the HIV‐negative PWID who had sex in the past three months. Of those, 2282 (34.5%) received condoms, and 1708 (25.9%) reported consistent use with all partners in the past three months. Older PWID and mixed‐drug users accessed condoms more frequently; whereas younger subgroups and opioid users used them more consistently. Conclusions: Overall, the cascade framework was useful to describe the status of HIV prevention among PWID in Ukraine and to identify areas for improvement in the programming and evaluation of HIV prevention. Access to needle/syringe and condom programmes was substantially below the recommended levels. Effective use of clean syringes was reported by a vast majority of PWID, although likely affected by self‐report bias; whereas consistent condom use was infrequent. Socio‐demographic and behavioural variables showed significant associations in NSP and CP cascade analyses, with little consistency between the access and effective use outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Ukraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.Methods: We used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013-2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.Results: Recent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).Conclusion: HIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one's status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs. [ABSTRACT FROM AUTHOR]

Individuals with recent/acute HIV-infection have an increased likelihood of disease transmission. To evaluate effectiveness of identifying recent infections, we compared networks of recently and long-term HIV-infected individuals. The Transmission Reduction Intervention Project included two separate arms of recruitment, networks of recently HIV-infected individuals and networks of long-term HIV-infected individuals. Networks of each were recruited and tested for HIV and syphilis infection. The per-seed yield ratios of recruitment were compared between arms. Overall, 84 (41.6%) of 202 participants were identified as HIV-positive. HIV prevalence was higher (p < 0.001) among networks of recent seeds (33/96, 34.4%) compared to long-term seeds (6/31, 19.4%). More individuals were identified with active syphilis infection (p = 0.007) among networks of recent seeds (15/96, 15.6%), compared to networks of long-term seeds (3/31, 9.7%). Network-based recruitment of recently HIV-infected individuals was more effective at identifying HIV and syphilis infection. Allocation of public health resources may be improved by targeting interventions toward networks of recently HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Background: The Transmission Reduction Intervention Project (TRIP) is a network-based intervention that aims at decreasing human immunodeficiency virus type 1 (HIV-1) spread. We herein explore associations between transmission links as estimated by phylogenetic analyses, and social network-based ties among persons who inject drugs (PWID) recruited in TRIP.Methods: Phylogenetic trees were inferred from HIV-1 sequences of TRIP participants. Highly supported phylogenetic clusters (transmission clusters) were those fulfilling 3 different phylogenetic confidence criteria. Social network-based ties (injecting or sexual partners, same venue engagement) were determined based on personal interviews, recruitment links, and field observation.Results: TRIP recruited 356 individuals (90.2% PWID) including HIV-negative controls; recently HIV-infected seeds; long-term HIV-infected seeds; and their social network members. Of the 150 HIV-infected participants, 118 (78.7%) were phylogenetically analyzed. Phylogenetic analyses suggested the existence of 13 transmission clusters with 32 sequences. Seven of these clusters included 14 individuals (14/32 [43.8%]) who also had social ties with at least 1 member of their cluster. This proportion was significantly higher than what was expected by chance.Conclusions: Molecular methods can identify HIV-infected people socially linked with another person in about half of the phylogenetic clusters. This could help public health efforts to locate individuals in networks with high transmission rates. [ABSTRACT FROM AUTHOR]

As part of a network study of HIV infection among people who inject drugs (PWID) and their contacts, we discovered a connected subcomponent of 29 uninfected PWID. In the context of a just-declining large epidemic outbreak, this raised a question: What explains the existence of large pockets of uninfected people? Possible explanations include “firewall effects” (Friedman et al., 2000; Dombrowski et al., 2017) wherein the only HIV+ people that the uninfected take risks with have low viral loads; “bottleneck effects” wherein few network paths into the pocket of non-infection exist; low levels of risk behavior; and an impending outbreak. We considered each of these. Participants provided information on their enhanced sexual and injection networks and assisted us in recruiting network members. The largest connected component had 241 members. Data on risk behaviors in the last 6 months were collected at the individual level. Recent infection was determined by LAg (SediaTM Biosciences Corporation), data on recent seronegative tests, and viral load. HIV RNA was quantified using Artus HI Virus-1 RG RT-PCR (Qiagen). The 29 members of the connected subcomponent of uninfected participants were connected (network distance = 1) to 17 recently-infected and 24 long-term infected participants. Fourteen (48%) of these 29 uninfected were classified as “extremely high risk” because they self-reported syringe sharing and had at least one injection partner with viral load >100,000 copies/mL who also reported syringe sharing. Seventeen of the 29 uninfected were re-interviewed after 6 months, but none had seroconverted. These findings show the power of network research in discovering infection patterns that standard individual-level studies cannot. Theoretical development and exploratory network research studies may be needed to understand these findings and deepen our understanding of how HIV does and does not spread through communities. Finally, the methods developed here provide practical tools to study “bottleneck” and “firewall” network hypotheses in practice. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents an overview of different kinds of risk and social network methods and the kinds of research questions each can address.Recent Findings: It also reviews what network research has discovered about how network characteristics are associated with HIV and other infections, risk behaviors, preventive behaviors, and care, and discusses some ways in which network-based public health interventions have been conducted.Summary: Based on this, risk and social network research and interventions seem both feasible and valuable for addressing the many public health and social problems raised by the widespread use of opioids in the US South. [ABSTRACT FROM AUTHOR]

