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AbstractIntroductionIn 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower‐ and middle‐income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource‐limited environments.DiscussionHIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90‐90‐90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations.ConclusionsExperiences of often‐marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point‐of‐care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.

AbstractIntroductionIn light of the COVID‐19 pandemic, considerable effort is going into identifying and protecting those at risk. Criminalization, stigmatization and the psychological, physical, behavioural and economic consequences of substance use make people who inject drugs (PWID) extremely vulnerable to many infectious diseases. While relationships between drug use and blood‐borne and sexually transmitted infections are well studied, less attention has been paid to other infectious disease outbreaks among PWID.DiscussionCOVID‐19 is likely to disproportionally affect PWID due to a high prevalence of comorbidities that make the disease more severe, unsanitary and overcrowded living conditions, stigmatization, common incarceration, homelessness and difficulties in adhering to quarantine, social distancing or self‐isolation mandates. The COVID‐19 pandemic also jeopardizes essential for PWID services, such as needle exchange or substitution therapy programmes, which can be affected both in a short‐ and a long‐term perspective. Importantly, there is substantial evidence of other infectious disease outbreaks in PWID that were associated with factors that enable COVID‐19 transmission, such as poor hygiene, overcrowded living conditions and communal ways of using drugs.ConclusionsThe COVID‐19 crisis might increase risks of homelessnes, overdoses and unsafe injecting and sexual practices for PWID. In order to address existing inequalities, consultations with PWID advocacy groups are vital when designing inclusive health response to the COVID‐19 pandemic.

SUMMARY: The people of Ukraine, a country of 44 million, have suffered a widespread Russian Federation-led military invasion beginning 24 February, 2022, resulting in increasing loss of life, destruction of infrastructure, and deterioration of services. The conflict has kicked off a humanitarian crisis that is rapidly devolving into a catastrophe, with threats of massive numbers of internally displaced persons (IDP) and refugees, significant civilian deaths from indiscriminate aerial and rocket bombardment of urban areas by Russian military forces, and long term political and economic instability. In the short term, individual mental and physical trauma, and dismantling of communities and families may become widespread even in areas that see limited military impacts in the coming days. The rapidly changing environment, uncertainty in outcome and resolution of the conflict, and military threats will make provision of humanitarian relief difficult, necessitating a robust near-term stabilization of the security situation. To this end, we recommend immediate establishment of a North Atlantic Threat Organization (NATO)-led No Fly Zone (NFZ), humanitarian corridors for relief and movement displaced persons, and long term humanitarian commitment to the people of Ukraine. RECOMMENDATIONS: We describe the humanitarian and military rationale for establishing a NATO-led No Fly Zone to prevent Russian air attacks inside Ukraine, and speed an end to the conflict. The ultimate goal of US/NATO direct actions described in this commentary is complete withdrawal of Russian-backed forces from Ukraine and repatriation of Ukrainian territory. Only a resolution where Russian Federation withdraws its forces will facilitate longer term regional security. Moreover, continuation of economic sanctions, appropriate reparations, and referral of evidence to the International Criminal Court (ICC) for prosecution of war crimes against civilians are recommended. This commentary will be used as a resource and reference material for political and ...

SUMMARY: The people of Ukraine, a country of 44 million, have suffered a widespread Russian Federation-led military invasion beginning 24 February, 2022, resulting in increasing loss of life, destruction of infrastructure, and deterioration of services. The conflict has kicked off a humanitarian crisis that is rapidly devolving into a catastrophe, with threats of massive numbers of internally displaced persons (IDP) and refugees, significant civilian deaths from indiscriminate aerial and rocket bombardment of urban areas by Russian military forces, and long term political and economic instability. In the short term, individual mental and physical trauma, and dismantling of communities and families may become widespread even in areas that see limited military impacts in the coming days. The rapidly changing environment, uncertainty in outcome and resolution of the conflict, and military threats will make provision of humanitarian relief difficult, necessitating a robust near-term stabilization of the security situation. To this end, we recommend immediate establishment of a North Atlantic Treaty Organization (NATO)-led No Fly Zone (NFZ), humanitarian corridors for relief and movement displaced persons, and long term humanitarian commitment to the people of Ukraine. RECOMMENDATIONS: We describe the humanitarian and military rationale for establishing a NATO-led No Fly Zone to prevent Russian air attacks inside Ukraine, and speed an end to the conflict. The ultimate goal of US/NATO direct actions described in this commentary is complete withdrawal of Russian-backed forces from Ukraine and repatriation of Ukrainian territory. Only a resolution where Russian Federation withdraws its forces will facilitate longer term regional security. Moreover, continuation of economic sanctions, appropriate reparations, and referral of evidence to the International Criminal Court (ICC) for prosecution of war crimes against civilians are recommended. This commentary will be used as a resource and reference material for political and ...

