This series explores the broader implications of recently proposed changes in US policy and funding for science and public health in the US and around the globe. In this story, Dr. Sheela Shenoi discusses how cuts to USAID funding for primary care integration of HIV programs in Ukraine could lead to devastating consequences, especially for older adults with HIV. This threatens efforts to control the world's fastest growing HIV epidemic in Ukraine.
Please tell us about a research, patient care, or educational program you and your colleagues have been involved in and its significance to global public health.
Dr. Sheela Shenoi: Ukraine has one of the world’s fastest-growing HIV epidemics, with a population prevalence of about 1%. Historically, HIV care in Ukraine has been provided at specialized clinics due to stigma, with many patients not disclosing their status to primary care doctors out of embarrassment or fear of discrimination. Health reform in Ukraine aimed to integrate HIV care into primary care clinics. With funding from USAID, PATH supported these efforts by helping enhance HIV training for health workers, improve care protocols, and facilitate government oversight. This integration has become crucial following the Russian invasion, which has severely disrupted access to specialty care.
In 2023, Dr. Julia Rozanova, Dr. Rick Altice, and I began collaborating with PATH to improve care for older adults with HIV in Ukraine. Although often overlooked, older adults account for an increasing proportion of incident HIV cases and rising HIV-related mortality in Ukraine. With support from NIH, we have been developing and evaluating strategies to improve older adult engagement in HIV care, including peer navigation and HIV disclosure tools.
How have new federal policies impacted this work in the short term?
We recently developed training materials to improve the care of older adults with HIV in primary care clinics. These materials covered proven HIV interventions and strategies for reducing transmission and mortality, such as “Undetectable equals Untransmissible (U=U)”; screening for comorbidities like diabetes, cardiovascular disease, mental health, substance use disorders, malignancies, and bone loss; and delivering essential vaccinations. We had also planned to compile testimonials from older adults with HIV to enhance understanding and reduce stigma among healthcare workers and peers.
However, since this work was entirely USAID-funded, it has been completely halted. Many members of PATH’s team in the US and Ukraine have received layoff notices.
The termination of USAID support for PATH’s critical work in Ukraine is undermining patient care for tens of thousands of people with HIV, including older adults.
If they continue, how will the new policies impact this work and public health over the longer term?
The termination of USAID funding for PATH’s critical work in Ukraine is undermining patient care for tens of thousands of people with HIV, including older adults. We are particularly concerned about the impact on Ukrainian HIV clinicians, who will lose the professional support and training they received through the PATH project. This training in evidence-based HIV medicine is vital for sustaining and improving care, especially during the ongoing humanitarian crisis. The project's end also leaves clinicians without support, disrupting professional relationships and potentially leading to higher patient mortality and increased HIV transmission as people disengage from primary care.