Yuliia Sereda | Independent Researcher (original) (raw)

Papers by Yuliia Sereda

Для кращого розуміння потреб пацієнтів та причин не- задовільної прихильності до лікування, Центр... more Для кращого розуміння потреб пацієнтів та причин не- задовільної прихильності до лікування, Центр громадського здоров’я МОЗ України провів дослідження бар’єрів лікування ТБ із застосуванням кількісних та якісних методів. Попередні дослідження не дозволяли оцінити поширеність бар’єрів та не враховували зміни у організації лікування, зокрема розширення послуг медико-соціального супроводу. Завданнями цього дослідження було визначення бар’єрів лікування ТБ, як з точки зору пацієнтів, так і зацікавлених сторін, зокрема медичних працівників, представників громадських організацій та екс- пертів, а також оцінка поширеності бар’єрів.

Background: The Symptom Checklist-90-Revised (SCL-90-R) is a widely used symptomatic distress que... more Background: The Symptom Checklist-90-Revised (SCL-90-R) is a widely used symptomatic distress questionnaire. A translated version of the SCL-90-R has been applied in Ukrainian general population surveys several times but has not yet been validated in this country. The SCL-90-R and its short versions (BSI-53, SCL-27, BSI-18, SCL-14 and SCL-9-K) were investigated in order to comparatively assess their properties and applications in Ukraine.
Methods: Secondary analysis of three nationally representative cross-sectional surveys (1997, 1999 and 2014) using SCL-90-R was applied. Two thousand sixty nine respondents participated in 2014; the sample size for the 1997 and 1999 surveys was 1810 respondents per wave. Statistical data analysis is based on calculating internal consistencies with Cronbach’s Alpha, confirmatory factor analysis, nonparametric correlations and effect sizes for the equivalence of the full and short versions.
Results: The scales of SCL-90-R and its shortened versions showed equally high internal consistencies. With regard to factorial validity, 2014 data confirmed the dimensional structure of all versions. Unsatisfactory results were found in 1997 and 1999 for SCL-90-R and in 1997 for SCL-27, based on the Chi-square criterion (χ2/degrees of freedom > 5), though other indexes suggested satisfactory model fit (RMSEA < 0.06; CFI, TLI > 0.95). Analysis of the equivalence of shortened and full versions of the SCL-90-R has shown the presence of small effect sizes.
Conclusion: BSI-18 and SCL-9-K are recommended for use in general population surveys as more economical versions of SCL-90-R. Both versions revealed satisfactory validity in 1997, 1999 and 2014.

Background: Georgia has countrywide drug susceptibility testing (DST) coverage, but it has never ... more Background: Georgia has countrywide drug susceptibility testing (DST) coverage, but it has never been determined what proportion of drug-resistant tuberculosis (DR-TB) patients receive treatment in compliance with the DST profile and whether this compliance is associated with the treatment outcome.
Objective: The aim of the study was to determine the extent of treatment adjustment and its association with treatment outcomes among DR-TB patients in Georgia.
Methods: A retrospective cohort study was conducted among 670 DR-TB patients aged 18 years and older, from the 2015 and 2016 cohorts.
Results: The initially prescribed treatment regimens of 319 (47.6%) DR-TB cases required adjustment. Of these, in 137 (42.9%) cases the regimen was completely adjusted and in 182 (57.0%) cases it was not completely adjusted: in 33 (33/182) cases the regimen was only partially adjusted and in 149 (149/182) cases it was not adjusted at all.
Analysis shows that complete adjustment of treatment is significantly associated with successful treatment outcomes.
Conclusion: For successful outcomes, all DR-TB treatment regimens, including resistant drug(s), should be adjusted based on the DST profile, regardless of the type of resistance, the number or type of resistant drug(s), and new or repurposed drugs being included in the regimen.

У цьому звіті представлені ключові результати біоповедінкового дослідження серед ЛВНІ, яке було п... more У цьому звіті представлені ключові результати біоповедінкового дослідження серед ЛВНІ, яке було проведено наприкінці 2017 року. Результати описують соціально-демографічні характеристики, ризиковані сексуальні та ін’єкційні практики, охоплення профілактичними сервісами, поширеність ВІЛ-інфекції та гепатиту С.

