HIV Pre-exposure Prophylaxis (PrEP) Uptake and Persistence in Wartime Ukraine: Analysis of Data from a Scaled PrEP Program

Russia's invasion of Ukraine and the ongoing war have had devastating effects on health programs. This observational study assessed uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) during wartime. The study included newly-initiating daily PrEP users from 94 clinics who enrolled on PrEP from October 2022 through September 2023. PrEP persistence was defined as returning for a PrEP refill no later than 7 days after the expected refill date. We used Kaplan-Meier curves and sex-stratified Cox regression to explore PrEP discontinuation by sex, key population group, age group, and wartime location. 4537 clients initiated daily PrEP, with 31.9% being men who have sex with men (MSM), 29.7% based in a frontline location, and 16.7% aged 18-25. Six-month persistence was 37.3% overall. It was lower among MSM (28.6%), young adults aged 18-25 (17.2%), and frontline residents (15.6%), and higher among sex workers (SW) (81.5%). In adjusted analysis among women, SW had a lower risk of discontinuing PrEP compared with discordant couples (adjusted hazard ratio [aHR]: 0.22, 95% confidence interval [CI] 0.14-0.34). In both sexes, clients aged 18-25 had a higher risk of discontinuing PrEP (aHR: 1.43, 95% CI 1.25-1.65 for men; aHR: 1.60, 95% CI 1.16-2.20 for women), as did those based in frontline locations (aHR: 2.19, 95% CI 1.99-2.41 for men; aHR: 1.26, 95% CI 1.04-1.53 for women). The findings highlight the resilience of Ukraine's PrEP program and the need to support PrEP persistence among younger and frontline populations.