BACKGROUND: Since February 2022, armed conflict has challenged the Ukrainian health system to sustain delivery of HIV and related services. Through the USAID/PEPFAR-funded Community Action for HIV Control project, community-led monitoring (CLM) measures service availability and quality for key populations (KP). We assessed the availability of four services against the number of conflict events to identify factors related to service resilience.
DESCRIPTION: We retrospectively compared CLM data for HIV testing services, pre-exposure prophylaxis (PrEP), antiretroviral therapy, and medication-assisted treatment (MAT) availability with the number of air and drone strikes, armed clashes, and shelling attacks from the Armed Conflict Location & Event Data Project in Kyiv city and 12 regions between April - September 2022. Community monitors recorded service availability reported by five or more clients each month, which was verified with other informants or service sites. Generally, each region has monitors representing each KP community. Service availability was graded as available, available with barriers, or unavailable and color-coded on a CLM dashboard for rapid visual representation.
LESSONS LEARNED: Overall, regions with few or no armed conflict events (Cherkasy, Poltava, Ivano-Frankivska) had limited to no service interruptions. Of conflict-affected regions, Mykolaiv, Zaporizhia, and Dnipro had the fewest service interruptions or barriers. MAT and PrEP were services most frequently impacted in conflict-affected regions. Service interruption patterns varied within specific regions (e.g., Donetsk), related to proximity to conflict and type of events (i.e., greater reported disruption with armed clashes). Some regions (e.g., Lviv, Ternopil) with few events experienced barriers to or lack of services, partly attributed to internally displaced persons creating unexpected higher client flow. In conflict-affected regions, service availability was typically restored within one to two months of the highest conflict event numbers. CLM data were shared with the Centre for Public Health (CPH), who coordinated a rapid response to supply chain and human resource issues across partners to restore services.
CONCLUSIONS: While conflict-affected regions had more reported service interruptions or barriers, secondary effects of conflict, like displacement, created service disruptions in regions with fewer conflict events. Service availability recovered quickly due to CPH response to notifications from monitors and KP community members, including through social media.