Ukraine has one of the largest HIV epidemics in Europe, historically driven by people who inject drugs (PWID). The epidemic showed signs of stabilization in 2012, but the recent war in eastern Ukraine may be reigniting virus spread. We investigated the movement of HIV-infected people within Ukraine before and during the conflict. We analyzed HIV-1 subtype-A pol nucleotide sequences sampled during 2012-2015 from 427 patients of 24 regional AIDS centers and used phylogeographic analysis to reconstruct virus movement among different locations in Ukraine. We then tested for correlations between reported PWID behaviors and reconstructed patterns of virus spread. Our analyses suggest that Donetsk and Lugansk, two cities not controlled by the Ukrainian government in eastern Ukraine, were significant exporters of the virus to the rest of the country. Additional analyses showed that viral dissemination within the country changed after 2013. Spearman correlation analysis showed that incoming virus flow was correlated with the number of HIV-infected internally displaced people. Additionally, there was a correlation between more intensive virus movement and locations with a higher proportion of PWID practicing risky sexual behaviors. Our findings suggest that effective prevention responses should involve internally displaced people and people who frequently travel to war-affected regions. Scale-up of harm reduction services for PWID will be an important factor in preventing new local HIV outbreaks in Ukraine. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Providing HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach-based testing or respondent-driven sampling (RDS) in Odessa, Ukraine. METHODS: The Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently-infected and longer-term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects. RESULTS: TRIP tested 1252 people (21% women) in seeds' risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently-infected participants' networks contained higher proportions of undiagnosed positives (16.3%) than LTs' networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing. CONCLUSIONS: TRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV-positive people efficiently. They should be integrated with standard practice to improve case-finding. Research should test these techniques in other socio-epidemiologic contexts. [ABSTRACT FROM AUTHOR]

Background We studied the association between sex in exchange for money, drugs or goods and HIV for women who inject drugs (WWID) in Ukraine, as previous data on this association from the post-USSR region are contradictory. Methods Data come from the Integrated Bio-Behavioral Survey of Ukrainian people who inject drugs collected in 2011 using respondentdriven sampling. Participants were interviewed and tested with rapid HIV tests. Results The sample included 2465 WWID (24% HIV positive); 214 (8.7%) of which reported having had exchange sex during the last 90 days. Crude analysis showed no association between exchange sex and HIV (OR = 0.644; 95% CI 0.385-1.077). No confounders were found to alter this result in a multivariable analysis. Further modeling showed that exchange sex modifies association between HIV and alcohol use: no association between HIV and daily alcohol use was found for those women who exchanged sex (OR = 1.699, 95% CI 0.737-3.956); while not engaging in sex work and daily using alcohol reduced odds to be HIV infected (OR = 0.586, 95% CI 0.389--0.885). Conclusions Exchange sex may have less impact on the HIV status of WWID who are exposed to injecting risks. The finding that daily alcohol use appears protective against HIV among WWID who do not exchange sex requires more research. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Assessment of the long-term population-level effects of HIV interventions is an ongoing public health challenge. Following the implementation of a Transmission Reduction Intervention Project (TRIP) in Odessa, Ukraine, in 2013–2016, we obtained HIV pol gene sequences and used phylogenetics to identify HIV transmission clusters. We further applied the birth-death skyline model to the sequences from Odessa (n = 275) and Kyiv (n = 92) in order to estimate changes in the epidemic's effective reproductive number (Re) and rate of becoming uninfectious (δ). We identified 12 transmission clusters in Odessa; phylogenetic clustering was correlated with younger age and higher average viral load at the time of sampling. Estimated Re were similar in Odessa and Kyiv before the initiation of TRIP; Re started to decline in 2013 and is now below Re = 1 in Odessa (Re = 0.4, 95%HPD 0.06–0.75), but not in Kyiv (Re = 2.3, 95%HPD 0.2–5.4). Similarly, estimates of δ increased in Odessa after the initiation of TRIP. Given that both cities shared the same HIV prevention programs in 2013–2019, apart from TRIP, the observed changes in transmission parameters are likely attributable to the TRIP intervention. We propose that molecular epidemiology analysis can be used as a post-intervention effectiveness assessment tool. [ABSTRACT FROM AUTHOR]

