Background: Rapid expansion of ART, including implementation of ''Test-and-Start'' approach, is a top priority for national HIV programs in Ukraine and globally. Key national stakeholders and international donors have set ambitious fast track goals to increase the number of patients from 88,270 on 01/01/2018 to 140,000 by the end of the year. This study was commenced to obtain reliable data on key treatment quality indicators, contributing factors and trends to inform program planning.
Methods: Data from medical charts of all patients who received care at HIV facilities in 2010-2016 in 18 out of 27 regions of Ukraine were entered into an electronic medical record system. After verification of data quality, depersonalized datasets linked by unique patient code were extracted at each facility and merged for analysis. Entire dataset, excluding children younger than 15 at diagnosis, was analyzed using time-to-event methods, including Kaplan-Meier and log-rank test to assess difference between sub-groups.
Results: The cohort included 52,813 patients with HIV infection, approximately 40% of all patients receiving care in Ukraine in 2016. 46.5% were females. Median time from diagnosis to ART receipt decreased from 69 months (95%CI: 65.2-72.8) among patients diagnosed in 2010 to 3 months (95%CI: 2.6-3.4) in 2016 (p< 0.001). Proportion of patients who had received ART within 12 months after diagnosis increased from 19.4% to 55.8%, with most notable increase among patients with CD4>350, from 7.8% to 70.2% (see Figure; p< 0.001 for all strata).
Coverage with viral load testing within 12 months after ART initiation moderately increased from 53.8% in 2010 to 60.6% in 2012, then declined to 23.8% in 2016 (p< 0.001). Among those tested, proportion reaching viral suppression (< 1000 copies/ml) within 12 months after treatment initiation declined from 87.9% to 83.5% (p< 0.001).
Conclusions: First results of the analysis of the large national clinical dataset confirm rapid acceleration of ART uptake, especially among those with less severe immunosuppression, reflecting the change in national guidelines. On the other hand, access to viral load testing and level of suppression remains suboptimal, calling for urgent programmatic actions to improve clinical management of virologic failure and to ensure uninterrupted availability of laboratory services.



[ART coverage and viral suppression in Ukraine]