Study outcomes were enrollment into CITI and initiating antiretroviral treatment (ART). Factors a... more Study outcomes were enrollment into CITI and initiating antiretroviral treatment (ART). Factors associated with outcomes were estimated by logistic regressions with random effects. Results: Among the study participants, 54% enrolled into CITI and 23% initiated ART. CITI enrolment was associated with being married (adjusted odds ratio (AOR) = 1.17; 95%: 1.02-1.34); less than weekly compared to daily (AOR = 1.31; 95%: 1.13-1.52); less than 5 years of drug use compared to > 14 years (AOR = 1.73; 95%: 1.40-2.13), and having no criminal records (AOR = 1.30; 95%: 1.12-1.50). Factors of non-ART initiation were male gender (AOR = 1.33; 95%: 1.16-1.53); being single (AOR = 1.48; 95%: 1.21-1.82); drug use duration > 14 years compared to < 5 years (AOR = 1.38; 95%: 1.03-1.85), unemployment (AOR = 1.45; 95%: 1.15-1.83) and history of incarceration (AOR = 1.21; 95%: 1.003-1.45). Conclusion: Mobilizing the NGO community and PWID to engage in outreach HIV testing activity and harm reduction for key populations has succeeded in opening the gateway to prevention, care and ART for thousands of PWID in Ukraine.

Between October 2015 and March 2018, we conducted the Modified Antiretroviral Treatment Access St... more Between October 2015 and March 2018, we conducted the Modified Antiretroviral Treatment Access Study (MARTAS), a nurse-delivered case management intervention to improve linkage-to-care for persons recently tested HIV positive. Adult participants from nine urban clinics in three regions of Ukraine were randomized to either MARTAS or standard of care (SOC) using individual, parallel, two-arm design. The main study outcome was linkage-to-care (defined as registration at an HIV clinic) within a 3-month period from enrollment in the study. Intention-to-treat analysis of MARTAS (n = 135) versus SOC (n = 139) showed intervention efficacy in linkage to HIV care (84.4% vs. 33.8%; adjusted RR 2.45; 95% CI 1.72, 3.47; p < 0.001). MARTAS is recommended for implementation in Ukraine and may be helpful in other countries with similar gaps in linkage-to-care. Clinicaltrials.gov registration number: NCT02338024.

The purpose of this report is to build on previous economic evaluations of the HIV/AIDS epidemic ... more The purpose of this report is to build on previous economic evaluations of the HIV/AIDS epidemic in Ukraine to understand the cost drivers of HIV services and identify a cost-effective mix of HIV/ AIDS services, within existing budget constraints, to achieve the UNAIDS Fast-Track goals .

Background Ukraine's HIV prevention and management efforts focus on continuous and sustained scal... more Background Ukraine's HIV prevention and management efforts focus on continuous and sustained scale-up of services. To reach UNAIDS 90-90-90 targets by 2020, Ukraine should increase investments in diagnosing, enrolling and retaining people living with HIV in treatment and care. We evaluated the relationship between expenditure on HIV services and client perception of service quality, as client satisfaction has been linked to retention in the HIV care continuum. Methods We interviewed 617 clients who received HIV services at 43 healthcare facilities. Perceived service quality was measured across five domains: comprehensiveness of services, accessibility, user-friendliness, confidentiality and privacy, and overall satisfaction. Annual unit costs were estimated for HIV counseling and testing (HCT), antiretroviral treatment (ART), opioid substitution therapy (OST) and the needle and syringe program (NSP). Linkages between perceived service quality scores that were dichotomized at median and unit costs were measured using logistic regressions among subsets of clients who received respective HIV services. Results Median annual unit costs for HIV services varied from 7.94to7.94 to 7.94to661.84. Odds of HCT comprehensiveness increased linearly with the unit cost for HCT services (OR = 3.54, 95% CI 1.43-10.27). ART comprehensiveness was not linked to ART costs (OR = 0.46, 95% CI: 0.04-4.53). There was a negative relationship between confidentiality and privacy and OST costs (OR = 0.61, 95% CI: 0.38-0.96). Overall satisfaction was positively linked only to HCT costs (OR = 2.54, 95% CI 1.12-6.29), and no association was found for NSP costs (OR = 2.28, 95% CI 0.47-12.56). Conclusions Unit costs for HCT services were associated with better perception of service quality and overall satisfaction, whereas other unit costs were negatively linked (OST) or were not associated (ART, NSP). Mixed results suggest that higher unit costs for some HIV services do not necessarily translate into better quality and consequently into improved retention in care. The lack of positive associations between unit costs and perceived quality of some services highlights the need to explore how HIV resource allocations can be improved in Ukraine to achieve better outcomes.