SUMMARY: The people of Ukraine, a country of 44 million, have suffered a widespread Russian Federation-led military invasion beginning 24 February, 2022, resulting in increasing loss of life, destruction of infrastructure, and deterioration of services. The conflict has kicked off a humanitarian crisis that is rapidly devolving into a catastrophe, with threats of massive numbers of internally displaced persons (IDP) and refugees, significant civilian deaths from indiscriminate aerial and rocket bombardment of urban areas by Russian military forces, and long term political and economic instability. In the short term, individual mental and physical trauma, and dismantling of communities and families may become widespread even in areas that see limited military impacts in the coming days. The rapidly changing environment, uncertainty in outcome and resolution of the conflict, and military threats will make provision of humanitarian relief difficult, necessitating a robust near-term stabilization of the security situation. To this end, we recommend immediate establishment of a North Atlantic Treaty Organization (NATO)-led No Fly Zone (NFZ), humanitarian corridors for relief and movement displaced persons, and long term humanitarian commitment to the people of Ukraine. RECOMMENDATIONS: We describe the humanitarian and military rationale for establishing a NATO-led No Fly Zone to prevent Russian air attacks inside Ukraine, and speed an end to the conflict. The ultimate goal of US/NATO direct actions described in this commentary is complete withdrawal of Russian-backed forces from Ukraine and repatriation of Ukrainian territory. Only a resolution where Russian Federation withdraws its forces will facilitate longer term regional security. Moreover, continuation of economic sanctions, appropriate reparations, and referral of evidence to the International Criminal Court (ICC) for prosecution of war crimes against civilians are recommended. This commentary will be used as a resource and reference material for political and ...

SUMMARY: The people of Ukraine, a country of 44 million, have suffered a widespread Russian Federation-led military invasion beginning 24 February, 2022, resulting in increasing loss of life, destruction of infrastructure, and deterioration of services. The conflict has kicked off a humanitarian crisis that is rapidly devolving into a catastrophe, with threats of massive numbers of internally displaced persons (IDP) and refugees, significant civilian deaths from indiscriminate aerial and rocket bombardment of urban areas by Russian military forces, and long term political and economic instability. In the short term, individual mental and physical trauma, and dismantling of communities and families may become widespread even in areas that see limited military impacts in the coming days. The rapidly changing environment, uncertainty in outcome and resolution of the conflict, and military threats will make provision of humanitarian relief difficult, necessitating a robust near-term stabilization of the security situation. To this end, we recommend immediate establishment of a North Atlantic Treaty Organization (NATO)-led No Fly Zone (NFZ), humanitarian corridors for relief and movement displaced persons, and long term humanitarian commitment to the people of Ukraine. RECOMMENDATIONS: We describe the humanitarian and military rationale for establishing a NATO-led No Fly Zone to prevent Russian air attacks inside Ukraine, and speed an end to the conflict. The ultimate goal of US/NATO direct actions described in this commentary is complete withdrawal of Russian-backed forces from Ukraine and repatriation of Ukrainian territory. Only a resolution where Russian Federation withdraws its forces will facilitate longer term regional security. Moreover, continuation of economic sanctions, appropriate reparations, and referral of evidence to the International Criminal Court (ICC) for prosecution of war crimes against civilians are recommended. This commentary will be used as a resource and reference material for political and ...

