Ensuring quality HIV care for people displaced from Ukraine – Poland
Since the beginning of the aggression of the Russian Federation against Ukraine on February 24, 2022 and until April 11, 2022, more than 4 million Ukrainians had fled to Poland, Hungary, Slovakia, Romania and the Republic of Moldova (1). While countries bordering Ukraine have so far taken in most of the displaced, it is expected that there will be further migration across Europe in the coming weeks.
It is estimated that before the war, more than 250,000 people (1% of the total population) were living with HIV in Ukraine, of whom around 130,000 were receiving antiretroviral treatment.
As the displacement of people from Ukraine escalates, it is imperative that countries in Europe hosting these displaced people are prepared to ensure high standards of HIV prevention, treatment and care.
The European Council adopted a Directive on temporary protection (2) which offers an appropriate response to the current situation by providing immediate protection and rights, including the right to medical assistance.
Partners of the European AIDS Clinical Society (EACS), together with the Euroguidelines in Central and Eastern Europe (ECEE) network group, the WHO Collaborating Center at the Center of Excellence for Health, Immunity and infections (CHIP), in Denmark, were commissioned by the WHO Regional Office for Europe will work with the Public Health Center of the Ministry of Health of Ukraine to produce a standardized protocol for the clinical management and sharing medical data for displaced people living with HIV from Ukraine (3).
To ensure that appropriate systems are in place for clinical management and data sharing for IDPs from Ukraine living with HIV across Europe, it is essential that countries consider the following actions:
a) urgently develop and roll out national plans to provide free and easily accessible HIV care, including the provision of antiretroviral treatment, treatment of co-infections, prevention of opportunistic infections and opioid agonist therapy, where appropriate, for the Ukrainian population;
(b) provide a network of designated and accessible clinics to provide HIV testing and antiretroviral therapy, as well as testing and management of viral hepatitis, tuberculosis and sexually transmitted infections; these services must take into account the language, culture and mental health needs of displaced persons;
c) ensure the secure electronic transfer of medical information between Ukraine and host countries using the link and form provided (3), and within and between countries to facilitate the safe and timely provision of care ;
d) hold sufficient stocks of antiretroviral therapy to provide at least 90 days of therapy to displaced persons in case of onward transit to other European countries, preferably using the same treatment regimen as prescribed in Ukraine;
e) seize the opportunity to facilitate access to testing for HIV and other blood-borne viruses to displaced persons as part of general medical screening and to those admitted to hospital for care; and (f) provide documentation confirming HIV status, details of tests performed and antiretroviral therapy provided for those transiting in or out of the country.
Addressing these considerations would provide the highest standards of care for people living with HIV fleeing Ukraine and would ensure that the displacement of people from Ukraine does not negatively impact aspirations to achieve the Goals United Nations Sustainable Development Goals by 2030.
References* 1. Operational Data Portal. Situation of Ukrainian refugees [online database]. Geneva: United Nations Refugee Agency; 2022 (https://data2.unhcr.org/en/situations/ukraine).
Council Directive 2001/55/EC of 20 July 2001 on minimum standards for granting temporary protection in the event of a mass influx of displaced persons and on measures promoting a balance of efforts between Member States to reception of these people and management of their consequences. PLAY 2021, L 212:12–23 (https://eur-lex.europa.eu/legalcontent/EN/TXT/HTML/?uri=CELEX:32001L0055&from=LT).
Standardized clinical management and medical data sharing protocol for people living with HIV among refugees from Ukraine. Copenhagen: WHO Regional Office for Europe; 2022 (https://apps.who.int/iris/handle/10665/353083).