Introduction: This paper examines the extent to which an intervention succeeded in locating people who had recently become infected with HIV in the context of the large‐scale Ukrainian epidemic. Locating and intervening with people who recently became infected with HIV (people with recent infection, or PwRI) can reduce forward HIV transmission and help PwRI remain healthy. Methods: The Transmission Reduction Intervention Project (TRIP) recruited recently‐infected and longer‐term infected seeds in Odessa, Ukraine, in 2013 to 2016, and asked them to help recruit their extended risk network members. The proportions of network members who were PwRI were compared between TRIP arms (i.e. networks of recently‐infected seeds vs. networks of longer‐term infected seeds) and to the proportion of participants who were PwRI in an RDS‐based Integrated Biobehavioral Surveillance of people who inject drugs in 2013. Results: The networks of PwRI seeds and those of longer‐term infected seeds had similar (2%) proportions who were themselves PwRI. This was higher than the 0.25% proportion in IBBS (OR = 7.80; p = 0.016). The odds ratio among the subset of participants who injected drugs was 11.17 (p = 0.003). Cost comparison analyses using simplified ingredients‐based methods found that TRIP spent no more than US $4513 per PwRI located whereas IBBS spent $11,924. Conclusions: Further research is needed to confirm these results and improve TRIP further, but our findings suggest that interventions that trace the networks of people who test HIV‐positive are a cost‐effective way to locate PwRI and reduce HIV transmission and should therefore be implemented. [ABSTRACT FROM AUTHOR]

Early treatment, soon after infection, reduces HIV transmissions and benefits patients. The Transmission Reduction Intervention Project (TRIP) evaluated a network intervention to detect individuals recently infected (in the past 6 months). TRIP was conducted in Greece (2013-2015) and focused on drug injector networks. Based on HIV status, testing history, and the results of an assay to detect recent infections, TRIP classified drug injector 'Seeds' into groups: Recent Seeds (RS), and Control Seeds with Long-term HIV infection (LCS). The network members of RS and LCS were traced for two steps. The analysis included 23 RS, 171 network members of the RS, 19 LCS, and 65 network members of the LCS. The per-seed number of recents detected in the network of RS was 5 times the number in the network of LCS (Ratio RS vs. LCS: 5.23; 95% Confidence Interval (CI): 1.54-27.61). The proportion of recents among HIV positives in the network of RS (27%) was approximately 3 times (Ratio RS vs. LCS: 3.30; 95% CI: 1.04-10.43) that in the network of LCS (8%). Strategic network tracing that starts with recently infected persons could support public health efforts to find and treat people early in their HIV infection. [ABSTRACT FROM AUTHOR]

BACKGROUND. "Project Protect" aims to find highly infectious individuals through screening for acute/recent infection cases and prevent HIV transmission in the risk networks of these cases through contact tracing of these networks' participants, distributing community alerts about risk of acute infection among them and accurate post-test counseling. METHODS. An ongoing pilot phase of the intervention began in Kriviy Rig and Lviv, Ukraine in November, 2011. Participants are recruited through: 1) screening for cases of acute/recent infection at voluntary counseling and testing (VCT) sites and in partner organizations (including AIDS-Centers) which conduct VCT; 2) visits to drug use venues, chain-referral and contact tracing. Genscreen ultra HIV Ag-Ab "special-tests" are used to detect cases of acute infection. Recent infection is defined as positive test result and preceding negative result within 6 months and/or age younger than 21 years old. RESULTS. In the two cities 173 respondents were recruited to the project, 118 special tests were done. No cases of acute infection and eleven cases of recent infection were found (8 injection drug users (IDUs) with preceding negative result within 6 months, 2 IDUs younger than 21 recruited by project team; one non-IDU with preceding negative result within 6 months referred from AIDS-Center). Six recent cases were recruited through screening at VCT sites, 5 others through contact tracing. Psychologists conducted 41 interviews with recent infection cases and their risk networks' members; 176 community alert flyers were distributed to members of risk networks during the interview by psychologist, at the venue by social worker and by participants themselves; 3 drug use venues were visited by project team with concomitant HIV-testing of people present at the venue. CONCLUSIONS. Network tracing seems to be feasible and to help find recently infected people. Further research is needed to tell whether this intervention reduces HIV transmission rates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ukraine has the most severe HIV epidemic in Europe. There is an urgent need to improve the effectiveness of the preventive measures to stop further spread of the epidemic. PDI was implemented as an alternative to traditional outreach work in educating IDUs and reducing their injection and sexual risky practices. METHODS: The first wave of the intervention was implemented in 8 cities of Ukraine in November 2008 - June 2009, the second - in 2 cities of Ukraine in December 2009 - June 2010. The follow-up of both waves was conducted in August 2010 - January 2011. Two interviews (during the first/second wave and follow-up) with questions regarding socio-demographic information, drug use, risk-related behavior , knowledge about safer drug injection, overdose, sexual behavior , questions related to health and HIV-testing, and financial questions were performed with participants. After the interview, participants were educated about safer drug use practices and HIV. SPSS analysis was conducted to see whether participants' risky injection and sexual practices changed to safer. Cross-tabulation and McNemar statistics test were used as a primary way of data analysis. RESULTS: Total number of 3054 participants were covered by first/second wave and follow-up (72.9% men). Both injection and sexual risky practices showed significant change between first (first/second wave) and second (follow-up) interviews: participants reported less using other's previously used syringe (decrease from 15.2% to 11.0%), always filling syringe from the shared container (30.6% to 28.4%), always buying drug in pre-filled syringe (10.3% to 9,2%), never using condoms during sexual intercourse in previous 30 days (31.9% to 27.7%). CONCLUSION: The first analysis shows that those who participated in PDI were likely to report safer behavior after the follow-up period than during the first interview. Further analysis will be focused on stratifying participants by different factors to define which groups were affected more. [ABSTRACT FROM AUTHOR]