AbstractIntroductionProviding HIV healthcare and Treatment as Prevention both depend on diagnosing HIV cases, preferably soon after initial infection. We hypothesized that tracing risk networks recruits higher proportions of undiagnosed positives than outreach‐based testing or respondent‐driven sampling (RDS) in Odessa, Ukraine.MethodsThe Transmission Reduction Intervention Project (TRIP) used risk network tracing to recruit sexual and injection networks of recently‐infected and longer‐term infected (LTs) seeds (2013 to 2016). Integrated Biobehavioural Surveillance (IBBS) (2013) used RDS to recruit people who inject drugs (PWID). Outreach Testing tested PWID for HIV at community outreach sites (2013 to 2016). Proportions of undiagnosed positives among those tested were compared TRIP versus IBBS; TRIP versus Outreach Testing and between TRIP arms. Costs were compared across the projects.ResultsTRIP tested 1252 people (21% women) in seeds' risk networks; IBBS tested 400 (18% women); Outreach Testing 13,936 (31% women). TRIP networks included a higher proportion of undiagnosed positives (14.6%) than IBBS (5.0%) or Outreach Testing (2.4%); odds ratio (OR) 3.25 (95% CI 2.07, 5.12) versus IBBS and 7.03 (CI 5.95, 8.31) versus Outreach Testing respectively. Findings remained significant in analyses stratified by sex and when PWID in TRIP networks were compared with Outreach Testing and IBBS. Within TRIP, recently‐infected participants' networks contained higher proportions of undiagnosed positives (16.3%) than LTs' networks (12.2%); OR 1.41 (CI 1.01, 1.95). TRIP located undiagnosed positives less expensively than did RDS or Outreach Testing.ConclusionsTRIP's recruiting techniques, including prioritizing networks of the recently infected, find undiagnosed HIV‐positive people efficiently. They should be integrated with standard practice to improve case‐finding. Research should test these techniques in other socio‐epidemiologic contexts.Clinical trial registryRegistered ClinicalTrials.gov: NCT01827228.

AbstractIntroductionThis paper examines the extent to which an intervention succeeded in locating people who had recently become infected with HIV in the context of the large‐scale Ukrainian epidemic. Locating and intervening with people who recently became infected with HIV (people with recent infection, or PwRI) can reduce forward HIV transmission and help PwRI remain healthy.MethodsThe Transmission Reduction Intervention Project (TRIP) recruited recently‐infected and longer‐term infected seeds in Odessa, Ukraine, in 2013 to 2016, and asked them to help recruit their extended risk network members. The proportions of network members who were PwRI were compared between TRIP arms (i.e. networks of recently‐infected seeds vs. networks of longer‐term infected seeds) and to the proportion of participants who were PwRI in an RDS‐based Integrated Biobehavioral Surveillance of people who inject drugs in 2013.ResultsThe networks of PwRI seeds and those of longer‐term infected seeds had similar (2%) proportions who were themselves PwRI. This was higher than the 0.25% proportion in IBBS (OR = 7.80; p = 0.016). The odds ratio among the subset of participants who injected drugs was 11.17 (p = 0.003). Cost comparison analyses using simplified ingredients‐based methods found that TRIP spent no more than US $4513 per PwRI located whereas IBBS spent $11,924.ConclusionsFurther research is needed to confirm these results and improve TRIP further, but our findings suggest that interventions that trace the networks of people who test HIV‐positive are a cost‐effective way to locate PwRI and reduce HIV transmission and should therefore be implemented.

Abstract
Internally displaced persons are often excluded from HIV molecular epidemiology surveillance due to structural, behavioral, and social barriers in access to treatment. We test a field-based molecular epidemiology framework to study HIV transmission dynamics in a hard-to-reach and highly stigmatized group, internally displaced people who inject drugs (IDPWIDs). We inform the framework by Nanopore generated HIV pol sequences and IDPWID migration history. In June–September 2020, we recruited 164 IDPWID in Odesa, Ukraine, and obtained 34 HIV sequences from HIV-infected participants. We aligned them to publicly available sequences (N = 359) from Odesa and IDPWID regions of origin and identified 7 phylogenetic clusters with at least 1 IDPWID. Using times to the most recent common ancestors of the identified clusters and times of IDPWID relocation to Odesa, we infer potential post-displacement transmission window when infections likely to happen to be between 10 and 21 months, not exceeding 4 years. Phylogeographic analysis of the sequence data shows that local people in Odesa disproportionally transmit HIV to the IDPWID community. Rapid transmissions post-displacement in the IDPWID community might be associated with slow progression along the HIV continuum of care: only 63% of IDPWID were aware of their status, 40% of those were in antiviral treatment, and 43% of those were virally suppressed. Such HIV molecular epidemiology investigations are feasible in transient and hard-to-reach communities and can help indicate best times for HIV preventive interventions. Our findings highlight the need to rapidly integrate Ukrainian IDPWID into prevention and treatment services following the dramatic escalation of the war in 2022.

