Scientific rationale for an organizational and functional model to improve antiretroviral-based HIV prevention in Ukraine
DOI:
https://doi.org/10.12775/JEHS.2026.95.77287Keywords
HIV infection, antiretroviral-based prevention, antiretroviral therapy, pre-exposure prophylaxis, organizational and functional modelAbstract
Background. Improving antiretroviral-based HIV prevention requires coordinated prevention and treatment services, sustained access to interventions, continuity of care, and adequate professional competencies among healthcare and social service workers.
Aim. To provide a scientific rationale for an organizational and functional model to improve antiretroviral-based HIV prevention in Ukraine.
Materials and Methods. The study combined an analytical synthesis of published evidence on pre-exposure prophylaxis (PrEP), an analysis of regulatory and organizational requirements for timely antiretroviral therapy (ART) initiation in HIV/tuberculosis coinfection, and cross-sectional surveys assessing the professional capacity of 3,478 healthcare workers and 203 social workers. Descriptive statistics, Pearson’s chi-square test, Cramér’s V, and structural-functional modeling were applied.
Results. Potential organizational bottlenecks affecting PrEP access and continuity were identified, taking into account changes in individual HIV acquisition risk. Five groups of potential barriers to timely ART initiation in HIV/tuberculosis coinfection were systematized. Among healthcare workers, 60.5% demonstrated an intermediate level of professional capacity, 27.2% a high level, and 12.2% a low level. Differences and shared competency gaps among healthcare and social workers highlighted the need for differentiated professional development and interprofessional collaboration. Integration of the findings informed a six-component model comprising epidemiological and analytical, clinical and preventive, organizational and referral, retention and continuity of prevention and treatment, workforce capacity, and monitoring and management components.
Conclusions. The proposed model integrates clinical, organizational, workforce-related, and managerial mechanisms for antiretroviral-based HIV prevention. Its distinguishing feature is the linkage between critical service delivery gaps, organizational interventions, monitoring indicators, and management decisions. Its effectiveness requires further evaluation in real-world implementation settings.
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