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The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war.
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Background: Communicative competence for massage therapists with visual impairments is an important aspect in ensuring their successful integration into the profession and society. However, visually impaired massage therapists face numerous barriers to effective communication during their education, hiring process, and professional employment. Aim: To study why communicative competence is important for students with visual impairments; to research features of communication of persons with visual impairments; to identify barriers and effective strategies for formation of communicative competence in the educational process. Design: A qualitative descriptive study with focus groups and semi-structured interviews. Settings: Higher education institution in Lviv (Ukraine) offering a nursing programme for students with visual impairments. Participants: Three groups of respondents, namely visually impaired alumni of Lviv Medical Academy, Ukraine (n = 6), alumni's employers and co-workers (n = 4), and experts in the education of visually impaired persons (n = 11), participated in the research. Methods: Two focus groups and in-depth semi-structured interviews were used to collect data. Interviews were transcribed verbatim and thematic coding was used to analyze transcripts. Results: Five themes arose: significance of communication for nurse massage therapists with visual impairments; features of communication of persons with visual impairments; barriers to communication of persons with visual impairments; tools and approaches to improve communicative competence of massage therapists with visual impairments; ineffective methods in teaching communication to visually impaired students. Conclusions: Communication barriers faced by visually impaired nursing students include isolation in specialized institutions, parental hypervigilance, and the challenge of establishing eye contact, which impedes reading nonverbal cues. To enhance communicative competence, it is essential to implement interactive teaching methods, involve students in various activities, ensure educational accessibility, and adopt an individualized and empathetic approach. Both inclusive and special education have advantages and disadvantages. It is recommended to advocate for a "reasonable accommodation" model to ensure high-quality education for visually impaired massage therapists.
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BACKGROUND: Ukraine has implemented ambitious HIV-prevention programs since 1999 and began offering preexposure prophylaxis (PrEP) in 2017. Little is known about PrEP uptake and persistence in this setting. SETTING: We analyzed data from 40 facilities providing PrEP in 11 oblasts (regions) of Ukraine between October 2020 and February 2022. METHODS: We estimated the time between PrEP visits and conducted Kaplan-Meier analyses to estimate retention on PrEP stratified by sex, age, and key populations (KPs): men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), discordant couples, and others vulnerable to HIV acquisition (DC/other). We used Cox regression to estimate the risk of PrEP discontinuation by KP group and sex, adjusting for age. RESULTS: Overall, 2033 clients initiated PrEP across regions; the majority (51%) were DC/other, 22% were MSM, 22% were PWID, and 5% were SW. The overall 3-month persistence was 52.3% (95% confidence interval [CI]: 49.9% to 54.8%) and was lowest among MSM (46.7%; 95% CI: 41.9% to 52.2%) and SW (25.9%; 95% CI: 18.2% to 36.9%) (P < 0.05 for differences by KP group). After adjusting for age, PrEP discontinuation was not statistically significantly different across groups, although female PWID tended to have the lowest discontinuation risk (adjusted hazard ratio [aHR] 0.59; 95% CI: 0.31 to 1.11) while male SW tended to have the highest risk (aHR 1.87, 95% CI: 0.57 to 6.11) compared with females in the DC/other group. CONCLUSION: Three-month PrEP persistence was low across KP groups, especially in SW. Further research examining the barriers and enablers of persistence by KPs is needed.