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The Effects of Complex Humanitarian Disaster on HIV Care Engagement and Health Outcomes among HIV-Positive People Who Use Drugs in Ukraine

Award Number: R01DA060590
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/15/2024
PERIOD OF PERFORMANCE END DATE: 02/28/2029

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The Effects of Complex Humanitarian Disaster on HIV Care Engagement and Health Outcomes among HIV-Positive People Who Use Drugs in Ukraine - This longitudinal, mixed methods study investigates the relationship between disaster-related stressors, social determinants of health, and health outcomes among HIV-positive people who use drugs (PWUD) in Ukraine and the strategies that health and social service providers have adopted to maintain access to care. In Ukraine, people who use drugs (PWUD) and live with HIV are a vulnerable population and at least 38% of all people with a new HIV diagnosis and at least 50% of all people living with HIV (PLWH) indicate injection drug use as the route of transmission. The war in Ukraine that began in February 2022 precipitated massive immediate and potentially long-term disruptions to all aspects of daily life in Ukraine, with unknown consequences for HIV-positive PWUD. War is both a disaster and a form of mass trauma that involves widespread destruction, loss of life, and psychological distress for those directly and indirectly affected by it. The impact of mass traumas may have disproportionately negative consequences for already vulnerable populations, including those who are economically precarious and socially marginalized. Social determinants of health—the social conditions and economic circumstances that influence health—are key contributors to HIV care and treatment outcomes. The specific aims of this study are: (1) To measure the effects of disaster-related stressors (personal, interpersonal, and environmental) and mediating effects of SDOH and adaptation on primary clinical outcomes of HIV care engagement, ART adherence, and viral suppression and secondary outcomes of drug treatment engagement and risky substance use in a longitudinal cohort followed up to 3 years; (2) To qualitatively characterize at baseline and longitudinally the effects of conflict on social determinants of health and adaptation trajectories of HIV-positive PWUD; and (3) To explore how service providers who work with PWUD and PLWH modify policies and practices in the context of supply chain disruptions, workforce depletion, and population displacement to promote continued care engagement. This project will use an innovative instrumental variables approach to assess how mass trauma and resulting changes to SDOH causally affect substance use and HIV outcomes and link these findings to structural and resources changes that resulted from the war. This approach will leverage a natural experiment in which residence in areas of Ukraine most affected by the war (proximal to the frontlines) approximates a random assignment to mass trauma exposure. Identifying how people remain connected to HIV and substance use care in contexts of disruption and the strategies that health care and social service providers use to keep people engaged have potential broad transferability. The immediate and longer-term consequences of mass trauma for HIV outcomes are unknown. Identifying how people remain connected to HIV care in contexts of disruption and the strategies that health care and social service providers use to keep people engaged have potential broad transferability.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $689,999 )
2026	2026	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	000	3	3/24/2026	NON-COMPETING CONTINUATION	$295,280
2026	2026	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	002	3	8/25/2026	SUPPLEMENT FOR EXPANSION	$100,000
2026	2026	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	001	3	4/6/2026	SUPPLEMENT FOR EXPANSION	$294,719
														Subtotal = $689,999

Issue Date FY: 2025 ( Subtotal = $598,861 )
2025	2025	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	000	2	8/28/2025	NON-COMPETING CONTINUATION	$274,672
2025	2025	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	001	2	8/29/2025	SUPPLEMENT FOR EXPANSION	$324,189
														Subtotal = $598,861

Issue Date FY: 2024 ( Subtotal = $629,923 )
2024	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Drug Use and Addiction Research Programs	000	1	5/13/2024	NEW	$629,923
														Subtotal = $629,923

Grand Total All Awards = $1,918,783

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The Effects of Complex Humanitarian Disaster on HIV Care Engagement and Health Outcomes among HIV-Positive People Who Use Drugs in Ukraine

Award Number: R01DA060590

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/15/2024

PERIOD OF PERFORMANCE END DATE: 02/28/2029

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