# Adapting a disclosure decision-aid to improve HIV outcomes for older adults in Ukraine

> **NIH NIH R34** · YALE UNIVERSITY · 2023 · $223,380

## Abstract

Ukraine, an emblematic LMIC in Eastern Europe and Central Asia (EECA), is the only world region with
increasing HIV incidence and mortality. Among the 360,000 PWH in Ukraine, OPWH account for 25% of people
with HIV but are 1.7 times more likely to have AIDS at diagnosis, 51% less likely to start ART, and 3.6 times
more likely to be lost to follow-up than those <50 years old. PWH who disclose their HIV status are more likely
to achieve better social support and HIV outcomes. But in Ukraine 66% of OPWH have not disclosed their HIV
status and are 20% less likely to adhere to ART in the last month, and twice less likely to adhere to therapy for
non-HIV comorbidities, than peers who disclosed. As long-term geriatric care outside of the family in Ukraine is
limited, HIV disclosure decision to support networks is essential when planning for HIV care over aging. But
disclosure interventions to date have prioritized sexual/IDU partner notification and maternal and child health
care, while overlooking disclosure to OPWH support networks. Decision Aid (DA) can facilitate informed
decisions based on patient's unique needs and values. With input from Community Working Group (CWG) we
established in Ukraine, we intend to tailor DA for OPWH using ADAPT-ITT, an evidence-based adaptation
strategy, to develop PORADA (Pursuing Optimal Results over Aging via Decision Aid, “porada” means “advice”
in Ukrainian), and pilot test it to assist OPWH make HIV disclosure decisions aligned with their needs. To help
participants weigh pros and cons and empower them to stay in care in case of stigmatizing reactions, PORADA
will include culturally relevant quotes from OPWH representing key populations, and links to local resources like
hotlines and support groups for PWH. During the pilot RCT Research Assistants will deliver PORADA with a
brief consultation to 80 OPWH who have at least one person they consider important to them to whom they have
not disclosed their HIV status, compared to 40 OPWH receiving TAU. Randomization will be stratified by time
since HIV diagnosis and participants will be followed for 12 months. Outcomes will include measures of
acceptability, feasibility, and preliminary efficacy. We hypothesize that PORADA will increase HIV disclosure
(primary outcome) relative to TAU. We will also collect data on decisional conflict, supportive vs stigmatizing
reactions to disclosure, social support, intersectional stigma, and several HIV and non-HIV indicators, to
understand potential distal outcomes, which will be exploratory. Public health benefit is high given growing
OPWH numbers globally, high levels of OPWH non-disclosure, and poor HIV outcomes including high mortality.
Innovation is high based on the adaptation of a DA for OPWH, focus on HIV disclosure to support networks, and
assessing disengagement from HIV and non-HIV care. To ensure compatibility with the community, findings will
be shared with stakeholders including a Community Working Group (peers, clinici...

## Key facts

- **NIH application ID:** 10693381
- **Project number:** 5R34MH130260-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Julia Rozanova
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $223,380
- **Award type:** 5
- **Project period:** 2022-09-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10693381

## Citation

> US National Institutes of Health, RePORTER application 10693381, Adapting a disclosure decision-aid to improve HIV outcomes for older adults in Ukraine (5R34MH130260-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10693381. Licensed CC0.

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