Background: Prior studies have shown that high client satisfaction and quality of services are im... more Background: Prior studies have shown that high client satisfaction and quality of services are important drivers of uptake and retention in human immunodeficiency virus (HIV) care. Study objectives were to assess the perceived quality of HIV services, satisfaction and associated factors across different types of health facilities in Ukraine. Methods: We conducted a cross-sectional study among 649 individuals receiving HIV services across 47 health facilities in three regions of Ukraine. Primary outcomes were satisfaction and perceived quality of services measured along five dimensions: accessibility, user-friendliness, privacy and confidentiality, comprehensiveness (separately for testing and treatment services). Quality dimensions were constructed by confirmatory factor analysis. Links between quality dimensions, satisfaction and related factors were measured by structural equation modelling. Results: Median scores for accessibility, user-friendliness, privacy and confidentiality, compre-hensiveness of services and overall satisfaction ranged from 0.75 to 1 out of 1. User-friendliness was the main determinant associated with satisfaction (total effect: = 0.515, P < 0.001). Satisfaction was higher at primary healthcare centres (direct effect: = 0.145, P < 0.001; indirect effect through accessibility: = 0.060, P < 0.001), narcological/tuberculosis dispensaries (direct effect: = 0.105, P = 0.006; indirect effect through accessibility: = 0.060, P < 0.001) and hospitals (indirect effects through user-friendliness and accessibility: = 0.180, P < 0.

Introduction: Co-located treatment for HIV and opioid use disorder has been shown to improve care... more Introduction: Co-located treatment for HIV and opioid use disorder has been shown to improve care outcomes for HIV-positive people who inject drugs (PWID) in Ukraine. However, patients continue to be stigmatized for both HIV and substance use. This study aimed to assess whether co-located care for HIV-positive PWID receiving opioid agonist treatment (OAT) services in Ukraine is associated with less stigma and better perceived quality of HIV services. Methods: This cross-sectional study enrolled 191 HIV-positive PWID who received OAT services at three healthcare facilities providing substance use treatment (OAT only) and at four facilities that provided co-located care (both OAT and HIV treatment) in six regions in Ukraine during July-September, 2017. Primary outcomes were HIV stigma (Berger scale), substance use stigma (Substance Abuse Stigma Scale) and intersectional stigma (both stigma forms above 75th percentile). Secondary outcome was quality of HIV care, a composite score based on a package of received services. Linear and ordinal regressions were used to assess the predictors of selected outcomes. Results: Study participants were 75% male, mean age 40 AE 7 years; 47% received co-located care, and 10.5% had both high HIV and substance use stigma. Co-located care was neither associated with HIV nor substance use stigma but it was linked to better quality of HIV care (adjusted odds ratio: 4.13; 95% CI: 2.31, 7.54). HIV stigma was associated with suicide attempts (adjusted beta (ab): 5.90; 95% CI: 2.05, 9.75), and substance use stigma was linked to poor mental health (ab: À0.26; 95% CI: À0.44, À0.08) and lower likelihood of receipt of services from non-governmental organization (NGO; ab: À6.40; 95% CI: À10.23, À2.57). Conclusion: One in ten people with HIV in this cohort who received OAT services experienced high levels of both HIV and substance use stigma, which was associated with poorer mental health and less NGO support. Co-located HIV and OAT services were linked to better perceived quality of HIV care, but did not seem to reduce stigma for this key population. Stigma interventions for PWID, possibly delivered involving NGOs, may be an approach to mitigate this challenge.

Journal of epidemiology and community health, 2011

Conference Presentations by Yuliia Sereda

Globally, PWID living with HIV have significant losses along the HIV care cascade. In Ukraine, 1/... more Globally, PWID living with HIV have significant losses along the HIV care cascade. In Ukraine, 1/3 of individuals living with HIV which aware of their status remain outside of HIV care. This study assessed whether behavioral intervention “Steps towards Health” was superior than the standard of service for re-engaging HIV-infected PWID with medical care and treatment.

Books by Yuliia Sereda

The main purpose of the Project was to ensure access to effective innovative viral hepatitis C tr... more The main purpose of the Project was to ensure access to effective innovative viral hepatitis C treatment with DAAs for key populations. The Project started when DAAs were not yet registered in Ukraine and were not used for viral hepatitis C treatment. Focusing on scaling up access to comprehensive prevention, diagnosis, and treatment of HIV/AIDS, tuberculosis, viral hepatitis, the Alliance was the first in Ukraine to launch,
in 2015, the modern treatment of HCV-infection with DAAs and made it accessible for the most challenging patients. The Project was rolled out in three phases. Alliance provided a total of 1 907 DAA-based HCV treatment courses with (sofosbuvir and sofosbuvir/ledipasvir) for representatives of key populations throughout Ukraine. Out of 1 907 treatment courses, administered to key populations’ representatives within the Project, 468 included combination of ledipasvir/soforbuvir, and 953 treatment regimens
were interferon-free. 1,873 patients retained in the program and successfully completed full treatment course.

The report was prepared on the basis of 2015 study "Monitoring of behavior and HIV prevalence amo... more The report was prepared on the basis of 2015 study "Monitoring of behavior and HIV prevalence among sex workers as component of second generation HIV surveillance". The report presents the survey results regarding the social and demographic structure of sex workers, risky behavior, access to prevention and treatment programs, HIV, HBV, HCV and syphilis prevalence.

Journal of epidemiology and community health, 2011