Using Nominal Group Technique With Human-Centered Design to Inform Preimplementation Planning for Combined Rapid-Start Initiation of Antiretroviral and Opioid Agonist Therapies in People Who Inject Drugs With HIV in Ukraine

ABSTRACT: International guidelines recommend rapid-start antiretroviral therapy (RS-ART) for people with HIV. Guidance for implementing RS-ART among people who inject drugs (PWID), a population often denied equitable treatment due to stigma and rights violations, remains limited. Using human-centered design, barriers and facilitators to combined RS-ART and opioid agonist therapy initiation in Ukraine were explored, where HIV is concentrated among PWID with opioid use disorder. Using nominal group technique, a human-centered design method involving client input, five focus groups (6-12 participants each and 42 participants total) with PWID with HIV in four Ukrainian cities most affected by HIV were conducted. Responses were rank-ordered and grouped using NVivo along the socioecological model. The most common barriers were organizational, including nonintegration of ART and opioid agonist therapy services (45%), followed by individual (22%), such as fear of withdrawal symptoms, policy/regulatory (20%), including the national addiction registry, and relationship (13%) barriers, including pervasive stigma. Solutions focused on equity, promoting behavioral design interventions like choice architecture, nudging, and message framing.