During the COVID-19 pandemic, genomics and bioinformatics have emerged as essential public health tools. The genomic data acquired using these methods have supported the global health response, facilitated the development of testing methods and allowed the timely tracking of novel SARS-CoV-2 variants. Yet the virtually unlimited potential for rapid generation and analysis of genomic data is also coupled with unique technical, scientific and organizational challenges. Here, we discuss the application of genomic and computational methods for efficient data-driven COVID-19 response, the advantages of the democratization of viral sequencing around the world and the challenges associated with viral genome data collection and processing.

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) ; Human immunodeficiency virus type 1 (HIV-1) was discovered in the early 1980s when the virus had already established a pandemic. For at least three decades the epidemic in the Western World has been dominated by subtype B infections, as part of a sub-epidemic that traveled from Africa through Haiti to United States. However, the pattern of the subsequent spread still remains poorly understood. Here we analyze a large dataset of globally representative HIV-1 subtype B strains to map their spread around the world over the last 50years and describe significant spread patterns. We show that subtype B travelled from North America to Western Europe in different occasions, while Central/Eastern Europe remained isolated for the most part of the early epidemic. Looking with more detail in European countries we see that the United Kingdom, France and Switzerland exchanged viral isolates with non-European countries than with European ones. The observed pattern is likely to mirror geopolitical landmarks in the post-World War II era, namely the rise and the fall of the Iron Curtain and the European colonialism. In conclusion, HIV-1 spread through specific migration routes which are consistent with geopolitical factors that affected human activities during the last 50 years, such as migration, tourism and trade. Our findings support the argument that epidemic control policies should be global and incorporate political and socioeconomic factors. ; info:eu-repo/semantics/publishedVersion

Human immunodeficiency virus type 1 (HIV-1) was discovered in the early 1980s when the virus had already established a pandemic. For at least three decades the epidemic in the Western World has been dominated by subtype B infections, as part of a sub-epidemic that traveled from Africa through Haiti to United States. However, the pattern of the subsequent spread still remains poorly understood. Here we analyze a large dataset of globally representative HIV-1 subtype B strains to map their spread around the world over the last 50 years and describe significant spread patterns. We show that subtype B travelled from North America to Western Europe in different occasions, while Central/Eastern Europe remained isolated for the most part of the early epidemic. Looking with more detail in European countries we see that the United Kingdom, France and Switzerland exchanged viral isolates with non-European countries than with European ones. The observed pattern is likely to mirror geopolitical landmarks in the post-World War II era, namely the rise and the fall of the Iron Curtain and the European colonialism. In conclusion, HIV-1 spread through specific migration routes which are consistent with geopolitical factors that affected human activities during the last 50 years, such as migration, tourism and trade. Our findings support the argument that epidemic control policies should be global and incorporate political and socioeconomic factors.

Human immunodeficiency virus type 1 (HIV-1) was discovered in the early 1980s when the virus had already established a pandemic. For at least three decades the epidemic in the Western World has been dominated by subtype B infections, as part of a sub-epidemic that traveled from Africa through Haiti to United States. However, the pattern of the subsequent spread still remains poorly understood. Here we analyze a large dataset of globally representative HIV-1 subtype B strains to map their spread around the world over the last 50 years and describe significant spread patterns. We show that subtype B travelled from North America to Western Europe in different occasions, while Central/Eastern Europe remained isolated for the most part of the early epidemic. Looking with more detail in European countries we see that the United Kingdom, France and Switzerland exchanged viral isolates with non-European countries than with European ones. The observed pattern is likely to mirror geopolitical landmarks in the post-World War II era, namely the rise and the fall of the Iron Curtain and the European colonialism. In conclusion, HIV-1 spread through specific migration routes which are consistent with geopolitical factors that affected human activities during the last 50 years, such as migration, tourism and trade. Our findings support the argument that epidemic control policies should be global and incorporate political and socioeconomic factors.