BACKGROUND: Integrated biobehavioral surveys (IBBS) have been used to evaluate the impact of HIV prevention efforts among most-at-risk groups in Ukraine since 2007. Harm reduction program coverage among injecting-drug users (IDUs) increased substantially from 96,000 in 2008 to 170,000 in 2010 with support from the Global Fund, and IBBS have shown declining HIV prevalence. Aim of the study was to examine the changes in HIV prevalence, drug use patterns and risky behaviors in IDUs on national and city level. METHODS: For this analysis, three IDU-IBBS datasets were combined - 2008 (N=3711), 2009 (N=3962), and 2011 (N=9069). The analysis included 25 cities that participated in either 2008 or 2009, and 2011. Changes in HIV prevalence, drug use, and risk behaviors were compared between 2008/9 and 2011. RESULTS: The surveyed IDU population in 2011 was older than in 2008/9 (31.0 vs. 32.8 years; p<.0001), and included more females (23.5% vs. 25.5%; p=.0038), with substantial variation across cities. Overall HIV prevalence in the sample declined slightly (22.9% to 21.6%; p=.05). In eight cities, HIV prevalence decreased significantly (-5% to -18%), while significant increases were seen in five cities (8% to 15%). Prevalence among IDUs younger than 25 years declined (9.9% to 7.2%; p=.0078). The combined dataset showed no difference in opioid or stimulant past-30-day use, with variation at city level. Clean needle/syringe use during last injection increased significantly (88.8% to 97.0%; p<.0001), with no opposing trend in any city. Three cities had an increase in past-30-day needle/syringe sharing; nine -- in container sharing; twelve -- in use of preloaded syringes. Changes in condom use were not significant (54.1% to 54.9%, p=.32). CONCLUSIONS: IDUs in Ukraine are ageing and HIV seroprevalence among IDUs continues to decline, especially among young IDUs. However , prevention programming needs to respond to significant regional variations in risk behaviors and HIV transmission. [ABSTRACT FROM AUTHOR]

An abstract of the article "Relying on injection drug users to prevent HIV in Ukraine - follow-up results of peer-driven interventions," by Oleksandra Datsenko, Pavlo Smyrnov, and Robert Broadhead is presented.

An abstract of the article "Accessing and educating female sex workers in Ukraine via a peer-driven intervention," by Oksana Matiyash, Pavlo Smyrnov, and Robert Broadhead is presented.

BACKGROUND. Network epidemiology is a promising area of an epidemiological research that can facilitate understanding of an infection transmission within a population. An empirical base of the network epidemiology is developing. A theoretical background was established and tested on computer-simulated models. One of the most difficult tasks in moving to empirical field is developing a feasible method of gathering reliable information on network links. This is particularly challenging when those links represent sexual and drug use relationships within a hidden group of injecting drug users. METHODS. Combination of a coupon referral system and a personal network name-generator was used. All participants were asked to provide information about drug users with whom they communicated personally or their sexual partners during the last 30 days. This information was entered into the name-generator. Coupons were provided only for the current "risk" contacts, i.e. those injecting drug users with whom participants had sex or injected together. There was no limit to recruitment of "risk" contacts. All recruited and non-recruited but named "risk" contacts formed egocentric networks of the study participants. These egocentric networks were linked through referral chains into larger network clusters. Repeated referrals provided information for new links. RESULTS. Most of the study participants named and recruited their "risk" contacts. At each of the 5 study sites not less than 300 injecting drug users were selected from name generators of their peers and recruited through coupon referral system. CONCLUSIONS. Respondent driven sampling was modified to sample net- work links. Thus recruitment links in the current study are also the "risk" links through which infection can be transmitted when it is present in the network. These links form the "risk" network that can be studied by the network analysis methods. [ABSTRACT FROM AUTHOR]